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D'Amora P, Silva IDCG, Tewari KS, Bristow RE, Cappuccini F, Evans SS, Salzgeber MB, Addis-Bernard PJ, Palma AM, Marchioni DML, Carioca AAF, Penner KR, Alldredge J, Longoria T, Nagourney RA. Platinum resistance in gynecologic malignancies: Response, disease free and overall survival are predicted by biochemical signature: A metabolomic analysis. Gynecol Oncol 2021; 163:162-170. [PMID: 34446269 DOI: 10.1016/j.ygyno.2021.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/22/2021] [Accepted: 08/01/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Platinum resistance, defined as the lack of response or relapse within six months of platinum-based chemotherapy, is an important determinant of survival in gynecologic cancer. We used quantitative Mass Spectrometry to identify metabolic signatures that predict platinum resistance in patients receiving chemotherapy for gynecologic cancers. METHODS In this study 47 patients with adenocarcinoma of the ovary or uterus who were candidates for carboplatin plus paclitaxel submitted blood for quantitation of metabolites and surgical specimens for the isolation 3-dimensional organoids used to measure individual patient platinum resistance, ex vivo. Results were correlated with response, time to progression and survival. RESULTS Of 47 patients, 27 (64.3%) achieved complete remission with a mean time to progression of 1.9 years (± 1.5), disease-free survival of 1.7 years (± 1.4) and overall survival of 2.6 years (± 1.6) and a mean cisplatin lethal concentration 50% (LC50) = 1.15 μg/ml (range 0.4-3.1). Cisplatin LC50's correlated with a non-significant decrease in complete remission (RR [95% CI] =0.76 [0.46-1.27]), diminished disease-free survival (median: 1.15 vs. 2.99 years, p = 0.038) and with biochemical signatures of 186 metabolites. Receiver operating curves (ROC) of lipid ratios, branched chain amino acids and the tryptophan to kynurenine ratio identified patients at the highest risk of relapse and death (AUC = 0.933) with a sensitivity of 92.0% and specificity of 86.0% (p < 0.001). CONCLUSIONS Metabolic signatures in gynecologic cancer identify patients at the highest risk of relapse and death offering new diagnostic and prognostic tools for management of the advanced gynecologic tumors.
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Affiliation(s)
- Paulo D'Amora
- Molecular Gynecology and Metabolomics Lab, Gynecology Department, College of Medicine of the Federal University of São Paulo (EPM-UNIFESP), Rua Pedro de Toledo, 781 - 4o. andar frente, 04039-032 São Paulo, SP, Brazil; Nagourney Cancer Institute, 750 East 29th Street, 90806 Long Beach, CA, USA; Metabolomycs, Inc., 750 East 29th Street, 90806 Long Beach, CA, USA.
| | - Ismael Dale C G Silva
- Molecular Gynecology and Metabolomics Lab, Gynecology Department, College of Medicine of the Federal University of São Paulo (EPM-UNIFESP), Rua Pedro de Toledo, 781 - 4o. andar frente, 04039-032 São Paulo, SP, Brazil; Metabolomycs, Inc., 750 East 29th Street, 90806 Long Beach, CA, USA
| | - Krishnansu S Tewari
- Memorial Medical Center of Long Beach, Todd Cancer Institute, 2810 Long Beach Blvd, Long Beach 90806, CA, USA; Department of Obstetrics and Gynecology, University of California Irvine (UCI) School of Medicine, 101 The City Drive South, Orange 92868, CA, USA
| | - Robert E Bristow
- Memorial Medical Center of Long Beach, Todd Cancer Institute, 2810 Long Beach Blvd, Long Beach 90806, CA, USA; Department of Obstetrics and Gynecology, University of California Irvine (UCI) School of Medicine, 101 The City Drive South, Orange 92868, CA, USA
| | - Fabio Cappuccini
- Memorial Medical Center of Long Beach, Todd Cancer Institute, 2810 Long Beach Blvd, Long Beach 90806, CA, USA; Department of Obstetrics and Gynecology, University of California Irvine (UCI) School of Medicine, 101 The City Drive South, Orange 92868, CA, USA
| | - Steven S Evans
- Nagourney Cancer Institute, 750 East 29th Street, 90806 Long Beach, CA, USA; Metabolomycs, Inc., 750 East 29th Street, 90806 Long Beach, CA, USA
| | - Marcia B Salzgeber
- Molecular Gynecology and Metabolomics Lab, Gynecology Department, College of Medicine of the Federal University of São Paulo (EPM-UNIFESP), Rua Pedro de Toledo, 781 - 4o. andar frente, 04039-032 São Paulo, SP, Brazil
| | | | - Anton M Palma
- Institute for Clinical and Translational Science (ICTS), University of California Irvine (UCI), 843 Health Science Rd, Irvine 92697, CA, USA
| | - Dirce M L Marchioni
- Nutrition Department, School of Public Health, University of São Paulo School of Medicine (FMUSP), Av. Dr Arnaldo 715, 01246-904 São Paulo, SP, Brazil
| | - Antonio A F Carioca
- Nutrition Department, University of Fortaleza (UNIFOR), Av. Washington Soares, 1321, 60811-905 Fortaleza, CE, Brazil
| | - Kristine R Penner
- Kaiser Permanente South Bay Medical Center, 25825 S Vermont Ave, Harbor City 90710, CA, USA
| | - Jill Alldredge
- UCHealth Cancer Care - Anschutz Medical Campus, University of Colorado Cancer Center, 1665 Aurora Court, Aurora 80045, CO, USA
| | - Teresa Longoria
- Scripps Clinic John R. Anderson V Medical Pavilion, 9898 Genesee Ave, La Jolla 92037, CA, USA
| | - Robert A Nagourney
- Nagourney Cancer Institute, 750 East 29th Street, 90806 Long Beach, CA, USA; Metabolomycs, Inc., 750 East 29th Street, 90806 Long Beach, CA, USA; Memorial Medical Center of Long Beach, Todd Cancer Institute, 2810 Long Beach Blvd, Long Beach 90806, CA, USA; Department of Obstetrics and Gynecology, University of California Irvine (UCI) School of Medicine, 101 The City Drive South, Orange 92868, CA, USA
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