Citations

Purpose: The authors aimed to determine key features of IgG4-related ophthalmic disease (IgG4-ROD) and Graves orbitopathy (GO) to aid in diagnosis. Methods: The authors retrospectively identified ophthalmology patients seen between June 2009 and November 2013 with clinical overlap of GO and IgG4-ROD. Patient findings were reviewed to characterize the 2 conditions. Results: Among 8 patients (7 male and 1 female), the mean age was 45.8 years. Time between diagnoses of GO and IgG4-ROD ranged from 1 month to 8 years. Imaging showed enlarged extraocular muscles in all patients. Enlarged infraorbital nerves were seen in 4 patients. Tissue biopsy showed CD20+ lymphocytes with a large proportion of IgG4 plasma cells in 7 of 8 orbital specimens. Six patients had a ratio of IgG4:IgG cells >40%. Discussion: No pathognomonic clinical findings for GO or IgG4-ROD have been reported, but some key features can help distinguish the conditions. GO is likely if findings include increased thyrotropin receptor antibodies, lid retraction/lid lag, and enlarged extraocular muscles with typical tendon-sparing morphology. Findings suggestive of IgG4-ROD include history of asthma and progressive orbital disease in patients with previous diagnosis of GO, disproportionately large lateral rectus muscle, and enlarged infraorbital nerves. Increased serum IgG4 level and biopsy showing >10 IgG4+ plasma cells/high-power field and IgG4:IgG ratio >40% will support the diagnosis of IgG4-ROD. Conclusions: GO and IgG4-ROD are complicated inflammatory processes affecting the orbit and present diagnostic challenges. The authors recommend biopsy for patients who do not follow the usual clinical course of GO or have clinical characteristics of IgG4-ROD.

Abstract Background: Acquired PARP inhibitor (PARPi) resistance in high-grade serous ovarian cancer (HGSOC) as a result of restored homologous recombination has been observed following secondary mutations that restore full-length protein in BRCA1, BRCA2, RAD51C, and RAD51D. Additionally, loss of BRCA1 methylation has also been shown to confer resistance. However, little is known about the role of RAD51C methylation in acquired PARPi resistance. In ARIEL2 Part 1, a phase 2 study of the PARPi rucaparib in ovarian carcinoma, four (2%) tumors demonstrated RAD51C methylation. The present study utilizes HGSOC patient derived xenografts (PDXs) and recurrent samples from ARIEL2 to assess the role of RAD51C methylation in the development of PARPi resistance. Methods: To drive PARPi resistance, PDX039, an extremely PARPi-sensitive model lacking demonstrable mutations in DNA repair genes, was treated cyclically with niraparib (100 mg/kg) for 21 days, after which the tumor was allowed to regrow and re-established in new mice for the next treatment round. To evaluate the frequency of methylation change, RAD51C methylation was analyzed in 12 rucaparib-treated mice (300 or 450 mg/kg) harboring PDX183, a PARPi-sensitive model without mutations in DNA repair genes. Global changes in gene expression following development of PARPi resistance were assessed by RNA sequencing. RAD51C promoter methylation was evaluated by bisulfite sequencing. Subsequent functional analysis included qRT-PCR, IHC, and western blot. DNA damage response pathways are being evaluated by immunofluorescence ex vivo following niraparib, rucaparib, or IR. Results: PDX039 grew through PARPi treatment by the third and fourth cycle of therapy. RAD51C was the only DNA repair gene to show significant change in RNAseq analysis (log2 fold-change=8.43; p=2e-192), corresponding with a loss of RAD51C methylation. Moreover, after just one round of PARPi treatment, RAD51C methylation was lost in 1 of 12 PARPi-treated PDX183 xenografts. RAD51C methylation loss ultimately resulted in restoration of expression, for which functional analysis is ongoing. Analysis of patient samples is currently underway. Conclusions: In HGSOC PDX models, RAD51C methylation affords PARPi sensitivity in the absence of DNA repair gene mutations. Treatment pressure with PARPi can reverse RAD51C methylation and restore RAD51C expression. Isolated changes in methylation of the RAD51C locus are sufficient to restore HR and convey PARPi resistance. Citation Format: Rachel M. Hurley, Ksenija Nesic, Cordelia McGehee, Olga Kondrashova, Maria I. Harrell, Paula A. Schneider, Xiaonan Hou, Cristina Correia, Karen S. Flatten, Giada V. Zapparoli, Alexander Dobrovic, Kevin K. Lin, Thomas C. Harding, Andrea E. Wahner Hendrickson, Elizabeth M. Swisher, Matthew Wakefield, S. John Weroha, Clare L. Scott, Scott H. Kaufmann. Loss of RAD51C promoter hypermethylation confers PARP inhibitor resistance [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5885.

Abstract Despite a good response rate to front-line treatment, most of the patients with epithelial ovarian cancer (EOC) will eventually develop an incurable state of platinum (Pt)-resistant disease. Pt resistance is a multifactorial event driven by different molecular mechanisms such as increased ability to tolerate or repair DNA lesions, tendency to plasticity with acquisition of mesenchymal phenotype, and ability to modify/reprogram cellular metabolism. We recently identified in EOC relevant alterations in all of these factors, largely contributing to EOC aggressiveness. Focusing our attention on microRNAs (miRNAs), the master regulator of gene expression, we identified a cluster of miRNAs located on ChrXq27.3 (miR-506 family) whose downregulation is associated with advanced-stage EOC early relapse, and we found it to be the main contributor of a 35-miRNA based predictor (MiROvaR) of EOC risk of progression/relapse. We also contributed in defining altered choline metabolism in EOC that, through overexpression of choline kinase alpha (ChoK/CHKA) enzyme whose activity sustains tumor addiction to antioxidants, fosters EOC aggressiveness also by increasing chemoresistance. By in vitro and ex vivo studies performed in human EOC cell lines, non-tumoral immortalized ovarian cells and ex vivo EOC patient-derived ascitic tumor cells (PDAT), here we analyzed the role of miR-506 in regulating molecular network associated with drug resistance and evaluated the druggability of the cholinic phenotype, exploring its possible crosstalk with the immune system. We confirmed miR-506 to directly regulate the predicted target RAD17, a gene with a key role in guiding BRCA1 to DNA damage sites and stabilizing active signaling. Since an inactivation of DNA repair genes (BRCA1/2) is associated with better prognosis due to sensitization to DNA-damaging drugs, we investigated whether miR-506 can regulate DNA repair machinery by phenocopying/supporting the effects of BRCA1/2 mutation on Pt and PARP inhibitor sensitivity. We observed that miR-506 forced expression or RAD17 knockdown sensitized EOC cells to Pt and PARP inhibitors and, interestingly, showed a synthetic lethal effect with inhibitors of cell-cycle checkpoint kinases CHK1 and WEE1. Association of miR-506 cluster expression (RT-qPCR) with the BRCAness-phenotype is currently ongoing on a retrospective FFPE case material. We also recently link EOC cells plasticity, miRNAs expression, and Pt-sensitivity. Indeed, E-cadherin can exert a new and unexpected functional role in EOC cells by contributing to Pt susceptibility. We determined that overexpression of PLEKHA7 (Pleckstrin homology domain-containing family A member 7), a component of the zonula adherens in polarized epithelia and expressed at low levels in EOC biopsies, inhibits cell tumorigenicity and sensitizes EOC cells to Pt treatment. We will evaluate PLEKHA7 ability to regulate miRNAs driving tumor progression, including some of the miR-506 family. Concerning chemoresistance associated with metabolic rewiring, we showed that CHKA silencing altered the cellular oxidative stress redox status, decreasing glutathione content and raising reactive oxygen species (ROS) levels. Interestingly, the increase in intracellular ROS species improved EOC cells’ sensitivity to Pt/taxane treatments, contributing to cell death triggering. Moreover, upon CHKA silencing both in vitro and in PDAT cells, we observed an enhanced sensitization of cancer cells to TRAIL-mediated citotoxicity due to an augmented expression of pro-apoptotic/reduced expression of anti-apoptotic TRAIL receptor members, thus further increasing tumor cells’ weakness. Exploiting tumor’s reliance on these altered molecular and metabolic pathways is expected to be an appropriate strategy to improve efficacy of current treatment, possibly circumventing drug resistance. Funded by CARIPLO Foundation, AIRC and 5x1000 Institutional Research Funding. Citation Format: Marina Bagnoli, Roberta Nicoletti, Andrea Rizzo, Francesca Roggiani, Alessandro Satta, Mariangela Figini, Wei Zhang, Panagiotis Z. Anastasiadis, Egidio Iorio, Silvana Canevari, Antonella Tomassetti, Francesco Raspagliesi, Delia Mezzanzanica. An integrated molecular and metabolic approach for harnessing early relapse and chemoresistance in ovarian cancer. [abstract]. In: Proceedings of the AACR Conference: Addressing Critical Questions in Ovarian Cancer Research and Treatment; Oct 1-4, 2017; Pittsburgh, PA. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(15_Suppl):Abstract nr A39.

Linked ContentThis article is linked to Tse et al and Ma and Kotze paper. To view these articles visit https://doi.org/10.1111/apt.14829 and https://doi.org/10.1111/apt.14858.

Purpose Intermediate-risk rhabdomyosarcoma (RMS) includes patients with either nonmetastatic, unresected embryonal RMS (ERMS) with an unfavorable primary site or nonmetastatic alveolar RMS (ARMS). The primary aim of this study was to improve the outcome of patients with intermediate-risk RMS by substituting vincristine and irinotecan (VI) for half of vincristine, dactinomycin, and cyclophosphamide (VAC) courses. All patients received a lower dose of cyclophosphamide and earlier radiation therapy than in previous trials. Patients and Methods Patients were randomly assigned at study entry to either VAC (cumulative cyclophosphamide dose, 16.8 g/m 2 ) or VAC/VI (cumulative cyclophosphamide dose, 8.4 g/m 2 ) for 42 weeks of therapy. Radiation therapy started at week 4, with individualized local control plans permitted for patients younger than 24 months. The primary study end point was event-free survival (EFS). The study design had an 80% power (5% one-sided α-level) to detect an improved long-term EFS from 65% (with VAC) to 76% (with VAC/VI). Results A total of 448 eligible patients were enrolled in the study. At a median follow-up of 4.8 years, the 4-year EFS was 63% with VAC and 59% with VAC/VI ( P = .51), and 4-year overall survival was 73% for VAC and 72% for VAC/VI ( P = .80). Within the ARMS and ERMS subgroups, no difference in outcome by treatment arm was found. Severe hematologic toxicity was less common with VAC/VI therapy. Conclusion The addition of VI to VAC did not improve EFS or OS for patients with intermediate-risk RMS. VAC/VI had less hematologic toxicity and a lower cumulative cyclophosphamide dose, making VAC/VI an alternative standard therapy for intermediate-risk RMS.

Abstract In this review, we aimed to provide insight into the microbiome and its association with endometrial and ovarian cancer and their risk factors. We reviewed the literature focusing on the relationship between the microbiome and cancer, as well as the relationship between gynecologic diseases and cancers. The human body contains different kinds of microorganisms in various body parts, which is termed the microbiome . The number of microorganisms that live in and on the human body is greater than that of the human germ and somatic cells by 10‐fold. The relationship between a human and their microbiome is complex; it is also one of the most important components of homeostasis. Impairment of microbiome–host homeostasis has been associated with obesity, several cancers, preterm labor, inflammatory and allergic conditions and neurodevelopmental disorders. Direct and strong causal relationships have been established for several cancers and microorganisms, such as gastric lymphoma and Helicobacter pylori infection. Interestingly, eradication of the infectious agents has also been shown to be therapeutic. The association between cancer and the microbiome, however, is more complicated than a 1 bacteria–1 cancer model, and a shift in a healthy microbiome can result in various cancers via inflammation, change in microenvironment or DNA‐damaging toxins. The human microbiome is an integral part of homeostasis. Understanding the mechanisms that cause dysbiosis will enable us to elucidate the pathways that result in malignancy and investigate new treatment modalities.