TRF2 as novel marker of tumor response to taxane-based therapy: from mechanistic insight to clinical implication

BACKGROUND

Breast Cancer (BC) can be classified, due to its heterogeneity, into multiple subtypes that differ for prognosis and clinical management. Notably, triple negative breast cancer (TNBC) - the most aggressive BC form - is refractory to endocrine and most of the target therapies. In this view, taxane-based therapy still represents the elective strategy for the treatment of this tumor. However, due variability in patients' response, management of TNBC still represents an unmet medical need. Telomeric Binding Factor 2 (TRF2), a key regulator of telomere integrity that is over-expressed in several tumors, including TNBC, has been recently found to plays a role in regulating autophagy, a degradative process that is involved in drug detoxification. Based on these considerations, we pointed, here, at investigating if TRF2, regulating autophagy, can affect tumor sensitivity to therapy.

METHODS

Human TNBC cell lines, over-expressing or not TRF2, were subjected to treatment with different taxanes and drug efficacy was tested in terms of autophagic response and cell proliferation. Autophagy was evaluated first biochemically, by measuring the levels of LC3, and then by immunofluorescence analysis of LC3-puncta positive cells. Concerning the proliferation, cells were subjected to colony formation assays associated with western blot and FACS analyses. The obtained results were then confirmed also in mouse models. Finally, the clinical relevance of our findings was established by retrospective analysis on a cohort of TNBC patients subjected to taxane-based neoadjuvant chemotherapy.

RESULTS

This study demonstrated that TRF2, inhibiting autophagy, is able to increase the sensitivity of TNBC cells to taxanes. The data, first obtained in in vitro models, were then recapitulated in preclinical mouse models and in a cohort of TNBC patients, definitively demonstrating that TRF2 over-expression enhances the efficacy of taxane-based neoadjuvant therapy in reducing tumor growth and its recurrence upon surgical intervention.

CONCLUSIONS

Based on our finding it is possible to conclude that TRF2, already known for its role in promoting tumor formation and progression, might represents an Achilles' heel for cancer. In this view, TRF2 might be exploited as a putative biomarker to predict the response of TNBC patients to taxane-based neoadjuvant chemotherapy.

DARPP-32 and t-DARPP in the development of resistance to anti-HER2 agents. Pre-clinical evidence from the STEP study

The therapeutic scenario of Human Epidermal Growth Factor Receptor 2 positive advanced breast cancer (ABC) has been recently enriched by a number of innovative agents, which are reshaping treatment sequence. While randomized trials have documented an advantage in terms of efficacy, for the newly available agents we lack effectiveness and tolerability evidence from the real-world setting. Similarly, the identification of predictive biomarkers might improve clinical decision. We herein describe the outline of a prospective/retrospective study which aims to explore the optimal sequence of treatment in HER2+, pertuzumab pre-treated ABC patients treated in II line with anti-HER2 agents in clinical practice. As part of the pre-clinical tasks envisioned by the STEP study, in vitro cell models of resistance were exploited to investigate molecular features associated with reduced efficacy of HER2 targeting agents at the transcript level. The aggressive behavior of resistant cell populations was measured by growth assessment in mouse models. This approach led to the identification of DARPP-32 and t-DARPP proteins as possible predictive biomarkers of efficacy of anti-HER2 agents. Biomarkers validation and the clinical goals will be reached through patients' inclusion into two independent cohorts, i.e., the prospective and retrospective cohorts, whose setup is currently ongoing.

Role of neutrophil-to-lymphocyte, platelet-to-lymphocyte and myelocite-to-lymphocyte ratio as prognostic markers for immunotherapy response in patients with advanced solid tumors, a retrospective analysis from a single institution

e14529

Background: PD-L1 is the only biomarker that has been accepted to identify patients who could potentially benefit from immune checkpoint inhibitors (ICIs) administration, but also PD-L1 negative tumors respond to immunotherapy. However, other biomarkers have been proposed but they are too expensive and actually, there is not a consensus for detection and analytical methods. Thus, there is an urgent need for inexpensive and reproducible tests to better optimize the clinical use of ICIs. Recent findings suggest that host parameters may help to select patients to treat with ICIs: performance status (PS) and some laboratory parameters, such as lactate dehydrogenase (LDH) and blood cells count. Inflammation and inflammatory response have been considered surrogate biomarkers of host immunity. An elevated neutrophil-to-lymphocyte (NLR), myeloid-to-lymphocyte (MLR) and platelet-to-lymphocyte (PLR) ratio have been associated with systemic inflammation and some evidences suggest that these biomarkers could play a role as prognostic factors. Methods: We performed a retrospective analysis of 250 patients treated with ICIs at our institution. The associations between basal NLR, MLR and PLR, clinicopathological features and their impact on progression free survival (PFS), overall survival (OS) and toxicities were assessed. Results: From May 2015 to January 2022, 250 patients were screened, of whom 66 were excluded from the analysis. A total of 184 patients (64.7% men), with a median age of 68 years (37-90) a PS 0 (52.2%), 1 (39.7%) and 2 (8.1%), were enrolled. The primary tumor origin was lung (93 adenocarcinoma, 19 squamous, 14 small cell lung cancer), urothelial (33), melanoma (4) and renal (21). Nivolumab was used in 103 patients, Pembrolizumab in 67 and atezolizumab in 18. At 24 months median follow up there were 131 progression diseases and 122 deaths. Overall, the median value of NLR, PLR and MLR was 3.15 (1-41), 168 (4-797) and 3.5 (0-245), respectively. Lower values of NLR and PLR were associated with a better median PFS (HR for NLR 1.7, 95% CI 1.2-2.4, p = 0.002; HR for PLR 2.2, 95% CI, 1.6 - 3.2, p < 0.0001) and OS (HR for NLR 1.5, 95%CI 1.1-2.2, p = 0.017; HR for PLR 1.9, 95%CI 1.3-2.7 p < 0.0001). MLR was not statistically significant. According to primary tumor origin, renal cancer reported a value significantly under the median of NLR and PLR (p = 0.015 and p = 0.021 respectively). Toxicity and clinico-pathological factors showed a significant association between female sex and both severe fatigue (p = 0.002) and pain (p = 0.018). Pain was also related to younger age (p = 0.009) and to a PS ≥2 (p = 0.003). Conclusions: Our study shows that NLR and PLR represent inexpensive, reproducible and reliable markers that may help identifying patients who can have a greater benefit from immunotherapy.

Primary leiomyosarcoma of the oral tongue: magnetic resonance and ultrasonography findings with histopathologic correlation

Leiomyosarcoma is a malignant smooth muscle tumor that frequently occurs in the gastrointestinal tract and female genital tract. It is aggressive and tends to recur and metastasize. Clinical behavior is unpredictable, mostly influenced by a proper surgical approach. Oral leiomyosarcoma, in particular of the tongue, is extremely rare and poorly documented in the radiology literature. Diagnostic assessment of oral leiomyosarcoma is often challenging, mostly founded on its peculiar immunohistological features. However, imaging evaluation is essential in staging and for preoperative planning. We illustrate the case of a 52-year-old woman with 2-months history of a painless growing mass on the left hemitongue, with magnetic resonance and ultrasonographic features correlated to histopathologic examination.

Blake's pouch cyst: an entity within the Dandy-Walker continuum

Abnormal cerebrospinal fluid (CSF) collections within the posterior fossa are defined by the Dandy-Walker complex (DWC) and by arachnoid cysts (AC). The DWC includes the Dandy-Walker malformation (DWM), the Dandy-Walker variant (DWV) and the mega-cisterna magna (MCM). In addition, Tortori-Donati et al. added persistent Blake's pouch cyst (BPC) as an independent entity within the DWC. BPC represents a posterior ballooning of the superior medullary velum into the cisterna magna. All of these malformations are overlapping developmental anomalies characterized by varying degrees of malformation of the medullary vela, the cerebellar vermis and hemispheres, the fourth ventricle choroid plexus, the posterior fossa subarachnoid cisterns and the enveloping meningeal structures. We present two cases of persistent BPC detected in two adult women without history of gestational or subsequent growth problems. They underwent neuroradiological investigation because of headache and because of recurrent episodes of loss of consciousness, respectively. The MRI findings included tetraventricular hydrocephalus, wide communication of the fourth ventricle and the cystic posterior fossa (i.e. BPC), inferior posterior fossa mass effect with or without hypoplasia of both the cerebellar vermis and the medial aspects of the cerebellar hemispheres, and absence of communication between fourth ventricle and the basal subarachnoid space in the midline posteriorly. Persistent BPC is defined by a failure of embryonic assimilation of the area membranacea anterior within the tela choroidea associated with imperforation of the foramen of Magendie. Typically this condition becomes symptomatic early in life. In the current cases the normal function of the laterally positioned foramina of Luschka probably helped to maintain some CSF flow between intraventricular and subarachnoid spaces, with the establishment of a precarious equilibrium characterized by a compensatory enlargement of the cerebral ventricular system (i.e. hydrocephalus).

[Brain magnetic resonance with magnetization transfer in multiple sclerosis. Lesion hyperintensity before and after intravenous gadolinium administration]

PURPOSE

To evaluate lesion contrast enhancement in brain magnetic resonance (MR) images with and without magnetization transfer pulse (MT) in patients affected with multiple sclerosis (MS).

MATERIAL AND METHODS

Ten patients affected with relapsing-remitting MS underwent a 1.5-T (Magnetom Vision, Siemens) MR examination with T1-weighted spin-echo sequences without MT (TR/TE = 630/14 ms) and with MT (840/14 ms) using the following common parameters: 21 para-axial slices (thickness 5 mm, 10% gap); matrix 256 x 256; field of view 25 cm (rectangular 5/8); 2 excitations. The postcontrast sequences with and without MT were acquired in a randomized order, starting 5 minutes after the intravenous injection of 0.1 mmol/kg Gadoteridol (ProHance, Bracco). The images were blindly evaluated in four separate sessions: only the postcontrast images with MT (post-Gd with MT); only the postcontrast images without MT (post-Gd without MT); comparing the pre- and postcontrast images with MT (pre/post-Gd with MT); comparing the pre- and postcontrast images without MT (pre/post-Gd without MT). The number of hyperintense areas referred to contrast enhancement and the evaluation time were measured for each session. The Wilcoxon test was used for statistical analysis.

RESULTS

The number of areas referred to lesion contrast enhancement per patient were as follows: post-Gd with MT, 6.9 +/- 6.8 (mean +/- standard deviation) (range 1-24); post-Gd without MT, 3.6 +/- 4.3 (0-14); pre/post-Gd with MT, 5.2 +/- 6.1 (1-21); pre/post-Gd without MT, 3.6 +/- 4.9 (0-16). A nonsignificant difference was found for the comparison between post-Gd without MT and pre/post-Gd without MT while significant differences were found between post-Gd with MT and pre/post-Gd with MT (p = .028), pre/post-Gd without MT and pre/post-Gd with MT (p = .012), as well as between post-Gd without and post-Gd with MT (p = .008). The mean evaluation time for the different sessions was always less than a minute, ranging from 33 seconds for pre/post-Gd without MT to 51 seconds for post-Gd with MT.

CONCLUSIONS

The postcontrast sequence obtained with the MT pulse detects more active lesions than the postcontrast sequence without MT. However, the comparison with the plain images with the MT pulse is mandatory to exclude pseudoenhancement foci, i.e. hyperintense areas already present in the precontrast images with the MT pulse, without disruption of the blood-brain barrier. The post-Gd without MT sequence needs not be compared with the precontrast images without MT. Differences in evaluation time are practically negligible.

Anterior clinoid mucocele: a trans-nasal endoscopic approach

The goals of the treatment of paranasal sinuses mucocele are the relief of the symptoms due to compression and the prevention of recurrence. Because of the benignity of the pathology, it is mandatory to choose the approach that minimizes the surgical trauma. When an anterior clinoid mucocele is found, the conventional approaches are the trans-nasoethmoidal, the subtemporal or the pterional ones: we think that as a really mini-invasive approach, the transnasal endoscopy may be proposed. Anterior clinoid localization may be reached by a trans-sphenoidal way and treated by endoscopic microsurgery with a very low morbility. This paper deals with a case of anterior clinoid mucocele treated by this way with good anatomic and functional results and stresses the importance of the pre-operative imaging (CT/MR) allowing one to make a sure diagnosis and to choose the cases suitable for this surgical approach.

Lateral ventricle subependymomas. Case report taking into particular consideration the aspects of magnetic resonance and review of the literature

Subependymomas are rare neuroectodermic tumours. The authors report a case of a patient he had a subendymoma in the left lateral ventricle, with particular attention to the MR aspects on these lesions and review of the literature.

Orbital pseudotumor as a presenting sign of temporal arteritis

Both unilateral proptosis (2 cases) and radiological evidence of orbital inflammatory pseudotumor in the absence of exophthalmos (1 case) have been separately described as presenting signs of temporal arteritis. We report a patient presenting with bilateral exophthalmos associated with CT and MRI signs of orbital inflammation, who had biopsy-proven temporal arteritis. Our case is unique in view of the association of the above clinical and radiological features, and the bilateral involvement of orbital tissues.

Gas bubbles within acute intracranial epidural haematomas

In order to assess the actual incidence of gas bubbles trapped within acute intracranial epidural haematomas, as revealed by computed tomography (CT) of the skull, a series of 204 patients with surgically verified epidural haematomas was retrospectively reviewed. Gas bubbles were observed on CT scan in 22.5% of the cases, with the incidence rising to 37% when CT scanners of the last generation were employed. The available data failed to demonstrate the actual source of intracranial gas. No correlation was found between the presence of gas bubbles and outcome. No patient in the whole series showed any sign of intracranial infection.

Degenerative changes in hypophyseal adenomas: CT features

16 patients with hypophyseal adenoma undergoing degenerative changes, namely necrotic-cystic changes, bleeding and calcification, were subjected to CT and the resulting density values studied. The cases were verified at operation and at histological examination. Evaluation of these features, despite the limitations of the method, proved to be very useful in differential diagnosis and in the planning of treatment.

[Altered plasma lipid and protein patterns in schizophrenic patients (author's transl)]

The plasma lipid and lipoprotein pattern (total cholesterol, triglycerides and total lipid concentration; electrophoretic separation of the lipoproteins) and plasma protein profile (total protein concentration; electrophoretic separation of the plasma proteins) have been determined in a group of 60 chronic schizophrenic patients (47 men and 13 women, mean age 30,3 +/- 22 years). When compared to a control group matched for age and sex, the schizophrenic patients exhibited significantly lower cholesterol concentration and altered distribution pattern of the plasma lipid fractions. Similarly, the plasma a1,- a2,- and beta-globulin patterns are also altered in schizophrenic group. It is concluded that the altered plasma lipid and protein patterns may suggest that (auto)-immunologic and/or metabolic factors may be involved in the pathogenesis of schizophrenic disease.

[Neuropsychological aspects of schizophrenic mental deterioration]

The authors have administered a test of intelligence (WAIS) and a test of attention (Color Naming) to a group of patients affected by chronic schizophrenic impairment. The scores give shape to a picture of mental deterioration, especially characterized by a decrease of attentive power. This results validates the possibility of a neuropsychological approach to the etiopatogenesis of schizophrenia and supports the hypothesis that an impairment of mental synthesis power may explain both clinical and psychometric features of the disease.

Regional cerebral mode transit time and the derivative of the regional cerebral function recorded for intravenous administration of a non-diffusible tracer

The meaning of the time from origin to first peak and from peak to peak of the derivative of the regional cerebral functions recorded after intravenous administration of a non-diffusible tracer is analyzed. Data obtained by cerebral and cardiac monitoring and evaluation of both times in patients with carotid thrombosis, indicates that the time from origin to first peak may be a better estimate of regional cerebral mode transit time than the time from peak to peak.