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  1. Article ; Online: Multifactoral immune modulation potentiates durable remission in multiple models of aggressive malignancy.

    Halpert, Matthew M / Burns, Briana A / Rosario, Spencer R / Withers, Henry G / Trivedi, Akshar J / Hofferek, Colby J / Gephart, Benjamin D / Wang, Haotong / Vazquez-Perez, Jonathan / Amanya, Sharon B / Hyslop, Sean T / Yang, Jianhua / Kemnade, Jan O / Sandulache, Vlad C / Konduri, Vanaja / Decker, William K

    FASEB journal : official publication of the Federation of American Societies for Experimental Biology

    2024  Volume 38, Issue 10, Page(s) e23644

    Abstract: Tumors typically lack canonical danger signals required to activate adaptive immunity and also frequently employ substantial immunomodulatory mechanisms that downregulate adaptive responses and contribute to escape from immune surveillance. Given the ... ...

    Abstract Tumors typically lack canonical danger signals required to activate adaptive immunity and also frequently employ substantial immunomodulatory mechanisms that downregulate adaptive responses and contribute to escape from immune surveillance. Given the variety of mechanisms involved in shielding tumors from immune recognition, it is not surprising that single-agent immunomodulatory approaches have been largely unsuccessful in generating durable antitumor responses. Here we report a unique combination of immunomodulatory and cytostatic agents that recondition the tumor microenvironment and eliminate complex and/or poor-prognosis tumor types including the non-immunogenic 4T-1 model of TNBC, the aggressive MOC-2 model of HNSCC, and the high-risk MYCN-amplified model of neuroblastoma. A course of therapy optimized for TNBC cured a majority of tumors in both ectopic and orthotopic settings and eliminated metastatic spread in all animals tested at the highest doses. Immune responses were transferable between therapeutic donor and naïve recipient through adoptive transfer, and a sizeable abscopal effect on distant, untreated lesions could be demonstrated experimentally. Similar results were observed in HNSCC and neuroblastoma models, with characteristic remodeling of the tumor microenvironment documented in all model systems. scRNA-seq analysis implicated upregulation of innate immune responses and antigen presentation in tumor cells and the myeloid cell compartment as critical early events. This analysis also highlighted the potential importance of the autonomic nervous system in the governance of inflammatory processes. The data indicate that the targeting of multiple pathways and mechanisms of action can result in substantial synergistic antitumor effects and suggest follow-up in the neoadjuvant setting may be warranted.
    MeSH term(s) Animals ; Mice ; Tumor Microenvironment/immunology ; Cell Line, Tumor ; Neuroblastoma/immunology ; Neuroblastoma/therapy ; Neuroblastoma/pathology ; Female ; Humans ; Immunomodulation ; Mice, Inbred C57BL
    Language English
    Publishing date 2024-05-13
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 639186-2
    ISSN 1530-6860 ; 0892-6638
    ISSN (online) 1530-6860
    ISSN 0892-6638
    DOI 10.1096/fj.202302675R
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    Zs.A 2266: Show issues Location:
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  2. Article: Deployment of cisplatin in Veterans with oropharyngeal cancer: toxicity and impact on oncologic outcomes.

    Soliman, Ola / Wilde, David C / Kemnade, Jan O / Sabichi, Anita L / Chen, George / Chen, Albert / Little, Samantha N / Huang, Andrew T / Hernandez, David J / Sandulache, Vlad C

    Laryngoscope investigative otolaryngology

    2023  Volume 8, Issue 4, Page(s) 895–902

    Abstract: Objective: Cisplatin forms the backbone of systemic chemotherapy treatment for oropharyngeal squamous cell carcinoma (OPSCC). The ideal cisplatin dosing regimen remains yet to be fully defined for achieving optimal efficacy and toxicity profiles in ... ...

    Abstract Objective: Cisplatin forms the backbone of systemic chemotherapy treatment for oropharyngeal squamous cell carcinoma (OPSCC). The ideal cisplatin dosing regimen remains yet to be fully defined for achieving optimal efficacy and toxicity profiles in patients with comorbidity.
    Methods: We retrospectively reviewed oncologic and toxicity data for patients with OPSCC treated at the Michael E. DeBakey Veterans Affairs Medical Center between 2000 and 2020 who initiated curative intent, definitive chemo-radiation with one of three single agent regimens: high dose (HD) cisplatin, low dose (LD) cisplatin or cetuximab.
    Results: Patients with HPV-associated tumors and nonsmokers demonstrated improved overall and disease-free survival along with locoregional and distant metastatic control regardless of chemotherapy regimen. Regardless of regimen selection, patients which received a cumulative cisplatin dose ≥200 mg/m
    Conclusions: Both HD and LD cisplatin regimens can be safely delivered to a Veteran OPSCC patient population which should allow for straightforward application of conclusions drawn from completed and active clinical trials testing cisplatin regimens.
    Level of evidence: 4.
    Language English
    Publishing date 2023-07-14
    Publishing country United States
    Document type Journal Article
    ISSN 2378-8038
    ISSN 2378-8038
    DOI 10.1002/lio2.1115
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  3. Article ; Online: Phase I / II trial of metformin as a chemo-radiosensitizer in a head and neck cancer patient population.

    Kemnade, Jan O / Florez, Marcus / Sabichi, Anita / Zhang, Jun / Jhaveri, Pavan / Chen, George / Chen, Albert / Miller-Chism, Courtney / Shaun, Bulsara / Hilsenbeck, Susan G / Hernandez, David J / Skinner, Heath D / Sandulache, Vlad C

    Oral oncology

    2023  Volume 145, Page(s) 106536

    Abstract: Objectives: Retrospective studies have shown that head and neck squamous cell carcinoma (HNSCC) patients taking metformin demonstrate superior survival compared to their counterparts. We sought to determine whether metformin combined with chemoradiation ...

    Abstract Objectives: Retrospective studies have shown that head and neck squamous cell carcinoma (HNSCC) patients taking metformin demonstrate superior survival compared to their counterparts. We sought to determine whether metformin combined with chemoradiation would improve HNSCC patient survival compared to historical controls.
    Materials and methods: We conducted a Phase I/II prospective, single arm clinical trial in patients with newly diagnosed HNSCC (NCT02949700). Patients received platinum-based chemoradiation in combination with orally dosed metformin at one of 2 doses- 850 mg BID or 1500 mg BID administered during radiation, with a 2-week lead-in phase. Toxicity, disease response and survival metrics were ascertained throughout the study period.
    Results: A total of 25 patients were evaluable for toxicity and survival; 9 failed to reach the predetermined 70% compliance with the study drug. No dose limiting toxicities were identified in the Phase I component and there were no grade 4 adverse events likely related to metformin throughout the study. The primary outcome for the Phase II component was met with a response rate of 96%. Three-year overall survival was ∼70% in the per protocol p16 + cohort and 0% in the per protocol p16- cohort. Survival among participants with a ≥70% metformin compliance to <70% metformin compliance demonstrated a trend towards improvement in the ≥70% compliance cohort, though this did not reach significance.
    Conclusion: Metformin is well tolerated during concurrent chemoradiation for HNSCC. Its effectiveness as a chemo-radiosensitizer remains unclear and will require further study with randomized controlled clinical trials in this patient population.
    MeSH term(s) Humans ; Squamous Cell Carcinoma of Head and Neck/drug therapy ; Retrospective Studies ; Metformin/therapeutic use ; Prospective Studies ; Head and Neck Neoplasms/drug therapy
    Chemical Substances Metformin (9100L32L2N)
    Language English
    Publishing date 2023-08-08
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1120465-5
    ISSN 1879-0593 ; 0964-1955 ; 1368-8375
    ISSN (online) 1879-0593
    ISSN 0964-1955 ; 1368-8375
    DOI 10.1016/j.oraloncology.2023.106536
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    Zs.A 4869: Show issues Location:
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    Zs.A 456: Show issues Location:
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  4. Article ; Online: Metformin generates profound alterations in systemic and tumor immunity with associated antitumor effects.

    Veeramachaneni, Ratna / Yu, Wangjie / Newton, Jared M / Kemnade, Jan O / Skinner, Heath D / Sikora, Andrew G / Sandulache, Vlad C

    Journal for immunotherapy of cancer

    2021  Volume 9, Issue 7

    Abstract: Background: Metformin is a commonly used antidiabetic medication which has demonstrated promise as an anticancer agent alone and in combination with conventional treatment regimens. There is increasing evidence that metformin can also generate ... ...

    Abstract Background: Metformin is a commonly used antidiabetic medication which has demonstrated promise as an anticancer agent alone and in combination with conventional treatment regimens. There is increasing evidence that metformin can also generate immunomodulatory effects in solid tumors and is currently being investigated as an adjunct to immune checkpoint inhibitors (ICIs). We hypothesized that metformin would generate a shift in immunity unfavorable to tumor growth and tested this hypothesis in a preclinical model of head and neck cancer.
    Methods: Using a syngeneic mouse model of human papillomavirus-associated head and neck cancer (mEER/MTEC), we tested the impact of metformin on systemic and local immunity and tumor growth velocity. We compared the effects of acute and chronic treatment regimens on immunocyte presence and activation using a combination of flow cytometry and targeted transcriptomic analysis.
    Results: Acute metformin exposure generated measurable shifts in systemic myeloid and T-cell populations in non-tumor-bearing mice and decreased myeloid derived suppressor cell (MDSC) levels in tumor draining lymph nodes of tumor-bearing mice. Although metformin decreased regulatory T-cell (T-reg) and MDSC levels and increased CD8+ levels in murine tumors when combined with ICIs, acute metformin exposure was insufficient to generate substantial antitumor activity. Conversely, long-term metformin treatment significantly reduced tumor growth velocity, increased the CD8+/T-reg ratio, increased tumor infiltrating lymphocyte levels and upregulated component genes of the previously validated T-cell inflamed expression profile.
    Conclusions: Metformin generates complex systemic and local immune effects which vary as a function of treatment duration. Combinatorial strategies with ICIs must take into account both the complexity and variability of these effects in order to generate maximal antitumor activity in future clinical trials.
    MeSH term(s) Animals ; Antineoplastic Agents/pharmacology ; Antineoplastic Agents/therapeutic use ; Cell Line, Tumor ; Disease Models, Animal ; Female ; Humans ; Hypoglycemic Agents/pharmacology ; Hypoglycemic Agents/therapeutic use ; Male ; Metformin/pharmacology ; Metformin/therapeutic use ; Mice ; Neoplasms/drug therapy ; Neoplasms/immunology
    Chemical Substances Antineoplastic Agents ; Hypoglycemic Agents ; Metformin (9100L32L2N)
    Language English
    Publishing date 2021-07-04
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 2719863-7
    ISSN 2051-1426 ; 2051-1426
    ISSN (online) 2051-1426
    ISSN 2051-1426
    DOI 10.1136/jitc-2021-002773
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  5. Article ; Online: Consistent multimodality approach to oral cavity and high-risk oropharyngeal cancer in veterans.

    Hernandez, David J / Alam, Bahar / Kemnade, Jan O / Huang, Andrew T / Chen, Albert C / Sandulache, Vlad C

    American journal of otolaryngology

    2021  Volume 42, Issue 6, Page(s) 103166

    Abstract: Purpose: High-risk oropharyngeal squamous cell carcinoma (OPSCC) associated with tobacco exposure remains difficult to treat due to high rates of locoregional recurrence similar to oral cavity squamous cell carcinoma (OCSCC). Current NCCN guidelines ... ...

    Abstract Purpose: High-risk oropharyngeal squamous cell carcinoma (OPSCC) associated with tobacco exposure remains difficult to treat due to high rates of locoregional recurrence similar to oral cavity squamous cell carcinoma (OCSCC). Current NCCN guidelines allow for surgical management of this disease, but oncologic and functional data in the modern era remain scarce. We sought to compare and contrast oncologic and functional considerations for surgical management of OPSCC and OCSCC in a cohort of Veterans.
    Materials and methods: We conducted a retrospective review of patients treated at the Michael E. DeBakey Veterans Affairs Medical Center between 2017 and 2020, treated using a homogenous, multi-modality algorithm.
    Results: OPSCC tumors presented with a higher rate of perineural invasion (p < 0.05) and extranodal extension (p = 0.02) compared to OCSCC tumors. Compliance with NCCN guidelines for adjuvant treatment were lower for OPSCC patients primarily due to a higher rate of previous irradiation; re-irradiation could be delivered in 75% of patients when recommended by NCCN guidelines. Total glossectomy was accompanied by concomitant total laryngectomy in 100% of OPSCC patients and 0% of OCSCC.
    Conclusion: Surgical resection and free flap reconstruction of high-risk OPSCC generates oncologic outcomes comparable to OCSCC with comparable complication rates but a lower overall functional status. Reconstruction focused on rapid healing allows for high-rates of re-irradiation and minimal treatment delays.
    Level of evidence: level 4.
    MeSH term(s) Aged ; Combined Modality Therapy ; Female ; Free Tissue Flaps ; Glossectomy ; Humans ; Laryngectomy ; Male ; Middle Aged ; Mouth/surgery ; Neoplasm Invasiveness ; Oropharyngeal Neoplasms/pathology ; Oropharyngeal Neoplasms/radiotherapy ; Oropharyngeal Neoplasms/surgery ; Otorhinolaryngologic Surgical Procedures/methods ; Practice Guidelines as Topic ; Radiotherapy, Adjuvant ; Retrospective Studies ; Risk ; Squamous Cell Carcinoma of Head and Neck/pathology ; Squamous Cell Carcinoma of Head and Neck/radiotherapy ; Squamous Cell Carcinoma of Head and Neck/surgery ; Treatment Outcome ; Veterans ; Veterans Health
    Language English
    Publishing date 2021-07-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 604541-8
    ISSN 1532-818X ; 0196-0709
    ISSN (online) 1532-818X
    ISSN 0196-0709
    DOI 10.1016/j.amjoto.2021.103166
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    Zs.A 1637: Show issues Location:
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  6. Article ; Online: Persistent ethnicity-associated disparity in anti-tumor effectiveness of immune checkpoint inhibitors despite equal access.

    Florez, Marcus A / Kemnade, Jan O / Chen, Nan / Du, Wendy / Sabichi, Anita L / Wang, Daniel Y / Huang, Quillan / Miller-Chism, Courtney N / Jotwani, Aparna / Chen, Albert C / Hernandez, David / Sandulache, Vlad C

    Cancer research communications

    2021  Volume 2022

    Abstract: We reviewed response to immune checkpoint inhibitors (ICI) of 207 patients with diagnoses of lung or head and neck cancer treated with chemotherapy/ICI combination therapy and ICI monotherapy between 2015 and 2020 at one of three clinical pavilions ... ...

    Abstract We reviewed response to immune checkpoint inhibitors (ICI) of 207 patients with diagnoses of lung or head and neck cancer treated with chemotherapy/ICI combination therapy and ICI monotherapy between 2015 and 2020 at one of three clinical pavilions associated with the Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine. Two of these pavilions (Harris Health System and the Michael E. DeBakey Veterans Affairs Medical Center) serve large minority populations and provide equal access to care regardless of means. 174 patients had a diagnosis of lung cancer (non-small cell or small cell) and 33 had a diagnosis of head and neck squamous cell carcinoma (HNSCC). 38% self-identified as Black, 45% as non-Hispanic White, and 18% as Hispanic. The objective response rate (ORR) was similar for lung cancer (35.057%) and HNSCC patients (30.3%) (p=0.894). The ORR for Hispanic and Black patients was lower compared to non-Hispanic White patients (H 27.0%, B 32.5%, W 38.7%; H vs. W p=0.209; B vs. W p=0.398). When considering only patients treated with ICI monotherapy, the ORR for Hispanic patients dropped further to 20.7% while the ORR of Black and non-Hispanic White patients remained about the same (B 29.3% and W 35.9%, H vs. W p=0.133; B vs. W p=0.419). Immune related adverse events were the lowest in the Hispanic population occurring in only 30% of patients compared to 40% of patients in the Black cohort and 50% of the non-Hispanic White cohorts.
    MeSH term(s) Humans ; Ethnicity ; Squamous Cell Carcinoma of Head and Neck/drug therapy ; Immune Checkpoint Inhibitors/pharmacology ; Retrospective Studies ; Head and Neck Neoplasms/drug therapy ; Lung Neoplasms/drug therapy
    Chemical Substances Immune Checkpoint Inhibitors
    Language English
    Publishing date 2021-11-10
    Publishing country United States
    Document type Review ; Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, Non-U.S. Gov't
    ISSN 2767-9764
    ISSN (online) 2767-9764
    DOI 10.1158/2767-9764.CRC-21-0143
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  7. Article ; Online: Oropharyngeal cancer outcomes correlate with p16 status, multinucleation and immune infiltration.

    Wilde, David C / Castro, Patricia D / Bera, Kaustav / Lai, Syeling / Madabhushi, Anant / Corredor, German / Koyuncu, Can / Lewis, James S / Lu, Cheng / Frederick, Mitchell J / Frederick, Allan M / Haugen, Avery E / Zevallos, Jose P / Sturgis, Erich M / Shi, Justin / Huang, Andrew T / Hernandez, David J / Skinner, Heath D / Kemnade, Jan O /
    Yu, Wendong / Sikora, Andrew G / Sandulache, Vlad C

    Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc

    2022  Volume 35, Issue 8, Page(s) 1045–1054

    Abstract: Oropharyngeal squamous cell carcinoma (OPSCC), largely fueled by the human papillomavirus (HPV), has a complex biological and immunologic phenotype. Although HPV/p16 status can be used to stratify OPSCC patients as a function of survival, it remains ... ...

    Abstract Oropharyngeal squamous cell carcinoma (OPSCC), largely fueled by the human papillomavirus (HPV), has a complex biological and immunologic phenotype. Although HPV/p16 status can be used to stratify OPSCC patients as a function of survival, it remains unclear what drives an improved treatment response in HPV-associated OPSCC and whether targetable biomarkers exist that can inform a precision oncology approach. We analyzed OPSCC patients treated between 2000 and 2016 and correlated locoregional control (LRC), disease-free survival (DFS) and overall survival (OS) with conventional clinical parameters, risk parameters generated using deep-learning algorithms trained to quantify tumor-infiltrating lymphocytes (TILs) (OP-TIL) and multinucleated tumor cells (MuNI) and targeted transcriptomics. P16 was a dominant determinant of LRC, DFS and OS, but tobacco exposure, OP-TIL and MuNI risk features correlated with clinical outcomes independent of p16 status and the combination of p16, OP-TIL and MuNI generated a better stratification of OPSCC risk compared to individual parameters. Differential gene expression (DEG) analysis demonstrated overlap between MuNI and OP-TIL and identified genes involved in DNA repair, oxidative stress response and tumor immunity as the most prominent correlates with survival. Alteration of inflammatory/immune pathways correlated strongly with all risk features and oncologic outcomes. This suggests that development of OPSCC consists of an intersection between multiple required and permissive oncogenic and immunologic events which may be mechanistically linked. The strong relationship between tumor immunity and oncologic outcomes in OPSCC regardless of HPV status may provide opportunities for further biomarker development and precision oncology approaches incorporating immune checkpoint inhibitors for maximal anti-tumor efficacy.
    MeSH term(s) Cyclin-Dependent Kinase Inhibitor p16/analysis ; Head and Neck Neoplasms ; Humans ; Oropharyngeal Neoplasms/pathology ; Papillomaviridae ; Papillomavirus Infections/pathology ; Precision Medicine ; Prognosis ; Squamous Cell Carcinoma of Head and Neck
    Chemical Substances Cyclin-Dependent Kinase Inhibitor p16
    Language English
    Publishing date 2022-02-18
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, N.I.H., Extramural
    ZDB-ID 645073-8
    ISSN 1530-0285 ; 0893-3952
    ISSN (online) 1530-0285
    ISSN 0893-3952
    DOI 10.1038/s41379-022-01024-8
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