94 results on '"Pillarisetty VG"'
Search Results
2. Mobilization of CD8+ T Cells via CXCR4 Blockade Facilitates PD-1 Checkpoint Therapy in Human Pancreatic Cancer
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Seo, YD, primary, Jiang, X, additional, Sullivan, KM, additional, Jilikis, FG, additional, Smythe, KS, additional, Abbasi, A, additional, Vignali, M, additional, Park, JO, additional, Daniel, SK, additional, Pollack, SM, additional, Kim, TS, additional, Yeung, R, additional, Crispe, IN, additional, Peirce, RH, additional, Robins, H, additional, and Pillarisetty, VG, additional
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3. Evaluating surgeon communication of pancreatic cancer prognosis using the VitalTalk ADAPT framework.
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Dickerson LK, Lipson TA, Chauhan SSB, Allen GI, Young B, Park JO, Pillarisetty VG, O'Connell KM, and Sham JG
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Background and Objectives: Few data exist to guide optimal communication practices for surgical oncologists. VitalTalk, an evidence-based communication skills training model for clinicians, offers the five-step ADAPT tool for discussing prognosis. This study aimed to characterize surgeon communication of pancreatic cancer prognosis using VitalTalk's ADAPT framework., Methods: Contemporaneous audio recordings from 12 initial surgeon-patient encounters for borderline resectable pancreatic cancer were transcribed. Directed qualitative content analysis based on ADAPT (Ask, Discover, Anticipate, Provide, and Track) was used to deductively code transcripts., Results: All encounters contained at least one ADAPT step while only one (8%) incorporated four or five steps. Surgeons provided prognostic information (Provide) in all but one encounter (92%); most was qualitative and clustered into themes: serious illness, surgical candidacy, prognostic ambiguity, and cancer recurrence. Surgeons elicited understanding (Ask), requested information preferences (Discover), anticipated ambivalence (Anticipate), and responded to emotion (Track) in a minority of encounters (25%-42%); of 15 patient emotional cues, six were not addressed by surgeons., Conclusions: During an initial encounter for pancreatic cancer, surgeons focus heavily on providing information but omit critical prognostic communication steps. Future studies are needed to investigate if surgeon training in palliative care-based communication is feasible and impacts patient-perceived quality of communication., (© 2024 Wiley Periodicals LLC.)
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- 2024
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4. Prophylactic somatostatin analogs for postoperative pancreatic fistulas: a cross-sectional survey of AHPBA surgeons.
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Chauhan SSB, Vierra B, Park JO, Pillarisetty VG, Davidson GH, and Sham JG
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Background: Postoperative pancreatic fistulas lead to substantially increased morbidity, mortality, and healthcare costs after pancreatectomy. Studies have reported conflicting data on the role of prophylactic somatostatin analogs in the reduction of postoperative pancreatic fistula. Current practice patterns, surgeon beliefs, and barriers to using these drugs in the Americas is not known., Methods: An online 26-question cross-sectional survey was distributed via email to the members of the Americas Hepato-Pancreato-Biliary Association in April 2023., Results: One hundred and two surgeons responded in spring 2023. 48.0% of respondents reported using prophylactic SSAs during their surgical training, however, only 29.4% do so in their current practice, most commonly when performing Whipple procedures. Octreotide was the most frequently used SSA (34.3%), followed by octreotide LAR (12.7%) and pasireotide (11.8%). Reasons for not prescribing included a lack of high-quality data (62.7%), perception of limited efficacy (34.3%) and high cost (30.4%)., Conclusion: These results highlight key areas for future study including understanding surgeon rationale for patient and drug selection. Variable practice patterns amongst surgeons also underscore the importance of generalizability in the design of future clinical trials in order to maximize impact., (Copyright © 2024 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
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- 2024
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5. Enhanced Complement Expression in the Tumor Microenvironment Following Neoadjuvant Therapy: Implications for Immunomodulation and Survival in Pancreatic Ductal Adenocarcinoma.
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Zhang X, Lan R, Liu Y, Pillarisetty VG, Li D, Zhao CL, Sarkar SA, Liu W, Hanna I, Gupta M, Hajdu C, Melamed J, Shusterman M, Widmer J, Allendorf J, and Liu YZ
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Background: Neoadjuvant therapy (NAT) is increasingly being used for pancreatic ductal adenocarcinoma (PDAC) treatment. However, its specific effects on carcinoma cells and the tumor microenvironment (TME) are not fully understood. This study aims to investigate how NAT differentially impacts PDAC's carcinoma cells and TME., Methods: Spatial transcriptomics was used to compare gene expression profiles in carcinoma cells and the TME between 23 NAT-treated and 13 NAT-naïve PDAC patients, correlating with their clinicopathologic features. Analysis of an online single-nucleus RNA sequencing (snRNA-seq) dataset was performed for validation of the specific cell types responsible for NAT-induced gene expression alterations., Results: NAT not only induces apoptosis and inhibits proliferation in carcinoma cells but also significantly remodels the TME. Notably, NAT induces a coordinated upregulation of multiple key complement genes (C3, C1S, C1R, C4B and C7) in the TME, making the complement pathway one of the most significantly affected pathways by NAT. Patients with higher TME complement expression following NAT exhibit improved overall survival. These patients also exhibit increased immunomodulatory and neurotrophic cancer-associated fibroblasts (CAFs); more CD4
+ T cells, monocytes, and mast cells; and reduced immune exhaustion gene expression. snRNA-seq analysis demonstrates C3 complement was specifically upregulated in CAFs but not in other stroma cell types., Conclusions: NAT can enhance complement production and signaling within the TME, which is associated with reduced immunosuppression in PDAC. These findings suggest that local complement dynamics could serve as a novel biomarker for prognosis, evaluating treatment response and resistance, and guiding therapeutic strategies in NAT-treated PDAC patients., Competing Interests: COMPETING INTERESTS The authors declare that they have no conflict of interest.- Published
- 2024
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6. Are enhanced recovery protocols after pancreatoduodenectomy still efficient when applied in elderly patients? A systematic review and individual patient data meta-analysis.
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Kuemmerli C, Balzano G, Bouwense SA, Braga M, Coolsen M, Daniel SK, Dervenis C, Falconi M, Hwang DW, Kagedan DJ, Kim SC, Lavu H, Nussbaum D, Partelli S, Passeri MJ, Pecorelli N, Pillarisetty VG, Pucci MJ, Sutcliffe RP, Tingstedt B, van der Kolk M, Vrochides D, Armstrong M, Wei A, Williamsson C, Yeo CJ, Zani S, Zouros E, Rozzini R, and Abu Hilal M
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- Humans, Aged, Aged, 80 and over, Age Factors, Recovery of Function, Female, Male, Patient Readmission statistics & numerical data, Pancreaticoduodenectomy adverse effects, Enhanced Recovery After Surgery, Length of Stay statistics & numerical data, Postoperative Complications epidemiology
- Abstract
Background: This meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared to conventional care on postoperative outcomes in patients aged 70 years or older undergoing pancreatoduodenectomy (PD)., Methods: Five databases were systematically searched. Comparative studies with available individual patient data (IPD) were included. The main outcomes were postoperative morbidity, length of stay, readmission and postoperative functional recovery elements. To assess an age-dependent effect, the group was divided in septuagenarians (70-79 years) and older patients (≥80 years)., Results: IPD were obtained from 15 of 31 eligible studies comprising 1109 patients. The overall complication and major complication rates were comparable in both groups (OR 0.92 [95% CI: 0.65-1.29], p = .596 and OR 1.22 [95% CI: 0.61-2.46], p = .508). Length of hospital stay tended to be shorter in the ERAS group compared to the conventional care group (-0.14 days [95% CI: -0.29 to 0.01], p = .071) while readmission rates were comparable and the total length of stay including days in hospital after readmission tended to be shorter in the ERAS group (-0.28 days [95% CI: -0.62 to 0.05], p = .069). In the subgroups, the length of stay was shorter in octogenarians treated with ERAS (-0.36 days [95% CI: -0.71 to -0.004], p = .048). The readmission rate increased slightly but not significantly while the total length of stay was not longer in the ERAS group., Conclusion: ERAS in the elderly is safe and its benefits are preserved in the care of even in patients older than 80 years. Standardized care protocol should be encouraged in all pancreatic centers., (© 2024 Japanese Society of Hepato‐Biliary‐Pancreatic Surgery.)
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- 2024
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7. Intratumoral T-cell receptor repertoire composition predicts overall survival in patients with pancreatic ductal adenocarcinoma.
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Pothuri VS, Hogg GD, Conant L, Borcherding N, James CA, Mudd J, Williams G, Seo YD, Hawkins WG, Pillarisetty VG, DeNardo DG, and Fields RC
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- Humans, T-Lymphocytes, Receptors, Antigen, T-Cell genetics, Biomarkers, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms genetics, Carcinoma, Pancreatic Ductal diagnosis, Carcinoma, Pancreatic Ductal genetics
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Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy that is refractory to immune checkpoint inhibitor therapy. However, intratumoral T-cell infiltration correlates with improved overall survival (OS). Herein, we characterized the diversity and antigen specificity of the PDAC T-cell receptor (TCR) repertoire to identify novel immune-relevant biomarkers. Demographic, clinical, and TCR-beta sequencing data were collated from 353 patients across three cohorts that underwent surgical resection for PDAC. TCR diversity was calculated using Shannon Wiener index, Inverse Simpson index, and "True entropy." Patients were clustered by shared repertoire specificity. TCRs predictive of OS were identified and their associated transcriptional states were characterized by single-cell RNAseq. In multivariate Cox regression models controlling for relevant covariates, high intratumoral TCR diversity predicted OS across multiple cohorts. Conversely, in peripheral blood, high abundance of T-cells, but not high diversity, predicted OS. Clustering patients based on TCR specificity revealed a subset of TCRs that predicts OS. Interestingly, these TCR sequences were more likely to encode CD8
+ effector memory and CD4+ T-regulatory (Tregs) T-cells, all with the capacity to recognize beta islet-derived autoantigens. As opposed to T-cell abundance, intratumoral TCR diversity was predictive of OS in multiple PDAC cohorts, and a subset of TCRs enriched in high-diversity patients independently correlated with OS. These findings emphasize the importance of evaluating peripheral and intratumoral TCR repertoires as distinct and relevant biomarkers in PDAC., Competing Interests: N.B. is a consultant for Santa Ana Bio and Omniscope. No potential conflicts of interest were reported by the other authors., (© 2024 The Author(s). Published with license by Taylor & Francis Group, LLC.)- Published
- 2024
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8. Reversing immunosuppression in the tumor microenvironment of fibrolamellar carcinoma via PD-1 and IL-10 blockade.
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Daniel SK, Sullivan KM, Dickerson LK, van den Bijgaart RJE, Utria AF, Labadie KP, Kenerson HL, Jiang X, Smythe KS, Campbell JS, Pierce RH, Kim TS, Riehle KJ, Yeung RS, Carter JA, Barry KC, and Pillarisetty VG
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- Humans, Immunosuppression Therapy, Receptors, Antigen, T-Cell, Tumor Microenvironment, Carcinoma, Hepatocellular pathology, Carcinoma, Hepatocellular therapy, Interleukin-10 antagonists & inhibitors, Interleukin-10 metabolism, Liver Neoplasms pathology, Programmed Cell Death 1 Receptor antagonists & inhibitors, Programmed Cell Death 1 Receptor metabolism
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Fibrolamellar carcinoma (FLC) is a rare liver tumor driven by the DNAJ-PKAc fusion protein that affects healthy young patients. Little is known about the immune response to FLC, limiting rational design of immunotherapy. Multiplex immunohistochemistry and gene expression profiling were performed to characterize the FLC tumor immune microenvironment and adjacent non-tumor liver (NTL). Flow cytometry and T cell receptor (TCR) sequencing were performed to determine the phenotype of tumor-infiltrating immune cells and the extent of T cell clonal expansion. Fresh human FLC tumor slice cultures (TSCs) were treated with antibodies blocking programmed cell death protein-1 (PD-1) and interleukin-10 (IL-10), with results measured by cleaved caspase-3 immunohistochemistry. Immune cells were concentrated in fibrous stromal bands, rather than in the carcinoma cell compartment. In FLC, T cells demonstrated decreased activation and regulatory T cells in FLC had more frequent expression of PD-1 and CTLA-4 than in NTL. Furthermore, T cells had relatively low levels of clonal expansion despite high TCR conservation across individuals. Combination PD-1 and IL-10 blockade signficantly increased cell death in human FLC TSCs. Immunosuppresion in the FLC tumor microenvironment is characterized by T cell exclusion and exhaustion, which may be reversible with combination immunotherapy., (© 2024. The Author(s).)
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- 2024
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9. Toll-Like Receptor 4 Agonist Injection With Concurrent Radiotherapy in Patients With Metastatic Soft Tissue Sarcoma: A Phase 1 Nonrandomized Controlled Trial.
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Seo YD, Lu H, Black G, Smythe K, Yu Y, Hsu C, Ng J, Hermida de Viveiros P, Warren EH, Schroeder BA, O'Malley RB, Cranmer LD, Loggers ET, Wagner MJ, Bonham L, Pillarisetty VG, Kane G, Berglund P, Hsu FJ, Mi X, Alexiev BA, Pierce RH, Riddell SR, Jones RL, Ter Meulen J, Kim EY, and Pollack SM
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- Humans, Female, Aged, Male, Toll-Like Receptor 4 agonists, T-Lymphocytes, Receptors, Antigen, T-Cell, Soft Tissue Neoplasms drug therapy, Soft Tissue Neoplasms radiotherapy, Sarcoma drug therapy, Sarcoma radiotherapy
- Abstract
Importance: Metastatic soft tissue sarcomas (STSs) have limited systemic therapy options, and immunomodulation has not yet meaningfully improved outcomes. Intratumoral (IT) injection of the toll-like receptor 4 (TLR4) agonist glycopyranosyl lipid A in stable-emulsion formulation (GLA-SE) has been studied as immunotherapy in other contexts., Objective: To evaluate the safety, efficacy, and immunomodulatory effects of IT GLA-SE with concurrent radiotherapy in patients with metastatic STS with injectable lesions., Design, Setting, and Participants: This phase 1 nonrandomized controlled trial of patients with STS was performed at a single academic sarcoma specialty center from November 17, 2014, to March 16, 2016. Data analysis was performed from August 2016 to September 2022., Interventions: Two doses of IT GLA-SE (5 μg and 10 μg for 8 weekly doses) were tested for safety in combination with concurrent radiotherapy of the injected lesion., Main Outcomes and Measures: Primary end points were safety and tolerability. Secondary and exploratory end points included local response rates as well as measurement of antitumor immunity with immunohistochemistry and T-cell receptor (TCR) sequencing of tumor-infiltrating and circulating lymphocytes., Results: Twelve patients (median [range] age, 65 [34-78] years; 8 [67%] female) were treated across the 2 dose cohorts. Intratumoral GLA-SE was well tolerated, with only 1 patient (8%) experiencing a grade 2 adverse event. All patients achieved local control of the injected lesion after 8 doses, with 1 patient having complete regression (mean regression, -25%; range, -100% to 4%). In patients with durable local response, there were detectable increases in tumor-infiltrating lymphocytes. In 1 patient (target lesion -39% at 259 days of follow-up), TCR sequencing revealed expansion of preexisting and de novo clonotypes, with convergence of numerous rearrangements coding for the same binding sequence (suggestive of clonal convergence to antitumor targets). Single-cell sequencing identified these same expanded TCR clones in peripheral blood after treatment; these T cells had markedly enhanced Tbet expression, suggesting TH1 phenotype., Conclusions and Relevance: In this nonrandomized controlled trial, IT GLA-SE with concurrent radiotherapy was well tolerated and provided more durable local control than radiotherapy alone. Patients with durable local response demonstrated enhanced IT T-cell clonal expansion, with matched expansion of these clonotypes in the circulation. Additional studies evaluating synergism of IT GLA-SE and radiotherapy with systemic immune modulation are warranted., Trial Registration: ClinicalTrials.gov Identifier: NCT02180698.
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- 2023
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10. Production of an interleukin-10 blocking antibody by genetically engineered macrophages increases cancer cell death in human gastrointestinal tumor slice cultures.
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Labadie KP, Kreuser SA, Brempelis KJ, Daniel SK, Jiang X, Sullivan KM, Utria AF, Kenerson HL, Kim TS, Crane CA, and Pillarisetty VG
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- Humans, Apoptosis genetics, Interleukin-10 antagonists & inhibitors, Interleukin-10 immunology, Leukocytes, Mononuclear, Macrophages pathology, Tumor Microenvironment genetics, Gastrointestinal Neoplasms genetics, Gastrointestinal Neoplasms therapy, Pancreatic Neoplasms therapy, Pancreatic Neoplasms drug therapy
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Although it can promote effector T-cell function, the summative effect of interleukin-10 (IL-10) in the tumor microenvironment (TME) appears to be suppressive; therefore, blocking this critical regulatory cytokine has therapeutic potential to enhance antitumor immune function. As macrophages efficiently localize to the TME, we hypothesized that they could be used as a delivery vehicle for drugs designed to block this pathway. To test our hypothesis, we created and evaluated genetically engineered macrophages (GEMs) that produce an IL-10-blocking antibody (αIL-10). Healthy donor human peripheral blood mononuclear cells were differentiated and transduced with a novel lentivirus (LV) encoding BT-063, a humanized αIL-10 antibody. The efficacy of αIL-10 GEMs was assessed in human gastrointestinal tumor slice culture models developed from resected specimens of pancreatic ductal adenocarcinoma primary tumors and colorectal cancer liver metastases. LV transduction led to sustained production of BT-063 by αIL-10 GEMs for at least 21 days. Transduction did not alter GEM phenotype as evaluated by flow cytometry, but αIL-10 GEMs produced measurable quantities of BT-063 in the TME that was associated with an ~5-fold higher rate of tumor cell apoptosis than control., (© 2023. The Author(s), under exclusive licence to Springer Nature America, Inc.)
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- 2023
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11. Leiomyosarcoma of the inferior vena cava: An uncommon malignancy requiring unique reconstructive approaches.
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Goodsell KE, Sharib JM, Pillarisetty VG, and Sham JG
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- Humans, Vena Cava, Inferior surgery, Vena Cava, Inferior pathology, Nephrectomy, Combined Modality Therapy, Leiomyosarcoma surgery, Plastic Surgery Procedures
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Surgery is considered for patients without metastatic disease and with resectable primary tumor. Pre-operatively, high quality imaging is reviewed to determine the likely extent of resection, specifically including the need for potential en-bloc resection of adjacent organs. In cases where up-front surgical approach would expose the patient to excessive morbidity (such as bilateral nephrectomy, multi-visceral resection, or prohibitively high risk of positive margins), neoadjuvant chemotherapy and/or chemoradiotherapy is considered. Though data are sparse in LMS, a neoadjuvant regimen of doxorubicin and dacarbazine is typically considered for borderline resectable tumors at our institution; patients may be treated for up to 4 months with interval imaging every 2 months to evaluate for tumor response. Postoperatively, adjuvant systemic therapy or radiation may be considered for patients with positive surgical margins or high-grade tumors., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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12. Emerging interleukin targets in the tumour microenvironment: implications for the treatment of gastrointestinal tumours.
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Dickerson LK, Carter JA, Kohli K, and Pillarisetty VG
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- Humans, Interleukins, Cytokines, Immunotherapy, Lymphocytes, Tumor-Infiltrating, Tumor Microenvironment, Neoplasms, Gastrointestinal Neoplasms drug therapy
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The effectiveness of antitumour immunity is dependent on intricate cytokine networks. Interleukins (ILs) are important mediators of complex interactions within the tumour microenvironment, including regulation of tumour-infiltrating lymphocyte proliferation, differentiation, migration and activation. Our evolving and increasingly nuanced understanding of the cell type-specific and heterogeneous effects of IL signalling has presented unique opportunities to fine-tune elaborate IL networks and engineer new targeted immunotherapeutics. In this review, we provide a primer for clinicians on the challenges and potential of IL-based treatment. We specifically detail the roles of IL-2, IL-10, IL-12 and IL-15 in shaping the tumour-immune landscape of gastrointestinal malignancies, paying particular attention to promising preclinical findings, early-stage clinical research and innovative therapeutic approaches that may properly place ILs to the forefront of immunotherapy regimens., Competing Interests: Competing interests: VGP is a member of the scientific advisory board for TriSalus Life Sciences. He has served as a consultant for GlaxoSmithKline in 2019, Imvax in 2019, Takeda in 2020, and Umoja and Sensei in 2022. He has had research funding from AstraZeneca, Ipsen, Merck, NGM and OncoResponse., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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13. Perioperative Chemotherapy and Chemoradiotherapy for Patients With Resectable and Borderline Resectable Pancreatic Adenocarcinoma.
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Coveler AL, Pillarisetty VG, Koh WJ, Zhen DB, Park JO, King GG, Sham JG, Hannan LM, Mann GN, Baker KK, Redman MW, Swanson PE, Chiorean EG, and Whiting SH
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- Humans, Capecitabine, Oxaliplatin, Chemoradiotherapy methods, Antineoplastic Combined Chemotherapy Protocols adverse effects, Neoadjuvant Therapy adverse effects, Neoadjuvant Therapy methods, Fluorouracil, Pancreatic Neoplasms, Pancreatic Neoplasms pathology, Adenocarcinoma drug therapy, Carcinoma, Pancreatic Ductal surgery, Carcinoma, Pancreatic Ductal drug therapy
- Abstract
Objectives: Pancreatic ductal adenocarcinoma (PDA) is the third most common cause of cancer death in the United States. Most patients who undergo resection develop recurrence. Standard treatment confers a median overall survival (OS) of 24 months. Exposure to alternate regimens may prevent chemoresistance. This study evaluated multiagent perioperative therapy for potentially resectable PDA patients to improve OS., Methods: A single center, phase 2, trial of patients with resectable or borderline resectable PDA. Patients received neoadjuvant therapy with induction chemotherapy (gemcitabine, docetaxel, capecitabine) for 3 cycles, chemoradiation (intensity-modulated radiation therapy with capecitabine and oxaliplatin) followed by surgery, and 2 months of adjuvant gemcitabine and oxaliplatin and 2 months of gemcitabine. The primary endpoint was OS. The secondary endpoint was recurrence-free survival (RFS)., Results: Thirty-two eligible patients were enrolled. Twenty-two patients underwent surgical resection. After a median follow-up of 56.8 months, mOS was 31.6 months (95% confidence interval [CI], 14.2-58.1) for all patients, 58.1 months (95% CI, 31.6 to NR) for those who completed surgery. The mRFS was 31.3 months (95% CI, 12.5 to NR)., Conclusions: Perioperative therapy with GTX, chemoradiotherapy, and adjuvant GemOx/Gem resulted in promising survival of 58 months for patients who underwent resection and may represent another treatment option for PDA., Competing Interests: Conflict of Interest: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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14. Blockade of interleukin 10 potentiates antitumour immune function in human colorectal cancer liver metastases.
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Sullivan KM, Jiang X, Guha P, Lausted C, Carter JA, Hsu C, Labadie KP, Kohli K, Kenerson HL, Daniel SK, Yan X, Meng C, Abbasi A, Chan M, Seo YD, Park JO, Crispe IN, Yeung RS, Kim TS, Gujral TS, Tian Q, Katz SC, and Pillarisetty VG
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- Animals, Humans, Mice, Carcinoembryonic Antigen immunology, CD8-Positive T-Lymphocytes immunology, Immunotherapy, Adoptive, Lymphocyte Activation, Receptors, Antigen, T-Cell metabolism, Antibodies, Blocking immunology, Carcinoma immunology, Carcinoma secondary, Colorectal Neoplasms pathology, Interleukin-10 antagonists & inhibitors, Liver Neoplasms immunology, Liver Neoplasms secondary, Receptors, Chimeric Antigen genetics, Receptors, Chimeric Antigen metabolism, Receptors, Interleukin-10 antagonists & inhibitors
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Objective: Programmed cell death protein 1 (PD-1) checkpoint inhibition and adoptive cellular therapy have had limited success in patients with microsatellite stable colorectal cancer liver metastases (CRLM). We sought to evaluate the effect of interleukin 10 (IL-10) blockade on endogenous T cell and chimeric antigen receptor T (CAR-T) cell antitumour function in CRLM slice cultures., Design: We created organotypic slice cultures from human CRLM (n=38 patients' tumours) and tested the antitumour effects of a neutralising antibody against IL-10 (αIL-10) both alone as treatment and in combination with exogenously administered carcinoembryonic antigen (CEA)-specific CAR-T cells. We evaluated slice cultures with single and multiplex immunohistochemistry, in situ hybridisation, single-cell RNA sequencing, reverse-phase protein arrays and time-lapse fluorescent microscopy., Results: αIL-10 generated a 1.8-fold increase in T cell-mediated carcinoma cell death in human CRLM slice cultures. αIL-10 significantly increased proportions of CD8
+ T cells without exhaustion transcription changes, and increased human leukocyte antigen - DR isotype (HLA-DR) expression of macrophages. The antitumour effects of αIL-10 were reversed by major histocompatibility complex class I or II (MHC-I or MHC-II) blockade, confirming the essential role of antigen presenting cells. Interrupting IL-10 signalling also rescued murine CAR-T cell proliferation and cytotoxicity from myeloid cell-mediated immunosuppression. In human CRLM slices, αIL-10 increased CEA-specific CAR-T cell activation and CAR-T cell-mediated cytotoxicity, with nearly 70% carcinoma cell apoptosis across multiple human tumours. Pretreatment with an IL-10 receptor blocking antibody also potentiated CAR-T function., Conclusion: Neutralising the effects of IL-10 in human CRLM has therapeutic potential as a stand-alone treatment and to augment the function of adoptively transferred CAR-T cells., Competing Interests: Competing interests: VGP is a member of the scientific advisory board for TriSalus Life Sciences. He has served as a consultant for Merck & Company in 2018, GlaxoSmithKline in 2019, Imvax in 2019, Takeda in 2020 and Umoja in 2022. He has research funding from AstraZeneca, Ipsen, Merck, OncoResponse and NGM. The funders had no role in the conceptualisation, design, data collection, analysis, decision to publish or preparation of the manuscript. The anti-CEA CAR vector was provided by TNK Therapeutics, who had no role in the conceptualisation, design, data collection, analysis or preparation of the manuscript. SCK served as an advisor for TNK Therapeutics until December 2019, is currently Chief Medical Officer of TriSalus Life Sciences and SAB member of Nkarta, Takeda and Sentibio, and has received research funding from Takeda and Nkata., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2023
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15. KRAS Mutation Variants and Co-occurring PI3K Pathway Alterations Impact Survival for Patients with Pancreatic Ductal Adenocarcinomas.
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Diehl AC, Hannan LM, Zhen DB, Coveler AL, King G, Cohen SA, Harris WP, Shankaran V, Wong KM, Green S, Ng N, Pillarisetty VG, Sham JG, Park JO, Reddi D, Konnick EQ, Pritchard CC, Baker K, Redman M, and Chiorean EG
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- Humans, Retrospective Studies, Genomics, Mutation, Proto-Oncogene Proteins p21(ras) genetics, Phosphatidylinositol 3-Kinases genetics, Neoplasms
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Background: KRAS variant alleles may have differential biological properties which impact prognosis and therapeutic options in pancreatic ductal adenocarcinomas (PDA)., Materials and Methods: We retrospectively identified patients with advanced PDA who received first-line therapy and underwent blood and/or tumor genomic sequencing at the University of Washington between 2013 and 2020. We examined the incidence of KRAS mutation variants with and without co-occurring PI3K or other genomic alterations and evaluated the association of these mutations with clinicopathological characteristics and survival using a Cox proportional hazards model., Results: One hundred twenty-six patients had genomic sequencing data; KRAS mutations were identified in 111 PDA and included the following variants: G12D (43)/G12V (35)/G12R (23)/other (10). PI3K pathway mutations (26% vs. 8%) and homologous recombination DNA repair (HRR) defects (35% vs. 12.5%) were more common among KRAS G12R vs. non-G12R mutated cancers. Patients with KRAS G12R vs. non-G12R cancers had significantly longer overall survival (OS) (HR 0.55) and progression-free survival (PFS) (HR 0.58), adjusted for HRR pathway co-mutations among other covariates. Within the KRAS G12R group, co-occurring PI3K pathway mutations were associated with numerically shorter OS (HR 1.58), while no effect was observed on PFS., Conclusions: Patients with PDA harboring KRAS G12R vs. non-G12R mutations have longer survival, but this advantage was offset by co-occurring PI3K alterations. The KRAS/PI3K genomic profile could inform therapeutic vulnerabilities in patients with PDA., (© The Author(s) 2022. Published by Oxford University Press.)
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- 2022
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16. A novel rat model for the study of postoperative pancreatic fistula.
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Utria AF, Labadie KP, Abbasi A, Gui X, Pillarisetty VG, Park JO, and Sham JG
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- Rats, Animals, Risk Factors, Pancreas surgery, Postoperative Complications etiology, Pancreatic Fistula etiology, Pancreatic Fistula prevention & control, Pancreatic Fistula surgery, Pancreaticoduodenectomy
- Abstract
While over the past several decades mortality after pancreatic surgery has decreased to <5%, postoperative morbidity remains remarkably high, ranging from 15% to 65%. The development of a postoperative pancreatic fistula (POPF) is a significant contributor to morbidity in patients undergoing pancreatic surgery. POPF can lead to life-threatening conditions such as intra-abdominal abscess, uncontrolled hemorrhage, sepsis, and death. Rates of POPF have not significantly changed over time, despite the introduction of multiple technical and pharmacologic interventions aimed at their treatment and prevention. Unfortunately, there are few POPF experimental models that have been described in the literature and existing models are unable to reliably reproduce the clinical sequelae of POPF, limiting the development of new methods to prevent and treat POPF. Herein, we describe a new rat experimental model that reliably creates a POPF via transection of the common pancreatic duct.
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- 2022
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17. A phase II trial of lanreotide for the prevention of postoperative pancreatic fistula.
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Pillarisetty VG, Abbasi A, Park JO, and Sham JG
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- Humans, Pancreatectomy adverse effects, Pancreaticoduodenectomy adverse effects, Retrospective Studies, Risk Factors, Pancreatic Fistula etiology, Pancreatic Fistula prevention & control, Postoperative Complications etiology, Postoperative Complications prevention & control, Somatostatin adverse effects
- Abstract
Background: Clinically relevant postoperative pancreatic fistula (CR-POPF) is a significant contributor to morbidity after pancreatectomy. Somatostatin analogues have shown variable efficacy in the prevention of CR-POPF. Lanreotide is a somatostatin analogue ideally suited for perioperative use due to its long half-life and favorable side effect profile., Methods: We conducted a phase II single-arm trial of a single dose of preoperative lanreotide (120 mg) in patients undergoing either pancreaticoduodenectomy (PD) or distal pancreatectomy (DP). The primary outcome was development of CR-POPF or intra-abdominal abscess. Secondary outcomes included biochemical leak and overall morbidity., Results: A total of 98 patients completed the study. Sixty-two underwent PD (63.3%) and 36 underwent DP (36.7%). The primary outcome was observed in eight (8%) patients in the overall cohort, one from the DP group and seven from the PD group. Biochemical leak was detected in 12 (12.2%) patients in the overall cohort. Twenty-seven (27.5%) patients developed complications, of which 14 (14.2%) were major complications. Drug-related adverse events were limited to mild skin reactions in two (2%) patients., Conclusion: Patients who received preoperative lanreotide developed CR-POPF at rates significantly lower than historical controls or published literature. This provides strong justification for a randomized controlled trial., (Copyright © 2022 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
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- 2022
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18. Combination immunotherapy for pancreatic cancer: challenges and future considerations.
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Gössling GCL, Zhen DB, Pillarisetty VG, and Chiorean EG
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- Humans, Immune Checkpoint Inhibitors, Immunotherapy, Tumor Microenvironment, Pancreatic Neoplasms, Pancreatic Neoplasms drug therapy, Pancreatic Neoplasms metabolism, Carcinoma, Pancreatic Ductal drug therapy, Carcinoma, Pancreatic Ductal pathology
- Abstract
Introduction: Immune checkpoint inhibitors (ICI) have not yielded significant efficacy in pancreatic ductal adenocarcinoma (PDA), despite the role of the innate and adaptive immune systems on progression and survival. However, recently identified pathways have identified new targets and generated promising clinical investigations into promoting an effective immune-mediated antitumor response in PDA., Areas Covered: We review biological mechanisms associated with immunotherapy resistance and outline strategies for therapeutic combinations with established and novel therapies in PDA., Expert Opinion: Pancreatic cancers rarely benefit from treatment with ICI due to an immunosuppressive tumor microenvironment (TME). New understandings of factors associated with the suppressive TME include low- and poor-quality neoantigens, constrained effector T cells infiltration, and the presence of a dense, suppressive myeloid cell population. These findings have been translated into new clinical investigations evaluating novel therapies in combination with ICI and/or standard systemic chemotherapy and radiotherapy. The epithelial, immune, and stromal compartments are intricately related in PDA, and the framework for successful targeting of this disease requires a comprehensive and personalized approach.
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- 2022
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19. Hypoxia-inducible lentiviral gene expression in engineered human macrophages.
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Chinn HK, Gardell JL, Matsumoto LR, Labadie KP, Mihailovic TN, Lieberman NAP, Davis A, Pillarisetty VG, and Crane CA
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- Animals, Cell Hypoxia genetics, Cytokines metabolism, Gene Expression, Humans, Mice, Tumor Microenvironment, Lentivirus genetics, Macrophages metabolism, Macrophages virology
- Abstract
Background: Human immune cells, including monocyte-derived macrophages, can be engineered to deliver proinflammatory cytokines, bispecific antibodies, and chimeric antigen receptors to support immune responses in different disease settings. When gene expression is regulated by constitutively active promoters, lentiviral payload gene expression is unregulated, and can result in potentially toxic quantities of proteins. Regulated delivery of lentivirally encoded proteins may allow localized or conditional therapeutic protein expression to support safe delivery of adoptively transferred, genetically modified cells with reduced capacity for systemic toxicities., Methods: In this study, we engineered human macrophages to express genes regulated by hypoxia responsive elements included in the lentiviral promoter region to drive conditional lentiviral gene expression only under hypoxic conditions. We tested transduced macrophages cultured in hypoxic conditions for the transient induced expression of reporter genes and the secreted cytokine, interleukin-12. Expression of hypoxia-regulated genes was investigated both transcriptionally and translationally, and in the presence of human tumor cells in a slice culture system. Finally, hypoxia-regulated gene expression was evaluated in a subcutaneous humanized-mouse cancer model., Results: Engineered macrophages were shown to conditionally and tranisently express lentivirally encoded gene protein products, including IL-12 in hypoxic conditions in vitro. On return to normoxic conditions, lentiviral payload expression returned to basal levels. Reporter genes under the control of hypoxia response elements were upregulated under hypoxic conditions in the presence of human colorectal carcinoma cells and in the hypoxic xenograft model of glioblastoma, suggesting utility for systemic engineered cell delivery capable of localized gene delivery in cancer., Conclusions: Macrophages engineered to express hypoxia-regulated payloads have the potential to be administered systemically and conditionally express proteins in tissues with hypoxic conditions. In contrast to immune cells that function or survive poorly in hypoxic conditions, macrophages maintain a proinflammatory phenotype that may support continued gene and protein expression when regulated by conditional hypoxia responsive elements and naturally traffic to hypoxic microenvironments, making them ideal vehicles for therapeutic payloads to hypoxic tissues, such as solid tumors. With the ability to fine-tune delivery of potent proteins in response to endogenous microenvironments, macrophage-based cellular therapies may therefore be designed for different disease settings., Competing Interests: Competing interests: CAC is an inventor on a patent US20170087185A1, Genetic engineering of macrophages for immunotherapy. CAC receives research support and is on the scientific advisory board for BlueRock Therapeutics., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2022
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20. Neoantigen-specific CD4 + T cells in human melanoma have diverse differentiation states and correlate with CD8 + T cell, macrophage, and B cell function.
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Veatch JR, Lee SM, Shasha C, Singhi N, Szeto JL, Moshiri AS, Kim TS, Smythe K, Kong P, Fitzgibbon M, Jesernig B, Bhatia S, Tykodi SS, Hall ET, Byrd DR, Thompson JA, Pillarisetty VG, Duhen T, McGarry Houghton A, Newell E, Gottardo R, and Riddell SR
- Subjects
- Animals, Antigens, Neoplasm genetics, CD4-Positive T-Lymphocytes, Humans, Macrophages, Mice, Tumor Microenvironment, CD8-Positive T-Lymphocytes, Melanoma genetics
- Abstract
CD4
+ T cells that recognize tumor antigens are required for immune checkpoint inhibitor efficacy in murine models, but their contributions in human cancer are unclear. We used single-cell RNA sequencing and T cell receptor sequences to identify signatures and functional correlates of tumor-specific CD4+ T cells infiltrating human melanoma. Conventional CD4+ T cells that recognize tumor neoantigens express CXCL13 and are subdivided into clusters expressing memory and T follicular helper markers, and those expressing cytolytic markers, inhibitory receptors, and IFN-γ. The frequency of CXCL13+ CD4+ T cells in the tumor correlated with the transcriptional states of CD8+ T cells and macrophages, maturation of B cells, and patient survival. Similar correlations were observed in a breast cancer cohort. These results identify phenotypes and functional correlates of tumor-specific CD4+ T cells in melanoma and suggest the possibility of using such cells to modify the tumor microenvironment., Competing Interests: Declaration of interests S.R.R. is a co-founder of Lyell Immunopharma. J.R.V and S.R.R. have received grant funding and have intellectual property licensed to Lyell Immunopharma. J.R.V. and A.M.H. have received research support from Bristol Myers Squibb. R.G. has received consulting income from Illumina and declares ownership in Ozette Technologies, Modulus Therapeutics, and minor stock ownerships in 10X Genomics., (Copyright © 2022 Elsevier Inc. All rights reserved.)- Published
- 2022
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21. Correction to: Postoperative Morbidity After Resection of Recurrent Retroperitoneal Sarcoma: A Report from the Transatlantic Australasian RPS Working Group (TARPSWG).
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Nessim C, Raut CP, Callegaro D, Barretta F, Miceli R, Fairweather M, Rutkowski P, Blay JY, Strauss D, Gonzalez R, Ahuja N, Grignani G, Quagliuolo V, Stoeckle E, De Paoli A, Pillarisetty VG, Swallow CJ, Bagaria SP, Canter RJ, Mullen JT, Schrage Y, Pennacchioli E, van Houdt W, Cardona K, Fiore M, Gronchi A, and Lahat G
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- 2022
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22. Correction to: Analysis of Differentiation Changes and Outcomes at Time of First Recurrence of Retroperitoneal Liposarcoma by Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG).
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Nessim C, Raut CP, Callegaro D, Barretta F, Miceli R, Fairweather M, Blay JY, Strauss D, Rutkowski P, Ahuja N, Gonzalez R, Grignani G, Quagliuolo V, Stoeckle E, Lahat G, De Paoli A, Pillarisetty VG, Canter RJ, Mullen JT, Pennacchioli E, van Houdt W, Swallow CJ, Schrage Y, Cardona K, Fiore M, Gronchi A, and Bagaria SP
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- 2022
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23. Impact of enhanced recovery protocols after pancreatoduodenectomy: meta-analysis.
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Kuemmerli C, Tschuor C, Kasai M, Alseidi AA, Balzano G, Bouwense S, Braga M, Coolsen M, Daniel SK, Dervenis C, Falconi M, Hwang DW, Kagedan DJ, Kim SC, Lavu H, Liang T, Nussbaum D, Partelli S, Passeri MJ, Pecorelli N, Pillai SA, Pillarisetty VG, Pucci MJ, Su W, Sutcliffe RP, Tingstedt B, van der Kolk M, Vrochides D, Wei A, Williamsson C, Yeo CJ, Zani S, Zouros E, and Abu Hilal M
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- Humans, Length of Stay, Patient Readmission, Postoperative Complications prevention & control, Recovery of Function, Enhanced Recovery After Surgery, Pancreaticoduodenectomy adverse effects
- Abstract
Background: This individual-patient data meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared with conventional care on postoperative outcomes in patients undergoing pancreatoduodenectomy., Methods: The Cochrane Library, MEDLINE, Embase, Scopus, and Web of Science were searched systematically for articles reporting outcomes of ERAS after pancreatoduodenectomy published up to August 2020. Comparative studies were included. Main outcomes were postoperative functional recovery elements, postoperative morbidity, duration of hospital stay, and readmission., Results: Individual-patient data were obtained from 17 of 31 eligible studies comprising 3108 patients. Time to liquid (mean difference (MD) -3.23 (95 per cent c.i. -4.62 to -1.85) days; P < 0.001) and solid (-3.84 (-5.09 to -2.60) days; P < 0.001) intake, time to passage of first stool (MD -1.38 (-1.82 to -0.94) days; P < 0.001) and time to removal of the nasogastric tube (3.03 (-4.87 to -1.18) days; P = 0.001) were reduced with ERAS. ERAS was associated with lower overall morbidity (risk difference (RD) -0.04, 95 per cent c.i. -0.08 to -0.01; P = 0.015), less delayed gastric emptying (RD -0.11, -0.22 to -0.01; P = 0.039) and a shorter duration of hospital stay (MD -2.33 (-2.98 to -1.69) days; P < 0.001) without a higher readmission rate., Conclusion: ERAS improved postoperative outcome after pancreatoduodenectomy. Implementation should be encouraged., (© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2022
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24. IWATE criteria are associated with perioperative outcomes in robotic hepatectomy: a retrospective review of 225 resections.
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Labadie KP, Droullard DJ, Lois AW, Daniel SK, McNevin KE, Gonzalez JV, Seo YD, Sullivan KM, Bilodeau KS, Dickerson LK, Utria AF, Calhoun J, Pillarisetty VG, Sham JG, Yeung RS, and Park JO
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- Bile Ducts, Intrahepatic pathology, Hepatectomy adverse effects, Humans, Length of Stay, Postoperative Complications epidemiology, Postoperative Complications etiology, Postoperative Complications surgery, Retrospective Studies, Bile Duct Neoplasms surgery, Laparoscopy adverse effects, Liver Neoplasms, Robotic Surgical Procedures adverse effects
- Abstract
Background: Robotic hepatectomy (RH) is increasingly utilized for minor and major liver resections. The IWATE criteria were developed to classify minimally invasive liver resections by difficulty. The objective of this study was to apply the IWATE criteria in RH and to describe perioperative and oncologic outcomes of RH over the last decade at our institution., Methods: Perioperative and oncologic outcomes of patients who underwent RH between 2011 and 2019 were retrospectively collected. The difficulty level of each operation was assessed using the IWATE criteria, and outcomes were compared at each level. Univariate linear regression was performed to characterize the relationship between IWATE criteria and perioperative outcomes (OR time, EBL, and LOS), and a multivariable model was also developed to address potential confounding by patient characteristics (age, sex, BMI, prior abdominal surgery, ASA class, and simultaneous non-hepatectomy operation)., Results: Two hundred and twenty-five RH were performed. Median IWATE criteria for RH were 6 (IQR 5-9), with low, intermediate, advanced, and expert resections accounting for 23% (n = 51), 34% (n = 77), 32% (n = 72), and 11% (n = 25) of resections, respectively. The majority of resections were parenchymal-sparing approaches, including anatomic segmentectomies and non-anatomic partial resections. 30-day complication rate was 14%, conversion to open surgery occurred in 9 patients (4%), and there were no deaths within 30 days postoperatively. In the univariate linear regression analysis, IWATE criteria were positively associated with OR time, EBL, and LOS. In the multivariable model, IWATE criteria were independently associated with greater OR time, EBL, and LOS. Two-year overall survival for hepatocellular carcinoma and intrahepatic cholangiocarcinoma was 94% and 50%, respectively., Conclusion: In conclusion, the IWATE criteria are associated with surgical outcomes after RH. This series highlights the utility of RH for difficult hepatic resections, particularly parenchymal-sparing resections in the posterosuperior sector, extending the indication of minimally invasive hepatectomy in experienced hands and potentially offering select patients an alternative to open hepatectomy or other less definitive liver-directed treatment options., (© 2021. The Author(s).)
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- 2022
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25. Key chemokines direct migration of immune cells in solid tumors.
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Kohli K, Pillarisetty VG, and Kim TS
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- Cell Movement, Chemokines, Humans, Neoplasms pathology, Tumor Microenvironment
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Immune cell infiltration into solid tumors, their movement within the tumor microenvironment (TME), and interaction with other immune cells are controlled by their directed migration towards gradients of chemokines. Dysregulated chemokine signaling in TME favors the growth of tumors, exclusion of effector immune cells, and abundance of immunosuppressive cells. Key chemokines directing the migration of immune cells into tumor tissue have been identified. In this review, we discuss well-studied chemokine receptors that regulate migration of effector and immunosuppressive immune cells in the context of cancer immunology. We discuss preclinical models that have described the role of respective chemokine receptors in immune cell migration into TME and review preclinical and clinical studies that target chemokine signaling as standalone or combination therapies., (© 2021. The Author(s).)
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- 2022
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26. Analysis of Differentiation Changes and Outcomes at Time of First Recurrence of Retroperitoneal Liposarcoma by Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG).
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Nessim C, Raut CP, Callegaro D, Barretta F, Miceli R, Fairweather M, Blay JY, Strauss D, Rutkowski P, Ahuja N, Gonzalez R, Grignani G, Quagliuolo V, Stoeckle E, Lahat G, De Paoli A, Pillarisetty VG, Canter RJ, Mullen JT, Pennacchioli E, van Houdt W, Swallow CJ, Schrage Y, Cardona K, Fiore M, Gronchi A, and Bagaria SP
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- Humans, Neoplasm Recurrence, Local surgery, Retrospective Studies, Liposarcoma surgery, Retroperitoneal Neoplasms surgery, Sarcoma
- Abstract
Background: Local recurrence following resection of retroperitoneal liposarcoma (RLPS) is common. Well-differentiated (WD) and dedifferentiated (DD) RLPS are distinct entities with differing outcomes. A few reports suggest that WDLPS can recur as DDLPS and that DDLPS can recur as WDLPS. This study evaluates whether this change in differentiation from the primary tumor to the first local recurrence impacts long-term outcomes., Methods: Retrospective review from 22 sarcoma centers identified consecutive patients who underwent resection for a first locally recurrent RLPS from January 2002 to December 2011. Outcomes measured included overall survival, local recurrence, and distant metastasis., Results: A total of 421 RPLS patients were identified. Of the 230 patients with primary DDLPS, 34 (15%) presented WDLPS upon recurrence (DD → WD); and of the 191 patients with primary WDLPS, 54 (28%) presented DDLPS upon recurrence (WD → DD). The 6-year overall survival probabilities (95% CI) for DD → DD, DD → WD, WD → WD, and WD → DD were 40% (32-48%), 73% (58-92%), 76% (68-85%), and 56% (43-73%) (p < 0.001), respectively. The 6-year second local recurrence incidence was 66% (59-73%), 63% (48-82%), 66% (57-76%), and 77% (66-90%), respectively. The 6-year distant metastasis incidence was 13% (9-19%), 3% (0.4-22%), 5% (2-11%), and 4% (1-16%), respectively. On multivariable analysis, DD → WD was associated with improved overall survival when compared with DD → DD (p < 0.001). Moreover, WD → DD was associated with a higher risk of LR (p = 0.025) CONCLUSION: A change in RLPS differentiation from primary tumor to first local recurrence appears to impact survival. These findings may be useful in counseling patients on their prognosis and subsequent management., (© 2021. Society of Surgical Oncology.)
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- 2021
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27. Neuroendocrine and Adrenal Tumors, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology.
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Shah MH, Goldner WS, Benson AB, Bergsland E, Blaszkowsky LS, Brock P, Chan J, Das S, Dickson PV, Fanta P, Giordano T, Halfdanarson TR, Halperin D, He J, Heaney A, Heslin MJ, Kandeel F, Kardan A, Khan SA, Kuvshinoff BW, Lieu C, Miller K, Pillarisetty VG, Reidy D, Salgado SA, Shaheen S, Soares HP, Soulen MC, Strosberg JR, Sussman CR, Trikalinos NA, Uboha NA, Vijayvergia N, Wong T, Lynn B, and Hochstetler C
- Subjects
- Humans, Medical Oncology, Adrenal Gland Neoplasms diagnosis, Adrenal Gland Neoplasms genetics, Adrenal Gland Neoplasms therapy, Neuroendocrine Tumors diagnosis, Neuroendocrine Tumors genetics, Neuroendocrine Tumors therapy
- Abstract
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Neuroendocrine and Adrenal Gland Tumors focus on the diagnosis, treatment, and management of patients with neuroendocrine tumors (NETs), adrenal tumors, pheochromocytomas, paragangliomas, and multiple endocrine neoplasia. NETs are generally subclassified by site of origin, stage, and histologic characteristics. Appropriate diagnosis and treatment of NETs often involves collaboration between specialists in multiple disciplines, using specific biochemical, radiologic, and surgical methods. Specialists include pathologists, endocrinologists, radiologists (including nuclear medicine specialists), and medical, radiation, and surgical oncologists. These guidelines discuss the diagnosis and management of both sporadic and hereditary neuroendocrine and adrenal tumors and are intended to assist with clinical decision-making. This article is focused on the 2021 NCCN Guidelines principles of genetic risk assessment and counseling and recommendations for well-differentiated grade 3 NETs, poorly differentiated neuroendocrine carcinomas, adrenal tumors, pheochromocytomas, and paragangliomas.
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- 2021
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28. Protocol for tissue slice cultures from human solid tumors to study therapeutic response.
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Kenerson HL, Sullivan KM, Labadie KP, Pillarisetty VG, and Yeung RS
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- High-Throughput Screening Assays, Humans, Neoplasms pathology, Treatment Outcome, Tumor Microenvironment, Neoplasms therapy, Tissue Culture Techniques
- Abstract
The impact of systemic therapy on the tumor microenvironment has been difficult to study in human solid tumors. Our protocol describes steps for establishing slice cultures to investigate response to chemotherapies, immunotherapies, or adoptive cell therapies. Endpoints include changes in viability, histology, live-cell imaging, and multi-omics analyses. The protocol has been applied to a broad array of gastrointestinal malignancies. Culture conditions and treatment parameters can be modified for specific experiments. The platform is highly flexible and easy to manipulate. For complete details on the use and execution of this protocol, please refer to Kenerson et al. (2020), Jabbari et al. (2020), Brempelis et al. (2020), and Jiang et al. (2017)., Competing Interests: The authors declare no competing interests., (© 2021 The Author(s).)
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- 2021
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29. IL-15 mediated expansion of rare durable memory T cells following adoptive cellular therapy.
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Kohli K, Yao L, Nowicki TS, Zhang S, Black RG, Schroeder BA, Farrar EA, Cao J, Sloan H, Stief D, Cranmer LD, Wagner MJ, Hawkins DS, Pillarisetty VG, Ribas A, Campbell J, Pierce RH, Kim EY, Jones RL, Riddell SR, Yee C, and Pollack SM
- Subjects
- Adult, Antigens, Neoplasm genetics, Antigens, Neoplasm metabolism, Cell Line, Tumor, Coculture Techniques, Cyclophosphamide therapeutic use, Cytotoxicity, Immunologic drug effects, Humans, Immunologic Memory, Liposarcoma, Myxoid immunology, Liposarcoma, Myxoid metabolism, Membrane Proteins genetics, Membrane Proteins metabolism, Memory T Cells immunology, Memory T Cells metabolism, Middle Aged, Myeloablative Agonists therapeutic use, Pilot Projects, Sarcoma, Synovial immunology, Sarcoma, Synovial metabolism, Time Factors, Transplantation Conditioning, Treatment Outcome, Tumor Microenvironment, Antigens, Neoplasm immunology, Cell Proliferation drug effects, Immunotherapy, Adoptive adverse effects, Interleukin-15 pharmacology, Liposarcoma, Myxoid therapy, Lymphocyte Activation drug effects, Membrane Proteins immunology, Memory T Cells drug effects, Memory T Cells transplantation, Sarcoma, Synovial therapy
- Abstract
Background: Synovial sarcoma (SS) and myxoid/round cell liposarcoma (MRCL) are ideal solid tumors for the development of adoptive cellular therapy (ACT) targeting NY-ESO-1, as a high frequency of tumors homogeneously express this cancer-testes antigen. Data from early phase clinical trials have shown antitumor activity after the adoptive transfer of NY-ESO-1-specific T cells. In these studies, persistence of NY-ESO-1 specific T cells is highly correlated with response to ACT, but patients often continue to have detectable transferred cells in their peripheral blood following progression., Method: We performed a phase I clinical trial evaluating the safety of NY-ESO-1-specific endogenous T cells (ETC) following cyclophosphamide conditioning. Peripheral blood mononuclear cells (PBMCs) from treated patients were evaluated by flow cytometry and gene expression analysis as well as through ex vivo culture assays with and without IL-15., Results: Four patients were treated in a cohort using ETC targeting NY-ESO-1 following cyclophosphamide conditioning. Treatment was well tolerated without significant toxicity, but all patients ultimately had disease progression. In two of four patients, we obtained post-treatment tumor tissue and in both, NY-ESO-1 antigen was retained despite clear detectable persisting NY-ESO-1-specific T cells in the peripheral blood. Despite a memory phenotype, these persisting cells lacked markers of proliferation or activation. However, in ex vivo culture assays, they could be induced to proliferate and kill tumor using IL-15. These results were also seen in PBMCs from two patients who received gene-engineered T-cell receptor-based products at other centers., Conclusions: ETC targeting NY-ESO-1 with single-agent cyclophosphamide alone conditioning was well tolerated in patients with SS and those with MRCL. IL-15 can induce proliferation and activity in persisting NY-ESO-1-specific T cells even in patients with disease progression following ACT. These results support future work evaluating whether IL-15 could be incorporated into ACT trials post-infusion or at the time of progression., Competing Interests: Competing interests: SMP receives research funding from Merck, EMD Serono, Incyte, Presage, Janssen, Oncosec and Juno. He has consulting, honoraria and advisory activity with GlaxoSmith Kline, Daiichi Sankyo and Blueprint Medicine. SRR has received equity, consulting fees and research funding from Juno Therapeutics/a BMS company and Lyell Immunopharma. He has received consulting fees and equity from Adaptive Biotechnologies.VGP receives research funding from Merck, AstraZeneca, and Ipsen. He has had consulting, honoraria and advisory activity with Merck, GlaxoSmithKline, Imvax, and Takeda. VGP receives research funding from Merck, AstraZeneca, and Ipsen. He has had consulting, honoraria and advisory activity with Merck, GlaxoSmithKline, Imvax, and Takeda.GlaxoSmithKline, Imvax, and Takeda., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2021
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30. Postoperative Morbidity After Resection of Recurrent Retroperitoneal Sarcoma: A Report from the Transatlantic Australasian RPS Working Group (TARPSWG).
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Nessim C, Raut CP, Callegaro D, Barretta F, Miceli R, Fairweather M, Rutkowski P, Blay JY, Strauss D, Gonzalez R, Ahuja N, Grignani G, Quagliuolo V, Stoeckle E, De Paoli A, Pillarisetty VG, Swallow CJ, Bagaria SP, Canter RJ, Mullen JT, Schrage Y, Pennacchioli E, van Houdt W, Cardona K, Fiore M, Gronchi A, and Lahat G
- Subjects
- Female, Humans, Male, Middle Aged, Morbidity, Neoplasm Recurrence, Local surgery, Retrospective Studies, Survival Rate, Liposarcoma surgery, Retroperitoneal Neoplasms surgery, Sarcoma surgery
- Abstract
Background: This study aimed to evaluate perioperative morbidity after surgery for first locally recurrent (LR1) retroperitoneal sarcoma (RPS). Data concerning the safety of resecting recurrent RPS are lacking., Methods: Data were collected on all patients undergoing resection of RPS-LR1 at 22 Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) centers from 2002 to 2011. Uni- and multivariable logistic models were fitted to study the association between major (Clavien-Dindo grade ≥ 3) complications and patient/surgery characteristics as well as outcome. The resected organ score, a method of standardizing the number of organs resected, as previously described by the TARPSWG, was used., Results: The 681 patients in this study had a median age of 59 years, and 51.8% were female. The most common histologic subtype was de-differentiated liposarcoma (43%), the median resected organ score was 1, and 83.3% of the patients achieved an R0 or R1 resection. Major complications occurred for 16% of the patients, and the 90-day mortality rate was 0.4%. In the multivariable analysis, a transfusion requirement was found to be a significant predictor of major complications (p < 0.001) and worse overall survival (OS) (p = 0.010). However, having a major complication was not associated with a worse OS or a higher incidence of local recurrence or distant metastasis., Conclusions: A surgical approach to recurrent RPS is relatively safe and comparable with primary RPS in terms of complications and postoperative mortality when performed at specialized sarcoma centers. Because alternative effective therapies still are lacking, when indicated, resection of a recurrent RPS is a reasonable option. Every effort should be made to minimize the need for blood transfusions.
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- 2021
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31. DNA Damage Repair Defects and Survival Outcomes for Patients With Resected Pancreatic Ductal Adenocarcinoma.
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Chang AE, Radke MR, Zhen DB, Baker KK, Coveler AL, Wong KM, Pillarisetty VG, Reddi D, Redman MW, Swisher E, and Chiorean EG
- Subjects
- Carcinoma, Pancreatic Ductal genetics, Carcinoma, Pancreatic Ductal mortality, Carcinoma, Pancreatic Ductal pathology, Humans, Pancreatic Neoplasms genetics, Pancreatic Neoplasms mortality, Pancreatic Neoplasms pathology, Retrospective Studies, Time Factors, Treatment Outcome, Biomarkers, Tumor genetics, Carcinoma, Pancreatic Ductal surgery, DNA Damage, Mutation, Pancreatectomy adverse effects, Pancreatectomy mortality, Pancreatic Neoplasms surgery, Recombinational DNA Repair
- Abstract
Competing Interests: The authors declare no conflict of interest.
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- 2021
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32. Modulation of Immune Checkpoints by Chemotherapy in Human Colorectal Liver Metastases.
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Jabbari N, Kenerson HL, Lausted C, Yan X, Meng C, Sullivan KM, Baloni P, Bergey D, Pillarisetty VG, Hood LE, Yeung RS, and Tian Q
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- Antineoplastic Combined Chemotherapy Protocols, Camptothecin therapeutic use, Colorectal Neoplasms immunology, Hepatitis A Virus Cellular Receptor 2 immunology, Humans, Irinotecan therapeutic use, Liver Neoplasms pathology, Organoplatinum Compounds therapeutic use, Oxaliplatin therapeutic use, Programmed Cell Death 1 Receptor immunology, Colorectal Neoplasms drug therapy, Liver Neoplasms drug therapy, Neoplasm Metastasis pathology, Tumor Microenvironment immunology
- Abstract
Metastatic colorectal cancer (CRC) is a major cause of cancer-related death, and incidence is rising in younger populations (younger than 50 years). Current chemotherapies can achieve response rates above 50%, but immunotherapies have limited value for patients with microsatellite-stable (MSS) cancers. The present study investigates the impact of chemotherapy on the tumor immune microenvironment. We treat human liver metastases slices with 5-fluorouracil (5-FU) plus either irinotecan or oxaliplatin, then perform single-cell transcriptome analyses. Results from eight cases reveal two cellular subtypes with divergent responses to chemotherapy. Susceptible tumors are characterized by a stemness signature, an activated interferon pathway, and suppression of PD-1 ligands in response to 5-FU+irinotecan. Conversely, immune checkpoint TIM-3 ligands are maintained or upregulated by chemotherapy in CRC with an enterocyte-like signature, and combining chemotherapy with TIM-3 blockade leads to synergistic tumor killing. Our analyses highlight chemomodulation of the immune microenvironment and provide a framework for combined chemo-immunotherapies., Competing Interests: The authors report no competing interests., (© 2020 The Author(s).)
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- 2020
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33. Pancreatic paraganglioma mimicking pancreatic neuroendocrine tumor.
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Abbasi A, Wakeman KM, and Pillarisetty VG
- Abstract
Extra-adrenal paragangliomas are rare tumors arising from the chromaffin cells of the autonomic nervous system. Retroperitoneal paragangliomas may present as a pancreatic mass. We present a case of a 61-year-old woman with an incidentally found pancreatic mass (7.2 × 6.5 cm) in the CT scan. EUS- guided FNA result was compatible with pancreatic neuroendocrine tumor. Patient underwent pancreaticoduodenectomy and histopathologic assessment revealed the mass was an extra-adrenal paraganglioma. Preoperative diagnosis of pancreatic paragangliomas can be challenging due to imaging and histopathologic similarities with pancreatic neuroendocrine tumors., Competing Interests: Declaration of conflicting interest: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)
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- 2020
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34. Patterns of recurrence and survival probability after second recurrence of retroperitoneal sarcoma: A study from TARPSWG.
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van Houdt WJ, Fiore M, Barretta F, Rutkowski P, Blay JY, Lahat G, Strauss D, Gonzalez RJ, Ahuja N, Grignani G, Quagliuolo V, Stoeckle E, De Paoli A, Schrage Y, Cardona K, Pennacchioli E, Pillarisetty VG, Nessim C, Swallow CJ, Bagaria SP, Canter R, Mullen JT, Callegaro D, Fairweather M, Miceli R, Raut CP, Gronchi A, and Gladdy RA
- Subjects
- Female, Humans, Male, Middle Aged, Neoplasm Recurrence, Local, Survival Analysis, Retroperitoneal Neoplasms mortality, Sarcoma mortality
- Abstract
Background: In this series from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG), the authors examined longitudinal outcomes of patients with a second recurrence of retroperitoneal sarcoma (RPS) after complete resection of a first local recurrence (LR)., Methods: Data from patients undergoing resection of a first LR from January 2002 to December 2011were collected from 22 sarcoma centers. The primary outcome was overall survival (OS) after second recurrence., Results: Second recurrences occurred in 400 of 567 patients (70.5%) after an R0/R1 resection of a first locally recurrent RPS. Patterns of disease recurrence were LR in 323 patients (80.75%), distant metastases (DM) in 55 patients (13.75%), and both LR and DM in 22 patients (5.5%). The main subtype among the LR group was liposarcoma (77%), whereas DM mainly were leiomyosarcomas (43.6%). In patients with a second LR only, a total of 200 patients underwent re-resection (61.9%). The 5-year OS rate varied significantly based on the pattern of failure (P < .001): 45.6% for the LR group, 25.5% for the DM group, and 0% for the group with LR and DM. The only factors found to be associated with improved OS on multivariable analysis were both time between second surgery and the development of the second recurrence (32 months vs 8 months: hazard ratio, 0.44 [P < .001]) and surgery for second recurrence (yes vs no: hazard ratio, 3.25 [P < .001]). The 5-year OS rate for patients undergoing surgery for a second LR was 59% versus 18% in the patients not deemed suitable for surgical resection., Conclusions: Survival rates after second recurrence of RPS varied based on patterns of disease recurrence and treatment. Durable disease-free survivors were identified after surgery for second LR in patients selected for this intervention., (© 2020 American Cancer Society.)
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- 2020
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35. γδ T Cells Support Pancreatic Oncogenesis by Restraining αβ T Cell Activation.
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Daley D, Zambirinis CP, Seifert L, Akkad N, Mohan N, Werba G, Barilla R, Torres-Hernandez A, Hundeyin M, Kumar Mani VR, Avanzi A, Tippens D, Narayanan R, Jang JE, Newman E, Pillarisetty VG, Dustin ML, Bar-Sagi D, Hajdu C, and Miller G
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- 2020
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36. Silver linings at the bench and bedside.
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Katz SC and Pillarisetty VG
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- Humans, COVID-19 Vaccines therapeutic use, COVID-19 prevention & control, COVID-19 therapy
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- 2020
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37. Genetically engineered macrophages persist in solid tumors and locally deliver therapeutic proteins to activate immune responses.
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Brempelis KJ, Cowan CM, Kreuser SA, Labadie KP, Prieskorn BM, Lieberman NAP, Ene CI, Moyes KW, Chinn H, DeGolier KR, Matsumoto LR, Daniel SK, Yokoyama JK, Davis AD, Hoglund VJ, Smythe KS, Balcaitis SD, Jensen MC, Ellenbogen RG, Campbell JS, Pierce RH, Holland EC, Pillarisetty VG, and Crane CA
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- Animals, Disease Models, Animal, Humans, Mice, Genetic Engineering methods, Immunotherapy methods, Macrophages metabolism, Neoplasms immunology, Tumor Microenvironment immunology
- Abstract
Background: Though currently approved immunotherapies, including chimeric antigen receptor T cells and checkpoint blockade antibodies, have been successfully used to treat hematological and some solid tumor cancers, many solid tumors remain resistant to these modes of treatment. In solid tumors, the development of effective antitumor immune responses is hampered by restricted immune cell infiltration and an immunosuppressive tumor microenvironment (TME). An immunotherapy that infiltrates and persists in the solid TME, while providing local, stable levels of therapeutic to activate or reinvigorate antitumor immunity could overcome these challenges faced by current immunotherapies., Methods: Using lentivirus-driven engineering, we programmed human and murine macrophages to express therapeutic payloads, including Interleukin (IL)-12. In vitro coculture studies were used to evaluate the effect of genetically engineered macrophages (GEMs) secreting IL-12 on T cells and on the GEMs themselves. The effects of IL-12 GEMs on gene expression profiles within the TME and tumor burden were evaluated in syngeneic mouse models of glioblastoma and melanoma and in human tumor slices isolated from patients with advanced gastrointestinal malignancies., Results: Here, we present a cellular immunotherapy platform using lentivirus-driven genetic engineering of human and mouse macrophages to constitutively express proteins, including secreted cytokines and full-length checkpoint antibodies, as well as cytoplasmic and surface proteins that overcomes these barriers. GEMs traffic to, persist in, and express lentiviral payloads in xenograft mouse models of glioblastoma, and express a non-signaling truncated CD19 surface protein for elimination. IL-12-secreting GEMs activated T cells and induced interferon-gamma (IFNγ) in vitro and slowed tumor growth resulting in extended survival in vivo. In a syngeneic glioblastoma model, IFNγ signaling cascades were also observed in mice treated with mouse bone-marrow-derived GEMs secreting murine IL-12. These findings were reproduced in ex vivo tumor slices comprised of intact MEs. In this setting, IL-12 GEMs induced tumor cell death, chemokines and IFNγ-stimulated genes and proteins., Conclusions: Our data demonstrate that GEMs can precisely deliver titratable doses of therapeutic proteins to the TME to improve safety, tissue penetrance, targeted delivery and pharmacokinetics., Competing Interests: Competing interests: The authors declare the following competing interests: CAC, KWM, NAPL and MCJ are inventors on 'Genetic Engineering of Macrophages for Immunotherapy,' Patent Number: US20170087185A1, which pertains to the development and use of GEMs as immunotherapy. CAC receives research support and is on the scientific advisory board for BlueRock Therapeutics. MCJ receives research support from Juno Therapeutics, A Bristol-Myers Squibb Company., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2020
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38. The CXCL12-CXCR4/CXCR7 axis as a mechanism of immune resistance in gastrointestinal malignancies.
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Daniel SK, Seo YD, and Pillarisetty VG
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- Apoptosis drug effects, Cell Proliferation drug effects, Chemokine CXCL12 immunology, Drug Resistance, Neoplasm genetics, Gastrointestinal Neoplasms genetics, Gastrointestinal Neoplasms therapy, Humans, Receptors, CXCR immunology, Receptors, CXCR4 immunology, Signal Transduction genetics, Signal Transduction immunology, Tumor Microenvironment drug effects, Chemokine CXCL12 genetics, Drug Resistance, Neoplasm immunology, Gastrointestinal Neoplasms immunology, Receptors, CXCR genetics, Receptors, CXCR4 genetics
- Abstract
Single agent checkpoint inhibitor therapy has not been effective for most gastrointestinal solid tumors, but combination therapy with drugs targeting additional immunosuppressive pathways is being attempted. One such pathway, the CXCL12-CXCR4/CXCR7 chemokine axis, has attracted attention due to its effects on tumor cell survival and metastasis as well as immune cell migration. CXCL12 is a small protein that functions in normal hematopoietic stem cell homing in addition to repair of damaged tissue. Binding of CXCL12 to CXCR4 leads to activation of G protein signaling kinases such as P13K/mTOR and MEK/ERK while binding to CXCR7 leads to β-arrestin mediated signaling. While some gastric and colorectal carcinoma cells have been shown to make CXCL12, the primary source in pancreatic cancer and peritoneal metastases is cancer-associated fibroblasts. Binding of CXCL12 to CXCR4 and CXCR7 on tumor cells leads to anti-apoptotic signaling through Bcl-2 and survivin upregulation, as well as promotion of the epithelial-to-mesechymal transition through the Rho-ROCK pathway and alterations in cell adhesion molecules. High levels of CXCL12 seen in the bone marrow, liver, and spleen could partially explain why these are popular sites of metastases for many tumors. CXCL12 is a chemoattractant for lymphocytes at lower levels, but becomes chemorepellant at higher levels; it is unclear exactly what gradient exists in the tumor microenvironment and how this influences tumor-infiltrating lymphocytes. AMD3100 (Plerixafor or Mozobil) is a small molecule CXCR4 antagonist and is the most frequently used drug targeting the CXCL12-CXCR4/CXCR7 axis in clinical trials for gastrointestinal solid tumors currently. Other small molecules and monoclonal antibodies against CXCR4 are being trialed. Further understanding of the CXCL12- CXCR4/CXCR7 chemokine axis in the tumor microenvironment will allow more effective targeting of this pathway in combination immunotherapy., Competing Interests: Declaration of Competing Interest VGP: Laboratory research funding from Merck., (Copyright © 2019 Elsevier Ltd. All rights reserved.)
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- 2020
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39. Challenges in assessing solid tumor responses to immunotherapy.
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Chai LF, Prince E, Pillarisetty VG, and Katz SC
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- Disease Progression, Humans, Response Evaluation Criteria in Solid Tumors, Immunotherapy, Neoplasms therapy
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With the advent of immunotherapy as an integral component of multidisciplinary solid tumor treatment, we are confronted by an unfamiliar and novel pattern of radiographic responses to treatment. Enlargement of tumors or even new lesions may not represent progression, but rather reflect what will ultimately evolve into a clinically beneficial response. In addition, the kinetics of radiographic changes in response to immunotherapy treatments may be distinct from what has been observed with cytotoxic chemotherapy and radiation. The phenomenon of pseudoprogression has been documented in patients receiving immunotherapeutic agents, such as checkpoint inhibitors and cellular therapies. Currently, there are no clinical response guidelines that adequately account for pseudoprogression and solid tumor responses to immunotherapy in general. Even so, response criteria have evolved to account for the radiographic manifestations of novel therapies. The evolution of World Health Organization (WHO) criteria and Response Evaluation Criteria in Solid Tumors (RECIST), along with the emergence of immune-related response criteria (irRC) and the immune Response Evaluation Criteria in Solid Tumors (iRECIST) reflect the need for new frameworks. This review evaluates the relationship between pseudoprogression, clinical outcomes, and our current understanding of the biology of pseudoprogression. To achieve our goal, we discuss unusual response patterns in patients receiving immunotherapy. We seek to develop a deeper understanding of radiographic responses to immunotherapy such that clinical benefit is not underappreciated in individual patients and during clinical investigation.
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- 2020
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40. A Phase II Trial of Pembrolizumab and Vorinostat in Recurrent Metastatic Head and Neck Squamous Cell Carcinomas and Salivary Gland Cancer.
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Rodriguez CP, Wu QV, Voutsinas J, Fromm JR, Jiang X, Pillarisetty VG, Lee SM, Santana-Davila R, Goulart B, Baik CS, Chow LQM, Eaton K, and Martins R
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- Adult, Aged, Aged, 80 and over, Antibodies, Monoclonal, Humanized administration & dosage, Drug Resistance, Neoplasm, Female, Head and Neck Neoplasms pathology, Humans, Male, Middle Aged, Neoplasm Metastasis, Neoplasm Recurrence, Local pathology, Salivary Gland Neoplasms pathology, Squamous Cell Carcinoma of Head and Neck pathology, Survival Rate, Vorinostat administration & dosage, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Head and Neck Neoplasms drug therapy, Neoplasm Recurrence, Local drug therapy, Salivary Gland Neoplasms drug therapy, Squamous Cell Carcinoma of Head and Neck drug therapy
- Abstract
Purpose: This clinical trial combined pembrolizumab and vorinostat in recurrent/metastatic squamous cell carcinomas of the head and neck (HN), and salivary gland cancer (SGC)., Patients and Methods: Patients with progressing incurable HN and SGC, Eastern Cooperative Oncology Group (ECOG) ≤1, no prior immunotherapy, RECIST1.1 measurable disease, and normal organ function were eligible. Pembrolizumab 200 mg was given intravenous every 21 days, and vorinostat 400 mg given orally 5 days on and 2 days off during each 21-day cycle. Primary endpoints were safety and objective response rates., Results: From November 2015 to August 2017, 25 patients with HN and 25 SGC were enrolled. Median age was 61 (range, 33-86) years, 39 (78%) were male, 21 (62%) were never smokers, and 27 (54%) had ECOG 0. In HN, 13 (52%) were p16+ oropharynx. Most common SGC histologies were adenoid cystic 12 (48%), acinic cell 3 (12%), and mucoepidermoid 3 (12%). Adverse events (AEs) in all patients were: 27 (54%) with grade ≥ 1 and 18 (36%) with grade ≥ 3. The most common AEs in all patients were renal insufficiency in seven, (14%), fatigue in six, (12%), and nausea in three (6%). There were three (12%) deaths on study. Responses in HN were complete response (CR) 0, partial response (PR) eight (32%), and stable disease (SD) five (20%). Efficacy in SGCs was CR 0, PR four (16%) in one lymphoepithelioma-like carcinoma, two acinic cell, one adenoid cystic, and SD 14 (56%). In the HN group, median follow-up (mFUP) was 12.6 months, median overall survival (mOS) was 12.6 months, and median progression-free survival (mPFS) was 4.5 months. In SGC, mFUP was 13.1 months, mOS was 14.0 months, and mPFS was 6.9 months., Conclusions: This combination demonstrated activity in HN, with fewer responses in SGC. Toxicities were higher than reported with pembrolizumab alone., (©2019 American Association for Cancer Research.)
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- 2020
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41. Tumor slice culture as a biologic surrogate of human cancer.
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Kenerson HL, Sullivan KM, Seo YD, Stadeli KM, Ussakli C, Yan X, Lausted C, Pillarisetty VG, Park JO, Riehle KJ, Yeh M, Tian Q, and Yeung RS
- Abstract
Background: The tumor microenvironment (TME) is critical to every aspect of cancer biology. Organotypic tumor slice cultures (TSCs) preserve the original TME and have demonstrated utility in predicting drug sensitivity, but the association between clinicopathologic parameters and in vitro TSC behavior has not been well-defined., Methods: One hundred and eight fresh tumor specimens from liver resections at a tertiary academic center were procured and precisely cut with a Vibratome to create 250 μm × 6 mm slices. These fixed-dimension TSCs were grown on polytetrafluoroethylene inserts, and their metabolic activities were determined by a colorimetric assay. Correlation between baseline activities and clinicopathologic parameters was assessed. Tissue CEA mRNA expression was determined by RNAseq., Results: By standardizing the dimensions of a slice, we found that adjacent tumor slices have equivalent metabolic activities, while those derived from different tumors exhibit >30-fold range in baseline MTS absorbances, which correlated significantly with the percentage of tumor necrosis based on histologic assessment. Extending this to individual cancers, we were able to detect intra-tumoral heterogeneity over a span of a few millimeters, which reflects differences in tumor cell density and Ki-67 positivity. For colorectal cancers, tissue CEA expression based on RNAseq of tumor slices was found to correlate with clinical response to chemotherapies., Conclusions: We report a standardized method to assess and compare human cancer growth ex vivo across a wide spectrum of tumor samples. TSC reflects the state of tumor behavior and heterogeneity, thus providing a simple approach to study of human cancers with an intact TME., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare., (2020 Annals of Translational Medicine. All rights reserved.)
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- 2020
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42. Dendritic Cells in the Tumor Microenvironment.
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Kohli K and Pillarisetty VG
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- Adaptive Immunity, Cell Movement, Dendritic Cells immunology, Humans, Dendritic Cells cytology, Neoplasms immunology, Tumor Microenvironment immunology
- Abstract
Dendritic cells (DCs) are professional antigen-presenting cells (APCs) of the immune system. They capture foreign antigens and can present them to lymphocytes, that is, T cells and B cells, to activate them. DCs are the most potent of all immune cells at inducing the adaptive immune system. Thus, the presence of DCs at the anatomical site of the immune challenge is imperative for the immune system to mount an effective immune response. From the anatomical site of the immune challenge, DCs cargo antigens to the draining lymph nodes, specialized immune organs where adaptive immunity is generated. DCs are heterogeneous as a type of immune cell, and various subsets of DCs have been reported and their functions described. In this chapter, we discuss various aspects of DC development and function. We further discuss how various tumor microenvironments can affect DC development, function, and migration, thus evading a strong adaptive immune response.
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- 2020
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43. Screening for Pancreatic Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.
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Henrikson NB, Aiello Bowles EJ, Blasi PR, Morrison CC, Nguyen M, Pillarisetty VG, and Lin JS
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- Adenocarcinoma genetics, Adenocarcinoma mortality, Adenocarcinoma surgery, Adult, Female, Humans, Male, Mass Screening adverse effects, Pancreas diagnostic imaging, Pancreatic Neoplasms genetics, Pancreatic Neoplasms mortality, Pancreatic Neoplasms surgery, Postoperative Complications, Quality of Life, Risk Factors, Sensitivity and Specificity, Adenocarcinoma diagnostic imaging, Early Detection of Cancer adverse effects, Pancreatic Neoplasms diagnosis
- Abstract
Importance: Pancreatic adenocarcinoma is the third most common cause of cancer death among men and women in the United States., Objective: To systematically review benefits and harms of screening for pancreatic adenocarcinoma to inform the US Preventive Services Task Force., Data Sources: MEDLINE, PubMed, and the Cochrane Collaboration Registry of Controlled Trials, from January 2002 through April 27, 2018; surveillance through March 22, 2019., Study Selection: Studies of adults with or without risk factors for pancreatic adenocarcinoma (eg, family history of pancreatic cancer, personal history of new-onset diabetes) undergoing imaging-based screening; studies of treatment for adults with screen-detected or asymptomatic pancreatic adenocarcinoma. Included study designs were randomized clinical trials, nonrandomized controlled intervention studies, diagnostic accuracy studies with a reference standard, cohort studies, and case-control studies (for evaluation of harms only). Studies consisting entirely of populations with known genetic syndromes associated with pancreatic cancer were excluded., Data Extraction and Synthesis: Two investigators independently reviewed abstracts and full-text articles and rated included studies for quality; data were quantitatively analyzed to calculate a pooled diagnostic yield and narratively synthesized., Main Outcomes and Measures: Mortality, morbidity, or quality of life; diagnostic accuracy of screening tests; any harm of screening or treatment., Results: Thirteen fair-quality prospective cohort screening studies (N = 1317) conducted predominantly in populations at high familial risk for pancreatic adenocarcinoma were included. No studies reported on the effect of screening on morbidity or mortality or on the effectiveness of treatment for screen-detected pancreatic adenocarcinoma. Although no studies evaluated the diagnostic accuracy of screening tests, all 13 studies reported the diagnostic yield. Yields ranged from 0 to 75 cases per 1000 persons in studies using endoscopic ultrasound, magnetic resonance imaging, and/or computed tomography-based screening. In total, 18 cases of pancreatic adenocarcinoma were detected in 1156 adults at increased familial risk and 0 cases were detected in 161 average-risk adults. In 8 studies (n = 675) assessing procedural harms of screening, no serious harms from initial screening were reported. Two studies (n = 271) found no evidence of psychosocial harms related to screening. Evidence of surgical harms was limited., Conclusions and Relevance: Imaging-based screening in groups at high familial risk can detect pancreatic adenocarcinoma with limited evidence of minimal harms. However, the effect of screening on morbidity and mortality in groups at high familial risk has not been studied, and no data are available in average-risk populations. There is limited evidence to assess benefits or harms of surgical intervention for screen-detected pancreatic adenocarcinoma.
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- 2019
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44. Screening for Pancreatic Cancer: A Systematic Evidence Review for the U.S. Preventive Services Task Force
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Henrikson NB, Bowles EJA, Blasi PR, Morrison CC, Nguyen M, Pillarisetty VG, and Lin JS
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Objective: We conducted a systematic evidence review to support the U.S. Preventive Services Task Force (USPSTF) in updating their recommendation on screening for pancreatic cancer. Our review addresses the following Key Questions (KQs): 1. Does screening for pancreatic adenocarcinoma improve cancer morbidity or mortality or all-cause mortality; and 1a) Does screening effectiveness vary by clinically relevant subpopulations (e.g., by age group, family history of pancreatic cancer, personal history of new-onset diabetes, or other risk factors)? 2. What is the diagnostic accuracy of screening tests for pancreatic adenocarcinoma? 3. What are the harms of screening for pancreatic adenocarcinoma? 4. Does treatment of screen-detected or asymptomatic pancreatic adenocarcinoma improve cancer mortality, all-cause mortality, or quality of life? 5. What are the harms of treatment of screen-detected pancreatic adenocarcinoma?, Data Sources: We searched Cochrane Central Register of Controlled Trials, Medline, and PubMed, and reference lists of relevant systematic reviews. We searched for articles published from 2002 to October 3, 2017, and updated our search on April 27, 2018. We also searched ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP), for relevant ongoing studies., Study Selection: We reviewed 19,596 abstracts and 824 articles against specified inclusion criteria. Eligible studies included those written in English and conducted in adults age 18 years or older with or without risk factors for pancreatic cancer. For key questions on screening, we included imaging-based screening protocols. For key questions on treatment, we included studies of adults with screen-detected or asymptomatic pancreatic adenocarcinoma., Data Analysis: We conducted dual, independent critical appraisal of all provisionally included studies and abstracted study details and results from fair- and good-quality studies. Because of the limited number of studies and the population heterogeneity, we provided a narrative synthesis of results and used summary tables to allow for comparisons across studies. After confirming that the yield of different imaging modalities was similar across studies, we calculated a pooled diagnostic yield across studies and produced forest plots to illustrate the range of effects seen across studies. For harms of screening (KQ3) and harms of treatment (KQ5), we stratified results by procedural and psychosocial harms., Results: We included 13 unique prospective cohort screening studies (24 articles) reporting results for 1,317 people. Studies were conducted in the U.S., Canada, and Europe, and all screening populations except one small comparison group were exclusively in persons at elevated familial or genetic risk for pancreatic cancer. No studies reported on the effect of screening for pancreatic adenocarcinoma on cancer morbidity, mortality, or all-cause mortality (KQ1); and no studies reported on the effectiveness of treatment for screen-detected pancreatic adenocarcinoma (KQ4). Thirteen fair quality studies reported on the diagnostic accuracy of screening tests for pancreatic adenocarcinoma (KQ2). Across these studies, 18 cases of pancreatic adenocarcinoma were detected.. Twelve of 18 cases (66.7%) were detected at stage I or II or classified as “resectable.” Pooled yield for all screening tests to detect pancreatic adenocarcinoma on initial screening in high-risk populations was 7.8 per 1000 (95% confidence interval, 3.6 to 14.7); and for total yield including both initial and repeat screening, it was 15.6 per 1000 (95% CI, 9.3 to 24.5). Harms of screening for pancreatic adenocarcinoma Procedural harms of screening were evaluated in eight screening studies (n=675); psychological harms were assessed in two studies (n=277). Details on the assessment of harms were variably reported. In two studies (n=277) in which 150 individuals received ERCP as a diagnostic followup test, 15 people (10%) reported acute pancreatitis, nine of which required hospitalization. No evidence of increased worry, distress, depression, or anxiety after screening was reported, compared to before screening. Harms of treatment of screen-detected pancreatic adenocarcinoma Of the 57 people who underwent surgery across all studies, six studies (n=32 people receiving surgery) assessed harms of treatment of screen-detected pancreatic adenocarcinoma (KQ5), with 7 harms detected in two studies. Methods of assessing harms were variably reported. Harms included one person experiencing stricture to the hepaticojejunal anastomosis at 11 months after surgery, one with unspecified post-operative complications, 2 with post-operative fistula and 3 cases of diabetes. In the two studies that systematically assessed harms in all surgical patients (n=12 people receiving surgery), no harms were reported., Limitations: No randomized trials of screening were identified. The body of evidence includes observational screening studies with limited sample sizes and focused on populations with known familial risk, many with a substantial proportion of people with known genetic mutations. No studies included a clinical followup or unscreened comparison group, limiting assessment of diagnostic accuracy. Of those studies that reported harms of screening or treatment, limitations included inadequate description of the methods of assessing harms, including whether all participants were systematically assessed., Conclusions: Imaging-based screening in groups at high familial risk can detect pancreatic adenocarcinoma with limited evidence of minimal harms. However, the clinical impact of screening is not well documented. There is insufficient evidence to assess benefits or harms of surgical intervention for screen-detected pancreatic adenocarcinoma.
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- 2019
45. Systemic Interferon-γ Increases MHC Class I Expression and T-cell Infiltration in Cold Tumors: Results of a Phase 0 Clinical Trial.
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Zhang S, Kohli K, Black RG, Yao L, Spadinger SM, He Q, Pillarisetty VG, Cranmer LD, Van Tine BA, Yee C, Pierce RH, Riddell SR, Jones RL, and Pollack SM
- Subjects
- Adult, Aged, Antigens, Neoplasm immunology, Biomarkers, Biopsy, Cytokines, Female, Humans, Immunophenotyping, Liposarcoma, Myxoid etiology, Liposarcoma, Myxoid immunology, Liposarcoma, Myxoid pathology, Liposarcoma, Myxoid therapy, Lymphocytes, Tumor-Infiltrating pathology, Male, Middle Aged, Sarcoma, Synovial etiology, Sarcoma, Synovial immunology, Sarcoma, Synovial pathology, Sarcoma, Synovial therapy, Young Adult, Histocompatibility Antigens Class I genetics, Histocompatibility Antigens Class I immunology, Interferon-gamma metabolism, Lymphocytes, Tumor-Infiltrating immunology, Lymphocytes, Tumor-Infiltrating metabolism, T-Lymphocytes immunology, T-Lymphocytes metabolism
- Abstract
Interferon-γ (IFNγ) has been studied as a cancer treatment with limited evidence of clinical benefit. However, it could play a role in cancer immunotherapy combination treatments. Despite high expression of immunogenic cancer-testis antigens, synovial sarcoma (SS) and myxoid/round cell liposarcoma (MRCL) have a cold tumor microenvironment (TME), with few infiltrating T cells and low expression of major histocompatibility complex class I (MHC-I). We hypothesized that IFNγ treatment could drive inflammation in a cold TME, facilitating further immunotherapy. We conducted a phase 0 clinical trial treating 8 SS or MRCL patients with weekly systemic IFNγ. We performed pre- and posttreatment biopsies. IFNγ changed the SS and MRCL TME, inducing tumor-surface MHC-I expression and significant T-cell infiltration ( P < 0.05). Gene-expression analysis suggested increased tumor antigen presentation and less exhausted phenotypes of the tumor-infiltrating T cells. Newly emergent antigen-specific humoral and/or T-cell responses were found in 3 of 7 evaluable patients. However, increased expression of PD-L1 was observed on tumor-infiltrating myeloid cells and in some cases tumor cells. These findings suggest that systemic IFNγ used to convert SS and MRCL into "hot" tumors will work in concert with anti-PD-1 therapy to provide patient benefit., (©2019 American Association for Cancer Research.)
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- 2019
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46. Mobilization of CD8 + T Cells via CXCR4 Blockade Facilitates PD-1 Checkpoint Therapy in Human Pancreatic Cancer.
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Seo YD, Jiang X, Sullivan KM, Jalikis FG, Smythe KS, Abbasi A, Vignali M, Park JO, Daniel SK, Pollack SM, Kim TS, Yeung R, Crispe IN, Pierce RH, Robins H, and Pillarisetty VG
- Subjects
- CD8-Positive T-Lymphocytes, Humans, Programmed Cell Death 1 Receptor, Receptors, CXCR4, Tumor Microenvironment, Carcinoma, Pancreatic Ductal, Pancreatic Neoplasms
- Abstract
Purpose: Pancreatic ductal adenocarcinoma (PDA) is rarely cured, and single-agent immune checkpoint inhibition has not demonstrated clinical benefit despite the presence of large numbers of CD8
+ T cells. We hypothesized that tumor-infiltrating CD8+ T cells harbor latent antitumor activity that can be reactivated using combination immunotherapy., Experimental Design: Preserved human PDA specimens were analyzed using multiplex IHC (mIHC) and T-cell receptor (TCR) sequencing. Fresh tumor was treated in organotypic slice culture to test the effects of combination PD-1 and CXCR4 blockade. Slices were analyzed using IHC, flow cytometry, and live fluorescent microscopy to assess tumor kill, in addition to T-cell expansion and mobilization., Results: mIHC demonstrated fewer CD8+ T cells in juxtatumoral stroma containing carcinoma cells than in stroma devoid of them. Using TCR sequencing, we found clonal expansion in each tumor; high-frequency clones had multiple DNA rearrangements coding for the same amino acid binding sequence, which suggests response to common tumor antigens. Treatment of fresh human PDA slices with combination PD-1 and CXCR4 blockade led to increased tumor cell death concomitant with lymphocyte expansion. Live microscopy after combination therapy demonstrated CD8+ T-cell migration into the juxtatumoral compartment and rapid increase in tumor cell apoptosis., Conclusions: Endogenous tumor-reactive T cells are present within the human PDA tumor microenvironment and can be reactivated by combined blockade of PD-1 and CXCR4. This provides a new basis for the rational selection of combination immunotherapy for PDA. See related commentary by Medina and Miller, p. 3747 ., (©2019 American Association for Cancer Research.)- Published
- 2019
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47. Predicting Survival in Patients Undergoing Resection for Locally Recurrent Retroperitoneal Sarcoma: A Study and Novel Nomogram from TARPSWG.
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Raut CP, Callegaro D, Miceli R, Barretta F, Rutkowski P, Blay JY, Lahat G, Strauss DC, Gonzalez R, Ahuja N, Grignani G, Quagliuolo V, Stoeckle E, De Paoli A, Pillarisetty VG, Nessim C, Swallow CJ, Bagaria S, Canter R, Mullen J, Gelderblom HJ, Pennacchioli E, van Coevorden F, Cardona K, Fiore M, Fairweather M, and Gronchi A
- Subjects
- Aged, Combined Modality Therapy, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Neoplasm Grading, Neoplasm Recurrence, Local, Neoplasm Staging, Nomograms, Prognosis, Retroperitoneal Neoplasms pathology, Retroperitoneal Neoplasms therapy, Sarcoma pathology, Sarcoma therapy, Treatment Outcome, Retroperitoneal Neoplasms mortality, Retroperitoneal Neoplasms surgery, Sarcoma mortality, Sarcoma surgery
- Abstract
Purpose: The role of surgery for first relapse locally recurrent retroperitoneal sarcoma (RPS-LR1) is uncertain. We report outcomes of the largest RPS-LR1 series and propose a new prognostic nomogram., Experimental Design: Patients with consecutive RPS-LR1 without distant metastases who underwent resection at 22 centers (2002-2011) were included. Endpoints were disease-free and overall survival (DFS, OS) and crude-cumulative-incidence (CCI) of local/distant recurrence from second surgery. Nomograms predicting DFS and OS from second surgery were developed and validated (calibration plots); discrimination was assessed (Harrell C index)., Results: Of 684 patients identified, full prognostic variable data were available for 602. Initial surgery for primary RPS was performed at our institutions in 188 patients (31%) and elsewhere in 414 (69%). At a median follow-up of 119 months [Interquartile range (IQR), 80-169] from initial surgery and 75 months (IQR 50-105) from second surgery, 6-year DFS and OS were 19.2% [95% confidence interval (CI), 16.0-23.0%] and 54.1% (95% CI, 49.8-58.8%), respectively. Recurrence patterns and survival probability were histology-specific, with liposarcoma subtypes having the highest 6-year CCI of second local recurrence (LR, 60.2%-70.9%) and leiomyosarcoma (LMS) having higher 6-year CCI of distant metastasis (DM, 36.3%). Nomograms included age at second surgery, multifocality, grade, completeness of second surgery, histology, chemotherapy/radiotherapy at first surgery, and number of organs resected at first surgery. OS and DFS nomograms showed good calibration and discriminative ability (C index 0.70 and 0.67, respectively)., Conclusions: We developed nomograms to predict DFS and OS for patients undergoing RPS-LR1 resection. Nomograms provide individualized, disease-relevant estimations of survival for RPS-LR1 patients and assist in clinical decisions., (©2019 American Association for Cancer Research.)
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- 2019
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48. Hypoxia as a barrier to immunotherapy in pancreatic adenocarcinoma.
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Daniel SK, Sullivan KM, Labadie KP, and Pillarisetty VG
- Abstract
Pancreatic ductal adenocarcinoma (PDA) is a lethal disease with limited response to cytotoxic chemoradiotherapy, as well as newer immunotherapies. The PDA tumor microenvironment contains infiltrating immune cells including cytotoxic T cells; however, there is an overall immunosuppressive milieu. Hypoxia is a known element of the solid tumor microenvironment and may promote tumor survival. Through various mechanisms including, but not limited to, those mediated by HIF-1α, hypoxia also leads to increased tumor proliferation and metabolic changes. Furthermore, epithelial to mesenchymal transition is promoted through several pathways, including NOTCH and c-MET, regulated by hypoxia. Hypoxia-promoted changes also contribute to the immunosuppressive phenotype seen in many different cell types within the microenvironment and thereby may inhibit an effective immune system response to PDA. Pancreatic stellate cells (PSCs) and myofibroblasts appear to contribute to the recruitment of myeloid derived suppressor cells (MDSCs) and B cells in PDA via cytokines increased due to hypoxia. PSCs also increase collagen secretion in response to HIF-1α, which promotes a fibrotic stroma that alters T cell homing and migration. In hypoxic environments, B cells contribute to cytotoxic T cell exhaustion and produce chemokines to attract more immunosuppressive regulatory T cells. MDSCs inhibit T cell metabolism by hoarding key amino acids, modulate T cell homing by cleaving L-selectin, and prevent T cell activation by increasing PD-L1 expression. Immunosuppressive M2 phenotype macrophages promote T cell anergy via increased nitric oxide (NO) and decreased arginine in hypoxia. Increased numbers of regulatory T cells are seen in hypoxia which prevent effector T cell activation through cytokine production and increased CTLA-4. Effective immunotherapy for pancreatic adenocarcinoma and other solid tumors will need to help counteract the immunosuppressive nature of hypoxia-induced changes in the tumor microenvironment. Promising studies will look at combination therapies involving checkpoint inhibitors, chemokine inhibitors, and possible targeting of hypoxia. While no model is perfect, assuring that models incorporate the effects of hypoxia on cancer cells, stromal cells, and effector immune cells will be crucial in developing successful therapies.
- Published
- 2019
- Full Text
- View/download PDF
49. Establishment of Slice Cultures as a Tool to Study the Cancer Immune Microenvironment.
- Author
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Jiang X, Seo YD, Sullivan KM, and Pillarisetty VG
- Subjects
- Biopsy, Carcinoma, Pancreatic Ductal immunology, Carcinoma, Pancreatic Ductal pathology, Carcinoma, Pancreatic Ductal therapy, Coculture Techniques instrumentation, Coculture Techniques methods, Fluorescent Dyes chemistry, Humans, Immunotherapy methods, Microscopy, Fluorescence instrumentation, Microscopy, Fluorescence methods, Pancreas immunology, Pancreas pathology, Pancreatic Neoplasms immunology, Pancreatic Neoplasms pathology, Pancreatic Neoplasms therapy, Spleen immunology, Spleen pathology, Staining and Labeling instrumentation, Tissue Culture Techniques instrumentation, Treatment Outcome, Staining and Labeling methods, Tissue Culture Techniques methods, Tumor Microenvironment immunology
- Abstract
Although immunotherapy is currently being widely applied to treat a variety of cancers, there is great heterogeneity in the response to these treatments. Many in the field hypothesize that this may be attributable to the characteristics of each individual tumor immune microenvironment, in addition to systemic immune factors. Therefore, understanding the immune cell microenvironment in a variety of tumors is critically important. Specifically, the interactions among immune, stromal, and cancer cells, along with other factors in tumors, may hold the key to developing rational personalized combinations of immunotherapeutic drugs. We recently developed an organotypic slice culture technique, which enables precise study of the pancreatic ductal adenocarcinoma (PDA) tumor microenvironment. We used a Vibratome to cut fresh human tumor tissue into 250 μm thick slices, and cultured slices on cell culture inserts with 0.4 μm pore to produce our tumor slice culture (TSC) system. We showed that TSC maintained many elements of the original tumor microenvironment and architecture for approximately one week. Using this slice culture technique for PDA, we demonstrated that immune cells, including T cells and macrophages, cancer cells, and stromal myofibroblasts were present throughout the culture period. TSCs were functionally responsive to drug treatment. Live PDA slices could be stained for multicolor immunofluorescence imaging of each of the primary cellular constituents of the tumor. Finally, autologous CFSE-labeled splenocytes were observed to readily migrate into cocultured tumor slices.
- Published
- 2019
- Full Text
- View/download PDF
50. Standardization of perioperative care facilitates safe discharge by postoperative day five after pancreaticoduodenectomy.
- Author
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Daniel SK, Thornblade LW, Mann GN, Park JO, and Pillarisetty VG
- Subjects
- Adult, Aged, Comorbidity, Female, Humans, Male, Middle Aged, Odds Ratio, Retrospective Studies, Risk Factors, Length of Stay, Pancreaticoduodenectomy methods, Pancreaticoduodenectomy standards, Patient Discharge, Perioperative Care methods, Perioperative Care standards
- Abstract
Introduction: Pancreaticoduodenectomy is a complex surgical procedure associated with high morbidity and prolonged length of stay. Enhanced recovery after surgery principles have reduced complications rate and length of stay for multiple types of operations. We hypothesized that implementation of a standardized perioperative care pathway would facilitate safe discharge by five days after pancreaticoduodenectomy., Methods: We performed a retrospective cohort study of patients undergoing pancreaticoduodenectomy 18 months prior to and 18 months following implementation of a perioperative care pathway at a quaternary center performing high volume pancreatic surgery., Results: A total of 145 patients underwent pancreaticoduodenectomy (mean age 63 ± 10 years, 52% female), 81 before and 64 following pathway implementation, and the groups were similar in terms of preoperative comorbidities. The percentage of patients discharged within 5 days of surgery increased from 36% to 64% following pathway implementation (p = 0.001), with no observed differences in post-operative serious adverse events (p = 0.34), pancreatic fistula grade B or C (p = 0.28 and p = 0.27 respectively), or delayed gastric emptying (p = 0.46). Multivariate regression analysis showed length of stay ≤5 days three times more likely after pathway implementation. Rates of readmission within 30 days (20% pre- vs. 22% post-pathway (p = 0.75)) and 90 days (27% pre- vs. 36% post-pathway (p = 0.27)) were unchanged after pathway implementation, and were no different between patients discharged before or after day 5 at both 30 days (19% ≤5 days vs. 23% ≥ 6 days (p = 0.68)) and 90 days (32% ≤5 days vs. 30% ≥ 6 days (p = 0.81))., Conclusions: Standardizing perioperative care via enhanced recovery protocols for patients undergoing pancreaticoduodenectomy facilitates safe discharge by post-operative day five., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2018
- Full Text
- View/download PDF
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