Detection of PD-L1 in cell surface vimentin positive circulating tumor cells is associated with poor survival in cancer patients

UT MD Anderson Cancer Center, Houston, TX.

Proceedings: AACR 106th Annual Meeting 2015; April 18-22, 2015; Philadelphia, PA

Abstract 1596

Circulating tumor cells (CTCs) are the cells that detach from the primary tumor of patients and enter in to the blood stream and these can be represented as the seeds of metastasis. Increasing evidence has shown the detection of circulating tumor cells (CTCs) from blood of cancer patients parallels with tumor burden and is associated with poor prognosis. Although CTC counts change indicates a good modality to detect therapeutic response to drug treatments, there is an increasing need of a reliable marker that can be used to predict survival in cancer patients. One of the most prevalent markers detected in cancer patients is the cell surface glycoprotein called PD-L1 (also called B7-H1 and CD274). Aberrant expression of PD-L1 has been reported in several cancer types. Here in this study we tested the hypothesis that detection of PD-L1 in CTCs is associated with poor prognosis. To validate the hypothesis, we isolated cell-surface vimentin (CSV) positive CTCs from colorectal cancer patients using 84-1 method and analyzed for PD-L1 expression. Our results indicated that PD-L1 detection in CTCs was associated with poor overall survival (HR, 2.43; 95% CI, 1.11 to 5.35; p, 0.0264) in colorectal cancer patients undergoing treatment. These findings thus suggest that PD-L1 detection in CSV CTC could serve as a new prognostic tool. We further extend our observations in other types of cancers including breast, prostate and sarcoma. 

Citation Format: Arun Satelli, Zachary Brownlee, Hyangsoon Noh, Qing H. Meng, Scott Kopetz, Michael Overman, Shulin Li. Detection of PD-L1 in cell surface vimentin positive circulating tumor cells is associated with poor survival in cancer patients. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1596. doi:10.1158/1538-7445.AM2015-1596 

• ©2015 American Association for Cancer Research.

NEW TECHNOLOGY IN MEDICINE IS AWESOME!

New technology in medicine is awesome! 

https://www.youtube.com/watch?v=27eUg20QRVI

VALUE-BASED CANCER CARE

Robert C. Young, M.D.

November 18, 2015DOI: 10.1056/NEJMp1508387

     

     In June 2015, the American Society of Clinical Oncology (ASCO) published a proposed framework for assessing the value of various cancer treatments.1 The goal was to evaluate selected treatment regimens on the basis of their clinical benefit, toxicity, and cost. ASCO's ideas about cost had been incubating for a long time: the organization had created a Task Force on the Cost of Cancer Care in 2007, although, like most medical specialty organizations, it had generally remained silent on the issue of cost. But the cost of cancer care has been growing rapidly: though it accounts for a relatively small portion of overall U.S. health care expenditures, it is expected to increase from $125 billion in 2010 to $158 billion in 2020.

     The costs of cancer drugs amount to only 5 to 20% of the total costs of cancer care, depending on how many of the multiple cost components are included. But the average cost of some newer cancer drugs is now $10,000 to $30,000 per month, and combinations of checkpoint inhibitors cost as much as $100,000 per month. Virtually none of these treatments are curative, and some improve only disease-free survival, not overall survival. The costs of copayments, out-of-pocket expenses, and rising insurance premiums exceed many patients' capacity to pay. A 20% copayment for checkpoint inhibitors might cost the patient $60,000 for a full course of treatment. Many patients elect to simply forgo treatment.

More in the following link…

http://www.nejm.org/doi/full/10.1056/NEJMp1508387?query=TOC

Source: NEJM

MAYO RESEARCHERS FIND CANCER BIOPSIES DO NOT PROMOTE CANCER SPREAD

Mayo Researchers Find Cancer Biopsies Do Not Promote Cancer Spread

JACKSONVILLE, Fla. — A study of more than 2,000 patients by researchers at Mayo Clinic’s campus, has dispelled the myth that cancer biopsies cause cancer to spread. In the Jan. 9 online issue of Gut, they show that patients who received a biopsy had a better outcome and longer survival than patients who did not have a biopsy.

The image shows a pancreas tumor being biopsied with a needle as visualized by endoscopic ultrasound. The endoscope was located within the stomach (passed via the mouth). An ultrasound probe at the tip of the endoscope allows visualization of the pancreas which is located immediately next to the stomach. A long needle is guided through the endoscope and into the tumor under ultrasound guidance.

The researchers studied pancreatic cancer, but the findings likely apply to other cancers because diagnostic technique used in this study — fine needle aspiration — is commonly used across tumor types, says the study’s senior investigator and gastroenterologist Michael Wallace, M.D.

Fine needle aspiration is a minimally invasive technique that uses a thin and hollow needle to extract a few cells from a tumor mass. A long-held belief by a number of patients and even some physicians has been that a biopsy can cause some cancer cells to spread.

While there have been a few case reports that suggest this can happen — but very rarely — there is no need for patients to be concerned about biopsies, says Dr. Wallace.

“This study shows that physicians and patients should feel reassured that a biopsy is very safe,” he says. “We do millions of biopsies of cancer a year in the U.S., but one or two case studies have led to this common myth that biopsies spread cancer.”

Biopsies offer “very valuable information that allow us to tailor treatment. In some cases, we can offer chemotherapy and radiation before surgery for a better outcome, and in other cases, we can avoid surgery and other therapy altogether,” Dr. Wallace says.

Surgery for pancreatic cancer is “a very big operation,” and “most people should want to make sure they have cancer before they undergo surgery,” he says. One study has shown that 9 percent of patients who underwent surgery because of suspected pancreatic cancer actually had benign disease.

Dr. Wallace and his team have conducted two separate studies to examine the risk of biopsy.

In a 2013 study published in Endoscopy, the researchers examined outcomes in 256 pancreatic cancer patients treated at Mayo Clinic in Jacksonville, Florida. They found no difference in cancer recurrence between 208 patients who had ultrasound-guided fine needle aspiration (EUS-FNA) and the 48 patients who did not have a biopsy.

In the current study, they examined 11 years (1998–2009) of Medicare data on patients with non-metastatic pancreatic cancer who underwent surgery. The researchers examined overall survival and pancreatic cancer-specific survival in 498 patients who had EUS-FNA and 1,536 patients who did not have a biopsy.

During a mean follow-up time of 21 months, 285 patients (57 percent) in the EUS-FNA group and 1,167 patients (76 percent) in the non-EUS-FNA group died. Pancreatic cancer was identified as the cause of death for 251 patients (50 percent) in the EUS-FNA group and 980 patients (64 percent) in the non-EUS-FNA group.

Median overall survival in the EUS-FNA group was 22 months compared to 15 months in the non-EUS-FNA group.

“Biopsies are incredibly valuable. They allow us to practice individualized medicine — treatment that is tailored for each person and designed to offer the best outcome possible,” Dr. Wallace says.

Source: Mayo Clinic News Network

THE COST OF NEW DRUGS FOR BREAST CANCER PATIENTS

The newest recommendation of the American Society of Clinical Oncology (ASCO) 2014 for HER2+ metastatic breast cancer patients recommends the use of new drugs like pertuzumab and T-DM1 for first and second line, respectively.  The Perjecta costs is 6.000 USD a month and for trastuzumab is 4500 USD a month. Thus, the costs for first line (without including the costs for taxotere) will be over 10000 USD a month!. For the T-DM1 (recommended second line), the drug will cost 9800 USD a month! … it is clear that but the costs of such new medicines for uninsured patients or 99% of patients from countries in development will be impossible to afford! I strongly disagree with this!

© Luis Mendoza

RAMUCIRUMAB STEAM AHEAD: NOW LUNG CANCER TRIAL SUCCEEDS

The investigational drug ramucirumab (Lilly) is steaming ahead through clinical development. The company has just announced positive top-line results from a phase 3 trial in non-small cell lung cancer (NSCLC).

This is the third successful pivotal trial for the drug; the other 2 were in gastric cancer. In all of the 3 trials reported so far, it has shown a significant improvement in both overall and progression-free survival.

Two more pivotal trials, in hepatocellular and in colorectal cancer, are in progress, with results expected in 2014. But a large trial in breast cancer has failed.

Ramucirumab is an angiogenesis inhibitor, a targeted antibody that specifically blocks VEGF-2. It is seen as a successor to bevacizumab (Genentech/Avastin), and is predicted by analysts to have similar blockbuster sales potential.

Success in NSCLC Trial

The latest trial, known as REVEL, was a global phase 3 trial in more than 1200 patients with NSCLC (both squamous and nonsquamous) who had progressed after failure of platinum-based chemotherapy. Patients were randomized to received docetaxel alone or docetaxel with ramucirumab.

"REVEL is the first positive phase 3 study of a biologic in combination with chemotherapy to demonstrate improved overall survival compared to chemotherapy alone in second-line NSCLC," the company said.

Full results of this study are due to be presented at an upcoming meeting, and the company plans to submit these data to regulatory authorities in 2014.

Success Also in Gastric Cancer

Ramucirumab is already awaiting approval for use in gastric cancer in both the United States and Europe. That application was based on the just-published REGARD trial, conducted in patients with advanced gastric cancer who had progressed after chemotherapy ( Lancet. 2014;383:31-39). Monotherapy with ramucirumab showed an improvement in overall survival (5.2 vs 3.8 months with placebo), and was hailed by experts as a " new standard of care" when the results were presented at a meeting.

A second trial in gastric cancer, known as RAINBOW, involved a similar patient population and showed that the combination of ramucirumab with paclitaxel was superior to paclitaxel used alone as second-line therapy.

The company says that it plans to also submit these data for approval.

Failed in Breast Cancer

However, a phase 3 trial in breast cancer was not successful. Known as ROSE, this trial compared ramucirumab and docetaxel with placebo and docetaxel as a first-line treatment in 1144 patients with unresectable, locally recurrent, or metastatic HER2-negative breast cancer. It found no improvement in progression-free survival.

Source: medspace