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Background: Intra-tumour genetic heterogeneity has been reported in both leukaemias and solid tumours and is implicated in the development of drug resistance in CML and AML. The role of genetic heterogeneity in drug response in solid tumours is unknown.Methods: To investigate intra-tumour genetic heterogeneity and chemoradiation response in advanced cervical cancer, we analysed 10 cases treated on the CTCR-CE01 clinical study. Core biopsies for molecular profiling were taken from four quadrants of the cervix pre-treatment, and weeks 2 and 5 of treatment. Biopsies were scored for cellularity and profiled using Agilent 180k human whole genome CGH arrays. We compared genomic profiles from 69 cores from 10 patients to test for genetic heterogeneity and treatment effects at weeks 0, 2 and 5 of treatment.Results: Three patients had two or more distinct genetic subpopulations pre-treatment. Subpopulations within each tumour showed differential responses to chemoradiotherapy. In two cases, there was selection for a single intrinsically resistant subpopulation that persisted at detectable levels after 5 weeks of chemoradiotherapy. Phylogenetic analysis reconstructed the order in which genomic rearrangements occurred in the carcinogenesis of these tumours and confirmed gain of 3q and loss of 11q as early events in cervical cancer progression.Conclusion: Selection effects from chemoradiotherapy cause dynamic changes in genetic subpopulations in advanced cervical cancers, which may explain disease persistence and subsequent relapse. Significant genetic heterogeneity in advanced cervical cancers may therefore be predictive of poor outcome. [ABSTRACT FROM AUTHOR]

This prospective study aims to evaluate the feasibility of DWI at 3 Tesla in patients with advanced ovarian cancer and investigate the differences in vascular signal fraction (VSF) and apparent diffusion coefficient (ADC) values between primary ovarian mass and metastatic disease. Twenty patients with suspected advanced ovarian carcinoma were enrolled in the study. High-resolution T2W FRFSE images were used to confirm the position of three marker lesions: primary ovarian mass, omental cake and peritoneal deposit. Multislice DWI was acquired in a single breath-hold using multiple b-values. The three marker lesions were outlined by an experienced radiologist on ADC and VSF maps. Ovarian lesions showed the highest ADC values. The mean ADC value for peritoneal deposits was significantly lower than for both ovarian lesions (p = 0.03) and omental cake (p = 0.03). The VSF for omental cake was significantly higher than for ovarian lesions (p = 0.01) and peritoneal deposits (p = 0.04). There was a significant positive correlation between ADC and VSF for peritoneal deposits (p = 0.04). DWI in advanced ovarian cancer is feasible at 3 T. There are significant differences in baseline ADC and VSF values between ovarian cancer, omental cake and peritoneal deposits that may explain the mixed treatment response that occurs at different disease sites. [ABSTRACT FROM AUTHOR]

In patients with suspected advanced ovarian carcinoma, a precise histological diagnosis is required before commencing neo-adjuvant chemotherapy. This study aims to determine the diagnostic accuracy and complication rate of percutaneous biopsies performed under ultrasound or computed tomography guidance. Between 2002 to 2007, 60 consecutive image-guided percutaneous biopsies were performed in patients with suspected ovarian cancer. The following variables were recorded: tissue biopsied, imaging technique, experience of operator, biopsy needle gauge, number of passes, complications, and final histology. Forty-seven patients had omental biopsies, 12 pelvic mass biopsies, and 1 para-aortic lymph node biopsy. Thirty-five biopsies were performed under ultrasound, 25 under computed tomography guidance. Biopsy needle gauges ranged from 14-20 swg with two to five passes for each patient. There were no complications. Histology was obtained in 52 (87%) patients. Percutaneous image-guided biopsy of peritoneal disease or pelvic mass is safe with high diagnostic accuracy. The large-gauge biopsy needle is as safe as the small gauge needle, but has the added value of obtaining tissue samples for immunohistochemistry and genomic studies. [ABSTRACT FROM AUTHOR]

The hypothalamic decapeptide gonadotrophin-releasing hormone (GnRH), modulates gonadotrophin synthesis and secretion and is essential for the preovulatory luteinising hormone (LH) surge. As females age, there is a gradual attenuation and eventual loss of the preovulatory LH surge and oestrous cyclicity. Data from previous studies have demonstrated evidence of compromised GnRH neuronal function at this time. The present study begins to explore the hypothesis that the age-related attenuation of the LH surge and decline in GnRH neuronal function are due, in part, to increased inhibitory influences on GnRH neurones. In situ hybridisation (ISH) was used to assess relative levels of mRNA for one isoform of glutamic acid decarboxylase (GAD), the rate-limiting enzyme for GABA synthesis. Ovariectomised young and middle-aged rats were injected with oestradiol benzoate and progesterone in a regimen for LH surge induction. Animals were killed at time points prior to, during the ascending phase, and during the peak and early descending phase of the LH surge. Dynamic changes in GAD67 mRNA levels were observed in young but not middle-aged females in two regions known to be important for LH surge induction, the rostral proeptic area in the region of the organum vasculosum of the lamina terminalis (OVLT) and in the ventral periventricular preoptic area. Furthermore, GAD67 mRNA levels were elevated in middle-aged relative to young females in the region of the OVLT at the time of LH surge induction and in the ventral periventricular preoptic area prior to surge induction. Age-related differences were not observed in other brain regions analysed. These data suggest that GABA synthesis may be elevated in middle-aged relative to young females in specific brain regions at critical times in conjunction with the LH surge, and that the lack of dynamic changes in GABA levels in these regions may contribute to the attenuated LH surge observed in middle-aged females. [ABSTRACT FROM AUTHOR]

Background The extreme genomic heterogeneity of high-grade serous ovarian carcinoma (HGSOC) is a major barrier to precision medicine approaches. We have developed mutational signature analysis from shallow whole genome sequencing (sWGS) for molecular stratification and therapeutic prediction. PARP inhibitor therapy has significant survival advantage for women with germline BRCA1/2 mutations, but treatments and predictive biomarkers for women without homologous recombination deficiency have not been developed. MYC amplification is the most common driver in HGSOC, present in 42% of the TCGA cases. The best responder from the phase 1 trial of AZD2014 (dual m-TORC1/2 inhibitor) and paclitaxel in HGSOC had a mutation in MYC and we have hypothesised that biosynthetic effects of MYC are mediated through the mTOR pathway and blocked by AZD2014 perturbation. Methods Primary ovarian cancer spheroids were purified from 28 human ascites and profiled with sWGS. Ex-vivo therapeutic response was measured to four standard of care chemotherapeutic agents and eight inhibitors targeting nodal points of the PI3K and DNA damage repair pathways. RNA seq data from the TCGA HGSOC cohort was used to establish the genes whose expression was highly correlated with the expression of MYC. Results Ex-vivo assays were predictive of first-line clinical response to chemotherapy agents (P < 0.001). 11/19 (58%) HGSOC spheroid samples showed significantly reduced viability with dual mTOR inhibition (AZD2014). MYC amplification was associated with AZD2014 and paclitaxel response. Expression of MYC and mTOR genes are strongly correlated in TCGA data. Conclusions Our results suggest that therapeutic strategies combining paclitaxel and inhibition of mTOR pathway can be used as personalised treatment in the context of MYC-amplified HGSOC. We are currently examining gene expression after AZD2014 pertubation in HGSOC models and performing the genomic analysis of cases from the phase 1 trial of AZD2014 and paclitaxel. Legal entity responsible for the study The authors. Funding Academy of Medical Sciences, Addenbrookes Charitable Trust, Cancer Research UK, University of Cambridge. Disclosure F.C. Martins: Research grant / Funding (self), The Clinical Lectureship from the Experimental Medicine Initiative is partly funded by AstraZeneca: AstraZeneca. All other authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]