BACKGROUND: Soft tissue sarcomas (STSs) are a diverse group of cancers that originate from mesenchymal tissue and are estimated to result in 13,130 new cases and 5,350 deaths this year. These neoplasms are hard to detect, which results in physicians struggling to treat late-stage STSs with a limited number of ineffective treatments. Currently, surgical excision is the primary treatment with radiation therapy administered when possible. However, even with optimal margins, the rate of recurrence is high, and the overall survival is low. There is a desperate need for new, more effective treatments. Immune checkpoint blockade (ICB) has recently had widespread success in treating melanoma, and in recent trials, SARC028 and Alliance A091401, have shown demonstrated activity of ICBs in STS in the neoadjuvant setting. Two histological subtypes of STS showed more promise than others: dedifferentiated liposarcoma (DDLPS) and undifferentiated pleomorphic sarcoma (UPS). Another issue plaguing the field of STS is that there is no universal indicator of response. The percentage of hyalinization found within the tumor was recently identified as a better marker of response than radiographic imaging or percent viable tumor. METHODS: This study was an investigator-initiated, single-center, randomized, open-label, phase II study (NCT03307616), in which 23 patients with either DDLPS of the retroperitoneum (RP) or UPS of the extremity/trunk (ET) were separated by disease into Cohort 1 and 2, respectively. Subjects in each cohort were randomized into two neoadjuvant treatment arms per cohort. Arm A (n=7) of Cohort 1 received nivolumab (anti-PD-1) monotherapy, while Arm B (n=7) of Cohort 1 received nivolumab and ipilimumab (anti-CTLA-4) combination therapy. Arm C (n=5) of Cohort 2 received nivolumab monotherapy and radiation therapy, whereas Arm D (n=4) of Cohort 2 received nivolumab/ipilimumab combination therapy and radiation therapy. A tumor biopsy was obtained before treatment, and another sample was taken during the primary treatment of surgical excision. These samples were processed and analyzed by a pathologist who determined the percentage of viable tumor, hyalinization, and necrosis in each sample. Radiographic imaging was also taken throughout to make RECIST 1.1 response determinations. RESULTS: The average treatment response (1 - % viable tumor) for Cohort 1 was 25 ± 23 and there was no difference between Arm A and Arm B, p=0.48. The average treatment response in Cohort 2 was higher at 85 ± 27, but there was also no significant difference between the arms, p = 0.46. The mean percent hyalinization for Cohort 1 was 13 ± 13%, and for Cohort 2 was 69 ± 35%. Again, there was no significant difference between the arms in the Cohort 1 or 2, p = 0.45 and p = 0.54, respectively. Lastly, the mean % necrosis in Cohort 1 was 13 ± 13 %, and in Cohort 2 was 17 ± 24%, and neither had significantly different results in the arms, p = 0.60 and p = 0.92. The RECIST 1.1 results were independent of the arms of the study, and the radiographic response (percent image change) did not correlate to any metric of histologic response. Those who received Ipilimumab had higher rates of adverse events. CONCLUSION: There is significant evidence that ICBs elicited a response in RP DDLPS and ET UPS, and the response of ET UPS was profound. However, there was no apparent benefit from the combination therapy compared to the monotherapy in either cohort. The higher response in ET UPS may be due to the additional radiation therapy or to the nature of UPS itself. Finally, radiographic imaging does not show the response which is apparent at the histological level, so treatment regimens and future experiments should no longer rely on radiographic imaging as a marker for response. / 2021-06-07T00:00:00Z

La protéine Klotho (KL) possède des propriétés anti-vieillissement et anti-cancer. Les données cliniques montrent que l’expression de KL est associée à une meilleure survie des patients atteints de liposarcome. De plus, elle est réduite par rapport au tissu sain dans les liposarcomes dédifférenciés (DDLPS), un type de tumeur maligne rare mais de mauvais pronostic. Nos résultats montrent que KL sensibilise les DDLPS aux chimiothérapies (gemcitabine, navitoclax). L’abondance de KL dans les tumeurs pourrait donc servir de biomarqueur pour prédire l’efficacité des chimiothérapies et mettre en place une médecine plus personnalisée. De plus, des médicaments utilisés pour d’autres pathologies et connus pour stimuler l’expression de KL (Cozaar) pourraient être testés en association avec la chimiothérapie. Enfin, inspirés par le mode d’action de KL, nous avons testé la combinaison de la gemcitabine avec le navitoclax, qui s’est révélée très efficace sur les DDLPS. / Klotho (KL) is both an anti-ageing and anti-cancer protein. Analysis of clinical data highlights that high expression of KL is associated with a better overall survival of liposarcoma patients. Moreover, its expression in downregulated in dedifferentiated liposarcomas (DDLPS), a rare type of tumor associated with a poor prognosis due to high chemoresistance. Our results show that KL sensitizes DDLPS cells to chemotherapeutic agents (gemcitabine, navitoclax). So, abundance of KL in tumoral tissues could serve as a biomarker for predicting gemcitabine efficacy and so, could help for establishing personalized therapy. Moreover, drugs increasing KL expression could be tested in combination with chemotherapy. Based on KL mechanism of action, we also highlight that the combination between gemcitabine and navitoclax is very effective for killing DDLPS cells.

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Os sarcomas cutâneos primários são tumores raros e de grande heterogeniedade histológica. Com a evolução da oncologia cutânea e da cirurgia dermatológica, os dermatologistas têm sido cada vez mais requisitados para diagnóstico e orientação terapêutica de tumores menos freqüentes. Entretanto são escassos os estudos sobre o tema, sobretudo na literatura nacional. O presente trabalho apresenta como objetivos estudar casos diagnosticados como sarcoma cutâneo primário pelo Laboratório de Dermatopatologia da Divisão de Dermatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo no período de 1992 a 2002. Os casos levantados foram revisados histologicamente, selecionando 65 casos que foram classificados em subtipos histológicos. Foi realizado revisão de prontuários médicos e estudadas as características demográficas, clínicas, evolutivas, histológicas e imuno-histoquímicas. O sarcoma de Káposi foi excluído deste estudo por possuir características epidemiológicas e etiopatogênicas específicas. Dos 65 casos, 34 foram de dermatofibrossarcoma protuberans (DFSP), 10 angiossarcomas, cinco sarcomas epitelióides, quatro fibroxantomas atípicos, três leiomiossarcomas, três mixofibrossarcomas, dois sarcomas pleomórficos, um fibrohistiocitoma maligno, um lipossarcoma, um rabdomiossarcoma, um fibrossarcoma. A análise dos resultados permitiu avaliar o perfil epidemiológico, clínico, anatomopatológico e imuno-histoquímico dos casos, bem como os tratamentos empregados e evolução dos pacientes. Os achados epidemiológicos deste estudo não diferiram significativamente da bibliografia consultada, demonstrando tratar-se de tumores raros representando cerca de um caso para cada 1000 biópsias neste serviço no mesmo período. Quanto a distribuição por idade e sexo os dados foram superponíveis à literatura com exceção feita ao angiossarcoma que mostrou-se mais freqüente no sexo feminino. A cirurgia micrográfica mostrou ser o melhor método para abordagem terapêutica do DFSP. Os casos de angiossarcoma e sarcoma epitelióide apresentaram pior prognóstico. / Soft tissue tumours represent a heterogeneous group of mesenchymal and neural lesions. The cutaneous presentation of these tumours is rare. With the evolution of dermatologic surgery and cutaneous oncology, dermatologists have emerged as the primary physicians for skin cancers management. The lack of epidemiological data about this topic in the brazilian population guided us to present this study. Our goal was to systematically review cases of primary cutaneous sarcomas diagnosed at the Dermatophatology laboratory of the Dermatology division of Hospital das Clínicas of São Paulo from January 1992 to December 2002. After a thorough chart review we could retrieve demographic and clinical data, histopathological and immunohistochemical characteristics, in addition to the type of treatment, response to treatment and follow up from each case studied. Kapos\'s sarcoma due to its peculiar characteristics was not included in this study. A total of 65 cases of primary cutaneous sarcoma were included. In respect to its pathological characterization 34 cases were diagnosed dermatofibrosarcoma protuberans (DFSP), 10 angiosarcoma, five epithelioid sarcoma, four atipical fibroxanthoma, tree leiomyosarcoma, tree myxofibrosarcoma, two pleomorfic sarcoma, one malignant fibrohistiocytoma, one liposarcoma, one rabdomyossarcoma, one fibrossarcoma. Our findings were in agreement with international published data available after a medline search. In summary, sarcomas with primary cutaneous presentation are rare tumors with an incidence of 0.1% from all the pathology slides received in our service during this period. Angiosarcoma and epithelioid sarcomas had the worse prognosis and micrographic surgery was the best treatment for the DFSP.

Os sarcomas cutâneos primários são tumores raros e de grande heterogeniedade histológica. Com a evolução da oncologia cutânea e da cirurgia dermatológica, os dermatologistas têm sido cada vez mais requisitados para diagnóstico e orientação terapêutica de tumores menos freqüentes. Entretanto são escassos os estudos sobre o tema, sobretudo na literatura nacional. O presente trabalho apresenta como objetivos estudar casos diagnosticados como sarcoma cutâneo primário pelo Laboratório de Dermatopatologia da Divisão de Dermatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo no período de 1992 a 2002. Os casos levantados foram revisados histologicamente, selecionando 65 casos que foram classificados em subtipos histológicos. Foi realizado revisão de prontuários médicos e estudadas as características demográficas, clínicas, evolutivas, histológicas e imuno-histoquímicas. O sarcoma de Káposi foi excluído deste estudo por possuir características epidemiológicas e etiopatogênicas específicas. Dos 65 casos, 34 foram de dermatofibrossarcoma protuberans (DFSP), 10 angiossarcomas, cinco sarcomas epitelióides, quatro fibroxantomas atípicos, três leiomiossarcomas, três mixofibrossarcomas, dois sarcomas pleomórficos, um fibrohistiocitoma maligno, um lipossarcoma, um rabdomiossarcoma, um fibrossarcoma. A análise dos resultados permitiu avaliar o perfil epidemiológico, clínico, anatomopatológico e imuno-histoquímico dos casos, bem como os tratamentos empregados e evolução dos pacientes. Os achados epidemiológicos deste estudo não diferiram significativamente da bibliografia consultada, demonstrando tratar-se de tumores raros representando cerca de um caso para cada 1000 biópsias neste serviço no mesmo período. Quanto a distribuição por idade e sexo os dados foram superponíveis à literatura com exceção feita ao angiossarcoma que mostrou-se mais freqüente no sexo feminino. A cirurgia micrográfica mostrou ser o melhor método para abordagem terapêutica do DFSP. Os casos de angiossarcoma e sarcoma epitelióide apresentaram pior prognóstico. / Soft tissue tumours represent a heterogeneous group of mesenchymal and neural lesions. The cutaneous presentation of these tumours is rare. With the evolution of dermatologic surgery and cutaneous oncology, dermatologists have emerged as the primary physicians for skin cancers management. The lack of epidemiological data about this topic in the brazilian population guided us to present this study. Our goal was to systematically review cases of primary cutaneous sarcomas diagnosed at the Dermatophatology laboratory of the Dermatology division of Hospital das Clínicas of São Paulo from January 1992 to December 2002. After a thorough chart review we could retrieve demographic and clinical data, histopathological and immunohistochemical characteristics, in addition to the type of treatment, response to treatment and follow up from each case studied. Kapos\'s sarcoma due to its peculiar characteristics was not included in this study. A total of 65 cases of primary cutaneous sarcoma were included. In respect to its pathological characterization 34 cases were diagnosed dermatofibrosarcoma protuberans (DFSP), 10 angiosarcoma, five epithelioid sarcoma, four atipical fibroxanthoma, tree leiomyosarcoma, tree myxofibrosarcoma, two pleomorfic sarcoma, one malignant fibrohistiocytoma, one liposarcoma, one rabdomyossarcoma, one fibrossarcoma. Our findings were in agreement with international published data available after a medline search. In summary, sarcomas with primary cutaneous presentation are rare tumors with an incidence of 0.1% from all the pathology slides received in our service during this period. Angiosarcoma and epithelioid sarcomas had the worse prognosis and micrographic surgery was the best treatment for the DFSP.

<p>Liposarcoma (LPS) arises from adipocytes and is a rare malignancy among all cancer types, but represents the most common form of soft tissue sarcoma, with approximately 2,000 new cases reported annually. Clinically, liposarcomas are classified into four subtypes based on histological analysis: well-differentiated liposarcoma (WDLPS), dedifferentiated liposarcoma (DDLPS), myxoid/round cell liposarcoma, and pleomorphic liposarcoma. Although histological analysis provides useful information for identifying various liposarcoma subtypes, treatment options rely on a fundamental understanding of driver mutations and molecular mechanisms underlying tumorigenesis. This thesis focuses on elucidating important driver mutations and therapeutic targets to eradicate DDLPS. Notch signaling is an evolutionarily conserved signaling pathway essential for organ development and stem cell function. Aberrant Notch signaling underlies the tumorigenesis of many cancers including LPS. However, the specific role of Notch signaling in development of LPS remains elusive. In Chapter 2, I provide evidence demonstrating that Notch signaling plays a key role in cancer stem cells (CSCs), also referred to as tumor-initiating cells (TICs), that drive aggressive DDLPS. I used serial transplantation to enrich and generate a murine DDLPS cell line with constitutively activated Notch signaling (NICDOE). My analyses revealed that NICDOE DDLPS cells are heterogeneous and contain TICs that express cancer stem cell markers. Chapter 3 elucidates how Notch signaling regulates CSCs of LPS. I analyzed human LPS samples to establish a strong correlation between Notch signaling activation and tumor marker expression and prognosis. I further performed gene expression and metabolic analyses of NICDOE DDLPS cells. These assays revealed that NICDOE reduced mitochondrial respiration in DDLPS cells, which was associated with diminished expression of peroxisome proliferator-activated receptor gamma coactivator 1α (PGC-1α), a master regulator of mitochondrial biogenesis. CRISPR/CAS9-mediated deletion of the NICDOE cassette rescued the expression of PGC-1α and mitochondrial respiration in DDLPS cells. Similarly, overexpression of PGC-1α was sufficient to rescue mitochondrial biogenesis in DDLPS cells. Together, these data demonstrate that Notch signaling regulates CSCs, at least partially by controlling PGC-1α mediated mitochondria biogenesis.</p>

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