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Wakkerman FC, Wu J, Putter H, Jürgenliemk-Schulz IM, Jobsen JJ, Lutgens LCHW, Haverkort MAD, de Jong MA, Mens JWM, Wortman BG, Nout RA, Léon-Castillo A, Powell ME, Mileshkin LR, Katsaros D, Alfieri J, Leary A, Singh N, de Boer SM, Nijman HW, Smit VTHBM, Bosse T, Koelzer VH, Creutzberg CL, Horeweg N. Prognostic impact and causality of age on oncological outcomes in women with endometrial cancer: a multimethod analysis of the randomised PORTEC-1, PORTEC-2, and PORTEC-3 trials. Lancet Oncol 2024:S1470-2045(24)00142-6. [PMID: 38701815 DOI: 10.1016/s1470-2045(24)00142-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Numerous studies have shown that older women with endometrial cancer have a higher risk of recurrence and cancer-related death. However, it remains unclear whether older age is a causal prognostic factor, or whether other risk factors become increasingly common with age. We aimed to address this question with a unique multimethod study design using state-of-the-art statistical and causal inference techniques on datasets of three large, randomised trials. METHODS In this multimethod analysis, data from 1801 women participating in the randomised PORTEC-1, PORTEC-2, and PORTEC-3 trials were used for statistical analyses and causal inference. The cohort included 714 patients with intermediate-risk endometrial cancer, 427 patients with high-intermediate risk endometrial cancer, and 660 patients with high-risk endometrial cancer. Associations of age with clinicopathological and molecular features were analysed using non-parametric tests. Multivariable competing risk analyses were performed to determine the independent prognostic value of age. To analyse age as a causal prognostic variable, a deep learning causal inference model called AutoCI was used. FINDINGS Median follow-up as estimated using the reversed Kaplan-Meier method was 12·3 years (95% CI 11·9-12·6) for PORTEC-1, 10·5 years (10·2-10·7) for PORTEC-2, and 6·1 years (5·9-6·3) for PORTEC-3. Both overall recurrence and endometrial cancer-specific death significantly increased with age. Moreover, older women had a higher frequency of deep myometrial invasion, serous tumour histology, and p53-abnormal tumours. Age was an independent risk factor for both overall recurrence (hazard ratio [HR] 1·02 per year, 95% CI 1·01-1·04; p=0·0012) and endometrial cancer-specific death (HR 1·03 per year, 1·01-1·05; p=0·0012) and was identified as a significant causal variable. INTERPRETATION This study showed that advanced age was associated with more aggressive tumour features in women with endometrial cancer, and was independently and causally related to worse oncological outcomes. Therefore, our findings suggest that older women with endometrial cancer should not be excluded from diagnostic assessments, molecular testing, and adjuvant therapy based on their age alone. FUNDING None.
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Affiliation(s)
- Famke C Wakkerman
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Jiqing Wu
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hein Putter
- Department of Biostatistics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Jan J Jobsen
- Department of Radiotherapy, Medisch Spectrum Twente, Enschede, Netherlands
| | | | | | - Marianne A de Jong
- Radiotherapy Institute Friesland, Radiation Oncology, Leeuwarden, Netherlands
| | - Jan Willem M Mens
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Bastiaan G Wortman
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Remi A Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | - Melanie E Powell
- Department of Clinical Oncology, Barts Health NHS Trust, London, UK
| | - Linda R Mileshkin
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Dionyssios Katsaros
- Gynecology and Obstetrics, Departments of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Joanne Alfieri
- Division of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Alexandra Leary
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Naveena Singh
- Department of Pathology, Barts Health NHS Trust, London, UK
| | - Stephanie M de Boer
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Hans W Nijman
- Department of Gynaecologic Oncology, University Medical Center Groningen, Groningen, Netherlands
| | | | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Nanda Horeweg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands.
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Olthof EP, Bergink-Voorthuis BJ, Wenzel HHB, Mongula J, van der Velden J, Spijkerboer AM, Adam JA, Bekkers RLM, Beltman JJ, Slangen BFM, Nijman HW, Smolders RGV, van Trommel NE, Zusterzeel PLM, Zweemer RP, Stalpers LJA, Mom CH, van der Aa MA. Diagnostic accuracy of MRI, CT, and [ 18F]FDG-PET-CT in detecting lymph node metastases in clinically early-stage cervical cancer - a nationwide Dutch cohort study. Insights Imaging 2024; 15:36. [PMID: 38332397 PMCID: PMC10853153 DOI: 10.1186/s13244-023-01589-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/29/2023] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES Imaging is increasingly used to assess lymph node involvement in clinically early-stage cervical cancer. This retrospective study aimed to evaluate the diagnostic accuracy of MRI, CT, and [18F]FDG-PET-CT. METHODS Women with International Federation of Gynaecology and Obstetrics (FIGO) 2009 stage IA2-IIA cervical cancer and pretreatment imaging between 2009 and 2017 were selected from the Netherlands Cancer Registry. Patient-based and region-based (i.e. pelvic and common iliac) nodal status was extracted from radiology reports. Pathology results were considered the reference standard for calculating accuracy indices. Multiple imputation was used for missing pathology to limit verification bias risk. RESULTS Nodal assessment was performed in 1676 patients with MRI, 926 with CT, and 379 with [18F]FDG-PET-CT, with suspicious nodes detected in 17%, 16%, and 48%, respectively. [18F]FDG-PET-CT was used to confirm MRI/CT results in 95% of patients. Pathology results were imputed for 30% of patients. [18F]FDG-PET-CT outperformed MRI and CT in detecting patient-based nodal metastases with sensitivities of 80%, 48%, and 40%, and AUCs of 0.814, 0.706, and 0.667, respectively, but not in specificity: 79%, 92%, and 92%. Region-based analyses showed similar indices in the pelvic region, but worse performance in the common iliac region with AUCs of 0.575, 0.554, and 0.517, respectively. CONCLUSIONS [18F]FDG-PET-CT outperformed MRI and CT in detecting nodal metastases, which may be related to its use as a verification modality. However, MRI and CT had the highest specificity. As MRI is generally performed routinely to assess local and regional spread of cervical cancer, [18F]FDG-PET-CT can be used to confirm suspicious nodes. CRITICAL RELEVANCE STATEMENT Accurate assessment of the nodal status in clinically early-stage cervical cancer is essential for tumour staging, treatment decision making and prognosis. KEY POINTS • The accuracy of MRI, CT or [18F]FDG-PET-CT for nodal staging in early cervical cancer is a subject of discussion. • Overall, [18F]FDG-PET-CT outperformed MRI, followed by CT, when used as a verification modality. • Staging with MRI and the addition of [18F]FDG-PET-CT to verify high-risk cases seems to be a good approach.
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Affiliation(s)
- Ester P Olthof
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, DT, Utrecht, 3511, The Netherlands.
- Department of Gynecological Oncology, Amsterdam University Medical Center, Center for Gynecologic Oncology Amsterdam (CGOA), Amsterdam, The Netherlands.
| | - Brenda J Bergink-Voorthuis
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Hans H B Wenzel
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, DT, Utrecht, 3511, The Netherlands
| | - Jordy Mongula
- Department of Obstetrics and Gynaecology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Jacobus van der Velden
- Department of Gynecological Oncology, Amsterdam University Medical Center, Center for Gynecologic Oncology Amsterdam (CGOA), Amsterdam, The Netherlands
| | - Anje M Spijkerboer
- Department of Radiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Judit A Adam
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Obstetrics and Gynecology, Medical Center and GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Jogchum J Beltman
- Department of Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Brigitte F M Slangen
- Department of Obstetrics and Gynecology, Medical Center and GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ramon G V Smolders
- Department of Gynaecological Oncology, Erasmus MC Cancer Institute University Medical Center, Rotterdam, The Netherlands
| | - Nienke E van Trommel
- Center for Gynaecologic Oncology Amsterdam (CGOA), The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Petra L M Zusterzeel
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ronald P Zweemer
- Department of Gynaecological Oncology, University Medical Centre Utrecht, Utrecht Cancer Centre, Utrecht, The Netherlands
| | - Lukas J A Stalpers
- Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Constantijne H Mom
- Department of Gynecological Oncology, Amsterdam University Medical Center, Center for Gynecologic Oncology Amsterdam (CGOA), Amsterdam, The Netherlands
| | - Maaike A van der Aa
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, DT, Utrecht, 3511, The Netherlands
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Fan X, Nijman HW, de Bruyn M, Elsinga PH. ImmunoPET provides a novel way to visualize the CD103 + tissue-resident memory T cell to predict the response of immune checkpoint inhibitors. EJNMMI Res 2024; 14:5. [PMID: 38182929 PMCID: PMC10769965 DOI: 10.1186/s13550-023-01062-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/17/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have made significant progress in oncotherapy improving survival of patients. However, the benefits are limited to only a small subgroup of patients who could achieve durable responses. Early prediction of response may enable treatment optimization and patient stratification. Therefore, developing appropriate biomarkers is critical to monitoring efficacy and assessing patient response to ICIs. MAIN BODY Herein, we first introduce a new potential biomarker, CD103, expressed on tissue-resident memory T cells, and discuss the potential application of CD103 PET imaging in predicting immune checkpoint inhibitor treatment. In addition, we describe the current targets of ImmunoPET and compare these targets with CD103. To assess the benefit of PET imaging, a comparative analysis between ImmunoPET and other imaging techniques commonly employed for tumor diagnosis was performed. Additionally, we compare ImmunoPET and immunohistochemistry (IHC), a widely utilized clinical method for biomarker identification with respect to visualizing the immune targets. CONCLUSION CD103 ImmunoPET is a promising method for determining tumor-infiltrating lymphocytes (TILs) load and response to ICIs, thereby addressing the lack of reliable biomarkers in cancer immunotherapy. Compared to general T cell markers, CD103 is a specific marker for tissue-resident memory T cells, which number increases during successful ICI therapy. ImmunoPET offers noninvasive, dynamic imaging of specific markers, complemented by detailed molecular information from immunohistochemistry (IHC). Radiomics can extract quantitative features from traditional imaging methods, while near-infrared fluorescence (NIRF) imaging aids tumor detection during surgery. In the era of precision medicine, combining such methods will offer a more comprehensive approach to cancer diagnosis and treatment.
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Affiliation(s)
- Xiaoyu Fan
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marco de Bruyn
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Philip H Elsinga
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Fan X, Ważyńska MA, Kol A, Perujo Holland N, Fernandes B, van Duijnhoven SMJ, Plat A, van Eenennaam H, Elsinga PH, Nijman HW, de Bruyn M. Development of [ 89Zr]Zr-hCD103.Fab01A and [ 68Ga]Ga-hCD103.Fab01A for PET imaging to noninvasively assess cancer reactive T cell infiltration: Fab-based CD103 immunoPET. EJNMMI Res 2023; 13:100. [PMID: 37985555 PMCID: PMC10661679 DOI: 10.1186/s13550-023-01043-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/16/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND CD103 is an integrin specifically expressed on the surface of cancer-reactive T cells. The number of CD103+ T cells significantly increases during successful immunotherapy and might therefore be an attractive biomarker for noninvasive PET imaging of immunotherapy response. Since the long half-life of antibodies preclude repeat imaging of CD103+ T cell dynamics early in therapy, we therefore here explored PET imaging with CD103 Fab fragments radiolabeled with a longer (89Zr) and shorter-lived radionuclide (68Ga). METHODS Antihuman CD103 Fab fragment Fab01A was radiolabeled with 89Zr or 68Ga, generating [89Zr]Zr-hCD103.Fab01A and [68Ga]Ga-hCD103.Fab01A, respectively. In vivo evaluation of these tracers was performed in male nude mice (BALB/cOlaHsd-Foxn1nu) with established CD103-expressing CHO (CHO.CD103) or CHO-wildtype (CHO.K1) xenografts, followed by serial PET imaging and ex vivo bio-distribution. RESULTS [89Zr]Zr-hCD103.Fab01A showed high tracer uptake in CD103+ xenografts as early as 3 h post-injection. However, the background signal remained high in the 3- and 6-h scans. The background was relatively low at 24 h after injection with sufficient tumor uptake. [68Ga]Ga-hCD103.Fab01Ashowed acceptable uptake and signal-to-noise ratio in CD103+ xenografts after 3 h, which decreased at subsequent time points. CONCLUSION [89Zr]Zr-hCD103.Fab01A demonstrated a relatively low background and high xenograft uptake in scans as early as 6 h post-injection and could be explored for repeat imaging during immunotherapy in clinical trials. 18F or 64Cu could be explored as alternative to 68Ga in optimizing half-life and radiation burden of the tracer.
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Affiliation(s)
- Xiaoyu Fan
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marta A Ważyńska
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arjan Kol
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Noemi Perujo Holland
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bruna Fernandes
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Annechien Plat
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Philip H Elsinga
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marco de Bruyn
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Brummel K, Eerkens AL, de Bruyn M, Nijman HW. Prognostic benefit of TILs independent of clinicopathological and molecular factors. Br J Cancer 2023; 129:737-738. [PMID: 37443345 PMCID: PMC10449827 DOI: 10.1038/s41416-023-02335-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/15/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Affiliation(s)
- Koen Brummel
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anneke L Eerkens
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marco de Bruyn
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Ważyńska MA, Butera R, Requesens M, Plat A, Zarganes-Tzitzikas T, Neochoritis CG, Plewka J, Skalniak L, Kocik-Krol J, Musielak B, Magiera-Mularz K, Rodriguez I, Blok SN, de Bruyn M, Nijman HW, Elsinga PH, Holak TA, Dömling A. Design, Synthesis, and Biological Evaluation of 2-Hydroxy-4-phenylthiophene-3-carbonitrile as PD-L1 Antagonist and Its Comparison to Available Small Molecular PD-L1 Inhibitors. J Med Chem 2023. [PMID: 37450644 PMCID: PMC10388299 DOI: 10.1021/acs.jmedchem.3c00254] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
In search of a potent small molecular PD-L1 inhibitor, we designed and synthesized a compound based on a 2-hydroxy-4-phenylthiophene-3-carbonitrile moiety. Ligand's performance was tested in vitro and compared side-by-side with a known PD-L1 antagonist with a proven bioactivity BMS1166. Subsequently, we modified both compounds to allow 18F labeling that could be used for PET imaging. Radiolabeling, which is used in drug development and diagnosis, was applied to investigate the properties of those ligands and test them against tissue sections with diverse expression levels of PD-L1. We confirmed biological activity toward hPD-L1 for this inhibitor, comparable with BMS1166, while holding enhanced pharmacological properties.
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Affiliation(s)
- Marta A Ważyńska
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Roberto Butera
- Department of Drug Design, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Marta Requesens
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Annechien Plat
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Tryfon Zarganes-Tzitzikas
- Centre for Medicines Discovery, Nuffield Department of Medicine, Alzheimer's Research UK Oxford Drug Discovery Institute, NDM Research Building, Roosevelt Drive, OX3 7FZ Oxford, U.K
| | | | - Jacek Plewka
- Department of Organic Chemistry, Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Krakow, Poland
| | - Lukasz Skalniak
- Department of Organic Chemistry, Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Krakow, Poland
| | - Justyna Kocik-Krol
- Department of Organic Chemistry, Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Krakow, Poland
- Doctoral School of Exact and Natural Sciences, Jagiellonian University, Prof. St. Łojasiewicz St 11, 30-348 Krakow, Poland
| | - Bogdan Musielak
- Department of Organic Chemistry, Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Krakow, Poland
| | - Katarzyna Magiera-Mularz
- Department of Organic Chemistry, Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Krakow, Poland
| | - Ismael Rodriguez
- Department of Organic Chemistry, Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Krakow, Poland
- Doctoral School of Exact and Natural Sciences, Jagiellonian University, Prof. St. Łojasiewicz St 11, 30-348 Krakow, Poland
| | - Simon N Blok
- Department of Nuclear Medicine and MolecularImaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Marco de Bruyn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Philip H Elsinga
- Department of Nuclear Medicine and MolecularImaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Tad A Holak
- Department of Organic Chemistry, Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Krakow, Poland
| | - Alexander Dömling
- Department of Drug Design, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry and Czech Advanced Technology and Research Institute, Palacky University in Olomouc, Olomouc 77900, Czech Republic
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Oymans EJ, de Kroon CD, Bart J, Nijman HW, van der Aa MA. Incidence of gynaecological cancer during the COVID-19 pandemic: A population-based study in the Netherlands. Cancer Epidemiol 2023; 85:102405. [PMID: 37356263 PMCID: PMC10281225 DOI: 10.1016/j.canep.2023.102405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/16/2023] [Accepted: 06/18/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To study the impact of the COVID-19 pandemic and consequent lockdown on the number of diagnoses of gynaecological malignancies in the Netherlands. METHODS We performed a retrospective cohort study using data from the Netherlands Cancer Registry (NCR) on women of 18 years and older diagnosed with invasive endometrial, ovarian, cervical or vulvar cancer in the period 2017-2021. Analyses were stratified for age, socioeconomical status (SES) and region. RESULTS The incidence rate of gynaecological cancer was 67/100.000 (n = 4832) before (2017-2019) and 68/100.000 (n = 4833) during (2020) the COVID-19 pandemic. Comparing the number of diagnoses of the two periods for the four types of cancer separately showed no significant difference. During the first wave of COVID-19 (March-June 2020), a clear decrease in number of gynaecological cancer diagnoses was visible (20-34 %). Subsequently, large increases in number of diagnoses were visible (11-29 %). No significant differences in incidence were found between different age groups, SES and regions. In 2021 an increase of 5.9 % in number of diagnoses was seen. CONCLUSION In the Netherlands, a clear drop in number of diagnoses was visible for all four types of gynaecological cancers during the first wave, with a subsequent increase in number of diagnoses in the second part of 2020 and in 2021. No differences between SES groups were found. This illustrates good organisation of and access to health care in the Netherlands.
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Affiliation(s)
- Eline J Oymans
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands; Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
| | - Cor D de Kroon
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Joost Bart
- University of Groningen, University Medical Center Groningen, Department of Pathology, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Maaike A van der Aa
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands
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Wenzel HHB, Hardie AN, Moncada-Torres A, Høgdall CK, Bekkers RLM, Falconer H, Jensen PT, Nijman HW, van der Aa MA, Martin F, van Gestel AJ, Lemmens VEPP, Dahm-Kähler P, Alfonzo E, Persson J, Ekdahl L, Salehi S, Frøding LP, Markauskas A, Fuglsang K, Schnack TH. A federated approach to identify women with early-stage cervical cancer at low risk of lymph node metastases. Eur J Cancer 2023; 185:61-68. [PMID: 36965329 DOI: 10.1016/j.ejca.2023.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVE Lymph node metastases (pN+) in presumed early-stage cervical cancer negatively impact prognosis. Using federated learning, we aimed to develop a tool to identify a group of women at low risk of pN+, to guide the shared decision-making process concerning the extent of lymph node dissection. METHODS Women with cervical cancer between 2005 and 2020 were identified retrospectively from population-based registries: the Danish Gynaecological Cancer Database, Swedish Quality Registry for Gynaecologic Cancer and Netherlands Cancer Registry. Inclusion criteria were: squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma; The International Federation of Gynecology and Obstetrics 2009 IA2, IB1 and IIA1; treatment with radical hysterectomy and pelvic lymph node assessment. We applied privacy-preserving federated logistic regression to identify risk factors of pN+. Significant factors were used to stratify the risk of pN+. RESULTS We included 3606 women (pN+ 11%). The most important risk factors of pN+ were lymphovascular space invasion (LVSI) (odds ratio [OR] 5.16, 95% confidence interval [CI], 4.59-5.79), tumour size 21-40 mm (OR 2.14, 95% CI, 1.89-2.43) and depth of invasion>10 mm (OR 1.81, 95% CI, 1.59-2.08). A group of 1469 women (41%)-with tumours without LVSI, tumour size ≤20 mm, and depth of invasion ≤10 mm-had a very low risk of pN+ (2.4%, 95% CI, 1.7-3.3%). CONCLUSION Early-stage cervical cancer without LVSI, a tumour size ≤20 mm and depth of invasion ≤10 mm, confers a low risk of pN+. Based on an international privacy-preserving analysis, we developed a useful tool to guide the shared decision-making process regarding lymph node dissection.
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Affiliation(s)
- Hans H B Wenzel
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
| | - Anna N Hardie
- Department of Pelvic Cancer, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Arturo Moncada-Torres
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Claus K Høgdall
- Department of Gynaecology, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Henrik Falconer
- Department of Pelvic Cancer, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Pernille T Jensen
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hans W Nijman
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Maaike A van der Aa
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Frank Martin
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Anna J van Gestel
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Valery E P P Lemmens
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Pernilla Dahm-Kähler
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital and Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emilia Alfonzo
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital and Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Persson
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital and Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, Lund, Sweden
| | - Linnea Ekdahl
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital and Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, Lund, Sweden
| | - Sahar Salehi
- Department of Pelvic Cancer, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ligita P Frøding
- Department of Gynaecology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Katrine Fuglsang
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Tine H Schnack
- Department of Gynaecology, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Gynaecology, Odense University Hospital, Odense, Denmark
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9
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Fremond S, Andani S, Wolf JB, Ørtoft G, Høgdall E, Dijkstra J, Jobsen JJ, Jürgenliemk-Schulz IM, Lutgens LCHW, Powell ME, Singh N, Mileshkin LR, Mackay HJ, Leary A, Katsaros D, Nijman HW, de Boer SM, Nout RA, Smit VT, Creutzberg CL, Horeweg N, Koelzer VH, Bosse T. Abstract 5695: Deep learning risk prediction model of distant recurrence from H&E endometrial cancer slides. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-5695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Accurate risk prediction of distant recurrence (DR) is crucial for personalized adjuvant systemic therapy of endometrial cancer (EC) stage I-III patients, as DR is associated with a 5-year overall survival of 10-20%. Risk stratification and treatment recommendation are currently based on histopathological and molecular markers, which is challenging due to high inter-observer variability and testing costs respectively. Deep Learning (DL) models can predict prognosis by identifying relevant visual features from H&E whole slide images (WSIs) at different resolutions without prior assumptions. Here, we developed and tested the first interpretable state-of-the-art DL model for WSI-based risk prediction of DR of stage I-III EC (DeREC) from the randomized PORTEC-1/-2/-3 trials and three clinical cohorts with long-term follow-up data. We used one representative H&E WSI each from 1761 EC patients, excluding those who received adjuvant chemotherapy as it lowers the risk of DR. We randomly sampled 20% as a held-out internal test set (N=353 with 62 events; 8.45 year median follow-up) and performed a 5-fold cross-validation on the training set (N=1408). WSIs were partitioned into 360 micron patches at 40x magnification. DeREC combined self-supervised representation learning of patches using a multi-resolution vision transformer and a WSI-level graph attention-based time-to-event prediction model. The model performance of correctly ranking patients by predicted risk scores and true time to DR was measured with the concordance-index and compared with a Cox’ Proportional Hazards (CPH) model fitted on histopathological variables (histotype, grade, lymphovascular space invasion, stage). Discriminative quality of the predicted risk groups was investigated with Kaplan-Meier analysis and the log-rank test. Most predictive patches by predicted risk groups were reviewed by an expert gynecopathologist for identification of prognostic morphological features. DeREC achieved a concordance-index of 0.764 [95%CI 0.754-0.773] on 5-fold cross validation and 0.757 on the test set, as compared to 0.704 [95%CI 0.662-0.746] with CPH. Predicted risk groups around quartiles 1 and 3 accurately stratified patients between low (N=89), intermediate (N=175), high (N=89) risk of DR (p<0.0001). Among the predicted low-risk group only 3 (3.37%) patients relapsed whereas intermediate and high-risk groups counted 27 (15.43%) and 32 (35.96%) events respectively. DeREC is the first DL model accurately distinguishing EC patients at high risk of DR from those at low risk using one H&E WSI, which would aid decisions on adjuvant treatment. DeREC outperformed standard statistical prediction methods using histopathological variables, indicating that it identified prognostic visual features which can be further investigated. Future development includes the integration of clinicopathological and molecular information.
Citation Format: Sarah Fremond, Sonali Andani, Jurriaan Barkey Wolf, Gitte Ørtoft, Estrid Høgdall, Jouke Dijkstra, Jan J. Jobsen, Ina M. Jürgenliemk-Schulz, Ludy CHW Lutgens, Melanie E. Powell, Naveena Singh, Linda R. Mileshkin, Helen J. Mackay, Alexandra Leary, Dionyssios Katsaros, Hans W. Nijman, Stephanie M. de Boer, Remi A. Nout, Vincent T.H.B.M Smit, Carien L. Creutzberg, Nanda Horeweg, Viktor H. Koelzer, Tjalling Bosse. Deep learning risk prediction model of distant recurrence from H&E endometrial cancer slides. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5695.
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Affiliation(s)
- Sarah Fremond
- 1Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Sonali Andani
- 2ETH Zurich, University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Gitte Ørtoft
- 3Copenhagen University Hospital, Copenhagen, Denmark
| | - Estrid Høgdall
- 4Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jouke Dijkstra
- 1Leiden University Medical Center (LUMC), Leiden, Netherlands
| | | | | | | | | | - Naveena Singh
- 9Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Helen J. Mackay
- 11Odette Cancer Center Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | | | | | - Hans W. Nijman
- 14University Medical Center Groningen, Groningen, Netherlands
| | | | - Remi A. Nout
- 15Erasmus University Medical Center, Rotterdam, Netherlands
| | | | | | - Nanda Horeweg
- 1Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Viktor H. Koelzer
- 16University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tjalling Bosse
- 1Leiden University Medical Center (LUMC), Leiden, Netherlands
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10
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De Decker K, Wenzel HHB, Bart J, van der Aa MA, Kruitwagen RFPM, Nijman HW, Kruse A. Stage, treatment and survival of low-grade serous ovarian carcinoma in the Netherlands: A nationwide study. Acta Obstet Gynecol Scand 2023; 102:246-256. [PMID: 36734363 PMCID: PMC9951382 DOI: 10.1111/aogs.14518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/28/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Serous ovarian carcinomas constitute the largest group of epithelial ovarian cancer (60%-75%) and are further classified into high- and low-grade serous carcinoma. Low-grade serous carcinoma (LGSC) is a relatively rare subtype (approximately 5% of serous carcinomas) and epidemiologic studies of large cohorts are scarce. With the present study we aimed to report trends in stage, primary treatment and relative survival of LGSC of the ovary in a large cohort of patients in an effort to identify opportunities to improve clinical practice and outcome of this relatively rare disease. MATERIAL AND METHODS Patients diagnosed with LGSC between 2000 and 2019 were identified from the Netherlands Cancer Registry (n = 855). Trends in FIGO stages and primary treatment were analyzed with the Cochran-Armitage trend test, and differences in and trends of 5-year relative survival were analyzed using multivariable Poisson regression. RESULTS Over time, LGSC was increasingly diagnosed as stage III (39.9%-59.0%) and IV disease (5.7%-14.4%) and less often as stage I (34.6%-13.5%; p < 0.001). Primary debulking surgery was the most common strategy (76.2%), although interval debulking surgery was preferred more often over the years (10.6%-31.1%; p < 0.001). Following primary surgery, there was >1 cm residual disease in only 15/252 patients (6%), compared with 17/95 patients (17.9%) after interval surgery. Full cohort 5-year survival was 61% and survival after primary debulking surgery was superior to the outcome following interval debulking surgery (60% vs 34%). Survival following primary debulking surgery without macroscopic residual disease (73%) was better compared with ≤1 cm (47%) and >1 cm residual disease (22%). Survival following interval debulking surgery without macroscopic residual disease (51%) was significantly higher than after >1 cm residual disease (24%). Except FIGO stage II (85%-92%), survival did not change significantly over time. CONCLUSIONS Over the years, LGSC has been diagnosed as FIGO stage III and stage IV disease more often and interval debulking surgery has been increasingly preferred over primary debulking in these patients. Relative survival did not change over time (except for stage II) and worse survival outcomes after interval debulking surgery were observed. The results support the common recommendation to perform primary debulking surgery in patients eligible for primary surgery.
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Affiliation(s)
- Koen De Decker
- Department of Obstetrics and GynecologyIsala HospitalZwolleThe Netherlands,Department of Obstetrics and GynecologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Hans H. B. Wenzel
- Department of Obstetrics and GynecologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands,Department of Research & DevelopmentNetherlands Comprehensive Cancer OrganizationUtrechtThe Netherlands
| | - Joost Bart
- Department of Pathology and Medical BiologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Maaike A. van der Aa
- Department of Research & DevelopmentNetherlands Comprehensive Cancer OrganizationUtrechtThe Netherlands
| | - Roy F. P. M. Kruitwagen
- Department of Obstetrics and GynecologyMaastricht University Medical CenterMaastrichtThe Netherlands,GROW ‐ School for Oncology and ReproductionUniversity of MaastrichtMaastrichtThe Netherlands
| | - Hans W. Nijman
- Department of Obstetrics and GynecologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Arnold‐Jan Kruse
- Department of Obstetrics and GynecologyIsala HospitalZwolleThe Netherlands
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11
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Brummel K, Eerkens AL, de Bruyn M, Nijman HW. Tumour-infiltrating lymphocytes: from prognosis to treatment selection. Br J Cancer 2023; 128:451-458. [PMID: 36564565 PMCID: PMC9938191 DOI: 10.1038/s41416-022-02119-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Tumour-infiltrating lymphocytes (TILs) are considered crucial in anti-tumour immunity. Accordingly, the presence of TILs contains prognostic and predictive value. In 2011, we performed a systematic review and meta-analysis on the prognostic value of TILs across cancer types. Since then, the advent of immune checkpoint blockade (ICB) has renewed interest in the analysis of TILs. In this review, we first describe how our understanding of the prognostic value of TIL has changed over the last decade. New insights on novel TIL subsets are discussed and give a broader view on the prognostic effect of TILs in cancer. Apart from prognostic value, evidence on the predictive significance of TILs in the immune therapy era are discussed, as well as new techniques, such as machine learning that strive to incorporate these predictive capacities within clinical trials.
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Affiliation(s)
- Koen Brummel
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands
| | - Anneke L Eerkens
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands
| | - Marco de Bruyn
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands
| | - Hans W Nijman
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands.
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12
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Fremond S, Andani S, Barkey Wolf J, Dijkstra J, Melsbach S, Jobsen JJ, Brinkhuis M, Roothaan S, Jurgenliemk-Schulz I, Lutgens LCHW, Nout RA, van der Steen-Banasik EM, de Boer SM, Powell ME, Singh N, Mileshkin LR, Mackay HJ, Leary A, Nijman HW, Smit VTHBM, Creutzberg CL, Horeweg N, Koelzer VH, Bosse T. Interpretable deep learning model to predict the molecular classification of endometrial cancer from haematoxylin and eosin-stained whole-slide images: a combined analysis of the PORTEC randomised trials and clinical cohorts. Lancet Digit Health 2023; 5:e71-e82. [PMID: 36496303 DOI: 10.1016/s2589-7500(22)00210-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endometrial cancer can be molecularly classified into POLEmut, mismatch repair deficient (MMRd), p53 abnormal (p53abn), and no specific molecular profile (NSMP) subgroups. We aimed to develop an interpretable deep learning pipeline for whole-slide-image-based prediction of the four molecular classes in endometrial cancer (im4MEC), to identify morpho-molecular correlates, and to refine prognostication. METHODS This combined analysis included diagnostic haematoxylin and eosin-stained slides and molecular and clinicopathological data from 2028 patients with intermediate-to-high-risk endometrial cancer from the PORTEC-1 (n=466), PORTEC-2 (n=375), and PORTEC-3 (n=393) randomised trials and the TransPORTEC pilot study (n=110), the Medisch Spectrum Twente cohort (n=242), a case series of patients with POLEmut endometrial cancer in the Leiden Endometrial Cancer Repository (n=47), and The Cancer Genome Atlas-Uterine Corpus Endometrial Carcinoma cohort (n=395). PORTEC-3 was held out as an independent test set and a four-fold cross validation was performed. Performance was measured with the macro and class-wise area under the receiver operating characteristic curve (AUROC). Whole-slide images were segmented into tiles of 360 μm resized to 224 × 224 pixels. im4MEC was trained to learn tile-level morphological features with self-supervised learning and to molecularly classify whole-slide images with an attention mechanism. The top 20 tiles with the highest attention scores were reviewed to identify morpho-molecular correlates. Predictions of a nuclear classification deep learning model serve to derive interpretable morphological features. We analysed 5-year recurrence-free survival and explored prognostic refinement by molecular class using the Kaplan-Meier method. FINDINGS im4MEC attained macro-average AUROCs of 0·874 (95% CI 0·856-0·893) on four-fold cross-validation and 0·876 on the independent test set. The class-wise AUROCs were 0·849 for POLEmut (n=51), 0·844 for MMRd (n=134), 0·883 for NSMP (n=120), and 0·928 for p53abn (n=88). POLEmut and MMRd tiles had a high density of lymphocytes, p53abn tiles had strong nuclear atypia, and the morphology of POLEmut and MMRd endometrial cancer overlapped. im4MEC highlighted a low tumour-to-stroma ratio as a potentially novel characteristic feature of the NSMP class. 5-year recurrence-free survival was significantly different between im4MEC predicted molecular classes in PORTEC-3 (log-rank p<0·0001). The ten patients with aggressive p53abn endometrial cancer that was predicted as MMRd showed inflammatory morphology and appeared to have a better prognosis than patients with correctly predicted p53abn endometrial cancer (p=0·30). The four patients with NSMP endometrial cancer that was predicted as p53abn showed higher nuclear atypia and appeared to have a worse prognosis than patients with correctly predicted NSMP (p=0·13). Patients with MMRd endometrial cancer predicted as POLEmut had an excellent prognosis, as do those with true POLEmut endometrial cancer. INTERPRETATION We present the first interpretable deep learning model, im4MEC, for haematoxylin and eosin-based prediction of molecular endometrial cancer classification. im4MEC robustly identified morpho-molecular correlates and could enable further prognostic refinement of patients with endometrial cancer. FUNDING The Hanarth Foundation, the Promedica Foundation, and the Swiss Federal Institutes of Technology.
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Affiliation(s)
- Sarah Fremond
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Sonali Andani
- Department of Computer Science, ETH Zurich, Zurich, Switzerland; Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | | | - Jouke Dijkstra
- Department of Vascular and Molecular Imaging, Leiden University Medical Center, Leiden, Netherlands
| | - Sinéad Melsbach
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Jan J Jobsen
- Department of Radiation Oncology, Medisch Spectrum Twente, Enschede, Netherlands
| | | | | | - Ina Jurgenliemk-Schulz
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ludy C H W Lutgens
- Department of Radiation Oncology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Remi A Nout
- Department of Radiation Oncology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Stephanie M de Boer
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Melanie E Powell
- Department of Clinical Oncology, Barts Health NHS Trust, London, UK
| | - Naveena Singh
- Department of Pathology, Barts Health NHS Trust, London, UK
| | - Linda R Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Center, Melbourne, VIC, Australia
| | - Helen J Mackay
- Department of Medical Oncology and Hematology, Odette Cancer Center Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Alexandra Leary
- Medical Oncology Department, Gustave Roussy Institute, Villejuif, France
| | - Hans W Nijman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, Netherlands
| | | | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Nanda Horeweg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands.
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Kol A, Fan X, Wazynska MA, van Duijnhoven SM, Giesen D, Plat A, Van Eenennaam H, Elsinga PH, Nijman HW, de Bruyn M. Development of 89Zr-anti-CD103 PET imaging for non-invasive assessment of cancer reactive T cell infiltration. J Immunother Cancer 2022; 10:jitc-2022-004877. [PMID: 36600560 PMCID: PMC9723959 DOI: 10.1136/jitc-2022-004877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE CD103, an integrin specifically expressed on the surface of cancer-reactive T cells, is significantly increased during successful immunotherapy across human malignancies. In this study, we describe the generation and zirconium-89 (89Zr) radiolabeling of monoclonal antibody (mAb) clones that specifically recognize human CD103 for non-invasive immune positron-emission tomography (PET) imaging of T cell infiltration as potential biomarker for effective anticancer immune responses. EXPERIMENTAL DESIGN First, to determine the feasibility of anti-CD103 immuno-PET to visualize CD103-positive cells at physiologically and clinically relevant target densities, we developed an 89Zr-anti-murine CD103 PET tracer. Healthy, non-tumor bearing C57BL/6 mice underwent serial PET imaging after intravenous injection, followed by ex vivo biodistribution. Tracer specificity and macroscopic tissue distribution were studied using autoradiography combined with CD103 immunohistochemistry. Next, we generated and screened six unique mAbs that specifically target human CD103 positive cells. Optimal candidates were selected for 89Zr-anti-human CD103 PET development. Nude mice (BALB/cOlaHsd-Foxn1nu) with established CD103 expressing Chinese hamster ovary (CHO) or CHO wild-type xenografts were injected with 89Zr-anti-human CD103 mAbs and underwent serial PET imaging, followed by ex vivo biodistribution. RESULTS 89Zr-anti-murine CD103 PET imaging identified CD103-positive tissues at clinically relevant target densities. For human anti-human CD103 PET development two clones were selected based on strong binding to the CD103+ CD8+ T cell subpopulation in ovarian cancer tumor digests, non-overlapping binding epitopes and differential CD103 blocking properties. In vivo, both 89Zr-anti-human CD103 tracers showed high target-to-background ratios, high target site selectivity and a high sensitivity in human CD103 positive xenografts. CONCLUSION CD103 immuno-PET tracers visualize CD103 T cells at relevant densities and are suitable for future non-invasive assessment of cancer reactive T cell infiltration.
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Affiliation(s)
- Arjan Kol
- Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Xiaoyu Fan
- Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marta A. Wazynska
- Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Danique Giesen
- Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annechien Plat
- Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Philip H. Elsinga
- Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hans W. Nijman
- Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marco de Bruyn
- Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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14
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van Wagensveld L, van Baal JOAM, Timmermans M, Gaillard D, Borghuis L, Coffelt SB, Rosenberg EH, Lok CAR, Nijman HW, Kooreman LFS, Sanders J, de Bruijn M, Wessels LFA, van der Wiel R, Rausch C, Broeks A, Kruitwagen RFPM, van der Aa MA, Sonke GS, Schouten PC, Van de Vijver KK, Horlings HM. Homologous Recombination Deficiency and Cyclin E1 Amplification Are Correlated with Immune Cell Infiltration and Survival in High-Grade Serous Ovarian Cancer. Cancers (Basel) 2022; 14:cancers14235965. [PMID: 36497449 PMCID: PMC9738162 DOI: 10.3390/cancers14235965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND How molecular profiles are associated with tumor microenvironment (TME) in high-grade serous ovarian cancer (HGSOC) is incompletely understood. Therefore, we analyzed the TME and molecular profiles of HGSOC and assessed their associations with overall survival (OS). METHODS Patients with advanced-stage HGSOC treated in three Dutch hospitals between 2008-2015 were included. Patient data were collected from medical records. BRCA1/2 mutation, BRCA1 promotor methylation analyses, and copy number variations were used to define molecular profiles. Immune cells were assessed with immunohistochemical staining. RESULTS 348 patients were categorized as BRCA mutation (BRCAm) (BRCAm or promotor methylation) (30%), non-BRCA mutated HRD (19%), Cyclin E1 (CCNE1)-amplification (13%), non-BRCAmut HRD and CCNE1-amplification (double classifier) (20%), and no specific molecular profile (NSMP) (18%). BRCAm showed highest immune cell densities and CCNE1-amplification lowest. BRCAm showed the most favorable OS (52.5 months), compared to non-BRCAmut HRD (41.0 months), CCNE1-amplification (28.0 months), double classifier (27.8 months), and NSMP (35.4 months). Higher immune cell densities showed a favorable OS compared to lower, also within the profiles. CD8+, CD20+, and CD103+ cells remained associated with OS in multivariable analysis. CONCLUSIONS Molecular profiles and TME are associated with OS. TME differs per profile, with higher immune cell densities showing a favorable OS, even within the profiles. HGSOC does not reflect one entity but comprises different entities based on molecular profiles and TME.
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Affiliation(s)
- Lilian van Wagensveld
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), 3511 DT Utrecht, The Netherlands
- Department of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- GROW, School for Oncology and Reproduction, 6229 HX Maastricht, The Netherlands
- Correspondence:
| | - Juliette O. A. M. van Baal
- Department of Gynecology, Center for Gynecologic Oncology Amsterdam (CGOA), 1066 CX Amsterdam, The Netherlands
| | - Maite Timmermans
- Department of Obstetrics and Gynecology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Duco Gaillard
- Department of Molecular Carcinogenesis, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Lauri Borghuis
- Department of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Seth B. Coffelt
- Division of Tumor Biology & Immunology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- Institute of Cancer Sciences, University of Glasgow, Glasgow G12 8QQ, UK
- Cancer Research UK, Beatson Institute, Glasgow G61 1BD, UK
| | - Efraim H. Rosenberg
- Department of Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Christianne A. R. Lok
- Department of Gynecology, Center for Gynecologic Oncology Amsterdam (CGOA), 1066 CX Amsterdam, The Netherlands
| | - Hans W. Nijman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Loes F. S. Kooreman
- GROW, School for Oncology and Reproduction, 6229 HX Maastricht, The Netherlands
- Department of Pathology, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Joyce Sanders
- Department of Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Marco de Bruijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Lodewyk F. A. Wessels
- Department of Molecular Carcinogenesis, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Rianne van der Wiel
- Department of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Christian Rausch
- Department of Pathology, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
- BioLizard nv, 9000 Ghent, Belgium
| | - Annegien Broeks
- Core Facility Molecular Pathology & Biobanking, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Roy F. P. M. Kruitwagen
- GROW, School for Oncology and Reproduction, 6229 HX Maastricht, The Netherlands
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Maaike A. van der Aa
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), 3511 DT Utrecht, The Netherlands
| | - Gabe S. Sonke
- Department of Medical Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Philip C. Schouten
- Department of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Koen K. Van de Vijver
- Department of Gynecology, Center for Gynecologic Oncology Amsterdam (CGOA), 1066 CX Amsterdam, The Netherlands
- Department of Pathology & Cancer Research Institute Ghent (CRIG), Ghent University Hospital, 9000 Ghent, Belgium
| | - Hugo M. Horlings
- Department of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
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Vermij L, Léon-Castillo A, Singh N, Powell ME, Edmondson RJ, Genestie C, Khaw P, Pyman J, McLachlin CM, Ghatage P, de Boer SM, Nijman HW, Smit VTHBM, Crosbie EJ, Leary A, Creutzberg CL, Horeweg N, Bosse T. p53 immunohistochemistry in endometrial cancer: clinical and molecular correlates in the PORTEC-3 trial. Mod Pathol 2022; 35:1475-1483. [PMID: 35752743 PMCID: PMC7613653 DOI: 10.1038/s41379-022-01102-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 12/13/2022]
Abstract
Standard molecular classification of endometrial cancers (EC) is now endorsed by the WHO and identifies p53-abnormal (p53abn) EC as the subgroup with the poorest prognosis and the most likely to benefit from adjuvant chemo(radio)therapy. P53abn EC are POLE wildtype, mismatch repair proficient and show abnormal immunohistochemical (IHC) staining for p53. Correct interpretation of routinely performed p53 IHC has therefore become of paramount importance. We aimed to comprehensively investigate abnormal p53 IHC patterns and their relation to clinicopathological and molecular features. Tumor material of 411 molecularly classified high-risk EC from consenting patients from the PORTEC-3 clinical trial were collected. p53 IHC was successful in 408 EC and was considered abnormal when the tumor showed a mutant expression pattern (including subclonal): overexpression, null or cytoplasmic. The presence of pathogenic mutations was determined by next generation sequencing (NGS). Abnormal p53 expression was observed in 131/408 (32%) tumors. The most common abnormal p53 IHC pattern was overexpression (n = 89, 68%), followed by null (n = 12, 9%) and cytoplasmic (n = 3, 2%). Subclonal abnormal p53 staining was observed in 27 cases (21%), which was frequently but not exclusively, associated with POLE mutations and/or MMRd (n = 22/27; p < 0.001). Agreement between p53 IHC and TP53 NGS was observed in 90.7%, resulting in a sensitivity and specificity of 83.6% and 94.3%, respectively. Excluding POLEmut and MMRd EC, as per the WHO-endorsed algorithm, increased the accuracy to 94.5% with sensitivity and specificity of 95.0% and 94.1%, respectively. Our data shows that awareness of the abnormal p53 IHC patterns are prerequisites for correct EC molecular classification. Subclonal abnormal p53 expression is a strong indicator for POLEmut and/or MMRd EC. No significant differences in clinical outcomes were observed among the abnormal p53 IHC patterns. Our data support use of the WHO-endorsed algorithm and combining the different abnormal p53 IHC patterns into one diagnostic entity (p53abn EC).
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Affiliation(s)
- Lisa Vermij
- Departments of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alicia Léon-Castillo
- Departments of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Naveena Singh
- Departments of Pathology, Barts Health NHS Trust, London, UK
| | | | - Richard J Edmondson
- Division of Cancer Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
| | | | - Pearly Khaw
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jan Pyman
- Department of Anatomical Pathology, Royal Women's Hospital, Parkville, VIC, Australia
| | - C Meg McLachlin
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
| | - Prafull Ghatage
- Department of Gynecological Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Stephanie M de Boer
- Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans W Nijman
- Department of Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Vincent T H B M Smit
- Departments of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Emma J Crosbie
- Division of Cancer Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
- Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Carien L Creutzberg
- Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nanda Horeweg
- Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tjalling Bosse
- Departments of Pathology, Leiden University Medical Center, Leiden, The Netherlands.
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16
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Olthof EP, Wenzel H, van der Velden J, Spijkerboer AM, Bekkers R, Beltman JJ, Nijman HW, Slangen B, Smolders R, van Trommel N, Zusterzeel PLM, Zweemer R, Stalpers LJA, van der Aa M, Mom C. Treatment of bulky lymph nodes in locally advanced cervical cancer: boosting versus debulking. Int J Gynecol Cancer 2022; 32:861-868. [PMID: 35483738 PMCID: PMC9279830 DOI: 10.1136/ijgc-2022-003357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Treatment strategies for bulky lymph nodes in patients with locally advanced cervical cancer scheduled for definitive chemoradiation include nodal boosting with radiotherapy, surgical debulking, or both. The aim of this retrospective cohort study was to compare survival and toxicity in patients receiving these treatments and to compare them with a group that received neither form of treatment. Methods Women diagnosed between January 2009 and January 2017 with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB2, IIA2–IVA cervical cancer with lymph nodes ≥1.5 cm without upper limit on pretreatment imaging and treated with definitive chemoradiation were selected from the Netherlands Cancer Registry. Patients were categorized by intention-to-treat strategy: boosting, debulking, or neither treatment, with subgroup analysis for patients receiving both treatments, that is, debulking with boosting. Overall and relapse-free survival outcomes were compared by Kaplan-Meier and Cox regression analyses and toxicity by logistic regression analysis. Results Of 190 patients, 101 (53%) received only nodal boosting, 31 (16%) debulking alone, 29 (15%) debulking combined with boosting, and 29 (15%) received neither treatment. The 5 year overall and relapse-free survival for the treatment groups were 58%, 45% and 45% (p=0.19), and 47%, 44% and 46% (p=0.87), respectively. Multivariable Cox regression analyses demonstrated no differences in overall and relapse-free survival. Combination of debulking with boosting was associated with decreased overall and relapse-free survival compared with debulking alone (HR 2.47, 95% CI 1.22 to 5.00; and HR 2.37, 95% CI 1.14 to 4.93). Nodal boosting was independently associated with a decreased toxicity risk compared with debulking strategy (OR 0.37, 95% CI 0.16 to 0.83). Conclusions This study showed no survival benefit from either nodal boosting or debulking strategy in patients with suspicious bulky nodes. Nodal boosting might, however, be associated with less toxicity. Dual treatment with debulking and boosting showed a worse survival outcome because this group probably represents patients with poor prognostic factors.
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Affiliation(s)
- Ester Paulien Olthof
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands .,Department of Gynecological Oncology, Amsterdam University Medical Centres, Centre for Gynecological Oncology Amsterdam (CGOA), Amsterdam, The Netherlands
| | - Hans Wenzel
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jacobus van der Velden
- Department of Gynecological Oncology, Amsterdam University Medical Centres, Centre for Gynecological Oncology Amsterdam (CGOA), Amsterdam, The Netherlands
| | - Anje M Spijkerboer
- Department of Radiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Ruud Bekkers
- Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jogchum J Beltman
- Department of Gynecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Brigitte Slangen
- Department of Gynecologic Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ramon Smolders
- Department of Gynecological Oncology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Nienke van Trommel
- Department of Gynecological Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Centre for Gynecologic Oncology Amsterdam (CGOA), Amsterdam, The Netherlands
| | - Petra L M Zusterzeel
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ronald Zweemer
- Department of Gynecological Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lukas J A Stalpers
- Department of Radiation Oncology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Maaike van der Aa
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Constantijne Mom
- Department of Gynecological Oncology, Amsterdam University Medical Centres, Centre for Gynecological Oncology Amsterdam (CGOA), Amsterdam, The Netherlands
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17
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Lubbers JM, Ważyńska MA, van Rooij N, Kol A, Workel HH, Plat A, Paijens ST, Vlaming MR, Spierings DCJ, Elsinga PH, Bremer E, Nijman HW, de Bruyn M. Expression of CD39 Identifies Activated Intratumoral CD8+ T Cells in Mismatch Repair Deficient Endometrial Cancer. Cancers (Basel) 2022; 14:cancers14081924. [PMID: 35454831 PMCID: PMC9028869 DOI: 10.3390/cancers14081924] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Identification of human cancer-reactive CD8+ T cells is crucial for the stratification of patients for immunotherapy and determination of immune-therapeutic effects. Here, we report on the CD103− CD39+ subset of CD8+ T cells in tumors and reveal this subset to be activated and likely tumor-reactive. Our data further suggest that TGF-β signaling in the tumor micro-environment causes the differentiation of these recently activated CD103− CD39+ CD8+ T cells towards a CD39+ CD103+ tissue-resident memory-like phenotype. Abstract Identification of human cancer-reactive CD8+ T cells is crucial for the stratification of patients for immunotherapy and determination of immune-therapeutic effects. To date, these T cells have been identified mainly based on cell surface expression of programmed cell death protein 1 (PD-1) or co-expression of CD103 and CD39. A small subset of CD103− CD39+ CD8+ T cells is also present in tumors, but little is known about these T cells. Here, we report that CD103− CD39+ CD8+ T cells from mismatch repair-deficient endometrial tumors are activated and characterized predominantly by expression of TNFRSF9. In vitro, transforming growth factor-beta (TGF-β) drives the disappearance of this subset, likely through the conversion of CD103− CD39+ cells to a CD103+ phenotype. On the transcriptomic level, T cell activation and induction of CD39 was associated with a number of tissue residence and TGF-β responsive transcription factors. Altogether, our data suggest CD39+ CD103− CD8+ tumor-infiltrating T cells are recently activated and likely rapidly differentiate towards tissue residence upon exposure to TGF-β in the tumor micro-environment, explaining their relative paucity in human tumors.
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Affiliation(s)
- Joyce M. Lubbers
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.M.L.); (M.A.W.); (N.v.R.); (A.K.); (H.H.W.); (A.P.); (S.T.P.); (H.W.N.)
| | - Marta A. Ważyńska
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.M.L.); (M.A.W.); (N.v.R.); (A.K.); (H.H.W.); (A.P.); (S.T.P.); (H.W.N.)
| | - Nienke van Rooij
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.M.L.); (M.A.W.); (N.v.R.); (A.K.); (H.H.W.); (A.P.); (S.T.P.); (H.W.N.)
| | - Arjan Kol
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.M.L.); (M.A.W.); (N.v.R.); (A.K.); (H.H.W.); (A.P.); (S.T.P.); (H.W.N.)
| | - Hagma H. Workel
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.M.L.); (M.A.W.); (N.v.R.); (A.K.); (H.H.W.); (A.P.); (S.T.P.); (H.W.N.)
| | - Annechien Plat
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.M.L.); (M.A.W.); (N.v.R.); (A.K.); (H.H.W.); (A.P.); (S.T.P.); (H.W.N.)
| | - Sterre T. Paijens
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.M.L.); (M.A.W.); (N.v.R.); (A.K.); (H.H.W.); (A.P.); (S.T.P.); (H.W.N.)
| | - Martijn R. Vlaming
- Department of Hematology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.R.V.); (E.B.)
| | - Diana C. J. Spierings
- European Research Institute for the Biology of Ageing, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands;
| | - Philip H. Elsinga
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Edwin Bremer
- Department of Hematology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.R.V.); (E.B.)
| | - Hans W. Nijman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.M.L.); (M.A.W.); (N.v.R.); (A.K.); (H.H.W.); (A.P.); (S.T.P.); (H.W.N.)
| | - Marco de Bruyn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.M.L.); (M.A.W.); (N.v.R.); (A.K.); (H.H.W.); (A.P.); (S.T.P.); (H.W.N.)
- Correspondence:
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18
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Eerkens AL, Vledder A, Rooij N, Foijer F, Nijman HW, Bruyn M. Rapid and efficient generation of antigen‐specific isogenic T cells from cryopreserved blood samples. Immunol Cell Biol 2022; 100:285-295. [PMID: 35194830 PMCID: PMC9314923 DOI: 10.1111/imcb.12538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/04/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022]
Abstract
Clustered regularly interspaced short palindromic repeats/CRISPR‐associated protein 9 (CRISPR/Cas9)‐mediated gene editing has been leveraged for the modification of human and mouse T cells. However, limited experience is available on the application of CRISPR/Cas9 electroporation in cryopreserved T cells collected during clinical trials. To address this, we aimed to optimize a CRISPR/Cas9‐mediated gene editing protocol compatible with peripheral blood mononuclear cells (PBMCs) samples routinely produced during clinical trials. PBMCs from healthy donors were used to generate knockout T‐cell models for interferon‐γ, Cbl proto‐oncogene B (CBLB), Fas cell surface death receptor (Fas) and T‐cell receptor (TCRαβ) genes. The effect of CRISPR/Cas9‐mediated gene editing on T cells was evaluated using apoptosis assays, cytokine bead arrays and ex vivo and in vitro stimulation assays. Our results demonstrate that CRISPR/Cas9‐mediated gene editing of ex vivo T cells is efficient and does not overtly affect T‐cell viability. Cytokine release and T‐cell proliferation were not affected in gene‐edited T cells. Interestingly, memory T cells were more susceptible to CRISPR/Cas9 gene editing than naïve T cells. Ex vivo and in vitro stimulation with antigens resulted in equivalent antigen‐specific T‐cell responses in gene‐edited and untouched control cells, making CRISPR/Cas9‐mediated gene editing compatible with clinical antigen‐specific T‐cell activation and expansion assays. Here, we report an optimized protocol for rapid, viable and highly efficient genetic modification in ex vivo human antigen‐specific T cells, for subsequent functional evaluation and/or expansion. Our platform extends CRISPR/Cas9‐mediated gene editing for use in gold‐standard clinically used immune‐monitoring pipelines and serves as a starting point for development of analogous approaches, such as those including transcriptional activators and/or epigenetic modifiers.
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Affiliation(s)
- Anneke L Eerkens
- Department of Obstetrics and Gynecology University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - Annegé Vledder
- Department of Obstetrics and Gynecology University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - Nienke Rooij
- Department of Obstetrics and Gynecology University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - Floris Foijer
- European Research Institute for the Biology of Ageing University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynecology University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - Marco Bruyn
- Department of Obstetrics and Gynecology University of Groningen University Medical Center Groningen Groningen The Netherlands
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19
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Hendriks N, Koeneman MM, van de Sande AJ, Penders CG, Piek JM, Kooreman LF, van Kuijk SM, Hoosemans L, Sep SJ, de Vos Van Steenwijk PJ, van Beekhuizen HJ, Slangen BF, Nijman HW, Kruitwagen RF, Kruse AJ. Topical Imiquimod Treatment of High-grade Cervical Intraepithelial Neoplasia (TOPIC-3): A Nonrandomized Multicenter Study. J Immunother 2022; 45:180-186. [PMID: 35180719 PMCID: PMC8906243 DOI: 10.1097/cji.0000000000000414] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 01/13/2022] [Indexed: 11/25/2022]
Abstract
Topical imiquimod could be an alternative, noninvasive, treatment modality for high-grade cervical intraepithelial neoplasia (CIN). However, evidence is limited, and there are no studies that compared treatment effectiveness and side effects of topical imiquimod cream to standard large loop excision of the transformation zone (LLETZ) treatment. A multi-center, nonrandomized controlled trial was performed among women with a histologic diagnosis of CIN 2/3. Women were treated with either vaginal imiquimod (6.25 mg 3 times weekly for 8 to 16 wk) or LLETZ according to their own preference. Successful treatment was defined as the absence of high-grade dysplasia at the first follow-up interval after treatment (at 20 wk for the imiquimod group and at 26 wk for the LLETZ group). Secondary outcome measures were high-risk human papillomavirus (hrHPV) clearance, side effects, and predictive factors for successful imiquimod treatment. Imiquimod treatment was successful in 60% of women who completed imiquimod treatment and 95% of women treated with LLETZ. hrHPV clearance occurred in 69% and 67% in the imiquimod group and LLETZ group, respectively. This study provides further evidence on topical imiquimod cream as a feasible and safe treatment modality for high-grade CIN. Although the effectiveness is considerably lower than LLETZ treatment, imiquimod treatment could prevent initial surgical treatment in over 40% of women and should be offered to a selected population of women who wish to avoid (repeated) surgical treatment of high-grade CIN.
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Affiliation(s)
- Natasja Hendriks
- Departments of Obstetrics and Gynecology
- GROW—School for Oncology and Developmental Biology
| | - Margot M. Koeneman
- Departments of Obstetrics and Gynecology
- GROW—School for Oncology and Developmental Biology
| | | | - Charlotte G.J. Penders
- Departments of Obstetrics and Gynecology
- GROW—School for Oncology and Developmental Biology
| | - Jurgen M.J. Piek
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven
| | | | - Sander M.J. van Kuijk
- Department of Methodology and Statistics
- CAPHRI—School for Care and Public health Research Institute, Maastricht University, Maastricht
| | | | - Simone J.S. Sep
- Internal Medicine, Maastricht University Medical Center
- CAPHRI—School for Care and Public health Research Institute, Maastricht University, Maastricht
| | | | | | - Brigitte F.M. Slangen
- Departments of Obstetrics and Gynecology
- GROW—School for Oncology and Developmental Biology
| | - Hans W. Nijman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen
| | - Roy F.P.M. Kruitwagen
- Departments of Obstetrics and Gynecology
- GROW—School for Oncology and Developmental Biology
| | - Arnold-Jan Kruse
- Departments of Obstetrics and Gynecology
- GROW—School for Oncology and Developmental Biology
- Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, The Netherlands
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20
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Horeweg N, Workel HH, Loiero D, Church DN, Vermij L, Léon-Castillo A, Krog RT, de Boer SM, Nout RA, Powell ME, Mileshkin LR, MacKay H, Leary A, Singh N, Jürgenliemk-Schulz IM, Smit VTHBM, Creutzberg CL, Koelzer VH, Nijman HW, Bosse T, de Bruyn M. Tertiary lymphoid structures critical for prognosis in endometrial cancer patients. Nat Commun 2022; 13:1373. [PMID: 35296668 PMCID: PMC8927106 DOI: 10.1038/s41467-022-29040-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 02/23/2022] [Indexed: 02/07/2023] Open
Abstract
B-cells play a key role in cancer suppression, particularly when aggregated in tertiary lymphoid structures (TLS). Here, we investigate the role of B-cells and TLS in endometrial cancer (EC). Single cell RNA-sequencing of B-cells shows presence of naïve B-cells, cycling/germinal center B-cells and antibody-secreting cells. Differential gene expression analysis shows association of TLS with L1CAM overexpression. Immunohistochemistry and co-immunofluorescence show L1CAM expression in mature TLS, independent of L1CAM expression in the tumor. Using L1CAM as a marker, 378 of the 411 molecularly classified ECs from the PORTEC-3 biobank are evaluated, TLS are found in 19%. L1CAM expressing TLS are most common in mismatch-repair deficient (29/127, 23%) and polymerase-epsilon mutant EC (24/47, 51%). Multivariable Cox regression analysis shows strong favorable prognostic impact of TLS, independent of clinicopathological and molecular factors. Our data suggests a pivotal role of TLS in outcome of EC patients, and establishes L1CAM as a simple biomarker.
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Affiliation(s)
- Nanda Horeweg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Hagma H Workel
- Department of Gynaecologic Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Dominik Loiero
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - David N Church
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
- Oxford NIHR Comprehensive Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Lisa Vermij
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alicia Léon-Castillo
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ricki T Krog
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
- Department Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Stephanie M de Boer
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Remi A Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Melanie E Powell
- Department of Clinical Oncology, Barts Health NHS Trust, London, United Kingdom
| | - Linda R Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Helen MacKay
- Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - Alexandra Leary
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Naveena Singh
- Department of Pathology, Barts Health NHS Trust, London, United Kingdom
| | | | - Vincent T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Oncology and Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Hans W Nijman
- Department of Gynaecologic Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marco de Bruyn
- Department of Gynaecologic Oncology, University Medical Center Groningen, Groningen, the Netherlands
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21
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De Decker K, Jaroch KH, Bart J, Kooreman LFS, Kruitwagen RFPM, Nijman HW, Kruse AJ. Borderline ovarian tumor frozen section diagnoses with features suspicious of invasive cancer: a retrospective study. J Ovarian Res 2021; 14:139. [PMID: 34686192 PMCID: PMC8539880 DOI: 10.1186/s13048-021-00897-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background A frozen section diagnosis of a borderline ovarian tumor with suspicious features of invasive carcinoma (“at least borderline” or synonymous descriptions) presents us with the dilemma of whether or not to perform a full ovarian cancer staging procedure. Quantification of this dilemma may help us with the issue of this clinical decision. The present study assessed and compared both the prevalence of straightforward borderline and “at least borderline” frozen section diagnoses and the proportion of these women with a final histopathological diagnosis of invasive carcinoma, with a special interest in histologic subtypes. Methods A retrospective cohort study was performed in three hospitals in The Netherlands. All women that underwent ovarian surgery with perioperative frozen section evaluation in one of these hospitals between January 2007 and July 2018 were identified and included in case of a borderline or “at least borderline” frozen section diagnosis and a borderline ovarian tumor or invasive carcinoma as a final diagnosis. Results A total of 223 women were included, of which 41 women (18.4%) were diagnosed with “at least borderline” at frozen section. Thirteen of forty-one women (31.7%) following “at least borderline” frozen section diagnosis and 14 of 182 women (7.7%) following a straightforward borderline frozen section diagnosis were diagnosed with invasive carcinoma at paraffin section evaluation (p < 0.001). When compared to straightforward borderline frozen section diagnoses, the proportion of women diagnosed with invasive carcinoma increased from 3.1 to 35.7% for serous tumors (p = 0.001), 10.0 to 21.7% for mucinous tumors (p = 0.129) and 50.0 to 75.0% (p = 0.452) in case of other histologic subtypes following an “at least borderline” frozen section diagnosis. Conclusions Overall, when compared to women with a decisive borderline frozen section diagnosis, women diagnosed with “at least borderline” frozen section diagnoses were found to have a higher chance of carcinoma upon final diagnosis (7.7% vs 31.7%). Especially in the serous subtype, full staging during initial surgery might be considered after preoperative consent to prevent a second surgical procedure or chemotherapy in unstaged women. Further studies are needed to evaluate whether additional sampling in case of an “at least borderline” diagnosis may decrease the risk of surgical over-treatment.
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Affiliation(s)
- Koen De Decker
- Department of Obstetrics and Gynaecology, Isala Hospital, Zwolle, The Netherlands. .,Department of Obstetrics and Gynaecology, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
| | | | - Joost Bart
- Department Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Loes F S Kooreman
- Department of Pathology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Roy F P M Kruitwagen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Arnold-Jan Kruse
- Department of Obstetrics and Gynaecology, Isala Hospital, Zwolle, The Netherlands.,Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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22
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Wortman BG, Post CCB, Powell ME, Khaw P, Fyles A, D'Amico R, Haie-Meder C, Jürgenliemk-Schulz IM, McCormack M, Do V, Katsaros D, Bessette P, Baron MH, Nout RA, Whitmarsh K, Mileshkin L, Lutgens LCHW, Kitchener HC, Brooks S, Nijman HW, Astreinidou E, Putter H, Creutzberg CL, de Boer SM. Radiation Therapy Techniques and Treatment-Related Toxicity in the PORTEC-3 Trial: Comparison of 3-Dimensional Conformal Radiation Therapy Versus Intensity-Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2021; 112:390-399. [PMID: 34610387 DOI: 10.1016/j.ijrobp.2021.09.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE Radiation therapy techniques have developed from 3-dimensional conformal radiation therapy (3DCRT) to intensity modulated radiation therapy (IMRT), with better sparing of the surrounding normal tissues. The current analysis aimed to investigate whether IMRT, compared to 3DCRT, resulted in fewer adverse events (AEs) and patient-reported symptoms in the randomized PORTEC-3 trial for high-risk endometrial cancer. METHODS AND MATERIALS Data on AEs and patient-reported quality of life (QoL) of the PORTEC-3 trial were available for analysis. Physician-reported AEs were graded using Common Terminology Criteria for Adverse Events v3.0. QoL was assessed by the European Organisation for Research and Treatment of Cancer QLQC30, CX24, and OV28 questionnaires. Data were compared between 3DCRT and IMRT. A P value of ≤ .01 was considered statistically significant due to the risk of multiple testing. For QoL, combined scores 1 to 2 ("not at all" and "a little") versus 3 to 4 ("quite a bit" and "very much") were compared between the techniques. RESULTS Of 658 evaluable patients, 559 received 3DCRT and 99 IMRT. Median follow-up was 74.6 months. During treatment no significant differences were observed, with a trend for more grade ≥3 AEs, mostly hematologic and gastrointestinal, after 3DCRT (37.7% vs 26.3%, P = .03). During follow-up, 15.4% (vs 4%) had grade ≥2 diarrhea, and 26.1% (vs 13.1%) had grade ≥2 hematologic AEs after 3DCRT (vs IMRT) (both P < .01). Among 574 (87%) patients evaluable for QoL, 494 received 3DCRT and 80 IMRT. During treatment, 37.5% (vs 28.6%) reported diarrhea after 3DCRT (vs IMRT) (P = .125); 22.1% (versus 10.0%) bowel urgency (P = 0039), and 18.2% and 8.6% abdominal cramps (P = .058). Other QoL scores showed no differences. CONCLUSIONS IMRT resulted in fewer grade ≥3 AEs during treatment and significantly lower rates of grade ≥2 diarrhea and hematologic AEs during follow-up. Trends toward fewer patient-reported bowel urgency and abdominal cramps were observed after IMRT compared to 3DCRT.
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Affiliation(s)
- Bastiaan G Wortman
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Cathalijne C B Post
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Melanie E Powell
- Department of Clinical Oncology, Barts Health NHS Trust, London, United Kingdom
| | - Pearly Khaw
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Anthony Fyles
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Romerai D'Amico
- Department of Radiotherapy, Azienda Socio Sanitaria Territoriale, Lecco, Italy
| | | | | | - Mary McCormack
- Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Viet Do
- Radiation Oncology, Liverpool & Macarthur Cancer Therapy Center, NSW, Australia
| | - Dionyssios Katsaros
- Department of Surgical Sciences, Gynecologic Oncology, Città della Salute and Sant'Anna Hospital, University of Turin, Turin, Italy
| | - Paul Bessette
- Gynecologic Oncology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie Hélène Baron
- Department of Radiotherapy, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | - Remi A Nout
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Linda Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Henry C Kitchener
- Institute of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Susan Brooks
- Department of Radiation Oncology, Auckland City Hospital, Auckland, New Zealand
| | - Hans W Nijman
- Department of Gynecologic Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Eleftheria Astreinidou
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Stephanie M de Boer
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
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23
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Melief CJM, Welters MJP, Vergote I, Kroep JR, Kenter GG, Ottevanger PB, Tjalma WAA, Denys H, van Poelgeest MIE, Nijman HW, Reyners AKL, Velu T, Goffin F, Lalisang RI, Loof NM, Boekestijn S, Krebber WJ, Hooftman L, Visscher S, Blumenstein BA, Stead RB, Gerritsen W, van der Burg SH. Strong vaccine responses during chemotherapy are associated with prolonged cancer survival. Sci Transl Med 2021; 12:12/535/eaaz8235. [PMID: 32188726 DOI: 10.1126/scitranslmed.aaz8235] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/18/2020] [Indexed: 12/23/2022]
Abstract
Therapeutic cancer vaccines have effectively induced durable regressions of premalignant oncogenic human papilloma virus type 16 (HPV16)-induced anogenital lesions. However, the treatment of HPV16-induced cancers requires appropriate countermeasures to overcome cancer-induced immune suppression. We previously showed that standard-of-care carboplatin/paclitaxel chemotherapy can reduce abnormally high numbers of immunosuppressive myeloid cells in patients, allowing the development of much stronger therapeutic HPV16 vaccine (ISA101)-induced tumor immunity. We now show the clinical effects of ISA101 vaccination during chemotherapy in 77 patients with advanced, recurrent, or metastatic cervical cancer in a dose assessment study of ISA101. Tumor regressions were observed in 43% of 72 evaluable patients. The depletion of myeloid suppressive cells by carboplatin/paclitaxel was associated with detection of low frequency of spontaneous HPV16-specific immunity in 21 of 62 tested patients. Patients mounted type 1 T cell responses to the vaccine across all doses. The group of patients with higher than median vaccine-induced immune responses lived longer, with a flat tail on the survival curve. This demonstrates that chemoimmunotherapy can be exploited to the benefit of patients with advanced cancer based on a defined mode of action.
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Affiliation(s)
- Cornelis J M Melief
- ISA Pharmaceuticals, J.H. Oortweg 19, 2333 CH Leiden, Netherlands. .,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Marij J P Welters
- Oncode Institute, Jaarbeursplein 6, 3521 AL Utrecht, Netherlands.,Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Ignace Vergote
- Department of Gynecologic Oncology, University Hospital, Leuven Cancer Institute, UZ Herestraat 49, 3000 Leuven, Belgium
| | - Judith R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Gemma G Kenter
- Center for Gynecologic Oncology Amsterdam, Plesmanlaan 121, 1066 CX Amsterdam, Netherlands
| | - Petronella B Ottevanger
- Department of Medical Oncology, Nijmegen University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Netherlands
| | - Wiebren A A Tjalma
- Multidisciplinary Breast Clinic-Unit Gynecological Oncology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Hannelore Denys
- Department of Medical Oncology, University Hospital, De Pintelaan 185, 9000 Gent, Belgium
| | | | - Hans W Nijman
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, Netherlands
| | - Anna K L Reyners
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, Netherlands
| | - Thierry Velu
- Chirec Cancer Institute, Medical Centre Edith Cavell, Rue Edith Cavell 32, 1180 Brussels, Belgium
| | - Frederic Goffin
- Chirec Cancer Institute, Medical Centre Edith Cavell, Rue Edith Cavell 32, 1180 Brussels, Belgium
| | - Roy I Lalisang
- Department of Medical Oncology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, Netherlands
| | - Nikki M Loof
- Oncode Institute, Jaarbeursplein 6, 3521 AL Utrecht, Netherlands.,Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Sanne Boekestijn
- Oncode Institute, Jaarbeursplein 6, 3521 AL Utrecht, Netherlands.,Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | | | - Leon Hooftman
- ISA Pharmaceuticals, J.H. Oortweg 19, 2333 CH Leiden, Netherlands
| | - Sonja Visscher
- ISA Pharmaceuticals, J.H. Oortweg 19, 2333 CH Leiden, Netherlands
| | | | - Richard B Stead
- BioPharma Consulting Services, 691 96th Avenue Southeast, Bellevue, WA 98004, USA
| | - Winald Gerritsen
- Department of Medical Oncology, Nijmegen University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Netherlands
| | - Sjoerd H van der Burg
- Oncode Institute, Jaarbeursplein 6, 3521 AL Utrecht, Netherlands. .,Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
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24
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Kol A, Lubbers JM, Terwindt ALJ, Workel HH, Plat A, Wisman GBA, Bart J, Nijman HW, De Bruyn M. Combined STING levels and CD103+ T cell infiltration have significant prognostic implications for patients with cervical cancer. Oncoimmunology 2021; 10:1936391. [PMID: 34178428 PMCID: PMC8205031 DOI: 10.1080/2162402x.2021.1936391] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Activation of STimulator of INterferon Genes (STING) is important for induction of anti-tumor immunity. A dysfunctional STING pathway is observed in multiple cancer types and associates with poor prognosis and inferior response to immunotherapy. However, the association between STING and prognosis in virally induced cancers such as HPV-positive cervical cancer remains unknown. Here, we investigated the prognostic value of STING protein levels in cervical cancer using tumor tissue microarrays of two patient groups, primarily treated with surgery (n = 251) or radio(chemo)therapy (n = 255). We also studied CD103, an integrin that marks tumor-reactive cytotoxic T cells that reside in tumor epithelium and that is reported to associate with improved prognosis. Notably, we found that a high level of STING protein was an independent prognostic factor for improved survival in both the surgery and radio(chemo)therapy group. High infiltration of CD103+ T cells was associated with improved survival in the radio(chemo)therapy group. The combination of STING levels and CD103+ T cell infiltration is strongly associated with improved prognosis. We conclude that combining the prognostic values of STING and CD103 may improve the risk stratification of cervical cancer patients, independent from established clinical prognostic parameters.
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Affiliation(s)
- Arjan Kol
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, The Netherlands
| | - Joyce M Lubbers
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, The Netherlands
| | - Anouk L J Terwindt
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, The Netherlands
| | - Hagma H Workel
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, The Netherlands
| | - Annechien Plat
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, The Netherlands
| | - G Bea A Wisman
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, The Netherlands
| | - Joost Bart
- University of Groningen, University Medical Center Groningen, Department of Pathology, The Netherlands
| | - Hans W Nijman
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, The Netherlands
| | - Marco De Bruyn
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, The Netherlands
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25
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Wenzel HHB, Bekkers RLM, Lemmens VEPP, Van der Aa MA, Nijman HW. No improvement in survival of older women with cervical cancer-A nationwide study. Eur J Cancer 2021; 151:159-167. [PMID: 33993062 DOI: 10.1016/j.ejca.2021.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/26/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
AIM This study aims to report trends in primary treatment and survival in cervical cancer (CC) to identify opportunities to improve clinical practice and disease outcome. METHODS Patients diagnosed with CC between 1989 and 2018 were identified from the Netherlands Cancer Registry (N = 21,644). Trends in primary treatment and 5-year relative survival were analysed with the Cochran-Armitage trend test and multivariable Poisson regression, respectively. RESULTS In early CC, surgery remains the preferred treatment for ages 15-74. Overall, it was applied more often in younger than in older patients (92% in 15-44; 64% in 65-74). For 75+, surgery use was stable over time (38%-41%, p=0.368), while administration of radiotherapy decreased (57%-29%, p < 0.001). In locally advanced CC, chemoradiation use increased over time (5%-65%, p < 0.001). It was applied least often for 75+, in which radiotherapy remains most common (54% in 2014-2018). In metastatic CC, chemotherapy use increased over time (11%-28%, p < 0.001), but varied across age groups (6%-40% in 2014-2018). In patients treated with primary chemoradiation, regardless of stage, brachytherapy use increased over time (p ≤ 0.001). Full cohort 5-year survival increased from 68% to 74% (relative excess risk 0.55; 95% confidence interval [0.50-0.62]). Increases were most significant in locally advanced CC (38%-60%; 0.55 [0.47-0.65]). Survival remained stable in 75+ (38%-34%; 0.82 [0.66-1.02]). CONCLUSION Relative survival for cervical cancer increased over the last three decades. The proportion of older patients receiving preferred treatment lags behind. Consequently, survival did not improve in the oldest patients.
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Affiliation(s)
- Hans H B Wenzel
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Valery E P P Lemmens
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Maaike A Van der Aa
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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26
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Butera R, Ważyńska M, Magiera-Mularz K, Plewka J, Musielak B, Surmiak E, Sala D, Kitel R, de Bruyn M, Nijman HW, Elsinga PH, Holak TA, Dömling A. Design, Synthesis, and Biological Evaluation of Imidazopyridines as PD-1/PD-L1 Antagonists. ACS Med Chem Lett 2021; 12:768-773. [PMID: 34055224 PMCID: PMC8155249 DOI: 10.1021/acsmedchemlett.1c00033] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/21/2021] [Indexed: 12/12/2022] Open
Abstract
![]()
The PD-1/PD-L1 axis
has proven to be a highly efficacious target
for cancer immune checkpoint therapy with several approved antibodies.
Also, small molecules based on a biphenyl core can antagonize PD-1/PD-L1,
leading to the in vitro formation of PD-L1 dimers. However, their
development remains challenging, as we do not yet fully understand
their mode of action. In this work, we designed a new scaffold based
on our previously solved high-resolution structures of low-molecular-weight
inhibitors bound to PD-L1. A small compound library was synthesized
using the Groebke–Blackburn–Bienaymé multicomponent
reaction (GBB-3CR), resulting in the structure–activity relationship
of imidazo[1,2-a]pyridine-based inhibitors. These
inhibitors were tested for their biological activity using various
biophysical assays giving potent candidates with low-micromolar PD-L1
affinities. An obtained PD-L1 cocrystal structure reveals the binding
to PD-L1. Our results open the door to an interesting bioactive scaffold
that could lead to a new class of PD-L1 antagonists.
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Affiliation(s)
- Roberto Butera
- Department of Drug Design, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Marta Ważyńska
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Katarzyna Magiera-Mularz
- Department of Crystal Chemistry and Crystal Physics Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Kraków, Poland
| | - Jacek Plewka
- Department of Crystal Chemistry and Crystal Physics Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Kraków, Poland
| | - Bogdan Musielak
- Department of Crystal Chemistry and Crystal Physics Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Kraków, Poland
| | - Ewa Surmiak
- Department of Crystal Chemistry and Crystal Physics Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Kraków, Poland
| | - Dominik Sala
- Department of Crystal Chemistry and Crystal Physics Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Kraków, Poland
| | - Radoslaw Kitel
- Department of Crystal Chemistry and Crystal Physics Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Kraków, Poland
| | - Marco de Bruyn
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Hans W. Nijman
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Philip H. Elsinga
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Tad A. Holak
- Department of Crystal Chemistry and Crystal Physics Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Kraków, Poland
| | - Alexander Dömling
- Department of Drug Design, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
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27
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Abstract
The clinical success of cancer immune checkpoint blockade (ICB) has refocused attention on tumor-infiltrating lymphocytes (TILs) across cancer types. The outcome of immune checkpoint inhibitor therapy in cancer patients has been linked to the quality and magnitude of T cell, NK cell, and more recently, B cell responses within the tumor microenvironment. State-of-the-art single-cell analysis of TIL gene expression profiles and clonality has revealed a remarkable degree of cellular heterogeneity and distinct patterns of immune activation and exhaustion. Many of these states are conserved across tumor types, in line with the broad responses observed clinically. Despite this homology, not all cancer types with similar TIL landscapes respond similarly to immunotherapy, highlighting the complexity of the underlying tumor-immune interactions. This observation is further confounded by the strong prognostic benefit of TILs observed for tumor types that have so far respond poorly to immunotherapy. Thus, while a holistic view of lymphocyte infiltration and dysfunction on a single-cell level is emerging, the search for response and prognostic biomarkers is just beginning. Within this review, we discuss recent advances in the understanding of TIL biology, their prognostic benefit, and their predictive value for therapy.
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Affiliation(s)
- Sterre T Paijens
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annegé Vledder
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marco de Bruyn
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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De Decker K, Jaroch KH, Edens MA, Bart J, Kooreman LFS, Kruitwagen RFPM, Nijman HW, Kruse AJ. Frozen section diagnosis of borderline ovarian tumors with suspicious features of invasive cancer is a devil's dilemma for the surgeon: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2021; 100:1369-1376. [PMID: 33539545 PMCID: PMC8359269 DOI: 10.1111/aogs.14105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 12/26/2022]
Abstract
Introduction Frozen section diagnoses of borderline ovarian tumors are not always straightforward and a borderline frozen section diagnosis with suspicious features of invasive carcinoma (reported as “at least borderline” or synonymous descriptions) presents us with the dilemma of whether or not to perform a full surgical staging procedure. By performing a systematic review and meta‐analysis, the prevalence of straightforward borderline and “at least borderline” frozen section diagnoses, as well as proportion of patients with a final diagnosis of invasive carcinoma in these cases, were assessed and compared, as quantification of this dilemma may help us with the issue of this clinical decision. Material and methods PubMed, EMBASE and Cochrane library databases were searched and studies discussing “at least borderline” frozen section diagnoses were included in the review. Numbers of specific frozen section diagnoses and subsequent final histological diagnoses were extracted and pooled analysis was performed to compare the proportion of patients diagnosed with invasive carcinoma following borderline and “at least borderline” frozen section diagnoses, presented as risk ratio and risk difference with 95% confidence intervals (95% CI). Results Of 4940 screened records, eight studies were considered eligible for quantitative analysis. A total of 921 women was identified and 230 (25.0%) of these women were diagnosed with “at least borderline” ovarian tumor at the time of frozen section. Final histological diagnoses were reported in five studies, including 61 women with an “at least borderline” diagnosis and 290 women with a straightforward borderline frozen section diagnosis. Twenty‐five of 61 women (41.0%) of the “at least borderline” group had invasive cancer at final diagnosis, compared with 28 of 290 women (9.7%) of the straightforward borderline frozen section group (risk difference −0.34, 95% CI −0.53 to −0.15; relative risk 0.25, 95% CI 0.13–0.50). Conclusions Women diagnosed with “at least borderline” frozen section diagnoses were found to have a higher chance of carcinoma upon final diagnosis when compared with women with a straightforward borderline frozen section diagnosis (41.0% vs 9.7%). Especially in the serous subtype, and after preoperative consent, full staging during initial surgery might be considered in these cases to prevent a second surgical procedure.
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Affiliation(s)
- Koen De Decker
- Department of Obstetrics and Gynecology, Isala Hospital, Zwolle, The Netherlands.,Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Mireille A Edens
- Department of Innovation and Science, Isala Hospital, Zwolle, The Netherlands
| | - Joost Bart
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Loes F S Kooreman
- Department of Pathology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Roy F P M Kruitwagen
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - Arnold-Jan Kruse
- Department of Obstetrics and Gynecology, Isala Hospital, Zwolle, The Netherlands.,Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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29
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Lubbers JM, Koopman B, de Klerk‐Sluis JM, van Rooij N, Plat A, Pijper H, Koopman T, van Hemel BM, Hollema H, Wisman B, Nijman HW, de Bruyn M. Association of homozygous variants of STING1 with outcome in human cervical cancer. Cancer Sci 2021; 112:61-71. [PMID: 33040406 PMCID: PMC7780010 DOI: 10.1111/cas.14680] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/24/2020] [Accepted: 10/02/2020] [Indexed: 01/04/2023] Open
Abstract
DNA-sensing receptor Cyclic GMP-AMP Synthase (cGAS) and its downstream signaling effector STimulator of INterferon Genes (STING) have gained significant interest in the field of tumor immunology, as a dysfunctional cGAS-STING pathway is associated with poor prognosis and worse response to immunotherapy. However, studies so far have not taken into account the polymorphic nature of the STING-encoding STING1 gene. We hypothesized that the presence of allelic variance in STING1 would cause variation between individuals as to their susceptibility to cancer development, cancer progression, and potential response to (immuno)therapy. To start to address this, we defined the genetic landscapes of STING1 in cervical scrapings and investigated their corresponding clinical characteristics across a unique cohort of cervical cancer patients and compared them with independent control cohorts. Although we did not observe an enrichment of particular STING1 allelic variants in cervical cancer patients, we did find that the occurrence of homozygous variants HAQ/HAQ and R232H/R232H of STING1 were associated with both younger age of diagnosis and higher recurrence rate. These findings were accompanied by worse survival, despite comparable mRNA and protein levels of STING and numbers of infiltrated CD8+ T cells. Our findings suggest that patients with HAQ/HAQ and R232H/R232H genotypes may have a dysfunctional cGAS-STING pathway that fails to promote efficient anticancer immunity. Interestingly, the occurrence of these genotypes coincided with homozygous presence of the V48V variant, which was found to be individually associated with worse outcome. Therefore, we propose V48V to be further evaluated as a novel prognostic marker for cervical cancer.
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Affiliation(s)
- Joyce M. Lubbers
- Department of Obstetrics and GynecologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Bart Koopman
- Department of PathologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Jessica M. de Klerk‐Sluis
- Department of Obstetrics and GynecologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Nienke van Rooij
- Department of Obstetrics and GynecologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Annechien Plat
- Department of Obstetrics and GynecologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Harry Pijper
- Department of Obstetrics and GynecologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Timco Koopman
- Department of PathologyPathologie FrieslandLeeuwardenThe Netherlands
| | - Bettien M. van Hemel
- Department of PathologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Harry Hollema
- Department of PathologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Bea Wisman
- Department of Obstetrics and GynecologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Hans W. Nijman
- Department of Obstetrics and GynecologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Marco de Bruyn
- Department of Obstetrics and GynecologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
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30
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Horeweg N, de Bruyn M, Nout RA, Stelloo E, Kedziersza K, León-Castillo A, Plat A, Mertz KD, Osse M, Jürgenliemk-Schulz IM, Lutgens LCHW, Jobsen JJ, van der Steen-Banasik EM, Smit VT, Creutzberg CL, Bosse T, Nijman HW, Koelzer VH, Church DN. Prognostic Integrated Image-Based Immune and Molecular Profiling in Early-Stage Endometrial Cancer. Cancer Immunol Res 2020; 8:1508-1519. [PMID: 32999003 DOI: 10.1158/2326-6066.cir-20-0149] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/02/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022]
Abstract
Optimum risk stratification in early-stage endometrial cancer combines clinicopathologic factors and the molecular endometrial cancer classification defined by The Cancer Genome Atlas (TCGA). It is unclear whether analysis of intratumoral immune infiltrate improves this. We developed a machine-learning, image-based algorithm to quantify density of CD8+ and CD103+ immune cells in tumor epithelium and stroma in 695 stage I endometrioid endometrial cancers from the PORTEC-1 and -2 trials. The relationship between immune cell density and clinicopathologic/molecular factors was analyzed by hierarchical clustering and multiple regression. The prognostic value of immune infiltrate by cell type and location was analyzed by univariable and multivariable Cox regression, incorporating the molecular endometrial cancer classification. Tumor-infiltrating immune cell density varied substantially between cases, and more modestly by immune cell type and location. Clustering revealed three groups with high, intermediate, and low densities, with highly significant variation in the proportion of molecular endometrial cancer subgroups between them. Univariable analysis revealed intraepithelial CD8+ cell density as the strongest predictor of endometrial cancer recurrence; multivariable analysis confirmed this was independent of pathologic factors and molecular subgroup. Exploratory analysis suggested this association was not uniform across molecular subgroups, but greatest in tumors with mutant p53 and absent in DNA mismatch repair-deficient cancers. Thus, this work identified that quantification of intraepithelial CD8+ cells improved upon the prognostic utility of the molecular endometrial cancer classification in early-stage endometrial cancer.
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Affiliation(s)
- Nanda Horeweg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marco de Bruyn
- Department of Gynaecologic Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Remi A Nout
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ellen Stelloo
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Katarzyna Kedziersza
- Wellcome Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford, United Kingdom
| | - Alicia León-Castillo
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Annechien Plat
- Department of Gynaecologic Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Kirsten D Mertz
- Cantonal Hospital Baselland, Institute of Pathology, Liestal, Switzerland
| | - Michelle Osse
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Jan J Jobsen
- Department of Radiotherapy, Medisch Spectrum Twente, Enschede, the Netherlands
| | | | - Vincent T Smit
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans W Nijman
- Department of Gynaecologic Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University of Zurich, Zurich, Switzerland
- Department of Oncology and Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - David N Church
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands.
- Oxford Cancer Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Oxford NIHR Comprehensive Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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31
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Komdeur FL, Singh A, van de Wall S, Meulenberg JJM, Boerma A, Hoogeboom BN, Paijens ST, Oyarce C, de Bruyn M, Schuuring E, Regts J, Marra R, Werner N, Sluis J, van der Zee AGJ, Wilschut JC, Allersma DP, van Zanten CJ, Kosterink JGW, Jorritsma-Smit A, Yigit R, Nijman HW, Daemen T. First-in-Human Phase I Clinical Trial of an SFV-Based RNA Replicon Cancer Vaccine against HPV-Induced Cancers. Mol Ther 2020; 29:611-625. [PMID: 33160073 PMCID: PMC7854293 DOI: 10.1016/j.ymthe.2020.11.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/08/2020] [Accepted: 10/31/2020] [Indexed: 12/15/2022] Open
Abstract
A first-in-human phase I trial of Vvax001, an alphavirus-based therapeutic cancer vaccine against human papillomavirus (HPV)-induced cancers was performed assessing immunological activity, safety, and tolerability. Vvax001 consists of replication-incompetent Semliki Forest virus replicon particles encoding HPV16-derived antigens E6 and E7. Twelve participants with a history of cervical intraepithelial neoplasia were included. Four cohorts of three participants were treated per dose level, ranging from 5 × 105 to 2.5 × 108 infectious particles per immunization. The participants received three immunizations with a 3-week interval. For immune monitoring, blood was drawn before immunization and 1 week after the second and third immunization. Immunization with Vvax001 was safe and well tolerated, with only mild injection site reactions, and resulted in both CD4+ and CD8+ T cell responses against E6 and E7 antigens. Even the lowest dose of 5 × 105 infectious particles elicited E6/E7-specific interferon (IFN)-γ responses in all three participants in this cohort. Overall, immunization resulted in positive vaccine-induced immune responses in 12 of 12 participants in one or more assays performed. In conclusion, Vvax001 was safe and induced immune responses in all participants. These data strongly support further clinical evaluation of Vvax001 as a therapeutic vaccine in patients with HPV-related malignancies.
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Affiliation(s)
- Fenne L Komdeur
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Amrita Singh
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stephanie van de Wall
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Annemarie Boerma
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Baukje Nynke Hoogeboom
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sterre T Paijens
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Cesar Oyarce
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marco de Bruyn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ed Schuuring
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Joke Regts
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ruben Marra
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Naomi Werner
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jessica Sluis
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ate G J van der Zee
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jan C Wilschut
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Derk P Allersma
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Coba J van Zanten
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jos G W Kosterink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Annelies Jorritsma-Smit
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Refika Yigit
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Toos Daemen
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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32
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Post CCB, de Boer SM, Powell ME, Mileshkin L, Katsaros D, Bessette P, Haie-Meder C, Ottevanger NPB, Ledermann JA, Khaw P, D'Amico R, Fyles A, Baron MH, Kitchener HC, Nijman HW, Lutgens LCHW, Brooks S, Jürgenliemk-Schulz IM, Feeney A, Goss G, Fossati R, Ghatage P, Leary A, Do V, Lissoni AA, McCormack M, Nout RA, Verhoeven-Adema KW, Smit VTHBM, Putter H, Creutzberg CL. Long-Term Toxicity and Health-Related Quality of Life After Adjuvant Chemoradiation Therapy or Radiation Therapy Alone for High-Risk Endometrial Cancer in the Randomized PORTEC-3 Trial. Int J Radiat Oncol Biol Phys 2020; 109:975-986. [PMID: 33129910 DOI: 10.1016/j.ijrobp.2020.10.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE The survival results of the PORTEC-3 trial showed a significant improvement in both overall and failure-free survival with chemoradiation therapy versus pelvic radiation therapy alone. The present analysis was performed to compare long-term adverse events (AE) and health-related quality of life (HRQOL). METHODS AND MATERIALS In the study, 660 women with high-risk endometrial cancer were randomly assigned to receive chemoradiation therapy (2 concurrent cycles of cisplatin followed by 4 cycles of carboplatin/paclitaxel) or radiation therapy alone. Toxicity was graded using Common Terminology Criteria for Adverse Events, version 3.0. HRQOL was measured using EORTC QLQ-C30 and CX24/OV28 subscales and compared with normative data. An as-treated analysis was performed. RESULTS Median follow-up was 74.6 months; 574 (87%) patients were evaluable for HRQOL. At 5 years, grade ≥2 AE were scored for 78 (38%) patients who had received chemoradiation therapy versus 46 (24%) who had received radiation therapy alone (P = .008). Grade 3 AE did not differ significantly between the groups (8% vs 5%, P = .18) at 5 years, and only one new late grade 4 toxicity had been reported. At 3 and 5 years, sensory neuropathy toxicity grade ≥2 persisted after chemoradiation therapy in 6% (vs 0% after radiation therapy, P < .001) and more patients reported significant tingling or numbness at HRQOL (27% vs 8%, P < .001 at 3 years; 24% vs 9%, P = .002 at 5 years). Up to 3 years, more patients who had chemoradiation therapy reported limb weakness (21% vs 5%, P < .001) and lower physical (79 vs 87, P < .001) and role functioning (78 vs 88, P < .001) scores. Both treatment groups reported similar long-term global health/quality of life scores, which were better than those of the normative population. CONCLUSIONS This study shows a long-lasting, clinically relevant, negative impact of chemoradiation therapy on toxicity and HRQOL, most importantly persistent peripheral sensory neuropathy. Physical and role functioning impairments were seen until 3 years. These long-term data are essential for patient information and shared decision-making regarding adjuvant chemotherapy for high-risk endometrial cancer.
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Affiliation(s)
- Cathalijne C B Post
- Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Stephanie M de Boer
- Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Melanie E Powell
- Clinical Oncology, Barts Health NHS Trust, London, United Kingdom
| | - Linda Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Dionyssios Katsaros
- Surgical Sciences and Gynecology, Città della Salute and S Anna Hospital, Torino, Italy
| | - Paul Bessette
- Gynaecologic Oncology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | | | | | - Jonathan A Ledermann
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, United Kingdom
| | - Pearly Khaw
- Radiation Oncology, Peter MacCallum Cancer Center, Melbourne, Australia
| | - Romerai D'Amico
- Radiotherapy, Azienda Socio Sanitaria Territoriale, Lecco, Italy
| | - Anthony Fyles
- Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Marie Hélène Baron
- Radiotherapy, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | - Henry C Kitchener
- Institute of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Hans W Nijman
- Gynecologic Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Susan Brooks
- Radiation Oncology, Auckland City Hospital, Auckland, New Zealand
| | | | - Amanda Feeney
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, United Kingdom
| | - Geraldine Goss
- Medical Oncology, Box Hill Hospital, Melbourne, Australia
| | - Roldano Fossati
- Medical Oncology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Prafull Ghatage
- Gynecologic Oncology, Calgary-Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Alexandra Leary
- Cancer Medicine and Gynecological Tumor Translational Research Lab, Gustave Roussy Cancer Center, INSERM U981, Université Paris Saclay, Villejuif, France
| | - Viet Do
- Radiation Oncology, Liverpool & Macarthur Cancer Therapy Centre, NSW, Australia
| | | | - Mary McCormack
- Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Remi A Nout
- Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Karen W Verhoeven-Adema
- Central Data Management and Trial Coordination, Comprehensive Cancer Center Netherlands, Rotterdam, The Netherlands
| | | | - Hein Putter
- Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Carien L Creutzberg
- Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
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33
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van den Heerik ASVM, Horeweg N, Nout RA, Lutgens LCHW, van der Steen-Banasik EM, Westerveld GH, van den Berg HA, Slot A, Koppe FLA, Kommoss S, Mens JWM, Nowee ME, Bijmolt S, Cibula D, Stam TC, Jurgenliemk-Schulz IM, Snyers A, Hamann M, Zwanenburg AG, Coen VLMA, Vandecasteele K, Gillham C, Chargari C, Verhoeven-Adema KW, Putter H, van den Hout WB, Wortman BG, Nijman HW, Bosse T, Creutzberg CL. PORTEC-4a: international randomized trial of molecular profile-based adjuvant treatment for women with high-intermediate risk endometrial cancer. Int J Gynecol Cancer 2020; 30:2002-2007. [PMID: 33046573 PMCID: PMC7788476 DOI: 10.1136/ijgc-2020-001929] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Vaginal brachytherapy is currently recommended as adjuvant treatment in patients with high-intermediate risk endometrial cancer to maximize local control and has only mild side effects and no or limited impact on quality of life. However, there is still considerable overtreatment and also some undertreatment, which may be reduced by tailoring adjuvant treatment to the patients' risk of recurrence based on molecular tumor characteristics. PRIMARY OBJECTIVES To compare the rates of vaginal recurrence in women with high-intermediate risk endometrial cancer, treated after surgery with molecular-integrated risk profile-based recommendations for either observation, vaginal brachytherapy or external pelvic beam radiotherapy or with standard adjuvant vaginal brachytherapy STUDY HYPOTHESIS: Adjuvant treatment based on a molecular-integrated risk profile provides similar local control and recurrence-free survival as current standard adjuvant brachytherapy in patients with high-intermediate risk endometrial cancer, while sparing many patients the morbidity of adjuvant treatment and reducing healthcare costs. TRIAL DESIGN A multicenter, international phase III randomized trial (2:1) of molecular-integrated risk profile-based adjuvant treatment (experimental arm) or adjuvant vaginal brachytherapy (standard arm). MAJOR INCLUSION/EXCLUSION CRITERIA Women aged 18 years and over with a histological diagnosis of high-intermediate risk endometrioid endometrial cancer after total abdominal or laparoscopic hysterectomy and bilateral salpingo-oophorectomy. High-intermediate risk factors are defined as: (i) International Federation of Gynecology and Obstetrics stage IA (with invasion) and grade 3; (ii) stage IB grade 1 or 2 with age ≥60 and/or lymph-vascular space invasion; (iii) stage IB, grade 3 without lymph-vascular space invasion; or (iv) stage II (microscopic and grade 1). ENDPOINTS The primary endpoint is vaginal recurrence. Secondary endpoints are recurrence-free and overall survival; pelvic and distant recurrence; 5-year vaginal control (including treatment for relapse); adverse events and patient-reported symptoms and quality of life; and endometrial cancer-related healthcare costs. SAMPLE SIZE 500 eligible and evaluable patients. ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS Estimated date for completing accrual will be late 2021. Estimated date for presentation of (first) results is expected in 2023. TRIAL REGISTRATION The trial is registered at clinicaltrials.gov (NCT03469674) and ISRCTN (11659025).
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Affiliation(s)
| | - Nanda Horeweg
- Radiation Oncology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Remi A Nout
- Radiation Oncology, Erasmus Medical Center - Cancer Institute, Rotterdam, Zuid-Holland, The Netherlands
| | - Ludy C H W Lutgens
- Radiation Oncology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
| | | | - G Henrike Westerveld
- Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Hetty A van den Berg
- Radiation Oncology, Catharina Hospital, Eindhoven, Noord-Brabant, The Netherlands
| | - Annerie Slot
- Radiation Oncology, Radiotherapy Institute Friesland, Leeuwarden, Friesland, The Netherlands
| | - Friederike L A Koppe
- Radiation Oncology, Institute Verbeeten, Tilburg, Noord-Brabant, The Netherlands
| | - Stefan Kommoss
- Women's Health, Universitätsklinikum Tübingen, Tübingen, Baden-Württemberg, Germany
| | - Jan Willem M Mens
- Radiation Oncology, Erasmus Medical Center - Cancer Institute, Rotterdam, Zuid-Holland, The Netherlands
| | - Marlies E Nowee
- Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Stefan Bijmolt
- Radiation Oncology, University Medical Centre Groningen, University of Groningen, Groningen, Groningen, The Netherlands
| | - David Cibula
- Gynecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tanja C Stam
- Radiation Oncology, Haaglanden Medical Center, Den Haag, Zuid-Holland, The Netherlands
| | | | - An Snyers
- Radiation Oncology, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Moritz Hamann
- Women's Health, Rotkreuzklinikum Munchen, Munchen, Bayern, Germany
| | | | - Veronique L M A Coen
- Radiation Oncology, Zuidwest Radiotherapeutic Institute, Vlissingen, Zeeland, The Netherlands
| | | | - Charles Gillham
- Radiation Oncology, St. Luke's Hospital Dublin, Dublin, Ireland
| | - Cyrus Chargari
- Radiation Oncology, Institut Gustave-Roussy, Villejuif, Île-de-France, France
| | | | - Hein Putter
- Medical Statistics, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Wilbert B van den Hout
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Bastiaan G Wortman
- Radiation Oncology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Hans W Nijman
- Obstetrics & Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, Groningen, The Netherlands
| | - Tjalling Bosse
- Pathology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Carien L Creutzberg
- Radiation Oncology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
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Broekman KE, Hof MAJ, Touw DJ, Gietema JA, Nijman HW, Lefrandt JD, Reyners AKL, Jalving M. Phase I study of metformin in combination with carboplatin/paclitaxel chemotherapy in patients with advanced epithelial ovarian cancer. Invest New Drugs 2020; 38:1454-1462. [PMID: 32146550 PMCID: PMC7497683 DOI: 10.1007/s10637-020-00920-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/28/2020] [Indexed: 12/24/2022]
Abstract
Background Metformin use is associated with reduced cancer risk in epidemiological studies and has preclinical anti-cancer activity in ovarian cancer models. The primary objective of this phase I study was to determine the recommended phase II dose (RP2D) of metformin in combination with carboplatin/paclitaxel in patients with ovarian cancer. Secondary objectives were to describe safety and pharmacokinetics. Methods In this single-center trial the RP2D of metformin in combination with carboplatin area under the concentration-time curve (AUC) 6 and paclitaxel 175 mg/m2 every 3 weeks (q3w) in patients with advanced epithelial ovarian cancer was determined using a 3 + 3 escalation rule at three fixed dose levels: 500 mg three times daily (tds), 850 mg tds and 1000 mg tds. Metformin was commenced on day 3 of cycle 1 and continued until 3 weeks after the last chemotherapy administration. The RP2D was defined as the dose level at which 0 of 3 or ≤ 1 of 6 evaluable subjects experienced a metformin-related dose-limiting toxicity (DLT). Safety was assessed according to CTCAE v4.0. Plasma and serum samples for pharmacokinetic (PK) analyses were collected during treatment cycles 1 and 2. Results Fifteen patients with epithelial ovarian cancer and an indication for neo-adjuvant (n = 5) or palliative (n = 10) treatment were included. No DLTs were observed. Three patients discontinued study treatment during cycle 1 for other reasons than DLT. Six patients were treated at the RP2D of metformin 1000 mg tds. The most frequent low-grade toxicities were anemia, hypomagnesemia and diarrhea. Grade 3 adverse events (AEs) occurred in ten patients, most common were leucopenia (n = 4), thrombocytopenia (n = 3) and increased GGT (n = 3). There were no grade 4 AEs. Metformin increased the platinum (Pt) AUC (Δ22%, p = 0.013) and decreased the Pt clearance (Δ-28%, p = 0.013). Metformin plasma levels were all within the therapeutic range for diabetic patients (0.1-4 mg/L). Conclusion The RP2D of metformin in combination with carboplatin and paclitaxel in advanced ovarian cancer is 1000 mg tds. This is higher than the RP2D reported for combination with targeted agents. A potential PK interaction of metformin with carboplatin was identified.
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Affiliation(s)
- K Esther Broekman
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Marieke A J Hof
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jourik A Gietema
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Joop D Lefrandt
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - An K L Reyners
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Mathilde Jalving
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands.
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León-Castillo A, de Boer SM, Powell ME, Mileshkin LR, Mackay HJ, Leary A, Nijman HW, Singh N, Pollock PM, Bessette P, Fyles A, Haie-Meder C, Smit VTHBM, Edmondson RJ, Putter H, Kitchener HC, Crosbie EJ, de Bruyn M, Nout RA, Horeweg N, Creutzberg CL, Bosse T. Molecular Classification of the PORTEC-3 Trial for High-Risk Endometrial Cancer: Impact on Prognosis and Benefit From Adjuvant Therapy. J Clin Oncol 2020; 38:3388-3397. [PMID: 32749941 PMCID: PMC7527156 DOI: 10.1200/jco.20.00549] [Citation(s) in RCA: 339] [Impact Index Per Article: 84.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The randomized Adjuvant Chemoradiotherapy Versus Radiotherapy Alone in Women With High-Risk Endometrial Cancer (PORTEC-3) trial investigated the benefit of combined adjuvant chemotherapy and radiotherapy (CTRT) versus radiotherapy alone (RT) for women with high-risk endometrial cancer (EC). Because The Cancer Genome Atlas defined an EC molecular classification with strong prognostic value, we investigated prognosis and impact of chemotherapy for each molecular subgroup using tissue samples from PORTEC-3 trial participants. METHODS Paraffin-embedded tissues of 423 consenting patients were collected. Immunohistochemistry for p53 and mismatch repair (MMR) proteins, and DNA sequencing for POLE exonuclease domain were done to classify tumors as p53 abnormal (p53abn), POLE-ultramutated (POLEmut), MMR-deficient (MMRd), or no specific molecular profile (NSMP). The primary end point was recurrence-free survival (RFS). Kaplan-Meier method, log-rank test, and Cox model were used for analysis. RESULTS Molecular analysis was successful in 410 high-risk EC (97%), identifying the 4 subgroups: p53abn EC (n = 93; 23%), POLEmut (n = 51; 12%), MMRd (n = 137; 33%), and NSMP (n = 129; 32%). Five-year RFS was 48% for patients with p53abn EC, 98% for POLEmut EC, 72% for MMRd EC, and 74% for NSMP EC (P < .001). The 5-year RFS with CTRT versus RT for p53abn EC was 59% versus 36% (P = .019); 100% versus 97% for patients with POLEmut EC (P = .637); 68% versus 76% (P = .428) for MMRd EC; and 80% versus 68% (P = .243) for NSMP EC. CONCLUSION Molecular classification has strong prognostic value in high-risk EC, with significantly improved RFS with adjuvant CTRT for p53abn tumors, regardless of histologic type. Patients with POLEmut EC had an excellent RFS in both trial arms. EC molecular classification should be incorporated in the risk stratification of these patients as well as in future trials to target specific subgroups of patients.
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Affiliation(s)
- Alicia León-Castillo
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Stephanie M de Boer
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Melanie E Powell
- Department of Clinical Oncology, Barts Health National Health Service Trust, London, United Kingdom
| | - Linda R Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Helen J Mackay
- Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Alexandra Leary
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Hans W Nijman
- Department of Medical Oncology, Gustave Roussy, Villejuif, France.,Department of Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Naveena Singh
- Department of Pathology, Barts Health National Health Service Trust, London, United Kingdom
| | - Pamela M Pollock
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Paul Bessette
- Canadian Cancer Trials Group, Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Anthony Fyles
- Canadian Cancer Trials Group, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Vincent T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Richard J Edmondson
- Division of Cancer Sciences, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - Hein Putter
- Department of Biostatistics, Leiden University Medical Center, Leiden, the Netherlands
| | - Henry C Kitchener
- Division of Cancer Sciences, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - Emma J Crosbie
- Division of Cancer Sciences, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - Marco de Bruyn
- Department of Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Remi A Nout
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nanda Horeweg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
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Krämer P, Talhouk A, Brett MA, Chiu DS, Cairns ES, Scheunhage DA, Hammond RFL, Farnell D, Nazeran TM, Grube M, Xia Z, Senz J, Leung S, Feil L, Pasternak J, Dixon K, Hartkopf A, Krämer B, Brucker S, Heitz F, du Bois A, Harter P, Kommoss FKF, Sinn HP, Heublein S, Kommoss F, Vollert HW, Manchanda R, de Kroon CD, Nijman HW, de Bruyn M, Thompson EF, Bashashati A, McAlpine JN, Singh N, Tinker AV, Staebler A, Bosse T, Kommoss S, Köbel M, Anglesio MS. Endometrial Cancer Molecular Risk Stratification is Equally Prognostic for Endometrioid Ovarian Carcinoma. Clin Cancer Res 2020; 26:5400-5410. [PMID: 32737030 DOI: 10.1158/1078-0432.ccr-20-1268] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/18/2020] [Accepted: 07/26/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Endometrioid ovarian carcinoma (ENOC) is generally associated with a more favorable prognosis compared with other ovarian carcinomas. Nonetheless, current patient treatment continues to follow a "one-size-fits-all" approach. Even though tumor staging offers stratification, personalized treatments remain elusive. As ENOC shares many clinical and molecular features with its endometrial counterpart, we sought to investigate The Cancer Genome Atlas-inspired endometrial carcinoma (EC) molecular subtyping in a cohort of ENOC. EXPERIMENTAL DESIGN IHC and mutation biomarkers were used to segregate 511 ENOC tumors into four EC-inspired molecular subtypes: low-risk POLE mutant (POLEmut), moderate-risk mismatch repair deficient (MMRd), high-risk p53 abnormal (p53abn), and moderate-risk with no specific molecular profile (NSMP). Survival analysis with established clinicopathologic and subtype-specific features was performed. RESULTS A total of 3.5% of cases were POLEmut, 13.7% MMRd, 9.6% p53abn, and 73.2% NSMP, each showing distinct outcomes (P < 0.001) and survival similar to observations in EC. Median OS was 18.1 years in NSMP, 12.3 years in MMRd, 4.7 years in p53abn, and not reached for POLEmut cases. Subtypes were independent of stage, grade, and residual disease in multivariate analysis. CONCLUSIONS EC-inspired molecular classification provides independent prognostic information in ENOC. Our findings support investigating molecular subtype-specific management recommendations for patients with ENOC; for example, subtypes may provide guidance when fertility-sparing treatment is desired. Similarities between ENOC and EC suggest that patients with ENOC may benefit from management strategies applied to EC and the opportunity to study those in umbrella trials.
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Affiliation(s)
- Pauline Krämer
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aline Talhouk
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
| | - Mary Anne Brett
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Derek S Chiu
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Evan S Cairns
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniëlla A Scheunhage
- Department of Pathology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Rory F L Hammond
- Barts Health National Health Service Trust, Department of Pathology, London, United Kingdom
| | - David Farnell
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tayyebeh M Nazeran
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marcel Grube
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Zhouchunyang Xia
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janine Senz
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Samuel Leung
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lukas Feil
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jana Pasternak
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Katherine Dixon
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andreas Hartkopf
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Bernhard Krämer
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Sara Brucker
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Florian Heitz
- Kliniken Essen Mitte, Department of Gynecology and Gynecologic Oncology, Essen, Germany
- Charité Campus Virchow-Klinikum, Department for Gynecology with the Center for Oncologic Surgery, Berlin, Germany
| | - Andreas du Bois
- Kliniken Essen Mitte, Department of Gynecology and Gynecologic Oncology, Essen, Germany
| | - Philipp Harter
- Kliniken Essen Mitte, Department of Gynecology and Gynecologic Oncology, Essen, Germany
| | - Felix K F Kommoss
- Heidelberg University Hospital, Institute of Pathology, Heidelberg, Germany
| | - Hans-Peter Sinn
- Heidelberg University Hospital, Institute of Pathology, Heidelberg, Germany
| | - Sabine Heublein
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg and National Center for Tumor Diseases, Heidelberg, Germany
| | - Friedrich Kommoss
- Medizin Campus Bodensee, Institute of Pathology, Friedrichshafen, Germany
| | - Hans-Walter Vollert
- Department of Obstetrics and Gynecology, Medizin Campus Bodensee, Friedrichshafen, Germany
| | - Ranjit Manchanda
- Barts CRUK Cancer Centre, Wolfson Institute of Preventative Medicine, Queen Mary University of London, Charterhouse Square, London, United Kingdom
- Department of Gynaecological Oncology, St. Bartholomew's Hospital, London, United Kingdom
| | - Cornelis D de Kroon
- Department of Gynecology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marco de Bruyn
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Emily F Thompson
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ali Bashashati
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica N McAlpine
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
| | - Naveena Singh
- Barts Health National Health Service Trust, Department of Pathology, London, United Kingdom
| | - Anna V Tinker
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Annette Staebler
- University Hospital Tuebingen, Institute of Pathology and Neuropathology, Tuebingen, Germany
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Stefan Kommoss
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Martin Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael S Anglesio
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
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Workel HH, van Rooij N, Plat A, Spierings DC, Fehrmann RSN, Nijman HW, de Bruyn M. Transcriptional Activity and Stability of CD39+CD103+CD8+ T Cells in Human High-Grade Endometrial Cancer. Int J Mol Sci 2020; 21:E3770. [PMID: 32471032 PMCID: PMC7312498 DOI: 10.3390/ijms21113770] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/13/2022] Open
Abstract
Tumor-infiltrating CD8+ T cells (TIL) are of the utmost importance in anti-tumor immunity. CD103 defines tumor-resident memory T cells (TRM cells) associated with improved survival and response to immune checkpoint blockade (ICB) across human tumors. Co-expression of CD39 and CD103 marks tumor-specific TRM with enhanced cytolytic potential, suggesting that CD39+CD103+ TRM could be a suitable biomarker for immunotherapy. However, little is known about the transcriptional activity of TRM cells in situ. We analyzed CD39+CD103+ TRM cells sorted from human high-grade endometrial cancers (n = 3) using mRNA sequencing. Cells remained untreated or were incubated with PMA/ionomycin (activation), actinomycin D (a platinum-like chemotherapeutic that inhibits transcription), or a combination of the two. Resting CD39+CD103+ TRM cells were transcriptionally active and expressed a characteristic TRM signature. Activated CD39+CD103+ TRM cells differentially expressed PLEK, TWNK, and FOS, and cytokine genes IFNG, TNF, IL2, CSF2 (GM-CSF), and IL21. Findings were confirmed using qPCR and cytokine production was validated by flow cytometry of cytotoxic TIL. We studied transcript stability and found that PMA-responsive genes and mitochondrial genes were particularly stable. In conclusion, CD39+CD103+ TRM cells are transcriptionally active TRM cells with a polyfunctional, reactivation-responsive repertoire. Secondly, we hypothesize that differential regulation of transcript stability potentiates rapid responses upon TRM reactivation in tumors.
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Affiliation(s)
- Hagma H. Workel
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (H.H.W.); (N.v.R.); (A.P.); (H.W.N.)
| | - Nienke van Rooij
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (H.H.W.); (N.v.R.); (A.P.); (H.W.N.)
| | - Annechien Plat
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (H.H.W.); (N.v.R.); (A.P.); (H.W.N.)
| | - Diana C.J. Spierings
- European Research Institute for the Biology of Ageing, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Rudolf S. N. Fehrmann
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Hans W. Nijman
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (H.H.W.); (N.v.R.); (A.P.); (H.W.N.)
| | - Marco de Bruyn
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (H.H.W.); (N.v.R.); (A.P.); (H.W.N.)
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Wenzel HHB, Smolders RGV, Beltman JJ, Lambrechts S, Trum HW, Yigit R, Zusterzeel PLM, Zweemer RP, Mom CH, Bekkers RLM, Lemmens VEPP, Nijman HW, Van der Aa MA. Survival of patients with early-stage cervical cancer after abdominal or laparoscopic radical hysterectomy: a nationwide cohort study and literature review. Eur J Cancer 2020; 133:14-21. [PMID: 32422504 DOI: 10.1016/j.ejca.2020.04.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 01/15/2023]
Abstract
AIM Recently, the safety of laparoscopic radical hysterectomy (LRH) has been called into question in early-stage cervical cancer. This study aimed to evaluate overall survival (OS) and disease-free survival (DFS) in patients treated with abdominal radical hysterectomy (ARH) and LRH for early-stage cervical cancer and to provide a literature review. METHODS Patients diagnosed between 2010 and 2017 with International Federation of Gynaecology and Obstetrics (2009) stage IA2 with lymphovascular space invasion, IB1 and IIA1, were identified from the Netherlands Cancer Registry. Cox regression with propensity score, based on inverse probability treatment weighting, was applied to examine the effect of surgical approach on 5-year survival and calculate hazard ratios (HR) and 95% confidence intervals (CIs). Literature review included observational studies with (i) analysis on tumours ≤4 cm (ii) median follow-up ≥30 months (iii) ≥5 events per predictor parameter in multivariable analysis or a propensity score. RESULTS Of the 1109 patients, LRH was performed in 33%. Higher mortality (9.4% vs. 4.6%) and recurrence (13.1% vs. 7.3%) were observed in ARH than LRH. However, adjusted analyses showed similar DFS (89.4% vs. 90.2%), HR 0.92 [95% CI: 0.52-1.60]) and OS (95.2% vs. 95.5%), HR 0.94 [95% CI: 0.43-2.04]). Analyses on tumour size (<2/≥2 cm) also gave similar survival rates. Review of nine studies showed no distinct advantage of ARH, especially in tumours <2 cm. CONCLUSION After adjustment, our retrospective study showed equal oncological outcomes between ARH and LRH for early-stage cervical cancer - also in tumours <2 cm. This is in correspondence with results from our literature review.
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Affiliation(s)
- Hans H B Wenzel
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
| | - Ramon G V Smolders
- Department of Gynaecological Oncology, Erasmus MC Cancer Institute University Medical Center, Rotterdam, the Netherlands
| | - Jogchum J Beltman
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Sandrina Lambrechts
- Department of Obstetrics and Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Hans W Trum
- Department of Gynaecologic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Refika Yigit
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Petra L M Zusterzeel
- Department of Gynaecological Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Ronald P Zweemer
- Department of Gynaecological Oncology, University Medical Centre Utrecht, Utrecht Cancer Centre, Utrecht, the Netherlands
| | - Constantijne H Mom
- Department of Gynaecologic Oncology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Valery E P P Lemmens
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Maaike A Van der Aa
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
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Brunekreeft KL, Paijens ST, Wouters MC, Komdeur FL, Eggink FA, Lubbers JM, Workel HH, Van Der Slikke EC, Pröpper NE, Leffers N, Adam J, Pijper H, Plat A, Kol A, Nijman HW, De Bruyn M. Deep immune profiling of ovarian tumors identifies minimal MHC-I expression after neoadjuvant chemotherapy as negatively associated with T-cell-dependent outcome. Oncoimmunology 2020; 9:1760705. [PMID: 32923120 PMCID: PMC7458665 DOI: 10.1080/2162402x.2020.1760705] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/30/2020] [Indexed: 12/12/2022] Open
Abstract
Epithelial Ovarian cancer (EOC) is the most lethal gynecological malignancy and has limited curative therapeutic options. Immunotherapy for EOC is promising, but clinical efficacy remains restricted to a small percentage of patients. Several lines of evidence suggest that the low response rate might be improved by combining immunotherapy with carboplatin and paclitaxel, the standard-of-care chemotherapy for EOC. Here, we assessed the immune contexture of EOC tumors, draining lymph nodes, and peripheral blood mononuclear cells during carboplatin/paclitaxel chemotherapy. We observed that the immune contexture of EOC patients is defined by the tissue of origin, independent of exposure to chemotherapy. Summarized, draining lymph nodes were characterized by a quiescent microenvironment composed of mostly non-proliferating naïve CD4 + T cells. Circulating T cells shared phenotypic features of both lymph nodes and tumor-infiltrating immune cells. Immunologically 'hot' ovarian tumors were characterized by ICOS, GITR, and PD-1 expression on CD4 + and CD8 + cells, independent of chemotherapy. The presence of PD-1 + cells in tumors prior to, but not after, chemotherapy was associated with disease-specific survival (DSS). Accordingly, we observed high MHC-I expression in tumors prior to chemotherapy, but minimal MHC-I expression in tumors after neoadjuvant chemotherapy, even though there were no differences in the number of tumor-infiltrating lymphocytes (TIL) in both groups. We therefore speculate that the TIL influx into the chemotherapy tumor microenvironment may be a consequence of the general inflammatory nature of chemotherapy-experienced tumors. Strategies to upregulate MHC-I during or after neoadjuvant chemotherapy may thus improve treatment outcome in these patients.
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Affiliation(s)
- Kim L. Brunekreeft
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Sterre T. Paijens
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, The Netherlands
| | | | - Fenne L. Komdeur
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Florine A. Eggink
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Joyce M. Lubbers
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Hagma H. Workel
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Elisabeth C. Van Der Slikke
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Noor E.J. Pröpper
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Ninke Leffers
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Julien Adam
- Department of Clinical Biology, Institut De Cancérologie Gustave Roussy, Paris, France
| | - Harry Pijper
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Annechien Plat
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Arjan Kol
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Hans W. Nijman
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Marco De Bruyn
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, The Netherlands
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Wenzel HHB, Van Kol KGG, Nijman HW, Lemmens VEPP, Van der Aa MA, Ebisch RMF, Bekkers RLM. Cervical cancer with ≤5 mm depth of invasion and >7 mm horizontal spread - Is lymph node assessment only required in patients with LVSI? Gynecol Oncol 2020; 158:282-286. [PMID: 32381363 DOI: 10.1016/j.ygyno.2020.04.705] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/24/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Cervical cancer with ≤5 mm depth of invasion and >7 mm horizontal spread is classified FIGO IA instead of FIGO IB in the revised staging system, as horizontal spread is no longer considered. We aimed to determine the incidence of lymph node metastasis (LNM) and, consequently, the necessity of pelvic lymph node assessment. METHODS Patients diagnosed between January 2015 and May 2019 with cervical cancer FIGO (2009) stage IB with ≤5 mm depth of invasion and >7 mm horizontal spread, were identified from the Netherlands Cancer Registry. Associations between disease-characteristics and lymph node metastasis (LNM), and overall survival, were assessed. RESULTS Of 170 patients, six (3.5%) had LNM: 4/53 (7.6%) with adenocarcinoma and 2/117 (1.7%) with squamous cell carcinoma (p = .077). Four-year overall survival was 98.2%. LNM was observed more often in tumours with LVSI (4/43 patients, 9.3%) than without LVSI (2/117 patients, 1.7%) (p = .045). In adenocarcinoma with 3-5 mm depth of invasion LNM rate was 10% (4/40). None of the following tumours were observed with LNM: squamous cell carcinoma without LVSI (0/74); adenocarcinoma with <3 mm depth of invasion (0/13); <3 mm depth of invasion without LVSI (0/36). CONCLUSIONS Lymph node assessment is essential in any tumour with LVSI or in adenocarcinoma with 3-5 mm depth of invasion. It can be omitted in squamous cell carcinoma without LVSI, in adenocarcinoma with <3 mm depth of invasion and in any tumours without LVSI and with <3 mm depth of invasion.
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Affiliation(s)
- Hans H B Wenzel
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
| | - Kim G G Van Kol
- Department of Obstetrics and Gynaecology, Catherina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Valery E P P Lemmens
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Maaike A Van der Aa
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Renée M F Ebisch
- Department of Obstetrics and Gynaecology, Catherina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, Catherina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands; Department of Obstetrics and Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
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Abdulrahman Z, de Miranda N, van Esch EMG, de Vos van Steenwijk PJ, Nijman HW, J P Welters M, van Poelgeest MIE, van der Burg SH. Pre-existing inflammatory immune microenvironment predicts the clinical response of vulvar high-grade squamous intraepithelial lesions to therapeutic HPV16 vaccination. J Immunother Cancer 2020; 8:e000563. [PMID: 32169871 PMCID: PMC7069269 DOI: 10.1136/jitc-2020-000563] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Vulvar high-grade squamous intraepithelial lesion (vHSIL) is predominantly induced by high-risk human papilloma virus type 16 (HPV16). In two independent trials, therapeutic vaccination against the HPV16 E6 and E7 oncoproteins resulted in objective partial and complete responses (PRs/CRs) in half of the patients with HPV16+ vHSIL at 12-month follow-up. Here, the prevaccination and postvaccination vHSIL immune microenvironment in relation to the vaccine-induced clinical response was investigated. METHODS Two novel seven-color multiplex immunofluorescence panels to identify T cells (CD3, CD8, Foxp3, Tim3, Tbet, PD-1, DAPI) and myeloid cells (CD14, CD33, CD68, CD163, CD11c, PD-L1, DAPI) were designed and fully optimized for formalin-fixed paraffin-embedded tissue. 29 prevaccination and 24 postvaccination biopsies of patients with vHSIL, and 27 healthy vulva excisions, were stained, scanned with the Vectra multispectral imaging system, and automatically phenotyped and counted using inForm advanced image analysis software. RESULTS Healthy vulvar tissue is strongly infiltrated by CD4 and CD8 T cells expressing Tbet and/or PD-1 and CD14+HLA-DR+ inflammatory myeloid cells. The presence of such a coordinated pre-existing proinflammatory microenvironment in HPV16+ vHSIL is associated with CR after vaccination. In partial responders, a disconnection between T cell and CD14+ myeloid cell infiltration was observed, whereas clinical non-responders displayed overall lower immune cell infiltration. Vaccination improved the coordination of local immunity, reflected by increased numbers of CD4+Tbet+ T cells and HLA-DR+CD14+ expressing myeloid cells in patients with a PR or CR, but not in patients with no response. CD8+ T cell infiltration was not increased after vaccination. CONCLUSION A prevaccination inflamed type 1 immune contexture is required for stronger vaccine-induced immune infiltration and is associated with better clinical response. Therapeutic vaccination did not overtly increase immune infiltration of cold lesions.
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Affiliation(s)
- Ziena Abdulrahman
- 'Gynaecology' and 'Pathology', Leiden Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands
| | - Noel de Miranda
- Pathology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Edith M G van Esch
- Gynaecology, Leiden Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands
| | | | - Hans W Nijman
- Gynecology, Universitair Medisch Centrum Groningen, Groningen, The Netherlands
| | - Marij J P Welters
- Medical Oncology, Oncode Institute, Leiden Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands
| | | | - Sjoerd H van der Burg
- Medical Oncology, Oncode Institute, Leiden Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands
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42
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Wenzel HHB, Kruitwagen RFPM, Nijman HW, Bekkers RLM, van Gorp T, de Kroon CD, van Lonkhuijzen LRCW, Massuger LFAG, Smolders RGV, van Trommel NE, Yigit R, Zweemer RP, van der Aa MA. Short-term surgical complications after radical hysterectomy-A nationwide cohort study. Acta Obstet Gynecol Scand 2020; 99:925-932. [PMID: 31955408 DOI: 10.1111/aogs.13812] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Centralization has, among other aspects, been argued to have an impact on quality of care in terms of surgical morbidity. Next, monitoring quality of care is essential in identifying areas of improvement. This nationwide cohort study was conducted to determine the rate of short-term surgical complications and to evaluate its possible predictors in women with early-stage cervical cancer. MATERIAL AND METHODS Women diagnosed with early-stage cervical cancer, 2009 FIGO stages IB1 and IIA1, between 2015 and 2017 who underwent radical hysterectomy with pelvic lymphadenectomy in 1 of the 9 specialized medical centers in the Netherlands, were identified from the Netherlands Cancer Registry. Women were excluded if primary treatment consisted of hysterectomy without parametrial dissection or radical trachelectomy. Women in whom radical hysterectomy was aborted during the procedure, were also excluded. Occurrence of intraoperative and postoperative complications and type of complications, developing within 30 days after surgery, were prospectively registered. Multivariable logistic regression analysis was used to identify predictors of surgical complications. RESULTS A total of 472 women were selected, of whom 166 (35%) developed surgical complications within 30 days after radical hysterectomy. The most frequent complications were urinary retention with catheterization in 73 women (15%) and excessive perioperative blood loss >1000 mL in 50 women (11%). Open surgery (odds ratio [OR] 3.42; 95% CI 1.73-6.76), chronic pulmonary disease (OR 3.14; 95% CI 1.45-6.79), vascular disease (OR 1.90; 95% CI 1.07-3.38), and medical center (OR 2.83; 95% CI 1.18-6.77) emerged as independent predictors of the occurrence of complications. Body mass index (OR 0.94; 95% CI 0.89-1.00) was found as a negative predictor of urinary retention. Open surgery (OR 36.65; 95% CI 7.10-189.12) and body mass index (OR 1.15; 95% CI 1.08-1.22) were found to be independent predictors of excessive perioperative blood loss. CONCLUSIONS Short-term surgical complications developed in 35% of the women after radical hysterectomy for early-stage cervical cancer in the Netherlands, a nation with centralized surgical care. Comorbidities predict surgical complications, and open surgery is associated with excessive perioperative blood loss.
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Affiliation(s)
- Hans H B Wenzel
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands.,Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Roy F P M Kruitwagen
- Department of Obstetrics and Gynecology and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynecology and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands.,Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Toon van Gorp
- Department of Obstetrics and Gynecology and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Cornelis D de Kroon
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Luc R C W van Lonkhuijzen
- Department of Gynecological Oncology, Amsterdam University Medical Center-Center for Gynecological Oncology Amsterdam, Amsterdam, the Netherlands
| | - Leon F A G Massuger
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ramon G V Smolders
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Nienke E van Trommel
- Department of Gynecological Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Refika Yigit
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ronald P Zweemer
- Department of Gynecological Oncology, University Medical Center, Utrecht Cancer Center, Utrecht, the Netherlands
| | - Maaike A van der Aa
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
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Jorritsma-Smit A, van Zanten CJ, Schoemaker J, Meulenberg JJ, Touw DJ, Kosterink JG, Nijman HW, Daemen T, Allersma DP. GMP manufacturing of Vvax001, a therapeutic anti-HPV vaccine based on recombinant viral particles. Eur J Pharm Sci 2020; 143:105096. [DOI: 10.1016/j.ejps.2019.105096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/20/2019] [Accepted: 09/30/2019] [Indexed: 02/07/2023]
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de Boer SM, Powell ME, Mileshkin L, Katsaros D, Bessette P, Haie-Meder C, Ottevanger PB, Ledermann JA, Khaw P, D'Amico R, Fyles A, Baron MH, Jürgenliemk-Schulz IM, Kitchener HC, Nijman HW, Wilson G, Brooks S, Gribaudo S, Provencher D, Hanzen C, Kruitwagen RF, Smit VTHBM, Singh N, Do V, Lissoni A, Nout RA, Feeney A, Verhoeven-Adema KW, Putter H, Creutzberg CL. Adjuvant chemoradiotherapy versus radiotherapy alone in women with high-risk endometrial cancer (PORTEC-3): patterns of recurrence and post-hoc survival analysis of a randomised phase 3 trial. Lancet Oncol 2019; 20:1273-1285. [PMID: 31345626 PMCID: PMC6722042 DOI: 10.1016/s1470-2045(19)30395-x] [Citation(s) in RCA: 256] [Impact Index Per Article: 51.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND The PORTEC-3 trial investigated the benefit of combined adjuvant chemotherapy and radiotherapy versus pelvic radiotherapy alone for women with high-risk endometrial cancer. We updated the analysis to investigate patterns of recurrence and did a post-hoc survival analysis. METHODS In the multicentre randomised phase 3 PORTEC-3 trial, women with high-risk endometrial cancer were eligible if they had International Federation of Gynaecology and Obstetrics (FIGO) 2009 stage I, endometrioid grade 3 cancer with deep myometrial invasion or lymphovascular space invasion, or both; stage II or III disease; or stage I-III disease with serous or clear cell histology; were aged 18 years and older; and had a WHO performance status of 0-2. Participants were randomly assigned (1:1) to receive radiotherapy alone (48·6 Gy in 1·8 Gy fractions given on 5 days per week) or chemoradiotherapy (two cycles of cisplatin 50 mg/m2 given intravenously during radiotherapy, followed by four cycles of carboplatin AUC5 and paclitaxel 175 mg/m2 given intravenously), by use of a biased coin minimisation procedure with stratification for participating centre, lymphadenectomy, stage, and histological type. The co-primary endpoints were overall survival and failure-free survival. Secondary endpoints of vaginal, pelvic, and distant recurrence were analysed according to the first site of recurrence. Survival endpoints were analysed by intention-to-treat, and adjusted for stratification factors. Competing risk methods were used for failure-free survival and recurrence. We did a post-hoc analysis to analyse patterns of recurrence with 1 additional year of follow-up. The study was closed on Dec 20, 2013; follow-up is ongoing. This study is registered with ISRCTN, number ISRCTN14387080, and ClinicalTrials.gov, number NCT00411138. FINDINGS Between Nov 23, 2006, and Dec 20, 2013, 686 women were enrolled, of whom 660 were eligible and evaluable (330 in the chemoradiotherapy group, and 330 in the radiotherapy-alone group). At a median follow-up of 72·6 months (IQR 59·9-85·6), 5-year overall survival was 81·4% (95% CI 77·2-85·8) with chemoradiotherapy versus 76·1% (71·6-80·9) with radiotherapy alone (adjusted hazard ratio [HR] 0·70 [95% CI 0·51-0·97], p=0·034), and 5-year failure-free survival was 76·5% (95% CI 71·5-80·7) versus 69·1% (63·8-73·8; HR 0·70 [0·52-0·94], p=0·016). Distant metastases were the first site of recurrence in most patients with a relapse, occurring in 78 of 330 women (5-year probability 21·4%; 95% CI 17·3-26·3) in the chemoradiotherapy group versus 98 of 330 (5-year probability 29·1%; 24·4-34·3) in the radiotherapy-alone group (HR 0·74 [95% CI 0·55-0·99]; p=0·047). Isolated vaginal recurrence was the first site of recurrence in one patient (0·3%; 95% CI 0·0-2·1) in both groups (HR 0·99 [95% CI 0·06-15·90]; p=0·99), and isolated pelvic recurrence was the first site of recurrence in three women (0·9% [95% CI 0·3-2·8]) in the chemoradiotherapy group versus four (0·9% [95% CI 0·3-2·8]) in the radiotherapy-alone group (HR 0·75 [95% CI 0·17-3·33]; p=0·71). At 5 years, only one grade 4 adverse event (ileus or obstruction) was reported (in the chemoradiotherapy group). At 5 years, reported grade 3 adverse events did not differ significantly between the two groups, occurring in 16 (8%) of 201 women in the chemoradiotherapy group versus ten (5%) of 187 in the radiotherapy-alone group (p=0·24). The most common grade 3 adverse event was hypertension (in four [2%] women in both groups). At 5 years, grade 2 or worse adverse events were reported in 76 (38%) of 201 women in the chemoradiotherapy group versus 43 (23%) of 187 in the radiotherapy-alone group (p=0·002). Sensory neuropathy persisted more often after chemoradiotherapy than after radiotherapy alone, with 5-year rates of grade 2 or worse neuropathy of 6% (13 of 201 women) versus 0% (0 of 187). No treatment-related deaths were reported. INTERPRETATION This updated analysis shows significantly improved overall survival and failure-free survival with chemoradiotherapy versus radiotherapy alone. This treatment schedule should be discussed and recommended, especially for women with stage III or serous cancers, or both, as part of shared decision making between doctors and patients. Follow-up is ongoing to evaluate long-term survival. FUNDING Dutch Cancer Society, Cancer Research UK, National Health and Medical Research Council, Project Grant, Cancer Australia Grant, Italian Medicines Agency, and the Canadian Cancer Society Research Institute.
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Affiliation(s)
- Stephanie M de Boer
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands,Correspondence to: Dr Stephanie de Boer, Department of Radiation Oncology, K1-P, Leiden University Medical Center, 2300 RC Leiden, Netherlands
| | - Melanie E Powell
- Department of Clinical Oncology, Barts Health NHS Trust, London, UK
| | - Linda Mileshkin
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Dionyssios Katsaros
- Department of Surgical Sciences, Gynecologic Oncology, Città della Salute and S Anna Hospital, University of Turin, Turin, Italy
| | - Paul Bessette
- Canadian Cancer Trials Group, Department of Obstetrics and Gynaecology, University of Sherbrooke, Sherbrooke, QC, Canada
| | | | | | - Jonathan A Ledermann
- Cancer Research UK, London, UK,UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - Pearly Khaw
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Romerai D'Amico
- Division of Radiation Oncology, ASST-Lecco, Ospedale AManzoni, Lecco, Italy
| | - Anthony Fyles
- Canadian Cancer Trials Group, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Marie-Helene Baron
- Department of Radiotherapy, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | | | - Henry C Kitchener
- Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - Hans W Nijman
- Department of Gynaecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Godfrey Wilson
- Department of Pathology, Central Manchester Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK
| | - Susan Brooks
- Department of Radiation Oncology, Auckland City Hospital, Auckland, New Zealand
| | - Sergio Gribaudo
- Department of Oncology – Radiotherapy, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Diane Provencher
- Department of Gynaecologic Oncology, Hôpital Notre-Dame de Montreal, Montreal, QC, Canada
| | - Chantal Hanzen
- Department of Radiation Oncology, Centre Henri Becquerel, Rouen, France
| | - Roy F Kruitwagen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, Netherlands,GROW - School for Oncology and Developmental Biology, Maastricht, Netherlands
| | | | - Naveena Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Viet Do
- Department of Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool, NSW, Australia
| | - Andrea Lissoni
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Remi A Nout
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Amanda Feeney
- Cancer Research UK, London, UK,UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | | | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, Netherlands
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
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Melief CJM, Welters MJ, Vergote I, Kroep JR, Kenter GG, Ottevanger N, Tjalma WA, Denys H, Poelgeest MV, Nijman HW, Reyners AK, Velu T, Goffin F, Lalisang R, Krebber WJ, Hooftman L, Visscher S, Blumenstein BA, Stead RB, Gerritsen W, Burg SVD. Abstract CT002: A strong HPV-specific T-cell response after chemo-immunotherapy for advanced cervical cancer is associated with prolonged survival. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-ct002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The therapeutic synthetic long peptide (SLP) vaccine ISA101 selectively enlarges the pool of tumor-specific T cells recognizing the human papillomavirus type 16 (HPV16) antigens E6 and E7. Vaccine monotherapy for HPV16-induced pre-malignant anogenital lesions is effective, inducing durable complete regressions in approximately 50% of treated patients. However, cancer treatment requires appropriate countermeasures to overcome the suppression of T-cell activation, expansion and effector function imposed by suppressive myeloid cell populations, regulatory T cells and co-inhibitory molecule expression. We recently showed that carboplatin/paclitaxel chemotherapy can normalize the abnormally high levels of immune suppressive myeloid cells, allowing the development of much stronger therapeutic ISA101-induced tumor immunity1. Here we show the effects of ISA101 vaccination during chemotherapy in 77 patients with advanced, recurrent or metastatic cervical cancer in a dose assessment study. Study design involved a single arm dose escalation study with four different ISA101 doses (20, 40, 100 and 300 µg per peptide) with or without immunomodulator pegylated interferon alpha (Pegitron), given concomitantly with standard of care chemotherapy (carboplatin, AUC 6; paclitaxel, 175 mg/m2). Objective regressions were observed in 43% of 72 evaluable patients. The depletion of myeloid suppressive cells by carboplatin/paclitaxel was associated with detection of low level spontaneous HPV16-specific immunity in 26 of the 61 tested patients. Patients mounted type 1 T-cell responses to the vaccine across all doses. No significant differences were observed between the different doses and strength of vaccine-induced T cell responses; the results were therefore combined. Patients with an above median HPV16-specific T cell immune response to ISA101, measured by a validated IFNγ-Elispot, displayed a significantly prolonged median overall survival (OS) of 16.8 months compared to those with a lower HPV-specific immune response (OS 11.2 months, logrank p=0.012). Importantly, this effect was not due to differences in general immune status, as measured by T-cell reactivity to unrelated common microbial recall
antigens. In conclusion, our study demonstrates that chemo-immunotherapy can be exploited to the benefit of patients with cervical cancer and warrants confirmation of the benefit of this type of chemo-immunotherapy in a randomized controlled study in HPV16-induced cancer patients.
1Welters, M. J. et al. Vaccination during myeloid cell depletion by cancer chemotherapy fosters robust T cell responses. Sci Transl Med 8, 334ra352, doi:10.1126/scitranslmed.aad8307 (2016).
Citation Format: Cornelis J M Melief, Marij J. Welters, Ignace Vergote, Judith R. Kroep, Gemma G. Kenter, Nelleke Ottevanger, Wiebren A. Tjalma, Hannelore Denys, Mariette van Poelgeest, Hans W. Nijman, Anna K. Reyners, Thierry Velu, Frederic Goffin, Roy Lalisang, Willem-Jan Krebber, Leon Hooftman, Sonja Visscher, Brent A. Blumenstein, Richard B. Stead, Winald Gerritsen, Sjoerd van der Burg. A strong HPV-specific T-cell response after chemo-immunotherapy for advanced cervical cancer is associated with prolonged survival [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr CT002.
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Affiliation(s)
| | | | | | | | - Gemma G. Kenter
- 4Center for Gynecological Oncology Free University, Amsterdam, Netherlands
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Workel HH, Lubbers JM, Arnold R, Prins TM, van der Vlies P, de Lange K, Bosse T, van Gool IC, Eggink FA, Wouters MCA, Komdeur FL, van der Slikke EC, Creutzberg CL, Kol A, Plat A, Glaire M, Church DN, Nijman HW, de Bruyn M. A Transcriptionally Distinct CXCL13 +CD103 +CD8 + T-cell Population Is Associated with B-cell Recruitment and Neoantigen Load in Human Cancer. Cancer Immunol Res 2019; 7:784-796. [PMID: 30872264 DOI: 10.1158/2326-6066.cir-18-0517] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/03/2018] [Accepted: 03/06/2019] [Indexed: 11/16/2022]
Abstract
The chemokine CXCL13 mediates recruitment of B cells to tumors and is essential for the formation of tertiary lymphoid structures (TLSs). TLSs are thought to support antitumor immunity and are associated with improved prognosis. However, it remains unknown whether TLSs are formed in response to the general inflammatory character of the tumor microenvironment, or rather, are induced by (neo)antigen-specific adaptive immunity. We here report on the finding that the TGFβ-dependent CD103+CD8+ tumor-infiltrating T-cell (TIL) subpopulation expressed and produced CXCL13. Accordingly, CD8+ T cells from peripheral blood activated in the presence of TGFβ upregulated CD103 and secreted CXCL13. Conversely, inhibition of TGFβ receptor signaling abrogated CXCL13 production. CXCL13+CD103+CD8+ TILs correlated with B-cell recruitment, TLSs, and neoantigen burden in six cohorts of human tumors. Altogether, our findings indicated that TGFβ plays a noncanonical role in coordinating immune responses against human tumors and suggest a potential role for CXCL13+CD103+CD8+ TILs in mediating B-cell recruitment and TLS formation in human tumors.
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Affiliation(s)
- Hagma H Workel
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Joyce M Lubbers
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Roland Arnold
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Thalina M Prins
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pieter van der Vlies
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Kim de Lange
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Inge C van Gool
- Department of Pathology, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Florine A Eggink
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Maartje C A Wouters
- Trev and Joyce Deeley Research Centre, BC Cancer, Victoria, British Columbia, Canada
| | - Fenne L Komdeur
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Elisabeth C van der Slikke
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Arjan Kol
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Annechien Plat
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Mark Glaire
- Molecular and Population Genetics Laboratory, The Wellcome Trust Centre for Human Genetics and Oxford Cancer Centre, University of Oxford, Oxford, United Kingdom
| | - David N Church
- Molecular and Population Genetics Laboratory, The Wellcome Trust Centre for Human Genetics and Oxford Cancer Centre, University of Oxford, Oxford, United Kingdom.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust and John Radcliffe Hospital, Oxford, United Kingdom
| | - Hans W Nijman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marco de Bruyn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Bagnoli M, Shi TY, Gourley C, Speiser P, Reuss A, Nijman HW, Creutzberg CL, Scholl S, Negrouk A, Brady MF, Hasegawa K, Oda K, McNeish IA, Kohn EC, Oza AM, MacKay H, Millan D, Bennett K, Scott C, Mezzanzanica D. Gynecological Cancers Translational, Research Implementation, and Harmonization: Gynecologic Cancer InterGroup Consensus and Still Open Questions. Cells 2019; 8:E200. [PMID: 30813545 PMCID: PMC6468728 DOI: 10.3390/cells8030200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 12/14/2022] Open
Abstract
In the era of personalized medicine, the introduction of translational studies in clinical trials has substantially increased their costs, but provides the possibility of improving the productivity of trials with a better selection of recruited patients. With the overall goal of creating a roadmap to improve translational design for future gynecological cancer trials and of defining translational goals, a main discussion was held during a brainstorming day of the Gynecologic Cancer InterGroup (GCIG) Translational Research Committee and overall conclusions are here reported. A particular emphasis was dedicated to the new frontier of the immunoprofiling of gynecological cancers. The discussion pointed out that to maximize patients' benefit, translational studies should be integral to clinical trial design with standardization and optimization of procedures including a harmonization program of Standard Operating Procedures. Pathology-reviewed sample collection should be mandatory and ensured by dedicated funding. Biomarker validation and development should be made public and transparent to ensure rapid progresses with positive outcomes for patients. Guidelines/templates for patients' informed consent are needed. Importantly for the public, recognized goals are to increase the involvement of advocates and to improve the reporting of translational data in a forum accessible to patients.
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Affiliation(s)
- Marina Bagnoli
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy.
| | - Ting Yan Shi
- Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Charlie Gourley
- University of Edinburgh Cancer Research UK Centre, MRC IGMM, Edinburgh EH4 2XU, UK.
| | - Paul Speiser
- Department of Gynaecologic Oncology, Medical University Vienna, General Hospital Vienna, 1090 Wien, Austria.
| | - Alexander Reuss
- Coordinating Center for Clinical Trials, at the Philipps-University of Marburg, 35043 Marburg, Germany.
| | - Hans W Nijman
- Department of Obstetrics & Gynecology, University Medical Center Groningen, 9700 RB Groningen, The Netherlands.
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
| | - Suzy Scholl
- Department of Drug Development and Innovation, Institut Curie, 75005 Paris, France.
| | - Anastassia Negrouk
- European Organisation for Research and Treatment of Cancer (EORTC), 1200 Brussels, Belgium.
| | - Mark F Brady
- Department of Biostatistics & Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY 14203, USA.
| | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama 1397-1, Japan.
| | - Katsutoshi Oda
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan.
| | - Iain A McNeish
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK.
| | - Elise C Kohn
- Clinical Investigations Branch, Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, MD 20852, USA.
| | - Amit M Oza
- Department of Medicine, Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2M9, Canada.
| | - Helen MacKay
- Division of Medical Oncology, University of Toronto/Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada.
| | - David Millan
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow G51 4TR, UK.
| | - Katherine Bennett
- Gynecologic Cancer InterGroup, Operations, Kingston, ON K7K-7A6, Canada.
| | - Clare Scott
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3052, Australia.
| | - Delia Mezzanzanica
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy.
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Kruse AJ, ter Brugge HG, de Haan HH, Van Eyndhoven HW, Nijman HW. Vaginal hysterectomy with or without bilateral salpingo-oophorectomy may be an alternative treatment for endometrial cancer patients with medical co-morbidities precluding standard surgical procedures: a systematic review. Int J Gynecol Cancer 2019; 29:299-304. [DOI: 10.1136/ijgc-2018-000015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 09/20/2018] [Accepted: 10/09/2018] [Indexed: 11/03/2022] Open
Abstract
ObjectiveVaginal hysterectomy with bilateral salpingo-oophorectomy may be an alternative strategy for patients with low-risk endometrial cancer and medical co-morbidities precluding laparoscopic or abdominal procedures. The current study evaluates the prevalence of co-existent ovarian malignancy in patients with endometrial cancer and the influence of bilateral salpingo-oophorectomy on survival outcomes in these patients.MethodsMedline and EMBASE were searched for studies published between January 1, 2000 and November 20, 2017 that investigated (1) the prevalence of co-existing ovarian malignancy (either metastases or primary synchronous ovarian cancer in women with endometrial cancer, and (2) the influence of bilateral salpingo-oophorectomy on recurrence and/or survival rates.ResultsOf the pre-menopausal and post-menopausal patients (n=6059), 373 were identified with metastases and 106 were identified with primary synchronous ovarian cancer. Of the post-menopausal patients (n=6016), 362 were identified with metastases and 44 were identified with primary synchronous ovarian cancer. Survival outcomes did not differ for pre-menopausal patients with endometrial cancer with and without bilateral salpingo-oophorectomy (5-year overall survival rates were 89–94.5% and 86–97.8%, respectively).ConclusionBilateral salpingo-oophorectomy during vaginal hysterectomy seems to have a limited impact on disease outcome in patients with endometrial cancer. These results support the view that vaginal hysterectomy alone or with bilateral salpingo-oophorectomy may be an option for patients with endometrial cancer who are not ideal surgical candidates.
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Timmermans M, Sonke GS, Van de Vijver KK, Ottevanger PB, Nijman HW, van der Aa MA, Kruitwagen RFPM. Localization of distant metastases defines prognosis and treatment efficacy in patients with FIGO stage IV ovarian cancer. Int J Gynecol Cancer 2019; 29:392-397. [PMID: 30665898 DOI: 10.1136/ijgc-2018-000100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 10/10/2018] [Accepted: 12/27/2018] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Patients with ovarian cancer who are diagnosed with Federation of Gynecology and Obstetrics (FIGO) stage IV disease are a highly heterogeneous group with possible survival differences. The FIGO staging system was therefore updated in 2014. OBJECTIVE To evaluate the 2014 changes to FIGO stage IV ovarian cancer on overall survival. METHODS We identified all patients diagnosed with FIGO stage IV disease between January 2008 and December 2015 from the Netherlands Cancer Registry. We analyzed the prognostic effect of FIGO IVa versus IVb. In addition, patients with extra-abdominal lymph node involvement as the only site of distant disease were analyzed separately. Overall survival was analyzed by Kaplan-Meier curves and multivariable Cox regression models. RESULTS We identified 2436 FIGO IV patients, of whom 35% were diagnosed with FIGO IVa disease. Five-year overall survival of FIGO IVa and IVb patients (including those with no or limited therapy) was 8.9% and 13.0%, respectively (p=0.51). Patients with only extra-abdominal lymph node involvement had a significant better overall survival than all other FIGO IV patients (5-year overall survival 25.9%, hazard ratio 0.77 [95% CI 0.62 to 0.95]). CONCLUSION Our study shows that the FIGO IV sub-classification into FIGO IVa and IVB does not provide additional prognostic information. Patients with extra-abdominal lymph node metastases as the only site of FIGO IV disease, however, have a better prognosis than all other FIGO IV patients. These results warrant a critical appraisal of the current FIGO IV sub-classification.
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Affiliation(s)
- Maite Timmermans
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands .,Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - G S Sonke
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - K K Van de Vijver
- Department of Pathology, Ghent University Hospital, Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - P B Ottevanger
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - H W Nijman
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - M A van der Aa
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - R F P M Kruitwagen
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht, The Netherlands
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50
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De Decker K, ter Brugge HG, Bart J, Kruitwagen RF, Nijman HW, Kruse AJ. Borderline tumours of the ovary: Common practice in the Netherlands. Gynecol Oncol Rep 2018; 27:25-30. [PMID: 30581952 PMCID: PMC6297066 DOI: 10.1016/j.gore.2018.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/09/2018] [Indexed: 12/17/2022] Open
Abstract
Objectives Discordance between frozen section diagnosis and the definite histopathological diagnosis and the fact that the frozen section result is not always unambiguous, may contribute to differences in clinical practice regarding perioperative treatment and follow-up of borderline ovarian tumours (BOTs) patients amongst gynaecologic oncologists, which may lead to over- and undertreatment. The aim of the study was to map the Dutch gynaecologists' preferred treatment and follow-up strategy in case of BOTs. Methods A questionnaire was sent to all Dutch gynaecologists involved in ovarian surgery with perioperative frozen section analysis, and the outcomes were assessed using descriptive statistics. Results Nearly half of the respondents (41.0%) would not perform a staging procedure in case of a BOT. In case of an ambiguous frozen section diagnosis, tending towards invasive carcinoma, a considerable number (sBOT 56.4%; mBOT 30.8%) would perform a lymph node sampling as part of the staging procedure. A relaparotomy/relaparoscopy, to perform a lymph node sampling in case of a serous or mucinous carcinoma after a BOT frozen section diagnosis, would be performed by 97.4% and 48.7% of the respondents, respectively. Conclusions A considerable number of gynaecologists would perform a staging procedure that is recommended for ovarian cancer in case of an ambiguous BOT frozen section diagnosis, especially for serous tumours. In addition, nearly all gynaecologists would perform a second procedure including a lymph node sampling in case of a serous invasive carcinoma after a BOT frozen section diagnosis, which applies to half of the gynaecologists in case of a mucinous carcinoma. In case of an unambiguous frozen section BOT diagnosis, a staging procedure is omitted by nearly half of the gynaecologists. When the frozen section BOT diagnosis is ambiguous, a full ovarian cancer staging procedure is frequently performed. Most gynaecologists perform a second procedure to complete staging when definitive diagnosis shows invasive ovarian cancer. Full staging is performed more frequently in case of serous histopathology, when compared to mucinous tumours.
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Affiliation(s)
- Koen De Decker
- Isala Hospital, Department of Obstetrics and Gynaecology, Zwolle, the Netherlands
- University Medical Center Groningen, Department of Obstetrics and Gynaecology, Groningen, the Netherlands
- Corresponding author at: Isala Clinics, Department of Obstetrics and Gynaecology, PO Box 10400, 8000 GK Zwolle, the Netherlands.
| | - Henk G. ter Brugge
- Isala Hospital, Department of Obstetrics and Gynaecology, Zwolle, the Netherlands
| | - Joost Bart
- Isala Hospital, Department of Pathology, Zwolle, the Netherlands
| | - Roy F.P.M. Kruitwagen
- Maastricht University Medical Centre, Department of Obstetrics and Gynaecology, Maastricht, the Netherlands
- GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Hans W. Nijman
- University Medical Center Groningen, Department of Obstetrics and Gynaecology, Groningen, the Netherlands
| | - Arnold-Jan Kruse
- Isala Hospital, Department of Obstetrics and Gynaecology, Zwolle, the Netherlands
- Isala Hospital, Department of Pathology, Zwolle, the Netherlands
- Maastricht University Medical Centre, Department of Obstetrics and Gynaecology, Maastricht, the Netherlands
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