L’efficacité de la chimiothérapie contre la croissance tumourale repose sur l'induction d'une mort des cellules tumourales dite immunogène. Les cellules tumourales mourantes agissent alors comme un vaccin thérapeutique en stimulant une réponse immunitaire anti-tumourale capable de contrôler, voire d'éliminer, les cellules cancéreuses résiduel. Les trois marqueurs principales de la mort cellulaire immunogène (MCI), sont (i) l'exposition pré-apoptotique de la calréticuline (CRT) à la surface des cellules, (ii) la sécrétion de l'ATP pendant l'apoptose qui dépend du processus d'autophagie, et (iii) le relargage post-apoptotique de la protéine non-histone de fixation à la chromatine HMGB1 (High Mobility Group B1). CRT, ATP et HMGB1 se lient respectivement à CD91, au récepteur purinergique P2RX7 (Purinergic Receptor P2X, ligand-gated ion channel 7) et au récepteur TLR4 (Toll-like Receptor 4) situés à la surface des cellules dendritiques. En retour, ces interactions initient respectivement la phagocytose des cellules mourantes, la production de l'interleukine-1β et la cross-présentation des antigènes tumouraux aux lymphocytes T.Notre laboratoire a précédemment démontré que la chimiothérapie adjuvante présente une efficacité réduite chez des patients atteints de cancers colorectaux et du sein portant un polymorphisme d'un seul nucléotide ou SNP (Single-Nucleotide Polymorphism) compromettent la fonction des gènes P2RX7 et TLR4, notamment rs3751143 (496Glu>Ala) pour le gène P2RX7 et rs4986790 (299Asp>Gly) pour le gène TLR4.Compte tenu des ces résultats que mettent en évidence la relation étroite entre l’efficacité de la chimiothérapie anticancéreuse et un système immunitaire opérationnel, nous avons décidé d'étudier l'effet de ces SNPs, soit sur la survie globale soit sur la survie sans événement, chez des patients atteints de cancer pulmonaire non à petites cellules ou NSCLC (Non-Small Cell Lung Carcinoma) et de cancers de la tête et du cou ou HNSCC (Head and Neck Squamous Cell Carcinoma). De plus, nous avons porté notre attention sur un autre SNP affectant le gène ATG16L1 (Autophagy-related 16-Like 1), notamment rs2241880 (300Thr>Ala) qui compromet l’activité d’un gène fondamental dans le processus d’autophagie.Dans les cancers NSCLC, les allèles mutants "perte de fonction" des gènes ATG16L1, P2RX7 et TLR4 n'affectent pas la survie globale, indépendamment du type de chimiothérapie administrée. Au contraire, les patientes atteintes de HNSCC, portant au moins un allèle "perte de fonction" d’ATG16L1 et TLR4, présentent un taux de survie sans récidive inferieure par rapport aux patients qui présentent un genotype sauvage. Ce travail décrit pour la première fois un biomarqueur prognostique pour ce type de cancer.De plus, nous avons pu définir, par génotypage à haut débit, une signature de SNPs prédictive de la réponse à la chimiothérapie neoadjuvantes à base d'anthracyclines et des taxanes chez les patients atteints de cancer du sein. En particulier, la combinaison des deux paramètres clinicopathologiques classiques (âge lors du diagnostic et récepteur aux œstrogènes) avec les génotypes rs1076669 du gène ECE1 (Endothelin Converting Enzyme 1; 341Thr>Ile) et rs2277413 du gène PZP (Pregnancy-Zone Protein; 813Val>Ala) a permis de définir trois grandes catégories des patients et leur probabilité respective d'atteindre la réponse complète pathologique après traitement.L'identification de nouveaux biomarqueurs associés à une absence/diminution de réponse à la chimiothérapie apparaît critique pour choisir des alternatives thérapeutiques appropriées et éviter les effets secondaires indésirables chez les non-répondeurs. / Successful chemotherapeutics can induce a type of tumour cell death that is immunogenic, implying that patient’s dying cancer cells function as a therapeutic vaccine and elicit an anti-tumour immune response that controls the residual disease. The three main hallmarks of immunogenic cell death (ICD) are the pre-apoptotic exposure of calreticulin (CRT) on the cell surface, the autophagy-dependent secretion of ATP during the blebbing phase of apoptosis and the post-apoptotic release of the chromatin-binding non-histone protein high mobility group B1 (HMGB1). CRT, ATP and HMGB1 interact with CD91, purinergic receptor P2X, ligand-gated ion channel, 7 (P2RX7) and Toll-like receptor 4 (TLR4), respectively, on the surface of dendritic cells (DCs), thus promoting the engulfment of dying cells, the production of IL-1β and the cross-presentation of tumour-associated antigens to T cells, respectively.Our laboratory has demonstrated that adjuvant chemotherapy exhibits a reduced efficacy in breast and colorectal cancer patients bearing single-nucleotide polymorphisms (SNPs) that compromise the function of P2RX7 or TLR4, such as rs3751143 in P2RX7 (Glu496Ala) and rs4986790 in TLR4 (Asp299Gly).Driven by these results, underpinning the intimate relationship between the success of anti-cancer chemotherapy and an operational immune system, we decided to investigate the effect of these SNPs on disease outcome among non-small cell lung carcinoma (NSCLC) and head and neck squamous cell carcinoma (HNSCC) patients. Additionally, we focused our attention on a SNP in autophagy related 16-like 1 (ATG16L1), namely rs2241880 (Thr300Ala), which compromises the activity of one pivotal autophagic gene. In NSCLC patients, loss-of-function ATG16L1, P2RX7 and TLR4 alleles do not affect overall survival, irrespective of the administration and type of chemotherapy. Conversely, HNSCC patients bearing at least one loss-of-function ATG16L1 or TLR4 allele exhibit a reduced disease-free survival when compared to their wild-type counterparts. This is the first report highlighting a putative prognostic biomarker for this malignancy. Furthermore, taking advantage of a high throughput genotyping study, we delineated a SNP-based signature that predicts the response of breast cancer patients to anthracycline- and taxane-based neoadjuvant chemotherapy. Particularly, the combination of two classical clinicophatological parameters (age at diagnosis and estrogen receptor) and genotype at the ECE1 (rs1076669 Thr341Ile) and PZP (rs2277413 Val813Ala) loci allowed us to define three broad categories with a correspondent probability of achieving pathological complete response. The identification of new biomarkers associated with a reduced/absent response to chemotherapy appears critical for selecting appropriate therapeutic alternatives, and avoiding undesired side effects among non-responders.

O colágeno V vem emergindo como um potente indutor de morte celular (apoptose) via caspase. Nosso objetivo, neste estudo, foi examinar a interface entre o colágeno dos tipos I, III e V, apoptose tumoral e endotelial, angiogênese e células imunes, assim como o impacto desses fatores no prognóstico de pacientes com carcinomas não de pequenas células (CNPC) de pulmão. As amostras foram obtidas de 65 pacientes com CNPC de pulmão cirurgicamente excisados. Foram utilizados imunofluorescência e histomorfometria para colágenos I, III e V; imunohistoquímica e histomorfometria para avaliar apoptose endotelial e epitelial pelas caspases 5, 6, 8, 9 e via TUNEL, antiapoptose pela expressão do Bcl-2 e Bcl-6, densidade microvascular utilizando CD34, atividade vascular através da endotelina, VCAM e CD54, além da laminina. As células imunes foram imunomarcadas pelo CD3, CD4, CD8, CD20, CD56 Cd1a, S100, CD68 e as seguintes citocinas foram quantificadas: IL-4, IL-6, IL-8 e TGF-. O modelo de sobrevida de Cox mostrou que, quando controlados pelo estadiamento patológico linfonodal N, somente o colágeno do tipo V e a apoptose endotelial via caspase-9 foram significativamente associados com a sobrevida. Uma medida de corte ao nível da mediana para o colágeno do tipo V e caspase-9 dividiu os pacientes em dois grupos distintos de prognóstico. Aqueles com colágeno V maior do que 9,40% e apoptose vascular maior que 1,09% apresentaram baixo risco de morte (0,27 e 0,41, respectivamente), comparados com aqueles com colágeno V inferior a 9,40% e apoptose vascular inferior a 1,09%. Foi observada também menor densidade de células imunes e citocinas no microambiente tumoral do que não tumoral. O modelo de sobrevida de Cox, associando todas as variáveis estudadas, mostrou que baixo risco de morte associou-se com tabagismo menor que 41 maços/ano, estadiamento linfonodal N0, tratamento cirúrgico, ao tipo histológico carcinoma de células escamosas, fração de linfócitos CD4 > 16,2%, macrófagos CD68 > 4,5%, citocina IL-4 > 0,8%, citocina IL-6 > 2,2%, células dendríticas Cd1a > 1,6% e colágeno V > 9,4%. Coletivamente, os dados indicaram que o CNPC de pulmão não desencadeou uma resposta imune efetiva no sítio tumoral. Além disso, baixa síntese no colágeno V e apoptose endotelial pela caspase-9 em CNPC de pulmão estão fortemente associadas à sobrevida, sugerindo que estratégias destinadas a prevenir a baixa síntese de colágeno V, baixos índices de apoptose e resposta imune inata e adaptativa têm impacto no prognóstico dos CNPC de pulmão e podem ser marcadores promissores em novas abordagens na imunoterapia, podendo, assim, ter grande impacto no tratamento do câncer de pulmão / Type V collagen emerging promise as inductor of death response (apoptosis) via caspase. Our aim was to verify the remodeling of the microenvironment by type V collagen, tumoral/vascular apoptosis, angiogenesis, immune response and their impact on prognosis of patients with non-small cell lung carcinomas (NSCLC). Collagen, apoptosis, angiogenesis and immune cells were examined in tumor tissues from 65 patients with surgically excised NSCLC. We used immunofluoresce, immunohistochemistry, morphometry, 3D reconstruction and real-time PCR to evaluate the amount, structure and mRNA chains expression of type V collagen, endothelium and epithelial apoptosis caspases 5, 6, 8, 9 and via TUNEL; anti-apoptotic expression Bcl-2 and Bcl-6; immune cells CD3, CD4, CD8, CD20, CD56 Cd1a, S100 and CD68 and IL-4, IL-6, IL-8 e TGF- cytokines; microvessel density (CD34) and vascular activity by endotelin, V-CAM and Cd54. Impact of these markers was tested on follow-up until death from recurrent lung cancer. Decreased and abnormal synthesis of collagen V leads to increased angiogenesis by low endothelial death rate, and low immune response. Cox model analysis demonstrated that controlled for N stage, just two variables were significantly associated with survival time: collagen V and endothelium apoptosis caspase 9 +. Once these two variables were accounted for, none of the others related to survival. A cutpoint at the median for collagen V and endothelium apoptosis caspase 9 divided patients into two groups with distinctive prognosis. Those with collagen V > 9.40% and endothelium apoptosis caspase 9 > 1.09% have low risk of death (0.27 and 0.41, respectively) than those with collagen V < 9.40% and endothelium apoptosis caspase 9 + < 1.09%.In addition low levels of immune cells and cytokines in the tumour environment when compared with non-tumour environment. Cox model analysis with all variables showed low risk of death for tabagism < 41 packs/year, N0 stage, SCC, CD4+ > 16.81%,macrophages/monocytes > 4.5%cytokine IL-4 > 0,8%, cytokines IL-6 > 2,2%, dendritic cells Cd1a > 1,6% and collagen V > 9,4%. Collectively, the data indicated that NSCLC did not trigger a substantive immune cell infiltrate at tumour sites. More over Collagen V and endothelium apoptosis caspase 9 + in resected NSCLC are strongly related to prognosis, suggesting that strategies aimed at preventing the low collagen V synthesis, or local responses to low endothelium apoptosis and immune cell infiltration has impact on NSCLC prognosis and may be a promising marker for new immunotherapeutic approaches and may have a greater impact in lung cancer

Cellular senescence is a permanent cell cycle arrest that is induced as a response to cellular stress. Replicative senescence is a well-described mechanism that limits the replicative capacity of cells and must be overcome by cancer cells. Oncogene-induced senescence (OIS) is a form of premature senescence and a potent tumor suppressor mechanism. OIS is induced in normal cells as a result of deregulated oncogene or tumor suppressor gene expression. An exciting area of research is the identification of novel targets that induce senescence in cancer cells as a therapeutic approach. In this study, a novel mechanism is described where the inhibition of Hsp90 in small cell lung cancer (SCLC) cells induced premature senescence rather than cell death. The senescence induced following Hsp90 inhibition was p21-dependent and the loss of p21 allowed SCLC cells to bypass the induction of senescence. Additionally, we identified a novel mechanism where the depletion of PKCι induced senescence in glioblastoma multiforme (GBM) cells. PKCι depletion-induced senescence did not activate the DNA-damage response pathway and was p21-dependent. Further perturbations of mitosis, using an aurora kinase inhibitor, increased the number of senescent cells when combined with PKCι depletion. This suggests that PKCι depletion-induced senescence involves defects in mitotic progression. Senescent glioblastoma cells at a basal level of senescence in culture, induced by p21 overexpression, and induced after PKCι depletion had aberrant centrosomes. Mitotic slippage is an early exit from mitosis without cell division that occurs when the spindle assembly checkpoint (SAC) is not satisfied. Senescent glioblastoma cells had multiple markers of mitotic slippage. Therefore, PKCι depletion-induced senescence involves mitotic slippage and results in aberrant centrosomes. A U87MG cell line with a doxycycline-inducible shRNA targeting PKCι was developed to deplete PKCι in established xenografts. PKCι was depleted in established glioblastoma xenografts in mice and resulted in decreased cell proliferation, delayed tumor growth and improved survival. This study has demonstrated that both Hsp90 and PKCι are novel targets to induce senescence in cancer cells as a potential therapeutic approach.

No description available.

Cellular senescence is a permanent cell cycle arrest that is induced as a response to cellular stress. Replicative senescence is a well-described mechanism that limits the replicative capacity of cells and must be overcome by cancer cells. Oncogene-induced senescence (OIS) is a form of premature senescence and a potent tumor suppressor mechanism. OIS is induced in normal cells as a result of deregulated oncogene or tumor suppressor gene expression. An exciting area of research is the identification of novel targets that induce senescence in cancer cells as a therapeutic approach. In this study, a novel mechanism is described where the inhibition of Hsp90 in small cell lung cancer (SCLC) cells induced premature senescence rather than cell death. The senescence induced following Hsp90 inhibition was p21-dependent and the loss of p21 allowed SCLC cells to bypass the induction of senescence. Additionally, we identified a novel mechanism where the depletion of PKCι induced senescence in glioblastoma multiforme (GBM) cells. PKCι depletion-induced senescence did not activate the DNA-damage response pathway and was p21-dependent. Further perturbations of mitosis, using an aurora kinase inhibitor, increased the number of senescent cells when combined with PKCι depletion. This suggests that PKCι depletion-induced senescence involves defects in mitotic progression. Senescent glioblastoma cells at a basal level of senescence in culture, induced by p21 overexpression, and induced after PKCι depletion had aberrant centrosomes. Mitotic slippage is an early exit from mitosis without cell division that occurs when the spindle assembly checkpoint (SAC) is not satisfied. Senescent glioblastoma cells had multiple markers of mitotic slippage. Therefore, PKCι depletion-induced senescence involves mitotic slippage and results in aberrant centrosomes. A U87MG cell line with a doxycycline-inducible shRNA targeting PKCι was developed to deplete PKCι in established xenografts. PKCι was depleted in established glioblastoma xenografts in mice and resulted in decreased cell proliferation, delayed tumor growth and improved survival. This study has demonstrated that both Hsp90 and PKCι are novel targets to induce senescence in cancer cells as a potential therapeutic approach.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O aumento exponencial dos gastos em saúde demanda estudos econômicos que subsidiem as decisões de agentes públicos ou privados quanto à incorporação de novas tecnologias aos sistemas de saúde. A tomografia de emissão de pósitrons (PET) é uma tecnologia de imagem da área de medicina nuclear, de alto custo e difusão ainda recente no país. O nível de evidência científica acumulada em relação a seu uso no câncer pulmonar de células não pequenas (CPCNP) é significativo, com a tecnologia mostrando acurácia superior às técnicas de imagem convencionais no estadiamento mediastinal e à distância. Avaliação econômica realizada em 2013 aponta para seu custo-efetividade no estadiamento do CPCNP em comparação à estratégia atual de manejo baseada no uso da tomografia computadorizada, na perspectiva do SUS. Sua incorporação ao rol de procedimentos disponibilizados pelo SUS pelo Ministério da Saúde (MS) ocorreu em abril de 2014, mas ainda se desconhecem os impactos econômico-financeiros decorrentes desta decisão. Este estudo buscou estimar o impacto orçamentário (IO) da incorporação da tecnologia PET no estadiamento do CPCNP para os anos de 2014 a 2018, a partir da perspectiva do SUS como financiador da assistência à saúde. As estimativas foram calculadas pelo método epidemiológico e usaram como base modelo de decisão do estudo de custo-efetividade previamente realizado. Foram utilizados dados nacionais de incidência; de distribuição de doença e acurácia das tecnologias procedentes da literatura e de custos, de estudo de microcustos e das bases de dados do SUS. Duas estratégias de uso da nova tecnologia foram analisadas: (a) oferta da PET-TC a todos os pacientes; e (b) oferta restrita àqueles que apresentem resultados de TC prévia negativos. Adicionalmente, foram realizadas análises de sensibilidade univariadas e por cenários extremos, para avaliar a influência nos resultados de possíveis fontes de incertezas nos parâmetros utilizados. A incorporação da PET-TC ao SUS implicaria a necessidade de recursos adicionais de R$ 158,1 (oferta restrita) a 202,7 milhões (oferta abrangente) em cinco anos, e a diferença entre as duas estratégias de oferta é de R$ 44,6 milhões no período. Em termos absolutos, o IO total seria de R$ 555 milhões (PET-TC para TC negativa) e R$ 600 milhões (PET-TC para todos) no período. O custo do procedimento PET-TC foi o parâmetro de maior influência sobre as estimativas de gastos relacionados à nova tecnologia, seguido da proporção de pacientes submetidos à mediastinoscopia. No cenário por extremos mais otimista, os IOs incrementais reduzir-se-iam para R$ 86,9 (PET-TC para TC negativa) e R$ 103,9 milhões (PET-TC para todos), enquanto no mais pessimista os mesmos aumentariam para R$ 194,0 e R$ 242,2 milhões, respectivamente. Resultados sobre IO, aliados às evidências de custo-efetividade da tecnologia, conferem maior racionalidade às decisões finais dos gestores. A incorporação da PET no estadiamento clínico do CPCNP parece ser financeiramente factível frente à magnitude do orçamento do MS, e potencial redução no número de cirurgias desnecessárias pode levar à maior eficiência na alocação dos recursos disponíveis e melhores desfechos para os pacientes com estratégias terapêuticas mais bem indicadas. / The exponential increase in health spending requires economic studies, in order to support decisions of public or private agents related to the incorporation of new technologies to health systems. Positron emission tomography (PET) is an imaging technology in the field of nuclear medicine, of high cost and still recent in the country. Scientific evidence accumulated in relation to its use in non-small cell lung cancer (NSCLC) is significant, and technology proves to be of higher accuracy than conventional imaging techniques in mediastinal and distance staging. Economic evaluation conducted in 2013 indicates its cost-effectiveness in NSCLC staging compared to current management strategy based on the use of computed tomography (CT) in the perspective of the Brazilian Health System (SUS). It was incorporated to the list of procedures available through SUS by Ministry of Health (MoH) in April, 2014; however, the economic and financial impacts of this decision are still unknown. This study aimed to estimate the budgetary impact (BI) of the incorporation of PET in NSCLC staging for 2014 to 2018 from the perspective of SUS as the financier of health care. Estimates were calculated by the epidemiological method, and used as basis decision model from previous cost-effectiveness study. National data on incidence of the disease; distribution of prevalence of the disease and technologies accuracy from literature; and costs from microcosting study and SUS database were used. Two strategies of use of the new technology were analyzed: offer (a) to all patients, and (b) restricted to those with negative result of CT. Additionally, univariate and extreme scenarios sensitivity analysis were performed to assess the influence on the results of possible sources of uncertainty in the parameters used. The incorporation of PET-CT to SUS implies the need of additional resources from R$ 158.1 (limited offer) to 202.7 million (comprehensive offer) in five years, and the difference between the two strategies is R$ 44.6 million in the period. In absolute terms, the total BI would be of R$ 555 million (PET-CT for negative CT) and R$ 600 million (PET-CT for all) in the period. The cost of the procedure PET-CT was the most influential parameter on the expenditures estimates related to new technology, followed by the proportion of patients undergoing mediastinoscopy. In the most optimistic extreme scenario, incremental BI would drop to R$ 86.9 (PET-CT for negative CT) and R$ 103.9 million (PET-CT for all), while in the most pessimistic scenario it would increase to R$ 194.0 and R$ 242.2 million, respectively. Results of BI, combined with evidence of cost-effectiveness of the technology gives greater rationality to the final decisions of policymakers. The incorporation of PET in NSCLC staging seems financially feasible when faced to the magnitude of the MoH budget, and potential reduction in the number of unnecessary surgeries can lead to more efficient allocation of resources and better outcomes for patients with better indicated therapeutic strategies.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O aumento exponencial dos gastos em saúde demanda estudos econômicos que subsidiem as decisões de agentes públicos ou privados quanto à incorporação de novas tecnologias aos sistemas de saúde. A tomografia de emissão de pósitrons (PET) é uma tecnologia de imagem da área de medicina nuclear, de alto custo e difusão ainda recente no país. O nível de evidência científica acumulada em relação a seu uso no câncer pulmonar de células não pequenas (CPCNP) é significativo, com a tecnologia mostrando acurácia superior às técnicas de imagem convencionais no estadiamento mediastinal e à distância. Avaliação econômica realizada em 2013 aponta para seu custo-efetividade no estadiamento do CPCNP em comparação à estratégia atual de manejo baseada no uso da tomografia computadorizada, na perspectiva do SUS. Sua incorporação ao rol de procedimentos disponibilizados pelo SUS pelo Ministério da Saúde (MS) ocorreu em abril de 2014, mas ainda se desconhecem os impactos econômico-financeiros decorrentes desta decisão. Este estudo buscou estimar o impacto orçamentário (IO) da incorporação da tecnologia PET no estadiamento do CPCNP para os anos de 2014 a 2018, a partir da perspectiva do SUS como financiador da assistência à saúde. As estimativas foram calculadas pelo método epidemiológico e usaram como base modelo de decisão do estudo de custo-efetividade previamente realizado. Foram utilizados dados nacionais de incidência; de distribuição de doença e acurácia das tecnologias procedentes da literatura e de custos, de estudo de microcustos e das bases de dados do SUS. Duas estratégias de uso da nova tecnologia foram analisadas: (a) oferta da PET-TC a todos os pacientes; e (b) oferta restrita àqueles que apresentem resultados de TC prévia negativos. Adicionalmente, foram realizadas análises de sensibilidade univariadas e por cenários extremos, para avaliar a influência nos resultados de possíveis fontes de incertezas nos parâmetros utilizados. A incorporação da PET-TC ao SUS implicaria a necessidade de recursos adicionais de R$ 158,1 (oferta restrita) a 202,7 milhões (oferta abrangente) em cinco anos, e a diferença entre as duas estratégias de oferta é de R$ 44,6 milhões no período. Em termos absolutos, o IO total seria de R$ 555 milhões (PET-TC para TC negativa) e R$ 600 milhões (PET-TC para todos) no período. O custo do procedimento PET-TC foi o parâmetro de maior influência sobre as estimativas de gastos relacionados à nova tecnologia, seguido da proporção de pacientes submetidos à mediastinoscopia. No cenário por extremos mais otimista, os IOs incrementais reduzir-se-iam para R$ 86,9 (PET-TC para TC negativa) e R$ 103,9 milhões (PET-TC para todos), enquanto no mais pessimista os mesmos aumentariam para R$ 194,0 e R$ 242,2 milhões, respectivamente. Resultados sobre IO, aliados às evidências de custo-efetividade da tecnologia, conferem maior racionalidade às decisões finais dos gestores. A incorporação da PET no estadiamento clínico do CPCNP parece ser financeiramente factível frente à magnitude do orçamento do MS, e potencial redução no número de cirurgias desnecessárias pode levar à maior eficiência na alocação dos recursos disponíveis e melhores desfechos para os pacientes com estratégias terapêuticas mais bem indicadas. / The exponential increase in health spending requires economic studies, in order to support decisions of public or private agents related to the incorporation of new technologies to health systems. Positron emission tomography (PET) is an imaging technology in the field of nuclear medicine, of high cost and still recent in the country. Scientific evidence accumulated in relation to its use in non-small cell lung cancer (NSCLC) is significant, and technology proves to be of higher accuracy than conventional imaging techniques in mediastinal and distance staging. Economic evaluation conducted in 2013 indicates its cost-effectiveness in NSCLC staging compared to current management strategy based on the use of computed tomography (CT) in the perspective of the Brazilian Health System (SUS). It was incorporated to the list of procedures available through SUS by Ministry of Health (MoH) in April, 2014; however, the economic and financial impacts of this decision are still unknown. This study aimed to estimate the budgetary impact (BI) of the incorporation of PET in NSCLC staging for 2014 to 2018 from the perspective of SUS as the financier of health care. Estimates were calculated by the epidemiological method, and used as basis decision model from previous cost-effectiveness study. National data on incidence of the disease; distribution of prevalence of the disease and technologies accuracy from literature; and costs from microcosting study and SUS database were used. Two strategies of use of the new technology were analyzed: offer (a) to all patients, and (b) restricted to those with negative result of CT. Additionally, univariate and extreme scenarios sensitivity analysis were performed to assess the influence on the results of possible sources of uncertainty in the parameters used. The incorporation of PET-CT to SUS implies the need of additional resources from R$ 158.1 (limited offer) to 202.7 million (comprehensive offer) in five years, and the difference between the two strategies is R$ 44.6 million in the period. In absolute terms, the total BI would be of R$ 555 million (PET-CT for negative CT) and R$ 600 million (PET-CT for all) in the period. The cost of the procedure PET-CT was the most influential parameter on the expenditures estimates related to new technology, followed by the proportion of patients undergoing mediastinoscopy. In the most optimistic extreme scenario, incremental BI would drop to R$ 86.9 (PET-CT for negative CT) and R$ 103.9 million (PET-CT for all), while in the most pessimistic scenario it would increase to R$ 194.0 and R$ 242.2 million, respectively. Results of BI, combined with evidence of cost-effectiveness of the technology gives greater rationality to the final decisions of policymakers. The incorporation of PET in NSCLC staging seems financially feasible when faced to the magnitude of the MoH budget, and potential reduction in the number of unnecessary surgeries can lead to more efficient allocation of resources and better outcomes for patients with better indicated therapeutic strategies.

INTRODUÇÃO: O carcinoma de pulmão de pequenas células (CPPC) e o carcinoma neuroendócrino (CNE) extra-pulmonar apresentam características histopatológicas e tratamentos similares, porém os desfechos encontrados nos dois grupos podem ser diferentes. Avaliamos a expressão de alguns biomarcadores e a associação destes com taxa de resposta (TR) à quimioterapia baseada em platina e sobrevida global (SG) nos dois grupos. METODOS: Realizamos estudo retrospectivo de pacientes com CPPC e CNE extra-pulmonares tratados com quimioterapia baseada em platina. Todas as amostras tumorais foram revisadas pelo mesmo patologista (R.S.S.M.) e analisadas quanto a expressão imunoistoquímica de Ki-67, ERCC1, Bcl-2 e Lin28a, a qual foi determinada através do H-escore (calculado multiplicando o produto da intensidade da coloração - 0 a 3 - com a porcentagem de células positivas - 0 a 100 -, podendo variar de 0 a 300 - positivo quando >= 200). Os biomarcadores foram analisados tanto como variáveis contínuas quanto categóricas e a TR foi determinada por RECIST 1.1. A associação entre a expressão de cada biomarcador e a TR foi avaliada através do teste de qui-quadrado ou teste exato de Fisher para variáveis categóricas e regressão logística simples para variáveis contínuas. Sobrevida global foi estimada por Kaplan-Meier e as curvas foram comparadas por log-rank. O modelo de regressão de cox foi utilizado para avaliar associação entre SG e a expressão de biomarcadores como variável contínua. RESULTADOS: Entre Julho de 2006 e Julho de 2014, 142 pacientes foram identificados: N=82 (57,7%) com CPPC e N=60 (42,3%) com CNE extra-pulmonar. As características clínicas eram semelhantes em ambos os grupos. Mediana de ki67 foi de 60% (7-100) no CPPC e de 50% (20-95%) no segundo grupo (p=0,858). Com uma mediana de 5 ciclos por paciente (N=123 elegíveis para análise de TR), a TR foi de 86,8% no CPPC, enquanto nos com CNE extra-pulmonar, foi de 44,6% (p < 0.001). A mediana de SG (N=132 elegíveis para análise da SG) foi similar entre os grupos (10,3 meses em CPPC e 11,1 meses em CNE extra-pulmonar; p=0,069). Não houve diferença no padrão de expressão do ERCC1 (p=0,277) e do Lin28a (p=0,051) entre os grupos. Bcl2 foi expresso em 38 pacientes (46,3%) com CPPC e em 17 pacientes (28,3%) com CNE extra-pulmonar (p=0,030). Apenas no grupo com CNE extra-pulmonar, a alta expressão do Bcl2 foi associada com pior prognóstico (8,0 meses vs 14,7 meses; p=0,025). A expressão dos demais marcadores em CNE extra-pulmonar e dos quatro em CPPC não apresentou influência sobre a SG, não havendo também associação entre estes e a taxa de resposta à quimioterapia. Dentre os pacientes com CNE extra-pulmonar, não houve diferença na SG ou na TR entre os pacientes com carcinoma bem diferenciado (N=13;) e com carcinoma pouco diferenciado (N=47). CONCLUSÃO: Apesar do CPPC e do CNE extra-pulmonar serem tratados de forma semelhante, nesta coorte a taxa de resposta entre os grupos foi significativamente diferente. Quando comparado com CPPC, os pacientes com CNE extra-pulmonar apresentam uma menor responsividade à quimioterapia baseada em platina, mas com tendência a maior SG. Dentre os CNE extra-pulmonares, a alta expressão de Bcl-2 foi associada a pior prognóstico. Os demais biomarcadores não apresentaram papel preditor de resposta ou prognóstico / INTRODUCTION: Small cell lung cancer (SCLC) and high-grade extrapulmonary neuroendocrine carcinomas (EPNEC) share similar histopathological features and treatment, but outcomes may differ. We evaluated the expression of biomarkers and their association with response rate (RR) to platin-based chemotherapy and overall survival (OS) in these entities. METHODS: We conducted a retrospective analysis of patients with advanced EPNEC and SCLC treated with platinum-based chemotherapy. A single pathologist (R.S.S.M.) revised all samples. Paraffin-embedded tumor samples were tested for Ki-67, ERCC1, Bcl-2 and Lin28a expression by immunohistochemistry (IHC). Final IHC score (H-score) was calculated multiplying the intensity of staining by grading (0-300, with >= 200 considered positive). Biomarkers were analyzed as both categorical and continuous variables. RR was determined by RECIST 1.1. Associations between each biomarkers expression and RR were assessed using Chi-square or Fisher\'s exact test for categorical variables and univariate logistic regression for continuous variables. OS was estimated by the Kaplan-Meier method and curves were compared by log-rank. Cox regression analysis was used to evaluate any association between biomarkers expression (continuous variables) and OS. RESULTS: From July 2006 to July 2014, 142 patients were identified: N=82 (57,7%) with SCLC and N=60 (42,3%) with EPNEC. Baseline clinical characteristics were similar. Median Ki67 was 60% (7-100) among SCLC patients and 50% (20-95%) in EPNEC (p=0,858). With a median of 5 cycles per patient in both groups (N=123 evaluable patients), the RR was significantly higher in the SCLC group (86,8% vs 44.6%; p < 0.001). Median OS (N=132 evaluable patients) was similar between the groups (10.3 months in SCLC and 11.1 months in EPNEC; p=0,069). In the EPNEC group, there wasn\'t any difference in OS or RR between the patients with welldifferentiated (N=13) and poorly differentiated carcinoma (N=47). ERCC1 (p=0.277) and Lin28a (p=0.051) were similarly expressed between the groups. Bcl2 was expressed in 38 SCLC patients (46.3%) and in 17 EPNEC patients (28.3%; p=0.030). Only in the EPNEC group, Bcl2 high expression was associated with worse survival (8.0 months vs 14.7 months; p = 0.025). RR to chemotherapy was not influenced by the expression of the ERCC1, Lin28a, Bcl-2, Ki-67 in either EPNEC or SCLC groups. CONCLUSION: Even though SCLC and EPNEC are treated similarly, in this cohort, the rate response differed significantly. When compared with SCLC, patients with EPNEC apparently had tumors less responsive to platin-based chemotherapy, but tended to live longer. In EPNEC treated with platin, high expression of Bcl2 was associated with poor prognosis. We could not identify additional predictive or prognostic biomarkers

Cellular senescence is a permanent cell cycle arrest that is induced as a response to cellular stress. Replicative senescence is a well-described mechanism that limits the replicative capacity of cells and must be overcome by cancer cells. Oncogene-induced senescence (OIS) is a form of premature senescence and a potent tumor suppressor mechanism. OIS is induced in normal cells as a result of deregulated oncogene or tumor suppressor gene expression. An exciting area of research is the identification of novel targets that induce senescence in cancer cells as a therapeutic approach. In this study, a novel mechanism is described where the inhibition of Hsp90 in small cell lung cancer (SCLC) cells induced premature senescence rather than cell death. The senescence induced following Hsp90 inhibition was p21-dependent and the loss of p21 allowed SCLC cells to bypass the induction of senescence. Additionally, we identified a novel mechanism where the depletion of PKCι induced senescence in glioblastoma multiforme (GBM) cells. PKCι depletion-induced senescence did not activate the DNA-damage response pathway and was p21-dependent. Further perturbations of mitosis, using an aurora kinase inhibitor, increased the number of senescent cells when combined with PKCι depletion. This suggests that PKCι depletion-induced senescence involves defects in mitotic progression. Senescent glioblastoma cells at a basal level of senescence in culture, induced by p21 overexpression, and induced after PKCι depletion had aberrant centrosomes. Mitotic slippage is an early exit from mitosis without cell division that occurs when the spindle assembly checkpoint (SAC) is not satisfied. Senescent glioblastoma cells had multiple markers of mitotic slippage. Therefore, PKCι depletion-induced senescence involves mitotic slippage and results in aberrant centrosomes. A U87MG cell line with a doxycycline-inducible shRNA targeting PKCι was developed to deplete PKCι in established xenografts. PKCι was depleted in established glioblastoma xenografts in mice and resulted in decreased cell proliferation, delayed tumor growth and improved survival. This study has demonstrated that both Hsp90 and PKCι are novel targets to induce senescence in cancer cells as a potential therapeutic approach.

This PhD research relates to the design, fabrication, characterization, and optimization of on-chip electrochemical microelectrode arrays (MEAs) for measurement of transient concentrations and gradients, focusing on fast transients and physiological applications. In particular, this work presents the determination of kinetic mechanisms taking place at an active interface (either physiological or non-physiological) in contact with a liquid phase using the MEA device to simultaneously estimate the concentration and gradient of the analyte of interest at the surface of the active interface. The design approach of the MEA device and the corresponding measurement methodology to acquire reliable concentration information is discussed. The ability of the MEA device to measure fast (i.e., in sub-second time scale) transient gradients is demonstrated experimentally using a controllable diffusion-reaction system which mimics the consumption of hydrogen peroxide by a 2D cell culture. The proposed MEA device and measurement methodology meet effectively most of the requirements for physiological applications and as a demonstration of this, two physiological applications are presented. In one application, the MEA device was tailored to measure the hydrogen peroxide uptake rate of human astrocytes and glioblastoma multiforme cells in 2D cell culture as a function of hydrogen peroxide concentration at the cell surface; the results allowed to quantitatively determine the uptake kinetics mechanisms which are well-described by linear and Michaelis-Menten expressions, in agreement with the literature. In the other application, further customization of the MEA device was realized to study the glucose uptake kinetics of human bronchial epithelial and small cell lung cancer cells, these latter with and without DDX5 gene knockdown; the results allowed to distinguish mechanistic differences in the glucose uptake kinetics among the three cell lines. These results were complemented with measurements of glycolytic and respiration rates to obtain a bigger picture of the glucose metabolism of the three cell lines. Finally, additional applications, both physiological and non-physiological, are proposed for the developed MEA device.