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Nikolouzakis TK, Chrysos E, Docea AO, Fragkiadaki P, Souglakos J, Tsiaoussis J, Tsatsakis A. Current and Future Trends of Colorectal Cancer Treatment: Exploring Advances in Immunotherapy. Cancers (Basel) 2024; 16:1995. [PMID: 38893120 PMCID: PMC11171065 DOI: 10.3390/cancers16111995] [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: 04/12/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Cancer of the colon and rectum (CRC) has been identified among the three most prevalent types of cancer and cancer-related deaths for both sexes. Even though significant progress in surgical and chemotherapeutic techniques has markedly improved disease-free and overall survival rates in contrast to those three decades ago, recent years have seen a stagnation in these improvements. This underscores the need for new therapies aiming to augment patient outcomes. A number of emerging strategies, such as immune checkpoint inhibitors (ICIs) and adoptive cell therapy (ACT), have exhibited promising outcomes not only in preclinical but also in clinical settings. Additionally, a thorough appreciation of the underlying biology has expanded the scope of research into potential therapeutic interventions. For instance, the pivotal role of altered telomere length in early CRC carcinogenesis, leading to chromosomal instability and telomere dysfunction, presents a promising avenue for future treatments. Thus, this review explores the advancements in CRC immunotherapy and telomere-targeted therapies, examining potential synergies and how these novel treatment modalities intersect to potentially enhance each other's efficacy, paving the way for promising future therapeutic advancements.
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Affiliation(s)
| | - Emmanuel Chrysos
- Department of General Surgery, University General Hospital of Heraklion, 71110 Heraklion, Greece; (T.K.N.); (E.C.)
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Persefoni Fragkiadaki
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece; (P.F.); (A.T.)
| | - John Souglakos
- Laboratory of Translational Oncology, Medical School, University of Crete, 70013 Heraklion, Greece;
| | - John Tsiaoussis
- Department of Anatomy, Medical School, University of Crete, 70013 Heraklion, Greece;
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece; (P.F.); (A.T.)
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Uziel O, Kanner AA, Beery E, Lev S, Lahav M, Horn‐Fichman S, Nof SH, Laviv Y, Yust‐Katz S, Amiel A, Shkara RA, Siddeeq M, Levy‐Barda A, Raanani P, Sela Y, Cohen Z, Siegal T. Is serum-derived exosomal hTERT transcript a marker of oncogenic activity in primary brain tumors? An exploratory study. Cancer Med 2023; 13:e6784. [PMID: 38155481 PMCID: PMC10823760 DOI: 10.1002/cam4.6784] [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: 03/19/2023] [Revised: 08/01/2023] [Accepted: 10/03/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND In order to proliferate indefinitely, all tumors require a telomere maintenance mechanism. The expression of human telomerase reverse transcriptase (hTERT) enables telomere maintenance and provides cancer cells with limitless replicative potential. As such, it may serve as an attractive biomarker for oncogenic activity. This study explored whether a liquid biopsy that analyses blood derived exosomal hTERT transcript (e-hTERT-trans) may serve as such a biomarker in gliomas and meningiomas when compared to healthy controls. METHODS Exosomes were isolated from the pre-operative sera of patients' samples stored in the biobank of both Rabin and Sheba Medical Centers. The levels of e-hTERT-trans were measured in 81 healthy controls, 117 meningiomas, 17 low-grade gliomas, and 61 glioblastomas. Clinical parameters of the patients were collected retrospectively and compared to the levels of the e-hTERT-trans. RESULTS The upper normal limit of controls e-hTERT-trans was 1.85 relative quantitation (RQ). The rate of detection increased with rising tumor grade and correlated with tumor recurrence in meningiomas: mean RQ without recurrence (2.17 ± 11.7) versus with recurrence (3.59 ± 4.42; p = 0.002). In glioblastomas, preoperative measurements correlated with tumor volume and with the disease course on serial sampling. CONCLUSIONS We demonstrated for the first time that the expression of e-hTERT-trans transcript can be measured in the serum of primary brain tumors. This exosomal marker carries the potential to serve as a biomarker once used in conjunction with other clinical and radiological parameters. Future studies are required to investigate whether the sensitivity could be augmented and whether it can be implemented into routine patients care.
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Affiliation(s)
- Orit Uziel
- The Felsenstein Medical Research CenterPetah TikvaIsrael
- Institute of HematologyDavidoff Cancer Center, Rabin Medical CenterPetah TikvaIsrael
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - Andrew A. Kanner
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
- Department of NeurosurgeryRabin Medical CenterPetah TikvaIsrael
| | - Einat Beery
- The Felsenstein Medical Research CenterPetah TikvaIsrael
| | - Sapir Lev
- Department of NeurosurgeryRabin Medical CenterPetah TikvaIsrael
| | - Meir Lahav
- The Felsenstein Medical Research CenterPetah TikvaIsrael
- Institute of HematologyDavidoff Cancer Center, Rabin Medical CenterPetah TikvaIsrael
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - Suzana Horn‐Fichman
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
- Neuropathology, Department of PathologyRabin Medical CenterPetah TikvaIsrael
| | - Sagi Har Nof
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
- Department of NeurosurgeryRabin Medical CenterPetah TikvaIsrael
| | - Yuseph Laviv
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
- Department of NeurosurgeryRabin Medical CenterPetah TikvaIsrael
| | - S. Yust‐Katz
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
- Neurooncology UnitDavidoff Cancer Center, Rabin Medical CenterPetah TikvaIsrael
| | - Alexandra Amiel
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
- Neurooncology UnitDavidoff Cancer Center, Rabin Medical CenterPetah TikvaIsrael
| | | | - Mustafa Siddeeq
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
- Department of NeurosurgerySheba Medical CenterRamat‐GanIsrael
| | - Adva Levy‐Barda
- Biobank, Department of PathologyRabin Medical CenterPetah TikvaIsrael
| | - Pia Raanani
- The Felsenstein Medical Research CenterPetah TikvaIsrael
- Institute of HematologyDavidoff Cancer Center, Rabin Medical CenterPetah TikvaIsrael
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - Yaron Sela
- The Center of Internet Psychology Reichman UniversityHerzliyaIsrael
| | - Zvi Cohen
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
- Department of NeurosurgerySheba Medical CenterRamat‐GanIsrael
| | - Tali Siegal
- Neurooncology UnitDavidoff Cancer Center, Rabin Medical CenterPetah TikvaIsrael
- Hebrew University and Medical SchoolJerusalemIsrael
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Rotem O, Zer A, Yosef L, Beery E, Goldvaser H, Gutkin A, Levin R, Dudnik E, Berger T, Feinmesser M, Levy-Barda A, Lahav M, Raanani P, Uziel O. Blood-Derived Exosomal hTERT mRNA in Patients with Lung Cancer: Characterization and Correlation with Response to Therapy. Biomedicines 2023; 11:1730. [PMID: 37371825 DOI: 10.3390/biomedicines11061730] [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: 04/25/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Background: Telomerase (human telomerase reverse transcriptase (hTERT) is considered a hallmark of cancer, being active in cancer cells but repressed in human somatic cells. As such, it has the potential to serve as a valid cancer biomarker. Exosomal hTERT mRNA can be detected in the serum of patients with solid malignancies but not in healthy individuals. We sought to evaluate the feasibility of measuring serum exosomal hTERT transcripts levels in patients with lung cancer. Methods: A prospective analysis of exosomal hTERT mRNA levels was determined in serum-derived exosomes from 76 patients with stage III-IV lung cancer (11 SCLC and 65 NSCLC). An hTERT level above RQ = 1.2 was considered "detectable" according to a previous receiver operating characteristic curve (ROC) curve. Sequential measurements were obtained in 33 patients. Demographic and clinical data were collected retrospectively from patients' charts. Data on response to systemic therapy (chemotherapy, immunotherapy, and tyrosine kinase inhibitors) were collected by the treating physicians. Results: hTERT was detected in 53% (40/76) of patients with lung cancer (89% of SCLC and 46% of NSLCC). The mean hTERT levels were 3.7 in all 76 patients, 5.87 in SCLC patients, and 3.62 in NSCLC patients. In total, 25 of 43 patients with sequential measurements had detectable levels of hTERT. The sequential exosomal hTERT mRNA levels reflected the clinical course in 23 of them. Decreases in hTERT levels were detected in 17 and 5 patients with partial and complete response, respectively. Eleven patients with a progressive disease had an increase in the level of exosomal hTERT, and seven with stable disease presented increases in its exosomal levels. Another patient who progressed on the first line of treatment and had a partial response to the second line of treatment exhibited an increase in exosomal hTERT mRNA levels during the progression and a decrease during the response. Conclusions: Exosomal hTERT mRNA levels are elevated in over half of patients with lung cancer. The potential association between hTERT levels and response to therapy suggests its utility as a promising cancer biomarker for response to therapy. This issue should be further explored in future studies.
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Affiliation(s)
- Ofer Rotem
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva 49100, Israel
| | - Alona Zer
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Lilach Yosef
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva 49100, Israel
| | - Einat Beery
- The Felsenstein Medical Research Center, Rabin Medical Center, Petah Tikva 49100, Israel
| | - Hadar Goldvaser
- Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Rehovot 7612001, Israel
| | - Anna Gutkin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- The Felsenstein Medical Research Center, Rabin Medical Center, Petah Tikva 49100, Israel
| | - Ron Levin
- Sheba Medical Center, Ramat Gan 5262000, Israel
| | - Elizabeth Dudnik
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva 49100, Israel
| | - Tamar Berger
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Institute of Hematology, Rabin Medical Center, Petah Tikva 49100, Israel
| | - Meora Feinmesser
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Biobank, Department of Pathology, Rabin Medical Center, Petah Tikva 49100, Israel
| | - Adva Levy-Barda
- Biobank, Department of Pathology, Rabin Medical Center, Petah Tikva 49100, Israel
| | - Meir Lahav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- The Felsenstein Medical Research Center, Rabin Medical Center, Petah Tikva 49100, Israel
- Institute of Hematology, Rabin Medical Center, Petah Tikva 49100, Israel
| | - Pia Raanani
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- The Felsenstein Medical Research Center, Rabin Medical Center, Petah Tikva 49100, Israel
- Institute of Hematology, Rabin Medical Center, Petah Tikva 49100, Israel
| | - Orit Uziel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- The Felsenstein Medical Research Center, Rabin Medical Center, Petah Tikva 49100, Israel
- Institute of Hematology, Rabin Medical Center, Petah Tikva 49100, Israel
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