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Mambetsariev I, Fricke J, Gruber SB, Tan T, Babikian R, Kim P, Vishnubhotla P, Chen J, Kulkarni P, Salgia R. Clinical Network Systems Biology: Traversing the Cancer Multiverse. J Clin Med 2023; 12:4535. [PMID: 37445570 DOI: 10.3390/jcm12134535] [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: 05/12/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
In recent decades, cancer biology and medicine have ushered in a new age of precision medicine through high-throughput approaches that led to the development of novel targeted therapies and immunotherapies for different cancers. The availability of multifaceted high-throughput omics data has revealed that cancer, beyond its genomic heterogeneity, is a complex system of microenvironments, sub-clonal tumor populations, and a variety of other cell types that impinge on the genetic and non-genetic mechanisms underlying the disease. Thus, a systems approach to cancer biology has become instrumental in identifying the key components of tumor initiation, progression, and the eventual emergence of drug resistance. Through the union of clinical medicine and basic sciences, there has been a revolution in the development and approval of cancer therapeutic drug options including tyrosine kinase inhibitors, antibody-drug conjugates, and immunotherapy. This 'Team Medicine' approach within the cancer systems biology framework can be further improved upon through the development of high-throughput clinical trial models that utilize machine learning models, rapid sample processing to grow patient tumor cell cultures, test multiple therapeutic options and assign appropriate therapy to individual patients quickly and efficiently. The integration of systems biology into the clinical network would allow for rapid advances in personalized medicine that are often hindered by a lack of drug development and drug testing.
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Affiliation(s)
- Isa Mambetsariev
- Department of Medical Oncology and Therapeutic Research, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Jeremy Fricke
- Department of Medical Oncology and Therapeutic Research, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Stephen B Gruber
- Department of Medical Oncology and Therapeutic Research, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Tingting Tan
- Department of Medical Oncology and Therapeutic Research, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Razmig Babikian
- Department of Medical Oncology and Therapeutic Research, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Pauline Kim
- Department of Pharmacy, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Priya Vishnubhotla
- Department of Medical Oncology and Therapeutic Research, City of Hope National Medical Center, Duarte, CA 91010, USA
- Department of Medical Oncology, City of Hope Atlanta, Newnan, GA 30265, USA
| | - Jianjun Chen
- Department of Systems Biology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Prakash Kulkarni
- Department of Medical Oncology and Therapeutic Research, City of Hope National Medical Center, Duarte, CA 91010, USA
- Department of Systems Biology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Ravi Salgia
- Department of Medical Oncology and Therapeutic Research, City of Hope National Medical Center, Duarte, CA 91010, USA
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Ashing KT, Jones V, Bedell F, Phillips T, Erhunmwunsee L. Calling Attention to the Role of Race-Driven Societal Determinants of Health on Aggressive Tumor Biology: A Focus on Black Americans. JCO Oncol Pract 2022; 18:15-22. [PMID: 34255546 PMCID: PMC8758120 DOI: 10.1200/op.21.00297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Blacks have the highest incidence and mortality from most cancers. The reasons for these disparities remain unclear. Blacks are exposed to adverse social determinants because of historic and contemporary racist polices; however, how these determinants affect the disparities that Blacks experience is understudied. As a result of discriminatory community policies, like redlining, Blacks have higher exposure to air pollution and neighborhood deprivation. Studies investigating how these factors affect tumor biology are emerging. We highlight the literature that connects racism-related community exposure to the tumor biology in breast, lung, prostate, and colorectal cancer. Further investigations that clarify the link between adverse social determinants that result from systemic racism and aggressive tumor biology are required if health equity is to be achieved. Without recognition that racism is a public health risk with carcinogenic impact, health care delivery and cancer care will never achieve excellence. In response, health systems ought to establish corrective actions to improve Black population health and bring medical justice to marginalized racialized groups.
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Affiliation(s)
- Kimlin T. Ashing
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA,African-Caribbean Cancer Consortium, Fox Chase Cancer Center, Philadelphia, PA,Kimlin T. Ashing, PhD, CCARE—Department of Population Sciences, City of Hope Comprehensive Cancer Center, 1500 E Duarte Rd, Duarte, CA 91010-3000; e-mail:
| | - Veronica Jones
- African-Caribbean Cancer Consortium, Fox Chase Cancer Center, Philadelphia, PA
| | - Fornati Bedell
- Division of Urology and Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Tanyanika Phillips
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Loretta Erhunmwunsee
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA,Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA
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Atta I. The extent of expression of thyroid transcription factor 1, cytokeratin 7, and anaplastic lymphoma kinase in lung adenocarcinoma. J Microsc Ultrastruct 2022; 10:10-14. [PMID: 35433257 PMCID: PMC9012410 DOI: 10.4103/jmau.jmau_42_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/18/2020] [Accepted: 10/29/2020] [Indexed: 11/17/2022] Open
Abstract
Background: New forms of genetic alteration were developed giving a new era of lung adenocarcinoma (AdC) with diverse clinical and pathological features. Aim and Objectives: The aim is to investigate the ALK-rearranged gene as one of these genetic alterations in AdC. The role of TTF-1 and CK7 is to exclude the metastases. Material and Methods: Paraffin-embedded 50 AdC specimens were cut into 4-mm thick sections and stained with the primary antibody, using an anti-TTF-1 antibody, (all at a 1:200 dilution, mouse monoclonal antibody; Dako, Denmark), anti-CK 7 antibody (DAKO, Carpentaria, CA), and the rabbit monoclonal anti- ALK antibody (D5F3) (Ventana, USA). Positive reactivity was considered as brown nuclear immunostaining for TTF-1 and cytoplasmic for CK 7and both cytoplasmic and nuclear for ALK. Results: The median age was 56±2, with male to female ratio 7:3. Forty-four cases revealed a mixed pattern (88%), with focal intraluminal mucin. Forty-one cases (82%) were positive for TTF-1, of these; weak (13; %), moderate (16; %) and strong (12; %). Regarding CK7; 48 cases (96%) were positive; weak (7 cases; 14.5; %), moderate (18 cases; 37.5%) and strong (23 case; 47.9 %) of the positive cases. Regarding D5F3; five cases (10%) were positive; weak (1 case; 20 %), moderate (2 cases; 40 %) and strong (2 cases; 40%) out of the positive cases. Four ALK-positive cases were male and ALK-positive patients ranged from 42-55 years with median 48. Conclusion: Despite the incidence of ALk-AdC is uncommon, it might be suspected in lesions of lower age group especially with mucinous foci.
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Noh KW, Buettner R, Klein S. Shifting Gears in Precision Oncology-Challenges and Opportunities of Integrative Data Analysis. Biomolecules 2021; 11:biom11091310. [PMID: 34572523 PMCID: PMC8465238 DOI: 10.3390/biom11091310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/26/2021] [Accepted: 09/01/2021] [Indexed: 02/07/2023] Open
Abstract
For decades, research relating to modification of host immunity towards antitumor response activation has been ongoing, with the breakthrough discovery of immune-checkpoint blockers. Several biomarkers with potential predictive value have been reported in recent studies for these novel therapies. However, with the plethora of therapeutic options existing for a given cancer entity, modern oncology is now being confronted with multifactorial interpretation to devise “the best therapy” for the individual patient. Into the bargain come the multiverse guidelines for established and emerging diagnostic biomarkers, as well as the complex interplay between cancer cells and tumor microenvironment, provoking immense challenges in the therapy decision-making process. Through this review, we present various molecular diagnostic modalities and techniques, such as genomics, immunohistochemistry and quantitative image analysis, which have the potential of becoming powerful tools in the development of an optimal treatment regime when analogized with patient characteristics. We will summarize the underlying complexities of these methods and shed light upon the necessary considerations and requirements for data integration. It is our hope to provide compelling evidence to emphasize on the need for inclusion of integrative data analysis in modern cancer therapy, and thereupon paving a path towards precision medicine and better patient outcomes.
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Affiliation(s)
- Ka-Won Noh
- Institute for Pathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (K.-W.N.); (R.B.)
| | - Reinhard Buettner
- Institute for Pathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (K.-W.N.); (R.B.)
| | - Sebastian Klein
- Gerhard-Domagk-Institute of Pathology, University Hospital Münster, 48149 Münster, Germany
- Correspondence: ; Tel.: +49-251-83-57670
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Erhunmwunsee L, Wing SE, Shen J, Hu H, Sosa E, Lopez LN, Raquel C, Sur M, Ibarra-Noriega P, Currey M, Lee J, Kim JY, Raz DJ, Amini A, Sampath S, Koczywas M, Massarelli E, West HL, Reckamp KL, Kittles RA, Salgia R, Seewaldt VL, Neuhausen SL, Gray SW. The Association between Polluted Neighborhoods and TP53-Mutated Non-Small Cell Lung Cancer. Cancer Epidemiol Biomarkers Prev 2021; 30:1498-1505. [PMID: 34088750 PMCID: PMC8338883 DOI: 10.1158/1055-9965.epi-20-1555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/13/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Poor patients often reside in neighborhoods of lower socioeconomic status (SES) with high levels of airborne pollutants. They also have higher mortality from non-small cell lung cancer (NSCLC) than those living in wealthier communities. We investigated whether living in polluted neighborhoods is associated with somatic mutations linked with lower survival rates, i.e., TP53 mutations. METHODS In a retrospective cohort of 478 patients with NSCLC treated at a comprehensive cancer center between 2015 and 2018, we used logistic regression to assess associations between individual demographic and clinical characteristics, including somatic TP53 mutation status and environmental risk factors of annual average particulate matter (PM2.5) levels, and neighborhood SES. RESULTS 277 patients (58%) had somatic TP53 mutations. Of those, 45% lived in neighborhoods with "moderate" Environmental Protection Agency-defined PM2.5 exposure, compared with 39% of patients without TP53 mutations. We found significant associations between living in neighborhoods with "moderate" versus "good" PM2.5 concentrations and minority population percentage [OR, 1.06; 95% confidence interval (CI), 1.04-1.08]. There was a significant association between presence of TP53 mutations and PM2.5 exposure (moderate versus good: OR, 1.66; 95% CI, 1.02-2.72) after adjusting for patient characteristics, other environmental factors, and neighborhood-level SES. CONCLUSIONS When controlling for individual- and neighborhood-level confounders, we find that the odds of having a TP53-mutated NSCLC are increased in areas with higher PM2.5 exposure. IMPACT The link between pollution and aggressive biology may contribute to the increased burden of adverse NSCLC outcomes in individuals living in lower SES neighborhoods.
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Affiliation(s)
- Loretta Erhunmwunsee
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California.
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Sam E Wing
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jenny Shen
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Hengrui Hu
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Ernesto Sosa
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Lisa N Lopez
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Catherine Raquel
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Melissa Sur
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Pilar Ibarra-Noriega
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Madeline Currey
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Janet Lee
- Vital Research, Los Angeles, California
| | - Jae Y Kim
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Dan J Raz
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Arya Amini
- Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Sagus Sampath
- Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Marianna Koczywas
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Erminia Massarelli
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Howard L West
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Karen L Reckamp
- Department of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Rick A Kittles
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Ravi Salgia
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Victoria L Seewaldt
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Susan L Neuhausen
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Stacy W Gray
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
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Rajurkar S, Mambetsariev I, Pharaon R, Leach B, Tan T, Kulkarni P, Salgia R. Non-Small Cell Lung Cancer from Genomics to Therapeutics: A Framework for Community Practice Integration to Arrive at Personalized Therapy Strategies. J Clin Med 2020; 9:E1870. [PMID: 32549358 PMCID: PMC7356243 DOI: 10.3390/jcm9061870] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 12/25/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is a heterogeneous disease, and therapeutic management has advanced with the identification of various key oncogenic mutations that promote lung cancer tumorigenesis. Subsequent studies have developed targeted therapies against these oncogenes in the hope of personalizing therapy based on the molecular genomics of the tumor. This review presents approved treatments against actionable mutations in NSCLC as well as promising targets and therapies. We also discuss the current status of molecular testing practices in community oncology sites that would help to direct oncologists in lung cancer decision-making. We propose a collaborative framework between community practice and academic sites that can help improve the utilization of personalized strategies in the community, through incorporation of increased testing rates, virtual molecular tumor boards, vendor-based oncology clinical pathways, and an academic-type singular electronic health record system.
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Affiliation(s)
| | | | | | | | | | | | - Ravi Salgia
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (S.R.); (I.M.); (R.P.); (B.L.); (T.T.); (P.K.)
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