Chemoresistance mechanisms in digestive cancers : impact of CDX2 and ABC transporters

La chimiorésistance est un enjeu majeur dans la prise en charge des patients atteints de cancers digestifs et peut se manifester par l’efflux de molécules cytotoxiques via la surexpression des transporteurs ABC. Le facteur de transcription CDX2 est un régulateur important de l’identité intestinale et agit comme gène suppresseur de tumeur dans le côlon. Il pourrait être impliqué dans des phénomènes de chimiorésistance des cancers colorectaux (CCR) car le transporteur MDR1/ABCB1 correspond à un de ses gènes cibles. Nous avons confirmé le rôle de CDX2 dans la chimiorésistance des CCR. Nous avons montré par une approche translationnelle, que la surexpression de CDX2 était impliquée dans la résistance au 5-fluorouracile (5-FU) dans les CCR. Le transporteur du 5-FU ABCC11 a été identifié comme gène cible de CDX2 dont l’activité contribue à la résistance au 5-FU des cellules cancéreuses coliques. L’expression d’ABCC11 corrèle avec celle de CDX2 dans les CCR humains mais également avec celle de la DYPD, enzyme impliquée dans le catabolisme du 5-FU. Cette étude montre pour la première fois que CDX2 contribue à la chimiorésistance au 5-FU en impliquant des mécanismes régulant son métabolisme.Chemoresistance represents a major drawback in digestive cancers’ management and may be achieved particularly through active efflux of the drug through overexpression of ABC transporters The transcription factor CDX2 is a master regulator of intestinal identity that acts as a tumor suppressor in the colon and may be important for drug resistance in colorectal cancer (CRC) as MDR1/ABCB1 was recently identified as one of its target genes. Here, we confirmed the role of CDX2 in the chemoresistance of CRC. We showed through a translational approach that CDX2 overexpression is implicated in 5-fluorouracil (5-FU) chemoresistance in CRC and described the molecular mechanisms implicated in this finding. We identified the 5-FU transporter ABCC11 as a new transcriptional target of CDX2 whose activity contributes to the 5-FU-chemoresistance of colon cancer cells. Remarkably, CDX2 expression correlates with the expression of ABCC11 in human colon tumors, but also with the one of the DPYD, enzyme involved in the 5-FU break down. Thus, our study links for the first time CDX2 to the 5-FU metabolism and provides a molecular mechanism for its impact on 5-FU-based chemotherapy

Chemoresistance mechanisms in digestive cancers : impact of CDX2 and ABC transporters

La chimiorésistance est un enjeu majeur dans la prise en charge des patients atteints de cancers digestifs et peut se manifester par l’efflux de molécules cytotoxiques via la surexpression des transporteurs ABC. Le facteur de transcription CDX2 est un régulateur important de l’identité intestinale et agit comme gène suppresseur de tumeur dans le côlon. Il pourrait être impliqué dans des phénomènes de chimiorésistance des cancers colorectaux (CCR) car le transporteur MDR1/ABCB1 correspond à un de ses gènes cibles. Nous avons confirmé le rôle de CDX2 dans la chimiorésistance des CCR. Nous avons montré par une approche translationnelle, que la surexpression de CDX2 était impliquée dans la résistance au 5-fluorouracile (5-FU) dans les CCR. Le transporteur du 5-FU ABCC11 a été identifié comme gène cible de CDX2 dont l’activité contribue à la résistance au 5-FU des cellules cancéreuses coliques. L’expression d’ABCC11 corrèle avec celle de CDX2 dans les CCR humains mais également avec celle de la DYPD, enzyme impliquée dans le catabolisme du 5-FU. Cette étude montre pour la première fois que CDX2 contribue à la chimiorésistance au 5-FU en impliquant des mécanismes régulant son métabolisme.Chemoresistance represents a major drawback in digestive cancers’ management and may be achieved particularly through active efflux of the drug through overexpression of ABC transporters The transcription factor CDX2 is a master regulator of intestinal identity that acts as a tumor suppressor in the colon and may be important for drug resistance in colorectal cancer (CRC) as MDR1/ABCB1 was recently identified as one of its target genes. Here, we confirmed the role of CDX2 in the chemoresistance of CRC. We showed through a translational approach that CDX2 overexpression is implicated in 5-fluorouracil (5-FU) chemoresistance in CRC and described the molecular mechanisms implicated in this finding. We identified the 5-FU transporter ABCC11 as a new transcriptional target of CDX2 whose activity contributes to the 5-FU-chemoresistance of colon cancer cells. Remarkably, CDX2 expression correlates with the expression of ABCC11 in human colon tumors, but also with the one of the DPYD, enzyme involved in the 5-FU break down. Thus, our study links for the first time CDX2 to the 5-FU metabolism and provides a molecular mechanism for its impact on 5-FU-based chemotherapy

Etude des mécanismes de chimiorésistance dans les cancers digestifs : impact de CDX2 et des transporteurs ABC

Chemoresistance represents a major drawback in digestive cancers’ management and may be achieved particularly through active efflux of the drug through overexpression of ABC transporters The transcription factor CDX2 is a master regulator of intestinal identity that acts as a tumor suppressor in the colon and may be important for drug resistance in colorectal cancer (CRC) as MDR1/ABCB1 was recently identified as one of its target genes. Here, we confirmed the role of CDX2 in the chemoresistance of CRC. We showed through a translational approach that CDX2 overexpression is implicated in 5-fluorouracil (5-FU) chemoresistance in CRC and described the molecular mechanisms implicated in this finding. We identified the 5-FU transporter ABCC11 as a new transcriptional target of CDX2 whose activity contributes to the 5-FU-chemoresistance of colon cancer cells. Remarkably, CDX2 expression correlates with the expression of ABCC11 in human colon tumors, but also with the one of the DPYD, enzyme involved in the 5-FU break down. Thus, our study links for the first time CDX2 to the 5-FU metabolism and provides a molecular mechanism for its impact on 5-FU-based chemotherapy.La chimiorésistance est un enjeu majeur dans la prise en charge des patients atteints de cancers digestifs et peut se manifester par l’efflux de molécules cytotoxiques via la surexpression des transporteurs ABC. Le facteur de transcription CDX2 est un régulateur important de l’identité intestinale et agit comme gène suppresseur de tumeur dans le côlon. Il pourrait être impliqué dans des phénomènes de chimiorésistance des cancers colorectaux (CCR) car le transporteur MDR1/ABCB1 correspond à un de ses gènes cibles. Nous avons confirmé le rôle de CDX2 dans la chimiorésistance des CCR. Nous avons montré par une approche translationnelle, que la surexpression de CDX2 était impliquée dans la résistance au 5-fluorouracile (5-FU) dans les CCR. Le transporteur du 5-FU ABCC11 a été identifié comme gène cible de CDX2 dont l’activité contribue à la résistance au 5-FU des cellules cancéreuses coliques. L’expression d’ABCC11 corrèle avec celle de CDX2 dans les CCR humains mais également avec celle de la DYPD, enzyme impliquée dans le catabolisme du 5-FU. Cette étude montre pour la première fois que CDX2 contribue à la chimiorésistance au 5-FU en impliquant des mécanismes régulant son métabolisme

Discovery of a duplicated inferior vena cava during surgical resection for retroperitoneal sarcoma

International audienceNo abstract availabl

Implementation of an enhanced recovery program for complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a referral center: a case control prospective study

Current recommendations regarding enhanced recovery programs (ERPs) after complete cytoreductive surgery (CCRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are based on a low level of evidence. The aim of this study is to evaluate the effect of implementing an adapted ERP for CCRS and HIPEC in a referral center

Could a Feeding Jejunostomy be Integrated into a Standardized Preoperative Management of Oeso-gastric Junction Adenocarcinoma?

International audiencePURPOSE:To evaluate the impact of a feeding jejunostomy (FJ) on the preoperative management of patients with an oesogastric adenocarcinoma (OGA).METHODS:From January 2007 to December 2014, patients with potentially resectable OGA were enrolled in a perioperative chemotherapy protocol. FJ was performed before starting perioperative treatments in patients presenting with dysphagia or with a nutritional risk index (NRI) <97.5. The patients who did not require a FJ served as a control group.RESULTS:Among the 114 patients with OGA consecutively admitted in our surgical department, 88 (77.2%) were enrolled for neoadjuvant treatment. A FJ was placed in 50 patients (56.8%) before the neoadjuvant treatment (FJ group), whereas 38 patients (43.2%) started neoadjuvant treatments without FJ (control group). Ninety-six percent of patients (n = 48) in the FJ group successfully completed the neoadjuvant treatment but only 81.6% of patients without FJ (n = 31; p = 0.004). The FJ group was divided between responders: 37 patients with a weight response (74%), and nonresponders: 13 patients without weight response (26%). In the FJ group, the nutritional response during preoperative chemotherapy was a significant predictive factor for the achievement of second stage oesogastric resection (p = 0.002).CONCLUSIONS:FJ with enteral nutritional support during the preoperative management of OGA is a safe and effective support for the completion of the preoperative chemotherapy. The weight response to the enteral support is a predictor factor for a completion of the preoperative chemotherapy and could identify a group of patients who would have a better chance of reaching radical surgery

Pseudozyma aphidis fungemia after abdominal surgery: First adult case

Pseudozyma aphidis is an environmental Basidiomycete yeast, and has been involved in the ten past years in rare cases of invasive infection. Pseudozyma species are naturally resistant to caspofungin and often present decreased susceptibility or resistance to fluconazole. This fungus may be difficult to recognize and misidentifications are reported with conventional phenotypical methods. We report a case of P. aphidis invasive infection in an adult with a metastatic ampulloma who had gone through digestive surgery

Conformity to Clinical Practice Guidelines at Initial Management in Adult Soft Tissue and Visceral Tumors since the Implementation of the NetSarc Network in Eastern France

Number: 8 PMID: 31073021 PMCID: PMC6693707BACKGROUND: Soft tissue sarcomas are rare and heterogenous tumors that are hard to diagnose. The aim of this study was to evaluate local practices and conformity to clinical practice guidelines (CPGs) for their initial diagnostic management. MATERIALS AND METHODS: Patients were carriers of a soft tissue or visceral tumor, presented at a sarcoma tumor board (STB) between 2010 and 2016. Conformity to CPGs was evaluated using ten criteria designed for this purpose. Associations between different factors and conformity to composite criteria, reflecting the three main diagnostic steps (imaging, biopsy and histological report) were analyzed. RESULTS: A total of 643 patients were included. A preoperative tumor imaging assessment and a biopsy were performed according to CPGs in 80.8% and 36.8% of the cases, respectively. When done, the first surgical resection was R0 in 30.3% of cases, R1 in 28.6%, and R2 in 10.9%. The rest of the operated patients with sarcoma had a second surgical excision (11.4%), an intraoperative fragmentation (4.3%), or margins were unknown (14.4%). Six of the ten quality criteria presented a conformity rate higher than 70%. Two criteria with a conformity rate lower than 20% were the most controversial: presentation at a STB before biopsy and freezing of a tumor fragment. A multivariate analysis revealed that the common predictor of nonconformity to composite criteria was the initial management in a nonexpert center. CONCLUSION: Initial diagnostic management requires improvement, especially outside of specialized centers. IMPLICATIONS FOR PRACTICE: This article supports the essential need to refer patients with soft tissue tumors to specialized centers to improve the management of sarcomas beginning at the diagnostic phase. Indeed, the reported data were very similar to those already described at the national level of the NetSarc network and indicate the necessity to keep raising awareness about this simple issue: early referral to reference centers will save lives

Peritoneal carcinomatosis with synchronous liver metastases from colorectal cancer: Who will benefit from complete cytoreductive surgery?

International audienceh i g h l i g h t s Combined treatment for peritoneal and liver metastases from colon cancer was evaluated. Toxicity to preoperative chemotherapy and size of LM were poor prognostic factors. These criteria could help in better selecting patients for such extensive surgery. a b s t r a c t Purpose: Selection of patients for resection of synchronous liver metastases (LM) and peritoneal carci-nomatosis (PC) of colorectal cancer (CRC) remains a debated issue since morbidity of this surgery is not negligible. We aimed to define overall survival (OS) prognostic criteria in patients undergoing PC surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) and LM resection. Methods: This monocentric and comparative study included all consecutive patients operated for LM (LM group, n ¼ 77), PC (HIPEC group, n ¼ 18) and PC þ LM (LM þ HIPEC group, n ¼ 9) from January 2007 to May 2011. Characteristics of the 3 groups were prospectively collected and retrospectively compared. Results: Median follow-up was 56,5 months. Major morbidity and mortality were respectively 14% and 3%. Two-year disease free and overall survival rates were respectively 23% and 76%. There were significantly more Dindo grade III-IV complications in LM þ HIPEC group. In multivariate analysis, grade II and III preoperative chemotherapy-induced toxicity and size of LM were identified as poor OS prognostic factors whereas response to preoperative chemotherapy significantly increases OS. OS was not different (p ¼ 0.235) between the 3 groups. Conclusion: Toxicity to preoperative chemotherapy and size of LM were identified as poor prognostic factors in patients undergoing simultaneous PC and LM surgery. These criteria could help in better selecting patients for such extensive surgery