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Jin K, Xu J, Su X, Xu Z, Li B, Liu G, Liu H, Wang Y, Zhu Y, Xu L, Zhang W, Liu Z, Wang Z, Chang Y, Xu J. TP53 disruptive mutation predicts platinum-based chemotherapy and PD-1/PD-L1 blockade response in urothelial carcinoma. J Pathol 2024; 263:139-149. [PMID: 38380548 DOI: 10.1002/path.6266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/31/2023] [Accepted: 01/22/2024] [Indexed: 02/22/2024]
Abstract
TP53 mutation is one of the most common genetic alterations in urothelial carcinoma (UrCa), and heterogeneity of TP53 mutants leads to heterogeneous clinical outcomes. This study aimed to investigate the clinical relevance of specific TP53 mutations in UrCa. In this study, a total of eight cohorts were enrolled, along with matched clinical annotation. TP53 mutations were classified as disruptive and nondisruptive according to the degree of disturbance of p53 protein function and structure. We evaluated the clinical significance of TP53 mutations in our local datasets and publicly available datasets. The co-occurring events of TP53 mutations in UrCa, along with their therapeutic indications, functional effects, and the tumor immune microenvironment, were also investigated. TP53 mutations were identified in 49.7% of the UrCa patients. Within this group, 25.1% of patients carried TP53Disruptive mutations, a genetic alteration correlated with a significantly poorer overall survival (OS) when compared to individuals with TP53Nondisruptive mutations and those with wild-type TP53. Significantly, patients with TP53Disruptive mutations exhibit an increased probability of responding favorably to PD-1/PD-L1 blockade and chemoimmunotherapy. Meanwhile, there was no noteworthy distinction in OS among patients with varying TP53 mutation status who underwent chemotherapy. Samples with TP53Disruptive mutations showed an enriched APOBEC- and POLE-related mutational signature, as well as an elevated tumor mutation burden. The sensitivity to immunotherapy in tumors carrying TP53Disruptive mutation may be attributed to the inflamed tumor microenvironment characterized by increased CD8+T cell infiltration and interferon-gamma signaling activation. In conclusion, UrCa patients with TP53Disruptive mutations have shown reduced survival rates, yet they may respond well to PD-1/PD-L1 blockade therapy and chemoimmunotherapy. By distinguishing specific TP53 mutations, we can improve risk stratification and offer personalized genomics-guided therapy to UrCa patients. © 2024 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Kaifeng Jin
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, PR China
- NHC Key Laboratory of Glycoconjugate Research, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, PR China
| | - Jingtong Xu
- Department of Immunology, School of Basic Medical Sciences, Fudan University, Shanghai, PR China
| | - Xiaohe Su
- NHC Key Laboratory of Glycoconjugate Research, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, PR China
| | - Ziyue Xu
- NHC Key Laboratory of Glycoconjugate Research, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, PR China
| | - Bingyu Li
- Department of Immunology, School of Basic Medical Sciences, Fudan University, Shanghai, PR China
| | - Ge Liu
- NHC Key Laboratory of Glycoconjugate Research, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, PR China
| | - Hailong Liu
- Department of Urology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yiwei Wang
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yu Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, PR China
| | - Le Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Weijuan Zhang
- Department of Immunology, School of Basic Medical Sciences, Fudan University, Shanghai, PR China
| | - Zhaopei Liu
- NHC Key Laboratory of Glycoconjugate Research, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, PR China
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, PR China
| | - Zewei Wang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Yuan Chang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, PR China
| | - Jiejie Xu
- NHC Key Laboratory of Glycoconjugate Research, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, PR China
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2
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Klümper N, Cox A, Eckstein M, Kuppe C, Ritter M, Brossart P, Luetkens J, Hölzel M, Stein J, Saal J. High serum sodium predicts immunotherapy response in metastatic renal cell and urothelial carcinoma. Eur J Cancer 2024; 204:114089. [PMID: 38703618 DOI: 10.1016/j.ejca.2024.114089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/10/2024] [Accepted: 04/21/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES The development of reliable biomarkers for the prediction of immune checkpoint inhibition (ICI) response in patients with metastatic renal cell carcinoma (mRCC) and urothelial carcinoma (mUC) remains an unresolved challenge. Conventional ICI biomarkers typically focus on tumor-related factors such as PD-L1 expression. However, a comprehensive evaluation of the predictive value of serum electrolyte levels, a so far widely unexplored area, is still pending. METHODS We conducted a post-hoc analysis of baseline sodium, potassium, chloride, magnesium and calcium levels in two independent phase 3 clinical trials: IMvigor211 for mUC comparing atezolizumab to chemotherapy, and IMmotion151 for mRCC comparing atezolizumab+bevacizumab to sunitinib. This analysis aimed to evaluate the prognostic and predictive value of these electrolyte levels in these clinical settings. A total of 1787 patients (IMvigor211 n = 901; IMmotion151 n = 886) were analyzed. RESULTS We found a linear correlation of baseline serum sodium and chloride with prognosis across both trials, which was not found for potassium, magnesium and calcium. In multivariate analysis, the prognostic capacity of sodium was limited to patients receiving ICI as compared to the control group. Interestingly, in both studies, the chance of achieving an objective response was highest in the patient subgroup with high baseline serum sodium levels of > 140 mmol/L (IMmotion151: Complete response in 17.9% versus 2.0% in patients with mRCC with baseline sodium < 135 mmol/L). Serum sodium outperformed tumor PD-L1 expression as a predictor for immunotherapy efficacy. CONCLUSIONS Patients exhibiting elevated serum sodium levels derive the greatest benefit from immunotherapy, suggesting that baseline serum concentration could serve as a valuable and cost-effective predictive biomarker for immunotherapy across entities.
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MESH Headings
- Humans
- Kidney Neoplasms/drug therapy
- Kidney Neoplasms/blood
- Kidney Neoplasms/pathology
- Kidney Neoplasms/immunology
- Male
- Carcinoma, Renal Cell/drug therapy
- Carcinoma, Renal Cell/blood
- Carcinoma, Renal Cell/immunology
- Carcinoma, Renal Cell/secondary
- Carcinoma, Renal Cell/pathology
- Female
- Sodium/blood
- Aged
- Middle Aged
- Immunotherapy/methods
- Antibodies, Monoclonal, Humanized/therapeutic use
- Bevacizumab/therapeutic use
- Biomarkers, Tumor/blood
- Immune Checkpoint Inhibitors/therapeutic use
- Prognosis
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Sunitinib/therapeutic use
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/blood
- Carcinoma, Transitional Cell/secondary
- Carcinoma, Transitional Cell/immunology
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Affiliation(s)
- Niklas Klümper
- Department of Urology, University Hospital Bonn (UKB), Bonn, Germany; Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany; Institute of Experimental Oncology, University Hospital Bonn (UKB), Bonn, Germany
| | - Alexander Cox
- Department of Urology, University Hospital Bonn (UKB), Bonn, Germany; Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Bavarian Center for Cancer Research (Bayerisches Zentrum für Krebsforschung, BZKF)
| | - Christoph Kuppe
- Department of Nephrology, Rheumatology, and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany
| | - Manuel Ritter
- Department of Urology, University Hospital Bonn (UKB), Bonn, Germany; Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany
| | - Peter Brossart
- Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany; Medical Clinic III for Oncology, Hematology, Immune-Oncology and Rheumatology, University Hospital Bonn (UKB), Germany
| | - Julian Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Michael Hölzel
- Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany; Institute of Experimental Oncology, University Hospital Bonn (UKB), Bonn, Germany
| | - Johannes Stein
- Department of Urology, University Hospital Bonn (UKB), Bonn, Germany; Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany
| | - Jonas Saal
- Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany; Department of Nephrology, Rheumatology, and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany; Medical Clinic III for Oncology, Hematology, Immune-Oncology and Rheumatology, University Hospital Bonn (UKB), Germany.
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3
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Mao X, Chen X, Xu Z, Ding L, Luo W, Lin Y, Wang R, Xia L, Wang M, Li G. The identification of a N 6-methyladenosin-modifed immune pattern to predict immunotherapy response and survival in urothelial carcinoma. Aging (Albany NY) 2024; 16:7774-7798. [PMID: 38696324 DOI: 10.18632/aging.205782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/29/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Dysregulation of the immune system and N6-methyladenosine (m6A) contribute to immune therapy resistance and cancer progression in urothelial carcinoma (UC). This study aims to identify immune-related molecules, that are m6A-modified, and that are associated with tumor progression, poor prognosis, and immunotherapy response. METHODS We identified prognostic immune genes (PIGs) using Cox analysis and random survival forest variable hunting algorithm (RSF-VH) on immune genes retrieved from the Immunology Database and Analysis Portal database (ImmPort). The RM2Target database and MeRIP-seq analysis, combined with a hypergeometric test, assessed m6A methylation in these PIGs. We analyzed the correlation between the immune pattern and prognosis, as well as their association with clinical factors in multiple datasets. Moreover, we explored the interplay between immune patterns, tumor immune cell infiltration, and m6A regulators. RESULTS 28 PIGs were identified, of which the 10 most significant were termed methylated prognostic immune genes (MPIGs). These MPIGs were used to create an immune pattern score. Kaplan-Meier and Cox analyses indicated this pattern as an independent risk factor for UC. We observed significant associations between the immune pattern, tumor progression, and immune cell infiltration. Differential expression analysis showed correlations with m6A regulators expression. This immune pattern proved effective in predicting immunotherapy response in UC in real-world settings. CONCLUSION The study identified a m6A-modified immune pattern in UC, offering prognostic and therapeutic response predictions. This emphasizes that immune genes may influence tumor immune status and progression through m6A modifications.
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Affiliation(s)
- Xudong Mao
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Xianjiong Chen
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Zhehao Xu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Lifeng Ding
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Wenqin Luo
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Yudong Lin
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Ruyue Wang
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Liqun Xia
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Mingchao Wang
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Gonghui Li
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
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4
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Bertucci F, de Nonneville A, Finetti P, Cohendet A, Guille A, Mamessier E. The co-expression of antigen targets as a rationale for ADC combination in urothelial cancer. Ann Oncol 2024; 35:477-478. [PMID: 38364991 DOI: 10.1016/j.annonc.2024.02.001] [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: 12/04/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/18/2024] Open
Affiliation(s)
- F Bertucci
- Predictive Oncology Laboratory, Marseille Cancer Research Center (CRCM), Aix-Marseille University, U1068 INSERM, U7258 CNRS, Institut Paoli-Calmettes, Marseille; Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France.
| | - A de Nonneville
- Predictive Oncology Laboratory, Marseille Cancer Research Center (CRCM), Aix-Marseille University, U1068 INSERM, U7258 CNRS, Institut Paoli-Calmettes, Marseille; Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - P Finetti
- Predictive Oncology Laboratory, Marseille Cancer Research Center (CRCM), Aix-Marseille University, U1068 INSERM, U7258 CNRS, Institut Paoli-Calmettes, Marseille
| | - A Cohendet
- Predictive Oncology Laboratory, Marseille Cancer Research Center (CRCM), Aix-Marseille University, U1068 INSERM, U7258 CNRS, Institut Paoli-Calmettes, Marseille
| | - A Guille
- Predictive Oncology Laboratory, Marseille Cancer Research Center (CRCM), Aix-Marseille University, U1068 INSERM, U7258 CNRS, Institut Paoli-Calmettes, Marseille
| | - E Mamessier
- Predictive Oncology Laboratory, Marseille Cancer Research Center (CRCM), Aix-Marseille University, U1068 INSERM, U7258 CNRS, Institut Paoli-Calmettes, Marseille
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5
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van Wilpe S, Gorris MAJ, van der Woude LL, Sultan S, Koornstra RHT, van der Heijden AG, Gerritsen WR, Simons M, de Vries IJM, Mehra N. Spatial and Temporal Heterogeneity of Tumor-Infiltrating Lymphocytes in Advanced Urothelial Cancer. Front Immunol 2022; 12:802877. [PMID: 35046958 PMCID: PMC8761759 DOI: 10.3389/fimmu.2021.802877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022] Open
Abstract
Checkpoint inhibitors targeting PD-(L)1 induce objective responses in 20% of patients with metastatic urothelial cancer (UC). CD8+ T cell infiltration has been proposed as a putative biomarker for response to checkpoint inhibitors. Nevertheless, data on spatial and temporal heterogeneity of tumor-infiltrating lymphocytes in advanced UC are lacking. The major aims of this study were to explore spatial heterogeneity for lymphocyte infiltration and to investigate how the immune landscape changes during the disease course. We performed multiplex immunohistochemistry to assess the density of intratumoral and stromal CD3+, CD8+, FoxP3+ and CD20+ immune cells in longitudinally collected samples of 49 UC patients. Within these samples, spatial heterogeneity for lymphocyte infiltration was observed. Regions the size of a 0.6 tissue microarray core (0.28 mm2) provided a representative sample in 60.6 to 71.6% of cases, depending on the cell type of interest. Regions of 3.30 mm2, the median tumor surface area in our biopsies, were representative in 58.8 to 73.8% of cases. Immune cell densities did not significantly differ between untreated primary tumors and metachronous distant metastases. Interestingly, CD3+, CD8+ and FoxP3+ T cell densities decreased during chemotherapy in two small cohorts of patients treated with neoadjuvant or palliative platinum-based chemotherapy. In conclusion, spatial heterogeneity in advanced UC challenges the use of immune cell infiltration in biopsies as biomarker for response prediction. Our data also suggests a decrease in tumor-infiltrating T cells during platinum-based chemotherapy.
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Affiliation(s)
- Sandra van Wilpe
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Mark A. J. Gorris
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- Oncode Institute, Nijmegen, Netherlands
| | - Lieke L. van der Woude
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- Oncode Institute, Nijmegen, Netherlands
| | - Shabaz Sultan
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Antoine G. van der Heijden
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Winald R. Gerritsen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Michiel Simons
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - I. Jolanda M. de Vries
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Niven Mehra
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
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6
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Lindskrog SV, Prip F, Lamy P, Taber A, Groeneveld CS, Birkenkamp-Demtröder K, Jensen JB, Strandgaard T, Nordentoft I, Christensen E, Sokac M, Birkbak NJ, Maretty L, Hermann GG, Petersen AC, Weyerer V, Grimm MO, Horstmann M, Sjödahl G, Höglund M, Steiniche T, Mogensen K, de Reyniès A, Nawroth R, Jordan B, Lin X, Dragicevic D, Ward DG, Goel A, Hurst CD, Raman JD, Warrick JI, Segersten U, Sikic D, van Kessel KEM, Maurer T, Meeks JJ, DeGraff DJ, Bryan RT, Knowles MA, Simic T, Hartmann A, Zwarthoff EC, Malmström PU, Malats N, Real FX, Dyrskjøt L. An integrated multi-omics analysis identifies prognostic molecular subtypes of non-muscle-invasive bladder cancer. Nat Commun 2021; 12:2301. [PMID: 33863885 PMCID: PMC8052448 DOI: 10.1038/s41467-021-22465-w] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [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: 06/11/2020] [Accepted: 03/09/2021] [Indexed: 12/13/2022] Open
Abstract
The molecular landscape in non-muscle-invasive bladder cancer (NMIBC) is characterized by large biological heterogeneity with variable clinical outcomes. Here, we perform an integrative multi-omics analysis of patients diagnosed with NMIBC (n = 834). Transcriptomic analysis identifies four classes (1, 2a, 2b and 3) reflecting tumor biology and disease aggressiveness. Both transcriptome-based subtyping and the level of chromosomal instability provide independent prognostic value beyond established prognostic clinicopathological parameters. High chromosomal instability, p53-pathway disruption and APOBEC-related mutations are significantly associated with transcriptomic class 2a and poor outcome. RNA-derived immune cell infiltration is associated with chromosomally unstable tumors and enriched in class 2b. Spatial proteomics analysis confirms the higher infiltration of class 2b tumors and demonstrates an association between higher immune cell infiltration and lower recurrence rates. Finally, the independent prognostic value of the transcriptomic classes is documented in 1228 validation samples using a single sample classification tool. The classifier provides a framework for biomarker discovery and for optimizing treatment and surveillance in next-generation clinical trials.
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Affiliation(s)
- Sia Viborg Lindskrog
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Frederik Prip
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Philippe Lamy
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Ann Taber
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Clarice S Groeneveld
- Cartes d'Identité des Tumeurs (CIT) Program, Ligue Nationale Contre le Cancer, Paris, France
- Oncologie Moleculaire, UMR144, Institut Curie, Paris, France
| | - Karin Birkenkamp-Demtröder
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jørgen Bjerggaard Jensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Urology, Aarhus University Hospital, Aarhus N, Denmark
| | - Trine Strandgaard
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Iver Nordentoft
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Emil Christensen
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mateo Sokac
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nicolai J Birkbak
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lasse Maretty
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Gregers G Hermann
- Department of Urology, Herlev hospital, Copenhagen University, Copenhagen, Denmark
| | - Astrid C Petersen
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Veronika Weyerer
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Marcus Horstmann
- Department of Urology, Jena University Hospital, Jena, Germany
- Department of Urology, Malteser Hospital St. Josephshospital, Krefeld Uerdingen, Krefeld, Germany
| | - Gottfrid Sjödahl
- Division of Urological Research, Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Mattias Höglund
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Torben Steiniche
- Department of Pathology, Aarhus University Hospital, Aarhus N, Denmark
| | - Karin Mogensen
- Department of Urology, Herlev hospital, Copenhagen University, Copenhagen, Denmark
| | - Aurélien de Reyniès
- Cartes d'Identité des Tumeurs (CIT) Program, Ligue Nationale Contre le Cancer, Paris, France
| | - Roman Nawroth
- Department of Urology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Brian Jordan
- Departments of Pathology, Urology, Biochemistry and Molecular Genetics, Northwestern University School of Medicine, Chicago, IL, USA
| | - Xiaoqi Lin
- Departments of Pathology, Urology, Biochemistry and Molecular Genetics, Northwestern University School of Medicine, Chicago, IL, USA
| | - Dejan Dragicevic
- Clinic of Urology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Douglas G Ward
- Bladder Cancer Research Centre, Institute of Cancer and Genomic Sciences, College of Medicine and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anshita Goel
- Bladder Cancer Research Centre, Institute of Cancer and Genomic Sciences, College of Medicine and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Carolyn D Hurst
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Jay D Raman
- Department of Surgery, Division of Urology, Pennsylvania State University, Hershey, PA, USA
| | - Joshua I Warrick
- Department of Pathology and Laboratory Medicine, Division of Urology, Department of Biochemistry and Molecular Biology, Pennsylvania State University, Hershey, PA, USA
| | - Ulrika Segersten
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Danijel Sikic
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Kim E M van Kessel
- Department of Pathology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tobias Maurer
- Department of Urology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Department of Urology and Martini-Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joshua J Meeks
- Departments of Pathology, Urology, Biochemistry and Molecular Genetics, Northwestern University School of Medicine, Chicago, IL, USA
| | - David J DeGraff
- Department of Pathology and Laboratory Medicine, Division of Urology, Department of Biochemistry and Molecular Biology, Pennsylvania State University, Hershey, PA, USA
| | - Richard T Bryan
- Bladder Cancer Research Centre, Institute of Cancer and Genomic Sciences, College of Medicine and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Margaret A Knowles
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Tatjana Simic
- Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Ellen C Zwarthoff
- Department of Pathology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Per-Uno Malmström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Núria Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), CIBERONC, Madrid, Spain
| | - Francisco X Real
- Epithelial Carcinogenesis Group, Spanish National Cancer Research Center (CNIO), Madrid, Spain
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, CIBERONC, Barcelona, Spain
| | - Lars Dyrskjøt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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7
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Su X, Lu X, Bazai SK, Compérat E, Mouawad R, Yao H, Rouprêt M, Spano JP, Khayat D, Davidson I, Tannir NN, Yan F, Malouf GG. Comprehensive integrative profiling of upper tract urothelial carcinomas. Genome Biol 2021; 22:7. [PMID: 33397444 PMCID: PMC7780630 DOI: 10.1186/s13059-020-02230-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 05/31/2020] [Accepted: 12/09/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Crosstalk between genetic, epigenetic, and immune alterations in upper tract urothelial carcinomas and their role in shaping muscle invasiveness and patient outcome are poorly understood. RESULTS We perform an integrative genome- and methylome-wide profiling of diverse non-muscle-invasive and muscle-invasive upper tract urothelial carcinomas. In addition to mutations of FGFR3 and KDM6A, we identify ZFP36L1 as a novel, significantly mutated tumor suppressor gene. Overall, mutations of ZFP36 family genes (ZFP36, ZFP36L1, and ZFP36L2) are identified in 26.7% of cases, which display a high mutational load. Unsupervised DNA methylation subtype classification identifies two epi-clusters associated with distinct muscle-invasive status and patient outcome, namely, EpiC-low and EpiC-high. While the former is hypomethylated, immune-depleted, and enriched for FGFR3-mutated, the latter is hypermethylated, immune-infiltrated, and tightly associated with somatic mutations of SWI/SNF genes. CONCLUSIONS Our study delineates for the first time the key role for convergence between genetic and epigenetic alterations in shaping clinicopathological and immune upper tract urothelial carcinoma features.
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Affiliation(s)
- Xiaoping Su
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiaofan Lu
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Sehrish Khan Bazai
- Department of Cancer and Functional Genomics, Institute of Genetics and Molecular and Cellular Biology, CNRS/INSERM/UNISTRA, 67400, Illkirch, France
- Equipe Labellisée Ligue Nationale Contre le Cancer, Paris, France
| | - Eva Compérat
- Department of Pathology, GRC No. 5, Predictive Onco Uro, AP-HP, Hôpital Tenon, Sorbonne University, Paris, France
| | - Roger Mouawad
- Department of Medical Oncology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - Hui Yao
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Morgan Rouprêt
- Department of Urology, GRC No. 5, Predictive Onco Uro, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - Jean-Philippe Spano
- Department of Medical Oncology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - David Khayat
- Department of Medical Oncology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - Irwin Davidson
- Department of Cancer and Functional Genomics, Institute of Genetics and Molecular and Cellular Biology, CNRS/INSERM/UNISTRA, 67400, Illkirch, France
- Equipe Labellisée Ligue Nationale Contre le Cancer, Paris, France
| | - Nizar N Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fangrong Yan
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, 210009, China.
| | - Gabriel G Malouf
- Department of Cancer and Functional Genomics, Institute of Genetics and Molecular and Cellular Biology, CNRS/INSERM/UNISTRA, 67400, Illkirch, France.
- Equipe Labellisée Ligue Nationale Contre le Cancer, Paris, France.
- Department of Medical Oncology, Institut de Cancérologie de Strasbourg-Europe, Strasbourg, France.
- Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France.
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8
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Fukushima H, Kijima T, Fukuda S, Moriyama S, Uehara S, Yasuda Y, Tanaka H, Yoshida S, Yokoyama M, Matsuoka Y, Saito K, Matsubara N, Numao N, Sakai Y, Yuasa T, Masuda H, Yonese J, Kageyama Y, Fujii Y. Impact of radiotherapy to the primary tumor on the efficacy of pembrolizumab for patients with advanced urothelial cancer: A preliminary study. Cancer Med 2020; 9:8355-8363. [PMID: 32886446 PMCID: PMC7666746 DOI: 10.1002/cam4.3445] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/14/2020] [Accepted: 08/19/2020] [Indexed: 01/15/2023] Open
Abstract
Radiotherapy plus immune checkpoint inhibitors can potentially induce synergistic antitumor immune responses. However, little clinical evidence is established regarding their combination therapy. Here, we aimed to assess whether radiotherapy to the primary tumor impacts on the efficacy of pembrolizumab in advanced urothelial cancer. We retrospectively reviewed 98 advanced urothelial cancer patients receiving pembrolizumab in a second- or later-line setting using our multicenter cohort. Patients were categorized according to a history of radiotherapy to the primary tumor: patients previously exposed to radiotherapy to the primary tumor (Radiotherapy group, 17 patients [17%]) and those not (Nonradiotherapy group, 81 patients [83%]). The associations of radiotherapy to the primary tumor with objective response and survival were evaluated. The Radiotherapy group showed a significantly higher objective response ratio than did the Non-radiotherapy group (65% vs 19%; P < .001). The Radiotherapy group had a higher progression-free survival rate compared with the Nonradiotherapy group (52% vs 28% at 12 months; P = .078), but statistical significance was not reached. The Radiotherapy group had a significantly higher overall survival rate compared with the Non-radiotherapy group (77% vs 50% at 12 months; P = .025). From multivariate analysis, radiotherapy to the primary tumor was an independent predictor for longer overall survival (hazard ratio, 0.31; P = .032) along with Eastern Cooperative Oncology Group performance status ≤1 and the absence of visceral metastasis. Therefore, radiotherapy to the primary tumor may enhance the efficacy of pembrolizumab for patients with advanced urothelial cancer.
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MESH Headings
- Aged
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- Carcinoma, Transitional Cell/immunology
- Carcinoma, Transitional Cell/mortality
- Carcinoma, Transitional Cell/pathology
- Carcinoma, Transitional Cell/therapy
- Chemoradiotherapy/adverse effects
- Chemoradiotherapy/mortality
- Female
- Humans
- Male
- Middle Aged
- Progression-Free Survival
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Time Factors
- Tokyo
- Tumor Microenvironment
- Urinary Bladder Neoplasms/immunology
- Urinary Bladder Neoplasms/mortality
- Urinary Bladder Neoplasms/pathology
- Urinary Bladder Neoplasms/therapy
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Affiliation(s)
| | - Toshiki Kijima
- Department of UrologyTokyo Medical and Dental UniversityTokyoJapan
| | - Shohei Fukuda
- Department of UrologyTokyo Medical and Dental UniversityTokyoJapan
| | - Shingo Moriyama
- Department of UrologyTokyo Medical and Dental UniversityTokyoJapan
| | - Sho Uehara
- Department of UrologyTokyo Medical and Dental UniversityTokyoJapan
| | - Yosuke Yasuda
- Department of UrologyTokyo Medical and Dental UniversityTokyoJapan
| | - Hajime Tanaka
- Department of UrologyTokyo Medical and Dental UniversityTokyoJapan
| | - Soichiro Yoshida
- Department of UrologyTokyo Medical and Dental UniversityTokyoJapan
| | - Minato Yokoyama
- Department of UrologyTokyo Medical and Dental UniversityTokyoJapan
| | - Yoh Matsuoka
- Department of UrologyTokyo Medical and Dental UniversityTokyoJapan
| | - Kazutaka Saito
- Department of UrologyTokyo Medical and Dental UniversityTokyoJapan
| | - Nobuaki Matsubara
- Department of Breast and Medical OncologyNational Cancer Center Hospital EastKashiwaJapan
| | - Noboru Numao
- Department of UrologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | | | - Takeshi Yuasa
- Department of UrologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Hitoshi Masuda
- Department of UrologyNational Cancer Center Hospital EastKashiwaJapan
| | - Junji Yonese
- Department of UrologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | | | - Yasuhisa Fujii
- Department of UrologyTokyo Medical and Dental UniversityTokyoJapan
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9
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Abstract
BACKGROUND Great advances have been made for the treatment of urothelial carcinoma by the introduction of checkpoint inhibitors (CPI). Single-agent immunotherapy with CPIs has been approved for patients with metastatic or locally advanced inoperable urothelial carcinoma who have either progressed during or after platinum-based chemotherapy or who are cisplatin-ineligible. For cisplatin-ineligible patients, approval is restricted to patients with high programmed cell death ligand 1 (PD-L1) expression. For patients with nonmuscle invasive bladder cancer (NMIBC) or patients with muscle invasive bladder cancer (MIBC) who receive curative therapy, no CPIs have received approval in Germany. OBJECTIVES To provide an overview of the current landscape of immunotherapy in patients with urothelial carcinoma. METHODS Summary of the therapeutic landscape and resulting challenges based on currently published data using a PubMed search. RESULTS In the treatment of metastatic or inoperable urothelial carcinoma, CPIs represent standard treatment. Depending on the results of currently performed trials, an extension of its use to the perioperative setting (neoadjuvant/adjuvant) and to patients with Bacillus Calmette Guérin (BCG) unresponsive NMIBC in the near future is currently being discussed. CONCLUSIONS Immuno-oncologic treatment using CPIs has become an integral part of the management of patients with advanced bladder cancer. For biomarker-based patient selection and combination therapies, there is an urgent need for further investigations within clinical trial protocols.
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Affiliation(s)
| | - M Boegemann
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1 GB A1, 48149, Münster, Deutschland.
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10
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Lillesand M, Kvikstad V, Mangrud OM, Gudlaugsson E, van Diermen-Hidle B, Skaland I, Baak JPA, Janssen EAM. Mitotic activity index and CD25+ lymphocytes predict risk of stage progression in non-muscle invasive bladder cancer. PLoS One 2020; 15:e0233676. [PMID: 32484812 PMCID: PMC7266352 DOI: 10.1371/journal.pone.0233676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/10/2020] [Indexed: 11/19/2022] Open
Abstract
In urothelial cell type non-muscle invasive urinary bladder carcinoma, TNM stage and WHO grade are widely used to classify patients into low and high‑risk groups for prognostic and therapeutic decision-making. However, stage and grade reproducibility and prediction accuracy are wanting. This may lead to suboptimal treatment. We evaluated whether proliferation features, nuclear area of the epithelial cancer cells and the composition of stromal and tumor infiltrating lymphocytes have independent prognostic value. In 183 primary non-muscle invasive bladder cancer patients with long follow-up (median for stage progression cohort: 119 months, range 5-173; median for tumor recurrence cohort: 82, range 3-165) proliferation features Ki67, PPH3 and Mitotic Activity Index (MAI), Mean Nuclear Area (MNA), lymphocyte subsets (CD8+, CD4+, CD25+) and plasma cells (CD138+) were assessed on consecutive sections. Post-resection instillation treatments (none, mitomycin, BCG) were strictly standardized during the intake period. Risk of recurrence was associated with expression of Ki67 (≤ 39 vs. > 39) and Multifocality (p = 0.01). Patients with low Ki67 had a higher recurrence rate than those with high Ki67. Lymphocyte composition did not predict recurrence. Stage progression was strongly associated with high values for MAI (>15) and CD25+ (>0.2%). In a multivariate analysis the combination of MAI and CD25+ was the single most prognostic feature (p<0.001). Validation of these results in additional, independent studies is warranted.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Transitional Cell/genetics
- Carcinoma, Transitional Cell/immunology
- Carcinoma, Transitional Cell/pathology
- Disease Progression
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Interleukin-2 Receptor alpha Subunit/metabolism
- Kaplan-Meier Estimate
- Ki-67 Antigen/metabolism
- Lymphocytes, Tumor-Infiltrating/immunology
- Lymphocytes, Tumor-Infiltrating/metabolism
- Male
- Middle Aged
- Mitotic Index
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/immunology
- Neoplasm Staging
- Prognosis
- Reproducibility of Results
- Urinary Bladder/pathology
- Urinary Bladder Neoplasms/genetics
- Urinary Bladder Neoplasms/immunology
- Urinary Bladder Neoplasms/mortality
- Urinary Bladder Neoplasms/pathology
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Affiliation(s)
- Melinda Lillesand
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
- * E-mail:
| | - Vebjørn Kvikstad
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
- Department of Mathematics and Natural Science, University of Stavanger, Stavanger, Norway
| | | | - Einar Gudlaugsson
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | | | - Ivar Skaland
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | - Jan P. A. Baak
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
- Jan Baak AS, Tananger, Norway
| | - Emiel A. M. Janssen
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
- Department of Mathematics and Natural Science, University of Stavanger, Stavanger, Norway
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11
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Packeiser EM, Hewicker-Trautwein M, Thiemeyer H, Mohr A, Junginger J, Schille JT, Murua Escobar H, Nolte I. Characterization of six canine prostate adenocarcinoma and three transitional cell carcinoma cell lines derived from primary tumor tissues as well as metastasis. PLoS One 2020; 15:e0230272. [PMID: 32168360 PMCID: PMC7069630 DOI: 10.1371/journal.pone.0230272] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/25/2020] [Indexed: 12/13/2022] Open
Abstract
Canine prostate adenocarcinoma (PAC) and transitional cell carcinoma (TCC) of prostate and urinary bladder are highly invasive and metastatic tumors of closely neighbored organs. Cell lines are valuable tools to investigate tumor mechanisms and therapeutic approaches in vitro. PAC in dogs is infrequent, difficult to differentiate from TCC and usually characterized by poor prognosis, enhancing the value of the few available cell lines. However, as cell lines adapt to culturing conditions, a thorough characterization, ideally compared to original tissue, is indispensable. Herein, six canine PAC cell lines and three TCC cell lines were profiled by immunophenotype in comparison to respective original tumor tissues. Three of the six PAC cell lines were derived from primary tumor and metastases of the same patient. Further, two of the three TCC cell lines were derived from TCCs invading into or originating from the prostate. Cell biologic parameters as doubling times and chemoresistances to commonly used drugs in cancer treatment (doxorubicin, carboplatin and meloxicam) were assessed. All cell lines were immunohistochemically close to the respective original tissue. Compared to primary tumor cell lines, metastasis-derived cell lines were more chemoresistant to doxorubicin, but equally susceptive to carboplatin treatment. Two cell lines were multiresistant. COX-2 enzyme activity was demonstrated in all cell lines. However, meloxicam inhibited prostaglandin E2 production in only seven of nine cell lines and did neither influence metabolic activity, nor proliferation. The characterized nine cell lines represent excellent tools to investigate PAC as well as TCC in prostate and urinary bladder of the dog. Furthermore, the profiled paired cell lines from PAC primary tumor and metastasis provide the unique opportunity to investigate metastasis-associated changes PAC cells undergo in tumor progression. The combination of nine differently chemoresistant PAC and TCC cell lines resembles the heterogeneity of canine lower urinary tract cancer.
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Affiliation(s)
- Eva-Maria Packeiser
- Small Animal Clinic, University of Veterinary Medicine Hannover, Hannover, Germany
- Department of Internal Medicine, Medical Clinic III, Clinic for Hematology, Oncology and Palliative Care, University Medical Centre Rostock, Rostock, Germany
| | | | - Heike Thiemeyer
- Small Animal Clinic, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Annika Mohr
- Small Animal Clinic, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Johannes Junginger
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Jan Torben Schille
- Small Animal Clinic, University of Veterinary Medicine Hannover, Hannover, Germany
- Department of Internal Medicine, Medical Clinic III, Clinic for Hematology, Oncology and Palliative Care, University Medical Centre Rostock, Rostock, Germany
| | - Hugo Murua Escobar
- Small Animal Clinic, University of Veterinary Medicine Hannover, Hannover, Germany
- Department of Internal Medicine, Medical Clinic III, Clinic for Hematology, Oncology and Palliative Care, University Medical Centre Rostock, Rostock, Germany
- * E-mail: (HME); (IN)
| | - Ingo Nolte
- Small Animal Clinic, University of Veterinary Medicine Hannover, Hannover, Germany
- * E-mail: (HME); (IN)
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12
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McGregor BA, Sonpavde G. Enfortumab Vedotin, a fully human monoclonal antibody against Nectin 4 conjugated to monomethyl auristatin E for metastatic urothelial Carcinoma. Expert Opin Investig Drugs 2019; 28:821-826. [PMID: 31526130 DOI: 10.1080/13543784.2019.1667332] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 07/16/2019] [Accepted: 09/10/2019] [Indexed: 12/27/2022]
Abstract
Introduction: The conventional management of most patients with metastatic urothelial carcinoma (UC) is platinum-based chemotherapy followed by immunotherapy. Erdafitinib is an option in post-platinum patients with activating mutations in fibroblast growth factor receptor (FGFR)-3 and -2. Salvage therapy with taxanes or vinflunine has demonstrated minimal efficacy. Enfortumab Vedotin (EV), a monoclonal antibody-drug conjugate (ADC) targeting nectin-4 is under investigation in patients with advanced UC. Areas covered: This review describes the epidemiology and unmet needs of patients with metastatic UC and is focused specifically on heavily treated patients. We explore the rationale for targeting nectin 4 and the clinical development of EV; efficacy and safety data from the completed phase I and II studies are examined. Ongoing trials to definitively assess clinical outcomes in comparison to current therapy and trials exploring EV in combination are also highlighted. Expert opinion: There is an unmet need for new therapies in most patients with advanced UC and who progress after platinum and immunotherapy. EV has shown promising efficacy and safety in this population in phase 1 and 2 trials including those with poor prognostic factors such as liver metastases. Ongoing trials exploring this agent in combination will continue to advance the treatment of UC.
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Affiliation(s)
- Bradley A McGregor
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute , Boston , MA , USA
- Department of Medicine, Harvard Medical School , Boston , MA , USA
| | - Guru Sonpavde
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute , Boston , MA , USA
- Department of Medicine, Harvard Medical School , Boston , MA , USA
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13
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Hodgson A, Jungbluth AA, Katabi N, Xu B, Downes MR. Evaluation of cancer testis antigen (CT10, PRAME) and MHC I expression in high-grade urothelial carcinoma of the bladder. Virchows Arch 2019; 476:535-542. [PMID: 31485721 PMCID: PMC8596305 DOI: 10.1007/s00428-019-02661-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/22/2019] [Accepted: 08/27/2019] [Indexed: 01/17/2023]
Abstract
Immunotherapeutic strategies are increasingly used in the treatment of a number of malignancies including high grade urothelial carcinoma (HGUC) of the bladder. Because of this, detailed and accurate assessment of the tumour immune microenvironment is paramount. In this study, we aimed to correlate the composition of the tumour immune microenvironment with oncologic outcome and the expression of two cancer testis antigens (CTAs), CT10 and PRAME, potential cancer vaccine targets, as well as major histocompatibility complex I (MHC I), a molecule associated with tumour immune escape and resistance to immunotherapy. Triplicate tissue microarrays (TMAs) were constructed using 207 cases of HGUC of the bladder. Oncologic outcome data was gathered for each case. Consecutive sections from the TMA blocks were stained with CD3, CD4, CD8, FOXP3, PD1, PD-L1, CT10, PRAME, and MHC I. 21% and 15% of cases expressed CT10 and PRAME, respectively. 88% of cases showed absent or decreased MHC I expression. CT10-expressing tumours showed a significantly worse disease specific survival (p = 0.007, hazard ratio 2.245, confidence interval 1.223–4.122). CT10, PRAME, and MHC I expression significantly correlated with other some immune parameters. CT10 and PRAME are expressed in a subset of HGUC and CTA and MHC I expression correlate with a number of important immune parameters. Together, these findings highlight the potential for exploring novel immune therapeutic strategies in HGUC. Additional studies evaluating the clinical relevance of these findings are warranted.
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Affiliation(s)
- Anjelica Hodgson
- Division of Anatomic Pathology, Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle, Toronto, ON, Canada
| | - Achim A Jungbluth
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
| | - Nora Katabi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
| | - Michelle R Downes
- Division of Anatomic Pathology, Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle, Toronto, ON, Canada.
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14
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Hsu MM, Balar AV. PD-1/PD-L1 Combinations in Advanced Urothelial Cancer: Rationale and Current Clinical Trials. Clin Genitourin Cancer 2019; 17:e618-e626. [PMID: 31005473 DOI: 10.1016/j.clgc.2019.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 09/20/2018] [Revised: 01/14/2019] [Accepted: 03/17/2019] [Indexed: 12/27/2022]
Abstract
Chemotherapy is no longer the only viable option for patients with locally advanced or metastatic urothelial carcinoma. Immunotherapy, as checkpoint inhibition, has received United States Food and Drug Administration approval in the preceding several years, both in the second-line and first-line for cisplatin-ineligible patients. Those who respond often do so durably; however, response rates in the first line are 23% to 24%, and are lower in the second line. With a focus on urothelial carcinoma, this review discusses the tumor microenvironment and its negative influence on anti-tumor immunity, as well as measures to counteract immune suppression or evasion. The review then describes a range of current clinical trials implementing these measures in the form of programmed death-combination therapy, specifically in advanced bladder and urothelial cancers.
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Affiliation(s)
- Miles M Hsu
- New York University School of Medicine, New York, NY.
| | - Arjun V Balar
- New York University Perlmutter Cancer Center, New York, NY
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15
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Holland BC, Sood A, Delfino K, Dynda DI, Ran S, Freed N, Alanee S. Age and sex have no impact on expression levels of markers of immune cell infiltration and immune checkpoint pathways in patients with muscle-invasive urothelial carcinoma of the bladder treated with radical cystectomy. Cancer Immunol Immunother 2019; 68:991-997. [PMID: 30997535 PMCID: PMC11028177 DOI: 10.1007/s00262-019-02340-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/10/2018] [Accepted: 04/06/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Advanced age and female sex have been associated with worse outcomes in patients undergoing radical cystectomy for muscle-invasive bladder cancer. A reduced immune response has been implicated as a mechanism. The objective of our study was to analyze the expression patterns of various cellular proteins active in bladder cancer immune pathways, and assess the correlation between age, sex, and the expression of these immune markers. METHODS We obtained surgical tissue samples from equally distributed male/female patients with/without lymph node metastasis who had undergone radical cystectomy for urothelial carcinoma (UC) of the bladder (n = 50). Immunohistochemistry (IHC) for CD3 (cluster of differentiation), CD4, CD8, CD56, LAG-3 (lymphocyte-activation gene), TIM-3 (T-cell immunoglobulin and mucin-domain), PD-1 (programmed death) and PD-L1 molecules was performed and scored by a single pathologist (high versus low). Spearman's correlation and Chi square tests investigated the association between age, sex, and IHC results. RESULTS Mean age at surgery was 67 years (range 50-78 years); all patients were Caucasians. The following percent of patients scored high for a stain: 18% CD3, 10% CD4, 0% CD8, 0% CD56, 20% LAG-3, 4% TIM-3, 0% PD-1 and 0% PD-L1. There was no association between patients' age, sex, and the expression of any of the immune markers (p > 0.05 for all). CONCLUSIONS The association between advanced age, female sex, and worse outcomes in bladder cancer may be independent of the immune pathways active in the disease that we examined in this study.
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Affiliation(s)
- Bradley C Holland
- Department of Surgery, Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Akshay Sood
- VCORE-Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, 2799 W. Grand Boulevard, Detroit, MI, 48202, USA
| | - Kristin Delfino
- Department of Surgery, Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Danuta I Dynda
- Department of Surgery, Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Sophia Ran
- Department of Medical Microbiology, Immunology and Cell Biology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Natalie Freed
- Pathology Associates of Central Illinois, Springfield, IL, USA
| | - Shaheen Alanee
- Department of Surgery, Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA.
- VCORE-Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, 2799 W. Grand Boulevard, Detroit, MI, 48202, USA.
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16
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Nabel CS, Severgnini M, Hung YP, Cunningham-Bussel A, Gjini E, Kleinsteuber K, Seymour LJ, Holland MK, Cunningham R, Felt KD, Vivero M, Rodig SJ, Massarotti EM, Rahma OE, Harshman LC. Anti-PD-1 Immunotherapy-Induced Flare of a Known Underlying Relapsing Vasculitis Mimicking Recurrent Cancer. Oncologist 2019; 24:1013-1021. [PMID: 31088979 DOI: 10.1634/theoncologist.2018-0633] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/09/2019] [Accepted: 03/06/2019] [Indexed: 12/13/2022] Open
Abstract
Safe use of immune checkpoint blockade in patients with cancer and autoimmune disorders requires a better understanding of the pathophysiology of immunologic activation. We describe the immune correlates of reactivation of granulomatosis with polyangiitis (GPA)-an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis-in a patient with metastatic urothelial carcinoma treated with pembrolizumab. After PD-1 blockade, an inflammatory pulmonary nodule demonstrated a granulomatous, CD4+ T-cell infiltrate, correlating with increased CD4+ and CD8+ naïve memory cells in the peripheral blood without changes in other immune checkpoint receptors. Placed within the context of the existing literature on GPA and disease control, our findings suggest a key role for PD-1 in GPA self-tolerance and that selective strategies for immunotherapy may be needed in patients with certain autoimmune disorders. We further summarize the current literature regarding reactivation of autoimmune disorders in patients undergoing immune checkpoint blockade, as well as potential immunosuppressive strategies to minimize the risks of further vasculitic reactivation upon rechallenge with anti-PD-1 blockade. KEY POINTS: Nonspecific imaging findings in patients with cancer and rheumatological disorders may require biopsy to distinguish underlying pathology.Patients with rheumatologic disorders have increased risk of reactivation with PD-(L)1 immune checkpoint blockade, requiring assessment of disease status before starting treatment.Further study is needed to evaluate the efficacy of treatment regimens in preventing and controlling disease reactivation.
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MESH Headings
- Adrenalectomy
- Antibodies, Monoclonal, Humanized/adverse effects
- Carcinoma, Transitional Cell/diagnosis
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/immunology
- Chemoradiotherapy, Adjuvant/adverse effects
- Chemoradiotherapy, Adjuvant/methods
- Cystectomy
- Diagnosis, Differential
- Granulomatosis with Polyangiitis/chemically induced
- Granulomatosis with Polyangiitis/diagnosis
- Granulomatosis with Polyangiitis/immunology
- Humans
- Male
- Middle Aged
- Multiple Endocrine Neoplasia Type 2a/immunology
- Multiple Endocrine Neoplasia Type 2a/therapy
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/immunology
- Nephroureterectomy
- Programmed Cell Death 1 Receptor/antagonists & inhibitors
- Programmed Cell Death 1 Receptor/immunology
- Prostatectomy
- Symptom Flare Up
- Urinary Bladder Neoplasms/diagnosis
- Urinary Bladder Neoplasms/drug therapy
- Urinary Bladder Neoplasms/immunology
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Affiliation(s)
- Christopher S Nabel
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Mariano Severgnini
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Yin P Hung
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Amy Cunningham-Bussel
- Division of Rheumatology, Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Evisa Gjini
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Katja Kleinsteuber
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lake J Seymour
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Martha K Holland
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Rachel Cunningham
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kristin D Felt
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Marina Vivero
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Scott J Rodig
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elena M Massarotti
- Division of Rheumatology, Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Osama E Rahma
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren C Harshman
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
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17
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Yang G, Zhang L, Liu M, Liu Q, Duan X, Bo J. CD163+ macrophages predict a poor prognosis in patients with primary T1 high-grade urothelial carcinoma of the bladder. World J Urol 2019; 37:2721-2726. [PMID: 30868239 DOI: 10.1007/s00345-018-02618-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/02/2018] [Accepted: 12/24/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Macrophages are a major cell type that can infiltrate solid tumors and exhibit distinct phenotypes in different tumor microenvironments. This study investigates the prognostic value of tumor-infiltrated CD163+ macrophages in patients with T1 high-grade (T1HG) bladder cancer. METHODS CD163+ macrophages were assessed by immunohistochemistry in 94 T1HG bladder cancer samples. Kaplan-Meier analyses and Cox proportional hazards' regression models were applied to evaluate recurrence-free survival, progression-free survival and disease-specific survival. RESULTS With a median follow-up of 60 months, 37 (39.4%) patients experienced disease recurrence, 14 (14.9%) progression, 11 (11.7%) disease-specific mortality. High CD163+ macrophages were associated with higher risk of disease recurrence and progression (P < 0.05, for both). In multivariate Cox proportional hazards regression analysis, high CD163+ macrophages were a significant negative predictor of recurrence-free survival, progression-free survival and disease-specific survival (P < 0.05 for all). CONCLUSION CD163+ macrophages are a poor prognostic factor in T1HG bladder cancer. This finding provide the ground for further testing it in predicting the outcome of this challenging disease.
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Affiliation(s)
- Guoliang Yang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lianhua Zhang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mengyao Liu
- Clinical Stem Cell Research Center, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiang Liu
- Department of Pathology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xuehui Duan
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Juanjie Bo
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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18
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Leiserson MDM, Syrgkanis V, Gilson A, Dudik M, Gillett S, Chayes J, Borgs C, Bajorin DF, Rosenberg JE, Funt S, Snyder A, Mackey L. A multifactorial model of T cell expansion and durable clinical benefit in response to a PD-L1 inhibitor. PLoS One 2018; 13:e0208422. [PMID: 30596661 PMCID: PMC6312275 DOI: 10.1371/journal.pone.0208422] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/17/2018] [Indexed: 01/05/2023] Open
Abstract
Checkpoint inhibitor immunotherapies have had major success in treating patients with late-stage cancers, yet the minority of patients benefit. Mutation load and PD-L1 staining are leading biomarkers associated with response, but each is an imperfect predictor. A key challenge to predicting response is modeling the interaction between the tumor and immune system. We begin to address this challenge with a multifactorial model for response to anti-PD-L1 therapy. We train a model to predict immune response in patients after treatment based on 36 clinical, tumor, and circulating features collected prior to treatment. We analyze data from 21 bladder cancer patients using the elastic net high-dimensional regression procedure and, as training set error is a biased and overly optimistic measure of prediction error, we use leave-one-out cross-validation to obtain unbiased estimates of accuracy on held-out patients. In held-out patients, the model explains 79% of the variance in T cell clonal expansion. This predicted immune response is multifactorial, as the variance explained is at most 23% if clinical, tumor, or circulating features are excluded. Moreover, if patients are triaged according to predicted expansion, only 38% of non-durable clinical benefit (DCB) patients need be treated to ensure that 100% of DCB patients are treated. In contrast, using mutation load or PD-L1 staining alone, one must treat at least 77% of non-DCB patients to ensure that all DCB patients receive treatment. Thus, integrative models of immune response may improve our ability to anticipate clinical benefit of immunotherapy.
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MESH Headings
- Adult
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- B7-H1 Antigen/antagonists & inhibitors
- B7-H1 Antigen/immunology
- Biomarkers, Pharmacological/analysis
- Biomarkers, Tumor/analysis
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/immunology
- Carcinoma, Transitional Cell/pathology
- Cell Proliferation/drug effects
- Cell Proliferation/genetics
- Clonal Evolution/drug effects
- Clonal Evolution/genetics
- Female
- Humans
- Immunotherapy/methods
- Lymphocytes, Tumor-Infiltrating/drug effects
- Lymphocytes, Tumor-Infiltrating/physiology
- Male
- Models, Statistical
- Mutation
- Protein Kinase Inhibitors/therapeutic use
- Risk Assessment
- T-Lymphocytes/drug effects
- T-Lymphocytes/physiology
- Treatment Outcome
- Urinary Bladder Neoplasms/drug therapy
- Urinary Bladder Neoplasms/immunology
- Urinary Bladder Neoplasms/pathology
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Affiliation(s)
- Mark D. M. Leiserson
- Microsoft Research New England, Cambridge, MA, United States of America
- University of Maryland, College Park, Department of Computer Science, College Park, MD, United States of America
| | - Vasilis Syrgkanis
- Microsoft Research New England, Cambridge, MA, United States of America
| | - Amy Gilson
- Microsoft Research New England, Cambridge, MA, United States of America
| | - Miroslav Dudik
- Microsoft Research New York, New York, NY, United States of America
| | - Sharon Gillett
- Microsoft Research New England, Cambridge, MA, United States of America
| | - Jennifer Chayes
- Microsoft Research New England, Cambridge, MA, United States of America
- Microsoft Research New York, New York, NY, United States of America
| | - Christian Borgs
- Microsoft Research New England, Cambridge, MA, United States of America
| | - Dean F. Bajorin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
- Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
| | - Jonathan E. Rosenberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Samuel Funt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
- Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
| | - Alexandra Snyder
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
- Adaptive Biotechnologies, Seattle, WA, United States of America
| | - Lester Mackey
- Microsoft Research New England, Cambridge, MA, United States of America
- * E-mail:
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19
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Antonaci S, Piccinno A, Lucivero G, Miglietta A, Piccininno A, Bonomo L. Effect of BCG Immunotherapy on Cell-Mediated Cytotoxicity in Bladder Cancer Patients following Surgical Treatment. Tumori 2018; 67:177-82. [PMID: 6974423 DOI: 10.1177/030089168106700303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Peripheral blood lymphocytes from bladder cancer patients display in vitro cytotoxicity against established bladder tumor target cells. Following surgery and after separation of lymphocytes in non-T and T with high affinity and low affinity for sheep erythrocytes fractions, the cytotoxic activity was significantly decreased in all subsets. After BCG therapy the cytotoxic capacity was restored and the effect was equally distributed in the different subpopulations. The monocyte-enriched fraction did not show any change in the cytotoxic activity after treatment.
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20
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Powles T, Necchi A, Rosen G, Hariharan S, Apolo AB. Anti-Programmed Cell Death 1/Ligand 1 (PD-1/PD-L1) Antibodies for the Treatment of Urothelial Carcinoma: State of the Art and Future Development. Clin Genitourin Cancer 2018; 16:117-129. [PMID: 29325739 PMCID: PMC5878995 DOI: 10.1016/j.clgc.2017.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/13/2017] [Accepted: 11/27/2017] [Indexed: 01/10/2023]
Abstract
Immunotherapy with programmed cell death 1/ligand 1 (PD-1/PD-L1) checkpoint inhibitors has expanded a previously limited pool of effective treatment options for patients with metastatic urothelial carcinoma, particularly those with recurring or refractory disease and those who are ineligible for cisplatin. This review reports key findings from completed and ongoing clinical trials that highlight the potential of PD-1/PD-L1 blockade in urothelial carcinoma. A literature search was performed of PubMed, Embase, ClinicalTrials.gov, and selected annual congress abstracts. Prospective studies, reviews, editorials, and descriptions of ongoing anti-PD-1/PD-L1 studies in bladder cancer were included. Anti-PD-1/PD-L1 monoclonal antibodies have shown efficacy and safety across patient subgroups with urothelial carcinoma, including those with poor prognostic factors. Efficacy was similar across different anti-PD-1/PD-L1 agents. Although these antibodies have demonstrated durable responses in a subset of patients with urothelial carcinoma, clinicians are currently unable to predict which patients may derive benefit from immune checkpoint blockade. Anti-PD-1/PD-L1 antibodies have shown favorable clinical activity and tolerability in patients with metastatic urothelial carcinoma refractory to platinum-based therapy or who are ineligible for cisplatin. The activity of PD-1/PD-L1 inhibitors is now also being studied as first-line monotherapy in cisplatin-eligible patients in combination with chemotherapy as maintenance therapy after first-line chemotherapy, and in earlier disease states, such as muscle-invasive and non-muscle-invasive bladder cancer. Better predictive tools to define target patient populations are needed, as are further investigations to define optimal combinations or sequencing of treatments.
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Affiliation(s)
- Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, St Bartholomew's Hospital, London, UK
| | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | - Andrea B Apolo
- Bladder Cancer Section, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
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21
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Mehra KK, Petrylak DP. Response and Development of Immune-Related Adverse Events in an 83-Year-Old Man With Metastatic Urothelial Cancer. Oncology (Williston Park) 2018; 32:132-136. [PMID: 29548069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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22
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Grenga I, Donahue RN, Gargulak ML, Lepone LM, Roselli M, Bilusic M, Schlom J. Anti-PD-L1/TGFβR2 (M7824) fusion protein induces immunogenic modulation of human urothelial carcinoma cell lines, rendering them more susceptible to immune-mediated recognition and lysis. Urol Oncol 2018; 36:93.e1-93.e11. [PMID: 29103968 PMCID: PMC5835162 DOI: 10.1016/j.urolonc.2017.09.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 06/30/2017] [Revised: 09/01/2017] [Accepted: 09/29/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Avelumab has recently been approved by the Food and Drug Administration for the therapy of Merkel cell carcinoma and urothelial carcinoma. M7824 is a novel first-in-class bifunctional fusion protein comprising a monoclonal antibody against programmed death-ligand 1 (PD-L1, avelumab), fused to the extracellular domain of human transforming growth factor beta (TGFβ) receptor 2, which functions as a TGFβ "trap." Advanced urothelial tumors have been shown to express TGFβ, which possesses immunosuppressive properties that promote cancer progression and metastasis. The rationale for a combined molecule is to block the PD-1/PD-L1 interaction between tumor cells and immune cell infiltrate and simultaneously reduce or eliminate TGFβ from the tumor microenvironment. In this study, we explored the effect of M7824 on invasive urothelial carcinoma cell lines. METHODS Human urothelial (transitional cell) carcinoma cell lines HTB-4, HTB-1, and HTB-5 were treated with M7824, M7824mut (M7824 that is mutated in the anti-PD-L1 portion of the molecule and thus does not bind PD-L1), anti-PD-L1 (avelumab), or IgG1 isotype control monoclonal antibody, and were assessed for gene expression, cell-surface phenotype, and sensitivity to lysis by TRAIL, antigen-specific cytotoxic T lymphocytes and natural killer cells. RESULTS M7824 retains the ability to mediate antibody-dependent cellular cytotoxicity of tumor cells, although in some cases to a lesser extent than anti-PD-L1. However, compared to anti-PD-L1, M7824 increases (A) gene expression of molecules involved in T-cell trafficking in the tumor (e.g., CXCL11), (B) TRAIL-mediated tumor cell lysis, and (C) antigen-specific CD8+ T-cell-mediated lysis of tumor cells. CONCLUSIONS These studies demonstrate the immunomodulatory properties of M7824 on both tumor cell phenotype and immune-mediated lysis. Compared to anti-PD-L1 or M7824mut, M7824 induces immunogenic modulation of urothelial carcinoma cell lines, rendering them more susceptible to immune-mediated recognition and lysis. These findings show the relevance of the dual blockade of PD-L1 and TGFβ in urothelial carcinoma cell lines and thus support the rationale for future clinical studies of M7824 in patients with urothelial cancer.
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MESH Headings
- Antibodies, Monoclonal/genetics
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibody-Dependent Cell Cytotoxicity/drug effects
- Antibody-Dependent Cell Cytotoxicity/immunology
- Antineoplastic Agents/therapeutic use
- B7-H1 Antigen/antagonists & inhibitors
- B7-H1 Antigen/metabolism
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/immunology
- Carcinoma, Transitional Cell/pathology
- Cell Line, Tumor
- Drug Evaluation, Preclinical
- Humans
- Killer Cells, Natural/drug effects
- Killer Cells, Natural/immunology
- Protein Serine-Threonine Kinases/genetics
- Protein Serine-Threonine Kinases/pharmacology
- Protein Serine-Threonine Kinases/therapeutic use
- Receptor, Transforming Growth Factor-beta Type II
- Receptors, Transforming Growth Factor beta/genetics
- Receptors, Transforming Growth Factor beta/therapeutic use
- Recombinant Fusion Proteins/genetics
- Recombinant Fusion Proteins/pharmacology
- Recombinant Fusion Proteins/therapeutic use
- T-Lymphocytes, Cytotoxic/drug effects
- T-Lymphocytes, Cytotoxic/immunology
- Tumor Microenvironment/drug effects
- Tumor Microenvironment/immunology
- Urologic Neoplasms/drug therapy
- Urologic Neoplasms/immunology
- Urologic Neoplasms/pathology
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Affiliation(s)
- Italia Grenga
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Renee N Donahue
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Morgan L Gargulak
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Lauren M Lepone
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mario Roselli
- Department of Systems Medicine, Medical Oncology, School of Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Marijo Bilusic
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jeffrey Schlom
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
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23
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Garcia-Carbonero R, Salazar R, Duran I, Osman-Garcia I, Paz-Ares L, Bozada JM, Boni V, Blanc C, Seymour L, Beadle J, Alvis S, Champion B, Calvo E, Fisher K. Phase 1 study of intravenous administration of the chimeric adenovirus enadenotucirev in patients undergoing primary tumor resection. J Immunother Cancer 2017; 5:71. [PMID: 28923104 PMCID: PMC5604344 DOI: 10.1186/s40425-017-0277-7] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/14/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Enadenotucirev (formerly ColoAd1) is a tumor-selective chimeric adenovirus with demonstrated preclinical activity. This phase 1 Mechanism of Action study assessed intravenous (IV) delivery of enadenotucirev in patients with resectable colorectal cancer (CRC), non-small-cell lung cancer (NSCLC), urothelial cell cancer (UCC), and renal cell cancer (RCC) with a comparator intratumoral (IT) dosed CRC patient cohort. METHODS Seventeen patients scheduled for primary tumor resection were enrolled. IT injection of enadenotucirev (CRC only) was administered as a single dose (≤ 3 × 1011 viral particles [vp]) on day 1, followed by resection during days 8-15. IV infusion of enadenotucirev was administered by three separate doses (1 × 1012 vp) on days 1, 3, and 5, followed by resection during days 8-15 (CRC) or days 10-25 (NSCLC, UCC, and RCC). Enadenotucirev activity was measured using immunohistochemical staining of nuclear viral hexon and quantitative polymerase chain reaction for viral genomic DNA. RESULTS Delivery of enadenotucirev was observed in most tumor samples following IV infusion, with little or no demonstrable activity in normal tissue. This virus delivery (by both IV and IT dosing) was accompanied by high local CD8+ cell infiltration in 80% of tested tumor samples, suggesting a potential enadenotucirev-driven immune response. Both methods of enadenotucirev delivery were well tolerated, with no treatment-associated serious adverse events. CONCLUSIONS This study provides key delivery and feasibility data to support the use of IV infusion of enadenotucirev, or therapeutic transgene-bearing derivatives of it, in clinical trials across a range of epithelial tumors, including the ongoing combination study of enadenotucirev with the checkpoint inhibitor nivolumab. It also provides insights into the potential immune-stimulating properties of enadenotucirev. TRIAL REGISTRATION This MOA study was a phase 1, multicenter, non-randomized, open-label study to investigate the administration of enadenotucirev in a preoperative setting (ClinicalTrials.gov: NCT02053220).
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MESH Headings
- Adenoviruses, Human/genetics
- Adenoviruses, Human/physiology
- Administration, Intravenous
- CD8-Positive T-Lymphocytes/metabolism
- Carcinoma, Non-Small-Cell Lung/immunology
- Carcinoma, Non-Small-Cell Lung/therapy
- Carcinoma, Renal Cell/immunology
- Carcinoma, Renal Cell/therapy
- Carcinoma, Transitional Cell/immunology
- Carcinoma, Transitional Cell/therapy
- Colorectal Neoplasms/immunology
- Colorectal Neoplasms/therapy
- Combined Modality Therapy
- DNA, Viral/genetics
- Digestive System Surgical Procedures
- Humans
- Lung Neoplasms/immunology
- Lung Neoplasms/therapy
- Oncolytic Virotherapy
- Oncolytic Viruses/genetics
- Oncolytic Viruses/physiology
- Pulmonary Surgical Procedures
- Treatment Outcome
- Urologic Surgical Procedures
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Affiliation(s)
- Rocio Garcia-Carbonero
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Ramon Salazar
- Medical Oncology Department, Catalan Institute of Oncology, IDIBELL, University of Barcelona, Barcelona, Spain
| | - Ignacio Duran
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Ignacio Osman-Garcia
- Unidad de Urología-Oncológica, UGC de Urología y Nefrología, Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidadde Sevilla, Seville, Spain
| | - Luis Paz-Ares
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Juan M. Bozada
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Valentina Boni
- START Madrid, Centro Integral Oncológico Clara Campal, Hospital Madrid Norte Sanchinarro, Madrid, Spain
| | | | - Len Seymour
- Department of Oncology, Oxford University, Oxford, UK
| | - John Beadle
- PsiOxus Therapeutics Limited, Milton Park, Abingdon, UK
| | - Simon Alvis
- PsiOxus Therapeutics Limited, Milton Park, Abingdon, UK
| | | | - Emiliano Calvo
- START Madrid, Centro Integral Oncológico Clara Campal, Hospital Madrid Norte Sanchinarro, Madrid, Spain
| | - Kerry Fisher
- PsiOxus Therapeutics Limited, Milton Park, Abingdon, UK
- Department of Oncology, Oxford University, Oxford, UK
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24
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Abstract
The FDA has approved one PD-1 checkpoint inhibitor, pembrolizumab, and two PD-L1 checkpoint inhibitors, avelumab and durvalumab, to treat metastatic urothelial carcinoma in patients whose disease continues to progress despite platinum-based chemotherapy. This brings the total number of checkpoint inhibitors for the disease to five, prompting questions about how best to use them.
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25
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Abstract
Therapeutic intervention using oncolytic viruses is called virotherapy. This type of virus is defined by the ability to replicate in tumor cells only and to destroy these cells upon replication. In addition, this virus type is able to induce a tumor-directed immune response. Early clinical trials have confirmed the safety profile of oncolytic viruses. Currently, different groups are working on the development of oncolytic viruses with a focus on treatment of nonmuscle invasive bladder cancer (NMIBC). A preliminary active recruiting clinical phase II/III trial ongoing in patients with a NMIBC was recently implemented in the United States. Our research group developed an oncolytic adenovirus that will soon enter a clinical phase I trial in patients diagnosed with glioma. This virus is being further modified for the treatment of NMIBC. In this review article, recent developments in the design and use of virotherapy in bladder cancer are summarized.
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Affiliation(s)
- P S Holm
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
| | - M Retz
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - J E Gschwend
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - R Nawroth
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
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Zhang Q, Hao C, Cheng G, Wang L, Wang X, Li C, Qiu J, Ding K. High CD4⁺ T cell density is associated with poor prognosis in patients with non-muscle-invasive bladder cancer. Int J Clin Exp Pathol 2015; 8:11510-11516. [PMID: 26617883 PMCID: PMC4637699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/25/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE The aim of this study was to investigate the clinical significance of CD4(+) T cells in non-muscle-invasive bladder cancer (NMIBC) tissues in situ. METHODS Immunohistochemistry was used to examine the distribution of CD4(+) T cells in 131 NMIBC tissues. Kaplan-Meier analysis and Cox proportional hazards regression models were applied to estimate overall survival (OS) and recurrence-free survival (RFS). RESULTS NMIBC patients were divided into two groups based on the median frequency of CD4(+) T cells (median, 1/×400 high resolution). On univariate analysis, CD4(+) T cell density was inversely associated with overall survival (P = 0.01). In those patients with high CD4(+) T density, 5-year OS rates was only 77%, compared with 86% in those with low density, respectively. Although CD4(+) T cell density showed no prognostic significance for RFS (P = 0.36), 5-year RFS rates of patients with high CD4(+) T density (58%) was lower than those of patients with low CD4(+) T density (65%, respectively). By multivariate analysis, tumor infiltrating CD4(+) T cell density emerged as an independent prognostic factor for OS (HR, 2.75; P = 0.004). In addition, no association was found between CD4(+) T cell density and any clinicopathological variables (P > 0.05). CONCLUSION Our findings suggest that CD4(+) T cells could potentially serve as a poor prognostic marker for patients with NMIBC.
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Affiliation(s)
- Qinglei Zhang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, Shandong, China
- Department of Urology, Tengzhou Central People’s HospitalZaozhuang, Shangdong, China
| | - Chongli Hao
- Department of Oncology, Tengzhou Central People’s HospitalZaozhuang, Shangdong, China
| | - Guangzhou Cheng
- Department of Urology, Tengzhou Central People’s HospitalZaozhuang, Shangdong, China
| | - Lei Wang
- Department of Urology, Tengzhou Central People’s HospitalZaozhuang, Shangdong, China
| | - Xiang Wang
- Department of Urology, Tengzhou Central People’s HospitalZaozhuang, Shangdong, China
| | - Chang Li
- Department of Pathology, Tengzhou Central People’s HospitalZaozhuang, Shangdong, China
| | - Juhui Qiu
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, Shandong, China
| | - Kejia Ding
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, Shandong, China
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Abstract
PURPOSE OF REVIEW Inhibition of immune escape mechanisms, such as the programed death-ligand 1 pathway, has demonstrated rapid, durable responses in multiple tumor types, including advanced urothelial carcinoma. This review discusses emerging immunotherapies for urothelial carcinoma in various stages of clinical development. RECENT FINDINGS Urothelial carcinoma has a high mutational burden, which may increase the number of tumor antigens and potentially enhance the ability of the immune system to recognize tumor cells as foreign. However, urothelial carcinoma can evade the immune system by downregulating tumor-antigen presentation, upregulating various immune checkpoints, and inactivating cytotoxic T cells. Immunotherapies for urothelial carcinoma target each of these steps to restore immune-mediated cytotoxicity. Many of these agents are in clinical trials for urothelial carcinoma. SUMMARY Immunotherapies are active in urothelial carcinoma, but only in a fraction of patients, implying the presence of persistent immune escape. Identifying the mechanisms of immune escape and developing rational combinatorial regimens may make the benefit of immunotherapy accessible to a broader population.
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Affiliation(s)
- Joseph W. Kim
- Prostate and Urologic Cancers Program, Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Yusuke Tomita
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jane Trepel
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrea B. Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Ardelt PU, Ebbing J, Adams F, Reiss C, Arap W, Pasqualini R, Bachmann A, Wetterauer U, Riedmiller H, Kneitz B. An anti-ubiquitin antibody response in transitional cell carcinoma of the urinary bladder. PLoS One 2015; 10:e0118646. [PMID: 25742283 PMCID: PMC4351094 DOI: 10.1371/journal.pone.0118646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/08/2015] [Indexed: 12/05/2022] Open
Abstract
Background To use combinatorial epitope mapping (“fingerprinting”) of the antibody response to identify targets of the humoral immune response in patients with transitional cell carcinoma (TCC) of the bladder. Methods A combinatorial random peptide library was screened on the circulating pool of immunoglobulins purified from an index patient with a high risk TCC (pTa high grade plus carcinoma in situ) to identify corresponding target antigens. A patient cohort was investigated for antibody titers against ubiquitin. Results We selected, isolated, and validated an immunogenic peptide motif from ubiquitin as a dominant epitope of the humoral response. Patients with TCC had significantly higher antibody titers against ubiquitin than healthy donors (p<0.007), prostate cancer patients (p<0.0007), and all patients without TCC taken together (p<0.0001). Titers from superficial tumors were not significantly different from muscle invasive tumors (p = 0.0929). For antibody response against ubiquitin, sensitivity for detection of TCC was 0.44, specificity 0.96, positive predictive value 0.96 and negative predictive value 0.41. No significant titer changes were observed during the standard BCG induction immunotherapy. Conclusions This is the first report to demonstrate an anti-ubiquitin antibody response in patients with TCC. Although sensitivity of antibody production was low, a high specificity and positive predictive value make ubiquitin an interesting candidate for further diagnostic and possibly immune modulating studies.
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Affiliation(s)
- Peter U. Ardelt
- Department of Urology, University Hospital Basel, Basel, Switzerland
- Department of Urology and Pediatric Urology, Medical School, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
- Department of Urology, Bavarian Julius Maximilians-University Medical School, Würzburg, Germany
- * E-mail:
| | - Jan Ebbing
- Department of Urology, University Hospital Basel, Basel, Switzerland
| | - Fabian Adams
- Department of Urology and Pediatric Urology, Medical School, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Cora Reiss
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Wadih Arap
- Division of Hematology/Oncology and Division of Molecular Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
| | - Renata Pasqualini
- Division of Hematology/Oncology and Division of Molecular Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
| | | | - Ulrich Wetterauer
- Department of Urology and Pediatric Urology, Medical School, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Hubertus Riedmiller
- Department of Urology, Bavarian Julius Maximilians-University Medical School, Würzburg, Germany
| | - Burkhard Kneitz
- Department of Urology, Bavarian Julius Maximilians-University Medical School, Würzburg, Germany
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Piana S, Bernardi C, Zoino JL. Itchy erythroderma in a neoplastic patient—mind the mite! Eur J Intern Med 2015; 26:139-40. [PMID: 25087690 DOI: 10.1016/j.ejim.2014.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/25/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Simonetta Piana
- Pathology Unit, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
| | - Chiara Bernardi
- Department of Internal Medicine, Ospedale Sant'Anna, Castelnovo Monti, Reggio Emilia, Italy
| | - Jorge Luis Zoino
- Department of Internal Medicine, Ospedale Sant'Anna, Castelnovo Monti, Reggio Emilia, Italy
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Faraj SF, Munari E, Guner G, Taube J, Anders R, Hicks J, Meeker A, Schoenberg M, Bivalacqua T, Drake C, Netto GJ. Assessment of tumoral PD-L1 expression and intratumoral CD8+ T cells in urothelial carcinoma. Urology 2015; 85:703.e1-6. [PMID: 25733301 PMCID: PMC4695997 DOI: 10.1016/j.urology.2014.10.020] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/14/2014] [Accepted: 10/15/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate programmed death ligand 1 (PD-L1) expression in urothelial carcinoma of the bladder in relationship with tumor-infiltrating CD8+ T cells. MATERIALS AND METHODS Tissue microarrays were prepared from 56 cystectomy specimens performed at our hospital (1994-2002). PD-L1 immunoexpression was assessed using the murine antihuman PD-L1 monoclonal antibody 5H1. Extent of membranous PD-L1 expression was assigned in each spot. Spots showing ≥5% expression were considered positive. Average PD-L1 expression per tumor was also calculated (5% positivity cutoff). "High CD8 density" was defined as the presence of ≥60 CD8+ intraepithelial lymphocytes per high power field in a given spot. A tumor was considered high density if ≥50% of its spots were of high density. RESULTS PD-L1 expression was positive in approximately 20% of tumors. None of the benign urothelium spots expressed PD-L1. High CD8 density was observed in approximately 20% of cases. CD8 density did not correlate with PD-L1 expression. Overall survival (OS) and disease-specific survival (DSS) rates were 14% and 28%, respectively (median follow-up, 31.5 months). PD-L1 expression was associated with age at cystectomy (P = .01). Remaining clinicopathologic parameters were not associated with PD-L1 expression or CD8 density. High CD8 density was associated with favorable OS (P = .02) and DSS (P = .02). The same was true when CD8 density was adjusted for demographic and clinicopathologic parameters. There was no correlation between PD-L1 expression and outcome. CONCLUSION High intratumoral CD8+ T cell density is associated with better OS and DSS in invasive urothelial carcinoma of the bladder. We found no correlation between PD-L1 expression and outcome.
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Affiliation(s)
- Sheila F Faraj
- Department of Pathology, Johns Hopkins University, Baltimore, MD
| | - Enrico Munari
- Department of Pathology, Johns Hopkins University, Baltimore, MD
| | - Gunes Guner
- Department of Pathology, Johns Hopkins University, Baltimore, MD
| | - Janis Taube
- Department of Pathology, Johns Hopkins University, Baltimore, MD
| | - Robert Anders
- Department of Pathology, Johns Hopkins University, Baltimore, MD
| | - Jessica Hicks
- Department of Pathology, Johns Hopkins University, Baltimore, MD
| | - Alan Meeker
- Department of Pathology, Johns Hopkins University, Baltimore, MD
| | - Mark Schoenberg
- Department of Urology, Johns Hopkins University, Baltimore, MD; Department of Oncology, Johns Hopkins University, Baltimore, MD
| | - Trinity Bivalacqua
- Department of Urology, Johns Hopkins University, Baltimore, MD; Department of Oncology, Johns Hopkins University, Baltimore, MD
| | - Charles Drake
- Department of Urology, Johns Hopkins University, Baltimore, MD; Department of Oncology, Johns Hopkins University, Baltimore, MD
| | - George J Netto
- Department of Pathology, Johns Hopkins University, Baltimore, MD; Department of Urology, Johns Hopkins University, Baltimore, MD; Department of Oncology, Johns Hopkins University, Baltimore, MD.
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Dalpiaz O, Ehrlich GC, Mannweiler S, Hernández JMM, Gerger A, Stojakovic T, Pummer K, Zigeuner R, Pichler M, Hutterer GC. Validation of pretreatment neutrophil-lymphocyte ratio as a prognostic factor in a European cohort of patients with upper tract urothelial carcinoma. BJU Int 2013; 114:334-9. [PMID: 24053693 DOI: 10.1111/bju.12441] [Citation(s) in RCA: 29] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate the potential prognostic significance of the neutrophil-lymphocyte ratio (NLR) in a large European cohort of patients with upper urinary tract urothelial cell carcinoma (UUT-UCC). PATIENTS AND METHODS We retrospectively evaluated data from 202 consecutive patients with non-metastatic upper urinary tract urothelial cell carcinoma (UUT-UCC), who underwent surgery between 1990 and 2012 at a single tertiary academic centre. Patients' cancer-specific survival (CSS) and overall survival (OS) were assessed using the Kaplan-Meier method. To evaluate the independent prognostic significance of the NLR, multivariate proportional Cox regression models were applied for both endpoints. RESULTS A higher NLR was significantly associated with shorter CSS (P = 0.002, log-rank test), as well as with shorter OS (P < 0.001, log-rank test). Multivariate analysis identified a high NLR as an independent prognostic factor for patients' CSS (hazard ratio 2.72, 95% CI 1.25-5.93, P = 0.012), and OS (hazard ratio 2.48, 95% CI 1.31-4.70, P = 0.005). CONCLUSIONS In the present cohort, patients with a high preoperative NLR had higher cancer-specific and overall mortality after radical surgery for UUT-UCC, compared with those with a low preoperative NLR. This easily identifiable laboratory measure should be considered as an additional prognostic factor in UUT-UCC in future.
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Affiliation(s)
- Orietta Dalpiaz
- Department of Urology, Medical University of Graz, Graz, Austria
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Yılmaz E, Uğur Özalp A, Cekmen A, Eren B, Onal B, Akkuş E, Erdoğan E. Types of HLA in the bladder transitional cell carcinoma (TCC). Med Glas (Zenica) 2013; 10:133-136. [PMID: 23348175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 07/12/2012] [Indexed: 06/01/2023]
Abstract
HLA plays a complementary role in the interaction between tumor and body immunology. The aim of this study was to determine the existence of the association between the HLA system and transitional cell carcinoma (TCC). Using standard micro-lymphocytotoxic method of Terasaki, HLA-A, B, DR and DQ antigen types of 30 patients with TCC of the bladder were compared with the control group (30 healthy people). In the TCC patient group, HLA -DQ6(1) and HLA -DQ7(3) antigens were detected with a significantly higher frequency than in the control group (p=0.018 and p=0.038, respectively), whereas HLA-A10, B4, DR53 and DQ1 antigens were detected with significantly higher frequency in the control group (p less 0.05 in all). It suggests that patients who had the antigens detected were at higher risk of TCC, and the ones who had the antigens displaying protective features as were detected in the control group, were at lesser risk.
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Affiliation(s)
- Erkan Yılmaz
- 1Blood Bank, Tissue Typing Laboratory, 2Urology Department; School of Medicine, Istanbul University, Cerrahpaşa, 3Bursa Morgue Department, Council of Forensic Medicine of Turkey, 3Bursa Morgue Department, Council of Forensic Medicine of Tur- key, Bursa, 4Pediatric Surgery Department, Cerrahpasa School of Medicine, Istanbul University; Turkey
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Zhang JM, Wu XH, Zhang X, Zhang Y, Luo CL. [Glycosyl-phosphatidylinositol-anchored interleukin-2 expressed on tumor-derived exosomes induces anti-tumor immune response]. Zhonghua Zhong Liu Za Zhi 2011; 33:564-569. [PMID: 22325213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To prepare IL-2-anchored and tumor-derived exosomes vaccine, and investigate the antitumor efficiency of the special cytotoxic T-lymphocytes induced by Ex/GPI-IL-2. METHODS To construct pEGFP-N1-IL2gpi plasmid coding a fusion gene of a DNA oligo encoding GPI-anchor signal sequence attaching to human IL-2 cDNA. Then T24 cell lines stably expressing GPI-IL-2 proteins (T24/GPI-IL-2) were established. Ex/GPI-IL-2 were isolated and purified by ultrafiltration and sucrose gradient centrifugation, and the morphology and molecule markers were analyzed. The mixed lymphocyte reaction study and cytotoxic study were performed to determine the proliferative effect of T lymphocytes and the cytotoxicity induced by Ex/GPI-IL-2. RESULTS The pEGFP-N1-IL2gpi plasmid was successfully constructed, and cell lines stably expressing GPI-IL-2 fusion proteins were established. Ex/GPI-IL-2 were small vesicular and saucer-shaped in diameter of 30-90 nm, containing heat shock protein 70, intercellular adhesion molecule-1, MAGE-1 and GPI-IL-2. Ex/GPI-IL-2-pulsed could dendritic cells induce proliferation of T cells and cytotoxic immune response more efficiently (P<0.05). CONCLUSIONS GPI-IL-2 gene-modified tumor cells can make the exosomes containing GPI-IL-2 with an increased anti-tumor effect. Our study provides a feasible approach for exosome-based tumor immunotherapy of bladder transitional cell tumors.
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Affiliation(s)
- Jia-Mo Zhang
- Department of Urology, Yong Chuan Hospital, Chongqing Medical University, Chongqing 402160, China
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Vita F, Siracusano S, Abbate R, Ciciliato S, Borelli V, Soranzo MR, Zabucchi G. BCG prophylaxis in bladder cancer produces activation of recruited neutrophils. Can J Urol 2011; 18:5517-5523. [PMID: 21333042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Bacillus Calmette-Guerin (BCG) is used to treat high risk superficial bladder cancer, but its anti-tumor effect remains incompletely defined. Recently a role for polymophonuclear (PMN) neutrophils has been suggested. To investigate the role of granulocytes, we monitored the activation state of these cells in the urine of BCG-treated patients. MATERIALS AND METHODS Ten patients with stage T1, grade 3 (T1G3) transitional cell carcinoma received an 8 week course of BCG after undergoing transurethral resection of the bladder. Cytological and enzymatic analyses of urine samples collected before and 2 hours after the physiological expulsion of BCG were performed. The activation state of urine granulocytes and the presence of activating factors within the urine samples were monitored. RESULTS BCG immunotherapy stimulated, through soluble factors, the activation of PMN neutrophils, which transmigrated into the bladder, and the degree of activation of the PMN neutrophils was related directly to the number of epithelial cells detached from the urothelial layer. CONCLUSIONS This study suggests that PMN neutrophils can participate in reducing the recurrence of bladder cancer by promoting urothelial cell turnover proportionally to their degree of activation. Our results provide further evidence to support the role of PMN neutrophils in BCG immunotherapy.
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Chuang CK, Chuang KL, Hsieh CH, Shen YC, Liao SK. Epstein-Barr virus-infected cell line TCC36B derived from B lymphocytes infiltrating renal pelvis urothelial carcinoma. Anticancer Res 2010; 30:3473-3478. [PMID: 20944125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
UNLABELLED This study reports an initial analysis of an EBV-infected B cell line (TCC36B), established from an urothelial carcinoma (UC) lesion of the renal pelvis. MATERIALS AND METHODS Cytofluorometric and G-banding analyses were performed for phenotyping and cytogenetics. PCR was used to detect EBV DNA, and sequence analysis to investigate mutations and deletions of the latent membrane protein (LMP)-1 gene of EBV. RESULTS TCC36B cells proliferated in vitro and showed positivity for surface CD19, CD20, HLA-DR and IgG(λ), indicating that they belong to B-cells. Cytogenetic analysis showed 46,XX with a unique clonal abnormality of dup(2)(p13p25). EBV DNA was detected in TCC36B cells. Sequence analysis revealed a 30-bp deletion and 7 point mutations on the LMP-1 gene in TCC36B cells. CONCLUSION These results suggest the involvement of an EBV variant in the pathogenesis of UC. This cell line should thus facilitate further investigations on the aetiological role of EBV in urothelial cancer.
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Affiliation(s)
- Cheng-Keng Chuang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University Taoyuan 333, Taiwan, ROC
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Chen Z, Tan WL, Huang X, Liang ZK, Xu CX, Gao JM. [Immobilization of streptavidin-tagged bioactive hTNF-alpha on biotinylated mucosal surface of the bladder wall for treatment of superficial bladder cancer in mice]. Nan Fang Yi Ke Da Xue Xue Bao 2010; 30:936-940. [PMID: 20501361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To investigate a novel immunotherapy through immobilization of streptavidin-tagged hTNF-alpha on the biotinylated mucosal surface of the bladder wall for bladder cancer treatment in mice. METHODS A total of 120 female C57BL/6j mice were randomized into 5 equal groups, namely blank control, PBS, soluble hTNF-alpha, SA-GFP, and SA-hTNF-alpha treatment groups. Twenty-four hours after establishment of a mouse model of orthotopic superficial bladder cancer, SA-hTNF-alpha fusion protein was immobilized on the biotinylated mucosal surface of the bladder wall, which was repeated every 4 days for a total of 6 sessions. Immunohistochemistry was performed to detect the retention time of SA-hTNF-alpha fusion protein in the biotinylated mouse bladder mucosa and the distribution of CD4(+) and CD8(+) lymphocytes in the mucosa and tumor tissues, with the tumor growth and mouse survival also observed. The cytotoxiciy of the tumor-specific lymphocytes was evaluated. The mice responding well to the treatment were re-challenged by MB49 and monitored for survival. RESULTS SA-hTNF-alpha could be efficiently and stably immobilized on the bladder mucosal surface for as long as 7 days. On day 60 after MB49 implantation, 18 out of 22 SA- hTNF-alpha-treated mice survived, with 9 appearing tumor-free, but all the mice in PBS control group died. Five out of 9 tumor-free mice in SA-hTNF-alpha group showed resistance to a re-challenge with intravesical MB49. The numbers of CD4(+) and CD8(+) lymphocytes were significantly greater in SA-hTNF-alpha group than in the other groups (P<0.05). The cytotoxicity of the tumor-specific lymphocytes was significantly stronger in SA-hTNF-alpha group than in the other groups (P<0.05). CONCLUSION SA-hTNF-alpha immobilized on the biotinylated mucosal surface of the bladder wall can significantly inhibit the tumor growth and promote the survival of the mice bearing orthotopic superficial bladder cancer.
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Affiliation(s)
- Zhong Chen
- Department of Urologic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
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di Capua Sacoto C, Luján Marco S, Bahilo Mateu P, Budía Alba A, Pontones Moreno JL, Jiménez Cruz JF. [De novo urological neoplasms in kidney transplant patients: experience in 1,751 patients]. Actas Urol Esp 2010; 34:88-94. [PMID: 20223138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Immunosuppressive treatment promotes development of neoplasms in kidney transplant patients. Cancer prevalence in these patients is 4 to 5 times higher as compared to the general population. Tumors are also known to behave more aggressively in transplant patients. OBJECTIVE To perform a descriptive analysis of de novo urological tumors in kidney transplant patients and to analyze patient survival. MATERIALS AND METHODS A retrospective study was conducted in 1751 transplant patients from January 1980 to December 2006. Patients in whom the tumor occurred in the first year after transplantation were excluded. The primary variables considered included sex, age at transplant, age at cancer diagnosis, site, clinical stage, treatment, and outcome. A Chi-square test was used for univariate statistical analysis. Survival was assessed using the Kaplan-Meier method. RESULTS Twenty-nine de novo tumors (1.6%) were diagnosed in the 1751 transplanted patients, with a median follow-up of 35.28 months (2-121) from tumor diagnosis. Tumors were found in 24 males (82%) and 5 females (18%). Median age at transplantation was 50.8 (17-70) years, and median age at tumor diagnosis was 56.4 (19-79) years. Eleven patients (38%) were diagnosed with prostate cancer, seven (24%) with bladder tumors, 4 (60%) with non-muscle invasive tumors, and 3 (40%) with muscle invasive tumors. A renal adenocarcinoma in the primitive kidney was diagnosed in 6 patients (20%). Five patients (18%) were detected a tumor in the transplanted kidney. Median survival was 75 months for patients with bladder tumors, 82 months for prostate cancer, 59 months for tumors in the native kidney, and 86 months for graft tumors. CONCLUSIONS In our series, de novo urological tumors in kidney transplant recipients were more common in males. Prostate cancer is the most common tumor and renal cell carcinoma of the native kidney has the worst survival rate.
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Affiliation(s)
- C di Capua Sacoto
- Servicio de Urología, Hospital Universitario La Fe, Valencia, España.
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Liang PH, Zhang KQ, Xu GL, Li YF, Wang LF, Nie ZL, Ye J, Wu G, Ge CG, Jin FS. Construction of a DNA vaccine encoding Flk-1 extracellular domain and C3d fusion gene and investigation of its suppressing effect on tumor growth. Cancer Immunol Immunother 2010; 59:93-101. [PMID: 19543726 PMCID: PMC11030964 DOI: 10.1007/s00262-009-0727-2] [Citation(s) in RCA: 12] [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: 12/06/2008] [Accepted: 06/02/2009] [Indexed: 10/20/2022]
Abstract
Although the critical role of complement component C3d as a molecular adjuvant in preventing virus infection is well established, its role in cancer prophylaxis and treatment is unclear. In this study, we constructed a recombinant plasmid encoding Flk-1 and C3d3 fusion proteins and investigated its transient expression in vitro in transfected eukaryotic cells and its antibody response in immunized mice. Subsequently, we investigated the vaccine's ability to elicit an immune response leading to suppression of angiogenesis and tumor growth in mice bearing bladder transitional cell carcinoma. Using Western blotting, immunocytochemistry, and flow cytometry, we detected the expression of Flk-1 and C3d3 fusion proteins in COS-7 cells transfected with these recombinant plasmids. Further binding experiment using CR2 (C3d receptor) positive Raji cells that were incubated with transfected COS-7 supernatant indicated that C3d was successfully fused to Flk-1. Although both vaccines elicited peak antibody levels at 5 weeks, Flk-1-specific antibody titer in pSG.SS.Flk-1(ECD).C3d3.YL-immunized mice was significantly higher when compared to pSG.SS.Flk-1(ECD).YL-immunized mice. The results of experiments with bladder tumor-bearing mice showed that the vaccine inhibited tumor growth significantly. These results suggest that C3d plays a critical role in tumor immunotherapy by promoting antibody response in Flk-1-based DNA vaccines. This approach may provide a new strategy for the rational design of anti-angiogenic therapies for the treatment of solid tumors and provide a basis for the further exploitation and application of the anti-angiogenesis DNA vaccines.
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MESH Headings
- Adjuvants, Immunologic
- Animals
- Cancer Vaccines/genetics
- Cancer Vaccines/immunology
- Cancer Vaccines/therapeutic use
- Carcinoma, Transitional Cell/immunology
- Carcinoma, Transitional Cell/pathology
- Carcinoma, Transitional Cell/therapy
- Cell Line, Tumor
- Chlorocebus aethiops
- Complement C3d/genetics
- Complement C3d/immunology
- Female
- Mice
- Mice, Inbred BALB C
- Neoplasm Transplantation
- Protein Structure, Tertiary
- Recombinant Fusion Proteins/genetics
- Recombinant Fusion Proteins/immunology
- Urinary Bladder Neoplasms/immunology
- Urinary Bladder Neoplasms/pathology
- Urinary Bladder Neoplasms/therapy
- Vaccines, DNA/genetics
- Vaccines, DNA/immunology
- Vaccines, DNA/therapeutic use
- Vascular Endothelial Growth Factor Receptor-2/genetics
- Vascular Endothelial Growth Factor Receptor-2/immunology
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Affiliation(s)
- Pei-he Liang
- Department of Urology, Daping Hospital, The Third Military Medical University, 10 Changjiang Branch Road, Yuzhong District, Chongqing, China.
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39
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Zhu X, Hu XZ, Ma LL, Tian Y. [Level of CD4(+) CD25(high) CD127(low/-) regulatory T cells in transitional cell carcinoma patients and its clinical significance]. Zhonghua Yi Xue Za Zhi 2009; 89:2269-2272. [PMID: 20095340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate the expressions of CD4+ CD25high CD127low/- regulatory T cells (Treg) in peripheral blood from patients with transitional cell carcinoma (TCC) in urinary system. METHODS The proportion of Treg population in CD4+ T cells from 93 patients with transitional cell carcinoma was evaluated. And flow cytometry was employed to analyze different clinicopathologic characteristics and detect the pre- and post-operative changes in 38 patients with benign urinary diseases and 37 healthy subjects. RESULTS The proportion of Treg population in CD4+ T cells in peripheral blood of patients with TCC significantly increased as compared with those with benign urinary diseases and healthy subjects. There was a strong correlation between the proportion of Treg and tumor recurrence, quantity, lymph node metastasis (P < 0. 01) as well as pathological stage; no correlation was found between the proportion of Treg and clinical TNM stage (P > 0. 05). The proportion of Treg was also different at pre- and post-operation (P < 0. 05). CONCLUSION CD4+ CD25high CD127low/- regulatory T cells in peripheral blood from patients with TCC significantly increased as compared with that in patients with benign urinary diseases and in healthy subjects. It may be responsible for immune suppression in TCC patients. Tumor resection could decrease the proportion of Treg in peripheral blood, but the long-term change in immune function requires further investigations.
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Affiliation(s)
- Xi Zhu
- Department of Urology, Friendship Hospital Affiliated to Capital Medical University, Beijing, China
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40
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Zaharoff DA, Hoffman BS, Hooper HB, Benjamin CJ, Khurana KK, Hance KW, Rogers CJ, Pinto PA, Schlom J, Greiner JW. Intravesical immunotherapy of superficial bladder cancer with chitosan/interleukin-12. Cancer Res 2009; 69:6192-9. [PMID: 19638573 PMCID: PMC2788203 DOI: 10.1158/0008-5472.can-09-1114] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [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] [Indexed: 12/20/2022]
Abstract
Intravesical BCG has been used successfully to treat superficial bladder cancer for three decades. However, 20% to 30% of patients will fail initial BCG therapy and 30% to 50% of patients will develop recurrent tumors within 5 years. Alternative or complementary strategies for the management of superficial bladder cancer are needed. Interleukin-12 (IL-12) is a potent T(H)1 cytokine with robust antitumor activity and the ability to potentiate immunologic memory. Unfortunately, intravesical IL-12 did not show antitumor efficacy in a recent clinical study of patients with recurrent superficial bladder cancer. We hypothesized that coformulation of IL-12 with chitosan, a biocompatible, mucoadhesive polysaccharide, could improve intravesical IL-12 delivery and provide an effective and durable alternative for the treatment of superficial bladder cancer. In antitumor studies, 88% to 100% of mice bearing orthotopic bladder tumors were cured after four intravesical treatments with chitosan/IL-12. In contrast, only 38% to 60% of mice treated with IL-12 alone and 0% treated with BCG were cured. Antitumor responses following chitosan/IL-12 treatments were durable and provided complete protection from intravesical tumor rechallenge. Urinary cytokine analysis showed that chitosan/IL-12 induced multiple T(H)1 cytokines at levels significantly higher than either IL-12 alone or BCG. Immunohistochemistry revealed moderate to intense tumor infiltration by T cells and macrophages following chitosan/IL-12 treatments. Bladder submucosa from cured mice contained residual populations of immune cells that returned to baseline levels after several months. Intravesical chitosan/IL-12 is a well-tolerated, effective immunotherapy that deserves further consideration for testing in humans for the management of superficial bladder cancer.
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Affiliation(s)
- David A. Zaharoff
- Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Benjamin S. Hoffman
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - H. Brooks Hooper
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Compton J. Benjamin
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Kiranpreet K. Khurana
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Kenneth W. Hance
- Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Connie J. Rogers
- Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter A. Pinto
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jeffrey Schlom
- Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - John W. Greiner
- Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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41
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Hadaschik BA, Zhang K, So AI, Bell JC, Thüroff JW, Rennie PS, Gleave ME. [Oncolytic vesicular stomatitis viruses as intravesical agents against non-muscle-invasive bladder cancer]. Urologe A 2008; 47:1145-51. [PMID: 18670747 DOI: 10.1007/s00120-008-1827-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 11/26/2022]
Abstract
Patients with high-risk bladder cancer who do not respond to bacillus Calmette-Guerin (BCG) immunotherapy represent a significant therapeutic challenge. The addition of interferon to BCG has recently evolved as a second-line treatment option; however, many high-grade tumors are nonresponsive to interferon. Thus, replication-competent oncolytic vesicular stomatitis viruses (VSV) that selectively target interferon-refractory tumors are promising intravesical agents. In vitro, wild-type VSV as well as a mutant variant (AV3) that has an impaired ability to shut down innate immunity preferentially killed undifferentiated, interferon-nonresponsive bladder cancer cells. Testing of these viruses in an orthotopic murine model of high-grade bladder cancer, which we have recently validated, revealed that both AV3 and wild-type VSV significantly inhibited orthotopic tumor growth. Despite the use of immunocompromised nude mice, there was no evidence of toxicity. In conclusion, VSV instillation therapy demonstrated strong antitumor activity and safety in an orthotopic model of high-risk disease. These findings provide preclinical proof-of-principle for the intravesical use of VSV, especially in interferon-refractory patients.
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Affiliation(s)
- B A Hadaschik
- Prostate Centre, Vancouver General Hospital, Vancouver, BC, Canada.
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42
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Bunimovich-Mendrazitsky S, Byrne H, Stone L. Mathematical Model of Pulsed Immunotherapy for Superficial Bladder Cancer. Bull Math Biol 2008; 70:2055-76. [PMID: 18716846 DOI: 10.1007/s11538-008-9344-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Accepted: 05/23/2008] [Indexed: 11/28/2022]
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43
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Dudelzak J, Curtis AR, Sheehan DJ, Lesher JL. New-onset psoriasis and psoriatic arthritis in a patient treated with Bacillus Calmette-Guérin (BCG) immunotherapy. J Drugs Dermatol 2008; 7:684. [PMID: 18664162] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Jacob Dudelzak
- Division of Dermatology, Department of Medicine, Medical College of Georgia, Augusta, GA, USA
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44
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Olbert PJ, Schrader AJ, Hegele A, Hofmann R. [Focus on tumor immunology of transitional cell carcinoma]. Urologe A 2008; 46:1135-7. [PMID: 17605116 DOI: 10.1007/s00120-007-1464-9] [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] [Indexed: 11/24/2022]
Affiliation(s)
- P J Olbert
- Klinik fũr Urologie und Kinderurologie, Philipps-Universität Marburg,
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45
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Helmy A, Hammam OA, El Lithy TR, El Deen Wishahi MM. The role of TGF-beta-1 protein and TGF-beta-R-1 receptor in immune escape mechanism in bladder cancer. MedGenMed 2007; 9:34. [PMID: 18311384 PMCID: PMC2234299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Tumor cells have numerous immune surveillance escape mechanisms as well as means of resistance to apoptosis. This study tried to clarify one of these mechanisms in bladder cancer with the hope of being able to develop targeted therapy that will sensitize the tumor cells to immune-mediated apoptosis. METHODS In this study, electron microscopic examination and expression of TGF-beta-1 protein and TGF-beta-R-1 receptor using immunoelectronmicroscopic and immunocytochemical techniques were investigated in urine and peripheral blood mononuclear cells (PBMNCs). Samples were obtained from 5 healthy controls (Group 1) and 60 study patients who were classified according to the cytopathologic examination of their urine into 2 main subgroups: chronic cystitis (bilharzial and nonbilharzial, Group 2, n = 15) and bladder cancer (transitional cell carcinoma and squamous cell carcinoma, Group 3, n = 45). RESULTS Examination of PBMNCs by immunoelectronmicroscopic and immunocytochemical techniques showed a significant increase in the percentage of positive cases expressing both TGF-beta-1 protein and TGF-beta-R-1 receptors in bladder cancer in comparison with the control (P < .01 and P < .05, respectively) and with chronic cystitis (P < .05). By electron microscopic examination, 42 out of 45 bladder cancer cases (93.3%) revealed remarkable apoptotic changes represented by cell shrinkage, surface blebs, nuclear chromatin condensation, and vacuolated cytoplasm. Urine examination by immunoelectronmicroscopic and immunocytochemical techniques revealed a statistically significant decrease in the percentage of positive cases expressing TGF-beta-R1 receptor in bladder cancer in comparison with either chronic cystitis cases or controls (P < .01), while TGF-beta-1 protein was significantly increased (P < .01). By electron microscopic examination, exfoliated necrotic malignant epithelial (urothelial) cells and many inflammatory cells were detected. CONCLUSIONS This work helps researchers and clinicians to better understand one of the escape mechanisms in bladder cancer that may facilitate the reverse of tumor escape from the immune system. It also draws attention to TGF-beta-1 protein and TGF-beta-R1 receptor; TGF-beta-1 protein can be used as an attractive target for anticancer therapy, and the absence of TGF-beta-R1 can be considered a marker for malignant transformation of urothelial cells in bladder cancer.
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MESH Headings
- Aged
- Apoptosis/immunology
- Biomarkers/analysis
- Carcinoma, Squamous Cell/immunology
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/urine
- Carcinoma, Transitional Cell/immunology
- Carcinoma, Transitional Cell/pathology
- Carcinoma, Transitional Cell/urine
- Case-Control Studies
- Cystitis/diagnosis
- Cystitis/immunology
- Cystitis/urine
- Female
- Humans
- In Situ Nick-End Labeling
- Leukocytes, Mononuclear/immunology
- Male
- Microscopy, Immunoelectron
- Middle Aged
- Receptors, Transforming Growth Factor beta/analysis
- Receptors, Transforming Growth Factor beta/immunology
- Reference Values
- Risk Assessment
- Sensitivity and Specificity
- Transforming Growth Factor beta1/analysis
- Transforming Growth Factor beta1/immunology
- Urinalysis
- Urinary Bladder Neoplasms/immunology
- Urinary Bladder Neoplasms/pathology
- Urinary Bladder Neoplasms/urine
- Urine/cytology
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Affiliation(s)
- Amira Helmy
- Theodor Bilharz Research Institute, Electron Microscopy Department, Cairo, Egypt.
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46
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Abstract
Transitional cell carcinoma (TCC), which is the pathological diagnosis for the majority of bladder cancers, is a solid tumor entity that is responsive to immunotherapy as evidenced by a substantial cure rate documented with the use of intravesical bacillus Calmette-Guérin (BCG) therapy in selected patients with high-grade superficial disease. The nonspecific immune modulation that occurs as a result of BCG therapy is not well understood; however, the success of BCG therapy provides a basis for the exploration of mechanisms related to immune responses and the development of novel immunotherapeutic agents for the treatment of high-risk disease. In this review, we discuss the complexity of the immune system and therapies that are considered capable of manipulating it to potentially benefit patients with bladder cancer.
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Affiliation(s)
- Padmanee Sharma
- Department of Genitourinary Medical Oncology and Immunology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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47
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Singh NP, Prakash A, Kubba S, Ganguli A, Agarwal SK, Dinda AK, Aggarwal PN. Nephrotic syndrome as a complication of intravesical BCG treatment of transitional cell carcinoma of urinary bladder. Ren Fail 2007; 29:227-9. [PMID: 17365941 DOI: 10.1080/08860220601098961] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Nephrotic syndrome can be associated with various neoplasms, especially solid tumors and lymphomas. This patient presented with painless hematuria of transitional cell carcinoma of urinary bladder, underwent transurethral resection, but developed recurrence 16 months later. Repeat resection was done and intravesical Bacillus Calmette-Guerin (BCG) injections were started. After six months, the patient developed hypertension and nephrotic syndrome with a biopsy revealing membranous glomerulonephritis, though there was no radiological evidence of tumor. This is the first case of nephrotic syndrome with intravesical BCG instillation in a bladder carcinoma patient.
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Affiliation(s)
- N P Singh
- Department of Medicine, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India
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48
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Bunimovich-Mendrazitsky S, Shochat E, Stone L. Mathematical Model of BCG Immunotherapy in Superficial Bladder Cancer. Bull Math Biol 2007; 69:1847-70. [PMID: 17457655 DOI: 10.1007/s11538-007-9195-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Accepted: 12/20/2006] [Indexed: 11/27/2022]
Abstract
Immunotherapy with Bacillus Calmette-Guérin (BCG)-an attenuated strain of Mycobacterium bovis (M. bovis) used for anti tuberculosis immunization-is a clinically established procedure for the treatment of superficial bladder cancer. However, the mode of action has not yet been fully elucidated, despite much extensive biological experience. The purpose of this paper is to develop a first mathematical model that describes tumor-immune interactions in the bladder as a result of BCG therapy. A mathematical analysis of the ODE model identifies multiple equilibrium points, their stability properties, and bifurcation points. Intriguing regimes of bistability are identified in which treatment has potential to result in a tumor-free equilibrium or a full-blown tumor depending only on initial conditions. Attention is given to estimating parameters and validating the model using published data taken from in vitro, mouse and human studies. The model makes clear that intensity of immunotherapy must be kept in limited bounds. While small treatment levels may fail to clear the tumor, a treatment that is too large can lead to an over-stimulated immune system having dangerous side effects for the patient.
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49
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Vázquez-Lavista LG, Flores-Balcázar CH, Llorente L. [The bacillus Calmette-Guérin as immunomodulator in bladder cancer]. Rev Invest Clin 2007; 59:146-52. [PMID: 17633803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The bacillus Calmette-Guérin (BCG) is regarded as the most successful immunotherapy against superficial bladder carcinoma recurrences to date. BCG intravesical therapy for superficial bladder cancer has shown its efficacy and advantage over classical therapeutic strategies. This efficacy is based on complex and long lasting immune activation. The initial step is the binding of mycobacteria to the urothelial lining, which depends on the interaction of a fibronectin attachment protein on the bacteria surface with fibronectin in the bladder wall. Granulocytes and other immunocompetent mononuclear cells became attracted to the bladder wall and a cascade of proinflammatory cytokines sustains the immune response. In the bladder wall a largely TH1 based cytokine milieu and granuloma-like cellular foci are established. Within this scenario, the most important effector mechanisms might be the direct antitumor activity of interferons and the cytotoxic activity of NK cells. Current treatment consists of an induction phase of 6 weeks and a maintenance dose schedule of 3 weeks every three months up to 36. The majority of patients present adverse events related to dose administration due to bladder inflammatory response and on only a few occasions, there are mayor complications like granulomatous prostatitis. Among all the neoplasms only in superficial bladder cancer the BCG is proved to be effective.
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MESH Headings
- Adjuvants, Immunologic/adverse effects
- Adjuvants, Immunologic/therapeutic use
- Administration, Intravesical
- BCG Vaccine/adverse effects
- BCG Vaccine/therapeutic use
- Bacterial Adhesion
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/immunology
- Cystitis/etiology
- Cytotoxicity, Immunologic
- Female
- Humans
- Killer Cells, Natural/immunology
- Lymphocytes, Tumor-Infiltrating/immunology
- Lymphokines/metabolism
- Male
- Models, Immunological
- Mycobacterium bovis
- Neoplasm Recurrence, Local/prevention & control
- Neoplasm Recurrence, Local/therapy
- Prostatitis/etiology
- Th1 Cells/metabolism
- Urinary Bladder Neoplasms/drug therapy
- Urinary Bladder Neoplasms/immunology
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50
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Camain JY, Hammel P, Cazals-Hatem D, Levy P, Belghiti J, Ruszniewski P. [Metastatic transitional cell carcinoma with high CA 19.9 serum levels]. ACTA ACUST UNITED AC 2007; 31:102-5. [PMID: 17273142 DOI: 10.1016/s0399-8320(07)89337-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/20/2022]
Abstract
We report the case of a 75-year-old woman with liver metastases of a urothelial carcinoma accompanied by a marked increased in CA 19-9 serum level. The mechanisms leading to this elevation, similar to that observed in biliary tract diseases, are discussed.
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Affiliation(s)
- Jean-Yves Camain
- Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, Clichy
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