24 results on '"van Eijck, Casper H J"'
Search Results
2. Preoperative chemotherapy, radiotherapy and surgical decision-making in patients with borderline resectable and locally advanced pancreatic cancer
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Stoop, Thomas F., Theijse, Rutger T., Seelen, Leonard W. F., Groot Koerkamp, Bas, van Eijck, Casper H. J., Wolfgang, Christopher L., van Tienhoven, Geertjan, van Santvoort, Hjalmar C., Molenaar, I. Quintus, Wilmink, Johanna W., Del Chiaro, Marco, Katz, Matthew H. G., Hackert, Thilo, and Besselink, Marc G.
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- 2024
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3. ASO Visual Abstract: Nationwide Use and Outcome of Surgery for Locally Advanced Pancreatic Cancer Following Induction Chemotherapy
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Stoop, Thomas F., Seelen, Leonard W. F., van’t Land, Freek R., Lutchman, Kishan R. D., van Dieren, Susan, Lips, Daan J., van der Harst, Erwin, Kazemier, Geert, Patijn, Gijs A., de Hingh, Ignace H., Wijsman, Jan H., Erdmann, Joris I., Festen, Sebastiaan, Groot Koerkamp, Bas, Mieog, J. Sven D., Dulk, Marcel den, Stommel, Martijn W. J., Busch, Olivier R., de Wilde, Roeland F., de Meijer, Vincent E., Riele, Wouter te, Molenaar, I. Quintus, van Eijck, Casper H. J., van Santvoort, Hjalmar C., and Besselink, Marc G.
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- 2024
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4. ASO Author Reflections: Nationwide Experience on Locally Advanced Pancreatic Cancer Surgery After Induction Chemotherapy in the Netherlands: A Stepping Stone for the PREOPANC-4 Trial
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Stoop, Thomas F., Seelen, Leonard W. F., van ‘t Land, Freek R., van Eijck, Casper H. J., van Santvoort, Hjalmar C., and Besselink, Marc G.
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- 2024
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5. Long-Term Outcome of Immediate Versus Postponed Intervention in Patients With Infected Necrotizing Pancreatitis (POINTER): Multicenter Randomized Trial
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Van Veldhuisen, Charlotte L., Sissingh, Noor J., Boxhoorn, Lotte, van Dijk, Sven M., van Grinsven, Janneke, Verdonk, Robert C., Boermeester, Marja A., Bouwense, Stefan A.W., Bruno, Marco J., Cappendijk, Vincent C., van Duijvendijk, Peter, van Eijck, Casper H J., Fockens, Paul, van Goor, Harry, Hadithi, Muhammed, Haveman, Jan Willem, Jacobs, Maarten A.J.M., Jansen, Jeroen M., Kop, Marnix P.M., Manusama, Eric R., Mieog, J. Sven D., Molenaar, I. Quintus, Nieuwenhuijs, Vincent B., Poen, Alexander C., Poley, Jan-Werner, Quispel, Rutger, Römkens, Tessa E.H., Schwartz, Matthijs P., Seerden, Tom C., Dijkgraaf, Marcel G.W., Stommel, Martijn W.J., Straathof, Jan Willem A., Venneman, Niels G., Voermans, Rogier P., van Hooft, Jeanin E., van Santvoort, Hjalmar C., and Besselink, Marc G.
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- 2024
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6. Prophylactic abdominal drainage after distal pancreatectomy (PANDORINA): an international, multicentre, open-label, randomised controlled, non-inferiority trial
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van Bodegraven, Eduard A, Balduzzi, Alberto, van Ramshorst, Tess M E, Malleo, Giuseppe, Vissers, Frederique L, van Hilst, Jony, Festen, Sebastiaan, Abu Hilal, Mohammad, Asbun, Horacio J, Michiels, Nynke, Koerkamp, Bas Groot, Busch, Olivier R C, Daams, Freek, Luyer, Misha D P, Ramera, Marco, Marchegiani, Giovanni, Klaase, Joost M, Molenaar, I Quintus, de Pastena, Matteo, Lionetto, Gabriella, Vacca, Pier Giuseppe, van Santvoort, Hjalmar C, Stommel, Martijn W J, Lips, Daan J, Coolsen, Mariëlle M E, Mieog, J Sven D, Salvia, Roberto, van Eijck, Casper H J, and Besselink, Marc G
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- 2024
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7. Neoadjuvant chemotherapy is associated with suppression of the B cell-centered immune landscape in pancreatic ductal adenocarcinoma
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Rupp, Luise, primary, Dietsche, Ina, additional, Kießler, Maximilian, additional, Sommer, Ulrich, additional, Muckenhuber, Alexander, additional, Steiger, Katja, additional, van Eijck, Casper W. F., additional, Richter, Leonard, additional, Istvanffy, Rouzanna, additional, Jäger, Carsten, additional, Friess, Helmut, additional, van Eijck, Casper H. J., additional, Demir, Ihsan Ekin, additional, Reyes, Carmen Mota, additional, and Schmitz, Marc, additional
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- 2024
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8. Polymorphisms in transcription factor binding sites and enhancer regions and pancreatic ductal adenocarcinoma risk
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Ünal, Pelin, primary, Lu, Ye, additional, Bueno-de-Mesquita, Bas, additional, van Eijck, Casper H. J., additional, Talar-Wojnarowska, Renata, additional, Szentesi, Andrea, additional, Gazouli, Maria, additional, Kreivenaite, Edita, additional, Tavano, Francesca, additional, Małecka-Wojciesko, Ewa, additional, Erőss, Bálint, additional, Oliverius, Martin, additional, Bunduc, Stefania, additional, Nóbrega Aoki, Mateus, additional, Vodickova, Ludmila, additional, Boggi, Ugo, additional, Giaccherini, Matteo, additional, Kondrackiene, Jurate, additional, Chammas, Roger, additional, Palmieri, Orazio, additional, Theodoropoulos, George E., additional, Bijlsma, Maarten F., additional, Basso, Daniela, additional, Mohelnikova-Duchonova, Beatrice, additional, Soucek, Pavel, additional, Izbicki, Jakob R., additional, Kiudelis, Vytautas, additional, Vanella, Giuseppe, additional, Arcidiacono, Paolo Giorgio, additional, Włodarczyk, Barbara, additional, Hackert, Thilo, additional, Schöttker, Ben, additional, Uzunoglu, Faik G., additional, Bambi, Franco, additional, Goetz, Mara, additional, Hlavac, Viktor, additional, Brenner, Hermann, additional, Perri, Francesco, additional, Carrara, Silvia, additional, Landi, Stefano, additional, Hegyi, Péter, additional, Dijk, Frederike, additional, Maiello, Evaristo, additional, Capretti, Giovanni, additional, Testoni, Sabrina Gloria Giulia, additional, Petrone, Maria Chiara, additional, Stocker, Hannah, additional, Ermini, Stefano, additional, Archibugi, Livia, additional, Gentiluomo, Manuel, additional, Cavestro, Giulia Martina, additional, Pezzilli, Raffaele, additional, Di Franco, Gregorio, additional, Milanetto, Anna Caterina, additional, Sperti, Cosimo, additional, Neoptolemos, John P., additional, Morelli, Luca, additional, Vokacova, Klara, additional, Pasquali, Claudio, additional, Lawlor, Rita T., additional, Bazzocchi, Francesca, additional, Kupcinskas, Juozas, additional, Capurso, Gabriele, additional, Campa, Daniele, additional, and Canzian, Federico, additional
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- 2024
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9. Association of blood cell‐based inflammatory markers with gut microbiota and cancer incidence in the Rotterdam study
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Najjary, Shiva, primary, Kros, Johan M., additional, Stricker, Bruno H., additional, Ruiter, Rikje, additional, Shuai, Yu, additional, Kraaij, Robert, additional, Van Steen, Kristel, additional, van der Spek, Peter, additional, Van Eijck, Casper H. J., additional, Ikram, M. Arfan, additional, and Ahmad, Shahzad, additional
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- 2024
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10. Early experience with robotic pancreatoduodenectomy versus open pancreatoduodenectomy: nationwide propensity-score-matched analysis
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de Graaf, Nine, primary, Zwart, Maurice J W, additional, van Hilst, Jony, additional, van den Broek, Bram, additional, Bonsing, Bert A, additional, Busch, Olivier R, additional, Coene, Peter-Paul L O, additional, Daams, Freek, additional, van Dieren, Susan, additional, van Eijck, Casper H J, additional, Festen, Sebastiaan, additional, de Hingh, Ignace H J T, additional, Lips, Daan J, additional, Luyer, Misha D P, additional, Mieog, J Sven D, additional, van Santvoort, Hjalmar C, additional, van der Schelling, George P, additional, Stommel, Martijn W J, additional, de Wilde, Roeland F, additional, Molenaar, I Quintus, additional, Groot Koerkamp, Bas, additional, and Besselink, Marc G, additional
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- 2024
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11. Minimum and Optimal CA19-9 Response After Two Months Induction Chemotherapy in Patients With Locally Advanced Pancreatic Cancer A Nationwide Multicenter Study.
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Seelen, Leonard W. F., Doppenberg, Deesje, Stoop, Thomas F., Nagelhout, Anne, Brada, Lilly J. H., Bosscha, Koop, Busch, Olivier R., Cirkel, Geert A., den Dulk, Marcel, Daams, Freek, van Dieren, Susan, van Eijck, Casper H. J., Festen, Sebastiaan, Koerkamp, Bas Groot, Mohammad, Nadia Haj, de Hingh, Ignace H. J. T., Lips, Daan J., Los, Maartje, de Meijer, Vincent E., and Patijn, Gijs A.
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Objective: This nationwide multicenter study aimed to define clinically relevant thresholds of relative serum CA19-9 response after 2 months of induction chemotherapy in patients with locally advanced pancreatic cancer (LAPC). Background: CA19-9 is seen as leading biomarker for response evaluation in patients with LAPC, but early clinically useful cut-offs are lacking. Methods: All consecutive patients with LAPC after 4 cycles (m)FOLFIRINOX or 2 cycles gemcitabine-nab-paclitaxel induction chemotherapy ( ± radiotherapy) with CA19-9 ≥5 U/mL at baseline were analyzed (2015–2019). The association of CA19-9 response with median OS (mOS) was evaluated for different CA19-9 cut-off points. Minimum and optimal CA19-9 response were established via log-rank test. Predictors for OS were analyzed using COX regression analysis. Results: Overall, 212 patients were included, of whom 42 (19.8%) underwent resection. Minimum CA19-9 response demonstrating a clinically significant median OS difference (12.7 vs. 19.6 months) was seen at ≥ 40% CA19-9 decrease. The optimal cutoff for CA19-9 response was ≥ 60% decrease (21.7 vs. 14.0 mo, P = 0.021). Only for patients with elevated CA19-9 levels at baseline (n = 184), CA19-9 decrease ≥ 60% [hazard ratio (HR) = 0.59, 95% CI, 0.36–0.98, P = 0.042] was independently associated with prolonged OS, as were SBRT (HR = 0.42, 95% CI, 0.25–0.70; P = 0.001), and resection (HR = 0.25, 95% CI, 0.14–0.46, P < 0.001), and duration of chemotherapy (HR = 0.75, 95% CI, 0.69–0.82, P < 0.001). Conclusions: CA19-9 decrease of ≥60% following induction chemotherapy as optimal response cut-off in patients with LAPC is an independent predictor for OS when CA19-9 is increased at baseline. Furthermore, ≥40% is the minimum cut-off demonstrating survival benefit. These cut-offs may be used when discussing treatment strategies during early response evaluation. [ABSTRACT FROM AUTHOR]
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- 2024
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12. Implementation of Best Practices in Pancreatic Cancer Care in the Netherlands: A Stepped-Wedge Randomized Clinical Trial
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Mackay, Tara M., Latenstein, Anouk E. J., Augustinus, Simone, van der Geest, Lydia G., Bogte, Auke, Bonsing, Bert A., Cirkel, Geert A., Hol, Lieke, Busch, Olivier R., den Dulk, Marcel, van Driel, Lydi M. J.W., Festen, Sebastiaan, de Groot, Derk-Jan A., de Groot, Jan-Willem B., Groot Koerkamp, Bas, Haj Mohammad, Nadia, Haver, Joyce T., van der Harst, Erwin, de Hingh, Ignace H., Homs, Marjolein Y. V., Los, Maartje, Luelmo, Saskia A. C., de Meijer, Vincent E., Mekenkamp, Leonie, Molenaar, I. Quintus, Patijn, Gijs A., Quispel, Rutger, Römkens, Tessa E. H., van Santvoort, Hjalmar C., Stommel, Martijn W.J., Venneman, Niels G., Verdonk, Robert C., van Vilsteren, Frederike G. I., de Vos-Geelen, Judith, van Werkhoven, C. Henri, van Hooft, Jeanin E., van Eijck, Casper H. J., Wilmink, Johanna W., van Laarhoven, Hanneke W. M., and Besselink, Marc G.
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IMPORTANCE: Implementation of new cancer treatment strategies as recommended by evidence-based guidelines is often slow and suboptimal. OBJECTIVE: To improve the implementation of guideline-based best practices in the Netherlands in pancreatic cancer care and assess the impact on survival. DESIGN, SETTING, AND PARTICIPANTS: This multicenter, stepped-wedge cluster randomized trial compared enhanced implementation of best practices with usual care in consecutive patients with all stages of pancreatic cancer. It took place from May 22, 2018 through July 9, 2020. Data were analyzed from April 1, 2022, through February 1, 2023. It included all patients in the Netherlands with pathologically or clinically diagnosed pancreatic ductal adenocarcinoma. This study reports 1-year follow-up (or shorter in case of deceased patients). INTERVENTION: The 5 best practices included optimal use of perioperative chemotherapy, palliative chemotherapy, pancreatic enzyme replacement therapy (PERT), referral to a dietician, and use of metal stents in patients with biliary obstruction. A 6-week implementation period was completed, in a randomized order, in all 17 Dutch networks for pancreatic cancer care. MAIN OUTCOMES AND MEASURES: The primary outcome was 1-year survival. Secondary outcomes included adherence to best practices and quality of life (European Organisation for Research and Treatment of Cancer [EORTC] global health score). RESULTS: Overall, 5887 patients with pancreatic cancer (median age, 72.0 [IQR, 64.0-79.0] years; 50% female) were enrolled, 2641 before and 2939 after implementation of best practices (307 during wash-in period). One-year survival was 24% vs 23% (hazard ratio, 0.98, 95% CI, 0.88-1.08). There was no difference in the use of neoadjuvant chemotherapy (11% vs 11%), adjuvant chemotherapy (48% vs 51%), and referral to a dietician (59% vs 63%), while the use of palliative chemotherapy (24% vs 30%; odds ratio [OR], 1.38; 95% CI, 1.10-1.74), PERT (34% vs 45%; OR, 1.64; 95% CI, 1.28-2.11), and metal biliary stents increased (74% vs 83%; OR, 1.78; 95% CI, 1.13-2.80). The EORTC global health score did not improve (area under the curve, 43.9 vs 42.8; median difference, −1.09, 95% CI, −3.05 to 0.94). CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, implementation of 5 best practices in pancreatic cancer care did not improve 1-year survival and quality of life. The finding that most patients received no tumor-directed treatment paired with the poor survival highlights the need for more personalized treatment options. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03513705
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- 2024
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13. Nationwide use and Outcome of Minimally Invasive Distal Pancreatectomy in IDEAL Stage IV following a Training Program and Randomized Trial.
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Korrel, Maarten, van Hilst, Jony, Bosscha, Koop, Busch, Olivier R. C., Daams, Freek, van Dam, Ronald, van Eijck, Casper H. J., Festen, Sebastiaan, Koerkamp, Bas Groot, van der Harst, Erwin, Lips, Daan J., Luyer, Misha D., de Meijer, Vincent E., Molenaar, J. Sven D. Mieog I. Quintus, Patijn, Gijs A., van Santvoort, Hjalmar C., van der Schelling, George P., Stommel, Martijn W. J., and Besselink, Marc G.
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Objective: To assess the nationwide long-term uptake and outcomes of minimally invasive distal pancreatectomy (MIDP) after a nationwide training program and randomized trial. Background: Two randomized trials demonstrated the superiority of MIDP over open distal pancreatectomy (ODP) in terms of functional recovery and hospital stay. Data on implementation of MIDP on a nationwide level are lacking. Methods: Nationwide audit-based study including consecutive patients after MIDP and ODP in 16 centers in the Dutch Pancreatic Cancer Audit (2014 to 2021). The cohort was divided into three periods: early implementation, during the LEOPARD randomized trial, and late implementation. Primary endpoints were MIDP implementation rate and textbook outcome. Results: Overall, 1496 patients were included with 848 MIDP (56.5%) and 648 ODP (43.5%). From the early to the late implementation period, the use of MIDP increased from 48.6% to 63.0% and of robotic MIDP from 5.5% to 29.7% ( P <0.001). The overall use of MIDP (45% to 75%) and robotic MIDP (1% to 84%) varied widely between centers ( P <0.001). In the late implementation period, 5/16 centers performed >75% of procedures as MIDP. After MIDP, in-hospital mortality and textbook outcome remained stable over time. In the late implementation period, ODP was more often performed in ASA score III-IV (24.9% vs. 35.7%, P =0.001), pancreatic cancer (24.2% vs. 45.9%, P <0.001), vascular involvement (4.6% vs. 21.9%, P <0.001), and multivisceral involvement (10.5% vs. 25.3%, P <0.001). After MIDP, shorter hospital stay (median 7 vs. 8 d, P <0.001) and less blood loss (median 150 vs. 500 mL, P <0.001), but more grade B/C postoperative pancreatic fistula (24.4% vs. 17.2%, P =0.008) occurred as compared to ODP. Conclusion: A sustained nationwide implementation of MIDP after a successful training program and randomized trial was obtained with satisfactory outcomes. Future studies should assess the considerable variation in the use of MIDP between centers and, especially, robotic MIDP. [ABSTRACT FROM AUTHOR]
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- 2024
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14. Enhanced antitumour immunity following neoadjuvant chemoradiotherapy mediates a favourable prognosis in women with resected pancreatic cancer.
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van Eijck, Casper W. F., Mustafa, Dana A. M., Vadgama, Disha, de Miranda, Noel F. C. C., Koerkamp, Bas Groot, van Tienhoven, Geertjan, van der Burg, Sjoerd H., Malats, Núria, and van Eijck, Casper H. J.
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RECTAL cancer ,PANCREATECTOMY ,PANCREATIC surgery ,PANCREATIC cancer ,PROGNOSIS ,CHEMORADIOTHERAPY ,GENE expression - Published
- 2024
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15. The tumor immune microenvironment in resected treatment-naive pancreatic cancer patients with long-term survival.
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van Eijck CWF, Ju J, van 't Land FR, Verheij M, Li Y, Stubbs A, Doukas M, Lila K, Heij LR, Wiltberger G, Alonso L, Malats N, Groot Koerkamp B, Vietsch EE, and van Eijck CHJ
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Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers worldwide. Presently, only a fraction of patients undergo successful surgical resection, the most effective treatment. Enhancing treatment strategies necessitates a deep comprehension of the factors underlying extended survival after surgical resection in patients., Methods: This study aims to identify the important factors of PDAC patients' long-term survival with metatranscriptomics and multiplex immunofluorescence (IF) staining analyses. Specifically, differences in tumor immune microenvironment (TIME) were investigated between treatment-naïve PDAC short-term survivors (STS, overall survival <6 months) and long-term survivors (LTS, overall survival >5 years)., Results: As a result, we detected 589 over-expressed genes, including HOXB9, CDA, and HOXB8, and 507 under-expressed genes, including AMY2B, SCARA5, and SLC2A2 in LTS. Most of the Reactome overbiological pathways enriched in our data were over-expressed in LTS, such as RHO GTPase Effectors and Cell Cycle Checkpoints. Eleven microbiomes significantly differed between LTS and STS, including Sphingopyxis and Capnocytophaga. Importantly, we demonstrate that the TIME profile with an increased abundance of memory B cells and the reduction of M0 and pro-tumoral M2 macrophages are associated with a good prognosis in PDAC., Conclusions: In this study, we delved into the TIME with metatranscriptomics and IF staining analyses to understand the prerequisite of prolonged survival in PDAC patients. In LTS, several biological pathways were overexpressed, and specific microbiomes were identified. Furthermore, apparent differences in driven immune factors were found that provide valuable insights into developing new treatment strategies., (Copyright © 2024. Published by Elsevier B.V.)
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- 2024
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16. Rintatolimod in Advanced Pancreatic Cancer Enhances Antitumor Immunity through Dendritic Cell-Mediated T-Cell Responses.
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van Eijck CWF, Haddaoui HE, Kucukcelebi S, Vadgama D, Fellah A, Mustafa DAM, Aerts JGJV, van Eijck CHJ, and Willemsen M
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- Humans, Female, Male, Toll-Like Receptor 3 agonists, Middle Aged, Aged, T-Lymphocytes immunology, T-Lymphocytes drug effects, T-Lymphocytes metabolism, Carcinoma, Pancreatic Ductal drug therapy, Carcinoma, Pancreatic Ductal immunology, Carcinoma, Pancreatic Ductal pathology, Dendritic Cells immunology, Dendritic Cells drug effects, Dendritic Cells metabolism, Pancreatic Neoplasms drug therapy, Pancreatic Neoplasms immunology, Pancreatic Neoplasms pathology
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Purpose: Amid the need for new approaches to improve survival in pancreatic ductal adenocarcinoma (PDAC), immune-based therapies have garnered interest. Rintatolimod, a Toll-like receptor 3 (TLR-3) agonist, is a potential candidate due to its dual impact on restraining PDAC cell functions and boosting the antitumor immune response. This study investigates the effect of TLR-3 activation through rintatolimod on the peripheral immune landscape of patients with advanced PDAC., Experimental Design: Paired blood samples of 30 patients with advanced PDAC, collected at baseline and after 12 rintatolimod intravenous infusions, underwent comprehensive transcriptomic NanoString and proteomic flow cytometry profiling. The impact of rintatolimod and immunologic factors on survival outcomes was assessed through univariate Cox proportional hazards models., Results: Rintatolimod treatment enhances peripheral immune activity at the transcriptomic and proteomic levels, particularly involving type 1 conventional dendritic cells (cDC1) and T cells. Post-rintatolimod, the increased peripheral abundance of BTLA+ XCR1+ cDC1s and CD4+SELL+ T cells correlated with improved clinical outcomes. Patients with stable disease exhibited pronouncedDCand T-cell activation gene overexpression. Notably, the expression of immune checkpoints PD-L1 and PD-L2 decreased post-rintatolimod across all patients. However, those with progressive disease showed increased expression of genes encoding IDO1 and PD-1., Conclusions: This study presents compelling evidence of the immune-stimulatory properties linked to TLR-3 activation through rintatolimod. Rintatolimod may break immunologic tolerance by enhancing antitumor immunity through DC-mediated Th-cell responses. Furthermore, our findings lay the groundwork for investigating the potential synergy between TLR-3 activation and immune checkpoint inhibitor therapy to improve therapeutic outcomes. See related commentary by Martínez-Riaño et al., p. 3355., (©2024 American Association for Cancer Research.)
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- 2024
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17. Metformin boosts antitumor immunity and improves prognosis in upfront resected pancreatic cancer: an observational study.
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van Eijck CWF, Vadgama D, van Eijck CHJ, and Wilmink JW
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- Humans, Male, Female, Prognosis, Aged, Middle Aged, Neoadjuvant Therapy methods, Gemcitabine, Deoxycytidine analogs & derivatives, Deoxycytidine therapeutic use, Deoxycytidine administration & dosage, Hypoglycemic Agents therapeutic use, Metformin therapeutic use, Metformin pharmacology, Pancreatic Neoplasms immunology, Pancreatic Neoplasms drug therapy, Pancreatic Neoplasms mortality, Pancreatic Neoplasms surgery, Carcinoma, Pancreatic Ductal immunology, Carcinoma, Pancreatic Ductal drug therapy, Carcinoma, Pancreatic Ductal mortality, Carcinoma, Pancreatic Ductal therapy, Carcinoma, Pancreatic Ductal surgery
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Background: Beyond demographic and immune factors, metabolic considerations, particularly metformin's recognized impact in oncology, warrant exploration in treating pancreatic cancer. This study aimed to investigate the influence of metformin on patient survival and its potential correlation with distinct immune profiles in pancreatic ductal adenocarcinoma (PDAC) tumors., Methods: We included 82 upfront resected and 66 gemcitabine-based neoadjuvant chemoradiotherapy (nCRT)-treated patients from the PREOPANC randomized controlled trial (RCT). Transcriptomic NanoString immunoprofiling was performed for a subset of 96 available resected specimens., Results: Disparities in survival outcomes and immune profiles were apparent between metformin and non-metformin users in upfront resected patients but lacking in nCRT-treated patients. Compared to non-metformin users, upfront resected metformin users showed a higher median overall survival (OS) of 29 vs 14 months and a better 5-year OS rate of 19% vs 5%. Furthermore, metformin use was a favorable prognostic factor for OS in the upfront surgery group (HR = 0.56; 95% CI = 0.32 to 0.99). Transcriptomic data revealed that metformin users significantly underexpressed genes related to pro-tumoral immunity, including monocyte to M2 macrophage polarization and activation. Furthermore, the relative abundance of anti-inflammatory CD163+ MRC1+ M2 macrophages in non-metformin users and immune-activating CD1A+ CD1C+ dendritic cells in metformin users was heightened (P < .001)., Conclusion: This study unveils immune profile changes resulting from metformin use in upfront resected pancreatic cancer patients, possibly contributing to prolonged survival outcomes. Specifically, metformin use may decrease the abundance and activity of pro-tumoral M2 macrophages and increase the recruitment and function of tumor-resolving DCs, favoring antitumor immunity.[PREOPANC trial EudraCT: 2012-003181-40]., (© The Author(s) 2024. Published by Oxford University Press.)
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- 2024
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18. Dendritic Cell-Based Immunotherapy in Patients With Resected Pancreatic Cancer.
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van 't Land FR, Willemsen M, Bezemer K, van der Burg SH, van den Bosch TPP, Doukas M, Fellah A, Kolijn PM, Langerak AW, Moskie M, van der Oost E, Rozendaal NEM, Baart SJ, Aerts JGJV, and van Eijck CHJ
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Purpose: Immunotherapies have shown limited responses in patients with advanced pancreatic cancer. Recently, we reported that dendritic cell (DC)-based immunotherapy induced T-cell responses against pancreatic cancer antigens. The primary objective of this study was to determine the efficacy of DC-based immunotherapy to prevent recurrence of disease., Methods: This was a single-center, open-label, single-arm, combined phase I/II trial. The primary end point was the 2-year recurrence-free survival (RFS) rate. A 2-year RFS rate of ≥60% was defined as a clinically meaningful improvement. We included patients with pancreatic cancer after resection and completion of standard-of-care (SOC) treatment without recurrent disease on cross-sectional imaging. Patients were treated with autologous DCs pulsed with an allogeneic mesothelioma tumor cell lysate, comprising antigens also expressed in pancreatic ductal adenocarcinoma., Results: Thirty-eight patients were included in the analysis of the primary end point (47% male, 53% female). The median age was 62 years (IQR, 55-68). Twenty-eight patients (74%) received five DC vaccinations and completed the study protocol. Three patients (8%) received four vaccinations, and seven patients (16%) received three vaccinations. After a median follow-up of 25.5 months, 26 patients (68%) had not developed recurrence of disease. The estimated 2-year RFS was 64%. Vaccination led to the enrichment of circulating activated CD4+ T cells and the detection of treatment-induced immune responses in vitro. T-cell receptor-sequencing analyses of a resected solitary lung metastasis showed influx of vaccine-specific T cells., Conclusion: This study reached its primary end point of a 2-year RFS rate of ≥60% following pancreatectomy after SOC treatment and adjuvant DC-based immunotherapy in patients with pancreatic cancer. These results warrant a future randomized trial.
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- 2024
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19. Preoperative chemoradiotherapy but not chemotherapy is associated with reduced risk of postoperative pancreatic fistula after pancreatoduodenectomy for pancreatic ductal adenocarcinoma: a nationwide analysis.
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Wismans LV, Suurmeijer JA, van Dongen JC, Bonsing BA, Van Santvoort HC, Wilmink JW, van Tienhoven G, de Hingh IH, Lips DJ, van der Harst E, de Meijer VE, Patijn GA, Bosscha K, Stommel MW, Festen S, den Dulk M, Nuyttens JJ, Intven MPW, de Vos-Geelen J, Molenaar IQ, Busch OR, Koerkamp BG, Besselink MG, and van Eijck CHJ
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- Humans, Female, Male, Middle Aged, Aged, Netherlands epidemiology, Neoadjuvant Therapy methods, Neoadjuvant Therapy adverse effects, Chemoradiotherapy adverse effects, Chemoradiotherapy methods, Prospective Studies, Preoperative Care methods, Pancreaticoduodenectomy adverse effects, Pancreatic Fistula prevention & control, Pancreatic Fistula etiology, Pancreatic Fistula epidemiology, Carcinoma, Pancreatic Ductal therapy, Carcinoma, Pancreatic Ductal surgery, Pancreatic Neoplasms therapy, Pancreatic Neoplasms surgery, Postoperative Complications prevention & control, Postoperative Complications epidemiology, Postoperative Complications etiology
- Abstract
Background: Postoperative pancreatic fistula remains the leading cause of significant morbidity after pancreatoduodenectomy for pancreatic ductal adenocarcinoma. Preoperative chemoradiotherapy has been described to reduce the risk of postoperative pancreatic fistula, but randomized trials on neoadjuvant treatment in pancreatic ductal adenocarcinoma focus increasingly on preoperative chemotherapy rather than preoperative chemoradiotherapy. This study aimed to investigate the impact of preoperative chemotherapy and preoperative chemoradiotherapy on postoperative pancreatic fistula and other pancreatic-specific surgery related complications on a nationwide level., Methods: All patients after pancreatoduodenectomy for pancreatic ductal adenocarcinoma were included in the mandatory nationwide prospective Dutch Pancreatic Cancer Audit (2014-2020). Baseline and treatment characteristics were compared between immediate surgery, preoperative chemotherapy, and preoperative chemoradiotherapy. The relationship between preoperative chemotherapy, chemoradiotherapy, and clinically relevant postoperative pancreatic fistula (International Study Group of Pancreatic Surgery grade B/C) was investigated using multivariable logistic regression analyses., Results: Overall, 2,019 patients after pancreatoduodenectomy for pancreatic ductal adenocarcinoma were included, of whom 1,678 underwent immediate surgery (83.1%), 192 (9.5%) received preoperative chemotherapy, and 149 (7.4%) received preoperative chemoradiotherapy. Postoperative pancreatic fistula occurred in 8.3% of patients after immediate surgery, 4.2% after preoperative chemotherapy, and 2.0% after preoperative chemoradiotherapy (P = .004). In multivariable analysis, the use of preoperative chemoradiotherapy was associated with reduced risk of postoperative pancreatic fistula (odds ratio, 0.21; 95% confidence interval, 0.03-0.69; P = .033) compared with immediate surgery, whereas preoperative chemotherapy was not (odds ratio, 0.59; 95% confidence interval, 0.25-1.25; P = .199). Intraoperatively hard, or fibrotic pancreatic texture was most frequently observed after preoperative chemoradiotherapy (53% immediate surgery, 62% preoperative chemotherapy, 77% preoperative chemoradiotherapy, P < .001)., Conclusion: This nationwide analysis demonstrated that in patients undergoing pancreatoduodenectomy for pancreatic ductal adenocarcinoma, only preoperative chemoradiotherapy, but not preoperative chemotherapy, was associated with a reduced risk of postoperative pancreatic fistula., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
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- 2024
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20. GATA6 identifies an immune-enriched phenotype linked to favorable outcomes in patients with pancreatic cancer undergoing upfront surgery.
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van Eijck CWF, Real FX, Malats N, Vadgama D, van den Bosch TPP, Doukas M, van Eijck CHJ, and Mustafa DAM
- Subjects
- Humans, Male, Female, Prognosis, Aged, Middle Aged, Macrophages immunology, Macrophages metabolism, Treatment Outcome, Neoadjuvant Therapy methods, Biomarkers, Tumor metabolism, Biomarkers, Tumor genetics, GATA6 Transcription Factor metabolism, GATA6 Transcription Factor genetics, Pancreatic Neoplasms immunology, Pancreatic Neoplasms pathology, Pancreatic Neoplasms therapy, Carcinoma, Pancreatic Ductal immunology, Carcinoma, Pancreatic Ductal pathology, Carcinoma, Pancreatic Ductal therapy, Phenotype
- Abstract
This study underscores GATA6's role in distinguishing classical and basal-like pancreatic ductal adenocarcinoma (PDAC) phenotypes. Retrospective studies associate GATA6 immunohistochemistry (IHC) expression with survival outcomes, warranting prospective validation. In a prospective treatment-naive cohort of patients with resected PDAC, GATA6 IHC proves a prognostic discriminator, associating high GATA6 expression with extended survival and the classical PDAC phenotype. However, GATA6's prognostic significance is numerically lower after gemcitabine-based neoadjuvant chemoradiotherapy compared to its significance in patients treated with upfront surgery. Furthermore, GATA6 is implicated in immunomodulation, although a comprehensive investigation of its immunological role is lacking. Treatment-naive PDAC tumors with varying GATA6 expression yield distinct immunological landscapes. Tumors highly expressing GATA6 show reduced infiltration of immunosuppressive regulatory T cells and M2 macrophages but increased infiltration of immune-stimulating, antigen-presenting, and activated T cells. Our findings caution against solely relying on GATA6 for molecular subtyping in clinical trials and open avenues for exploring immune-based combination therapies., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
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- 2024
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21. Improved Clinical Staging System for Localized Pancreatic Cancer Using the ABC Factors: A TAPS Consortium Study.
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Dekker EN, van Dam JL, Janssen QP, Besselink MG, DeSilva A, Doppenberg D, van Eijck CHJ, Nasar N, O'Reilly EM, Paniccia A, Prakash LR, Tzeng CD, Verkolf EMM, Wei AC, Zureikat AH, Katz MHG, and Groot Koerkamp B
- Subjects
- Humans, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Retrospective Studies, Fluorouracil therapeutic use, Leucovorin therapeutic use, Prognosis, Neoadjuvant Therapy, Pancreatic Neoplasms drug therapy, Carcinoma, Pancreatic Ductal drug therapy
- Abstract
Purpose: Previous studies suggest that besides anatomy (A: resectable, borderline resectable [BR], or locally advanced [LA]) also biologic (B: carbohydrate antigen 19-9 [CA 19-9]) and conditional (C: performance status) factors should be considered when staging patients with localized pancreatic ductal adenocarcinoma (PDAC). The prognostic value of the combined ABC factors has not been quantitatively validated., Methods: In this retrospective cohort study, we evaluated patients with localized PDAC treated with initial (modified) fluorouracil with leucovorin, irinotecan, and oxaliplatin ([m]FOLFIRINOX) at five high-volume pancreatic cancer centers in the United States and the Netherlands (2012-2019). Multivariable Cox proportional hazards analysis was used to investigate the impact of the ABC factors for overall survival (OS)., Results: Overall, 1,835 patients with localized PDAC were included. Tumor stage at diagnosis was potentially resectable in 346 (18.9%), BR in 531 (28.9%), and LA in 958 (52.2%) patients. The baseline CA 19-9 was >500 U/mL in 559 patients (32.5%). Performance status was ≥1 in 1,110 patients (60.7%). Independent poor prognostic factors for OS were BR disease (hazard ratio [HR], 1.26 [95% CI, 1.06 to 1.50]), LA disease (HR, 1.71 [95% CI, 1.45 to 2.02]), CA 19-9 >500 U/mL (HR, 1.36 [95% CI, 1.21 to 1.52]), and WHO performance status ≥1 (HR, 1.31 [95% CI, 1.16 to 1.47]). Patients were assigned 1 point for each poor ABC factor and 2 points for LA disease. The median OS for patients with score 0-4 was 49.7, 29.9, 22.0, 19.1, and 14.9 months with corresponding 5-year OS rates of 47.0%, 28.9%, 19.2%, 9.3%, and 4.8%, respectively., Conclusion: The ABC factors of tumor anatomy, CA 19-9, and performance status at diagnosis were independent prognostic factors for OS in patients with localized PDAC treated with initial (m)FOLFIRINOX. Staging of patients with localized PDAC at diagnosis should be based on anatomy, CA 19-9, and performance status.
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- 2024
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22. Splanchnic vein thrombosis in necrotizing pancreatitis: a post-hoc analysis of a nationwide prospective cohort.
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Sissingh NJ, Timmerhuis HC, Groen JV, de Jong MJP, Besselink MG, Boekestijn B, Bollen TL, Bonsing BA, Bouwense SAW, Hazen WL, Klok FA, van Santvoort HC, van Eijck CHJ, Verdonk RC, Mieog JSD, and van Hooft JE
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- Humans, Prospective Studies, Anticoagulants therapeutic use, Necrosis complications, Necrosis drug therapy, Disease Progression, Splanchnic Circulation, Venous Thrombosis diagnostic imaging, Venous Thrombosis epidemiology, Venous Thrombosis etiology, Pancreatitis, Acute Necrotizing diagnosis, Pancreatitis, Acute Necrotizing diagnostic imaging
- Abstract
Background: Treatment guidelines for splanchnic vein thrombosis in necrotizing pancreatitis are lacking due to insufficient data on the full clinical spectrum., Methods: We performed a post-hoc analysis of a nationwide prospective necrotizing pancreatitis cohort. Multivariable analyses were used to identify risk factors and compare the clinical course of patients with and without SVT., Results: SVT was detected in 97 of the 432 included patients (22%) (median onset: 4 days). Risk factors were left, central, or subtotal necrosis (OR 28.52; 95% CI 20.11-40.45), right or diffuse necrosis (OR 5.76; 95% CI 3.89-8.51), and younger age (OR 0.94; 95% CI 0.90-0.97). Patients with SVT had higher rates of bleeding (n = 10,11%) and bowel ischemia (n = 4,4%) compared to patients without SVT (n = 14,4% and n = 2,0.6%; OR 3.24; 95% CI 1.27-8.23 and OR 7.29; 95% CI 1.31-40.4, respectively), and were independently associated with ICU admission (adjusted OR 2.53; 95% CI 1.37-4.68). Spontaneous recanalization occurred in 62% of patients (n = 40/71). Radiological and clinical outcomes did not differ between patients treated with and without anticoagulants., Discussion: SVT is a common and early complication of necrotizing pancreatitis, associated with parenchymal necrosis and younger age. SVT is associated with increased complications and a worse clinical course, whereas anticoagulant use does not appear to affect outcomes., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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23. A liquid biomarker signature of inflammatory proteins accurately predicts early pancreatic cancer progression during FOLFIRINOX chemotherapy.
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van Eijck CWF, Sabroso-Lasa S, Strijk GJ, Mustafa DAM, Fellah A, Koerkamp BG, Malats N, and van Eijck CHJ
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- Humans, Antineoplastic Combined Chemotherapy Protocols adverse effects, Bayes Theorem, Fluorouracil therapeutic use, Biomarkers, Tumor, Irinotecan, Oxaliplatin, Leucovorin, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms drug therapy, Pancreatic Neoplasms genetics, Carcinoma, Pancreatic Ductal diagnosis, Carcinoma, Pancreatic Ductal drug therapy, Carcinoma, Pancreatic Ductal genetics
- Abstract
Background: Pancreatic ductal adenocarcinoma (PDAC) is often treated with FOLFIRINOX, a chemotherapy associated with high toxicity rates and variable efficacy. Therefore, it is crucial to identify patients at risk of early progression during treatment. This study aims to explore the potential of a multi-omics biomarker for predicting early PDAC progression by employing an in-depth mathematical modeling approach., Methods: Blood samples were collected from 58 PDAC patients undergoing FOLFIRINOX before and after the first cycle. These samples underwent gene (GEP) and inflammatory protein expression profiling (IPEP). We explored the predictive potential of exclusively IPEP through Stepwise (Backward) Multivariate Logistic Regression modeling. Additionally, we integrated GEP and IPEP using Bayesian Kernel Regression modeling, aiming to enhance predictive performance. Ultimately, the FOLFIRINOX IPEP (FFX-IPEP) signature was developed., Results: Our findings revealed that proteins exhibited superior predictive accuracy than genes. Consequently, the FFX-IPEP signature consisted of six proteins: AMN, BANK1, IL1RL2, ITGB6, MYO9B, and PRSS8. The signature effectively identified patients transitioning from disease control to progression early during FOLFIRINOX, achieving remarkable predictive accuracy with an AUC of 0.89 in an independent test set. Importantly, the FFX-IPEP signature outperformed the conventional CA19-9 tumor marker., Conclusions: Our six-protein FFX-IPEP signature holds solid potential as a liquid biomarker for the early prediction of PDAC progression during toxic FOLFIRINOX chemotherapy. Further validation in an external cohort is crucial to confirm the utility of the FFX-IPEP signature. Future studies should expand to predict progression under different chemotherapies to enhance the guidance of personalized treatment selection in PDAC., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2024
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24. FOLFIRINOX chemotherapy modulates the peripheral immune landscape in pancreatic cancer: Implications for combination therapies and early response prediction.
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van Eijck CWF, Strijk G, Vietsch EE, van der Sijde F, Verheij M, Mustafa DAM, Vink M, Aerts JGJV, van Eijck CHJ, and Willemsen M
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- Humans, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Irinotecan therapeutic use, Fluorouracil therapeutic use, Leucovorin therapeutic use, Blood Proteins, Pancreatic Neoplasms
- Abstract
Background: FOLFIRINOX chemotherapy has improved outcomes for pancreatic cancer patients, but poor long-term survival outcomes and high toxicity remain challenges. This study investigates the impact of FOLFIRINOX on plasma proteins and peripheral immune cells to guide immune-based combination therapies and, ideally, to identify a potential biomarker to predict early disease progression during FOLFIRINOX., Methods: Blood samples were collected from 86 pancreatic cancer patients before and two weeks after the first FOLFIRINOX cycle and subjected to comprehensive immune cell and proteome profiling. Principal Component Analysis and Linear Mixed Effect Regression models were used for data analysis. FOLFIRINOX efficacy was radiologically evaluated after the fourth cycle., Results: One cycle of FOLFIRINOX diminished tumour-cell-related pathways and enhanced pathways related to immune activation, illustrated by an increase in pro-inflammatory IL-18, IL-15, and TNFRSF4. Similarly, FOLFIRINOX promoted the activation of CD4 + and CD8 + T cells, the proliferation of NK(T), and the activation of antigen-presenting cells. Furthermore, high pre-treatment levels of VEGFA and PRDX3 and an elevation in FCRL3 levels after one cycle predicted early progression under FOLFIRINOX. Finally, patients with progressive disease exhibited high levels of inhibitory markers on B cells and CD8 + T cells, while responding patients exhibited high levels of activation markers on CD4 + and CD8 + T cell subsets., Conclusion: FOLFIRINOX has immunomodulatory effects, providing a foundation for clinical trials exploring immune-based combination therapies that harness the immune system to treat pancreatic cancer. In addition, several plasma proteins hold potential as circulating predictive biomarkers for early prediction of FOLFIRINOX response in patients with pancreatic cancer., Competing Interests: Declaration of Competing Interest J.G.J.V. Aerts reports personal fees and nonfinancial support from MSD, personal fees from BMS, Boehringer Ingelheim, Amphera, Eli‐Lilly, Takeda, Bayer, Roche, Astra Zeneca outside the submitted work; in addition, J.G.J.V. Aerts holds ownership interest (including patients) in Amphera BV and is a consultant/advisory board member for Amphera. The other authors declare that they have no competing interests., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2024
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