BET Inhibition-Induced GSK3β Feedback Enhances Lymphoma Vulnerability to PI3K Inhibitors

The phosphatidylinositol 3 kinase (PI3K)-glycogen synthase kinase β (GSK3β) axis plays a central role in MYC-driven lymphomagenesis, and MYC targeting with bromodomain and extraterminal protein family inhibitors (BETi) is a promising treatment strategy in lymphoma. In a high-throughput combinatorial drug screening experiment, BETi enhance the antiproliferative effects of PI3K inhibitors in a panel of diffuse large B cell lymphoma (DLBCL) and Burkitt lymphoma cell lines. BETi or MYC silencing upregulates several PI3K pathway genes and induces GSK3β S9 inhibitory phosphorylation, resulting in increased β-catenin protein abundance. Furthermore, BETi or MYC silencing increases GSK3β S9 phosphorylation levels and β-catenin protein abundance through downregulating the E2 ubiquitin conjugating enzymes UBE2C and UBE2T. In a mouse xenograft DLBCL model, BETi decrease MYC, UBE2C, and UBE2T and increase phospho-GSK3β S9 levels, enhancing the anti-proliferative effect of PI3K inhibitors. Our study reveals prosurvival feedbacks induced by BETi involving GSK3β regulation, providing a mechanistic rationale for combination strategies.

Development of a survivorship needs assessment planning tool for head and neck cancer survivors and their caregivers: a preliminary study

PURPOSE

The purpose of this study was to characterize primary end-of-treatment challenges in head and neck cancer (HNC) to drive the development of a survivorship needs assessment planning (SNAP) tool and evaluate its acceptability and feasibility.

METHODS

Using qualitative methods (focus groups, interviews), we identified physical, emotional, and social post-treatment challenges from the perspectives of survivors (N = 17), caregivers (N = 14), and healthcare providers (N = 14) and pretested the SNAP tool. After Advisory Board ratings and consensus, the tool was finalized.

RESULTS

Survivors, caregivers and clinicians consistently highlighted the importance of assessing symptoms and functional abilities (e.g., dry mouth, speech/swallowing difficulties, weight loss), health behaviors (e.g., smoking, alcohol), emotional concerns (e.g., depression, isolation, nutritional distress), and social challenges (e.g., support, finances). Caregivers were overwhelmed and intensely focused on survivors' nutrition and trach/feeding tube care while clinicians emphasized financial and access concerns. Most participants were enthusiastic about the tool and directed a flexible care plan design due to variability in dyad needs. Over 75% reported high comfort using and navigating questions on a tablet and were in strong agreement that the care plan would help families practically and emotionally. Coordination of survivorship visits with follow-up care was critical to address travel and time barriers. While survivors and clinicians recommended waiting 1-6 months after treatment, caregivers preferred earlier survivorship visits.

CONCLUSIONS

Results pinpointed optimal end-of-treatment domains for routine assessment and support the feasibility of implementing a SNAP tool in the clinic.

IMPLICATIONS FOR CANCER SURVIVORS

Capitalizing on technology to direct HNC survivorship care is promising.

Pilot-Testing a Survivorship Needs Assessment Planning Tool for Head and Neck Cancer Survivors and Caregivers

The purpose of this study was to develop and pilot-test a tablet-based survivorship needs assessment planning (SNAP) tool to assess head and neck cancer (HNC) survivor and caregiver needs after treatment and generate tailored care plans. We recruited survivors completing treatment <24 months ago, and their caregivers. Participants completed baseline surveys, a clinic session with SNAP assessments (symptoms, unmet needs, behaviors) and care plan delivery, and 6-week follow-up surveys. We tracked intervention delivery/acceptability and used paired t-tests to explore changes in psychosocial factors over time. We enrolled 25 survivors (65% male, mean age = 63, 65% stage IVA) and their caregivers (73% female, mean age = 56, 77% partners). The average time to complete SNAP assessments was 11 and 6 minutes for survivors and caregivers, respectively. Algorithm-driven care plans included messages (mean = 19), educational materials (mean = 13) and referrals (mean = 4.5). Top referrals included Behavioral Medicine, Nutrition and Physical Therapy (84, 77 and 65% flagged, respectively). In those declining referrals, main reasons included being overwhelmed, seeing local provider or lacking interest. Participants rated SNAP favorably with >80% reporting high comfort using tablets and navigating questions. Dyads strongly agreed that care plans were helpful emotionally (>75%) and provided practical information (>73%). After the session, both survivors and caregivers reported significantly fewer unmet needs (7.7 versus 2.9, P = 0.001 survivors; 7.0 versus 4.1, P = 0.02, caregivers) and higher survivorship preparedness (4.9 versus 5.2 in both, P = 0.02 and P = 0.03). While depression, symptom distress and symptom management abilities were stable in survivors, caregivers had significantly lower depression (P = 0.01) and symptom distress (P = 0.03), and higher ratings of perceived patient symptom management abilities (P = 0.004) at follow-up. Open-ended responses highlighted that SNAP visits helped pull together complex medical information and made families feel supported. Participants desired more information about cancer stage and caregivers preferred earlier intervention. Results support the feasibility of implementing SNAP in the HNC clinic and highlighted needed modifications for system improvement.