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Nowak AK, Giroux DJ, Eisele M, Rosenthal A, Bille A, Gill RR, Kindler HL, Pass HI, Rice D, Ripley RT, Wolf A, Friedberg J, Nishimura K, Rusch VW. The IASLC Pleural Mesothelioma Staging Project: Proposal for Revision of the TNM Stage Groupings in the Forthcoming (Ninth) Edition of the TNM Classification for Pleural Mesothelioma. J Thorac Oncol 2024:S1556-0864(24)00207-7. [PMID: 38734072 DOI: 10.1016/j.jtho.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/28/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION The eighth edition of the tumor, node and metastases (TNM) classification of pleural mesothelioma (PM) saw substantial changes in T and N components and stage groupings. The International Association for the Study of Lung Cancer collected data into a multinational database in order to further refine this classification. This 9th edition proposal incorporates changes proposed in the clinical (c)T component, but not the pathologic (p)T component, to include size criteria, and further refines TNM stage groupings for PM. METHODS Data were submitted via electronic data capture (EDC) or batch transfer from institutional databases. Survival was measured from diagnosis date. Candidate stage groups were developed using a recursive partitioning and amalgamation (RPA) algorithm applied to all cM0 cases for clinical stage and subsequently for pathological stage. Cox models were developed to estimate survival for each stage group. RESULTS Of 3598 submitted cases, 2192 were analyzable for overall cStage and 445 for overall pStage. RPA generated survival tree on OS outcomes restricted to cM0 with newly proposed (9th edition) cT and cN component-derived optimal stage groupings of: stage I (T1N0), II (T1N1; T2N0), IIIA (T1N2; T2N1/2; any T3), IIIB (any T4), and IV (any M1). Although cT and pT descriptors are different in the 9th edition, aligning pStage groupings with cStage produced better discrimination than retaining 8th edition pStage groupings. CONCLUSIONS This revision of the clinical TNM classification for PM is the first to incorporate the measurement-based proposed changes in clinical T category. The pathological TNM aligns with clinical TNM.
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Affiliation(s)
- Anna K Nowak
- Medical School, the University of Western Australia.
| | | | - Megan Eisele
- Cancer Research And Biostatistics, Seattle, Washington, USA
| | - Adam Rosenthal
- Cancer Research And Biostatistics, Seattle, Washington, USA
| | - Andrea Bille
- Thoracic Surgery, Guy's Hospital, Thoracic Surgery, London, UK
| | - Ritu R Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Hedy L Kindler
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Illinois, USA
| | - Harvey I Pass
- Thoracic Surgery, NYU Langone Medical Center, New York, USA
| | - David Rice
- Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - R Taylor Ripley
- Department of Thoracic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Andrea Wolf
- Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joseph Friedberg
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | | | - Valerie W Rusch
- Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Bille A, Ripley RT, Giroux DJ, Gill RR, Kindler HL, Nowak AK, Opitz I, Pass HI, Wolf A, Rice D, Rusch VW. The IASLC Mesothelioma Staging Project: Proposals for the 'N' descriptors in the forthcoming 9th edition of the TNM classification for Pleural Mesothelioma. J Thorac Oncol 2024:S1556-0864(24)00208-9. [PMID: 38734073 DOI: 10.1016/j.jtho.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/29/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION The International Association for the Study of Lung Cancer developed an international database to inform potential revisions in the 9th edition of the Tumor, Node, Metastasis classification of diffuse pleural mesothelioma (PM). This study analyzed the clinical and pathological N categories to determine whether revisions were indicated relative to the 8th edition staging system. METHODS Of 7,338 PM cases diagnosed 2013 to 2022, 3,598 met all inclusion criteria for planned analyses. Data on 2,836 patients without metastases were included in this study. Overall survival (OS) was measured from date of diagnosis. Patients were included regardless of whether they received neoadjuvant treatment. For the pathological N analysis, patients who underwent resection (extrapleural pneumonectomy or pleurectomy/decortication) were included. N subgroups were analyzed and overall survival (OS) assessed by the Kaplan Meier method. RESULTS The existing 8th edition N categories performed adequately in the 9th edition dataset. A median OS advantage was noted for clinical and pathological N0 versus N1 patients: 23.2 versus 18.5 and 33.8 vs. 25.0 months, respectively. Patients with resected pN0 had a 3-year OS of 48%. No difference in OS was noted for single versus multiple station nodal metastases. The number of nodal stations sampled at the time of resection was not associated with a difference in OS. CONCLUSIONS Data regarding clinical and pathological N categories corroborate those used in the 8th edition. No changes in the N categories are recommended in the 9th edition of PM staging system.
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Affiliation(s)
- Andrea Bille
- Thoracic Surgery Department, Guy's Hospital, London, UK.
| | - R Taylor Ripley
- Department of Thoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Ritu R Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hedy L Kindler
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Anna K Nowak
- National Centre for Asbestos-Related Diseases, Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital, Zurich, Switzerland
| | - Harvey I Pass
- Department of Thoracic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Andrea Wolf
- Department of Cardiothoracic Surgery, Icahn School of Medicine at Mt. Sinai, New York, NY, USA
| | - David Rice
- Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Medina CG, Xu Y, Ripley RT. International Prognostic Modeling: A Platform for Collaborative Approach for Patients With Mesothelioma. J Thorac Oncol 2023; 18:1618-1620. [PMID: 37993213 DOI: 10.1016/j.jtho.2023.09.1441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/13/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Cristian G Medina
- David J. Sugarbaker Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Yuan Xu
- David J. Sugarbaker Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - R Taylor Ripley
- David J. Sugarbaker Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
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Ripley RT, Holmes HM, Whitlock RS, Groth SS, Medina CG, Choi EA, Burt BM, Sugarbaker PH. Pleurectomy and decortication are associated with better survival for bicavitary cytoreductive surgery for mesothelioma compared with extrapleural pneumonectomy. J Thorac Cardiovasc Surg 2023; 165:1722-1730. [PMID: 36740497 DOI: 10.1016/j.jtcvs.2022.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Mesothelioma is a nearly uniformly fatal tumor. Multimodality therapy including cytoreductive surgery and chemotherapy is associated with long-term survival in some patients. Cytoreductive surgery for thoracic disease includes a lung-sparing operation called an "extended pleurectomy/decortication" or a lung-sacrificing surgery called an "extrapleural pneumonectomy." The benefit of cytoreductive surgery for bicavitary disease (chest and abdomen) is poorly understood. Our objective was to evaluate the long-term survivals for patients undergoing cytoreductive surgery for bicavitary disease and to determine whether any prognostic factors were associated with outcome. METHODS We reviewed our Institutional Review Board-approved, institutional, International Association for the Study of Lung Cancer Mesothelioma Staging Project database. Inclusion criteria were all patients who underwent cytoreductive surgery for bicavitary disease. Overall survival was calculated by Kaplan-Meier methodology. All International Association for the Study of Lung Cancer database elements were evaluated by univariable analysis. RESULTS From February 2014 to August 2021, 440 patients with mesothelioma were evaluated. Fourteen patients (3%) underwent cytoreductive surgery of both chest and abdomen as a planned 2-stage operation. Most patients (13/14; 93%) underwent chest surgery before abdomen surgery. For the entire cohort, the median overall survival was 33.6 months with a 5-year survival of 20%. Extended pleurectomy/decortication was associated with a better outcome compared with extrapleural pneumonectomy, with median overall survivals of 58.2 versus 13.5 months, respectively. CONCLUSIONS For a highly selected group of patients with bicavitary mesothelioma, long-term survival can be achieved with an aggressive, staged surgical approach. The patients who undergo extended pleurectomy/decortication with preservation of the lung appear to have more favorable outcomes compared with patients undergoing extrapleural pneumonectomy.
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Affiliation(s)
- R Taylor Ripley
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
| | - Hudson M Holmes
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Richard S Whitlock
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Shawn S Groth
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Cristian G Medina
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Eugene A Choi
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Bryan M Burt
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Paul H Sugarbaker
- Center for Gastrointestinal Malignancy, MedStar Washington Hospital Center, Washington, DC
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Ripley RT, Antonoff M, Huang J, Suzuki K, Gibney BC. Management of Multiple Ground Glass Opacities before or after Lobectomy. Semin Thorac Cardiovasc Surg 2023; 35:574-582. [PMID: 37087345 DOI: 10.1053/j.semtcvs.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Indexed: 04/24/2023]
Affiliation(s)
- R Taylor Ripley
- Micheal E. DeBakey Department of Surgery, Division of General Thoracic Surgery, Baylor College of Medicine, Houston, Texas.
| | - Mara Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Barry C Gibney
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
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Lee HS, Jang HJ, Ramineni M, Wang DY, Ramos D, Choi JM, Splawn T, Espinoza M, Almarez M, Hosey L, Jo E, Hilsenbeck S, Amos CI, Ripley RT, Burt BM. A Phase II Window of Opportunity Study of Neoadjuvant PD-L1 versus PD-L1 plus CTLA-4 Blockade for Patients with Malignant Pleural Mesothelioma. Clin Cancer Res 2023; 29:548-559. [PMID: 36469573 PMCID: PMC9898180 DOI: 10.1158/1078-0432.ccr-22-2566] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/13/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE We report the results of a phase II, randomized, window-of-opportunity trial of neoadjuvant durvalumab versus durvalumab plus tremelimumab followed by surgery in patients with resectable malignant pleural mesothelioma (MPM; NCT02592551). PATIENTS AND METHODS The primary objective was alteration of the intratumoral CD8/regulatory T cell (Treg) ratio after combination immune checkpoint blockade (ICB) therapy. Secondary and exploratory objectives included other changes in the tumor microenvironment, survival, safety, tumor pathologic response (PR), and systemic immune responses. RESULTS Nine patients received monotherapy and 11 received combination therapy. Seventeen of the 20 patients (85%) receiving ICB underwent planned thoracotomy. Both ICB regimens induced CD8 T-cell infiltration into MPM tumors but did not alter CD8/Treg ratios. At 34.1 months follow-up, patients receiving combination ICB had longer median overall survival (not reached) compared with those receiving monotherapy (14.0 months). Grade ≥3 immunotoxicity occurred in 8% of patients in the monotherapy group and 27% of patients in the combination group. Tumor PR occurred in 6 of 17 patients receiving ICB and thoracotomy (35.3%), among which major PR (>90% tumor regression) occurred in 2 (11.8%). Single-cell profiling of tumor, blood, and bone marrow revealed that combination ICB remodeled the immune contexture of MPM tumors; mobilized CD57+ effector memory T cells from the bone marrow to the circulation; and increased the formation of tertiary lymphoid structures in MPM tumors that were rich in CD57+ T cells. CONCLUSIONS These data indicate that neoadjuvant durvalumab plus tremelimumab orchestrates de novo systemic immune responses that extend to the tumor microenvironment and correlate with favorable clinical outcomes.
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Affiliation(s)
- Hyun-Sung Lee
- Systems Onco-Immunology Laboratory, David J. Sugarbaker Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Hee-Jin Jang
- Systems Onco-Immunology Laboratory, David J. Sugarbaker Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Maheshwari Ramineni
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX 77030
| | - Daniel Y. Wang
- Section of Hematology and Oncology, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Daniela Ramos
- Systems Onco-Immunology Laboratory, David J. Sugarbaker Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jong Min Choi
- Systems Onco-Immunology Laboratory, David J. Sugarbaker Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Taylor Splawn
- Systems Onco-Immunology Laboratory, David J. Sugarbaker Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Monica Espinoza
- Systems Onco-Immunology Laboratory, David J. Sugarbaker Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Michelle Almarez
- Systems Onco-Immunology Laboratory, David J. Sugarbaker Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Leandria Hosey
- Systems Onco-Immunology Laboratory, David J. Sugarbaker Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Eunji Jo
- Advanced Technology Cores, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Susan Hilsenbeck
- Advanced Technology Cores, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Christopher I. Amos
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX
| | - R. Taylor Ripley
- David J. Sugarbaker Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Bryan M. Burt
- Systems Onco-Immunology Laboratory, David J. Sugarbaker Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
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Brown K, Jenkins LMM, Crooks DR, Surman DR, Mazur SJ, Xu Y, Arimilli BS, Yang Y, Lane AN, Fan TWM, Schrump DS, Linehan WM, Ripley RT, Appella E. Targeting mutant p53-R248W reactivates WT p53 function and alters the onco-metabolic profile. Front Oncol 2023; 12:1094210. [PMID: 36713582 PMCID: PMC9874945 DOI: 10.3389/fonc.2022.1094210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
TP53 is the most commonly mutated gene in cancer, and gain-of-function mutations have wide-ranging effects. Efforts to reactivate wild-type p53 function and inhibit mutant functions have been complicated by the variety of TP53 mutations. Identified from a screen, the NSC59984 compound has been shown to restore activity to mutant p53 in colorectal cancer cells. Here, we investigated its effects on esophageal adenocarcinoma cells with specific p53 hot-spot mutations. NSC59984 treatment of cells reactivated p53 transcriptional regulation, inducing mitochondrial intrinsic apoptosis. Analysis of its effects on cellular metabolism demonstrated increased utilization of the pentose phosphate pathway and inhibition of glycolysis at the fructose-1,6-bisphosphate to fructose 6-phosphate junction. Furthermore, treatment of cells with NSC59984 increased reactive oxygen species production and decreased glutathione levels; these effects were enhanced by the addition of buthionine sulfoximine and inhibited by N-acetyl cysteine. We found that the effects of NSC59984 were substantially greater in cells harboring the p53 R248W mutation. Overall, these findings demonstrate p53-dependent effects of NSC59984 on cellular metabolism, with increased activity in cells harboring the p53 R248W mutation. This research highlights the importance of defining the mutational status of a particular cancer to create a patient-centric strategy for the treatment of p53-driven cancers.
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Affiliation(s)
- Kate Brown
- Laboratory of Cell Biology, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States,*Correspondence: Kate Brown,
| | - Lisa M. Miller Jenkins
- Laboratory of Cell Biology, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Daniel R. Crooks
- Urologic Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Deborah R. Surman
- Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Sharlyn J. Mazur
- Laboratory of Cell Biology, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Yuan Xu
- Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Bhargav S. Arimilli
- Urologic Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Ye Yang
- Urologic Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Andrew N. Lane
- Center for Environmental and Systems Biochemistry, Department of Toxicology and Cancer Biology, Markey Cancer Center, UK, Lexington, KY, United States
| | - Teresa W-M. Fan
- Center for Environmental and Systems Biochemistry, Department of Toxicology and Cancer Biology, Markey Cancer Center, UK, Lexington, KY, United States
| | - David S. Schrump
- Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - W. Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
| | - R. Taylor Ripley
- Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Ettore Appella
- Laboratory of Cell Biology, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
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Ripley RT, Mansfield AS, Sepesi B, Bueno R, Burt BM. Checkpoint blockade in unresectable pleural mesothelioma: Event horizon for multimodal therapy. J Thorac Cardiovasc Surg 2023; 165:364-368. [PMID: 35221030 DOI: 10.1016/j.jtcvs.2022.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/27/2021] [Accepted: 01/11/2022] [Indexed: 12/16/2022]
Affiliation(s)
- R Taylor Ripley
- Division of General Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | | | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Raphael Bueno
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Bryan M Burt
- Division of General Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
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Jang HJ, Truong CY, Lo EM, Holmes HM, Ramos D, Ramineni M, Lee JS, Wang DY, Pietropaolo M, Ripley RT, Burt BM, Lee HS. Inhibition of Cyclin Dependent Kinase 4/6 Overcomes Primary Resistance to Programmed Cell Death 1 Blockade in Malignant Mesothelioma. Ann Thorac Surg 2022; 114:1842-1852. [PMID: 34592265 PMCID: PMC8957629 DOI: 10.1016/j.athoracsur.2021.08.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/20/2021] [Accepted: 08/30/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Despite the profound number of malignant pleural mesothelioma (MPM) patients now treated with programmed cell death 1 (PD-1) blockade, insight into the underpinnings of rational therapeutic strategies to treat resistance to checkpoint immunotherapy remains unrealized. Our objective was to develop a novel therapeutic approach to overcome primary resistance to PD-1 blockade in MPM. METHODS We generated a transcriptome signature of resistance to PD-1 blockade in MPM patients treated with nivolumab (4 responders and 4 nonresponders). We used The Cancer Genome Atlas MPM cohort (n = 73) to determine what genomic alterations were associated with the resistance signature. We tested whether regulation of identified molecules could overcome resistance to PD-1 blockade in an immunocompetent mouse malignant mesothelioma model. RESULTS Immunogenomic analysis by applying our anti-PD-1 resistance signature to The Cancer Genome Atlas cohort revealed that deletion of cyclin dependent kinase inhibitor 2A (CDKN2A) was highly associated with primary resistance to PD-1 blockade. Under the hypothesis that resistance to PD-1 blockade can be overcome by cyclin dependent kinase 4/6 (CDK4/6) inhibition, we tested whether CDK4/6 inhibitors could overcome resistance to PD-1 blockade in subcutaneous tumors derived from Cdkn2a-/- AB1 malignant mesothelioma cells, which were resistant to PD-1 blockade. The combination of daily oral administration of CDK4/6 inhibitors (abemaciclib or palbociclib) and intraperitoneal anti-PD-1 treatment markedly suppressed tumor growth compared with anti-PD-1 or CDK4/6 inhibitor alone. CONCLUSIONS We identified a therapeutic target, CDK4/6, to overcome primary resistance to PD-1 blockade through comprehensive immunogenomic approaches. These data provide a rationale for undertaking clinical trials of CDK4/6 inhibitors in more than 40% of patients with MPM who demonstrate loss of CDKN2A.
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Affiliation(s)
- Hee-Jin Jang
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Cynthia Y Truong
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Eric M Lo
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Hudson M Holmes
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Daniela Ramos
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Ju-Seog Lee
- Department of Systems Biology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel Y Wang
- Department of Hematology and Oncology, Baylor College of Medicine, Houston, Texas
| | - Massimo Pietropaolo
- Division of Endocrinology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - R Taylor Ripley
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Bryan M Burt
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Hyun-Sung Lee
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
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Jang HJ, Lee HS, Yu W, Ramineni M, Truong CY, Ramos D, Splawn T, Choi JM, Jung SY, Lee JS, Wang DY, Sederstrom JM, Pietropaolo M, Kheradmand F, Amos CI, Wheeler TM, Ripley RT, Burt BM. Therapeutic Targeting of Macrophage Plasticity Remodels the Tumor-Immune Microenvironment. Cancer Res 2022; 82:2593-2609. [PMID: 35709756 PMCID: PMC9296613 DOI: 10.1158/0008-5472.can-21-3506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/31/2022] [Accepted: 05/04/2022] [Indexed: 01/21/2023]
Abstract
SIGNIFICANCE Comprehensive single-cell proteomics analyses of lung adenocarcinoma progression reveal the role of tumor-associated macrophages in resistance to PD-1 blockade therapy. See related commentary by Lee et al., p. 2515.
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Affiliation(s)
- Hee-Jin Jang
- Systems Onco-Immunology Laboratory, Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.,Hee-Jin Jang and Hyun-Sung Lee have equally contributed as first authors
| | - Hyun-Sung Lee
- Systems Onco-Immunology Laboratory, Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.,Hee-Jin Jang and Hyun-Sung Lee have equally contributed as first authors.,Hyun-Sung Lee and Bryan M. Burt have equally contributed as corresponding authors
| | - Wendong Yu
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Maheshwari Ramineni
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Cynthia Y. Truong
- Systems Onco-Immunology Laboratory, Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Daniela Ramos
- Systems Onco-Immunology Laboratory, Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Taylor Splawn
- Systems Onco-Immunology Laboratory, Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jong Min Choi
- Systems Onco-Immunology Laboratory, Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Sung Yun Jung
- Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Ju-Seog Lee
- Department of Systems Biology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Daniel Y. Wang
- Division of Hemato-Oncology, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Joel M. Sederstrom
- Advanced Technology Cores, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Massimo Pietropaolo
- Division of Endocrinology, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Farrah Kheradmand
- Division of Pulmonology, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.,Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Department of Veterans Affairs, Houston, TX, United States
| | - Christopher I. Amos
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX
| | - Thomas M. Wheeler
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX 77030, USA
| | - R. Taylor Ripley
- Systems Onco-Immunology Laboratory, Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Bryan M. Burt
- Systems Onco-Immunology Laboratory, Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.,Hyun-Sung Lee and Bryan M. Burt have equally contributed as corresponding authors
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11
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Ripley RT, Loor G, Bharat A, Machuca T, Cypel M, Hoetzenecker K. Seminars AATS International Roundtable of Lung Transplantation for COVID-19. Semin Thorac Cardiovasc Surg 2022; 34:1028-1039. [PMID: 35697136 PMCID: PMC9187862 DOI: 10.1053/j.semtcvs.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/17/2022]
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12
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Ripley RT. Commentary: Immuno-chemo-radio-therapy before esophagectomy: Our next standard? JTCVS Open 2022; 9:300-301. [PMID: 36003458 PMCID: PMC9390731 DOI: 10.1016/j.xjon.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 11/21/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022]
Affiliation(s)
- R. Taylor Ripley
- Address for reprints: R. Taylor Ripley, MD, Department of Surgery, Division of General Thoracic Surgery, Baylor College of Medicine, 7200 Cambridge St, Suite 6A, Houston, TX 77030.
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13
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Drake JA, Diggs LP, Martin SP, Wach MM, Jafferji MS, Steinberg SM, Blakely AM, Davis JL, Hoang CD, Ripley RT, Hernandez JM. Characteristics of Matriculants to Thoracic Surgery Residency Training Programs. Ann Thorac Surg 2021; 112:2070-2075. [PMID: 33378696 PMCID: PMC9913615 DOI: 10.1016/j.athoracsur.2020.12.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 11/27/2020] [Accepted: 12/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Thoracic surgery (TS) residency positions are in high demand. There is no study describing the nationwide attributes of successful matriculants in this specialty. We examined the characteristics of TS resident applicants and identified factors associated with acceptance. METHODS Applicant data from 2014 to 2017 application cycles was extracted from the Electronic Residency Application System and stratified by matriculation status. Medical education, type of general surgery residency, and research achievements were analyzed. The number of peer-reviewed publications and the corresponding impact factor for the journals where they were published were quantified. RESULTS There were 492 applicants and 358 matriculants. The overall population was primarily male (79.5%), white (55.1%), educated at United States allopathic medical schools (66.5%), and trained at university-based general surgery residencies (59.6%). Education at United States allopathic schools (odds ratio [OR], 2.54; P < .0001), being a member of the American Osteopathic Association (OR, 3.27; P = .021), general surgery residency affiliation with a TS residency (OR, 2.41; P = .0003) or National Cancer Institute designated Comprehensive Cancer Center (OR, 1.76; P = .0172), and being a first-time applicant (OR, 4.71, P < .0001) were independently associated with matriculation. Matriculants published a higher number of manuscripts than nonmatriculants (median of 3 vs 2, P < .0001) and more frequently published in higher impact journals (P < .0001). CONCLUSIONS Our study includes objective and quantifiable data from recent application cycles and represents an in-depth examination of applicants to TS residency. The type of medical school and residency, as well as academic productivity, correlate with successful matriculation.
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Affiliation(s)
- Justin A Drake
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Laurence P Diggs
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sean P Martin
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael M Wach
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mohammad S Jafferji
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Andrew M Blakely
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jeremy L Davis
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Chuong D Hoang
- Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - R Taylor Ripley
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Jonathan M Hernandez
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
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14
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Mandl A, Welch JM, Kapoor G, Parekh VI, Schrump DS, Ripley RT, Walter MF, Del Rivero J, Jha S, Simonds WF, Jensen RT, Weinstein LS, Blau JE, Agarwal SK. Two distinct classes of thymic tumors in patients with MEN1 show LOH at the MEN1 locus. Endocr Relat Cancer 2021; 28:L15-L19. [PMID: 34515662 PMCID: PMC8558845 DOI: 10.1530/erc-21-0226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/10/2021] [Indexed: 11/08/2022]
Abstract
Patients with the multiple endocrine neoplasia type 1 (MEN1) syndrome carry germline heterozygous loss-of-function mutations in the MEN1 gene which predisposes them to develop various endocrine and non-endocrine tumors. Over 90% of the tumors show loss of heterozygosity (LOH) at chromosome 11q13, the MEN1 locus, due to somatic loss of the wild-type MEN1 allele. Thymic neuroendocrine tumors (NETs) or thymic carcinoids are uncommon in MEN1 patients but are a major cause of mortality. LOH at the MEN1 locus has not been demonstrated in thymic tumors. The goal of this study was to investigate the molecular aspects of MEN1-associated thymic tumors including LOH at the MEN1 locus and RNA-sequencing (RNA-Seq) to identify genes associated with tumor development and potential targeted therapy. A retrospective chart review of 294 patients with MEN1 germline mutations identified 14 patients (4.8%) with thymic tumors (12 thymic NETs and 2 thymomas). LOH at the MEN1 locus was identified in 10 tumors including the 2 thymomas, demonstrating that somatic LOH at the MEN1 locus is also the mechanism for thymic tumor development. Unsupervised principal component analysis and hierarchical clustering of RNA-Seq data showed that thymic NETs formed a homogenous transcriptomic group separate from thymoma and normal thymus. KSR2 (kinase suppressor of Ras 2), that promotes Ras-mediated signaling, was abundantly expressed in thymic NETs, a potential therapeutic target. The molecular insights gained from our study about thymic tumors combined with similar data from other MEN1-associated tumors may lead to better surveillance and treatment of these rare tumors.
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Affiliation(s)
- Adel Mandl
- Metabolic Diseases Branch, Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
| | - James M Welch
- Metabolic Diseases Branch, Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
| | - Gayathri Kapoor
- Metabolic Diseases Branch, Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
| | - Vaishali I Parekh
- Metabolic Diseases Branch, Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
| | - David S Schrump
- Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - R Taylor Ripley
- Division of General Thoracic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Mary F Walter
- NIDDK Clinical Core, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
| | - Jaydira Del Rivero
- Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Smita Jha
- Metabolic Diseases Branch, Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
| | - William F Simonds
- Metabolic Diseases Branch, Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
| | - Robert T Jensen
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
| | - Lee S Weinstein
- Metabolic Diseases Branch, Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
| | - Jenny E Blau
- Metabolic Diseases Branch, Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
| | - Sunita K Agarwal
- Metabolic Diseases Branch, Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
- Correspondence should be addressed to S K Agarwal:
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15
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Ripley RT. Commentary: Limitations of Data for Primary Pericardial Mesothelioma. Semin Thorac Cardiovasc Surg 2021; 34:1120-1121. [PMID: 34469797 DOI: 10.1053/j.semtcvs.2021.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/11/2022]
Affiliation(s)
- R Taylor Ripley
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
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16
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Zhang M, Hong JA, Kunst TF, Bond CD, Kenney CM, Warga CL, Yeray J, Lee MJ, Yuno A, Lee S, Miettinen M, Ripley RT, Hoang CD, Gnjatic S, Trepel JB, Schrump DS. Randomized phase II trial of a first-in-human cancer cell lysate vaccine in patients with thoracic malignancies. Transl Lung Cancer Res 2021; 10:3079-3092. [PMID: 34430349 PMCID: PMC8350099 DOI: 10.21037/tlcr-21-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 05/21/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Although most malignancies express cancer-testis antigens (CTA), immune responses to these proteins are limited in thoracic oncology patients. This trial was undertaken to examine if a cancer cell lysate vaccine could induce immunity to CTA, and to ascertain if metronomic cyclophosphamide and celecoxib enhances vaccine-induced immune responses. METHODS Eleven patients with primary thoracic malignancies and 10 patients with extrathoracic neoplasms metastatic to the chest rendered NED by conventional therapies were randomized to receive H1299 lung cancer cell lysates (10 mg protein/vaccine) with Iscomatrix™ adjuvant via deep intradermal injection q 4 weeks ×6 with or without daily oral metronomic cyclophosphamide/celecoxib. The primary endpoint was serologic response to purified CTA assessed 1 month after the 6th vaccination. Secondary endpoints included assessment of the effects of cyclophosphamide and celecoxib on frequency and magnitude of vaccine-induced immune responses to CTA. Exploratory endpoints included evaluation of the effects of the vaccine regimens on peripheral immune subsets. Standard of care imaging studies were obtained at baseline and 1 month after the 3rd and 6th vaccinations. RESULTS All patients exhibited local and systemic inflammatory responses lasting 72-96 hours following vaccinations. There were no dose limiting treatment related toxicities. Fourteen patients (67%) completed all six vaccinations. Eight of 14 patients (57%) exhibited serologic responses to NY-ESO-1. One patient developed antibodies to GAGE7; several patients exhibited reactivity to XAGE and MAGE-C2. Vaccine therapy decreased the percent of Tregs (P=0.0068), PD-1 expression on Tregs (P=0.0027), PD-L1 expression on CD14+ monocytes (P=0.0089), PD-L1 expression on classical monocytes (P=0.016), and PD-L1 expression on intermediate monocytes (P=0.0031). Cyclophosphamide/celecoxib did not appear to increase immune responses or enhance vaccine-induced alterations in peripheral immune subsets. CONCLUSIONS H1299 lysate vaccines with Iscomatrix™ induce immune responses to CTA and modulate peripheral immune subsets in a manner that may enhance antitumor immunity in patients with thoracic malignancies.
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Affiliation(s)
- Mary Zhang
- Thoracic Epigenetics Section, Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Julie A. Hong
- Thoracic Epigenetics Section, Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Tricia F. Kunst
- Thoracic Epigenetics Section, Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Colleen D. Bond
- Thoracic Epigenetics Section, Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Cara M. Kenney
- Thoracic Epigenetics Section, Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Cheryl L. Warga
- Thoracic Epigenetics Section, Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Javier Yeray
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Min-Jung Lee
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Akira Yuno
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Sunmin Lee
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Markku Miettinen
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - R. Taylor Ripley
- Thoracic Epigenetics Section, Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Chuong D. Hoang
- Thoracic Epigenetics Section, Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Sacha Gnjatic
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jane B. Trepel
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - David S. Schrump
- Thoracic Epigenetics Section, Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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17
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Gul NH, Ripley RT. Commentary: Radiomics: Can We Demystify the Subsolid Nodules? Semin Thorac Cardiovasc Surg 2021; 34:711. [PMID: 34089827 DOI: 10.1053/j.semtcvs.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/25/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Nabeel H Gul
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - R Taylor Ripley
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
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18
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Ali A, Holmes H, Wang H, Prather LL, Sabichi AL, Burt BM, Ripley RT, Lee HS, Wang DY. Anti-PD-1 monotherapy in patients with malignant mesothelioma: A retrospective single institution experience. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e20564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20564 Background: Malignant mesothelioma (MM) patients historically have poor outcomes, but immune checkpoint inhibitors have shown promising results in certain patients. We aimed to retrospectively assess efficacy and safety with use of anti-PD-1 monotherapy (aPD-1 Tx) in patients with MM at our institution from Dec 2015 to Dec 2020. Methods: We identified patients with MM treated with nivolumab or pembrolizumab. Clinical details including demographics, efficacy, and toxicity were collected. Efficacy was characterized based on overall response rate (ORR), progression-free survival (PFS) and overall survival (OS). Survival curves were generated using the Kaplan-Meier method, and intergroup comparisons were performed with the log-rank test. Univariable Cox regression analysis was used to determine whether variables were associated with survival. Results: We identified 61 patients treated with aPD-1 Tx for MM. Majority of patients (90%) had malignant pleural mesothelioma. Forty-two (69%) patients were male. The median age of initiation was 65 years (range: 30-84). Most patients (66%) had an ECOG performance status (PS) of 0-1. Known asbestos exposure was noted in 19 (31%) patients. Most patients had received prior chemotherapy (74%) and treated with nivolumab (89%). Only 66% of patients with known PD-L1 had positive expression ( > = 1%). There were 43 (70%) patients with epithelioid histology. Median follow-up was 22.2 months. ORR was 33% with stable disease in 25% of patients. In first-line aPD-1 Tx, ORR was 50%. PFS and OS at 12 months were 26% and 65%, respectively. The median PFS and OS were 5.1 and 15.6 months, respectively. PD-L1 positivity was not associated with improved PFS or OS. Univariable analysis demonstrated that ECOG PS 0-1 had significantly better OS with hazard ratio (HR) 0.40 (95% CI 0.20 – 0.83; p = 0.01). Immune-related adverse events (irAE) were seen in 33% of patients with 13 patients with grade 3 or higher (nephritis, pneumonitis, arthritis, leukocytosis, dermatitis, colitis, type 1 diabetes mellitus, tongue angioedema, and thrombocytopenia). One patient had grade 5 irAE due to severe thrombocytopenia. Patients who developed an irAE had significantly improved median OS (32.1 vs 12.1 months, p = 0.01). Conclusions: Anti-PD-1 monotherapy showed clinical efficacy and safety in malignant mesothelioma as both a first-line treatment and in pre-treated patients based on our real-world experience. The development of irAE may predict benefit, although fatal side effects can occur.
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Affiliation(s)
- Atif Ali
- UT Health Science Center at Houston, Houston, TX
| | | | | | | | - Anita Lyn Sabichi
- Baylor College of Medicine, Dan L. Duncan Comprehensive Cancer Center, Houston, TX
| | - Bryan M. Burt
- Division of General Thoracic Surgery, Baylor College of Medicine, Houston, TX
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19
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Ripley RT. Commentary: To Preserve or Not Preserve (The Lung): That Is the MPM Question. Semin Thorac Cardiovasc Surg 2021; 33:882-883. [PMID: 33878435 DOI: 10.1053/j.semtcvs.2021.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 11/11/2022]
Affiliation(s)
- R Taylor Ripley
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
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20
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Diggs LP, Martin SP, Drake JA, Ripley RT. Video-assisted thoracoscopic surgery pleurectomy: a suitable alternative for treating malignant pleural effusions. J Thorac Dis 2021; 13:2177-2183. [PMID: 34012568 PMCID: PMC8107536 DOI: 10.21037/jtd-19-3261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Malignant pleural effusions (MPEs) are common manifestations of metastatic cancers and are associated with a dismal prognosis. Talc pleurodesis has been proven to be effective in the management of MPEs, however, class-action lawsuits linking talc to ovarian adenocarcinoma have rendered it unavailable at many institutions. As a result, surgeons have resorted to less effective chemical pleurodesis as an alternative to indwelling pleural drainage catheters. Given the absence of talc, we explored the effectiveness of video-assisted thoracoscopic surgery (VATS) partial pleurectomy (VPP) for treating MPEs. Methods We performed a retrospective review of patients with MPEs managed after talc became unavailable at our institution. Between 2016 and 2018, we identified five patients who refused pleural drainage catheters and underwent VPP. Symptoms at presentation included fatigue, dyspnea, and pleuritic chest pain. All had unilateral MPEs (left n=3, right n=2). VPP included removal of parietal surfaces of the pleura other than the pleura overlying the subclavian vessels, the mediastinum, and the lung viscera. Results There were no significant perioperative adverse events and post-operative pain was well controlled. Chest tubes were removed between post-operative day (POD) 3 and 7. Follow-up time ranged from four to 36 weeks. All patients had symptomatic relief and radiographic evidence of improved MPEs. No patients required re-interventions. One patient expired six months after surgery while the remaining four were alive at last follow-up. Conclusions VPP offers an effective alternative to chemical pleurodesis for managing MPEs in patients who prefer to avoid pleural drainage catheters.
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Affiliation(s)
- Laurence P Diggs
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sean P Martin
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Justin A Drake
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - R Taylor Ripley
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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21
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Ripley RT, Palivela N. Extended pleurectomy and decortication: Video atlas of operative steps. JTCVS Tech 2021; 7:324-330. [PMID: 34318281 PMCID: PMC8312143 DOI: 10.1016/j.xjtc.2021.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/10/2021] [Accepted: 01/27/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- R Taylor Ripley
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Nihanth Palivela
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
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22
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Ripley RT, Burt BM, Groth SS. Commentary: The enemy of good: Wishing we always have randomized data. J Thorac Cardiovasc Surg 2021; 163:1682-1683. [PMID: 33712234 DOI: 10.1016/j.jtcvs.2021.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 11/17/2022]
Affiliation(s)
- R Taylor Ripley
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
| | - Bryan M Burt
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Shawn S Groth
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
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23
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Ripley RT. Commentary: Interleukin 2: The gasoline that lit the immunotherapeutic fire. J Thorac Cardiovasc Surg 2020; 163:e329-e330. [PMID: 33422309 DOI: 10.1016/j.jtcvs.2020.11.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 11/18/2022]
Affiliation(s)
- R Taylor Ripley
- Division of General Thoracic Surgery, Department of Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
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Ripley RT, Palivela N, Groth SS, Choi EA, Cornwell LD, Carrott PW, Van Buren G, Splawn TG, Sugarbaker DJ, Burt BM. Diagnostic Laparoscopy Improves Staging of Malignant Pleural Mesothelioma With Routine Positron Emission Tomography Imaging. Ann Thorac Surg 2020; 112:1568-1574. [PMID: 33275932 DOI: 10.1016/j.athoracsur.2020.08.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 07/08/2020] [Accepted: 08/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND With a multimodal treatment strategy, cytoreductive surgery extends survival in malignant pleural mesothelioma. Improving the accuracy of staging can refine patient selection. Our objective was to determine whether diagnostic laparoscopy (DL) improves staging for patients with malignant pleural mesothelioma with the routine use of positron emission tomography (PET). METHODS We performed a retrospective review of our prospectively maintained database from February 2014 to May 2019. Inclusion criteria were patients who had disease in the chest that was deemed potentially resectable by radiographic criteria and who underwent DL as part of the staging evaluation before surgery. RESULTS Of 187 patients (71% men, 80% epithelial) who underwent DL during staging, 76% proceeded to surgery; 22% were unresectable at exploratory thoracotomy and 78% underwent resection (pleurectomy and decortication, 68%; extrapleural pneumonectomy, 32%). Also, 89% had a PET computed tomography (CT), and 11% had a preoperative CT without PET. DL revealed peritoneal disease in 17%. Among patients with pathologically proven disease at DL, 77% had negative PET-CT imaging. Based on the pathologic findings at DL the sensitivity, specificity, positive predictive value, and negative predictive value of PET-CT were 23%, 78%, 17%, and 83%, respectively. The accuracy of PET-CT was 68%. CONCLUSIONS PET-CT has low sensitivity and diagnostic accuracy to identify peritoneal disease in malignant pleural mesothelioma. DL as part of the preoperative staging defines an important subset of patients with bicavitary disease. We recommend DL as a component of staging before surgery.
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Affiliation(s)
- R Taylor Ripley
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
| | - Nihanth Palivela
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Shawn S Groth
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Eugene A Choi
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Lorraine D Cornwell
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Philip W Carrott
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - George Van Buren
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Taylor G Splawn
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - David J Sugarbaker
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Bryan M Burt
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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van Beek EJAH, Hernandez JM, Goldman DA, Davis JL, McLoughlin KC, Ripley RT, Kim TS, Tang LH, Hechtman JF, Zheng J, Capanu M, Schultz N, Hyman DM, Ladanyi M, Berger MF, Solit DB, Janjigian YY, Strong VE. Correction to: Rates of TP53 Mutation are Significantly Elevated in African American Patients with Gastric Cancer. Ann Surg Oncol 2020; 27:963. [PMID: 31898094 DOI: 10.1245/s10434-019-08107-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In the original article Kaitlin C. McLoughlin's name is spelled incorrectly. It is correct as reflected here.
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Affiliation(s)
- Elke J A H van Beek
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Jonathan M Hernandez
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Debra A Goldman
- Department of Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Jeremy L Davis
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - R Taylor Ripley
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Teresa S Kim
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Laura H Tang
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Jaclyn F Hechtman
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Jian Zheng
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Marinela Capanu
- Department of Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Nikolaus Schultz
- Department of Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- Marie-Josée & Henry R. Kravis Center for Molecular Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - David M Hyman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Michael F Berger
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- Marie-Josée & Henry R. Kravis Center for Molecular Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - David B Solit
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- Marie-Josée & Henry R. Kravis Center for Molecular Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Yelena Y Janjigian
- Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Vivian E Strong
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Lee HS, Hamaji M, Palivela N, Jang HJ, Splawn T, Ramos D, Lee AK, Raghuram AC, Ramineni M, Amos CI, Ripley RT, Burt BM. Prognostic Role of Programmed Cell Death 1 Ligand 1 in Resectable Pleural Mesothelioma. Ann Thorac Surg 2020; 112:1575-1583. [PMID: 33248997 DOI: 10.1016/j.athoracsur.2020.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/08/2020] [Accepted: 10/25/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The prognostic role of programmed cell death 1 ligand 1 (PD-L1) in malignant pleural mesothelioma (MPM) is incompletely understood. Our objectives were to evaluate the evidence for tumor PD-L1 as a prognostic biomarker in MPM through meta-analysis and to determine whether tumor PD-L1 expression is associated with survival in MPM patients undergoing macroscopic complete resection. METHODS Meta-analysis was performed to determine the association of PD-L1 with overall survival in MPM (n = 1655) from 14 studies containing overall survival and tumor PD-L1 expression. Univariable and multivariable analyses tested the relationship of tumor PD-L1 with overall survival and recurrence-free survival in an institutional cohort of MPM patients treated by macroscopic complete resection (n = 75). To validate the association of PD-L1 with overall survival, we utilized two independent MPM cohorts (n = 284). RESULTS Meta-analysis demonstrated that high tumor PD-L1 expression was associated with poor overall survival. Among 75 patients undergoing macroscopic complete resection, 49 tumors (65%) expressed PD-L1 (1% or more), and high PD-L1 (50% or greater) was more commonly expressed on nonepithelial (29%) compared with epithelial tumors (14%). High tumor PD-L1 expression was independently associated with poor overall survival (P < .001, hazard ratio 5.67) and recurrence-free survival (P = .003, hazard ratio 3.28). The association of PD-L1 overexpression with unfavorable survival was more significant in epithelial MPMs than nonepithelial MPMs. These findings were validated in RNA sequencing analyses in two independent cohorts. Exploratory transcriptome analysis revealed that MPM tumors with PD-L1 overexpression displayed coexpression of other immune regulatory molecules, programmed cell death 1 ligand 2 and T-cell immunoglobulin mucin receptor 3. CONCLUSIONS Tumor PD-L1 expression is a prognostic biomarker in patients undergoing surgical resection for MPM and may be useful in perioperative decision making.
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Affiliation(s)
- Hyun-Sung Lee
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Nihanth Palivela
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Hee-Jin Jang
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Taylor Splawn
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Daniela Ramos
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Alice K Lee
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Kinesiology, Rice University, Houston, Texas
| | - Anjali C Raghuram
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Christopher I Amos
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - R Taylor Ripley
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Bryan M Burt
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
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Creden SP, Ripley RT. Commentary: A tool in the arsenal for persistent air leaks. JTCVS Tech 2020; 4:341-342. [PMID: 34318068 PMCID: PMC8307458 DOI: 10.1016/j.xjtc.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/01/2020] [Accepted: 10/09/2020] [Indexed: 10/28/2022] Open
Affiliation(s)
- Samuel P Creden
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - R Taylor Ripley
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
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Abstract
Extended pleurectomy and decortication (ePD) is a difficult operation performed for the surgical resection of malignant pleural mesothelioma that can achieve a macroscopic complete resection with preservation of the lung. With lower perioperative mortality, similar long-term survival, and better tolerance in patients with lower performance status, ePD has become the preferred operation rather than extrapleural pneumonectomy despite lack of a direct comparison. As ePD has become more popular, international collaboration is underway to create surgical guidelines based on collection of operative data. These efforts will improve the safety and standardization of this operation.
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Affiliation(s)
- R Taylor Ripley
- Department of Surgery, Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
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Abstract
Staging of malignant pleural mesothelioma has been challenging because of a paucity of cases and poor survival. At least 5 staging systems were proposed before 1990 until the first consensus system was published in 1995. This system used tumor, node, metastasis designations and borrowed heavily from parenchymal lung cancer descriptors. With the establishment of a database to collect cases from 1995 to 2013, evidence-based revisions to the 1995 staging classification were published in 2016. With improving imaging technology, clinical staging will become more refined and, it is hoped, more useful for prognostication even without operative resection.
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Affiliation(s)
- Caleb J Euhus
- Department of Surgery, Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - R Taylor Ripley
- Department of Surgery, Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
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30
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Groth SS, Ripley RT. Commentary: Cisplatin-induced nephrotoxicity following cytoreductive surgery and heated intraoperative chemotherapy for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2020; 161:1519-1520. [PMID: 32771233 DOI: 10.1016/j.jtcvs.2020.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Shawn S Groth
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - R Taylor Ripley
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
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31
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Farmer DM, Ripley RT. Commentary: EGFR mutations lung adenocarcinoma-Is the driver removed with the lobe? J Thorac Cardiovasc Surg 2020; 162:675-676. [PMID: 32680643 DOI: 10.1016/j.jtcvs.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Douglas M Farmer
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - R Taylor Ripley
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
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32
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Ripley RT. Commentary: Keep swinging for the fence-some patients will survive. JTCVS Tech 2020; 3:365-366. [PMID: 34317933 PMCID: PMC8304913 DOI: 10.1016/j.xjtc.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- R. Taylor Ripley
- Address for reprints: R. Taylor Ripley, MD, Division of General Thoracic Surgery, Department of Surgery, Baylor College of Medicine, 7200 Cambridge St, Suite 6A, Houston, TX 77030.
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33
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Corsini EM, Ripley RT. Commentary: KRAS-mutant lung adenocarcinomas-a work in progress. J Thorac Cardiovasc Surg 2020; 163:e87-e88. [PMID: 32771234 DOI: 10.1016/j.jtcvs.2020.06.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 01/15/2023]
Affiliation(s)
- Erin M Corsini
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - R Taylor Ripley
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
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34
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Carrott PW, Ripley RT. Commentary: New strategies for old techniques. J Thorac Cardiovasc Surg 2020; 161:1636-1637. [PMID: 32381337 DOI: 10.1016/j.jtcvs.2020.03.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Philip W Carrott
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Transplantation and Circulatory Support, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - R Taylor Ripley
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
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35
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Ripley RT. Commentary: Filling up my truck from an oil tanker: Can big 'omic' data influence our clinical decisions? J Thorac Cardiovasc Surg 2020; 160:1086-1087. [PMID: 32359793 DOI: 10.1016/j.jtcvs.2020.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 11/18/2022]
Affiliation(s)
- R Taylor Ripley
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
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36
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Ripley RT. Commentary: Drawing the target after shooting the arrow: The importance of trial design. J Thorac Cardiovasc Surg 2020; 161:443-444. [PMID: 32359791 DOI: 10.1016/j.jtcvs.2020.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/09/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Affiliation(s)
- R Taylor Ripley
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
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Groth SS, Ripley RT, Carrott PW, Burt BM. Commentary: Focused attention on proactive identification of deep venous thrombosis after pleurectomy/decortication for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2020; 160:1075-1076. [PMID: 32061393 DOI: 10.1016/j.jtcvs.2019.12.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Shawn S Groth
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
| | - R Taylor Ripley
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Philip W Carrott
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Bryan M Burt
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
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Ripley RT. Commentary: Minimally-invasive thymectomy with minimal concerns. J Thorac Cardiovasc Surg 2019; 160:570-571. [PMID: 31761347 DOI: 10.1016/j.jtcvs.2019.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 11/28/2022]
Affiliation(s)
- R Taylor Ripley
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
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Cornwell LD, Ripley RT. Commentary: Beyond the eyeball test. J Thorac Cardiovasc Surg 2019; 160:285-286. [PMID: 31757460 DOI: 10.1016/j.jtcvs.2019.10.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Lorraine D Cornwell
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - R Taylor Ripley
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
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40
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Groh EM, Hyun N, Check D, Heller T, Ripley RT, Hernandez JM, Graubard BI, Davis JL. Trends in Major Gastrectomy for Cancer: Frequency and Outcomes. J Gastrointest Surg 2019; 23:1748-1757. [PMID: 30511132 PMCID: PMC8132293 DOI: 10.1007/s11605-018-4061-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/15/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Declining incidence of gastric cancer in the USA has presumably resulted in lower rates of major gastrectomy for cancer. The impact on perioperative outcomes remains undefined. The aims of this study were to characterize national trends in frequency of major gastrectomy for cancer, identify factors associated with in-hospital mortality, and examine outcome disparities by race/ethnicity. METHODS Nationwide inpatient sample data from 1993 to 2013 were queried for procedural and diagnostic codes (ICD-9) relating to total and partial gastrectomy procedures. Gastric resections for cancer were compared to those for peptic ulcer disease for reference. Patient demographics, comorbidity score, mortality, and hospital characteristics were recorded as covariates. RESULTS A significant decrease in annual rates of partial and total gastrectomy was observed from 1993 to 2013 (p < 0.0001). The change in absolute number and percent decline was greater for partial gastrectomy (- 39.3%) than total gastrectomy (- 19%). There was a 34.0% decrease in gastrectomy for cancer in Whites and a 61.2% increase among Hispanic patients over two decades. In-hospital mortality also significantly decreased over the study period (7.7% to 2.7%). Factors associated with lower mortality rates included male sex and treatment at urban teaching hospitals. Analysis of trends revealed that gastrectomy for cancer was performed with increasing frequency at urban teaching hospitals. CONCLUSIONS The frequency of major gastric resections in the USA has declined over two decades. Overall, in-hospital mortality rates also have decreased significantly. Declining in-hospital mortality after gastrectomy for cancer is associated with more frequent treatment at urban teaching hospitals.
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Affiliation(s)
- Eric M. Groh
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 4-3742, Bethesda, MD 20892, USA
| | - Noorie Hyun
- Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - David Check
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Theo Heller
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA,NIH Foregut Team, Center for Cancer Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - R. Taylor Ripley
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 4-3742, Bethesda, MD 20892, USA,NIH Foregut Team, Center for Cancer Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jonathan M. Hernandez
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 4-3742, Bethesda, MD 20892, USA,NIH Foregut Team, Center for Cancer Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Barry I. Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jeremy L. Davis
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 4-3742, Bethesda, MD 20892, USA,NIH Foregut Team, Center for Cancer Research, National Institutes of Health, Bethesda, MD 20892, USA
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41
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Burt BM, Nguyen D, Groth SS, Palivela N, Ripley RT, Makris KI, Farjah F, Cornwell L, Massarweh NN. Utilization of Minimally Invasive Thymectomy and Margin-Negative Resection for Early-Stage Thymoma. Ann Thorac Surg 2019; 108:405-411. [DOI: 10.1016/j.athoracsur.2019.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 01/11/2023]
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42
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Groth SS, Ripley RT, Carrott P, Burt BM. Commentary: Usurping the king: A step toward planning a biological checkmate on non-small cell lung carcinoma. J Thorac Cardiovasc Surg 2019; 158:922-923. [PMID: 31277817 DOI: 10.1016/j.jtcvs.2019.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Shawn S Groth
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
| | - R Taylor Ripley
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Philip Carrott
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Bryan M Burt
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
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Singh A, Bhattacharyya N, Srivastava A, Pruett N, Ripley RT, Schrump DS, Hoang CD. MicroRNA-215-5p Treatment Suppresses Mesothelioma Progression via the MDM2-p53-Signaling Axis. Mol Ther 2019; 27:1665-1680. [PMID: 31227395 DOI: 10.1016/j.ymthe.2019.05.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/14/2019] [Accepted: 05/19/2019] [Indexed: 01/20/2023] Open
Abstract
Malignant pleural mesothelioma (MPM) is an incurable, aggressive neoplasm with distinctive features, including preservation of wild-type p53, irrespective of histologic subtype. We posited that this consistent molecular characteristic represents an underexploited therapeutic target that can be approached by leveraging biologic effects of microRNA (miRNA). The Cancer Genome Atlas was surveyed to identify p53-responsive prognostic miRNA(s) in MPM. Using patient samples, in vitro MPM cell lines, and murine tumor xenograft models, we verified specific gene pathways targeted by these miRNAs, and we examined their therapeutic effects. miR-215-5p is a poor prognosis miRNA downregulated in MPM tissues, which has not been recognized previously. When miR-215-5p was ectopically re-expressed in MPM cells and delivered in vivo to tumor xenografts, it exerted significant cell killing by activating p53 function and inducing apoptosis. The mechanistic basis for this effect is due to combinatorial effects of a positive feedback loop of miR-215-MDM2-p53 signaling, additional mouse double minute 2 (MDM2)-p53 positive feedback loop(s) with other miRNAs such as miR-145-5p, and suppression of diverse gene targets associated with cell cycle dynamics not previously drug treatable in MPM clinical studies. Our results suggest a potential pathophysiologic role for and therapeutic significance of miR-215-5p in MPM.
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Affiliation(s)
- Anand Singh
- Thoracic Surgery Branch, National Cancer Institute, NIH, CCR and The Clinical Center, Bethesda, MD 20892, USA
| | - Nisan Bhattacharyya
- National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD 20892, USA
| | | | - Nathanael Pruett
- Thoracic Surgery Branch, National Cancer Institute, NIH, CCR and The Clinical Center, Bethesda, MD 20892, USA
| | - R Taylor Ripley
- Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - David S Schrump
- Thoracic Surgery Branch, National Cancer Institute, NIH, CCR and The Clinical Center, Bethesda, MD 20892, USA
| | - Chuong D Hoang
- Thoracic Surgery Branch, National Cancer Institute, NIH, CCR and The Clinical Center, Bethesda, MD 20892, USA.
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Zhang L, Singh A, Plaisier C, Pruett N, Ripley RT, Schrump DS, Hoang CD. Metadherin Is a Prognostic Apoptosis Modulator in Mesothelioma Induced via NF-κB-Mediated Signaling. Transl Oncol 2019; 12:859-870. [PMID: 31054476 PMCID: PMC6500914 DOI: 10.1016/j.tranon.2019.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 12/15/2022] Open
Abstract
Therapies against malignant pleural mesothelioma (MPM) have yielded disappointing results, in part, because pathologic mechanisms remain obscure. In searching for rational molecular targets, we identified metadherin (MTDH), a multifunctional gene associated with several tumor types but previously unrecognized in MPM. Cox proportional hazards regression analysis delineated associations between higher MTDH expression and lower patient survival from three independent MPM cohorts (n = 349 patients). Through in vitro assays with overexpression and downregulation constructs in MPM cells, we characterized the role of MTDH. We confirmed in vivo the phenotype of altered MTDH expression in a murine xenograft model. Transcriptional regulators of MTDH were identified by chromatin immunoprecipitation. Overexpression of both MTDH mRNA (12-fold increased) and protein levels was observed in tumor tissues. MTDH stable overexpression significantly augmented proliferation, invasiveness, colony formation, chemoresistance, and an antiapoptosis phenotype, while its suppression showed opposite effects in MPM cells. Interestingly, NF-κB and c-Myc (in a feed-forward loop motif) contributed to modulating MTDH expression. Knockdown of MTDH expression profoundly retarded xenograft tumor growth. Thus, our findings support the notion that MTDH integrates upstream signals from certain transcription factors and mediates pathogenic interactions contributing to MPM traits. MTDH represents a new MPM-associated gene that can contribute to insights of MPM biology and, as such, suggest other treatment strategies.
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Affiliation(s)
- Li Zhang
- Thoracic Surgery Branch, NCI, National Institutes of Health, Bethesda, MD, USA
| | - Anand Singh
- Thoracic Surgery Branch, NCI, National Institutes of Health, Bethesda, MD, USA
| | - Christopher Plaisier
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Nathanael Pruett
- Thoracic Surgery Branch, NCI, National Institutes of Health, Bethesda, MD, USA
| | - R Taylor Ripley
- Dept. of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - David S Schrump
- Thoracic Surgery Branch, NCI, National Institutes of Health, Bethesda, MD, USA
| | - Chuong D Hoang
- Thoracic Surgery Branch, NCI, National Institutes of Health, Bethesda, MD, USA.
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Groth SS, Burt BM, Ripley RT. Commentary: Adjuvant intensity-modulated radiation therapy for malignant pleural mesothelioma: Suspension of intention. J Thorac Cardiovasc Surg 2019; 158:932-933. [PMID: 31030959 DOI: 10.1016/j.jtcvs.2019.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 03/11/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Shawn S Groth
- Mesothelioma Treatment Center, Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
| | - Bryan M Burt
- Mesothelioma Treatment Center, Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - R Taylor Ripley
- Mesothelioma Treatment Center, Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
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Hughes MS, Lo WM, Beresnev T, Merino M, Shutack Y, Ripley RT, Hernandez JM, Davis JL. A Phase II Trial of Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Recurrent Adrenocortical Carcinoma. J Surg Res 2019; 232:383-388. [PMID: 30463745 DOI: 10.1016/j.jss.2018.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/02/2018] [Accepted: 06/01/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recurrent adrenocortical carcinoma (ACC) is an aggressive disease with few options offering durable survival benefit. Despite metastasectomy, recurrence is common. Cytoreduction and intraperitoneal chemotherapy have offered improved survival in other advanced cancers. We sought to evaluate the use of cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of recurrent intraperitoneal ACC. METHODS A phase II, single institution clinical trial was approved for patients with radiographic evidence of resectable ACC limited to the peritoneum. Patients underwent treatment if optimal cytoreduction was deemed possible at exploratory laparotomy. Primary outcome was intraperitoneal progression-free survival. Secondary outcomes were treatment-related morbidities and overall survival. RESULTS Sixty-three patients were evaluated, of whom 11 met eligibility criteria. Nine patients underwent cytoreduction and HIPEC, including one patient who recurred and was re-treated (n = 10 treatments). One patient could not be optimally cytoreduced for HIPEC and therefore did not receive intraperitoneal chemotherapy. There was no perioperative mortality; perioperative comorbidities were limited to Clavien-Dindo grade 2 or 3 and included hematologic, infectious, and neurologic complications. Seven patients experienced disease recurrence and two patients died of disease during follow-up (median 24 mo). Intraperitoneal progression-free survival was 19 mo, and median overall survival has not yet been reached. CONCLUSIONS Cytoreduction and HIPEC can be performed safely in selected patients. Patients with recurrent ACC confined to the peritoneal cavity can be considered for regional therapy in experienced hands. However, disease recurrence is common, and other treatment options should be explored.
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Affiliation(s)
- Marybeth S Hughes
- Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia
| | - Winifred M Lo
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Tatiana Beresnev
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Maria Merino
- Translational Surgical Pathology Section, National Cancer Institute, Bethesda, Maryland
| | - Yvonne Shutack
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - R Taylor Ripley
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Jonathan M Hernandez
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Jeremy L Davis
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, Bethesda, Maryland.
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Ripley RT, Groth SS. Commentary: Perioperative transfusion-Awakening the immunologic beast, or alerting us to unrecognized frailty? J Thorac Cardiovasc Surg 2019; 157:2478-2479. [PMID: 30853227 DOI: 10.1016/j.jtcvs.2019.01.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
Affiliation(s)
- R Taylor Ripley
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
| | - Shawn S Groth
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
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Diggs LP, Ripley RT. Can Maximally Invasive Surgery Be Minimized? Semin Thorac Cardiovasc Surg 2019; 31:310-311. [PMID: 30807846 DOI: 10.1053/j.semtcvs.2019.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/15/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Laurence P Diggs
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - R Taylor Ripley
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
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Groth SS, Ripley RT, Burt BM. A thinner peel to peel: Pleural thickness is prognostic in mesothelioma. J Thorac Cardiovasc Surg 2018; 157:414-415. [PMID: 30557957 DOI: 10.1016/j.jtcvs.2018.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Shawn S Groth
- Mesothelioma Treatment Center, Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
| | - R Taylor Ripley
- Mesothelioma Treatment Center, Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Bryan M Burt
- Mesothelioma Treatment Center, Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
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50
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Burt BM, Ripley RT, Groth SS. To slay a dragon: Timing of chemotherapy in resectable pleural mesothelioma. J Thorac Cardiovasc Surg 2018; 157:767-768. [PMID: 30527720 DOI: 10.1016/j.jtcvs.2018.10.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Bryan M Burt
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
| | - R Taylor Ripley
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Shawn S Groth
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
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