Cancer is a leading cause of death worldwide and is currently the second leading cause of death in the United States. Conventional treatment options for tumors include cytotoxic therapies such as radiation therapy (RT) and chemotherapy. Local tumor control by surgery or RT can fail because of eventual metastatic progression, even in the presence of systemic therapy. More recently immunotherapies have been proposed as possible treatment options to inhibit metastatic progression, both alone and in combination with other therapies. Immunotherapies include check-point inhibitors, tumor vaccines and adoptive cell transfer. Although immunotherapies have shown promise in the treatment of some solid tumors, such as melanoma and renal-cell carcinoma, immunotherapies have been less successful in other more fibrotic tumors such as pancreatic cancer. Even within cancer types, there are subsets of responders and non-responders, such that many people are less than ideally treated.
Although RT can be used to treat cancers, the cytotoxic effect of RT can limit its usefulness. For example, RT of tumors located on an organ can substantially damage the organ where the tumors are located. Metastatic tumors can be situated at locations remote from the primary tumor, such that the primary and metastatic tumors are located on more than one organ. Due to cytotoxic effects, RT of more than one organ can lead to damage to more than one organ in at least some instances.
In light of the above, it would be desirable to have improved methods and apparatus of treating cancer. Ideally, these methods and apparatus would inhibit metastatic progression of cancer and allow treatment of tumors on delicate organs and tissue structures with causing damage.
The present methods and apparatus provide improved treatment of cancer with RT. A tumor can be treated with an ablative amount of radiation, and a subsequent sub-ablative treatment at the same or a different location. The subsequent sub-ablative treatment can be applied within a time from about 1 hour to about 4 days from the ablative treatment, in order provide an adaptive immune response to antigens on the cancer cells. The subsequent sub-ablative treatment can be applied at many locations, such as the same location on the tumor receiving the ablative dose, another tumor, or locations susceptible to metastasis. In some embodiments, the time between the ablative treatment and the sub-ablative treatment allows for structural changes to the tumor microenvironment, including the vasculature of the tumor. Because the subsequent treatment is sub-ablative, the subsequent treatment can be applied at many locations, even locations without an identified tumor, and the subsequent treatment may comprise a whole body treatment, for example. The radiotherapy can be administered in many ways, such as with a radiotherapy machine or brachytherapy and combinations thereof.
While the treatment can be performed in many ways, in some embodiments an initial ablative radiotherapy treatment generates a significant number of antigens, which are presented to the immune system. An adaptive immune response is generated in response to the antigens presented from the first treatment. A subsequent sub-ablative treatment can affect the tumor microenvironment and increase the extent to which immune cells can enter the tumor. The subsequent sub-ablative treatment can result in increased perfusion of the tumor (e.g. “cracking” of the tumor) so as to modify the tumor microenvironment, and can result in other changes to the tumor microenvironment that promotes an immune response. Although reference is made to treating a tumor with a sub-ablative dose of RT, tissues susceptible to tumors can be prophylactically treated with RT to inhibit tumor growth in those tissues.
In some embodiments, described herein is a method of treating a cancer in a subject, the method comprising providing an ablative dose of radiation therapy to a first region comprising the cancer followed by a sub-ablative dose to a second region, wherein the sub-ablative dose is administered after the ablative dose. In certain embodiments, the sub-ablative dose is administered at least 1 hour after the ablative dose. In certain embodiments, the sub-ablative dose is administered at least 1 day after the ablative dose. In certain embodiments, the sub-ablative dose is administered no more than 4 days after the ablative dose.
In some embodiments, disclosed herein is a method of treating a cancer in a subject, the method comprising providing an ablative dose of radiation therapy to a first region comprising the cancer followed by a sub-ablative dose to a second region, wherein the sub-ablative dose is administered within 1 hour to 4 days after the ablative dose. In some embodiments, a cumulative amount of radio therapy delivered to the second region throughout a course of treatment comprises less than an ablative dose. In some embodiments, the cumulative amount less than an ablative dose comprises a plurality of sub-ablative doses. In some embodiments, the first region comprises a region of a tumor and optionally the second region comprises the region of the tumor. In some embodiments, the first region comprises a region of a first tumor and the second region comprises a region of a second tumor. In some embodiments, the first tumor comprises a primary tumor and the second tumor comprises a metastatic tumor. In some embodiments, the first tumor comprises a metastatic tumor and the second tumor comprises a primary tumor. In some embodiments, the second region comprises a plurality of second regions and each of the plurality of second regions receives a cumulative amount of radiotherapy which is less than an ablative dose. In some embodiments, the second region comprises a different region from the first region. In some embodiments, the second region comprises a region of a tumor. In some embodiments, the second region comprises a region likely to develop a metastatic tumor and optionally the second region comprises a region of an organ selected from the group consisting of bones, lymph node, lung, liver, brain, adrenal gland, breast, eye, kidney, muscles, pancreas, salivary gland, and spleen. In some embodiments, the second region comprises a whole body of the subject scanned with the sub-ablative dose. In some embodiments, the first region comprises a region of a primary tumor of an organ selected from the group consisting of breast, bladder, brain, colon, rectal, endometrial, kidney, pancreas, prostate, liver, lung, skin, thyroid, uterus, lymph node, tonsil, thymus, spleen and bone marrow and the second region comprises a region of a metastatic tumor of an organ selected from the group consisting of bones, lymph node, lung, liver, brain, adrenal gland, breast, eye, kidney, muscles, pancreas, salivary gland, and spleen. In some embodiments, the first region comprises a region of a metastatic tumor of an organ selected from the group consisting of bone, lymph node, lung, liver, brain, adrenal gland, breast, eye, kidney, muscles, pancreas, salivary gland and spleen, and the second region comprises a primary tumor of an organ selected from the group consisting of breast, bladder, brain, colon, rectal, endometrial, kidney, pancreas, prostate, liver, lung, skin, thyroid, uterus, lymph node, tonsil, thymus, spleen and bone marrow. In some embodiments, the first region comprises an identified tumor and the second region does not comprise an identified tumor.
In some embodiments, disclosed herein is a computer readable medium configured with instructions that, when executed, cause a processor to provide instructions to a radiotherapy system to deliver an ablative dose of radiation therapy to a first region followed by delivery of a sub-ablative dose to a second region after the ablative dose. In some embodiments, the sub-ablative dose is delivered at least 1 hour after the ablative dose. In some embodiments, the sub-ablative dose is delivered at least 1 day after the ablative dose. In some embodiments, the sub-ablative dose is delivered no more than 4 days after the ablative dose.
In some embodiments, disclosed herein is a computer readable medium configured with instructions that, when executed, cause a processor to provide instructions to a radiotherapy system for an ablative dose of radiation therapy to a first region followed by a sub-ablative dose to a second region within 1 hour to 4 days after the ablative dose. In some embodiments, a cumulative amount of radio therapy delivered to the second region throughout a course of treatment comprises an amount of radio therapy which is less than an ablative dose. In some embodiments, the cumulative amount of radio therapy less than an ablative dose comprises a plurality of sub-ablative doses. In some embodiments, the first region comprises a region of a tumor and optionally the second region comprises the region of the tumor. In some embodiments, the first region comprises a region of a first tumor and the second region comprises a region of a second tumor. In some embodiments, the first tumor comprises a primary tumor and the second tumor comprises a metastatic tumor. In some embodiments, the first tumor comprises a metastatic tumor and the second tumor comprises a primary tumor. In some embodiments, the second region comprises a plurality of second regions and each of the plurality of second regions receives a cumulative amount of radiotherapy which is less than an ablative dose. In some embodiments, the second region comprises a different region from the first region. In some embodiments, the second region comprises a region of a tumor. In some embodiments, the second region comprises a region likely to develop a metastatic tumor and optionally the second region comprises a region of an organ selected from the group consisting of bones, lymph node, lung, liver, brain, adrenal gland, breast, eye, kidney, muscles, pancreas, salivary gland, and spleen. In some embodiments, the second region comprises a whole body of the subject scanned with the sub-ablative dose. In some embodiments, the first region comprises a region of a primary tumor of an organ selected from the group consisting of breast, bladder, brain, colon, rectal, endometrial, kidney, pancreas, prostate, liver, lung, skin, thyroid, uterus, lymph node, tonsil, thymus, spleen and bone marrow and the second region comprises a region of a metastatic tumor of an organ selected from the group consisting of bones, lymph node, lung, liver, brain, adrenal gland, breast, eye, kidney, muscles, pancreas, salivary gland, and spleen. In some embodiments, the first region comprises a region of a metastatic tumor of an organ selected from the group consisting of bone, lymph node, lung, liver, brain, adrenal gland, breast, eye, kidney, muscles, pancreas, salivary gland and spleen, and the second region comprises a primary tumor of an organ selected from the group consisting of breast, bladder, brain, colon, rectal, endometrial, kidney, pancreas, prostate, liver, lung, skin, thyroid, uterus, lymph node, tonsil, thymus, spleen and bone marrow. In some embodiments, the first region comprises an identified tumor and the second region does not comprise an identified tumor.
In some embodiments, disclosed herein is a radiotherapy system comprising a source of radiation to provide an ablative dose and a sub-ablative dose; and a processor coupled to the source of radiation, wherein the processor is configured with the instructions of described above. In some embodiments, the ablative dose comprises between 20 and 100 Gy at the first region. In some embodiments, the ablative dose comprises between 20 and 60 Gy at the first region. In some embodiments, the sub-ablative dose comprises between 0.1 and 2 Gy and optionally the sub-ablative dose comprises a plurality of sub-ablative doses and each of the plurality of sub-ablative doses comprises between 0.1 and 2 Gy at the second region. In some embodiments, the sub-ablative dose comprises between 0.1 and 0.5 Gy and optionally the sub-ablative dose comprises a plurality of sub-ablative doses and each of the plurality of sub-ablative dose/s comprises between 0.1 and 5 Gy at the second region. In some embodiments, three sub-ablative doses are administered. In some embodiments, more than three sub-ablative doses are administered. In some embodiments, a first sub-ablative dose is administered within 24 hours after the administration of the ablative dose. In some embodiments, a first sub-ablative dose is administered between 6 and 26 hours after the administration of the ablative dose. In some embodiments, the treatment reduces the size or intensity of the treated tumor as measured by imaging selected from the group consisting of a computed tomography scan, magnetic resonance imaging, positron emission tomography, a computed tomography scan. In some embodiments, the treatment increases the survival of the subject, reduces the number or severity of symptoms experienced by the subject, increases a number of immune cells in a microenvironment of the tumor, or increases a number of activated immune cells in a tumor microenvironment. In some embodiments, the radiation is selected from the group consisting of x-ray radiation, gamma ray radiation, alpha particle radiation, beta particle radiation, neutron particle radiation, external beam radiation and brachytherapy.
All publications, patents, and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference.
The novel features of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are utilized, and the accompanying drawings of which:
The presently disclosed methods and apparatus can treat cancer with an ablative RT dose followed by a sub-ablative RT dose. The ablative RT dose can generate an adaptive immune response and the subsequent sub-ablative RT treatment can affect the tumor micro environment and may trigger production of antigenic material in cancer cells, which can result in an immunogenic response to the cancer cells. This sub-ablative does can be used to generate an immune response in delicate tissues in a manner that spares these delicate tissues such that these tissues remain viable subsequent to treatment. The presently disclosed methods and apparatus are well suited for combination with prior methods, compounds and apparatus for treating cancer. For example, the ablative and sub-ablative doses as described herein can be delivered with radiotherapy system as are known to one of ordinary skill in the art. The radiotherapy system can be programmed with software instructions to treat the tumor with ablative and sub-ablative doses. The software instructions may comprise treatment planning software so as to control the locations and timing of the ablative and sub-ablative doses. Alternatively, or in combination, the radiotherapy may comprise brachytherapy. For example, radioactive seeds may be placed near a tumor such as a prostate tumor, and sub-ablative treatments can be applied with a radiotherapy machine at locations away from the prostate. The presently disclosed methods and apparatus can be combined with prior methods, apparatus and compounds for treating cancer, such as immunomodulatory therapy, for example.
Without being bound by any particular theory, it is believed that ablative doses can release large amounts of immunogenic antigens from cancer cells, and subsequent treatment with the sub-ablative dose may cause the cancer cells exposed to the sub-ablative dose to present similar antigens, so as to trigger an immune response. Also, the treatment with the subsequent sub-ablative dose may play a role with respect to the tumor micro-environment and decrease the extent to which the tumor provides an immune-privileged site.
Differing schedules and doses of radiation on tumors may have differing immune-modulatory effects. Treatment plans of longer than seven days can be immunosuppressive and single ablative doses, releasing large amounts of antigen can be immunogenic. The current disclosure provides radiation schemes in the treatment of solid tumors, leading to increased immunogenicity and increased accessibility of the tumor to immune cells and therapeutic agents. In some embodiments the radiation schemes described herein combine non-ablative immune priming followed by ablation, termed “Immune Priming Ablation” (IPA), and can lead to a more potent in situ vaccine.
Prior therapies have generally been ineffective in the treatment of certain solid tumors due in part to the tumor microenvironment behaving as an immune privileged site and leading to chemo- and radio-resistance. There are multiple factors contributing to the immunosuppressive tumor microenvironment including tumor-promoting immune cells, the desmoplastic reaction and the disorganized tumor vascular. There can be a large population of immunosuppressive stromal cells present in tumors, such as, myeloid derived suppressor cells (MDSCs), cancer associated fibroblasts (CAFs) and tumor associated macrophages (TAMs). TAMs and CAFs can be key players in the creation of excessive extracellular matrix (ECM) by collaborating to induce a fibrotic reaction, similar to “wound healing” response after injury. Tumor associated macrophages constitute a large portion of the resident immune cells in pancreatic cancer, influencing the inhibition of infiltrating cytotoxic T cells and generally can be characterized as M1, anti-tumorigenic, and M2, pro-tumorigenic. Dendritic cells (DCs) are a very small population of immune cells, but those residing in the tumor are often tolerogenic and lead to the induction of immunosuppressive regulatory T cells (Tregs) and inhibition of cytotoxic T cells. Many tumor cells down regulate the expression of major histocompatibility complex (MHC) Class I, and components of antigen presentation machinery, which can essentially prevent MHC-peptide presentation, thereby escaping recognition by immune effector cells. The desmoplastic reaction creates a fibrotic meshwork, which further hinders accessibility of cytotoxic immune cells and separates tumor cells and blood vessels, while also decreasing permeability.
The disorganized and inefficient tumor vasculature can also play a role in perpetrating the immunosuppressive tumor microenvironment and is created in part by the unregulated growth of the tumor. As the tumor progresses, angiogenesis is often unable to match the rate of growth and therefor a structured vessel network is unable to effectively form. The tumor vasculature is also characterized by immature and leaky vessels and contributes to the increased interstitial pressure seen in many solid tumors, which can lead to decreased immune cell extravasation. This disorganization can help lead to chemo- and radio-resistance due to increased hypoxia and lack of accessibility of not only drugs, but immune infiltration as well.
Radiation therapy has a well-established role in local tumor control through direct cell death. Anecdotal evidence suggests that tumor ablation can on rare occasions produce a response at distant sites, this has been postulated to arise from the induction of systemic immunity. Radiation has been shown to induce immunogenic cell death (ICD) and can be the first step in anti-tumor immunity.
Damage and cell stress caused by radiation treatment can promote activation and maturation of dendritic cells (DCs). DCs are antigen-presenting cells (APCs) that engulf antigen from their environment and present it to T cells on MHC Class I or II receptors. Activation of T cells depends not only on the presentation of antigen from DCs but also on co-stimulatory molecules, and is one of the most important phases of adaptive-dependent anti-tumor immunity. Activation of T cells can often be ineffective because of the immunosuppressive tumor microenvironment. Harnessing radiation's activating potential while limiting its negative impact in accordance with embodiments described herein can lead to much more effective clinical outcomes.
There are three dosing regimens applicable clinically in the treatment of cancer: conventional fractionation, sub-ablative hypo-fractionation and ablative hypo-fractionation (Table 1). These prior dosing regimens can be combined with sub-ablative treatments in accordance with some embodiments. Conventional fractionation in the treatment of cancer consists of many low dose fractions delivered over longer periods of time (more than seven days) and is typically considered immunosuppressive, repeatedly killing any radiosensitive infiltrating immune cells. Sub-ablative hypo-fractionation consists of larger non-lethal doses delivered in under seven days and has some immune-modulatory effects. While this regimen increases the anti-tumor immune response, cytotoxicity of the treatment alone is not as effective at controlling tumor growth. Ablative hypo-fractionation causes direct cell death, releasing large amounts of antigen, and can control local tumor growth. The disadvantage of a single ablative fraction RT is the induction of a pro-tumor fibrotic response, orchestrated in part by tumor associated macrophages in a tumorigenic phenotype secreting TGFβ, and the attraction of immunosuppressive cells to the tumor microenvironment, which can diminish the anti-tumor response. The effects of different forms of fractionated radiotherapy are summarized in Tables 1 and 2 and suitable for combination in accordance with some embodiments.
Treating tumors with a combination of an ablative treatment (e.g. a single ablative treatment) and one or more sub-ablative treatments can combine the benefits of both the ablative treatment that generates antigens and kills cells with the benefits of the sub-ablative treatment that improves immune access to the tumor site and activates the immune system. The initial ablative treatment results in an increase in tumor antigen release, and in damage associated molecular pattern expression and an up-regulation of MHC Class I on surviving tumor cells, thus reversing immune escape of the tumor. Following this treatment with one or more sub-ablative doses over a short period of time, for example less than seven days, can provide further immune-modulatory benefits including normalization of vasculature, up-regulation of damage associated molecular patterns, MHC Class I, and adhesion markers and increased release of chemokines, thus attracting effector T cells to the tumor, and reducing the influx of immunosuppressive regulatory T cells. The effects of these two treatments may be synergistic, resulting in a much larger therapeutic effect than would be expected from the effect of either alone. Hypothesized effects of this treatment are summarized in Table 2.
The radiation module 22 can also include a modulation device 34 operable to modify or modulate the radiation beam 30. The modulation device 34 provides the modulation of the radiation beam 30 and directs the radiation beam 30 toward the patient 14. Specifically, the radiation beam 34 is directed toward a portion of the patient. Broadly speaking, the portion may include the entire body, or may be smaller than the entire body and can be defined by a two-dimensional area and/or a three-dimensional volume. A portion desired to receive the radiation is an example of a region of interest. The region of interest, 38, may comprise a first treatment site, a second treatment site, or a subsequent treatment site. The region of interest 38 may also include a margin around or partially around the target. Another type of region of interest is a region at risk of radiation damage. If a portion includes a region at risk of radiation damage, the radiation beam is preferably diverted from the region. The patient 14 may have more than one region that receives radiation therapy as described herein.
The sub-ablative doses of the radiotherapy, delivered subsequent to the ablative dose, can increase the immune reaction against the tumor and improve the treatment response. For example, as shown in
In some cases, after treatment of a first tumor with an ablative dose, one or more sub-ablative doses may be administered to the entire body. In some cases, the one or more sub-ablative doses may be administered to an entire peritoneal cavity, for example. In some cases, the one or more sub-ablative doses may be administered to an entire organ which is known to contain one or more metastatic tumors, or to an entire organ which is known to be a likely site for the development of metastatic tumors. For example, patients with breast cancer develop metastatic tumors in the bones, lungs, liver or brain. Patients with lung cancer can develop metastatic tumors in the other lung, or in the adrenal gland, bones, brain and liver. Examples of organs which may be likely to develop metastatic tumors include, but are not limited to, bones, lymph node, lung, liver, brain, adrenal gland, breast, eye, kidney, muscles, pancreas, salivary gland, and spleen.
After the first region has been identified, a second treatment region is identified at step 410. In some embodiments, the second treatment region may comprise a location which has a tumor. In some cases, the second treatment region may be a different region from the first treatment region. In some cases, the second treatment region may comprise the same region as the first treatment region. In some cases, the second treatment region may be within the same organ as the first treatment region, or in a different organ from the first treatment region. The second treatment region may be a location which has a secondary tumor, or a primary tumor. In some cases, the second treatment region has a smaller tumor than the first treatment region. In some cases, the second treatment region is a location which is difficult to treat with radiation. In some cases, the second treatment region is a location which is more sensitive to adverse effects of radiation treatment than the first treatment region. In some cases, the second treatment region is a location which does not have an identified tumor, but is known to be a likely area for the development of metastatic tumors.
The next step 415 comprises registering a radiotherapy system with a patient to target the first treatment region. The radiotherapy system may comprise components any radiotherapy system known in the art, such as the known radiotherapy systems commercially available from Varian Medical and Accuray, for example. For example, the radiotherapy system may comprise the system of
Once the first treatment region is registered, it may be treated with an ablative dose of radiation at a step 420. An ablative dose may be a dose of between about 10 Gy and about 60 Gy, between about 20 Gy and about 40 Gy, or between about 20 Gy and about 30 Gy. In some cases, an ablative dose is about 10 Gy, 12 Gy, 14 Gy, 16 Gy, 18 Gy, 20 Gy, 22 Gy, 24 Gy, 26 Gy, 28 Gy, 30 Gy, 32 Gy, 34 Gy, 36 Gy, 38 Gy, 40 Gy, 42 Gy, 44 Gy, 46 Gy, 48 Gy, 50 Gy, 52 Gy, 54 Gy, 56 Gy, 58 Gy, or 60 Gy, or within a range defined by any two of the preceding values.
Following the first treatment, a step 425 in the process 400 involves waiting for a predetermined period of time before proceeding with a subsequent treatment. The predetermined period of time may be between about 1 hour and about 4 days, for example. In some cases, the predetermined period of time may be between about 1 hour and about 36 hours, between about 6 hours and about 30 hours, between about 12 hours and about 26 hours, between about 20 hours and about 28 hours, or between about 22 hours and about 26 hours. A person of ordinary skill in the art can determine an appropriate amount of time to wait in accordance with the presently disclosed teachings.
At a step 430, the radiotherapy system is registered at the second treatment region, and the second treatment region may be treated with a sub-ablative dose at a step 435. A sub-ablative dose may comprise a dose of between about 0.1 Gy and about 3 Gy, between about 0.2 Gy and about 2 Gy, between about 0.3 Gy and about 1 Gy, between about 0.3 Gy and about 0.7 Gy, between about 0.1 Gy and 0.5 Gy, or between about 0.8 Gy and about 1.2 Gy. Steps 425 to 435 may be repeated a number of times. In some cases, steps 425-435 are repeated two times, three times, four times, five times, six times or more than six times in order to induce an immunogenic response without ablation at the second treatment region or in additional sub-ablative treatment regions. In some cases, a sub-ablative dose comprises a plurality of sub-ablative doses and each of the plurality of sub-ablative doses comprises a dose of between about 0.1 Gy and about 3 Gy, between about 0.2 Gy and about 2 Gy, between about 0.3 Gy and about 1 Gy, between about 0.3 Gy and about 0.7 Gy, between about 0.1 Gy and 0.5 Gy, or between about 0.8 Gy and about 1.2 Gy. The radiotherapy system may next be registered at the third treatment region at a step 440, and the third treatment region treated with a sub-ablative dose at a step 445. The sub-ablative dose may be a dose of between about 0.1 Gy and about 3 Gy, between about 0.2 Gy and about 2 Gy, between about 0.3 Gy and about 1 Gy, between about 0.3 Gy and about 0.7 Gy, or between about 0.8 Gy and about 1.2 Gy. Steps 440 and 445 may be repeated any number of times if beneficial to inducing an immunogenic response without ablation at the third treatment region.
After treating at the third treatment region the system waits for a predetermined period of time, 450, and then may repeat steps 440-450 one, two, three, four, or more than four times. The predetermined period of time may be between about 1 hour and about 4 days. In some cases, the predetermined period of time may be between about 1 hour and about 36 hours, between about 6 hours and about 30 hours, between about 12 hours and about 26 hours, between about 20 hours and about 28 hours, or between about 22 hours and about 26 hours.
A processor as described herein can be configured with instructions to perform the method 400.
While
In some cases, a cumulative amount of radio therapy delivered to the second region throughout a course of treatment comprises less than an ablative dose. In some cases, the cumulative sub-ablative amount comprises a plurality of sub-ablative doses.
The methods and systems disclosed herein may be used to treat a patient. In some cases, the patient is a human. In some cases, the patient has been diagnosed with a cancer. In some cases, the patient has been diagnosed with a solid cancer. Examples of types of cancer include, but are not limited to: esophageal cancer, breast cancer, gastric cancer, cholangiocarcinoma, pancreatic cancer, colon cancer, lung cancer, thymic carcinoma, mesothelioma, ovarian cancer, and endometrial cancer. In some cases, the first region may comprise a region of a primary tumor of an organ. Examples of organs which may develop a cancer include, but are not limited to, breast, bladder, brain, colon, rectal, endometrial, kidney, pancreas, prostate, liver, lung, skin, thyroid, uterus, lymph node, tonsil, thymus, spleen and bone marrow. In some cases, the patient may have more than one different types of cancer. In some cases, the patient has at least one detected tumor. In some cases, the patient's cancer has not responded to another therapy, or has stopped responding to another therapy.
In some embodiments, described herein is a method of treating a cancer in a subject, the method comprising providing an ablative dose of radiation therapy to a first region comprising the cancer followed by a sub-ablative dose to a second region, wherein the sub-ablative dose is administered after the ablative dose. In certain embodiments, the sub-ablative dose is administered at least 1 hour after the ablative dose. In certain embodiments, the sub-ablative dose is administered at least 1 day after the ablative dose. In certain embodiments, the sub-ablative dose is administered no more than 4 days after the ablative dose.
In some embodiments, the platforms, systems, media, and methods described herein include a digital processing device, or use of the same. In further embodiments, the digital processing device includes one or more hardware central processing units (CPUs), general purpose graphics processing units (GPGPUs), or field programmable gate arrays (FPGAs) that carry out the device's functions. In still further embodiments, the digital processing device further comprises an operating system configured to perform executable instructions. In some embodiments, the digital processing device is optionally connected a computer network. In further embodiments, the digital processing device is optionally connected to the Internet such that it accesses the World Wide Web. In still further embodiments, the digital processing device is optionally connected to a cloud computing infrastructure. In other embodiments, the digital processing device is optionally connected to an intranet. In other embodiments, the digital processing device is optionally connected to a data storage device.
In accordance with the description herein, suitable digital processing devices include, by way of non-limiting examples, server computers, desktop computers, laptop computers, notebook computers, sub-notebook computers, netbook computers, netpad computers, set-top computers, media streaming devices, handheld computers, Internet appliances, mobile smartphones, tablet computers, personal digital assistants, video game consoles, and vehicles. Those of skill in the art will recognize that many smartphones are suitable for use in the system described herein. Those of skill in the art will also recognize that select televisions, video players, and digital music players with optional computer network connectivity are suitable for use in the system described herein. Suitable tablet computers include those with booklet, slate, and convertible configurations, known to those of skill in the art.
In some embodiments, the digital processing device includes an operating system configured to perform executable instructions. The operating system is, for example, software, including programs and data, which manages the device's hardware and provides services for execution of applications. Those of skill in the art will recognize that suitable server operating systems include, by way of non-limiting examples, FreeBSD, OpenBSD, NetBSD®, Linux, Apple® Mac OS X Server®, Oracle® Solaris®, Windows Server®, and Novell® NetWare®. Those of skill in the art will recognize that suitable personal computer operating systems include, by way of non-limiting examples, Microsoft® Windows®, Apple® Mac OS X®, UNIX®, and UNIX-like operating systems such as GNU/Linux®. In some embodiments, the operating system is provided by cloud computing. Those of skill in the art will also recognize that suitable mobile smart phone operating systems include, by way of non-limiting examples, Nokia® Symbian® OS, Apple® iOS®, Research In Motion® BlackBerry OS®, Google® Android®, Microsoft® Windows Phone® OS, Microsoft® Windows Mobile® OS, Linux®, and Palm® WebOS®. Those of skill in the art will also recognize that suitable media streaming device operating systems include, by way of non-limiting examples, Apple TV®, Roku®, Boxee®, Google TV®, Google Chromecast®, Amazon Fire®, and Samsung® HomeSync®. Those of skill in the art will also recognize that suitable video game console operating systems include, by way of non-limiting examples, Sony® PS3®, Sony® PS4®, Microsoft® Xbox 360®, Microsoft Xbox One, Nintendo® Wii®, Nintendo® Wii U®, and Ouya®.
In some embodiments, the device includes a storage and/or memory device. The storage and/or memory device is one or more physical apparatuses used to store data or programs on a temporary or permanent basis. In some embodiments, the device is volatile memory and requires power to maintain stored information. In some embodiments, the device is non-volatile memory and retains stored information when the digital processing device is not powered. In further embodiments, the non-volatile memory comprises flash memory. In some embodiments, the non-volatile memory comprises dynamic random-access memory (DRAM). In some embodiments, the non-volatile memory comprises ferroelectric random access memory (FRAM). In some embodiments, the non-volatile memory comprises phase-change random access memory (PRAM). In other embodiments, the device is a storage device including, by way of non-limiting examples, CD-ROMs, DVDs, flash memory devices, magnetic disk drives, magnetic tapes drives, optical disk drives, and cloud computing based storage. In further embodiments, the storage and/or memory device is a combination of devices such as those disclosed herein.
In some embodiments, the digital processing device includes a display to send visual information to a user. In some embodiments, the display is a cathode ray tube (CRT). In some embodiments, the display is a liquid crystal display (LCD). In further embodiments, the display is a thin film transistor liquid crystal display (TFT-LCD). In some embodiments, the display is an organic light emitting diode (OLED) display. In various further embodiments, on OLED display is a passive-matrix OLED (PMOLED) or active-matrix OLED (AMOLED) display. In some embodiments, the display is a plasma display. In other embodiments, the display is a video projector. In still further embodiments, the display is a combination of devices such as those disclosed herein.
In some embodiments, the digital processing device includes an input device to receive information from a user. In some embodiments, the input device is a keyboard. In some embodiments, the input device is a pointing device including, by way of non-limiting examples, a mouse, trackball, track pad, joystick, game controller, or stylus. In some embodiments, the input device is a touch screen or a multi-touch screen. In other embodiments, the input device is a microphone to capture voice or other sound input. In other embodiments, the input device is a video camera or other sensor to capture motion or visual input. In further embodiments, the input device is a Kinect, Leap Motion, or the like. In still further embodiments, the input device is a combination of devices such as those disclosed herein.
Referring to
Continuing to refer to
Continuing to refer to
Continuing to refer to
Methods as described herein can be implemented by way of machine (e.g., computer processor) executable code stored on an electronic storage location of the digital processing device 601, such as, for example, on the memory 610 or electronic storage unit 615. The machine executable or machine readable code can be provided in the form of software. During use, the code can be executed by the processor 605. In some cases, the code can be retrieved from the storage unit 615 and stored on the memory 610 for ready access by the processor 605. In some situations, the electronic storage unit 615 can be precluded, and machine-executable instructions are stored on memory 610.
In some embodiments, disclosed herein is a computer readable medium configured with instructions that, when executed, cause a processor to provide instructions to a radiotherapy system to deliver an ablative dose of radiation therapy to a first region followed by delivery of a sub-ablative dose to a second region after the ablative dose. In some embodiments, the sub-ablative dose is delivered at least 1 hour after the ablative dose. In some embodiments, the sub-ablative dose is delivered at least 1 day after the ablative dose. In some embodiments, the sub-ablative dose is delivered no more than 4 days after the ablative dose.
In some embodiments, the platforms, systems, media, and methods disclosed herein include one or more non-transitory computer readable storage media encoded with a program including instructions executable by the operating system of an optionally networked digital processing device. In further embodiments, a computer readable storage medium is a tangible component of a digital processing device. In still further embodiments, a computer readable storage medium is optionally removable from a digital processing device. In some embodiments, a computer readable storage medium includes, by way of non-limiting examples, CD-ROMs, DVDs, flash memory devices, solid state memory, magnetic disk drives, magnetic tape drives, optical disk drives, cloud computing systems and services, and the like. In some cases, the program and instructions are permanently, substantially permanently, semi-permanently, or non-transitorily encoded on the media.
In some embodiments, the platforms, systems, media, and methods disclosed herein include at least one computer program, or use of the same. A computer program includes a sequence of instructions, executable in the digital processing device's CPU, written to perform a specified task. Computer readable instructions may be implemented as program modules, such as functions, objects, Application Programming Interfaces (APIs), data structures, and the like, that perform particular tasks or implement particular abstract data types. In light of the disclosure provided herein, those of skill in the art will recognize that a computer program may be written in various versions of various languages.
The functionality of the computer readable instructions may be combined or distributed as desired in various environments. In some embodiments, a computer program comprises one sequence of instructions. In some embodiments, a computer program comprises a plurality of sequences of instructions. In some embodiments, a computer program is provided from one location. In other embodiments, a computer program is provided from a plurality of locations. In various embodiments, a computer program includes one or more software modules. In various embodiments, a computer program includes, in part or in whole, one or more web applications, one or more mobile applications, one or more standalone applications, one or more web browser plug-ins, extensions, add-ins, or add-ons, or combinations thereof.
In some embodiments, a computer program includes a web application. In light of the disclosure provided herein, those of skill in the art will recognize that a web application, in various embodiments, utilizes one or more software frameworks and one or more database systems. In some embodiments, a web application is created upon a software framework such as Microsoft® .NET or Ruby on Rails (RoR). In some embodiments, a web application utilizes one or more database systems including, by way of non-limiting examples, relational, non-relational, object oriented, associative, and XML database systems. In further embodiments, suitable relational database systems include, by way of non-limiting examples, Microsoft® SQL Server, mySQL™ and Oracle®. Those of skill in the art will also recognize that a web application, in various embodiments, is written in one or more versions of one or more languages. A web application may be written in one or more markup languages, presentation definition languages, client-side scripting languages, server-side coding languages, database query languages, or combinations thereof. In some embodiments, a web application is written to some extent in a markup language such as Hypertext Markup Language (HTML), Extensible Hypertext Markup Language (XHTML), or eXtensible Markup Language (XML). In some embodiments, a web application is written to some extent in a presentation definition language such as Cascading Style Sheets (CSS). In some embodiments, a web application is written to some extent in a client-side scripting language such as Asynchronous Javascript and XML (AJAX), Flash® Actionscript, Javascript, or Silverlight. In some embodiments, a web application is written to some extent in a server-side coding language such as Active Server Pages (ASP), ColdFusion®, Perl, Java™, JavaServer Pages (JSP), Hypertext Preprocessor (PHP), Python™, Ruby, Tcl, Smalltalk, WebDNA®, or Groovy. In some embodiments, a web application is written to some extent in a database query language such as Structured Query Language (SQL). In some embodiments, a web application integrates enterprise server products such as IBM® Lotus Domino®. In some embodiments, a web application includes a media player element. In various further embodiments, a media player element utilizes one or more of many suitable multimedia technologies including, by way of non-limiting examples, Adobe® Flash HTML 5, Apple® QuickTime®, Microsoft® Silverlight Java™, and Unity®.
In some embodiments, a computer program includes a mobile application provided to a mobile digital processing device. In some embodiments, the mobile application is provided to a mobile digital processing device at the time it is manufactured. In other embodiments, the mobile application is provided to a mobile digital processing device via the computer network described herein.
In view of the disclosure provided herein, a mobile application is created by techniques known to those of skill in the art using hardware, languages, and development environments known to the art. Those of skill in the art will recognize that mobile applications are written in several languages. Suitable programming languages include, by way of non-limiting examples, C, C++, C#, Objective-C, Java™, Javascript, Pascal, Object Pascal, Python™, Ruby, VB.NET, WML, and XHTML/HTML with or without CSS, or combinations thereof.
Suitable mobile application development environments are available from several sources. Commercially available development environments include, by way of non-limiting examples, AirplaySDK, alcheMo, Appcelerator, Celsius, Bedrock, Flash Lite, .NET Compact Framework, Rhomobile, and WorkLight Mobile Platform. Other development environments are available without cost including, by way of non-limiting examples, Lazarus, MobiFlex, MoSync, and Phonegap. Also, mobile device manufacturers distribute software developer kits including, by way of non-limiting examples, iPhone and iPad (iOS) SDK, Android™ SDK, BlackBerry® SDK, BREW SDK, Palm® OS SDK, Symbian SDK, webOS SDK, and Windows® Mobile SDK.
Those of skill in the art will recognize that several commercial forums are available for distribution of mobile applications including, by way of non-limiting examples, Apple® App Store, Google® Play, Chrome Web Store, BlackBerry® App World, App Store for Palm devices, App Catalog for webOS, Windows® Marketplace for Mobile, Ovi Store for Nokia® devices, Samsung® Apps, and Nintendo® DSi Shop.
In some embodiments, a computer program includes a standalone application, which is a program that is run as an independent computer process, not an add-on to an existing process, e.g., not a plug-in. Those of skill in the art will recognize that standalone applications are often compiled. A compiler is a computer program(s) that transforms source code written in a programming language into binary object code such as assembly language or machine code. Suitable compiled programming languages include, by way of non-limiting examples, C, C++, Objective-C, COBOL, Delphi, Eiffel, Java™, Lisp, Python™, Visual Basic, and VB .NET, or combinations thereof. Compilation is often performed, at least in part, to create an executable program. In some embodiments, a computer program includes one or more executable complied applications.
In some embodiments, the computer program includes a web browser plug-in (e.g., extension, etc.). In computing, a plug-in is one or more software components that add specific functionality to a larger software application. Makers of software applications support plug-ins to enable third-party developers to create abilities which extend an application, to support easily adding new features, and to reduce the size of an application. When supported, plug-ins enable customizing the functionality of a software application. For example, plug-ins are commonly used in web browsers to play video, generate interactivity, scan for viruses, and display particular file types. Those of skill in the art will be familiar with several web browser plug-ins including, Adobe® Flash® Player, Microsoft® Silverlight®, and Apple® QuickTime®. In some embodiments, the toolbar comprises one or more web browser extensions, add-ins, or add-ons. In some embodiments, the toolbar comprises one or more explorer bars, tool bands, or desk bands.
In view of the disclosure provided herein, those of skill in the art will recognize that several plug-in frameworks are available that enable development of plug-ins in various programming languages, including, by way of non-limiting examples, C++, Delphi, Java™ PHP, Python™, and VB .NET, or combinations thereof.
Web browsers (also called Internet browsers) are software applications, designed for use with network-connected digital processing devices, for retrieving, presenting, and traversing information resources on the World Wide Web. Suitable web browsers include, by way of non-limiting examples, Microsoft® Internet Explorer®, Mozilla® Firefox®, Google® Chrome, Apple® Safari®, Opera Software® Opera®, and KDE Konqueror. In some embodiments, the web browser is a mobile web browser. Mobile web browsers (also called mircrobrowsers, mini-browsers, and wireless browsers) are designed for use on mobile digital processing devices including, by way of non-limiting examples, handheld computers, tablet computers, netbook computers, subnotebook computers, smartphones, music players, personal digital assistants (PDAs), and handheld video game systems. Suitable mobile web browsers include, by way of non-limiting examples, Google® Android® browser, RIM BlackBerry® Browser, Apple® Safari®, Palm® Blazer, Palm® WebOS® Browser, Mozilla® Firefox® for mobile, Microsoft® Internet Explorer® Mobile, Amazon® Kindle® Basic Web, Nokia® Browser, Opera Software® Opera® Mobile, and Sony® PSP™ browser. Software modules
In some embodiments, the platforms, systems, media, and methods disclosed herein include software, server, and/or database modules, or use of the same. In view of the disclosure provided herein, software modules are created by techniques known to those of skill in the art using machines, software, and languages known to the art. The software modules disclosed herein are implemented in a multitude of ways. In various embodiments, a software module comprises a file, a section of code, a programming object, a programming structure, or combinations thereof. In further various embodiments, a software module comprises a plurality of files, a plurality of sections of code, a plurality of programming objects, a plurality of programming structures, or combinations thereof. In various embodiments, the one or more software modules comprise, by way of non-limiting examples, a web application, a mobile application, and a standalone application. In some embodiments, software modules are in one computer program or application. In other embodiments, software modules are in more than one computer program or application. In some embodiments, software modules are hosted on one machine. In other embodiments, software modules are hosted on more than one machine. In further embodiments, software modules are hosted on cloud computing platforms. In some embodiments, software modules are hosted on one or more machines in one location. In other embodiments, software modules are hosted on one or more machines in more than one location.
In some embodiments, the platforms, systems, media, and methods disclosed herein include one or more databases, or use of the same. In view of the disclosure provided herein, those of skill in the art will recognize that many databases are suitable for storage and retrieval of information. In various embodiments, suitable databases include, by way of non-limiting examples, relational databases, non-relational databases, object-oriented databases, object databases, entity-relationship model databases, associative databases, and XML databases. Further non-limiting examples include SQL, PostgreSQL, MySQL, Oracle, DB2, and Sybase. In some embodiments, a database is internet-based. In further embodiments, a database is web-based. In still further embodiments, a database is cloud computing-based. In other embodiments, a database is based on one or more local computer storage devices.
To investigate the efficacy of PAM-RT for local tumor control, C57BL/6 mice with palpable, subcutaneous, 3LL tumors were divided into five treatment cohorts for pilot studies—untreated, 24 Gy at day 1 or day 5 of treatment, 1 Gy×4 followed by 20 Gy or 20 Gy followed by 1 Gy×4. Basically, four fractions of 1 Gy delivered either before or after a single fraction of 20 Gy to the primary tumor were compared with a 24 Gy single fraction of RT. When compared to single-dose RT, pre-treatment with low-dose RT showed minimal tumor control, but there was a significant growth delay and improvement in survival after PAM-RT of 1 Gy×4 fractions, as shown in
Since 3LL tumors grow rapidly, priming-RT efficacy could have been impacted by the tumor size difference for ablative RT on the fifth day of treatment. Further studies of tumor growth led to the adoption of PAM-RT with 0.5 Gy×4 fraction as the optimal modulation doses for all further experiments. As before, a single-dose ablative fractionation of 24 Gy was compared with 22 Gy followed by 4 fractions of 0.5 Gy PAM-RT. A schematic of the dosing schedule is shown in
The immunomodulatory effects of PAM-RT on 3LL cells were also studied in vitro. An experimental scheme is shown in
To examine the effect of PAM-RT on immune cells in vitro bone marrow-derived macrophages and splenic T cells were harvested from wild-type C57Bl/6 mice. Macrophages were polarized with cytokines to M1 or M2 differentiation, or left untreated. Splenic T cells were sorted into the three main T cell populations: CD8+, CD4+CD25−, and CD4+CD25+ (Tregs). All populations were treated with low dose RT (0.5 Gy×4), one day after polarization or sorting. Ablative doses were not included in treatment due to the radio-sensitivity of immune cells. Characterization of T cell populations 6 hours after the final dose showed a significant decrease in Treg viability, which was not seen in the CD8 or CD4+CD25− T cells populations, see
To investigate the immunological consequences of PAM-RT on the tumor microenvironment (TME), irradiated 3LL tumors were harvested on day 6 and day 10 after start of RT, as shown in
To examine the immune cells in the secondary lymphoid organs, tumor draining lymph nodes and spleens were harvested, 6 and 10 days after start of RT, as with previous studies (e.g.
To investigate whether PAM-RT of metastases-prone organs can prevent progression after a course of hypofractionated ablative RT to the primary tumor in a poorly immunogenic, highly metastatic cancer course of local PAM-RT (22 Gy+0.5 Gy×4) was administered to orthotopic 4T1 breast cancer in Balb/c mice. Although primary tumor PAM-RT trended to delay local tumor progression, there was no increase in survival with all treated mice succumbing to metastatic disease (
Systemic PAM-RT Remodels the Metastatic Niche with Decreased Tregs in Lungs
Characterization of immune cells in PAM-RT treated lungs showed similar results to local PAM-RT treatment, with a decrease in immunosuppressive phenotype of these cells. There was a significant decrease in Tregs, seen Figure in
The murine cell line Lewis Lung Carcinoma, 3LL, was purchased from the ATCC and grown in supplemented DMEM (10% FBS, 5% Sodium Pyruvate, 2.5% NEAA, 1% Anti-bacterial/Anti-mitotic). The murine breast carcinoma cell line, 4T1, was purchased from ATCC and grown in supplemented DMEM (10% FBS, 1% Anti-bacterial/Anti-mitotic). Cell lines were used between 4 and 8 passages and mycoplasma was tested every 4 months with MycoAlert (Lonza LT07-705). Six to eight week old C57BL/6 mice and ten to twelve week on BalB/C mice were ordered from NCI and athymic nude mice were ordered from Charles River. The Institutional Animal Care and Use Committee approved all studies performed.
C57BL/6 mice were challenged with 1.5×105 3LL cells subcutaneously and BalB/C mice were challenged orthotopically with 2×105 4T1 cells in the mammary fat pad. Tumors are allowed to grow until 5 mm in diameter before treatment. Tumor size was measured twice a week. Tumor volume was calculated using an ellipsoid formula: V=(π/6×length×width×height). CT guided radiation therapy of tumor-bearing mice
Radiation is delivered using Xstrahl's Limited Small Animal Radiation Research Platform(SARRP). Image guided radiation therapy is performed using the SARRPs on-board cone beam CT (CBCT). Following CBCT acquisition, the treatment plan is constructed using Muriplan.
Tumor cells were cultured, plated, and treated with the specified radiation schemes. Cells were harvest 6 and 24 hours after the last treatment on day 5. Cells were harvested and stained for flow cytometry. Bone marrow derived macrophages were polarization to M1 (100 ng/mL LPS+50 ng/mL IFNg), M2 (10 ng/mL IL-4) and treated with radiation 24 hours later. T cell populations were sorted from spleens of naïve C57BL/6 mice with CD3, CD8, CD4, CD25 antibodies and allowed to rest overnight before radiation treatment. Immune cells were harvest 6 hours after final radiation dose.
Tumors or whole lungs are harvested on ice, weighed and washed. After manual dissection with razor, the tumor or whole lung is transferred to 1 mL Digestion buffer (10% FBS, Collagenase I and IV at 100 u/mL(Sigma) and 1× DNase 1(Thermo Scientific)) in a 15 mL conical tube with a magnetic stir bar. Tubes are incubated at 37° C. for 15 min while rotating and transferred to a stir plate for 15 minutes manual digestion. Single cell suspensions are filtered. Cells are re-suspended for flow cytometry.
Cells were stained at 4° C. for 30 minutes with surface stain antibodies. Antibodies used included CD45, CD3, CD4, FOXP3, CD8, GzB, CD11b, WICK IL-10, TNFa and CD206. After washing, the cells are fixed with 4% PFA or permeabilized for intracellular staining BD Pharminogen Transcription Factor buffer set as per instructions. Intracellular stains are FOXP3, TNFa, IL-10 and Granzyme B, followed by fixation with 4% PFA. Cells are collected on the LSRII flow cytometer (BD Biosciences) and analyzed via Flow Jo software (Tree Star).
Spleen and draining lymph nodes were harvested on ice and processed to single cell suspensions. In spleens, red blood cells were lysed with ACK lysis buffer (Lonza). Cells are counted before re-suspension in complete RPMI (10% heat-inactivated FBS, 1% Anti-biotic/Anti-mitotic). For intracellular cytokine analysis, Golgi-stop and monensin were added for 3 hours at 37° C. Single cell suspensions are further processed for flow cytometry analysis as done with tumor.
Spleens processed for immune analysis were plated in coated ELISPOT plates at 1×10{circumflex over ( )}6 cells per well and incubated overnight before further processing. Reagents for IFNγ ELISPOTS were ordered from BD biosciences and manufacturer protocol followed. Regents for granzyme B ELISPOTs were ordered from R&D and manufacturer protocol followed.
Tumors and lungs were harvested, and transferred into 4% PFA or 10% formalin and stored at 4° C. Samples were then transferred to 70% and embedded in Paraffin. Blocks were sectioned and dual stained with CD8 and FOXP3.
Statistical analysis was performed using PRISM 7 (Graphpad Software) software. Analyses were performed using student's t test or ANOVA analysis with multiple group comparison. Data are representative mean±standard deviation. Survival curves were analyzed by Log Rank (Mantel-cox) and Grehan-Breslow-Wilcoxon tests. P values are represented as * p<0.05, ** p<0.005, *** p<0.0005, **** p<0.0001 for statistical significance.
Six days after treatment start, tumors are harvested on ice and weighed. On ice, tumor is manually dissected and transferred to RNA later. For processing, samples are thawed on ice and Trizol is used to extract RNA as per manufacturers protocol. RNA is quantified on the Nanodrop with a 260 nm/280 nm ratio of around 2. cDNA synthesis is achieved using the Verso cDNA synthesis kit (Thermo Fisher) following the kit protocol. The Powerup SYBR green kit (Thermo Fisher) was used for the RT-PCR in a 384 well plate on an ABI 7900HT. Primers used are FOXP3 F-ACTCGCATGTTCGCCTACTTCAG and R-GGCGGATGGCATTCTTCCAGGT and β 2-microglobulin F-TTCTGGTGCTTGTCTCACTGA and R-CAGTATGTTCGGCTTCCCATTC. Delta CTs were calculated using SDS2.4 and compared against non treated controls.
Mice were fasted overnight and brought to the imaging facility. Mice were injected with 300-400 uCi (12-15 MBq) in 0.1 ml normal saline [18F] fluoro-2-deoxyglucose (FDG) via tail vein and imaging begins 1 hour after injection. Mice were anesthetized with isoflourane and imaged on an Inveon Multimodality scanner (Siemens). Analysis is performed using either ASIPRO and IRW (both Siemens) dedicated software.
Treated 4T1 tumor bearing mice were sacrificed. Lungs were inflated with 10% India Ink by intra-tracheal injection. Lungs were harvested and washed in 1 L of water before storage in Feket's solution (300 ml 70% EtOH, 30 ml 37% formaldehyde, 5 ml glacial acetic acid) to allow for bleaching of macro-metastases. Metastatic lesions were enumerated by counting.
To test the radiation treatment scheme, six-week-old C57BL/6 mice were inoculated with 3LL subcutaneously in the dorsum of the foot. Tumors were allowed to grow until 50 mm3 before treatment. Tumor size was measured three times a week for the duration of the study. Tumor volume was calculated using an ellipsoid formula: V=(π/6×length×width×height).
The inoculated mice were divided into four treatment groups. The first group received no treatment, the second group received a single dose of 24 Gy, the third group received a single dose of 22 Gy, followed 1 day later by four doses of 0.5 Gy, administered 1 day apart, and the fourth group received four doses of 0.5 Gy, administered 1 day apart, followed 1 day later by a single dose of 22 Gy. Tumor size was measured three times per week, and survival was assessed daily. As shown in
To investigate possible immune effects an additional experiment was performed using immunocompromised C57B16 mice and nude mice, which were split into three groups and treated like the first, second and third groups above. In the C57B16 mice tumor growth in the third group was slower than in the first and second groups, as seen in
To investigate the effect of the radiation treatment on the immune response three different tumor cell lines were used: 1×105 3LL, 2×105 UN-KC-6141, and 4×105 MOE HPV E6/7/H-Ras cells. C57Bl6 mice were inoculated with the cells as above, and mice treated with each cell type were divided into six treatment groups: (1) no treatment, (2) 24 Gy, (3) 20 Gy followed 1 day later by four daily doses of 1 Gy, (4) 22 Gy followed 1 day later by four daily doses of 0.5 Gy, (5) four daily doses of 1 Gy, and (6) four daily doses of 0.5 Gy. Six days after the first treatment the tumors were harvested, and infiltration of leukocytes was analyzed by flow cytometry as described below. Increased infiltration of leukocytes was seen in group 3 compared to the other groups for all cell lines tested, see
To determine whether the radiation schemes above are effective in combination therapies mice were injected with tumor cells as above and treated with Trabectadin alone, 24 Gy and Trabectedin or 22 Gy followed 1 day later with three weekly doses of 0.5 Gy and three weekly Trabectadin doses. Survival and tumor growth were recorded for each group.
A further combination experiment was performed with mice which were inoculated with 4T1 cells into the 4th mammary fat pad. About eight days later the mice were treated as follows:
1. three doses of 20 Gy,
2. three doses of 20 Gy and an anti-PD1 therapeutic,
3. three doses of 20 Gy followed twelve days later by four daily doses of 0.5 Gy (administered to the whole lung), or
4. three doses of 20 Gy and an anti PD1 therapeutic, followed twelve days later by four daily doses of 0.5 Gy (administered to the whole lung) and an anti PD1 therapeutic. The treatment regime is illustrated in
The murine cell line Lewis Lung Carcinoma, 3LL, was purchased from the ATCC and grown in supplemented DMEM (10% FBS, 5% Sodium Pyruvate, 2.5% NEAA, 1% Pen/Strep). The 4T1 Murine Breast Carcinoma was purchased from ATCC and grown in supplemented DMEM (10% FBS, 1% Pen/Strep)
Six-week old C57BL/6 mice were ordered from NCI and maintained under pathogen-free conditions.
Radiation is delivered using Xstrahl's Limited Small Animal Radiation Research Platform(SARRP). Image guided radiation therapy is performed using the SARRPs on-board cone beam CT (CBCT). Following CBCT acquisition, the treatment plan is constructed using Muriplan.
Tumor bearing mice randomized to the immunotherapy treatment groups received 200 ug PD-1 i.p. every three days for a total of 5 doses, αCD40, 4-1BBL or GM-CSF, with or without antigenic vaccination.
Syntac constructs conjugating a T cell co-stimulatory domain 41BBL to antigen specific for the tumor model will be used to induce activated antigen specific effector CD8+ T cells. Tumor bearing mice randomized to syntac receive one 300 ug i.p. treatment. Mice receiving antigen specific syntac treatment are compared to mice treated with an irrelevant syntac or the co-stimulatory domain 4-1BBL alone.
Tumors were harvested on ice and weighed. After manual dissection with razor blades into 1 mm×1 mm pieces, the tumors were transferred to 1 mL Digestion buffer, 5% FBS, Collagenase I and IV at 100 u/mL(Sigma) and 1× DNase 1(Thermo Scientific), in a 15 mL conical tube with a magnetic stir bar. Tubes were incubated at 37° C. for 30 min and transferred to a stir plate for 30 minutes manual digestion. Single cell suspensions were filtered and re-suspended for analysis.
Single cell suspension cells were stained at 4° C. for 30 minutes with surface stain antibodies. After washing, the cells were fixed with 4% PFA or permeabilized for intracellular staining. BD Pharminogen Transcription Factor buffer set as per instructions. Intracellular stains were FOXP3 and Ki-67 followed by fixation with 4% PFA. Cells were collected on the LSRII flow cytometer (BD Biosciences) and analyzed via Flow Jo software (Tree Star).
Immunoflourescence antibodies: Primary antibodies used were CD3, CD8, CD4, CD11b, Gr1 (BD Pharminogen). Secondary antibodies were goat anti-rabbit FITC and goat anti-rat APC (Abcam).
Flow cytometry antibodies: CD45, CD3, CD4, CD8, CD69, PD1, CD11b, Gr1, Ly6C, LY6G, CD11c, NK1.1, NKG2D, MEW II (IA) and F4/80.
Six days after treatment, tumors were harvested on ice and weighed. Being kept on ice, tumors were transferred to 1.7 mL Eppendorf tubes and were homogenized in 4.5 uL PBS with 1× Protease and phosphatase inhibitor(Cell signaling) per milligram of tissue. Tubes were spun down at 14,000 g for 15 minutes. Supernatants were transferred to a clean tube and stored at −80° C.
Vascular Density Quantification with FITC Dextran
Mice were injected with 1×10{circumflex over ( )}5 3LL subcutaneously in the flank. Tumors were allowed to for 14 days to about 6 mm. Mice were randomized to no treatment, 24 Gy day 1, 22 Gy+0.5 Gy×4, or 0.5 Gy×4 starting on day 2. Six days after start of treatment, 70 kDa FITC Dextran(25 mg/mL) was injected intravenously and allowed to circulate for 20 min. Mice were then sacrificed and blood and tumor harvested. Tumors were weighed and incubated overnight with 1.5 mL Collagenase IV at 37 C. Tumors were then homogenized and cell debris spun down at 14000 rpm for 5 min. Supernatants were collected and run at 485/535 for fluorescence. Fluorescence per mg was then calculated. Blood sera was used as an injection control.
While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. It should be understood that various alternatives to the embodiments of the invention described herein may be employed in practicing the invention. It is intended that the following claims define the scope of the invention and that methods and structures within the scope of these claims and their equivalents be covered thereby.
This application claims the benefit of U.S. Provisional Application No. 62/892,273 filed on Aug. 27, 2019, which is incorporated by referenced herein in its entirety.
This invention was made with government support under R01CA22686 (CG),1S100D019961-01 and 1S10RR029545-01, awarded by National Institutes of Health. The government has certain rights in the invention.
Filing Document | Filing Date | Country | Kind |
---|---|---|---|
PCT/US2020/048020 | 8/26/2020 | WO |
Number | Date | Country | |
---|---|---|---|
62892273 | Aug 2019 | US |