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Coombes RC, Badman PD, Lozano-Kuehne JP, Liu X, Macpherson IR, Zubairi I, Baird RD, Rosenfeld N, Garcia-Corbacho J, Cresti N, Plummer R, Armstrong A, Allerton R, Landers D, Nicholas H, McLellan L, Lim A, Mouliere F, Pardo OE, Ferguson V, Seckl MJ. Author Correction: Results of the phase IIa RADICAL trial of the FGFR inhibitor AZD4547 in endocrine resistant breast cancer. Nat Commun 2023; 14:260. [PMID: 36650166 PMCID: PMC9845345 DOI: 10.1038/s41467-023-35969-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- R C Coombes
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - P D Badman
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - J P Lozano-Kuehne
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - X Liu
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - I R Macpherson
- Cancer Research UK Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - I Zubairi
- Cancer Research UK Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - R D Baird
- Medical Oncology, Addenbrooke's Hospital, Breast Cancer Research Unit, Cancer Research UK Cambridge Centre, Cambridge, UK
| | - N Rosenfeld
- Medical Oncology, Addenbrooke's Hospital, Breast Cancer Research Unit, Cancer Research UK Cambridge Centre, Cambridge, UK
| | - J Garcia-Corbacho
- Medical Oncology, Addenbrooke's Hospital, Breast Cancer Research Unit, Cancer Research UK Cambridge Centre, Cambridge, UK
| | - N Cresti
- Sir Bobby Robson Cancer Trials Research Centre, Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK
| | - R Plummer
- Sir Bobby Robson Cancer Trials Research Centre, Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK
| | - A Armstrong
- Breast Research Office, The Christie NHS Foundation Trust, Christie Hospital, Manchester, UK
| | - R Allerton
- C8 Admin Offices, Russell's Hall Hospital, Russells Hall, UK
| | | | - H Nicholas
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - L McLellan
- ECMC Programme Office, Research and Innovation, Cancer Research UK, London, UK
| | - A Lim
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - F Mouliere
- Medical Oncology, Addenbrooke's Hospital, Breast Cancer Research Unit, Cancer Research UK Cambridge Centre, Cambridge, UK
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pathology, Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - O E Pardo
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - V Ferguson
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - M J Seckl
- Department of Surgery and Cancer, Imperial College London, London, UK.
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Coombes RC, Badman PD, Lozano-Kuehne JP, Liu X, Macpherson IR, Zubairi I, Baird RD, Rosenfeld N, Garcia-Corbacho J, Cresti N, Plummer R, Armstrong A, Allerton R, Landers D, Nicholas H, McLellan L, Lim A, Mouliere F, Pardo OE, Ferguson V, Seckl MJ. Results of the phase IIa RADICAL trial of the FGFR inhibitor AZD4547 in endocrine resistant breast cancer. Nat Commun 2022; 13:3246. [PMID: 35688802 PMCID: PMC9187670 DOI: 10.1038/s41467-022-30666-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 09/21/2021] [Accepted: 05/12/2022] [Indexed: 01/21/2023] Open
Abstract
We conducted a phase IIa, multi-centre, open label, single arm study (RADICAL; NCT01791985) of AZD4547 (a potent and selective inhibitor of Fibroblast Growth Factor Receptor (FGFR)-1, 2 and 3 receptor tyrosine kinases) administered with anastrozole or letrozole in estrogen receptor positive metastatic breast cancer patients who had become resistant to aromatase inhibitors. After a safety run-in study to assess safety and tolerability, we recruited 52 patients. The primary endpoint was change in tumour size at 12 weeks, and secondary endpoints were to assess response at 6 weeks, 20 weeks and every 8 weeks thereafter and tolerability of the combined treatment. Two partial responses (PR) and 19 stable disease (SD) patients were observed at the 12-week time point. At 28 weeks, according to centrally reviewed Response Evaluation Criteria in Solid Tumours (RECIST) criteria, five PR and 8 SD patients were observed in 50 assessable cases. Overall, objective response rate (5 PR) was of 10%, meeting the pre-specified endpoint. Fourteen patients discontinued due to adverse events. Eleven patients had retinal pigment epithelial detachments which was asymptomatic and reversible in all but one patient. Exploratory ribonucleic acid sequencing (RNA-Seq) analysis was done on patients' samples: 6 differentially-expressed-genes could distinguish those who benefited from the addition of AZD4547.
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Affiliation(s)
- R C Coombes
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - P D Badman
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - J P Lozano-Kuehne
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - X Liu
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - I R Macpherson
- Cancer Research UK Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - I Zubairi
- Cancer Research UK Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - R D Baird
- Medical Oncology, Addenbrooke's Hospital, Breast Cancer Research Unit, Cancer Research UK Cambridge Centre, Cambridge, UK
| | - N Rosenfeld
- Medical Oncology, Addenbrooke's Hospital, Breast Cancer Research Unit, Cancer Research UK Cambridge Centre, Cambridge, UK
| | - J Garcia-Corbacho
- Medical Oncology, Addenbrooke's Hospital, Breast Cancer Research Unit, Cancer Research UK Cambridge Centre, Cambridge, UK
| | - N Cresti
- Sir Bobby Robson Cancer Trials Research Centre, Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK
| | - R Plummer
- Sir Bobby Robson Cancer Trials Research Centre, Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK
| | - A Armstrong
- Breast Research Office, The Christie NHS Foundation Trust, Christie Hospital, Manchester, UK
| | - R Allerton
- C8 Admin Offices, Russell's Hall Hospital, Russells Hall, UK
| | | | - H Nicholas
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - L McLellan
- ECMC Programme Office, Research and Innovation, Cancer Research UK, London, UK
| | - A Lim
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - F Mouliere
- Medical Oncology, Addenbrooke's Hospital, Breast Cancer Research Unit, Cancer Research UK Cambridge Centre, Cambridge, UK
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pathology, Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - O E Pardo
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - V Ferguson
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - M J Seckl
- Department of Surgery and Cancer, Imperial College London, London, UK.
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Porter A, Barcelon JM, Budker RL, Marsh L, Moriarty JM, Aguiar X, Rao J, Ghorani E, Kaur B, Maher G, Seckl MJ, Konecny GE, Cohen JG. Treatment of metastatic placental site trophoblastic tumor with surgery, chemotherapy, immunotherapy and coil embolization of multiple pulmonary arteriovenous fistulate. Gynecol Oncol Rep 2021; 36:100782. [PMID: 34036138 PMCID: PMC8134973 DOI: 10.1016/j.gore.2021.100782] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/25/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022] Open
Abstract
Placental site trophoblastic tumor can be resistant to chemotherapy. Multidisciplinary care is required for management of advanced disease. Increased PD-L1 expression can help guide use of immunotherapies. Complete responses are possible with aggressive multidisciplinary management.
Placental Site Trophoblastic Tumor (PSTT) is a rare malignancy that often presents with extensive disease and can be resistant to traditional treatments. We present the case of a woman with stage IV PSTT who was initially managed with neoadjuvant chemotherapy followed by tumor debulking. Adjuvant therapy was guided by further pathologic analysis that revealed high levels of staining for PD-L1 as well as the presence of tumor infiltrating lymphocytes (TILs). Subsequently, the patient was treated with traditional chemotherapy with the EP/EMA regimen with the addition of pembrolizumab. The patient’s treatment course was complicated by the development of pulmonary arteriovenous malformations, autoimmune thyroiditis thought to be secondary to immunotherapy, and significant tinnitus secondary to platinum agents. Currently the patient is in follow up and remains in a complete remission.
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Affiliation(s)
- A Porter
- University of California Los Angeles, Division of Hematology Oncology, Los Angeles, CA, USA
| | - J M Barcelon
- University of California Los Angeles, Division of Gynecologic Oncology, Los Angeles, CA, USA
| | - R L Budker
- University of California Los Angeles, Division of Gynecologic Oncology, Los Angeles, CA, USA
| | - L Marsh
- University of California Los Angeles, Division of Gynecologic Oncology, Los Angeles, CA, USA
| | - J M Moriarty
- University of California Los Angeles, Division of Interventional Radiology, Los Angeles, CA, USA
| | - X Aguiar
- California Los Angeles, Department of Pathology, Los Angeles, CA, USA
| | - J Rao
- California Los Angeles, Department of Pathology, Los Angeles, CA, USA
| | - E Ghorani
- Gestational Trophoblastic Disease Centre, Charing Cross Hospital Campus of Imperial College London, United Kingdom
| | - B Kaur
- Gestational Trophoblastic Disease Centre, Charing Cross Hospital Campus of Imperial College London, United Kingdom
| | - G Maher
- Gestational Trophoblastic Disease Centre, Charing Cross Hospital Campus of Imperial College London, United Kingdom
| | - M J Seckl
- Gestational Trophoblastic Disease Centre, Charing Cross Hospital Campus of Imperial College London, United Kingdom
| | - G E Konecny
- University of California Los Angeles, Division of Hematology Oncology, Los Angeles, CA, USA
| | - J G Cohen
- University of California Los Angeles, Division of Gynecologic Oncology, Los Angeles, CA, USA
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Cortés-Charry R, Hennah L, Froeling FEM, Short D, Aguiar X, Tin T, Harvey R, Unsworth N, Kaur B, Savage P, Sarwar N, Seckl MJ. Increasing the human chorionic gonadotrophin cut-off to ≤1000 IU/l for starting actinomycin D in post-molar gestational trophoblastic neoplasia developing resistance to methotrexate spares more women multi-agent chemotherapy. ESMO Open 2021; 6:100110. [PMID: 33845362 PMCID: PMC8044379 DOI: 10.1016/j.esmoop.2021.100110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/19/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 01/01/2023] Open
Abstract
Background A human chorionic gonadotropin (hCG) cut-off of ≤300 IU/l for starting actinomycin D (ActD) in post-molar gestational trophoblastic neoplasia (GTN) patients developing methotrexate resistance (MTX-R) reduced the number of women needing toxic multi-agent chemotherapy (etoposide, MTX and ActD alternating weekly with cyclophosphamide and vincristine; EMA/CO) without affecting survival. Here we assess whether an increased hCG cut-off of ≤1000 IU/l spares more women EMA/CO. Patients and methods All post-molar GTN patients treated with first-line methotrexate and folinic acid (MTX/FA) were identified in a national cohort between 2009 and 2016. Data collected included age, FIGO score, the hCG levels at MTX-R, and treatment outcomes. Results In total, 609 GTN patients commenced treatment with MTX/FA achieving a complete response in 57% (348/609). Resistance developed in 25.1% (153/609) at an hCG ≤ 1000 IU/l and switching to ActD achieved remission in 92.8% without any major toxicity with the remaining 7.2% remitting on EMA/CO. Comparative analysis of patients switching at an hCG <100 versus 100-300 versus 300-1000 IU/l revealed a significant fall in the cure rate with second-line ActD from 97% (93/96) to 87% (34/39) to 78% (14/18), respectively, P = 0.009. However, by increasing the hCG cut-off from ≤300 to ≤1000 IU/l, 14 patients were spared EMA/CO chemotherapy. Moreover, in the present series, all post-molar GTN remain in remission. Conclusion This study demonstrates that increasing the hCG cut-off from ≤300 to ≤1000 IU/l for choosing patients for ActD following MTX-R spares more women with GTN from the greater toxicity of EMA/CO without compromising 100% survival outcomes. An hCG cut-off of ≤1000 IU/l for ActD over EMA/CO treatment in MTX-R GTN spares women toxicity without affecting survival. On developing MTX-R, as the hCG cut-off for selecting ActD versus EMA/CO rises, the complete response rate for ActD falls. Half of FIGO-7 patients were cured on single-agent treatment (MTX/FA or sequential ActD), warranting further investigation.
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Affiliation(s)
- R Cortés-Charry
- Department of Obstetrics and Gynecology, Gestational Trophoblastic Disease Unit, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
| | - L Hennah
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - F E M Froeling
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - D Short
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - X Aguiar
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - T Tin
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - R Harvey
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - N Unsworth
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - B Kaur
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - P Savage
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - N Sarwar
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - M J Seckl
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
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Savage P, Winter M, Parker V, Harding V, Sita-Lumsden A, Fisher RA, Harvey R, Unsworth N, Sarwar N, Short D, Aguiar X, Tidy J, Hancock B, Coleman R, Seckl MJ. Demographics, natural history and treatment outcomes of non-molar gestational choriocarcinoma: a UK population study. BJOG 2020; 127:1102-1107. [PMID: 32146729 DOI: 10.1111/1471-0528.16202] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the demographics, natural history and treatment outcomes of non-molar gestational choriocarcinoma. DESIGN A retrospective national population-based study. SETTING UK 1995-2015. POPULATION A total of 234 women with a diagnosis of gestational choriocarcinoma, in the absence of a prior molar pregnancy, managed at the UKs two gestational trophoblast centres in London and Sheffield. METHODS Retrospective review of the patient's demographic and clinical data. Comparison with contemporary UK birth and pregnancy statistics. MAIN OUTCOMES Incidence statistics for non-molar choriocarcinoma across the maternal age groups. Cure rates for patients by FIGO prognostic score group. RESULTS Over the 21-year study period, there were 234 cases of non-molar gestational choriocarcinoma, giving an incidence of 1:66 775 relative to live births and 1:84 226 to viable pregnancies. For women aged under 20, the incidence relative to viable pregnancies was 1:223 494, for ages 30-34, 1:80 227, and for ages 40-45, 1:41 718. Treatment outcomes indicated an overall 94.4% cure rate. Divided by FIGO prognostic groups, the cure rates were low-risk group 100%, high-risk group 96% and ultra-high-risk group 80.5%. CONCLUSIONS Non-molar gestational choriocarcinoma is a very rare diagnosis with little prior detailed information on the demographics and natural history. The data in this study give age-related incidence data based on a large national population study. The results also demonstrated the widely varying natural history of this rare malignancy and the marked correlation of disease incidence with rising maternal age. TWEETABLE ABSTRACT National gestational choriocarcinoma database indicates a close association between increasing maternal age and incidence.
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Affiliation(s)
- P Savage
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - M Winter
- Sheffield Trophoblastic Disease Centre, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - V Parker
- Sheffield Trophoblastic Disease Centre, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - V Harding
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - A Sita-Lumsden
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - R A Fisher
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - R Harvey
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - N Unsworth
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - N Sarwar
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - D Short
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - X Aguiar
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - J Tidy
- Sheffield Trophoblastic Disease Centre, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - B Hancock
- Sheffield Trophoblastic Disease Centre, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - R Coleman
- Sheffield Trophoblastic Disease Centre, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M J Seckl
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
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Frijstein MM, Lok CAR, Trommel NE, ten Kate‐Booij MJ, Massuger LFAG, Werkhoven E, Short D, Aguiar X, Fisher RA, Kaur B, Sarwar N, Sebire NJ, Seckl MJ. Lung metastases in low‐risk gestational trophoblastic neoplasia: a retrospective cohort study. BJOG 2019; 127:389-395. [DOI: 10.1111/1471-0528.16036] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2019] [Indexed: 12/01/2022]
Affiliation(s)
- MM Frijstein
- Department of Gynaecological Oncology Centre of Gynaecological Oncology Amsterdam Amsterdam the Netherlands
- Department of Obstetrics and Gynaecology Erasmus University Medical Centre Rotterdam the Netherlands
- Department of Obstetrics and Gynaecology Radboud University Medical Centre Nijmegen the Netherlands
| | - CAR Lok
- Department of Gynaecological Oncology Centre of Gynaecological Oncology Amsterdam Amsterdam the Netherlands
| | - NE Trommel
- Department of Gynaecological Oncology Centre of Gynaecological Oncology Amsterdam Amsterdam the Netherlands
| | - MJ ten Kate‐Booij
- Department of Obstetrics and Gynaecology Erasmus University Medical Centre Rotterdam the Netherlands
| | - LFAG Massuger
- Department of Obstetrics and Gynaecology Radboud University Medical Centre Nijmegen the Netherlands
| | - E Werkhoven
- Department of Biometrics Netherlands Cancer Institute – Antoni van Leeuwenhoek Amsterdam the Netherlands
| | - D Short
- Department of Medical Oncology Charing Cross Hospital London UK
| | - X Aguiar
- Department of Medical Oncology Charing Cross Hospital London UK
| | - RA Fisher
- Department of Medical Oncology Charing Cross Hospital London UK
| | - B Kaur
- Department of Medical Oncology Charing Cross Hospital London UK
| | - N Sarwar
- Department of Medical Oncology Charing Cross Hospital London UK
| | - NJ Sebire
- Department of Medical Oncology Charing Cross Hospital London UK
| | - MJ Seckl
- Department of Medical Oncology Charing Cross Hospital London UK
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7
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Frijstein MM, Lok CAR, Short D, Singh K, Fisher RA, Hancock BW, Tidy JA, Sarwar N, Kanfer E, Winter MC, Savage PM, Seckl MJ. The results of treatment with high-dose chemotherapy and peripheral blood stem cell support for gestational trophoblastic neoplasia. Eur J Cancer 2019; 109:162-171. [PMID: 30731277 DOI: 10.1016/j.ejca.2018.12.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 08/27/2018] [Revised: 12/13/2018] [Accepted: 12/23/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the effect of high-dose chemotherapy (HDC) with peripheral blood stem cell support (PBSCS) on survival of patients with gestational trophoblastic neoplasia (GTN) with either refractory choriocarcinomas or a poor-prognosis placental site/epithelioid trophoblastic tumours (PSTT/ETTs). METHODS Databases of two referral centres for gestational trophoblastic disease were searched, and 32 patients treated with HDC between 1994 and 2015 were identified. Tissue samples were retrieved for genetic evaluation. Cox regression analyses were performed to identify possible predictors of overall survival (OS). RESULTS HDC induced a sustained complete response in 7 patients. Overall, 41% (13/32) of the patients remained disease free after HDC with or without additional treatment. Patients who survived had much lower human chorionic gonadotropin (hCG) values (all ≤12 IU/L) before and after HDC than those who died of disease. Univariable Cox regression analysis demonstrated that hCG >12 IU/L before or after HDC, International Federation of Gynaecology and Obstetrics (FIGO) stage II-IV and presence of metastases at the time of diagnosis were significantly associated with adverse OS. However, only hCG values before HDC remained significant in a multivariable model (p < 0.001). Five of 11 (45%) patients with PSTT/ETT presenting ≥48 months after antecedent pregnancy and 6 of 14 (43%) patients with refractory choriocarcinoma were in remission. Three treatment-related deaths occurred. CONCLUSIONS Despite 3 treatment-induced deaths, HDC with PBSCS appears to be active in salvaging selected patients with poor-prognosis PSTT/ETTs and refractory choriocarcinomas. Low hCG values before HDC seems a beneficial predictor of OS and may suggest that HDC acts more like a consolidation therapy.
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Affiliation(s)
- M M Frijstein
- Department of Gynaecology, Center of Gynaecologic Oncology Amsterdam, the Netherlands
| | - C A R Lok
- Department of Gynaecology, Center of Gynaecologic Oncology Amsterdam, the Netherlands
| | - D Short
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College, London, UK
| | - K Singh
- Sheffield Trophoblastic Disease Centre, Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - R A Fisher
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College, London, UK
| | - B W Hancock
- Sheffield Trophoblastic Disease Centre, Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - J A Tidy
- Sheffield Trophoblastic Disease Centre, Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - N Sarwar
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College, London, UK
| | - E Kanfer
- Dept of Haematology, Hammersmith Hospital Campus of Imperial College, London, UK
| | - M C Winter
- Sheffield Trophoblastic Disease Centre, Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - P M Savage
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College, London, UK
| | - M J Seckl
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College, London, UK.
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8
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Frijstein MM, Lok CAR, van Trommel NE, Ten Kate-Booij MJ, Massuger LFAG, van Werkhoven E, Kaur B, Tidy JA, Sarwar N, Golfier F, Winter MC, Hancock BW, Seckl MJ. Management and prognostic factors of epithelioid trophoblastic tumors: Results from the International Society for the Study of Trophoblastic Diseases database. Gynecol Oncol 2018; 152:361-367. [PMID: 30473257 DOI: 10.1016/j.ygyno.2018.11.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 09/06/2018] [Revised: 11/04/2018] [Accepted: 11/11/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Epithelioid Trophoblastic Tumor (ETT) is an extremely rare form of Gestational Trophoblastic Neoplasia (GTN). Knowledge on prognostic factors and optimal management is limited. We identified prognostic factors, optimal treatment, and outcome from the world's largest case series of patients with ETT. METHODS Patients were selected from the international Placental Site Trophoblastic Tumor (PSTT) and ETT database. Fifty-four patients diagnosed with ETT or mixed PSTT/ETT between 2001 and 2016 were included. Cox regression analysis was used to identify prognostic factors for overall survival (OS). RESULTS Forty-five patients with ETT and 9 patients with PSTT/ETT were included. Thirty-six patients had FIGO stage I and 18 had stages II-IV disease. Patients were treated with surgery (n = 23), chemotherapy (n = 6), or a combination of surgery and chemotherapy (n = 25). In total, 39 patients survived, including 22 patients with complete sustained hCG remission for at least 1 year. Patients treated with surgery as first line treatment had early-stage disease and all survived. Most patients treated with chemotherapy with or without surgery had FIGO stages II-IV disease (55%). They underwent multiple lines of chemotherapy. Eleven of them did not survive. Interval since antecedent pregnancy and FIGO stage were prognostic factors of OS (p = 0.012; p = 0.023 respectively). CONCLUSIONS Advanced-stage disease and an interval of ≥48 months since the antecedent pregnancy are poor prognostic factors of ETT. Surgery seems adequate for early-stage disease with a shorter interval. Advanced-stage disease requires a combination of treatment modalities. Because of its rarity, ETT should be treated in a centre with experience in GTN.
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Affiliation(s)
- M M Frijstein
- Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, the Netherlands.
| | - C A R Lok
- Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, the Netherlands
| | - N E van Trommel
- Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, the Netherlands
| | - M J Ten Kate-Booij
- Department of Gynaecologic Oncology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - L F A G Massuger
- Department of Gynaecology and Obstetrics, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - E van Werkhoven
- Department of Biometrics, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - B Kaur
- Department of Histopathology, Charing Cross Hospital, London, United Kingdom
| | - J A Tidy
- Trophoblastic Disease Centre, Weston Park Hospital, Sheffield, United Kingdom
| | - N Sarwar
- Department of Medical Oncology, Charing Cross Hospital, London, United Kingdom
| | - F Golfier
- Department of Gynaecological Surgery and Oncology, University Hospital Lyon Sud, France
| | - M C Winter
- Trophoblastic Disease Centre, Weston Park Hospital, Sheffield, United Kingdom
| | - B W Hancock
- Trophoblastic Disease Centre, Weston Park Hospital, Sheffield, United Kingdom
| | - M J Seckl
- Department of Medical Oncology, Charing Cross Hospital, London, United Kingdom
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9
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Eysbouts YK, Ottevanger PB, Massuger LFAG, IntHout J, Short D, Harvey R, Kaur B, Sebire NJ, Sarwar N, Sweep FCGJ, Seckl MJ. Can the FIGO 2000 scoring system for gestational trophoblastic neoplasia be simplified? A new retrospective analysis from a nationwide dataset. Ann Oncol 2018; 28:1856-1861. [PMID: 28459944 DOI: 10.1093/annonc/mdx211] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Worldwide introduction of the International Fedaration of Gynaecology and Obstetrics (FIGO) 2000 scoring system has provided an effective means to stratify patients with gestational trophoblastic neoplasia to single- or multi-agent chemotherapy. However, the system is quite elaborate with an extensive set of risk factors. In this study, we re-evaluate all prognostic risk factors involved in the FIGO 2000 scoring system and examine if simplification is feasible. Patients and methods Between January 2003 and December 2012, 813 patients diagnosed with gestational trophoblastic neoplasia were identified at the Trophoblastic Disease Centre in London and scored using the FIGO 2000. Multivariable analysis and stepwise logistic regression were carried out to evaluate whether the FIGO 2000 scoring system could be simplified. Results Of the eight FIGO risk factors only pre-treatment serum human chorionic gonadotropin (hCG) levels exceeding 10 000 IU/l (OR = 5.0; 95% CI 2.5-10.4) and 100 000 IU/l (OR = 14.3; 95% CI 4.7-44.1), interval exceeding 7 months since antecedent pregnancy (OR = 4.1; 95% CI 1.0-16.2), and tumor size of over 5 cm (OR = 2.2; 95% CI 1.3-3.6) were identified as independently predictive for single-agent resistance. In addition, increased risk was apparent for antecedent term pregnancy (OR = 3.4; 95% CI 0.9-12.7) and the presence of five or more metastases (OR = 3.5; 95% CI 0.4-30.4), but patient numbers in these categories were relatively small. Stepwise logistic regression identified a simplified risk scoring model comprising age, pretreatment serum hCG, number of metastases, antecedent pregnancy, and interval but omitting tumor size, previous failed chemotherapy, and site of metastases. With this model only 1 out 725 patients was classified different from the FIGO 2000 system. Conclusion Our simplified alternative using only five of the FIGO prognostic factors appears to be an accurate system for discriminating patients requiring single as opposed to multi-agent chemotherapy. Further work is urgently needed to validate these findings.
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Affiliation(s)
| | | | | | - J IntHout
- Department of Health Evidence, Section Biostatistics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - D Short
- Department of Medical Oncology
| | | | - B Kaur
- Department of Pathology, Charing Cross and Hammersmith Campuses, Imperial College London, London, UK
| | - N J Sebire
- Department of Pathology, Charing Cross and Hammersmith Campuses, Imperial College London, London, UK
| | | | - F C G J Sweep
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
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10
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Ray-Coquard I, Trama A, Seckl MJ, Fotopoulou C, Pautier P, Pignata S, Kristensen G, Mangili G, Falconer H, Massuger L, Sehouli J, Pujade-Lauraine E, Lorusso D, Amant F, Rokkones E, Vergote I, Ledermann JA. Rare ovarian tumours: Epidemiology, treatment challenges in and outside a network setting. Eur J Surg Oncol 2017; 45:67-74. [PMID: 29108961 DOI: 10.1016/j.ejso.2017.09.025] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/26/2017] [Accepted: 09/30/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE OF THE REVIEW More than 50% of all gynaecological cancers can be classified as rare tumours (defined as an annual incidence of <6 per 100,000) and such tumours represent an important challenge for clinicians. RECENT FINDINGS Rare cancers account for more than one fifth of all new cancer diagnoses, more than any of the single common cancers alone. Reviewing the RARECAREnet database, some of the tumours occur infrequently, whilst others because of their natural history have a high prevalence, and therefore appear to be more common, although their incidence is also rare. Harmonization of medical practice, guidelines and novel trials are needed to identify rare tumours and facilitate the development of new treatments. Ovarian tumours are the focus of this review, but we comment on other rare gynaecological tumours, as the diagnosis and treatment challenges faced are similar. FUTURE This requires European collaboration, international partnerships, harmonization of treatment and collaboration to overcome the regulatory barriers to conduct international trials. Whilst randomized trials can be done in many tumour types, there are some for which conducting even single arm studies may be challenging. For these tumours alternative study designs, robust collection of data through national registries and audits could lead to improvements in the treatment of rare tumours. In addition, concentring the care of patients with rare tumours into a limited number of centres will help to build expertise, facilitate trials and improve outcomes.
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Affiliation(s)
- I Ray-Coquard
- Dpt of Medical Oncology, Centre Leon Berard, University Claude Bernard LyonI, Lyon, France.
| | - AnnaLisa Trama
- AnnaLisa Trama, Fondazione IRCCS istituto nazionale dei tumori Milan, Italy
| | - M J Seckl
- Charing Cross Hospital, Campus of Imperial College London, Fulham Palace Rd, W68RF London, UK
| | - C Fotopoulou
- Dept of Surgery and Cancer, Imperial College London, UK
| | - P Pautier
- Medical Oncology, Dpt Gustave Roussy Institution, Villejuif, France
| | - S Pignata
- Medical Oncology, Department of Urology and Gynecology, Istituto Nazionale Tumori - IRCSS - Fondazione G. Pascale, Naples Italy
| | - G Kristensen
- Dept of Gynecologic Oncology, Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
| | - G Mangili
- Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Milan, Italy
| | - H Falconer
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet/University Hospital, 171 76 Stockholm, Sweden
| | - L Massuger
- Department of Obstetrics and Gynaecology, Radboudumc, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - J Sehouli
- Department of Gynecology with Center for Oncological Surgery, European Competence Center for Ovarian Cancer, Campus Virchow Klinikum, Medical University of Berlin, Germany
| | | | - D Lorusso
- Gynecologic Oncology Unit, Fondazione IRCCS istituto nazionale dei tumori Milan, Italy
| | - F Amant
- Center Gynaecologic Oncology Amsterdam (CGOA), Netherlands Cancer Institute, University of Amsterdam & Gynaecologic Oncology KU Leuven, The Netherlands
| | - E Rokkones
- Dept. of Gynaecological Oncology, The Norwegian Radium Hospital, Division of Cancer Medicine Oslo University Hospital, PO Box 4950 Nydalen, 0424 Oslo, Norway
| | - I Vergote
- Gynaecological Oncologist, University Hospital Leuven, European Union, Herestraat 49, B-3000 Leuven, Belgium
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Eagles N, Sebire NJ, Short D, Savage PM, Seckl MJ, Fisher RA. Risk of recurrent molar pregnancies following complete and partial hydatidiform moles. Hum Reprod 2016; 31:1379. [PMID: 27076498 DOI: 10.1093/humrep/dew079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Eagles
- Trophoblast Tumour Screening & Treatment Centre, Imperial College Healthcare NHS Trust, Charing Cross Campus, Fulham Palace Road, London W6 8RF
| | - N J Sebire
- Trophoblast Tumour Screening & Treatment Centre, Imperial College Healthcare NHS Trust, Charing Cross Campus, Fulham Palace Road, London W6 8RF Department of Paediatric Laboratory Medicine, UCL Institute of Child Health, London WC1N 3JH
| | - D Short
- Trophoblast Tumour Screening & Treatment Centre, Imperial College Healthcare NHS Trust, Charing Cross Campus, Fulham Palace Road, London W6 8RF
| | - P M Savage
- Trophoblast Tumour Screening & Treatment Centre, Imperial College Healthcare NHS Trust, Charing Cross Campus, Fulham Palace Road, London W6 8RF
| | - M J Seckl
- Trophoblast Tumour Screening & Treatment Centre, Imperial College Healthcare NHS Trust, Charing Cross Campus, Fulham Palace Road, London W6 8RF Department of Surgery and Cancer, Imperial College London, London W12 0NN
| | - R A Fisher
- Trophoblast Tumour Screening & Treatment Centre, Imperial College Healthcare NHS Trust, Charing Cross Campus, Fulham Palace Road, London W6 8RF Department of Surgery and Cancer, Imperial College London, London W12 0NN
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12
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Taylor F, Short D, Harvey R, Winter MC, Tidy J, Hancock BW, Savage PM, Sarwar N, Seckl MJ, Coleman RE. Late spontaneous resolution of persistent molar pregnancy. BJOG 2016; 123:1175-81. [DOI: 10.1111/1471-0528.13867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 11/30/2022]
Affiliation(s)
- F Taylor
- Sheffield Centre for Trophoblastic Disease Sheffield Cancer Research Centre Weston Park Hospital Sheffield UK
| | - D Short
- Charing Cross Gestational Trophoblastic Disease Centre Department of Medical Oncology Charing Cross Hospital Campus of Imperial College London London UK
| | - R Harvey
- Charing Cross Gestational Trophoblastic Disease Centre Department of Medical Oncology Charing Cross Hospital Campus of Imperial College London London UK
| | - MC Winter
- Sheffield Centre for Trophoblastic Disease Sheffield Cancer Research Centre Weston Park Hospital Sheffield UK
| | - J Tidy
- Sheffield Centre for Trophoblastic Disease Sheffield Cancer Research Centre Weston Park Hospital Sheffield UK
| | - BW Hancock
- Sheffield Centre for Trophoblastic Disease Sheffield Cancer Research Centre Weston Park Hospital Sheffield UK
| | - PM Savage
- Charing Cross Gestational Trophoblastic Disease Centre Department of Medical Oncology Charing Cross Hospital Campus of Imperial College London London UK
| | - N Sarwar
- Charing Cross Gestational Trophoblastic Disease Centre Department of Medical Oncology Charing Cross Hospital Campus of Imperial College London London UK
| | - MJ Seckl
- Charing Cross Gestational Trophoblastic Disease Centre Department of Medical Oncology Charing Cross Hospital Campus of Imperial College London London UK
| | - RE Coleman
- Sheffield Centre for Trophoblastic Disease Sheffield Cancer Research Centre Weston Park Hospital Sheffield UK
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13
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Braga A, Maestá I, Short D, Savage P, Harvey R, Seckl MJ. Hormonal contraceptive use before hCG remission does not increase the risk of gestational trophoblastic neoplasia following complete hydatidiform mole: a historical database review. BJOG 2015; 123:1330-5. [PMID: 26444183 DOI: 10.1111/1471-0528.13617] [Citation(s) in RCA: 15] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To re-evaluate the safety of hormonal contraceptives (HC) after uterine evacuation of complete hydatidiform mole (CHM). DESIGN Historical database review. SETTING Charing Cross Hospital Gestational Trophoblastic Disease Centre, London, United Kingdom. POPULATION Two thousand four hundred and twenty-three women with CHM of whom 154 commenced HC while their human chorionic gonadotropin (hCG) was still elevated, followed between 2003 and 2012. METHODS We compared time to hCG remission between HC users and nonusers. The relationship between HC use and gestational trophoblastic neoplasia (GTN) development was assessed. The relationship between HC use and a high International Federation of Gynecology and Obstetrics (FIGO) risk score was determined. MAIN OUTCOME MEASURES Time to hCG remission, risk of developing postmolar GTN and proportion of women with high FIGO risk score. RESULTS No relationship was observed between HC use with mean time to hCG remission (HC users versus non-users: 12 weeks in both, P = 0.19), GTN development (HC users versus non-users: 20.1 and 16.7%, P = 0.26) or high-risk FIGO score (HC users versus nonusers: 0% and 8%, P = 0.15). Moreover, no association between HC and GTN development was found, even when an age-adjusted model was used (OR = 1.37, 95% CI 0.91-2.08, P = 0.13). CONCLUSIONS The use of current HC is not associated with development of postmolar GTN or delayed time to hCG remission. Therefore, HC can be safely used to prevent a new conception following CHM regardless of hCG level. TWEETABLE ABSTRACT Non-concurrent cohort study to re-evaluate the safety of low dose HCs after uterine evacuation of CHM.
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Affiliation(s)
- A Braga
- Trophoblastic Disease Center, Maternity School of Rio de Janeiro Federal University and Antonio Pedro University Hospital at Fluminense Federal University, Rio de Janeiro, Brazil.,Postdoctoral Program of Science without Borders (Brazilian Government) - Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital, Imperial College School of Medicine, London, UK.,Postdoctoral Program of Gynecology, Obstetrics and Mastology Postgraduate of Botucatu Medical School, UNESP- São Paulo State University, Botucatu, São Paulo, Brazil.,Trophoblastic Disease Center, Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP - São Paulo State University, Botucatu, São Paulo, Brazil
| | - I Maestá
- Trophoblastic Disease Center, Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP - São Paulo State University, Botucatu, São Paulo, Brazil
| | - D Short
- Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital, Imperial College School of Medicine, London, UK
| | - P Savage
- Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital, Imperial College School of Medicine, London, UK
| | - R Harvey
- Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital, Imperial College School of Medicine, London, UK
| | - M J Seckl
- Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital, Imperial College School of Medicine, London, UK
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Schlegel CR, Georgiou ML, Misterek MB, Stöcker S, Chater ER, Munro CE, Pardo OE, Seckl MJ, Costa-Pereira AP. DAPK2 regulates oxidative stress in cancer cells by preserving mitochondrial function. Cell Death Dis 2015; 6:e1671. [PMID: 25741596 PMCID: PMC4385915 DOI: 10.1038/cddis.2015.31] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 06/11/2014] [Revised: 12/12/2014] [Accepted: 12/15/2014] [Indexed: 12/24/2022]
Abstract
Death-associated protein kinase (DAPK) 2 is a serine/threonine kinase that belongs to the DAPK family. Although it shows significant structural differences from DAPK1, the founding member of this protein family, DAPK2 is also thought to be a putative tumour suppressor. Like DAPK1, it has been implicated in programmed cell death, the regulation of autophagy and diverse developmental processes. In contrast to DAPK1, however, few mechanistic studies have been carried out on DAPK2 and the majority of these have made use of tagged DAPK2, which almost invariably leads to overexpression of the protein. As a consequence, physiological roles of this kinase are still poorly understood. Using two genetically distinct cancer cell lines as models, we have identified a new role for DAPK2 in the regulation of mitochondrial integrity. RNA interference-mediated depletion of DAPK2 leads to fundamental metabolic changes, including significantly decreased rate of oxidative phosphorylation in combination with overall destabilised mitochondrial membrane potential. This phenotype is further corroborated by an increase in the production of mitochondrial superoxide anions and increased oxidative stress. This then leads to the activation of classical stress-activated kinases such as ERK, JNK and p38, which is observed on DAPK2 genetic ablation. Interestingly, the generation of oxidative stress is further enhanced on overexpression of a kinase-dead DAPK2 mutant indicating that it is the kinase domain of DAPK2 that is important to maintain mitochondrial integrity and, by inference, for cellular metabolism.
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Affiliation(s)
- C R Schlegel
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital Campus, ICTEM, Du Cane Road, London W12 0NN, UK
| | - M L Georgiou
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital Campus, ICTEM, Du Cane Road, London W12 0NN, UK
| | - M B Misterek
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital Campus, ICTEM, Du Cane Road, London W12 0NN, UK
| | - S Stöcker
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital Campus, ICTEM, Du Cane Road, London W12 0NN, UK
| | - E R Chater
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital Campus, ICTEM, Du Cane Road, London W12 0NN, UK
| | - C E Munro
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital Campus, ICTEM, Du Cane Road, London W12 0NN, UK
| | - O E Pardo
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital Campus, ICTEM, Du Cane Road, London W12 0NN, UK
| | - M J Seckl
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital Campus, ICTEM, Du Cane Road, London W12 0NN, UK
| | - A P Costa-Pereira
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital Campus, ICTEM, Du Cane Road, London W12 0NN, UK
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Pardo OE, Arcaro A, Salerno G, Tetley TD, Valovka T, Gout I, Seckl MJ. Erratum: Novel cross talk between MEK and S6K2 in FGF-2 induced proliferation of SCLC cells. Oncogene 2014. [DOI: 10.1038/onc.2014.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Schlegel CR, Fonseca AV, Stöcker S, Georgiou ML, Misterek MB, Munro CE, Carmo CR, Seckl MJ, Costa-Pereira AP. DAPK2 is a novel modulator of TRAIL-induced apoptosis. Cell Death Differ 2014; 21:1780-91. [PMID: 25012503 DOI: 10.1038/cdd.2014.93] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 12/22/2022] Open
Abstract
Targeting molecules involved in TRAIL-mediated signalling has been hailed by many as a potential magic bullet to kill cancer cells efficiently, with little side effects on normal cells. Indeed, initial clinical trials showed that antibodies against TRAIL receptors, death receptor (DR)4 and DR5, are well tolerated by cancer patients. Despite efficacy issues in the clinical setting, novel approaches to trigger TRAIL-mediated apoptosis are being developed and its clinical potential is being reappraised. Unfortunately, as observed with other cancer therapies, many patients develop resistance to TRAIL-induced apoptosis and there is thus impetuous for identifying additional resistance mechanisms that may be targetable and usable in combination therapies. Here, we show that the death-associated protein kinase 2 (DAPK2) is a modulator of TRAIL signalling. Genetic ablation of DAPK2 using RNA interference causes phosphorylation of NF-κB and its transcriptional activity in several cancer cell lines. This then leads to the induction of a variety of NF-κB target genes, which include proapoptotic DR4 and DR5. DR4 and DR5 protein expression is correspondingly increased on the cell surface and this leads to the sensitisation of resistant cells to TRAIL-induced killing, in a p53-independent manner. As DAPK2 is a kinase, it is imminently druggable, and our data thus offer a novel avenue to overcome TRAIL resistance in the clinic.
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Affiliation(s)
- C R Schlegel
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital, Hammersmith Hospital Campus, ICTEM, Du Cane Road, London W12 0NN, UK
| | - A-V Fonseca
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital, Hammersmith Hospital Campus, ICTEM, Du Cane Road, London W12 0NN, UK
| | - S Stöcker
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital, Hammersmith Hospital Campus, ICTEM, Du Cane Road, London W12 0NN, UK
| | - M L Georgiou
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital, Hammersmith Hospital Campus, ICTEM, Du Cane Road, London W12 0NN, UK
| | - M B Misterek
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital, Hammersmith Hospital Campus, ICTEM, Du Cane Road, London W12 0NN, UK
| | - C E Munro
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital, Hammersmith Hospital Campus, ICTEM, Du Cane Road, London W12 0NN, UK
| | - C R Carmo
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital, Hammersmith Hospital Campus, ICTEM, Du Cane Road, London W12 0NN, UK
| | - M J Seckl
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital, Hammersmith Hospital Campus, ICTEM, Du Cane Road, London W12 0NN, UK
| | - A P Costa-Pereira
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital, Hammersmith Hospital Campus, ICTEM, Du Cane Road, London W12 0NN, UK
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Pinato DJ, Shiner RJ, Seckl MJ, Stebbing J, Sharma R, Mauri FA. Prognostic performance of inflammation-based prognostic indices in primary operable non-small cell lung cancer. Br J Cancer 2014; 110:1930-5. [PMID: 24667648 PMCID: PMC3992503 DOI: 10.1038/bjc.2014.145] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [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: 12/12/2013] [Revised: 02/11/2014] [Accepted: 02/24/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND At least 30% of patients with primary resectable non-small cell lung cancer (NSCLC) will experience a relapse in their disease within 5 years following definitive treatment. Clinicopathological predictors have proved to be suboptimal in identifying high-risk patients. We aimed to establish whether inflammation-based scores offer an improved prognostic ability in terms of estimating overall (OS) and recurrence-free survival (RFS) in a cohort of operable, early-stage NSCLC patients. METHODS Clinicopathological, demographic and treatment data were collected prospectively for 220 patients operated for primary NSCLC at the Hammersmith Hospital from 2004 to 2011. Pretreatment modified Glasgow Prognostic Score (mGPS), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were tested together with established prognostic factors in uni- and multivariate Cox regression analyses of OS and RFS. RESULTS Half of the patients were male, with a median age of 65. A total of 57% were classified as stage I with adenocarcinoma being the most prevalent subtype (60%). Univariate analyses of survival revealed stage (P<0.001), grade (P=0.02), lymphovascular (LVI, P=0.001), visceral pleural invasion (VPI, P=0.003), mGPS (P=0.02) and NLR (P=0.04) as predictors of OS, with stage (P<0.001), VPI (P=0.02) and NLR (P=0.002) being confirmed as independent prognostic factors on multivariate analyses. Patients with more advanced stage (P<0.001) and LVI (P=0.008) had significantly shorter RFS. CONCLUSIONS An elevated NLR identifies operable NSCLC patients with a poor prognostic outlook and an OS difference of almost 2 years compared to those with a normal score at diagnosis. Our study validates the clinical utility of the NLR in early-stage NSCLC.
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Affiliation(s)
- D J Pinato
- Division of Experimental Medicine, Hammersmith Campus of Imperial College London, Du Cane Road, W120HS London, UK
| | - R J Shiner
- Department of Respiratory Medicine, National Heart and Lung Institute, Hammersmith Hospital, Du Cane Road, W120HS London, UK
| | - M J Seckl
- Division of Oncology, Hammersmith Campus of Imperial College London, Du Cane Road, W120HS London, UK
| | - J Stebbing
- Division of Oncology, Hammersmith Campus of Imperial College London, Du Cane Road, W120HS London, UK
| | - R Sharma
- Division of Experimental Medicine, Hammersmith Campus of Imperial College London, Du Cane Road, W120HS London, UK
| | - F A Mauri
- Department of Pathology, Hammersmith Campus of Imperial College London, Du Cane Road, W120HS London, UK
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Seckl MJ, Sebire NJ, Fisher RA, Golfier F, Massuger L, Sessa C. Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 Suppl 6:vi39-50. [PMID: 23999759 DOI: 10.1093/annonc/mdt345] [Citation(s) in RCA: 206] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Savage PM, Sita-Lumsden A, Dickson S, Iyer R, Everard J, Coleman R, Fisher RA, Short D, Casalboni S, Catalano K, Seckl MJ. The relationship of maternal age to molar pregnancy incidence, risks for chemotherapy and subsequent pregnancy outcome. J OBSTET GYNAECOL 2013; 33:406-11. [DOI: 10.3109/01443615.2013.771159] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sita-Lumsden A, Medani H, Fisher R, Harvey R, Short D, Sebire N, Savage P, Lim A, Seckl MJ, Agarwal R. Uterine artery pulsatility index improves prediction of methotrexate resistance in women with gestational trophoblastic neoplasia with FIGO score 5-6. BJOG 2013; 120:1012-5. [PMID: 23759086 DOI: 10.1111/1471-0528.12196] [Citation(s) in RCA: 25] [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] [Accepted: 01/30/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The Uterine Artery Pulsatility Index (UAPI) is an ultrasound measure of tumour vascularity. In this study, we hypothesised that a UAPI ≤ 1 (high vascularity) would identify women with gestational trophoblastic neoplasia (GTN) at increased risk of resistance to first-line single-agent methotrexate (MTX-R). DESIGN Single-centre cohort study. SETTING Charing Cross Hospital, a UK national centre for the treatment of trophoblastic disease. POPULATION All women with a GTN FIGO score 5-6 treated with methotrexate (n = 92), between 1999 and 2011, at Charing Cross Hospital. METHODS UAPI was measured before the start of chemotherapy, and women were monitored for the development of MTX-R. MAIN OUTCOME MEASURES Frequency of MTX-R in women with UAPI ≤ 1 compared with UAPI >1. RESULTS UAPI was measured before chemotherapy in 73 of 92 women with GTN FIGO score 5-6. UAPI ≤ 1 predicted MTX-R independent of the FIGO score (hazard ratio 2.9, P = 0.04), with an absolute risk of MTX-R in women with a UAPI ≤ 1 of 67% (95% CI 53-79%) compared with 42% (95% CI 24-61%) with a UAPI >1 (P = 0.036). CONCLUSION Our results suggest UAPI is an independent predictor of MTX-R in women with FIGO 5-6 GTN.
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Affiliation(s)
- A Sita-Lumsden
- Department of Medical Oncology, Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital, London, UK
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Saso S, Chatterjee J, Yazbek J, Thum Y, Keefe KW, Abdallah Y, Naji O, Lindsay I, Savage PM, Seckl MJ, Smith JR. A case of pregnancy following a modified Strassman procedure applied to treat a placental site trophoblastic tumour. BJOG 2012; 119:1665-7. [DOI: 10.1111/j.1471-0528.2012.03501.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sita-Lumsden A, Short D, Lindsay I, Sebire NJ, Adjogatse D, Seckl MJ, Savage PM. Treatment outcomes for 618 women with gestational trophoblastic tumours following a molar pregnancy at the Charing Cross Hospital, 2000-2009. Br J Cancer 2012; 107:1810-4. [PMID: 23059744 PMCID: PMC3504950 DOI: 10.1038/bjc.2012.462] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: Post-molar pregnancy gestational trophoblastic tumours (GTT) have been curable with chemotherapy treatment for over 50 years. Because of the rarity of the diagnosis, detailed structured information on prognosis, treatment escalations and outcome is limited. Methods: We have reviewed the demographics, prognostic variables, treatment course and clinical outcomes for the post-mole GTT patients treated at Charing Cross Hospital between 2000 and 2009. Results: Of the 618 women studied, 547 had a diagnosis of complete mole, 13 complete mole with a twin conception and 58 partial moles. At the commencement of treatment, 94% of patients were in the FIGO low-risk group (score 0–6). For patients treated with single-agent methotrexate, the primary cure rate ranged from 75% for a FIGO score of 0–1 through to 31% for those with a FIGO score of 6. Conclusion: In the setting of a formal follow-up programme, the expected cure rate for GTT after a molar pregnancy should be 100%. Prompt treatment and diagnosis should limit the exposure of most patients to combination chemotherapy. Because of the post-treatment relapse rate of 3% post-chemotherapy, hCG monitoring should be performed routinely.
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Affiliation(s)
- A Sita-Lumsden
- Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
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Saso S, Haddad J, Ellis P, Lindsay I, Sebire NJ, McIndoe A, Seckl MJ, Smith JR. Placental site trophoblastic tumours and the concept of fertility preservation. BJOG 2011; 119:369-74; discussion 374. [DOI: 10.1111/j.1471-0528.2011.03230.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- C Alifrangis
- Department of Medical Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 8RF, UK
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25
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Lara R, Mauri FA, Taylor H, Derua R, Shia A, Gray C, Nicols A, Shiner RJ, Schofield E, Bates PA, Waelkens E, Dallman M, Lamb J, Zicha D, Downward J, Seckl MJ, Pardo OE. An siRNA screen identifies RSK1 as a key modulator of lung cancer metastasis. Oncogene 2011; 30:3513-21. [PMID: 21423205 DOI: 10.1038/onc.2011.61] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [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: 07/05/2010] [Revised: 11/29/2010] [Accepted: 02/02/2011] [Indexed: 12/17/2022]
Abstract
We performed a kinome-wide siRNA screen and identified 70 kinases altering cell migration in A549 lung cancer cells. In particular, ribosomal S6 kinase 1 (RSK1) silencing increased, whereas RSK2 and RSK4 downregulation inhibited cell motility. In a secondary collagen-based three-dimensional invasion screen, 38 of our hits cross-validated, including RSK1 and RSK4. In two further lung cancer cell lines, RSK1 but not RSK4 silencing showed identical modulation of cell motility. We therefore selected RSK1 for further investigation. Bioinformatic analysis followed by co-immunoprecipitation-based validation revealed that the actin regulators VASP and Mena interact with RSK1. Moreover, RSK1 phosphorylated VASP on T278, a site regulating its binding to actin. In addition, silencing of RSK1 enhanced the metastatic potential of these cells in vivo using a zebrafish model. Finally, we investigated the relevance of this finding in human lung cancer samples. In isogenically matched tissue, RSK1 was reduced in metastatic versus primary lung cancer lesions. Moreover, patients with RSK1-negative lung tumours showed increased number of metastases. Our results suggest that the findings of our high-throughput in vitro screen can reliably identify relevant clinical targets and as a proof of principle, RSK1 may provide a biomarker for metastasis in lung cancer patients.
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Affiliation(s)
- R Lara
- Department of Oncology, Hammersmith Campus, Cyclotron Building, London, UK
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Bircher C, Smith RP, Seckl MJ, Brown D, Short D, Rees H, McCarthy A, Nirmal DM. Metastatic choriocarcinoma presenting and treated during viable pregnancy: a case report. BJOG 2011; 118:1672-5. [DOI: 10.1111/j.1471-0528.2011.03062.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McGrath S, Short D, Harvey R, Schmid P, Savage PM, Seckl MJ. The management and outcome of women with post-hydatidiform mole 'low-risk' gestational trophoblastic neoplasia, but hCG levels in excess of 100 000 IU l(-1). Br J Cancer 2010; 102:810-4. [PMID: 20160727 PMCID: PMC2833242 DOI: 10.1038/sj.bjc.6605529] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [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: 02/07/2023] Open
Abstract
Background: Gestational trophoblastic neoplasia (GTN) after a hydatidiform mole is either treated with single- or multi-agent chemotherapy determined by a multifactorial scoring system. Women with human chorionic gonadotrophin (hCG) levels >100 000 IU l−1 can remain within the low-risk/single-agent category and usually choose one drug therapy. Here we compare the success and duration of single- vs multi-agent chemotherapy in this patient group. Methods: Between 1980 and 2008, 65 women had a pre-treatment hCG >100 000 IU l−1 and were low risk. The initial hCG level, treatment regimens, changes and duration and overall survival were recorded. Results: Of 37 patients starting low-risk/single-agent treatment, 11 (29.7%) were treated successfully, whereas 26 (70.3%) required additional multi-agent chemotherapy to achieve complete remission (CR). Combination chemotherapy was initially commenced in 28 women, and 2 (7%) required additional drugs for CR. The overall duration of therapy for those commencing and completing single- or multi-agent chemotherapy was 130 and 123 days (P=0.78), respectively. The median-treatment duration for patients commencing single-agent but changing to multi-agent chemotherapy was 13 days more than those receiving high-risk treatment alone (136 vs 123 days; P=0.07). All 3 patients with an initial hCG >400 000 IU l−1 and treated with single-agent therapy developed drug resistance. Overall survival for all patients was 100%. Conclusion: Low-risk post-molar GTN patients with a pre-treatment hCG >100 000 and <400 000 IU l−1 can be offered low-risk single-agent therapy, as this will cure 30%, is relatively non-toxic and only prolongs treatment by 2 weeks if a change to combination agents is required. Patients whose hCG is >400 000 IU l−1 should receive multi-agent chemotherapy from the outset.
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Affiliation(s)
- S McGrath
- Department Medical Oncology, Charing Cross Hospital Trophoblastic Disease Screening and Treatment Centre, Imperial College NHS Healthcare Trust, Fulham Palace Road, London, UK
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29
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Pardo OE, Latigo J, Jeffery RE, Nye E, Poulsom R, Spencer-Dene B, Lemoine NR, Stamp GW, Aboagye EO, Seckl MJ. The Fibroblast Growth Factor Receptor Inhibitor PD173074 Blocks Small Cell Lung Cancer Growth In vitro and In vivo. Cancer Res 2009; 69:8645-51. [DOI: 10.1158/0008-5472.can-09-1576] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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30
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Kerkmeijer LG, Thomas CM, Harvey R, Sweep FC, Mitchell H, Massuger LF, Seckl MJ. External validation of serum hCG cutoff levels for prediction of resistance to single-agent chemotherapy in patients with persistent trophoblastic disease. Br J Cancer 2009; 100:979-84. [PMID: 19293810 PMCID: PMC2661779 DOI: 10.1038/sj.bjc.6604849] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [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: 11/12/2022] Open
Abstract
Van Trommel et al have previously shown that serum human chorionic gonadotropin (hCG) cutoff levels can provide early prediction of resistance to first-line methotrexate (MTX) in patients with persistent trophoblastic disease (PTD). In this study, we validate this approach of prediction of resistance to single-agent chemotherapy in an independent and larger cohort of PTD patients using a different hCG assay. Receiver operating characteristics (ROC) curves were constructed to determine hCG cutoff levels and sensitivity between patients cured on single-agent chemotherapy (control group) and patients requiring change to combination chemotherapy (study group). Receiver operating characteristics analysis identified an hCG cutoff value of 737 IU l−1 that enabled us to predict the subsequent development of single-agent chemotherapy resistance in 52% of patients before their fourth MTX course at 97.5% specificity. This would have enabled an earlier switch to combination chemotherapy reducing the MTX exposure by an average of 2.5 courses. The present findings confirm that serum hCG cutoff levels predict resistance to single-agent therapy earlier than traditional methods. Change to combination chemotherapy should be considered for patients whose serum hCG levels exceed these hCG cutoff values. For patients not exceeding the hCG cutoff levels, static or rising hCG levels should still be included in the criteria for change of chemotherapy.
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Affiliation(s)
- L G Kerkmeijer
- Department of Chemical Endocrinology, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen 6500 HB, The Netherlands.
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Wang CM, Dixon PH, Decordova S, Hodges MD, Sebire NJ, Ozalp S, Fallahian M, Sensi A, Ashrafi F, Repiska V, Zhao J, Xiang Y, Savage PM, Seckl MJ, Fisher RA. Identification of 13 novel NLRP7 mutations in 20 families with recurrent hydatidiform mole; missense mutations cluster in the leucine-rich region. J Med Genet 2009; 46:569-75. [DOI: 10.1136/jmg.2008.064196] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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32
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Affiliation(s)
- N J Sebire
- Trophoblastic Disease Centre, Department of Medical Oncology, Charing Cross Hospital, London W6 8RF
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33
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Affiliation(s)
- Paul E Pfeffer
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College London, London W6 8RF, UK
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34
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Sebire NJ, Foskett M, Short D, Savage P, Stewart W, Thomson M, Seckl MJ. Shortened duration of human chorionic gonadotrophin surveillance following complete or partial hydatidiform mole: evidence for revised protocol of a UK regional trophoblastic disease unit. BJOG 2007; 114:760-2. [PMID: 17516969 DOI: 10.1111/j.1471-0528.2007.01320.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Following hydatidiform mole, women are at increased risk of persistent gestational trophoblastic neoplasia (pGTN) and are therefore monitored using serum human chorionic gonadotrophin (hCG) concentration measurements. We retrospectively evaluated the policy of extended (2 year) follow up for women with hCG concentrations returning to normal >56 days after evacuation. Of 6701 women registered for hCG follow up, 422 (6%) developed pGTN, 412 (98%) of these women presented within 6 months after evacuation. Three developed pGTN at 402, 677 and 1267 days after evacuation following spontaneous normalisation of hCG levels. Only one woman was detected by routine extended follow up. Prolonged surveillance after molar pregnancy causes significant anxiety and is not cost-effective. Therefore, the current revised protocol comprises hCG follow up for 6 months after spontaneous return of hCG levels to normal for all women.
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Affiliation(s)
- N J Sebire
- Trophoblastic Disease Unit, Department of Cancer Medicine, Charing Cross Hospital, London, UK
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35
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Patterson DM, Murugaesu N, Holden L, Seckl MJ, Rustin GJS. A review of the close surveillance policy for stage I female germ cell tumors of the ovary and other sites. Int J Gynecol Cancer 2007; 18:43-50. [PMID: 17466047 DOI: 10.1111/j.1525-1438.2007.00969.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Ovarian germ cell tumors are rare but very curable at all stages of disease. There is good evidence that surveillance for stage I dysgerminomas is a safe option although many centers worldwide still advocate adjuvant chemotherapy for stage IA nondysgerminomatous tumors, despite the significant risk of developing long-term treatment side effects. Here, we review the safety of our ongoing surveillance program of all stage IA female germ cell tumors. Thirty-seven patients (median age 26, range 14-48 years) with stage I disease were referred to Mount Vernon and Charing Cross Hospitals between 1981 and 2003. Patients underwent surgery and staging followed by intense surveillance, which included regular tumor markers and imaging. The median period of follow-up was 6 years. Relapse rates for stage IA nondysgerminomatous tumors and dysgerminomas were 8 of 22 (36%) and 2 of 9 (22%), respectively, plus one patient with mature teratoma and glial implants also relapsed; 10 of these 11 patients (91%) were successfully cured with platinum-based chemotherapy. Only one patient died from chemoresistant disease. All relapses occurred within 13 months of initial surgery. The overall disease-specific survival of malignant ovarian germ cell tumors was 94%. Over 50% of patients who underwent fertility-sparing surgery went on to have successful pregnancies. We have confirmed again that surveillance of all stage IA ovarian germ cell tumors is very safe and that the outcome is comparable with testicular tumors. We question the need for potentially toxic adjuvant chemotherapy in nondysgerminoma patients who have greater than 90% chance of being salvaged with chemotherapy if they relapse later.
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Affiliation(s)
- D M Patterson
- Department of Medical Oncology, Mount Vernon Hospital, Northwood, Middlesex, United Kingdom.
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36
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Powles T, Savage PM, Stebbing J, Short D, Young A, Bower M, Pappin C, Schmid P, Seckl MJ. A comparison of patients with relapsed and chemo-refractory gestational trophoblastic neoplasia. Br J Cancer 2007; 96:732-7. [PMID: 17299394 PMCID: PMC2360082 DOI: 10.1038/sj.bjc.6603608] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The majority of women requiring chemotherapy for gestational trophoblastic disease (GTN) are cured with their initial chemotherapy treatment. However, a small percentage either become refractory to treatment, or relapse after the completion of treatment. This study investigates the characteristics and outcome of these patients. Patients were identified from the Charing Cross Hospital GTD database. The outcome of these patients with relapsed disease was compared to those with refractory disease. Between 1980 and 2004, 1708 patients were treated with chemotherapy for GTN. Sixty (3.5%) patents relapsed following completion of initial therapy. The overall 5-year survival for patients with relapsed GTN was 93% (95% CI 86-100%). The overall survival for patients with low-risk and high-risk disease at presentation, who subsequently relapsed was 100% (n=35), and 84% (n=25) (95% CI: 66-96%: P<0.05), respectively. Eleven patients were identified who failed to enter remission and had refractory disease. These patients had a worse outcome compared to patients with relapsed disease (5-year survival 43% (95% CI:12-73% P<0.01)). The outcome of patients with relapsed GTN is good. However, patients with primary chemo-refractory disease do poorly and novel therapies are required for this group of patients.
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Affiliation(s)
- T Powles
- Department of Medical Oncology, Charing Cross Gestational Trophoblastic Disease Centre, Hammersmith Hospitals Campus of Imperial College London, London, UK.
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37
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Fowler DJ, Lindsay I, Seckl MJ, Sebire NJ. Histomorphometric features of hydatidiform moles in early pregnancy: relationship to detectability by ultrasound examination. Ultrasound Obstet Gynecol 2007; 29:76-80. [PMID: 17171630 DOI: 10.1002/uog.3880] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The majority of partial (PHM) and complete (CHM) hydatidiform moles are diagnosed in early pregnancy. About half are identified as molar on ultrasonographic examination prior to evacuation. It is uncertain whether unsuspected cases represent an intrinsically different molar phenotype or are simply dependant on sonographer expertise. We measured a microscopic parameter, average villus diameter, of evacuated PHMs and CHMs to ascertain the cause of non-detection on ultrasound. METHODS Fifty-four molar pregnancies were examined from the files of the Trophoblastic Disease Unit, in which results of an ultrasound examination prior to evacuation were known. In each, the average cross-sectional diameter of the largest 10 villi was recorded. Maximum villus diameters were compared between gestational age groups (<14 weeks and >or=14 weeks), and ultrasound detection groups (detected (d) and not detected (nd)). RESULTS The average maximum villus diameter of the largest hydropic villi was significantly less in the first trimester for both PHMs and CHMs that were undetected by ultrasound examination compared to those identified as molar sonographically (P<0.001 and P<0.001, respectively). There was no significant difference in the maximum villus diameter between PHMs and CHMs that were not detected sonographically in the first trimester (P=0.44). Beyond 14 weeks of gestation, there was no significant difference between PHMs detected and undetected sonographically (P=0.88). CONCLUSION The average diameter of the largest, most hydropic villi, is significantly greater in cases of PHMs and CHMs detected by ultrasound examination in the first trimester compared to that of those not detected sonographically, but beyond 14 weeks such differences are minimal. These findings suggest that, although sonographer expertise could potentially increase ultrasound detection rates somewhat for PHMs and CHMs, a significant proportion of cases demonstrate minimal hydropic change in the first trimester and are therefore likely to remain unidentifiable by ultrasound examination prior to evacuation, even with improved sonographer expertise.
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Affiliation(s)
- D J Fowler
- Trophoblastic Disease Unit, Department of Cancer Medicine, Charing Cross Hospital, London, UK
| | - I Lindsay
- Trophoblastic Disease Unit, Department of Cancer Medicine, Charing Cross Hospital, London, UK
| | - M J Seckl
- Trophoblastic Disease Unit, Department of Cancer Medicine, Charing Cross Hospital, London, UK
| | - N J Sebire
- Trophoblastic Disease Unit, Department of Cancer Medicine, Charing Cross Hospital, London, UK
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Powles T, Young A, Sanitt A, Sammit A, Stebbing J, Short D, Bower M, Savage PM, Seckl MJ, Schmid P. The significance of the time interval between antecedent pregnancy and diagnosis of high-risk gestational trophoblastic tumours. Br J Cancer 2006; 95:1145-7. [PMID: 17031399 PMCID: PMC2360575 DOI: 10.1038/sj.bjc.6603416] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
It is thought that the time interval between the antecedent pregnancy and diagnosis of gestational trophoblastic tumours (GTTs) may influence the outcome of these patients. In this study, we investigate the significance of this time interval. Multivariate analysis was used to investigate if the time interval was of prognostic significance from our cohort of 241 high-risk patients with GTT. Subsequent cutpoint analysis was used to determine an optimal cutpoint for the interval covariate. The outcome of these patients was plotted according to the Kaplan-Meier method. The time interval was of prognostic significance on multivariate analysis. A period of greater than 2.8 years after pregnancy was found to be of most significance. The 5-year overall survival was 62.0% (95% CI: 47-76%) for greater than 2.8 years vs 94% (95% CI: 91-97%) for less than 2.8 years (P<0.001). Multivariate analysis showed the presence of liver metastasis and the number of metastasis was also of prognostic importance. The interval between antecedent pregnancy and diagnosis in high-risk GTT is of prognostic significance. This gives some insight into the pathogenesis of the disease.
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Affiliation(s)
- T Powles
- Charing Cross Gestational Trophoblastic Centre, London, UK.
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Zhao J, Xiang Y, Huang SZ, Wan XR, Cui QC, Seckl MJ, Fisher RA. [Genetic heterogeneity for familial recurrent hydatidiform mole]. Zhonghua Yi Xue Yi Chuan Xue Za Zhi 2006; 23:511-4. [PMID: 17029197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To determine the parental origin of the genome in the molar pregnancies of two familes with familial recurrent hydatidiform mole (FRHM) and to investigate whether the gene responsible for FRHM is likely to be located within the 19q13.4 region in these familes. METHODS The features of complete hydatidiform mole (CHM) were confirmed by pathological examination. DNA of CHM was prepared from sections of formalin-fixed paraffin-embedded blocks of molar tissue following laser capture microdissection. The polymerace chain reaction was used to amplify microsatellite polymorphisms in DNA from the patients, their husbands and the captured molar tissue. Parental contributions to the molar tissue were determined using ABI 310 GeneScan software. Genotyping and haplotype analysis of the candidate region on 19q13.4 was performed for members of both families using 25 microsatellite markers. RESULTS One CHM from each family was identified as a biparental complete hydatidiform mole. All patients were heterozygous for most of the markers in the chromosome region of interest. In addition the two affected sisters in one of the families had different genotypes for the 19q13.4 region, suggesting that mutations in a different locus might be responsible for the disorder in this family. CONCLUSION The location of the gene responsible for FRHM is unlikely to be located in the 19q13.4 chromosomal region in these two families suggesting that FRHM shows genetic heterogeneity.
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Affiliation(s)
- Jun Zhao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, 100730 PR China
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Allen SD, Lim AK, Seckl MJ, Blunt DM, Mitchell AW. Radiology of gestational trophoblastic neoplasia. Clin Radiol 2006; 61:301-13. [PMID: 16546459 DOI: 10.1016/j.crad.2005.12.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [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: 09/05/2005] [Revised: 10/26/2005] [Accepted: 12/05/2005] [Indexed: 12/20/2022]
Abstract
Gestational trophoblastic neoplasia (GTN) encompasses a broad spectrum of placental lesions from the pre-malignant hydatidiform mole (complete and partial) through to the malignant invasive mole, choriocarcinoma and rare placental site trophoblastic tumour (PSTT). Ultrasound remains the radiological investigation of choice for initial diagnosis, and it can also predict invasive and recurrent disease. Magnetic resonance imaging is of invaluable use in assessing extra-uterine tumour spread, tumour vascularity, and overall staging. Positron emission tomography and computed tomography undoubtedly have a role in recurrent and metastatic disease, while angiography has a place in disease and complication management. This review will describe the relevant pathophysiology and natural history of GTN, and the use of imaging techniques in the diagnosis and management of these conditions.
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Affiliation(s)
- S D Allen
- Department of Radiology, Charing Cross Hospital, Hammersmith Hospitals NHS Trust, London, UK
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Khanzada UK, Pardo OE, Meier C, Downward J, Seckl MJ, Arcaro A. Potent inhibition of small-cell lung cancer cell growth by simvastatin reveals selective functions of Ras isoforms in growth factor signalling. Oncogene 2006; 25:877-87. [PMID: 16170339 DOI: 10.1038/sj.onc.1209117] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The impact of the 3-hydroxy-3methylglutaryl CoA reductase inhibitor simvastatin on human small-cell lung cancer (SCLC) cell growth and survival was investigated. Simvastatin profoundly impaired basal and growth factor-stimulated SCLC cell growth in vitro and induced apoptosis. SCLC cells treated with simvastatin were sensitized to the effects of the chemotherapeutic agent etoposide. Moreover, SCLC tumour growth in vivo was inhibited by simvastatin. These responses correlated with the inhibition of stem cell factor (SCF)-stimulated activation of extracellular signal-regulated kinase (Erk), protein kinase B (PKB) and ribosomal S6 kinase by simvastatin. Constitutive activation of the Erk pathway was sufficient to rescue SCLC cell from the effects of simvastatin. The drug did not directly affect activation of c-Kit or its localization to lipid rafts, but in addition to its ability to block Ras membrane localization, it selectively downregulated H-Ras protein levels at the post-translational level. Downregulation of either H- or K-Ras by RNA interference (RNAi) did not impair Erk activation by growth factors, whereas an RNAi specific for N-Ras inhibited activation of Erk, PKB and SCLC cell growth. Together our data demonstrate that inhibiting Ras signalling with simvastatin potently disrupts growth and survival in human SCLC cells.
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Affiliation(s)
- U K Khanzada
- Lung Cancer Biology Group, Division of Medicine, Imperial College Faculty of Medicine, Hammersmith Hospital, London, UK
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42
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Affiliation(s)
- S Khan
- Department of Health Gestational Trophoblastic Disease Centre, Charing Cross Hospital, London, UK
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43
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Powles T, Savage P, Short D, Young A, Pappin C, Seckl MJ. Residual lung lesions after completion of chemotherapy for gestational trophoblastic neoplasia: should we operate? Br J Cancer 2006; 94:51-4. [PMID: 16404359 PMCID: PMC2361065 DOI: 10.1038/sj.bjc.6602899] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The significance of residual lung metastasis from malignant gestational trophoblastic neoplasm (GTN) after the completion of chemotherapy is unknown. We currently do not advocate resection of these masses. Here, we investigate the outcome of these patients. Patients with residual lung abnormalities after the completion of treatment for GTN were compared to those who had a complete radiological resolution of the disease. None of the residual masses post-treatment were surgically removed. In all, 76 patients were identified. Overall 53 (70%) patients had no radiological abnormality on CXR or CT after completion of treatment. Eight (11%) patients had residual disease on CXR alone 15 patients had residual disease on CT (19%). During follow-up, two patients (2.6%) relapsed. One of these had had a complete radiological response post-treatment whereas the other had residual disease on CT. Patients with residual lung lesions after completing treatment for GTN do not appear to have an increased chance of relapse compared to those with no residual abnormality. We continue to recommend that these patients do not require pulmonary surgery for these lesions.
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Affiliation(s)
- T Powles
- Department of Health Charing Cross Gestational Trophoblastic Disease Centre, Hammersmith Hospitals Campus of Imperial College London, Palace Rd, London W68RF, UK
| | - P Savage
- Department of Health Charing Cross Gestational Trophoblastic Disease Centre, Hammersmith Hospitals Campus of Imperial College London, Palace Rd, London W68RF, UK
| | - D Short
- Department of Health Charing Cross Gestational Trophoblastic Disease Centre, Hammersmith Hospitals Campus of Imperial College London, Palace Rd, London W68RF, UK
| | - A Young
- Department of Health Charing Cross Gestational Trophoblastic Disease Centre, Hammersmith Hospitals Campus of Imperial College London, Palace Rd, London W68RF, UK
| | - C Pappin
- Department of Health Charing Cross Gestational Trophoblastic Disease Centre, Hammersmith Hospitals Campus of Imperial College London, Palace Rd, London W68RF, UK
| | - M J Seckl
- Department of Health Charing Cross Gestational Trophoblastic Disease Centre, Hammersmith Hospitals Campus of Imperial College London, Palace Rd, London W68RF, UK
- Department of Health Charing Cross Gestational Trophoblastic Disease Centre, Hammersmith Hospitals Campus of Imperial College London, Palace Rd, London W68RF, UK. E-mail:
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Abstract
Wide ranging experimental evidence suggests that human small-cell lung cancer (SCLC) has a number of molecular and subcellular characteristics normally associated with neurones. This review outlines and discusses these characteristics in the light of recent developments in the field. Emphasis is placed upon neuronal cell adhesion molecules, neurone-restrictive silencer factor, neurotransmitters/peptides and voltage-gated ion, especially Na(+) channels. The hypothesis is put forward that acquisition of such characteristics and the membrane 'excitability' that would follow can accelerate metastatic progression. The clinical potential of the neuronal characteristics of SCLC, in particular ion channel expression/activity, is discussed in relation to possible novel diagnostic and therapeutic modalities.
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Affiliation(s)
- P U Onganer
- Division of Cell and Molecular Biology, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - M J Seckl
- Cancer Medicine, Imperial College London, Hammersmith Campus, London SW7 2AZ, UK
| | - M B A Djamgoz
- Division of Cell and Molecular Biology, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
- Neuroscience Solutions to Cancer Research Group, Division of Cell and Molecular Biology, Sir Alexander Fleming Building, South Kensington Campus, Imperial College London, London SW7 2AZ, UK. E-mail:
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Fowler DJ, Lindsay I, Seckl MJ, Sebire NJ. Routine pre-evacuation ultrasound diagnosis of hydatidiform mole: experience of more than 1000 cases from a regional referral center. Ultrasound Obstet Gynecol 2006; 27:56-60. [PMID: 16273594 DOI: 10.1002/uog.2592] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To examine the accuracy of sonographic findings of routine ultrasound examinations in patients with a proven histological diagnosis of complete or partial hydatidiform mole referred to a supra-regional referral center, and to examine the relationship of sonographic findings to gestational age across the first and early second trimesters. METHODS Review of consecutive cases referred to a trophoblastic disease unit from June 2002 to January 2005 with a diagnosis of possible or probable hydatidiform mole in whom results of a pre-evacuation ultrasound examination were documented. Ultrasound detection rates for partial and complete hydatidiform moles were calculated and comparison of detection rates between complete and partial mole, and gestational age groups carried out. RESULTS 1053 consecutive cases were examined. The median maternal age was 31 (range, 15-54) years and the median gestational age was 10 (range, 5-27) weeks. 859 had a final review diagnosis of partial or complete hydatidiform mole (82%), including 253 (29%) complete moles and 606 (71%) partial moles. Non-molar hydropic miscarriage was diagnosed following histological review in 194 (18%). Overall, 378 (44%) cases with a final diagnosis of complete or partial hydatidiform mole had a pre-evacuation ultrasound diagnosis suggesting hydatidiform mole, including 200 complete moles and 178 partial moles, representing 79% and 29%, respectively, of those with complete (253) or partial (606) moles in the final review diagnosis. The ultrasound detection rate was significantly better for complete versus partial hydatidiform moles (Z = 13.4, P < 0.001). There was a non-significant trend towards improved ultrasound detection rate with increasing gestational age, with an overall detection rate of 35-40% before 14 weeks' gestation compared to around 60% after this gestation. The sensitivity, specificity, positive predictive value and negative predictive value for routine pre-evacuation ultrasound examination for detection of hydatidiform mole of any type were 44%, 74%, 88% and 23%, respectively. CONCLUSIONS Routine pre-evacuation ultrasound examination identifies less than 50% of hydatidiform moles, the majority sonographically appearing as missed or incomplete miscarriage. Detection rates are, however, higher for complete compared to partial moles, and improve after 14 weeks' gestation. Histopathological examination of products of conception remains the current gold standard for the identification of gestational trophoblastic neoplasia.
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Affiliation(s)
- D J Fowler
- Trophoblastic Disease Unit, Department of Cancer Medicine, Charing Cross Hospital, London, UK
| | - I Lindsay
- Trophoblastic Disease Unit, Department of Cancer Medicine, Charing Cross Hospital, London, UK
| | - M J Seckl
- Trophoblastic Disease Unit, Department of Cancer Medicine, Charing Cross Hospital, London, UK
| | - N J Sebire
- Trophoblastic Disease Unit, Department of Cancer Medicine, Charing Cross Hospital, London, UK
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El-Helw LM, Seckl MJ, Haynes R, Evans LS, Lorigan PC, Long J, Kanfer EJ, Newlands ES, Hancock BW. High-dose chemotherapy and peripheral blood stem cell support in refractory gestational trophoblastic neoplasia. Br J Cancer 2005; 93:620-1. [PMID: 16222307 PMCID: PMC2361618 DOI: 10.1038/sj.bjc.6602771] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We present retrospectively our experience in the use of high-dose chemotherapy and haematopoietic stem cell support (HSCS) for refractory gestational trophoblastic neoplasia (GTN) in the largest series so far reported. In all, 11 patients have been treated at three Trophoblast Centres between 1993 and 2004. The conditioning regimens comprised either Carbop-EC-T (carboplatin, etoposide, cyclophosphamide, paclitaxel and prednisolone) or CEM (carboplatin, etoposide and melphalan) or ICE (ifosfamide, carboplatin, etoposide). Two patients had complete human chorionic gonadotrophin responses, one for 4 and the other for 12 months. Three patients had partial tumour marker responses for 1–2 months. High-dose chemotherapy and HSCS for GTN is still unproven. Further studies are needed, perhaps in high-risk patients who fail their first salvage treatment.
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Affiliation(s)
- L M El-Helw
- YCR Academic Unit of Clinical Oncology, Weston Park Hospital, Whitham road, Sheffield S10 2SJ, UK
| | - M J Seckl
- Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - R Haynes
- Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - L S Evans
- YCR Academic Unit of Clinical Oncology, Weston Park Hospital, Whitham road, Sheffield S10 2SJ, UK
| | - P C Lorigan
- YCR Academic Unit of Clinical Oncology, Weston Park Hospital, Whitham road, Sheffield S10 2SJ, UK
| | - J Long
- Waikato Hospital, Selwyn Street, PO Box 934, Hamilton, New Zealand
| | - E J Kanfer
- Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - E S Newlands
- Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - B W Hancock
- YCR Academic Unit of Clinical Oncology, Weston Park Hospital, Whitham road, Sheffield S10 2SJ, UK
- YCR Academic Unit of Clinical Oncology, Weston Park Hospital, Whitham road, Sheffield S10 2SJ, UK. E-mail:
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Zhao J, Moss J, Sebire NJ, Cui QC, Seckl MJ, Xiang Y, Fisher RA. Analysis of the chromosomal region 19q13.4 in two Chinese families with recurrent hydatidiform mole. Hum Reprod 2005; 21:536-41. [PMID: 16239310 DOI: 10.1093/humrep/dei357] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [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] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Familial recurrent hydatidiform mole is an extremely rare autosomal recessive condition in which affected individuals have a predisposition to molar pregnancies that are diploid but biparental, rather than androgenetic, in origin. A gene for this condition has been previously mapped to a 1.1 Mb region of chromosome 19q13.4. However, investigation of further families is needed to refine the location of the specific gene(s) involved. METHODS We have recently identified two novel Chinese families in which four affected women had recurrent pregnancy loss including 14 complete hydatidiform moles (CHM). Fluorescent microsatellite genotyping was used to determine the origin of CHM in both families. Using a panel of polymorphic microsatellite markers, genotyping and haplotype analysis of the 19q13.4 chromosomal region was performed in both families. RESULTS Genotyping of CHM from affected individuals confirmed their biparental origin and diagnosis of familial recurrent hydatidiform mole in both families. However, no significant homozygosity for the 19q13.4 candidate region was found in affected members of either family. CONCLUSION Genotyping and haplotype analysis has shown that a mutation in 19q13.4 is unlikely to be responsible for recurrent CHM in the two Chinese families investigated and provides further evidence to support the hypothesis that, although extremely rare, this condition shows genetic heterogeneity.
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Affiliation(s)
- J Zhao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China
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Abstract
Partial or complete hydatidiform mole (HM) affects approximately 1 in 500 to 1,000 pregnancies. Previous small series suggest that histopathologic diagnosis of HM may be difficult in tubal ectopic pregnancies. The histopathology database of a regional Trophoblastic Disease Unit was searched to identify cases with a referral diagnosis of tubal HM, and the histopathologic findings were reviewed. During the study period (1986-2004 inclusive), there were 132 cases. After central review by specialist histopathologists, the final diagnosis was ectopic partial mole in two, ectopic complete mole in five, and ectopic hydatidiform mole (not otherwise specified) in one. The final diagnosis of definite hydatidiform mole was made in eight (6%) cases, significantly less than in referred uterine curettage specimens, in which approximately 90% have a confirmatory diagnosis of HM (Z = 12.9; p < 0.0001). No cases in this series developed persistent gestational trophoblastic disease, the human chorionic gonadotropin concentration spontaneously returning to normal. Ectopic pregnancies, where managed surgically, should be submitted for histopathologic examination; however, the pathologist should be aware that the degree of extravillus trophoblastic proliferation may appear more florid compared with evacuated uterine products of conception. Molar pregnancy should only be diagnosed when strict criteria regarding morphologic abnormalities previously described in uterine evacuation material are applied.
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Affiliation(s)
- N J Sebire
- Department of Histopathology, Trophoblastic Disease Unit, Charing Cross Hospital, London, UK
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Sebire NJ, Lindsay I, Fisher RA, Seckl MJ. Intraplacental choriocarcinoma: experience from a tertiary referral center and relationship with infantile choriocarcinoma. Fetal Pediatr Pathol 2005; 24:21-9. [PMID: 16175749 DOI: 10.1080/15227950590961180] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The development of persistent gestational trophoblastic disease following an apparently uncomplicated term pregnancy is well-recognized; however, reports of confirmed intraplacental choriocarcinoma are rare. We report four cases of histologically reviewed intraplacental choriocarcinoma occurring in third-trimester pregnancies from the files of a regional trophoblastic disease unit. In all cases, macroscopic examination of the placenta appeared unremarkable, with small nondescript lesions being identified, thought to be fresh infarcts or intervillus thrombi. Histological examination demonstrated the presence of focal intraplacental choriocarcinoma. Review of the literature demonstrates primary intraplacental choriocarcinoma rarely may be associated with obstetric complications such as intrauterine death or fetal distress. But in most cases, the disease is initially asymptomatic, the diagnosis only being made following histopathological placental examination for other indications. Intraplacental choriocarcinoma may therefore manifest as a spectrum of clinical disease ranging from an incidental lesion diagnosed on placental pathological examination with no adverse effects on mother or baby, through to metastatic maternal disease that is present in about half of the cases, to disseminated fatal infantile choriocarcinoma.
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Affiliation(s)
- N J Sebire
- Department of Histopathology, Trophoblastic Disease Unit, Charing Cross Hospital, London, UK.
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Sebire NJ, Foskett M, Fisher RA, Lindsay I, Seckl MJ. Persistent gestational trophoblastic disease is rarely, if ever, derived from non-molar first-trimester miscarriage. Med Hypotheses 2005; 64:689-93. [PMID: 15694683 DOI: 10.1016/j.mehy.2004.11.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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: 11/18/2004] [Accepted: 11/18/2004] [Indexed: 11/16/2022]
Abstract
Traditional epidemiologic data suggest that persistent gestational trophoblastic disease (pGTD), may follow, and be derived from, either molar pregnancy, non-molar term pregnancy or first-trimester non-molar miscarriage. We examined a database of cases of possible or probable hydatidiform moles and proven pGTD derived from the Regional Trophoblastic Disease Unit, Charing Cross Hospital, London. There were 424 cases (6%), in whom the initial registered diagnosis was that of PHM or CHM but central histopathological review diagnosed a definite non-molar hydropic abortion (HA). In eight of the 424 (2%), although the histology of the most recent index pregnancy was that of non-molar miscarriage, there was a previous history of pregnancy affected by hydatidiform mole; two of these developed subsequent pGTD. Of a further 86 cases referred for a histopathological opinion prior to registration which demonstrated definite non-molar HA, none developed pGTD (zero of 510 (0%, 95% CI 0-0.7%)). During the same period there were 352 cases with pGTD requiring chemotherapy. In 31 cases, the only known pregnancy was the preceding apparent non-molar HA. However, of these, there were only three cases in whom the preceding histological products of conception had been centrally reviewed and were suggestive of non-molar pregnancy. However, in all three of these cases, the specimens were inadequate for definite exclusion of molar pregnancy. In one case in whom no material was available for review, molecular genetic analysis using restriction fragment length polymorphisms was carried out, and the choriocarcinoma was genetically derived from a previous molar pregnancy rather than the preceding HA. There were therefore no cases identified on the database of the trophoblastic disease unit of pGTD requiring treatment in whom the trophoblastic tumour could be genetically proven to have arisen from the preceding first trimester non-molar HA. We suggest that the risk of pGTD developing from a histologically confirmed non-molar HA is less than 1 in 50,000 and that the majority of pGTD cases previously reported to have been caused by a non-molar miscarriage probably represent disease due to an unrecognised early molar pregnancy.
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Affiliation(s)
- N J Sebire
- Trophoblastic Disease Unit, Charing Cross Hospital, London WC1N 3JH, UK.
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