Systems approach for congruence and selection of cancer models towards precision medicine

Cancer models are instrumental as a substitute for human studies and to expedite basic, translational, and clinical cancer research. For a given cancer type, a wide selection of models, such as cell lines, patient-derived xenografts, organoids and genetically modified murine models, are often available to researchers. However, how to quantify their congruence to human tumors and to select the most appropriate cancer model is a largely unsolved issue. Here, we present Congruence Analysis and Selection of CAncer Models (CASCAM), a statistical and machine learning framework for authenticating and selecting the most representative cancer models in a pathway-specific manner using transcriptomic data. CASCAM provides harmonization between human tumor and cancer model omics data, systematic congruence quantification, and pathway-based topological visualization to determine the most appropriate cancer model selection. The systems approach is presented using invasive lobular breast carcinoma (ILC) subtype and suggesting CAMA1 followed by UACC3133 as the most representative cell lines for ILC research. Two additional case studies for triple negative breast cancer (TNBC) and patient-derived xenograft/organoid (PDX/PDO) are further investigated. CASCAM is generalizable to any cancer subtype and will authenticate cancer models for faithful non-human preclinical research towards precision medicine.

Mobile and eHealth technologies in the management and prevention of nephrolithiasis: A systematic review

INTRODUCTION

Kidney stone disease (KSD) is a common urological condition that often requires long-term care. Mobile health (mHealth) and eHealth technologies have the potential to enhance chronic disease management and behavioral change. To assess opportunities to apply these tools to improve KSD treatment and prevention, we aimed to assess current evidence on the use, benefits, and limitations of mHealth and eHealth in KSD.

METHODS

We performed a systematic review of primary research studies of mHealth and eHealth in the evaluation and management of KSD. Two independent researchers screened citations by title and abstract for relevance, then full-text review was performed for descriptive summary of the studies.

RESULTS

A total of 37 articles were included for analysis. Primary domains of evidence included: 1) "smart" water bottles and mobile-device apps for tracking fluid consumption, which showed increased intake in most studies; 2) ureteral stent tracking platforms, which improved the rate of long-term retained stents; 3) virtual stone clinics, which have been suggested to increase access, lower costs, and have satisfactory outcomes; 4) smartphone-based endoscopy platforms, which offered cost-effective image quality in resource-limited settings; 5) patient information about KSD online, which was typically characterized as poor quality and/or accuracy, particularly on YouTube. Most studies were proof-of-concept or single-arm intervention designs, with limited assessment of effectiveness or long-term clinical outcomes.

CONCLUSIONS

Mobile and eHealth technologies have significant real-world applications to KSD prevention, intervention, and patient education. A lack of rigorous effectiveness studies currently limits evidence-based conclusions and incorporation in clinical guidelines.

Mixed invasive ductal lobular carcinoma is clinically and pathologically more similar to invasive lobular than ductal carcinoma

BACKGROUND

Mixed invasive ductal lobular carcinoma (mDLC) remains a poorly understood subtype of breast cancer composed of coexisting ductal and lobular components.

METHODS

We sought to describe clinicopathologic characteristics and determine whether mDLC is clinically more similar to invasive ductal carcinoma (IDC) or invasive lobular carcinoma (ILC), using data from patients seen at the University of Pittsburgh Medical Center.

RESULTS

We observed a higher concordance in clinicopathologic characteristics between mDLC and ILC, compared to IDC. There is a trend for higher rates of successful breast-conserving surgery after neoadjuvant chemotherapy in patients with mDLC compared to patients with ILC, in which it is known to be lower than in those with IDC. Metastatic patterns of mDLC demonstrate a propensity to develop in sites characteristic of both IDC and ILC. A meta-analysis evaluating mDLC showed shared features with both ILC and IDC with significantly more ER-positive and fewer high grades in mDLC compared to IDC, although mDLCs were significantly smaller and included fewer late-stage tumours compared to ILC.

CONCLUSIONS

These findings support clinicopathologic characteristics of mDLC driven by individual ductal vs lobular components and given the dominance of lobular pathology, mDLC features are often more similar to ILC than IDC. This study exemplifies the complexity of mixed disease.

Abstract PS19-06: Role of the calcium-sensing receptor (CaSR) in invasive lobular breast carcinoma metastasis to the ovary

Invasive lobular carcinoma (ILC) is the second most common histological subtype of breast cancer, after the more common invasive ductal carcinoma (IDC). ILC accounts for 10 to 15% of all invasive breast carcinomas, affecting approx. 26,000-40,000 women in 2020 in the US alone. Despite 95% of ILC being Luminal A conferring patients a favorable prognosis, patients with ILC have poorer long-term outcomes when compared to patients with Luminal A IDC. ILC spread to common sites of ER+ breast cancer metastasis such as the bones, but are also three times more likely to spread to the ovaries, peritoneum, and gastrointestinal tract compared to IDC, and these unique aspects of metastases remain poorly understood. To better understand metastasis to the ovary we performed DNA and RNA sequencing of 11 pairs of primary breast tumor and ovarian metastasis as well as 13 orphan breast cancer ovarian metastases. Our cohort was enriched for lobular histology, with 13 samples originating from ILC, 6 from IDC and 6 from mixed ILC/IDC. We found mutations in CDH1 (43%), PIK3CA (40%), and FOXA1 (29%) highlighting the enrichment in ILC cases present in our cohort. Gene expression analysis lead to identification of 874 differentially expressed between primary tumors and ovarian metastases. We identified the calcium-sensing receptor CaSR as one of the top upregulated in ovarian metastases compared to primary tumor in 10 out of the 11 paired samples. Other genes highly expressed in ovarian metastases included TAC3, GLRA2, ALLC, MUC19, CHRNA2, PIP, CST4, and TEX15. Pathways analyses showed an enrichment of signaling through glutamate receptor and glycine receptor families. To assess the contribution of CaSR to breast cancer cell proliferation and metastatic properties, and due to the absence of breast cancer cell lines expressing CaSR, we generated CaSR overexpression models using lentiviral infection in MDA-MB-134, MDA-MB-330, BCK4 and SUM44PE ILC cell lines. While overexpression of CaSR alone did not confer a cell growth advantage or migratory ability to the cell lines, stimulation with calcium or a calcium mimetic resulted in enhanced migration in transwell assays in 3 of the 4 cell lines. Scratch assays further confirmed the stimulation of cell migration in cells with CaSR overexpression in the presence of calcium. Cell migration in CaSR overexpression models could be stimulated with the calcimimetic R568, and inhibited by the calcilytics NPS2143, and F-actin staining confirmed the need to activate the receptor to enhance migratory properties. Our studies further revealed that the induced migratory properties of CaSR overexpressing cells required estradiol and ER signaling, and that migration could be blocked with ER inhibitors such as ICI 182,780 and tamoxifen. Western blotting data revealed that the enhanced cell migratory properties of CaSR overexpressing cells was via activation of the MEK/ERK pathway and migration could be inhibited using specific small molecule pathway inhibitors.Altogether, our study provides insight on the potential mechanism by which upregulation of the CaSR supports breast cancer ovarian metastasis. We hope that these studies will not only deepen our understanding of ILC ovarian metastasis but will eventually lead to the development of more effective therapies and improve the outcome of patients with this understudied type of breast cancer.

Citation Format: Ye Qin, Laura Savariau, Ahmed Mohammed Basudan, Osama Shah, Zheqi Li, Tiantong Liu, Nilgun Tasdemir, Lan Coffman, Esther Elishaev, Jennifer M Atkinson, Peter Lucas, Adrian V Lee, Steffi Oesterreich. Role of the calcium-sensing receptor (CaSR) in invasive lobular breast carcinoma metastasis to the ovary [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS19-06.

Abstract PS7-15: Mixed invasive ductal lobular carcinomas (mDLC) are clinically more similar to invasive lobular carcinoma (ILC) than to invasive ductal carcinoma (IDC)

Clinicopathologic differences between histological subtypes of invasive breast cancer are increasingly being appreciated. Mixed invasive ductal lobular carcinomas (mDLC) are thought to be composed of both ductal and lobular components, and we sought to determine whether mDLC clinically align more closely with invasive ductal (IDC) or invasive lobular (ILC) carcinoma subtypes or if they display intermediate or unique features dissimilar to either type. Key clinical and histologic parameters were compared between cohorts of patients with mDLC (N = 410), IDC (N = 12,979), and ILC (N = 1,569) identified from cancer registry data of a single large healthcare system.Patients with mDLC were older (59 years (49 - 68)) than those with IDC (57 years (48 - 67), p = 0.014)) and younger than those with ILC (61 years (51 - 70), p = 0.006). Tumor size in mDLC was larger (19mm (12 - 27)) than IDC (16mm (10 - 25), p < 0.001) and smaller than ILC (20mm (12 - 35), p = 0.036). Similar to ILC, mDLC were more likely than IDC to be ER+ (92% vs 78% in IDC, p < 0.001), and less likely to be HER2+ (8% vs 15% in IDC, p = 0.04). mDLC were also similar to ILC with regards to higher likelihood of diagnosis at higher stage (p < 0.001), yet with lower grade (p < 0.001), at diagnosis as compared to IDC. Heatmap visualization, as well as dimension reduction by multidimentional scaling (MDS), demonstrates significant overlap of the mDLC and ILC cohorts. Furthermore, an elastic net regression model based on clinicopathologic parameters predicts mDLC to align more closely with ILC than IDC. For patients for whom oncotype Dx scores were available, there was a trend for enrichment of low risk RS scores with rare high-risk RS tumors in mDLC, similar to ILC. With regards to response to neoadjuvant chemotherapy, a subset of the aforementioned cohorts who had received neoadjuvant chemotherapy, mDLC (N = 17), IDC (N = 180), and ILC (N = 57), were compared. Among patients in whom breast conserving surgery (BCS) was attempted, patients with IDC were more likely to have a successful BCS than those with ILC, with less margin positivity thereby avoiding re-excision and/or completion mastectomy (70% vs 32%, respectively; p = 0.003). Successful BCS was achieved with mDLC 56% of the time, although compared to IDC and ILC statistical significance was not reached. In a limited cohort receiving neoadjuvant endocrine therapy (mDLC (N = 7), IDC (N = 37), and ILC (N = 21)) no differences with regard to rates of successful BCS were identified. Pathologic complete response rates (pCR) were additionally evaluated, although small study numbers precluded our ability to perform statistical analysis.Collectively, the aforementioned findings support a higher concordance between mDLC and ILC as compared to IDC. It is feasible that the lobular component of mDLC tumors is predominant, leading to the observed histopathologic similarities noted between mDC and ILC cohorts. We are planning meta-analyses including data from other institutions, and molecular studies to further understand complexities of mDLC.The authors acknowledge grant support from ASCO Conquer Cancer (to NW and AN).

Citation Format: Azadeh Nasrazadani, Yujia Li, Yusi Fang, Osama Shah, Jennifer M Atkinson, Joanna S Lee, Priscilla F McAuliffe, Adrian V Lee, George Tseng, Peter Lucas, Steffi Oesterreich, Norman Wolmark. Mixed invasive ductal lobular carcinomas (mDLC) are clinically more similar to invasive lobular carcinoma (ILC) than to invasive ductal carcinoma (IDC) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-15.

Abstract PS1-10: Outcomes after sentinel lymph node biopsy and radiation therapy in women over 70 years old with ER+, HER2-, clinically node negative breast cancer

Overtreatment of early-stage breast cancer with favorable tumor biology in elderly patients can result in higher rates of complications and morbidities without impacting survival. Guidelines directed towards deimplementation of sentinel lymph node biopsy (SLNB) (Choosing Wisely) and radiation therapy (RT) (National Comprehensive Cancer Network) have been recommended. We sought to describe rates and impact on disease recurrence and survival of SLNB and RT in elderly patients with early breast cancer. Patient data were obtained from the cancer registry and electronic health record from University of Pittsburgh Medical Center, multicenter, single health care system. Consecutive female patients aged ≥ 70 with ER+, HER2- clinically node-negative breast cancer within a health care system from 2010 to 2018 were identified. Rates and patient characteristics associated with receipt of SLNB and RT, as well as local recurrence free survival (LRFS) and disease-free survival (DFS) were compared for patients that were diagnosed between 2010 and 2014 to allow for adequate follow up time. Cox proportional hazards regression was used to estimate hazard ratios (HRs) of mortality. Among 3,361 identified women, 2,195 (65.3%) received SLNB and 1,828 (54.4%) received RT. Rates of SLNB steadily increased (1.0% per year); this trend persisted in 2017 and 2018, even after the Society of Surgical Oncology adopted the Choosing Wisely Guidelines in 2016. During the same time period, rates of RT declined (3.4% per year). To examine outcomes, we limited the analysis to 2109 cases from 2010-2014; median (IQR) follow up time was 4.1 (2.5-5.7) years. Median (IQR) age was 77 (73-82) years. 1373 (65.1%) received SLNB and 1,219 (57.8%) received RT. Patients receiving SLNB were younger (P < 0.001) with smaller (P < 0.0001) and lower stage (P < 0.0001) tumors. They had fewer comorbidities (P < 0.001), longer follow-up times (P < 0.001), were less likely on Medicaid/Medicare (P = 0.0091), and were more often seen at an academic center (P < 0.0001). There was no difference in grade between those that did and did not receive SLNB (P = 0.31) and those that did and did not receive RT (P = 0.13). Multivariate cox proportional hazard analysis showed no effect of SLNB on LRFS (HR = 1.17, 95% CI 0.29-4.75, P = 0.83) or DFS (HR = 0.90, 95% CI 0.44-1.83, P = 0.77). Log rank test showed no difference in 5-year LRFS (P = 0.78) between patients who received (98.5%, 95% CI 97.7%-99.7%) and did not receive (98.1%, 95% CI 96.7%-99.5%) SLNB, but an increase was seen with 5-year DFS (P = 0.023), with 96.2% (95% CI 95.0%-97.4%) of patients disease-free among those who did receive SLNB vs. 93.0% (95% CI 90.6%-95.4%) with no SLNB. Multivariate cox proportional hazard analysis showed that RT was associated with improved LRFS (HR = 0.13, 95% CI 0.03-0.51, P < 0.01) and DFS (HR = 0.32, 95% CI 0.15-0.68, P < 0.01). Log rank test showed a difference in 5-year LRFS (P < 0.0001) for those who received RT (99.4%, 95% CI 98.8%-100%) against those who did not (96.5%, 95% CI 95.0%-98.1%), and a similar difference in 5-year DFS (P < 0.0001) in patients who did (97.0%, 95% CI 95.8%-98.1%) and did not (92.4%, 95% CI 90.2%-94.7%) receive RT. Lower age (OR = 0.89, 95% CI 0.87-0.92) and comorbidities (OR = 0.79, 95% CI 0.66-0.94) were associated with receipt of SLNB, while only age (OR = 0.91, 95% CI 0.88-0.94) was associated with receipt of RT.

We conclude that receipt of SLNB has no impact upon DFS or LRFS. This data supports deimplementation of SLNB for this patient population. Receipt of RT is important for controlling locoregional recurrence, supporting use of RT in this patient cohort.

Citation Format: Priscilla F McAuliffe, Neil M Carleton, Jian Zou, Yusi Fang, Stephen E Koscumb, Osama Shah, Fangyuan Chen, Sushil Beriwal, Emilia J Diego, Adam M Brufsky, Steffi Oesterreich, Steve D Shapiro, Robert Ferris, Leisha A Emens, George Tseng, Oscar C Marroquin, Adrian V Lee. Outcomes after sentinel lymph node biopsy and radiation therapy in women over 70 years old with ER+, HER2-, clinically node negative breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-10.

Stem cell-based treatments for Type 1 diabetes mellitus: bone marrow, embryonic, hepatic, pancreatic and induced pluripotent stem cells

Type 1 diabetes mellitus--characterized by the permanent destruction of insulin-secreting β-cells--is responsive to cell-based treatments that replace lost β-cell populations. The current gold standard of pancreas transplantation provides only temporary independence from exogenous insulin and is fraught with complications, including increased mortality. Stem cells offer a number of theoretical advantages over current therapies. Our review will focus on the development of treatments involving tissue stem cells from bone marrow, liver and pancreatic cells, as well as the potential use of embryonic and induced pluripotent stem cells for Type 1 diabetes therapy. While the body of research involving stem cells is at once promising and inconsistent, bone marrow-derived mesenchymal stem cell transplantation seems to offer the most compelling evidence of efficacy. These cells have been demonstrated to increase endogenous insulin production, while partially mitigating the autoimmune destruction of newly formed β-cells. However, recently successful experiments involving induced pluripotent stem cells could quickly move them into the foreground of therapeutic research. We address the limitations encountered by present research and look toward the future of stem cell treatments for Type 1 diabetes.

Analysis of apical soft tissue margins during radical retropubic prostatectomy

PURPOSE

We determine the use of information gained with intraoperative biopsy and frozen section analysis of the apical soft tissue margin during nerve sparing radical retropubic prostatectomy.

MATERIALS AND METHODS

A separate 2 to 3 mm. circumferential biopsy was obtained from the apical soft tissue margin, and was sent for frozen and permanent section analysis during radical retropubic prostatectomy in 95 men with clinically localized adenocarcinoma of the prostate. A single pathologist examined the surgical and apical soft tissue margin specimens for evidence and extent of benign or malignant prostate tissue. Urinary continence was evaluated at catheter removal and 3 months postoperatively.

RESULTS

Of the patients 26% had positive surgical margins, of which 64% were positive apical margins. Permanent section of the apical soft tissue biopsy revealed no prostate in 39%, benign prostate in 54% and prostate cancer in 7% of patients. Because of the frozen section finding of adenocarcinoma in 3 patients, the apical soft tissue margin was further resected until the specimen was negative for malignancy. The apical soft tissue margin was the only positive margin site in 2 of these 3 patients. Positive surgical and apical margins, and percent tumor volumes greater than 26% on prostatectomy specimen had a significantly higher likelihood for positive apical soft tissue margins. The pathological finding of a positive apical margin on the surgical specimen had sensitivity, specificity, and positive and negative predictive values of 57%, 86%, 25% and 96%, respectively, for detecting prostate cancer on the apical soft tissue biopsy. Of the apical soft tissue biopsies 54% contained an element of benign prostatic tissue, although 92% of them contained benign tissue in less than 25% of the total specimen. Mean continence score in the men with and those without benign prostate tissue on apical soft tissue biopsy was 15.6 and 14.4, respectively (p = 0.15). The percent of men who required no protective pads for urinary continence at 3 months was 53% and 65% for those who had no prostate and those who had benign prostate tissue, respectively, in the apical soft tissue margin.

CONCLUSIONS

Excising and submitting an additional 2 to 3 mm. of apical soft tissue margin for permanent section analysis after prostate removal during radical prostatectomy represent an effective method for decreasing residual prostate tissue. Attempts at maximizing urethral length when dividing the prostato-urethral junction likely increases the chance of leaving residual prostate without improving continence.

The influence of out-of-plane geometry on the flow within a distal end-to-side anastomosis

This paper describes a computational and experimental investigation of flow in a proto-type model geometry of a fully occluded 45 deg distal end-to-side anastomosis. Previous investigations have considered a similar configuration where the centerlines of the bypass and host vessels lie within a plane, thereby producing a plane of symmetry within the flow. We have extended these investigations by deforming the bypass vessel out of the plane of symmetry, thereby breaking the symmetry of the flow and producing a nonplanar geometry. Experimental data were obtained using magnetic resonance imaging of flow within perspex models and computational data were obtained from simulations using a high-order spectral/hp element method. We found that the nonplanar three-dimensional flow notably alters the distribution of wall shear stress at the bed of the anastomosis, reducing the peak wall shear stress peak by approximately 10 percent when compared with the planar model. Furthermore, an increase in the absolute flux of velocity into the occluded region, proximal to the anastomosis, of 80 percent was observed in the nonplanar geometry when compared with the planar geometry.