Study of Metabolic Changes in the Transformation Malignant Precancerous Skin Lesions

Study Overview
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Brief Summary
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Skin carcinomas are the most frequent cancers in the world, including basal cell carcinomas and cutaneous squamous cell carcinoma (cSCCs), with more than 60.000 new annual cases in France. Their incidence increases mainly due to ultraviolet (UV) exposure and population ageing. Then from 1994 to 2006, the incidence of cSCC has increased by 300%. CSCCs typically manifests as a spectrum from a precursor actinic keratosis (AK) - possible spontaneous regression at this stage- to in situ cSCC invasive cSCC and finally metastatic cSCC.

Detailed Description
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Although growing evidence indicates that bioenergetic metabolism plays an important role in the progression of tumorigenesis, little information is available on the contribution of reprogramming of energy metabolism in cancer initiation and how it influences further the bioenergetic behavior of tumors. By applying a quantitative proteomic approach, the consortium has recently found that specific metabolic modifications precede cSCC. This study will investigate the role of energy metabolism in malignant transformation of premalignant skin lesions into cSCC, and in cSCC progression, with correlation with clinical characteristics and metastatic outcomes. Using several cutting-edge technologies in human samples, the team will evaluate whether targeting energy metabolism has the potential to be used as curative treatments for cSCC and whether pre-determined metabolic alterations could be exploited as new preventive strategies. These modifications in energy metabolism could be used as prognostic and diagnostic biomarkers.

Official Title
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Study of Metabolic Changes in the Transformation Malignant Precancerous Skin Lesions

Conditions
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Cutaneous Squamous Cell Carcinoma, Basal Cell Carcinomas

Intervention / Treatment
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* Other: biopsy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Every patient with suspected lesion : AK, in situ cSCC, infiltrative cSSC cSCC with recurrent disease cSCC with cutaneous metastases. Patients 18 years of age or older, Patients with suspected AK or BCC lesions (in situ, infiltrating or metastatic), Patient able to sign a consent form, Patient affiliated with a Social Security system. Exclusion Criteria: Prior systemic treatment such as checkpoint inhibitors or chemotherapy. Patients with cSCC or AK localized on visible zone of the face or folds

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Patients with actinic keratoses<br> | Other: biopsy<br>* Skin biopsies will be performed according to standard practices in the usual aseptic conditions, the operator wearing sterile gloves. A circular knife 3 mm will be used. Procedure interventions do not involve a drug or a device.<br>|
| Experimental: patients with squamous cell carcinoma in situ<br> | Other: biopsy<br>* Skin biopsies will be performed according to standard practices in the usual aseptic conditions, the operator wearing sterile gloves. A circular knife 3 mm will be used. Procedure interventions do not involve a drug or a device.<br>|
| Experimental: patients with squamous cell carcinomas<br> | Other: biopsy<br>* Skin biopsies will be performed according to standard practices in the usual aseptic conditions, the operator wearing sterile gloves. A circular knife 3 mm will be used. Procedure interventions do not involve a drug or a device.<br>|
| Experimental: patient with invasive metastates<br> | Other: biopsy<br>* Skin biopsies will be performed according to standard practices in the usual aseptic conditions, the operator wearing sterile gloves. A circular knife 3 mm will be used. Procedure interventions do not involve a drug or a device.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of patients who have a glycolysis profile (proteomic analysis liquid chromatography-mass spectrometry (LC-MS/MS)) | Metabolic profiling of different stages of carcinogenesis: glycolysis, oxidative phosphorylation | Day 1 | 
| Proportion of patients who have an oxidative profile (proteomic analysis liquid chromatography-mass spectrometry (LC-MS/MS)) | Metabolic profiling of different stages of carcinogenesis: glycolysis, oxidative phosphorylation | Day 1 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluation of skin differentiation markers | % of samples in each category (AK, in situ, ...) that present differentiation features are assessed by immunostaining of loricrin, filaggrin, K10 | Day 1 | 
| Evaluation of cSCC aggressiveness markers | % of samples expressing aggressive markers will be assessed by evaluating the proliferation index, degree of differentiation, invasion beyond subcutaneous fat, perineural invasion, vascular invasion level of infiltration following immunohistochemistry analyses on formalin-fixed paraffin-embedded tissue sections. | Day 1 | 
| Evaluation of skin apoptotic markers | % of samples with high apoptotic cell death level will be assessed by immunostaining using antibody against cleaved caspase-3. | Day 1 | 
| Evaluation of mitochondrial metabolism on skin biopsies | % of samples with high mitochondrial activity will be evaluated by comparing oxygen consumption rate by different fresh samples. | Day 1 | 
| Evaluation of cancer proliferative features on skin biopsies | % of samples that are highly proliferative will be calculated by measuring the ability of colony formation (SRB Test) and cell cycle progression (flow cytometer, western). | Day 1 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Actinic keratosis, mitochondria, metabolism