Outcome Analysis of Treatment Modalities for Thoracic Sarcomas

BACKGROUND Primary chest wall sarcomas are a rare and heterogeneous group of chest wall tumors that require multimodal oncologic and surgical therapy. The aim of this study was to review our experience regarding the surgical treatment of chest wall sarcomas, evaluating the short- and long-term results. METHODS In this retrospective single-center study, patients who underwent surgery for soft tissue and bone sarcoma of the chest wall between 1999 and 2018 were included. We analyzed the oncologic and surgical outcomes of chest wall resections and reconstructions, assessing overall and recurrence-free survival and the associated clinical factors. RESULTS In total, 44 patients underwent chest wall resection for primary chest wall sarcoma, of which 18 (41%) received surgery only, 10 (23%) received additional chemoradiotherapy, 7% (3) received surgery with chemotherapy, and 30% (13) received radiotherapy in addition to surgery. No perioperative mortality occurred. Five-year overall survival was 51.5% (CI 95%: 36.1-73.4%), and median overall survival was 1973 days (CI 95% 1461; -). As determined in the univariate analysis, the presence of metastasis upon admission and tumor grade were significantly associated with shorter survival (p = 0.037 and p < 0.01, respectively). Five-year recurrence-free survival was 71.5% (95% CI 57.6%; 88.7%). Tumor resection margins and metastatic disease upon diagnosis were significantly associated with recurrence-free survival (p < 0.01 and p < 0.01, respectively). CONCLUSION Surgical therapy is the cornerstone of the treatment of chest wall sarcomas and can be performed safely. Metastasis and high tumor grade have a negative influence on overall survival, while tumor margins and metastasis have a negative influence on local recurrence

Mutational Landscape and Expression of PD-L1 in Patients with Non-Small Cell Lung Cancer Harboring Genomic Alterations of the MET gene

BACKGROUND Mesenchymal-to-epithelial transition (MET) exon 14 skipping mutations and MET gene amplification occur in 3-5% of non-small cell lung cancer (NSCLC) patients. Tyrosine kinase inhibitors (TKIs) targeting MET alterations have shown promising results in these patients. OBJECTIVE The aim of this study was to describe the genomic profile, PD-L1 expression and clinicopathological features of MET dysregulated NSCLC. PATIENTS AND METHODS We identified 188 patients with advanced-stage NSCLC with data on MET expression by immunohistochemistry (IHC). IHC for PD-L1 expression was performed in 131 patient samples, and next-generation sequencing (NGS) analysis was performed in 109 patient samples. RESULTS MET exon 14 skipping alterations were identified in 16 (14.7%) samples, MET amplifications with cut-off ≥4 copy number variations were identified in 11 (10.1%) samples, and an oncogenic MET mutation (MET p.D1228N) was identified in 1 (0.9%) sample. 12/15 tumors (80.0%) harboring MET exon 14 alterations and 7/11 (63.6%) MET-amplified tumors expressed PD-L1 in ≥1% of tumor cells. Tumors harboring MET exon 14 skipping alterations expressed PD-L1 more frequently than MET wild-type IHC-positive tumors (p = 0.045). Twenty-five percent of MET exon 14-altered cases and 33% of MET-amplified cases harbored potentially targetable oncogenic co-mutations in KRAS, BRAF, and EGFR. The most frequent co-occurring mutations in all MET-altered tumors were TP53, KRAS, BRAF, and CDK4. CONCLUSIONS We demonstrated that MET exon 14 skipping alterations and MET amplification are not mutually exclusive to other oncogenic co-mutations, and report the association of genomic MET alterations with PD-L1 expression. Since genomic MET alterations are emerging targets requiring upfront treatment, optimal understanding of the co-mutational landscape for this patient population is needed

Comprehensive Statistical Exploration of Prognostic (Bio-)Markers for Responses to Immune Checkpoint Inhibitor in Patients with Non-Small Cell Lung Cancer

Metastatic non-small cell lung cancer (NSCLC) patients treated with immune checkpoint inhibitors (ICIs) may suffer from heavy side effects and not all patients benefit from the treatment. We conducted a comprehensive statistical analysis to identify promising (bio-)markers for treatment response. We analyzed retrospective data from NSCLC patients treated with ICIs in first- or further-line therapy settings at the University Hospital Zurich. We investigated 16 possible prognostic markers with respect to overall survival, tumor size reduction, and the development of an immune-related adverse event (irAE) and assessed the robustness of our results. For the further-line patient group, the most significant result was that increased basophil counts were associated with increased odds of tumor size reduction within three months and with the development of an irAE. For the first-line patient group, the most significant results were that increased lymphocyte counts, the histology of adenocarcinoma, and the intake of non-steroidal anti-rheumatic drugs (NSAR) were associated with decreased hazards of dying. Our study yielded new hypotheses for predictive (bio-)markers for response to ICIs in NSCLC patients. The possibly beneficial role of high basophil counts is a particularly interesting finding. Our results should be tested on independent data in a prospective fashion

Unravelling homologous recombination repair deficiency and therapeutic opportunities in soft tissue and bone sarcoma.

Defects in homologous recombination repair (HRR) in tumors correlate with poor prognosis and metastases development. Determining HRR deficiency (HRD) is of major clinical relevance as it is associated with therapeutic vulnerabilities and remains poorly investigated in sarcoma. Here, we show that specific sarcoma entities exhibit high levels of genomic instability signatures and molecular alterations in HRR genes, while harboring a complex pattern of chromosomal instability. Furthermore, sarcomas carrying HRDness traits exhibit a distinct SARC-HRD transcriptional signature that predicts PARP inhibitor sensitivity in patient-derived sarcoma cells. Concomitantly, HRD$^{high}$ sarcoma cells lack RAD51 nuclear foci formation upon DNA damage, further evidencing defects in HRR. We further identify the WEE1 kinase as a therapeutic vulnerability for sarcomas with HRDness and demonstrate the clinical benefit of combining DNA damaging agents and inhibitors of DNA repair pathways ex vivo and in the clinic. In summary, we provide a personalized oncological approach to treat sarcoma patients successfully

18F-FET PET for Diagnosis of Pseudoprogression of Brain Metastases in Patients With Non–Small Cell Lung Cancer

PURPOSE: To evaluate whether F-fluoroethyltyrosine (FET) PET can discriminate progression from pseudoprogression of brain metastases in patients with non-small cell lung cancer undergoing immunotherapy and radiotherapy to the brain. METHODS: Retrospective analysis of F-FET PET scans in cases with documented progression of brain metastases on MRI in a cohort of 53 patients with non-small cell lung cancer receiving immune-checkpoint inhibitors and radiotherapy of brain metastases at the University Hospital of Zürich from June 2015 until January 2019. Response to radiotherapy was assessed by MRI. In case of equivocal findings and/or radiological progression in clinically asymptomatic patients, further assessment with F-FET PET was performed. RESULTS: From the cohort of 53 patients, the restaging MRI showed in 30 patients (56.6%) progression of at least 1 treated metastasis. Thereof, F-FET PET was performed in 11 patients, based on the absence of neurological symptoms or presence of systemic response and physicians' decision. F-FET PET correctly identified pseudoprogression in 9 of 11 patients (81.8%). In patients who did not undergo F-FET PET, 5 of 19 (26.3%) were diagnosed with pseudoprogression. CONCLUSIONS: Pseudoprogression of brain metastases occurred in 50% of patients diagnosed with progression on MRI. F-FET PET may help differentiate pseudoprogression from real progression in order to avoid discontinuation of effective therapy or unneeded interventions

Unravelling homologous recombination repair deficiency and therapeutic opportunities in soft tissue and bone sarcoma.

Defects in homologous recombination repair (HRR) in tumors correlate with poor prognosis and metastases development. Determining HRR deficiency (HRD) is of major clinical relevance as it is associated with therapeutic vulnerabilities and remains poorly investigated in sarcoma. Here, we show that specific sarcoma entities exhibit high levels of genomic instability signatures and molecular alterations in HRR genes, while harboring a complex pattern of chromosomal instability. Furthermore, sarcomas carrying HRDness traits exhibit a distinct SARC-HRD transcriptional signature that predicts PARP inhibitor sensitivity in patient-derived sarcoma cells. Concomitantly, HRDhigh sarcoma cells lack RAD51 nuclear foci formation upon DNA damage, further evidencing defects in HRR. We further identify the WEE1 kinase as a therapeutic vulnerability for sarcomas with HRDness and demonstrate the clinical benefit of combining DNA damaging agents and inhibitors of DNA repair pathways ex vivo and in the clinic. In summary, we provide a personalized oncological approach to treat sarcoma patients successfully

CXCL10-mucin-GPI induces rolling and tight adhesion of CXCR3⁺ NK cells under conditions of physiologic flow.

<p>Laminar flow assays were performed to test if resting primary human microvascular endothelial cells treated with the GPI-anchored CXCL10 fusion proteins could recruit freely flowing CXCR3⁺ NK cells (YT) under conditions of physiologic flow. <b>A</b>: Resting primary human endothelial cells from fetal foreskin, selected for blood vessel endothelial cells, were treated with 0.34 nM of GPI-anchored CXCL10 fusion proteins or with identically diluted sEGFP-GPI protein for 1 h. Other slides were treated with commercially available CXCL10 at 1000-fold higher concentration as additional control (rhCXCL10). All samples contained the same percentage of chromatography buffer and detergent. Subsequently, YT cells were perfused over the endothelial cells with 1 dyn/cm² and the number of cells accumulating on the endothelial cells was counted. Data shown here are derived from six independent experiments, each performed using independent protein preparations and separate batches of cells. Bars represent the average numbers of cells adhering to the endothelium, +/− SEM. Statistical significance was calculated using the Kruskal-Wallis test (P = 0.0022) followed by Dunńs post test; ** = P<0.01. <b>B</b>: Experiments were performed as detailed in A. Tight adhesion was defined as an event in which a particular NK cell adhered to the endothelium and did not move further than one cell diameter within 30 sec. Rolling adhesion was defined as an event in which the NK cell adhered to the endothelium, but was dragged along the endothelium by the shear forces exerted by the buffer at a higher speed than one cell diameter per 30 sec or detached again. Cells displaying both rolling and tight adhesion were counted only as tightly adherent. Bars represent averaged values derived from four independent experiments +/− SEM. Statistical significance was calculated using the Kruskal-Wallis test (P = 0.0038 for rolling adhesion and 0.0021 for tight adhesion) followed by Dunńs post test; * = P<0.05, ** = P<0.01.</p

Purified GPI-anchored proteins incorporate into cell membranes.

<p><b>A</b>: In order to test the capacity of the purified recombinant fusion proteins to reincorporate into cell membranes, non-transfected CHO cells were incubated with the purified GPI-anchored proteins (0.9 nM) for 1 h at 37°C. As controls, two samples were treated either with identically diluted chromatography buffer (buffer) or MEM alpha medium (medium). The soluble CXCL10-mucin-Stop protein served as an additional control as it lacks a GPI anchor. All samples except the medium control contained the same percentage of chromatography buffer and detergent. Following incubation, the cells were washed and tested for the presence of the proteins on their surface by FACS staining. Dead cells were identified by 7-AAD staining and the histograms shown are gated on viable cells. The black lines indicate staining with isotype-matched control antibodies, blue lines staining with anti c-myc antibodies. Mean fluorescence intensities (MFIs) are given for each sample. This experiment was performed routinely to monitor protein quality after purification and the data shown here therefore stand representative for over 20 independent experiments. <b>B</b>: To verify the subcellular localization of the incorporated proteins, immunofluorescence microscopy was performed. Primary microvascular endothelial cells were treated with purified CXCL10-GPI, CXCL10-mucin-GPI or a buffer control diluted in culture medium, with all samples containing the same percentage of buffer to exclude artifacts. After treatment, the cells were washed, fixed with Paraformaldehyde and incorporated proteins were detected using anti c-myc primary and biotinylated secondary antibodies followed by RPE-labeled streptavidin. The figure shows fluorescence images and corresponding bright field images from a representative experiment, which was performed three times. All images within each row were acquired using the same exposure time. The black bars indicate 50 µm.</p