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Frenkel N, Poghosyan S, van Wijnbergen JW, Rinkes IB, Kranenburg O, Hagendoorn J. Differential cytokine and chemokine expression after ablation vs. resection in colorectal cancer liver metastasis. Surg Open Sci 2024; 18:29-34. [PMID: 38318321 PMCID: PMC10838949 DOI: 10.1016/j.sopen.2024.01.005] [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: 08/01/2023] [Revised: 11/23/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024] Open
Abstract
Background Surgical resection remains the main curative treatment for colorectal liver metastases (CRLM). Radiofrequency ablation (RFA) is increasingly employed for small, deep lying or otherwise inoperable lesions. However, RFA can induce pro-tumorigenic effects on residual tumor cells, hereby possibly promoting tumor recurrence. Contrastingly, post-RFA tumor debris as an antigen source can also generate anti-cancer immune responses. Utilizing this, current studies on combining RFA with immune therapy appear promising. Here, in an attempt to shed light on this controversy, cytokines involved in inflammation, (lymph)angiogenesis, immune cell recruitment and tumor cell invasion were investigated post-RFA versus post-resection in CRLM patients. Methods Cytokine and chemokine serum levels pre-operation, 4 h and 24 h post-operation were analyzed in CRLM patients undergoing RFA (n = 8) or partial hepatectomy (n = 9) using Multiplex immunoassays. Statistical analyses were performed between as well as within individual intervention groups. Results Post-RFA, significantly increased levels of acute phase proteins SAA1 and S100A8, IL-6, IL-1Ra, MIP3b (CCL19) and MMP9 were observed along with decreases in Fibronectin, MCP-1 (CCL2), and Tie-2. Post-resection, increased levels of PDGFbb, I309 (CCL1), Apelin, MIF, IL-1b and TNFα were seen. All p-values <0.05. Conclusion Pro-inflammatory responses mediated by different cytokines were seen after both RFA and resection, possibly influencing residual tumor cells and tumor recurrence. As both ablation and resection trigger inflammation and immune cell recruitment (albeit via distinct mechanisms), these data suggest that further research may explore combining immune therapy with not only RFA but also resection. Key message Analysis of patients' serum after radiofrequency ablation versus resection of colorectal liver metastases (CRLM) showed that these interventions trigger inflammation and immune cell recruitment, via different cyto- and chemokine pathways. This suggests a possible future strategy of combining immune therapy with not only ablative techniques but also with resection of CRLM.
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Affiliation(s)
| | | | - Jan Willem van Wijnbergen
- Laboratory for Translational Oncology, University Medical Center Utrecht and Utrecht University, Heidelberglaan 100, 3584CX Utrecht, the Netherlands
| | - Inne Borel Rinkes
- Laboratory for Translational Oncology, University Medical Center Utrecht and Utrecht University, Heidelberglaan 100, 3584CX Utrecht, the Netherlands
| | - Onno Kranenburg
- Laboratory for Translational Oncology, University Medical Center Utrecht and Utrecht University, Heidelberglaan 100, 3584CX Utrecht, the Netherlands
| | - Jeroen Hagendoorn
- Laboratory for Translational Oncology, University Medical Center Utrecht and Utrecht University, Heidelberglaan 100, 3584CX Utrecht, the Netherlands
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Pepple AL, Guy JL, McGinnis R, Felsted AE, Song B, Hubbard R, Worlikar T, Garavaglia H, Dib J, Chao H, Boyle N, Olszewski M, Xu Z, Ganguly A, Cho CS. Spatiotemporal local and abscopal cell death and immune responses to histotripsy focused ultrasound tumor ablation. Front Immunol 2023; 14:1012799. [PMID: 36756111 PMCID: PMC9900174 DOI: 10.3389/fimmu.2023.1012799] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/02/2023] [Indexed: 01/24/2023] Open
Abstract
Introduction Histotripsy is a novel focused ultrasound tumor ablation modality with potent immunostimulatory effects. Methods To measure the spatiotemporal kinetics of local andabscopal responses to histotripsy, C57BL/6 mice bearing bilateral flank B16 melanoma or Hepa1-6 hepatocellular carcinoma tumors were treated with unilateral sham or partial histotripsy. Treated and contralateral untreated (abscopal) tumors were analyzed using multicolor immunofluorescence, digital spatial profiling, RNA sequencing (RNASeq), and flow cytometry. Results Unilateral histotripsy triggered abscopal tumor growth inhibition. Within the ablation zone, early high mobility group box protein 1 (HMGB1) release and necroptosis were accompanied by immunogenic cell death transcriptional responses in tumor cells and innate immune activation transcriptional responses in infiltrating myeloid and natural killer (NK) cells. Delayed CD8+ T cell intratumoral infiltration was spatiotemporally aligned with cancer cell features of ferroptosis; this effect was enhanced by CTLA-4 blockade and recapitulated in vitro when tumor-draining lymph node CD8+ T cells were co-cultured with tumor cells. Inoculation with cell-free tumor fractions generated by histotripsy but not radiation or freeze/thaw conferred partial protection from tumor challenge. Discussion We propose that histotripsy may evoke local necroptotic immunogenic cell death, priming systemic adaptive immune responses and abscopal ferroptotic cancer cell death.
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Affiliation(s)
- Ashley L. Pepple
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United States
- Research Service, Ann Arbor VA Healthcare, Ann Arbor, MI, United States
| | - Joey L. Guy
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United States
- Research Service, Ann Arbor VA Healthcare, Ann Arbor, MI, United States
| | - Reliza McGinnis
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United States
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Amy E. Felsted
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Brian Song
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United States
- Research Service, Ann Arbor VA Healthcare, Ann Arbor, MI, United States
| | - Ryan Hubbard
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Tejaswi Worlikar
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Hannah Garavaglia
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Joe Dib
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Hannah Chao
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Nicoleen Boyle
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United States
- Research Service, Ann Arbor VA Healthcare, Ann Arbor, MI, United States
| | - Michal Olszewski
- Research Service, Ann Arbor VA Healthcare, Ann Arbor, MI, United States
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Anutosh Ganguly
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United States
- Research Service, Ann Arbor VA Healthcare, Ann Arbor, MI, United States
| | - Clifford S. Cho
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United States
- Research Service, Ann Arbor VA Healthcare, Ann Arbor, MI, United States
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Qiao W, Wang Q, Hu C, Zhang Y, Li J, Sun Y, Yuan C, Wang W, Liu B, Zhang Y. Interim efficacy and safety of PD-1 inhibitors in preventing recurrence of hepatocellular carcinoma after interventional therapy. Front Immunol 2022; 13:1019772. [PMID: 36389724 PMCID: PMC9650042 DOI: 10.3389/fimmu.2022.1019772] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/13/2022] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Locoregional interventional therapy including transcatheter arterial chemoembolization (TACE) and ablation are the current standard of treatment for early-to-mid-stage hepatocellular carcinoma (HCC). However, questions remain unanswered regarding the management of recurrence after locoregional treatment. PD-1 inhibitors can block inhibitory signals of T-cell activation and proliferation to reduce the recurrence. We conducted a single-arm phase 2 trial to evaluate the efficacy and safety of PD-1 inhibitors following locoregional interventional therapy in HCC patients with high recurrence risk guided by our novel scoring system. METHODS Patients enrolled initially treated by TACE combined with ablation, then willingly joined the experimental group. One month later, they received the anti-PD-1 adjuvant therapy (intravenous injection of 200 mg), which was repeated every 3 weeks for a total of 4 or 8 cycles. Within this same period, other patients were screened into the control group to match the experimental group by 1:1 based on the propensity score matching method (PSM). The primary endpoint was relapse-free survival (RFS). Secondary endpoints included overall survival (OS) recurrence modality, safety, and quality of life. RESULT At the time of data cutoff, the median RFS of the control group was 7.0 months while the experimental group had not reached it. Moreover, the 1-year RFS rate was 73.3% in the experimental group and 46.7% in the control group, showing a significant difference (P =0.02). The rate of local tumor progression in the experimental group was clearly lower than that in the control group (P = 0.027). Benefits associated with anti-PD-1 adjuvant therapy were observed in patients with multiple tumors and tumor size ≤2cm. Univariate and multivariate analyses demonstrated that anti-PD-1 adjuvant therapy was an independent favorable prognostic factor for RFS in HCC patients. The most frequent AE observed in this study was RCCEP, and other AEs included diarrhea, hepatotoxicity, rash, pruritus, and fatigue. The incidence of GRADE ≥3 AE and withdrawal in this study was low with no deaths recorded. CONCLUSIONS Interim analysis from the study suggest the addition of anti-PD-1 adjuvant therapy after TACE combined with ablation could significantly prolong RFS with controllable safety for early-to-mid-stage HCC patients with high recurrence risk.
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Affiliation(s)
- Wenying Qiao
- Interventional Therapy Center for Oncology, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
- Center for Infectious Diseases, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
| | - Qi Wang
- Interventional Therapy Center for Oncology, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
| | - Caixia Hu
- Interventional Therapy Center for Oncology, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
| | - Yinghua Zhang
- Interventional Therapy Center for Oncology, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
| | - Jianjun Li
- Interventional Therapy Center for Oncology, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
| | - Yu Sun
- Interventional Therapy Center for Oncology, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
| | - Chunwang Yuan
- Interventional Therapy Center for Oncology, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
| | - Wen Wang
- Center for Infectious Diseases, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
| | - Biyu Liu
- Interventional Therapy Center for Oncology, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
| | - Yonghong Zhang
- Interventional Therapy Center for Oncology, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
- Research Center for Biomedical Resources, Beijing You ‘an Hospital, Capital Medical University, Beijing, China
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Jost R, Al-Shatti N, Ghosn M, Bonnet B, Champiat S, Deschamps F, Gelli M, Boige V, Danlos FX, Susini S, Hollebecque A, Ammari S, Marabelle A, de Baere T, Tselikas L. Synergizing liver systemic treatments with interventional oncology: friend or foe? Br J Radiol 2022; 95:20220548. [PMID: 36075034 PMCID: PMC9815737 DOI: 10.1259/bjr.20220548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 01/13/2023] Open
Abstract
Interventional radiology techniques provide excellent local tumor control for small tumors in various organs, but several limitations can hamper the oncological outcomes such as the tumor size or the number of lesions. Technical improvements, optimal patient selection and combination with systemic therapies, including immune checkpoint inhibitors, have been successfully developed to overcome these barriers.In this setting, chemotherapy and targeted therapies aim to diminish the tumor burden in addition to local treatments, while immunotherapies may have a synergistic effect in terms of mechanism of action on the tumor cell as well as the immune environment, with multiple treatment combinations being available. Finally, interventional Rrdiology treatments often increase tumor antigen exposure to the immune system, and thus stimulate a specific antitumor immune response that can act beyond the treated site. Notwithstanding their many benefits, combination treatment may also result in complications, the most feared may be auto-immune-related adverse events.In early studies, several combined therapies have shown promising levels of safety and efficacy, particularly in hepatocellular carcinoma.This review provides a comprehensive and up-to-date overview of results of combined therapies for primary and secondary liver malignancies. Recent advances and future perspectives will be discussed.
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Affiliation(s)
- Raphaël Jost
- Département d’Anésthésie, Chirurgie et Imagerie Interventionnelle, Gustave Roussy, Villejuif, France
| | | | - Mario Ghosn
- Département d’Anésthésie, Chirurgie et Imagerie Interventionnelle, Gustave Roussy, Villejuif, France
| | - Baptiste Bonnet
- Département d’Anésthésie, Chirurgie et Imagerie Interventionnelle, Gustave Roussy, Villejuif, France
| | | | - Frederic Deschamps
- Département d’Anésthésie, Chirurgie et Imagerie Interventionnelle, Gustave Roussy, Villejuif, France
| | - Maximiliano Gelli
- Département d’Anésthésie, Chirurgie et Imagerie Interventionnelle, Gustave Roussy, Villejuif, France
| | - Valérie Boige
- Department of medical oncology, Gustave Roussy, Villejuif, France
| | | | | | - Antoine Hollebecque
- Département d’Innovation Thérapeutique et d’Essais Précoces (DITEP), Gustave Roussy, Villejuif, France
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Li Z, Li Q, Wang X, Chen W, Jin X, Liu X, Ye F, Dai Z, Zheng X, Li P, Sun C, Liu X, Zhang Q, Luo H, Liu R. Hyperthermia ablation combined with transarterial chemoembolization versus monotherapy for hepatocellular carcinoma: A systematic review and meta-analysis. Cancer Med 2021; 10:8432-8450. [PMID: 34655179 PMCID: PMC8633247 DOI: 10.1002/cam4.4350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/15/2021] [Accepted: 10/03/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND AIMS The existing evidence has indicated that hyperthermia ablation (HA) and HA combined with transarterial chemoembolization (HATACE) are the optimal alternative to surgical resection for patients with hepatocellular carcinoma (HCC) in the COVID-19 crisis. However, the evidence for decision-making is lacking in terms of comparison between HA and HATACE. Herein, a comprehensive evaluation was performed to compare the efficacy and safety of HATACE with monotherapy. MATERIALS AND METHODS Worldwide studies were collected to evaluate the HATACE regimen for HCC due to the practical need for global extrapolation of applicative population. Meta-analyses were performed using the RevMan 5.3 software (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). RESULTS Thirty-six studies involving a large sample of 5036 patients were included finally. Compared with HA alone, HATACE produced the advantage of 5-year overall survival (OS) rate (OR:1.90; 95%CI:1.46,2.46; p < 0.05) without increasing toxicity (p ≥ 0.05). Compared with TACE alone, HATACE was associated with superior 5-year OS rate (OR:3.54; 95%CI:1.96,6.37; p < 0.05) and significantly reduced the incidences of severe liver damage (OR:0.32; 95%CI:0.11,0.96; p < 0.05) and ascites (OR:0.42; 95%CI:0.20,0.88; p < 0.05). Subgroup analysis results of small (≤3 cm) HCC revealed that there were no significant differences between the HATACE group and HA monotherapy group in regard to the OS rates (p ≥ 0.05). CONCLUSIONS Compared with TACE alone, HATACE was more effective and safe for HCC. Compared with HA alone, HATACE was more effective for non-small-sized (>3 cm) HCC with comparable safety. However, the survival benefit of adjuvant TACE in HATACE regimen was not found for the patients with small (≤3 cm) HCC.
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Image-guided locoregional non-intravascular interventional treatments for hepatocellular carcinoma: Current status. J Interv Med 2021; 4:1-7. [PMID: 34805939 PMCID: PMC8562266 DOI: 10.1016/j.jimed.2020.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/26/2020] [Accepted: 10/10/2020] [Indexed: 01/04/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most deadly and frequent cancers worldwide, although great advancement in the treatment of this malignancy have been made within the past few decades. It continues to be a major health issue due to an increasing incidence and a poor prognosis. The majority of patients have their HCC diagnosed at an intermediate or advanced stage in theUSA or China. Curative therapy such as surgical resection or liver transplantation is not considered anoption of treatment at these stages. Transarterial chemoembolization (TACE), the most widely used locoregional therapeutic approach, used to be the mainstay of treatment for cases with unresectable cancer entities. However, for those patients with hypovascular tumors or impaired liver function reserve, TACE is a suboptimal treatment option. For example, embolization does not result in complete coverage of a hypovascular tumor, and may rather promotes postoperative tumor recurrence, or leave residual tumor, in these TACE-resistance patients. In addition, TACE carries a higher risk of hepatic decompensation in patients with poor liver function or reserve. Non-vascular interventional locoregional therapies for HCC include radiofrequency ablation (RFA), microwave ablation (MWA), high-intensity focused ultrasound (HIFU), laser-induced thermotherapy (LITT), cryosurgical ablation (CSA), irreversible Electroporation (IRE), percutaneous ethanol injection (PEI), and brachytherapy. Recent advancements in these techniques have significantly improved the treatment efficacy of HCC and expanded the population of patients who qualify for treatment. This review embraces the current status of imaging-guided locoregional non-intravascular interventional treatments for HCCs, with a primary focus on the clinical evaluation and assessment of the efficacy of combined therapies using these interventional techniques.
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Xie A, Xia F, Pei J, Sun X, Song Z. Advanced hepatocellular carcinoma treated by radiofrequency ablation combined with oncolytic virus and anti-PD-1 antibody therapy: a case report and literature review. J Int Med Res 2021; 49:3000605211044596. [PMID: 34559020 PMCID: PMC8485298 DOI: 10.1177/03000605211044596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The development of an effective therapy for advanced hepatocellular carcinoma (HCC) represents an important global concern. In recent years, the combination of multiple treatment methods with immunotherapy has achieved great progress in patients with advanced HCC. Patient survival has been significantly prolonged, but cases of complete response (CR) remain rare. Here, we report two cases in which CR was achieved by radiofrequency ablation combined with an oncolytic virus (recombinant human adenovirus type 5) and anti-programmed cell death protein 1 antibody. Additionally, a literature review is presented to describe similar advancements in this field and explore viable methods for the treatment of advanced HCC.
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Affiliation(s)
- Anqing Xie
- Department of Hepatobiliary Surgery, The People's Hospital of Zhongxian, Chongqing, China.,Institute of Hepatobiliary Surgery, The Southwest Hospital of Army Medical University, Chongqing, China
| | - Feng Xia
- Institute of Hepatobiliary Surgery, The Southwest Hospital of Army Medical University, Chongqing, China
| | - Jun Pei
- Institute of Hepatobiliary Surgery, The Southwest Hospital of Army Medical University, Chongqing, China
| | - Ximing Sun
- Institute of Hepatobiliary Surgery, The Southwest Hospital of Army Medical University, Chongqing, China
| | - Zongtao Song
- Institute of Hepatobiliary Surgery, The Southwest Hospital of Army Medical University, Chongqing, China
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Immunological Markers, Prognostic Factors and Challenges Following Curative Treatments for Hepatocellular Carcinoma. Int J Mol Sci 2021; 22:ijms221910271. [PMID: 34638613 PMCID: PMC8508906 DOI: 10.3390/ijms221910271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 01/27/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortalities worldwide. Patients with early-stage HCC are eligible for curative treatments, such as surgical resection, liver transplantation (LT) and percutaneous ablation. Although curative treatments provide excellent long-term survival, almost 70–80% of patients experience HCC recurrence after curative treatments. Tumor-related factors, including tumor size, number and differentiation, and underlying liver disease, are well-known risk factors for recurrence following curative therapies. Moreover, the tumor microenvironment (TME) also plays a key role in the recurrence of HCC. Many immunosuppressive mechanisms, such as an increase in regulatory T cells and myeloid-derived suppressor cells with a decrease in cytotoxic T cells, are implicated in HCC recurrence. These suppressive TMEs are also modulated by several factors and pathways, including mammalian target of rapamycin signaling, vascular endothelial growth factor, programmed cell death protein 1 and its ligand 1. Based on these mechanisms and the promising results of immune checkpoint blockers (ICBs) in advanced HCC, there have been several ongoing adjuvant studies using a single or combination of ICB following curative treatments in HCC. In this review, we strive to provide biologic and immunological markers, prognostic factors, and challenges associated with clinical outcomes after curative treatments, including resection, LT and ablation.
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Immune Responses Following Locoregional Treatment for Hepatocellular Carcinoma: Possible Roles of Adjuvant Immunotherapy. Pharmaceutics 2021; 13:pharmaceutics13091387. [PMID: 34575463 PMCID: PMC8471821 DOI: 10.3390/pharmaceutics13091387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/29/2021] [Accepted: 08/30/2021] [Indexed: 12/22/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a common cause of cancer-related deaths worldwide. Unlike other types of cancer, HCC can be treated with locoregional treatments (LRTs) such as radiofrequency ablation (RFA) or transarterial chemoembolization (TACE). However, recurrences following LRTs are common, and strategies to improve long-term outcomes need to be developed. The exhaustion of anti-tumor immunity in HCC has been well established in many reports and the immunomodulatory effects of LRTs (enhancement of tumor antigen-specific T cell responses after RFA, reduction of effector regulatory T cells after TACE) have also been reported in several previous studies. However, a comprehensive review of previous studies and the possible roles of immunotherapy following LRTs in HCC are not known. In this review, we discuss the immunological evidence of current clinical trials using LRTs and combined immunotherapies, and the possible role of this strategy.
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Luo C, Li T, Li Z, Zuo Y, He G, Lin J, Liu G, Dai L. Evaluation of Microwave Ablation Efficacy by Strain Elastography and Shear Wave Elastography in ex Vivo Porcine Liver. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2636-2645. [PMID: 34140168 DOI: 10.1016/j.ultrasmedbio.2021.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 05/04/2021] [Accepted: 05/09/2021] [Indexed: 06/12/2023]
Abstract
The aim of this study was to evaluate the efficacy of microwave ablation by ultrasound (US), strain elastography (SE) and shear-wave elastography (SWE). An ex vivo model of porcine liver was adopted. According to ablation power and duration, 30 samples were divided into three groups: group 1 (45 W, 30 s), group 2 (45 W, 15 s) and group 3 (30 W, 30 s). US was used to measure the largest transverse diameter (D1), vertical diameter (D2) and anteroposterior diameter (D3) of the ablated area. SE was used to measure the largest transverse diameter (SEL1), vertical diameter (SEL2) and anteroposterior diameter (SEL3). The actual size of the ablated area was measured as the largest transverse diameter (L1), vertical diameter (L2) and anteroposterior diameter (L3). SWE values and temperatures were measured in the central lesion (region a), marginal area (region b) and unablated area (region c). At 1 h post-ablation, the values measured by US (D1, D2, D3) were all significantly smaller than the ablated area (L1, L2, L3) in all three groups. Except for SEL2 in group 1, there was no significant difference in the results between SEL and L among the three groups. All SWE results were significantly higher post-ablation than pre-ablation in the central lesion (region a) and marginal area (region b, all p values <0.05). In regions a, b and c, the temperatures measured immediately and 5 min post-ablation were all higher than that measured pre-ablation. These results suggest that SE and SWE can be used to evaluate the ablation efficacy of liver tissue.
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Affiliation(s)
- Chunyue Luo
- Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Tao Li
- Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Zuojia Li
- Medical Apparatus and Equipment Department, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Yanling Zuo
- Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Guangmin He
- Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Jianying Lin
- Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Guancheng Liu
- Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Lu Dai
- Department of Thoracic Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, China.
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Halpern AL, Fitz JG, Fujiwara Y, Yi J, Anderson AL, Zhu Y, Schulick RD, El Kasmi KC, Barnett CC. Hepatic thermal injury promotes colorectal cancer engraftment in C57/black 6 mice. Am J Physiol Cell Physiol 2021; 320:C142-C151. [PMID: 33175574 PMCID: PMC7846977 DOI: 10.1152/ajpcell.00071.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 11/22/2022]
Abstract
Treatment options for liver metastases (primarily colorectal cancer) are limited by high recurrence rates and persistent tumor progression. Surgical approaches to management of these metastases typically use heat energy including electrocautery, argon beam coagulation, thermal ablation of surgical margins for hemostasis, and preemptive thermal ablation to prevent bleeding or to effect tumor destruction. Based on high rates of local recurrence, these studies assess whether local effects of hepatic thermal injury (HTI) might contribute to poor outcomes by promoting a hepatic microenvironment favorable for tumor engraftment or progression due to induction of procancer cytokines and deleterious immune infiltrates at the site of thermal injury. To test this hypothesis, an immunocompetent mouse model was developed wherein HTI was combined with concomitant intrasplenic injection of cells from a well-characterized MC38 colon carcinoma cell line. In this model, HTI resulted in a significant increase in engraftment and progression of MC38 tumors at the site of thermal injury. Furthermore, there were local increases in expression of messenger ribonucleic acid (mRNA) for hypoxia-inducible factor-1α (HIF1α), arginase-1, and vascular endothelial growth factor α and activation changes in recruited macrophages at the HTI site but not in untreated liver tissue. Inhibition of HIF1α following HTI significantly reduced discreet hepatic tumor development (P = 0.03). Taken together, these findings demonstrate that HTI creates a favorable local environment that is associated with protumorigenic activation of macrophages and implantation of circulating tumors. Discrete targeting of HIF1α signaling or inhibiting macrophages offers potential strategies for improving the outcome of surgical management of hepatic metastases where HTI is used.
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Affiliation(s)
- Alison L Halpern
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - J Gregory Fitz
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Yuki Fujiwara
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jeniann Yi
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Aimee L Anderson
- Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Yuwen Zhu
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Richard D Schulick
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Karim C El Kasmi
- Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Carlton C Barnett
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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12
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Qu S, Worlikar T, Felsted AE, Ganguly A, Beems MV, Hubbard R, Pepple AL, Kevelin AA, Garavaglia H, Dib J, Toma M, Huang H, Tsung A, Xu Z, Cho CS. Non-thermal histotripsy tumor ablation promotes abscopal immune responses that enhance cancer immunotherapy. J Immunother Cancer 2020; 8:jitc-2019-000200. [PMID: 31940590 PMCID: PMC7057529 DOI: 10.1136/jitc-2019-000200] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2019] [Indexed: 01/05/2023] Open
Abstract
Background Developing the ability to use tumor-directed therapies to trigger potentially therapeutic immune responses against cancer antigens remains a high priority for cancer immunotherapy. We hypothesized that histotripsy, a novel non-invasive, non-thermal ablation modality that uses ultrasound-generated acoustic cavitation to disrupt tissues, could engender adaptive immune responses to tumor antigens. Methods Immunocompetent C57BL/6 mice inoculated with flank melanoma or hepatocellular carcinoma tumors were treated with histotripsy, thermal ablation, radiation therapy, or cytotoxic T lymphocyte-associated protein-4 (CTLA-4) blockade checkpoint inhibition. Lymphocyte responses were measured using flow cytometric and immunohistochemical analyses. The impact of histotripsy on abscopal immune responses was assessed in mice bearing bilateral tumors, or unilateral tumors with pulmonary tumors established via tail vein injection. Results Histotripsy ablation of subcutaneous murine melanoma tumors stimulated potent local intratumoral infiltration of innate and adaptive immune cell populations. The magnitude of this immunostimulation was stronger than that seen with tumor irradiation or thermal ablation. Histotripsy also promoted abscopal immune responses at untreated tumor sites and inhibited growth of pulmonary metastases. Histotripsy was capable of releasing tumor antigens with retained immunogenicity, and this immunostimulatory effect was associated with calreticulin translocation to the cellular membrane and local and systemic release of high mobility group box protein 1. Histotripsy ablation potentiated the efficacy of checkpoint inhibition immunotherapy in murine models of melanoma and hepatocellular carcinoma. Conclusions These preclinical observations suggest that non-invasive histotripsy ablation can be used to stimulate tumor-specific immune responses capable of magnifying the impact of checkpoint inhibition immunotherapy.
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Affiliation(s)
- Shibin Qu
- Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Department of Hepatobiliary Surgery, Xijing Hospital, Xian, Shaanxi, China
| | - Tejaswi Worlikar
- Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Amy E Felsted
- Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Anutosh Ganguly
- Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Surgery, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Megan V Beems
- Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryan Hubbard
- Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | - Joe Dib
- Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mariam Toma
- Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Hai Huang
- Surgery, Ohio State University Medical Center, Columbus, Ohio, USA
| | - Allan Tsung
- Surgery, Ohio State University Medical Center, Columbus, Ohio, USA
| | - Zhen Xu
- Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Clifford Suhyun Cho
- Surgery, University of Michigan, Ann Arbor, Michigan, USA .,Surgery, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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13
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Hack SP, Spahn J, Chen M, Cheng AL, Kaseb A, Kudo M, Lee HC, Yopp A, Chow P, Qin S. IMbrave 050: a Phase III trial of atezolizumab plus bevacizumab in high-risk hepatocellular carcinoma after curative resection or ablation. Future Oncol 2020; 16:975-989. [PMID: 32352320 DOI: 10.2217/fon-2020-0162] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Hepatocellular carcinoma recurs in 70-80% of cases following potentially curative resection or ablation and the immune component of the liver microenvironment plays a key role in recurrence. Many immunosuppressive mechanisms implicated in HCC recurrence are modulated by VEGF and/or immune checkpoints such as PD-L1. Atezolizumab (PD-L1 inhibitor) plus bevacizumab (VEGF inhibitor) has been shown to significantly improve overall survival, progression-free survival and overall response rate in unresectable HCC. Dual PD-L1/VEGF blockade may be effective in reducing HCC recurrence by creating a more immune-favorable microenvironment. We describe the rationale and design of IMbrave 050 (NCT04102098), a randomized, open-label, Phase III study comparing atezolizumab plus bevacizumab versus active surveillance in HCC patients at high-risk of recurrence following curative resection or ablation. The primary end point is recurrence-free survival. Clinical Trial Registration: NCT04102098.
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Affiliation(s)
- Stephen P Hack
- Genentech, Inc, 1 DNA Way, South San Francisco, CA 94080, USA
| | - Jessica Spahn
- Genentech, Inc, 1 DNA Way, South San Francisco, CA 94080, USA
| | - Minshan Chen
- Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, PR China
| | - Ann-Lii Cheng
- National Taiwan University Cancer Center & National Taiwan University Hospital, Taipei, Taiwan
| | - Ahmed Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Masatoshi Kudo
- Department of Gastroenterology & Hepatology, Kindai University School of Medicine, Osaka, Japan
| | - Han Chu Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Adam Yopp
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Pierce Chow
- Division of Surgical Oncology, National Cancer Centre, Singapore
| | - Shukui Qin
- PLA Cancer Center, People's Liberation Army (PLA) 81 Hospital, Nanjing 210016, PR China
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Werthmann PG, Kempenich R, Lang-Avérous G, Kienle GS. Long-term survival of a patient with advanced pancreatic cancer under adjunct treatment with Viscum album extracts: A case report. World J Gastroenterol 2019; 25:1524-1530. [PMID: 30948915 PMCID: PMC6441914 DOI: 10.3748/wjg.v25.i12.1524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/22/2019] [Accepted: 03/02/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Advanced pancreatic cancer (aPC) has a poor prognosis with limited survival benefit from current standard treatment. Viscum album extracts (VAE) are used by many cancer patients, showing immune-stimulating effects, improved quality of life, and a survival benefit in patients with aPC.
CASE SUMMARY A 59-year-old architect developed epigastric pain. A cystic lesion of the pancreas of 45-mm diameter was detected. In a follow-up magnetic resonance imaging, about one year later, multiple lesions were seen in the corpus and the tail of the pancreas; CA-19-9 was elevated to 58.5 U/mL. A distal pancreatectomy with splenectomy was performed, and a tumor of 7 cm × 5 cm × 3.5 cm was excised. Histologic investigation showed an intraductal papillary mucinous neoplasm-associated invasive adenocarcinoma with invasion of the lymph vessels, perineural invasion, and positive nodes (2/27); surgical margins showed tumor cells, and the tumor was classified as pT3 N1 M0 R1. The patient was treated with radiation of the tumor bed and capecitabine/oxaliplatin followed by gemcitabine and FOLFIRINOX. Seven months after surgery, a liver metastasis was detected and treatment with FOLFIRINOX was started. Four months after detection of the metastasis, the patient opted for additional treatment with VAE. Another month later, the metastasis was treated with radiofrequency ablation (RFA). Eight months later, the hepatic lesion recurred and was again treated with RFA. The continuous VAE treatment was increased in dose, and the patient stayed recurrence-free for the next 39 mo in good health and working full-time (as of the time this case report was written).
CONCLUSION We present the case of a patient with aPC with R1-resection with development of liver metastasis during the course of treatment who showed an overall survival of 63 mo and a relapse-free survival of 39 mo under increasing VAE therapy. The possible synergistic effect on tumor control of RFA treatment and immune-stimulatory effects of VAE should be further investigated.
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Affiliation(s)
- Paul G Werthmann
- Department of Methodology, Institute for Applied Epistemology and Medical Methodology (IFAEMM), Freiburg 79111, Germany
- Center for Complementary Medicine, Institute for Environmental Health Sciences and Hospital Infection Control, Medical Center - University of Freiburg, Freiburg 79106, Germany
| | - Robert Kempenich
- Private Praxis, General Practitioner with Specialization in Oncology, Strasbourg F-67000, France
| | - Gerlinde Lang-Avérous
- Department of Pathology, Hôpital de Hautepierre, University Hospital of Strasbourg, Strasbourg F-67000, France
| | - Gunver S Kienle
- Department of Methodology, Institute for Applied Epistemology and Medical Methodology (IFAEMM), Freiburg 79111, Germany
- Center for Complementary Medicine, Institute for Environmental Health Sciences and Hospital Infection Control, Medical Center - University of Freiburg, Freiburg 79106, Germany
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15
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Huang S, Qu N, Men Y, Liu Z. Effects of thermal ablation on Treg/Th17 in hepatocellular carcinoma of mice. EUR J INFLAMM 2019. [DOI: 10.1177/2058739219832489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The study was aimed to explore the possible function of thermal ablation treatment on T helper 17 (Th17) cells and regulatory T (Treg) cells in transplantation of hepatocellular carcinoma in mice. In total, 60 male C57BL/6 mice were divided into control group, model group, and treat group. Flow cytometry was used to detect the frequency of Th17 and Treg cells in peripheral blood. The levels of interleukin (IL)-17, IL-23, IL-10, and transforming growth factor beta (TGF-β) in serum were detected by enzyme-linked immunosorbent assay (ELISA).The levels of IL-17, RORγt, Foxp3, and TGF-β mRNA in tumor tissues were detected by real-time fluorescence quantitative PCR (qRT-PCR). Compared with the model group, tumor size was significantly decreased after thermal ablation treatment. After treatment, the frequency of Th17 cells in peripheral blood was significantly decreased, while the frequency of Treg cells was profoundly increased ( P < 0.05). The levels of IL-17 and IL-23 were significantly downregulated, while IL-10 and TGF-β levels were upregulated ( P < 0.05). IL-17 and RORγt mRNA levels in tumor tissues were significantly decreased ( P < 0.05), and Foxp3 and TGF-β mRNA levels were significantly increased ( P < 0.05). Thermal ablation treatment plays a positive role in the treatment of hepatoma in mice through affecting the imbalance of Th17/Treg cells.
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Affiliation(s)
- Shengchuan Huang
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Nina Qu
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yanming Men
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Zhen Liu
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
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Schoenberg SO, Attenberger UI, Solomon SB, Weissleder R. Developing a Roadmap for Interventional Oncology. Oncologist 2018; 23:1162-1170. [PMID: 29959284 PMCID: PMC6263130 DOI: 10.1634/theoncologist.2017-0654] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 04/05/2018] [Indexed: 01/05/2023] Open
Abstract
Interventional oncology uses image-guided procedures to enhance cancer care. Today, this specialty plays an increasingly critical role in cancer diagnosis (e.g., biopsy), cancer therapy (e.g., ablation or embolization), and cancer symptom palliation (e.g., nephrostomies or biliary drainages). Although the number of procedures and technical capabilities has improved over the last few years, challenges remain. In this article we discuss the need to advance existing procedures, develop new ones, and focus on several operational aspects that will dictate future interventional techniques to enhance cancer care, particularly by accelerating drug development and improving patient outcomes. IMPLICATIONS FOR PRACTICE Interventional oncology is vital for cancer diagnosis, therapy, and symptom palliation. This report focuses on current interventional procedures and techniques with a look toward future improvements that will improve cancer care and patient outcomes.
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Affiliation(s)
- Stefan O Schoenberg
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ulrike I Attenberger
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Ralph Weissleder
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
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17
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Tan W, Sun W, Li X, Zhao L, Wang C, Zang A, Kong X. Preablation neutrophil-to-lymphocyte ratio as an independent prognostic factor in locally advanced hepatocellular carcinoma patients following radiofrequency ablation. J Cancer Res Ther 2018. [PMID: 29516965 DOI: 10.4103/jcrt.jcrt_835_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background and Aims Neutrophil-to-lymphocyte ratio (NLR), as an inflammation-based marker, plays critical roles in hepatocellular carcinoma (HCC). This study was aimed to investigate the prognostic value of preablation NLR in locally advanced HCC patients following radiofrequency ablation (RFA) and to determine an optimal cutoff value for NLR. Materials and Methods From September 2008 to May 2017, 402 locally advanced HCC patients treated with RFA were retrospectively evaluated. Several prognostic factors including NLR was assessed with univariate and multivariate analysis. The optimal cutoff value of NLR was determined with a maximally selected log-rank test. Other prognostic factors influenced the overall survival (OS) were also evaluated. Results Based on the univariate analysis of 16 prognostic factors for OS, the type of hepatitis, a-fetoprotein (AFP), NLR, alanine aminotransferase, aspartate aminotransferase, and serum albumin were identified as independent prognostic factors; and based on multivariate analysis of 6 prognostic factors for OS, AFP, and NLR were identified (P < 0.05). A NLR of 2.2 was determined to be the optimal cutoff value (area under the curve = 0.855, P < 0.001). In a comparison between the high NLR group and the low NLR group, there was a difference of 7 months in the median OS (24 vs. 31 months, P < 0.001). Conclusions Preablation NLR was a valuable predictor in locally advanced HCC patients treated with RFA. NLR ≥2.2 indicated a poor prognosis. These findings suggested that preablation NLR may be a convenient, easily-obtained, low cost, and reliable biomarker with prognostic potential for HCC patients.
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Affiliation(s)
- Wei Tan
- Department of Ultrasound, Qingdao Municipal Hospital, The Affiliated Hospital of Qingdao University, Qindao, China
| | - Wenkui Sun
- Department of Ultrasound, Weifang People's Hospital, Weifang, Shandong, China
| | - Xia Li
- Department of Ultrasound, Qingdao Municipal Hospital, The Affiliated Hospital of Qingdao University, Qindao, China
| | - Lei Zhao
- Department of Ultrasound, Qingdao Municipal Hospital, The Affiliated Hospital of Qingdao University, Qindao, China
| | - Chun Wang
- Department of Ultrasound, Qingdao Municipal Hospital, The Affiliated Hospital of Qingdao University, Qindao, China
| | - Aihua Zang
- Department of Ultrasound, Qingdao Municipal Hospital, The Affiliated Hospital of Qingdao University, Qindao, China
| | - Xiangchong Kong
- Department of Ultrasound, Qingdao Municipal Hospital, The Affiliated Hospital of Qingdao University, Qindao, China
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Zhao K, Yang W. Effect of ablation of solid tumors on immune function: Clinical application of combined immunotherapy. Shijie Huaren Xiaohua Zazhi 2018; 26:1385-1389. [DOI: 10.11569/wcjd.v26.i23.1385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Ablation, as a minimally invasive therapy for solid tumors, has been widely used in clinical practice and achieved satisfactory outcome. Tumor ablation has an effect on the tumor microenvironment so that a good environment for tumor specific immune recognition can be provided. Thus, combined immunotherapy can enhance the antitumor immune effect and improve the long-term outcome. The effect of tumor ablation on the immune function of the body and the combination of immunotherapy have become a hot topic in recent years. In this article, we will summarize the related clinical studies and comments on the effect of ablation of solid tumors on immune function and the status of combined immunotherapy.
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Affiliation(s)
- Kun Zhao
- Department of Ultrasound, Peking University Hospital, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing 100142, China
| | - Wei Yang
- Department of Ultrasound, Peking University Hospital, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing 100142, China
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19
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Liu D, Qi X, Manjunath Y, Kimchi ET, Ma L, Kaifi JT, Staveley-O’Carroll KF, Li G. Sunitinib and Sorafenib Modulating Antitumor Immunity in Hepatocellular Cancer. JOURNAL OF IMMUNOLOGY RESEARCH AND THERAPY 2018; 3:115-123. [PMID: 30123861 PMCID: PMC6093187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sorafenib and sunitinib are multiple tyrosine kinase inhibitors. Both of them have been approved by the US FDA in the treatment of patients with malignancies. In order to develop an effective and clinically useful chemoimmunotherapy modality against hepatocellular cancer (HCC), we investigate their tumoricidal and immune modulatory effect in the setting of HCC. In vitro experiments suggested that sunitinib and sorafenib both induced HCC cell apoptosis at an equivalent level, but stronger suppressive function to cell proliferation was detected in sorafenib. Correspondingly, treatment of tumor-bearing mice with sorafenib led to the suppression of tumor growth to a larger extent than sunitinib. Flow cytometry showed that treatment with sunitinib, not sorafenib, significantly reduced the frequency of regulatory T cells (Tregs) and myeloid-derived suppressive cells (MDSCs) in tumor-bearing mice; and allowed splenic lymphocytes to produce equivalent levels of IFN-γ and TNF-α in response to vaccination as that in wild type mice. This activation was not detected in control and sorafenib-treated tumor mice. In addition, treatment of tumor-bearing mice with sunitinib followed by adoptive transfer of tumor antigen-specific CD8+ T cells and immunization resulted in the additional suppression to tumor growth compared to sunitinib monotherapy. These results imply treatment with sunitinib, not sorafenib, is able to prevent tumor-induced immunotolerance and activate antitumorimmunity. Our data suggest that sunitinib may be a preferable chemotherapeutic agent to use in combination with immunotherapy for the treatment of HCC.
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Affiliation(s)
- Dai Liu
- Department of Surgery, University of Missouri-Columbia, Columbia
- Ellis Fischel Cancer Center, University of Missouri-Columbia, Columbia
| | - Xiaoqiang Qi
- Department of Surgery, University of Missouri-Columbia, Columbia
- Ellis Fischel Cancer Center, University of Missouri-Columbia, Columbia
| | - Yariswamy Manjunath
- Department of Surgery, University of Missouri-Columbia, Columbia
- Ellis Fischel Cancer Center, University of Missouri-Columbia, Columbia
| | - Eric T. Kimchi
- Department of Surgery, University of Missouri-Columbia, Columbia
- Ellis Fischel Cancer Center, University of Missouri-Columbia, Columbia
| | - Lixin Ma
- Department of Radiology, University of Missouri-Columbia, Coumbia, MO65212, Harry S. Truman Memorial VA Hospital Biomolecular Imaging Center, USA
| | - Jussuf T. Kaifi
- Department of Surgery, University of Missouri-Columbia, Columbia
- Ellis Fischel Cancer Center, University of Missouri-Columbia, Columbia
| | - Kevin F. Staveley-O’Carroll
- Department of Surgery, University of Missouri-Columbia, Columbia
- Ellis Fischel Cancer Center, University of Missouri-Columbia, Columbia
| | - Guangfu Li
- Department of Surgery, University of Missouri-Columbia, Columbia
- Ellis Fischel Cancer Center, University of Missouri-Columbia, Columbia
- Department of Molecular Microbiology and Immunology, University of Missouri-Columbia, Columbia
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20
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Lewandowski RJ, Salem R. Microwave or radiofrequency ablation: clinically equivalent? Lancet Gastroenterol Hepatol 2018; 3:291-292. [DOI: 10.1016/s2468-1253(18)30046-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/07/2018] [Indexed: 11/25/2022]
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Fang M, Zheng WJ, Yao M, Dong ZZ, Yao DF. Novel specific markers for hepatocellular carcinoma: Perspective on clinical applications. Shijie Huaren Xiaohua Zazhi 2017; 25:865-873. [DOI: 10.11569/wcjd.v25.i10.865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. Despite continuous global efforts aimed at HCC eradication and improvements in various treatment techniques, the prognosis of HCC remains very poor. How to monitor malignant transformation of hepatocytes or diagnose HCC at early stage is still a medical challenge. A growing understanding of the multiple pathogenic factors including hepatitis B virus or hepatitis C virus infection, lipid accumulation, aflatoxin B1 intake and so on suggests that hepatocarcinogenesis is a multistep process. A large number of oncogenes or tumor suppressor genes have been identified. Early screening of HCC patients has been reported to confer a survival benefit. Although serum alpha-fetoprotein (AFP) and hepatoma-specific AFP have been used as conventional tumor markers, they often show false-positive results and lack sufficient sensitivity and specificity. In order to provide optimal treatment for each patient with HCC, more precise and effective biomarkers are urgently needed in all phases of management from early detection to staging, treatment monitoring, and prognosis evaluation. Recently, numerous studies have shown the clinical utility of novel blood-based biomarkers, such as circulating tumor cells, key signal molecules or specific proteins, long non-coding RNAs, and microRNAs. In this article, we will review some novel HCC-related biomarkers and discuss their future perspective on clinical applications.
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22
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Qi X, Lam SS, Liu D, Kim DY, Ma L, Alleruzzo L, Chen W, Hode T, Henry CJ, Kaifi J, Kimchi ET, Li G, Staveley-O'Carroll KF. Development of inCVAX, In situ Cancer Vaccine, and Its Immune Response in Mice with Hepatocellular Cancer. ACTA ACUST UNITED AC 2016; 7. [PMID: 27656328 PMCID: PMC5027967 DOI: 10.4172/2155-9899.1000438] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Manipulation of immune system toward the rejection of established cancers has become the standard of care in some patients. Here we propose the development of an in situ autologous cancer vaccine, inCVAX, for the treatment of hepatocellular cancer (HCC). inCVAX is based on the induction of local immunogenic cancer cell death combined with local dendritic cell stimulation by intratumoral injection of the immune-activator N-dihydro-galacto-chitosan (GC). In a first set of experiments, cellular and molecular studies were performed to investigate the effect of inCVAX on immune activation in a murine model of HCC that we previously developed. Once large tumors were formed in mice, the tumor is surgically exposed and a laser fiber was inserted into the center of an individual tumor mass. Using a 10 mm diffuser tip, laser irradiation of 1.5 W was applied to heat the tumor at different durations (6-10 min) to assess tolerability of photothermal application at different temperatures. The laser application was followed by immediate injection of GC, and each mouse received one laser treatment and one GC injection. ELISA was used to assess the level of cytokines; immunohistochemical staining was conducted to analyze the effect of inCVAX on immune cell tumor-filtration and expression of tumor-specific antigens (TSAs) and tumor-associated antigens (TAAs). Results indicate that survival correlated to thermal exposure. At lower temperatures the photothermal effect was sufficient to induce tumor necrosis, but without obvious complication to the mice, although at these temperatures the treatment didn’t alter the level of TSAs and TAAs, so further optimization is suggested. Nevertheless, in response to the inCVAX treatment, cytotoxic cytokine IFN-γ was significantly increased, but suppressive cytokine TGF-β was dramatically reduced. Furthermore, inCVAX prompted tumor infiltration of CD3+, CD4+, and CD8+ T cells; but modulated macrophage subsets differently. In conclusion, while the protocol needs further optimization, it would appear that inCVAX for the treatment of HCC activates an immune response in tumor-bearing mice, which in turn may have potential for the treatment of HCC.
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Affiliation(s)
- Xiaoqiang Qi
- Department of Surgery, University of Missouri, Columbia, MO 65212, USA ; Ellis Fischel Cancer Center, University of Missouri, Columbia, MO 65212, USA
| | - Samuel Sk Lam
- Immunophotonics Inc., 4320 Forest Park Avenue #303, St. Louis, Missouri 63108, USA
| | - Dai Liu
- Department of Surgery, University of Missouri, Columbia, MO 65212, USA ; Ellis Fischel Cancer Center, University of Missouri, Columbia, MO 65212, USA
| | - Dae Young Kim
- Veterinary Medical Diagnostic Laboratory, College of Veterinary Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Lixin Ma
- Department of Radiology, University of Missouri, Columbia, MO 65212; Harry S. Truman Memorial VA Hospital Biomolecular Imaging Center, USA
| | - Lu Alleruzzo
- Immunophotonics Inc., 4320 Forest Park Avenue #303, St. Louis, Missouri 63108, USA
| | - Wei Chen
- Veterinary Medical and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Tomas Hode
- Immunophotonics Inc., 4320 Forest Park Avenue #303, St. Louis, Missouri 63108, USA
| | - Carolyn J Henry
- Department of Molecular Microbiology and Immunology, University of Missouri, Columbia, MO 65212, USA
| | - Jussuf Kaifi
- Department of Surgery, University of Missouri, Columbia, MO 65212, USA ; Ellis Fischel Cancer Center, University of Missouri, Columbia, MO 65212, USA
| | - Eric T Kimchi
- Department of Surgery, University of Missouri, Columbia, MO 65212, USA ; Ellis Fischel Cancer Center, University of Missouri, Columbia, MO 65212, USA
| | - Guangfu Li
- Department of Surgery, University of Missouri, Columbia, MO 65212, USA ; Ellis Fischel Cancer Center, University of Missouri, Columbia, MO 65212, USA
| | - Kevin F Staveley-O'Carroll
- Department of Surgery, University of Missouri, Columbia, MO 65212, USA ; Ellis Fischel Cancer Center, University of Missouri, Columbia, MO 65212, USA ; Department of Molecular Microbiology and Immunology, University of Missouri, Columbia, MO 65212, USA
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