Molecular Characterization of TFE3-Rearranged Renal Cell Carcinoma: A Comparative Study With Papillary and Clear Cell Renal Cell Carcinomas

TFE3-rearranged renal cell carcinoma (rRCC) is a rare subtype of renal cell carcinomas belonging to the MiT family translocation RCC. To further elucidate the co-alterations that occur along with TFE3 fusions in rRCC, we characterized the genomic, transcriptional, and immune landscapes in comparison to clear cell (ccRCC) and papillary renal cell carcinoma (pRCC). Next-generation sequencing of RNA (whole transcriptome) and DNA (592-gene panel or whole exome) for rRCC (N = 20), pRCC (N = 20), and ccRCC samples (N = 392) was performed. Patients with rRCC were significantly younger and more frequently female (median 44.5 years, 75.0% female) as compared with patients with pRCC (68.5 years, 25.0% female; P < .05) and ccRCC (62.0 years, 27.8% female; P < .05). A total of 8 unique fusion partners were observed, including a novel fusion with SRRM2::TFE3 in 2 patients. ccRCC exhibited significantly higher mutation rates of VHL (0% rRCC, 0% pRCC, 78.7% ccRCC; P < .05) and PBMR1 (0% rRCC, 5.0% pRCC, 49.4% ccRCC; P < .05). The genomic landscapes of rRCC were sparse with no mutations occurring with a prevalence higher than 10% other than pTERT (18.2% rRCC, 0% pRCC, 9.2% ccRCC). rRCC were associated with significantly less M1 macrophages (0.8%) as compared with pRCC (1.4%) and ccRCC (2.7%) (P < .05), suggesting a cold tumor-immune microenvironment. However, rRCC were more commonly PD-L1+ (rRCC 50%, pRCC 19.0%, ccRCC 12.2%; P < .05). Gene set enrichment analysis showed that rRCC are enriched in genes related to oxidative phosphorylation when compared with both ccRCC and pRCC. Despite having a colder tumor-immune microenvironment than pRCC and ccRCC, increased PDL1+ rates in rRCC suggest a potential benefit from immune checkpoint inhibitor therapy.

Expression of tumoral GSK3-β, PD-L1, and CD8 cell density in urothelial carcinomas, association with tumor grade and overall survival

Bladder cancer is the most common malignancy in the urinary tract, and is biologically and clinically quite heterogeneous. Around 90% of diagnoses are made in the 6th decade, being more prevalent in males. The programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1) axis play a putative role in immune checkpoint and as a means through which cancer evades the immune system. Inhibition of the glicogênio synthase kinase (GSK) 3 leads to the downregulation of PD-1 via upregulation of the transcription factor Tbet. The use of biomarkers PD-L1 and GSK-3β and evaluation of the immune infiltrate have very promising correlations with urothelial carcinoma prognosis and treatment prediction.

OBJECTIVE

To investigate the protein expression of PD-L1 and GSK-3β and the CD8-positive immune infiltrates in bladder carcinomas.

MATERIALS AND METHODS

This was a cross-sectional study of 140 samples of urothelial carcinomas from 2015 to 2018. Automated digitally assisted scoring and conventional analyses of the markers of GSK-3β (27C10), CD8 (7103β) and PDL-1 (22c3), were reviewed by two pathologists independently and a histologic score was calculated. The density of CD8 was also measured.

RESULTS

The immunoexpression of GSK-3β (91%) was presented in most samples, PD-L1 in 62.9% and CD8 cells present in 46.3% of cases. When analyzed in conjunction, the levels of GSK-3β and PD-L1 (P = 0.033), and CD8 and PD-L1 (P<0.002) showed significant correlations. No significant associations were observed between GSK-3β and CD8. The positivity of GSK-3β and PD-L1 was predominant in high-grade tumors.

CONCLUSION

Despite the tumor microenvironment heterogeneity, the expression of CD8, GSK-3β and PDL1 could be valuable and GSK-3β could be a potential target in advanced bladder cancer, especially in the context of immunotherapy.

Abstract 3947: Antitumor efficacy of combination treatment with ONC201 and enzalutamide or darolutamide in metastatic castration-resistant prostate cancer

The androgen receptor (AR) signaling pathway plays a primary role in prostate cancer progression. Various types of androgen receptor antagonists including enzalutamide, abiraterone and apalutamide have been widely used as single agents to treat patients with advanced disease. However, despite the initial improvements, patients with metastatic castration-resistant prostate cancer (mCPRC) frequently develop resistance, resulting in limited overall survival benefit. Darolutamide is a novel next-generation androgen receptor-signaling inhibitor currently in phase III clinical trials and has shown efficacy and tolerability in treating non-metastatic castration-resistant prostate cancer. ONC201 is a small molecule belonging to the imipridone class that activates the integrated stress response (ISR) pathway and upregulates TRAIL. ONC201 has demonstrated promising antiproliferative and proapoptotic effects in a variety of tumor types and is currently being evaluated in phase I/II clinical trials. This study investigates the integrated stress response and androgen receptor signaling as mechanisms for antitumor efficacy with ONC201 and enzalutamide or darolutamide as single agents or in combination against mCRPC in vitro and in vivo. Three mCRPC cell lines 22RV1, LNCaP, and PC3 were treated with ONC201, darolutamide, and enzalutamide as single agents or in combinations. In 22RV1, the single agent IC50 was calculated to be 1.22uM for ONC201, 51.5uM for darolutamide and &gt;80uM for enzalutamide. In LNCaP, the single agent IC50s are 1.67uM for ONC201, 58.7uM for darolutamide, and 4.05uM for enzalutamide. In 22RV1, the combination index (CI) of 0.38 was obtained when treated with 40uM of darolutamide and 1.25uM of ONC201, CI was 0.35 when treated with 80uM of enzalutamide and 1.25uM of ONC201. In LNCaP, CI of 0.19 was obtained when treated with 10uM of darolutamide and 0.3125uM of ONC201, CI was 0.45 when treated with 5uM of enzalutamide and 2uM of ONC201. Results showed that ONC201 synergized with darolutamide and enzalutamide and decreased cell viability. In both 22RV1 and LNCaP cell lines, when compared to single agents, combination treatments of ONC201 and darolutamide or enzalutamide reduced PSA level and demonstrated proapoptotic effects. Mouse xenograft models with luciferase expressing 22RV1 and LNCaP cell lines are currently being treated with ONC201 and darolutamide or enzalutamide as single agents or in combinations and the in vivo studies are ongoing. Our data provide insights to improved therapeutic benefits of combination treatment that can be further developed for more efficient anticancer strategies.

Citation Format: Jinxuan Laura Wu, Lanlan Zhou, Leiqing Zhang, Kelsey E. Huntington, Benedito Carneiro, Wafik S. El-Deiry. Antitumor efficacy of combination treatment with ONC201 and enzalutamide or darolutamide in metastatic castration-resistant prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3947.

Abstract 2593: Combined ATR+PARP inhibition exhibits potent synergy in colorectal and pancreatic cancer cytotoxicity

Precision medicine continues to expand treatment options for patients tailored to tumor phenotype. In homologous recombination (HR) deficient cancers like those with BRCA1/2-mutations, inhibition of poly (ADP-ribose) polymerase (PARP) has shown improved mortality compared to older gold standard therapies like DNA damaging agents. Unfortunately estimates upward of 40% of patients develop resistance to PARP inhibitor monotherapy during the course of their treatment. We explored potential synergistic drug combinations to re-sensitize tumors with acquired PARP inhibitor resistance in pancreatic and colorectal cancer. We hypothesized that dual inhibition of the DDR pathway through PARP and Ataxia telangiectasia and Rad3 related (ATR) inhibition would combine synergistically especially in cell lines with existing HR deficiencies through a synthetic lethality-mediated response. The ATR inhibitor Ceralasertib was selected for its potent antagonism of the DDR pathway, a key pathway associated with cell survival through DNA repair. Pancreatic and colorectal cell lines were carefully selected based on their varying mutational profiles to study differences in response to dual treatment. CellTiter-Glo® (CTG) was used after drug treatment to quantify IC-50. CTG synergy and combination indices were used to study drug combinations, and western blotting identified changes in protein expression among key mediators of cell survival and apoptosis. Colony forming assays and cytokine profiling using Luminex technology (and single cell cytokine profiling) were performed to study changes within the tumor microenvironment. We observed strong synergy and cytotoxicity in addition to increased apoptosis and cellular disassembly following treatment with dual ATR+PARP inhibition compared to monotherapy alone. Western Blot showed upregulation of cleaved PARP and cleaved Caspase 8 with combination therapy, and cytokine profiles provided insights into immune-suppressive versus stimulatory TME after drug treatment. There is potent synergy when ATR inhibitors are added to PARPi therapy in the context of pancreatic and colorectal cancers. Ongoing research efforts are further characterizing the mechanisms underlying these observed synergies in the same and additional tumor types such as prostate and ovarian cancer.

Citation Format: Anna M. Ochsner, Kelsey E. Huntington, Lanlan Zhou, Benedito Carneiro, Wafik El-Deiry. Combined ATR+PARP inhibition exhibits potent synergy in colorectal and pancreatic cancer cytotoxicity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2593.

CTNI-13. MALIGNANT GLIOMA SUBSET FROM ACTUATE 1801 PHASE 1/2 STUDY OF 9-ING-41, A GLYCOGEN SYNTHASE KINASE 3 BETA (GSK-3β) INHIBITOR, AS A SINGLE AGENT AND COMBINED WITH CHEMOTHERAPY REFRACTORY

BACKGROUND

GSK3β serine/threonine kinase regulates metabolism and glycogen biosynthesis. GSK3β overexpression promotes tumor progression and resistance through NF-κB and p53 apoptotic pathways. GSK3β inhibits immunomodulation by downregulating checkpoints, e.g. PD-L1 and LAG-3, and increasing NK and T-cell mediated tumor killing. 9-ING-41 is a small-molecule, potent, selective GSK3β inhibitor with preclinical activity. In chemoresistant PDX glioblastoma models, 9-ING-41 enhanced lomustine antitumor effect.

METHODS

Patients with refractory malignancies were treated with 9-ING-41 monotherapy (n=65) or combined with 8 cytotoxic regimens after prior exposure (n=162) in the first-in-human study (NCT03678883). The recurrent gliomas subset was treated with 9-ING-41 monotherapy IV TIW q21day cycles at 3.3, 5, 9.3, 15mg/kg, or combined with lomustine 30 mg/m² PO weekly q84day cycles. Primary objective was safety and tolerability.

RESULTS

An RP2D of 15mg/kg IV TIW was confirmed across all 9 regimens, no accentuation of chemotherapy toxicity noted. Of 18 glioma patients enrolled, 13 were glioblastoma, 2 anaplastic astrocytomas, 1 anaplastic oligodendroglioma, and 1 diffuse astrocytoma; 6 female, 12 male; median age 52 (30-69) years; median ECOG was 1 (0-2). All received initial radiation and temozolomide (18/18), prior salvage therapies included nitrosoureas (15/18), bevacizumab (8/18), TTFields (6/18), checkpoint inhibitor (4/18). Median recurrences 3 (1-6). NGS alterations included: IDH/wildtype (11), IDH/mutation(3); 1p19q/codeletion(10); MGMT/unmethylated(11), MGMT/methylated(1); EGFR/amplification(6), EGFR/v3mutation(3), TERT/mutation(6), PTEN/loss(3), NF1/rearrangement(2), ATRX/loss (2), TP53/mutation(4), CDKN2A/deletion(2), RB1/loss(1), PALB2/mutation(10). Four patients received 9-ING-41 monotherapy, 14 concurrently treated with lomustine. No SAEs or grade 3/4 AEs attributed to 9-ING-41 noted, only G1/2 vision changes (9/18, 50%), infusion reactions (4/18, 22%). Lomustine-related toxicities included G3/4 thrombocytopenia (3/14, 21%), and G1/2 fatigue (4/14, 28%). Median therapy duration was 55 (4-305); 1 partial response ( &gt;50%) noted with 9-ING-41/lomustine. Median PFS and OS were 1.9 (0.3-11.1) and 6.0 (1.6-16.6) months, respectively.

CONCLUSIONS

9-ING-41 plus/minus lomustine is safe and warrants further study in glioma patients.

Comparison of reproductive management programs for submission of Holstein heifers for first insemination with conventional or sexed semen based on expression of estrus, pregnancy outcomes, and cost per pregnancy

Our objective was to evaluate reproductive management programs for submission of Holstein heifers for first insemination with conventional or sexed semen. In experiment 1, nulliparous Holstein heifers (n = 462) were submitted to a 5-d progesterone-releasing intravaginal device (PRID)-Synch protocol [d 0, GnRH + PRID; d 5, PGF_2α - PRID; d 6, PGF_2α; d 8, GnRH + TAI] and were randomly assigned for PRID removal on d 5 or 6 of the protocol followed by timed artificial insemination (TAI) with conventional semen. Delaying PRID removal decreased early expression of estrus before scheduled TAI (0.9 vs. 12.2%), and pregnancies per AI (P/AI) did not differ between treatments. In experiment 2, nulliparous Holstein heifers (n = 736) from 3 commercial farms were randomized within farm to 1 of 3 treatments for first AI with sexed semen: (1) CIDR5 [d -6, GnRH + controlled internal drug release (CIDR); d -1, PGF_2α - CIDR; d 0, PGF_2α; d 2, GnRH + TAI]; (2) CIDR6 (d -6, GnRH + CIDR; d -1, PGF_2α; d 0, PGF_2α - CIDR; d 2, GnRH + TAI); and (3) EDAI (PGF_2α on d 0 followed by once-daily estrous detection and AI). Delaying CIDR removal decreased early expression of estrus before scheduled TAI (0.004 vs. 27.8%); however, CIDR5 heifers tended to have more P/AI at 35 (53 vs. 45 vs. 46%) and 64 (52 vs. 45 vs. 45%) days after AI than CIDR6 and EDAI heifers, respectively. Overall, CIDR5 and CIDR6 heifers had fewer days to first AI and pregnancy than EDAI heifers which resulted in less feed costs than EDAI heifers due to fewer days on feed until pregnancy. Despite greater hormonal treatment costs for CIDR5 heifers, costs per pregnancy were $16.66 less for CIDR5 than for EDAI heifers. In conclusion, delaying PRID removal by 24 h within a 5-d PRID-Synch protocol in experiment 1 suppressed early expression of estrus before TAI, and P/AI for heifers inseminated with conventional semen did not differ between treatments. By contrast, although delaying CIDR removal by 24 h within a 5-CIDR-Synch protocol in experiment 2 suppressed early expression of estrus before TAI, delaying CIDR removal by 24 h tended to decrease P/AI for heifers inseminated with sexed semen. Further, submission of heifers to a 5-d CIDR-Synch protocol for first AI tended to increase P/AI and decrease the cost per pregnancy compared with EDAI heifers.

ONC201 and imipridones: Anti-cancer compounds with clinical efficacy

ONC201 was originally discovered as TNF-Related Apoptosis Inducing Ligand (TRAIL)-inducing compound TIC10. ONC201 appears to act as a selective antagonist of the G protein coupled receptor (GPCR) dopamine receptor D2 (DRD2), and as an allosteric agonist of mitochondrial protease caseinolytic protease P (ClpP). Downstream of target engagement, ONC201 activates the ATF4/CHOP-mediated integrated stress response leading to TRAIL/Death Receptor 5 (DR5) activation, inhibits oxidative phosphorylation via c-myc, and inactivates Akt/ERK signaling in tumor cells. This typically results in DR5/TRAIL-mediated apoptosis of tumor cells; however, DR5/TRAIL-independent apoptosis, cell cycle arrest, or antiproliferative effects also occur. The effects of ONC201 extend beyond bulk tumor cells to include cancer stem cells, cancer associated fibroblasts and immune cells within the tumor microenvironment that can contribute to its efficacy. ONC201 is orally administered, crosses the intact blood brain barrier, and is under evaluation in clinical trials in patients with advanced solid tumors and hematological malignancies. ONC201 has single agent clinical activity in tumor types that are enriched for DRD2 and/or ClpP expression including specific subtypes of high-grade glioma, endometrial cancer, prostate cancer, mantle cell lymphoma, and adrenal tumors. Synergy with radiation, chemotherapy, targeted therapy and immune-checkpoint agents has been identified in preclinical models and is being evaluated in clinical trials. Structure-activity relationships based on the core pharmacophore of ONC201, termed the imipridone scaffold, revealed novel potent compounds that are being developed. Imipridones represent a novel approach to therapeutically target previously undruggable GPCRs, ClpP, and innate immune pathways in oncology.

Histone methyltransferase DOT1L coordinates AR and MYC stability in prostate cancer

The histone methyltransferase DOT1L methylates lysine 79 (K79) on histone H3 and is involved in Mixed Lineage Leukemia (MLL) fusion leukemogenesis; however, its role in prostate cancer (PCa) is undefined. Here we show that DOT1L is overexpressed in PCa and is associated with poor outcome. Genetic and chemical inhibition of DOT1L selectively impaired the viability of androgen receptor (AR)-positive PCa cells and organoids, including castration-resistant and enzalutamide-resistant cells. The sensitivity of AR-positive cells is due to a distal K79 methylation-marked enhancer in the MYC gene bound by AR and DOT1L not present in AR-negative cells. DOT1L inhibition leads to reduced MYC expression and upregulation of MYC-regulated E3 ubiquitin ligases HECTD4 and MYCBP2, which promote AR and MYC degradation. This leads to further repression of MYC in a negative feed forward manner. Thus DOT1L selectively regulates the tumorigenicity of AR-positive prostate cancer cells and is a promising therapeutic target for PCa.

Histone methyltransferase, DOTL1 is implicated in the pathogenesis of MLL-rearranged leukemia, however, not much is known of its role in prostate cancer (PCa). Here, the authors report that DOTL1 inhibition suppresses both androgen receptor and MYC pathways in a negative feed forward manner to reduce growth of AR-positive PCa.

Abstract 2959: Glycogen synthase kinase 3-β expression in prostate cancer (PCa) correlates with aggressive pathological features and its blockade with 9-ING-41 inhibits viability of PCa cell lines

Castration-resistant prostate cancer (CRPC) represents a lethal stage of disease with limited treatment options beyond androgen receptor (AR) inhibitors and chemotherapy. GSK-3β is a serine/threonine kinase established as a therapeutic target in several solid tumors. GSK-3β inhibitors reduce prostate cancer cell growth and inhibit AR-V7 transcriptional activity in vitro (Rinnab L et al 2008; Schütz SV et al 2011; Nakata et al 2017). This study aimed to characterize the GSK-3β expression in molecular subtypes of PCa and the antitumor activity of 9-ING-41, a selective small molecule GSK-3β inhibitor currently in phase 1/2 clinical studies (NCT03678883). We hypothesized that GSK3-β expression may correlate with sensitivity to GSK3-β inhibition as well as suppression of anti-apoptotic pathways. We evaluated the expression of GSK-3β in a tissue microarray of 134 specimens of PCa tumors from radical prostatectomies (median age 69, serum PSA 10.5 ± 7.6 ng/ml; grade groups (GG): 18 - GG 1 (13.4%), 67 - GG 2 (48.5%), 29 - GG 3 (21.4%), 7 - GG 4 (5.2%), 13 - GG 5 (9.7%); 72 patients (54.9%) had pT2 tumors, and 52 (39,1%) were pT3. Seven patients (5.7%) had positive lymph node (pN1 disease). ERG expression and PTEN loss were observed in 52% (71/134) and 42%, respectively. The GSK-3β histologic score (% of positive tumor cells multiplied by intensity 0-3) correlated with higher Gleason grade (p&lt;0.05), extraprostatic extension (pT3a, p&lt;0.05), but not with serum PSA, tumor volume, margin status or size of index nodule. Cases with predominant nuclear localization of GSK-3β (5%; N=7) had higher Gleason score, pathologic stage, and all but one had PTEN loss. The antiproliferative effect of 9-ING-41 in four PCa human cell lines (PC3, DU145, LNCAP and 22rV1) was investigated using Cell-Titer-Glo (CTG) viability assay. 9-ING-41 demonstrated a dose-dependent decrease in proliferation of AR positive (IC50s 0.3 μM LNCAP; 0.8 μM 22rV1) and AR negative cell lines (IC50 0.6 μM PC3, 0.2 μM DU145). 9-ING-41 induced robust apoptosis (cleaved PARP) in LNCAP and PC3 cells, but not in DU145. All four cell lines expressed GSK-3β, the target of 9-ING-41 and its level were not altered by treatment. 9-ING-41 decreased the expression of phosphorylated NF-kβ (Ser536), anti-apoptotic proteins MCL-1 and BCL-2 by western immunoblotting. Interestingly, the most sensitive cell line, DU145, had lower levels of NF-kβ and suppressed both MCL-1 and BCL-2 after exposure to 9-ING-41. Our current work is evaluating the extent of apoptosis versus growth arrest, especially in the DU145 cell line, where PARP cleavage was not observed. We are also evaluating the effects of the 9-ING-41 on cellular targets of GSK-3β as potential markers of drug efficacy. 9-ING-41 has potent anti-proliferative activity against PCa cell lines. These data support the inclusion of patients with CRPC in clinical studies of 9-ING-41 and its further investigation for the treatment of CRPC.

Citation Format: Fabio Tavora, Tamara Lotan, Marclesson Alves, Lanlan Zhou, Ali Amin, Navaraj Arunasalam, Andre De Souza, Anthony Mega, Dragan Golijanin, Frank Giles, Wafik El-Deiry, Benedito Carneiro. Glycogen synthase kinase 3-β expression in prostate cancer (PCa) correlates with aggressive pathological features and its blockade with 9-ING-41 inhibits viability of PCa cell lines [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2959.

Abstract 1836: ONC201 shows synergistic effect with the androgen receptor AR-inhibitor darotulamide in prostate cancer models

Prostate cancer (PC) is the most frequently diagnosed cancer among men in the United States and is the 3rd cause of cancer mortality. Despite advances in the treatment and understanding of pathogenesis, patients with metastatic PC invariably progress to a lethal stage of castration-resistant prostate cancer (CRPC). Inhibition of androgen signaling remains crucial for the treatment of CRPC, but novel treatment strategies are urgently needed. ONC201 is a first-in-class, selective inhibitor of dopamine receptor D2 that upregulates death-receptor 5 and induces apoptosis. ONC201 induced apoptosis in PC cell lines and showed synergy with enzalutamide, docetaxel and everolimus (Lev A Mol Cancer Res 2018). Darolutamide (DARO) is a novel androgen receptor (AR) antagonist approved for treatment of patients with non-metastatic CRPC. DARO has higher affinity to AR and preclinical activity against enzalutamide-resistant PC cell lines including AR variants associated with enzalutamide agonism (Borgmann H Eur Urol 2018). We treated human PC cell lines (LNCAP [castration sensitive, AR wild-type], 22Rv1 [castration-resistant cell line that expresses AR splice variant AR-V7], DU145 [AR negative], PC3 [AR negative]) with DARO alone and combined with ONC201. Single-agent DARO decreased PC cell viability in Cell-Titer-Glo assays (IC50s of 10 and 693 nM for LNCAP and DU145, respectively). ONC201 showed strong synergism with DARO in LNCAP cells (combination indices &lt; 1 at concentrations of 156, 312, 625 nM, and 1.25 µM of DARO with 2.5 μM ONC201). ONC201 induced robust apoptosis in 22Rv1 as measured by PARP cleavage, which was partially amplified by DARO. PARP cleavage was also observed in LNCAP cells with less intensity and not potentiated by DARO. ONC201 reduced the expression of phospho-AR (p-AR) in both 22Rv1 and LNCAP. The combination of ONC201 and DARO had a significant additive effect in reducing p-AR in 22Rv1, but not in LNCAP. ONC201 reduced PSA protein levels in LNCAP cells while DARO alone did not cause any significant change in PSA. Immunofluorescence experiments showed that DARO caused significant reduction of AR nuclear translocation in both 22rV1 and LNCAP cells. The combination with ONC201 potentiated this inhibition of AR translocation in both cell lines. ONC201 showed strong antiproliferative activity against PC cells lines independent of AR status. Combination of ONC201 with DARO demonstrated synergy in enzalutamide resistant 22Rv1 cells expressing AR-V7 with marked reduction of nuclear localization of AR. Our studies provide preclinical rationale for combination of ONC201 with DARO as a novel therapy of PC.

Citation Format: Fabio Tavora, Lanlan Zhou, Ali Amin, Safran Howard, Navaraj Arunasalam, Andre de Souza, Anthony Mega, Dragan Golijanin, Wafik El-Deiry, Benedito Carneiro. ONC201 shows synergistic effect with the androgen receptor AR-inhibitor darotulamide in prostate cancer models [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1836.

Abstract 2553: PSMA-specific, TGF-ß-insensitive CD8+ T cells derived from metastatic castration resistant prostate cancer (mCRPC) patients induce apoptosis of PSMA positive prostate cancer (PCa)

Introduction: Manufacture of tumor specific CD8+ T cells has been an obstacle for developing immunotherapies for PCa, especially in patients with mCRPC. Here we report a new immunotherapeutic approach using adoptive transfer of patient-derived PSMA-specific, TGF-ß-insensitive human CD8+ T cells to induce the apoptosis of PCa. Methods: Peripheral blood CD8+ T cells were collected from mCRPC patient by leukapheresis, and cultured in FDA approved Cell Processing Work Station with CD-3/CD28 beads. We developed a TßRIIDN-TK-IRES-PZ1 chimeric T cell receptor retroviral construct using an anti-PSMA IgTCR(ζ) gene (PZ1) and a dominant negative TGF-ß type II receptor (TßRIIDN), that could induce CD8+ T cells to be PSMA reactive and insensitive to TGF-ß. PC-3 cells (PSMA negative) or PSMA positive PC-3-PSMA cells were used for target cells for in vivo study. Subcutaneous injection of PC-3 and PC-3-PSMA cells (2x105 cells/each) into the left and right flank region respectively in each of 32 immunodeficient RAG-1 mice was performed. One week later, the animals were randomly assigned to one of three adoptive transfer groups (16 mice /each group, 2x106 CD8+ T cells/each mice): Group 1: PSMA-specific, TGF-ß-insensitive CD8+ T cells infected with TßRIIDN-TK-IRES-PZ1 (71.1% positive); Group 2: Naïve CD8+ T cells. The animals were provided 2 weekly adoptive transfer treatments and sacrificed after 3 weeks. The infiltration of CD8+ T cells and apoptosis of tumor tissue was evaluated by immunofluorescence staining and TUNEL assay. Results: In Group 1, the average tumor weight was significantly lower in the PC3-PSMA tumor (0.413g) compared to the PC3 tumor (2.75 g). There was no difference between the PC3 tumor (2.36g) compared to PC3-PSMA tumor (2.45g) in Group 2. H&E staining showed large amount of nuclear fusion, fragmentation and necrosis were found in PC3-PSMA tumors in Group 1 compared to Group 2. In Group 1, tumor apoptosis (72.5/1,000 μm2) and CD8+ T cell infiltration (45.5/1,000 μm2) in PC3-PSMA tumor parenchyma was significantly higher compared to PC3 tumor (6.7/1,000 μm2 and 3.1/1,000 μm2 respectively). There was no significant apoptosis or CD8+ T cells infiltration observed in either PC3 or PC3-PSMA tumor in Group 2 and Group 3. This result indicated that PSMA-specific, TGF-ß-insensitive CD8+ T cells can infiltrate into the PSMA positive tumor parenchyma and induce tumor apoptosis. Conclusion: This study demonstrated that our approach combines TGF-ß insensitive with PSMA selectivity can significantly enhance the specificity and anti-tumor ability of mCRPC patient's naïve CD8+ T cells, and simultaneously suppress the tumor by induce significant tumor apoptosis. Therefore, these PSMA-specific, TGF-ß-insensitive CD8+ T cells may offer a novel therapeutic intervention for both primary PCa treatment as well as for disease recurrence.

Citation Format: Qiang Zhang, Brian Helfand, Ximing Yang, Benedito Carneiro, Francis J. Giles, Timothy Kuzel, Chung Lee, Massimo Cristofanilli. PSMA-specific, TGF-ß-insensitive CD8+ T cells derived from metastatic castration resistant prostate cancer (mCRPC) patients induce apoptosis of PSMA positive prostate cancer (PCa) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2553.

Abstract 3687: Dot1l inhibition selectively impairs androgen receptor dependent prostate cancer growth through loss of telomere integrity

The histone methyltransferase DOT1L methylates lysine 79 (K79) on histone H3 and this histone mark is associated with activation of gene expression. DOT1L has a well-known role in MLL fusion leukemogenesis, however, its role in prostate cancer is yet to be elucidated. Here we show that DOT1L is overexpressed in many solid tumors including prostate cancer and is associated with a poor outcome. Genetic and chemical targeting of DOT1L showed a preferential loss in cell viability and colony formation in androgen receptor (AR)-signaling competent prostate cancer cells, including castration-resistant and enzalutamide-resistant cells. DOT1L inhibition reduced AR levels and upregulated enzymes involved in testosterone catabolism but only affected the expression of a subset of AR target genes. More importantly, loss of DOT1L selectively impaired telomere integrity by promoting telomere uncapping and shortening in AR-signaling competent cells. DOT1L inhibition also reduced the expression of telomerase and Shelterin complex genes including TRF2 and POT1. Recruitment of AR to telomeres and K79 methylation at sub-telomeric regions was also diminished. Consequently, loss of DOT1L leads to induction of Telomere dysfunction induced foci (TIF) and activates a cellular senescence program in these cells. Hence, these results provide compelling evidence for DOT1L inhibition as a novel therapeutic approach in advanced prostate cancers.

Citation Format: Rajita Vatapalli, Yara Rodriguez, Changsheng Zhao, Vinay Sagar, Jonathan Anker, Sahithi Pamarthi, Kenji Unno, Benedito Carneiro, Debabrata Chakravarti, Sarki Abdulkadir. Dot1l inhibition selectively impairs androgen receptor dependent prostate cancer growth through loss of telomere integrity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3687.

Adverse birth outcomes associated with Zika virus exposure during pregnancy in São José do Rio Preto, Brazil

OBJECTIVES

We aimed to report the first 54 cases of pregnant women infected by Zika virus (ZIKV) and their virologic and clinical outcomes, as well as their newborns' outcomes, in 2016, after the emergence of ZIKV in dengue-endemic areas of São Paulo, Brazil.

METHODS

This descriptive study was performed from February to October 2016 on 54 quantitative real-time PCR ZIKV-positive pregnant women identified by the public health authority of São José do Rio Preto, São Paulo, Brazil. The women were followed and had clinical and epidemiologic data collected before and after birth. Adverse outcomes in newborns were analysed and reported. Urine or blood samples from newborns were collected to identify ZIKV infection by reverse transcription PCR (RT-PCR).

RESULTS

A total of 216 acute Zika-suspected pregnant women were identified, and 54 had the diagnosis confirmed by RT-PCR. None of the 54 women miscarried. Among the 54 newborns, 15 exhibited adverse outcomes at birth. The highest number of ZIKV infections occurred during the second and third trimesters. No cases of microcephaly were reported, though a broad clinical spectrum of outcomes, including lenticulostriate vasculopathy, subependymal cysts, and auditory and ophthalmologic disorders, were identified. ZIKV RNA was detected in 18 of 51 newborns tested and in eight of 15 newborns with adverse outcomes.

CONCLUSIONS

Although other studies have associated many newborn outcomes to ZIKV infection during pregnancy, these same adverse outcomes were rare or nonexistent in this study. The clinical presentation the newborns we studied was mild compared to other reports, suggesting that there is significant heterogeneity in congenital Zika infection.

Abstract 1230: Talazoparib, a second generation PARP inhibitor, is a novel therapy for PTEN mutants in prostate cancer

Prostate cancer is the most common cancer among men, other than skin cancer, in the United States. When the cancer enters into the metastatic castration resistant stage (mCRPC), few treatment options are currently available and the disease is considered incurable. The purpose of this study is to investigate a new, targeted therapy against prostate cancers, including mCRPC. Talazoparib is a novel PARP inhibitor with up to 100-fold higher potency and PARP affinity when compared to PARP inhibitors such as olaparib, veliparib, and rucaparib. Current literature suggests that PTEN mutants have high sensitivity to talazoparib. PTEN is a tumor suppressor gene that is commonly lost in prostate cancers. A murine prostate cancer cell line, Myc-CaP, which has been modified to overexpress the oncogene Myc, was edited by the CRISPR-Cas9 system to knock out the PTEN gene. Myc-CaP and Myc-CaP PTEN KO cells were treated with olaparib, an FDA approved, first generation PARP inhibitor, and talazoparib. Talazoparib decreased cell viability significantly more in PTEN KO cells versus PTEN wild-type (WT) cells. No such trend was observed when these cells were treated with olaparib. In addition, IC50 values in prostate cancer cell lines with heterozygous or homozygous deletion of PTEN were up to 20 times lower with the talazoparib treatment when compared to olaparib. Not only does this indicate that talazoparib is much more potent than olaparib, but also preferentially impairs cell growth in PTEN mutants. PTEN’s signal transduction prevents the phosphorylation of AKT, which is necessary for cell proliferation. When cells were treated with an AKT inhibitor, MK2206, alone or in combination with talazoparib, pAKT protein levels decreased, but the greatest effect was seen when MK2206 was used in combination with a low dose of talazoparib in the Myc-Cap cell line with wt PTEN. Western blot analysis showed that PTEN was upregulated following talazoparib treatment. These results indicate synergy of talazoparib and MK2206 in reducing the phosphorylation of AKT in a dose-dependent manner. Talazoparib is by far the most potent PARP inhibitor developed to date. With talazoparib potentially acting on prostate cancer with PTEN mutations, talazoparib treatment may expand current PARP inhibitor treatment in advanced prostate cancers and thereby elicit a response in as many as 80% of patients. Thus, talazoparib has vast therapeutic potential in prostate cancer.

Citation Format: Zachary Z. Reinstein, Rajita Vatapalli, Jonathan Anker, Sahithi Pamarthy, Benedito Carneiro, Sarki Abdulkadir. Talazoparib, a second generation PARP inhibitor, is a novel therapy for PTEN mutants in prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1230. doi:10.1158/1538-7445.AM2017-1230

Abstract 5585: TGF-ß insensitive PSMA-specific CD8+ T cells derived from metastatic castration resistant prostate cancer (MCRPC) patients enhance the tumor killing ability

Introduction: Manufacturing tumor specific CD8+ T cells has been an obstacle for developing prostate cancer (PCa) immunotherapies for men with MCRPC. We report a highly efficient method to expand human TGF-ß insensitivity PSMA-specific CD8+ T cells from MCRPC patients using a FDA approved Cell Processing Work Station (CPWS, Panasonic). Methods: Peripheral blood CD8+ T cells were collected from men with MCRPC by leukapheresis, and cultured in CPWS in TexMACSTM medium with CD-3 Biotin/CD28/Anti-Biotin Beads, 5% human serum, and IL-2. We developed a TβRIIDN-TK-IRES-PZ1 chimeric T cell receptor retroviral construct using an anti-PSMA IgTCR(ζ) gene (PZ1) and a dominant negative TGF-ß type II receptor (TßRIIDN), that could induce CD8+ T cells to be PSMA reactive and insensitive to TGF-ß. PC-3 cells (PSMA negative) or PSMA positive PC-3-PSMA cells (PSMA positive) were exposed to TGF-ß and used as target cells. Cytotoxicity assays were performed by LDH/NADH analysis (target cells: CD8+ T cells at 1:20, 1:50 and 1:100 respectively). Live interactions between CD8+ T cells and PCa cells was recorded by Nikon BiostationIMQ. Apoptosis of PCa was evaluated by immunofluorescence staining for Annexin V and 7-Amino-actinomycin D (7-AAD) respectively. Results: On Day 0, 2x106 CD8 T cells were placed in culture, infected with TßRIIDN-TK-IRES-PZ-1 on Day 8, and expanded 96 fold (1.92x108) by Day 36. The cellular expansion plateaued by Day 40 (1.95x108), when the ratios of CD8+ (95.2%), CD45+ (96.6%) and CD3+ (97.2%) were maintained. The cells strongly expressed PZ1 and TK gene (71.1%), and p-SMAD2 was inhibited 95%. Under TGF-ß treatment for 7 days, the growth of infected CD8+ T cells was not significantly changed, while the naïve CD8+ T control cells were suppressed by 44.8%. PC3-PSMA cells released 25.64 and 4.19 nmol/50ul/105 NADH when co-cultured with infected CD8+ T cells or with naïve CD8+ T cells respectively (p&lt;0.05). There was no significant difference when PC3 cells were co-cultured with infected CD8+ T cells (7.35) or naïve CD8+ T cells (7.59). Infected CD8+ T cells induced 32.0% and 13.7% expression of Annexin V in PC3-PSMA and PC3 cells respectively, while naïve CD8+ T cells induced only 6.9% in both groups (p&lt;0.05). Furthermore, Infected CD8+ T cells induced significant higher expression of 7-AAD in PC3-PSMA (0.688%) compared to naïve CD8+ T cells treatment (0.03%). There were close interactions between infected CD8+ T cells and PC3-PSMA, which was not observed in other groups. Conclusion: Our study supports expansion and retroviral infection generating TGF-ß insensitive PSMA-specific CD8+ T cells ex-vivo within 4 weeks in CPWS without any exogenous specific stimulation signal. These cells can enhance the PSMA expressed PCa killing ability and escape the inhibition by tumor secreted TGF-ß, which have a potential to overcome many of the current barriers of immunotherapies for men with MCRPC.

Citation Format: Qiang Zhang, Timothy Kuzel, Brian Helfand, Ximing J. Yang, Weijun Qin, Chung Lee, Benedito Carneiro, Francis J. Giles. TGF-ß insensitive PSMA-specific CD8+ T cells derived from metastatic castration resistant prostate cancer (MCRPC) patients enhance the tumor killing ability [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5585. doi:10.1158/1538-7445.AM2017-5585

Abstract 2771: Correlation of tumor mutation burden and chemotherapy outcomes in colorectal cancer

Background: The Cancer Genome Atlas (TCGA) has identified 16% of colorectal cancers (CRC) to have defects in mechanisms that repair spontaneous DNA damage, and consequently have high tumor mutation burden (TMB). Although, there is accumulating evidence for activity of immunotherapy on tumors harboring high-TMB, its impact on response to chemotherapy is unknown.

Methods: In this retrospective cohort study, we analyzed progression free survival (PFS) of 74 patients with metastatic CRC (61 colon & 13 rectal cancer) treated at tertiary care oncology clinics and underwent next-generation sequencing (NGS) of their tumor sample using FoundationOne® (Foundation Medicine Inc., Cambridge, MA). Most recent available specimen was analyzed at the time of diagnosis of metastatic disease. TMB was calculated by counting all synonymous and nonsynonymous variants as well as indels across a 1.25 megabase coding region spanning 315 genes. Low TMB (TMB-L) and Intermediate/High TMB (TMB- I/H) were defined as ≤ 5 mutations per base (MB) or ≥ 6/MB respectively. Demographic and clinical information (including imaging results, chemotherapy treatment) were obtained by chart review. Treatment was captured as ‘oxaliplatin-based’ if the chemotherapy regimen contained oxaliplatin (i.e., FOLFOX, XELOX) or ‘irinotecan-based’ if the regimen contained irinotecan (i.e., FOLFIRI). Subsequent modifications of dose or omission of the drug due to toxicity were not captured. Continuous variables were reported as medians and inter-quartile ranges and compared between groups via the Wilcoxon rank-sum test. Categorical variables were reported as frequencies and percentages and compared between groups via Fisher’s exact test. Survival estimates were compared between groups via the log-rank test.

Results: There was no statistically different PFS in TMB-L (n=39) compared to TMB- I/H (n=26). (10.0 vs. 5.9 months, P = 0.18). In the TMB-L cohort, irinotecan-based chemotherapy (n=25) treated patients had improved PFS compared to oxaliplatin-based chemotherapy (n=10) treated CRC patients (11.9 vs. 6.5 months, P= &lt;0.001). No difference in PFS was observed between the two treatment cohorts in TMB-I/H group. In stage 2 and 3 colon cancer patients, there was no difference in time to recurrence in the TMB-L and TMB-I/H cohorts, when patients were treated with oxaliplatin-based therapy in peri-operative setting (detailed statistics including survival curves will accompany final presentation).

Conclusion: TMB status may be a predictive biomarker in a subset of patients treated with chemotherapy, specifically in TMB-L cohort. Confirming these findings in a larger repository of tissue from studies comparing irinotecan vs. oxaliplatin-based regimen is recommended.

Citation Format: Sachin G. Pai, Benedito Carneiro, Aparna Kalyan, Ricardo Costa, Irene Helenowski, Alfred Radmeaker, Hiral Shah, Daniel Olson, Young Chae, Francis Giles. Correlation of tumor mutation burden and chemotherapy outcomes in colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2771. doi:10.1158/1538-7445.AM2017-2771

Inhibition of the fibroblast growth factor receptor (FGFR) pathway: the current landscape and barriers to clinical application

The fibroblast growth factor/fibroblast growth factor receptor (FGF/FGFR) is a tyrosine kinase signaling pathway that has a fundamental role in many biologic processes including embryonic development, tissue regeneration, and angiogenesis. Increasing evidence indicates that this pathway plays a critical role in oncogenesis via gene amplification, activating mutations, or translocation in tumors of various histologies. With multiplex sequencing technology, the detection of FGFR aberrations has become more common and is tied to cancer cell proliferation, resistance to anticancer therapies, and neoangiogenesis. Inhibition of FGFR signaling appears promising in preclinical studies, suggesting a pathway of clinical interest in the development of targeted therapy. Phase I trials have demonstrated a manageable toxicity profile. Currently, there are multiple FGFR inhibitors under study with many non-selective (multi-kinase) inhibitors demonstrating limited clinical responses. As we progress from the first generation of non-selective drugs to the second generation of selective FGFR inhibitors, it is clear that FGFR aberrations do not behave uniformly across cancer types; thus, a deeper understanding of biomarker strategies is undoubtedly warranted. This review aims to consolidate data from recent clinical trials with a focus on selective FGFR inhibitors. As Phase II clinical trials emerge, concentration on patient selection as it pertains to predicting response to therapy, feasible methods for overcoming toxicity, and the likelihood of combination therapies should be utilized. We will also discuss qualities that may be desirable in future generations of FGFR inhibitors, with the hope that overcoming these current barriers will expedite the availability of this novel class of medications.

Abstract 4887: DNA repair mutations are associated with mutational burden and T-cell activation signature in lung adenocarcinoma

DNA repair deficiencies have been linked to the generation of immunogenic neo-antigens and increased efficacy of immunotherapies.

To determine the impact of mutations in DNA repair genes, specifically those involved in homologous recombination (HR) and mismatch repair (MMR), on infiltrating immune cells in lung adenocarcinoma, we analyzed the expression of “immune metagenes” linked to specific cell types (Angelova et al. 2015) utilizing RNAseq values from TCGA (515 patients, 230 sequenced).

Tumors infiltrated by activated CD4 and CD8, all combined T cells, and all combined cell types contained a higher somatic mutation count, while tumors infiltrated by Th17, NK56 bright, and mast cells were linked to lower mutation count (Table 1, * = p&lt;0.05). Patients with high mutational burden displayed a significant increase in infiltrating activated CD4 and CD8, effector memory CD4, all combined T cells, mature dendritic cells, and all combined cell types, as well as significantly increased mutations in HR genes, specifically BRCA2 and PALB2, and MMR genes, specifically MLH1, MSH4, MSH5, EXO1, RFC1, and RFC4. Tumors with HR mutations contained a significant 1.9-fold higher average mutation count with increased infiltrating activated CD4, neutrophils, and NKT cells, as well as decreased activated B cells. Similarly, MMR mutations were associated with a 2.7-fold increase in mutational burden and infiltration by all combined T cells. Further, the degree of alterations in DNA repair genes corresponded to escalating mutational burden, as tumors with 0, 1, or 2-3 mutated HR genes contained an average 188, 330, and 472 mutations, respectively, and those with 0, 1, or 2-3 MMR mutations contained 118, 439, and 639 mutations, respectively.

Our characterization revealed significant links between DNA repair deficiencies, mutational burden, and tumor infiltration by activated T cells, thereby identifying potential biomarkers to aid in patient selection for immunotherapy.

[J.A. and Y.C. contributed equally to this work.] Association between tumor infiltrating immune cell types and mutational burdenImmune Cell TypeAverage Mutation Count Fold ChangePercent of Patients with Infiltration (%)Effector Memory CD8 T cells2.23.1Memory B cells1.83.3Th1 T cells1.53.1Activated CD4 T cells*1.5*29.7Any immune cell type*1.5*73.0Any T cell*1.5*59.2Activated CD8 T cells*1.4*26.8NK cells1.43.1Effector Memory CD4 T cells1.39.1Dendritic cells1.33.9T gamma-delta cells1.25.6Macrophages1.14.3Mature dendritic cells1.110.9Activated B cells1.18.9Any NK cell1.115.0NK56 dim cells1.09.7Immature B cells0.99.1Plasmacytoid dendritic cells0.93.7Regulatory T cells0.84.1Th17 T cells*0.7*10.3Monocytes0.75.4NKT cells0.73.7NK56 bright cells*0.7*3.9Mast cells*0.6*7.0

Citation Format: Young Kwang Chae, Jonathan F. Anker, Massimo Cristofanilli, Aparna Kalyan, Jason Kaplan, Sunandana Chandra, Benedito Carneiro, Maria Matsangou, Cesar Santa-Maria, Francis Giles. DNA repair mutations are associated with mutational burden and T-cell activation signature in lung adenocarcinoma. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4887.

Repurposing metformin for cancer treatment: current clinical studies

In recent years, several studies have presented evidence suggesting a potential role for metformin in anti-cancer therapy. Preclinical studies have demonstrated several anticancer molecular mechanisms of metformin including mTOR inhibition, cytotoxic effects, and immunomodulation. Epidemiologic data have demonstrated decreased cancer incidence and mortality in patients taking metformin. Several clinical trials, focused on evaluation of metformin as an anti-cancer agent are presently underway. Data published from a small number of completed trials has put forth intriguing results. Clinical trials in pre-surgical endometrial cancer patients exhibited a significant decrease in Ki67 with metformin monotherapy. Another interesting observation was made in patients with breast cancer, wherein a trend towards improvement in cancer proliferation markers was noted in patients without insulin resistance. Data on survival outcomes with the use of metformin as an anti-cancer agent is awaited. This manuscript will critically review the role of metformin as a potential cancer treatment.

Statins as anti-cancer therapy; Can we translate preclinical and epidemiologic data into clinical benefit?

Statins, the most commonly prescribed class of drug, have demonstrated effects beyond cholesterol reduction including anti-tumor and immunomodulatory properties. Several epidemiological studies have suggested an anti-neoplastic effect of statins evidenced by reductions in cancer incidence and cancer-related mortality. Clinical trials on statins as part of therapy for cancer have generated interest in the oncology community. Statins have been investigated for a variety of cancers, early and late stage, and in combination with chemotherapy and radiation. So far promising results have been reported with statin use in pediatric brainstem tumors, early stage breast cancer, hepatocellular carcinoma (HCC), colorectal cancer (CRC), refractory or relapsed multiple myeloma (MM), and refractory acute myeloid leukemia (AML). There is still much investigation to be completed to determine which subtypes of patients benefit from statin therapy, how statins may potentiate other anticancer approaches, and the appropriate dosing schedule to use.

Evolving molecular-based targeted therapy for cancer: an exciting field

The development of molecular biology tools has led to the identification of numerous therapeutic targets in cancer cells. In this article, we discuss the rational and clinical data supporting the use of agents that selectively target epidermal and vascular endothelial growth factors in selected cancers.

Video fluoroscopic evaluation after glossectomy

BACKGROUND

The swallowing deficits that result from oral or oropharyngeal resections vary considerably depending on the site, extension of the resection, and type of reconstruction. Most patients will experience some degree of dysphagia despite the reconstructive effort. Furthermore, a glossectomy is frequently associated with voice and speech difficulties.

OBJECTIVES

To characterize swallowing in patients who underwent a glossectomy and to define the limits and the compensatory movements using video fluoroscopic analysis.

DESIGN AND SETTING

Video fluoroscopic evaluation of 15 patients who underwent glossectomies at the Centro de Tratamento e Pesquisa Hospital do Cancer A. C. Camargo, S*ao Paulo, Brazil.

PATIENTS

We examined 15 patients: 5 who underwent a partial glossectomy, 2 who underwent a subtotal glossectomy, and 8 who underwent a total glossectomy with laryngeal preservation and reconstruction with myocutaneous flaps (9 pectoralis major flaps and 1 latissimus dorsi flap). The 15 patients were enrolled in a program that included voice, speech, and swallowing rehabilitation.

RESULTS

All patients who underwent a partial glossectomy had difficulties with formation and anteroposterior propulsion of the bolus in the oral cavity and an increase in oral transit time, which was more evident with materials of thicker consistencies. All patients who underwent a total or subtotal glossectomy with laryngeal preservation had an increase in oral transit time and stasis of food in the oral cavity, the pharynx, and the superior esophageal sphincter. Of the 15 patients, 2 had moderate and asymptomatic aspiration. These 2 patients had swallowing compensations, such as increased buccal, mandibular, pharyngeal, and laryngeal activity and voluntary protection of the larynx during swallowing.

CONCLUSIONS

This study demonstrates the effectiveness of swallowing in patients who were enrolled in voice, speech, and swallowing rehabilitation after undergoing a partial or total glossectomy. An increase in oral transit time was detected in all patients. Only 2 of the 10 patients who underwent a total glossectomy had persistent asymptomatic aspiration.