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Gatto F, Bratulic S, Jonasch E, Limeta A, Maccari F, Galeotti F, Volpi N, Lundstam S, Nielsen J, Stierner U. Plasma and Urine Free Glycosaminoglycans as Monitoring and Predictive Biomarkers in Metastatic Renal Cell Carcinoma: A Prospective Cohort Study. JCO Precis Oncol 2023; 7:e2200361. [PMID: 36848607 DOI: 10.1200/po.22.00361] [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: 03/01/2023] Open
Abstract
PURPOSE No liquid biomarkers are approved in metastatic renal cell carcinoma (mRCC) despite the need to predict and monitor response noninvasively to tailor treatment choices. Urine and plasma free glycosaminoglycan profiles (GAGomes) are promising metabolic biomarkers in mRCC. The objective of this study was to explore if GAGomes could predict and monitor response in mRCC. PATIENTS AND METHODS We enrolled a single-center prospective cohort of patients with mRCC elected for first-line therapy (ClinicalTrials.gov identifier: NCT02732665) plus three retrospective cohorts (ClinicalTrials.gov identifiers: NCT00715442 and NCT00126594) for external validation. Response was dichotomized as progressive disease (PD) versus non-PD every 8-12 weeks. GAGomes were measured at treatment start, after 6-8 weeks, and every third month in a blinded laboratory. We correlated GAGomes with response and developed scores to classify PD versus non-PD, which were used to predict response at treatment start or after 6-8 weeks. RESULTS Fifty patients with mRCC were prospectively included, and all received tyrosine kinase inhibitors (TKIs). PD correlated with alterations in 40% of GAGome features. We developed plasma, urine, and combined glycosaminoglycan progression scores that monitored PD at each response evaluation visit with the area under the receiving operating characteristic curve (AUC) of 0.93, 0.97, and 0.98, respectively. For internal validation, the scores predicted PD at treatment start with the AUC of 0.66, 0.68, and 0.74 and after 6-8 weeks with the AUC of 0.76, 0.66, and 0.75. For external validation, 70 patients with mRCC were retrospectively included and all received TKI-containing regimens. The plasma score predicted PD at treatment start with the AUC of 0.90 and at 6-8 weeks with the AUC of 0.89. The pooled sensitivity and specificity were 58% and 79% at treatment start. Limitations include the exploratory study design. CONCLUSION GAGomes changed in association with mRCC response to TKIs and may provide biologic insights into mRCC mechanisms of response.
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Affiliation(s)
- Francesco Gatto
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden.,Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Sinisa Bratulic
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Eric Jonasch
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, MD Anderson Cancer Center of the University of Texas, Houston, TX
| | - Angelo Limeta
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Francesca Maccari
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Galeotti
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Volpi
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sven Lundstam
- Department of Urology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Oncology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jens Nielsen
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden.,BioInnovation Institute, Copenhagen, Denmark
| | - Ulrika Stierner
- Department of Oncology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Gatto F, Dabestani S, Bratulic S, Limeta A, Maccari F, Galeotti F, Volpi N, Stierner U, Nielsen J, Lundstam S. Plasma and Urine Free Glycosaminoglycans as Monitoring Biomarkers in Nonmetastatic Renal Cell Carcinoma—A Prospective Cohort Study. EUR UROL SUPPL 2022; 42:30-39. [PMID: 35911082 PMCID: PMC9334826 DOI: 10.1016/j.euros.2022.06.003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Francesco Gatto
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Corresponding authors. Department of Oncology-Pathology, Karolinska Institute, 171 64 Stockholm, Sweden (F. Gatto). Department of Urology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden (S. Lundstam).
| | - Saeed Dabestani
- Department of Translational Medicine, Division of Urological Cancers, Lund University, Kristianstad Central Hospital, Region Skane, Lund, Sweden
- Department of Urology, Kristianstad Central Hospital, Region Skane, Kristianstad, Sweden
| | - Sinisa Bratulic
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Angelo Limeta
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Francesca Maccari
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Galeotti
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Volpi
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Ulrika Stierner
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jens Nielsen
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
- BioInnovation Institute, Copenhagen N, Denmark
| | - Sven Lundstam
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Corresponding authors. Department of Oncology-Pathology, Karolinska Institute, 171 64 Stockholm, Sweden (F. Gatto). Department of Urology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden (S. Lundstam).
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Ny L, Jespersen H, Karlsson J, Alsén S, Filges S, All-Eriksson C, Andersson B, Carneiro A, Helgadottir H, Levin M, Ljuslinder I, Olofsson Bagge R, Sah VR, Stierner U, Ståhlberg A, Ullenhag G, Nilsson LM, Nilsson JA. The PEMDAC phase 2 study of pembrolizumab and entinostat in patients with metastatic uveal melanoma. Nat Commun 2021; 12:5155. [PMID: 34453044 PMCID: PMC8397717 DOI: 10.1038/s41467-021-25332-w] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [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] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/05/2021] [Indexed: 12/13/2022] Open
Abstract
Preclinical studies have suggested that epigenetic therapy could enhance immunogenicity of cancer cells. We report the results of the PEMDAC phase 2 clinical trial (n = 29; NCT02697630) where the HDAC inhibitor entinostat was combined with the PD-1 inhibitor pembrolizumab in patients with metastatic uveal melanoma (UM). The primary endpoint was objective response rate (ORR), and was met with an ORR of 14%. The clinical benefit rate at 18 weeks was 28%, median progression free survival was 2.1 months and the median overall survival was 13.4 months. Toxicities were manageable, and there were no treatment-related deaths. Objective responses and/or prolonged survival were seen in patients with BAP1 wildtype tumors, and in one patient with an iris melanoma that exhibited a UV signature. Longer survival also correlated with low baseline ctDNA levels or LDH. In conclusion, HDAC inhibition and anti-PD1 immunotherapy results in durable responses in a subset of patients with metastatic UM.Trial registration ClinicalTrials.gov registration number: NCT02697630 (registered 3 March 2016). EudraCT registration number: 2016-002114-50.
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Affiliation(s)
- Lars Ny
- Sahlgrenska Cancer Center, Department of Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Henrik Jespersen
- Sahlgrenska Cancer Center, Department of Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - Joakim Karlsson
- Sahlgrenska Cancer Center, Department of Surgery, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
- Harry Perkins Institute of Medical Research, University of Western Australia, Perth, WA, Australia
| | - Samuel Alsén
- Sahlgrenska Cancer Center, Department of Surgery, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stefan Filges
- Department of Laboratory Medicine, Wallenberg Centre for Molecular and Translational Medicine, Department of Clinical Genetics and Genomics, Sahlgrenska Cancer Center, Institute of Biomedicine, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Bengt Andersson
- Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ana Carneiro
- Department of Hematology Oncology and Radiation Physics, Skåne University Hospital, and Institute of Clinical Sciences, Lund University, Lund, Sweden
| | - Hildur Helgadottir
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Max Levin
- Sahlgrenska Cancer Center, Department of Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Roger Olofsson Bagge
- Sahlgrenska Cancer Center, Department of Surgery, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Vasu R Sah
- Sahlgrenska Cancer Center, Department of Surgery, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulrika Stierner
- Sahlgrenska Cancer Center, Department of Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Ståhlberg
- Department of Laboratory Medicine, Wallenberg Centre for Molecular and Translational Medicine, Department of Clinical Genetics and Genomics, Sahlgrenska Cancer Center, Institute of Biomedicine, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gustav Ullenhag
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Lisa M Nilsson
- Sahlgrenska Cancer Center, Department of Surgery, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
- Harry Perkins Institute of Medical Research, University of Western Australia, Perth, WA, Australia
| | - Jonas A Nilsson
- Sahlgrenska Cancer Center, Department of Surgery, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
- Harry Perkins Institute of Medical Research, University of Western Australia, Perth, WA, Australia.
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Gatto F, Bratulic S, Jonasch E, Limeta A, Maccari F, Galeotti F, Volpi N, Lundstam S, Nielsen J, Stierner U. Plasma and urine free glycosaminoglycans as monitoring and predictive biomarkers in metastatic renal cell carcinoma: A prospective observational study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e16540] [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
e16540 Background: No liquid biomarkers are approved in renal cell carcinoma (RCC). In metastatic RCC (mRCC), there is a need to predict and monitor response noninvasively to guide the choice of treatment. Urine and plasma glycosaminoglycan (GAGs) profiles – or GAGomes - are promising biomarkers reflective of RCC metabolism. Here, we explored if GAGomes could predict and monitor response noninvasively. Methods: A single-center prospective consecutive series of mRCC patients elected for first-line therapy was enrolled between June 2016 - April 2019 at Sahlgrenska University Hospital, Gothenburg, Sweden. Response was assessed by the investigator as progressive disease (PD) versus non-PD. Plasma and urine GAGomes were measured at treatment start, after 6 weeks, and every 3rd month in a blinded central laboratory. We conducted Bayesian estimation to correlate GAGomes to response and to design GAG scores to classify PD. So-trained GAG scores were validated to predict PD vs. non-PD at treatment start or after 6 weeks. Results: Fifty patients with treatment-naïve mRCC were enrolled (median age: 68.5 years, 33% female). All received tyrosine-kinase inhibitors (37 sunitinib, 4 pazopanib, 9 cabozantinib). The median follow-up time was 3.5 months, totaling 65 response evaluation visits - 23 PD and 42 non-PD. PD was compatible with alterations in 40% of the detectable GAGome features. These were used to design a plasma, urine, and combined GAG progression score to classify PD vs. non-PD at response evaluation. The area-under-the-curve (AUC) was 0.91 in plasma, 0.98 in urine, and 0.99 when combined. In validation, the AUC to predict PD at treatment start was 0.64 in plasma, 0.63 in urine, and 0.71 when combined (N = 50); and, after 6 weeks, 0.75 in plasma, 0.66 in urine, and 0.80 when combined (N = 47). The combined GAG progression score had 62% sensitivity and 86% specificity to PD at treatment start and 67% and 87% after 6 weeks. Conclusions: GAGomes correlated with treatment response in mRCC. GAG scores were validated for the early prediction of response. Their clinical utility remains to be ascertained. Clinical trial information: NCT02732665.
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Affiliation(s)
| | - Sinisa Bratulic
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Eric Jonasch
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Angelo Limeta
- Chalmers University of Technology, Gothenburg, Sweden
| | - Francesca Maccari
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Galeotti
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Volpi
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sven Lundstam
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jens Nielsen
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Ulrika Stierner
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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Gatto F, Bratulic S, Cavarretta ITR, Alfano M, Maccari F, Galeotti F, Volpi N, Edqvist PH, Levin M, Nyman J, Bergman B, Salonia A, Lundstam S, Stierner U, Kjölhede H, Nielsen J. Detection of any-stage cancer using plasma and urine glycosaminoglycans. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.3034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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
3034 Background: Non-invasive liquid biopsies promise to enable early cancer detection and improve patient outcomes. However, virtually all liquid biopsies rely on genomic biomarkers, with limited sensitivity to early-stage tumors and poor detection of cancers shedding little cell-free DNA, like genitourinary or brain tumors. Here, we explored the use of plasma and urine glycosaminoglycan (GAGs) profiles, or GAGomes, as biomarkers reflective of tumor metabolism to serve as an alternative pan-cancer liquid biopsy. Methods: In this case-control study, we enrolled retrospective and prospective cohorts from Sweden and Italy. Included cases were treatment-naïve early-stage/low-grade cancers or metastatic/high-grade cancers across 14 histological types. Included controls were healthy 22-78 y/o adults with no history of cancer. We measured GAGomes – encompassing 17 chondroitin sulfate (CS), heparan sulfate (HS), and hyaluronate (HA) disaccharides - using a standardized UHPLC-MS/MS-based kit in a central blind laboratory. We tested the top GAGome features different in cancer using Bayesian estimation. These were used to design one plasma and one urine GAG score for the binary classification of cancer vs. control in a discovery set. We computed the area-under-the-curve (AUC), and sensitivity at 98% specificity of each GAG score in the validation set. A subset analysis was performed in early-stage/low-grade cancers only. In the subset of cases with survival records, we used multivariable Cox regression to estimate the hazard ratio (HR) for overall survival (OS) on each GAG score adjusted for cancer type, age, and gender. Results: GAGomes were measured in 753 plasma samples (460 cancers across 14 types, median age = 66 y/o, 51% female vs. 293 healthy adults, median age = 58 y/o, 57% female) and 559 urine samples (219 cancers across 5 types, median age = 69 y/o, 23% female vs. 340 healthy adults, median age = 56 y/o, 60% female). In the discovery set, the urine GAG score had an AUC = 0.80 (95% CI: 0.74-0.85, 124 cancers across 5 types vs. 184 controls) while the plasma GAG score had an AUC = 0.82 (95% CI: 0.78-0.86, 153 cancers across 14 types vs. 282 controls). In the validation set, the urine GAG score had an AUC = 0.78 (95% CI: 0.71-0.84, 95 cancers across 5 types vs. 156 controls) with 35% sensitivity at 98% specificity. The plasma GAG score had an AUC = 0.84 (95% CI: 0.79-0.88, 178 cancers across 14 types vs. 140 controls) with 41% sensitivity at 98% specificity. In the subset of early-stage/low-grade cancers, the AUC was 0.78 and 0.72 in plasma and urine, respectively. The plasma and urine GAG scores were independent predictors of OS regardless of cancer type (HR = 1.39, p = 0.005 in plasma [ N = 283, 11 types, 67 deaths, median follow-up 17 months] and HR = 1.53, p = 0.016 in urine [ N = 161, 4 types, 32 deaths, median follow-up 15 months]). Conclusions: GAGomes were sensitive non-invasive metabolic biomarkers for any-stage cancer, including genitourinary and brain tumors.
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Affiliation(s)
| | - Sinisa Bratulic
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | | | - Massimo Alfano
- IRCCS Ospedale San Raffaele, Urological Research Institute, Milan, Italy
| | - Francesca Maccari
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Galeotti
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Volpi
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Max Levin
- The Wallenberg Laboratory, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Nyman
- Department of Oncology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bengt Bergman
- Department of Respiratory Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andrea Salonia
- IRCCS Ospedale San Raffaele, Urological Research Institute, Milan, Italy
| | - Sven Lundstam
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulrika Stierner
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Kjölhede
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jens Nielsen
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
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Gatto F, Volpi N, Nilsson H, Nookaew I, Maruzzo M, Roma A, Johansson ME, Stierner U, Lundstam S, Basso U, Nielsen J. Glycosaminoglycan profiling in patients' plasma and urine predicts the occurrence of metastatic clear cell renal cell carcinoma. Cell Rep 2021; 34:108795. [PMID: 33657373 DOI: 10.1016/j.celrep.2021.108795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Karlsson J, Nilsson LM, Mitra S, Alsén S, Shelke GV, Sah VR, Forsberg EMV, Stierner U, All-Eriksson C, Einarsdottir B, Jespersen H, Ny L, Lindnér P, Larsson E, Olofsson Bagge R, Nilsson JA. Molecular profiling of driver events in metastatic uveal melanoma. Nat Commun 2020; 11:1894. [PMID: 32313009 PMCID: PMC7171146 DOI: 10.1038/s41467-020-15606-0] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [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] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 03/19/2020] [Indexed: 12/16/2022] Open
Abstract
Metastatic uveal melanoma is less well understood than its primary counterpart, has a distinct biology compared to skin melanoma, and lacks effective treatments. Here we genomically profile metastatic tumors and infiltrating lymphocytes. BAP1 alterations are overrepresented and found in 29/32 of cases. Reintroducing a functional BAP1 allele into a deficient patient-derived cell line, reveals a broad shift towards a transcriptomic subtype previously associated with better prognosis of the primary disease. One outlier tumor has a high mutational burden associated with UV-damage. CDKN2A deletions also occur, which are rarely present in primaries. A focused knockdown screen is used to investigate overexpressed genes associated withcopy number gains. Tumor-infiltrating lymphocytes are in several cases found tumor-reactive, but expression of the immune checkpoint receptors TIM-3, TIGIT and LAG3 is also abundant. This study represents the largest whole-genome analysis of uveal melanoma to date, and presents an updated view of the metastatic disease.
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Affiliation(s)
- Joakim Karlsson
- Sahlgrenska Cancer Center, Departments of Surgery, Oncology or Transplantation Surgery, Institute of Clinical Sciences at University of Gothenburg and Sahlgrenska University Hospital, Box 425, 40530, Gothenburg, Sweden
| | - Lisa M Nilsson
- Sahlgrenska Cancer Center, Departments of Surgery, Oncology or Transplantation Surgery, Institute of Clinical Sciences at University of Gothenburg and Sahlgrenska University Hospital, Box 425, 40530, Gothenburg, Sweden
| | - Suman Mitra
- Sahlgrenska Cancer Center, Departments of Surgery, Oncology or Transplantation Surgery, Institute of Clinical Sciences at University of Gothenburg and Sahlgrenska University Hospital, Box 425, 40530, Gothenburg, Sweden
| | - Samuel Alsén
- Sahlgrenska Cancer Center, Departments of Surgery, Oncology or Transplantation Surgery, Institute of Clinical Sciences at University of Gothenburg and Sahlgrenska University Hospital, Box 425, 40530, Gothenburg, Sweden
| | - Ganesh Vilas Shelke
- Sahlgrenska Cancer Center, Departments of Surgery, Oncology or Transplantation Surgery, Institute of Clinical Sciences at University of Gothenburg and Sahlgrenska University Hospital, Box 425, 40530, Gothenburg, Sweden
| | - Vasu R Sah
- Sahlgrenska Cancer Center, Departments of Surgery, Oncology or Transplantation Surgery, Institute of Clinical Sciences at University of Gothenburg and Sahlgrenska University Hospital, Box 425, 40530, Gothenburg, Sweden
| | - Elin M V Forsberg
- Sahlgrenska Cancer Center, Departments of Surgery, Oncology or Transplantation Surgery, Institute of Clinical Sciences at University of Gothenburg and Sahlgrenska University Hospital, Box 425, 40530, Gothenburg, Sweden
| | - Ulrika Stierner
- Sahlgrenska Cancer Center, Departments of Surgery, Oncology or Transplantation Surgery, Institute of Clinical Sciences at University of Gothenburg and Sahlgrenska University Hospital, Box 425, 40530, Gothenburg, Sweden
| | | | - Berglind Einarsdottir
- Sahlgrenska Cancer Center, Departments of Surgery, Oncology or Transplantation Surgery, Institute of Clinical Sciences at University of Gothenburg and Sahlgrenska University Hospital, Box 425, 40530, Gothenburg, Sweden
| | - Henrik Jespersen
- Sahlgrenska Cancer Center, Departments of Surgery, Oncology or Transplantation Surgery, Institute of Clinical Sciences at University of Gothenburg and Sahlgrenska University Hospital, Box 425, 40530, Gothenburg, Sweden
| | - Lars Ny
- Sahlgrenska Cancer Center, Departments of Surgery, Oncology or Transplantation Surgery, Institute of Clinical Sciences at University of Gothenburg and Sahlgrenska University Hospital, Box 425, 40530, Gothenburg, Sweden
| | - Per Lindnér
- Sahlgrenska Cancer Center, Departments of Surgery, Oncology or Transplantation Surgery, Institute of Clinical Sciences at University of Gothenburg and Sahlgrenska University Hospital, Box 425, 40530, Gothenburg, Sweden
| | - Erik Larsson
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, University of Gothenburg, Box 440, 405 30, Göteborg, Sweden
| | - Roger Olofsson Bagge
- Sahlgrenska Cancer Center, Departments of Surgery, Oncology or Transplantation Surgery, Institute of Clinical Sciences at University of Gothenburg and Sahlgrenska University Hospital, Box 425, 40530, Gothenburg, Sweden
| | - Jonas A Nilsson
- Sahlgrenska Cancer Center, Departments of Surgery, Oncology or Transplantation Surgery, Institute of Clinical Sciences at University of Gothenburg and Sahlgrenska University Hospital, Box 425, 40530, Gothenburg, Sweden.
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Einarsdottir BO, Karlsson J, Söderberg EMV, Lindberg MF, Funck-Brentano E, Jespersen H, Brynjolfsson SF, Bagge RO, Carstam L, Scobie M, Koolmeister T, Wallner O, Stierner U, Berglund UW, Ny L, Nilsson LM, Larsson E, Helleday T, Nilsson JA. Correction: A patient-derived xenograft pre-clinical trial reveals treatment responses and a resistance mechanism to karonudib in metastatic melanoma. Cell Death Dis 2020; 11:99. [PMID: 32029719 PMCID: PMC7005267 DOI: 10.1038/s41419-020-2301-y] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
On Pubmed, the name of co-author Roger Olofsson Bagge appeared incorrectly as "Bagge RO" instead of "Olofsson Bagge, Roger". This has been corrected in the PDF and HTML versions.
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Affiliation(s)
- Berglind O Einarsdottir
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, Departments of Surgery and Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Joakim Karlsson
- Department of Medical Chemistry, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Elin M V Söderberg
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, Departments of Surgery and Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mattias F Lindberg
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, Departments of Surgery and Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisa Funck-Brentano
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, Departments of Surgery and Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Jespersen
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, Departments of Surgery and Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Siggeir F Brynjolfsson
- Department of Microbiology and Immunology, Institute for Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, Departments of Surgery and Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Louise Carstam
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Scobie
- Science for Life Laboratory, Division of Translational Medicine and Chemical Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Koolmeister
- Science for Life Laboratory, Division of Translational Medicine and Chemical Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Olof Wallner
- Science for Life Laboratory, Division of Translational Medicine and Chemical Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Stierner
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, Departments of Surgery and Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulrika Warpman Berglund
- Science for Life Laboratory, Division of Translational Medicine and Chemical Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Ny
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, Departments of Surgery and Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lisa M Nilsson
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, Departments of Surgery and Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Erik Larsson
- Department of Medical Chemistry, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Helleday
- Science for Life Laboratory, Division of Translational Medicine and Chemical Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Jonas A Nilsson
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, Departments of Surgery and Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
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9
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Jespersen H, Olofsson Bagge R, Ullenhag G, Carneiro A, Helgadottir H, Ljuslinder I, Levin M, All-Eriksson C, Andersson B, Stierner U, Nilsson L, Nilsson J, Ny L. Phase II multicenter open label study of pembrolizumab and entinostat in adult patients with metastatic uveal melanoma (PEMDAC study). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Abstract
Introduction: Phase III studies of PD-1 inhibitors have demonstrated remarkable improvements in the survival of patients with metastatic melanoma (MM). If these results are generalizable to an unselected patient population treated in clinical routine is unknown. This study aimed to investigate and describe clinical efficacy and safety of PD-1 inhibitors in patients with MM treated in routine clinical practice. Material and methods: A retrospective descriptive study of patients with metastatic or inoperable cutaneous melanoma treated with PD-1 inhibitors at a single institution (Department of Oncology, Sahlgrenska University Hospital) from 1 September 2015 to 31 August 2017. Data were obtained from medical records. Results: A total of 116 patients were included in the analyses. The overall survival (OS) at 12-month follow-up was 70.2% and the median OS was 27.9 months. Patients with BRAF mutated tumors had increased OS, whereas ECOG PS ≥2, LDH > ULN and presence or history of brain metastases (stage M1d) were associated with impaired survival. Immune-related AEs of any grade occurred in 64 (55.2%) patients and 15 (12.9%) patients experienced immune-related AEs of grades 3 and 4. Notably, rheumatic adverse events occurred at a higher rate (15.5%) than previously reported. The occurrence of immune-related AEs was associated with a benefit in OS, while the severity of immune-related AEs did not affect survival, nor did the use of systemic corticosteroids. Conclusions: The efficacy and safety of PD1 inhibitors in routine clinical practice appear comparable to that described in clinical trials.
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Affiliation(s)
- Anna Arheden
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Joanna Skalenius
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sara Bjursten
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulrika Stierner
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Ny
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Max Levin
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Jespersen
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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11
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Jespersen H, Olofsson Bagge R, Ullenhag G, Carneiro A, Helgadottir H, Ljuslinder I, Levin M, All-Eriksson C, Andersson B, Stierner U, Nilsson LM, Nilsson JA, Ny L. Concomitant use of pembrolizumab and entinostat in adult patients with metastatic uveal melanoma (PEMDAC study): protocol for a multicenter phase II open label study. BMC Cancer 2019; 19:415. [PMID: 31046743 PMCID: PMC6498539 DOI: 10.1186/s12885-019-5623-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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] [Received: 11/19/2018] [Accepted: 04/18/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND While recent years have seen a revolution in the treatment of metastatic cutaneous melanoma, no treatment has yet been able to demonstrate any prolonged survival in metastatic uveal melanoma. Thus, metastatic uveal melanoma remains a disease with an urgent unmet medical need. Reports of treatment with immune checkpoint inhibitors have thus far been disappointing. Based on animal experiments, it is reasonable to hypothesize that the effect of immunotherapy may be augmented by epigenetic therapy. Proposed mechanisms include enhanced expression of HLA class I and cancer antigens on cancer cells, as well as suppression of myeloid suppressor cells. METHODS The PEMDAC study is a multicenter, open label phase II study assessing the efficacy of concomitant use of the PD1 inhibitor pembrolizumab and the class I HDAC inhibitor entinostat in adult patients with metastatic uveal melanoma. Primary endpoint is objective response rate. Eligible patients have histologically confirmed metastatic uveal melanoma, ECOG performance status 0-1, measurable disease as per RECIST 1.1 and may have received any number of prior therapies, with the exception of anticancer immunotherapy. Twenty nine patients will be enrolled. Patients receive pembrolizumab 200 mg intravenously every third week in combination with entinostat 5 mg orally once weekly. Treatment will continue until progression of disease or intolerable toxicity or for a maximum of 24 months. DISCUSSION The PEMDAC study is the first trial to assess whether the addition of an HDAC inhibitor to anti-PD1 therapy can yield objective anti-tumoral responses in metastatic UM. TRIAL REGISTRATION ClinicalTrials.gov registration number: NCT02697630 . (Registered 3 March 2016). EudraCT registration number: 2016-002114-50.
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Affiliation(s)
- Henrik Jespersen
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Blå stråket 2, 413 45, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Blå stråket 5, 413 45, Gothenburg, Sweden
| | - Gustav Ullenhag
- Department of Radiology, Oncology and Radiation Science, Section of Oncology, Uppsala University, 751 05, Uppsala, Sweden
| | - Ana Carneiro
- Department of Oncology, Skåne University Hospital, Getingevägen 4, 221 85, Lund, Sweden
| | - Hildur Helgadottir
- Department of Oncology, Karolinska University Hospital, Karolinska vägen, 171 76, Stockholm, Sweden
| | - Ingrid Ljuslinder
- Department of Oncology, Norrlands University Hospital, 901 85, Umeå, Sweden
| | - Max Levin
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Blå stråket 2, 413 45, Gothenburg, Sweden
| | | | - Bengt Andersson
- Department of Clinical immunology and transfusion medicine, Sahlgrenska University Hospital, Guldhedsgatan 10, 413 45, Gothenburg, Sweden
| | - Ulrika Stierner
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Blå stråket 2, 413 45, Gothenburg, Sweden
| | - Lisa M Nilsson
- Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Medicinaregatan 1F, 405 30, Gothenburg, Sweden
| | - Jonas A Nilsson
- Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Medicinaregatan 1F, 405 30, Gothenburg, Sweden
| | - Lars Ny
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Blå stråket 2, 413 45, Gothenburg, Sweden.
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12
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Einarsdottir BO, Karlsson J, Söderberg EMV, Lindberg MF, Funck-Brentano E, Jespersen H, Brynjolfsson SF, Olofsson Bagge R, Carstam L, Scobie M, Koolmeister T, Wallner O, Stierner U, Berglund UW, Ny L, Nilsson LM, Larsson E, Helleday T, Nilsson JA. A patient-derived xenograft pre-clinical trial reveals treatment responses and a resistance mechanism to karonudib in metastatic melanoma. Cell Death Dis 2018; 9:810. [PMID: 30042422 PMCID: PMC6057880 DOI: 10.1038/s41419-018-0865-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 03/28/2018] [Revised: 06/29/2018] [Accepted: 07/05/2018] [Indexed: 12/19/2022]
Abstract
Karonudib (TH1579) is a novel compound that exerts anti-tumor activities and has recently entered phase I clinical testing. The aim of this study was to conduct a pre-clinical trial in patient-derived xenografts to identify the possible biomarkers of response or resistance that could guide inclusion of patients suffering from metastatic melanoma in phase II clinical trials. Patient-derived xenografts from 31 melanoma patients with metastatic disease were treated with karonudib or a vehicle for 18 days. Treatment responses were followed by measuring tumor sizes, and the models were categorized in the response groups. Tumors were harvested and processed for RNA sequencing and protein analysis. To investigate the effect of karonudib on T-cell-mediated anti-tumor activities, tumor-infiltrating T cells were injected in mice carrying autologous tumors and the mice treated with karonudib. We show that karonudib has heterogeneous anti-tumor effect on metastatic melanoma. Thus, based on the treatment responses, we could divide the 31 patient-derived xenografts in three treatment groups: progression group (32%), suppression group (42%), and regression group (26%). Furthermore, we show that karonudib has anti-tumor effect, irrespective of major melanoma driver mutations. Also, we identify high expression of ABCB1, which codes for p-gp pumps as a resistance biomarker. Finally, we show that karonudib treatment does not hamper T-cell-mediated anti-tumor responses. These findings can be used to guide future use of karonudib in clinical use with a potential approach as precision medicine.
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Affiliation(s)
- Berglind O Einarsdottir
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, Departments of Surgery and Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Joakim Karlsson
- Department of Medical Chemistry, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Elin M V Söderberg
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, Departments of Surgery and Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mattias F Lindberg
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, Departments of Surgery and Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisa Funck-Brentano
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, Departments of Surgery and Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Jespersen
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, Departments of Surgery and Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Siggeir F Brynjolfsson
- Department of Microbiology and Immunology, Institute for Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, Departments of Surgery and Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Louise Carstam
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Scobie
- Science for Life Laboratory, Division of Translational Medicine and Chemical Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Koolmeister
- Science for Life Laboratory, Division of Translational Medicine and Chemical Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Olof Wallner
- Science for Life Laboratory, Division of Translational Medicine and Chemical Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Stierner
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, Departments of Surgery and Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulrika Warpman Berglund
- Science for Life Laboratory, Division of Translational Medicine and Chemical Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Ny
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, Departments of Surgery and Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lisa M Nilsson
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, Departments of Surgery and Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Erik Larsson
- Department of Medical Chemistry, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Helleday
- Science for Life Laboratory, Division of Translational Medicine and Chemical Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Jonas A Nilsson
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, Departments of Surgery and Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
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13
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Bhadury J, Einarsdottir BO, Podraza A, Bagge RO, Stierner U, Ny L, Dávila López M, Nilsson JA. Hypoxia-regulated gene expression explains differences between melanoma cell line-derived xenografts and patient-derived xenografts. Oncotarget 2018; 7:23801-11. [PMID: 27009863 PMCID: PMC5029664 DOI: 10.18632/oncotarget.8181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Received: 01/25/2016] [Accepted: 03/04/2016] [Indexed: 01/09/2023] Open
Abstract
Cell line-derived xenografts (CDXs) are an integral part of drug efficacy testing during development of new pharmaceuticals against cancer but their accuracy in predicting clinical responses in patients have been debated. Patient-derived xenografts (PDXs) are thought to be more useful for predictive biomarker identification for targeted therapies, including in metastatic melanoma, due to their similarities to human disease. Here, tumor biopsies from fifteen patients and ten widely-used melanoma cell lines were transplanted into immunocompromised mice to generate PDXs and CDXs, respectively. Gene expression profiles generated from the tumors of these PDXs and CDXs clustered into distinct groups, despite similar mutational signatures. Hypoxia-induced gene signatures and overexpression of the hypoxia-regulated miRNA hsa-miR-210 characterized CDXs. Inhibition of hsa-miR-210 with decoys had little phenotypic effect in vitro but reduced sensitivity to MEK1/2 inhibition in vivo, suggesting down-regulation of this miRNA could result in development of resistance to MEK inhibitors.
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Affiliation(s)
- Joydeep Bhadury
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Berglind O Einarsdottir
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Agnieszka Podraza
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulrika Stierner
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Ny
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marcela Dávila López
- The Bioinformatics Core Facility at the University of Gothenburg, Gothenburg, Sweden
| | - Jonas A Nilsson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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14
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Muralidharan SV, Einarsdottir BO, Bhadury J, Lindberg MF, Wu J, Campeau E, Bagge RO, Stierner U, Ny L, Nilsson LM, Nilsson JA. BET bromodomain inhibitors synergize with ATR inhibitors in melanoma. Cell Death Dis 2017; 8:e2982. [PMID: 28796244 PMCID: PMC5596569 DOI: 10.1038/cddis.2017.383] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 02/22/2017] [Revised: 06/25/2017] [Accepted: 07/02/2017] [Indexed: 01/21/2023]
Abstract
Metastatic malignant melanoma continues to be a challenging disease despite clinical translation of the comprehensive understanding of driver mutations and how melanoma cells evade immune attack. In Myc-driven lymphoma, efficacy of epigenetic inhibitors of the bromodomain and extra-terminal domain (BET) family of bromodomain proteins can be enhanced by combination therapy with inhibitors of the DNA damage response kinase ATR. Whether this combination is active in solid malignancies like melanoma, and how it relates to immune therapy, has not previously investigated. To test efficacy and molecular consequences of combination therapies cultured melanoma cells were used. To assess tumor responses to therapies in vivo we use patient-derived xenografts and B6 mice transplanted with B16F10 melanoma cells. Concomitant inhibition of BET proteins and ATR of cultured melanoma cells resulted in similar effects as recently shown in lymphoma, such as induction of apoptosis and p62, implicated in autophagy, senescence-associated secretory pathway and ER stress. In vivo, apoptosis and suppression of subcutaneous growth of patient-derived melanoma and B16F10 cells were observed. Our data suggest that ATRI/BETI combination therapies are effective in melanoma.
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Affiliation(s)
| | | | - Joydeep Bhadury
- Sahlgrenska Cancer Center, Department of Surgery or University Hospital, Gothenburg, Sweden.,The Institute of Medical Science, Division of Stem Cell Therapy, The University of Tokyo, Tokyo, Japan
| | - Mattias F Lindberg
- Sahlgrenska Cancer Center, Department of Surgery or University Hospital, Gothenburg, Sweden
| | - Jin Wu
- Zenith Epigenetics Ltd, Calgary, Canada
| | | | - Roger Olofsson Bagge
- Sahlgrenska Cancer Center, Department of Surgery or University Hospital, Gothenburg, Sweden
| | - Ulrika Stierner
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and The Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Ny
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and The Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lisa M Nilsson
- Sahlgrenska Cancer Center, Department of Surgery or University Hospital, Gothenburg, Sweden
| | - Jonas A Nilsson
- Sahlgrenska Cancer Center, Department of Surgery or University Hospital, Gothenburg, Sweden
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15
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Xue Y, Martelotto L, Baslan T, Vides A, Solomon M, Mai TT, Chaudhary N, Riely GJ, Li BT, Scott K, Cechhi F, Stierner U, Chadalavada K, de Stanchina E, Schwartz S, Hembrough T, Nanjangud G, Berger MF, Nilsson J, Lowe SW, Reis-Filho JS, Rosen N, Lito P. An approach to suppress the evolution of resistance in BRAF V600E-mutant cancer. Nat Med 2017; 23:929-937. [PMID: 28714990 PMCID: PMC5696266 DOI: 10.1038/nm.4369] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [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: 05/03/2017] [Accepted: 06/15/2017] [Indexed: 12/12/2022]
Abstract
The principles governing evolution of tumors exposed to targeted therapy are poorly understood. Here we modeled the selection and propagation of BRAF amplification (BRAFamp) in patient-derived tumor xenografts (PDX) treated with a direct ERK inhibitor, alone or in combination with other pathway inhibitors. Single cell sequencing and multiplex-fluorescence in situ hybridization mapped the emergence of extra-chromosomal amplification in parallel evolutionary tracts, arising in the same tumor shortly after treatment. The evolutionary selection of BRAFamp is determined by the fitness threshold, the barrier subclonal populations need to overcome to regain fitness in the presence of therapy. This differed for ERK signaling inhibitors, suggesting that sequential monotherapy is ineffective and selects for a progressively higher BRAF copy number. Concurrent targeting of RAF, MEK and ERK, however, imposes a sufficiently high fitness threshold to prevent the propagation of subclones with high-level amplification. Administered on an intermittent schedule, this treatment inhibited tumor growth in 11/11-lung cancer and melanoma PDX without apparent toxicity in mice. Thus, gene amplification can be acquired and expanded through parallel evolution, enabling tumors to adapt while maintaining their intratumoral heterogeneity. Treatments that impose the highest fitness threshold will likely prevent the evolution of resistance-causing alterations and merit testing in patients.
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Affiliation(s)
- Yaohua Xue
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York, USA.,Weill Cornell-Rockefeller-Sloan Kettering Tri-institutional MD-PhD Program, New York, New York, USA
| | - Luciano Martelotto
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Timour Baslan
- Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alberto Vides
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York, USA
| | - Martha Solomon
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York, USA
| | - Trang Thi Mai
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York, USA
| | - Neelam Chaudhary
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York, USA
| | - Greg J Riely
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Bob T Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Ulrika Stierner
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg, Sweden
| | - Kalyani Chadalavada
- Molecular Cytogenetics Core Facility, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elisa de Stanchina
- Antitumor Assessment Core Facility, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Gouri Nanjangud
- Molecular Cytogenetics Core Facility, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michael F Berger
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Jonas Nilsson
- Sahlgrenska Translational Melanoma Group, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg, Sweden
| | - Scott W Lowe
- Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Neal Rosen
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Piro Lito
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Weill Cornell Medical College, Cornell University, New York, New York, USA
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16
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Hultborn R, Sand J, Kinhult S, Lundgren L, Stierner U, Turesson I, Albertsson P. Accelerated or conventional whole brain irradiation of malignant melanoma. Acta Oncol 2017; 56:1021-1023. [PMID: 28075181 DOI: 10.1080/0284186x.2016.1275777] [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] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/14/2016] [Accepted: 12/18/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Ragnar Hultborn
- a Department of Oncology , Sahlgrenska Academy, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Johanna Sand
- a Department of Oncology , Sahlgrenska Academy, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Sara Kinhult
- b Department of Oncology , Skane University Hospital , Lund , Sweden
| | - Lotta Lundgren
- b Department of Oncology , Skane University Hospital , Lund , Sweden
| | - Ulrika Stierner
- a Department of Oncology , Sahlgrenska Academy, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Ingela Turesson
- c Department of Immunology, Genetics and Pathology, Section of Experimental and Clinical Oncology , Uppsala University , Uppsala , Sweden
| | - Per Albertsson
- a Department of Oncology , Sahlgrenska Academy, Sahlgrenska University Hospital , Gothenburg , Sweden
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17
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Helgadottir H, Stierner U. [The melanoma incidence continues to rise]. Lakartidningen 2017; 114:ELAP. [PMID: 28485765] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Hildur Helgadottir
- Karolinska Universitetssjukhuset - Stockholm, Sweden - Stockholm, Sweden
| | - Ulrika Stierner
- Sahlgrenska universitetssjukhuset - Goteborg, Sweden Sahlgrenska universitetssjukhuset - Goteborg, Sweden
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18
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Bhadury J, Einarsdottir BO, Podraza A, Bagge RO, Stierner U, Ny L, López MD, Nilsson JA. Abstract 642: Hypoxia-regulated gene expression explains differences between cell line-derived xenografts and patient-derived xenografts. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-642] [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: 11/16/2022]
Abstract
Abstract
Cell line-derived xenografts (CDXs) are an integral part of drug efficacy testing during development of new pharmaceuticals against cancer but their accuracy in predicting clinical responses in patients have been debated. Patient-derived xenografts (PDXs) are thought to be more useful for predictive biomarker identification for targeted therapies, including metastatic melanoma, due to their similarities to human disease. Here, tumor biopsies from patients and ten widely-used melanoma cell lines were transplanted into immunocompromised mice to generate PDXs and CDXs, respectively. Gene expression profiles generated from the tumors of these PDXs and CDXs clustered into distinct groups, despite similar mutational signatures. Hypoxia-induced gene signatures and overexpression of the hypoxia-regulated miRNA hsa-miR-210 characterized CDXs. Inhibition of hsa-miR-210 with decoys had little phenotypic effect in vitro but resulted in reduced sensitivity to MEK1/2 inhibition in vivo, suggesting down-regulation of this miRNA could result in development of resistance to MEK inhibitors.
Citation Format: Joydeep Bhadury, Berglind O. Einarsdottir, Agnieszka Podraza, Roger Olofsson Bagge, Ulrika Stierner, Lars Ny, Marcela Dávila López, Jonas A. Nilsson. Hypoxia-regulated gene expression explains differences between cell line-derived xenografts and patient-derived xenografts. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 642.
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Affiliation(s)
| | | | | | | | | | - Lars Ny
- University of Gothenburg, Gothenburg, Sweden
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Tandstad T, Ståhl O, Dahl O, Haugnes H, Håkansson U, Karlsdottir Å, Kjellman A, Langberg C, Laurell A, Oldenburg J, Solberg A, Söderström K, Stierner U, Cavallin-Ståhl E, Wahlqvist R, Wall N, Cohn-Cedermark G. Treatment of stage I seminoma, with one course of adjuvant carboplatin or surveillance, risk-adapted recommendations implementing patient autonomy: a report from the Swedish and Norwegian Testicular Cancer Group (SWENOTECA). Ann Oncol 2016; 27:1299-304. [DOI: 10.1093/annonc/mdw164] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/29/2016] [Indexed: 11/14/2022] Open
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Gatto F, Volpi N, Nilsson H, Nookaew I, Maruzzo M, Roma A, Johansson M, Stierner U, Lundstam S, Basso U, Nielsen J. Glycosaminoglycan Profiling in Patients’ Plasma and Urine Predicts the Occurrence of Metastatic Clear Cell Renal Cell Carcinoma. Cell Rep 2016; 15:1822-36. [DOI: 10.1016/j.celrep.2016.04.056] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/11/2016] [Accepted: 04/14/2016] [Indexed: 02/07/2023] Open
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Olofsson Bagge R, Ny L, All-Ericsson C, Sternby Eilard M, Rizell M, Cahlin C, Stierner U, Lönn U, Hansson J, Ljuslinder I, Lundgren L, Ullenhag G, Kiilgaard JF, Nilsson J, Lindnér P. Erratum to: Isolated hepatic perfusion as a treatment for uveal melanoma liver metastases (the SCANDIUM trial): study protocol for a randomized controlled trial. Trials 2015; 16:334. [PMID: 26246135 PMCID: PMC4527346 DOI: 10.1186/s13063-015-0809-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/16/2015] [Indexed: 12/02/2022] Open
Affiliation(s)
- Roger Olofsson Bagge
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.
| | - Lars Ny
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | | | - Malin Sternby Eilard
- Transplant Institute, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Magnus Rizell
- Transplant Institute, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Christian Cahlin
- Transplant Institute, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Ulrika Stierner
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Ulf Lönn
- Department of Oncology, Linköping University Hospital, Linköping, Sweden.
| | - Johan Hansson
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
| | - Ingrid Ljuslinder
- Department of Oncology, Norrlands University Hospital, Umeå, Sweden.
| | - Lotta Lundgren
- Department of Oncology, Skåne University Hospital, Lund, Sweden.
| | - Gustav Ullenhag
- Department of Radiology, Oncology and Radiation Science, Section of Oncology, Uppsala University, Uppsala, Sweden.
| | - Jens Folke Kiilgaard
- Department of Ophthalmology, Glostrup Hospital, Copenhagen University Hospital Glostrup, Glostrup, Denmark.
| | - Jonas Nilsson
- Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Per Lindnér
- Transplant Institute, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Einarsdottir BO, Bagge RO, Bhadury J, Jespersen H, Nilsson LM, Mattsson J, Truvé K, Naredi P, Nilsson O, Lopez MD, Stierner U, Ny L, Nilsson JA. Abstract B38: Melanoma patient-derived xenografts accurately models the disease and develop fast enough to guide treatment decisions. Cancer Res 2015. [DOI: 10.1158/1538-7445.mel2014-b38] [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: 11/16/2022]
Abstract
Abstract
The development of novel therapies against melanoma would benefit from individualized tumor models to ensure the rapid and accurate identification of biomarkers of therapy response. Previous studies have suggested that patient-derived xenografts (PDXes) could be used in biomarker of response discovery. However, the clinical utility of PDXes in guiding real-time treatment decisions have only been reported in anecdotal forms. In the present study we aimed to develop a platform of melanoma patient-derived xenografts (PDXes), to assess whether treatment responses in mice would be applicable as a pre-selection tool for clinical trials. To that end, tumor biopsies from patients with stage III and IV metastatic malignant melanoma were transplanted into immunocompromised mice. Most melanoma biopsies generated serially transplantable PDX models, and their histology, and mutation status resembled their corresponding patient biopsy. RNAseq demonstrated that the expression profiles of the tumors are maintained throughout several passages in mice. The potential treatment for one patient was revealed by an in vitro drug screen and treating PDXes with the MEK inhibitor trametinib. In another patient, the BRAF mutation predicted the response of both the patient and its corresponding PDXes to MAP kinase pathway-targeted therapy. Importantly, in this unselected group of patients, the time from biopsy for generation of PDXes until death was significantly longer than the time required to reach the treatment phase of the PDXes. Thus, we demonstrate that it would be clinically meaningful to use this type of platform for a large proportion of melanoma patients as a pre-selection tool in clinical trials.
Citation Format: Berglind O. Einarsdottir, Roger Olofsson Bagge, Joydeep Bhadury, Henrik Jespersen, Lisa M. Nilsson, Jan Mattsson, Katarina Truvé, Peter Naredi, Ola Nilsson, Marcela Davila Lopez, Ulrika Stierner, Lars Ny, Jonas A. Nilsson. Melanoma patient-derived xenografts accurately models the disease and develop fast enough to guide treatment decisions. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Melanoma: From Biology to Therapy; Sep 20-23, 2014; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(14 Suppl):Abstract nr B38.
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Affiliation(s)
| | | | | | | | | | - Jan Mattsson
- 2Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Ola Nilsson
- 1University of Gothenburg, Gothenburg, Sweden,
| | | | | | - Lars Ny
- 1University of Gothenburg, Gothenburg, Sweden,
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Einarsdottir BO, Bagge RO, Bhadury J, Jespersen H, Mattsson J, Nilsson LM, Truvé K, López MD, Naredi P, Nilsson O, Stierner U, Ny L, Nilsson JA. Melanoma patient-derived xenografts accurately model the disease and develop fast enough to guide treatment decisions. Oncotarget 2015; 5:9609-18. [PMID: 25228592 PMCID: PMC4259423 DOI: 10.18632/oncotarget.2445] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [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] [Indexed: 01/27/2023] Open
Abstract
The development of novel therapies against melanoma would benefit from individualized tumor models to ensure the rapid and accurate identification of biomarkers of therapy response. Previous studies have suggested that patient-derived xenografts (PDXes) could be useful. However, the utility of PDXes in guiding real-time treatment decisions has only been reported in anecdotal forms. Here tumor biopsies from patients with stage III and IV metastatic malignant melanoma were transplanted into immunocompromised mice to generate PDXes. 23/26 melanoma biopsies generated serially transplantable PDX models, and their histology, mutation status and expression profile resembled their corresponding patient biopsy. The potential treatment for one patient was revealed by an in vitro drug screen and treating PDXes with the MEK inhibitor trametinib. In another patient, the BRAF mutation predicted the response of both the patient and its corresponding PDXes to MAPK-targeted therapy. Importantly, in this unselected group of patients, the time from biopsy for generation of PDXes until death was significantly longer than the time required to reach the treatment phase of the PDXes. Thus, it could be clinically meaningful to use this type of platform for melanoma patients as a pre-selection tool in clinical trials.
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Affiliation(s)
- Berglind O Einarsdottir
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden. Sahlgrenska Translational Melanoma Group at the Sahlgrenska Cancer Center, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden. Sahlgrenska Translational Melanoma Group at the Sahlgrenska Cancer Center, Gothenburg, Sweden
| | - Joydeep Bhadury
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden. Sahlgrenska Translational Melanoma Group at the Sahlgrenska Cancer Center, Gothenburg, Sweden
| | - Henrik Jespersen
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden. Sahlgrenska Translational Melanoma Group at the Sahlgrenska Cancer Center, Gothenburg, Sweden
| | - Jan Mattsson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden. Sahlgrenska Translational Melanoma Group at the Sahlgrenska Cancer Center, Gothenburg, Sweden
| | - Lisa M Nilsson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden. Sahlgrenska Translational Melanoma Group at the Sahlgrenska Cancer Center, Gothenburg, Sweden
| | - Katarina Truvé
- The Bioinformatics Core Facility at the University of Gothenburg, Gothenburg, Sweden
| | - Marcela Dávila López
- Sahlgrenska Translational Melanoma Group at the Sahlgrenska Cancer Center, Gothenburg, Sweden. The Bioinformatics Core Facility at the University of Gothenburg, Gothenburg, Sweden
| | - Peter Naredi
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden. Sahlgrenska Translational Melanoma Group at the Sahlgrenska Cancer Center, Gothenburg, Sweden
| | - Ola Nilsson
- Department of Biomedicine, Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden. Sahlgrenska Translational Melanoma Group at the Sahlgrenska Cancer Center, Gothenburg, Sweden
| | - Ulrika Stierner
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden. Sahlgrenska Translational Melanoma Group at the Sahlgrenska Cancer Center, Gothenburg, Sweden
| | - Lars Ny
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden. Sahlgrenska Translational Melanoma Group at the Sahlgrenska Cancer Center, Gothenburg, Sweden
| | - Jonas A Nilsson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden. Sahlgrenska Translational Melanoma Group at the Sahlgrenska Cancer Center, Gothenburg, Sweden
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Tuominen R, Jewell R, van den Oord JJ, Wolter P, Stierner U, Lindholm C, Hertzman Johansson C, Lindén D, Johansson H, Frostvik Stolt M, Walker C, Snowden H, Newton-Bishop J, Hansson J, Egyházi Brage S. MGMT promoter methylation is associated with temozolomide response and prolonged progression-free survival in disseminated cutaneous melanoma. Int J Cancer 2015; 136:2844-53. [PMID: 25400033 DOI: 10.1002/ijc.29332] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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: 06/13/2014] [Accepted: 10/16/2014] [Indexed: 11/11/2022]
Abstract
To investigate the predictive and prognostic value of O(6) -methylguanine DNA methyltransferase (MGMT) inactivation by analyses of promoter methylation in pretreatment tumor biopsies from patients with cutaneous melanoma treated with dacarbazine (DTIC) or temozolomide (TMZ) were performed. The patient cohorts consisted of Belgian and Swedish disseminated melanoma patients. Patients were subdivided into those receiving single-agent treatment with DTIC/TMZ (cohort S, n = 74) and those treated with combination chemotherapy including DTIC/TMZ (cohort C, n = 79). Median follow-up was 248 and 336 days for cohort S and cohort C, respectively. MGMT promoter methylation was assessed by three methods. The methylation-related transcriptional silencing of MGMT mRNA expression was assessed by real-time RT-PCR. Response to chemotherapy and progression-free survival (PFS) and overall survival were correlated to MGMT promoter methylation status. MGMT promoter methylation was detected in tumor biopsies from 21.5 % of the patients. MGMT mRNA was found to be significantly lower in tumors positive for MGMT promoter methylation compared to tumors without methylation in both treatment cohorts (p < 0.005). DTIC/TMZ therapy response rate was found to be significantly associated with MGMT promoter methylation in cohort S (p = 0.0005), but did not reach significance in cohort C (p = 0.16). Significantly longer PFS was observed among patients with MGMT promoter-methylated tumors (p = 0.002). Multivariate Cox regression analysis identified presence of MGMT promoter methylation as an independent variable associated with longer PFS. Together, this implies that MGMT promoter methylation is associated with response to single-agent DTIC/TMZ and longer PFS in disseminated cutaneous melanoma.
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Affiliation(s)
- Rainer Tuominen
- Department of Oncology and Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Lyth J, Eriksson H, Hansson J, Ingvar C, Jansson M, Lapins J, Månsson-Brahme E, Naredi P, Stierner U, Ullenhag G, Carstensen J, Lindholm C. Trends in cutaneous malignant melanoma in Sweden 1997-2011: thinner tumours and improved survival among men. Br J Dermatol 2015; 172:700-6. [PMID: 25323770 DOI: 10.1111/bjd.13483] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Both patient survival and the proportion of patients diagnosed with thin cutaneous malignant melanoma (CMM) have been steadily rising in Sweden as in most Western countries, although the rate of improvement in survival appears to have declined in Sweden at the end of the last millennium. OBJECTIVES To analyse the most recent trends in the distribution of tumour thickness (T category) as well as CMM-specific survival in Swedish patients diagnosed during 1997-2011. METHODS This nationwide population-based study included 30,590 patients registered in the Swedish Melanoma Register (SMR) and diagnosed with a first primary invasive CMM during 1997-2011. The patients were followed through 2012 in the national Cause of Death Register. RESULTS Logistic and Cox regression analyses adjusting for age at diagnosis, tumour site and healthcare region were carried out. The odds ratio for being diagnosed with thicker tumours was significantly reduced (P < 0·001) and the CMM-specific survival significantly improved in men diagnosed during 2007-2011 compared with men diagnosed during 1997-2001 (hazard ratio = 0·81; 95% confidence interval 0·72-0·91; P < 0·001), while the corresponding differences for women were not significant. Women were diagnosed with significantly thicker tumours during 2002-2006 and a tendency towards decreased survival was observed compared with those diagnosed earlier (during 1997-2001) and later (during 2007-2011). CONCLUSIONS In Sweden, the CMMs of men are detected earlier over time and this seems to be followed by an improved CMM-specific survival for men. Women are still diagnosed with considerably thinner tumours and they experience a better survival than men.
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Affiliation(s)
- J Lyth
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Regional Cancer Center South East, University Hospital, Linköping, Sweden
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Vihinen P, Tervahartiala T, Sorsa T, Hansson J, Bastholt L, Aamdal S, Stierner U, Pyrhönen S, Syrjänen K, Lundin J, Hernberg M. Benefit of adjuvant interferon alfa-2b (IFN-α) therapy in melanoma patients with high serum MMP-8 levels. Cancer Immunol Immunother 2015; 64:173-80. [PMID: 25319807 PMCID: PMC11029364 DOI: 10.1007/s00262-014-1620-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 10/03/2014] [Indexed: 11/25/2022]
Abstract
Matrix metalloproteinases (MMPs) are important enzymes in tissue turnover and various inflammatory processes. In this study, it was evaluated whether serum MMP-8 can predict the response to adjuvant interferon alfa-2b (IFN-α) therapy in patients with operated high-risk cutaneous melanoma. Pre-treatment sera from 460 patients with stage IIB-IIIC melanoma were analyzed for MMP-8. The patients were randomized after surgery to adjuvant IFN-α for 12 or 24 months (n = 313) or observation only (n = 147). The median serum MMP-8 level was used to classify the patients into a low MMP-8 (n = 232) and a high MMP-8 (n = 228) group. In the high MMP-8 subgroup, IFN-α therapy significantly improved relapse-free survival (RFS). RFS was 36.8 months in patients with high MMP-8 levels receiving IFN-α therapy, whereas RFS for those with high MMP-8 levels with observation only was 10.6 months (P = 0.027). Median overall survival for patients with high MMP-8 and observation only was 36.7 versus 71.7 months in those receiving IFN-α (P = 0.13). In a multivariate model, IFN-α therapy was a significant predictor of favorable RFS (HR 0.74; 95 % CI 0.55-0.99; P = 0.048), after adjustment for pre-treatment MMP-8 (HR 1.17; 95 % CI 0.88-1.55; P = 0.28), gender (HR 1.16; 95 % CI 0.86-1.56; P = 0.32), age (HR 1.00; 95 % CI 1.00-1.02; P = 0.12), ulceration (HR 1.09; 95 % CI 0.81-1.46; P = 0.58), and the presence of node metastases (HR 1.36; 95 % CI 1.17-1.58; P < 0.0001). In conclusion, patients with high serum MMP-8 levels may benefit from adjuvant IFN-α therapy, but this observation should be further investigated.
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Affiliation(s)
- Pia Vihinen
- Department of Oncology and Radiotherapy, Turku University Hospital, POB 52, 20521, Turku, Finland,
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Einarsdottir BO, Olofsson R, Bhadury J, Jespersen H, Mattsson J, Nilsson L, Stierner U, Ny L, Nilsson J. Abstract 1215: Identifying new treatment options for metastatic melanoma using patient derived xenografts: Defining the role of Pim kinases. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-1215] [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: 11/16/2022]
Abstract
Abstract
Melanoma is considered to be one of the most aggressive form of human tumors and current therapies are only partly effective. The mutation rate is higher in melanoma compared to other cancer types. The most frequent mutation, BRAFV600E is found in 50-70% of melanomas and promotes proliferation and survival. BRAF inhibitors have shown a good clinical responds rate, however resistance eventually develops. Therefore research into other pathways active in melanoma remains important. Other oncoproteins with limited knowledge about in melanoma are the Pim kinases Pim1, 2 and 3. They are involved in several pro-survival pathways, are weakly oncogenic and found over-expressed in several cancer types. We have found that Pim3 is highly expressed in melanoma compared to other cancer types, while expression of Pim1 and Pim2 are relatively low. Previous work in the lab has shown that PIM3 is regulated by c-MYC, a gene known to be critical for melanoma proliferation and survival. This suggests that Pim kinase inhibitors could have efficacy in tumors expressing high levels of Pim3.
We have started the Sahlgrenska Translational Melanoma Group (SATMEG). The goal is to create a platform that can be used amongst other to test the effect of different drugs in mono- or combination therapy in vivo. Tumor biopsies from patients with stage III and IV melanoma are serially transplanted into immunocompromised mice making a patient derived xenograft (PDX) and analyzed for molecular characterization by expression sequencing. The mice can be divided in treatment groups and dosed with different compounds. Tumor growth can be monitored by in vivo imaging (IVIS) for evaluation of drug efficiency. The platform can also be used to increase the prediction value of clinical trials by pre-screening the patients using the PDXs and identifying a common biomarker for the responding PDXs. Thereby patients can be recruited to clinical trials based on molecular characteristics and those how would not benefit from the therapy can be excluded.
This study aims at analyzing the effect of Pim kinase inhibition on melanoma cells both in vitro and in vivo. Investigate if Pim kinase inhibition can synergize in a cytotoxic manner with other compounds and analyse Pim kinase downstream targets. The ultimate goal is to define a predictive biomarker to identify patients which would benefit from Pim kinase inhibitor mono- or combination therapy. Since the role of Pim kinases have not been characterized in melanoma it is important to fully explore this option as a new line of treatment. Data on the effect of Pim kinase inhibition on melanoma and the use of the platform will be presented.
Citation Format: Berglind Osk Einarsdottir, Roger Olofsson, Joydeep Bhadury, Henrik Jespersen, Jan Mattsson, Lisa Nilsson, Ulrika Stierner, Lars Ny, Jonas Nilsson. Identifying new treatment options for metastatic melanoma using patient derived xenografts: Defining the role of Pim kinases. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1215. doi:10.1158/1538-7445.AM2014-1215
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Affiliation(s)
| | | | | | | | - Jan Mattsson
- 2Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Lars Ny
- 2Sahlgrenska University Hospital, Gothenburg, Sweden
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Tandstad T, Ståhl O, Håkansson U, Dahl O, Haugnes HS, Klepp OH, Langberg CW, Laurell A, Oldenburg J, Solberg A, Söderström K, Cavallin-Ståhl E, Stierner U, Wahlquist R, Wall N, Cohn-Cedermark G. One course of adjuvant BEP in clinical stage I nonseminoma mature and expanded results from the SWENOTECA group. Ann Oncol 2014; 25:2167-2172. [PMID: 25114021 DOI: 10.1093/annonc/mdu375] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND SWENOTECA has since 1998 offered patients with clinical stage I (CS I) nonseminoma, adjuvant chemotherapy with one course of bleomycin, etoposide and cisplatin (BEP). The aim has been to reduce the risk of relapse, sparing patients the need of toxic salvage treatment. Initial results on 312 patients treated with one course of adjuvant BEP, with a median follow-up of 4.5 years, have been previously published. We now report mature and expanded results. PATIENTS AND METHODS In a prospective, binational, population-based risk-adapted treatment protocol, 517 Norwegian and Swedish patients with CS I nonseminoma received one course of adjuvant BEP. Patients with lymphovascular invasion (LVI) in the primary testicular tumor were recommended one course of adjuvant BEP. Patients without LVI could choose between surveillance and one course of adjuvant BEP. Data for patients receiving one course of BEP are presented in this study. RESULTS At a median follow-up of 7.9 years, 12 relapses have occurred, all with IGCCC good prognosis. The latest relapse occurred 3.3 years after adjuvant treatment. The relapse rate at 5 years was 3.2% for patients with LVI and 1.6% for patients without LVI. Five-year cause-specific survival was 100%. CONCLUSIONS The updated and expanded results confirm a low relapse rate following one course of adjuvant BEP in CS I nonseminoma. One course of adjuvant BEP should be considered a standard treatment in CS I nonseminoma with LVI. For patients with CS I nonseminoma without LVI, one course of adjuvant BEP is also a treatment option.
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Affiliation(s)
- T Tandstad
- The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway.
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Lund
| | - U Håkansson
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - O Dahl
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen; Haukeland University Hospital, Bergen
| | - H S Haugnes
- Institute of Clinical Medicine, University of Tromsø, Tromsø; University Hospital of North Norway, Tromsø
| | - O H Klepp
- Department of Oncology, Ålesund Hospital, Ålesund
| | - C W Langberg
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - A Laurell
- Department of Oncology, Uppsala University Hospital, Uppsala
| | - J Oldenburg
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - A Solberg
- The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
| | - K Söderström
- The Cancer Clinic, Norrland University Hospital, Umeå
| | | | - U Stierner
- Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - R Wahlquist
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - N Wall
- Institute of Clinical and Experimental Medicine, University of Linköping, Linköping
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
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Olofsson R, Ny L, Eilard MS, Rizell M, Cahlin C, Stierner U, Lönn U, Hansson J, Ljuslinder I, Lundgren L, Ullenhag G, Kiilgaard JF, Nilsson J, Lindnér P. Isolated hepatic perfusion as a treatment for uveal melanoma liver metastases (the SCANDIUM trial): study protocol for a randomized controlled trial. Trials 2014; 15:317. [PMID: 25106493 PMCID: PMC4138407 DOI: 10.1186/1745-6215-15-317] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/25/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Uveal melanoma is the most common primary intraocular malignancy in adults. Despite successful control of the primary tumor, metastatic disease will ultimately develop in approximately 50% of patients, with the liver being the most common site for metastases. The median survival for patients with liver metastases is between 6 and 12 months, and no treatment has in randomized trials ever been shown to prolong survival. A previous phase II trial using isolated hepatic perfusion (IHP) has suggested a 14-month increase in overall survival compared with a historic control group consisting of the longest surviving patients in Sweden during the same time period (26 versus 12 months). METHODS/DESIGN This is the protocol for a multicenter phase III trial randomizing patients with isolated liver metastases of uveal melanoma to IHP or best alternative care (BAC). Inclusion criteria include liver metastases (verified by biopsy) and no evidence of extra-hepatic tumor manifestations by positron emission tomography-computed tomography (PET-CT). The primary endpoint is overall survival at 24 months, with secondary endpoints including response rate, progression-free survival, and quality of life. The planned sample size is 78 patients throughout five years. DISCUSSION Patients with isolated liver metastases of uveal melanoma origin have a short expected survival and no standard treatment option exists. This is the first randomized clinical trial to evaluate IHP as a treatment option with overall survival being the primary endpoint. TRIAL REGISTRATION ClinicalTrials.gov registration number: NCT01785316 (registered 1 February 2013). EudraCT registration number: 2013-000564-29.
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Affiliation(s)
- Roger Olofsson
- />Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Blå stråket 5, 413 45 Gothenburg, Sweden
| | - Lars Ny
- />Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Blå stråket 5, 413 45 Gothenburg, Sweden
| | - Malin Sternby Eilard
- />Transplant Institute, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Magnus Rizell
- />Transplant Institute, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Christian Cahlin
- />Transplant Institute, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Ulrika Stierner
- />Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Blå stråket 5, 413 45 Gothenburg, Sweden
| | - Ulf Lönn
- />Department of Oncology, Linköping University Hospital, Garnisonsvägen 10, 581 85 Linköping, Sweden
| | - Johan Hansson
- />Department of Oncology, Karolinska University Hospital, Karolinska vägen, 171 76 Stockholm, Sweden
| | - Ingrid Ljuslinder
- />Department of Oncology, Norrlands University Hospital, 901 85 Umeå, Sweden
| | - Lotta Lundgren
- />Department of Oncology, Skåne University Hospital, Getingevägen 4, 221 85 Lund, Sweden
| | - Gustav Ullenhag
- />Department of Radiology, Oncology and Radiation Science, Section of Oncology, Uppsala University, 751 05 Uppsala, Sweden
| | - Jens Folke Kiilgaard
- />Department of Ophthalmology, Glostrup Hospital, Copenhagen University Hospital Glostrup, Nordre Ringvej 57, 2600 Glostrup, Denmark
| | - Jonas Nilsson
- />Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Medicinaregatan 1F, 405 30 Gothenburg, Sweden
| | - Per Lindnér
- />Transplant Institute, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
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Eriksson H, Lyth J, Månsson-Brahme E, Frohm-Nilsson M, Ingvar C, Lindholm C, Naredi P, Stierner U, Carstensen J, Hansson J. Later stage at diagnosis and worse survival in cutaneous malignant melanoma among men living alone: a nationwide population-based study from Sweden. J Clin Oncol 2014; 32:1356-64. [PMID: 24687828 DOI: 10.1200/jco.2013.52.7564] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [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
PURPOSE To investigate the association between cohabitation status, clinical stage at diagnosis, and disease-specific survival in cutaneous malignant melanoma (CMM). METHODS This nationwide population-based study included 27,235 patients from the Swedish Melanoma Register diagnosed with a primary invasive CMM between 1990 and 2007 and linked data to nationwide, population-based registers followed up through 2012. RESULTS After adjustment for age at diagnosis, level of education, living area, period of diagnosis, and tumor site, the odds ratios (ORs) of higher stage at diagnosis were significantly increased among men living alone versus men living with a partner (stage II v stage I: OR, 1.42; 95% CI, 1.29 to 1.57; stage III or IV v stage I: OR, 1.43; 95% CI, 1.14 to 1.79). The OR for stage II versus stage I disease was also increased among women living alone (OR, 1.15; 95% CI, 1.04 to 1.28). After adjustments for the factors listed earlier, the CMM-specific survival was significantly decreased among men living alone (hazard ratio [HR] for death, 1.48; 95% CI, 1.33 to 1.65; P < .001). After additional adjustments for all potential and established prognostic factors, CMM-specific survival among men living alone versus men living with a partner remained significantly decreased (HR, 1.31; 95% CI, 1.18 to 1.46; P < .001), suggesting a residual adverse effect on survival not accounted for by these parameters. CONCLUSION In all age groups among men, living alone is significantly associated with reduced CMM-specific survival, partially attributed to a more advanced stage at diagnosis. This emphasizes the need for improved prevention and early detection strategies for this group.
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Affiliation(s)
- Hanna Eriksson
- Hanna Eriksson, Eva Månsson-Brahme, Margareta Frohm-Nilsson, and Johan Hansson, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm; Johan Lyth and Christer Lindholm, Regional Cancer Center Southeast, Linköping University Hospital; Johan Lyth and John Carstensen, Linköping University, Linköping; Christian Ingvar, Lund University, Lund; Peter Naredi, Sahlgrenska Academy; and Ulrika Stierner, Sahlgrenska University Hospital, Gothenburg, Sweden
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Brandberg Y, Johansson H, Aamdal S, Bastholt L, Hernberg M, Stierner U, von der Maase H, Hansson J. Role functioning before start of adjuvant treatment was an independent prognostic factor for survival and time to failure. A report from the Nordic adjuvant interferon trial for patients with high-risk melanoma. Acta Oncol 2013; 52:1086-93. [PMID: 23621752 DOI: 10.3109/0284186x.2013.789140] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the role of health-related quality of life (HRQoL) at randomization as independent prognostic factors for survival and time to failure, and to explore associations between HRQoL and treatment effects. MATERIAL AND METHODS In the Nordic adjuvant interferon trial, a randomized trial evaluating if adjuvant therapy with intermediate-dose IFN had the same beneficial effects on overall and disease-free survival in high-risk melanoma as high-dose IFN, 855 patients in Denmark, Finland, Norway, and Sweden were included. The EORTC QLQ-C30 questionnaire was used to assess HRQoL before randomization. RESULTS A total of 785 (92%) agreed to participate in the HRQoL-study and provided baseline HRQoL data. Prognostic variables included in the multivariate model were age, sex, performance status, tumor thickness, stage, and number of positive lymph nodes. Univariate analyses revealed an association between prolonged survival and age, stage/ number of metastatic lymph nodes and the HRQoL variable role functioning (p ≤ 0.01). After controlling for other prognostic factors, these variables remained independently statistically significant for survival. The univariate analyses of time to failure showed significant associations with the clinical variable stage/nodes and with the HRQoL variables physical functioning and role functioning. Adjusted multivariate analyses including the same clinical conditions as above showed statistically significant relationships between time to failure and global quality of life, physical functioning, role functioning, social functioning and fatigue (p ≤ 0.01). No interactions between HRQoL variables and treatment were found, with the exception for cognitive functioning. CONCLUSION Role functioning was found to be an independent prognostic factor for time to failure and survival in patients with high-risk melanoma. Thus, also in this early stage of melanoma, HRQoL variables might be useful as important prognostic factors for time to failure and overall survival.
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Affiliation(s)
- Yvonne Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
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Skoogh J, Steineck G, Johansson B, Wilderäng U, Stierner U. Psychological needs when diagnosed with testicular cancer: findings from a population-based study with long-term follow-up. BJU Int 2013; 111:1287-93. [DOI: 10.1111/j.1464-410x.2012.11696.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Gunnar Steineck
- Department of Psychology; University of Gothenburg; Gothenburg
| | - Boo Johansson
- Division of Clinical Cancer Epidemiology; Department of Oncology-Pathology; Karolinska Institutet; Stockholm
| | - Ulrica Wilderäng
- Division of Clinical Cancer Epidemiology; Department of Oncology; Institute of Clinical Sciences; Sahlgrenska Academy; Gothenburg
| | - Ulrika Stierner
- Department of Oncology; Sahlgrenska University Hospital; Gothenburg; Sweden
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Lyth J, Hansson J, Ingvar C, Månsson-Brahme E, Naredi P, Stierner U, Wagenius G, Lindholm C. Prognostic subclassifications of T1 cutaneous melanomas based on ulceration, tumour thickness and Clark’s level of invasion: results of a population-based study from the Swedish Melanoma Register. Br J Dermatol 2013; 168:779-86. [DOI: 10.1111/bjd.12095] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ambring A, Björholt I, Lesén E, Stierner U, Odén A. Treatment with sorafenib and sunitinib in renal cell cancer: a Swedish register-based study. Med Oncol 2012; 30:331. [PMID: 23254966 PMCID: PMC3586400 DOI: 10.1007/s12032-012-0331-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 11/19/2012] [Accepted: 12/03/2012] [Indexed: 11/21/2022]
Abstract
Sorafenib and sunitinib are used for renal cell carcinoma (RCC). The objective was to study the treatment duration and time to death in Swedish RCC patients on sorafenib or sunitinib as first-line or monotherapy or as sequential therapy. Patients with an RCC diagnosis were identified in the Swedish Cancer Register. Information on treatment with sorafenib and sunitinib was collected from the Swedish Prescribed Drug Register, and time of death from the Cause of Death Register. Outcome measures were duration of treatment and time to death on sorafenib or sunitinib as first-line or monotherapy and sequential therapy (sorafenib–sunitinib versus sunitinib–sorafenib). Poisson regression models were used to estimate hazard ratios (HR) with 95 % confidence intervals (CI). No difference was observed for sorafenib (n = 123 patients) versus sunitinib (n = 261 patients) in treatment duration (HR 1.00; CI 0.80–1.24) or risk for death (HR 1.30; CI 0.91–1.85) when used as first-line or monotherapy. The same applied for sequential therapy with sorafenib–sunitinib (n = 43 patients) versus sunitinib–sorafenib (n = 54 patients), HR 1.47 (CI 0.71–3.02) and HR 2.01 (CI 0.86–4.68), respectively. There was a difference between the two treatments in how the duration of first-line treatment influenced the duration of second-line treatment and time to death, in favor of starting with sorafenib. In conclusion, no difference was detected between sorafenib and sunitinib in the duration of treatment or time to death when used as first-line or monotherapy. The impact of the duration of first-line treatment differed between the two sequences, and the results indicated that sorafenib as first-line treatment is a favorable choice.
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Affiliation(s)
- Anneli Ambring
- Nordic Health Economics, Medicinaregatan 8b, 413 90 Göteborg, Sweden
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Brandberg Y, Aamdal S, Bastholt L, Hernberg M, Stierner U, von der Maase H, Hansson J. Health-related quality of life in patients with high-risk melanoma randomised in the Nordic phase 3 trial with adjuvant intermediate-dose interferon alfa-2b. Eur J Cancer 2012; 48:2012-9. [DOI: 10.1016/j.ejca.2011.11.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 11/02/2011] [Accepted: 11/22/2011] [Indexed: 11/12/2022]
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Haugnes HS, Laurell A, Stierner U, Bremnes RM, Dahl O, Cavallin-Ståhl E, Cohn-Cedermark G. High-dose chemotherapy with autologous stem cell support in patients with metastatic non-seminomatous testicular cancer - a report from the Swedish Norwegian Testicular Cancer Group (SWENOTECA). Acta Oncol 2012; 51:168-76. [PMID: 22175254 DOI: 10.3109/0284186x.2011.641507] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The SWENOTECA IV protocol from 1995 is a prospective population-based study in metastatic non-seminomatous germ cell testicular cancer (NSGCT), designed for early identification of patients with poor response to standard cisplatin-based chemotherapy. A slow tumor marker decline (HCG T(½) > 3 days, AFP T(½) > 7 days) after BEP or BEP plus ifosfamide was regarded as poor response. The aim of this study was to present survival and toxicity data for patients treated with high-dose chemotherapy (HDCT) within the SWENOTECA IV cancer care program. MATERIAL AND METHODS In total 882 adult men diagnosed with metastatic NSGCT between July 1995 and June 2007 in Sweden and Norway (except one center) were included in SWENOTECA IV and treated accordingly. Among these, 55 men (6.2%) were treated with HDCT according to three different indications in the protocol: A) poor response to standard-dose intensified chemotherapy (BEP plus ifosfamide); B) vital cancer at surgery after intensified chemotherapy; and C) selected relapses after previous chemotherapy. In situation A and C two HDCT cycles and in situation B one HDCT cycle was recommended. Situation A was the reason for HDCT in 36 patients, B in seven and C in 12 patients. The first HDCT cycle consisted of carboplatin 28 × (GFR + 25) mg, cyclofosfamide 6000 mg/m(2) and etoposide 1750 mg/m(2), administered over four days. In cycle two, etoposide was replaced by tiotepa 480 mg/m(2). RESULTS After a median follow-up of 7.5 years, overall survival was 72%, 100% and 58%, while failure-free survival was 64%, 71% and 42% in situation A, B and C, respectively. Three patients (5.5%) died during HDCT (renal failure or intracerebral hemorrhage). Nephrotoxicity was the most common non-hematological grade 4 toxicity (n = 5, 9%). CONCLUSION The population-based SWENOTECA strategy, selecting patients who do not respond adequately to primary standard-dose chemotherapy for immediate treatment intensification with HDCT, is feasible and might be advantageous.
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Skoogh J, Steineck G, Stierner U, Cavallin-Ståhl E, Wilderäng U, Wallin A, Gatz M, Johansson B. Testicular-cancer survivors experience compromised language following chemotherapy: findings in a Swedish population-based study 3-26 years after treatment. Acta Oncol 2012; 51:185-97. [PMID: 21851186 DOI: 10.3109/0284186x.2011.602113] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Studies suggest an increased risk for compromised cognitive function among cancer survivors. It is unclear to what extent chemotherapy is the cause and how the dysfunction, when present, affects everyday life. The objective was to study self-reported behaviours that may depend on cognitive function, among testicular-cancer survivors who received various cycles of cisplatin-based chemotherapy by comparing them with those who did not. MATERIAL AND METHODS We identified 1173 eligible men diagnosed with non-seminomatous testicular cancer treated according to the national cancer-care programs SWENOTECA I-IV between 1981 and 2004. During an 18-month qualitative phase we constructed a study-specific questionnaire including questions about specific activities and behaviour in everyday life. RESULTS We obtained information from 960 of 1173 (82%) testicular-cancer survivors diagnosed on average 11 years previously. The prevalence of "saying similar but incorrect words" at least once a week was 5% among those having received no chemotherapy versus 16% among those having received five or more cycles, giving a prevalence ratio ("relative risk", RR) of 3.3 with a 95% confidence interval of 1.5 to 7.1. The corresponding figure for "saying words in the wrong order" was 3.1 (1.7-5.8), for "difficulties understanding what other people mean" 3.1 (1.3-7.7), for "saying words other than planned" 2.2 (1.1-4.5) and for "difficulties completing sentences" 2.0 (1.0-3.6). The relative risks for those with a low level of education ranged between 4.9 (1.6-14.9) and 15.3 (1.9-120.5). CONCLUSION Testicular-cancer survivors in Sweden who have received five or more cycles of cisplatin-based chemotherapy experience an increased incidence of long-term compromised language; the effect is primarily seen among men with a low level of education.
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Affiliation(s)
- Johanna Skoogh
- Clinical Cancer Epidemiology, Sahlgrenska Academy at University of Gothenburg, Sweden.
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Hauqnes H, Laurell A, Stierner U, Bremnes R, Dahl O, Cavallin-Stáhl E, Cohn-Cedermark G. 7111 POSTER DISCUSSION High-dose Chemotherapy With Autologous Stem-cell Support in Patients With Metastatic Non-seminomatous Testicular Cancer -a Report From the Swedish Norwegian Testicular Cancer Group (SWENOTECA). Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Olofsson SE, Tandstad T, Jerkeman M, Dahl O, Ståhl O, Klepp O, Bremnes RM, Cohn-Cedermark G, Langberg CW, Laurell A, Solberg A, Stierner U, Wahlqvist R, Wijkström H, Anderson H, Cavallin-Ståhl E. Population-based study of treatment guided by tumor marker decline in patients with metastatic nonseminomatous germ cell tumor: a report from the Swedish-Norwegian Testicular Cancer Group. J Clin Oncol 2011; 29:2032-9. [PMID: 21482994 DOI: 10.1200/jco.2010.29.1278] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE From 1995 to 2003, 603 adult patients from Sweden and Norway with metastatic testicular nonseminomatous germ cell tumor (NSGCT) were included prospectively in a population-based protocol with strict guidelines for staging, treatment, and follow-up. Patients with extragonadal primary tumor or previous treatment for contralateral testicular tumor were excluded. The basic strategy was to individualize treatment according to initial tumor marker response. METHODS Initial treatment for all patients was two courses of standard bleomycin, etoposide, and cisplatin (BEP), with tumor markers analyzed weekly. Good response was defined as a half-life (t(1/2)) for α-fetoprotein (AFP) of ≤ 7 days and/or for β-human chorionic gonadotropin (β-HCG) of ≤ 3 days. Patients with prolonged marker t(1/2) (ie, poor response) received intensification with addition of ifosfamide (BEP-if/PEI) in step 1. If poor response continued, the treatment was intensified with high-dose chemotherapy with stem-cell rescue as step 2. RESULTS Overall, 99% of all patients with metastatic testicular NSGCT in the population were included in the protocol. Median follow-up was 8.2 years. Seventy-seven percent of the patients were treated with BEP alone; 18% received intensification step 1%, and 5% received intensification step 2. Grouped according to International Germ Cell Consensus Classification, 10-year overall survival was 94.7% in good-prognosis patients, 90.0% in intermediate-prognosis patients, and 67.4% in poor-prognosis patients. CONCLUSION With detailed treatment protocols and a dedicated collaborative group of specialists, treatment results comparable to those reported from large single institutions can be achieved at national level. With the treatment principles used in Swedish-Norwegian Testicular Cancer Group study SWENOTECA IV, the survival of intermediate-prognosis patients is remarkable and close to that of good-prognosis patients.
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Hansson J, Aamdal S, Bastholt L, Brandberg Y, Hernberg M, Nilsson B, Stierner U, von der Maase H. Two different durations of adjuvant therapy with intermediate-dose interferon alfa-2b in patients with high-risk melanoma (Nordic IFN trial): a randomised phase 3 trial. Lancet Oncol 2011; 12:144-52. [DOI: 10.1016/s1470-2045(10)70288-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tandstad T, Cohn-Cedermark G, Dahl O, Stierner U, Cavallin-Stahl E, Bremnes R, Klepp O. Long-term follow-up after risk-adapted treatment in clinical stage 1 (CS1) nonseminomatous germ-cell testicular cancer (NSGCT) implementing adjuvant CVB chemotherapy. A SWENOTECA study. Ann Oncol 2010; 21:1858-1863. [DOI: 10.1093/annonc/mdq026] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Skoogh J, Steineck G, Cavallin-Ståhl E, Wilderäng U, Håkansson UK, Johansson B, Stierner U. Feelings of loss and uneasiness or shame after removal of a testicle by orchidectomy: a population-based long-term follow-up of testicular cancer survivors. ACTA ACUST UNITED AC 2010; 34:183-92. [DOI: 10.1111/j.1365-2605.2010.01073.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tandstad T, Småland R, Klepp OH, Cavallin-Stahl E, Stierner U, Laurell A, Flodgren P, Dahl O, Cohn-Cedermark G. Results from SWENOTECA V: A population-based protocol for seminomatous testicular cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
INTRODUCTION Peginterferon has an increased plasma half-life and enables a constant exposure to interferon. This modification might increase the antiangiogenic effect of the treatment and influence the efficacy. We report the results of a phase II open-label study with Peginterferon alfa-2b (Pegintron Schering-Plough) on efficacy and tolerability in patients with advanced renal cell carcinoma (MRCC). MATERIALS AND METHODS Twenty eight patients with MRCC were treated with Peginterferon in escalating doses of 0.5 microg/kg once weekly until 2 microg/kg was reached or prohibited toxicity occurred. Lesions were evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST). RESULTS Thirteen patients tolerated a dose of 2 microg/kg/week. At 6 months 16 patients (57%) had disease control of which four had partial response (PR) and 12 stable disease whereas 12 (43%) had progressed. PR was only seen in the lung parenchyma or mediastinum. Median time to progression (TTP) was 8 months in all patients and 13 months for PR and SD patients. Correspondingly, median survival was 19.5 months and 28 months, respectively (seven patients received second-line treatment with tyrosine kinase inhibitor). The mean dose during long-term treatment was 1.5 and at the end of treatment 1.2 microg/kg/week. Most side effects were grade 1-2 and only two patients stopped treatment for that reason. VEGF levels in serum before and during treatment did not correlate to the therapeutic response. DISCUSSION Peginterferon was well tolerated in MRCC albeit with dose modification during long-term treatment. Response pattern seems to be the same as with nonpegylated interferon. Peginterferon may be used as monotherapy in selected patients and in trials of combinations with targeted drugs.
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Affiliation(s)
- David Lyrdal
- Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Ulrika Stierner
- Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Sven Lundstam
- Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden
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Lyrdal D, Boijsen M, Suurküla M, Lundstam S, Stierner U. Evaluation of sorafenib treatment in metastatic renal cell carcinoma with 2-fluoro-2-deoxyglucose positron emission tomography and computed tomography. Nucl Med Commun 2009; 30:519-24. [PMID: 19522059 DOI: 10.1097/mnm.0b013e32832cc220] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE New potent tyrosine kinase inhibitors such as sorafenib are the most effective treatment for metastatic renal cell carcinoma (MRCC) today. In this study, we used [18F]-2-fluoro-2-deoxyglucose (FDG) with positron emission tomography (PET) combined with computed tomography (CT) to evaluate early effects of sorafenib in patients with MRCC. METHODS Ten patients, eight males and two females, with a mean age of 61 years (49-72 years), with MRCC were enrolled. A total of 52 lesions, two to nine lesions/patient, out of which 39 were soft lesions, were evaluated. The [18F]FDG-PET/CT was performed before treatment and after 1-2 months. A region of interest (ROI) was identified including the lesions where the glucose uptake was measured, calculating the average value within the ROI and using the cerebellum as the reference. The same ROI was measured in the subsequent FDG-PET. The sum of the diameters was measured in CT according to the Response Evaluation Criteria in Solid Tumors (RECIST). Sorafenib was given 400 mg twice daily orally. RESULTS After 1-2 months, the mean glucose uptake in all lesions decreased to 75% (32-105%) of initial values of ROI as measured by FDG-PET. The mean glucose uptake in soft lesions decreased to 71% (32-108%) and in skeletal lesions to 82% (53-101%). The sum of the diameters measured by CT decreased to 80% (57-94%) of the initial value in soft lesions according to the RECIST. CONCLUSION An early decrease in the mean glucose uptake was found in both soft and skeletal lesions after treatment with sorafenib. FDG-PET thus seems to be advantageous, compared with RECIST evaluation, which is limited to soft lesions.
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Affiliation(s)
- David Lyrdal
- Department of Urology, Sahlgrenska University Hospital, Göteborg S-41345, Sweden.
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Bouwhuis MG, Suciu S, Collette S, Aamdal S, Kruit WH, Bastholt L, Stierner U, Salès F, Patel P, Punt CJA, Hernberg M, Spatz A, ten Hagen TLM, Hansson J, Eggermont AMM. Autoimmune antibodies and recurrence-free interval in melanoma patients treated with adjuvant interferon. J Natl Cancer Inst 2009; 101:869-77. [PMID: 19509353 DOI: 10.1093/jnci/djp132] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Appearance of autoantibodies and clinical manifestations of autoimmunity in melanoma patients treated with adjuvant interferon (IFN)-alpha2b was reported to be associated with improved prognosis. We assessed the association of the appearance of autoantibodies after initiation of treatment with recurrence-free interval in two randomized trials that compared intermediate doses of IFN with observation for the treatment of melanoma patients. METHODS Serum levels of anticardiolipin, antithyroglobulin, and antinuclear antibodies were determined using enzyme-linked immunosorbent assays in 187 and 356 patients in the European Organization for Research and Treatment of Cancer (EORTC) 18952 and Nordic IFN trials, respectively, immediately before and up to 3 years after random assignment. The association of the presence of at least one of the three autoantibodies with risk of recurrence was assessed by three Cox models in patients negative for all three autoantibodies at baseline (125 from the EORTC 18952 trial and 230 from the Nordic IFN trial): 1) a model that considered appearance of autoantibodies as a time-independent variable, 2) one that considered a patient autoantibody positive once a positive test for an autoantibody was obtained, and 3) a model in which the status of the patient was defined by the most recent autoantibody test. All statistical tests were two-sided. RESULTS When treated as a time-independent variable (model 1), appearance of autoantibodies was associated with improved relapse-free interval in both trials (EORTC 18952, hazard ratio [HR] = 0.41, 95% confidence interval [CI] = 0.25 to 0.68, P < .001; and Nordic IFN, HR = 0.51, 95% CI = 0.34 to 0.76, P < .001). However, on correction for guarantee-time bias, the association was weaker and not statistically significant (model 2: EORTC 18952, HR = 0.81, 95% CI = 0.46 to 1.40, P = .44; and Nordic IFN, HR = 0.85, 95% CI = 0.55 to 1.30, P = .45; model 3: EORTC 18952, HR = 1.05, 95% CI = 0.59 to 1.87, P = .88; and Nordic IFN, HR = 0.78, 95% CI = 0.49 to 1.24, P = .30). CONCLUSIONS In two randomized trials of IFN for the treatment of melanoma patients, appearance of autoantibodies was not strongly associated with improved relapse-free interval when correction was made for guarantee-time bias.
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Affiliation(s)
- Marna G Bouwhuis
- Department of Surgical Oncology, Erasmus University MC-Daniel den Hoed Cancer Center, 301 Groene Hilledijk, Rotterdam, the Netherlands
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Olofsson S, Dahl O, Jerkeman M, Cohn-Cedermark G, Klepp O, Stierner U, Törnblom M, Wahlqvist R, Cavallin-Ståhl E. Individualized intensification of treatment based on tumor marker decline in metastatic nonseminomatous germ cell testicular cancer (NSGCT): A report from the Swedish Norwegian Testicular Cancer Group, SWENOTECA. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5015] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5015 Background: From July 1995 to December 2003, 602 adult patients from Sweden and Norway with metastatic testicular NSGCT were included in a population-based multicenter SWENOTECA protocol with strict guidelines for staging, treatment and follow-up. Methods: The basic strategy of this protocol was to individualize treatment according to AFP and β-HCG decline (t1/2). Satisfactory response to treatment was defined as a t½ for AFP ≤ 7 days and/or β-HCG ≤ 3 days. Initial treatment for all patients was 2 courses of standard BEP. Tumor markers were analyzed once a week during treatment. Patients with satisfactory response went on with BEP while patients with unsatisfactory t1/2 received intensified treatment in two steps with addition of ifosfamide (BEP-if/PEI) in step 1. If still unsatisfactory response the treatment was intensified according to step 2 involving high-dose chemotherapy with stem cell rescue. Postchemotherapy surgery was performed according to protocol guidelines. Results: 99,7% (602 of 604) of all patients with metastatic testicular NSGCT in the population were included in the protocol. Median FU was 72 months. 75% of the patients were treated with BEP, median 4 courses, without intensification, 19% according to intensification step 1 and 6% according to intensification step 2. Five year progression free survival (PFS), cancer specific survival (CSS) and overall survival (OS) grouped according to IGCCCG prognostic score are given in the Table below. There was no significant difference in PFS between the good and intermediate risk group. Death due to all causes was 10,1% (n=61) and treatment related deaths were 1,3 % (n=8). Conclusions: Our results, in a population based patient material, with individualized treatment based on tumor marker decline, are highly encouraging in all risk groups, but most notably in the intermediate risk group. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- S. Olofsson
- University Hospital Lund, Lund, Sweden; University of Bergen, Bergen, Norway; Karolinska University Hospital, Stockholm, Sweden; St. Olavs University Hospital, Trondheim, Norway; Sahlgrenska University Hospital, Göteborg, Sweden; Södersjukhuset, Stockholm, Sweden; Aker University Hospital, Oslo, Norway
| | - O. Dahl
- University Hospital Lund, Lund, Sweden; University of Bergen, Bergen, Norway; Karolinska University Hospital, Stockholm, Sweden; St. Olavs University Hospital, Trondheim, Norway; Sahlgrenska University Hospital, Göteborg, Sweden; Södersjukhuset, Stockholm, Sweden; Aker University Hospital, Oslo, Norway
| | - M. Jerkeman
- University Hospital Lund, Lund, Sweden; University of Bergen, Bergen, Norway; Karolinska University Hospital, Stockholm, Sweden; St. Olavs University Hospital, Trondheim, Norway; Sahlgrenska University Hospital, Göteborg, Sweden; Södersjukhuset, Stockholm, Sweden; Aker University Hospital, Oslo, Norway
| | - G. Cohn-Cedermark
- University Hospital Lund, Lund, Sweden; University of Bergen, Bergen, Norway; Karolinska University Hospital, Stockholm, Sweden; St. Olavs University Hospital, Trondheim, Norway; Sahlgrenska University Hospital, Göteborg, Sweden; Södersjukhuset, Stockholm, Sweden; Aker University Hospital, Oslo, Norway
| | - O. Klepp
- University Hospital Lund, Lund, Sweden; University of Bergen, Bergen, Norway; Karolinska University Hospital, Stockholm, Sweden; St. Olavs University Hospital, Trondheim, Norway; Sahlgrenska University Hospital, Göteborg, Sweden; Södersjukhuset, Stockholm, Sweden; Aker University Hospital, Oslo, Norway
| | - U. Stierner
- University Hospital Lund, Lund, Sweden; University of Bergen, Bergen, Norway; Karolinska University Hospital, Stockholm, Sweden; St. Olavs University Hospital, Trondheim, Norway; Sahlgrenska University Hospital, Göteborg, Sweden; Södersjukhuset, Stockholm, Sweden; Aker University Hospital, Oslo, Norway
| | - M. Törnblom
- University Hospital Lund, Lund, Sweden; University of Bergen, Bergen, Norway; Karolinska University Hospital, Stockholm, Sweden; St. Olavs University Hospital, Trondheim, Norway; Sahlgrenska University Hospital, Göteborg, Sweden; Södersjukhuset, Stockholm, Sweden; Aker University Hospital, Oslo, Norway
| | - R. Wahlqvist
- University Hospital Lund, Lund, Sweden; University of Bergen, Bergen, Norway; Karolinska University Hospital, Stockholm, Sweden; St. Olavs University Hospital, Trondheim, Norway; Sahlgrenska University Hospital, Göteborg, Sweden; Södersjukhuset, Stockholm, Sweden; Aker University Hospital, Oslo, Norway
| | - E. Cavallin-Ståhl
- University Hospital Lund, Lund, Sweden; University of Bergen, Bergen, Norway; Karolinska University Hospital, Stockholm, Sweden; St. Olavs University Hospital, Trondheim, Norway; Sahlgrenska University Hospital, Göteborg, Sweden; Södersjukhuset, Stockholm, Sweden; Aker University Hospital, Oslo, Norway
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Tandstad T, Dahl O, Cohn-Cedermark G, Cavallin-Stahl E, Stierner U, Solberg A, Langberg C, Bremnes RM, Laurell A, Wijkstrøm H, Klepp O. Risk-Adapted Treatment in Clinical Stage I Nonseminomatous Germ Cell Testicular Cancer: The SWENOTECA Management Program. J Clin Oncol 2009; 27:2122-8. [PMID: 19307506 DOI: 10.1200/jco.2008.18.8953] [Citation(s) in RCA: 169] [Impact Index Per Article: 11.3] [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
PurposeTo offer minimized risk-adapted adjuvant treatment on a nationwide basis for patients with clinical stage 1 (CS1) nonseminomatous germ-cell testicular cancer (NSGCT). The aim was to reduce the risk of relapse and thereby reducing the need of later salvage chemotherapy while maintaining a high cure rate.Patients and MethodsFrom 1998 to 2005, 745 Norwegian and Swedish patients were included into a prospective, community-based multicenter Swedish and Norwegian Testicular Cancer Project (SWENOTECA) management program. Treatment strategy depended on the presence or absence of vascular tumor invasion (VASC). VASC-positive patients were recommended brief adjuvant chemotherapy (ACT) with bleomycin, etoposide, and cisplatin (BEP), whereas VASC-negative patients could choose between ACT and surveillance.ResultsAt a median follow-up of 4.7 years, there have been 51 relapses. On surveillance, 41.7% of VASC+ patients relapsed, compared with 13.2% of VASC− patients. After one course of BEP, 3.2% of VASC+ and 1.3% of VASC− patients relapsed. The toxicity of adjuvant BEP was low. Eight patients have died, none died from progressive disease.ConclusionOne course of adjuvant BEP reduces the risk of relapse by approximately 90% in both VASC+ and VASC− CS1 NSGCT, and may be a new option as initial treatment for all CS1 NSGCT. One course of adjuvant BEP for VASC+ CS1 reduces the total burden of chemotherapy compared with surveillance or two courses of BEP. SWENOTECA currently recommends one course of BEP as standard treatment of VASC+ CS1 NSGCT, whereas both surveillance and one course of BEP are options for VASC− CS1 NSGCT.
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Affiliation(s)
- Torgrim Tandstad
- From the Department of Oncology, St Olavs University Hospital, Trondheim; Department of Oncology, Haukeland Hospital and Section of Oncology, Institute of Medicine, University of Bergen, Bergen; Cancer Center, Ullevål University Hospital, Oslo; Department of Oncology, University Hospital of Northern Norway and University of Tromsø, Tromsø; Department of Oncology, Ålesund Hospital, Ålesund, Norway; Department of Oncology, Karolinska University Hospital, Stockholm; Department of Oncology, Lund University
| | - Olav Dahl
- From the Department of Oncology, St Olavs University Hospital, Trondheim; Department of Oncology, Haukeland Hospital and Section of Oncology, Institute of Medicine, University of Bergen, Bergen; Cancer Center, Ullevål University Hospital, Oslo; Department of Oncology, University Hospital of Northern Norway and University of Tromsø, Tromsø; Department of Oncology, Ålesund Hospital, Ålesund, Norway; Department of Oncology, Karolinska University Hospital, Stockholm; Department of Oncology, Lund University
| | - Gabriella Cohn-Cedermark
- From the Department of Oncology, St Olavs University Hospital, Trondheim; Department of Oncology, Haukeland Hospital and Section of Oncology, Institute of Medicine, University of Bergen, Bergen; Cancer Center, Ullevål University Hospital, Oslo; Department of Oncology, University Hospital of Northern Norway and University of Tromsø, Tromsø; Department of Oncology, Ålesund Hospital, Ålesund, Norway; Department of Oncology, Karolinska University Hospital, Stockholm; Department of Oncology, Lund University
| | - Eva Cavallin-Stahl
- From the Department of Oncology, St Olavs University Hospital, Trondheim; Department of Oncology, Haukeland Hospital and Section of Oncology, Institute of Medicine, University of Bergen, Bergen; Cancer Center, Ullevål University Hospital, Oslo; Department of Oncology, University Hospital of Northern Norway and University of Tromsø, Tromsø; Department of Oncology, Ålesund Hospital, Ålesund, Norway; Department of Oncology, Karolinska University Hospital, Stockholm; Department of Oncology, Lund University
| | - Ulrika Stierner
- From the Department of Oncology, St Olavs University Hospital, Trondheim; Department of Oncology, Haukeland Hospital and Section of Oncology, Institute of Medicine, University of Bergen, Bergen; Cancer Center, Ullevål University Hospital, Oslo; Department of Oncology, University Hospital of Northern Norway and University of Tromsø, Tromsø; Department of Oncology, Ålesund Hospital, Ålesund, Norway; Department of Oncology, Karolinska University Hospital, Stockholm; Department of Oncology, Lund University
| | - Arne Solberg
- From the Department of Oncology, St Olavs University Hospital, Trondheim; Department of Oncology, Haukeland Hospital and Section of Oncology, Institute of Medicine, University of Bergen, Bergen; Cancer Center, Ullevål University Hospital, Oslo; Department of Oncology, University Hospital of Northern Norway and University of Tromsø, Tromsø; Department of Oncology, Ålesund Hospital, Ålesund, Norway; Department of Oncology, Karolinska University Hospital, Stockholm; Department of Oncology, Lund University
| | - Carl Langberg
- From the Department of Oncology, St Olavs University Hospital, Trondheim; Department of Oncology, Haukeland Hospital and Section of Oncology, Institute of Medicine, University of Bergen, Bergen; Cancer Center, Ullevål University Hospital, Oslo; Department of Oncology, University Hospital of Northern Norway and University of Tromsø, Tromsø; Department of Oncology, Ålesund Hospital, Ålesund, Norway; Department of Oncology, Karolinska University Hospital, Stockholm; Department of Oncology, Lund University
| | - Roy M. Bremnes
- From the Department of Oncology, St Olavs University Hospital, Trondheim; Department of Oncology, Haukeland Hospital and Section of Oncology, Institute of Medicine, University of Bergen, Bergen; Cancer Center, Ullevål University Hospital, Oslo; Department of Oncology, University Hospital of Northern Norway and University of Tromsø, Tromsø; Department of Oncology, Ålesund Hospital, Ålesund, Norway; Department of Oncology, Karolinska University Hospital, Stockholm; Department of Oncology, Lund University
| | - Anna Laurell
- From the Department of Oncology, St Olavs University Hospital, Trondheim; Department of Oncology, Haukeland Hospital and Section of Oncology, Institute of Medicine, University of Bergen, Bergen; Cancer Center, Ullevål University Hospital, Oslo; Department of Oncology, University Hospital of Northern Norway and University of Tromsø, Tromsø; Department of Oncology, Ålesund Hospital, Ålesund, Norway; Department of Oncology, Karolinska University Hospital, Stockholm; Department of Oncology, Lund University
| | - Hans Wijkstrøm
- From the Department of Oncology, St Olavs University Hospital, Trondheim; Department of Oncology, Haukeland Hospital and Section of Oncology, Institute of Medicine, University of Bergen, Bergen; Cancer Center, Ullevål University Hospital, Oslo; Department of Oncology, University Hospital of Northern Norway and University of Tromsø, Tromsø; Department of Oncology, Ålesund Hospital, Ålesund, Norway; Department of Oncology, Karolinska University Hospital, Stockholm; Department of Oncology, Lund University
| | - Olbjørn Klepp
- From the Department of Oncology, St Olavs University Hospital, Trondheim; Department of Oncology, Haukeland Hospital and Section of Oncology, Institute of Medicine, University of Bergen, Bergen; Cancer Center, Ullevål University Hospital, Oslo; Department of Oncology, University Hospital of Northern Norway and University of Tromsø, Tromsø; Department of Oncology, Ålesund Hospital, Ålesund, Norway; Department of Oncology, Karolinska University Hospital, Stockholm; Department of Oncology, Lund University
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Johansson C, Adamsson U, Stierner U, Lindsten T. Interaction by cholestyramine on the uptake of hydrocortisone in the gastrointestinal tract. Acta Med Scand 2009; 204:509-12. [PMID: 735882 DOI: 10.1111/j.0954-6820.1978.tb08481.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
An absolute reduction of the plasma cortisol levels and a delay of the peak concentrations were recorded in 10 healthy subjects, when a bile-sequestering anionic exchange resin, cholestyramine, was given prior to a single oral hydrocortisone dose, indicating that the resin interferes with the uptake of a neutral sterol in the human gastrointestinal tract. The possibility of a direct binding of drug to resin is supported by the affinity of hydrocortisone to cholestyramine in vitro, which was uninfluenced by the presence of sodium taurocholate. Cholestyramine significantly delayed the gastric emptying of a glucose solution, indicating that the resin not only decreases but also delays hydrocortisone absorption. Careful supervision is recommended when treatment with cholestyramine is given concomitant to neutral sterol drugs.
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Lyrdal D, Boijsen M, Suurküla M, Lundstam S, Stierner U. POD-6.04: Evaluation of Sorafenib Treatment in Metastatic Renal Cell Carcinoma with Positron Emission Tomography. Urology 2008. [DOI: 10.1016/j.urology.2008.08.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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