Importance of interdisciplinarity in modern oncology: results of a national intergroup survey of the Young Oncologists United (YOU)

PURPOSE

Modern, personalized treatment concepts in oncology require an interdisciplinary and multiprofessional collaboration. In addition to its relevance in patient care, interdisciplinary collaboration is also becoming increasingly important in clinical research as well as medical education and resident training in oncology.

METHODS

Between November 2021 and March 2022, an online survey was conducted among German early career research groups, represented by Young Oncologists United (YOU). The aim was to identify the status and need for interdisciplinarity at clinic, educational, and research levels.

RESULTS

A total of 294 participants completed the questionnaire in full. 90.7% of the respondents fully or predominantly agreed with the statement that interdisciplinary work plays a major role in their daily clinical work. 78.9% wished for more interdisciplinary collaboration. Of the 49.7% of participants who have never participated in an interdisciplinary research project, 80.1% said they would like to participate in such a study project in the future. Lack of time resources, too much organizational effort, and possible political conflicts between institutions were identified as factors that make practical implementation difficult. 74.1% declared their willingness to become active in an oncology early career research group.

CONCLUSION

Interdisciplinary collaboration has become increasingly important in oncology. Networks that span different disciplines could help to promote interdisciplinary research projects among young scientists and improve exchange in professional practice and education with the implication of improved patient care.

Loss of TGFβ signaling promotes colon cancer progression and tumor-associated inflammation

TGFβ has both tumor suppressive and tumor promoting effects in colon cancer. Also, TGFβ can affect the extent and composition of inflammatory cells present in tumors, contextually promoting and inhibiting inflammation. While colon tumors display intratumoral inflammation, the contributions of TGFβ to this process are poorly understood. In human patients, we found that epithelial loss of TGFβ signaling was associated with increased inflammatory burden; yet overexpression of TGFβ was also associated with increased inflammation. These findings were recapitulated in mutant APC models of murine tumorigenesis, where epithelial truncation of TGFBR2 led to lethal inflammatory disease and invasive colon cancer, mediated by IL8 and TGFβ1. Interestingly, mutant APC mice with global suppression of TGFβ signals displayed an intermediate phenotype, presenting with an overall increase in IL8-mediated inflammation and accelerated tumor formation, yet with a longer latency to the onset of disease observed in mice with epithelial TGFBR-deficiency. These results suggest that the loss of TGFβ signaling, particularly in colon epithelial cells, elicits a strong inflammatory response and promotes tumor progression. This implies that treating colon cancer patients with TGFβ inhibitors may result in a worse outcome by enhancing inflammatory responses.

Abstract B40: Mutations in KRAS are increased in sporadic colon cancers of African Americans compared to Non-Hispanic Whites

Introduction: African Americans (AA) have a higher incidence and mortality of colorectal cancer (CRC) when compared to Non-Hispanic Whites (NHW) and tumors present at later stages. Possible underlying factors include differences in diet, access to care and demographic differences, as well as variances in racial disease-specific gene mutations. Understanding mechanisms for this racial disparity is critical to delivery of better care. Several studies have investigated sporadic CRC mutational somatic differences between AAs and NHWs, but due to small study sizes and conflicting results, no definitive conclusions have been reached. Mutations in KRAS, BRAF, and PI3CA occur frequently in sporadic CRC and are associated with a worse prognosis. Therefore we investigated the frequency of these gene mutations in AA versus NHW populations as a possible causative factor in racial disparity of CRC. Here, we present the first systematic literature review and meta-analysis investigating the mutational differences in sporadic CRC between AAs and NHWs.

Methods: We searched the PubMed database with a query designed to identify publications reporting mutations in KRAS, BRAF and PI3CA in CRC. Inclusion criteria were sporadic CRC, human subjects, English language, information on ethnicity (AA, NHW or both), total subject number >20, and information on KRAS, BRAF or PI3CA mutation frequencies. Each study was evaluated by two investigators to confirm presence of study criteria.

Results: Our search identified 6162 publication. Twelve studies met the inclusion criteria, detected mutations in AAs and NHWs, and had extractable data. Ten studies reported on KRAS (n=4529), 6 studies on BRAF (n=2063), and 3 studies on PI3CA (n=662). We did not observe a statistically significant difference in the frequency of PI3CA (odds ratio 0.870 CI 0.559-1.36 p=0.5396) or BRAF mutations (odds ratio 1.24 CI 0.689-2.25, p=0.4683) when comparing CRC in AAs versus NHWs. However, KRAS mutations were more frequent in CRC in AAs when compared to NHWs (odds ratio 0.634 CI 0.529 - 0.760, p=0.0001).

Conclusion: Here, we report on the mutational patterns of KRAS, BRAF and PI3CA in sporadic CRC of AAs and NHWs in the first systematic meta-analysis on this topic of previously published data. For the first time, we identify an increase in KRAS mutations in sporadic CRC in AAs which may contribute to worse prognosis and increased mortality of CRC in AAs. Future studies investigating health care disparities in CRC in AAs should account for KRAS mutational frequency.

Citation Format: Nancy L. Krett, Jonas Staudacher, Ahmer Khalid, Vadim Bul, Joseph Zeidan, Cemal Yazici, Barbara Jung. Mutations in KRAS are increased in sporadic colon cancers of African Americans compared to Non-Hispanic Whites. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B40.

Abstract A43: Activin receptor type IA in pancreatic cancer and its implications in tumor progression

Several studies have shown the importance of the Transforming Growth Factor Beta (TGFβ) pathway in pancreatic tumorigenesis and cancer progression, displaying a seemingly paradoxical role in tumor development. However, Activin, a TGFβ family member and its contributions to tumor development and progression are largely understudied in most cancers, particularly pancreatic cancer. The functions of Activin through its receptors are context and cell-type specific, as they exert different effects in various cancer types, including colon, breast and prostate. In normal pancreas, Activin A isoform levels in serum are low, while in pancreatic cancer Activin A levels positively correlate with shorter survival and metastasis. Activin, like TGFβ, signals through a complex containing Activin A type I and type II receptors. A type II homodimer comprised of Activin receptor type IIA (ACVRIIA) or IIB (ACVRIIB) binds ligand via an extracellular domain and recruits a homodimer of Activin receptor type IA (ACVRIA) or IB (ACVRIB), leading to formation of a tetrameric complex and phosphorylation of type I receptor by the type II serine/threonine kinase activity. ACVRIA and ACVRIB differ in amino acid sequence within the activation region, called the GS region, presumably giving receptor specificity and differences in regulation of canonical (SMAD-dependent) and non-canonical (SMAD-independent) downstream signaling. Human pancreatic ductal adenocarcinomas contain somatic mutations in the ACVR1B gene, and one recent study in vivo showed that pancreatic-specific loss of ACVR1B accelerates development of mutant KRAS-induced intraductal papillary mucinous neoplasms in mice. Our in silico data compiled from human pancreatic cancer patients demonstrates that there is a significant 50% loss of ACVR1B mRNA in cancer patients compared to normal tissue from the same cohort. Moreover, pancreatic cancer patients show a significant 80% upregulation of ACVR1A mRNA compared to normal. Yet, Activin effects through ACVRIA in pancreatic cancer have not yet been established. Our studies aim to characterize the effects of ACVR1A activation in pancreatic tumor development and progression. We hypothesize that the opposing effects of Activin signaling in pancreatic cancer may be due to ACVRIA activation and its subsequent pro-survival and pro-tumorigenic functions.

Pancreatic cancer cell lines were analyzed for levels of ACVR1A expression, MIA PaCa-2 showed the highest level of expression followed by AsPC-1, with PANC-1 showing the lowest expression. MIA PaCa-2 and AsPC-1 cell lines showed increased migration in scratch assays compared to control following treatment with Activin A. We are currently establishing MIA PaCa-2 and AsPC-1 stable cell lines with a knockdown of ACVR1A to assess migratory and proliferative changes upon Activin treatment when ACVR1A is downregulated. Human and murine tissue immunostaining of ACVR1A showed expression of the receptor in the normal pancreas as well as tumor tissue samples. Human pancreas staining for ACVR1A was stronger in the carcinoma sections of tumor tissue samples compared to a lighter staining in normal tissue samples. Murine tissues showed staining in the neoplastic lesions of KC and EL-KRAS transgenic mice, while no strong staining was observed in the wild type mouse.

We conclude that not only TGFβ exerts dual effects in regards to pro and anti-tumor promoting effects in the context of pancreatic cancer, but rather Activin signaling pathway is also important in pancreatic carcinogenesis and a novel target that can be useful for therapeutic interventions in pancreatic cancer. Determining Activin signaling through ACVR1A can be essential in deciphering the role of Activin in pancreatic tumor development and progression.

Citation Format: Georgina E. Mancinelli, Jonas Staudacher, Barbara Jung, Paul J. Grippo.{Authors}. Activin receptor type IA in pancreatic cancer and its implications in tumor progression. [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer: Advances in Science and Clinical Care; 2016 May 12-15; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2016;76(24 Suppl):Abstract nr A43.

[Quality management in a radiology department]

PURPOSE

To increase the quality of internal and external interactions (patients, clinical colleagues, technicians, radiologists) in a department of radiology.

METHOD

Accompanied by a well-experienced adviser workshops have been performed dealing with different topics like "contact to patients," "performance of the radiological report and interaction with the referring colleague" or "research and teaching." A catalogue of different actions was defined to reduce hindrances within the internal and external work-flow.

RESULTS

A total number of 53 actions was defined and related to different persons who were responsible for the realisation of the measures within a time interval. Six months after starting the quality management 46 (86%) of the defined actions were realised successfully, and another 4 (8%) measures were still running. There was a moderate increase of satisfaction of the patients and clinical colleagues considering the waiting time.

CONCLUSIONS

A quality management in a radiological department allows an optimisation of the internal and external interactions. However, the guidance of a well-experienced adviser is as essential as the continuous control of successful finished measures.