1
|
Tota JE, Engels EA, Lingen MW, Agrawal N, Kerr AR, Zumsteg ZS, Cheung LC, Katki HA, Abnet CC, Chaturvedi AK. Inflammatory Tongue Conditions and Risk of Oral Tongue Cancer Among the US Elderly Individuals. J Clin Oncol 2023:JCO2300729. [PMID: 38033283 DOI: 10.1200/jco.23.00729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/12/2023] [Accepted: 09/29/2023] [Indexed: 12/02/2023] Open
Abstract
PURPOSE The incidence of oral tongue cancers has increased since the 1980s among US men and women for unknown reasons. We investigated associations of inflammatory tongue conditions with risk of cancers of the oral tongue, other oral cavity, and oropharynx among the US elderly individuals (age 65 years or older). METHODS We conducted a case-control study (2,534 oral tongue cancers, 6,832 other oral cavity cancers, 9,373 oropharyngeal cancers, and 200,000 controls) within the SEER-Medicare data set (1992-2013). Medicare records were used to identify patients with clinically diagnosed inflammatory tongue conditions (glossitis, benign migratory glossitis, median rhomboid glossitis, atrophic glossitis, glossodynia, other specified conditions [eg, atrophy and hypertrophy], and other unspecified conditions) and oral precancer (leukoplakia/erythroplakia). Only conditions preceding cancer/control selection by >12 months were included. RESULTS The prevalence of inflammatory tongue conditions was significantly higher in patients with tongue cancer than controls (6.0% v 0.6%; odds ratios [ORs], adjusted for age, sex, race, Medicare utilization, and precancer, 5.8 [95% CI, 4.7 to 7.2]). This overall association primarily arose from glossitis, 5.6 (95% CI, 4.4 to 7.2); other specified conditions, 9.1 (95% CI, 5.5 to 15.2); and other unspecified conditions, 13.7 (95% CI, 8.0 to 23.7). These associations remained strongly elevated >5 years preceding tongue cancer (arguing against reverse causation), for conditions diagnosed by a specialist (arguing against misclassification), and among patients who received an oral biopsy (arguing against missed cancer). During 2013, an estimated 1 in 11 patients with oral tongue cancer had a preceding diagnosis of inflammatory tongue conditions. Associations of inflammatory tongue conditions were relatively weak for other oral cavity cancers (ORs, 1.8 [95% CI, 1.5 to 2.3]) and oropharyngeal cancer (OR, 1.3 [95% CI, 1.0 to 1.6]) and were observed only closest to cancer diagnosis. CONCLUSION Inflammatory tongue conditions were associated with strongly increased risks of oral tongue cancers and preceded cancer diagnosis by several years, underscoring the need for increased clinical surveillance among patients with such apparently benign diagnoses.
Collapse
Affiliation(s)
- Joseph E Tota
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
- Merck & Co, Inc, Rahway, NJ
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Mark W Lingen
- University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Nishant Agrawal
- University of Chicago Pritzker School of Medicine, Chicago, IL
| | | | | | - Li C Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Christian C Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Anil K Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| |
Collapse
|
2
|
Nigam N, Bernard B, Sevilla S, Kim S, Dar MS, Tsai D, Robbins Y, Burkitt K, Sievers C, Allen CT, Bennett RL, Tettey TT, Carter B, Rinaldi L, Lingen MW, Sater H, Edmondson EF, Moshiri A, Saeed A, Cheng H, Luo X, Brennan K, Koparde V, Chen C, Das S, Andresson T, Abdelmaksoud A, Murali M, Sakata S, Takeuchi K, Chari R, Nakamura Y, Uppaluri R, Sunwoo JB, Van Waes C, Licht JD, Hager GL, Saloura V. SMYD3 represses tumor-intrinsic interferon response in HPV-negative squamous cell carcinoma of the head and neck. Cell Rep 2023; 42:112823. [PMID: 37463106 PMCID: PMC10407766 DOI: 10.1016/j.celrep.2023.112823] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/03/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023] Open
Abstract
Cancers often display immune escape, but the mechanisms are incompletely understood. Herein, we identify SMYD3 as a mediator of immune escape in human papilloma virus (HPV)-negative head and neck squamous cell carcinoma (HNSCC), an aggressive disease with poor response to immunotherapy with pembrolizumab. SMYD3 depletion induces upregulation of multiple type I interferon (IFN) response and antigen presentation machinery genes in HNSCC cells. Mechanistically, SMYD3 binds to and regulates the transcription of UHRF1, encoding for a reader of H3K9me3, which binds to H3K9me3-enriched promoters of key immune-related genes, recruits DNMT1, and silences their expression. SMYD3 further maintains the repression of immune-related genes through intragenic deposition of H4K20me3. In vivo, Smyd3 depletion induces influx of CD8+ T cells and increases sensitivity to anti-programmed death 1 (PD-1) therapy. SMYD3 overexpression is associated with decreased CD8 T cell infiltration and poor response to neoadjuvant pembrolizumab. These data support combining SMYD3 depletion strategies with checkpoint blockade to overcome anti-PD-1 resistance in HPV-negative HNSCC.
Collapse
Affiliation(s)
- Nupur Nigam
- Thoracic and GI Malignancies Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD 20892, USA
| | - Benjamin Bernard
- Thoracic and GI Malignancies Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD 20892, USA
| | - Samantha Sevilla
- Collaborative Bioinformatics Resource, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA; Advanced Biomedical Computational Science, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA
| | - Sohyoung Kim
- Laboratory of Receptor Biology and Gene Expression, NCI, NIH, Bethesda, MD 20892, USA
| | - Mohd Saleem Dar
- Thoracic and GI Malignancies Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD 20892, USA
| | - Daniel Tsai
- Thoracic and GI Malignancies Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD 20892, USA
| | - Yvette Robbins
- Translational Tumor Immunology Program, NIDCD, NIH, Bethesda, MD 20892, USA
| | - Kyunghee Burkitt
- Thoracic and GI Malignancies Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD 20892, USA
| | - Cem Sievers
- Translational Tumor Immunology Program, NIDCD, NIH, Bethesda, MD 20892, USA
| | - Clint T Allen
- Translational Tumor Immunology Program, NIDCD, NIH, Bethesda, MD 20892, USA
| | | | - Theophilus T Tettey
- Laboratory of Receptor Biology and Gene Expression, NCI, NIH, Bethesda, MD 20892, USA
| | - Benjamin Carter
- National Heart, Lung and Blood Institute, NIH, Bethesda, MD 20892, USA
| | - Lorenzo Rinaldi
- Laboratory of Receptor Biology and Gene Expression, NCI, NIH, Bethesda, MD 20892, USA
| | - Mark W Lingen
- University of Chicago, Department of Pathology, Chicago, IL 60637, USA
| | - Houssein Sater
- GU Malignancies Branch, NCI, NIH, Bethesda, MD 20892, USA
| | - Elijah F Edmondson
- Molecular Histopathology Laboratory, Frederick National Laboratory for Cancer Research, NIH, Frederick, MD 21702, USA
| | - Arfa Moshiri
- Thoracic and GI Malignancies Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD 20892, USA
| | - Abbas Saeed
- Thoracic and GI Malignancies Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD 20892, USA
| | - Hui Cheng
- National Institute of Deafness and Other Communication Disorders, NIH, Bethesda, MD 20892, USA
| | - Xiaolin Luo
- Ionis Pharmaceuticals, Carlsbad, CA 92010, USA
| | - Kevin Brennan
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Vishal Koparde
- Collaborative Bioinformatics Resource, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA; Advanced Biomedical Computational Science, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA
| | - Chen Chen
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Sudipto Das
- Protein Characterization Laboratory, Cancer Research Technology Program, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc, Frederick, MD 21702, USA
| | - Thorkell Andresson
- Protein Characterization Laboratory, Cancer Research Technology Program, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc, Frederick, MD 21702, USA
| | - Abdalla Abdelmaksoud
- Collaborative Bioinformatics Resource, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA; Advanced Biomedical Computational Science, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA
| | - Madhavi Murali
- Thoracic and GI Malignancies Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD 20892, USA
| | - Seiji Sakata
- Pathology Project for Molecular Targets, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-0063, Japan; Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-0063, Japan
| | - Kengo Takeuchi
- Pathology Project for Molecular Targets, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-0063, Japan; Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-0063, Japan; Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-0063, Japan
| | - Raj Chari
- Genome Modification Core, Laboratory Animal Sciences Program, Frederick National Lab for Cancer Research, Frederick, MD 21702, USA
| | - Yusuke Nakamura
- Cancer Precision Medicine Center, Japanese Foundation for Cancer Research, Tokyo 135-0063, Japan
| | | | - John B Sunwoo
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Carter Van Waes
- National Institute of Deafness and Other Communication Disorders, NIH, Bethesda, MD 20892, USA
| | | | - Gordon L Hager
- Laboratory of Receptor Biology and Gene Expression, NCI, NIH, Bethesda, MD 20892, USA
| | - Vassiliki Saloura
- Thoracic and GI Malignancies Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD 20892, USA.
| |
Collapse
|
3
|
Wolk R, Lingen MW. Proceedings of the North American Society of Head and Neck Pathology Companion Meeting, New Orleans, LA, March 12, 2023: Oral Cavity Dysplasia: Why Does Histologic Grading Continue to be Contentious? Head Neck Pathol 2023:10.1007/s12105-023-01544-y. [PMID: 37184731 DOI: 10.1007/s12105-023-01544-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/01/2023] [Indexed: 05/16/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the world's 6th most common malignancy. Oral cavity SCC (OCSCC) represents approximately one third of the HNSCC cases diagnosed annually in the United States. Despite therapeutic advances, OCSCC is frequently lethal, with a modest 5-year survival. Because OCSCC is often preceded by premalignant lesions, it is an ideal disease for screening initiatives. The conventional visual and tactile exam (CVTE), coupled with a tissue biopsy, remains the gold standard. However, CVTE alone cannot reliably differentiate between reactive/inflammatory and dysplastic lesions. Further, the histologic diagnosis of dysplasia is subjective in nature and a highly imperfect predictor of malignant transformation. This prognostic uncertainty creates a significant clinical management dilemma-watchful waiting with increased patient psychological and economic burdens versus unnecessary aggressive treatment. As such, the development and validation of novel diagnostic platforms such as Artificial Intelligence (AI) and prognostic molecular biomarkers may help address these critical unmet clinical needs.
Collapse
Affiliation(s)
- Rachelle Wolk
- Department of Pathology, University of Chicago Medicine, 5841 South Maryland Avenue, MC 6101, Chicago, IL, 60637, USA
| | - Mark W Lingen
- Department of Pathology, University of Chicago Medicine, 5841 South Maryland Avenue, MC 6101, Chicago, IL, 60637, USA.
| |
Collapse
|
4
|
Lingen MW. The promise and potential peril of at-home oral cancer testing. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:1-2. [PMID: 36470818 PMCID: PMC9636027 DOI: 10.1016/j.oooo.2022.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022]
|
5
|
Goldberg M, Manzi A, Birdi A, Laporte B, Conway P, Cantin S, Mishra V, Singh A, Pearson AT, Goldberg ER, Goldberger S, Flaum B, Hasina R, London NR, Gallia GL, Bettegowda C, Young S, Sandulache V, Melville J, Shun J, O’Neill SE, Aydin E, Zhavoronkov A, Vidal A, Soto A, Alonso MJ, Rosenberg AJ, Lingen MW, D’Cruz A, Agrawal N, Izumchenko E. Author Correction: A nanoengineered topical transmucosal cisplatin delivery system induces anti-tumor response in animal models and patients with oral cancer. Nat Commun 2022; 13:7865. [PMID: 36543765 PMCID: PMC9772340 DOI: 10.1038/s41467-022-35449-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Manijeh Goldberg
- grid.516087.dDavid H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA USA ,grid.116068.80000 0001 2341 2786Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA USA ,grid.225262.30000 0000 9620 1122Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, MA USA ,grid.430026.3Privo Technologies, Peabody, MA USA
| | - Aaron Manzi
- grid.516087.dDavid H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA USA ,grid.225262.30000 0000 9620 1122Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, MA USA ,grid.430026.3Privo Technologies, Peabody, MA USA
| | | | | | - Peter Conway
- grid.430026.3Privo Technologies, Peabody, MA USA
| | | | - Vasudha Mishra
- grid.170205.10000 0004 1936 7822Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL USA
| | - Alka Singh
- grid.170205.10000 0004 1936 7822Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL USA
| | - Alexander T. Pearson
- grid.170205.10000 0004 1936 7822Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL USA
| | | | | | | | - Rifat Hasina
- grid.170205.10000 0004 1936 7822Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL USA
| | - Nyall R. London
- grid.21107.350000 0001 2171 9311Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA ,grid.21107.350000 0001 2171 9311Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Gary L. Gallia
- grid.21107.350000 0001 2171 9311Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA ,grid.21107.350000 0001 2171 9311Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Chetan Bettegowda
- grid.21107.350000 0001 2171 9311Department of Neurosurgery and Oncology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Simon Young
- grid.267308.80000 0000 9206 2401Department of Oral Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Vlad Sandulache
- grid.39382.330000 0001 2160 926XDepartment of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, TX USA
| | - James Melville
- grid.267308.80000 0000 9206 2401Department of Oral Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Jonathan Shun
- grid.267308.80000 0000 9206 2401Department of Oral Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Sonya E. O’Neill
- grid.116068.80000 0001 2341 2786Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA USA ,grid.416498.60000 0001 0021 3995Massachusetts College of Pharmacy and Health Sciences, Boston, MA USA
| | - Erkin Aydin
- grid.516087.dDavid H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA USA
| | | | - Anxo Vidal
- grid.11794.3a0000000109410645Department of Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela, Galicia, Spain
| | - Atenea Soto
- grid.11794.3a0000000109410645Department of Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela, Galicia, Spain
| | - Maria Jose Alonso
- grid.11794.3a0000000109410645Department of Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela, Galicia, Spain
| | - Ari J. Rosenberg
- grid.170205.10000 0004 1936 7822Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL USA
| | - Mark W. Lingen
- grid.170205.10000 0004 1936 7822Department of Pathology, University of Chicago, Chicago, IL USA
| | - Anil D’Cruz
- Department of Oncology, Apollo Hospital, Mumbai, India
| | - Nishant Agrawal
- grid.170205.10000 0004 1936 7822Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL USA
| | - Evgeny Izumchenko
- grid.170205.10000 0004 1936 7822Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL USA
| |
Collapse
|
6
|
Rosenberg AJ, Agrawal N, Pearson AT, Gooi Z, Blair E, Portugal L, Cursio JF, Juloori A, Chin J, Rouse K, Villaflor VM, Seiwert TY, Izumchenko E, Lingen MW, Haraf DJ, Vokes EE. Phase I study of nab-paclitaxel-based induction followed by nab-paclitaxel-based concurrent chemotherapy and re-irradiation in previously treated head and neck squamous cell carcinoma. Br J Cancer 2022; 127:1497-1506. [PMID: 35945244 PMCID: PMC9553920 DOI: 10.1038/s41416-022-01941-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/19/2022] [Accepted: 07/29/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Recurrent head and neck squamous cell carcinoma (HNSCC) is associated with poor overall survival (OS). Prior studies suggested incorporation of nab-paclitaxel (A) may improve outcomes in recurrent HNSCC. METHODS This Phase I study evaluated induction with carboplatin and A followed by concomitant FHX (infusional 5-fluorouracil, hydroxyurea and twice-daily radiation therapy administered every other week) plus A with cohort dose escalation ranging from 10-100 mg/m2 in recurrent HNSCC. The primary endpoint was maximally tolerated dose (MTD) and dose-limiting toxicity (DLT) of A when given in combination with FHX (AFHX). RESULTS Forty-eight eligible pts started induction; 28 pts started AFHX and were evaluable for toxicity. Two DLTs occurred (both Grade 4 mucositis) at a dose level 20 mg/m2. No further DLTs were observed with subsequent dose escalation. The MTD and recommended Phase II dose (RP2D) of A was 100 mg/m2. CONCLUSIONS In this Phase I study, the RP2D of A with FHX is 100 mg/m2 (AFHX). The role of re-irradiation with immunotherapy warrants further investigation. CLINICAL TRIAL INFORMATION This clinical trial was registered with ClinicalTrials.gov identifier: NCT01847326.
Collapse
Affiliation(s)
- Ari J Rosenberg
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA.
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA.
| | - Nishant Agrawal
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
- Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL, USA
| | - Alexander T Pearson
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
| | - Zhen Gooi
- Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL, USA
| | - Elizabeth Blair
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
- Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL, USA
| | - Louis Portugal
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
- Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL, USA
| | - John F Cursio
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Aditya Juloori
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Jeffrey Chin
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Kathryn Rouse
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | | | - Tanguy Y Seiwert
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Evgeny Izumchenko
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
| | - Mark W Lingen
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Daniel J Haraf
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Everett E Vokes
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
| |
Collapse
|
7
|
Urquhart O, DeLong HR, Ziegler KM, Pilcher L, Pahlke S, Tampi MP, O'Brien KK, Patton LL, Agrawal N, Hofstede TM, Kademani D, Lingen MW, Treister NS, Tsai CJ, Carrasco-Labra A, Lipman RD. Effect of preradiation dental intervention on incidence of osteoradionecrosis in patients with head and neck cancer: A systematic review and meta-analysis. J Am Dent Assoc 2022; 153:931-942.e32. [PMID: 35985883 DOI: 10.1016/j.adaj.2022.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/23/2022] [Accepted: 06/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of this systematic review was to examine whether dental intervention involving bone or soft-tissue manipulation preradiotherapy (pre-RT) is associated with lower rates of osteoradionecrosis of the jaw (ORNJ) in patients with head and neck cancer (HNC). TYPES OF STUDIES REVIEWED The authors included relevant studies from MEDLINE, Embase, and Cochrane Library, including observational studies published from 2007 through 2021 and involving adults who underwent dental intervention pre-RT for HNC. Authors assessed evidence certainty by using the Grading of Recommendations Assessment, Development, and Evaluation approach. Random-effects models were used to calculate pooled relative risk estimates and hazard ratios. When meta-analysis was not possible, study-level measures of association and narrative summaries of the evidence were reported. RESULTS Twenty-two studies were included. From the pooled, unadjusted analysis, patients undergoing pre-RT extractions may have a 55% increased risk of experiencing ORNJ (relative risk, 1.55; 95% CI, 0.85 to 2.86; very low certainty); the unadjusted pooled hazard ratio was 3.19 (95% CI, 0.99 to 10.31; very low certainty), corresponding to a possible increased hazard of developing ORNJ (very low certainty). Findings for other pre-RT procedures manipulating bone or tissue relied on limited, observational studies with low or very low certainty evidence. CONCLUSIONS Mostly very low certainty evidence suggests that patients with HNC who need pre-RT dental intervention may have an increased risk of developing ORNJ compared with those who do not. PRACTICAL IMPLICATIONS Maintaining optimal oral health may help reduce the need for urgent pre-RT dental treatment, potentially reducing ORNJ risk and minimizing delay of oncologic treatment in patients with HNC.
Collapse
|
8
|
Goldberg M, Manzi A, Birdi A, Laporte B, Conway P, Cantin S, Mishra V, Singh A, Pearson AT, Goldberg ER, Goldberger S, Flaum B, Hasina R, London NR, Gallia GL, Bettegowda C, Young S, Sandulache V, Melville J, Shum J, O'Neill SE, Aydin E, Zhavoronkov A, Vidal A, Soto A, Alonso MJ, Rosenberg AJ, Lingen MW, D'Cruz A, Agrawal N, Izumchenko E. A nanoengineered topical transmucosal cisplatin delivery system induces anti-tumor response in animal models and patients with oral cancer. Nat Commun 2022; 13:4829. [PMID: 35977936 PMCID: PMC9385702 DOI: 10.1038/s41467-022-31859-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 02/05/2022] [Accepted: 07/06/2022] [Indexed: 12/25/2022] Open
Abstract
Despite therapeutic advancements, oral cavity squamous cell carcinoma (OCSCC) remains a difficult disease to treat. Systemic platinum-based chemotherapy often leads to dose-limiting toxicity (DLT), affecting quality of life. PRV111 is a nanotechnology-based system for local delivery of cisplatin loaded chitosan particles, that penetrate tumor tissue and lymphatic channels while avoiding systemic circulation and toxicity. Here we evaluate PRV111 using animal models of oral cancer, followed by a clinical trial in patients with OCSCC. In vivo, PRV111 results in elevated cisplatin retention in tumors and negligible systemic levels, compared to the intravenous, intraperitoneal or intratumoral delivery. Furthermore, PRV111 produces robust anti-tumor responses in subcutaneous and orthotopic cancer models and results in complete regression of carcinogen-induced premalignant lesions. In a phase 1/2, open-label, single-arm trial (NCT03502148), primary endpoints of efficacy (≥30% tumor volume reduction) and safety (incidence of DLTs) of neoadjuvant PRV111 were reached, with 69% tumor reduction in ~7 days and over 87% response rate. Secondary endpoints (cisplatin biodistribution, loco-regional control, and technical success) were achieved. No DLTs or drug-related serious adverse events were reported. No locoregional recurrences were evident in 6 months. Integration of PRV111 with current standard of care may improve health outcomes and survival of patients with OCSCC.
Collapse
Affiliation(s)
- Manijeh Goldberg
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, MA, USA.
- Privo Technologies, Peabody, MA, USA.
| | - Aaron Manzi
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, MA, USA
- Privo Technologies, Peabody, MA, USA
| | | | | | | | | | - Vasudha Mishra
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Alka Singh
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Alexander T Pearson
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | | | | | | | - Rifat Hasina
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL, USA
| | - Nyall R London
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gary L Gallia
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chetan Bettegowda
- Department of Neurosurgery and Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Simon Young
- Department of Oral Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Vlad Sandulache
- Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - James Melville
- Department of Oral Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jonathan Shum
- Department of Oral Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sonya E O'Neill
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
- Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
| | - Erkin Aydin
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Anxo Vidal
- Department of Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela, Galicia, Spain
| | - Atenea Soto
- Department of Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela, Galicia, Spain
| | - Maria Jose Alonso
- Department of Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela, Galicia, Spain
| | - Ari J Rosenberg
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Mark W Lingen
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Anil D'Cruz
- Department of Oncology, Apollo Hospital, Mumbai, India
| | - Nishant Agrawal
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL, USA.
| | - Evgeny Izumchenko
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA.
| |
Collapse
|
9
|
Mishra V, Singh A, Chen X, Rosenberg AJ, Pearson AT, Zhavoronkov A, Savage PA, Lingen MW, Agrawal N, Izumchenko E. Application of liquid biopsy as multi-functional biomarkers in head and neck cancer. Br J Cancer 2022; 126:361-370. [PMID: 34876674 PMCID: PMC8810877 DOI: 10.1038/s41416-021-01626-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/25/2021] [Accepted: 11/01/2021] [Indexed: 02/06/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is a molecularly heterogeneous disease, with a 5-year survival rate that still hovers at ~60% despite recent advancements. The advanced stage upon diagnosis, limited success with effective targeted therapy and lack of reliable biomarkers are among the key factors underlying the marginally improved survival rates over the decades. Prevention, early detection and biomarker-driven treatment adaptation are crucial for timely interventions and improved clinical outcomes. Liquid biopsy, analysis of tumour-specific biomarkers circulating in bodily fluids, is a rapidly evolving field that may play a striking role in optimising patient care. In recent years, significant progress has been made towards advancing liquid biopsies for non-invasive early cancer detection, prognosis, treatment adaptation, monitoring of residual disease and surveillance of recurrence. While these emerging technologies have immense potential to improve patient survival, numerous methodological and biological limitations must be overcome before their implementation into clinical practice. This review outlines the current state of knowledge on various types of liquid biopsies in HNSCC, and their potential applications for diagnosis, prognosis, grading treatment response and post-treatment surveillance. It also discusses challenges associated with the clinical applicability of liquid biopsies and prospects of the optimised approaches in the management of HNSCC.
Collapse
Affiliation(s)
- Vasudha Mishra
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Alka Singh
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Xiangying Chen
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Ari J Rosenberg
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Alexander T Pearson
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | | | - Peter A Savage
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Mark W Lingen
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Nishant Agrawal
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL, USA.
| | - Evgeny Izumchenko
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA.
| |
Collapse
|
10
|
Walsh T, Warnakulasuriya S, Lingen MW, Kerr AR, Ogden GR, Glenny AM, Macey R. Clinical assessment for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy adults. Cochrane Database Syst Rev 2021; 12:CD010173. [PMID: 34891214 PMCID: PMC8664456 DOI: 10.1002/14651858.cd010173.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The early detection of oral cavity squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD), followed by appropriate treatment, may improve survival and reduce the risk for malignant transformation respectively. This is an update of a Cochrane Review first published in 2013. OBJECTIVES To estimate the diagnostic test accuracy of conventional oral examination, vital rinsing, light-based detection, mouth self-examination, remote screening, and biomarkers, used singly or in combination, for the early detection of OPMD or OSCC in apparently healthy adults. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 20 October 2020), MEDLINE Ovid (1946 to 20 October 2020), and Embase Ovid (1980 to 20 October 2020). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. We conducted citation searches, and screened reference lists of included studies for additional references. SELECTION CRITERIA We selected studies that reported the test accuracy of any of the aforementioned tests in detecting OPMD or OSCC during a screening procedure. Diagnosis of OPMD or OSCC was provided by specialist clinicians or pathologists, or alternatively through follow-up. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts for relevance. Eligibility, data extraction, and quality assessment were carried out by at least two authors independently and in duplicate. Studies were assessed for methodological quality using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). We reported the sensitivity and specificity of the included studies. We provided judgement of the certainty of the evidence using a GRADE assessment. MAIN RESULTS We included 18 studies, recruiting 72,202 participants, published between 1986 and 2019. These studies evaluated the diagnostic test accuracy of conventional oral examination (10 studies, none new to this update), mouth self-examination (four studies, two new to this update), and remote screening (three studies, all new to this update). One randomised controlled trial of test accuracy directly evaluated conventional oral examination plus vital rinsing versus conventional oral examination alone. There were no eligible studies evaluating light-based detection or blood or salivary sample analysis (which tests for the presence of biomarkers for OPMD and OSCC). Only one study of conventional oral examination was judged as at overall low risk of bias and overall low concern regarding applicability. Given the clinical heterogeneity of the included studies in terms of the participants recruited, setting, prevalence of the target condition, the application of the index test and reference standard, and the flow and timing of the process, the data could not be pooled within the broader categories of index test. For conventional oral examination (10 studies, 25,568 participants), prevalence in the test accuracy sample ranged from 1% to 51%. For the seven studies with prevalence of 10% or lower, a prevalence more comparable to the general population, the sensitivity estimates were variable, and ranged from 0.50 (95% confidence interval (CI) 0.07 to 0.93) to 0.99 (95% CI 0.97 to 1.00); the specificity estimates were more consistent and ranged from 0.94 (95% CI 0.88 to 0.97) to 0.99 (95% CI 0.98 to 1.00). We judged the overall certainty of the evidence to be low, and downgraded for inconsistency and indirectness. Evidence for mouth self-examination and remote screening was more limited. We judged the overall certainty of the evidence for these index tests to be very low, and downgraded for imprecision, inconsistency, and indirectness. We judged the evidence for vital rinsing (toluidine blue) as an adjunct to conventional oral examination compared to conventional oral examination to be moderate, and downgraded for indirectness as the trial was undertaken in a high-risk population. AUTHORS' CONCLUSIONS There is a lack of high-certainty evidence to support the use of screening programmes for oral cavity cancer and OPMD in the general population. Frontline screeners such as general dentists, dental hygienists, other allied professionals, and community healthcare workers should remain vigilant for signs of OPMD and OSCC.
Collapse
Affiliation(s)
- Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Mark W Lingen
- Pritzker School of Medicine, Division of Biological Sciences, Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Alexander R Kerr
- Department of Oral and Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry, New York, USA
| | - Graham R Ogden
- Division of Oral and Maxillofacial Clinical Sciences, School of Dentistry, University of Dundee, Dundee, UK
| | - Anne-Marie Glenny
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Richard Macey
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| |
Collapse
|
11
|
Lingen MW, Kalmar JR. Why Doesn't Medicare Treat All Diagnostic Tests Equally? Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:1-2. [PMID: 34824030 DOI: 10.1016/j.oooo.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
|
12
|
Chao JL, Korzinkin M, Zhavoronkov A, Ozerov IV, Walker MT, Higgins K, Lingen MW, Izumchenko E, Savage PA. Effector T cell responses unleashed by regulatory T cell ablation exacerbate oral squamous cell carcinoma. Cell Rep Med 2021; 2:100399. [PMID: 34622236 PMCID: PMC8484691 DOI: 10.1016/j.xcrm.2021.100399] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 02/15/2021] [Revised: 07/08/2021] [Accepted: 08/23/2021] [Indexed: 12/16/2022]
Abstract
Immune suppression by CD4+FOXP3+ regulatory T (Treg) cells and tumor infiltration by CD8+ effector T cells represent two major factors impacting response to cancer immunotherapy. Using deconvolution-based transcriptional profiling of human papilloma virus (HPV)-negative oral squamous cell carcinomas (OSCCs) and other solid cancers, we demonstrate that the density of Treg cells does not correlate with that of CD8+ T cells in many tumors, revealing polarized clusters enriched for either CD8+ T cells or CD4+ Treg and conventional T cells. In a mouse model of carcinogen-induced OSCC characterized by CD4+ T cell enrichment, late-stage Treg cell ablation triggers increased densities of both CD4+ and CD8+ effector T cells within oral lesions. Notably, this intervention does not induce tumor regression but instead induces rapid emergence of invasive OSCCs via an effector T cell-dependent process. Thus, induction of a T cell-inflamed phenotype via therapeutic manipulation of Treg cells may trigger unexpected tumor-promoting effects in OSCC.
Collapse
Affiliation(s)
- Jaime L. Chao
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA
| | | | | | - Ivan V. Ozerov
- Insilico Medicine Hong Kong, Ltd., Pak Shek Kok, Hong Kong
| | - Matthew T. Walker
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA
| | - Kathleen Higgins
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA
| | - Mark W. Lingen
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA
| | - Evgeny Izumchenko
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Peter A. Savage
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA
| |
Collapse
|
13
|
Walsh T, Macey R, Kerr AR, Lingen MW, Ogden GR, Warnakulasuriya S. Diagnostic tests for oral cancer and potentially malignant disorders in patients presenting with clinically evident lesions. Cochrane Database Syst Rev 2021; 7:CD010276. [PMID: 34282854 PMCID: PMC8407012 DOI: 10.1002/14651858.cd010276.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/24/2022]
Abstract
BACKGROUND Squamous cell carcinoma is the most common form of malignancy of the oral cavity, and is often proceeded by oral potentially malignant disorders (OPMD). Early detection of oral cavity squamous cell carcinoma (oral cancer) can improve survival rates. The current diagnostic standard of surgical biopsy with histology is painful for patients and involves a delay in order to process the tissue and render a histological diagnosis; other diagnostic tests are available that are less invasive and some are able to provide immediate results. This is an update of a Cochrane Review first published in 2015. OBJECTIVES Primary objective: to estimate the diagnostic accuracy of index tests for the detection of oral cancer and OPMD, in people presenting with clinically evident suspicious and innocuous lesions. SECONDARY OBJECTIVE to estimate the relative accuracy of the different index tests. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: MEDLINE Ovid (1946 to 20 October 2020), and Embase Ovid (1980 to 20 October 2020). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were also searched for ongoing trials to 20 October 2020. No restrictions were placed on the language or date of publication when searching the electronic databases. We conducted citation searches, and screened reference lists of included studies for additional references. SELECTION CRITERIA We selected studies that reported the diagnostic test accuracy of the following index tests when used as an adjunct to conventional oral examination in detecting OPMD or oral cavity squamous cell carcinoma: vital staining (a dye to stain oral mucosa tissues), oral cytology, light-based detection and oral spectroscopy, blood or saliva analysis (which test for the presence of biomarkers in blood or saliva). DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts for relevance. Eligibility, data extraction and quality assessment were carried out by at least two authors, independently and in duplicate. Studies were assessed for methodological quality using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Meta-analysis was used to combine the results of studies for each index test using the bivariate approach to estimate the expected values of sensitivity and specificity. MAIN RESULTS This update included 63 studies (79 datasets) published between 1980 and 2020 evaluating 7942 lesions for the quantitative meta-analysis. These studies evaluated the diagnostic accuracy of conventional oral examination with: vital staining (22 datasets), oral cytology (24 datasets), light-based detection or oral spectroscopy (24 datasets). Nine datasets assessed two combined index tests. There were no eligible diagnostic accuracy studies evaluating blood or salivary sample analysis. Two studies were classed as being at low risk of bias across all domains, and 33 studies were at low concern for applicability across the three domains, where patient selection, the index test, and the reference standard used were generalisable across the population attending secondary care. The summary estimates obtained from the meta-analysis were: - vital staining: sensitivity 0.86 (95% confidence interval (CI) 0.79 to 0.90) specificity 0.68 (95% CI 0.58 to 0.77), 20 studies, sensitivity low-certainty evidence, specificity very low-certainty evidence; - oral cytology: sensitivity 0.90 (95% CI 0.82 to 0.94) specificity 0.94 (95% CI 0.88 to 0.97), 20 studies, sensitivity moderate-certainty evidence, specificity moderate-certainty evidence; - light-based: sensitivity 0.87 (95% CI 0.78 to 0.93) specificity 0.50 (95% CI 0.32 to 0.68), 23 studies, sensitivity low-certainty evidence, specificity very low-certainty evidence; and - combined tests: sensitivity 0.78 (95% CI 0.45 to 0.94) specificity 0.71 (95% CI 0.53 to 0.84), 9 studies, sensitivity very low-certainty evidence, specificity very low-certainty evidence. AUTHORS' CONCLUSIONS At present none of the adjunctive tests can be recommended as a replacement for the currently used standard of a surgical biopsy and histological assessment. Given the relatively high values of the summary estimates of sensitivity and specificity for oral cytology, this would appear to offer the most potential. Combined adjunctive tests involving cytology warrant further investigation. Potentially eligible studies of blood and salivary biomarkers were excluded from the review as they were of a case-control design and therefore ineligible. In the absence of substantial improvement in the tests evaluated in this updated review, further research into biomarkers may be warranted.
Collapse
Affiliation(s)
- Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Richard Macey
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Alexander R Kerr
- Department of Oral and Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry, New York, USA
| | - Mark W Lingen
- Pritzker School of Medicine, Division of Biological Sciences, Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Graham R Ogden
- Division of Oral and Maxillofacial Clinical Sciences, School of Dentistry, University of Dundee, Dundee, UK
| | | |
Collapse
|
14
|
Lingen MW. The journal welcomes new OMS section editor. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:1. [PMID: 34020917 DOI: 10.1016/j.oooo.2021.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 11/18/2022]
|
15
|
Shanmugam A, Hariharan AK, Hasina R, Nair JR, Katragadda S, Irusappan S, Ravichandran A, Veeramachaneni V, Bettadapura R, Bhati M, Ramaswamy V, Rao VUS, Bagadia RK, Manjunath A, NML M, Solomon MC, Maji S, Bahadur U, Bettegowda C, Papadopoulos N, Lingen MW, Hariharan R, Gupta V, Agrawal N, Izumchenko E. Ultrasensitive detection of tumor-specific mutations in saliva of patients with oral cavity squamous cell carcinoma. Cancer 2021; 127:1576-1589. [PMID: 33405231 PMCID: PMC8084899 DOI: 10.1002/cncr.33393] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/16/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Oral cavity squamous cell carcinoma (OCSCC) is the most common head and neck malignancy. Although the survival rate of patients with advanced-stage disease remains approximately 20% to 60%, when detected at an early stage, the survival rate approaches 80%, posing a pressing need for a well validated profiling method to assess patients who have a high risk of developing OCSCC. Tumor DNA detection in saliva may provide a robust biomarker platform that overcomes the limitations of current diagnostic tests. However, there is no routine saliva-based screening method for patients with OCSCC. METHODS The authors designed a custom next-generation sequencing panel with unique molecular identifiers that covers coding regions of 7 frequently mutated genes in OCSCC and applied it on DNA extracted from 121 treatment-naive OCSCC tumors and matched preoperative saliva specimens. RESULTS By using stringent variant-calling criteria, mutations were detected in 106 tumors, consistent with a predicted detection rate ≥88%. Moreover, mutations identified in primary malignancies were also detected in 93% of saliva samples. To ensure that variants are not errors resulting in false-positive calls, a multistep analytical validation of this approach was performed: 1) re-sequencing of 46 saliva samples confirmed 88% of somatic variants; 2) no functionally relevant mutations were detected in saliva samples from 11 healthy individuals without a history of tobacco or alcohol; and 3) using a panel of 7 synthetic loci across 8 sequencing runs, it was confirmed that the platform developed is reproducible and provides sensitivity on par with droplet digital polymerase chain reaction. CONCLUSIONS The current data highlight the feasibility of somatic mutation identification in driver genes in saliva collected at the time of OCSCC diagnosis.
Collapse
Affiliation(s)
| | | | - Rifat Hasina
- University of Chicago, Section of Otolaryngology-Head and Neck Surgery, Chicago, USA
| | | | | | | | | | | | | | | | | | - Vishal US Rao
- HealthCare Global (HCG) Cancer Centre, Bangalore, India
| | | | | | - Manjunath NML
- HealthCare Global (HCG) Cancer Centre, Bangalore, India
| | | | | | | | - Chetan Bettegowda
- Ludwig Center for Cancer Genetics and Therapeutics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Nickolas Papadopoulos
- Ludwig Center for Cancer Genetics and Therapeutics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Mark W. Lingen
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | | | | | - Nishant Agrawal
- University of Chicago, Section of Otolaryngology-Head and Neck Surgery, Chicago, USA
| | - Evgeny Izumchenko
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| |
Collapse
|
16
|
Chaturvedi AK, Udaltsova N, Engels EA, Katzel JA, Yanik EL, Katki HA, Lingen MW, Silverberg MJ. Oral Leukoplakia and Risk of Progression to Oral Cancer: A Population-Based Cohort Study. J Natl Cancer Inst 2021; 112:1047-1054. [PMID: 31860085 DOI: 10.1093/jnci/djz238] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/18/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The optimal clinical management of oral precancer remains uncertain. We investigated the natural history of oral leukoplakia, the most common oral precancerous lesion, to estimate the relative and absolute risks of progression to cancer, the predictive accuracy of a clinician's decision to biopsy a leukoplakia vis-à-vis progression, and histopathologic predictors of progression. METHODS We conducted a retrospective cohort study (1996-2012) of patients with oral leukoplakia (n = 4886), identified using electronic medical records within Kaiser Permanente Northern California. Among patients with leukoplakia who received a biopsy (n = 1888), we conducted a case-cohort study to investigate histopathologic predictors of progression. Analyses included indirect standardization and unweighted or weighted Cox regression. RESULTS Compared with the overall Kaiser Permanente Northern California population, oral cancer incidence was substantially elevated in oral leukoplakia patients (standardized incidence ratio = 40.8, 95% confidence interval [CI] = 34.8 to 47.6; n = 161 cancers over 22 582 person-years). Biopsied leukoplakias had a higher oral cancer risk compared with those that were not biopsied (adjusted hazard ratio = 2.38, 95% CI = 1.73 to 3.28). However, to identify a prevalent or incident oral cancer, the biopsy decision had low sensitivity (59.6%), low specificity (62.1%), and moderate positive-predictive value (5.1%). Risk of progression to oral cancer statistically significantly increased with the grade of dysplasia; 5-year competing risk-adjusted absolute risks were: leukoplakia overall = 3.3%, 95% CI = 2.7% to 3.9%; no dysplasia = 2.2%, 95% CI = 1.5% to 3.1%; mild-dysplasia = 11.9%, 95% CI = 7.1% to 18.1%; moderate-dysplasia = 8.7%, 95% CI = 3.2% to 17.9%; and severe dysplasia = 32.2%, 95% CI = 8.1%-60.0%. Yet 39.6% of cancers arose from biopsied leukoplakias without dysplasia. CONCLUSIONS The modest accuracy of the decision to biopsy a leukoplakia vis-à-vis presence or eventual development of oral cancer highlights the need for routine biopsy of all leukoplakias regardless of visual or clinical impression. Leukoplakia patients, particularly those with dysplasia, need to be closely monitored for signs of early cancer.
Collapse
Affiliation(s)
- Anil K Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | | | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Jed A Katzel
- Department of Oncology, Kaiser Permanente, San Francisco, CA, USA
| | | | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Mark W Lingen
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | | |
Collapse
|
17
|
Chaturvedi AK, Udaltsova N, Engels EA, Katzel JA, Yanik EL, Katki HA, Lingen MW, Silverberg MJ. Response to Brandt, Bednarz-Knoll, Kleinheinz et al. J Natl Cancer Inst 2021; 112:970-971. [PMID: 32483585 DOI: 10.1093/jnci/djaa075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anil K Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | | | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Jed A Katzel
- Department of Oncology, Kaiser Permanente, San Francisco, CA, USA
| | | | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Mark W Lingen
- Department of Pathology, University of Chicago, IL, USA
| | | |
Collapse
|
18
|
Thompson LDR, Fitzpatrick SG, Müller S, Eisenberg E, Upadhyaya JD, Lingen MW, Vigneswaran N, Woo SB, Bhattacharyya I, Bilodeau EA, Carlos R, Islam MN, Leon ME, Lewis JS, Magliocca KR, Mani H, Mehrad M, Purgina B, Richardson M, Wenig BM, Cohen DM. Proliferative Verrucous Leukoplakia: An Expert Consensus Guideline for Standardized Assessment and Reporting. Head Neck Pathol 2021; 15:572-587. [PMID: 33415517 PMCID: PMC8134585 DOI: 10.1007/s12105-020-01262-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/26/2020] [Indexed: 12/12/2022]
Abstract
The many diverse terms used to describe the wide spectrum of changes seen in proliferative verrucous leukoplakia (PVL) have resulted in disparate clinical management. The objective of this study was to produce an expert consensus guideline for standardized assessment and reporting by pathologists diagnosing PVL related lesions. 299 biopsies from 84 PVL patients from six institutions were selected from patients who had multifocal oral leukoplakic lesions identified over several years (a minimum follow-up period of 36 months). The lesions demonstrated the spectrum of histologic features described in PVL, and in some cases, patients developed oral cavity squamous cell carcinoma (SCC). An expert working group of oral and maxillofacial and head and neck pathologists reviewed microscopic features in a rigorous fashion, in combination with review of clinical photographs when available. The working group then selected 43 single slide biopsy cases for whole slide digital imaging (WSI) review by members of the consensus conference. The digital images were then reviewed in two surveys separated by a washout period of at least 90 days. Five non-PVL histologic mimics were included as controls. Cases were re-evaluated during a consensus conference with 19 members reporting on the cases. The best inter-observer diagnostic agreement relative to PVL lesions were classified as "corrugated ortho(para)hyperkeratotic lesion, not reactive" and "SCC" (chi-square p = 0.015). There was less than moderate agreement (kappa < 0.60) for lesions in the "Bulky hyperkeratotic epithelial proliferation, not reactive" category. There was ≥ moderate agreement (> 0.41 kappa) for 35 of 48 cases. This expert consensus guideline has been developed with support and endorsement from the leadership of the American Academy of Oral and Maxillofacial Pathology and the North American Society of Head and Neck Pathologists to recommend the use of standardized histopathologic criteria and descriptive terminology to indicate three categories of lesions within PVL: (1) "corrugated ortho(para)hyperkeratotic lesion, not reactive;" (2) "bulky hyperkeratotic epithelial proliferation, not reactive;" and (3) "suspicious for," or "squamous cell carcinoma." Classification of PVL lesions based on a combination of clinical findings and these histologic descriptive categories is encouraged in order to standardize reporting, aid in future research and potentially guide clinical management.
Collapse
Affiliation(s)
- Lester D. R. Thompson
- Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, 5601 De Soto Avenue Woodland Hills, CA 91364 Woodland Hills, USA
| | - Sarah G. Fitzpatrick
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL USA
| | - Susan Müller
- Atlanta Oral Pathology, Emory University School of Medicine, Decatur, GA USA
| | - Ellen Eisenberg
- Oral Health and Diagnostic Sciences, University of Connecticut Health, Farmington, CT USA
| | - Jasbir D. Upadhyaya
- Section of Diagnostic Sciences, Department of Applied Dental Medicine, Southern Illinois University School of Dental Medicine, Alton, IL USA
| | - Mark W. Lingen
- Department of Pathology, University of Chicago Medicine, Chicago, IL USA
| | - Nadarajah Vigneswaran
- Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry at Houston, Houston, TX USA
| | - Sook-Bin Woo
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA USA
| | - Indraneel Bhattacharyya
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL USA
| | - Elizabeth A. Bilodeau
- Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA USA
| | - Roman Carlos
- Centro Clínico de Cabeza y Cuello, Patología División, Guatemala City, Guatemala
| | - Mohammed N. Islam
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL USA
| | - Marino E. Leon
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL USA
| | - James S. Lewis
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Kelly R. Magliocca
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - Haresh Mani
- Department of Pathology, Inova Fairfax Hospital, Falls Church, VA USA
| | - Mitra Mehrad
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Bibianna Purgina
- Department of Pathology, University of Ottawa, Ottawa, Ontario Canada
| | - Mary Richardson
- Department of Pathology, MUSC Health-University Medical Center, Charleston, SC USA
| | - Bruce M. Wenig
- Department of Pathology, Moffitt Cancer Center, Tampa, FL USA
| | - Donald M. Cohen
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL USA
| |
Collapse
|
19
|
Schulte JJ, Steinmetz J, Furtado LV, Husain AN, Lingen MW, Cipriani NA. Metastatic HPV-Associated Oropharyngeal Versus Primary Pulmonary Squamous Cell Carcinoma: is p16 Immunostain Useful? Head Neck Pathol 2020; 14:966-973. [PMID: 32350806 PMCID: PMC7669977 DOI: 10.1007/s12105-020-01165-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 04/22/2020] [Indexed: 12/24/2022]
Abstract
The lungs are a common site of metastasis of head and neck (H&N) squamous cell carcinomas (SCC). This study attempts to define p16 immunoexpression and presence of HPV in primary SCC of the lung and determine their usefulness in discriminating between primary lung SCC and metastasis from HPV-associated oropharyngeal primary. Pathology archives were searched for patients with SCC of the lung without SCC elsewhere. Tissue microarray was constructed and immunohistochemistry performed using anti-p40 and anti-p16 antibodies. All cases were tested for HPV viral proteins E6/E7 by RNA in situ hybridization (ISH) and available positive cases for HPV DNA by polymerase chain reaction (PCR). Eight of 25 (32%) showed cytoplasmic and nuclear expression of p16: 2 (8%) strong and 2 (8%) moderate in > 70% of tumor cells; 1 (4%) strong, 1 (4%) moderate, and 1 (4%) weak in 50-70% of tumor cells; 1 (4%) weak in < 50% of tumor cells. E6/E7 mRNA ISH was negative in all cases. Seven of 8 (87.5%) p16-expressing cases were available for testing by HPV PCR; all were negative for HPV DNA. A retrospective control group of 12 patients with possible SCC metastatic to lung was also identified; high-risk HPV DNA was present in 3, confirming metastasis. p16 expression in lung SCC is not uncommon and may not discriminate between primary pulmonary SCC and metastasis from HPV-associated oropharyngeal primary. Confirmatory HPV testing (high risk HPV DNA or E6/E7 mRNA) is recommended to differentiate metastasis from oropharyngeal primary from two separate primaries.
Collapse
Affiliation(s)
- Jefree J Schulte
- Department of Pathology, The University of Chicago, 5841 S. Maryland Ave , Chicago, IL, 60637, USA.
| | - Jamie Steinmetz
- OSF Little Company of Mary Medical Center, Evergreen Park, IL, USA
| | - Larissa V Furtado
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Aliya N Husain
- Department of Pathology, The University of Chicago, 5841 S. Maryland Ave , Chicago, IL, 60637, USA
| | - Mark W Lingen
- Department of Pathology, The University of Chicago, 5841 S. Maryland Ave , Chicago, IL, 60637, USA
| | - Nicole A Cipriani
- Department of Pathology, The University of Chicago, 5841 S. Maryland Ave , Chicago, IL, 60637, USA
| |
Collapse
|
20
|
Lingen MW. Making oral pathology lemonade from COVID-19 lemons. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:1-2. [PMID: 33229288 DOI: 10.1016/j.oooo.2020.10.019] [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] [Received: 10/23/2020] [Accepted: 10/23/2020] [Indexed: 11/25/2022]
|
21
|
Rosenberg A, Agrawal N, Pearson AT, Seiwert TY, Gooi Z, Blair EA, Cursio J, Howard A, Chin J, Foster CC, Kochanny S, Lingen MW, Haraf DJ, Vokes EE. Dose and volume de-escalation for HPV-associated oropharyngeal cancer: Long-term follow-up of the OPTIMA trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6575 Background: Human papilloma virus (HPV) associated oropharyngeal cancer is associated with a favorable prognosis, but standard multimodality treatment is associated with substantial treatment related toxicity. A de-escalation treatment paradigm that optimizes oncologic outcomes while reducing toxicity is needed. We sought to further expound on our published OPTIMA data with long-term follow-up and additional pts subsequently treated using the OPTIMA treatment paradigm. Methods: Long-term follow-up of our institutional de-escalation OPTIMA trial (NCT02258659) and retrospective review of additional patients treated subsequently per OPTIMA outline was performed. Pts were classified as low-risk (LR) (≤T3, ≤N2B, ≤10PYH) or high-risk (HR) (T4, ≥N2c, > 10PYH). Pts received induction chemotherapy (IC) of 3 cycles of dose dense carboplatin and nab-paclitaxel (OPTIMA) or paclitaxel (subsequently treated). LR with ≥50% response received low-dose radiotherapy (RT) to 50 Gy. LR with 30-50% response or HR with ≥50% response received intermediate-dose chemoradiotherapy (CRT) to 45Gy. All others received full-dose CRT to 75Gy. Results: 108 pts consented and 107 were treated (61 on study; 46 subsequently) from October 2014 through November 2019. 1 pt transferred care post-enrollment. Median follow-up was 36 months (interquartile range 17-45). Median age was 63 years (range 33-84) and 95% were male. 47% were LR and 53% were HR. ≥50% tumor shrinkage occurred in 78/107 (73%) of pts overall, and 37/51 (73%) among LR; 41/56 (73%) among HR. 82% of pts received de-escalated (C)RT. Overall, 94% of pts were alive at last follow-up (98% LR; 89% HR). 3 pts (2 HR and 1 LR) developed disease recurrence (2.7%), with 2 local recurrences and 1 distant recurrence. Likelihood of G-tube placement was 3% in low-dose RT, 35% in intermediate-dose CRT, and 84% in full-dose CRT. Conclusions: IC followed by risk-adapted dose and volume de-escalated treatment for HPV+ oropharyngeal cancer demonstrates excellent oncologic and functional outcomes with long-term follow-up. Supported by Celgene, Alinea benefit supported by Grant Achatz/Nick Kokonas, and National Cancer Institute of the National Institutes of Health (NIH) through Grant Number P30 CA14599. Clinical trial information: NCT02258659 .
Collapse
Affiliation(s)
| | | | - Alexander T. Pearson
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | | | | | | | | | - Adam Howard
- University of Chicago Medical Center, Chicago, IL
| | | | - Corey Christian Foster
- Department of Radiation & Cellular Oncology, The University of Chicago Medicine, Chicago, IL
| | - Sara Kochanny
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Mark W. Lingen
- The University of Chicago Medicine and Biological Sciences, Chicago, IL
| | | | - Everett E. Vokes
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| |
Collapse
|
22
|
Izumchenko E, Hasina R, Hariharan AK, Shanmugam A, Irusappan S, Maji S, Bahadur U, Veeramachaneni V, Bettadapura R, Ravichandran A, Hariharan R, Gupta V, Rao VUS, Bagadia RK, N.M.L M, Lingen MW, Agrawal N. Detection of somatic mutations in saliva of patients with oral cavity squamous cell carcinoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6562 Background: Oral cavity squamous cell carcinoma (OCSCC) frequently presents as clinically advanced disease with poor prognosis. When diagnosed at early stages, survival rates approach 80%, underscoring the need for validated, cost-effective detection methods. OCSCC is driven by the serial acquisition of genetic alterations. Tumor-defining somatic mutations are attractive biomarkers and hence their presence in saliva may be associated with malignancy as shown in a few proof-of-concept studies, including our previous work. Based on this premise, we present a low-cost, accurate, next generation sequencing (NGS) test with high clinical utility aimed at detecting mutations in the saliva for early diagnosis and potential screening of OCSCC. Methods: We have designed a custom NGS panel that covers exons of 7 most frequently mutated genes in OSCC. This minimal gene set derived from the analysis from 3 public datasets, predicted incidence of at least one somatic aberration in 89% of patients. We recruited 91 treatment-naïve OCSCC patients and profiled DNA from tissue and matched pre-operative saliva using this test. We also tested DNA from 12 subjects with premalignant lesions with high-grade oral dysplasia and matched saliva. Results: Using stringent variant calling criteria, at least one somatic variant was detected in 88 (96%) of the 91 primary tumors. 90.9% of the matched saliva were concordant, with only a minor decrease in early stage disease. Tumor-specific mutations (≥5% AF) in driver genes were detected in 10 (83.3%) dysplastic lesions, suggesting that driving clonal events may occur early in disease development. Interestingly, in 3 matched saliva of the dysplastic samples, the same mutations were detected. To ensure a variant is not a false positive call, we performed a vigorous multistep analytical validation of this saliva-based test: (i) independent re-sequencing of 24 saliva confirmed 94% reproducibility; (ii) no functionally relevant variants were detected in saliva from 12 of 13 healthy subjects without history of tobacco and alcohol usage; (iii) reproducibility, sensitivity, and specificity were confirmed using a positive control with 7 loci at 0.25% AF across 8 independent saliva sequencing runs and a certified negative control and was found to be on par with droplet digital PCR. Conclusions: These data highlight the feasibility of saliva-based testing for early diagnosis of OCSCC and premalignant lesions.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Urvashi Bahadur
- Strand Center for Genomics and Personalized Medicine, Bangalore, India
| | - Vamsi Veeramachaneni
- Strand Center for Genomics and Personalized Medicine, Strand Life Sciences, Bangalore, India
| | | | | | - Ramesh Hariharan
- Strand Center for Genomics and Personalized Medicine, Strand Life Sciences, Bangalore, India
| | - Vaijayanti Gupta
- Strand Center for Genomics and Personalized Medicine, Bangalore, India
| | | | | | | | - Mark W. Lingen
- The University of Chicago Medicine and Biological Sciences, Chicago, IL
| | | |
Collapse
|
23
|
Lingen MW. We have a “ring around the collar” problem. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:1-2. [DOI: 10.1016/j.oooo.2019.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 10/25/2019] [Indexed: 11/16/2022]
|
24
|
Seiwert TY, Foster CC, Blair EA, Karrison TG, Agrawal N, Melotek JM, Portugal L, Brisson RJ, Dekker A, Kochanny S, Gooi Z, Lingen MW, Villaflor VM, Ginat DT, Haraf DJ, Vokes EE. OPTIMA: a phase II dose and volume de-escalation trial for human papillomavirus-positive oropharyngeal cancer. Ann Oncol 2019; 30:1673. [PMID: 31168601 DOI: 10.1093/annonc/mdz171] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
25
|
Lee SSY, Bindokas VP, Lingen MW, Kron SJ. Nondestructive, multiplex three-dimensional mapping of immune infiltrates in core needle biopsy. J Transl Med 2019; 99:1400-1413. [PMID: 30401959 PMCID: PMC6502706 DOI: 10.1038/s41374-018-0156-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/18/2018] [Accepted: 10/05/2018] [Indexed: 12/21/2022] Open
Abstract
Enumeration of tumor-infiltrating lymphocytes (TILs) in H&E stained tissue sections has demonstrated limited value in predicting immune responses to cancer immunotherapy, likely reflecting the diversity of cell types and immune activation states among tumor infiltrates. Multiparametric flow cytometry enables robust phenotypic and functional analysis to distinguish suppression from activation, but tissue dissociation eliminates spatial context. Multiplex methods for immunohistochemistry (IHC) are emerging, but these interrogate only a single tissue section at a time. Here, we report transparent tissue tomography (T3) as a tool for three-dimensional (3D) imaging cytometry in the complex architecture of the tumor microenvironment, demonstrating multiplexed immunofluorescent analysis in core needle biopsies. Using T3 imaging, image processing and machine learning to map CD3+CD8+ cytotoxic T cells (CTLs) in whole core needle biopsies from Her2+ murine mammary tumors and human head and neck surgical specimens revealed marked inhomogeneity within single needle cores, confirmed by serial section IHC. Applying T3 imaging cytometry, we discovered a strong spatial correlation between CD3+CD8+ CTLs and microvasculature in the EGFR+ parenchyma, revealing significant differences among head and neck cancer patients. These results show that T3 offers simple and rapid access to three-dimensional and quantitative maps of the tumor microenvironment and immune infiltrate, offering a new diagnostic tool for personalized cancer immunotherapy.
Collapse
Affiliation(s)
- Steve Seung-Young Lee
- Department of Molecular Genetics and Cell Biology, The University of Chicago, Chicago, IL.,Ludwig Center for Metastasis Research, The University of Chicago, Chicago, IL
| | | | - Mark W. Lingen
- Department of Pathology, The University of Chicago, Chicago, IL
| | - Stephen J. Kron
- Department of Molecular Genetics and Cell Biology, The University of Chicago, Chicago, IL.,Ludwig Center for Metastasis Research, The University of Chicago, Chicago, IL.,Correspondence to:
| |
Collapse
|
26
|
Lingen MW, Tampi MP, Urquhart O, Abt E, Agrawal N, Chaturvedi AK, Cohen E, D'Souza G, Gurenlian J, Kalmar JR, Kerr AR, Lambert PM, Patton LL, Sollecito TP, Truelove E, Banfield L, Carrasco-Labra A. Adjuncts for the evaluation of potentially malignant disorders in the oral cavity: Diagnostic test accuracy systematic review and meta-analysis-a report of the American Dental Association. J Am Dent Assoc 2019; 148:797-813.e52. [PMID: 29080605 DOI: 10.1016/j.adaj.2017.08.045] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Oral squamous cell carcinoma is the most common manifestation of malignancy in the oral cavity. Adjuncts are available for clinicians to evaluate lesions that seem potentially malignant. In this systematic review, the authors summarized the available evidence on patient-important outcomes, diagnostic test accuracy (DTA), and patients' values and preferences (PVPs) when using adjuncts for the evaluation of clinically evident lesions in the oral cavity. TYPES OF STUDIES REVIEWED The authors searched for preexisting systematic reviews and assessed their quality using the Assessing the Methodological Quality of Systematic Reviews tool. The authors updated the selected reviews and searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials and DTA and PVPs studies. Pairs of reviewers independently conducted study selection, data extraction, and assessment of the certainty in the evidence by using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS The authors identified 4 existing reviews. DTA reviews included 37 studies. The authors retrieved 7,534 records, of which 9 DTA and 10 PVPs studies were eligible. Pooled sensitivity and specificity of adjuncts ranged from 0.39 to 0.96 for the evaluation of innocuous lesions and from 0.31 to 0.95 for the evaluation of suspicious lesions. Cytologic testing used in suspicious lesions appears to have the highest accuracy among adjuncts (sensitivity, 0.92; 95% confidence interval, 0.86 to 0.98; specificity, 0.94; 95% confidence interval, 0.88 to 0.99; low-quality evidence). CONCLUSIONS AND PRACTICAL IMPLICATIONS Cytologic testing appears to be the most accurate adjunct among those included in this review. The main concerns are the high rate of false-positive results and serious issues of risk of bias and indirectness of the evidence. Clinicians should remain skeptical about the potential benefit of any adjunct in clinical practice.
Collapse
|
27
|
Koutlas IG, Dolan M, Lingen MW, Argyris PP. Plasmacytoid cells in salivary pleomorphic adenoma: an alternative interpretation of their immunohistochemical characteristics highlights function and capability for epithelial-mesenchymal transition. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:515-529. [PMID: 31400990 DOI: 10.1016/j.oooo.2019.01.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/02/2019] [Accepted: 01/29/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Plasmacytoid cells (PLCs) in salivary pleomorphic adenoma (SPA) are regarded as modified neoplastic myoepithelia and define plasmacytoid myoepithelioma (pMYO). However, histochemically, immunohistochemically and ultrastructurally, PLCs fail to demonstrate frank myogenous properties. Epithelial-mesenchymal transition (EMT) may explain the phenotypes in SPA. Our aim was to evaluate (1) PLCs with accepted or purported myoepithelial and EMT-related markers; and (2) pMYOs for PLAG1 aberrations by using fluorescence in situ hybridization. STUDY DESIGN Eight SPAs with or without PLC-predominance and 3 pMYOs were immunohistochemically studied. RESULTS PLCs in SPA and pMYO exhibited strong, scattered to diffuse positivity for K7, rare K14 positivity and were mostly negative for α-smooth muscle actin, h-caldesmon, and p63/p40. S100 staining was strong and diffuse, whereas calponin was variable. DOG1 was negative. PLCs in pMYO and PLC-rich SPA exhibited selective or diffuse WT1 and D2-40 immunoreactivity. EMT markers SNAIL/SLUG exhibited strong and variable immunoreactivity in PLCs in contrast to weak or absent E-cadherin expression. SOX10 was diffusely and strongly positive. PLAG1 rearrangement was present in 1 pMYO. CONCLUSIONS PLCs mostly fail to express myoepithelial markers; PLCs are neoplastic cells adapting to microenvironmental changes and capable of EMT; and tumors composed solely of PLCs are apparently SPAs depleted of a ductal component.
Collapse
Affiliation(s)
- Ioannis G Koutlas
- Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.
| | - Michelle Dolan
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Mark W Lingen
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Prokopios P Argyris
- Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, Minneapolis, MN, USA; Department of Biochemistry, Molecular Biology and Biophysics, College of Biological Sciences, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
28
|
Abstract
Historical records as far back as 3000 BCE show that oral and head and neck cancer was a disease process well known to Egyptian physicians. Luminaries such as Hippocrates, Galen, Pott, and Virchow were instrumental in shaping our understanding of the etiology and pathogenesis of cancer. During the 20th century, evidence-based medicine catalyzed the development of rigorous science-based diagnostic and treatment protocols. The use of surgery, therapeutic radiation, and chemotherapy as single-treatment agents or in combination with one another gradually emerged as the preferred approach to cancer therapy. The recognition of tobacco, alcohol, and human papillomavirus as etiological agents in oral and head and neck cancer prompted the development of new diagnostic aids and treatment strategies to mitigate cancer progression. More in-depth mechanistic insights into the multistep process of oral and head and neck cancer were made possible by the use of the hamster buccal pouch and mouse models. New technologies, such as the sequencing of the human genome, metabolomics, and proteomics, have provided the foundation for what we today call precision medicine. The future success of tailored medical treatment for cancer patients will depend on the discovery of new druggable targets with improved therapeutic efficacy. As the precision and sensitivity of existing tools for prevention and risk assessment improve, greater accuracy will be achieved in predicting health outcomes.
Collapse
Affiliation(s)
- P J Polverini
- 1 Department of Periodontics and Oral Medicine, Division of Oral Medicine, Pathology, and Radiology, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,2 Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA.,3 University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - M W Lingen
- 4 Department of Pathology, University of Chicago, Chicago, IL, USA
| |
Collapse
|
29
|
Seiwert TY, Foster CC, Blair EA, Karrison TG, Agrawal N, Melotek JM, Portugal L, Brisson RJ, Dekker A, Kochanny S, Gooi Z, Lingen MW, Villaflor VM, Ginat DT, Haraf DJ, Vokes EE. OPTIMA: a phase II dose and volume de-escalation trial for human papillomavirus-positive oropharyngeal cancer. Ann Oncol 2019; 30:297-302. [PMID: 30481287 DOI: 10.1093/annonc/mdy522] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with HPV+ oropharyngeal squamous cell carcinoma were assigned to dose and volume de-escalated radiotherapy (RT) or chemoradiotherapy (CRT) based on response to induction chemotherapy in an effort to limit treatment-related toxicity while preserving efficacy. PATIENTS AND METHODS Patients were classified as low-risk (≤T3, ≤N2B, ≤10 pack-year history) or high-risk (T4 or ≥N2C or >10 PYH). After three cycles of carboplatin/nab-paclitaxel, response was assessed using Response Evaluation Criteria in Solid Tumors 1.1. Low-risk patients with ≥50% response received 50 Gray (Gy) RT (RT50) while low-risk patients with 30%-50% response or high-risk patients with ≥50% response received 45 Gy CRT (CRT45). Patients with lesser response received standard-of-care 75 Gy CRT (CRT75). RT/CRT was limited to the first echelon of uninvolved nodes. The primary end point was 2-year progression-free survival compared with a historic control of 85%. Secondary end points included overall survival and toxicity. RESULTS Sixty-two patients (28 low risk/34 high risk) were enrolled. Of low-risk patients, 71% received RT50 while 21% received CRT45. Of high-risk patients, 71% received CRT45. With a median follow-up of 29 months, 2-year PFS and OS were 95% and 100% for low-risk patients and 94% and 97% for high-risk patients, respectively. The overall 2-year PFS was 94.5% and within the 11% noninferiority margin for the historic control. Grade 3+ mucositis occurred in 30%, 63%, and 91% of the RT50, CRT45, and CRT75 groups, respectively (P = 0.004). Rates of any PEG-tube use were 0%, 31%, and 82% for RT50, CRT45, and CRT75 groups, respectively (P < 0.0001). CONCLUSIONS Induction chemotherapy with response and risk-stratified dose and volume de-escalated RT/CRT for HPV+ OPSCC is associated with favorable oncologic outcomes and reduced acute and chronic toxicity. Further evaluation of induction-based de-escalation in large multicenter studies is justified. CLINICAL TRIAL REGISTRATION Clinical trials.gov identifier: NCT02258659.
Collapse
Affiliation(s)
- T Y Seiwert
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, USA
| | - C C Foster
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, USA
| | - E A Blair
- Department of Otolaryngology, University of Chicago, Chicago, USA
| | - T G Karrison
- Department of Public Health Sciences, University of Chicago, Chicago, USA
| | - N Agrawal
- Department of Otolaryngology, University of Chicago, Chicago, USA
| | - J M Melotek
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, USA
| | - L Portugal
- Department of Otolaryngology, University of Chicago, Chicago, USA
| | - R J Brisson
- Oakland University William Beaumont School of Medicine, Rochester, USA
| | - A Dekker
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, USA
| | - S Kochanny
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, USA
| | - Z Gooi
- Department of Otolaryngology, University of Chicago, Chicago, USA
| | - M W Lingen
- Department of Pathology, University of Chicago, Chicago, USA
| | - V M Villaflor
- Department of Medicine, Division of Hematology/Oncology, Northwestern Memorial Hospital, Chicago, USA
| | - D T Ginat
- Department of Radiology, University of Chicago, Chicago, USA
| | - D J Haraf
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, USA
| | - E E Vokes
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, USA.
| |
Collapse
|
30
|
Lingen MW. Triple O Content Innovations and New Section Editors. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 127:1-2. [DOI: 10.1016/j.oooo.2018.10.004] [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] [Received: 10/12/2018] [Accepted: 10/12/2018] [Indexed: 10/28/2022]
|
31
|
Brand TM, Iida M, Stein AP, Corrigan KL, Braverman CM, Coan JP, Pearson HE, Bahrar H, Fowler TL, Bednarz BP, Saha S, Yang D, Gill PS, Lingen MW, Saloura V, Villaflor VM, Salgia R, Kimple RJ, Wheeler DL. Correction: AXL Is a Logical Molecular Target in Head and Neck Squamous Cell Carcinoma. Clin Cancer Res 2018; 24:6099. [PMID: 30510088 DOI: 10.1158/1078-0432.ccr-18-3194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
32
|
Geivelis MM, Lingen MW, Takemura A. Evaluation of In Situ Hardening β‐Tricalcium Phosphate/Poly(lactic‐co‐glycolide) Bone Substitute Used in Edentulous Ridge Preservation for Late Implant Placement: Case Series. Clin Adv Periodontics 2018; 9:55-58. [DOI: 10.1002/cap.10050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/05/2018] [Indexed: 11/06/2022]
Affiliation(s)
| | - Mark W. Lingen
- Department of PathologyUniversity of Chicago Medicine Chicago IL
| | | |
Collapse
|
33
|
Scherpelz KP, Wong AC, Lingen MW, Taxy JB, Cipriani NA. Histological features and prognostic significance of treatment effect in lymph node metastasis in head and neck squamous cell carcinoma. Histopathology 2018; 74:321-331. [PMID: 30144145 DOI: 10.1111/his.13742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 05/12/2018] [Accepted: 08/21/2018] [Indexed: 12/30/2022]
Abstract
AIMS AND OBJECTIVES Cervical lymph node metastasis in head and neck squamous cell carcinoma (HNSCC) is common. Pre-operative chemoradiotherapy (preCRT) and postoperative chemoradiotherapy (postCRT) is frequently employed in such patients. The prognostic value of viable SCC, treatment effect or no SCC in resected lymph nodes in patients who received or did not receive preCRT and postCRT was investigated. METHODS AND RESULTS Resected cervical lymph nodes from 146 patients with HNSCC were evaluated for viable SCC, treatment effect or no SCC. Immunostains for Ki67, cyclin D1, caspase 3 and H2AFX were performed on viable SCC or nucleate keratin debris. Clinical and histological data were correlated with tumour recurrence or persistence. Patients with nucleate keratin debris in lymph nodes had outcomes similar to those with diffuse treatment effect and no SCC. Viable tumour in lymph nodes was associated with worse prognosis in patients who received preCRT (P = 0.01). This relative worsening of prognosis was not observed in patients with oropharyngeal SCC or recurrent disease. Lower proliferation index in lymph node SCC was associated with preCRT and with worse outcomes (P = 0.0002). Overall, patients who received preCRT or postCRT had outcomes not significantly different from those who did not. CONCLUSION The presence of viable SCC in cervical lymph nodes has prognostic import when taken in context with the patient's history. Viable SCC in lymph nodes was significantly associated with worse outcome among patients with non-oropharyngeal SCC who received preCRT. Nucleate keratin debris should not be considered viable SCC in lymph nodes.
Collapse
Affiliation(s)
| | - Anthony C Wong
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Mark W Lingen
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Jerome B Taxy
- Department of Pathology, The University of Chicago, Chicago, IL, USA.,Department of Pathology and Laboratory Medicine, NorthShore University Health System, Evanston, IL, USA
| | - Nicole A Cipriani
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| |
Collapse
|
34
|
Fakhry C, Lacchetti C, Rooper LM, Jordan RC, Rischin D, Sturgis EM, Bell D, Lingen MW, Harichand-Herdt S, Thibo J, Zevallos J, Perez-Ordonez B. Human Papillomavirus Testing in Head and Neck Carcinomas: ASCO Clinical Practice Guideline Endorsement of the College of American Pathologists Guideline. J Clin Oncol 2018; 36:3152-3161. [DOI: 10.1200/jco.18.00684] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The College of American Pathologists produced an evidence-based guideline on testing, application, interpretation, and reporting of human papillomavirus (HPV) and surrogate marker tests in head and neck carcinomas that was determined to be relevant to the American Society of Clinical Oncology (ASCO) membership. Methods The College of American Pathologists HPV Testing in Head and Neck Carcinomas guideline was reviewed by ASCO content experts for clinical accuracy and by methodologists for developmental rigor. On favorable review, an ASCO Expert Panel was convened to review the guideline contents and recommendations. Results The ASCO Expert Panel determined that the recommendations from the HPV Testing in Head and Neck Carcinomas guideline, published in 2018, are clear, thorough, and based upon the most relevant scientific evidence. ASCO endorsed the guideline and added minor qualifying statements. Recommendations It is recommended that HPV tumor status should be determined for newly diagnosed oropharyngeal squamous cell carcinomas. HPV tumor status testing may be performed by surrogate marker p16 immunohistochemistry either on the primary tumor or from cervical nodal metastases only if an oropharyngeal primary tumor is present. The threshold for positivity is at least 70% nuclear and cytoplasmic expression with at least moderate to strong intensity. Additional confirmatory testing may be done at the discretion of the pathologist and/or treating clinician. Pathologists should not routinely determine HPV tumor status in nonsquamous carcinomas of the oropharynx or non–oropharyngeal squamous cell carcinomas of the head and neck. When there is uncertainty of histologic type or whether a poorly differentiated oropharyngeal tumor is nonsquamous, HPV tumor status testing may be warranted and at the discretion of the pathologist and/or treating clinician. Additional information is available at: www.asco.org/head-neck-cancer-guidelines .
Collapse
Affiliation(s)
- Carole Fakhry
- Carole Fakhry and Lisa M. Rooper, Johns Hopkins School of Medicine, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Richard C. Jordan, University of California, San Francisco, San Francisco, CA; Danny Rischin, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Erich M. Sturgis and Diana Bell, MD Anderson Cancer Center, Houston, TX; Mark W. Lingen, University of Chicago, Chicago, IL; Seema Harichand-Herdt, Mid Florida Cancer Center, Orange City, FL
| | - Christina Lacchetti
- Carole Fakhry and Lisa M. Rooper, Johns Hopkins School of Medicine, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Richard C. Jordan, University of California, San Francisco, San Francisco, CA; Danny Rischin, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Erich M. Sturgis and Diana Bell, MD Anderson Cancer Center, Houston, TX; Mark W. Lingen, University of Chicago, Chicago, IL; Seema Harichand-Herdt, Mid Florida Cancer Center, Orange City, FL
| | - Lisa M. Rooper
- Carole Fakhry and Lisa M. Rooper, Johns Hopkins School of Medicine, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Richard C. Jordan, University of California, San Francisco, San Francisco, CA; Danny Rischin, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Erich M. Sturgis and Diana Bell, MD Anderson Cancer Center, Houston, TX; Mark W. Lingen, University of Chicago, Chicago, IL; Seema Harichand-Herdt, Mid Florida Cancer Center, Orange City, FL
| | - Richard C. Jordan
- Carole Fakhry and Lisa M. Rooper, Johns Hopkins School of Medicine, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Richard C. Jordan, University of California, San Francisco, San Francisco, CA; Danny Rischin, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Erich M. Sturgis and Diana Bell, MD Anderson Cancer Center, Houston, TX; Mark W. Lingen, University of Chicago, Chicago, IL; Seema Harichand-Herdt, Mid Florida Cancer Center, Orange City, FL
| | - Danny Rischin
- Carole Fakhry and Lisa M. Rooper, Johns Hopkins School of Medicine, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Richard C. Jordan, University of California, San Francisco, San Francisco, CA; Danny Rischin, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Erich M. Sturgis and Diana Bell, MD Anderson Cancer Center, Houston, TX; Mark W. Lingen, University of Chicago, Chicago, IL; Seema Harichand-Herdt, Mid Florida Cancer Center, Orange City, FL
| | - Erich M. Sturgis
- Carole Fakhry and Lisa M. Rooper, Johns Hopkins School of Medicine, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Richard C. Jordan, University of California, San Francisco, San Francisco, CA; Danny Rischin, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Erich M. Sturgis and Diana Bell, MD Anderson Cancer Center, Houston, TX; Mark W. Lingen, University of Chicago, Chicago, IL; Seema Harichand-Herdt, Mid Florida Cancer Center, Orange City, FL
| | - Diana Bell
- Carole Fakhry and Lisa M. Rooper, Johns Hopkins School of Medicine, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Richard C. Jordan, University of California, San Francisco, San Francisco, CA; Danny Rischin, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Erich M. Sturgis and Diana Bell, MD Anderson Cancer Center, Houston, TX; Mark W. Lingen, University of Chicago, Chicago, IL; Seema Harichand-Herdt, Mid Florida Cancer Center, Orange City, FL
| | - Mark W. Lingen
- Carole Fakhry and Lisa M. Rooper, Johns Hopkins School of Medicine, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Richard C. Jordan, University of California, San Francisco, San Francisco, CA; Danny Rischin, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Erich M. Sturgis and Diana Bell, MD Anderson Cancer Center, Houston, TX; Mark W. Lingen, University of Chicago, Chicago, IL; Seema Harichand-Herdt, Mid Florida Cancer Center, Orange City, FL
| | - Seema Harichand-Herdt
- Carole Fakhry and Lisa M. Rooper, Johns Hopkins School of Medicine, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Richard C. Jordan, University of California, San Francisco, San Francisco, CA; Danny Rischin, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Erich M. Sturgis and Diana Bell, MD Anderson Cancer Center, Houston, TX; Mark W. Lingen, University of Chicago, Chicago, IL; Seema Harichand-Herdt, Mid Florida Cancer Center, Orange City, FL
| | - John Thibo
- Carole Fakhry and Lisa M. Rooper, Johns Hopkins School of Medicine, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Richard C. Jordan, University of California, San Francisco, San Francisco, CA; Danny Rischin, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Erich M. Sturgis and Diana Bell, MD Anderson Cancer Center, Houston, TX; Mark W. Lingen, University of Chicago, Chicago, IL; Seema Harichand-Herdt, Mid Florida Cancer Center, Orange City, FL
| | - Jose Zevallos
- Carole Fakhry and Lisa M. Rooper, Johns Hopkins School of Medicine, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Richard C. Jordan, University of California, San Francisco, San Francisco, CA; Danny Rischin, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Erich M. Sturgis and Diana Bell, MD Anderson Cancer Center, Houston, TX; Mark W. Lingen, University of Chicago, Chicago, IL; Seema Harichand-Herdt, Mid Florida Cancer Center, Orange City, FL
| | - Bayardo Perez-Ordonez
- Carole Fakhry and Lisa M. Rooper, Johns Hopkins School of Medicine, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Richard C. Jordan, University of California, San Francisco, San Francisco, CA; Danny Rischin, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Erich M. Sturgis and Diana Bell, MD Anderson Cancer Center, Houston, TX; Mark W. Lingen, University of Chicago, Chicago, IL; Seema Harichand-Herdt, Mid Florida Cancer Center, Orange City, FL
| |
Collapse
|
35
|
Kochanny S, Foster CC, Khattri A, Brisson RJ, Dekker A, Klema E, Acharya R, Segal J, Lingen MW, Cipriani N, Pearson AT, Saloura V, Vokes EE, Seiwert TY. High-accuracy HPV testing versus p16 IHC using multiple clinically relevant outcomes: The University of Chicago Experience. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.6020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sara Kochanny
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | - Corey Christian Foster
- Department of Radiation & Cellular Oncology, The University of Chicago Medicine, Chicago, IL
| | - Arun Khattri
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | - Ryan J. Brisson
- Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Allison Dekker
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | - Elaine Klema
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | - Rajesh Acharya
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | | | - Mark W. Lingen
- The University of Chicago Medicine and Biological Sciences, Chicago, IL
| | | | | | - Vassiliki Saloura
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | - Everett E. Vokes
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | - Tanguy Y. Seiwert
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| |
Collapse
|
36
|
Khattri A, Sheikh N, Acharya R, Tan YHC, Kochanny S, Lingen MW, Vokes EE, Seiwert TY. Mechanism of acquired resistance to cetuximab in head and neck cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Rajesh Acharya
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | - Yi-Hung Carol Tan
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | - Sara Kochanny
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | - Mark W. Lingen
- The University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Everett E. Vokes
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | - Tanguy Y. Seiwert
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| |
Collapse
|
37
|
Affiliation(s)
- Mark W Lingen
- Professor, Pathology, University of Chicago Medicine, Chicago, IL
| |
Collapse
|
38
|
Saintigny P, William WN, Foy JP, Papadimitrakopoulou V, Lang W, Zhang L, Fan YH, Feng L, Kim ES, El-Naggar AK, Lee JJ, Mao L, Hong WK, Lingen MW, Lippman SM. Met Receptor Tyrosine Kinase and Chemoprevention of Oral Cancer. J Natl Cancer Inst 2018; 110:4243526. [PMID: 29617836 PMCID: PMC5946820 DOI: 10.1093/jnci/djx186] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 06/20/2017] [Accepted: 08/08/2017] [Indexed: 12/11/2022] Open
Abstract
Background We have previously shown that gene expression profiles of oral leukoplakia (OL) may improve the prediction of oral cancer (OC) risk. To identify new targets for prevention, we performed a systematic survey of transcripts associated with an increased risk of oral cancer and overexpressed in OC vs normal mucosa (NM). Methods We used gene expression profiles of 86 patients with OL and available outcomes from a chemoprevention trial of OC and NM. MET expression was evaluated using immunohistochemistry in 120 OL patients, and its association with OC development was tested in multivariable analysis. Sensitivity to pharmacological Met inhibition was tested invitro in premalignant and OC cell lines (n = 33) and invivo using the 4-NQO model of oral chemoprevention (n = 20 mice per group). All statistical tests were two-sided. Results The overlap of 693 transcripts associated with an increased risk of OC with 163 transcripts overexpressed in OC compared with NM led to the identification of 23 overlapping transcripts, including MET. MET overexpression in OL was associated with a hazard ratio of 3.84 (95% confidence interval = 1.59 to 9.27, P = .003) of developing OC. Met activation was found in OC and preneoplastic cell lines. Crizotinib activity in preneoplastic and OC cell lines was comparable. ARQ 197 was more active in preneoplastic compared with OC cell lines. In the 4-NQO model, squamous cell carcinoma, dysplasia, and hyperkeratosis were observed in 75.0%, 15.0%, and 10.0% in the control group, and in 25.0%, 70.0%, and 5.0% in the crizotinib group (P < .001). Conclusion Together, these data suggest that MET activation may represent an early driver in oral premalignancy and a target for chemoprevention of OC.
Collapse
MESH Headings
- 4-Nitroquinoline-1-oxide/toxicity
- Animals
- Antineoplastic Agents/pharmacology
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/prevention & control
- Case-Control Studies
- Cell Proliferation
- Crizotinib/pharmacology
- Female
- Follow-Up Studies
- Gene Expression Regulation, Neoplastic
- Genomics
- Head and Neck Neoplasms/metabolism
- Head and Neck Neoplasms/pathology
- Head and Neck Neoplasms/prevention & control
- Humans
- Leukoplakia, Oral/metabolism
- Leukoplakia, Oral/pathology
- Leukoplakia, Oral/prevention & control
- Male
- Mice, Inbred CBA
- Middle Aged
- Mouth Mucosa/drug effects
- Mouth Mucosa/metabolism
- Mouth Mucosa/pathology
- Mouth Neoplasms/metabolism
- Mouth Neoplasms/pathology
- Mouth Neoplasms/prevention & control
- Neoplasm Invasiveness
- Precancerous Conditions/metabolism
- Precancerous Conditions/pathology
- Precancerous Conditions/prevention & control
- Prognosis
- Prospective Studies
- Proto-Oncogene Proteins c-met/antagonists & inhibitors
- Proto-Oncogene Proteins c-met/genetics
- Proto-Oncogene Proteins c-met/metabolism
- Pyrrolidinones/pharmacology
- Quinolines/pharmacology
- Quinolones/toxicity
- Survival Rate
- Tumor Cells, Cultured
Collapse
Affiliation(s)
- Pierre Saintigny
- Cancer Research Center of Lyon, UMR INSERM 1052-CNRS 5286, Centre Léon Bérard, Lyon, France
- Department of Medicine, Centre Léon Bérard, Lyon, France, Université Lyon 1, Lyon, France
| | - William N William
- Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Jean-Philippe Foy
- Cancer Research Center of Lyon, UMR INSERM 1052-CNRS 5286, Centre Léon Bérard, Lyon, France
- Department of Medicine, Centre Léon Bérard, Lyon, France, Université Lyon 1, Lyon, France
| | | | - Wenhua Lang
- Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Li Zhang
- Bioinformatics and Computational Biology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - You Hong Fan
- Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Lei Feng
- Biostatistics, Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Edward S Kim
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Adel K El-Naggar
- Biostatistics, Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - J Jack Lee
- Biostatistics, Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Li Mao
- Oncology and Diagnostic Science, University of Maryland Dental School, Baltimore, MD
| | - Waun Ki Hong
- Division of Cancer Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Mark W Lingen
- Department of Pathology, The University of Chicago, Chicago, IL
| | | |
Collapse
|
39
|
Khammanivong A, Sorenson BS, Ross KF, Dickerson EB, Hasina R, Lingen MW, Herzberg MC. Involvement of calprotectin (S100A8/A9) in molecular pathways associated with HNSCC. Oncotarget 2017; 7:14029-47. [PMID: 26883112 PMCID: PMC4924696 DOI: 10.18632/oncotarget.7373] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/29/2016] [Indexed: 02/07/2023] Open
Abstract
Calprotectin (S100A8/A9), a heterodimeric protein complex of calcium-binding proteins S100A8 and S100A9, plays key roles in cell cycle regulation and inflammation, with potential functions in squamous cell differentiation. While upregulated in many cancers, S100A8/A9 is downregulated in squamous cell carcinomas of the cervix, esophagus, and the head and neck (HNSCC). We previously reported that ectopic S100A8/A9 expression inhibits cell cycle progression in carcinoma cells. Here, we show that declining expression of S100A8/A9 in patients with HNSCC is associated with increased DNA methylation, less differentiated tumors, and reduced overall survival. Upon ectopic over-expression of S100A8/A9, the cancer phenotype of S100A8/A9-negative carcinoma cells was suppressed in vitro and tumor growth in vivo was significantly decreased. MMP1, INHBA, FST, LAMC2, CCL3, SULF1, and SLC16A1 were significantly upregulated in HNSCC but were downregulated by S100A8/A9 expression. Our findings strongly suggest that downregulation of S100A8/A9 through epigenetic mechanisms may contribute to increased proliferation, malignant transformation, and disease progression in HNSCC.
Collapse
Affiliation(s)
- Ali Khammanivong
- Department of Diagnostic and Biological Sciences, University of Minnesota, Minneapolis, MN, USA.,Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Brent S Sorenson
- Department of Diagnostic and Biological Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Karen F Ross
- Department of Diagnostic and Biological Sciences, University of Minnesota, Minneapolis, MN, USA.,Mucosal and Vaccine Research Center, Minneapolis VA Medical Center, Minneapolis, MN, USA
| | - Erin B Dickerson
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Rifat Hasina
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Mark W Lingen
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Mark C Herzberg
- Department of Diagnostic and Biological Sciences, University of Minnesota, Minneapolis, MN, USA.,Mucosal and Vaccine Research Center, Minneapolis VA Medical Center, Minneapolis, MN, USA
| |
Collapse
|
40
|
Can NT, Lingen MW, Mashek H, McElherne J, Briese R, Fitzpatrick C, van Zante A, Cipriani NA. Expression of Hormone Receptors and HER-2 in Benign and Malignant Salivary Gland Tumors. Head Neck Pathol 2017; 12:95-104. [PMID: 28681314 PMCID: PMC5873488 DOI: 10.1007/s12105-017-0833-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 06/19/2017] [Indexed: 11/24/2022]
Abstract
With the advent of targeted therapies, expression of sex hormone receptors and HER-2 in salivary gland tumors (SGTs) is of clinical interest. Previous reports of estrogen (ER) and progesterone (PR) receptor expression have varied. Androgen receptor (AR) and HER-2 overexpression are frequently reported in salivary duct carcinoma (SDC), but have not been studied systematically in other SGTs. This study examines ER, PR, AR, and HER-2 expression in SGTs. Immunohistochemistry for ER, PR, AR, and HER-2 was performed on 254 SGTs (134 malignant). ER, PR, and AR expression was scored using Allred system. HER-2 expression was scored using Dako HercepTest guidelines. FISH for HER-2 amplification was performed on select cases with HER-2 overexpression (2-3+). No SGT demonstrated strong expression of ER or PR. Combined strong AR and HER-2 expression was seen in 22 carcinomas: 14/25 SDC, 3/16 poorly differentiated, two oncocytic, and one each carcinoma ex pleomorphic adenoma, squamous cell, and intraductal carcinoma. Eighteen additional high grade carcinomas had HER-2 overexpression with absent, weak, or moderate AR expression; eight high grade carcinomas had isolated strong AR expression with 0-1+ HER-2 staining. Of 15 tested cases, six demonstrated HER-2 amplification by FISH, all of which had 3+ immunoreactivity. Neither benign nor malignant SGTs had strong expression of ER or PR. None of the benign SGTs overexpressed AR or HER-2. Coexpression of AR and HER-2 should not define SDC, but immunostaining should be considered in high grade salivary carcinomas, as some show overexpression and may benefit from targeted therapy.
Collapse
Affiliation(s)
- Nhu Thuy Can
- Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, MC 6101, Chicago, IL 60637 USA ,Department of Pathology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143 USA
| | - Mark W. Lingen
- Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, MC 6101, Chicago, IL 60637 USA
| | - Heather Mashek
- Constitutional Cytogenetics and Cytogenomics, Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, Chicago, IL 60637 USA
| | - James McElherne
- Constitutional Cytogenetics and Cytogenomics, Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, Chicago, IL 60637 USA
| | - Renee Briese
- Constitutional Cytogenetics and Cytogenomics, Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, Chicago, IL 60637 USA
| | - Carrie Fitzpatrick
- Constitutional Cytogenetics and Cytogenomics, Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, Chicago, IL 60637 USA
| | - Annemieke van Zante
- Department of Pathology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143 USA
| | - Nicole A. Cipriani
- Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, MC 6101, Chicago, IL 60637 USA
| |
Collapse
|
41
|
Khattri A, Zuo Z, Tan YHC, Agrawal N, Lingen MW, Vokes EE, Seiwert TY. Association of DRB1 and DRBQ haplotype 04:01~03:01 with HPV positive head and neck squamous cell carcinoma. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.6054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6054 Background: The incidence of human papilloma virus (HPV) associated oropharyngeal head and neck cancer (HNC) is increasing rapidly in the US, Europe, and Asia. HPV16 is etiologic in 90-95% of HPV+ HNC. Sexual transmission and inability to clear infection leading to viral genome integration or chronic presence of episomal HPV16 DNA are precursors to HPV+ HNC carcinogenesis. However it remains unclear why a majority of HPV16 exposed individuals are able to clear the initial infection and avoid the risk of cancer. We hypothesized that difference in the ability eradicate infection may be mediated by certain HLA haplotypes. Methods: HPV(+) HNC patients from the TCGA cohort were HLA-typed based on available exome sequencing data. HLA typing was performed using the ATHLATES algorithm. We compared the distribution of alleles and haplotypes of classical HLA genes (A, C, B, DRB1 and DQB1) among HPV(+) HNC patients with those found in HPV(-) patients. Furthermore we evaluated enrichment of candidate alleles compared to publically available data in Caucasian non-cancer individuals. Results: Out of 528 HNC samples in the TCGA cohort, 450 were of Caucasian ancestry. The DRB1~DQB1 haplotype 04:01~03:01 was significantly increased in HPV(+) HNSCC patients compared to normal, non-cancer individuals ( p-value = 0.0045, OR = 2.52, 95% CI = 1.2–5.03). This was not the case for HPV(-) HNC patients. The number of African American samples in TCGA was comparably small (N = 48, with N = 5 being HPV+) however the frequency of DRB1~DQB1 haplotype 04:01~03:01 in the general African American population is significantly lower. Conclusions: DRB1~DQB1 haplotype 04:01~03:01 associates with an elevated risk for HPV+ HNC. Similar findings were reported 17 years ago for cervical cancer (Br J Cancer, 82(7), 1348–1352), and further validate our findings across tumor types. Mechanistic studies to understand potential DRB1~DQB1 haplotype 04:01~03:01 HPV specific immune dysfunction, as well as evaluation in different risk and racial populations are indicated.
Collapse
Affiliation(s)
| | | | | | | | - Mark W. Lingen
- The University of Chicago Medicine and Biological Sciences, Chicago, IL
| | | | | |
Collapse
|
42
|
Saloura V, Fatima A, Zewde M, Kiyotani K, Brisson RJ, Park JH, Ikeda Y, Vougiouklakis T, Bao R, Seiwert TY, Cipriani N, Lingen MW, Vokes EE, Nakamura Y. Characterization of the T-cell receptor repertoire and immune microenvironment in patients with locoregionally advanced squamous cell carcinoma of the head and neck. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.3080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3080 Background: Immunotherapy with checkpoint blockade was recently approved for patients with recurrent/metastatic SCCHN, however it has not been investigated in the curative-intent setting yet. In this study, we investigated the T-cell receptor repertoire and the immune microenvironment in tumor tissues of SCCHN patients with locoregionally advanced disease. Methods: T-cell receptor sequencing and polymerase chain reaction for immune-related genes of tumor tissues from 44 patients with locoregionally advanced SCCHN prior to treatment with definitive chemoradiotherapy were conducted. T-cell receptor clonality and the mRNA expression levels of immune-related genes were correlated with various clinicopathological parameters. Results: In patients with locoregionally advanced SCCHN, tumor infiltrating T-cells clonally expand and GRZB mRNA levels were associated significantly with longer progression-free survival (PFS) (p = 0.003) independent of HPV status, tumor and nodal stage. The TCR-β DI was significantly lower in HPV-negative compared to HPV-positive tumors (p = 0.002), signifying more clonal T-cell expansion in HPV-negative tumors. A higher percentage of HPV-negative tumors expressed HLA-A protein compared to HPV-positive tumors (p = 0.049), suggesting that the greater T-cell clonal expansion might be due to more robust antigen presentation by HPV-negative tumors. Conclusions: This study suggests the pre-existence of clonally expanded T-cells in patients with locoregionally advanced SCCHN prior to treatment, and provides rationale to introduce immunotherapy in the curative-intent setting. The association of high GRZB mRNA levels with favorable PFS independent of HPV-status, tumor and nodal stage supports that the pre-existence of an intrinsically inflamed microenvironment enhances chemoradiotherapy effects. Finally, in HPV-positive tumors, the T-cell infiltrate seemed to be more diverse which could be secondary to virally-induced defective expression of HLA class I molecules.
Collapse
Affiliation(s)
| | | | | | | | - Ryan J. Brisson
- Oakland University William Beaumont School of Medicine, Rochester, MI
| | | | | | | | - Riyue Bao
- University of Chicago Center for Reseach Informatics, Chicago, IL
| | | | | | - Mark W. Lingen
- The University of Chicago Medicine and Biological Sciences, Chicago, IL
| | | | | |
Collapse
|
43
|
Seiwert TY, Bao R, Tan YHC, Acharya R, Brisson RJ, Kochanny S, Arshad S, Zuo Z, Saloura V, Agrawal N, Gooi Z, Blair EA, Lingen MW, Vokes EE, Gajewski T, Savage PA, Khattri A. Correlation of constitutive PD-1 resistance in HNC with GM-CSF expression and presence of myeloid derived suppressor cells (MDSCs). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.6049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6049 Background: PD-1 checkpoint blockade is active in head and neck squamous cell carcinomas (HNC) with a response rate of ~18% and significant impact on survival. However, only a subset of patients benefits (Seiwert, Lancet Oncol). Biomarkers such as PD-L1 IHC and the Interferon-Gamma gene expression profile (INF-G GEP) identify inflamed tumors with a higher chance of response (~35-40%). However, it remains unclear why the majority of INF-G inflamed tumors still do not respond, or how to overcome constitutive resistance. Methods: 50 anti-PD-1 treated recurrent/metastatic HNC patients were included. Tumor RNA was analyzed using a 638-gene immune panel on the Nanostring nCounter. HPV status was assessed by HPV E6/E7 mRNA. T-cell inflamed phenotype was calculated using the 6-gene INF-G GEP (geometric mean) using both a low (6) and a high cutpoint. Differential gene expression was determined between inflamed-benefitting (IB) patients (defined as OS ≥ 250days), and inflamed-non-benefitting (INB) patients. Candidate biomarkers were evaluated in the entire cohort. Results: CD8 correlated highly with INF-G GEP (R = 0.80), suggesting T cell-driven inflammation. Comparing inflamed benefitting with inflamed non-benefitting tumors, the most differentially expressed gene was CSF-2, encoding GM-CSF, with 4-fold higher expression in inflamed non-benefitting (INB) tumors (with both cutpoints). In the overall anti-PD-1 treated cohort of 50 patients, CSF-2/GM-CSF correlated strongly with poor overall survival (P = 0.02), outperforming both HPV status, or PD-L1 expression in cox PH multivariate analysis. GM-CSF expression has been linked to myeloid derived suppressor cells (MDSC); MDSC marker CD34, as well as JAK2/IL10 were significantly elevated in inflamed non-benefitting (INB) tumors. There was no difference in M2 macrophage marker CD163 between the two groups. Conclusions: Constitutive resistance to PD-1 checkpoint blockade in inflamed HNC associates with expression of GM-CSF and Myeloid Derived Suppressor Cell (MDSC) markers. Strategies to deplete MDSCs, such as chemotherapy, should be considered in combination or sequentially with anti-PD-1.
Collapse
Affiliation(s)
| | - Riyue Bao
- University of Chicago Center for Reseach Informatics, Chicago, IL
| | | | | | | | | | | | | | | | | | | | | | - Mark W. Lingen
- The University of Chicago Medicine and Biological Sciences, Chicago, IL
| | | | | | | | | |
Collapse
|
44
|
Banuelos J, Cao Y, Shin SC, Bochner BS, Avila P, Li S, Jiang X, Lingen MW, Schleimer RP, Lu NZ. Granulocyte colony-stimulating factor blockade enables dexamethasone to inhibit lipopolysaccharide-induced murine lung neutrophils. PLoS One 2017; 12:e0177884. [PMID: 28542361 PMCID: PMC5438114 DOI: 10.1371/journal.pone.0177884] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 05/04/2017] [Indexed: 01/13/2023] Open
Abstract
Glucocorticoids promote neutrophilic inflammation, the mechanisms of which are poorly characterized. Using a lipopolysaccharide (LPS)-induced acute murine lung injury model, we determined the role of granulocyte colony-stimulating factor (G-CSF) in mouse lung neutrophil numbers in the absence and presence of dexamethasone, a potent glucocorticoid. G-CSF was blocked using a neutralizing antibody. Airway neutrophil numbers, cytokine levels, and lung injury parameters were measured. Glucocorticoid treatment maintained LPS-induced airway G-CSF while suppressing TNF and IL-6. The addition of anti-G-CSF antibodies enabled dexamethasone to decrease airway G-CSF, neutrophils, and lung injury scores. In LPS-challenged murine lungs, structural cells and infiltrating leukocytes produced G-CSF. In vitro using BEAS 2B bronchial epithelial cells, A549 lung epithelial cells, human monocyte-derived macrophages, and human neutrophils, we found that dexamethasone and proinflammatory cytokines synergistically induced G-CSF. Blocking G-CSF production in BEAS 2B cells using shRNAs diminished the ability of BEAS 2B cells to protect neutrophils from undergoing spontaneous apoptosis. These data support that G-CSF plays a role in upregulation of airway neutrophil numbers by dexamethasone in the LPS-induced acute lung injury model.
Collapse
Affiliation(s)
- Jesus Banuelos
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Yun Cao
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Soon Cheon Shin
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Bruce S. Bochner
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Pedro Avila
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Shihong Li
- Department of Pharmacology and Human Tissue Resource Center, The University of Chicago, Chicago, Illinois, United States of America
| | - Xin Jiang
- Department of Pharmacology and Human Tissue Resource Center, The University of Chicago, Chicago, Illinois, United States of America
| | - Mark W. Lingen
- Department of Pharmacology and Human Tissue Resource Center, The University of Chicago, Chicago, Illinois, United States of America
| | - Robert P. Schleimer
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Nick Z. Lu
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- * E-mail:
| |
Collapse
|
45
|
Affiliation(s)
- P J Polverini
- 1 Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,2 Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - M W Lingen
- 3 Department of Pathology, The University of Chicago, Chicago, IL, USA
| |
Collapse
|
46
|
Lingen MW. Changing of the guard. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 123:1-2. [PMID: 27938941 DOI: 10.1016/j.oooo.2016.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 10/12/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Mark W Lingen
- Department of Pathology, The University of Chicago Medicine
| |
Collapse
|
47
|
Speight PM, Epstein J, Kujan O, Lingen MW, Nagao T, Ranganathan K, Vargas P. Screening for oral cancer-a perspective from the Global Oral Cancer Forum. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 123:680-687. [PMID: 27727113 DOI: 10.1016/j.oooo.2016.08.021] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/17/2016] [Accepted: 08/25/2016] [Indexed: 12/30/2022]
Abstract
Screening for oral cancer should be defined as the application of a test to people who are apparently free of disease to identify those who may have oral cancer and to distinguish them from those who may not. The aim of the test is not to be diagnostic but to identify changes that may be the earliest signs of impending disease. Defined in this way, screening is an ongoing public health measure, often funded by governments. A screening program must do no harm and must be cost effective. Governments demand that strict evidence of benefits and cost effectiveness be met before a program may be implemented. Although many studies have investigated the utility of potential screening tests, there have been few evaluations of screening programs and only one randomized controlled trial. Systematic reviews have concluded that there is insufficient evidence to show that oral cancer screening can reduce mortality from oral cancer, and to date, no country has implemented a formal oral cancer screening program. This paper reviews this evidence and tries to identify the barriers to screening and suggests areas of focus for future research.
Collapse
Affiliation(s)
- Paul M Speight
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
| | - Joel Epstein
- Division of Otolaryngology and Head and Neck Surgery, City of Hope, Duarte, CA, USA
| | - Omar Kujan
- School of Dentistry, The University of Western Australia, Perth, Western Australia, Australia
| | - Mark W Lingen
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Toru Nagao
- Department of Oral and Maxillofacial Surgery and Stomatology, Okazaki City Hospital, Okazaki, Japan
| | - Kannan Ranganathan
- Department of Oral and Maxillofacial Pathology, Ragas Dental College, Chennai, India
| | - Pablo Vargas
- Faculty of Dentistry, Piracicaba, University of Campinas, Piracicaba, São Paulo State, Brazil
| |
Collapse
|
48
|
William WN, Papadimitrakopoulou V, Lee JJ, Mao L, Cohen EEW, Lin HY, Gillenwater AM, Martin JW, Lingen MW, Boyle JO, Shin DM, Vigneswaran N, Shinn N, Heymach JV, Wistuba II, Tang X, Kim ES, Saintigny P, Blair EA, Meiller T, Gutkind JS, Myers J, El-Naggar A, Lippman SM. Erlotinib and the Risk of Oral Cancer: The Erlotinib Prevention of Oral Cancer (EPOC) Randomized Clinical Trial. JAMA Oncol 2016; 2:209-16. [PMID: 26540028 DOI: 10.1001/jamaoncol.2015.4364] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
IMPORTANCE Standard molecularly based strategies to predict and/or prevent oral cancer development in patients with oral premalignant lesions (OPLs) are lacking. OBJECTIVE To test if the epidermal growth factor receptor inhibitor erlotinib would reduce oral cancer development in patients with high-risk OPLs defined by specific loss of heterozygosity (LOH) profiles. Secondary objectives included prospective determination of LOH as a prognostic marker in OPLs. DESIGN The Erlotinib Prevention of Oral Cancer (EPOC) study was a randomized, placebo-controlled, double-bind trial. Accrual occurred from November 2006 through July 2012, with a median follow-up time of 35 months in an ambulatory care setting in 5 US academic referral institutions. Patients with OPLs were enrolled in the protocol, and each underwent LOH profiling (N = 379); they were classified as high-risk (LOH-positive) or low-risk (LOH-negative) patients based on their LOH profiles and oral cancer history. The randomized sample consisted of 150 LOH-positive patients. INTERVENTIONS Oral erlotinib treatment (150 mg/d) or placebo for 12 months. MAIN OUTCOMES AND MEASURES Oral cancer-free survival (CFS). RESULTS A total of 395 participants were classified with LOH profiles, and 254 were classified LOH positive. Of these, 150 (59%) were randomized, 75 each to the placebo and erlotinib groups. The 3-year CFS rates in placebo- and erlotinib-treated patients were 74% and 70%, respectively (hazard ratio [HR], 1.27; 95% CI, 0.68-2.38; P = .45). The 3-year CFS was significantly lower for LOH-positive compared with LOH-negative groups (74% vs 87%, HR, 2.19; 95% CI, 1.25-3.83; P = .01). Increased EGFR gene copy number correlated with LOH-positive status (P < .001) and lower CFS (P = .01). The EGFR gene copy number was not predictive of erlotinib efficacy. Erlotinib-induced skin rash was associated with improved CFS (P = .01). CONCLUSIONS AND RELEVANCE In this trial, LOH was validated as a marker of oral cancer risk and found to be associated with increased EGFR copy number (the target of the intervention). Erlotinib did not, however, improve CFS in high-risk patients with LOH-positive or high-EGFR-gene-copy-number OPLs. These results support incorporation of LOH testing as a prognostic tool in routine clinical practice but do not support erlotinib use in this setting. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00402779.
Collapse
Affiliation(s)
- William N William
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | | | - J Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Li Mao
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston3The Marlene and Stewart Greenebaum Cancer Center, University of Maryland, Baltimore4Department of Oncology and Diagnostic Sciences, University
| | - Ezra E W Cohen
- Moores Cancer Center, University of California San Diego, La Jolla6Department of Medicine, University of Chicago, Chicago, Illinois
| | - Heather Y Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Ann M Gillenwater
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Jack W Martin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Mark W Lingen
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Jay O Boyle
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dong M Shin
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Nadarajah Vigneswaran
- Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry, Houston
| | - Nancy Shinn
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston12Department of Palliative Care Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - John V Heymach
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Ignacio I Wistuba
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston13Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Ximing Tang
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston13Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Edward S Kim
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston14Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Pierre Saintigny
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston15INSERM U1052, Cancer Research Center of Lyon, Lyon, France16CNRS UMR 5286, Cancer Research Center of Lyon, Lyon, France
| | - Elizabeth A Blair
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Timothy Meiller
- The Marlene and Stewart Greenebaum Cancer Center, University of Maryland, Baltimore4Department of Oncology and Diagnostic Sciences, University of Maryland, Baltimore
| | - J Silvio Gutkind
- Moores Cancer Center, University of California San Diego, La Jolla18Oral and Pharyngeal Cancer Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland
| | - Jeffrey Myers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Adel El-Naggar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Scott M Lippman
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston5Moores Cancer Center, University of California San Diego, La Jolla
| |
Collapse
|
49
|
Seiwert TY, Melotek JM, Blair EA, Stenson KM, Salama JK, Witt ME, Brisson RJ, Chawla A, Dekker A, Lingen MW, Kocherginsky M, Villaflor VM, Cohen EEW, Haraf DJ, Vokes EE. Final Results of a Randomized Phase 2 Trial Investigating the Addition of Cetuximab to Induction Chemotherapy and Accelerated or Hyperfractionated Chemoradiation for Locoregionally Advanced Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2016; 96:21-9. [PMID: 27511844 DOI: 10.1016/j.ijrobp.2016.04.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/22/2016] [Accepted: 04/27/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE The role of cetuximab in the treatment of locoregionally advanced head and neck squamous cell cancer (LA-HNSCC) remains poorly defined. In this phase 2 randomized study, we investigated the addition of cetuximab to both induction chemotherapy (IC) and hyperfractionated or accelerated chemoradiation. METHODS AND MATERIALS Patients with LA-HNSCC were randomized to receive 2 cycles of weekly IC (cetuximab, paclitaxel, carboplatin) and either Cetux-FHX (concurrent cetuximab, 5-fluorouracil, hydroxyurea, and 1.5 Gy twice-daily radiation therapy every other week to 75 Gy) or Cetux-PX (cetuximab, cisplatin, and accelerated radiation therapy with delayed concomitant boost to 72 Gy in 42 fractions). The primary endpoint was progression-free survival (PFS), with superiority compared with historical control achieved if either arm had 2-year PFS ≥70%. RESULTS 110 patients were randomly assigned to either Cetux-FHX (n=57) or Cetux-PX (n=53). The overall response rate to IC was 91%. Severe toxicity on IC was limited to rash (23% grade ≥3) and myelosuppression (38% grade ≥3 neutropenia). The 2-year rates of PFS for both Cetux-FHX (82.5%) and Cetux-PX (84.9%) were significantly higher than for historical control (P<.001). The 2-year overall survival (OS) was 91.2% for Cetux-FHX and 94.3% for Cetux-PX. With a median follow-up time of 72 months, there were no significant differences in PFS (P=.35) or OS (P=.15) between the treatment arms. The late outcomes for the entire cohort included 5-year PFS, OS, locoregional failure, and distant metastasis rates of 74.1%, 80.3%, 15.7%, and 7.4%, respectively. The 5-year PFS and OS were 84.4% and 91.3%, respectively, among human papillomavirus (HPV)-positive patients and 65.9% and 72.5%, respectively, among HPV-negative patients. CONCLUSIONS The addition of cetuximab to IC and chemoradiation was tolerable and produced long-term control of LA-HNSCC, particularly among poor-prognosis HPV-negative patients. Further investigation of cetuximab may be warranted in the neoadjuvant setting and with non-platinum-based chemoradiation.
Collapse
Affiliation(s)
- Tanguy Y Seiwert
- Departments of Medicine, University of Chicago, Chicago, Illinois.
| | - James M Melotek
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Elizabeth A Blair
- Department of Otolaryngology, University of Chicago, Chicago, Illinois
| | | | - Joseph K Salama
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - Mary Ellyn Witt
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Ryan J Brisson
- Departments of Medicine, University of Chicago, Chicago, Illinois
| | - Apoorva Chawla
- Departments of Medicine, University of Chicago, Chicago, Illinois
| | - Allison Dekker
- Departments of Medicine, University of Chicago, Chicago, Illinois
| | - Mark W Lingen
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Masha Kocherginsky
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | | | - Ezra E W Cohen
- Moores Cancer Center, University of California, San Diego, San Diego, California
| | - Daniel J Haraf
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Everett E Vokes
- Departments of Medicine, University of Chicago, Chicago, Illinois
| |
Collapse
|
50
|
Rowley AH, Wylie KM, Kim KYA, Pink AJ, Yang A, Reindel R, Baker SC, Shulman ST, Orenstein JM, Lingen MW, Weinstock GM, Wylie TN. The transcriptional profile of coronary arteritis in Kawasaki disease. BMC Genomics 2015; 16:1076. [PMID: 26679344 PMCID: PMC4683744 DOI: 10.1186/s12864-015-2323-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [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] [Received: 06/25/2015] [Accepted: 12/15/2015] [Indexed: 12/31/2022] Open
Abstract
Background Kawasaki Disease (KD) can cause potentially life-threatening coronary arteritis in young children, and has a likely infectious etiology. Transcriptome profiling is a powerful approach to investigate gene expression in diseased tissues. RNA sequencing of KD coronary arteries could elucidate the etiology and the host response, with the potential to improve KD diagnosis and/or treatment. Methods Deep RNA sequencing was performed on KD (n = 8) and childhood control (n = 7) coronary artery tissues, revealing 1074 differentially expressed mRNAs. Non-human RNA sequences were subjected to a microbial discovery bioinformatics platform, and microbial sequences were analyzed by Metastats for association with KD. Results T lymphocyte activation, antigen presentation, immunoglobulin production, and type I interferon response were significantly upregulated in KD arteritis, while the tumor necrosis factor α pathway was not differentially expressed. Transcripts from known infectious agents were not specifically associated with KD coronary arteritis. Conclusions The immune transcriptional profile in KD coronary artery tissues has features of an antiviral immune response such as activated cytotoxic T lymphocyte and type I interferon-induced gene upregulation. These results provide new insights into the pathogenesis of KD arteritis that can guide selection of new immunomodulatory therapies for high-risk KD patients, and provide direction for future etiologic studies. Electronic supplementary material The online version of this article (doi:10.1186/s12864-015-2323-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Anne H Rowley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, 310 E Superior Street, Morton 4-685B, Chicago, IL, 60611, USA. .,Department of Microbiology and Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Kristine M Wylie
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO, USA.,The McDonnell Genome Institute at Washington University, Washington University School of Medicine, Saint Louis, MO, USA
| | - Kwang-Youn A Kim
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Adam J Pink
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, 310 E Superior Street, Morton 4-685B, Chicago, IL, 60611, USA
| | - Amy Yang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rebecca Reindel
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, 310 E Superior Street, Morton 4-685B, Chicago, IL, 60611, USA.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Present address: AbbVie, Inc, North Chicago, IL, USA
| | - Susan C Baker
- Department of Microbiology/Immunology, Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - Stanford T Shulman
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, 310 E Superior Street, Morton 4-685B, Chicago, IL, 60611, USA.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jan M Orenstein
- Department of Pathology, George Washington University School of Medicine, Washington, DC, USA
| | - Mark W Lingen
- Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - George M Weinstock
- The McDonnell Genome Institute at Washington University, Washington University School of Medicine, Saint Louis, MO, USA.,Present address: The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Todd N Wylie
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO, USA.,The McDonnell Genome Institute at Washington University, Washington University School of Medicine, Saint Louis, MO, USA
| |
Collapse
|