Hypertension treatment for patients receiving ibrutinib: a multicenter retrospective study

ABSTRACT

Although Bruton tyrosine kinase inhibitors (BTKis) are generally well tolerated and less toxic than chemotherapy alternatives used to treat lymphoid malignancies, BTKis like ibrutinib have the potential to cause new or worsening hypertension (HTN). Little is known about the optimal treatment of BTKi-associated HTN. Randomly selected patients with lymphoid malignancies on a BTKi and antihypertensive drug(s) and with at least 3 months of follow-up data were sorted into 2 groups: those diagnosed with HTN before BTKi initiation (prior-HTN), and those diagnosed with HTN after BTKi initiation (de novo HTN). Generalized estimating equations assessed associations between time varying mean arterial pressures (MAPs) and individual anti-HTN drug categories. Of 196 patients included in the study, 118 had prior-HTN, and 78 developed de novo HTN. Statistically significant mean MAP reductions were observed in patients with prior-HTN who took β blockers (BBs) with hydrochlorothiazide (HCTZ), (-5.05 mmHg; 95% confidence interval [CI], 10.0 to -0.0596; P = .047), and patients diagnosed with de novo HTN who took either an angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) with HCTZ (-5.47 mmHg; 95% CI, 10.9 to -0.001; P = .05). These regimens also correlated with the greatest percentages of normotensive MAPs. Treatment of HTN in patients taking a BTKi is challenging and may require multiple antihypertensives. Patients with prior-HTN appear to benefit from combination regimens with BBs and HCTZ, whereas patients with de novo HTN appear to benefit from ACEi/ARBs with HCTZ. These results should be confirmed in prospective studies.

Abstract 6422: Combined TGFβ/PD-L1 blockade enhances systemic antitumor immunity in head and neck cancer

Head and neck squamous cell carcinoma (HNSCC) unrelated to human papillomavirus (HPV) confers poor prognosis, with half of patients experiencing disease relapse in advanced stages. Response rates to traditional immunotherapies are low and novel approaches such as the bifunctional fusion protein Bintrafusp alfa (BA) that concurrently blocks PD-L1 signaling and neutralizes TGFβ are actively under investigation. Our group showed that when HNSCC patients received neoadjuvant BA therapy, it reversed exhaustion of tumor-infiltrating lymphocytes (TILs) by promoting antigen-mediated signaling. Additionally, we observed that BA promoted recirculation of TILs into peripheral blood possibly through decreased expression of the TGF-β-driven tissue-retention marker CD103. We hypothesize that addition of TGFβ neutralization to PD-L1 blockade can enhance systemic anti-tumor immunity compared to PD-L1 blockade alone. We assessed immune responses to BA in wild-type mice bearing established mouse oral cancer (MOC)-1 tumors that were randomized into the following groups: 1) vehicle; 2) anti-PD-L1 antibody (Avelumab); 3) TGFβ neutralizing construct with a mutated PD-L1 antibody (BA-M); 4) TGFβ neutralizing construct with a functional PD-L1 antibody (BA). Additionally, since our previous data suggests that BA responsiveness depends on CD8 T cell activity, we included two extra groups 5) CD8 depleting antibody alone or 6) in combination with BA. Three days after completing treatment, MOC-1 tumor cells were injected into the contralateral flank and engraftment and progression of secondary challenge tumors was analyzed. Primary tumor progression was significantly inhibited by BA and to a lesser extent avelumab compared to control or BA-M. Engraftment or progression of secondary challenge tumors was significantly inhibited by BA and to a lesser extent avelumab compared to control or BA-M. The growth inhibitory effects of BA were abrogated by CD8 depletion in both the primary and challenge tumors. Flow cytometry analysis of tissue collected on day 7 post-tumor challenge showed that BA-mediated clearance of the tumors was associated with a proportional increase of CD4+ and CD8+ TILs. We also observed that the frequency of CD103 expression among CD4+ TILs was reduced both in the primary and challenge tumors. Although TGFβ neutralization alone fails to induce anti-tumor immunity, the addition of TGFβ neutralization to PD-L1 blockade provides greater control of primary tumor growth and protection from engraftment of a challenge tumor compared to PD-L1 blockade alone. Through adoptive transfer of tumor-specific T cell receptor-engineered T cells, ongoing experiments aim to determine if TGFβ-driven CD103 expression is required for T cell tumor residency and if neutralization of TGFβ in the setting of PD-L1 immune checkpoint blockade allows for recirculation of tumor-specific T cells into the periphery.

Citation Format: Magdalena Rainey, Marco Craveiro, Yvette Robbins, Cem Sievers, Clint T. Allen. Combined TGFβ/PD-L1 blockade enhances systemic antitumor immunity in head and neck cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6422.

A multi-center analysis of the impact of DA-EPOCH-R dose-adjustment on clinical outcomes of patients with double/triple-hit lymphoma

Patients with double- and triple-hit lymphomas (DHL/THL) have inferior outcomes with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), and higher-intensity regimens such as dose-adjusted (DA)-EPOCH-R are standard. Dose-intensification of DA-EPOCH-R is guided by hematologic toxicity, without conclusive benefit for DHL/THL patients. To determine if cumulative doses of DA-EPOCH-R or compliance with dose adjustment impacts survival, we retrospectively evaluated detailed clinical data from 109 adult (age ≥18 years) patients with DHL/THL treated with ≥4 cycles of induction DA-EPOCH-R from 2014 to 2019 at six centers. A comprehensive multivariate analysis was performed. Survival outcomes for the entire cohort were comparable to historical estimates for DHL/THL treated with this regimen (median follow-up 27.9 months). Overall survival (OS) and progression-free survival (PFS) were not significantly associated with cumulative chemotherapy dose, dose escalation, or compliance with dose adjustment. Heterogeneous dosing practices were observed. Prospective investigation is warranted to evaluate the practice of dose adjustment of R-EPOCH for patients with DHL/THL.

Transcriptomic Features of Cribriform and Intraductal Carcinoma of the Prostate

BACKGROUND

Cribriform (CF) and/or intraductal carcinoma (IDC) are associated with more aggressive prostate cancer (CaP) and worse outcomes.

OBJECTIVE

The transcriptomic features that typify CF/IDC are not well described and the capacity for clinically utilized genomic classifiers to improve risk modeling for CF/IDC remains undefined.

DESIGN, SETTING, AND PARTICIPANTS

We performed a retrospective review of CaP patients who had Decipher testing at a single high-volume institution. Index lesions from radical prostatectomy specimens were identified by genitourinary pathologists who simultaneously reviewed prostatectomy specimens for the presence of CF and IDC features. Patients were grouped based on pathologic features, specifically the absence of CF/IDC (CF-/IDC-), CF positive only (CF+/IDC-), and CF/IDC positive (CF+/IDC+).

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Clinical, pathologic, and genomic categorical variables were assessed using the Pearson chi-square test, while quantitative variables were assessed with the Kruskal-Wallis test. Multivariable logistic regression was used to identify the predictors of high-risk Decipher scores (>0.60). A gene set enrichment analysis was performed to identify genes and gene networks associated with CF/IDC status.

RESULTS AND LIMITATIONS

A total of 463 patients were included. Patients who were CF+/IDC+ had the highest Decipher risk scores (CF+/IDC+: 0.79 vs CF+/IDC-: 0.71 vs CF-/IDC-: 0.56, p < 0.001). On multivariate logistic regression, predictors of high-risk Decipher scores included the presence of CF, both alone (CF+/IDC-; odds ratio [OR]: 5.45, p < 0.001) or in combination with positive IDC status (CF+/IDC+; OR: 6.87, p < 0.001). On the gene set enrichment analysis, MYC pathway upregulation was significantly enriched in tumor samples from CF/IDC-positive patients (normalized enrichment score [NES]: 1.65, p = 0.046). Other enriched pathways included E2F targets (NES: 1.69, p = 0.031) and oxidative phosphorylation (NES: 1.68, =0 .033).

CONCLUSIONS

This is the largest series identifying an association between a clinically validated genomic classifier and the presence of CF and IDC at radical prostatectomy. Tumors with CF and intraductal features were associated with aggressive transcriptomic signatures.

PATIENT SUMMARY

Genomic-based tests are becoming readily available for the management of prostate cancer. We observed that Decipher, a commonly used genomic test in prostate cancer, correlates with unfavorable features in tissue specimens.

A genomic classifier for prostate cancer correlates with adverse pathologic features: Transcriptomic features of cribriform and intraductal carcinoma of the prostate

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Background: Invasive cribriform and intraductal carcinoma (CF/IDC) portends an unfavorable prognosis for patients diagnosed with prostate cancer (CaP). Limited studies with small sample sizes have explored whether genomic classifiers are associated with IDC and/or CF status. We investigated the correlation between Decipher genomic risk score and IDC/CF status and assessed PCa transcriptomic features. Methods: We performed a retrospective review of CaP patients who had Decipher testing at a single high volume center between 2009-2020. The highest grade index lesion from radical prostatectomy specimens was identified by GU pathologists and used for Decipher testing. Genitourinary pathologists reviewed prostatectomy specimens for the presence of CF and IDC features. Patients were divided into three groups based on pathologic features, absent CF/IDC (CF-/IDC-), CF positive only (CF+/IDC-), and CF/IDC positive (CF+/IDC+). Categorical clinical, genomic, and pathologic variables were assessed using the Pearson Chi-Square test, quantitative with the Kruskal-Wallis test. Multivariable logistic regression was used to identify predictors of high-risk Decipher GC scores. The Kaplan-Meier method with log-rank was used to compare biochemical recurrence free survival. Differential gene expression and gene network analysis was used to identify genes and pathways associated with IDC/CF features. Results: 463 patients were included with a median follow-up of 25 months. Patients who were CF+/IDC+ had higher GC scores (CF+/IDC+: 0.77 vs. CF+/IDC-: 0.71 vs. CF-/IDC-: 0.61, p<0.001). Patients who were CF+/IDC+ had a higher percentage of Gleason grade group >3 (CF+/IDC+: 79% vs. CF+/IDC-: 52% vs. CF-/IDC-: 52%, p<0.001). On multivariate logistic regression, predictors of high-risk GC score were presence of CF+/IDC+ features on final pathology (OR: 3.94, p<0.001) and pathologic Gleason grade group >3 (OR: 1.58, p=0.04). Transcriptomic analysis revealed that the hallmark androgen response pathway was significantly upregulated in CF+/IDC+ patients (Log fold change: 15.7, p<0001). Conclusions: This is the largest series investigating the association of a clinically validated genomic classifier and pathologic features such as cribriform and intraductal carcinoma. These findings have implications for the use of genomic classifiers in settings where expert GU pathology is not readily available and in potentially unmasking adverse histology at the time of biopsy.[Table: see text]

Sex differences in response to red and blue light in human primary visual cortex: a bold fMRI study

Studies using a variety of investigative methods, including functional brain imaging and electroencephalography (EEG), have suggested that changes in central nervous system (CNS) dopamine function result in altered visual system processing. The discovery of abnormal retinal blue cone, but not red cone, electroretinogram in association with cocaine withdrawal and Parkinson's disease suggests that visual system response to blue light might be a marker for CNS dopamine tone. As there are numerous sex-related differences in central nervous system dopamine function, we predicted that blue and red light stimulation would produce sex-specific patterns of response in primary visual cortex when studied using the blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) technique. We analyzed the BOLD response to red and blue light in male and female human volunteers (N=20). Red and blue light responses in primary visual cortex (V1) to stepped intensities of red and blue light were compared by sex for threshold to detectable BOLD signal increase and for stimulus intensity vs. BOLD signal response. Near threshold, males and females showed similar BOLD signal change to red light, but males showed a threefold greater increase (0.52%) to blue light stimulation when compared to females (0.14%). Log-linear regression modeling revealed that the slope coefficients for the red light stimulus intensity vs. signal change curve were not significantly different for males and females (z=0.995, P=0.320), whereas the slope coefficients for the blue light stimulus intensity vs. signal change curve were significantly larger in males (z=2.251, P=0.024). These findings support a sex and color-dependent differential pattern of primary visual cortical response to photic stimulation and suggest a method for assessing the influence of specific dopamine agonist/antagonist medications on visual function.

The yeast CDC9 gene encodes both a nuclear and a mitochondrial form of DNA ligase I

BACKGROUND

The yeast CDC9 gene encodes a DNA ligase I activity required during nuclear DNA replication to ligate the Okazaki fragments formed when the lagging DNA strand is synthesised. The only other DNA ligase predicted from the yeast genome sequence, DNL4/LIG4, is specifically involved in a non-homologous DNA end-joining reaction. What then is the source of the DNA ligase activity required for replication of the yeast mitochondrial genome?

RESULTS

We report that CDC9 encodes two distinct polypeptides expressed from consecutive in-frame AUG codons. Translational initiation at these two sites gives rise to polypeptides differing by a 23 residue amino-terminal extension, which corresponds to a functional mitochondrial pre-sequence sufficient to direct import into yeast mitochondria. Initiation at the first AUG codon results in a 755 amino-acid polypeptide that is imported into mitochondria, whereupon the pre-sequence is proteolytically removed to yield the mature mitochondrial form of Cdc9p. Initiation at the second AUG codon produces a 732 amino-acid polypeptide, which is localised to the nucleus. Cells expressing only the nuclear isoform were found to be specifically defective in the maintenance of the mitochondrial genome.

CONCLUSIONS

CDC9 encodes two distinct forms of DNA ligase I. The first is targeted to the mitochondrion and is required for propagation and maintenance of mitochondrial DNA, the second localises to the nucleus and is sufficient for the essential cell-division function associated with this gene.

Phase III study of BCOP v CHOP in unfavorable categories of malignant lymphoma: a Southeastern Cancer Study Group trial

A total of 296 evaluable patients with unfavorable categories of malignant lymphoma were randomly assigned treatment with cyclophosphamide, vincristine, and prednisone plus BCNU (BCOP) or doxorubicin (CHOP). In diffuse histiocytic (DH) lymphoma, CHOP produced superior complete (54% v 34%) and total (70% v 46%) response rates. Among the responders to either therapy, no differences were seen in duration of response or survival times. Median duration of response has not been reached with follow-up in excess of 50 months. In categories of lymphoma other than DH (including small-cell, mixed, and nodular histiocytic lymphomas), complete (27% v 29%) and total (48% v 54%) responses were similar for BCOP and CHOP, as were durations of response and survival. These data suggest that BCOP and CHOP are equivalent regimens for other categories of malignant lymphomas. CHOP appears preferable for diffuse large-cell categories, since it resulted in greater overall survival in patients with DH lymphoma; this was due to a significantly greater response rate, since patients with DH lymphoma who did respond to BCOP maintained their response and survived as long as did the CHOP responders.

Two monoclonal antibodies raised against a Burkitt lymphoma cell line recognise different cell types within lymphoid follicles

Monoclonal antibodies were raised against a laboratory derived variant of the Raji Burkitt lymphoma cell line. We have characterized two of these antibodies by screening on haematopoietic cell lines, and frozen sections of both reactive and neoplastic lymphoid tissue, and found reactivity with separate cellular components of lymphoid follicles. Monoclonal FW37.4.D5 reacts in section specifically with follicular dendritic reticular cells. Monoclonal 35.1C5 reacts with a subpopulation of splenic marginal zone, and lymph node mantle zone, B lymphocytes, but stains only rare cells within germinal centres. This monoclonal is operationally B lymphocyte specific, distinguishing an 'intermediate' B cell subset, represented in lymphoma by B chronic lymphocytic leukaemia, B hairy cell leukaemia and centrocytic lymphoma.

T lymphoblastic lymphoma with LEU-7 positive phenotype and unusual clinical course: a multiparameter study

Immunologic phenotype studies were performed on cells and on frozen sections of involved tissue from a 20 year old female with typical T-cell lymphoblastic (convoluted) lymphoma. The cells demonstrated a thymic phenotype but in addition marked with Leu-7 (HNK-1)--an antibody reported to identify human natural killer/killer (NK/K) cells. Normal or neoplastic cells with this phenotype have not been previously reported. These findings support the existence of a thymic precursor for a T-cell subset of Leu-7 + cells. The unusual clinical response to therapy is another feature of this unique case.

The beta-receptor: isoproterenol anxiety states

To learn the effect of isoproterenol on patients meeting Research Diagnostic Criteria (RDC) for panic disorder, we administered isoproterenol, racemic sodium lactate, and glucose to them and to nonpsychiatric control subjects. Each subject received all 3 infusions, double-blind in random order. A 21-item self-rating panic scale was constructed from the RDC for panic disorder and was used to identify RDC panic attacks. The results of this study and the preliminary results from the infusions after treatment with imipramine are discussed in the text, and the results from the first patient to be reinfused after treatment are presented graphically.

The immunohistological demonstration of carcinoembryonic antigen in intra-epithelial and invasive squamous carcinoma of the cervix

Using the sensitive peroxidase, anti-peroxidase immunohistological technique, carcinoembryonic antigen (CEA) was studied in formalin-fixed, paraffin-embedded cervical specimens from 225 patients. CEA was demonstrated in 33% of moderate dysplasia, 78.5% of severe dysplasia, 79% of in-situ carcinoma and 78% of invasive carcinoma. CEA was not demonstrated in normal squamous epithelium, squamous metaplasia, reserve cell hyperplasia nor in mild dysplasia.

Carcinoembryonic antigen levels in cervico-vaginal fluid from patients with intra-epithelial and invasive carcinoma of the cervix

Carcinoembryonic antigen (CEA) levels have been measured in cervico-vaginal washout fluid using the direct CEA Roche radioimmunoassay. Raised CEA levels were found associated with cervical intra-epithelial neoplasia and invasive carcinoma (85% above 300 ng/ml) compared with benign cervical lesions (29% above 300 ng/ml), suggesting that estimation of local CEA levels might be a useful adjunct to cytology and biopsy in the investigation of cervical neoplasia.

Systemic administration of human leukocyte interferon to melanoma patients. II. Cellular events associated with changes in natural killer cytotoxicity

Treatment of patients with malignant melanoma with daily doses of human leukocyte interferon (IFN) resulted in natural killer (NK) cytotoxicity that increased during the 1st week of treatment and subsequently declined to pretreatment levels despite continued IFN administration; events involved in these changes were examined. The increased cytotoxicity was associated with an increased number of cells able to bind K562 targets and an increased proportion of cells able to mediate cytolysis of K562 targets. The period of increasing NK activity was also associated with an increased ability to generate in vitro cytotoxic effectors against K562 targets by stimulation with allogeneic lymphoblastoid cells. The responding cells in this system were depleted of NK activity by adherence to immune complexes. These results suggested that increased NK activity during week 1 of in vivo treatment was associated with augmentation of the development of NK cells from noncytotoxic precursors in addition to direct effects on NK cells. In contrast, the decline in NK activity appeared to be primarily a direct effect on NK cells, because these cells could no longer be augmented in vitro by additional IFN. The refractory state to IFN augmentation of cytotoxicity was limited to the period of IFN treatment in vivo, and responsiveness to IFN was promptly regained upon cessation of treatment. No evidence for the development of suppressor cells of NK effector function could be obtained.