Convergent evolution of BRCA2 reversion mutations under therapeutic pressure by PARP inhibition and platinum chemotherapy

Reversion mutations that restore wild-type function of the BRCA gene have been described as a key mechanism of resistance to Poly(ADP-ribose) polymerase (PARP) inhibitor therapy in BRCA-associated cancers. Here, we report a case of a patient with metastatic castration-resistant prostate cancer (mCRPC) with a germline BRCA2 mutation who developed acquired resistance to PARP inhibition. Extensive genomic interrogation of cell-free DNA (cfDNA) and tissue at baseline, post-progression, and postmortem revealed ten unique BRCA2 reversion mutations across ten sites. While several of the reversion mutations were private to a specific site, nine out of ten tumors contained at least one mutation, suggesting a powerful clonal selection for reversion mutations in the presence of therapeutic pressure by PARP inhibition. Variable cfDNA shed was seen across tumor sites, emphasizing a potential shortcoming of cfDNA monitoring for PARPi resistance. This report provides a genomic portrait of the temporal and spatial heterogeneity of prostate cancer under the selective pressure of a PARP inhibition and exposes limitations in the current strategies for detection of reversion mutations.

Integrated Multi-Tumor Radio-Genomic Marker of Outcomes in Patients with High Serous Ovarian Carcinoma

Purpose: Develop an integrated intra-site and inter-site radiomics-clinical-genomic marker of high grade serous ovarian cancer (HGSOC) outcomes and explore the biological basis of radiomics with respect to molecular signaling pathways and the tumor microenvironment (TME). Method: Seventy-five stage III-IV HGSOC patients from internal (N = 40) and external factors via the Cancer Imaging Archive (TCGA) (N = 35) with pre-operative contrast enhanced CT, attempted primary cytoreduction, at least two disease sites, and molecular analysis performed within TCGA were retrospectively analyzed. An intra-site and inter-site radiomics (cluDiss) measure was combined with clinical-genomic variables (iRCG) and compared against conventional (volume and number of sites) and average radiomics (N = 75) for prognosticating progression-free survival (PFS) and platinum resistance. Correlation with molecular signaling and TME derived using a single sample gene set enrichment that was measured. Results: The iRCG model had the best platinum resistance classification accuracy (AUROC of 0.78 [95% CI 0.77 to 0.80]). CluDiss was associated with PFS (HR 1.03 [95% CI: 1.01 to 1.05], p = 0.002), negatively correlated with Wnt signaling, and positively to immune TME. Conclusions: CluDiss and the iRCG prognosticated HGSOC outcomes better than conventional and average radiomic measures and could better stratify patient outcomes if validated on larger multi-center trials.

Is possible to rule out clinically significant prostate cancer using PI-RADS v2 for the assessment of prostate MRI?

OBJECTIVES

To evaluate the diagnostic performance and interobserver agreement of PI-RADS v2.

MATERIALS AND METHODS

In this Institutional Review Board approved single-center retrospective study, 98 patients with clinically suspected PCa who underwent 3-T multiparametric MRI followed by MRI/TRUS fusion-guided prostate biopsy were included from June 2013 to February 2015. Two radiologists (R1 and R2) with 8 and 1 years of experience in abdominal radiology reviewed the MRI scans and assigned PI-RADS v2 scores in all prostate zones. PI-RADS v2 were compared to MRI/TRUS fusion-guided biopsy results, which were classified as negative, PCa, and significant PCa (sPCa).

RESULTS

Sensitivity, specificity, NPV, PPV and accuracy for PCa was 85.7% (same for all metrics) for R1 and 81.6%, 79.6%, 81.2%, 80.0% and 80.6% for R2. For detecting sPCa, the corresponding values were 95.3%, 85.4%, 95.9%, 83.7% and 89.8% for R1 and 93.0%, 81.8%, 93.7%, 86.7% and 86.7% for R2. There was substantial interobserver agreement in assigning PI-RADS v2 score as negative (1, 2, 3) or positive (4, 5) (Kappa=0.78). On multivariate analysis, PI-RADS v2 (p <0.001) was the only independent predictor of sPCa compared with age, abnormal DRE, prostate volume, PSA and PSA density.

CONCLUSIONS

Our study population demonstrated that PI-RADS v2 had high diagnostic accuracy, substantial interobserver agreement, and it was the only independent predictor of sPCa.

Early MRI predictors of disease-free survival in locally advanced rectal cancer from the GRECCAR 4 trial

BACKGROUND

Tailored neoadjuvant treatment of locally advanced rectal cancer (LARC) may improve outcomes. The aim of this study was to determine early MRI prognostic parameters with which to stratify neoadjuvant treatment in patients with LARC.

METHODS

All patients from a prospective, phase II, multicentre randomized study (GRECCAR4; NCT01333709) were included, and underwent rectal MRI before treatment, 4 weeks after induction chemotherapy and after completion of chemoradiotherapy (CRT). Tumour volumetry, MRI tumour regression grade (mrTRG), T and N categories, circumferential resection margin (CRM) status and extramural vascular invasion identified by MRI (mrEMVI) were evaluated.

RESULTS

A total of 133 randomized patients were analysed. Median follow-up was 41·4 (95 per cent c.i. 36·6 to 45·2) months. Thirty-one patients (23·3 per cent) developed tumour recurrence. In univariable analysis, mrEMVI at baseline was the only prognostic factor associated with poorer outcome (P = 0·015). After induction chemotherapy, a larger tumour volume on MRI (P = 0·019), tumour volume regression of 60 per cent or less (P = 0·002), involvement of the CRM (P = 0·037), mrEMVI (P = 0·026) and a poor mrTRG (P = 0·023) were associated with poor outcome. After completion of CRT, the absence of complete response on MRI (P = 0·004), mrEMVI (P = 0·038) and a poor mrTRG (P = 0·005) were associated with shorter disease-free survival. A final multivariable model including all significant variables (baseline, after induction, after CRT) revealed that Eastern Cooperative Oncology Group performance status (P = 0·011), sphincter involvement (P = 0·009), mrEMVI at baseline (P = 0·002) and early tumour volume regression of 60 per cent or less after induction (P = 0·007) were associated with relapse.

CONCLUSION

Baseline and early post-treatment MRI parameters are associated with prognosis in LARC. Future preoperative treatment should stratify treatment according to baseline mrEMVI status and early tumour volume regression.

How clinical imaging can assess cancer biology

Human cancers represent complex structures, which display substantial inter- and intratumor heterogeneity in their genetic expression and phenotypic features. However, cancers usually exhibit characteristic structural, physiologic, and molecular features and display specific biological capabilities named hallmarks. Many of these tumor traits are imageable through different imaging techniques. Imaging is able to spatially map key cancer features and tumor heterogeneity improving tumor diagnosis, characterization, and management. This paper aims to summarize the current and emerging applications of imaging in tumor biology assessment.

Unravelling tumour heterogeneity using next-generation imaging: radiomics, radiogenomics, and habitat imaging

Tumour heterogeneity in cancers has been observed at the histological and genetic levels, and increased levels of intra-tumour genetic heterogeneity have been reported to be associated with adverse clinical outcomes. This review provides an overview of radiomics, radiogenomics, and habitat imaging, and examines the use of these newly emergent fields in assessing tumour heterogeneity and its implications. It reviews the potential value of radiomics and radiogenomics in assisting in the diagnosis of cancer disease and determining cancer aggressiveness. This review discusses how radiogenomic analysis can be further used to guide treatment therapy for individual tumours by predicting drug response and potential therapy resistance and examines its role in developing radiomics as biomarkers of oncological outcomes. Lastly, it provides an overview of the obstacles in these emergent fields today including reproducibility, need for validation, imaging analysis standardisation, data sharing and clinical translatability and offers potential solutions to these challenges towards the realisation of precision oncology.

The impact of FDG-PET/CT in the management of patients with vulvar and vaginal cancer

OBJECTIVES

To evaluate the changes in prognostic impression and patient management following PET/CT in patients with vulvar and vaginal carcinoma; and to compare PET/CT findings with those of conventional imaging modalities.

METHODS

We summarized prospectively and retrospectively collected data for 50 consecutive patients from our institution that enrolled in the National Oncologic PET Registry and underwent FDG-PET/CT for a suspected or known primary or recurrent vulvar/vaginal cancer.

RESULTS

54/83 (65%) studies included had a diagnosis of vulvar cancer, and the remaining 29/83 (35%), a diagnosis of vaginal cancer. Following FDG-PET/CT, the physician's prognostic impression changed in 51% of cases. A change in patient management, defined as a change to/from a non-interventional strategy (observation or additional imaging), to/from an interventional strategy (biopsy or treatment), was documented in 36% of studies. The electronic records demonstrated that 95% of the management strategies recorded in the physician questionnaires were implemented as planned. MRI and/or CT were performed within one month of the FDG-PET/CT in 20/83 (24%) and 28/83 (34%) cases, respectively. FDG-PET/CT detected nodes suspicious for metastases on 29/83 (35%) studies performed. MRI and CT detected positive nodes on 6 and 11 studies respectively. Distant metastases were identified in 10 cases imaged with FDG-PET and 5 cases that had additional conventional CT imaging. All suspicious lesions seen on CT were positively identified on PET/CT. In 4 cases, an abnormality identified on PET/CT, was not seen on diagnostic CT.

CONCLUSIONS

FDG-PET/CT may play an important role in the management of vulvar and vaginal carcinoma.

Macaria mirthae Vargas et al (Lepidoptera: Geometridae): Confirmation of the Use of an Invasive Host Plant in the Northern Atacama Desert of Chile Based on DNA Barcodes

Macaria mirthae Vargas et al (Lepidoptera: Geometridae) is a geometrid moth native to the northern Atacama Desert of Chile. Its oligophagous larvae are associated with native hosts of the plant family Fabaceae, the most important of which is Acacia macracantha. The invasive tree Leucaena leucocephala (Fabaceae) was recently recorded as a host plant for M. mirthae based on morphology. The taxonomic status of larvae collected on A. macracantha and L. leucocephala was assessed using sequences of the DNA barcode fragment of the cytochrome c oxidase subunit I (COI) gene. Genetic divergence between samples from the host plants was found to be 0%-0.8% (Kimura 2-parameter model). Neighbor-joining and maximum likelihood analyses were also performed, including additional barcode sequences of Neotropical geometrid moths from GenBank and BOLD databases. Sequences of the larvae from both host plants clustered in a single clade with high statistical support in both analyses. Based on these results, it is concluded that M. mirthae has effectively expanded its host range and its larvae are currently feeding on the exotic tree L. leucocephala. Additionally, the importance of this new host association in a highly disturbed habitat is briefly discussed in terms of the field biology of this native geometrid moth.

Volume-based quantitative FDG PET/CT metrics and their association with optimal debulking and progression-free survival in patients with recurrent ovarian cancer undergoing secondary cytoreductive surgery

OBJECTIVE

Our aim was to evaluate the associations between quantitative (18)F-fluorodeoxyglucose positron-emission tomography (FDG-PET) uptake metrics, optimal debulking (OD) and progression-free survival (PFS) in patients with recurrent ovarian cancer undergoing secondary cytoreductive surgery.

METHODS

Fifty-five patients with recurrent ovarian cancer underwent FDG-PET/CT within 90 days prior to surgery. Standardized uptake values (SUVmax), metabolically active tumour volumes (MTV), and total lesion glycolysis (TLG) were measured on PET. Exact logistic regression, Kaplan-Meier curves and the log-rank test were used to assess associations between imaging metrics, OD and PFS.

RESULTS

MTV (p = 0.0025) and TLG (p = 0.0043) were associated with OD; however, there was no significant association between SUVmax and debulking status (p = 0.83). Patients with an MTV above 7.52 mL and/or a TLG above 35.94 g had significantly shorter PFS (p = 0.0191 for MTV and p = 0.0069 for TLG). SUVmax was not significantly related to PFS (p = 0.10). PFS estimates at 3.5 years after surgery were 0.42 for patients with an MTV ≤ 7.52 mL and 0.19 for patients with an MTV > 7.52 mL; 0.46 for patients with a TLG ≤ 35.94 g and 0.15 for patients with a TLG > 35.94 g.

CONCLUSION

FDG-PET metrics that reflect metabolic tumour burden are associated with optimal secondary cytoreductive surgery and progression-free survival in patients with recurrent ovarian cancer.

KEY POINTS

• Both TLG and MTV were associated with optimal tumour debulking. • There was no significant association between SUVmax and tumour debulking status. • Patients with higher MTV and/or TLG had significantly shorter PFS. • SUVmax was not significantly related to PFS.

Egg Phenology of a Host-Specialist Butterfly in the Western Slopes of the Northern Chilean Andes

Phenological studies are especially important in order to understand the ecological process operating at temporal level. The western slopes of the northern Chilean Andes at about 3,500 m asl are a mosaic of arid environments in which precipitations are highly seasonal, mostly concentrated in summer. Teriocolias zelia andina Forbes (Lepidoptera: Pieridae) is one of the most conspicuous and regularly observed butterflies flying in this region; it is a host specialist associated with the native shrub Senna birostris var. arequipensis (Fabaceae). The objectives of this study were (1) to characterize the temporal variations in the relative abundance of eggs of this host-specialist butterfly and (2) to examine the relationship of these variations with leaf phenology. Monthly samplings of eggs were carried out from February 2011 to January 2012. Circular statistical analyses of the relative abundance of eggs indicated clustered distribution along the year with the mean vector in June. Temporal variation in the relative abundance of eggs was correlated (Spearman rank correlation test) with the availability of plant substrate for egg laying and larval feeding.

Role of endorectal prostate MRI in patients with initial suspicion of prostate cancer

PURPOSE

To evaluate the role of conventional endorectal prostate MRI in patients with initial suspicion of prostate cancer.

MATERIALS AND METHODS

Ethics board approval was received for this retrospective study of 87 men who underwent 1.5-Tesla conventional prostate MRI with a combination of endorectal and body phased-array coils for suspected prostate cancer before their first systematic 12-core TRUS-guided biopsy. Three radiologists independently analyzed the images, dividing the prostate into 12 regions corresponding to the biopsy scheme and scoring each region for the presence of prostate cancer on a 5-point scale. Results were analyzed by prostate region. ROC analysis was done and descriptive statistics were calculated. The negative predictive value, specificity, sensitivity and positive predictive value were calculated using dichotomized scores (benign tissue = scores of 1 and 2; malignant tissues = scores of 3, 4, and 5).

RESULTS

Biopsy revealed cancer in 47/87 patients (26 low-grade [Gleason score 6]; 21 high-grade [Gleason score ≥ 3 + 4]), and 184/1044 cores (77 low-grade and 107 high-grade) with a median of 3 positive cores per cancer patient (range 1 – 12). The areas under ROC curves were 0.65 – 0.67 for cancer detection by region overall and 0.75 – 0.76 for the detection of high-grade cancer by region. Statistic figures for the detection of all cancers/high-grade cancers by region were as follows: negative predictive value, 87.4 – 88.2 %/92.6 – 93.1 %; specificity, 72.3 – 79.4 %/71.5 – 79.8 %; sensitivity, 49.5 – 54.8 %/62.6 – 69.2 %; and positive predictive value, 29.3 – 34.0 %/29.4 – 34.7 %.

CONCLUSION

In patients with suspected prostate cancer, negative MRI findings indicate the absence of high-grade prostate cancer on subsequent TRUS-guided 12-core biopsy with high probability. However, agreement between conventional 1.5-T endorectal prostate MRI and systematic 12-core TRUS-guided biopsy for the detection of prostate cancer appears to be moderate.

Role of endorectal prostate MRI in patients with initial suspicion of prostate cancer

PURPOSE

To evaluate the role of conventional endorectal prostate MRI in patients with initial suspicion of prostate cancer.

MATERIALS AND METHODS

Ethics board approval was received for this retrospective study of 87 men who underwent 1.5-Tesla conventional prostate MRI with a combination of endorectal and body phased-array coils for suspected prostate cancer before their first systematic 12-core TRUS-guided biopsy. Three radiologists independently analyzed the images, dividing the prostate into 12 regions corresponding to the biopsy scheme and scoring each region for the presence of prostate cancer on a 5-point scale. Results were analyzed by prostate region. ROC analysis was done and descriptive statistics were calculated. The negative predictive value, specificity, sensitivity and positive predictive value were calculated using dichotomized scores (benign tissue = scores of 1 and 2; malignant tissues = scores of 3, 4, and 5).

RESULTS

Biopsy revealed cancer in 47/87 patients (26 low-grade [Gleason score 6]; 21 high-grade [Gleason score ≥ 3 + 4]), and 184/1044 cores (77 low-grade and 107 high-grade) with a median of 3 positive cores per cancer patient (range 1 - 12). The areas under ROC curves were 0.65 - 0.67 for cancer detection by region overall and 0.75 - 0.76 for the detection of high-grade cancer by region. Statistic figures for the detection of all cancers/high-grade cancers by region were as follows: negative predictive value, 87.4 - 88.2 %/92.6 - 93.1 %; specificity, 72.3 - 79.4 %/71.5 - 79.8 %; sensitivity, 49.5 - 54.8 %/62.6 - 69.2 %; and positive predictive value, 29.3 - 34.0 %/29.4 - 34.7 %.

CONCLUSION

In patients with suspected prostate cancer, negative MRI findings indicate the absence of high-grade prostate cancer on subsequent TRUS-guided 12-core biopsy with high probability. However, agreement between conventional 1.5-T endorectal prostate MRI and systematic 12-core TRUS-guided biopsy for the detection of prostate cancer appears to be moderate.

First record of Acrocercops serrigera serrigera Meyrick (Lepidoptera: Gracillariidae) from Chile

Acrocercops Wallengren (Gracillariidae) is recorded for the first time from Chile. The little known Acrocercops serrigera serrigera Meyrick is reported from the Azapa Valley, Arica Province, northern Chilean coastal desert. Specimens were reared from Malva nicaeensis and Waltheria ovata (both Malvaceae). Specimen identification is based on comparisons of the male genitalia with that of the lectotype of the species originated from Peru. Sequences of a fragment of the mitochondrial gene cytochrome oxidase subunit I of specimens reared on both plants indicate that there is only one Acrocercops species involved as only one substitution site was found over the 524-bp sequenced.

First host plant record for Teriocolias zelia andina Forbes (Lepidoptera: Pieridae) and evidence for local specialization

The shrub Senna birostris var. arequipensis (Fabaceae) is recorded as the first host plant for the little known butterfly Teriocolias zelia andina Forbes (Lepidoptera: Pieridae) in the occidental slopes of the Andes, northernmost Chile. Observations on egg-laying and larva-feeding behavior suggest that this butterfly is host specific.

Characterizing hypervascular and hypovascular metastases and normal bone marrow of the spine using dynamic contrast-enhanced MR imaging

BACKGROUND AND PURPOSE

The role of DCE-MR imaging in the study of bone marrow perfusion is only partially developed, though potential applications for routine use in the clinical setting are beginning to be described. We hypothesize that DCE-MR imaging can be used to discriminate between hypervascular and hypovascular metastases based on measured perfusion variables.

MATERIALS AND METHODS

We conducted a retrospective study of 26 patients using conventional MR imaging and DCE-MR imaging. Patients were assigned to a hypervascular or hypovascular group based on tumor pathology. ROIs were drawn around normal-appearing bone marrow (internal controls) and enhancing tumor areas. Average wash-in enhancement slope, average peak enhancement signal percentage change, and average peak enhancement signal percentage change in areas of highest wash-in enhancement slope were calculated. Indices were compared among control, hypervascular, and hypovascular groups. Conventional imaging was assessed by calculating pre- to postgadolinium signal percentage changes in hypervascular and hypovascular lesions.

RESULTS

Hypervascular and hypovascular tumors differed significantly with regard to wash-in enhancement slope (P < .01; hypervascular 95% CI, 22.5-26.5 AU/s; hypovascular 95% CI, 14.1-20.9 AU/s) and peak enhancement signal percentage change in areas of highest wash-in enhancement slope (P < .01; hypervascular 95% CI, 174.1-323.3%; hypovascular 95% CI, 39.5-150.5%). Peak enhancement signal percentage change over all voxels was not significant (P = .62). Areas of normal-appearing marrow showed no appreciable contrast enhancement. Conventional contrast-enhanced MR imaging was unable to differentiate between hypervascular and hypovascular tumors (P = .58).

CONCLUSIONS

Our data demonstrate that, unlike conventional MR imaging sequences, DCE-MR imaging may be a more accurate technique in discriminating hypervascular from hypovascular spinal metastases.

A new species of alucita L. (Lepidoptera: alucitidae) from northern Chile

Male and female adults of a new species of Alucita L. (Lepidoptera: Alucitidae) are described and illustrated from the Azapa Valley, northern Chile. Immature stages are associated with fruit of "chuve", Tecoma fulva (Cav.) D. Don. (Bignoniaceae). This is the first species of Alucitidae described from Chile.

Stigmella epicosma (Meyrick) (Lepidoptera: Nepticulidae): first distribution records from Chile and first host plant record

The presence of Stigmella epicosma (Meyrick) is reported for the first time from two coastal valleys from northern Chile: Azapa and Chaca. Adults examined were reared from leafminer larvae on Trixis cacalioides (Asteraceae), the first host plant known for S. epicosma.