Obesity-related T cell dysfunction impairs immunosurveillance and increases cancer risk.

Obesity is a well-established risk factor for human cancer, yet the underlying mechanisms remain elusive. Immune dysfunction is commonly associated with obesity but whether compromised immune surveillance contributes to cancer susceptibility in individuals with obesity is unclear. Here we use a mouse model of diet-induced obesity to investigate tumor-infiltrating CD8 + T cell responses in lean, obese, and previously obese hosts that lost weight through either dietary restriction or treatment with semaglutide. While both strategies reduce body mass, only dietary intervention restores T cell function and improves responses to immunotherapy. In mice exposed to a chemical carcinogen, obesity-related immune dysfunction leads to higher incidence of sarcoma development. However, impaired immunoediting in the obese environment enhances tumor immunogenicity, making the malignancies highly sensitive to immunotherapy. These findings offer insight into the complex interplay between obesity, immunity and cancer, and provide explanation for the obesity paradox observed in clinical immunotherapy settings.

Immune responses to SARS-CoV-2 in vaccinated patients receiving checkpoint blockade immunotherapy for cancer.

Vaccination against SARS-CoV-2 has been successful in protecting patients with cancer from severe infections, but how immune responses against COVID-19 vaccination interact with those elicited during cancer immunotherapy has not been fully described. Immune checkpoint blockade (ICB) disrupts inhibitory pathways in immune cells to improve function and induce tumor immunity but can often cause serious immune related adverse events (IRAEs). Because COVID-19 vaccination and ICB both boost immune responses, it is imperative to understand if combining these regimens causes synergistic enhancement of the immune system. Specifically, whether ICB impacts anti-vaccine immunity in previously vaccinated patients is important since a large percentage of newly diagnosed cancer patients eligible for immunotherapy will have already been vaccinated against COVID-19. To address this, we investigated the influence of ICB on SARS-CoV-2-spike protein (SP) antibody titers and T cell responses in cancer patients previously vaccinated against COVID-19. Human blood samples were collected from 29 vaccinated patients and 12 unvaccinated control patients at baseline (prior to ICB) and following two rounds of ICB infusion. Anti-SARS-CoV-2-SP IgG titers and T cell responses were quantified. Compared to responses at baseline, there was no significant difference in these immune responses after immunotherapy in vaccinated individuals (P=0.4583, P=0.4571, respectively). We interpret these results as evidence that ICB immunotherapy does not significantly enhance SARS-CoV-2-specific antibody titers or T cell responses. Although our study lacks corresponding IRAE rates, the results provide humoral and cellular immunological data that support recent reports documenting the clinical safety and efficacy of COVID-19 vaccination in patients receiving ICB. Additional longitudinal prospective studies, such as the VOICE study (ClinicalTrials.gov identifier NCT04715438) and CAPTURE study (ClinicalTrials.gov identifier NCT03226886), are warranted and will provide broader safety and immunological data defining the effect of systemic cancer therapies on COVID-19 immunity.

Utility of 18F-Fluciclovine PET/CT for Detecting Prostate Cancer Recurrence in Patients With Low (< 1 ng/mL) or Very Low (< 0.3 ng/mL) Prostate-Specific Antigen Levels.

OBJECTIVE. We reviewed a retrospective series of 126 18F-fluciclovine PET/CT studies of patients with biochemically recurrent prostate cancer at low (< 1 ng/mL) and very low (< 0.3 ng/mL) prostate-specific antigen (PSA) levels. CONCLUSION. The rate of PET/CT positivity was 33% (15/46) in patients with low PSA levels and 0% (0/17) in patients with very low PSA levels. Our results suggest that 18F-fluciclovine PET/CT can be helpful for localizing recurrence in patients with PSA levels between 0.3 and 1 ng/mL and that 18F-fluciclovine PET/CT is not recommended in patients with PSA levels less than 0.3 ng/mL.

Impact of a Same-Day Breast Biopsy Program on Disparities in Time to Biopsy.

BACKGROUND: Disparities in breast cancer diagnosis are established. In usual practice, biopsies are performed days or weeks after recommendation. Our aim was to measure the impact of a same-day biopsy program on disparities in time from biopsy recommendation to performance. METHODS: After Institutional Review Board approval, we identified all diagnostic examinations leading to biopsy pre- (September 2016 to March 2017) and post- (September 2017 to March 2018) implementation of our same-day biopsy program. We compared demographic characteristics (age, race, language, and insurance) and biopsy information (days from biopsy recommendation to biopsy, and proportion of same-day biopsies in all biopsies) in pre- versus postimplementation groups. Multivariable linear and logistic models in pre- and postimplementation groups assessed if days from biopsy recommendation to biopsy and having a same-day biopsy were associated with patient subgroups. RESULTS: In all, 663 and 482 patients underwent biopsy during pre- and postimplementation periods, respectively. Patient subgroups were similar between periods. For all patients, the same-day biopsy program decreased median time from diagnostic examination to biopsy from 8 (interquartile range: 4-13) to 0 (interquartile range: 0-4) days (P < .001). During the pre-implementation period, nonwhite patients and having Medicare insurance were associated with longer days to biopsy (nonwhite Adjusted Coefficient: 2.31, 95% confidence interval [CI]: 0.58-4.03; insurance Adjusted Coefficient: 2.47, 95% CI: 0.58-4.37; P < .05), after adjustment. During the postimplementation period, the previously seen disparities did not persist (nonwhite Adjusted Coefficient: -0.416, 95% CI: -2.16-1.33; insurance Adjusted Coefficient: 0.812, 95% CI: -1.18-2.80; P > .05). CONCLUSION: There was no evidence of racial/ethnic or insurance disparities in time from biopsy recommendation to performance after implementation of a same-day biopsy program.

Towards Consensus: Training in Procedural Skills for Diagnostic Radiology Residents-Current Opinions of Residents and Faculty at a Large Academic Center.

RATIONALE AND OBJECTIVES: The Diagnostic Radiology Milestones Project provides a framework for measuring resident competence in radiologic procedures, but there are limited data available to assist in developing these guidelines. We performed a survey of current radiology residents and faculty at our institution as a first step toward obtaining data for this purpose. The survey addressed attitudes toward procedural standardization and procedures that trainees should be competent by the end of residency. MATERIALS AND METHODS: Current residents and faculty members were surveyed about whether or not there should be standardization of procedural training, in which procedures residents should achieve competency, and the number of times a procedure needs to be performed to achieve competency. RESULTS: Survey data were received from 60 study participants with an overall response rate of 32%. Sixty-five percent of respondents thought that procedural training should be standardized. Standardization of procedural training would include both the list of procedures that trainees should be competent in at the end of residency and the standard minimum number of procedures to achieve competency. Procedures that both residents and faculty agreed are important in which to achieve competency included central line/port procedures; CT-guided abdominal, thoracic, and musculoskeletal procedures; minor fluoroscopic-guided procedures; general fluoroscopy; peripheral line placements; and US-guided abdominal procedures. For most of these categories, most respondents believed that these procedures needed to be performed 6-20 times to achieve competency. CONCLUSION: Both resident and faculty respondents agreed that procedural training should be standardized during residency, and competence in specific procedures should be achieved at the completion of residency. Although this study is limited to a single institution, our data may provide assistance in developing future guidelines for standardizing image-guided procedure training. Future studies could be expanded to create a national consensus regarding the implementation of the Diagnostic Radiology Milestones Project.

Expectations of Medical Student Neuroradiology Education: A Survey of Practicing Neuroradiologists and Neurologists.

The purpose of this study is to evaluate which neuroradiological diseases neuroradiologists and neurologists believe medical students should be exposed to during their neuroradiology rotation. Members of the American Society of Neuroradiology (ASNR) and the American Academy of Neurology (AAN) were surveyed. Respondents were presented 32 diseases with neuroimaging findings and asked which ones medical students should be exposed to during a neuroradiology rotation. Using a 50% response threshold per disease entity, results were tabulated into 3 groups: diagnoses that (1) more than 50% of neuroradiologists and neurologists felt medical students should see radiologically by rotation completion, (2) less than 50% of respondents in both the groups felt were important, and (3) both the groups disagree are important. Both the groups thought medical students should be exposed to imaging of intraparenchymal hemorrhage (ASNR = 80.4% vs AAN = 84.3%; P = 0.346) and subarachnoid hemorrhage (ASNR = 74% vs AAN = 78%; P = 0.394). Both the groups (>50%) thought subdural hematoma, acute ischemic stroke, epidural hematoma, and spinal cord compression are important. Conditions such as spine fractures, nonacute stroke, arteriovenous malformation, and ear-nose-throat pathology showed varied results between both the groups. Varying degrees of similarity and differences exist between the expectations of neuroradiologists and neurologists regarding medical student neuroradiology education, presenting a positive opportunity for greater consensus, dialogue, and joint curriculum formation.