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Yazaki S, Chiba Y, Kojima Y, Yoshida H, Takamizawa S, Kitadai R, Saito A, Kita S, Yamamoto K, Sumiyoshi-Okuma H, Nishikawa T, Sudo K, Shimoi T, Noguchi E, Uno M, Ishikawa M, Kato T, Fujiwara Y, Yonemori K. Folate Receptor Alpha Expression and the Tumor Immune Microenvironment in Patients with Cervical Cancer. Int J Gynecol Pathol 2024:00004347-990000000-00174. [PMID: 38914017 DOI: 10.1097/pgp.0000000000001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Folate receptor α (FRα) is a cell-surface protein and an attractive target for cancer treatment. We investigated the association between FRα expression and the tumor immune microenvironment in patients with cervical cancer. We examined whole tumor sections of 123 patients with cervical cancer: 67 and 56 sections of squamous cell carcinoma (SCC) and non-SCC, respectively. FRα expression was assessed using immunohistochemical staining with the anti-FRα monoclonal antibody clone 26B3. Programmed death-ligand 1 (PD-L1) expression was assessed using a combined positive score (CPS). The intratumoral CD3 and CD8 cell densities were calculated as the average number of positive cells in five independent areas. FRα-positivity was identified in 72.4% of the patients, and it differed by histology (SCC vs. non-SCC; 55.2% vs. 92.9%, P<0.001). PD-L1 status was positive (CPS ≥1) in 75.6% and was more commonly expressed in patients with SCC (SCC vs. non-SCC; 83.5% vs. 66.1%, P=0.02). FRα expression had a weak correlation with PD-L1 expression (r=-0.22, P<0.001) and CD8-positive cells (r=-0.19, P=0.03). FRα-positivity was more frequently observed in the PD-L1 CPS <10 group than in the PD-L1 CPS ≥10 group (81% vs. 64%, P=0.03). FRα-high was significantly associated with poor prognosis, especially in the PD-L1 CPS ≥10 groups (hazard ratio: 4.10, 95% confidence interval: 1.39-12.06, P=0.01). In conclusion, FRα expression was higher in patients with cervical cancer and PD-L1 CPS <10 than in those with CPS ≥10. Targeting FRα expression may be a potential therapeutic strategy for cervical cancer patients with low or negative PD-L1 expression.
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Affiliation(s)
- Shu Yazaki
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yohei Chiba
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuki Kojima
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Rui Kitadai
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ayumi Saito
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shousuke Kita
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kasumi Yamamoto
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Tadaaki Nishikawa
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuki Sudo
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tatsunori Shimoi
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Emi Noguchi
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masaya Uno
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Mitsuya Ishikawa
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoyasu Kato
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhiro Fujiwara
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kan Yonemori
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
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Diggs A, Huang Y, Melamed A, Szamreta E, Monberg MJ, Hershman D, Wright JD. Patterns of use of primary and first-line chemotherapy for recurrence among patients with cervical cancer. Int J Gynecol Cancer 2024:ijgc-2023-004860. [PMID: 38851239 DOI: 10.1136/ijgc-2023-004860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Little is known about real-world patterns of chemotherapy use in patients with cervical cancer. OBJECTIVE To examine the patterns of chemotherapy use in patients with cervical cancer METHODS: We identified patients with cervical cancer in the IBM MarketScan Database who underwent primary hysterectomy or radiation therapy between 2011 and 2020 and described their treatment in the primary setting and at first recurrence. RESULTS We identified 5390 patients: 2667 (49.5%) underwent primary hysterectomy and 2723 (50.5%) primary radiotherapy. Among patients who underwent primary hysterectomy, 979 (36.7%) received adjuvant radiation, and 617 (23.1%) received primary chemotherapy. The most common chemotherapy regimens were single-agent platinum (51.7%), platinum combination therapy (42.9%), and non-platinum (3.4%). Among patients treated with primary radiation, 73.6% received primary/concurrent chemotherapy, either platinum alone (66.4% of those who received chemotherapy), platinum combinations (32.2%), or non-platinum (1.4%). The median duration of primary chemotherapy was 1.2 months. Therapy for recurrent cervical cancer was initiated in 959 patients. The most common regimens were platinum combination (63.9%), non-platinum cytotoxic agents (16.5%), single-agent platinum (14.9%), targeted therapy with bevacizumab (6.0%), and immunotherapy with pembrolizumab (3.2%). Overall, the proportion of patients treated with single-agent platinum therapy increased from 17.4% in 2011 to 32.1% in 2019, while platinum combinations decreased from 64.1% to 41.5% over the same years. Use of non-platinum agents increased from 18.5% in 2011 to 32.9% in 2018 and 26.4% in 2019. CONCLUSIONS Platinum-based chemotherapy is the most commonly used therapy in patients with cervical cancer in the primary setting and at the time of recurrence. The rate of use of non-platinum agents at first recurrence has increased over time.
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Affiliation(s)
- Alexandra Diggs
- Columbia University College of Physicians and Surgeons, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
| | - Yongmei Huang
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Alexander Melamed
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Dawn Hershman
- Columbia University College of Physicians and Surgeons, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
- Merck & Co Inc, Rahway, New Jersey, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
- Merck & Co Inc, Rahway, New Jersey, USA
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Lou H, Cai H, Huang X, Li G, Wang L, Liu F, Qin W, Liu T, Liu W, Wang ZM, Li B, Xia Y, Wang J. Cadonilimab Combined with Chemotherapy with or without Bevacizumab as First-Line Treatment in Recurrent or Metastatic Cervical Cancer (COMPASSION-13): A Phase 2 Study. Clin Cancer Res 2024; 30:1501-1508. [PMID: 38372727 PMCID: PMC11016896 DOI: 10.1158/1078-0432.ccr-23-3162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/04/2023] [Accepted: 02/15/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE Immune checkpoint inhibitors (ICI) have been a potential treatment option for patients with cervical cancer in several clinical studies. We investigated the safety and efficacy of cadonilimab, a bispecific antibody targeting PD-1 and CTLA-4, plus standard therapy for the first-line treatment of R/M CC (recurrent and/or metastatic cervical cancer). PATIENTS AND METHODS Eligible patients were assigned to 3 cohorts: cohort A-15 (cadonilimab 15 mg/kg every 3 weeks (Q3W) plus chemotherapy), cohort A-10 (cadonilimb 10 mg/kg Q3W plus chemotherapy), and cohort B-10 (cadonilimab 10 mg/kg Q3W plus chemotherapy and bevacizumab). They received the corresponding treatments until disease progression, unacceptable toxicity, withdrawal of consent, or investigator decision. The primary objective was safety; the secondary endpoints included objective overall response (ORR), duration of response, disease control rate, progression-free survival, and overall survival. This study is registered with ClinicalTrials.gov (NCT04868708). RESULTS As of February 13, 2023, treatment-related adverse events (TRAE) occurred in 45 (100.0%) patients. Grade ≥3 TRAEs were reported in 33 (73.3%) patients. Immune-related adverse events (irAE) occurred in 29 (64.4%) patients and grade ≥3 irAEs were observed in 9 (20.0%) patients. Seven (15.6%) of 45 patients permanently discontinued cadonilimab treatment due to TRAEs. One death due to hemorrhagic shock occurred in cohort B-10. Among 44 patients who underwent at least one post-baseline tumor assessment, the ORR was 66.7% in cohort A-15, 68.8% in cohort A-10, 92.3% in cohort B-10, and 79.3% in cohorts A-10 and B-10 combined. CONCLUSIONS Cadonilimab combined with standard therapy was acceptable, with encouraging antitumor activity in patients with R/M CC.
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Affiliation(s)
- Hanmei Lou
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
| | - Hongbing Cai
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xin Huang
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Guiling Li
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Wang
- Henan Cancer Hospital, Zhengzhou, China
| | - Fei Liu
- Akeso Biopharma Inc., Zhongshan, China
| | | | - Ting Liu
- Akeso Biopharma Inc., Zhongshan, China
| | - Wei Liu
- Akeso Biopharma Inc., Zhongshan, China
| | | | | | - Yu Xia
- Akeso Biopharma Inc., Zhongshan, China
| | - Jing Wang
- Hunan Cancer Hospital, Changsha, China
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4
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Gass P, Thiel FC, Häberle L, Ackermann S, Theuser AK, Hummel N, Boehm S, Kimmig R, Reinthaller A, Becker S, Hilpert F, Janni W, Vergote I, Harter P, Emons J, Hein A, Beckmann MW, Fasching PA, Pöschke P. Primary results of the AGO-Zervix-1 Study: A prospective, randomized phase III study to compare the effects of paclitaxel and topotecan with those of cisplatin and topotecan in the treatment of patients with recurrent and persistent cervical cancer. Gynecol Oncol 2024; 183:25-32. [PMID: 38490057 DOI: 10.1016/j.ygyno.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Before the era of immunotherapies and antibody-drug conjugates, there were limited chemotherapeutic options for patients with recurrent and metastatic cervical cancer. Combination therapies with cisplatin have shown some superiority over monotherapy. This study examined platinum-free treatment regimens, comparing a combination of topotecan and paclitaxel (TP) with topotecan and cisplatin (TC) in patients with recurrent or metastatic cervical cancer, with or without prior platinum-based treatment. METHODS The AGO-Zervix-1 Study (NCT01405235) is a prospective, randomized phase III study in which patients were randomly assigned at a 1:1 ratio to treatment within the control arm with topotecan (0.75 mg/m2) on days 1-3 and cisplatin (50 mg/m2) on day 1 every 3 weeks and in the study arm topotecan (1.75 mg/m2) and paclitaxel (70 mg/m2) on days 1, 8, and 15 every 4 weeks or treatment. The primary study aim was overall survival; progression-free survival, toxicity, and quality of life were secondary aims. The interim and final analysis is here reported after recruitment of 173 of 312 planned patients. RESULTS Median overall survival in the TP arm was 9.6 months, compared with 12.0 months in the TC arm (log-rank test, P = 0.33). Median progression-free survival rates were 4.4 months with TP and 4.2 months with TC (log-rank test, P = 0.47). Leukopenia and nausea/vomiting were more frequent in the cisplatin-containing arm. Otherwise, toxicity profiles were comparable. There were no differences in FACT-G-assessed quality of life. CONCLUSION Platinum-based combination chemotherapy remains the standard of care chemotherapy regimen for patients with recurrent or metastatic cervical cancer.
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Affiliation(s)
- Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
| | - Falk C Thiel
- Department of Gynecology and Obstetrics, Alb Fils Clinics, Klinik am Eichert, Göppingen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany; Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany
| | - Sven Ackermann
- Department of Gynecology and Obstetrics, Klinikum Darmstadt, Darmstadt, Germany
| | | | - Nadine Hummel
- Institut für Frauengesundheit GmbH, Erlangen, Germany
| | - Sibylle Boehm
- Institut für Frauengesundheit GmbH, Erlangen, Germany
| | - Rainer Kimmig
- Department of Gynecology and Obstetrics, Essen University Hospital, Essen, Germany
| | - Alexander Reinthaller
- Department of Gynecology and Gynecologic Oncology, AKH Vienna University Hospital, Vienna, Austria
| | - Sven Becker
- Department of Gynecology and Obstetrics, Frankfurt University Hospital, Frankfurt am Main, Germany
| | - Felix Hilpert
- Onkologisches Therapiezentrum, Krankenhaus Jerusalem, Hamburg, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Ignace Vergote
- Department of Gynaecology and Obstetrics, Division of Gynaecological Oncology, Leuven University Hospitals, Leuven, Belgium
| | - Phlipp Harter
- Department of Gynecology & Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Hein
- Department of Gynaecology and Obstetrics, Klinikum Esslingen, Esslingen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Patrik Pöschke
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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5
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Fang C, Zhou Y, Feng Y, He L, Yu J, Li Y, Feng M, Pan M, Zhao L, Tang D, Li X, Tan B, An R, Zheng X, Si M, Zhang B, Li L, Kang X, Zhou Q, Liu J. QL1604 plus paclitaxel-cisplatin/carboplatin in patients with recurrent or metastatic cervical cancer: an open-label, single-arm, phase II trial. J Gynecol Oncol 2024; 35:35.e77. [PMID: 38606822 DOI: 10.3802/jgo.2024.35.e77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/28/2024] [Accepted: 02/25/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVE QL1604 is a highly selective, humanized monoclonal antibody against programmed death protein 1. We assessed the efficacy and safety of QL1604 plus chemotherapy as first-line treatment in patients with advanced cervical cancer. METHODS This was a multicenter, open-label, single-arm, phase II study. Patients with advanced cervical cancer and not previously treated with systemic chemotherapy were enrolled to receive QL1604 plus paclitaxel and cisplatin/carboplatin on day 1 of each 21-day cycle for up to 6 cycles, followed by QL1604 maintenance treatment. RESULTS Forty-six patients were enrolled and the median follow-up duration was 16.5 months. An 84.8% of patients had recurrent disease and 13.0% had stage IVB disease. The objective response rate (ORR) per Response Evaluation Criteria in Advanced Solid Tumors (RECIST) v1.1 was 58.7% (27/46). The immune ORR per immune RECIST was 60.9% (28/46). The median duration of response was 9.6 months (95% confidence interval [CI]=5.5-not estimable). The median progression-free survival was 8.1 months (95% CI=5.7-14.0). Forty-five (97.8%) patients experienced treatment-related adverse events (TRAEs). The most common grade≥3 TRAEs (>30%) were neutrophil count decrease (50.0%), anemia (32.6%), and white blood cell count decrease (30.4%). CONCLUSION QL1604 plus paclitaxel-cisplatin/carboplatin showed promising antitumor activity and manageable safety profile as first-line treatment in patients with advanced cervical cancer. Programmed cell death protein 1 inhibitor plus chemotherapy may be a potential treatment option for the patient population who have contraindications or can't tolerate bevacizumab, which needs to be further verified in phase III confirmatory study. Trial RegistrationClinicalTrials.gov Identifier: NCT04864782.
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Affiliation(s)
- Cheng Fang
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yun Zhou
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yanling Feng
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Liping He
- Department of Gynecological Oncology Surgery, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Jinjin Yu
- Department of Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Yuzhi Li
- Department of Gynecologic Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Mei Feng
- Department of Gynecological Radiation Oncology, Fujian Cancer Hospital, Fuzhou, China
| | - Mei Pan
- Department of Medical Oncology, Jiangxi Maternal and Child Health Care Hospital, Nanchang, China
| | - Lina Zhao
- Department of Radiotherapy, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Dihong Tang
- Gynecological Oncology Department IV, Hunan Cancer Hospital, Changsha, China
| | - Xiumin Li
- Department of Gynecology, Linyi Cancer Hospital, Linyi, China
| | - Buzhen Tan
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ruifang An
- Department of Gynecology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | | | - Meimei Si
- Qilu Pharmaceutical Co., Ltd., Jinan, China
| | | | - Lingyan Li
- Qilu Pharmaceutical Co., Ltd., Jinan, China
| | | | - Qi Zhou
- Gynecological Oncology Center, Chongqing University Cancer Hospital, Chongqing, China.
| | - Jihong Liu
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
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6
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Peng C, Li X, Tang W, Zhu W, Yan P, Chen J, Zhang X, Guo Q, Wu Q, Wang Q, Liu N, Ma A, Lu Y, Lv P, Liu J, Xie P. Real-world outcomes of first-line maintenance therapy for recurrent or metastatic cervical cancer: A multi-center retrospective study. Int Immunopharmacol 2024; 129:111578. [PMID: 38330795 DOI: 10.1016/j.intimp.2024.111578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Maintenance therapy (MT) for recurrent or metastatic cervical cancer remains non-standardized. This study assessed MT effectiveness using a comprehensive approach and identifies prognosis factors inpatients with recurrent or metastatic cervical cancer. METHODS From January 2019 and December 2021, over 6000 patients from six Chinese institutions were retrospectively examined. Patients had recurrent/metastatic cervical cancer and underwent first-line chemotherapy with or without MT. We calculated overall and progression-free survival using Kaplan-Meier analysis, comparing via log-rank test, and conducted Cox regression for prognostic factors. RESULTS Overall, 274 patients were stratified into an MT group (n = 77) and a non-MT group (n = 197). The 3-year OS rates were 52.5 % and 28.0 % for the MT and non-MT groups, respectively. The MT group had significantly enhanced median OS (37 vs. 21 months; HR, 0.43; 95 % CI, 0.30-0.61; P < 0.001) and PFS (21 vs. 14 months; HR, 0.65; 95 % CI, 0.47-0.90; P = 0.014) compared with the non-MT group. No significant differences in efficacy were observed among the various MT regimens, whether PD-1 monoclonal antibody, targeted therapeutic agents, or a combination of both. Extended PFS and OS were observed in patients receiving > 8 MT cycles. Multivariate analyses revealed that oligometastasis, MT, exclusive prior surgery (as opposed to combined surgery and radiotherapy), and extended interval before recurrence were independent OS predictors (P = 0.045, P < 0.001, P = 0.010, and P = 0.005, respectively); oligometastasis, concurrent radiotherapy, MT, and extended interval before recurrence were independent PFS predictors (P = 0.004, P = 0.007, P = 0.009, and P = 0.003). CONCLUSIONS The MT integration markedly extended PFS and OS in patients diagnosed with recurrent or metastatic cervical cancer.
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Affiliation(s)
- Chen Peng
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China; Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xiaolin Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Wenjie Tang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Wanqi Zhu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Peile Yan
- China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Jinlong Chen
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xueliang Zhang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Qiufen Guo
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Qian Wu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Qian Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Naifu Liu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Anqun Ma
- East Hospital of Shandong First Medical University Affiliated Provincial Hospital, Jinan, Shandong, China
| | - Yuanyuan Lu
- The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Pengzhong Lv
- The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, Shandong, China
| | - Jing Liu
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Peng Xie
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
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7
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Sitler CA, Tian C, Hamilton CA, Richardson MT, Chan JK, Kapp DS, Leath CA, Casablanca Y, Washington C, Chappell NP, Klopp AH, Shriver CD, Tarney CM, Bateman NW, Conrads TP, Maxwell GL, Phippen NT, Darcy KM. Immuno-Molecular Targeted Therapy Use and Survival Benefit in Patients with Stage IVB Cervical Carcinoma in Commission on Cancer ®-Accredited Facilities in the United States. Cancers (Basel) 2024; 16:1071. [PMID: 38473428 DOI: 10.3390/cancers16051071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/27/2024] [Accepted: 03/03/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE To investigate IMT use and survival in real-world stage IVB cervical cancer patients outside randomized clinical trials. METHODS Patients diagnosed with stage IVB cervical cancer during 2013-2019 in the National Cancer Database and treated with chemotherapy (CT) ± external beam radiation (EBRT) ± intracavitary brachytherapy (ICBT) ± IMT were studied. The adjusted hazard ratio (AHR) and 95% confidence interval (CI) for risk of death were estimated in patients treated with vs. without IMT after applying propensity score analysis to balance the clinical covariates. RESULTS There were 3164 evaluable patients, including 969 (31%) who were treated with IMT. The use of IMT increased from 11% in 2013 to 46% in 2019. Age, insurance, facility type, sites of distant metastasis, and type of first-line treatment were independently associated with using IMT. In propensity-score-balanced patients, the median survival was 18.6 vs. 13.1 months for with vs. without IMT (p < 0.001). The AHR was 0.72 (95% CI = 0.64-0.80) for adding IMT overall, 0.72 for IMT + CT, 0.66 for IMT + CT + EBRT, and 0.69 for IMT + CT + EBRT + ICBT. IMT-associated survival improvements were suggested in all subgroups by age, race/ethnicity, comorbidity score, facility type, tumor grade, tumor size, and site of metastasis. CONCLUSIONS IMT was associated with a consistent survival benefit in real-world patients with stage IVB cervical cancer.
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Affiliation(s)
- Collin A Sitler
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
| | - Chad A Hamilton
- Gynecologic Oncology Section, Women's Services and The Ochsner Cancer Institute, Ochsner Health, New Orleans, LA 70115, USA
| | - Michael T Richardson
- Department of Obstetrics and Gynecology, Los Angeles School of Medicine, University of California, Los Angeles, CA 90024, USA
| | - John K Chan
- Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA 94010, USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama at Birmingham, O'Neal Comprehensive Cancer Center, Birmingham, AL 35249, USA
| | - Yovanni Casablanca
- Gynecologic Oncology Division, Levine Cancer Institute, Atrium Health, Charlotte, NC 28204, USA
| | - Christina Washington
- Gynecologic Oncology Division, Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Nicole P Chappell
- Gynecologic Oncology Division, GW Medical Faculty Associates, George Washington University, Washington, DC 20037, USA
| | - Ann H Klopp
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Christopher M Tarney
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Nicholas W Bateman
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
| | - Thomas P Conrads
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA 22042, USA
| | - George Larry Maxwell
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA 22042, USA
| | - Neil T Phippen
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
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8
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Komatsu H, Matsumoto K, Morita M, Nagasawa T, Nishio H, Suzuki J, Nishio S, Kobara H, Yunokawa M, Ariyoshi K, Hirayama T, Tokunaga H, Ukita M, Yoriki K, Mori‐Uchino M, Furusawa A, Togami S, Nakamura H, Ishikawa M, Satoh T. A survey of carboplatin desensitization therapy in Japan: A multicenter retrospective study. Cancer Med 2024; 13:e6968. [PMID: 38491829 PMCID: PMC10943373 DOI: 10.1002/cam4.6968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 03/18/2024] Open
Abstract
INTRODUCTION Hypersensitivity reactions (HSRs) to chemotherapy are serious adverse events associated with cancer drug therapy and can occur with any antitumor drug. This study investigated the safety and efficacy of carboplatin desensitization therapy in Japan and established a method for treating carboplatin HSRs. METHODS Patients diagnosed with gynecological (ovarian, endometrial, or cervical) cancers who underwent carboplatin desensitization therapy between 2016 and 2020 at the Gynecologic Cancer Study Group of Japan Clinical Oncology Group were included. The carboplatin desensitization therapy at each institution and the implementation cases were registered in an online case report form. RESULTS This retrospective study enrolled 136 patients (ovarian, 108; endometrial, 17; and cervical cancer, 11). Pre-existing allergies were present in 37 (27.2%) patients, and 32 (23.5%) patients exhibited prodromal symptoms during treatment before HSR onset. Erythema was the most common symptom at HSR onset, affecting 93 (68.4%) patients, followed by itching in 72 (52.9%) patients and decreased oxygen saturation in 43 (31.6%) patients. Loss of consciousness occurred in three (2.2%) patients. The most common timing of HSR onset was during the first recurrence treatment (47%). The mean total carboplatin dose until HSR onset was 7331 (2620-18,282) mg, and the mean number of doses was 14 (4-63). Desensitization treatment was completed in 75% of cases, and breakthrough HSRs occurred in 25% (34/136). No deaths occurred in the study cohort. The risk factors for HSRs were not identified. CONCLUSION Although carboplatin desensitization therapy has high success rates in Japan, erythema and pruritus are important HSRs to consider.
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Affiliation(s)
- Hiroaki Komatsu
- Department of Obstetrics and GynecologyTottori University School of MedicineYonagoTottoriJapan
| | - Koji Matsumoto
- Department of Medical OncologyHyogo Cancer CenterAkashiHyogoJapan
| | - Mitsunori Morita
- Department of Medical OncologyHyogo Cancer CenterAkashiHyogoJapan
| | - Takayuki Nagasawa
- Department of Obstetrics and GynecologyIwate Medical University School of MedicineMoriokaIwateJapan
| | - Hiroshi Nishio
- Department of Obstetrics and GynecologyKeio University School of MedicineTokyoJapan
| | - Jiro Suzuki
- Department of Obstetrics and GynecologyThe Jikei University School of MedicineTokyoJapan
| | - Shin Nishio
- Department of Obstetrics and GynecologyKurume University School of MedicineKurumeJapan
| | - Hisanori Kobara
- Department of Obstetrics and GynecologyShinshu UniversityNaganoJapan
| | - Mayu Yunokawa
- Department of GynecologyThe Cancer Institute Hospital of JFCRTokyoJapan
| | - Kazuya Ariyoshi
- Department of Gynecology ServiceNational Kyushu Cancer CenterFukuokaJapan
| | - Takashi Hirayama
- Department of Obstetrics and GynecologyJuntendo University HospitalTokyoJapan
| | - Hideki Tokunaga
- Department of GynecologyTohoku University Graduate School of MedicineSendaiJapan
| | - Masayo Ukita
- Department of Gynecology and Obstetrics, Graduate School of MedicineKyoto UniversityKyotoJapan
| | - Kaori Yoriki
- Department of Obstetrics and Gynecology, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Mayuyo Mori‐Uchino
- Department of Obstetrics and Gynecology, Faculty of MedicineThe University of TokyoTokyoJapan
| | - Akiko Furusawa
- Department of GynecologyTokyo Metropolitan Cancer and Infectious Diseases Center, Komagome HospitalTokyoJapan
| | - Shinichi Togami
- Department of Obstetrics and Gynecology, Faculty of MedicineKagoshima UniversityKagoshimaJapan
| | - Hiroko Nakamura
- Department of Obstetrics and GynecologyNational Hospital Organization Kure Medical Center and Chugoku Cancer CenterKureJapan
| | - Mitsuya Ishikawa
- Department of Gynecology, National Cancer Center HospitalTokyoJapan
| | - Toyomi Satoh
- Department of Obstetrics and Gynecology, Institute of MedicineUniversity of TsukubaTsukubaJapan
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9
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Lin Z, Li X, Shi H, Cao R, Zhu L, Dang C, Sheng Y, Fan W, Yang Z, Wu S. Decoding the tumor microenvironment and molecular mechanism: unraveling cervical cancer subpopulations and prognostic signatures through scRNA-Seq and bulk RNA-seq analyses. Front Immunol 2024; 15:1351287. [PMID: 38482016 PMCID: PMC10933018 DOI: 10.3389/fimmu.2024.1351287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/13/2024] [Indexed: 04/13/2024] Open
Abstract
Background Cervical carcinoma (CC) represents a prevalent gynecological neoplasm, with a discernible rise in prevalence among younger cohorts observed in recent years. Nonetheless, the intrinsic cellular heterogeneity of CC remains inadequately investigated. Methods We utilized single-cell RNA sequencing (scRNA-seq) transcriptomic analysis to scrutinize the tumor epithelial cells derived from four specimens of cervical carcinoma (CC) patients. This method enabled the identification of pivotal subpopulations of tumor epithelial cells and elucidation of their contributions to CC progression. Subsequently, we assessed the influence of associated molecules in bulk RNA sequencing (Bulk RNA-seq) cohorts and performed cellular experiments for validation purposes. Results Through our analysis, we have discerned C3 PLP2+ Tumor Epithelial Progenitor Cells as a noteworthy subpopulation in cervical carcinoma (CC), exerting a pivotal influence on the differentiation and progression of CC. We have established an independent prognostic indicator-the PLP2+ Tumor EPCs score. By stratifying patients into high and low score groups based on the median score, we have observed that the high-score group exhibits diminished survival rates compared to the low-score group. The correlations observed between these groups and immune infiltration, enriched pathways, single-nucleotide polymorphisms (SNPs), drug sensitivity, among other factors, further underscore their impact on CC prognosis. Cellular experiments have validated the significant impact of ATF6 on the proliferation and migration of CC cell lines. Conclusion This study enriches our comprehension of the determinants shaping the progression of CC, elevates cognizance of the tumor microenvironment in CC, and offers valuable insights for prospective CC therapies. These discoveries contribute to the refinement of CC diagnostics and the formulation of optimal therapeutic approaches.
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Affiliation(s)
- Zhiheng Lin
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xinhan Li
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Hengmei Shi
- Department of Obstetrics and Gynecology, Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Renshuang Cao
- Wangjing Hospital of Chinese Academy of Chinese Medical Sciences, Beijing, China
| | - Lijun Zhu
- Longhua Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chunxiao Dang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yawen Sheng
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Weisen Fan
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | | | - Siyu Wu
- Department of Gynecology and Obstetrics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Qingdao, China
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10
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Huang Z, Yao W, Zhong Z, Yang G, Liu J, Gu H, Huang J. Chemotherapy alone versus chemotherapy plus 125I brachytherapy for the second-line treatment of locally recurrent cervical cancer after/with radical treatment: A propensity score analysis. Heliyon 2024; 10:e24666. [PMID: 38298696 PMCID: PMC10828072 DOI: 10.1016/j.heliyon.2024.e24666] [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] [Received: 11/29/2023] [Revised: 12/25/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
Rationale and objectives The primary aim of this study was to conduct a retrospective comparative analysis of the survival outcomes in patients with recurrent cervical cancer (CC). Specifically, we aimed to compare the efficacy of chemotherapy alone versus the combined approach of chemotherapy and 125I brachytherapy subsequent to the failure of initial chemotherapy treatment. Materials and methods Patients diagnosed with recurrent CC subsequent to the failure of initial chemotherapy from January 2007 to December 2016 were enrolled from 2 hospitals. These patients were then divided into two groups: Group A, which underwent second-line chemotherapy alone, and Group B, which received both second-line chemotherapy and 125I brachytherapy. The assessment of overall survival (OS) and progression-free survival (PFS) was carried out through propensity score matching (PSM) (1:1), Kaplan-Meier curves, log-rank tests, and Cox proportional hazard regression for survival analysis. Results A matched cohort comprising 88 patients each in Group A and Group B was included in the study. In Group A, the 1-, 2-, and 3-year cumulative PFS rates were 40.9 %, 15.9 %, and 5.7 % respectively, while in Group B, these rates were significantly higher at 79.5 %, 48.9 %, and 25.0 % (P = 0.003). Similarly, the 1-, 2-, and 3-year cumulative OS rates among Group A were 67.0 %, 27.3 %, and 5.7 % compared to 89.8 %, 63.6 %, and 30.7 % among Group B, suggesting a difference with statistical significance (P < 0.001) between the two groups. Moreover, the incidence of complications was similar between groups (P = 0.698). Conclusions Our findings suggest that the combined approach of chemotherapy and 125I brachytherapy yields superior therapeutic effects but similar complication rates compared to chemotherapy alone in patients experiencing local recurrence of CC following failed initial chemotherapy.
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Affiliation(s)
- Zhimei Huang
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, PR China
| | - Wang Yao
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Province Guangdong, PR China
| | - Zhihui Zhong
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, PR China
| | - Guang Yang
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, PR China
| | - Jihong Liu
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, PR China
| | - Haifeng Gu
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, PR China
| | - Jinhua Huang
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, PR China
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11
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Classen-von Spee S, Baransi S, Fix N, Rawert F, Luengas-Würzinger V, Lippert R, Bonin-Hennig M, Mallmann P, Lampe B. Pelvic Exenteration for Recurrent Vulvar Cancer: A Retrospective Study. Cancers (Basel) 2024; 16:276. [PMID: 38254766 PMCID: PMC10813412 DOI: 10.3390/cancers16020276] [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: 12/19/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
Pelvic exenteration (PE) is one of the most radical surgical approaches. In earlier times, PE was associated with high morbidity and mortality. Nowadays, due to improved selection of suitable patients, perioperative settings, and postoperative care, patients' outcomes have been optimized. To investigate patients' outcomes and identify possible influencing clinical and histopathological factors, we analysed 17 patients with recurrent vulvar cancer who underwent PE in our department between 2007 and 2022. The median age was 64.9 years, with a difference of 40 years between the youngest and the oldest patient (41 vs. 81 years). The mean overall survival time was 55.7 months; the longest survival time reached up to 164 months. The achievement of complete cytoreduction (p = 0.02), the indication for surgery (curative vs. palliative), and the presence of distant metastases (both p = 0.01) showed a significant impact on overall survival. The presence of lymphatic metastases (p = 0.11) seems to have an influence on overall survival (OS) time. Major complications appeared in 35% of the patients. Our results support the existing data for PE in cases of recurrent vulvar cancer; for a group of selected patients, PE is a treatment option with good overall survival times and acceptable morbidity.
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Affiliation(s)
- Sabrina Classen-von Spee
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
| | - Saher Baransi
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
| | - Nando Fix
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
| | - Friederike Rawert
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
| | - Verónica Luengas-Würzinger
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
| | - Ruth Lippert
- Department of Pathology, Evangelisches Krankenhaus Oberhausen, Virchowstraße 20, 46047 Oberhausen, Germany
| | - Michelle Bonin-Hennig
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany;
| | - Björn Lampe
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
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12
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García E, Ayoub N, Tewari KS. Recent breakthroughs in the management of locally advanced and recurrent/metastatic cervical cancer. J Gynecol Oncol 2024; 35:e30. [PMID: 38072400 PMCID: PMC10792211 DOI: 10.3802/jgo.2024.35.e30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 01/17/2024] Open
Abstract
Cervical cancer continues to be a global threat affecting individuals in resource poor communities disproportionately. The treatment paradigm for this disease is ever evolving with recent innovations propelling oncologic outcomes to a new frontier offering survival benefits for patients struggling with locally advanced disease and metastatic/recurrent carcinoma. Immunologic checkpoint inhibitors and anti-body drug conjugates represent two novel drug classes that have demonstrable activity in this disease, particularly in the first-line and second-line treatment paradigm for recurrence. The tolerability of these novel medicines and associated durable responses underscore regulatory approval by the U.S. Food and Drug Administrations and their implementation in clinic.
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Affiliation(s)
- Eduardo García
- University California, Irvine, Medical Center, Orange, CA, USA.
| | - Natalie Ayoub
- Adventist Health White Memorial, Medical Center, Los Angeles, CA, USA
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13
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Laville A, Ka K, El-Ayachi R, Achkar S, Bockel S, Gouy S, Espenel S, Morice P, Sun R, Pautier P, Chargari C. Locoregional Treatment in Patients With Metastatic Cervical Cancer: Benefit of Dose Escalation Strategies. Int J Radiat Oncol Biol Phys 2024; 118:192-202. [PMID: 37586615 DOI: 10.1016/j.ijrobp.2023.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/13/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE The objective of this work was to examine the benefit of an intensive locoregional treatment including an image guided adaptive brachytherapy (IGABT) among patients with cervical cancer and extrapelvic extension. METHODS AND MATERIALS Medical records of consecutive patients with a metastatic cervical cancer and receiving external beam radiation therapy and IGABT boost in Gustave Roussy Institute as part of their first line of treatment were examined. Depending on tumor sites, patients received pelvic ± para-aortic external beam radiation therapy. For those with visceral or supradiaphragmatic lymph node metastases, chemoradiation was delivered after usually 3 cycles of chemotherapy. All patients received a brachytherapy boost, guided by magnetic resonance imaging and aimed at increasing the dose to the high-risk clinical target volume (CTVHR). Local control (LC), patient overall survival (OS), progression-free survival, and radiation therapy-related side effects were examined, and prognostic factors were searched. RESULTS One hundred sixty-four patients were included; 76.2% had para-aortic lymph node extension without distant metastasis (N2) and 23.8% had distant metastatic sites (M1). There was not a statistically significant difference in survival between both groups. With a median follow-up of 36 months, OS, progression-free survival, and LC at 3 years were 55.5% (95% CI, 48%-64%), 40.6% (95% CI, 38%-54%), and 90% (95% CI, 85%-96%), respectively. In multivariate analysis, a D90CTVHR dose ≥80 Gy was significant for better OS (hazard ratio, 0.96; 95% CI, 0.94-0.98; P < .001). Most toxicities were mild to moderate, with 2% grade 3 late urinary toxicity, 7% late grade 2 vaginal sequelae, and 1 grade 3 proctitis. During follow-up, rectovaginal fistula occurred in 2 patients without local relapse. CONCLUSIONS IGABT permits dose escalation and high LC rates for patients with cervical cancer and extrapelvic extension. Dose/effect relationships for survival were shown. Because of high frequency of distant events, systemic intensification should be tested more specifically among these patients.
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Affiliation(s)
| | - Kanta Ka
- Department of Radiation Oncology
| | | | | | | | | | | | | | | | - Patricia Pautier
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
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Passarelli A, Pisano C, Coppola E, Ventriglia J, Cecere SC, Di Napoli M, Carideo L, Lastoria S, Pignata S. Complete and early response to cemiplimab associated to severe immune toxicity in advanced cervical cancer: a case report. Front Immunol 2023; 14:1303893. [PMID: 38193091 PMCID: PMC10773865 DOI: 10.3389/fimmu.2023.1303893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/29/2023] [Indexed: 01/10/2024] Open
Abstract
Cervical cancer (CC) is the second most commonly diagnosed cancer and the third leading cause of cancer death among females. The options of treatment for recurrent/advanced CC are limited and patients experiencing recurrence after first line platinum-based chemotherapy have a poor prognosis. In this context, immune checkpoint inhibitors (ICI)s antagonizing PD-1 and programmed death-ligand 1 (PD-L1) have profoundly changed the treatment scenario and outcomes in CC in the first or subsequent lines both as monotherapies or in combination with chemotherapy or other ICIs. Herein, we report the clinical case of a 74-year-old woman with metastatic CC with negative tumor PD-L1 expression who having disease progression after first-line of systemic treatment with platinum, thus undergoing to anti-PD-1 namely cemiplimab. The patient achieved a surprising, fast and complete metabolic response to cemiplimab immediately discontinued after only two cycles due to the onset of rare and severe immune-related adverse events (irAE)s such cardiovascular toxicity and hypertransaminasemia. Despite this, thirteen months later, the patient remains disease-free despite cemiplimab was withdrawn.
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Affiliation(s)
- Anna Passarelli
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Carmela Pisano
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Elisabetta Coppola
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Jole Ventriglia
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Sabrina Chiara Cecere
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Marilena Di Napoli
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Luciano Carideo
- Nuclear Medicine Unit, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Secondo Lastoria
- Nuclear Medicine Unit, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
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15
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Guo D, Huang Y, Wang K, Yang C, Ma L, Zhang Y, Yu H, Cui M, Tang Z. Preparation and Characterization Evaluation of Poly(L-Glutamic Acid)- g-Methoxy Poly(Ethylene Glycol)/Combretastatin A4/BLZ945 Nanoparticles for Cervical Cancer Therapy. Int J Nanomedicine 2023; 18:6901-6914. [PMID: 38026524 PMCID: PMC10676729 DOI: 10.2147/ijn.s441131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/12/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Cervical cancer (CC) is a highly vascularized tumor with abundant abnormal blood vessel, which could be targeted by therapeutic strategies. Poly(L-glutamic acid)-g-methoxy poly(ethylene glycol)/combretastatin A4 (CA4)/BLZ945 nanoparticles (CB-NPs) have shown great potential as nano vascular disrupting agents (VDAs) in the realm of synergistic cancer therapy. Methods In this study, we investigated the nanocharacteristics of CB-NPs, focusing on active pharmaceutical ingredients (API), as well as lyophilized samples combining API with protective agents (PAs). The in vivo efficacy of final sample (API + PAs) was evaluated. Results The assembled sphere of API with complex core and thin-shell structure was confirmed. PAs were found to significantly influence in vivo efficacy. Collaborative efforts between API and PAs, namely mannitol and lactose, resulted in the most promising lyophilized sample, ie, the final sample (FS2) for CC therapy. Impressively, FS2 demonstrated an exceptional 100% cure rate on the CC U14-bearing mice model. Conclusion FS2 has provided significant insights for cervical cancer therapy. It is also crucial to develop a comprehensive evaluation strategy for the formulation of nanomedicine, which has the potential to serve as a guideline for future clinical trials.
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Affiliation(s)
- Dongmei Guo
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, Jilin Province, 130041, People’s Republic of China
| | - Yue Huang
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, People’s Republic of China
| | - Kun Wang
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, People’s Republic of China
| | - Chenguang Yang
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, People’s Republic of China
| | - Lili Ma
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, People’s Republic of China
| | - Yu Zhang
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, People’s Republic of China
| | - Haiyang Yu
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, People’s Republic of China
| | - Manhua Cui
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, Jilin Province, 130041, People’s Republic of China
| | - Zhaohui Tang
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, People’s Republic of China
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Li J, Huang L, Wu H, Li J, Cao X, Liu Z. Re-irradiation for recurrent cervical cancer: A single institutional experience. Clin Transl Radiat Oncol 2023; 43:100690. [PMID: 37876912 PMCID: PMC10590764 DOI: 10.1016/j.ctro.2023.100690] [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] [Received: 06/20/2023] [Revised: 10/07/2023] [Accepted: 10/08/2023] [Indexed: 10/26/2023] Open
Abstract
Purpose Salvage treatment of recurrent cervical cancer of patients with a history of radiotherapy is currently a major clinical challenge. The purpose of our study was to retrospectively analyze clinical outcomes of radiation in patients with recurrent cancer who have previously received radiotherapy at our hospital and further explore the efficacy and safety of this treatment modality. Methods All consecutive patients who underwent re-irradiation were included in our department between January 2015 and December 2017. All the patients received Volumetric Modulated Arc Therapy (VMAT) alone or VMAT followed by three dimensional-image-guided brachytherapy (3D-IGBT). The volume and dose for re-irradiation depended on previous radiation fields, dosimetry and recurrence sites. All patients received systemic chemotherapy before or after re-irradiation. Results Fifty patients were included in our study. The median time from primary radiotherapy to re-irradiation was 12 months. Local recurrence, which was the most common failure following primary treatment, was present in 25 patients (50.0 %) while regional recurrence, loco-regional recurrence and distant recurrence combined in-filed recurrence was present in 8 (16.0 %), 9 (18.0 %) and 8 patients (16.0 %). Re-irradiation dose to lymph nodes was 45 Gy with or without a boost up to 55-60 Gy, and to the gross mass was 36-45 Gy with or without a boost up to 45-61 Gy. The median follow-up period was 22 (range,4-59) months. The 3-year local control (LC), progression-free survival (PFS), and overall survival (OS) rates were 58.0, 38.7, and 44.4 %, respectively. The median time of PFS and OS was 14 and 26 months, respectively. The interval between two successive radiotherapies beyond 12 months was significantly associated with better LC and PFS (p ≤ 0.05), but without the benefit of OS (p > 0.05). Serum SCC antigen level less than 1.5 ng/ml had a significantly better impact on PFS (p ≤ 0.05). Overall, 14 patients (28 %) experienced ≥ grade 3 acute toxicities, while 9 (18 %) experienced ≥ grade 3 late toxicities. Conclusions Re-irradiation with VMAT is an effective and safe salvage treatment option with a reasonably good clinical outcome and toxicity profile in selected patients. In our experience, recurrent cancer patients with an interval between two successive radiotherapy courses beyond 12 months and with a serum SCC-Ag level less than 1.5 ng/ml, had improved outcomes.
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Affiliation(s)
- Junyun Li
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center
| | - Lin Huang
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center
| | - Haiying Wu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center
| | - Jia Li
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center
| | - Xinping Cao
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center
| | - Zhimin Liu
- Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center
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Nagasawa T, Shoji T, Takatori E, Kaido Y, Kagabu M, Shimizu D, Shigeto T, Baba T, Sugiyama T, Yokoyama Y. A Phase II Study of S-1 plus Oxaliplatin for Patients with Recurrent Non-Squamous Cell Carcinoma of the Uterine Cervix (Tohoku Gynecologic Cancer Unit: TGCU206 Study). Cancers (Basel) 2023; 15:5201. [PMID: 37958375 PMCID: PMC10650927 DOI: 10.3390/cancers15215201] [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: 08/29/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Recurrent non-squamous cell carcinoma (non-SCC) of the uterine cervix is resistant to treatment and has a poor prognosis. The efficacy and safety of S-1/oxaliplatin (SOX) therapy in patients with recurrent non-SCC was examined in a phase II study. Fifteen patients were enrolled between August 2013 and March 2023. S-1 was administered orally at a daily dose of 80-120 mg for 14 days, and oxaliplatin was administered intravenously at a dose of 100 mg/m2 on day 1. Each treatment cycle lasted 21 days. The anti-tumor effects, adverse events, progression-free survival (PFS), and overall survival (OS) were investigated. The median patient age was 54 (41-74) years. The anti-tumor effect was rated as a partial response in five patients, stable disease in four, and progressive disease in 6. The overall response rate was 33% and the disease control rate was 60%. Regarding hematologic toxicities of grade 3 or more severity, leukopenia, neutropenia, anemia, and thrombocytopenia occurred in 26.6-40.0%. None of the patients discontinued the treatment because of adverse events. The median PFS and OS were 6 months (95% confidence interval [CI]: 2-11 months) and 22 months (95% CI: 11-23 months), respectively. No treatment-related deaths occurred. These results suggest that SOX therapy is useful for the treatment of recurrent non-SCC with promising anti-tumor effects and minimal adverse events.
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Affiliation(s)
- Takayuki Nagasawa
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, Yahaba 028-3695, Japan; (T.N.); (E.T.); (Y.K.); (M.K.); (T.B.)
| | - Tadahiro Shoji
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, Yahaba 028-3695, Japan; (T.N.); (E.T.); (Y.K.); (M.K.); (T.B.)
| | - Eriko Takatori
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, Yahaba 028-3695, Japan; (T.N.); (E.T.); (Y.K.); (M.K.); (T.B.)
| | - Yoshitaka Kaido
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, Yahaba 028-3695, Japan; (T.N.); (E.T.); (Y.K.); (M.K.); (T.B.)
| | - Masahiro Kagabu
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, Yahaba 028-3695, Japan; (T.N.); (E.T.); (Y.K.); (M.K.); (T.B.)
| | - Dai Shimizu
- Department of Obstetrics and Gynecology, Akita University School of Medicine, Akita 010-8543, Japan;
| | - Tatsuhiko Shigeto
- Department of Obstetrics and Gynecology, Hirosaki University School of Medicine, Aomori 036-8563, Japan; (T.S.); (Y.Y.)
| | - Tsukasa Baba
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, Yahaba 028-3695, Japan; (T.N.); (E.T.); (Y.K.); (M.K.); (T.B.)
| | - Toru Sugiyama
- Department of Obstetrics and Gynecology, St. Mary’s Hospital, Fukuoka 830-8543, Japan;
| | - Yoshihito Yokoyama
- Department of Obstetrics and Gynecology, Hirosaki University School of Medicine, Aomori 036-8563, Japan; (T.S.); (Y.Y.)
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Watkins DE, Craig DJ, Vellani SD, Hegazi A, Fredrickson KJ, Walter A, Stanbery L, Nemunaitis J. Advances in Targeted Therapy for the Treatment of Cervical Cancer. J Clin Med 2023; 12:5992. [PMID: 37762931 PMCID: PMC10531664 DOI: 10.3390/jcm12185992] [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: 07/31/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Cervical cancer is an international public health crisis, affecting several hundred thousand women annually. While not universally protective due to other risk factors, many such cases are preventable with vaccination against high-risk serotypes of the human papilloma virus (HPV 6, 11, 16, 18, 31, 33, 45, 53, 58). Advanced-stage and recurrent cervical cancers are typically lethal and have been the focus in recent years of the integration of immune checkpoint inhibitors (CPIs) to improve survival. We have consolidated information regarding the role of the immune system in both disease progression and disease clearance with the aid of targeted therapies and immunotherapeutic agents. Additionally, we have characterized the treatment modalities currently indicated as the standard of care-such as bevacizumab and the immune CPIs-and those recently approved or in development, including Tivdak, Vigil, and chimeric antigen receptor (CAR) T-cells.
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Affiliation(s)
- Dean E. Watkins
- University of Toledo Medical Center, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, USA
| | - Daniel J. Craig
- University of Toledo Medical Center, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, USA
| | - Shahnaz D. Vellani
- University of Toledo Medical Center, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, USA
| | - Ahmad Hegazi
- University of Toledo Medical Center, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, USA
| | - Kaylee J. Fredrickson
- University of Toledo Medical Center, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, USA
| | - Adam Walter
- ProMedica Toledo Hospital, Toledo, OH 43606, USA
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Wu M, Xue L, Chen Y, Tang W, Guo Y, Xiong J, Chen D, Zhu Q, Fu F, Wang S. Inhibition of checkpoint kinase prevents human oocyte apoptosis induced by chemotherapy and allows enhanced tumour chemotherapeutic efficacy. Hum Reprod 2023; 38:1769-1783. [PMID: 37451671 DOI: 10.1093/humrep/dead145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/26/2023] [Indexed: 07/18/2023] Open
Abstract
STUDY QUESTION Could inhibition of the checkpoint kinase (CHEK) pathway protect human oocytes and even enhance the anti-tumour effects, during chemotherapy? SUMMARY ANSWER CHEK inhibitors prevented apoptosis of human oocytes induced by chemotherapy and even enhanced the anti-tumour effects. WHAT IS KNOWN ALREADY CHEK inhibitors showed ovarian protective effects in mice during chemotherapy, while their role in human oocytes is unclear. STUDY DESIGN, SIZE, DURATION This experimental study evaluated the ovarian reserve of young patients (120 patients) with cancer, exposed or not exposed to taxane and platinum (TP)-combined chemotherapy. Single RNA-sequencing analysis of human primordial oocytes from 10 patients was performed to explore the mechanism of oocyte apoptosis induced by TP chemotherapy. The damaging effects of paclitaxel (PTX) and cisplatin on human oocytes were also evaluated by culturing human ovaries in vitro. A new mouse model that combines human ovarian xenotransplantation and patient-derived tumour xenografts was developed to explore adjuvant therapies for ovarian protection. The mice were randomly allocated to four groups (10 mice for each group): control, cisplatin, cisplatin + CK1 (CHEK1 inhibitor, SCH 900776), and cisplatin + CK2 (CHEK2 inhibitor, BML277). PARTICIPANTS/MATERIALS, SETTING, METHODS In the prospective cohort study, human ovarian follicles were counted and serum AMH levels were evaluated. RNA-sequencing analysis was conducted, and staining for follicular damage (phosphorylated H2AX histone; γH2AX), terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labelling (TUNEL) assays and assessments of apoptotic biomarkers (western blot and immunofluorescence) were conducted in human ovaries. After the treatments, histological analysis was performed on human ovarian samples to investigate follicular populations, and oocyte damage was measured by γH2AX staining, BAX staining, and TUNEL assays. At the same time, the tumours were evaluated for volume, weight, and apoptosis levels. MAIN RESULTS AND THE ROLE OF CHANCE Patients who received TP chemotherapy showed decreased ovarian reserves. Single RNA-sequencing analysis of human primordial oocytes indicated that TP chemotherapy induced apoptosis of human primordial oocytes by causing CHEK-mediated TAp63α phosphorylation. In vitro culture of human ovaries showed greater damaging effects on oocytes after cisplatin treatment compared with that after PTX treatment. Using the new animal model, CHEK1/2 inhibitors prevented the apoptosis of human oocytes induced by cisplatin and even enhanced its anti-tumour effects. This protective effect appeared to be mediated by inhibiting DNA damage via the CHEK-TAp63α pathway and by generation of anti-apoptotic signals in the oocytes. LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION This was a preclinical study performed with human ovarian samples, and clinical research is required for validation. WIDER IMPLICATIONS OF THE FINDINGS These findings highlight the therapeutic potential of CHEK1/2 inhibitors as a complementary strategy for preserving fertility in female cancer patients. STUDY FUNDING/COMPETING INTEREST(S) This work was financially supported by the National Natural Science Foundation of China (nos. 82001514 and 81902669) and the Fundamental Research Funds for the Central Universities (2021yjsCXCY087). The authors declare no conflict of interest.
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Affiliation(s)
- Meng Wu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China
- Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Liru Xue
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China
- Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Ying Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China
- Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Weicheng Tang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China
- Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Yican Guo
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China
- Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Jiaqiang Xiong
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Dan Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China
- Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Qingqing Zhu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China
- Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Fangfang Fu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China
- Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Shixuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China
- Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
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20
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Taguchi A, Kato K, Hara K, Furusawa A, Nakajima Y, Ishizawa C, Tanikawa M, Sone K, Mori M, Shimada M, Okamoto A, Takekuma M. Heterogeneous treatment effects of adjuvant therapy for patients with cervical cancer in the intermediate-risk group. Cancer Med 2023; 12:18557-18567. [PMID: 37584239 PMCID: PMC10557871 DOI: 10.1002/cam4.6460] [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: 05/16/2023] [Revised: 07/29/2023] [Accepted: 08/06/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND The efficacy of adjuvant therapy for patients with cervical cancer with intermediate risk (CC-IR) remains controversial. We examined the impact of adjuvant therapy on survival outcomes in patients with CC-IR and evaluated the heterogeneous treatment effects (HTEs) of adjuvant therapies based on clinicopathologic characteristics. METHODS We retrospectively analyzed a previous Japanese nationwide cohort of 6192 patients with stage IB-IIB cervical cancer who underwent radical hysterectomy. We created two pairs of propensity score-matched treatment/control groups to investigate the treatment effects of adjuvant therapies: (1) adjuvant therapy versus non-adjuvant therapy; (2) chemotherapy versus radiotherapy conditional on adjuvant therapy. Multivariate analyses with treatment interactions were performed to evaluate the HTEs. RESULTS Among the 1613 patients with CC-IR, 619 and 994 were in the non-treatment and treatment groups, respectively. Survival outcomes did not differ between the two groups: 3-year progression-free survival (PFS) rates were 88.1% and 90.3% in the non-treatment and treatment groups, respectively (p = 0.199). Of the patients in the treatment group, 654 and 340 received radiotherapy and chemotherapy, respectively. Patients who received chemotherapy had better PFS than those who received radiotherapy (3-year PFS, 90.9% vs. 82.9%, p = 0.010). Tumor size was a significant factor that affected the treatment effects of chemotherapy; patients with large tumors gained better therapeutic effects from chemotherapy than those with small tumors. CONCLUSION Adjuvant therapy is optional for some patients with CC-IR; however, chemotherapy can be recommended as adjuvant therapy, particularly for patients with large tumors.
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Affiliation(s)
- Ayumi Taguchi
- Department of Obstetrics and Gynecology, Graduate School of MedicineThe University of TokyoTokyoJapan
- Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Kosuke Kato
- Department of Obstetrics and Gynecology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Konan Hara
- Department of EconomicsUniversity of ArizonaTucsonArizonaUSA
| | - Akiko Furusawa
- Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
- Department of GynecologyShizuoka Cancer Center HospitalShizuokaJapan
| | - Yujiro Nakajima
- Department of Radiological SciencesKomazawa UniversityTokyoJapan
| | - Chihiro Ishizawa
- Department of Obstetrics and Gynecology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Michihiro Tanikawa
- Department of Obstetrics and Gynecology, Graduate School of MedicineThe University of TokyoTokyoJapan
- Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Kenbun Sone
- Department of Obstetrics and Gynecology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Mayuyo Mori
- Department of Obstetrics and Gynecology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Muneaki Shimada
- Department of Obstetrics and GynecologyTohoku University School of MedicineSendaiJapan
| | - Aikou Okamoto
- Department of Obstetrics and GynecologyThe Jikei University School of MedicineTokyoJapan
| | - Munetaka Takekuma
- Department of GynecologyShizuoka Cancer Center HospitalShizuokaJapan
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21
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Ling K, Dou Y, Yang N, Deng L, Wang Y, Li Y, Yang L, Chen C, Jiang L, Deng Q, Li C, Liang Z, Zhang J. Genome editing mRNA nanotherapies inhibit cervical cancer progression and regulate the immunosuppressive microenvironment for adoptive T-cell therapy. J Control Release 2023; 360:496-513. [PMID: 37423524 DOI: 10.1016/j.jconrel.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/11/2023]
Abstract
CRISPR/Cas9-based genome editing is promising for therapy of cervical cancer by precisely targeting human papillomavirus (HPV). To develop CRISPR/Cas9-based genome editing nanotherapies, a pH-responsive hybrid nonviral nanovector was constructed for co-delivering Cas9 mRNA and guide RNAs (gRNAs) targeting E6 or E7 oncogenes. The pH-responsive nanovector was fabricated using an acetalated cyclic oligosaccharide (ACD), in combination with low molecular weight polyethyleneimine. Thus obtained hybrid ACD nanoparticles (defined as ACD NP) showed efficient loading for both Cas9 mRNA and E6 or E7 gRNA, giving rise to two pH-responsive genome editing nanotherapies E6/ACD NP and E7/ACD NP, respectively. Cellularly, ACD NP exhibited high transfection but low cytotoxicity in HeLa cervical carcinoma cells. Also, efficient genome editing of target genes was achieved in HeLa cells, with minimal off-target effects. In mice bearing HeLa xenografts, treatment with E6/ACD NP or E7/ACD NP afforded effective editing of target oncogenes and considerable antitumor activities. More importantly, treatment with E6/ACD NP or E7/ACD NP notably promoted CD8+ T cell survival by reversing the immunosuppressive microenvironment, thereby leading to synergistic antitumor effects by combination therapy using the gene editing nanotherapies and adoptive T-cell transfer. Consequently, our pH-responsive genome editing nanotherapies deserve further development for the treatment of HPV-associated cervical cancer, and they can also serve as promising nanotherapies to improve efficacies of other immune therapies against different advanced cancers by regulating the immunosuppressive tumor microenvironment.
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Affiliation(s)
- Kaijian Ling
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Yin Dou
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University (Army Medical University), Chongqing 400038, China.
| | - Neng Yang
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Li Deng
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Yanzhou Wang
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Yudi Li
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Leiyan Yang
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Cheng Chen
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Lupin Jiang
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Qingchun Deng
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Chenwen Li
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Zhiqing Liang
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.
| | - Jianxiang Zhang
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University (Army Medical University), Chongqing 400038, China; State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.
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22
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Ollivier L, Moreau Bachelard C, Renaud E, Dhamelincourt E, Lucia F. The abscopal effect of immune-radiation therapy in recurrent and metastatic cervical cancer: a narrative review. Front Immunol 2023; 14:1201675. [PMID: 37539054 PMCID: PMC10394237 DOI: 10.3389/fimmu.2023.1201675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/30/2023] [Indexed: 08/05/2023] Open
Abstract
Despite human papillomavirus vaccination and screening, in about 5% of cases, cervical cancer (CC) is discovered at an initial metastatic stage. Moreover, nearly one-third of patients with locally advanced CC (LACC) will have a recurrence of their disease during follow-up. At the stage of recurrent or metastatic CC, there are very few treatment options. They are considered incurable with a very poor prognosis. For many years, the standard of care was the combination of platinum-based drug and paclitaxel with the possible addition of bevacizumab. The most recent years have seen the development of the use of immune checkpoint inhibitors (ICIs) (pembrolizumab, cemiplimab and others) in patients with CC. They have shown long term responses with improved overall survival of patients in 1st line (in addition to chemotherapy) or 2nd line (as monotherapy) treatment. Another emerging drug is tisotumab vedotin, an antibody-drug conjugate targeting tissue factor. Radiation therapy (RT) often has a limited palliative indication in metastatic cancers. However, it has been observed that RT can induce tumor shrinkage both in distant metastatic tumors beyond the radiation field and in primary irradiated tumors. This is a rarely observed phenomenon, called abscopal effect, which is thought to be related to the immune system and allows a tumor response throughout the body. It would be the activation of the immune system induced by the irradiation of cancer cells that would lead to a specific type of apoptosis, the immunogenic cell death. Today, there is a growing consensus that combining RT with ICIs may boost abscopal response or cure rates for various cancers. Here we will review the potential abscopal effect of immune-radiation therapy in metastatic cervical cancer.
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Affiliation(s)
- Luc Ollivier
- Department of Radiation Oncology, Institut De Cancérologie De L’Ouest (ICO), Saint-Herblain, France
| | | | - Emmanuelle Renaud
- Department of Medical Oncology, CHRU Morvan, University Hospital, Brest, France
| | | | - Francois Lucia
- Radiation Oncology Department, University Hospital, Brest, France
- LaTIM, INSERM, UMR 1101, Univ Brest, Brest, France
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Oonk MHM, Planchamp F, Baldwin P, Mahner S, Mirza MR, Fischerová D, Creutzberg CL, Guillot E, Garganese G, Lax S, Redondo A, Sturdza A, Taylor A, Ulrikh E, Vandecaveye V, van der Zee A, Wölber L, Zach D, Zannoni GF, Zapardiel I. European Society of Gynaecological Oncology Guidelines for the Management of Patients with Vulvar Cancer - Update 2023. Int J Gynecol Cancer 2023; 33:1023-1043. [PMID: 37369376 PMCID: PMC10359596 DOI: 10.1136/ijgc-2023-004486] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/20/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND As part of its mission to improve the quality of care for women with gynecological cancers across Europe, the European Society of Gynaecological Oncology (ESGO) first published in 2017 evidence-based guidelines for the management of patients with vulvar cancer. OBJECTIVE To update the ESGO guidelines based on the new evidence addressing the management of vulvar cancer and to cover new topics in order to provide comprehensive guidelines on all relevant issues of diagnosis and treatment of vulvar cancer. METHODS The ESGO Council nominated an international development group comprised of practicing clinicians who provide care to vulvar cancer patients and have demonstrated leadership through their expertize in clinical care and research, national and international engagement and profile as well as dedication to the topics addressed to serve on the expert panel (18 experts across Europe). To ensure that the statements were evidence-based, new data identified from a systematic search were reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Prior to publication, the guidelines were reviewed by 206 international practitioners in cancer care delivery and patient representatives. RESULTS The updated guidelines cover comprehensively diagnosis and referral, staging, pathology, pre-operative investigations, surgical management (local treatment, groin treatment, sentinel lymph node procedure, reconstructive surgery), (chemo)radiotherapy, systemic treatment, treatment of recurrent disease (vulvar, inguinal, pelvic, and distant recurrences), and follow-up. Management algorithms are also defined.
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Affiliation(s)
- Maaike H M Oonk
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Sven Mahner
- University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | | | - Daniela Fischerová
- Charles University First Faculty of Medicine, Prague, Czech Republic
- General University Hospital in Prague, Prague, Czech Republic
| | | | | | - Giorgia Garganese
- Catholic University of the Sacred Heart, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Sigurd Lax
- Hospital Graz II, Graz, Austria
- Johannes Kepler Universitat Linz, Linz, Austria
| | | | | | | | - Elena Ulrikh
- Almazov National Medical Research Center, Saint Petersburg, Russian Federation
| | | | - Ate van der Zee
- University Medical Center Groningen, Groningen, The Netherlands
| | - Linn Wölber
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Diana Zach
- Karolinska University Hospital, Stockholm, Sweden
- Karolinska Institutet Eugeniavägen, Stockholm, Sweden
| | - Gian Franco Zannoni
- Catholic University of the Sacred Heart, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Pautier P, Genestie C, Gladieff L, Kurtz JE, Lortholary A, de La Motte Rouge T, Gaillard AL, Ducassou A, Dubot C, Rouleau E, Narducci F, Demontoy S, Hennequin C. Recommandations pour la pratique clinique Nice/Saint-Paul-de-Vence 2022–2023 : Prise en charge du cancer du col de l'utérus avancé. Bull Cancer 2023; 110:6S44-6S50. [PMID: 37573038 DOI: 10.1016/s0007-4551(23)00333-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Abstract
French recommendations for clinical practice, Nice/Saint-Paul-de-Vence 2022-2023: Management of advanced cervical cancer The prognosis of cervical cancer remained pejorative until recently, first-line treatment consisting of platinum-based chemotherapy, associated with bevacizumab whenever possible, without any other therapeutic innovation for several years. However in 2022, immunotherapy appeared in the therapeutic landscape. Pembrolizumab can now be prescribed, thanks to the early access status granted by the HAS in September 2022, in patients with PD-L1 positive tumors. In parallel, bevacizumab generic is now reimbursed, allowing its association with chemotherapy on top of pembrolizumab, if indicated. For patient relapsing after platinium salts, and who never received immunotherapy, cemiplimab could be delivered and reimboursed since spring 2023, whatever could be PD-L1 status. Pretherapeutic work-up includes imaging combining MRI and PET/CT or CT of the chest, abdomen and pelvis, as well as evaluation of PD-L1 status on tumor and immune cells to define the CPS score that will determine eligibility to pembrolizumab treatment (CPS > 1). Possibilities of locoregional treatment depend on individual situations and are discussed on a case-by-case basis in multidisciplinary meetings. Early supportive care is always recommended and inclusion in clinical trials must be systematically considered.
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Affiliation(s)
- Patricia Pautier
- Département d'oncologie médicale, service de gynécologie, Gustave-Roussy, Villejuif, France.
| | | | - Laurence Gladieff
- Département d'oncologie médicale, institut Claudius-Régaud, Toulouse, France
| | - Jean-Emmanuel Kurtz
- Département d'oncologie médicale, institut de cancérologie de Strasbourg, Strasbourg, France
| | - Alain Lortholary
- Service d'oncologie médicale, institut de cancérologie Catherine-de-Sienne, Nantes, France
| | | | | | - Anne Ducassou
- Département de radiothérapie, institut Claudius-Régaud, Toulouse, France
| | - Coraline Dubot
- Département d'oncologie médicale, centre François-Baclesse, Caen, France
| | - Etienne Rouleau
- Service de génétique des tumeurs, Gustave-Roussy, Villejuif, France
| | - Fabrice Narducci
- Département de cancérologie gynécologique, centre Oscar-Lambret, Lille, France
| | - Sylvain Demontoy
- Département de radiothérapie, institut du cancer de Montpellier, Montpellier, France
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25
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Schubert M, Bauerschlag DO, Muallem MZ, Maass N, Alkatout I. Challenges in the Diagnosis and Individualized Treatment of Cervical Cancer. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050925. [PMID: 37241157 DOI: 10.3390/medicina59050925] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/25/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
Cervical cancer is still the fourth most common cancer in women throughout the world; an estimated 604,000 new cases were observed in 2020. Better knowledge of its pathogenesis, gained in recent years, has introduced new preventive and diagnostic approaches. Knowledge of its pathogenesis has made it possible to provide individualized surgical and drug treatment. In industrialized countries, cervical cancer has become a less frequent tumor entity due to the accessibility of the human papilloma virus vaccination, systematic preventive programs/early detection programs, health care infrastructure and the availability of effective therapy options. Nevertheless, globally, neither mortality nor morbidity has been significantly reduced over the past 10 years, and therapy approaches differ widely. The aim of this review is to address recent advances in the prevention, diagnostic investigation and treatment of cervical cancer globally, focusing on advances in Germany, with a view toward providing an updated overview for clinicians. The following aspects are addressed in detail: (a) the prevalence and causes of cervical cancer, (b) diagnostic tools using imaging techniques, cytology and pathology, (c) pathomechanisms and clinical symptoms of cervical cancer and (d) different treatment approaches (pharmacological, surgical and others) and their impact on outcomes.
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Affiliation(s)
- Melanie Schubert
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Dirk Olaf Bauerschlag
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Mustafa Zelal Muallem
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Virchow Campus Clinic, 13353 Berlin, Germany
| | - Nicolai Maass
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, 24105 Kiel, Germany
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Vergote I, Van Nieuwenhuysen E, Casado A, Laenen A, Lorusso D, Braicu EI, Guerra-Alia E, Zola P, Wimberger P, Debruyne PR, Falcó E, Ferrero A, Muallem MZ, Kerger J, García-Martinez E, Pignata S, Sehouli J, Van Gorp T, Gennigens C, Rubio MJ. Randomized phase II BGOG/ENGOT-cx1 study of paclitaxel-carboplatin with or without nintedanib in first-line recurrent or advanced cervical cancer. Gynecol Oncol 2023; 174:80-88. [PMID: 37167896 DOI: 10.1016/j.ygyno.2023.04.028] [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: 03/15/2023] [Revised: 04/19/2023] [Accepted: 04/29/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Nintedanib is an oral tyrosine kinase inhibitor targeting, among others, vascular endothelial growth factor receptor. The aim was to establish the role of nintedanib in addition to paclitaxel and carboplatin in first-line recurrent/metastatic cervical cancer. METHODS Double-blind phase II randomized study in patients with first-line recurrent or primary advanced (FIGO stage IVB) cervical cancer. Patients received carboplatin-paclitaxel with oral nintedanib 200 mg BID/placebo. The primary endpoint was progression-free survival (PFS) at 1.5 years and α = 0.15, β = 80%, one sided. RESULTS 120 patients (62 N, 58C) were randomized. Median follow-up was 35 months. Baseline characteristics were similar in both groups (total population: squamous cell carcinoma 62%, prior radiotherapy 64%, primary advanced 25%, recurrent 75%). The primary endpoint was met with a PFS at 1.5 years of 15.1% versus 12.8% in favor of the nintedanib arm (p = 0.057). Median overall survival (OS) was 21.7 and 16.4 months for N and C, respectively. Confirmed RECIST response rate was 48% for N and 39% for C. No new adverse events were noted for N. However, N was associated with numerically more serious adverse events for anemia and febrile neutropenia. Global health status during and at the end of the study was similar in both arms. CONCLUSION The study met its primary endpoint with a prolonged PFS in the N arm. No new safety signals were observed.
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Affiliation(s)
- I Vergote
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG) and University Hospitals Leuven, Division of Gynaecological Oncology, Leuven, European Union, Belgium.
| | - E Van Nieuwenhuysen
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG) and University Hospitals Leuven, Division of Gynaecological Oncology, Leuven, European Union, Belgium
| | - A Casado
- Hospital Clínico San Carlos, Spain and Grupo Español de Cáncer de Ovario (GEICO), Madrid, Spain
| | - A Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre, KU Leuven, Leuven, Belgium
| | - D Lorusso
- Multicentre Italian Trials in Ovarian Cancer and Gynecologic malignancies (MITO) and Fondazione Policlinico Universitario Gemelli IRCCS and Catholic University of Sacred Heart, Roma, Italy
| | - E I Braicu
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V (NOGGO) and Department of Gynecology with Center for Oncological Surgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, Berlin, Germany; Stanford University, Department of Obstetrics and Gynecology, CA, USA
| | - E Guerra-Alia
- Hospital Universitario Ramón y Cajal, and GEICO, Madrid, Spain
| | - P Zola
- Mario Negri Gynecologic Oncology Group (MaNGO) and Department of Surgical Sciences Università degli Studi di Torino, Italy
| | - P Wimberger
- NOGGO and Technische Universität Dresden and NCT Dresden, Dresden, Germany
| | - P R Debruyne
- BGOG and Kortrijk Cancer Centre, AZ Groeninge, Kortrijk, Belgium; School of Life Sciences, Anglia Ruskin University, Cambridge, UK; School of Nursing & Midwifery, University of Plymouth, Plymouth, UK
| | - E Falcó
- GEICO and Policlinica Miramar, Palma de Mallorca, Spain
| | - A Ferrero
- MaNGO and Mauriziano Hospital and University of Torino, Torino, Italy
| | - M Z Muallem
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V (NOGGO) and Department of Gynecology with Center for Oncological Surgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - J Kerger
- BGOG and Instituut Jules Bordet, Brussels, Belgium
| | - E García-Martinez
- Hospital General Universitario Morales Meseguer, Murcia, Spain and GEICO
| | - S Pignata
- MITO and Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, Italy
| | - J Sehouli
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V (NOGGO) and Department of Gynecology with Center for Oncological Surgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - T Van Gorp
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG) and University Hospitals Leuven, Division of Gynaecological Oncology, Leuven, European Union, Belgium
| | | | - M J Rubio
- Hospital Reina Sofía, Córdoba, Spain and GEICO
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Mileshkin LR, Moore KN, Barnes EH, Gebski V, Narayan K, King MT, Bradshaw N, Lee YC, Diamante K, Fyles AW, Small W, Gaffney DK, Khaw P, Brooks S, Thompson JS, Huh WK, Mathews CA, Buck M, Suder A, Lad TE, Barani IJ, Holschneider CH, Van Dyk S, Quinn M, Rischin D, Monk BJ, Stockler MR. Adjuvant chemotherapy following chemoradiotherapy as primary treatment for locally advanced cervical cancer versus chemoradiotherapy alone (OUTBACK): an international, open-label, randomised, phase 3 trial. Lancet Oncol 2023; 24:468-482. [PMID: 37080223 PMCID: PMC11075114 DOI: 10.1016/s1470-2045(23)00147-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Standard treatment for locally advanced cervical cancer is chemoradiotherapy, but many patients relapse and die of metastatic disease. We aimed to determine the effects on survival of adjuvant chemotherapy after chemoradiotherapy. METHODS The OUTBACK trial was a multicentre, open-label, randomised, phase 3 trial done in 157 hospitals in Australia, China, Canada, New Zealand, Saudi Arabia, Singapore, and the USA. Eligible participants were aged 18 year or older with histologically confirmed squamous cell carcinoma, adenosquamous cell carcinoma, or adenocarcinoma of the cervix (FIGO 2008 stage IB1 disease with nodal involvement, or stage IB2, II, IIIB, or IVA disease), Eastern Cooperative Oncology Group performance status 0-2, and adequate bone marrow and organ function. Participants were randomly assigned centrally (1:1) using a minimisation approach and stratified by pelvic or common iliac nodal involvement, requirement for extended-field radiotherapy, FIGO 2008 stage, age, and site to receive standard cisplatin-based chemoradiotherapy (40 mg/m2 cisplatin intravenously once-a-week for 5 weeks, during radiotherapy with 45·0-50·4 Gy external beam radiotherapy delivered in fractions of 1·8 Gy to the whole pelvis plus brachytherapy; chemoradiotherapy only group) or standard cisplatin-based chemoradiotherapy followed by adjuvant chemotherapy with four cycles of carboplatin (area under the receiver operator curve 5) and paclitaxel (155 mg/m2) given intravenously on day 1 of a 21 day cycle (adjuvant chemotherapy group). The primary endpoint was overall survival at 5 years, analysed in the intention-to-treat population (ie, all eligible patients who were randomly assigned). Safety was assessed in all patients in the chemoradiotherapy only group who started chemoradiotherapy and all patients in the adjuvant chemotherapy group who received at least one dose of adjuvant chemotherapy. The OUTBACK trial is registered with ClinicalTrials.gov, NCT01414608, and the Australia New Zealand Clinical Trial Registry, ACTRN12610000732088. FINDINGS Between April 15, 2011, and June 26, 2017, 926 patients were enrolled and randomly assigned to the chemoradiotherapy only group (n=461) or the adjuvant chemotherapy group (n=465), of whom 919 were eligible (456 in the chemoradiotherapy only group and 463 in the adjuvant chemotherapy group; median age 46 years [IQR 37 to 55]; 663 [72%] were White, 121 [13%] were Black or African American, 53 [6%] were Asian, 24 [3%] were Aboriginal or Pacific islander, and 57 [6%] were other races) and included in the analysis. As of data cutoff (April 12, 2021), median follow-up was 60 months (IQR 45 to 65). 5-year overall survival was 72% (95% CI 67 to 76) in the adjuvant chemotherapy group (105 deaths) and 71% (66 to 75) in the chemoradiotherapy only group (116 deaths; difference 1% [95% CI -6 to 7]; hazard ratio 0·90 [95% CI 0·70 to 1·17]; p=0·81). In the safety population, the most common clinically significant grade 3-4 adverse events were decreased neutrophils (71 [20%] in the adjuvant chemotherapy group vs 34 [8%] in the chemoradiotherapy only group), and anaemia (66 [18%] vs 34 [8%]). Serious adverse events occurred in 107 (30%) in the adjuvant chemotherapy group versus 98 (22%) in the chemoradiotherapy only group, most commonly due to infectious complications. There were no treatment-related deaths. INTERPRETATION Adjuvant carboplatin and paclitaxel chemotherapy given after standard cisplatin-based chemoradiotherapy for unselected locally advanced cervical cancer increased short-term toxicity and did not improve overall survival; therefore, it should not be given in this setting. FUNDING National Health and Medical Research Council and National Cancer Institute.
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Affiliation(s)
- Linda R Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, VIC, Australia.
| | - Kathleen N Moore
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, USA
| | - Elizabeth H Barnes
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Val Gebski
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Kailash Narayan
- Department of Radiation Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, VIC, Australia
| | - Madeleine T King
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Nathan Bradshaw
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Yeh Chen Lee
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Katrina Diamante
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Anthony W Fyles
- National Cancer Institute of Canada Clinical Trial Group, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernadin Cancer Center, Loyola University Chicago, Maywood, IL, USA
| | - David K Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Pearly Khaw
- Department of Radiation Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, VIC, Australia
| | - Susan Brooks
- Department of Medical Oncology, Auckland City Hospital, Auckland, New Zealand
| | - J Spencer Thompson
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, USA
| | - Warner K Huh
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cara A Mathews
- Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital, Brown University, Providence, RI, USA
| | - Martin Buck
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Aneta Suder
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Thomas E Lad
- Division of Hematology-Oncology, Cook County Hospital, Chicago, IL, USA
| | - Igor J Barani
- Department of Radiation Oncology, St Joseph's Hospital and Medical Centre, Phoenix, AZ, USA
| | | | - Sylvia Van Dyk
- Department of Radiation Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, VIC, Australia
| | - Michael Quinn
- Oncology Unit, Royal Women's Hospital and University of Melbourne, Melbourne, VIC, Australia
| | - Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, VIC, Australia
| | - Bradley J Monk
- Division of Gynecologic Oncology, HonorHealth Research Institute, University of Arizona, Creighton University, Phoenix, AZ, USA
| | - Martin R Stockler
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
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Xia X, Wang Y, Shao Y, Xu J, Liang B, Liu W, Zeng J, Li C, Guan H, Wang S, Xing D. Marine Sulfated Polysaccharide PMGS Synergizes with Paclitaxel in Inhibiting Cervical Cancer In Vitro. Mar Drugs 2023; 21:md21050259. [PMID: 37233453 DOI: 10.3390/md21050259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/16/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023] Open
Abstract
The incidence and mortality of cervical cancer in female malignancies are second only to breast cancer, which brings a heavy health and economic toll worldwide. Paclitaxel (PTX)-based regimens are the first-class choice; however, severe side effects, poor therapeutic effects, and difficulty in effectively preventing tumor recurrence or metastasis are unavoidable. Therefore, it is necessary to explore effective therapeutic interventions for cervical cancer. Our previous studies have shown that PMGS, a marine sulfated polysaccharide, exhibits promising anti-human papillomavirus (anti-HPV) effects through multiple molecular mechanisms. In this article, a continuous study identified that PMGS, as a novel sensitizer, combined with PTX exerted synergistic anti-tumor effects on cervical cancer associated with HPV in vitro. Both PMGS and PTX inhibited the proliferation of cervical cancer cells, and the combination of PMGS with PTX displayed significant synergistic effects on Hela cells. Mechanistically, PMGS synergizes with PTX by enhancing cytotoxicity, inducing cell apoptosis and inhibiting cell migration in Hela cells. Collectively, the combination of PTX and PMGS potentially provides a novel therapeutic strategy for cervical cancer.
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Affiliation(s)
- Xuan Xia
- Key Laboratory of Marine Drugs of Ministry of Education, and Shandong Provincial Key Laboratory of Glycoscience and Glycotechnology, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China
- Marine Biomedical Research Institute of Qingdao, Qingdao 266071, China
| | - Yanhong Wang
- Qingdao Cancer Institute, Qingdao University, Qingdao 266071, China
| | - Yingchun Shao
- Qingdao Cancer Institute, Qingdao University, Qingdao 266071, China
| | - Jiazhen Xu
- Qingdao Cancer Institute, Qingdao University, Qingdao 266071, China
| | - Bing Liang
- Qingdao Cancer Institute, Qingdao University, Qingdao 266071, China
| | - Wenjing Liu
- Qingdao Cancer Institute, Qingdao University, Qingdao 266071, China
| | - Jun Zeng
- Qingdao Cancer Institute, Qingdao University, Qingdao 266071, China
| | - Chunxia Li
- Key Laboratory of Marine Drugs of Ministry of Education, and Shandong Provincial Key Laboratory of Glycoscience and Glycotechnology, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China
- Marine Biomedical Research Institute of Qingdao, Qingdao 266071, China
| | - Huashi Guan
- Key Laboratory of Marine Drugs of Ministry of Education, and Shandong Provincial Key Laboratory of Glycoscience and Glycotechnology, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China
- Marine Biomedical Research Institute of Qingdao, Qingdao 266071, China
| | - Shixin Wang
- Key Laboratory of Marine Drugs of Ministry of Education, and Shandong Provincial Key Laboratory of Glycoscience and Glycotechnology, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, China
- Marine Biomedical Research Institute of Qingdao, Qingdao 266071, China
| | - Dongming Xing
- Qingdao Cancer Institute, Qingdao University, Qingdao 266071, China
- School of Life Sciences, Tsinghua University, Beijing 100084, China
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29
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Li T, Wang X, Qin S, Chen B, Yi M, Zhou J. Targeting PARP for the optimal immunotherapy efficiency in gynecologic malignancies. Biomed Pharmacother 2023; 162:114712. [PMID: 37075667 DOI: 10.1016/j.biopha.2023.114712] [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: 03/10/2023] [Revised: 04/05/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023] Open
Abstract
Gynecologic cancer, which includes ovarian, cervical, endometrial, vulvar, and vaginal cancer, is a major health concern for women all over the world. Despite the availability of various treatment options, many patients eventually progress to advanced stages and face high mortality rates. PARPi (poly (ADP-ribose) polymerase inhibitor) and immune checkpoint inhibitor (ICI) have both shown significant efficacy in the treatment of advanced and metastatic gynecologic cancer. However, both treatments have limitations, including inevitable resistance and a narrow therapeutic window, making PARPi and ICI combination therapy a promising approach to treating gynecologic malignancies. Preclinical and clinical trials have looked into the combination therapy of PARPi and ICI. PARPi improves ICI efficacy by inducing DNA damage and increasing tumor immunogenicity, resulting in a stronger immune response against cancer cells. ICI, conversly, can increase PARPi sensitivity by priming and activating immune cells, consequently prompting immune cytotoxic effect. Several clinical trials in gynecologic cancer patients have investigated the combination therapy of PARPi and ICI. When compared to monotherapy, the combination of PARPi and ICI increased progression-free survival and overall survival in ovarian cancer patients. The combination therapy has also been studied in other types of gynecologic cancer, including endometrial and cervical cancer, with promising results. Finally, the combination therapeutic strategy of PARPi and ICI is a promising approach in the treatment of gynecologic cancer, particularly advanced and metastatic stages. Preclinical studies and clinical trials have demonstrated the safety and efficacy of this combination therapy in improving patient outcomes and quality of life.
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Affiliation(s)
- Tianye Li
- Department of Gynecology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinrun Wang
- Department of Gynecology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuang Qin
- Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bingxin Chen
- Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ming Yi
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
| | - Jianwei Zhou
- Department of Gynecology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Tewari KS, Sill MW, Birrer MJ, Penson RT, Huang H, Moore DH, Ramondetta LM, Landrum LM, Oaknin A, Reid TJ, Leitao MM, Michael HE, Monk BJ. Final survival analysis of topotecan and paclitaxel for first-line treatment of advanced cervical cancer: An NRG oncology randomized study. Gynecol Oncol 2023; 171:141-150. [PMID: 36898292 PMCID: PMC10286827 DOI: 10.1016/j.ygyno.2023.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVE To determine whether a non‑platinum chemotherapy doublet improves overall survival (OS) among patients with recurrent/metastatic cervical carcinoma. METHODS Gynecologic Oncology Group protocol 240 is a phase 3, randomized, open-label, clinical trial that studied the efficacy of paclitaxel 175 mg/m2 plus topotecan 0.75 mg/m2 days 1-3 (n = 223) vs cisplatin 50 mg/m2 plus paclitaxel 135 or 175 mg/m2 (n = 229), in 452 patients with recurrent/metastatic cervical cancer. Each chemotherapy doublet was also studied with and without bevacizumab (15 mg/kg). Cycles were repeated every 21 days until progression, unacceptable toxicity, or complete response. The primary endpoints were OS and the frequency and severity of adverse effects. We report the final analysis of OS. RESULTS At the protocol-specified final analysis, median OS was 16.3 (cisplatin-paclitaxel backbone) and 13.8 months (topotecan-paclitaxel backbone) (HR 1.12; 95% CI, 0.91-1.38; p = 0.28). Median OS for cisplatin-paclitaxel and topotecan-paclitaxel was 15 vs 12 months, respectively (HR 1.10; 95% CI,0.82-1.48; p = 0.52), and for cisplatin-paclitaxel-bevacizumab and topotecan-paclitaxel-bevacizumab was 17.5 vs 16.2 months, respectively (HR 1.16; 95% CI, 0.86-1.56; p = 0.34). Among the 75% of patients in the study population previously exposed to platinum, median OS was 14.6 (cisplatin-paclitaxel backbone) vs 12.9 months (topotecan-paclitaxel backbone), respectively (HR 1.09; 95% CI, 0.86-1.38;p = 0.48). Post-progression survival was 7.9 (cisplatin-paclitaxel backbone) vs 8.1 months (topotecan-paclitaxel backbone) (HR 0.95; 95% CI, 0.75-1.19). Grade 4 hematologic toxicity was similar between chemotherapy backbones. CONCLUSIONS Topotecan plus paclitaxel does not confer a survival benefit to women with recurrent/metastatic cervical cancer, even among platinum-exposed patients. Topotecan-paclitaxel should not be routinely recommended in this population. NCT00803062.
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Affiliation(s)
| | - Michael W Sill
- Roswell Park Comprehensive Cancer Center, State University of New York at Buffalo, NY, USA.
| | - Michael J Birrer
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | | | - Helen Huang
- Roswell Park Comprehensive Cancer Center, State University of New York at Buffalo, NY, USA.
| | - David H Moore
- Franciscan S. Francis Health, Indianapolis, IN, USA.
| | | | | | - Ana Oaknin
- Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | - Thomas J Reid
- University of Cincinnati College of Medicine Kettering, OH, USA.
| | - Mario M Leitao
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
| | - Helen E Michael
- Indiana University School of Medicine, Indianapolis, IN, USA.
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Ishikawa M, Shibata T, Kataoka T, Takekuma M, Kobayashi H, Yaegashi N, Satoh T. Final analysis of a randomized phase II/III trial of conventional paclitaxel and carboplatin with or without bevacizumab versus dose-dense paclitaxel and carboplatin with or without bevacizumab, in stage IVB, recurrent, or persistent cervical carcinoma (JCOG1311). Int J Gynecol Cancer 2023; 33:692-700. [PMID: 36997229 DOI: 10.1136/ijgc-2022-004214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
OBJECTIVE To assess the efficacy of dose-dense weekly paclitaxel plus carboplatin in metastatic or recurrent cervical carcinoma, we conducted a phase II/III randomized controlled study comparing dose-dense paclitaxel and carboplatin with or without bevacizumab to conventional paclitaxel and carboplatin with or without bevacizumab. However, at the primary analysis of the phase II part, the response rate in the dose-dense arm was not higher than in the conventional arm and the study was terminated early before starting phase III. After a further 2 years of follow-up, we conducted this final analysis. METHODS 122 patients were enrolled and randomly assigned to either the conventional or dose-dense arm. After bevacizumab was approved in Japan, patients in both arms received bevacizumab if not contraindicated. In the final analysis, overall survival, progression-free survival, and adverse events were updated. RESULTS The median follow-up of surviving patients was 34.8 months (range 19.2-64.8). Median overall survival in the conventional arm was 17.7 months and in the dose-dense arm 18.5 months (p=0.71). Median progression-free survival in the conventional arm was 7.9 months and in the dose-dense arm 7.2 months (p=0.64). A platinum-free interval within 24 weeks and treatment without bevacizumab were identified as prognostic factors for overall and progression-free survival. Grade 3 to 4 non-hematologic toxicity occurred in 46.7% of patients who received the conventional regimen and in 43.3% of patients who received the dose-dense regimen. Adverse events related to bevacizumab in 82 patients included fistula in five (6.1%) and gastrointestinal perforation in three (3.7%). CONCLUSIONS It was confirmed that dose-dense paclitaxel plus carboplatin for metastatic or recurrent cervical carcinoma is not superior to conventional paclitaxel and carboplatin. Patients who had early refractory disease after prior chemoradiotherapy had the poorest prognosis. The development of treatments that improve the prognosis of such patients remains an important issue. CLINICAL TRIAL INFORMATION jRCTs031180007.
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Affiliation(s)
- Mitsuya Ishikawa
- Department of Gynecology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Taro Shibata
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Tomoko Kataoka
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Munetaka Takekuma
- Division of Gynecology, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka, Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Kagoshima, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Toyomi Satoh
- Obstetrics and Gynecology, University of Tsukuba, Tsukuba, Japan
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Lainé A, Gonzalez-Lopez AM, Hasan U, Ohkuma R, Ray-Coquard I. Immune Environment and Immunotherapy in Endometrial Carcinoma and Cervical Tumors. Cancers (Basel) 2023; 15:cancers15072042. [PMID: 37046702 PMCID: PMC10093320 DOI: 10.3390/cancers15072042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/22/2023] [Accepted: 03/26/2023] [Indexed: 04/14/2023] Open
Abstract
Endometrial cancer (EC) is the seventh most common tumor in women, and prognosis of recurrent and metastatic disease is poor. Cervical cancer (CC) represents the fifth most common gynecological cancer. While ECs are more common in developed countries, the incidence of CC has decreased due to the recent implementation of large screening and vaccination programs. Until very recently, patients with advanced or unresectable EC or CC had very limited treatment options and were receiving in first line setting platinum/taxane-based chemotherapy (CT). Significant progress in the treatment of gynecological cancers has occurred in the last few years, with the use of innovative targeted therapies and immunotherapy. However, targeting the immune system in patients with gynecological tumors remains challenging and is not always successful. In ovarian cancer, several immunotherapy treatment regimens have been investigated (as monotherapy and combination therapy in first and subsequent lines of treatment) and showed poor responses. Therefore, we specifically focused our review on EC and CC for their specific immune-related features and therapeutic results demonstrated with immunotherapy. We report recent and current immunotherapy-based clinical trials and provide a review of emerging data that are likely to impact immunotherapy development based on increased biomarkers' identification to monitor response and overcome resistance.
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Affiliation(s)
| | | | - Uzma Hasan
- CIRI, Team Enveloped Viruses, Vectors and ImmunotheRapy INSERM U1111/UCBL 1, Centre National de la Recherche Scientifique (CNRS), UMR5308, ENS de Lyon, Université Lyon, 69364 Lyon, France
- The Lyon Immunotherapy for Cancer Laboratory (LICL), Centre de Recherche en Cancérologie de Lyon (CRCL)/UMR Inserm 1052/CNRS 5286, CLB, 69373 Lyon CEDEX 08, France
| | - Ryotaro Ohkuma
- Team CISTAR, CRCL, INSERM-1052/CNRS-5286, CLB, Lyon, 69373 CEDEX 08, France
- Division of Medical Oncology, Department of Medicine, School of Medicine, Showa University, Tokyo 142-8555, Japan
| | - Isabelle Ray-Coquard
- Centre Léon Bérard, University Claude Bernard Lyon I, 69373 Lyon CEDEX 08, France
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Vergote I, Ray-Coquard I, Lorusso D, Oaknin A, Cibula D, Van Gorp T. Investigational drugs for recurrent or primary advanced metastatic cervical cancer: what is in the clinical development pipeline? Expert Opin Investig Drugs 2023; 32:201-211. [PMID: 36803278 DOI: 10.1080/13543784.2023.2179483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
INTRODUCTION Recurrent or primary advanced metastatic cervical cancer (R/M CC) has a poor prognosis with a 5-year-survival rate of 16.5%, demanding novel and improved therapies for the treatment of these patients. The first-line standard of care for R/M CC now benefits from the addition of the immune checkpoint inhibitor, pembrolizumab, to platinum-based chemotherapy with paclitaxel and bevacizumab. Additionally, new options for second-line treatment have become available in recent years. AREAS COVERED Here, we review current investigational drugs and discuss their relative targets, efficacies, and potential within the R/M CC treatment landscape. This review will focus on recently published data and key ongoing clinical trials in patients with R/M CC, covering multiple modes of action, including immunotherapies, antibody-drug conjugates, and tyrosine kinase inhibitors. We searched clinicaltrials.gov for ongoing trials and pubmed.ncbi.nih.gov for recently published trial data, as well as recent years' proceedings from the annual conferences of the American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), European Society of Gynaecological Oncology (ESGO), and the International Gynecologic Cancer Society (IGCS). EXPERT OPINION Therapeutics currently attracting attention include novel immune checkpoint inhibitors, therapeutic vaccinations, antibody-drug conjugates, such as tisotumab vedotin, tyrosine kinase inhibitors targeting HER2, and multitarget synergistic combinations.
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Affiliation(s)
- Ignace Vergote
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium; Belgium and Luxembourg Gynaecological Oncology Group (BGOG), Leuven, Belgium, European Union
| | - Isabelle Ray-Coquard
- Medical Oncology Department, Centre Léon Bérard and University Claude Bernard Lyon 1, GINECO, Lyon, France
| | - Domenica Lorusso
- Gynecologic Oncology Unit, Catholic University of Sacred Heart and Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Ana Oaknin
- Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - David Cibula
- Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic; Central and Eastern European Gynecologic Oncology Group (CEEGOG), Prague, Czech Republic
| | - Toon Van Gorp
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium; Belgium and Luxembourg Gynaecological Oncology Group (BGOG), Leuven, Belgium, European Union
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Ma X, Fang J, Zhang L, Huang Y, Shen H, Ma X, Zhang S, Zhang B. Efficacy and safety of adjuvant chemotherapy for locally advanced cervical cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2023; 184:103953. [PMID: 36889613 DOI: 10.1016/j.critrevonc.2023.103953] [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] [Received: 12/21/2022] [Revised: 01/31/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Locally advanced cervical cancer (LACC) is generally treated using concurrent chemo-radiotherapy (CCRT); yet, the effectiveness of adjuvant chemotherapy (ACT) following CCRT remains controversial. METHODS The databases Embase, Web of Science, and PubMed were analyzed for relevant research. Primary endpoints included overall survival (OS) and progression-free survival (PFS). RESULTS Fifteen trials with 4041 patients were included. Pooled HRs for PFS and OS were 0.81 (95 % CI: 0.67-0.96) and 0.69 (95 % CI: 0.51-0.93), respectively. However, subgroup analyses indicated that in randomized trials and trials with larger sample sizes (n > 100) as well as ACT cycles ≤ 3, ACT was not linked with improved PFS and OS. Moreover, ACT induced a greater rate of hematologic toxicities (P < 0.05). CONCLUSION Higher quality of evidence suggests that ACT could not yield additional survival benefits for LACC; however, identifying high-risk patients who may benefit from ACT is required to design further clinical trials and better inform treatment decisions.
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Affiliation(s)
- Xiao Ma
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Jin Fang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Lu Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Yao Huang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Hui Shen
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Xiaohua Ma
- Department of Medical Ultrasonics, Hongqi Hospital of Mudanjiang Medical University, Mudanjiang, Heilongjiang, China
| | - Shuixing Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
| | - Bin Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
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Paulino E, de Melo AC, de Andrade DAP, de Almeida MS. Systemic therapy for advanced cervical cancer: Leveraging the historical threshold of overall survival. Crit Rev Oncol Hematol 2023; 183:103925. [PMID: 36696932 DOI: 10.1016/j.critrevonc.2023.103925] [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: 01/10/2021] [Revised: 12/27/2022] [Accepted: 01/20/2023] [Indexed: 01/23/2023] Open
Abstract
Cervical cancer (CC) is a worldwide problem, especially in low- and middle-income countries, where patients are often diagnosed with locally advanced disease. Until recently, all chemotherapy drugs achieved low ORR and 12-month overall survival (12- month OS) for advanced CC after failure for platinum compounds. Advances in systemic therapy with immunotherapy, targeted therapy, and antibody-drug conjugates (ADC) have leveraged the 12-month OS limit. Recently, immunotherapy (pembrolizumab) has become the standard of care in first-line advanced CC combined with platinum and taxane and in second-line after platinum doublet failure.
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Affiliation(s)
- Eduardo Paulino
- Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Oncologia D'or, Rio de Janeiro, Brazil.
| | - Andreia Cristina de Melo
- Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Grupo Oncoclínicas, Rio de Janeiro, Brazil
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Popat PB, Maheshwari A, Manchanda S, Renganathan R, Sen S, Dhamija E, Thakur M, Deodhar K, Chopra S, Kanteti APK, Ghosh J, Shah S, Sable N, Baheti A, Chauhan S, Gala K, Kulkarni S. Imaging Recommendations for Diagnosis, Staging, and Management of Cervical Cancer. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
AbstractCervical cancer is the fourth most common cancer in women globally and the second most common cancer in Indian women, more common in lower socioeconomic strata. Improvement in survival and decrease in morbidity reflect the earlier detection with screening and imaging, as well as multifactorial multimodality therapy integrating surgery, and concurrent chemoradiation therapy providing superior therapeutic benefits. Imaging plays a vital role in assessing the extent of disease and staging of cervical cancer. The appropriateness criteria of a modality are different from its availability based on infrastructure, medical facilities, and resource status. Although in an ideal situation, magnetic resonance imaging (MRI) would be of greatest value in locoregional assessment of extent of disease and fluorodeoxyglucose positron emission tomography-computed tomography for distant staging; often, an ultrasonography, chest radiograph, and bone scans are utilized, with contrast-enhanced computed tomography representing a fair superior diagnostic accuracy, and can be reported as per the RECIST 1.1 criteria. MRI is also of good utility in the assessment of residual disease, predicting response and detecting small volume recurrence. MRI offers the highest diagnostic accuracy in determining parametrial invasion and hence surgical planning; so also, MRI-guided radiation planning helps in more accurate graded radiation dose planning in radiation therapy. Stage and therapy-based surveillance imaging should be encouraged and recommended.
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Affiliation(s)
- Palak Bhavesh Popat
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Amita Maheshwari
- Division of Gynaecologic Oncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Smita Manchanda
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rupa Renganathan
- Department of Diagnostic and Interventional Radiology, Kovai Medical Center and Hospitals, Coimbatore, Tamil Nadu, India
| | - Saugata Sen
- Department of Radiology and Imaging Sciences, Tata Medical Centre, Kolkata, West Bengal, India
| | - Ekta Dhamija
- Department of Radiodiagnosis, IRCH, AIIMS, New Delhi, India
| | - Meenakshi Thakur
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Pathology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Supriya Chopra
- Department of Radiation Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Aditya Pavan Kumar Kanteti
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jaya Ghosh
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nilesh Sable
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Akshay Baheti
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sonal Chauhan
- Department of Radiology, H. N. Reliance Hospital, Mumbai, Maharashtra, India
| | - Kunal Gala
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Suyash Kulkarni
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Li J, Li Y, Wang H, Shen L, Wang Q, Shao S, Shen Y, Xu H, Liu H, Cai R, Feng W. Neoadjuvant chemotherapy with weekly cisplatin and paclitaxel followed by chemoradiation for locally advanced cervical cancer. BMC Cancer 2023; 23:51. [PMID: 36641433 PMCID: PMC9840535 DOI: 10.1186/s12885-023-10517-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Currently, the standard treatment for locally advanced cervical cancer is concurrent chemoradiation (CCRT). Forty percent of patients present with disease recurrence. This study aims to investigate the feasibility, safety and efficacy of neoadjuvant chemotherapy (NACT) with weekly cisplatin and paclitaxel (TP) followed by CCRT. METHODS We are conducting a phase III trial comparing the efficacy and side effects of patients with cervical cancer (FIGO 2018 stage IIB to IVA) who were assigned to four cycles of NACT with cisplatin (40 mg/m2) and paclitaxel (60 mg/m2) weekly followed by CCRT or CCRT alone. In this report, we studied the medium-term effect of 50 patients enrolled in the NACT + CCRT arm. The primary endpoints were the response rate post-NACT and 12 weeks post-CCRT evaluated by MR/CT based on RECIST v 1.1. The secondary endpoints were 3-year OS (overall survival) and PFS (progression-free survival) measured by the Kaplan-Meier method. RESULTS Among 50 patients enrolled in the NACT + CCRT arm, the complete and partial response rates were 10.4% and 68.8%, post-NACT. Twelve weeks after treatment completion, the complete response rate was 72.0%, whereas the total response rate (complete and partial response) was 90.0%. After a median follow-up of 28 months, the 3-year OS rate was 83.9%, and the 3-year PFS rate was 73.6%. NACT response was related to superior PFS and OS compared with NACT nonresponse (P < 0.01). Late AEs were exiguous, while early AEs mainly included myelosuppression and gastrointestinal AEs. CONCLUSIONS This study showed a good response rate achieved by dose-dense weekly cisplatin and paclitaxel followed by standard CCRT. The treatment regimen is feasible, as evidenced by the acceptable toxicity of NACT and by the high compliance with radiotherapy. TRIAL REGISTRATION Protocol version number and date. Chinese clinical trial registry, ChiCTR1900025327; http://www.chictr.org.cn . Registered 24 August 2019. Retrospectively registered, medresman.org.cn/ChiCTR1900025326. The date recruitment began 01-01-2019.
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Affiliation(s)
- Jing Li
- grid.412277.50000 0004 1760 6738Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Ya Li
- grid.412277.50000 0004 1760 6738Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Huafeng Wang
- grid.412277.50000 0004 1760 6738Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Lifei Shen
- grid.412277.50000 0004 1760 6738Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Qun Wang
- grid.412277.50000 0004 1760 6738Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Siqi Shao
- grid.412277.50000 0004 1760 6738Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Yuhong Shen
- grid.412277.50000 0004 1760 6738Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Haoping Xu
- grid.412277.50000 0004 1760 6738Department of Radiotherapy, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Hua Liu
- grid.412277.50000 0004 1760 6738Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Rong Cai
- grid.412277.50000 0004 1760 6738Department of Radiotherapy, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Weiwei Feng
- grid.412277.50000 0004 1760 6738Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025 People’s Republic of China
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Duenas-Gonzalez A. Combinational therapies for the treatment of advanced cervical cancer. Expert Opin Pharmacother 2023; 24:73-81. [PMID: 35653267 DOI: 10.1080/14656566.2022.2084689] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION From a therapeutic standpoint, invasive cervical cancer can be designated as early, locally advanced, and advanced stages. Systemic treatment remains the primary therapeutical modality for advanced cervical cancer patients who are not candidates for local curative treatments (surgery and radiation). AREAS COVERED In this review, the author discusses recent clinical studies published in PubMed on the treatment of advanced cervical carcinoma. The author also provides his expert perspectives on the current state of play. EXPERT OPINION Survival outcomes for advanced cervical cancer patients have been steadily improving since 1981, when single-agent cisplatin was adopted as the standard of care. In 2014, bevacizumab increased median overall survival (MOS) to 17 months when combined with standard chemotherapy (platinum-paclitaxel). In 2021, the checkpoint inhibitor (CPI) pembrolizumab, when used in the first line added to platinum-paclitaxel-bevacizumab, increased mOS to 24 months. Two other CPIs are in phase III trials as first-line treatments. As for second-line therapy, cemiplimab has shown increased survival compared to single-agent chemotherapy, and a phase III trial with tisotumab vedotin is currently ongoing. Nevertheless, there is still an unmet need for new more effective treatments and significant efforts are needed in the discovery of drugs for advanced cervical cancer beyond the current 'me-too' drugs.
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Affiliation(s)
- Alfonso Duenas-Gonzalez
- Departamento de Medicina Genómica y Toxicologia Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autonoma de Mexico/Instituto Nacional de Cancerologia, Mexico City, Mexico
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Gao XS, Boere IA, van Beekhuizen HJ, Franckena M, Nout R, Kruip MJHA, Kulawska MD, van Doorn HC. Acute and long-term toxicity in patients undergoing induction chemotherapy followed by thermoradiotherapy for advanced cervical cancer. Int J Hyperthermia 2022; 39:1440-1448. [DOI: 10.1080/02656736.2022.2146213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- X. S. Gao
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - I. A. Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - H. J. van Beekhuizen
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - M. Franckena
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - R. Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - M. J. H. A. Kruip
- Department of Haematology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - M. D. Kulawska
- Department of Radiology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - H. C. van Doorn
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
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Feng J, Tang D, Wang J, Zhou Q, Peng J, Lou H, Sun Y, Cai Y, Chen H, Yang J, Liu P, Wang L, Zou J. SHR-1701, a Bifunctional Fusion Protein Targeting PD-L1 and TGFβ, for Recurrent or Metastatic Cervical Cancer: A Clinical Expansion Cohort of a Phase I Study. Clin Cancer Res 2022; 28:5297-5305. [PMID: 35653122 DOI: 10.1158/1078-0432.ccr-22-0346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/20/2022] [Accepted: 05/27/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Patients with recurrent or metastatic cervical cancer have limited treatment options after platinum-containing treatment. We initiated a phase I study to assess SHR-1701, a novel bifunctional fusion protein composed of a mAb against programmed death ligand 1 (PD-L1) fused with the extracellular domain of TGFβ receptor II, in solid tumors (NCT03774979). Here, results from the cervical cancer cohort are presented. PATIENTS AND METHODS Patients with recurrent or metastatic cervical cancer who progressed during or after platinum-based therapy were enrolled to receive SHR-1701 at 30 mg/kg every 3 weeks. Primary endpoint was objective response rate (ORR) per RECIST v1.1. RESULTS In total, 32 patients were recruited. ORR was 15.6% [95% confidence interval (CI), 5.3-32.8], and disease control rate was 50.0% (95% CI, 31.9-68.1). Responses were still ongoing in 80.0% of the responders; 6-month duration of response rate was 80.0% (95% CI, 20.4-96.9). Median progression-free survival (PFS) was 2.7 months (95% CI, 1.4-4.1). Of note, as assessed by immune-modified RECIST, median PFS was 4.1 months (95% CI, 1.6-4.3). Overall survival rate at 12 months was 54.6% (95% CI, 31.8-72.7). Treatment-related adverse events of grade 3 or 4 were reported in 11 (34.4%) patients. No treatment-related deaths occurred. No difference in ORR was found between patients with PD-L1 combined positive score ≥1 or <1; patients with high phosphorylated SMAD2 level in immune cells or tumor cells had numerically higher ORR. CONCLUSIONS SHR-1701 exhibits encouraging antitumor activity and controllable safety in patients with recurrent or metastatic cervical cancer after platinum-based regimens, and therefore might provide another treatment option for this population. See related commentary by Miller and Friedman, p. 5238.
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Affiliation(s)
- Jifeng Feng
- Department of Oncology, Jiangsu Cancer Hospital, Nanjing, P.R. China
| | - Dihong Tang
- Gynecologic Oncology, Hunan Cancer Hospital, Changsha, P.R. China
| | - Jing Wang
- Gynecologic Oncology, Hunan Cancer Hospital, Changsha, P.R. China
| | - Qi Zhou
- Department of Gynecologic Oncology, Chongqing University Cancer Hospital, Chongqing, P.R. China
| | - Jin Peng
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, P.R. China
| | - Hanmei Lou
- Gynecological Surgery, Zhejiang Cancer Hospital, Hangzhou, P.R. China
| | - Yuping Sun
- Medical Oncology, Jinan Central Hospital, Jinan, P.R. China
| | - Yunlang Cai
- Department of Gynecology and Obstetrics, Zhongda Hospital Southeast University, Nanjing, P.R. China
| | - Hongmin Chen
- Gynecology, Henan Cancer Hospital, Zhengzhou, P.R. China
| | - Junqin Yang
- Clinical Research and Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, P.R. China
| | - Pan Liu
- Clinical Research and Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, P.R. China
| | - Linna Wang
- Clinical Research and Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, P.R. China
| | - Jianjun Zou
- Clinical Research and Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, P.R. China
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Maiorano BA, Maiorano MFP, Ciardiello D, Maglione A, Orditura M, Lorusso D, Maiello E. Beyond Platinum, ICIs in Metastatic Cervical Cancer: A Systematic Review. Cancers (Basel) 2022; 14:cancers14235955. [PMID: 36497437 PMCID: PMC9737392 DOI: 10.3390/cancers14235955] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cervical cancer (CC) constitutes the fourth most common tumor among the female population. Therapeutic approaches to advanced CC are limited, with dismal results in terms of survival, mainly after progression to platinum-based regimens. Immune checkpoint inhibitors (ICIs) are remodeling the therapeutic scenario of many solid tumors. The role of ICIs in CC should be addressed. Therefore, we systematically reviewed the latest clinical trials employing ICIs in advanced CC to assess which ICIs have been employed and how ICIs might meet the need for new therapeutic options in terms of efficacy and safety. METHODS The review was conducted following the PRISMA guidelines. The following efficacy outcomes were specifically collected: overall response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS); for safety: type, number, and grade of adverse events (AEs). RESULTS A total of 17 studies were analyzed. Anti-PD1 (pembrolizumab, nivolumab, cemiplimab, balstilimab, and tislelizumab), anti-PD-L1 (atezolizumab), and anti-CTLA-4 (ipilimumab, zalifrelimab) agents were employed both as single agents or combinations. Overall ORR ranged from 0% to 65.9%. ORR ranged from 5.9% to 69.6% in PD-L1-positive patients and from 0% to 50% in PD-L1-negative patients. DCR was 30.6-94.1%. mPFS ranged from 2 to 10.4 months. mOS ranged from 8 months to not reached. PD-L1 status did not impact survival. A total of 33.9% to 100% of patients experienced AEs. CONCLUSION Immunotherapy represents an appealing strategy for patients with advanced CC, as 2 out of 3 patients seem to respond to ICIs. PD-L1 status might be an indicator of response without impacting survival.
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Affiliation(s)
- Brigida Anna Maiorano
- Oncology Unit, Fondazione Casa Sollievo della Sofferenza IRCCS, 71013 San Giovanni Rotondo, Italy
- Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Mauro Francesco Pio Maiorano
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70121 Bari, Italy
- Correspondence:
| | - Davide Ciardiello
- Oncology Unit, Fondazione Casa Sollievo della Sofferenza IRCCS, 71013 San Giovanni Rotondo, Italy
- Medical Oncology, Department of Precision Medicine, Luigi Vanvitelli University of Campania, 80131 Naples, Italy
| | - Annamaria Maglione
- Obstetrics and Gynecology Department, Fondazione Casa Sollievo della Sofferenza IRCCS, 71013 San Giovanni Rotondo, Italy
| | - Michele Orditura
- Medical Oncology, Department of Precision Medicine, Luigi Vanvitelli University of Campania, 80131 Naples, Italy
| | - Domenica Lorusso
- Department of Women and Child Health, Division of Gynaecologic Oncology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
- Scientific Directorate, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Evaristo Maiello
- Oncology Unit, Fondazione Casa Sollievo della Sofferenza IRCCS, 71013 San Giovanni Rotondo, Italy
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Takamizawa S, Yazaki S, Kojima Y, Yoshida H, Kitadai R, Nishikawa T, Shimoi T, Sudo K, Okuma HS, Tanioka M, Noguchi E, Uno M, Ishikawa M, Kato T, Fujiwara Y, Yonemori K. High mesothelin expression is correlated with non-squamous cell histology and poor survival in cervical cancer: a retrospective study. BMC Cancer 2022; 22:1215. [PMID: 36434635 PMCID: PMC9701073 DOI: 10.1186/s12885-022-10277-0] [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: 10/18/2021] [Accepted: 11/02/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Mesothelin (MSLN) is a cell-surface glycoprotein found in various solid tumours. Cancer therapies targeting MSLN have been developed in recent years; however, the available information on MSLN expression in cervical cancer is limited. This study aimed to evaluate MSLN expression in various histological types of cervical cancer and examine its relationship with prognosis. METHODS This retrospective study included patients with cervical cancer who underwent primary surgery between January 2000 and December 2020 at our institution. MSLN expression was evaluated by immunohistochemistry using clone SP74 and defined as positive if MSLN was expressed at any intensity. High MSLN expression was defined as an intensity of ≥ 2 + in ≥ 30% of tumour cells. The association between MSLN expression and clinicopathological factors was evaluated. RESULTS Overall, 123 patients were identified, and 140 tumour samples, including 17 paired primary and metastatic samples, were evaluated. Concerning histological type, 67 patients had squamous cell carcinoma (SCC), whereas 56 had non-SCC. MSLN expression was observed in 98.4% (121/123) of primary tumours. High MSLN expression was observed in 63.4% of samples (78/123), but it differed between the histological types (49.2% for SCC vs. 80.4% for non-SCC, p < 0.001). There was a significant correlation between MSLN expression in primary and metastatic lesions (Rs = 0.557, p = 0.015). In patients with common histological types, overall survival (OS) was shorter in the high MSLN expression group than in the low MSLN expression group (hazard ratio, 3.53; 95% confidence interval, 1.16-15.3, p = 0.03). CONCLUSIONS MSLN was highly expressed in patients with cervical cancer, especially in those with non-SCC. High MSLN expression in the primary lesion was significantly associated with poor OS, and its expression was maintained in metastatic lesions. Our findings indicate that MSLN may be an attractive therapeutic target for cervical cancer. TRIAL REGISTRATION Retrospectively registered. 2014-393. 1 June 2015.
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Affiliation(s)
- Shigemasa Takamizawa
- grid.272242.30000 0001 2168 5385Department of Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045 Japan
| | - Shu Yazaki
- grid.272242.30000 0001 2168 5385Department of Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045 Japan
| | - Yuki Kojima
- grid.272242.30000 0001 2168 5385Department of Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045 Japan
| | - Hiroshi Yoshida
- grid.272242.30000 0001 2168 5385Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Rui Kitadai
- grid.272242.30000 0001 2168 5385Department of Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045 Japan
| | - Tadaaki Nishikawa
- grid.272242.30000 0001 2168 5385Department of Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045 Japan
| | - Tatsunori Shimoi
- grid.272242.30000 0001 2168 5385Department of Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045 Japan
| | - Kazuki Sudo
- grid.272242.30000 0001 2168 5385Department of Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045 Japan
| | - Hitomi Sumiyoshi Okuma
- grid.272242.30000 0001 2168 5385Department of Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045 Japan
| | - Maki Tanioka
- grid.272242.30000 0001 2168 5385Department of Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045 Japan
| | - Emi Noguchi
- grid.272242.30000 0001 2168 5385Department of Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045 Japan
| | - Masaya Uno
- grid.272242.30000 0001 2168 5385Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Mitsuya Ishikawa
- grid.272242.30000 0001 2168 5385Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoyasu Kato
- grid.272242.30000 0001 2168 5385Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhiro Fujiwara
- grid.272242.30000 0001 2168 5385Department of Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045 Japan
| | - Kan Yonemori
- grid.272242.30000 0001 2168 5385Department of Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045 Japan
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Nguyen J, Epling D, Dolphin N, Paccaly A, Conrado D, Davis JD, Al‐Huniti N. Population pharmacokinetics modeling and exposure-response analyses of cemiplimab in patients with recurrent or metastatic cervical cancer. CPT Pharmacometrics Syst Pharmacol 2022; 11:1458-1471. [PMID: 36251220 PMCID: PMC9662200 DOI: 10.1002/psp4.12855] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
A population pharmacokinetic (PopPK) model was previously developed for cemiplimab in patients with solid tumors, including advanced cutaneous squamous cell carcinoma (CSCC). Here, we update the existing PopPK model and characterize exposure-response relationships using efficacy and safety data obtained in patients with recurrent or metastatic cervical cancer (R/M CC). To improve model stability and robustness of the existing PopPK model in 1062 patients, the random-effect error model was revised, and structural covariates were removed from the base model to be tested in the covariate analysis. The updated model was used for external validation of cemiplimab pharmacokinetics (PK) in patients with R/M CC on cemiplimab monotherapy (350 mg every 3 weeks intravenously) from a phase III study (NCT03257267). Exposure-response relationships for cemiplimab efficacy (overall survival [OS], progression-free survival [PFS], duration of response [DOR], objective response rate [ORR]), and safety (immune-related adverse events [irAEs]) were analyzed in 295 patients with R/M CC from the aforementioned study. The updated PopPK model showed improved stability with 94.8% successful bootstrap runs vs. 47.6% in the prior model. Cemiplimab exposure was similar across tumor types, including basal cell carcinoma, CSCC, and non-small cell lung cancer. External validation showed the updated model adequately described cemiplimab PK in patients with R/M CC. In exposure-response efficacy analyses, Cox proportional hazard modeling (CPHM) showed no trend between exposure and OS, Kaplan-Meier plots showed no trend between exposure and PFS or DOR, and logistic regression analyses conducted on ORR showed no exposure-response relationship. In exposure-response safety analyses, CPHM showed no trend between exposure and irAEs.
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Affiliation(s)
| | | | | | - Anne Paccaly
- Regeneron Pharmaceuticals, Inc.TarrytownNew YorkUSA
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Liu C, Feng H, Song L, Li S, Wu Y, Yang L. Synergistic effects of thalidomide and cisplatin are mediated via the PI3K/AKT and JAK1/STAT3 signaling pathways in cervical cancer. Oncol Rep 2022; 48:169. [PMID: 35920185 PMCID: PMC9478987 DOI: 10.3892/or.2022.8384] [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] [Received: 05/25/2022] [Accepted: 07/20/2022] [Indexed: 11/05/2022] Open
Abstract
Thalidomide (THD) has been found to synergize with cisplatin (DDP) in certain types of cancers; however, their combined use in the treatment of cervical cancer has not been reported to date, at least to the best of our knowledge. Thus, the present study aimed to explore the synergistic effects of THD and DDP and determine their regulatory effects on the phosphoinositide 3‑kinase (PI3K)/protein kinase B (AKT) and Janus kinase 1 (JAK1)/signal transducer and activator of transcription 3 (STAT3) pathways in cervical cancer. For this purpose, 0‑160 µM THD and 0‑64 µM DDP monotherapy or in combination were used to treat the HeLa and SiHa cervical cancer cell lines. This was followed by the calculation of the combination index (CI) and 160 µM THD and 16 µM DDP were then used to treat the cells. Relative cell viability and apoptosis, as well as the mRNA and protein levels of PI3K, AKT, JAK1 and STAT3 were evaluated. The results revealed that THD and DDP monotherapy suppressed the viability of the HeLa and SiHa cells in a concentration‑dependent manner. Moreover, THD and DDP treatment exerted a more prominent suppressive effect on the relative viability of HeLa and SiHa cells compared with DDP monotherapy at several concentration settings; further CI calculation revealed that the optimal synergistic concentrations were 160 µM for THD and 16 µM for DDP. Subsequently, combined treatment with THD and DDP suppressed relative cell viability, whereas it promoted cell apoptosis compared with THD or DPP monotherapy; it also inhibited the PI3K/AKT and JAK1/STAT3 signaling pathways compared with DPP or THD monotherapy in both HeLa and SiHa cells. On the whole, the present study demonstrated that THD synergizes with DDP to exert suppressive effects on cervical cancer cell lines. This synergistic action also inactivated the PI3K/AKT and JAK1/STAT3 pathways. Thus, these findings suggest that the combined use of THD and DPP may have potential for use in the treatment of cervical cancer.
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Affiliation(s)
- Cairu Liu
- Department of Gynecology and Obstetrics, HanDan Central Hospital, Handan, Hebei 056008, P.R. China
| | - Haiqin Feng
- Department of Gynecology and Obstetrics, HanDan Central Hospital, Handan, Hebei 056008, P.R. China
| | - Lihong Song
- Department of Gynecology and Obstetrics, HanDan Central Hospital, Handan, Hebei 056008, P.R. China
| | - Shuirui Li
- Department of Gynecology and Obstetrics, HanDan Central Hospital, Handan, Hebei 056008, P.R. China
| | - Yiping Wu
- Department of Gynecology and Obstetrics, HanDan Central Hospital, Handan, Hebei 056008, P.R. China
| | - Liping Yang
- Department of Gynecology and Obstetrics, HanDan Central Hospital, Handan, Hebei 056008, P.R. China
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Yazaki S, Kojima Y, Yoshida H, Takamizawa S, Kitadai R, Nishikawa T, Shimoi T, Sudo K, Saito A, Okuma HS, Tanioka M, Noguchi E, Uno M, Ishikawa M, Kato T, Fujiwara Y, Ohe Y, Yonemori K. High expression of folate receptor alpha is associated with poor prognosis in patients with cervical cancer. J Gynecol Oncol 2022; 33:e82. [PMID: 36245230 PMCID: PMC9634091 DOI: 10.3802/jgo.2022.33.e82] [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: 06/02/2021] [Revised: 08/03/2021] [Accepted: 08/11/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Folate receptor α (FRα) is a membrane protein expressed in various solid tumors but has limited expression in normal cells. Therefore, FRα is an attractive target for cancer treatment. This study aimed to investigate the relationship between FRα expression and the clinicopathological characteristics and survivals of cervical cancer. METHODS This retrospective study included patients with cervical cancer who underwent primary surgery between 2000 and 2020 at our institution. Immunohistochemical staining of FRα was performed using an anti-folate-binding protein/FBP antibody. FRα-positive staining was defined as ≥5% of tumor staining and FRα-high as ≥50% tumor staining with ≥2+ intensity. The association between FRα expression and survival was assessed using multivariate Cox regression analysis, adjusting for established prognostic factors. RESULTS Overall, 123 patients were identified, and 140 tumor samples, including 17 paired primary and metastatic samples, were evaluated. As histological types, 67 patients had squamous cell carcinoma (SCC), and 56 patients had non-SCC. All primary tumors were FRα-positive. High FRα expression was observed in 25% of the cases and differed according to histology (SCC vs. non-SCC, 14.9% vs. 37.5%, p=0.004). FRα expression was significantly higher in metastatic tumors than in primary (170 [IQR, 140-205] vs. 125 [IQR, 110-150], p=0.0006). High FRα expression was significantly associated with worse overall survival (hazard ratio, 6.73; 95% confidence interval, 2.21-20.53; p=0.001). CONCLUSION In cervical cancer, FRα expression was elevated in metastatic tumors and high expression was associated with a worse prognosis. Our study supports the development of FRα-targeted therapy for advanced cervical cancer.
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Affiliation(s)
- Shu Yazaki
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.,Department of Cancer Medicine, Jikei University Graduate School of Medicine, Tokyo, Japan
| | - Yuki Kojima
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Rui Kitadai
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tadaaki Nishikawa
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tatsunori Shimoi
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuki Sudo
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ayumi Saito
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Maki Tanioka
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Emi Noguchi
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masaya Uno
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Mitsuya Ishikawa
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoyasu Kato
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhiro Fujiwara
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuichiro Ohe
- Department of Cancer Medicine, Jikei University Graduate School of Medicine, Tokyo, Japan
| | - Kan Yonemori
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
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Abas BI, Demirbolat GM, Cevik O. Wharton jelly-derived mesenchymal stem cell exosomes induce apoptosis and suppress EMT signaling in cervical cancer cells as an effective drug carrier system of paclitaxel. PLoS One 2022; 17:e0274607. [PMID: 36108271 PMCID: PMC9477505 DOI: 10.1371/journal.pone.0274607] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
Mesenchymal stem cells can be obtained and multiplied from various sources and have a very high capacity to release exosomes. Exosomes are nano-sized extracellular vesicles containing biological signaling molecules. This study aimed to determine the effect of MSC-derived exosomes as a drug delivery system for paclitaxel in cervical cancer cells. In this study, human MSC were isolated from wharton jelly of umbilical cord tissue (WJ-MSC), and cells were characterized by CD44, CD90, CD105, and CD34 staining. Exosomes were released in WJ-MSC cells with serum-starved conditions for 48 hours, and particle sizes and structures were examined with zeta-sizer and TEM. In addition, exosomes CD9, CD63, and CD81 markers were checked by western blot. Paclitaxel was loaded into exosomes (Exo-PAC) by electroporation and then incubated with Hela cervical cancer cells for 24 hours. TGF-β, SMAD, Snail, Slug, β-catenin, Notch, Caspase-3, Caspase-9, Bax, Bcl-2 protein and gene expression levels were analyzed in Hela cells. As a result, low concentration Exo-PAC induced apoptosis, and suppressed epithelial-mesenchymal transition proteins in Hela cells. In this study, it has been demonstrated that WJ-MSCs can be used as drug delivery systems for cervical cancer if exosomes are produced scalably in the future.
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Affiliation(s)
- Burcin Irem Abas
- Department of Medicinal Biochemistry, School of Medicine, Aydin Adnan Menderes University, Aydin, Turkey
| | - Gulen Melike Demirbolat
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Acibadem University, Istanbul, Turkey
| | - Ozge Cevik
- Department of Medicinal Biochemistry, School of Medicine, Aydin Adnan Menderes University, Aydin, Turkey
- * E-mail:
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Gennigens C, Jerusalem G, Lapaille L, De Cuypere M, Streel S, Kridelka F, Ray-Coquard I. Recurrent or primary metastatic cervical cancer: current and future treatments. ESMO Open 2022; 7:100579. [PMID: 36108558 PMCID: PMC9588874 DOI: 10.1016/j.esmoop.2022.100579] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/19/2022] [Accepted: 08/12/2022] [Indexed: 11/12/2022] Open
Abstract
Despite screening programs for early detection and the approval of human papillomavirus vaccines, around 6% of women with cervical cancer (CC) are discovered with primary metastatic disease. Moreover, one-third of the patients receiving chemoradiation followed by brachytherapy for locally advanced disease will have a recurrence. At the end, the vast majority of recurrent or metastatic CC not amenable to locoregional treatments are considered incurable disease with very poor prognosis. Historically, cisplatin monotherapy, then a combination of cisplatin and paclitaxel were considered the standard of care. Ten years ago, the addition of bevacizumab to chemotherapy demonstrated favorable data in terms of response rate and overall survival. Even with this improvement, novel therapies are needed for the treatment of recurrent CC in first as well as later lines. In the last decades, a better understanding of the interactions between human papillomavirus infection and the host immune system response has focused interest on the use of immunotherapeutic drugs in CC patients. Indeed, immune checkpoint inhibitors (pembrolizumab, cemiplimab, and others) have recently emerged as novel therapeutic pillars that could provide durable responses with impact on overall survival in patients in the primary (in addition to chemotherapy) or recurrent (monotherapy) settings. Tisotumab vedotin, an antibody–drug conjugate targeting the tissue factor, is another emerging drug. Several trials in monotherapy or in combination with immunotherapy, chemotherapy, or bevacizumab showed very promising results. There is a high need for more potent biomarkers to better accurately determine which patients would receive the greatest benefit from all these aforementioned drugs, but also to identify patients with specific molecular characteristics that could benefit from other targeted therapies. The Cancer Genome Atlas Research Network identified several genes significantly mutated, potentially targetable. These molecular data have highlighted the molecular heterogeneity of CC. The majority of recurrent or metastatic CCs are considered incurable disease. Combination of chemotherapy with bevacizumab and pembrolizumab (PD-L1 CPS ≥1) is the new standard of care in first line. Tisotumab vedotin, an antibody–drug conjugate targeting the tissue factor, is another emerging drug. Need for more potent biomarkers to accurately determine which patients would receive the greatest benefit from these drugs.
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Affiliation(s)
- C Gennigens
- Department of Medical Oncology, CHU Liège, Liège, Belgium.
| | - G Jerusalem
- Department of Medical Oncology, CHU Liège, Liège, Belgium; Faculty of Medicine, University of Liège, Liège, Belgium
| | - L Lapaille
- Department of Medical Oncology, CHU Liège, Liège, Belgium
| | - M De Cuypere
- Department of Obstetrics and Gynaecology, CHU Liège, Liège, Belgium
| | - S Streel
- Department of Medical Oncology, CHU Liège, Liège, Belgium
| | - F Kridelka
- Faculty of Medicine, University of Liège, Liège, Belgium; Department of Obstetrics and Gynaecology, CHU Liège, Liège, Belgium
| | - I Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
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Yasunaga M, Yahata H, Okugawa K, Shimokawa M, Maeda Y, Hori E, Kodama K, Yagi H, Ohgami T, Onoyama I, Asanoma K, Kato K. Prognostic impact of adding bevacizumab to carboplatin and paclitaxel for recurrent, persistent, or metastatic cervical cancer. Taiwan J Obstet Gynecol 2022; 61:818-822. [PMID: 36088050 DOI: 10.1016/j.tjog.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Recent randomized phase III trial has shown significant benefit in overall survival (OS) for patients with advanced cervical cancer by adding bevacizumab to conventional chemotherapy. The aim of this study was to evaluate the prognostic impact for Japanese recurrent, persistent, or metastatic cervical cancer patients where bevacizumab was added to paclitaxel plus carboplatin. MATERIALS AND METHODS A retrospective analysis was performed on 90 patients with recurrent, persistent, or metastatic cervical cancer mainly treated by paclitaxel plus carboplatin between 2005 and 2019 at our hospital. Data for the following clinicopathological variables were analyzed: (1) bevacizumab use; (2) histology; (3) disease presentation; (4) performance status; (5) prior chemotherapy containing platinum agent; (6) pelvic disease; (7) prior pelvic radiotherapy; (8) location of target lesions. Survival analysis was performed using Kaplan-Meier curves, log-rank tests, Wilcoxon tests, and Cox proportional hazards models combined with propensity score matching. RESULTS Adding bevacizumab to paclitaxel plus carboplatin showed significantly increased complete response to compared with that of non-users. In a Cox regression hazard model, bevacizumab use tended to show better OS though without statistically significance. After propensity score matching, adding bevacizumab to paclitaxel plus carboplatin showed a significant better OS by univariate analysis using Wilcoxon test, not by log-rank test. CONCLUSION Adding bevacizumab to paclitaxel plus carboplatin showed a limited prognostic impact for recurrent, persistent or advanced cervical cancer patients in the real world. Further effective second-line treatments are needed to prolong OS of patients with recurrent, persistent or advanced cervical cancer.
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Affiliation(s)
- Masafumi Yasunaga
- Department of Gynecology and Obstetrics, Kyushu University Hospital, Fukuoka, Japan.
| | - Hideaki Yahata
- Department of Gynecology and Obstetrics, Kyushu University Hospital, Fukuoka, Japan
| | - Kaoru Okugawa
- Department of Gynecology and Obstetrics, Kyushu University Hospital, Fukuoka, Japan
| | - Mototsugu Shimokawa
- Department of Biostatistics, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Yumiko Maeda
- Department of Gynecology and Obstetrics, Kyushu University Hospital, Fukuoka, Japan
| | - Emiko Hori
- Department of Gynecology and Obstetrics, Kyushu University Hospital, Fukuoka, Japan
| | - Keisuke Kodama
- Department of Gynecology and Obstetrics, Kyushu University Hospital, Fukuoka, Japan
| | - Hiroshi Yagi
- Department of Gynecology and Obstetrics, Kyushu University Hospital, Fukuoka, Japan
| | - Tatsuhiro Ohgami
- Department of Gynecology and Obstetrics, Kyushu University Hospital, Fukuoka, Japan
| | - Ichiro Onoyama
- Department of Gynecology and Obstetrics, Kyushu University Hospital, Fukuoka, Japan
| | - Kazuo Asanoma
- Department of Gynecology and Obstetrics, Kyushu University Hospital, Fukuoka, Japan
| | - Kiyoko Kato
- Department of Gynecology and Obstetrics, Kyushu University Hospital, Fukuoka, Japan
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Inhibition of the PIN1-NRF2/GPX4 axis imparts sensitivity to cisplatin in cervical cancer cells. Acta Biochim Biophys Sin (Shanghai) 2022; 54:1325-1335. [PMID: 35983979 PMCID: PMC9827814 DOI: 10.3724/abbs.2022109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The incidence of cervical cancer (CC) ranks the fourth in female malignant tumors globally. Chemoresistance is one of the main causes of treatment failure in advanced recurrent CC. Prolyl isomerase 1 (PIN1) is overexpressed in a variety of tumors, and is closely associated with the malignant potential of tumor cells, such as transformation, proliferation, invasion and metastasis. In the present study, we demonstrate that cell death induced by suppression of PIN1 could be inhibited by ferrostatin-1 (Fer-1) and ferroptosis biomarkers including lactate dehydrogenase (LDH) release, lipid peroxidation and malondialdehyde (MDA) are upregulated by downregulating PIN1. We then discover that abrogation of PIN1 greatly decreases the level of glutathione peroxidase 4 (GPX4) and the level of PIN1 is positively correlated with the level of GPX4. Furthermore, the knockdown of PIN1 promotes ferroptosis induced by RSL3. The mechanism involves PIN1 silencing which downregulates GPX4 by decreasing the level of nuclear factor E2-related factor 2 (NRF2). Furthermore, overexpression of NRF2 inhibits RSL3-mediated ferroptosis of CC cells when PIN1 is silenced. In addition, our results indicate that cisplatin (DDP) induces ferroptosis, which is restrained by overexpression of PIN1. The PIN1 inhibitor, KPT-6566, promotes the cytotoxic effect of DDP. The present study reveals that PIN1 affects ferroptosis and sensitivity to DDP in CC cells via the NRF2/GPX4 axis, thereby identifying PIN1 as a potential therapeutic target for CC.
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Is There a Place for Adjuvant Chemotherapy in the Treatment of Locally Advanced Cervical Cancer? Curr Oncol 2022; 29:5223-5237. [PMID: 35892984 PMCID: PMC9332289 DOI: 10.3390/curroncol29080415] [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: 06/27/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Findings on the efficacy of adjuvant chemotherapy (ACT) of locally advanced cervical cancer (LACC) after the concurrent chemoradiation (CCRT) therapy were inconsistent, and the OUTBACK trial was expected to shed some light regarding the topic. Its results on ACT in LACC were negative, with the conclusion of not to use it. The objective of this review was to present the inconsistencies of previous studies, along with the OUTBACK trial in more detail, and to rethink whether its results provide an unambiguous and definite answer to the optimal position of ACT in the treatment of LACC. To critically appraise the OUTBACK trial and understand the consequences of its results, we used only randomized controlled studies (RCTs) on ACT in LACC that have been included in high-quality systematic reviews and meta-analyses. We calculated the pooled prediction intervals using a random effects meta-analysis of all published randomized studies including the OUTBACK trial. After combining the OUTBACK trial with the results of four previous randomized trials, the pooled hazard ratio for overall survival benefit of CCRT + ACT was 0.95 (95% CI 0.75; 1.20). The pooled hazard ratio of the four previous trials was 1.00 (95% CI 0.69; 1.44). The OUTBACK trial improved the precision of the pooled estimate, but the clinical heterogeneity and the consequent prediction intervals are still very wide, and with 95% reliability, we can expect that if the new study, using a similar approach to the ACT, on a randomly selected patient population from the presented five trials is conducted, its hazard ratio for overall survival after ACT would be between 0.47 and 1.93. In conclusion, there is an absolute need for further research in order to optimally define the position of ACT in the treatment of LACC.
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