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  • 1
    In: The Lancet Oncology, Elsevier BV, Vol. 20, No. 6 ( 2019-06), p. 862-876
    Type of Medium: Online Resource
    ISSN: 1470-2045
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2019
    detail.hit.zdb_id: 2049730-1
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  • 2
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2019
    In:  Journal of Clinical Oncology Vol. 37, No. 27_suppl ( 2019-09-20), p. 47-47
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 27_suppl ( 2019-09-20), p. 47-47
    Abstract: 47 Background: Evidence suggests that integrating palliative care into usual oncology care benefits patients with advanced cancer and their caregivers (Ferrell et al., 2017). We evaluated patients with an advanced cancer diagnosis with concurrent palliative care versus standard oncology care to determine how both clinical and financial outcomes differ in our cancer center. Methods: We conducted a retrospective analysis on 340 deceased cancer patients who attended an office visit at a medical/gynecologic oncology clinic between January 2018 and February 2019. Patients who received concurrent palliative care as well as patients that received usual oncologic care were included. Data available in the electronic health record (EHR) were abstracted to quantify patient and practice level data. We compared differences in advance care planning (ACP) documentation, DNR designation, hospice enrollment prior to death, chemotherapy in the last 14 days of life, and health care utilization and cost. Results: Forty-nine patients received a specialty palliative care consultation concurrent with their cancer care. Compared to their counterparts, patients who received a specialty palliative care consultation were more likely to have a completed advanced care plan (57% v 16%, p 〈 .05), have a DNR designation (29% v 4%, p 〈 .05) in the EHR, to enroll in hospice prior to death (78% v 50%, p 〈 .05), and at an earlier time (Mdiff = 14 days, p = .05). Patients who received a specialty palliative care consultation were also less likely to receive chemotherapy in the last 14 days of life (2% v 7%) and end-of-life acute care utilization was lower in patients with a specialty palliative care consultation, including ED visits (50% v 67%) and hospitalizations (20% v 59%), but these results were not statistically significant. Median per patient per month (PPPM) total cost of care was higher pre-consult ($9,307) versus post-consult ($6,088; Diff = -$3,219), but this result was statistically non-significant. Conclusions: These results provide additional support for advantage of concurrent specialty palliative care in patients with advanced cancer versus standard oncologic care.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2019
    detail.hit.zdb_id: 2005181-5
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  • 3
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    Online Resource
    Elsevier BV ; 2022
    In:  Gynecologic Oncology Vol. 166 ( 2022-08), p. S159-
    In: Gynecologic Oncology, Elsevier BV, Vol. 166 ( 2022-08), p. S159-
    Type of Medium: Online Resource
    ISSN: 0090-8258
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 1467974-7
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  • 4
    In: Gynecologic Oncology, Elsevier BV, Vol. 166 ( 2022-08), p. S30-S31
    Type of Medium: Online Resource
    ISSN: 0090-8258
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 1467974-7
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  • 5
    In: Gynecologic Oncology, Elsevier BV, Vol. 176 ( 2023-09), p. S169-S170
    Type of Medium: Online Resource
    ISSN: 0090-8258
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 1467974-7
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  • 6
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 79, No. 13_Supplement ( 2019-07-01), p. 4579-4579
    Abstract: Introduction: Tumor and immune cells can determine each other’s fate. Immunotherapy targets either the PD1-PD-L1 axis which modulates immune-checkpoints or the cytotoxic CTLA4-mediated immune invasion of tumor cells. Thus the success of cellular-dynamics based immunotherapy depends on the makeup of the immune landscape within a given tumor as compared to its adjacent normal tissue. Aim: We hypothesize that as the immune-environment directly or indirectly shapes and determines the fate, drug response, and progression of an established tumor, the immune-landscape of the tumor-microenvironment will be characteristically different from that of the tumor-adjacent normal tissue. We studied the distribution pattern of selected immune cells in the tumor and tumor-adjacent normal tissues from patients with cancers of lung and ovary. Methods: The study was approved by Avera IRB. FFPE tumor and tumor-adjacent normal tissue samples in pairs from surgically resected tissues were used for IHC to identify CD3 (Anti-CD3 [SP7] ab16669), CD4 ([EPR6855] ab133616), CD8 (ab85792), CD68 (Dako. #M0876), CD163 (Cell Signaling #93498), FOXP3 ([236A/E7] ab20034) in immune cells and PD-L1 (Clone 22C3; Dako. #M3653) in tumor cells & tumor-associated macrophages. Tonsil tissue was used for the IHC validation. Tumor and normal cells from paired specimens were compared using H & E stain & Ki-67, pS6RP, cl-caspase 3, CIP2A, and CD31 IHC-stains based on criteria of evaluation for individual protein(s). Anatomic pathological evaluation for the diagnosis of the disease was carried out by Pathologist. Results: IHC expression of CD3, CD4, CD8, CD68, CD163, and FOXP3 in immune cells and PD-L1 in tumor cells was found heterogeneous. Although each tumor presented an individual pattern of distribution of immune cells, in most tumor samples, the identified immune cells were of tumor-cooperating phenotypes. Tumoricidal cells were rarely observed within the tumor compartment, and barely present in spaces, while tumor-friendly immune cells were frequent. In lung tumors, alveolar macrophages were predominantly of tumor-cooperating M2 types (CD68+/CD163+), whereas tumoricidal M1 macrophages (CD68+) were either absent or rare. The expression of PD-L1 in tumors did not correlate participation of any other immune cells in the tumor-microenviroment. Lung macrophages were highly positive for PD-L1 in which the intensity ranged from punctate to high. Conclusion: We present for the first time, a tissue-based analysis of distribution pattern of different immune cells in histological subtypes of the lung and ovarian cancers, in the tumor and tumor-adjacent normal tissues. The relationship between the immune-landscape of the tumor and tumor-adjacent normal tissue is being worked out and will be presented in the meeting. Citation Format: Xiaoqian Lin, Read Sulaiman, Jennifer Aske, Paul Mayer, Luis Rojas-Espaillat, David Starks, Pradip De, Brian Leyland-Jones, Nandini Dey. A comparative immune-landscape within tumor-microenvironment: Pattern of distribution of immune cells in tumor versus tumor-adjacent normal tissues [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4579.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
    RVK:
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2019
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  • 7
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 78, No. 13_Supplement ( 2018-07-01), p. 3451-3451
    Abstract: INTRODUCTION: Ovarian cancer (OC) frequently harbors genetic or epigenetic alterations that aberrantly activate CDK4/CDK6 pathway (Nam & Kim. Int J Gynecol Cancer 2008). Ribociclib (R) is being used in Phase I clinical trial in metastatic epithelial ovarian cancer (NCT03294694). CDK4/6 inhibitor, abemaciclib (A) is effective in KRAS mutant NSCLC. Platinum-taxol chemotherapy is the part of the standard of care for epithelial OC patients. However, acquired resistance to the platinum therapy can poorly affect prognosis (Jayson et al., Lancet, 2014; Sonego et al., Sci. REP. 2017). Additionally, the recurrent resistant EOCs almost invariably grow as metastatic disease (Jayson et al., Lancet, 2014). AIM: We interrogated the genomic alterations of the RAS-RAF (RR) and the cell-cycle (CC) pathways to generate a signaling algorithm in precision medicine for testing rational combinations of RR pathway inhibitor, Trametinib (T) with Paclitaxel (P) or CDK4/6 inhibitor (R/A) in platinum-resistant OC. METHODS: We analyzed genomic alterations (FoundationOne) of 90 tumor samples from 75 consecutive OC patients (Avera Cancer Institute; ‘14-‘17). The genomic changes in FoundationOne results were resolved into RR and CC pathways. Parental and cis-platin resistant RAF mutated A2780 iso-genic cell lines were used to study time-dependent effect of T (MEK1/2 inhibitor) and A/R (CDK4/6 inhibitor), single or in combination with P on (1) proliferative signals (WB), (2) cell cycle (Flowcytometry), (3) live-dead staining, (4) apoptosis (Flowcytometry; TMRE-based Mitochondrial potential; Triple IF by MitoView Blue+NucView488 Casp3 substrate + CF 594 AnnexinV) and (5) 3D clonogenic growth. RESULTS: 100 genes were altered in a total of 87% metastatic and 11% adjuvant tumors with a predominant histological type of high grade serous (58%). 7 genes including NF1 & gt; KRAS & gt;MAP3K1 & gt;NF2 & gt;BRAF & gt;MAP2K4 & gt;NRAS of the RR pathway were altered in 33% of tumors. 10 CC pathway genes including CCNE1, CDKN2A/B, in addition to TP53 and MYC were altered. We observed that 20-24% tumors had co-alterations of the two pathways and importantly, all tumors with co-alterations were metastatic. Although treatment of R and P as single agent significantly increased pRSK in resistant cell line at 6 hours, a combination of T + P or T + A/R was effective in inhibiting proliferative signals and inducing apoptosis abrogating downstream pERK and pRSK. A combination of T+P was most effective in inducing cl-casp3 at 24 hours. 3D ON-TOP assay for 10 days demonstrated a significant blockade of clonogenic growth with T+P and T+R in resistant cells. CONCLUSION: Plotting an in-depth information about co-alterations of genes of the RR and the CC pathway on the landscape of cell signaling is a useful tool to crack the code of cis-platin-resistance for improved treatment options. Citation Format: Nandini Dey, Casey Williams, Kirstin Williams, Jessica Klein, Jennifer H. Carlson, David Starks, Luis Rojas Espaillat, Pradip De, Brian Leyland Jones. Testing signaling algorithm in platinum-resistant ovarian carcinomas: A simultaneous inhibition of RAS-RAF and cell-cycle pathways signals by trametinib with paclitaxel or ribociclib/abemaciclib [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 3451.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2018
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    detail.hit.zdb_id: 410466-3
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  • 8
    Online Resource
    Online Resource
    American Association for Cancer Research (AACR) ; 2020
    In:  Cancer Research Vol. 80, No. 16_Supplement ( 2020-08-15), p. 1427-1427
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 80, No. 16_Supplement ( 2020-08-15), p. 1427-1427
    Abstract: Objectives: We present mutations in the ARID1A gene and its co-occurrence with alterations of gene(s) of the PI3K pathway (GOP) in our clinical cohort of ovarian carcinomas (OC). We interrogated the signaling opportunity of the co-occurrence in tumorigenic transformation of OC. Methods: A comprehensive genomic-profiling (FoundationOne) was performed in 90 samples from patients admitted to the Avera Center Institute, USA. The mechanistic study included epithelial endometrioid adenoC cell line A2780 and A2780Cis. CRISPR-Cas9 edited OVCAR3 cell line was used for an ARID1A-incompetent model. Algorithmically chosen drugs, single or in combination were tested for their effect on cell cycle, proliferation, apoptosis, 3D growth, and cellular signals. Results: We recorded 87% metastatic and 11% adjuvant tumors with a predominant histological type of high grade serous (58%). A total of approximately 318 alterations in 100 genes was observed. Alterations (point mutation, frameshifts, and splice site) in the ARID1A was found in 8 patients whose tumors are predominantly clear cell carcinomas (6 out of 8). Interestingly none had alteration in germline BRCA1/2. All frameshift mutations were found in the adjuvant category while alterations in the metastatic category were more diverse. Alteration of GOP included PIK3CA, PIK3R1, AKT2, PTEN, AKT1, AKT3, MDM4, PIK3C2B, PIK3CB, TSC1, STK11, PPP2R1A, and FBXW7 with the most number of alterations in PIK3CA, PIK3R1, AKT2, PTEN genes. A heatmap showed that all patients with ARID1A alterations had alterations in at least one GOP. Treatment with PI3K inhibitor, copanlisib dose-dependently induced apoptosis both as a single agent and in combination with BMN673 in OC cells. Conclusion: OC expressing alteration of ARID1A frequently exhibit a co-alteration in at least one GOP, and the co-alteration provide a unique signaling opportunity to test rational combination of pathway-targeted drugs in OC. Our study provides an insight into the mechanism of how a loss of a tumor suppressor gene, ARID1A co-operates with gain of function mutation(s) of an oncogenic pathway, the PI3K pathway. Background: Nucleosome remodelers controls transcription of genes in human health and sickness by dynamic remodeling of human chromatin in a spatiotemporal manner. ARID1A, a core component of the mammalian SWI/SNF nucleosome remodeler complex, which interacts with DNA in a sequence-nonspecific way to regulate cellular processes, including proliferation and differentiation and hence reported to be involved in tumorigenesis (PMID: 25387058). The mutational (inactivating) status of ARID1A in a broad spectrum of gynecological neoplasms (PMID: 22009941) predominantly ovarian and endometrial cancers established its role as an epigenetic tumor suppressor (PMID: 23208470). The mechanistic study included OC cell line A2780 (epithelial), established from an untreated patient with ovarian endometroid adenocarcinoma and an isogenic cis-platin resistant cell line, A2780Cis. The results were being interrogated in the light of tumor cell signaling. Citation Format: Nandini Dey, Jennifer C. Aske, Ethan Thompson, Luis Rojas-Espaillat, David Starks, Pradip De. Co-alteration of the nucleosome remodeler, ARID1A with the PI3K-pathway genes: A signaling opportunity in ovarian cancers [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1427.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2020
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    detail.hit.zdb_id: 1432-1
    detail.hit.zdb_id: 410466-3
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  • 9
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 82, No. 12_Supplement ( 2022-06-15), p. 269-269
    Abstract: Background: In endometrial cancers (EC), the mechanistic contribution of PD-L1/L2 and PD-1 signaling of host’s stromal microenvironment (SME) [cancer-associated fibroblast (CAF) and immune cells] in relation to the tumor (T) cells is elusive. Aim: To understand the tumor-stroma-immune crosstalk in EC, we studied the compartmental pattern of PD-L1, PD-L2, and PD-1 expression in EC tissues and their matched CAFs from both T and tumor-adjacent normal (N) tissues. Method: Over 116 surgically resected T and N tissues were obtained from consented patients with EC at the Avera Cancer Institute (March ‘16 and September ’21). IHC expression was performed in T, N-epithelium, SME (mesenchyme) in the T and N tissues. The staining intensity and distribution pattern were evaluated by a pathologist using a standard scoring system (1% cut-off value). Since fibroblasts are the most abundant cells of SME, the PD-L1 was parallelly evaluated in the multiple passages of cultured T and N derived CAFs by the qRT-PCR, flow-cytometry, and ICC. Result: The expression of 3 immune checkpoint proteins in the epithelial and mesenchyme of N was limited to only rare and focal positivity for PD-L1. The epithelial compartments of the T tissue, in contrast, had 70% positivity for PD-L1, which was independent of differentiation status, presence of TILs, or lymphovascular invasion. PD-L1 positivity was 90% of the SME of tested samples, identified predominantly in the (1) immune component, including macrophages and lymphocytes, and (2) EpCAM-/SMA+/FAP+/S100A4+ CAFs. Both PD-L1 and PD-L2 were identified by flow, ICC, and qRT-PCR in NCAF and TCAF. The overall expression of PD-L2 was found to be qualitatively and quantitatively lesser than that of PD-L1, primarily contributed by SME/stromal macrophages and lymphocytes. PD-1 expression was restricted to the SME/stromal immune components, predominantly lymphocytes. The expression for PD-L1 and PD-L2 mRNA was higher in TCAF than NCAF in successive passages, which ICC and flow cytometry confirmed. Summary: The expression of immune checkpoint proteins, PD-L1, and PD-L2, are primarily tumor-driven and associated with the endometrioid (invasive) and serous adenocarcinomas of grades II and above with myometrial invasion. The expression of PD-L1 and PD-L2 are distributed in both tumor and SME/stromal components, while PD-1 expression is exclusively SME/stromal. Citation Format: Xiaoqian Lin, Jennifer Aske, Adam Dale, Nischal Koirala, Ethan Thompson, Mary Fagerness, Natasha Flier, Paige Davies, Stacy Kehoe, Cheryl Ageton, Kris Gaster, Luis Rojas Espaillat, David Starks, Raed Sulaiman, Pradip De, Nandini Dey. PD-L1 dominated tumor-CAF-immune cell crosstalk of stromal microenvironment: Endometrial tumor vs. tumor-adjacent normal [abstract] . In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 269.
    Type of Medium: Online Resource
    ISSN: 1538-7445
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2022
    detail.hit.zdb_id: 2036785-5
    detail.hit.zdb_id: 1432-1
    detail.hit.zdb_id: 410466-3
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  • 10
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 76, No. 14_Supplement ( 2016-07-15), p. 131-131
    Abstract: Uterine carcinosarcoma (UCS), also known as Malignant Mixed Mullerian Tumor, is a neoplasm of the female genital tract that shows histological features of both carcinoma and sarcoma. Some studies have indicated that UCS arises from sarcomatous differentiation of high-grade carcinoma while others have confirmed a bi-clonal nature of the tumor. Given these differences, further investigation in the origin of this tumor with newer approaches and technologies is warranted. In this study we determined the allelic imbalance (AI) profiles of the two components of UCS and compared the AI events that were shared by, or differed between, them. Samples were obtained from 10 patients diagnosed with UCS and were preserved in formalin fixed paraffin embedded (FFPE) blocks. The two components (carcinoma & sarcoma) were identified and micro-dissected, and whole-genome DNA micro-arrays were applied to the isolated DNA. We then applied a sensitive computational method that combines haplotype information with SNP array data to identify somatic segmental copy number variations and copy-neutral loss of heterozygosity (cnLOH). After we obtained the AI events we filtered small events ( & lt;2 MB) to rule out germline duplications. We then obtained events that are common to both components by using a criterion of 80% reciprocal overlap. All such events were classified as a gain, loss or cnLOH. We found that, on an average, 80% of the events found in the carcinoma component are common with the sarcoma component. Conversely, only 64% of events seen in the sarcoma component are found in the carcinoma. This may be in part due to the fact that the sarcoma component usually showed greater number of events and most of these events were larger than the corresponding carcinoma component. Also the sarcoma component showed an increased degree of allelic imbalance than the counterpart. We then looked into particular regions of known tumor suppressor and oncogenes and identified loss in the TP53 gene region (60% of tumors), gains in PIK3CA and PTEN gene regions (40% of tumors), among other events. Our analysis showed that the sarcomatous component shared major portions of the AI profile with the carcinomatous component, but also showed additional events and a greater degree of AI. One explanation for this observation can be that the sarcomatous component retains the AI profile of the carcinomatous component and also gathers additional imbalance. This suggests directionality to the development of UCS: that it arises by sarcomatous differentiation of already existing carcinoma of the uterus. We are pursuing additional assessments of point mutations and expression profiles to complement our existing analyses. Citation Format: Aditya S. Deshpande, Zachary Weber, Raed Sulaiman, Natasha Flier, Cheryl Ageton, Mary Fagerness, Joseph Sulaiman, Gareth E. Davies, David Starks, Luis Rojas-Espaillat, Paul A. Scheet, Erik Ehli. Allelic imbalance analysis of uterine carcinosarcoma: An inquiry into the dual nature of the neoplasm. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 131.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2016
    detail.hit.zdb_id: 2036785-5
    detail.hit.zdb_id: 1432-1
    detail.hit.zdb_id: 410466-3
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