bluuebunny/crossref_metadata_2025 huggingface dataset:
National and state models for relationships between social vulnerability and mammography rates.
Authors: Aijazuddin Ismail , Alloghbi Abdurahman , Sukari Ammar
Published: June 2024

1573

Background: Health disparities arise from the confluence of medical and non-medical factors that affect measures of prevention, treatment, and outcomes. One crucial preventative measure is mammography rate. Neighborhood-level analysis using tools such as the CDC’s Social Vulnerability Index (SVI) may identify correlates of disparity in mammography access and utilization. Such investigation may reveal drivers of disparity in communities with lower screening. Methods: Self-reported mammography rates among women aged 50-74 were obtained from the CDC’s 2018 PLACES dataset at the Census Tract level and merged with the CDC’s 2018 SVI release. Data were available for 72,075 Census Tracts across all states and Washington, D.C. National univariate and multivariate regressions were performed between mammography rates and percentiles for SVI percentiles. State-specific multivariate regressions were performed for each state's Census Tracts. Results: In the national analysis, significant correlations with non-negligible effect size (correlation coefficient > 0.20 or < -0.20) were found between mammography rate and the following: Theme 2 - Household Composition & Disability (R = -0.22, p < 0.0001), Mobile Homes (R = -0.36, p < 0.0001), Civilians with a Disability (R = -0.24, p < 0.0001), and Minority Status (R = 0.25, p < 0.0001). The national multivariate model achieved Multiple R of 0.54 and Significance F < 0.001. The variables with the most negative associations (lower mammography rates with increased vulnerability) were Income (coefficient = -4.05, p < 0.001) and Speaks English Less than Well (coefficient = -2.33, p < 0.001). Across the state multivariate models, mean Multiple R was 0.70 (95% CI 0.67-0.73), with Significance F < 0.05 in all states (Table). The variables with the most negative mean coefficients across models were Income (-3.20) and No High School Diploma (-2.98); the most positive was Minority status (6.11). Conclusions: Neighborhood-level social determinants correlate meaningfully with mammography rates. Although lower income, limited English proficiency, and lower educational attainment are most strongly associated with lower mammography, the effect sizes vary across geographies, and additional factors have meaningful influence in certain states. The stronger performance of most state-specific models than the national model reinforces this finding. It demonstrates the need for further analysis at the level of state and within narrower geographies. Ultimately, targeted interventions should address those disparities that are most relevant to specific neighborhoods. [Table: see text]
Niraparib efficacy in patients with newly-diagnosed glioblastoma: Clinical readout of a phase 0/2 "trigger" trial.
Authors: Sanai Nader , Umemura Yoshie , Margaryan Tigran , Molloy Jennifer , Zhang Hualin , Knight William , Harmon Jocelyn , Hong Amy , Wanebo John , Braun Kelly , Kennedy William R. , Garcia Michael A. , Barani Igor J. , Yoo Wonsuk , Tien An-Chi , Tovmasyan Artak , Mehta Shwetal
Published: June 2024

2002

Background: Poly (ADP-ribose) polymerase (PARP) mediates DNA damage response; niraparib is an investigational PARP1/2-selective inhibitor. This Phase 0 study evaluates newly-diagnosed glioblastoma (GBM) tumor pharmacokinetics (PK) and pharmacodynamics (PD), graduating patients with O6-methylguanine methyltransferase (MGMT) unmethylated tumors into a therapeutic regimen of niraparib plus fractionated radiotherapy when PK threshold is met. Methods: Presumed newly-diagnosed GBM patients received 4 days of niraparib (300/200 mg QD) prior to planned resection 3-5 (cohort 1) or 8-10 hours (cohort2) following the last dose. Tumor tissue (Gadolinium enhancing and non-enhancing regions), cerebrospinal fluid (CSF), and plasma were collected. Total and unbound niraparib concentrations were measured using validated LC-MS/MS methods. PARP inhibition was assessed by quantification of PAR induction after ex vivo irradiation of surgical vs non-irradiated tissue. A PK ‘trigger’ determined eligibility for the Phase 2 component of the study and was defined as unbound [niraparib] > 5-fold biochemical IC50 (i.e., 19 nM) in non-enhancing tumor. Patients with MGMT unmethylated tumors in excess of the PK threshold were eligible for Phase 2 dosing of niraparib plus radiotherapy followed by a maintenance phase of niraparib monotherapy. Results: All Phase 0 patients (n=46) met the PK threshold. In non-enhancing tumor regions, the mean unbound concentration of niraparib was 335.1 nM (n=43) for cohort 1 and 331.9 nM (n=3) for cohort 2. PAR suppression after ex vivo radiation was observed in 73% of the patients (24/33). Nineteen of 27 (70.3%) patients with unmethylated tumors were enrolled into Phase 2. Five patients in Phase 2 experienced Grade 4 thrombocytopenia related to niraparib. All adverse events resolved without sequelae. At time of data cutoff, median progression-free survival was 11.7 months. Mature overall survival (OS) data will be reported for the first time. Conclusions: Niraparib achieves pharmacologically relevant concentrations in non-enhancing, newly-diagnosed GBM tissue in excess of any other studied PARP inhibitor. Accompanying PD effects were observed in patient tumor tissue. For the first time, we report on the clinical efficacy of the study. A global Phase 3, open-label, randomized 2-arm study comparing niraparib versus temozolomide in adult patients with newly diagnosed, MGMT unmethylated glioblastoma is being planned. Clinical trial information: NCT05076513 .
Longitudinal tumor-wide sampling of glioblastoma reveals diverse genomic drivers of the earliest clonal expansion at diagnosis and recurrence.
Authors: Lerman Benjamin Joshua , Hong Chibo , Chen Lee , Smirnov Ivan V , Phillips Joanna J. , Shai Anny , Lupo Janine , Costello Joseph
Published: June 2024

2009

Background: Despite decades of clinical trials, glioblastoma (GBM) remains a rapidly fatal disease. Much of therapy resistance in GBM is attributed to intratumoral heterogeneity in which subclones rapidly evolve and treatment-resistant cell populations emerge. Understanding heterogeneity at diagnosis and its relationship to the origins of recurrence are critical to selecting therapies that are efficacious across the entire tumor. However, few genomic studies go beyond analyzing single tumor samples per patient. Methods: A spatially oriented, whole tumor sampling approach was used to obtain 43 biopsies from 3 GBMs at diagnosis and recurrence. Pyclone and ClonEvol were applied to whole exome sequencing to reconstruct clonal evolution, FACETs identified copy number variations and HATCHet estimated tumor purity. Candidate driver mutations were evaluated in relation to the Catalogue of Somatic Mutations In Cancer. Results: A single founding clone and multiple subclones were identified for each diagnosis-recurrence pair. Tumor-wide clonal alterations representing initial clonal expansions of these GBMs included both canonical changes (Chr 7 gain, Chr 10 loss, CDKN2A deletion, EGFR amplification) and a diverse set of large-scale copy number variations (Chr 19, 20 gain), driver mutations (PTEN, KDR, CDH11, CNTNAP2), and fusions (LIMCH1::UCHL1, KANK::DOCK8). A second subset of alterations (Chr 8 gain, ATRX mutation), appeared to be tumor wide at diagnosis but were not identified at recurrence. Cancer drivers were also present subclonally, including CDKN2A deletion, MDM2 amplification, and mutations in NF1, and GRM3. Evolutionary trees consisted of 5 generations of clones in Patient 323 (P323), 3 in P454, and 4 in P534. Divergence of the recurrent tumors from their matched primary occurred in the second generation in P454 and P534 and in the third in P323. As a result, an average of 37% of potential drivers of oncogenesis and clonal expansion across the cohort appear after divergence. Furthermore, each recurrent tumor contained at least one tumor wide driver alteration that was subclonal or undetected at diagnosis. Conclusions: Whole-tumor sampling of three GBM patients at both diagnosis and recurrence identified a diversity of genomic drivers and deeper and more complex genetic roots of individual GBM than previously seen in single-biopsy studies. Tumor recurrences consistently arose from a single subclone that diverged early in evolution of the primary tumor and contained clonal drivers either not detected or subclonal in the primary—suggesting a role for these drivers in persistence and expansion. In the age of personalized medicine, our study highlights the clinical potential of tumor wide sampling in identifying therapeutic targets that could avoid heterogeneity-related therapeutic failures.
Primary intracranial germ cell tumors in adolescents and adults: Results of an international, multicenter, retrospective cohort study.
Authors: Zschaebitz Stefanie , Heck Clarissa K , Kasim Rega , Seidel Christoph Alexander , Blum Veronika , Paffenholz Pia , Hentrich Marcus , Cathomas Richard , Augustin Marinela , Timmer Marco , Schäfers Christoph , Schäfer Sophia , Harrabi Semi , Jaeger Dirk , Beyer Joerg , Lorch Anja , Ochsenreither Sebastian
Published: June 2024

2061

Background: Primary Intracranial Germ Cell Tumors (iGCT) are rare. Previous prospective and retrospective studies mainly included pediatric patients (pts) with a median age of 10-14 years. The aim of this retrospective analysis was to evaluate characteristics, treatment and outcome of adolescents and adults with iGCT. Methods: Data were collected from 10 institutions in Germany and Switzerland. Pts aged >/= 16 years at first diagnosis or at relapse with a primary iGCT were included. Objective responses were evaluated by local investigators. Statistics (Cox proportional hazard model, progression-free survival (PFS) and overall survival (OS) analyzed by Kaplan-Meier method) were performed with SPSS v29. Results: We identified 75 pts (92.0% male) with a median age of 23 years (range 16-60, 94.7% >/= 18 years). At first diagnosis, histology was pure germinoma in 70.7%, pure teratoma in 10.7%, other non-germinomatous GCT (NGGCT) in 13.3%, unknown in 5.3% of pts. Localized, bifocal, and metastatic disease was found in 72.0, 6.7, and 21.3% of pts. As part of their first line (1L) treatment, 69.3%, 80.0%, and 62.7% received surgery, radiotherapy, and chemotherapy, respectively. High dose chemotherapy/ autologous stem cell transplantation (HDCT/ASCT) was part of 1L treatment in n=3 pts with NGGCT. Trimodal and bimodal treatment was performed in 48.0% and 32.0% of pts. Response to 1L therapy was complete remission (CR) in 61.3%, partial remission tumor marker negative (PRm-) in 16.0%, PRm+ in 4.0%, PR with tumor marker status unknown in 4.0%, progressive disease (PD) in 2.7%, and unknown in 12.0%. Relapse occurred in 13/75 pts (17.3%) with unknown histology (n=4), teratoma (n=2), other NGGCT (n=4), and germinoma (n=3). In 2 pts. in whom germinoma was diagnosed at time of first diagnosis, at time of recurrence PNET and Yolk sac tumor were histologically proven. Median time to relapse was 19.0 months (mo.; range 3-223). HDCT/ASCT as salvage treatment was performed in 5 pts with NGGCT and in one pt with germinoma as 2L (n=5) or 3L (n=1). NGGCT histology was associated with increased risk for recurrence or death (p=0.012 and 0.039).3-year PFS was 90.7% (germinoma: 98.1%, NGGCT: 73.9%) and 5-year OS was 92.0% (germinoma: 98.1%; NGGCT: 78.3%). Median follow-up time was 60 mo (range 0-339). Conclusions: Disease characteristics, treatment and outcomes of adolescent/ adult iGCT pts are comparable to those reported in pediatric pts. High cure rates are achieved in pts with pure germinoma and current treatment concepts. In pts with NGGCT further investigation is needed to improve survival outcomes.
A phase 0/1 trigger trial of BDTX-1535 in patients with recurrent high-grade glioma (HGG) with EGFR alterations or fusions.
Authors: Sanai Nader , Umemura Yoshie , Karapetyan Vahuni , Margaryan Tigran , Huttenlocher Dylan , Harmon Jocelyn , Hong Amy , Yoo Wonsuk , Tien An-Chi , Tovmasyan Artak , Mehta Shwetal
Published: June 2024

2069

Background: This Phase 0/1 clinical trial evaluates the pharmacokinetic (PK), pharmacodynamic (PD), and clinical response of recurrent high-grade glioma (HGG) patients with EGFR alterations and/or fusions to the ATP-competitive, irreversible EGFR inhibitor, BDTX-1535. Methods: Recurrent HGG patients with EGFR alterations (Arm A) or EGFR fusions (Arm B) received 5 days of BDTX-1535 (200 mg) prior to planned resection at 2-4 hours following the final dose. In the Phase 0 component of the study, total and unbound drug concentrations were measured in tumor tissue (Gadolinium enhancing and non-enhancing regions), cerebrospinal fluid (CSF), and plasma using validated LC-MS/MS methods. A PK ‘trigger’, defined as unbound drug concentration above 5-fold biochemical IC50 in Gadolinium (Gd)-nonenhancing tumor, determined eligibility for Phase 1. PD response was assessed by quantification of percentage of positive pEGFR, pERK and MIB-1 cells in the surgical tumor tissue compared to baseline pre-treatment tissue. Patients with tumors exceeding the PK threshold for unbound drug concentration were eligible for expansion phase therapeutic dosing of BDTX-1535. Results: A total of 7 patients with recurrent glioblastoma (Arm A) were enrolled in the Phase 0 component of the study. Two patients were excluded from PK analysis due to pseudoprogression. The mean unbound concentrations of BDTX-1535 in Gd-enhancing and nonenhancing tumor regions were 16.0 nM and 10.5 nM respectively. Four of five (80%) evaluable patients exceeded the PK threshold. The suppression of pEGFR and MIB1 was observed in 40% and 60% of patients, respectively. No serious adverse events were observed among patients in the Phase 1 component of the study and a clinical readout is planned in Q2 2024. Conclusions: BDTX-1535 is well-tolerated in recurrent HGG patients, achieves pharmacologically relevant concentrations in Gd-nonenhancing tumor tissue and is associated with suppression of EGFR signaling. Clinical trial information: NCT06072586 .
A novel liquid biopsy assay with an 88% detection rate of genomic alterations across CNS tumors.
Authors: Varga Matthew Gordon , Klosowski Christian , Bower Xavier , Tsao David , Palmer Gary A. , Kesari Santosh
Published: June 2024

2077

Background: Diagnosis and treatment decisions for CNS tumors rely upon imaging with subsequent histological and genomic analyses of tissue to identify appropriate courses of therapy. Genomic profiling of tumor tissue for informative alterations is used to guide treatment, however contemporaneous tissue can sometimes be unavailable, inconclusive or overlook possible actionable alterations given the high amount of spatial heterogeneity in certain tumor types such as glioblastomas GBMs. Liquid biopsies may pose a possible solution, as they are readily accessible and provide a holistic snapshot of the tumoral genomic landscape. However, detection of ctDNAs from CNS tumors is impeded by its inherently low shedding biology and poor permeability across the BBB resulting in low plasma variant allele fractions (VAFs), with alteration detection rates ranging 27-55%. Thus, current assays do not yet have the sensitivity to be clinically useful in aiding decision making for CNS tumors. Methods: 62 cases of primary CNS tumors were submitted commercially for assessment with Northstar Select, a tumor-naive, plasma-based ctDNA liquid biopsy assay. Cases were obtained from a single clinic dating from January-December 2023. Results: See table. Conclusions: There remains an unmet clinical need for a highly sensitive liquid biopsy assay for use in determining the genomic landscape of CNS tumors to aid in clinical decision making. Current assays do not have a low enough limit of detection (LoD) to accurately detect ctDNAs at low VAFs. Herein, we demonstrate that Northstar Select has a detection rate of 88.7% in all cases and 91.4% in GBMs, nearly doubling current rates. This is due to the assay’s uniquely low LoD of 0.13-0.16% VAF, which is below the 0.17% median VAF demonstrated across CNS tumors in this study, allowing for more low-abundance alterations to be detected. Given the increased total variant detection rate, nearly 50% of which were actionable when alterations were detected, these data support the clinical utility of Northstar Select to inform clinical decisions either as a complement to imaging and tissue analyses or independently when tissue biopsies are infeasible. These data further suggest that the clinical utility of Northstar Select may be expanded into metastatic brain disease and other low ctDNA shedding tumors. [Table: see text]
Unraveling the immunologic vulnerabilities of diffuse hemispheric glioma, H3 G34-mutant.
Authors: Galvin Robert Thomas , Sadeghipour Negar , Xiu Joanne , Ashley David M. , Ahluwalia Manmeet Singh , Aulakh Sonikpreet , Huang R. Stephanie , Largaespada David A
Published: June 2024

2082

Background: Recent insights into the molecular basis of diffuse hemispheric glioma, H3 G34-mutant (DHG-G34), an incurable high-grade glioma, have opened new therapeutic possibilities. The oncohistone mutation in DHG-G34 impairs the epigenetic regulator SETD2, which normally orchestrates DNA-mismatch-repair and negatively regulates the transcriptional silencing activity of the Polycomb Repressive Complex 2 (PRC2). In DHG-G34, a mismatch-repair-deficiency phenotype is predicted, but an anti-tumor immune response is notably absent in clinical observations, which we posit is linked to the aberrant transcriptional repression by PRC2. Here, we investigate DHG-G34 immunosuppression mechanisms in a large real-world multi-omics cohort and human cell lines. Methods: Clinical, molecular, and immunologic characteristics of a DHG-G34 cohort, sequenced (DNA and RNA) at Caris Life Sciences (Phoenix, AZ), are contrasted against diffuse midline glioma (DMG) and pediatric low-grade glioma (LGG). A significant difference between genomic subgroups was defined as fold-change > 1.2. Statistical significance was determined using chi-square, Fishers-exact, and Mann Whitney U tests with corrections for multiple hypothesis testing (q < 0.05).Hazard ratio (HR) was calculated using the Cox proportional hazards model. KNS-42 DHG-G34 cell line was exposed in triplicate to 1 µM valemetostat (an EZH1/2 inhibitor) or DMSO in vitro. Flow cytometry and RNA-sequencing were utilized to determine differential immunologic characteristics. Results: 29 DHG-G34, 51 DMG, and 52 LGG were identified in Caris database. Median OS among DHG-G34 was 15.4 mo., similar to DMG (HR = 1.1, 95% CI: 0.70-1.73, p = 0.686). Most frequent alterations in DHG-G34 were TP53 (93.1%), ATRX (69.0%), PDGFRA (31.0%). Tumor mutational burden (TMB) was high, >=10mt/MB, in 10% of DHG-G34 and 0/51 in DMG and 0/52 LGG (p < 0.01, q > 0.05), but immune fractions including dendritic cells, T cells, macrophages, microglia, and antigen-presenting genes were decreased (fold-change: 0.19 – 0.83, q < 0.05). In KNS-42, PRC2 inhibition upregulated MHC class 1 (p < 0.001). Of 402 KNS-42 missense variants, transcription of 43 were upregulated following EHZ2 inhibition, and 4 were downregulated (q < 0.05). Among immunostimulatory genes, P2RX7, which engages T-cells and stimulates an inflammatory response, was downregulated in patient samples (q < 0.001) and upregulated in KNS-42 following EZH2 inhibition (q < 0.001). Conclusions: DHG-G34 has an increased propensity for high TMB but remains immunologically cold. Our pilot experiment suggests inhibiting PRC2’s unique role in DHG-G34 may sensitize DHG-G34 to an immune response by inducing MHC class 1 expression and transcriptional readthrough of mutated transcripts. Understanding whether treatment induces TMB in DHG-G34 may affect timing of an immunotherapeutic intervention.
NFKBIA deletions reshape the epigenome antithetical to the IDH mutation and indication of prognosis in diffuse gliomas.
Authors: Bredel Markus , Espinosa Lluis , Pugh Stephanie L. , Chakravarti Arnab ,   NRG Oncology
Published: June 2024

2083

Background: Genetic alterations help predict the clinical behavior of diffuse gliomas, but some variability remains uncorrelated. The NFKBIA gene at 14q13.2 encodes IkBa, a protein that regulates the activity of NF-kB in the cytoplasm. Evidence that, in chromatin, nuclear NFKBIA dynamically interacts with histones H2A and H4 to regulate polycomb-dependent transcriptional repression and, thus, stem cell maturation and lineage specification and our characterization of NFKBIA as a tumor suppressor in glioblastoma prompted our investigation of the relationship of NFKBIA deletions to other genetic markers, alterations in the methylome, and the clinical course of gliomas. Methods: We analyzed the genetic profiles of 2,343 WHO grade 2 to 4 diffuse gliomas in multiple clinically well-characterized patient populations, including national randomized phase III consortium trial RTOG 9802, to determine whether incorporation of NFKBIA deletions could enhance the prognostic value of current molecular descriptions. Results: We demonstrate that haploinsufficient deletions of NFKBIA display distinct patterns of occurrence in relation to other genetic markers, including driver mutations IDH, TERT, ATRX, and PTEN, 1p19q codeletion, and CDKN2A/B deletion, and are disproportionally present at recurrence. NFKBIA haploinsufficiency is associated with unfavorable patient outcomes, independent of genetic and clinicopathologic predictors. NFKBIA deletions reshape the DNA and histone methylome antipodal to the IDH mutation. The methylome changes facilitated through NFKBIA deletions engender a transcriptome landscape partly reminiscent of H3K27M mutant pediatric gliomas and are highly enriched for neural stem cell and neurogenesis genes bearing repressive H3K27 marks. Our findings imply that the NFKBIA deletion in adult gliomas and the H3K27M mutation in pediatric diffuse midline gliomas define aggressive disease subtypes that may share an epigenetic state reflecting a common PRC2 loss-of-function phenotype antipodal to the quasi PRC2 gain-of-function phenotype of IDH mutant gliomas and their favorable clinical course. Lower-grade gliomas harboring NFKBIA deletions behave much like high-grade gliomas. In IDH mutant gliomas, NFKBIA deletions are common in tumors with a clinical course similar to that of IDH wildtype tumors. A sparse, easily interpretable, and externally validated nomogram model for estimating individual patient survival in IDH mutant gliomas, incorporating NFKBIA deletion and current best-established genetic and clinicopathologic factors, confirms that NFKBIA deletions predict comparatively brief survival. Conclusions: NFKBIA haploinsufficiency aligns with distinct epigenome changes, portends a poor prognosis, and should be incorporated into clinical models predicting the disease fate of diffuse gliomas.
Global, national, and regional burden of brain and central nervous system cancer in youth under 20 from 1990-2019: A benchmarking analysis.
Authors: Vemparala Priyatha , Lakkimsetti Mohit , Patel Dhruval Pinalkumar , Singh Kushagrita , Goel Shrey , Reyaz Ibrahim , Bathvar Pinank , Savaliya Prashantkumar , Ahmed Danish , Sharafeldin Mohammed Yassmeen , Sonani Shivani B , Patel Juhi , Koyani Himanshu Bharatkumar , Amin Vishrant , Gadhiya Dhruvkumar , Desai Hardik Dineshbhai
Published: June 2024

2084

Background: Brain and central nervous system (CNS) cancer ranks as the second leading cause of death among all cancer-related fatalities globally in individuals under 20 years old. Despite its significance, there is a notable dearth of data on brain and CNS cancer in this age group, necessitating a comprehensive cross-country comparison. Methods: Utilizing the Global Burden of Disease study framework, we estimated the prevalence, incidence, deaths, and disability-adjusted life years (DALYs) attributable to brain and CNS cancer by age, sex, year, and location across 204 countries and territories from 1990-2019. Results: The total prevalence increased from 153,334 (95%UI: 111,452-233,819) in 1990 to 212,459 (164,908-245,556) in 2019, with incidence rising from 47,373 (32,635-74,710) in 1990 to 47,600 (36,572-55,194) in 2019. Notably, the annual percentage change (APC) in deaths decreased by 21% (56-15), and DALYs by 22% (57-15) from 1990-2019. Sub-Saharan Africa and the African Union exhibited the highest APC increase in deaths, while Southeast Asia, East Asia, and Oceania experienced the most significant decrease. The highest APC in incidence occurred in the 10-14 years age group at 27%, with a slight increase of 1% in deaths observed in the 10-19 years age group. Females bore a higher burden compared to males, with APC in prevalence at 29% versus 51%, and incidence at -4% versus 7%. Conclusions: Brain and CNS cancer accounted for 9.55% of deaths among individuals under 20 globally in 2019. While the overall global trend has shown an increase over the last three decades, females exhibit a higher burden. Despite a decrease in deaths over the same period, strategies must be implemented to combat this burden, emphasizing the importance of early investigation and management, particularly in resource-limited settings worldwide. [Table: see text]
Emavusertib (CA-4948) in combination with ibrutinib in patients with relapsed/refractory primary central nervous system lymphoma (R/R PCNSL).
Authors: Grommes Christian , Tun Han W. , de la Fuente Burguera Adolfo , Dabrowska-Iwanicka Anna , Regales Lucia , Zhao Wanying , Ferrari Dora , Fowles Meaghan , Lane Maureen E , Wang Catherine , Von Roemeling Reinhard W. , Taszner Michal , D'angelo Christopher , Nowakowski Grzegorz S.
Published: June 2024

2087

Background: PCNSL is a rare and aggressive form of NHL in the central nervous system or vitreoretinal space. Despite high initial rates of responses to HD-MTX-based induction chemotherapies, most patients relapse in two years. R/R PCNSL is associated with poor prognosis, representing a clear unmet medical need, as there are no currently approved treatments for this disease. IRAK4 kinase activity is required for TLR and IL-1R signaling in a variety of myeloid and lymphoid cell types, including PCNSL. Recruitment of IRAK4 to these receptors and subsequent activation is facilitated by the MyD88 adaptor protein, which is mutated in ~70% of PCNSL. This leads to constitutive activation of the NF-κB signaling pathway, increased inflammation, and tumor growth. Emavusertib is a novel and potent oral inhibitor of IRAK4 and FLT3, which has demonstrated the ability to cross the blood-brain barrier in PCNSL xenografts. In preclinical studies, the combination of emavusertib with ibrutinib overcomes resistance to BTK inhibitors. This combination has an acceptable safety profile across a broad population of R/R NHL patients, including PCNSL. Here we present updated safety and efficacy data for emavusertib in combination with ibrutinib in patients with R/R PCNSL. Methods: The safety, clinical activity, and potential biomarkers of emavusertib in R/R PCNSL are being investigated in the ongoing open-label, Phase 1/2 TakeAim Lymphoma trial (NCT03328078). The eligible patients with R/R PCNSL received emavusertib (100-300 mg BID) in combination with ibrutinib (560 mg QD) in a 21-day cycle until tumor progression or unacceptable toxicity. Results: Here, we present updated data from R/R PCNSL patients with prior ibrutinib exposure who were treated with emavusertib in combination with ibrutinib. The median number of prior lines of anti-cancer therapies was 3 (range: 2-5), all patients were R/R to both frontline therapy and subsequent ibrutinib regimens. Prior responses to ibrutinib based regimens included only 1 CR. Here, we report a higher CR rate when these patients are subsequently treated with emavusertib in combination with ibrutinib.Results revealed no dose-limiting toxicities. Conclusions: Emavusertib in combination with ibrutinib was well tolerated with an acceptable safety profile and promising efficacy in R/R PCNSL patients with previous exposure to ibrutinib (BTKi). Enrollment in this trial is ongoing (NCT03328078). Clinical trial information: NCT03328078 .
Use of IL-3RB to mediate antitumor effect of CAR-T cells through the JAK-STAT signaling pathway.
Authors: Ma Qizhi , Shu Pei , Guo Fuchun , Liu Ning , Bai Yongmei , Zhang Benxia , Chen Yue , Wang Yongsheng
Published: June 2024

2541

Background: The application of CAR-T in solid tumors has not yet demonstrated significant clinical benefits. The continuous proliferation and decreased terminal differentiation of CAR-T cells in vivo are considered potential strategies that could alter this predicament. Cytokines, as the 3rd signal for T-cell activation, play a crucial role in the lifecycle and fate of T cells. In this study, we innovatively incorporated the IL-3 receptor β chain (IL-3RB) into the CAR structure to enhance signal transduction, potentially activating the anti-tumor function of CAR-T and maintaining the persistent proliferative activity. Methods: Transcriptional profiling analysis performed on HER2 or VEGFR1 CAR-T cells, with a specific focus on the gp140 cytokine family (IL-3/IL-5/CSF-2) and the receptor expression, validated by ELISA and Western blot. By cloning CAR genes containing different structural domains of the IL-3RB into the lentiviral vector pWPXLd, CAR expression, activation, depletion, proliferation, cytotoxicity, pSTAT3 and pSTAT5, and cytokine release of CAR-T cells were assessed using flow cytometry (FCM), Western blot (WB), RTCA, CCK-8, and ELISA. Subcutaneous/abdominal injections of SKOV3 cells or SKOV3-Luc cells into NSG mice, followed treated by CAR-T cells. Tumor burden was regularly monitored, and FCM and Q-PCR were utilized to assess the quantity and phenotype of CAR-T cells in vivo. Results: RNA-sequence, ELISA and WB revealed that upon activation of CAR-T cells, the expression of genes such as IL-3/IL-5/CSF-2 rapidly increased. However, their receptors were hardly expressed. IL-3RB modification did not affect the phenotype of resting CAR-T cells. But, co-cultured with target cells, IL-3RB significantly enhanced the anti-tumor effects of CAR-T cells. This was manifested by more rapid activation, promotion of persistent proliferation, delayed exhaustion phenotype, secretion of higher levels of cytokines (IL-2, IFN-γ, TNF-α) and efficient cytotoxicity. IL-3RB-expressing CAR-T cells exhibited activation of the JAK kinase and STAT3, STAT5 transcription factor signaling pathways in vitro. We established solid tumor models of subcutaneous (SKOV3) and intraperitoneal metastasis, where HER2/VEGFR1 CAR-T cells partially inhibited tumor cell growth in vivo. In contrast, IL-3RB-enhanced CAR-T cells completely eradicated tumor cells, and even achieving a state of complete remission. FCM and Q-PCR also confirmed that IL-3RB significantly improved the proliferation and survival of CAR-T cells in vivo. Conclusions: IL-3RB is scarcely expressed in T cells and not regulated by T cell activation. IL-3RB-modified CAR-T cells exhibit superior persistence and significant anti-tumor advantages in a solid tumor through the JAK-STAT signaling pathway. Our innovative CAR structure design has the potential to demonstrate promising anti-tumor effects in clinical translational applications.
The role of obesity on outcomes of adoptive cellular therapy in solid tumors.
Authors: Tao Derrick Law , Nardo Mirella , Leung Cheuk Hong , Lin Heather Y. , Kang Lei , Le Hung , Dumbrava Ecaterina Elena , Hong David S.
Published: June 2024

2544

Background: Anti-tumor response and toxicity outcomes with adoptive cell therapy (ACT) have been heterogeneous in solid tumors, and it is still unclear how host factors such as obesity may contribute to efficacy and immune-related safety events. Methods: We conducted a retrospective study including 95 consecutive advanced solid tumor patients who received ACT on protocol in the Department of Investigational Cancer Therapeutics between August 2017 and June 2023. We analyzed baseline clinical characteristics, immune-related safety events, response to ACT, and survival outcomes between obese and non-obese patients. Overweight was defined as body mass index (BMI) 25-29.99 kg/m2 and obesity was defined as BMI ≥ 30 kg/m2 at the time of treatment. Fisher’s exact test was used to compare the proportions of categorical variables between two groups. Pairwise comparison with Bonferroni correction was performed if necessary. T-test was used to compare the mean of continuous variables between two groups. The distributions of overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan-Meier method. Log-rank test was used to compare the distributions of OS and PFS by baseline characteristics. Hazard ratio was estimated in Cox proportional hazard regression model. A two-sided p-value < 0.05 was considered statistically significant. Results: The median age at treatment was 60.9 (range 20.5 – 84). Thirty-nine patients (41.1%) had a BMI (kg/m2) defined as normal weight, 26 (27.4%) as overweight, 27 (28.4%) as obese, and 3 (3.2%) as underweight. Eighty-four (88.4%) were Caucasian; 54 (56.8%) were female. The most prevalent cancers were gastrointestinal (21.1%), gynecologic (15.8%), sarcoma (11.6%), mesothelioma (10.5%), breast (8.4%). The median follow-up was 39.9 months, with a median PFS of 2.8 months (95% CI: 2.3, 3.5) and a median OS of 8.4 months (95% CI: 6.4, 11.0). The risk of death among the obese patients was 0.56 (95% CI: 0.31, 0.99) times the risk of death among normal weight patients (p = 0.045). No weight difference was found between responder and non-responder. While BMI was not associated with the development of cytokine release syndrome (CRS), the patients with normal weight had a higher proportion of immune effector cell-associated neurotoxicity syndrome (ICANS) than the obese patients (23.1% vs 0%, p = 0.049). Conclusions: Obesity was associated with improved survival and decreased ICANS rates following ACT. Our findings may suggest a differential interaction between obesity, different immunotherapeutic modalities, and hematologic vs nonhematologic cancers.
Effect of placental circulating T cells expressing CD16 on multiple hematological and solid tumor cancers through combination with various monoclonal antibodies.
Authors: Karasiewicz-Mendez Kathy , Tess Kristina , Djedaini Mansour , Huang Chenfei , Gleason Joseph , Lin Shengchen , Ruggeri Barbaro Natalia , Fitzgerald John , He Shuyang , Hariri Robert , Kilcoyne Adrian
Published: June 2024

2554

Background: PT-CD16VS is an allogeneic cell therapy derived from human postpartum placental circulating T (PT) cells that are genetically modified to express CD16 and endogenous T cell receptor (TCR) knockout. PT-CD16VS cells can be combined with various monoclonal antibodies to engage in anti-tumor antibody-dependent cellular cytotoxicity (ADCC) against diverse cancers with a “universal receptor” approach. Here we report the characterization and preclinical evaluation of PT-CD16VS in combination with monoclonal antibodies against both hematological and solid tumor cancers. Methods: PT cells were activated, transduced with a lentiviral vector containing a construct expressing a high affinity CD16 variant, CD16VS, and transfected to knock out the TCR. In vitro,functional activity of PT-CD16VS cells in combination with monoclonal antibodies was assessed in cytotoxicity, cytokine release, and proliferation assays. Invivo, PT-CD16VS was combined with Rituximab in a Raji xenograft model in NSG mice, and with Trastuzumab in a subcutaneous NCI-N87 xenograft model in NSG mice in which tumor volume was measured and tumor samples were evaluated for PT-CD16VS infiltration. Results: In vitro, PT-CD16VS exhibited potent ADCC and cytokine release when combined with Rituximab against CD20+ Burkitt's lymphoma (Daudi and Raji), with Trastuzumab against HER2+ gastric carcinoma (NCI-N87), with Trastuzumab or Avelumab against HER2+/PDL-1+ non-small cell lung carcinoma (NCI-H1975) and Trastuzumab-resistant metastatic mammary adenocarcinoma (JIMT-1), and with Cetuximab against EGFR+ triple negative metastatic mammary adenocarcinoma (MDA-MB-231). Moreover, examples of PT-CD16VS antigen-specific proliferation were demonstrated against Raji and NCI-N87 when cells were combined with Rituximab and Trastuzumab, respectively. In vivo, in combination with Rituximab in the Raji mouse model, PT-CD16VS exhibited significant survival benefit compared to vehicle and Rituximab alone treated groups. In the subcutaneous NCI-N87 solid tumor model, PT-CD16VS with Trastuzumab demonstrated significant reduction in tumor volume compared to vehicle, Trastuzumab, and Enhertu groups. In addition, PT-CD16VS infiltration into the tumor was shown to be Trastuzumab dependent, with infiltrating cells expressing high levels of CD16 and Ki67. Conclusions: Our results show that PT-CD16VS have potent in vitro and in vivo ADCC activity, and a single drug product has the potential to be combined with various monoclonal antibodies to target multiple cancers across hematological and solid tumor indications. This “universal receptor” with antibody-dependent targeting approach, together with the benefits of an allogeneic cell platform, may democratize accessibility of such therapies for patients.
Chimeric antigen receptor T-cell therapy in B-cell malignancies and DNA-methylation–based biological aging.
Authors: Nannini Drew Robert , Cortese Rene , Hildebrandt Gerhard
Published: June 2024

2562

Background: Chimeric antigen receptor T-cell (CAR T-cell) therapy, a type of cancer immunotherapy which leverages genetically altered T cells to target cancer cells, has shown to be an effective option for patients with acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma (NHL). Despite its growing use, the effect of CAR T-cell therapy on the aging process remains limited and findings may have implications for disease relapse and age-related diseases among survivors. The purpose of this study was to investigate the association between CAR T-cell therapy and markers of biological aging. Methods: DNA methylation and clinical data from a publicly available dataset (GSE179414) were used in this analysis. Transduced and untransduced T cells from patients with ALL (n=77) and NHL (n=37) underwent DNA methylation profiling using the Illumina Infinium MethylationEPIC BeadChip. Six DNA methylation-based biological age metrics were calculated: intrinsic epigenetic age acceleration (IEAA), extrinsic epigenetic age acceleration (EEAA), PhenoAge acceleration (PhenoAA), GrimAge acceleration (GrimAA), telomere length attrition (TLA), and DunedinPACE (Pace of Aging Calculated from the Epigenome). Multiple linear regression analyses were performed to examine the association between CAR T-cell therapy and the aging metrics by B-cell malignancy. Interaction and stratified analyses by chronological age was additionally performed. Results: DunedinPACE ( P=0.002) was positively associated with CAR T-cell therapy among patients with ALL with an approximately 1-month higher pace of aging in transduced T cells compared to untransduced T cells after adjusting for chronological age and sex. Moreover, chronological age significantly ( P=0.016) modified the association between CAR T-cell therapy and TLA among ALL patients. Specifically, transduced T cells exhibited a 0.46 higher ( P=0.053) and a 0.39 lower ( P=0.142) rate of TLA among patients 16 years of age or older and those younger than 16 years of age, respectively. Conclusions: We observed CAR T-cell therapy was associated with greater biological aging as estimated from DNA methylation among ALL patients and these associations are modified by chronological age. These findings suggest CAR T-cell therapy may be associated with age-related changes to the epigenome in ALL patients and strategies to limit or reverse this effect may have implications for the aging process in cancer survivors. [Table: see text]
Circulating metabolic profiling as a biomarker for immune checkpoint blockade efficacy.
Authors: Saldanha Erick Figueiredo , Lau Sally C. M. , Laister Robert C. , Wang Ben X , Penny Susanne , Pinto Devanand , Sacher Adrian G. , Saibil Samuel
Published: June 2024

2564

Background: Immune checkpoint blockade (ICB) has changed the treatment landscape of non-small cell lung cancer (NSCLC). Despite being the mainstay of treatment for advanced NSCLC, the development of resistance to ICB is common. Hence, identifying biomarkers that can be used to select patients (pts) who will benefit from ICB is crucial. Here, we interrogate the circulating metabolome to identify the metabolic parameters associated with ICB effectiveness. Methods: This single-center retrospective analysis used a mass-spectrometry (MS) targeted metabolomics approach to assess the relative abundance of 115 metabolites in baseline (pre-ICB) plasma of 55 pts with advanced NSCLC. Pts treated with ICB at the Princess Margaret Cancer Centre from 2018-2020 were included. Electronic medical records were reviewed to collect clinicopathological and treatment data. All pts had tumour next-generation sequencing (NGS) by a targeted gene panel. Descriptive statistics were used to summarize the patient characteristics, treatment modalities, and outcomes. Time-to-event outcomes were analyzed using the Kaplan-Meier method. Progression-free survival (rwPFS) and overall survival (rwOS) were defined as the time from the first treatment dose to radiographic or clinical progression or death from any cause and time from the first dose of treatment to death from any cause, respectively. The response rate was assessed using RECIST 1.1. Statistical significance was determined as a p-value <0.05. Results: Amongst the 55 pts profiled, 42 (76.3%) had adenocarcinoma. The most common molecular alterations included KRAS (n=15), BRAF non-V600 (n=5), and METex14 (n=3). The median PD-L1 score was 65% (IQR 22.5 – 59%). All pts were treated with a single-agent PD-1 inhibitor, and 67.2% of pts received ICB as the first line of treatment. Metabolomic analysis of the pre-ICB initiation plasma samples identified 8 metabolites whose relative abundance significantly differed between responding (CR/PR) and non-responding pts (SD/PD). Amongst these metabolites was the endogenous danger signal Glucosylceramide (d 18:1/24:0), whose abundance was increased in the plasma of the responding pts. When we stratified pts by circulating levels of glucosylceramide, we found a statistically significant higher rwPFS (8.5 vs. 1.6 months, p=0.0001) and rwOS (13.5 vs. 6.1 months, p=0.0001) in pts who had high baseline plasma levels of Glucosylceramide (d 18:1/24:0) (top 50%) versus those with lower levels (bottom 50%). Conclusions: Utilizing a targeted metabolomics approach, we identified the metabolite and endogenous danger signal glucosylceramide (d 18:1/24:0) as a potential metabolic biomarker of response to ICB therapy. Future work will aim to validate this finding in a larger cohort and to understand the biological mechanism underpinning this correlation.
Proteogenomic profiling of clonal hematopoiesis in the solid tumor microenvironment.
Authors: Buttigieg Marco M , Vlasschaert Caitlyn , Rauh Michael J , Vanner Robert
Published: June 2024

2567

Background: Clonal hematopoiesis (CH) is caused by somatic mutations that provide a fitness advantage in hematopoietic stem cells, contributing to inflammation and disease. CH is common in solid tumor patients, and has shown context-dependent associations with survival; however, its contribution to the tumor microenvironment (TME) remains unclear. Here, we employ proteogenomic methods to define CH-associated alterations in the TME. Methods: We tested 1,550 patients across 10 primary, treatment-naïve cancers in the Clinical Proteomic Tumor Analysis Consortium cohort. CH calls were derived from peripheral blood and tumour whole exome sequencing (WES) data, and CH was defined as the presence of a somatic driver mutation at variant allele frequency (VAF) ≥2% in blood. Overall survival (OS) analysis was conducted using Cox proportional hazard models, controlled for age, sex, tumor type, metastatic status, and smoking. Tumor bulk RNA-sequencing and mass spectrometry proteomics data were processed for differential expression and gene set enrichment analyses. Abundance of immune cell populations was estimated with CibersortX. Results: 349 CH mutations were identified in 283 patients (18.3%). CH was strongly associated with age and mutations were mostly found in the epigenetic regulators DNMT3A(37.8%, n=132) and TET2(20.6%, n=72). CH was most prevalent in ovarian cancer (30%, n=27/90) and colorectal cancer (CRC; 28.3%, n=30/106). 103 blood CH mutations were also detected in tumor WES (CHTum), with presence in the tumor associated with higher tumor immune infiltration and peripheral blood VAF ≥10%. CHTum, but not CH, was associated with worse OS (CHTum HR = 1.74 [1.13-2.69]; CH HR = 1.12 [0.83-1.50]). CHTum was also associated with a reduced likelihood of patients being classified as tumor free at follow up (OR = 0.39 [0.19-0.82]). We did not identify a pan-cancer proteogenomic signature of CH in the TME. At the tumor-specific level, we consistently observed associations between CH and its subtypes with dysregulated inflammation, with high transcriptomic-proteomic concordance. In CRC, TET2-mutant CH was associated with greater infiltration of CD4+ T cells, monocyte/macrophages, NK cells, and B cells, alongside an inflammatory response characterized by IL6/JAK/STAT3 signalling, TNF signalling via NFκB, and IL2/STAT5 signalling. Conclusions: CH is common, even prior to therapy, in solid tumor patients and the infiltration of CH-mutant immune clones into the TME is linked with poor outcomes. Beyond confounding molecular tumor diagnostics, CH in the TME also dysregulates the anti-tumor immune response, highlighting the value of a blood reference in precision oncology. The lack of a pan-cancer CH signature in the TME supports a tumor-specific influence of CH. Further study is needed for mechanistic discovery and biomarker development to realize the potential of CH in immuno-oncology and improve patient outcomes.