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Chang C, Chavarro VS, Gerstl JVE, Blitz SE, Spanehl L, Dubinski D, Valdes PA, Tran LN, Gupta S, Esposito L, Mazzetti D, Gessler FA, Arnaout O, Smith TR, Friedman GK, Peruzzi P, Bernstock JD. Recurrent Glioblastoma-Molecular Underpinnings and Evolving Treatment Paradigms. Int J Mol Sci 2024; 25:6733. [PMID: 38928445 PMCID: PMC11203521 DOI: 10.3390/ijms25126733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/13/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
Glioblastoma is the most common and lethal central nervous system malignancy with a median survival after progression of only 6-9 months. Major biochemical mechanisms implicated in glioblastoma recurrence include aberrant molecular pathways, a recurrence-inducing tumor microenvironment, and epigenetic modifications. Contemporary standard-of-care (surgery, radiation, chemotherapy, and tumor treating fields) helps to control the primary tumor but rarely prevents relapse. Cytoreductive treatment such as surgery has shown benefits in recurrent glioblastoma; however, its use remains controversial. Several innovative treatments are emerging for recurrent glioblastoma, including checkpoint inhibitors, chimeric antigen receptor T cell therapy, oncolytic virotherapy, nanoparticle delivery, laser interstitial thermal therapy, and photodynamic therapy. This review seeks to provide readers with an overview of (1) recent discoveries in the molecular basis of recurrence; (2) the role of surgery in treating recurrence; and (3) novel treatment paradigms emerging for recurrent glioblastoma.
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Affiliation(s)
- Christopher Chang
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA;
| | - Velina S. Chavarro
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (V.S.C.); (J.V.E.G.); (S.E.B.); (L.S.); (S.G.); (D.M.); (O.A.); (T.R.S.); (J.D.B.)
| | - Jakob V. E. Gerstl
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (V.S.C.); (J.V.E.G.); (S.E.B.); (L.S.); (S.G.); (D.M.); (O.A.); (T.R.S.); (J.D.B.)
| | - Sarah E. Blitz
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (V.S.C.); (J.V.E.G.); (S.E.B.); (L.S.); (S.G.); (D.M.); (O.A.); (T.R.S.); (J.D.B.)
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Lennard Spanehl
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (V.S.C.); (J.V.E.G.); (S.E.B.); (L.S.); (S.G.); (D.M.); (O.A.); (T.R.S.); (J.D.B.)
- Department of Neurosurgery, University of Rostock, 18055 Rostock, Germany; (D.D.); (F.A.G.)
| | - Daniel Dubinski
- Department of Neurosurgery, University of Rostock, 18055 Rostock, Germany; (D.D.); (F.A.G.)
| | - Pablo A. Valdes
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Lily N. Tran
- Division of Biology and Medicine, Brown University, Providence, RI 02912, USA;
| | - Saksham Gupta
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (V.S.C.); (J.V.E.G.); (S.E.B.); (L.S.); (S.G.); (D.M.); (O.A.); (T.R.S.); (J.D.B.)
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Luisa Esposito
- Department of Medicine and Surgery, Unicamillus University, 00131 Rome, Italy;
| | - Debora Mazzetti
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (V.S.C.); (J.V.E.G.); (S.E.B.); (L.S.); (S.G.); (D.M.); (O.A.); (T.R.S.); (J.D.B.)
| | - Florian A. Gessler
- Department of Neurosurgery, University of Rostock, 18055 Rostock, Germany; (D.D.); (F.A.G.)
| | - Omar Arnaout
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (V.S.C.); (J.V.E.G.); (S.E.B.); (L.S.); (S.G.); (D.M.); (O.A.); (T.R.S.); (J.D.B.)
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Timothy R. Smith
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (V.S.C.); (J.V.E.G.); (S.E.B.); (L.S.); (S.G.); (D.M.); (O.A.); (T.R.S.); (J.D.B.)
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Gregory K. Friedman
- Division of Pediatrics, Neuro-Oncology Section, MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Pierpaolo Peruzzi
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (V.S.C.); (J.V.E.G.); (S.E.B.); (L.S.); (S.G.); (D.M.); (O.A.); (T.R.S.); (J.D.B.)
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Joshua D. Bernstock
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (V.S.C.); (J.V.E.G.); (S.E.B.); (L.S.); (S.G.); (D.M.); (O.A.); (T.R.S.); (J.D.B.)
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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Jiménez VG, Doval MB, Bellvert CG, Goliney VG, Asencio OS, Martín AG, Domínguez JI. Quantitative analysis of MGMT promoter methylation status changes by pyrosequencing in recurrent glioblastoma. Neuropathology 2023; 43:306-312. [PMID: 36504469 DOI: 10.1111/neup.12887] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/07/2022] [Accepted: 11/13/2022] [Indexed: 08/03/2023]
Abstract
MGMT promoter methylation status can change in response to several factors, treatment with alkylating therapy being the mechanism more commonly cited in the literature. Some authors have attempted to quantify these alterations, with inconsistent results. This study aims to determine changes in MGMT promoter methylation status by pyrosequencing, which quantitatively yields results, in a cohort of patients reoperated for recurrent glioblastoma and having previously completed the Stupp protocol. Methylation status of the MGMT promoter gene of a total of 24 pairs of glioblastoma preselected tumor samples was retrospectively analyzed using pyrosequencing and depicted as percentages or categories (hypermethylated, intermediate methylation, unmethylated). Matched samples were compared using Wilcoxon signed-rank test, and log-rank test was used to establish a correlation with survival data. The median value of MGMT promoter methylation status declined after adjuvant treatment from 20.35% to 14.25% (p = 0.346). A significant correlation between methylation in primary samples and overall survival (p = 0.05) and progression-free survival (p = 0.024) was found. Intermediate methylation status at recurrence was linked to greater survival after progression, without reaching statistical significance (post-progression survival [PPS]) (p = 0.217). Although treatment with alkylating chemotherapy was a common feature in all patients of our cohort, switching in both directions was observed when MGMT promoter methylation status was analyzed as a continuous variable. These data suggest that the dynamics of epigenetics may be very complex and not entirely explained by clonal selection influenced by temozolomide.
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Affiliation(s)
| | - Marta Brell Doval
- Neurosurgical Department, Hospital Son Espases, Illes Balears, Spain
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Pibuel MA, Poodts D, Sias SA, Byrne A, Hajos SE, Franco PG, Lompardía SL. 4-Methylumbelliferone enhances the effects of chemotherapy on both temozolomide-sensitive and resistant glioblastoma cells. Sci Rep 2023; 13:9356. [PMID: 37291120 PMCID: PMC10249561 DOI: 10.1038/s41598-023-35045-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/11/2023] [Indexed: 06/10/2023] Open
Abstract
Glioblastoma (GBM) is the most frequent malignant primary tumor of the CNS in adults, with a median survival of 14.6 months after diagnosis. The effectiveness of GBM therapies remains poor, highlighting the need for new therapeutic alternatives. In this work, we evaluated the effect of 4-methylumbelliferone (4MU), a coumarin derivative without adverse effects reported, in combination with temozolomide (TMZ) or vincristine (VCR) on U251, LN229, U251-TMZ resistant (U251-R) and LN229-TMZ resistant (LN229-R) human GBM cells. We determined cell proliferation by BrdU incorporation, migration through wound healing assay, metabolic and MMP activity by XTT and zymography assays, respectively, and cell death by PI staining and flow cytometry. 4MU sensitizes GBM cell lines to the effect of TMZ and VCR and inhibits metabolic activity and cell proliferation on U251-R cells. Interestingly, the lowest doses of TMZ enhance U251-R and LN229-R cell proliferation, while 4MU reverts this and even sensitizes both cell lines to TMZ and VCR effects. We showed a marked antitumor effect of 4MU on GBM cells alone and in combination with chemotherapy and proved, for the first time, the effect of 4MU on TMZ-resistant models, demonstrating that 4MU would be a potential therapeutic alternative for improving GBM therapy even on TMZ-refractory patients.
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Affiliation(s)
- Matías A Pibuel
- Cátedra de Inmunología, Departamento de Microbiología, Inmunología y Biotecnología, Facultad de Farmacia y Bioquímica, Instituto de Estudios de la Inmunidad Humoral (IDEHU)- CONICET, Universidad de Buenos Aires, Junín 956 4° Piso, 1113, Capital Federal, Argentina.
| | - Daniela Poodts
- Cátedra de Inmunología, Departamento de Microbiología, Inmunología y Biotecnología, Facultad de Farmacia y Bioquímica, Instituto de Estudios de la Inmunidad Humoral (IDEHU)- CONICET, Universidad de Buenos Aires, Junín 956 4° Piso, 1113, Capital Federal, Argentina
| | - Sofía A Sias
- Cátedra de Inmunología, Departamento de Microbiología, Inmunología y Biotecnología, Facultad de Farmacia y Bioquímica, Instituto de Estudios de la Inmunidad Humoral (IDEHU)- CONICET, Universidad de Buenos Aires, Junín 956 4° Piso, 1113, Capital Federal, Argentina
| | - Agustín Byrne
- Departamento de Química Biológica, Facultad de Farmacia y Bioquímica, Instituto de Química y Fisicoquímica Biológicas (IQUIFIB)-CONICET, Universidad de Buenos Aires, 1113, Capital Federal, Argentina
| | - Silvia E Hajos
- Cátedra de Inmunología, Departamento de Microbiología, Inmunología y Biotecnología, Facultad de Farmacia y Bioquímica, Instituto de Estudios de la Inmunidad Humoral (IDEHU)- CONICET, Universidad de Buenos Aires, Junín 956 4° Piso, 1113, Capital Federal, Argentina
| | - Paula G Franco
- Departamento de Química Biológica, Facultad de Farmacia y Bioquímica, Instituto de Química y Fisicoquímica Biológicas (IQUIFIB)-CONICET, Universidad de Buenos Aires, 1113, Capital Federal, Argentina
| | - Silvina L Lompardía
- Cátedra de Inmunología, Departamento de Microbiología, Inmunología y Biotecnología, Facultad de Farmacia y Bioquímica, Instituto de Estudios de la Inmunidad Humoral (IDEHU)- CONICET, Universidad de Buenos Aires, Junín 956 4° Piso, 1113, Capital Federal, Argentina
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Webber C, Brundage M, Hanna TP, Booth CM, Kennedy E, Kong W, Peng Y, Whitehead M, Groome PA. Explaining regional variations in colon cancer survival in Ontario, Canada: a population-based retrospective cohort study. BMJ Open 2022; 12:e059597. [PMID: 36123112 PMCID: PMC9486232 DOI: 10.1136/bmjopen-2021-059597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Regional variation in cancer survival is an important health system performance measurement. We evaluated if regional variation in colon cancer survival may be driven by differences in the patient population, their health and healthcare utilisation, and/or cancer care delivery. DESIGN Population-based retrospective cohort study using routinely collected linked health administrative data. SETTING Ontario, Canada. PARTICIPANTS Patients with colon cancer diagnosed between 1 January 2009 and 31 December 2012. OUTCOME Cancer-specific survival was compared across the province's 14 health regions. Using accelerated failure time models, we assessed whether regional survival variations were mediated through differences in case mix, including age, sex, comorbidities, stage at diagnosis and colon subsite, potential marginalisation and/or prediagnosis healthcare. RESULTS The study population included 16 895 patients with colon cancer. There was statistically significant regional variation in cancer-specific survival. Three regions had cancer-specific survival that was between 30% (95% CI 1.03 to 1.65) and 39% (95% CI 1.13 to 1.71) longer and one region had cancer-specific survival that was 26% shorter (95% CI 0.58 to 0.93) than the reference region. For three of these regions, case mix explained between 26% and 56% of the survival variation. Further adjustment for rurality explained 22% of the remaining survival variation in one region. Adjustment for continuity of primary care and the diagnostic interval length explained 10% and 11% of the remaining survival variation in two other regions. Socioeconomic marginalisation, recent immigration and colonoscopy history did not explain colon cancer survival variation. CONCLUSIONS Case mix accounted for much of the regional variation in colon cancer survival, indicating that efforts to monitor the quality of cancer care through survival metrics should consider case mix when reporting regional survival differences. Future work should repeat this approach in other settings and other cancer sites considering a broad range of potential mediators.
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Affiliation(s)
- Colleen Webber
- Bruyere Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michael Brundage
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Timothy P Hanna
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Christopher M Booth
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Erin Kennedy
- University of Toronto, Toronto, Ontario, Canada
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Weidong Kong
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Yingwei Peng
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
- Department of Mathematics and Statistics, Queen's University, Kingston, Ontario, Canada
| | | | - Patti A Groome
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
- ICES, Kingston, Ontario, Canada
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Ieni A, Pizzimenti C, Broggi G, Caltabiano R, Germanò A, Barbagallo G, Vigneri P, Giuffrè G, Tuccari G. Immunoexpression of p62/SQSTM1/Sequestosome‑1 in human primary and recurrent IDH1/2 wild‑type glioblastoma: A pilot study. Oncol Lett 2022; 24:336. [PMID: 36039055 PMCID: PMC9404704 DOI: 10.3892/ol.2022.13456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/30/2022] [Indexed: 11/25/2022] Open
Abstract
p62/SQSTM1/Sequestosome-1 is an autophagic protein that serves a crucial role in cellular metabolism, proliferation and malignant growth. Notably, autophagy may influence the development and resistance to therapy of numerous types of human cancer. In the present pilot study, the immunohistochemical pattern of p62 was analyzed in a cohort of patients with isocitrate dehydrogenase (IDH)1/2 wild-type glioblastoma (GBM), in primary and recurrent samples, in order to verify the concordance or discordance between the primary and recurrent tumors. In addition, the association between p62, and patient outcome and O6-methylguanine-DNA methyltransferase (MGMT) status was assessed. The results revealed p62 immunoexpression in the nucleus and cytoplasm of neoplastic elements in 45% of primary and 55% of recurrent cases of GBM. A discordant p62 immunoreactivity was detected in 35% of cases, with a variation either with positive or negative conversion of p62 status. Statistically, p62 expression and MGMT status exhibited a significant prognostic value by univariate analysis, whereas only MGMT promoter methylation status emerged as an independent prognostic factor by multivariate analysis. Finally, the most favorable prognosis was documented when the same GBM case was positively concordant for both p62 expression and MGMT methylated status. Since little data are available regarding the association between p62 expression and MGMT in GBM, further investigations may be required to determine if new targeted therapies may be addressed against autophagy-related proteins, such as p62.
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Affiliation(s)
- Antonio Ieni
- Department of Human Pathology in Adult and Developmental Age ‘Gaetano Barresi’, Section of Pathology, University of Messina, I‑98125 Messina, Italy
| | - Cristina Pizzimenti
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, I‑98125 Messina, Italy
| | - Giuseppe Broggi
- Department of Medical, Surgical Sciences and Advanced Technologies ‘G.F. Ingrassia’, Section of Anatomic Pathology, University of Catania, I‑95123 Catania, Italy
| | - Rosario Caltabiano
- Department of Medical, Surgical Sciences and Advanced Technologies ‘G.F. Ingrassia’, Section of Anatomic Pathology, University of Catania, I‑95123 Catania, Italy
| | - Antonino Germanò
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, I‑98125 Messina, Italy
| | - Giuseppe Barbagallo
- Department of Medical, Surgical Sciences and Advanced Technologies ‘G.F. Ingrassia’, Section of Neurological Surgery, Policlinico ‘Rodolico‑San Marco’ University Hospital, University of Catania, I‑95123 Catania, Italy
| | - Paolo Vigneri
- Department of Clinical and Experimental Medicine, University of Catania; 7Center of Experimental Oncology and Hematology, A.O.U. Policlinico ‘G.Rodolico‑S.Marco’, I‑95123 Catania, Italy
| | - Giuseppe Giuffrè
- Department of Human Pathology in Adult and Developmental Age ‘Gaetano Barresi’, Section of Pathology, University of Messina, I‑98125 Messina
| | - Giovanni Tuccari
- Department of Human Pathology in Adult and Developmental Age ‘Gaetano Barresi’, Section of Pathology, University of Messina, I‑98125 Messina
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Bhatia S, Nghiem P, Veeranki SP, Vanegas A, Lachance K, Tachiki L, Chiu K, Boller E, Bharmal M. Real-world clinical outcomes with avelumab in patients with Merkel cell carcinoma treated in the USA: a multicenter chart review study. J Immunother Cancer 2022; 10:jitc-2022-004904. [PMID: 35981787 PMCID: PMC9394192 DOI: 10.1136/jitc-2022-004904] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background Merkel cell carcinoma (MCC) is a rare, aggressive, cutaneous neuroendocrine neoplasm with annual incidence rates of 0.13–1.6 cases/100,000/year worldwide as of 2018. Chemotherapy for metastatic MCC (mMCC) has high objective response rates (ORRs), but responses are not durable and overall survival (OS) is poor. Avelumab (anti-programmed death-ligand 1) has demonstrated meaningful survival benefit and durable responses in clinical trials for mMCC. This study investigated real-world clinical outcomes in avelumab-treated patients with advanced (stage IIIB/IV) MCC in US academic medical centers. Methods We conducted a retrospective chart review of patients with advanced MCC who initiated avelumab between March 1, 2017, and July 31, 2019, at six US academic centers. Data were requested for eligible patients from index date through December 31, 2020. Descriptive analyses were conducted to assess demographic and clinical characteristics, real-world ORR (rwORR), real-world duration of response, real-world progression-free survival (rwPFS), and OS. Results Ninety patients with advanced MCC (82%, stage IV; 18%, stage IIIB) received avelumab. Median follow-up was 20.8 months (95% CI: 19.1 to 24.2). Median age was 68 years (range, 48–83), and the majority of patients were men (58%) and white (93%). The primary tumor was most commonly located on the lower limb (38%), with metastases mostly located in lymph nodes (68%), lung (52%), and viscera (52%). Approximately 42% and 26% of patients had an Eastern Cooperative Oncology Group performance status of 2 and 3, respectively. Seventy-three patients (81%) received avelumab as first-line treatment of advanced MCC, while 17 (19%) received avelumab as second-line or later treatment. The median duration of avelumab treatment was 13.5 months (95% CI: 6.4 to 30.6), with 42% of patients still receiving avelumab by the end of follow-up. Patients with avelumab treatment had an rwORR of 73% (95% CI: 64 to 83), median rwPFS of 24.4 months (95% CI: 8.31 to not estimable (NE)), and median OS of 30.7 months (95% CI: 11.2 to NE). Conclusions This real-world study of patients with advanced MCC demonstrated that avelumab treatment resulted in a high response rate with durable responses and prolonged survival. The study findings validate the results demonstrated in prospective clinical trials and other observational studies.
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Affiliation(s)
- Shailender Bhatia
- Division of Medical Oncology, University of Washington, Seattle, Washington, USA .,Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Paul Nghiem
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,UW Medical Center at Lake Union, Seattle, Washington, USA
| | | | | | - Kristina Lachance
- Division of Medical Oncology, University of Washington, Seattle, Washington, USA
| | - Lisa Tachiki
- Division of Medical Oncology, University of Washington, Seattle, Washington, USA.,Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Kevin Chiu
- PRECISIONheor, Los Angeles, California, USA
| | | | - Murtuza Bharmal
- EMD Serono Research & Development Institute, Inc, Billerica, Massachusetts, USA, an affiliate of Merck KGaA
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Loughrey MB, Wong NACS. Clinical utility of GI pathology data: implications for practising pathologists. J Clin Pathol 2022; 75:519-524. [PMID: 35853655 DOI: 10.1136/jclinpath-2021-207472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/04/2022]
Abstract
Gastrointestinal (GI) tract pathology represents one of the largest individual specialties within cellular pathology departments globally. As with other specialties, clear communication with clinicians providing primary care for the patient is of utmost importance for optimal management and for appropriate use of resources such as endoscopy. A wide breadth of neoplastic and inflammatory conditions afflicts the GI tract. Here, we aim to illustrate how pathology reporting of GI tract specimens influences patient management and specifically how precise reporting of key parameters in different specimen types and different disease processes can directly impact patient care. We describe the potential clinical relevance of selected pathology data items pertinent to specific conditions and highlight areas of contention with respect to the significance of some pathology features. Recent guidelines are described where a change, for example, in diagnostic criteria for a condition is described, or criteria influencing further management such as endoscopic surveillance. The aim of this review is to focus on the clinical importance of careful written communication between the pathologist and primary clinician, illustrated by selective clinical scenarios involving the upper and lower GI tracts.
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Affiliation(s)
- Maurice B Loughrey
- Department of Cellular Pathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK .,Centre for Public Health, Queen's University Belfast, School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
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Groome PA, Webber C, Maxwell CJ, McClintock C, Seitz D, Mahar A, Marrie RA. Multiple Sclerosis and the Cancer Diagnosis: Diagnostic Route, Cancer Stage, and the Diagnostic Interval in Breast and Colorectal Cancer. Neurology 2022; 98:e1798-e1809. [PMID: 35501160 DOI: 10.1212/wnl.0000000000200163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The multiple sclerosis (MS) population's survival from breast cancer and colorectal cancer is compromised. Cancer screening and timely diagnoses affect cancer survival and have not been studied in the MS cancer population. We investigated whether the diagnostic route, cancer stage, or diagnostic interval differed in patients with cancer with and without MS. METHODS We conducted a matched population-based cross-sectional study of breast cancers (2007-2015) and colorectal cancers (2009-2012) in patients with MS from Ontario, Canada, using administrative data. Exclusion criteria included second or concurrent primary cancers, no health care coverage, and, for the patients without MS, those with any demyelinating disease. We based 1:4 matching of MS to non-MS on birth year, sex (colorectal only), postal code, and cancer diagnosis year (breast only). Cancer outcomes were diagnostic route (screen-detected vs symptomatic), stage (stage I vs all others), and diagnostic interval (time from first presentation to diagnosis). Multivariable regression analyses controlled for age, sex (colorectal only), diagnosis year, income quintile, urban/rural residence, and comorbidity. RESULTS We included 351 patients with MS and breast cancer, 1,404 matched patients with breast cancer without MS, 54 patients with MS and colorectal cancer, and 216 matched patients with colorectal cancer without MS. MS was associated with fewer screen-detected cancers in breast (odds ratio [OR] 0.68 [95% CI 0.52, 0.88]) and possibly colorectal (0.52 [0.21, 1.28]) cancer. MS was not associated with differences in breast cancer stage at diagnosis (stage I cancer, OR 0.81 [0.64, 1.04]). MS was associated with greater odds of stage I colorectal cancer (OR 2.11 [1.03, 4.30]). The median length of the diagnostic interval did not vary between people with and without MS in either the breast or colorectal cancer cohorts. Controlling for disability status attenuated some findings. DISCUSSION Breast cancers were less likely to be detected through screening and colorectal cancer more likely to be detected at early stage in people with MS than without MS. MS-related disability may prevent people from getting mammograms and colonoscopies. Understanding the pathways to earlier detection in both cancers is critical to developing and planning interventions to ameliorate outcomes for people with MS and cancer.
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Affiliation(s)
- Patti A Groome
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Colleen Webber
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Colleen J Maxwell
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Chad McClintock
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Dallas Seitz
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alyson Mahar
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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9
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Habbous S, Homenauth E, Barisic A, Kandasamy S, Majpruz V, Forster K, Yurcan M, Chiarelli AM, Groome P, Holloway CMB, Eisen A. Differences in breast cancer diagnosis by patient presentation in Ontario: a retrospective cohort study. CMAJ Open 2022; 10:E313-E330. [PMID: 35383035 PMCID: PMC9259434 DOI: 10.9778/cmajo.20210254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In Ontario, patients with breast cancer typically receive their diagnoses through the Ontario Breast Screening Program (OBSP) after an abnormal screen, through screening initiated by a primary care provider or other referring physician, or through follow-up of symptoms by patients' primary care providers. We sought to explore the association of the route to diagnosis (screening within or outside the OBSP or via symptomatic presentation) with use of OBSP-affiliated breast assessment sites (O-BAS), wait times until diagnosis or treatment, health care use and overall survival for patients with breast cancer. METHODS In this retrospective cohort study, we used the Ontario Cancer Registry to identify adults (aged 18-105 yr) who received a diagnosis of breast cancer from 2013 to 2017. We excluded patients if they were not Ontario residents or had missing age or sex, or who died before diagnosis. We used logistic regression to evaluate factors associated with categorical variables (whether patients were or were not referred to an OBAS, whether patients were screened or symptomatic) and Cox proportional hazards regression to identify factors associated with all-cause mortality. RESULTS Of 51 460 patients with breast cancer, 42 598 (83%) received their diagnoses at an O-BAS. Patients whose cancer was first detected through the OBSP were more likely than symptomatic patients to be given a diagnosis at an O-BAS (adjusted odds ratio 1.68, 95% confidence interval [CI] 1.57 to 1.80). Patients screened by the OBSP were given their diagnoses 1 month earlier than symptomatic patients, but diagnosis at an O-BAS did not affect the time until either diagnosis or treatment. Patients referred to an O-BAS had significantly better overall survival than those who were not referred (adjusted hazard ratio 0.73, 95% CI 0.66 to 0.80). INTERPRETATION Patients screened through the OBSP were given their diagnoses earlier than symptomatic patients and were more likely to be referred to an O-BAS, which was associated with better survival. Our findings suggest that individuals with signs and symptoms of breast cancer would benefit from similar referral processes, oversight and standards to those used by the OBSP.
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Affiliation(s)
- Steven Habbous
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont.
| | - Esha Homenauth
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Andriana Barisic
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Sharmilaa Kandasamy
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Vicky Majpruz
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Katharina Forster
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Marta Yurcan
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Anna M Chiarelli
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Patti Groome
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Claire M B Holloway
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Andrea Eisen
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont
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10
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Bhandoria GP, Nair N, Jones SEF, Eriksson AG, Hsu HC, Noll F, Ahmed W. International Gynaecological Cancer Society (IGCS) 2020 Annual Global Meeting: Twitter activity analysis. Int J Gynecol Cancer 2021; 31:1453-1458. [PMID: 34489352 DOI: 10.1136/ijgc-2021-002781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/20/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Twitter is the most frequently used social media platform by healthcare practitioners, at medical conferences. This study aimed to analyze Twitter conversations during the virtual International Gynecological Cancer Society 2020 conference to understand the interactions between Twitter users related to the conference. METHODS Tweets using the hashtag '#IGCS2020' were searched using the Twitter Search Application Programming Interface (API) during the period 10-13 September 2020. NodeXL Pro was used to retrieve data. The Clauset-Newman-Moore cluster algorithm clustered users into different groups or 'clusters' based on how users interacted. RESULTS There were 2009 registrants for the virtual IGCS 2020 conference. The total number of users within the network was 168, and there were 880 edges connecting users. Five types of edges were identified as follows: 'replies to' (n=18), 'mentions' (n=221), 'mentions in retweets' (n=375), retweets (n=198), and tweets (n=68). The most influential account was that of the IGCS account itself (@IGCSociety). The overall network shape resembled a community where distinct groups formed within the network. Our current analyses demonstrated that less than 10% of the total members interacted on Twitter. CONCLUSION This study identified the most influential Twitter users within the '#IGCS2020' community. he results also confirmed the community network shape of the #IGCS2020 hashtag and found that the most frequent co-related words were 'ovarian' and 'cancer' (n=39).
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Affiliation(s)
- Geetu Prakash Bhandoria
- Department of Obstetrics and Gynecology, Command Hospital Kolkata, Kolkata, West Bengal, India
| | - Navya Nair
- Department of Gynecologic Oncology, Louisiana State University, Baton Rouge, Louisiana, USA
| | | | - Ane Gerda Eriksson
- Department of Gynecologic Oncology, Norwegian Radium Hospital, Oslo, Norway
| | - Heng-Cheng Hsu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Florencia Noll
- Department of Gynecologic Oncology & Department of Obstetrics and Gynecology, Hospital Italiano de Buenos Aires & Sanatorio Allende Cerro, Buenos Aires & Córdoba, Argentina
| | - Wasim Ahmed
- Newcastle University, Business School, Newcastle, UK
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11
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Tomar MS, Kumar A, Srivastava C, Shrivastava A. Elucidating the mechanisms of Temozolomide resistance in gliomas and the strategies to overcome the resistance. Biochim Biophys Acta Rev Cancer 2021; 1876:188616. [PMID: 34419533 DOI: 10.1016/j.bbcan.2021.188616] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/25/2021] [Accepted: 08/15/2021] [Indexed: 02/06/2023]
Abstract
Temozolomide (TMZ) is a first-choice alkylating agent inducted as a gold standard therapy for glioblastoma multiforme (GBM) and astrocytoma. A majority of patients do not respond to TMZ during the course of their treatment. Activation of DNA repair pathways is the principal mechanism for this phenomenon that detaches TMZ-induced O-6-methylguanine adducts and restores genomic integrity. Current understanding in the domain of oncology adds several other novel mechanisms of resistance such as the involvement of miRNAs, drug efflux transporters, gap junction's activity, the advent of glioma stem cells as well as upregulation of cell survival autophagy. This review describes a multifaceted account of different mechanisms responsible for the intrinsic and acquired TMZ-resistance. Here, we summarize different strategies that intensify the TMZ effect such as MGMT inhibition, development of novel imidazotetrazine analog, and combination therapy; with an aim to incorporate a successful treatment and increased overall survival in GBM patients.
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Affiliation(s)
- Manendra Singh Tomar
- Center for Advance Research, Faculty of Medicine, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Ashok Kumar
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS) Bhopal, Saket Nagar, Bhopal 462020, Madhya Pradesh, India
| | - Chhitij Srivastava
- Department of Neurosurgery, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Ashutosh Shrivastava
- Center for Advance Research, Faculty of Medicine, King George's Medical University, Lucknow 226003, Uttar Pradesh, India.
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12
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Lang F, Liu Y, Chou FJ, Yang C. Genotoxic therapy and resistance mechanism in gliomas. Pharmacol Ther 2021; 228:107922. [PMID: 34171339 DOI: 10.1016/j.pharmthera.2021.107922] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 02/07/2023]
Abstract
Glioma is one of the most common and lethal brain tumors. Surgical resection followed by radiotherapy plus chemotherapy is the current standard of care for patients with glioma. The existence of resistance to genotoxic therapy, as well as the nature of tumor heterogeneity greatly limits the efficacy of glioma therapy. DNA damage repair pathways play essential roles in many aspects of glioma biology such as cancer progression, therapy resistance, and tumor relapse. O6-methylguanine-DNA methyltransferase (MGMT) repairs the cytotoxic DNA lesion generated by temozolomide (TMZ), considered as the main mechanism of drug resistance. In addition, mismatch repair, base excision repair, and homologous recombination DNA repair also play pivotal roles in treatment resistance as well. Furthermore, cellular mechanisms, such as cancer stem cells, evasion from apoptosis, and metabolic reprogramming, also contribute to TMZ resistance in gliomas. Investigations over the past two decades have revealed comprehensive mechanisms of glioma therapy resistance, which has led to the development of novel therapeutic strategies and targeting molecules.
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Affiliation(s)
- Fengchao Lang
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Yang Liu
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Fu-Ju Chou
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Chunzhang Yang
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA.
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13
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Darrigues E, Elberson BW, De Loose A, Lee MP, Green E, Benton AM, Sink LG, Scott H, Gokden M, Day JD, Rodriguez A. Brain Tumor Biobank Development for Precision Medicine: Role of the Neurosurgeon. Front Oncol 2021; 11:662260. [PMID: 33981610 PMCID: PMC8108694 DOI: 10.3389/fonc.2021.662260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/29/2021] [Indexed: 12/18/2022] Open
Abstract
Neuro-oncology biobanks are critical for the implementation of a precision medicine program. In this perspective, we review our first year experience of a brain tumor biobank with integrated next generation sequencing. From our experience, we describe the critical role of the neurosurgeon in diagnosis, research, and precision medicine efforts. In the first year of implementation of the biobank, 117 patients (Female: 62; Male: 55) had 125 brain tumor surgeries. 75% of patients had tumors biobanked, and 16% were of minority race/ethnicity. Tumors biobanked were as follows: diffuse gliomas (45%), brain metastases (29%), meningioma (21%), and other (5%). Among biobanked patients, 100% also had next generation sequencing. Eleven patients qualified for targeted therapy based on identification of actionable gene mutations. One patient with a hereditary cancer predisposition syndrome was also identified. An iterative quality improvement process was implemented to streamline the workflow between the operating room, pathology, and the research laboratory. Dedicated tumor bank personnel in the department of neurosurgery greatly improved standard operating procedure. Intraoperative selection and processing of tumor tissue by the neurosurgeon was integral to increasing success with cell culture assays. Currently, our institutional protocol integrates standard histopathological diagnosis, next generation sequencing, and functional assays on surgical specimens to develop precision medicine protocols for our patients. This perspective reviews the critical role of neurosurgeons in brain tumor biobank implementation and success as well as future directions for enhancing precision medicine efforts.
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Affiliation(s)
- Emilie Darrigues
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Benjamin W Elberson
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Annick De Loose
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Madison P Lee
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Ebonye Green
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Ashley M Benton
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Ladye G Sink
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Hayden Scott
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Murat Gokden
- Division of Neuropathology, Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - John D Day
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Analiz Rodriguez
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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14
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Lasri A, Sturrock M. The influence of methylation status on a stochastic model of MGMT dynamics in glioblastoma: Phenotypic selection can occur with and without a downshift in promoter methylation status. J Theor Biol 2021; 521:110662. [PMID: 33684406 DOI: 10.1016/j.jtbi.2021.110662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 01/02/2023]
Abstract
Glioblastoma originates in the brain and is one of the most aggressive cancer types. Glioblastoma represents 15% of all brain tumours, with a median survival of 15 months. Although the current standard of care for such a tumour (the Stupp protocol) has shown positive results for the prognosis of patients, O-6-methylguanine-DNA methyltransferase (MGMT) driven drug resistance has been an issue of increasing concern and hence requires innovative approaches. In addition to the well established drug resistance factors such as tumour location and blood brain barriers, it is also important to understand how the genetic and epigenetic dynamics of the glioblastoma cells can play a role. One important aspect of this is the study of methylation status of MGMT following administration of temozolomide. In this paper, we extend our previously published model that simulated MGMT expression in glioblastoma cells to incorporate the promoter methylation status of MGMT. This methylation status has clinical significance and is used as a marker for patient outcomes. Using this model, we investigate the causative relationship between temozolomide treatment and the methylation status of the MGMT promoter in a population of cells. In addition by constraining the model to relevant biological data using Approximate Bayesian Computation, we were able to identify parameter regimes that yield different possible modes of resistances, namely, phenotypic selection of MGMT, a downshift in the methylation status of the MGMT promoter or both simultaneously. We analysed each of the parameter sets associated with the different modes of resistance, presenting representative solutions as well as discovering some similarities between them as well as unique requirements for each of them. Finally, we used them to devise optimal strategies for inhibiting MGMT expression with the aim of minimising live glioblastoma cell numbers.
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Affiliation(s)
- Ayoub Lasri
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, York house, Dublin, Ireland.
| | - Marc Sturrock
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, York house, Dublin, Ireland
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15
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Choi HJ, Choi SH, You SH, Yoo RE, Kang KM, Yun TJ, Kim JH, Sohn CH, Park CK, Park SH. MGMT Promoter Methylation Status in Initial and Recurrent Glioblastoma: Correlation Study with DWI and DSC PWI Features. AJNR Am J Neuroradiol 2021; 42:853-860. [PMID: 33632732 DOI: 10.3174/ajnr.a7004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/16/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status in primary and recurrent glioblastoma may change during treatment. The purpose of this study was to correlate MGMT promoter methylation status changes with DWI and DSC PWI features in patients with recurrent glioblastoma after standard treatment. MATERIALS AND METHODS Between January 2008 and November 2016, forty patients with histologically confirmed recurrent glioblastoma were enrolled. Patients were divided into 3 groups according to the MGMT promoter methylation status for the initial and recurrent tumors: 2 groups whose MGMT promoter methylation status remained, group methylated (n = 13) or group unmethylated (n = 18), and 1 group whose MGMT promoter methylation status changed from methylated to unmethylated (n = 9). Normalized ADC and normalized relative CBV values were obtained from both the enhancing and nonenhancing regions, from which histogram parameters were calculated. The ANOVA and the Kruskal-Wallis test followed by post hoc tests were performed to compare histogram parameters among the 3 groups. The t test and Mann-Whitney U test were used to compare parameters between group methylated and group methylated to unmethylated. Receiver operating characteristic curve analysis was used to measure the predictive performance of the normalized relative CBV values between the 2 groups. RESULTS Group methylated to unmethylated showed significantly higher means and 90th and 95th percentiles of the cumulative normalized relative CBV values of the nonenhancing region of the initial tumor than group methylated and group unmethylated (all P < .05). The mean normalized relative CBV value of the nonenhancing region of the initial tumor was the best predictor of methylation status change (P < .001), with a sensitivity of 77.78% and specificity of 92.31% at a cutoff value of 2.594. CONCLUSIONS MGMT promoter methylation status might change in recurrent glioblastoma after standard treatment. The normalized relative CBV values of the nonenhancing region at the first preoperative MR imaging were higher in the MGMT promoter methylation change group from methylation to unmethylation in recurrent glioblastoma.
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Affiliation(s)
- H J Choi
- From the Department of Radiology (H.J.C.), Cha Bundang Medical Center, Cha University, Seongnam, Korea
| | - S H Choi
- Department of Radiology (S.H.C., R.-E.Y., K.M.K., T.J.Y., J.-h.K., C.-H.S.), Seoul National University Hospital, Seoul, Korea
| | - S-H You
- Department of Radiology (S.-H.Y.), Korea University Hospital, Seoul, Korea
| | - R-E Yoo
- Department of Radiology (S.H.C., R.-E.Y., K.M.K., T.J.Y., J.-h.K., C.-H.S.), Seoul National University Hospital, Seoul, Korea
| | - K M Kang
- Department of Radiology (S.H.C., R.-E.Y., K.M.K., T.J.Y., J.-h.K., C.-H.S.), Seoul National University Hospital, Seoul, Korea
| | - T J Yun
- Department of Radiology (S.H.C., R.-E.Y., K.M.K., T.J.Y., J.-h.K., C.-H.S.), Seoul National University Hospital, Seoul, Korea
| | - J-H Kim
- Department of Radiology (S.H.C., R.-E.Y., K.M.K., T.J.Y., J.-h.K., C.-H.S.), Seoul National University Hospital, Seoul, Korea
| | - C-H Sohn
- Department of Radiology (S.H.C., R.-E.Y., K.M.K., T.J.Y., J.-h.K., C.-H.S.), Seoul National University Hospital, Seoul, Korea
| | - C-K Park
- Department of Neurosurgery (C.-K.P.), Seoul National University Hospital, Seoul, Korea
| | - S-H Park
- Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul, Korea
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16
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Taslimi S, Ye VC, Wen PY, Zadeh G. Lessons learned from contemporary glioblastoma randomized clinical trials through systematic review and network meta-analysis: part 2 recurrent glioblastoma. Neurooncol Adv 2021; 3:vdab029. [PMID: 34042101 PMCID: PMC8134527 DOI: 10.1093/noajnl/vdab029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND There exists no consensus standard of treatment for patients with recurrent glioblastoma (GB). Here we used a network meta-analysis on treatments from randomized control trials (RCTs) to assess the effect on overall survival (OS) and progression-free survival (PFS) to determine if any consensus treatment can be determined for recurrent GB. METHODS We included all recurrent GB RCTs with at least 20 patients in each arm, and for whom patients underwent standard of care at the time of their GB initial diagnosis. Our primary outcome was OS, with secondary outcomes including PFS and adverse reactions. Hazard ratio (HR) and its 95% confidence interval (CI) of the comparison of study arms regarding OS and PFS were extracted from each paper. For comparative efficacy analysis, we utilized a frequentist network meta-analysis, an extension of the classic pair-wise meta-analysis. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses. RESULTS Fifteen studies were included representing 29 separate treatment arms and 2194 patients. In our network meta-analysis, combination treatment with tumor-treating field and Vascular endothelial growth factor (VEGF) inhibitor ranked first in improving OS (P = .80). Concomitant anti-VEGF and Lomustine treatment was superior to Lomustine alone for extending PFS (HR 0.57, 95% CI 0.41-0.79) and ranked first in improving PFS compared to other included treatments (P = .86). CONCLUSIONS Our analysis highlights the numerous studies performed on recurrent GB, with no proven consensus treatment that is superior to the current SOC. Intertrial heterogeneity precludes drawing strong conclusions, and confidence analysis was low to very low. Further confirmation by future trials is recommended for our exploratory results.
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Affiliation(s)
- Shervin Taslimi
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vincent C Ye
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Stathonikos N, Nguyen TQ, van Diest PJ. Rocky road to digital diagnostics: implementation issues and exhilarating experiences. J Clin Pathol 2020; 74:415-420. [PMID: 32988997 DOI: 10.1136/jclinpath-2020-206715] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/29/2020] [Indexed: 12/31/2022]
Abstract
Since 2007, we have gradually been building up infrastructure for digital pathology, starting with a whole slide scanner park to build up a digital archive to streamline doing multidisciplinary meetings, student teaching and research, culminating in a full digital diagnostic workflow where we are currently integrating artificial intelligence algorithms. In this paper, we highlight the different steps in this process towards digital diagnostics, which was at times a rocky road with definitely issues in implementation, but eventually an exciting new way to practice pathology in a more modern and efficient way where patient safety has clearly gone up.
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Affiliation(s)
| | - Tri Q Nguyen
- Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul J van Diest
- Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
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18
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Wang WH, Shen CY, Chien YC, Chang WS, Tsai CW, Lin YH, Hwang JJ. Validation of Enhancing Effects of Curcumin on Radiotherapy with F98/ FGT Glioblastoma-Bearing Rat Model. Int J Mol Sci 2020; 21:ijms21124385. [PMID: 32575632 PMCID: PMC7352749 DOI: 10.3390/ijms21124385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/17/2022] Open
Abstract
Glioblastoma, the most common and aggressive brain tumor with low survival rate, is difficult to be cured by neurosurgery or radiotherapy. Mounting evidence has reported the anti-inflammatory and anticancer effects of curcumin on several types of cancer in preclinical studies and clinical trials. To our knowledge, there is no platform or system that could be used to effectively and real-timely evaluate the therapeutic efficacy of curcumin for glioblastoma multiforme (GBM). In this study, we constructed a lentivirus vector with triple-reporter genes (Fluc/GFP/tk) and transduced into rat F98 glioblastoma cells to establish an orthotopic F98/FGT glioma-bearing rat model. In the model, the therapeutic efficacies for curcumin alone, radiation alone, and their combination were evaluated via noninvasive bioluminescent imaging and overall survival measurements. At the cell level, curcumin is capable of causing a G2/M cell cycle arrest and sensitizing the F98 cells to radiation. In animal model, curcumin synergistically enhances the effects of radiotherapy on suppressing the growth of both transplanted glioma cells and in situ brain tumors, and extending the overall survival periods longer than those of curcumin alone and radiation alone treatments. In conclusion, we have demonstrated that curcumin may serve as a novel radiosensitizer to combine with radiotherapy using the triple-reporter F98/FGT animal model for effective and simultaneous evaluation of therapeutic efficacy.
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Affiliation(s)
- Wei-Hsun Wang
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua 500, Taiwan;
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung 821, Taiwan
| | - Chao-Yu Shen
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; or
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Yi-Chun Chien
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Jiaosu Village, Kaohsiung 824, Taiwan;
- School of Medicine, I-Shou University, Jiaosu Village, Kaohsiung 824, Taiwan
| | - Wen-Shin Chang
- Terry Fox Cancer Research Laboratory, Department of Medical Research, China Medical University Hospital, Taichung 402, Taiwan; (W.-S.C.); (C.-W.T.)
| | - Chia-Wen Tsai
- Terry Fox Cancer Research Laboratory, Department of Medical Research, China Medical University Hospital, Taichung 402, Taiwan; (W.-S.C.); (C.-W.T.)
| | - Yi-Hsien Lin
- Division of Radiotherapy, Cheng Hsin General Hospital, No. 45, Cheng Hsin St, Beitou, Taipei 112, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Correspondence: (Y.-H.L.); (J.-J.H.); Tel.: +88-622-826-4400 (ext. 5750) (Y.-H.L.); +88-642-473-9595 (ext. 32138) (J.-J.H.); Fax: +88-622-826-4524 (Y.-H.L.); +88-642-324-8186 (J.-J.H.)
| | - Jeng-Jong Hwang
- Department of Medical Imaging, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo North Road, Taichung 402, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung 112, Taiwan
- Correspondence: (Y.-H.L.); (J.-J.H.); Tel.: +88-622-826-4400 (ext. 5750) (Y.-H.L.); +88-642-473-9595 (ext. 32138) (J.-J.H.); Fax: +88-622-826-4524 (Y.-H.L.); +88-642-324-8186 (J.-J.H.)
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20
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Yasaitis LC, Guan J, Ko DT, Chandra A, Stukel TA. Cardiac intervention rates for older patients with acute myocardial infarction in the United States and Ontario, 2003-2013: a retrospective cohort study. CMAJ Open 2020; 8:E437-E447. [PMID: 32527795 PMCID: PMC7850174 DOI: 10.9778/cmajo.20190190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Previous work showed lower cardiac intervention rates for patients with acute myocardial infarction (AMI) in Ontario than in the United States. We assessed whether Ontario's efforts to improve access to rapid percutaneous coronary intervention (PCI) for AMI were associated with improved timeliness of care and whether this closed the gap between the 2 jurisdictions. METHODS In this retrospective cohort study, we followed adults aged 66-99 years in the US and Ontario for 30 days after admission for incident AMI between 2003 and 2013 using health administrative data from both countries. We calculated the proportion of patients who received cardiac catheterization, PCI and coronary artery bypass grafting on the day of and within 30 days of admission overall and according to AMI type (ST-segment elevation AMI [STEMI] v. non-STEMI) and risk group (low, medium or high predicted risk of 30-d mortality). RESULTS We followed 414 216 patients in the US and 112 484 in Ontario. The large disparities in cardiac intervention rates observed in 2003 mostly disappeared over time. By 2013, the proportion of patients who received same-day PCI was only slightly higher in the US than in Ontario (22.3% v. 19.2%), whereas the converse was true for 30-day PCI (44.0% v. 41.3%). In 2013, patients with STEMI in the US and Ontario received PCI at nearly identical rates on the day of admission (66.3% v. 63.8%); however, more patients at high risk with STEMI in the US than in Ontario received PCI, both on the day of admission (55.5% v. 44.7%) and by 30 days (60.5% v. 55.0%). INTERPRETATION Despite differences in resources and organization of delivery systems, by 2013, timely receipt of PCI by Ontario patients with AMI lagged only slightly behind that by US patients. A higher supply of PCI centres in the US may have facilitated earlier intervention among patients at high risk with STEMI.
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Affiliation(s)
- Laura C Yasaitis
- Leonard Davis Institute of Health Economics (Yasaitis), University of Pennsylvania, Philadelphia, Pa.; ICES Central (Guan, Ko, Stukel); Department of Medicine (Ko), Schulich Heart Centre, Sunnybrook Health Sciences Centre, and Institute of Health Policy, Management and Evaluation (Ko, Stukel), University of Toronto, Toronto, Ont.; John F. Kennedy School of Government (Chandra), Harvard University; Harvard Business School (Chandra); National Bureau of Economics Research (Chandra), Cambridge, Mass.; The Dartmouth Institute for Health Policy & Clinical Practice (Stukel), Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Jun Guan
- Leonard Davis Institute of Health Economics (Yasaitis), University of Pennsylvania, Philadelphia, Pa.; ICES Central (Guan, Ko, Stukel); Department of Medicine (Ko), Schulich Heart Centre, Sunnybrook Health Sciences Centre, and Institute of Health Policy, Management and Evaluation (Ko, Stukel), University of Toronto, Toronto, Ont.; John F. Kennedy School of Government (Chandra), Harvard University; Harvard Business School (Chandra); National Bureau of Economics Research (Chandra), Cambridge, Mass.; The Dartmouth Institute for Health Policy & Clinical Practice (Stukel), Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Dennis T Ko
- Leonard Davis Institute of Health Economics (Yasaitis), University of Pennsylvania, Philadelphia, Pa.; ICES Central (Guan, Ko, Stukel); Department of Medicine (Ko), Schulich Heart Centre, Sunnybrook Health Sciences Centre, and Institute of Health Policy, Management and Evaluation (Ko, Stukel), University of Toronto, Toronto, Ont.; John F. Kennedy School of Government (Chandra), Harvard University; Harvard Business School (Chandra); National Bureau of Economics Research (Chandra), Cambridge, Mass.; The Dartmouth Institute for Health Policy & Clinical Practice (Stukel), Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Amitabh Chandra
- Leonard Davis Institute of Health Economics (Yasaitis), University of Pennsylvania, Philadelphia, Pa.; ICES Central (Guan, Ko, Stukel); Department of Medicine (Ko), Schulich Heart Centre, Sunnybrook Health Sciences Centre, and Institute of Health Policy, Management and Evaluation (Ko, Stukel), University of Toronto, Toronto, Ont.; John F. Kennedy School of Government (Chandra), Harvard University; Harvard Business School (Chandra); National Bureau of Economics Research (Chandra), Cambridge, Mass.; The Dartmouth Institute for Health Policy & Clinical Practice (Stukel), Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Therese A Stukel
- Leonard Davis Institute of Health Economics (Yasaitis), University of Pennsylvania, Philadelphia, Pa.; ICES Central (Guan, Ko, Stukel); Department of Medicine (Ko), Schulich Heart Centre, Sunnybrook Health Sciences Centre, and Institute of Health Policy, Management and Evaluation (Ko, Stukel), University of Toronto, Toronto, Ont.; John F. Kennedy School of Government (Chandra), Harvard University; Harvard Business School (Chandra); National Bureau of Economics Research (Chandra), Cambridge, Mass.; The Dartmouth Institute for Health Policy & Clinical Practice (Stukel), Geisel School of Medicine, Dartmouth College, Hanover, NH
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21
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Feldheim J, Kessler AF, Monoranu CM, Ernestus RI, Löhr M, Hagemann C. Changes of O 6-Methylguanine DNA Methyltransferase (MGMT) Promoter Methylation in Glioblastoma Relapse-A Meta-Analysis Type Literature Review. Cancers (Basel) 2019; 11:cancers11121837. [PMID: 31766430 PMCID: PMC6966671 DOI: 10.3390/cancers11121837] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/11/2019] [Accepted: 11/19/2019] [Indexed: 02/07/2023] Open
Abstract
Methylation of the O6-methylguanine DNA methyltransferase (MGMT) promoter has emerged as strong prognostic factor in the therapy of glioblastoma multiforme. It is associated with an improved response to chemotherapy with temozolomide and longer overall survival. MGMT promoter methylation has implications for the clinical course of patients. In recent years, there have been observations of patients changing their MGMT promoter methylation from primary tumor to relapse. Still, data on this topic are scarce. Studies often consist of only few patients and provide rather contrasting results, making it hard to draw a clear conclusion on clinical implications. Here, we summarize the previous publications on this topic, add new cases of changing MGMT status in relapse and finally combine all reports of more than ten patients in a statistical analysis based on the Wilson score interval. MGMT promoter methylation changes are seen in 115 of 476 analyzed patients (24%; CI: 0.21–0.28). We discuss potential reasons like technical issues, intratumoral heterogeneity and selective pressure of therapy. The clinical implications are still ambiguous and do not yet support a change in clinical practice. However, retesting MGMT methylation might be useful for future treatment decisions and we encourage clinical studies to address this topic.
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Affiliation(s)
- Jonas Feldheim
- Tumorbiology Laboratory, Department of Neurosurgery, University of Würzburg, Josef-Schneider-Str. 11, D-97080 Würzburg, Germany; (J.F.); (A.F.K.); (R.-I.E.); (M.L.)
| | - Almuth F. Kessler
- Tumorbiology Laboratory, Department of Neurosurgery, University of Würzburg, Josef-Schneider-Str. 11, D-97080 Würzburg, Germany; (J.F.); (A.F.K.); (R.-I.E.); (M.L.)
| | - Camelia M. Monoranu
- Department of Neuropathology, Institute of Pathology, University of Würzburg, Josef-Schneider-Str. 2, D-97080 Würzburg, Germany;
| | - Ralf-Ingo Ernestus
- Tumorbiology Laboratory, Department of Neurosurgery, University of Würzburg, Josef-Schneider-Str. 11, D-97080 Würzburg, Germany; (J.F.); (A.F.K.); (R.-I.E.); (M.L.)
| | - Mario Löhr
- Tumorbiology Laboratory, Department of Neurosurgery, University of Würzburg, Josef-Schneider-Str. 11, D-97080 Würzburg, Germany; (J.F.); (A.F.K.); (R.-I.E.); (M.L.)
| | - Carsten Hagemann
- Tumorbiology Laboratory, Department of Neurosurgery, University of Würzburg, Josef-Schneider-Str. 11, D-97080 Würzburg, Germany; (J.F.); (A.F.K.); (R.-I.E.); (M.L.)
- Correspondence: ; Tel.: +49-931-20124644
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22
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Shangguan W, Lv X, Tian N. FoxD2-AS1 is a prognostic factor in glioma and promotes temozolomide resistance in a O 6-methylguanine-DNA methyltransferase-dependent manner. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2019; 23:475-482. [PMID: 31680769 PMCID: PMC6819902 DOI: 10.4196/kjpp.2019.23.6.475] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/30/2019] [Accepted: 08/07/2019] [Indexed: 11/15/2022]
Abstract
Glioma is the most common brain tumor with a dismal prognosis. While temozolomide (TMZ) based chemotherapy significantly improves survival in glioma patients, resistance against this compound commonly leads to glioma treatment failure. Overexpression of long-noncoding RNA (LncRNA) FoxD2 adjacent opposite strand RNA 1 (FoxD2-AS1) was identified to promote glioma development, but the role in TMZ resistance remains unclear. In this paper, we found that FoxD2-AS1 was overexpressed in recurrent glioma, high FoxD2-AS1 expression was significantly correlated with poor patient outcome. Methylation of O6-methylguanine-DNA methyltransferase (MGMT) is significantly less frequent in high FoxD2-AS1 expression patients. Knockdown of FoxD2-AS1 decreased the proliferation, metastatic ability of glioma cells and promote the sensitivity to TMZ in glioma cells. Furthermore, knockdown of FoxD2-AS1 induced hypermethylation of the promoter region of MGMT. Our data suggested that FoxD2-AS1 is a clinical relevance LncRNA and mediates TMZ resistance by regulating the methylation status of the MGMT promoter region.
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Affiliation(s)
- Wenbing Shangguan
- Institute of Molecular Medicine, Life Science College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Xuyang Lv
- Institute of Molecular Medicine, Life Science College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Nan Tian
- Institute of Molecular Medicine, Life Science College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
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