Use of endoluminal vacuum therapy after anastomotic leak in a gynecologic oncology patient with rectosigmoid resection: A case report

•Anastomotic leak is an infrequent complication after colon resection and is associated with high morbidity and mortality.•Endoluminal vacuum therapy (EVAT) promotes wound closure by covering anastomotic leaks intraluminally and applying vacuum.•EVAT has been shown to be safe with mild adverse events.•EVAT should be considered in hemodynamically stable gynecologic oncology patients with a confined anastomotic leak.

Abstract 4203: Tumor-targeted delivery of a neoantigen surrogate by non-pathogenic Listeria reduces metastatic ovarian cancer

Objectives: End-stage ovarian cancer is commonly characterized by intraperitoneal (IP) carcinomatosis and chemoresistance. To date, immune-mediated therapies have shown little success in this population in part due to the absence of neoantigens in these tumors and strong immune suppression in the tumor microenvironment (TME) preventing T cell activation. Our laboratory has developed a novel microbial-based immunotherapeutic strategy for selective delivery of a highly immunogenic tetanus toxoid protein (TT856-1313) into tumor cells through in vivo infection with attenuated Listeria monocytogenes. In mice previously vaccinated against TT, this leads to reactivation of pre-existing TT-specific memory T cells which kill the infected tumor cells in mouse models of pancreatic cancer. The addition of gemcitabine (GEM) improves T cell responses by reducing immune suppression in the TME. We hypothesize that the regimen Listeria-TT+GEM will have efficacy in vivo in mice with advanced ovarian cancer.

Methods: Infection and killing of mouse and human ovarian tumor cells by Listeria-TT was analyzed in vitro. C57Bl/6 mice were vaccinated with the TT vaccine at six weeks of age. 3x106 luciferase-expressing ID8 syngeneic mouse tumor cells (Id8-Luc) were injected IP and tumor growth was monitored by Vivo Imaging Systems (IVIS.) Mice were divided into four treatment groups: saline, GEM, Listeria-TT, and Listeria-TT+GEM. Quantification of tumor burden was approximated by total flux (photons/second) within a region of interest (ROI) prior to, during, and at completion of therapy (days 0, 9, and 19 after tumor cell injection, respectively).

Results: In vitro analyses demonstrated efficient infection and killing of mouse Id8-Luc and chemoresistant human Hey ovarian tumor cells by Listeria-TT. The response of tumors and metastases to the four prespecified treatment regimens was evaluated by IVIS as described above. On Day 0, there was no significant difference in the quantified tumor burden between the four treatment groups. On Days 9 and 19, the tumor burden was significantly less in the Listeria-TT+GEM group compared to the saline group (Mann-Whitney p=0.0159). Neither GEM nor Listeria-TT alone were significantly different from the saline group on day 9, but the effect of GEM was significantly different from saline on day 19 (p=0.0079). In a follow up study, the survival time of the Listeria-TT+GEM-treated mice was improved by 50% compared to the saline mice. The survival of GEM compared to saline is under investigation.

Conclusions: Our results demonstrate that Listeria-TT+GEM strongly reduced metastatic ovarian cancer in mice. Additional experiments are ongoing to evaluate if more treatment cycles of Listeria-TT+GEM further improves the survival time. This study suggest that the combination therapy may be promising for human application.

Citation Format: Lisa R. Gabor, Olivia R. Khouri, Ken Lin, Nicole Nevadunsky, Dennis Yi-Shin Kuo, Claudia Gravekamp. Tumor-targeted delivery of a neoantigen surrogate by non-pathogenic Listeria reduces metastatic ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 4203.

COVID-19 outcomes of patients with gynecologic cancer in New York City

BACKGROUND

New York City (NYC) is the epicenter of severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) in the United States. Clinical characteristics and outcomes of vulnerable populations, such as those with gynecologic cancer who develop COVID-19 infections, is limited.

METHODS

Patients from 6 NYC-area hospital systems with known gynecologic cancer and a COVID-19 diagnosis were identified. Demographic and clinical outcome data were abstracted through a review of electronic medical records.

RESULTS

Records for 121 patients with gynecologic cancer and COVID-19 were abstracted; the median age at the COVID-19 diagnosis was 64.0 years (interquartile range, 51.0-73.0 years). Sixty-six of the 121 patients (54.5%) required hospitalization; among the hospitalized patients, 45 (68.2%) required respiratory intervention, 20 (30.3%) were admitted to the intensive care unit, and 9 (13.6%) underwent invasive mechanical ventilation. Seventeen patients (14.0%) died of COVID-19 complications. No patient requiring mechanical ventilation survived. On multivariable analysis, hospitalization was associated with an age ≥64 years (risk ratio [RR], 1.73; 95% confidence interval [CI], 1.18-2.51), African American race (RR, 1.56; 95% CI, 1.13-2.15), and 3 or more comorbidities (RR, 1.43; 95% CI, 1.03-1.98). Only recent immunotherapy use (RR, 3.49; 95% CI, 1.08-11.27) was associated with death due to COVID-19 on multivariable analysis; chemotherapy treatment and recent major surgery were not predictive of COVID-19 severity or mortality.

CONCLUSIONS

The case fatality rate among gynecologic oncology patients with a COVID-19 infection is 14.0%. Recent immunotherapy use is associated with an increased risk of mortality related to COVID-19 infection.

LAY SUMMARY

The case fatality rate among gynecologic oncology patients with a coronavirus disease 2019 (COVID-19) infection is 14.0%; there is no association between cytotoxic chemotherapy and cancer-directed surgery and COVID-19 severity or death. As such, patients can be counseled regarding the safety of continued anticancer treatments during the pandemic. This is important because the ability to continue cancer therapies for cancer control and cure is critical.

Disease severity and functional factors associated with walking performance in polyostotic fibrous dysplasia

The purpose of this study was to determine the association between measures of disease severity, impairment, and ambulation ability in persons with polyostotic fibrous dysplasia (PFD). A cross-sectional sample of 81 patients (ages 5-57) with polyostotic fibrous dysplasia was evaluated as part of an ongoing study. Subjects were scored on the Skeletal Disease Burden Score (SDBS), completed a 9-minute walk test (9MW), manual muscle testing (MMT), and measurements of range of motion (ROM). Correlations between continuous variables were calculated using the Pearson correlation coefficient and ordinal variables by Spearman correlation coefficient. It was found that subjects with more severe disease walked slower than those with less skeletal disease, with the exception of the youngest subjects. Walking velocity was faster in subjects with better hip strength and range of motion and slower in those with bilateral coxa vara. Those subjects with more severe disease had less range of motion, were weaker at the hips, and more likely to have leg length discrepancy. Skeletal disease severity was associated with hip weakness, leg length discrepancy, and loss of range of motion. In most cases, findings did not differ in the presence or absence of associated endocrinopathies. Skeletal disease severity, MMT and ROM each has an impact on walking efficiency in persons with PFD. These findings suggest that treatment focused on strategies to improve or, at least, maintain hip strength and range of motion, correct leg length discrepancies and hip malalignment may help preserve ambulation ability in persons with PFD and that treatment should begin at a young age.