Pembrolizumab Achieves a Complete Response in an NF-1 Mutated, PD-L1 Positive Malignant Peripheral Nerve Sheath Tumor: A Case Report and Review of the Benchmarks.

Malignant peripheral nerve sheath tumors (MPNSTs) represent a rare subtype of neural crest cell-derived soft tissue sarcomas (STS). Standard of care therapy comprises surgical resection followed by adjuvant radiation, and most clinical studies have demonstrated finite survival benefit of radiation and chemotherapy. In metastatic disease, palliative chemotherapy provides very limited efficacy. We report a 60-year-old male patient with a primary para vertebral tumor at T7-T8 with lung metastases who recurred after surgical resection and later progressed on epirubicin plus ifosfamide. He was an international patient and referred to the phase 1 clinic. Molecular profiling and immunohistochemistry of the tumor revealed a PD-L1 expression of 70% (2+) and pathogenic genetic alterations by next-generation sequencing in ARID1A, CDKN2A, KMT2A, NF1, and TP53. Immune checkpoint therapy (ICT) with pembrolizumab was commenced, and interval computed tomography revealed a complete remission by cycle 6. Randomized clinical trials illustrate that ICTs such as anti-PD-1 and anti-CTLA4 monoclonal antibodies in STS cohorts display low or modest response rates by variable PD-L1 expression. This and 3 other case reports of disparate PD-L1 expression demonstrate complete responses in PD-L1 positive MPNSTs treated with ICT. These case reports necessitate further study of ICT in neural crest cell subtype of STS.

Future of Personalized Therapy Targeting Aberrant Signaling Pathways in Multiple Myeloma.

Multiple myeloma (MM) is a genetically complex disease. Identification of mutations and aberrant signaling pathways that contribute to the progression of MM and drug resistance has potential to lead to specific targets and personalized treatment. Aberrant signal pathways include RAS pathway activation due to RAS or BRAF mutations (targeted by vemurafenib alone or combined with cobimetinib), BCL-2 overexpression in t(11:14) (targeted by venetoclax), JAK2 pathway activation (targeted by ruxolitinib), NF-κB pathway activation (treated with DANFIN combined with bortezomib), MDM2 overexpression, and PI3K/mTOR pathway activation (targeted by BEZ235). Cyclin D1 (CCND1) and MYC are also emerging as key potential targets. In addition, histone deacetylase inhibitors are already in use for the treatment of MM in combination therapy, and targeted inhibition of FGFR3 (AZD4547) is effective in myeloma cells with t(4;14) translocation. Bromodomain and extra terminal (BET) protein antagonists decrease the expression of MYC and have displayed promising antimyeloma activity. A better understanding of the alterations in signaling pathways that promote MM progression will further inform the development of precision therapy for patients.

Significant Risk of Graft-versus-Host Disease with Exposure to Checkpoint Inhibitors before and after Allogeneic Transplantation.

Investigators are using checkpoint inhibitors (CPIs) to treat aggressive hematologic malignancies in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) and in some patients with relapsed disease after allo-HSCT. CTLA-4 inhibitors and PD-1 inhibitors are 2 main types of CPIs, which work through activation of the immune system. On one hand, CPIs can achieve graft-versus-tumor effect, and on the other hand, there is a risk of graft-versus-host disease (GVHD). After a comprehensive literature review, we included data (n = 283) from 24 studies (11 original manuscripts and 13 case reports or case series) and evaluated the results to assess the safety and efficacy of CPI use in conjunction with allo-HSCT. Among the 283 patients, 107 received CPI before allo-HSCT, and 176 received CPI after allo-HSCT. The most common indication for CPI use was for Hodgkin lymphoma. The CPIs used in various studies included ipilimumab, nivolumab, and pembrolizumab. Among the patients exposed to CPI before allo-HSCT, 56% developed acute GVHD and 29% developed chronic GVHD. Investigators reported 20 deaths, 60% of which were GVHD-related. The overall mortality risk with GVHD is 11%. In this group, investigators noted an objective response rate (ORR) in 68% of patients, with complete remission (CR) in 47%, partial remission (PR) in 21%, and stable disease in 11%. Among the patients who received a CPI after allo-HSCT for disease relapse, 14% developed acute GVHD and 9% developed chronic GVHD. Investigators reported 40 deaths, 28% of which were GVHD-related. The mortality risk with GVHD is approximately 7%. Investigators reported ORR in 54% of patients, with CR in 33%, PR in 21%, and disease stabilization in 5%. After careful evaluation of collective data, we found that CPI use both before and after allo-HSCT can be highly effective, but exposure can lead to a significantly increased risk of GVHD-related morbidity and mortality in this patient population. Despite limited availability of data, there is need for extreme caution while making decisions regarding the use of CPIs. Detailed discussions and prospective well-designed clinical trials are needed to explore this issue further.

Blocking "don't eat me" signal of CD47-SIRPα in hematological malignancies, an in-depth review.

Hematological malignancies express high levels of CD47 as a mechanism of immune evasion. CD47-SIRPα triggers a cascade of events that inhibit phagocytosis. Preclinical research supports several models of antibody-mediated blockade of CD47-SIRPα resulting in cell death signaling, phagocytosis of cells bearing stress signals, and priming of tumor-specific T cell responses. Four different antibody molecules designed to target the CD47-SIRPα interaction in malignancy are currently being studied in clinical trials: Hu5F9-G4, CC-90002, TTI-621, and ALX-148. Hu5F9-G4, a humanized anti-CD47 blocking antibody is currently being studied in four different Phase I trials. These studies may lay the groundwork for therapeutic bispecific antibodies. Bispecific antibody (CD20-CD47SL) fusion of anti-CD20 (Rituximab) and anti-CD47 also demonstrated a synergistic effect against lymphoma in preclinical models. This review summarizes the large body of preclinical evidence and emerging clinical data supporting the use of antibodies designed to target the CD47-SIRPα interaction in leukemia, lymphoma and multiple myeloma.

miR-9a mediates the role of Lethal giant larvae as an epithelial growth inhibitor in Drosophila.

Drosophila lethal giant larvae (lgl) encodes a conserved tumor suppressor with established roles in cell polarity, asymmetric division, and proliferation control. Lgl's human orthologs, HUGL1 and HUGL2, are altered in human cancers, however, its mechanistic role as a tumor suppressor remains poorly understood. Based on a previously established connection between Lgl and Fragile X protein (FMRP), a miRNA-associated translational regulator, we hypothesized that Lgl may exert its role as a tumor suppressor by interacting with the miRNA pathway. Consistent with this model, we found that lgl is a dominant modifier of Argonaute1 overexpression in the eye neuroepithelium. Using microarray profiling we identified a core set of ten miRNAs that are altered throughout tumorigenesis in Drosophila lgl mutants. Among these are several miRNAs previously linked to human cancers including miR-9a, which we found to be downregulated in lgl neuroepithelial tissues. To determine whether miR-9a can act as an effector of Lgl in vivo, we overexpressed it in the context of lgl knock-down by RNAi and found it able to reduce the overgrowth phenotype caused by Lgl loss in epithelia. Furthermore, cross-comparisons between miRNA and mRNA profiling in lgl mutant tissues and human breast cancer cells identified thrombospondin (tsp) as a common factor altered in both fly and human breast cancer tumorigenesis models. Our work provides the first evidence of a functional connection between Lgl and the miRNA pathway, demonstrates that miR-9a mediates Lgl's role in restricting epithelial proliferation, and provides novel insights into pathways controlled by Lgl during tumor progression.

Llgl1 prevents metaplastic survival driven by epidermal growth factor dependent migration.

We have previously demonstrated that Llgl1 loss results in a gain of mesenchymal phenotypes and a loss of apicobasal and planar polarity. We now demonstrate that these changes represent a fundamental shift in cellular phenotype. Llgl1 regulates the expression of multiple cell identity markers, including CD44, CD49f, and CD24, and the nuclear translocation of TAZ and Slug. Cells lacking Llgl1 form mammospheres, where survival and transplantability is dependent upon the Epidermal Growth Factor Receptor (EGFR). Additionally, Llgl1 loss allows cells to grow in soft-agar and maintain prolonged survival as orthotopic transplants in NOD-SCIDmice. Lineage tracing and wound healing experiments demonstrate that mammosphere survival is due to enhanced EGF-dependent migration. The loss of Llgl1 drives EGFR mislocalization and an EGFR mislocalization point mutation (P667A) drives these same phenotypes, including activation of AKT and TAZ nuclear translocation. Together, these data indicate that the loss of Llgl1 results in EGFR mislocalization, promoting pre-neoplastic changes.

Hugl1 and Hugl2 in mammary epithelial cells: polarity, proliferation, and differentiation.

Loss of epithelial polarity is described as a hallmark of epithelial cancer. To determine the role of Hugl1 and Hugl2 expression in the breast, we investigated their localization in human mammary duct tissue and the effects of expression modulation in normal and cancer cell lines on polarity, proliferation and differentiation. Expression of Hugl1 and Hugl2 was silenced in both MCF10A cells and Human Mammary Epithelial Cells and cell lines were grown in 2-D on plastic and in 3-D in Matrigel to form acini. Cells in monolayer were compared for proliferative and phenotypic changes while acini were examined for differences in size, ability to form a hollow lumen, nuclear size and shape, and localization of key domain-specific proteins as a measure of polarity. We detected overlapping but distinct localization of Hugl1 and Hugl2 in the human mammary gland, with Hugl1 expressed in both luminal and myoepithelium and Hugl2 largely restricted to myoepithelium. On a plastic surface, loss of Hugl1 or Hugl2 in normal epithelium induced a mesenchymal phenotype, and these cells formed large cellular masses when grown in Matrigel. In addition, loss of Hugl1 or Hugl2 expression in MCF10A cells resulted in increased proliferation on Matrigel, while gain of Hugl1 expression in tumor cells suppressed proliferation. Loss of polarity was also observed with knockdown of either Hugl1 or Hugl2, with cells growing in Matrigel appearing as a multilayered epithelium, with randomly oriented Golgi and multiple enlarged nuclei. Furthermore, Hugl1 knock down resulted in a loss of membrane identity and the development of cellular asymmetries in Human Mammary Epithelial Cells. Overall, these data demonstrate an essential role for both Hugl1 and Hugl2 in the maintenance of breast epithelial polarity and differentiated cell morphology, as well as growth control.

Genetic population structure of an anchialine shrimp, Metabetaeus lohena (Crustacea: Alpheidae), in the Hawaiian Islands.

Anchialine habitats in the Hawaiian Islands, characterized as coastal bodies of land-locked salt or brackish water that fluctuate with the tides due to subterranean connections, are the only ecosystems of this type found within the United States. These habitats are currently subject to anthropogenic impacts that threaten their future existence. Previous research has shown strong genetic population structure of an endemic atyid shrimp, Halocaridina rubra, in these habitats. The native alpheid shrimp, Metabetaeus lohena, whose known range entirely overlaps that of H. rubra, has feeding and reproductive behaviors that are biologically distinct from H. rubra. Its historic scarcity and status as a candidate for the US Fish and Wildlife Department's Endangered Species List, make M. lohena an ideal species to compare against the known genetic structure of H. rubra. We investigated the population structure of this native anchialine shrimp to test the hypothesis that genetic population structure differs between the two shrimp species and that M. lohena is genetically unstructured across its range. A survey of 605 bp of the mitochondrial cytochrome c oxidase subunit I (COI) gene from 127 individuals collected at 7 sites spanning the islands of O'ahu, Maui and Hawaii revealed 43 haplotypes. The most common haplotype was represented in similar proportions from all sites sampled, accounting for 44% of the surveyed sequences. Analyses of molecular variation (AMOVA), pairwise PhiST values, Bayesian estimates of migration (M), Mantel tests and Nested Clade Analyses (NCAs) all failed to reveal evidence of major barriers to gene flow among most populations separated by inter-island channels. This lack of genetic structure in M. lohena is found to be in stark contrast with the highly structured population of H. rubra, and may be attributed to oceanic dispersal strategies and/or a recent introduction to the Hawaiian Islands.

Genetic population structure of an anchialine shrimp, Metabetaeus lohena (Crustacea: Alpheidae), in the Hawaiian Islands

Anchialine habitats in the Hawaiian Islands, characterized as coastal bodies of land-locked salt or brackish water that fluctuate with the tides due to subterranean connections, are the only ecosystems of this type found within the United States. These habitats are currently subject to anthropogenic impacts tha t threaten their future existence. Previous research has shown strong genetic population structure of an endemic atyid shrimp, Halocaridina rubra, in these habitats. The native alpheid shrimp, Metabetaeus lohena, whose known range entirely overlaps that of H. rubra, has feeding and reproductive behaviors that are biologically distinct from H. rubra. Its historic scarcity and status as a candidate for the US Fish and Wildlife Department’s Endangered Species List, make M. lohena an ideal species to compare against the known genetic structure of H. rubra. We investigated the population structure of this native anchialine shrimp to test the hypothesis that genetic population structure differs between the two shrimp species and that M. lohena is genetically unstructured across its range. A survey of 605 bp of the mitochondrial cytochrome c oxidase subunit I (COI) gene from 127 individuals collected at 7 sites spanning the islands of O’ahu, Maui and Hawaii revealed 43 haplotypes. The most common haplotype was represented in similar proportions from all sites sampled, accounting for 44% of the surveyed sequences. Analyses of molecular variation (AMOVA), pairwise ΦST values, Bayesian estimates of migration (M), Mantel tests and Nested Clade Analyses (NCAs) all failed to reveal evidence of major barriers to gene flow among most populations separated by inter-island channels. This lack of genetic structure in M. lohena is found to be in stark contrast with the highly structured population of H. rubra, and may be attributed to oceanic dispersal strategies and/or a recent introduction to the Hawaiian Islands. Rev. Biol. Trop. 58 (1): 159-170. Epub 2010 March 01.

Los hábitats de los alfeidos de las islas de Hawaii, se caracterizan por ser zonas cerradas de aguas saladas o salobres, que fluctúan con las mareas, debido a las conexiones subterráneas, son los únicos ecosistemas de este tipo que se encuentran en Estados Unidos. Estos hábitats actualmente están sujetos a impactos antropogénicos que amenazan su existencia futura. La investigación anterior ha demostrado una fuerte estructura genética de una población de camarones atíidos endémicos, Halocaridina rubra, en estos hábitats. El camarón alfeido nativo, Metabetaeus lohena, cuya área de distribución conocida se superpone totalmente con la de H. rubra, tiene comportamientos alimenticios y reproductivos que son biológicamente diferentes a los de H. rubra. Su escasez histórica y su condición de candidato para aparecer en la Lista de Especies en Peligro del Departamento de Pesca y Vida Silvestre de Estados Unidos, hace de M. lohena una especie ideal para comparar su estructura genética con la de H. rubra. Se investigó la estructura de la población de este camarón alfeido nativo para probar la hipótesis que la estructura genética de la población difiere entre las dos especies y que la de M. lohena está genéticamente no estructurada en todo su ámbito. El análisis de 605 pb de la oxidasa mitocondrial citocromo c subunidad I (COI) de genes de 127 individuos recolectados en 7 sitios que abarcan las islas de Oahu, Maui y Hawaii reveló 43 haplotipos. El haplotipo más común fue representado en proporciones similares en todos los sitios incluidos en la muestra, de acuerdo al 44% de las secuencias estudiadas. El análisis de variación molecular (AMOVA), los valores de ΦST pareados, la estimación bayesiana de la migración (M), las pruebas de Mantel y los Análisis Cladísticos no pudieron revelar la existencia de importantes barreras al flujo genético entre las poblaciones más separadas por los canales entre las islas. La falta de estructura genética en M. lohena contrasta con la muy estructurada población de H. rubra, y puede ser atribuida a las estrategias de dispersión oceánica y/o una introducción reciente en las islas hawaianas.