Kaplan-Meier Analysis Of Overall Survival Research Articles

Outcome of prostate cancer with CNS metastasis: An analysis of SEER database (2010-2020).

e17037 Background: Brain metastasis from prostate cancer is rare, with an estimated incidence of <1%, and its characteristics and outcomes are poorly understood. We report a contemporary analysis of outcomes in patients with CNS metastasis from prostate cancer in association with clinicopathological variables by utilizing the Survival, Epidemiology, and End Result (SEER) database with data from 2010 to 2020. Methods: From the SEER database, we identified histologically confirmed primary prostate cancers with any distant metastasis. Data for survival as well as multiple clinicopathological variables including age, race, prostate-specific antigen (PSA) level, Gleason score, prior radiotherapy, histology, and specific metastatic sites were extracted. Statistical analysis included chi-square. ANOVA, and Kaplan-Meier analysis for overall survival (OS) and disease-specific survival. Results: SEER database (2010-2020) identified 27,501 patients with metastatic prostate cancer, of which 27,118 (98.6%) were adenocarcinoma and 383 (1.4%) were prostate cancer with neuroendocrine features. Brain metastasis was seen in 282 (1.04%) and 15 (5.32%) patients in these histologic groups, respectively. Brain metastases were associated with worse prognosis with median OS of 14 months compared to bone-dominant and non-regional lymph node only diseases that showed median OS of 31 months and not reached, respectively (P < 0.01). Within the population with brain metastases, outcome comparison based on age (<65 vs. ≥65 years), ethnicity (Caucasian vs. African American vs. Hispanic), PSA (<98 vs. ≥98 ng/ml), and Gleason score (<9 vs. ≥9) showed no statistically significant difference (table). Presence of metastasis to other solid organs showed numerically worse outcome without statistical significance (OS: 26 months vs. 13 months, p=0.09). Significant OS difference was observed between the adenocarcinoma and neuroendocrine tumor within the brain metastasis subgroup (OS: 14 months vs. 6 months, p=0.03). Conclusions: CNS metastasis with prostate cancer carries worse prognosis in comparison to metastases to bone or distant lymph-nodes. Neuroendocrine tumor has higher risk of CNS metastasis although most of such cases are from adenocarcinoma due to its higher prevalence. OS analysis confirms worse outcome with neuroendocrine features compared to adenocarcinoma in CNS metastatic settings. [Table: see text]

Outcome of prostate cancer with CNS metastasis: An analysis of SEER database (2010-2020).

e17037 Background: Brain metastasis from prostate cancer is rare, with an estimated incidence of <1%, and its characteristics and outcomes are poorly understood. We report a contemporary analysis of outcomes in patients with CNS metastasis from prostate cancer in association with clinicopathological variables by utilizing the Survival, Epidemiology, and End Result (SEER) database with data from 2010 to 2020. Methods: From the SEER database, we identified histologically confirmed primary prostate cancers with any distant metastasis. Data for survival as well as multiple clinicopathological variables including age, race, prostate-specific antigen (PSA) level, Gleason score, prior radiotherapy, histology, and specific metastatic sites were extracted. Statistical analysis included chi-square. ANOVA, and Kaplan-Meier analysis for overall survival (OS) and disease-specific survival. Results: SEER database (2010-2020) identified 27,501 patients with metastatic prostate cancer, of which 27,118 (98.6%) were adenocarcinoma and 383 (1.4%) were prostate cancer with neuroendocrine features. Brain metastasis was seen in 282 (1.04%) and 15 (5.32%) patients in these histologic groups, respectively. Brain metastases were associated with worse prognosis with median OS of 14 months compared to bone-dominant and non-regional lymph node only diseases that showed median OS of 31 months and not reached, respectively (P < 0.01). Within the population with brain metastases, outcome comparison based on age (<65 vs. ≥65 years), ethnicity (Caucasian vs. African American vs. Hispanic), PSA (<98 vs. ≥98 ng/ml), and Gleason score (<9 vs. ≥9) showed no statistically significant difference (table). Presence of metastasis to other solid organs showed numerically worse outcome without statistical significance (OS: 26 months vs. 13 months, p=0.09). Significant OS difference was observed between the adenocarcinoma and neuroendocrine tumor within the brain metastasis subgroup (OS: 14 months vs. 6 months, p=0.03). Conclusions: CNS metastasis with prostate cancer carries worse prognosis in comparison to metastases to bone or distant lymph-nodes. Neuroendocrine tumor has higher risk of CNS metastasis although most of such cases are from adenocarcinoma due to its higher prevalence. OS analysis confirms worse outcome with neuroendocrine features compared to adenocarcinoma in CNS metastatic settings. [Table: see text]

Abstract 4889: Integrative multi-omic analysis reveals novel prognostic biological entities in pediatric medulloblastoma

Abstract Medulloblastoma is a cerebellar tumor for which relapses are associated with poor survival rates of less than 5%. Molecular heterogeneity and dose-limiting toxicities that occur with standard of care approaches, which include surgical resection, craniospinal irradiation, and chemotherapy, complicate the treatment of both primary and recurrent medulloblastoma due to adverse long-term sequela. While the integration of molecular analyses into the histopathology of pediatric medulloblastomas has changed the way these diseases are diagnosed, classified, and treated, there remains an unmet need to further understand the underpinnings of the disease to improve clinical outcomes and minimize neuronal, cognitive, and hormonal toxicities that occur with standard-of-care therapies. We therefore aimed to investigate novel subgroups of pediatric medulloblastoma as a basis for further defining biological properties and targets for the disease through multi-omic characterization. We derived single-nucleotide variant, copy number variant, expression, alternative splicing, and methylation array data from pediatric medulloblastomas profiled as part of the Children’s Brain Tumor Network (CBTN) and the Open Pediatric Cancer (OpenPedCan) projects. Using non-negative matrix factorization across the five datasets derived from genomic, transcriptomic, and epigenomic profiling, we identified 14 clusters found to be prognostically significant by Kaplan-Meier analysis of overall survival (p < 0.0001). Our model further subdivided sonic hedgehog (SHH) and Group 3/4 tumors, but not Wnt-driven tumors, suggesting that the latter forms a homogeneous molecular subgroup. Among our subgroups, we recapitulated the four classically defined medulloblastoma subtypes known to be associated with mutations in KDM6A, KMT2C, CTNNB1, PTCH1, TP53, KBTBD4, MYC, and MYCN. Cascading biological relationships across the copy number, methylation, and expression domains were observed among novel subgroups, potentially driving migratory, immuno-regulatory, GPCR-related, growth factor-related, and histone methylation biological programs. A comparison of subgroup expression profiles to transcriptional signatures from the Library of Integrated Network-Based Cellular Signatures (LINCS) program identified canonical oncogenic pathways unique to each subgroup as potentially targetable, including, but not limited to, MAPK, VEGFA, inflammatory, fatty acid metabolic, and PI3K/AKT signaling. Our work uncovers novel biological entities in pediatric medulloblastoma potentially driven by higher order mechanisms across the genome, transcriptome, and epigenome, with the possibility of informing novel precision medicine approaches for the disease. Citation Format: Komal Rathi, Varun Kesherwani, Ammar S. Naqvi, Yuankun Zhu, Alex Sickler, Xiaoyan Huang, Bo Zhang, Brian Rood, Adam C. Resnick, Adam A. Kraya. Integrative multi-omic analysis reveals novel prognostic biological entities in pediatric medulloblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4889.

Survival benefit of surgery for second primary esophageal cancer following gastrointestinal cancer: a population-based study

BackgroundThe incidence of second primary malignancy is increasing. However, although there is some information on second primary esophageal cancer (SPEC) itself, there is no study or guideline on the use of surgery for SPEC after gastrointestinal cancer (SPEC-GC). Thus, this study aimed to gather evidence for the benefits of surgery by analyzing a national cohort and determining the prognostic factors and clinical treatment decisions for SPEC-GC. MethodsData for patients with SPEC-GC were obtained from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2019. The prognostic factors of SPEC-GC were investigated by stepwise Cox proportional hazards regression and Kaplan-Meier analyses for overall survival and cancer-specific survival. ResultsA total of 8308 patients with SPEC were selected, including 582 patients with SPEC-GC. Multivariate analysis revealed that surgery, year of diagnosis, scope of regional lymph node surgery, tumor differentiation grade, SEER historic stage, and triple therapy were significant predictors of survival outcomes (P < .05). Surgery seemed to improve the prognosis of patients with SPEC-GC significantly compared with no surgery and chemoradiotherapy (P < .001). ConclusionsSurgery should be considered as the main treatment for SPEC-GC. Surgery, year of diagnosis, scope of regional lymph node surgery, tumor differentiation grade, SEER historic stage, and triple therapy were found to be independent prognostic factors for these patients. These factors should be considered in the clinical diagnosis and treatment of SPEC-GC.

The immune checkpoint adenosine 2A receptor is associated with aggressive clinical outcomes and reflects an immunosuppressive tumor microenvironment in human breast cancer.

The crosstalk between the immune system and cancer cells has aroused considerable interest over the past decades. To escape immune surveillance cancer cells evolve various strategies orchestrating tumor microenvironment. The discovery of the inhibitory immune checkpoints was a major breakthrough due to their crucial contribution to immune evasion. The A2AR receptor represents one of the most essential pathways within the TME. It is involved in several processes such as hypoxia, tumor progression, and chemoresistance. However, its clinical and immunological significance in human breast cancer remains elusive. The mRNA expression and protein analysis were performed by RT-qPCR and immunohistochemistry. The log-rank (Mantel-Cox) test was used to estimate Kaplan-Meier analysis for overall survival. Using large-scale microarray data (METABRIC), digital cytometry was conducted to estimate cell abundance. Analysis was performed using RStudio software (7.8 + 2023.03.0) with EPIC, CIBERSORT, and ImmuneCellAI algorithms. Tumor purity, stromal and immune scores were calculated using the ESTIMATE computational method. Finally, analysis of gene set enrichment (GSEA) and the TISCH2 scRNA-seq database were carried out. Gene and protein analysis showed that A2AR was overexpressed in breast tumors and was significantly associated with high grade, elevated Ki-67, aggressive molecular and histological subtypes, as well as poor survival. On tumor infiltrating immune cells, A2AR was found to correlate positively with PD-1 and negatively with CTLA-4. On the other hand, our findings disclosed more profuse infiltration of protumoral cells such as M0 and M2 macrophages, Tregs, endothelial and exhausted CD8+ T cells within A2ARhigh tumors. According to the Single-Cell database, A2AR is expressed in malignant, stromal and immune cells. Moreover, it is related to tumor purity, stromal and immune scores. Our results also revealed that CD8+T cells from A2ARhigh patients exhibited an exhausted functional profile. Finally, GSEA analysis highlighted the association of A2AR with biological mechanisms involved in tumor escape and progression. The present study is the first to elucidate the clinical and immunological relevance of A2AR in breast cancer patients. In light of these findings, A2AR could be deemed a promising therapeutic target to overcome immune evasion prevailing within the TME of breast cancer patients.

Dual-Time-Point Posttherapy 177Lu-PSMA-617 SPECT/CT Describes the Uptake Kinetics of mCRPC Lesions and Prognosticates Patients' Outcome.

177Lu-PSMA-617 is an effective therapeutic option in metastasized castration-resistant prostate cancer (mCRPC). However, some patients progress under treatment. We hypothesized that the tracer kinetics within the metastases may influence the therapy effectiveness and tested this hypothesis by analyzing uptake parameters on 2 consecutive posttherapy SPECT/CT scans. Methods: mCRPC patients treated with 177Lu-PSMA-617 and with available posttherapy SPECT/CT imaging (24 and 48 h after the first treatment) were enrolled retrospectively. Volumes of interest were defined on lymph node metastasis (LNM) and bone metastasis (BM) on both SPECT/CT scans. The reduction of the percentage injected dose (%IDred) between the 2 SPECT/CT scans was computed. We compared %IDred of responders (prostate-specific antigen drop ≥ 50% after 2 cycles of 177Lu-PSMA-617) and nonresponders. We tested the association of %IDred with progression-free survival and overall survival (OS) using a univariate Kaplan-Meier (KM) analysis and a multivariate Cox regression model. Results: Fifty-five patients (median age, 73 y; range, 54-87 y) were included. %IDred in LNM and BM was greater in nonresponders than in responders (for LNM, 36% in nonresponders [interquartile range (IQR), 26%-47%] vs. 24% in responders [IQR, 12%-33%] [P = 0.003]; for BM, 35% in nonresponders [IQR, 27%-52%] vs. 18% in responders [IQR, 15%-29%] [P = 0.002]). For progression-free survival, in KM analysis, greater %IDred in LNM (P = 0.008) and BM (P = 0.001) was associated with shorter survival, whereas in multivariate analysis, only %IDred in LNM was retained (P = 0.03). In univariate KM analysis of OS, greater %IDred in BM was associated with shorter survival (P = 0.002). In multivariate OS analysis, BM %IDred (P = 0.009) was retained. Conclusion: The 177Lu-PSMA-617 clearance rate from mCRPC metastases appears to be a relevant prognosticator of response and survival, with faster clearing possibly signaling a shorter radiopharmaceutical residence time and absorbed dose. Dual-time-point analysis appears to be a feasible and readily available approach to estimate the likelihood of response and patients' survival.

Prognostic Predictability of 2022 European Leukemianet (ELN) Risk Stratification in the Real World

Introduction The European LeukemiaNet (ELN) reported 2022 guideline of the recommendation for diagnosis and management of acute myeloid leukemia (AML). Compared to 2017, ELN 2022 recommendation has some significant changes in risk classification. First, an exclusion of the FLT3-ITD allelic ratio in the risk classification, and FLT-ITD without NPM1 mutation is no longer classified as adverse risk because of the incorporation of FLT3 inhibitor. Next, in-frame mutations affecting the basic leucine zipper region (bZIP) of CEBPA regardless of monoallelic or biallelic is classified as favorable risk group. Another important change is the inclusion of myelodysplasia-related gene mutations, and patients with these gene mutations are now categorized as adverse risk group. The purpose of this study was to verify and compare the prognostic predictability between previous and new recommendation in the real world. Patients and methods A total of 624 patients who were newly diagnosed with AML from October 1998 to October 2014 in seven institutions were included in this study. Patients who achieved complete remission (CR) received consolidation chemotherapy with or without allogeneic hematopoietic stem cell transplantation (HCT), depending on the availability of a matched donor. Genetic factors were not considered while considering allogeneic HCT. Cryopreserved bone marrow or peripheral blood samples obtained at diagnosis were archived. Genomic DNA was extracted using QIAamp DNA blood mini-kits (Qiagen, Valencia, CA, USA) according to the manufacturer's protocol. Genetic profiling included the targeted deep sequencing of 45 genes, which had been selected based on recurrent driver mutations from previous studies. Agilent custom probes were designed to cover the entire exon regions of targeted genes and sequenced using an Illumina HiSeq 2000 sequencer. The threshold of mutation positivity was defined as a variant allele frequency≥2%. Results All of the 624 patients were older than 18 years and age with median age was 51 years (range 18-84). All patients were treated with induction chemotherapy using a standard 3+7 protocol, and 523 patients (83.8%) achieved CR. Among them, 235 patients (44.9%) proceeded to allogeneic HCT. After median follow-up of 84.4 months, median overall survival (OS) was 22.0 months and median event-free survival (EFS) was 16.2 months in all patients. By applying the 2022 ELN risk classification, each risk groups showed significant prognostic difference with Kaplan-Meier analysis of OS (P<0.001) and EFS (P<0.001) in all patients. According to ELN 2017 risk stratification, 218 patients (34.9%) were in favorable risk group, 298 patients (47.8%) were in intermediate risk group, and 108 patients (17.3%) were in adverse risk group. Among the previously favorable group, 31 patients were reclassified as intermediate risk group and 3 patients as adverse risk group, and there was no significant prognostic difference in OS (P=0.289) and EFS (P=0.279) between patients newly classified as favorable risk group and those reclassified as intermediate or adverse risk groups. But in patients without allogeneic HCT, favorable group by 2022 edition showed significantly longer OS (P=0.003) and EFS (P<0.000) than intermediate or adverse groups. Among the previously intermediate risk group patients, 21 patients were reclassified as favorable group and 46 patients as adverse risk group, and each group showed significant difference of OS (P<0.001) and EFS (P<0.001). Also, in adverse risk group patients by the 2017 edition, 33 patients were reclassified as intermediate risk group. Because the anti-FLT3 inhibitor therapy was not available at that times, patients who reclassified as intermediate group showed no survival difference compared to the patients remaining in the adverse group. The survival analyses comparing ELN 2017 and ELN 2022 are described in figure 1. Conclusion ELN 2022 guideline is superior to the ELN 2017 for risk stratification and better predicts the prognosis of patients with AML in the real world. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Utilization of Antifungal Prophylaxis and Treatment for Newly Diagnosed AML Patients Treated with Venetoclax Based Regimens in Routine Clinical Practice - a Prospective Analysis from the Revive Study

Background: Venetoclax (VEN)-based low intensity combinations are approved for the treatment of patients (pts) with acute myeloid leukemia (AML) ineligible for intensive chemotherapy. These combinations can be associated with prolonged cytopenias in particular neutropenia. Invasive fungal infections (IFIs) remain a major cause of morbidity and mortality in pts with AML but their incidence and impact on pts treated with VEN-based low intensity approach are uncertain. In the current study we assess real-world patterns of IFI's and antifungal treatments among newly-diagnosed (ND) AML patients treated with VEN-based low intensity therapies. Methods: The REVIVE study is a prospective, real-life, observational study that assesses patterns of pt. selection, efficacy and toxicity. ND pts with AML were enrolled at the time of VEN-based therapy initiation from 12 medical centers in Israel. Demographic, clinical and pt.-related baseline characteristics were documented. Antifungal medication selection for prophylaxis or therapy use and the incidence of IFIs were documented. The impact of prophylactic antifungal use on the incidence of IFIs and on leukemia related outcomes were assessed. Results: Between August 12, 2019, and April 15, 2022(data cut) ,189 AML pts were enrolled to receive VEN based therapy. Overall, the incidence of possible IFIs was relatively low and was observed in 17 patients (9% of patients). 23 pts (12.1%) were reported to have received prophylactic antifungal treatment, whereas 166 pts (87.8%) did not receive. Baseline characteristics of these two groups are shown in Table 1. Of note, pts. receiving antifungal prophylaxis were more likely to be treated as outpatients. A trend towards treatment in a tertiary center and unfavorable ELN risk was observed in pts. receiving antifungal prophylaxis vs. pts not receiving prophylaxis. All other characteristics seemed equally balanced between both groups. Antifungal prophylaxis included fluconazole (18 pts), voriconazole (6 pts) and posaconzole (1 pt). Of note, 2 patients received two different prophylactic treatments. The incidence of IFIs was not reduced in pts receiving antifungal prophylaxis. Of the 23 patients who received antifungal prophylaxis, 4 were considered to have an IFI (17.4%) compared with 13 in the non-prophylactic group (7.8%). Antifungal treatment in pts with an IFI included fluconazole (10pts) voriconazole (5 pts) posaconazole (1 pt) amphotericin B (1 pt) and anidulafungin (1pt). Of note, 3 patients received two different antifungal treatments. No difference in 30-day mortality was observed between the two groups:1 pt in the prophylaxis group died compared with 8 pts in the no-prophylaxis group (4.3% vs 4.8% respectively, p=0.92). Prophylactic antifungal treatment did not affect the rate of adverse events (AEs) leading to treatment discontinuation: 4 pts in the prophylaxis group and 31 pts in the no prophylaxis group discontinued VEN based treatment due to adverse events (17.4% vs 18.7%, p=0.88). The efficacy of VEN based treatment for AML was similar between pts who received or did not receive antifungal prophylaxis. Composite complete remission (CRc) rates were 60.9% in the antifungal prophylaxis group vs 54.2% in pts with no antifungal prophylaxis (p=0.54). A Kaplan-Meier analysis for overall survival (OS) showed no difference between the prophylaxis and no prophylaxis groups (p=0.505). 1year OS rates were: 50.6% (CI 28-73.3) and 39.4% (CI 30.5-48.3) for prophylaxis and no prophylaxis groups respectively. Median follow up in the prophylaxis group was 237 days (CI 56-878) compared with 173 days (CI 19-850) in the no-prophylaxis group. Conclusion: In this prospective 'real world' observational study, a low rate of IFIs were noted despite low utilization rates of antifungal prophylaxis, mostly with non-mold active azoles. Moreover, administration of antifungal prophylaxis was not associated with a reduced incidence of IFIs. Reassuringly, use of antifungal azoles as prophylactic treatment, which requires VEN dose adjustments, did not affect CRc and OS rates. Similarly, azole based prophylaxis did not affect for the rate of treatment discontinuation due to AEs or early mortality. This study does not support the routine use of antifungal prophylaxis and suggests that such treatment is safe if deemed necessary. Additional insights on antifungal treatment patterns and strategies are pending. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Radiation-induced eosinophil increase ratio predicts patient outcomes in non-small celllung cancer.

Background and purposeRadiotherapy (RT) is a double-edged sword in regulating immune responses. This study aimed to investigate the impact of thoracic RT on circulating eosinophils and its association with patient outcomes in non-small cell lung cancer (NSCLC).Materials and methodsThis retrospective study included 240 patients with advanced NSCLC treated with definitive thoracic RT from January 2012 to January 2020. Statistics included Kaplan-Meier analysis of overall survival (OS) and progression-free survival (PFS), multivariate Cox analyses to identify significant variables, and Spearman’s correlation to qualify the relationship between dose-volume histogram (DVH) parameters and EIR.ResultsAbsolute eosinophil counts (AECs) showed an increasing trend during RT and an obvious peak in the 1st month after RT. Thresholds of eosinophil increase ratio (EIR) at the 1st month after RT for both OS and PFS were 1.43. Patients with high EIR above 1.43 experienced particularly favorable clinical outcomes (five-year OS: 21% versus 10%, P<0.0001; five-year PFS: 10% versus 8%, P=0.014), but may not derive PFS benefit from the addition of chemotherapy to RT. The higher a patient’s EIR, the larger the potential benefit in the absence of chemotherapy. DVH parameters including heart mean dose and heart V10 were negatively associated with EIR. None of these DVH parameters was correlated with the clinical outcomes.ConclusionEIR may serve as a potential biomarker to predict OS and PFS in NSCLC patients treated with RT. These findings require prospective studies to evaluate the role of such prognostic marker to identify patients at risk to tailor interventions.

Novel 3D magnetic resonance fingerprinting radiomics in adult brain tumors: a feasibility study.

To test the feasibility of using 3D MRF maps with radiomics analysis and machine learning in the characterization of adult brain intra-axial neoplasms. 3D MRF acquisition was performed on 78 patients with newly diagnosed brain tumors including 33 glioblastomas (grade IV), 6 grade III gliomas, 12 grade II gliomas, and 27 patients with brain metastases. Regions of enhancing tumor, non-enhancing tumor, and peritumoral edema were segmented and radiomics analysis with gray-level co-occurrence matrices and gray-level run-length matrices was performed. Statistical analysis was performed to identify features capable of differentiating tumors based on type, grade, and isocitrate dehydrogenase (IDH1) status. Receiver operating curve analysis was performed and the area under the curve (AUC) was calculated for tumor classification and grading. For gliomas, Kaplan-Meier analysis for overall survival was performed using MRF T1 features from enhancing tumor region. Multiple MRF T1 and T2 features from enhancing tumor region were capable of differentiating glioblastomas from brain metastases. Although no differences were identified between grade 2 and grade 3 gliomas, differentiation between grade 2 and grade 4 gliomas as well as between grade 3 and grade 4 gliomas was achieved. MRF radiomics features were also able to differentiate IDH1 mutant from the wild-type gliomas. Radiomics T1 features for enhancing tumor region in gliomas correlated to overall survival (p < 0.05). Radiomics analysis of 3D MRF maps allows differentiating glioblastomas from metastases and is capable of differentiating glioblastomas from metastases and characterizing gliomas based on grade, IDH1 status, and survival. • 3D MRF data analysis using radiomics offers novel tissue characterization of brain tumors. • 3D MRF with radiomics offers glioma characterization based on grade, IDH1 status, and overall patient survival.

No Evidence that CD33 rs12459419 Polymorphism Predicts Gemtuzumab Ozogamicin Response in Consolidation Treatment of Acute Myeloid Leukemia Patients: Experience of the PETHEMA Group.

Gemtuzumab ozogamicin (GO) is a conjugate of a monoclonal antibody and calicheamicin, which has been reapproved for the treatment of acute myeloid leukemia (AML). AML patients with the CD33 rs12459419 CC genotype might benefit from the addition of GO to intensive treatment in contrast to patients with CT/TT genotypes. Nevertheless, contradictory results have been reported. We sought to shed light on the prediction of GO response in AML patients with rs12459419 polymorphism who were treated with GO in the consolidation (n = 70) or reinduction (n = 20) phase. The frequency distribution of the rs12459419 polymorphism in the complete cohort of patients was 44.4% (n = 40), 50% (n = 45), and 5.6% (n = 5) for CC, CT, and TT genotypes, respectively. Regarding the patients treated with GO for consolidation, we performed a Kaplan-Meier analysis of overall survival and relapse-free survival according to the rs12459419 polymorphism (CC vs. CT/TT patients) and genetic risk using the European Leukemia Net (ELN) 2010 risk score. We also carried out a Cox regression analysis for the prediction of overall survival, with age and ELN 2010 as covariates. We found no statistical significance in the univariate or multivariate analysis. Additionally, we performed a global Kaplan-Meier analysis for the patients treated with GO for reinduction and did not find significant differences; however, our cohort was too small to draw any conclusion from this analysis. The use of GO in consolidation treatment is included in the approval of the compound; however, evidence regarding its efficacy in this setting is lacking. Rs12459419 polymorphism could help in the selection of patients who might benefit from GO. Regrettably, in our cohort, the rs12459419 polymorphism does not seem to be an adequate tool for the selection of patients who might benefit from the addition of GO in consolidation cycles.

Comprehensive analysis to identify the neurotransmitter receptor-related genes as prognostic and therapeutic biomarkers in hepatocellular carcinoma.

Background: Hepatocellular carcinoma (HCC) is a highly heterogeneous disease with high morbidity and mortality, which accounts for the fourth most common cause of cancer-related deaths. Reports suggest that the neurotransmitter receptor-related genes (NRGs) may influence the tumor microenvironment and the prognosis of patients with HCC. Methods: The clinical information and RNA-seq data of patients with HCC were acquired from the ICGC-LIRI-JP dataset and the TCGA-LIHC dataset. Effects of 115 NRGs on the prognosis of HCC patients were analyzed in the ICGC-LIRI-JP dataset. The least absolute shrinkage and selection operator (LASSO) regression model was utilized to generate a risk score formula based on the critical NRGs. Next, the risk score effectiveness was validated both in the TCGA-LIHC dataset and in our clinical HCC samples. Based on the risk scores, patients with HCC were divided into two groups. Moreover, differentially expressed genes (DEGs) were screened. The gene ontology (GO) was used to analyze the functional enrichments of DEGs and to identify potential signaling pathways. To test the diagnostic effectiveness of our model, the receiver operator characteristic curve (ROC) analysis and nomogram were used. Finally, potential targeted drug prediction was performed based on DEGs of nine clinical HCC samples. Results: Nine NRGs were correlated significantly with the prognosis of patients with HCC, and eight NRGs were successfully included in the LASSO regression model. The Kaplan-Meier analysis of overall survival (OS) suggested that patients in the high-risk score group had worse prognosis; on the other hand, ROC analysis revealed a high prognostic value of the risk score in HCC. Several critical signaling pathways, such as lipid metabolism, organic acid metabolism, cell migration, cell adhesion, and immune response, were enriched both in public datasets and clinical samples. Nomogram results also suggested that the risk scores correlated well with the patients’ prognosis. Potential targeted drugs prediction revealed that tubulin inhibitors might be the promising drugs for patients with HCC who have high risk scores based on the NRGs. Conclusion: We established a prognostic model based on critical NRGs. NRGs show a promising prognostic prediction value in HCC and are potential therapeutic targets for the disease treatment.

Discovery of novel RNA transcripts for endometrial cancer with copy-number high alterations using pan-cancer analysis of whole genomes (PCAWG) endometrial cancer dataset (275)

<b>Objectives:</b> Uterine serous carcinoma is an aggressive type of endometrial cancer that has a propensity for metastatic spread and disproportionately affects Black women. Several new drugs are being evaluated in clinical trials for uterine serous carcinoma, including trastuzumab, pembrolizumab - lenvatinib combination, and adavosertib. However, additional treatment options are greatly needed. The Cancer Genome Atlas (TCGA) endometrial cancer project has shown that endometrial cancer can be broadly divided into four molecular classifications. Within the four molecular subtypes, the copy-number high group consists of high-grade endometrioid carcinoma and uterine serous carcinoma, which are characterized by frequent <i>TP53</i> mutation and somatic copy number alterations. To better understand the biology of this aggressive subset of endometrial cancer, we have performed bioinformatic analysis using the dataset from the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium of the International Cancer Genome Consortium (ICGC) and TCGA. <b>Methods:</b> To better understand the biology of uterine serous carcinoma, we sought to identify novel or poorly characterized genes using the PCAWG dataset. We analyzed the RNA sequencing data from the TCGA endometrial cancer dataset, focusing on the copy-number high group. Genes that are highly expressed in the copy-number high endometrial cancer were identified by comparing the gene expression profiles between the copy-number high endometrial cancer dataset to genes expressed in normal endometrium obtained from the PCAWG project. Survival outcomes for genes of interest were evaluated using Kaplan-Meier Plotter, containing survival data extracted from the TCGA endometrial cancer dataset. <b>Results:</b> RNA transcripts that were significantly upregulated in copy-number high endometrial cancer were identified. Three of the most significantly upregulated transcripts were claudin-6 (<i>CLDN6</i>), cancer-testis antigen <i>MAGEA9B</i>, and long non-coding RNA <i>LINC01833</i>. Kaplan-Meier analysis of overall survival showed that high <i>CLDN6</i> expression was associated with worse overall survival when compared to low <i>CLDN6</i> expression (HR: 2.04 in White patients, p=0.0037; HR: 7.35 in Black patients, p=0.0002). High expression of <i>MAGEA9B</i> was also associated with worse overall survival than low <i>MAGEA9B</i> expression (HR: 1.78 in White patients, p=0.022; HR: 5.69 in Black patients, p=0.000033). In contrast, high expression of long non-coding RNA <i>LINC02159</i> was not associated with significant alteration in overall survival (HR: 1.28 in White patients, p=0.34, HR: 0.52 in Black patients, p=0.17). <b>Conclusions:</b> Integrated genomic analysis of the TCGA endometrial cancer dataset led to the identification of several novels, previously uncharacterized RNA transcripts that are associated with poor prognosis in copy-number high endometrial cancer. Further characterization of these transcripts in uterine serous carcinoma will improve our understanding of the biology of this disease and lead to novel therapeutic options.

Molecular Differences between Squamous Cell Carcinoma and Adenocarcinoma Cervical Cancer Subtypes: Potential Prognostic Biomarkers.

The most frequently diagnosed histological types of cervical cancer (CC) are squamous cell carcinoma (SCC) and adenocarcinoma (ADC). Clinically, the prognosis of both types is controversial. A molecular profile that distinguishes each histological subtype and predicts the prognosis would be of great benefit to CC patients. Methods: The transcriptome of CC patients from The Cancer Genome Atlas (TCGA) was analyzed using the DESeq2 package to obtain the differentially expressed genes (DEGs) between ADC and SCC. The DEGs were validated on a publicly available Mexican-Mestizo patient transcriptome dataset (GSE56303). The global biological pathways involving the DEGs were obtained using the Webgestalt platform. The associations of the DEGs with Overall Survival (OS) were assessed. Finally, three DEGs were validated by RT-qPCR in an independent cohort of Mexican patients. Results. The molecular profiles of ADC and SCC of the CC patients of the TCGA database and the Mexican-Mestizo cohort (GSE56303) were determined obtaining 1768 and 88 DEGs, respectively. Strikingly, 70 genes were concordant—with similar Log2FoldChange values—in both cohorts. The 70 DEGs were involved in IL-17, JAK/STAT, and Ras signaling. Kaplan-Meier OS analysis from the Mexican-Mestizo cohort showed that higher GABRB2 and TSPAN8 and lower TMEM40 expression were associated with better OS. Similar results were found in an independent Mexican cohort. Conclusions: Molecular differences were detected between the ADC and SCC subtypes; however, further studies are required to define the appropriate prognostic biomarker for each histological type.

Survival and Toxicities after 90Y Transarterial Radioembolization of Metastatic Colorectal Cancer in the RESIN Registry.

Background Patients with unresectable, chemorefractory hepatic metastases from colorectal cancer have considerable mortality. The role of transarterial radioembolization (TARE) with yttrium 90 (90Y) microspheres is not defined because most reports are from a single center with limited patient numbers. Purpose To report outcomes in participants with colorectal cancer metastases treated with resin 90Y microspheres from a prospective multicenter observational registry. Materials and Methods This study treated enrolled adult participants with TARE using resin microspheres for liver-dominant metastatic colorectal cancer at 42 centers, with enrollment from July 2015 through August 2020. TARE was used as the first-, second-, or third-line therapy or beyond. Overall survival (OS), progression-free survival (PFS), and toxicity outcomes were assessed by line of therapy by using Kaplan-Meier analysis for OS and PFS and Common Terminology Criteria for Adverse Events, version 5, for toxicities. Results A total of 498 participants (median age, 60 years [IQR, 52-69 years]; 298 men [60%]) were treated. TARE was used in first-line therapy in 74 of 442 participants (17%), second-line therapy in 180 participants (41%), and third-line therapy or beyond in 188 participants (43%). The median OS of the entire cohort was 15.0 months (95% CI: 13.3, 16.9). The median OS by line of therapy was 13.9 months for first-line therapy, 17.4 months for second-line therapy, and 12.5 months for third-line therapy (χ2 = 9.7; P = .002). Whole-group PFS was 7.4 months (95% CI: 6.4, 9.5). The median PFS by line of therapy was 7.9 months for first-line therapy, 10.0 months for second-line therapy, and 5.9 months for third-line therapy (χ2 = 8.3; P = .004). TARE-attributable grade 3 or 4 hepatic toxicities were 8.4% for bilirubin (29 of 347 participants) and 3.7% for albumin (13 of 347). Grade 3 and higher toxicities were greater with third-line therapy for bilirubin (P = .01) and albumin (P = .008). Conclusion Median overall survival (OS) after transarterial radioembolization (TARE) with yttrium 90 microspheres for liver-dominant metastatic colorectal cancer was 15.0 months. The longest OS was achieved when TARE was part of second-line therapy. Grade 3 or greater hepatic function toxicity rates were less than 10%. Clinical trial registration no. NCT02685631 Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Liddell in this issue.

Better Understanding the Timing Of Androgen Deprivation Trial Outcomes: Impacts of Prior Androgen Deprivation Therapy.

BackgroundThe Timing Of Androgen Deprivation (TOAD) trial found an overall survival benefit for immediate vs delayed androgen deprivation therapy (ADT) for prostate-specific antigen (PSA)–relapsed or noncurable prostate cancer. However, broad eligibility criteria allowed entry of a heterogeneous participant group, including those with prior ADT exposure, raising concerns about subsequent androgen sensitivity. For these reasons, we completed previously specified subgroup analyses to assess if prior ADT was associated with ADT timing efficacy after PSA relapse.MethodsWe examined TOAD trial patient-level data for participants with PSA relapse after local therapy. We performed Kaplan-Meier analyses for overall survival stratified by prior ADT and randomized treatment arm (immediate or delayed ADT). We compared group characteristics using Mann-Whitney U and Fisher exact tests. All hypothesis tests were 2-sided.ResultsWe identified 261 patients with PSA relapse, 125 of whom received prior ADT. Patients with prior ADT had higher PSA at presentation (12.1 vs 9.0 ng/mL; P < .001), more cT3 disease (38.4% vs 25.0%; P = .007), and more likely received radiotherapy as local treatment (80.0% vs 47.8%; P < .001) but were otherwise similar to patients without prior ADT exposure. Within this prior ADT group, those who received immediate ADT (n = 56) had improved overall survival compared with those who received delayed ADT (n = 69; P = .02). This benefit was not observed in the group with no prior ADT (P = .98).ConclusionsThe survival benefit demonstrated in the TOAD trial may be driven by patients who received ADT prior to trial entry. We provide possible explanations for this finding with implications for treatment of PSA-relapsed prostate cancer and future study planning.

N6-methyladenosine-related non-coding RNAs are potential prognostic and immunotherapeutic responsiveness biomarkers for bladder cancer

BackgroundBladder cancer (BC) is a commonly occurring malignant tumor of the urinary system, demonstrating high global morbidity and mortality rates. BC currently lacks widely accepted biomarkers and its predictive, preventive, and personalized medicine (PPPM) is still unsatisfactory. N6-methyladenosine (m6A) modification and non-coding RNAs (ncRNAs) have been shown to be effective prognostic and immunotherapeutic responsiveness biomarkers and contribute to PPPM for various tumors. However, their role in BC remains unclear.Methodsm6A-related ncRNAs (lncRNAs and miRNAs) were identified through a comprehensive analysis of TCGA, starBase, and m6A2Target databases. Using TCGA dataset (training set), univariate and least absolute shrinkage and selection operator (LASSO) regression analyses were performed to develop an m6A-related ncRNA–based prognostic risk model. Kaplan-Meier analysis of overall survival (OS) and receiver operating characteristic (ROC) curves were used to verify the prognostic evaluation power of the risk model in the GSE154261 dataset (testing set) from Gene Expression Omnibus (GEO). A nomogram containing independent prognostic factors was developed. Differences in BC clinical characteristics, m6A regulators, m6A-related ncRNAs, gene expression patterns, and differentially expressed genes (DEGs)–associated molecular networks between the high- and low-risk groups in TCGA dataset were also analyzed. Additionally, the potential applicability of the risk model in the prediction of immunotherapeutic responsiveness was evaluated based on the “IMvigor210CoreBiologies” data set.ResultsWe identified 183 m6A-related ncRNAs, of which 14 were related to OS. LASSO regression analysis was further used to develop a prognostic risk model that included 10 m6A-related ncRNAs (BAALC-AS1, MIR324, MIR191, MIR25, AC023509.1, AL021707.1, AC026362.1, GATA2-AS1, AC012065.2, and HCP5). The risk model showed an excellent prognostic evaluation performance in both TCGA and GSE154261 datasets, with ROC curve areas under the curve (AUC) of 0.62 and 0.83, respectively. A nomogram containing 3 independent prognostic factors (risk score, age, and clinical stage) was developed and was found to demonstrate high prognostic prediction accuracy (AUC = 0.83). Moreover, the risk model could also predict BC progression. A higher risk score indicated a higher pathological grade and clinical stage. We identified 1058 DEGs between the high- and low-risk groups in TCGA dataset; these DEGs were involved in 3 molecular network systems, i.e., cellular immune response, cell adhesion, and cellular biological metabolism. Furthermore, the expression levels of 8 m6A regulators and 12 m6A-related ncRNAs were significantly different between the two groups. Finally, this risk model could be used to predict immunotherapeutic responses.ConclusionOur study is the first to explore the potential application value of m6A-related ncRNAs in BC. The m6A-related ncRNA–based risk model demonstrated excellent performance in predicting prognosis and immunotherapeutic responsiveness. Based on this model, in addition to identifying high-risk patients early to provide them with focused attention and targeted prevention, we can also select beneficiaries of immunotherapy to deliver personalized medical services. Furthermore, the m6A-related ncRNAs could elucidate the molecular mechanisms of BC and lead to a new direction for the improvement of PPPM for BC.

Interim Analysis of a Single Arm Phase II Study of Cpi-613 in Combination with High Dose Cytarabine and Mitoxantrone for Patients with Relapsed or Refractory AML

Background:CPI-613 is a first in class agent that inhibits pyruvate dehydrogenase (PDH) and α-ketoglutarate dehydrogenase. We have previously shown CPI-613 inhibits mitochondrial respiration, causes phosphorylation of PDH, activation of adenosine monophosphate activated kinase in acute myeloid leukemia (AML) cells. We also showed that CPI-163 could be safely combined with high dose cytarabine (HiDAC) and mitoxantrone in patients with relapsed or refractory AML. Early efficacy data suggested that this combination increased the response rate and prolonged survival in elderly patients when compared to historical data.Methods:We opened a Phase II trial of CPI-613 in combination with HiDAC and mitoxantrone for relapsed or refractory AML patients to confirm the safety and efficacy seen in the Phase I trial, as well as to expand several dosing cohorts. In the current trial, patients are given CPI-613 as a 2-hour infusion on days 1 through 5. HiDAC is dosed at 3,000 mg/m² (if younger than 60) or at 1,500 mg/m² (if 60 years of age or older), given every 12 hours for 5 doses, starting on day 3 following the CPI-613 infusion. The mitoxantrone was dosed at 6 mg/m² and is given once daily following the first, third and fifth HiDAC doses. At day 14, nadir marrow was evaluated and, if significant residual leukemia was present, patients could be re-treated as above or with an abbreviated 3-day cycle. Nadir marrow was re-evaluated in patients receiving a second cycle, and those with residual disease at that point were removed from study and considered refractory. Responding patients were eligible to receive up to 2 abbreviated 3-day consolidation cycles. Patients who could not go on to allogeneic stem cell transplant could receive maintenance therapy consisting of CPI-613 at 2,500 mg/m², given on days 1 through 5 every 28 days. The first 7 patients were enrolled at the maximum tolerated dose of CPI-613 2,500 mg/m2, the next 17 patients were enrolled at a dose of 2,000 mg/m2 and 6 patients have been enrolled in the current 1,500 mg/m2 cohort.Results:At the time of this interim analysis, 30 patients are evaluable. The median age is 64 years (range 21-78). Disease was relapsed in 77% of patients (23/30) and refractory in in 23% (7/30). In patients with relapsed disease, the median duration of first complete response (CR) was 12 months. In 80% of patients, this was their first salvage regimen. AML was secondary in 5 patients, 4 with prior MDS and 1 with prior atypical chronic myeloid leukemia. Cytogenetics were poor risk in 12 patients, intermediate in 16, and good in 2. In the intention to treat (IIT) cohort (n=30) the overall response rate was 53% (10 CR + 5 CR with incomplete count recovery + 1 partial response), with a median survival of 10.4 months (Figure 1A). Response was significantly associated with survival, with a median survival of 12.5 months in responders compared to 1.6 months for all others (Figure 1B). In patients ≥60 years old, the response rate was 48% (10/21) with a median survival of 10 months. Consistent with the Phase I results, this was not significantly different from patients younger than 60 years old (p=0.6345, Figure 1C). After hematological and infectious, the most common clinically significant Grade 3 or 4 toxicities of the combination were diarrhea and anorexia. The 30-day mortality rate was 7% (2/30). Seven patients (23%) went on to allogeneic stem cell transplantation, 5 of whom were 60 years of age or older. Mutational status for FLT3, NPM, or CEBPa was available for all patients enrolled. Additional mutational testing was available for 57% of patients. In an exploratory analysis of recurring mutations, we found that 6 of 7 patients (86%) with a DNMT3a mutation achieved a response, as did all 8 patients (100%) with an NPM1 mutation (Table 1).Conclusions: TCA cycle inhibition with CPI-613 is a promising novel approach in the treatment of AML patients, especially in the elderly and those with NPM1 and DNMT3a mutations.Figure 1. Kaplan-Meier analyses of overall survival (OS) in: the entire IIT cohort (A), 60 years of age and older vs younger than 60 (B) and Responders vs No response (C). CHAM, combined high-dose AraC (cytarabine) and mitoxantrone; CR, complete remission; CRi, complete remission with incomplete count recovery; PR, partial remission. [Display omitted] DisclosuresPardee:Rafael Pharmaceuticals: Employment, Research Funding. Ellis:Alexion: Speakers Bureau. Powell:Rafael Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees.

Dynamics of Measurable Disease at Remission Determines Survival in Patients (Pts) with Philadelphia Chromosome Negative B-Cell Acute Lymphoblastic Leukemia (ALL)

Dynamics of Measurable Disease at Remission Determines Survival in Patients (Pts) with Philadelphia Chromosome Negative B-Cell Acute Lymphoblastic Leukemia (ALL)

IMbrave150: Exploratory analysis to examine the association between treatment response and overall survival (OS) in patients (pts) with unresectable hepatocellular carcinoma (HCC) treated with atezolizumab (atezo) + bevacizumab (bev) versus sorafenib (sor).

4071 Background: Based on IMbrave150 (NCT03434379) results, atezo + bev has been approved in &gt; 60 countries for pts with unresectable HCC who have not received prior systemic therapy (Finn RS, NEJM 2020). OS and objective response rate (ORR) improvements with atezo + bev vs sor were maintained with an additional 12 mo of follow up since primary analysis. Updated median OS was 19.2 mo with atezo + bev vs 13.4 mo with sor (stratified HR, 0.66; 95% CI: 0.52, 0.85). Updated ORR was 30% with atezo + bev vs 11% with sor by independently-assessed (IRF) RECIST 1.1 (Finn RS, ASCO GI 2021). Here, we report an exploratory analysis examining the association of response by RECIST 1.1 with OS and independent predictors of survival. Methods: Pts in this Ph III study were systemic treatment–naive with unresectable HCC, ≥1 measurable untreated lesion (RECIST 1.1), Child-Pugh class A liver function and ECOG PS 0/1. Pts were randomized 2:1 to atezo 1200 mg IV q3w + bev 15 mg/kg IV q3w or sor 400 mg bid until unacceptable toxicity or loss of clinical benefit per investigator. ORR was determined by IRF RECIST 1.1. Kaplan-Meier analyses of OS by response status were conducted without landmark and with 4- and 6-mo landmarks. Multivariate analysis was conducted using Cox modeling with time-dependent covariate (responder [yes/no]) with backwards elimination. These analyses only included pts treated with atezo + bev. Results: IMbrave150 enrolled 501 pts, including 336 treated with atezo + bev. Median follow-up was 15.6 mo. OS was longer in pts with confirmed response per RECIST 1.1 (responders, CR + PR) vs non-responders by Kaplan-Meier analyses without landmark and with 4- and 6-mo landmarks (Table). By multivariate analysis, in addition to responder (yes/no), 5 of the 10 initially included predictors of OS remained in the final Cox model ( P&lt; 0.10): ECOG PS (0/1), geographic region (Asia excluding Japan/rest of the world), etiology (hepatitis B/hepatitis C/non-viral), macrovascular invasion and/or extrahepatic spread (yes/no), and baseline alpha-fetoprotein ( &lt; 400 ng/mL/≥400 ng/mL). Conclusions: Atezo + bev is the new standard of care for pts with previously untreated, unresectable HCC. Here we showed that in IMbrave150 pts treated with atezo + bev, response by RECIST 1.1 was associated with OS, suggesting that confirmed response is an independent predictor of OS in these pts. Clinical trial information: NCT03434379. [Table: see text]