Publications by authors named "Charlotte L Zuur"

Article Synopsis
  • - Mucosal melanoma (MucM) is a rare and aggressive form of cancer that responds poorly to immune checkpoint inhibition (ICI), especially when compared to cutaneous melanoma (CM).
  • - Analysis of 101 MucM tumors revealed lower levels of the immune marker IFN-γ and indicated that head and neck MucM had more immune cells and higher IFN-γ levels than MucM from other body sites.
  • - The study found that immune features differed across tumor locations, with immune-infiltrated tumors showing potential resistance mechanisms to ICI, highlighting the need for personalized treatment approaches for MucM.
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Background: Concomitant high-dose cisplatin with radiotherapy is commonly used for treating head and neck squamous cell carcinoma (HNSCC). Cisplatin, often used with radiotherapy, is known for causing irreversible sensorineural hearing loss, with individual variability suggesting a genetic component. This study aims to enhance the predictive ability of the clinical prediction model for cisplatin-induced hearing loss (CIHL) in HNSCC patients, as outlined in Theunissen et al.

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Introduction: Patients with head and neck squamous cell carcinoma (HNSCC) treated with cisplatin-based chemoradiotherapy (CRT) frequently experience irreversible sensorineural hearing loss (SNHL). Patients with low lumbar skeletal muscle index (LSMI) may experience higher serum peak dosages of cisplatin. This study investigated whether pre-treatment low LSMI is associated with increased SNHL upon cisplatin-based CRT.

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The efficacy of anthracycline-based chemotherapeutics, which include doxorubicin and its structural relatives daunorubicin and idarubicin, remains almost unmatched in oncology, despite a side effect profile including cumulative dose-dependent cardiotoxicity, therapy-related malignancies and infertility. Detoxifying anthracyclines while preserving their anti-neoplastic effects is arguably a major unmet need in modern oncology, as cardiovascular complications that limit anti-cancer treatment are a leading cause of morbidity and mortality among the 17 million cancer survivors in the U.S.

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Article Synopsis
  • In a study comparing neoadjuvant (before surgery) and adjuvant (after surgery) immunotherapy for stage III melanoma, neoadjuvant treatment showed greater effectiveness.
  • The trial involved random assignment of 423 patients to receive either two cycles of neoadjuvant ipilimumab plus nivolumab followed by surgery, or surgery followed by 12 cycles of adjuvant nivolumab.
  • Results indicated a significantly higher 12-month event-free survival rate in the neoadjuvant group (83.7%) compared to the adjuvant group (57.2%), with neoadjuvant therapy leading to better patient outcomes and more major pathological responses despite a higher incidence of severe adverse events.
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Article Synopsis
  • Microbial communities in the human body play a crucial role in regulating the immune system and responses to cancer treatments, with complex communities found within primary tumors.
  • A comprehensive study involving 4,160 metastatic tumor biopsies revealed specific microbial patterns in different organs, higher levels of anaerobic bacteria in low-oxygen tumors, and links between microbial diversity and immune cell activity.
  • The research also highlighted the role of certain bacteria, like Fusobacterium, in cancer resistance and showed how microbial communities change over time with treatment, creating valuable data for improving cancer treatment approaches.
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Immune checkpoint inhibitors (ICI) can achieve remarkable responses in urothelial cancer (UC), which may depend on tumor microenvironment (TME) characteristics. However, the relationship between the TME, usually characterized by immune cell density, and response to ICI is unclear. Here, we quantify the TME immune cell densities and spatial relationships (SRs) of 24 baseline UC samples, obtained before pre-operative combination ICI treatment, using multiplex immunofluorescence.

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CD4 T cells can "help" or "license" conventional type 1 dendritic cells (cDC1s) to induce CD8 cytotoxic T lymphocyte (CTL) anticancer responses, as proven in mouse models. We recently identified cDC1s with a transcriptomic imprint of CD4 T-cell help, specifically in T-cell-infiltrated human cancers, and these cells were associated with a good prognosis and response to PD-1-targeting immunotherapy. Here, we delineate the mechanism of cDC1 licensing by CD4 T cells in humans.

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Article Synopsis
  • Salivary gland cancers (SGCs) are rare and aggressive, often lacking effective treatments when they spread, prompting a phase 2 trial of nivolumab and ipilimumab in 64 metastatic SGC patients.
  • Results showed some success in "other SGCs" cohort (16% response) but limited efficacy in adenoid cystic carcinoma (6% response), with notable adverse events occurring in 38% of patients.
  • Genetic and immune cell analyses indicated that responding tumors had active T cell responses and certain neoantigens, suggesting a potential path for treatment in non-ACC SGCs like salivary duct carcinomas.
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Article Synopsis
  • Recurrent and metastatic head and neck squamous cell carcinoma (HNSCC) has poor survival rates and limited effectiveness of immune checkpoint blockade (ICB) therapies, with current biomarkers like tumor mutational burden (TMB) offering only modest predictive value.
  • A study of 133 ICB-treated patients identified 6 distinct molecular subtypes of HNSCC tumors, which showed varied response rates to treatment and were separately validated in another patient group.
  • Researchers developed a predictive model using clinical and genomic features that more accurately forecasted patient outcomes compared to TMB alone, establishing a tool that can improve risk stratification for patients eligible for ICB treatment.
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Unlabelled: To dissect the effect of neoadjuvant PD-1 and CTLA4 blockade on intratumoral T cells in treatment-naive head and neck squamous cell carcinoma, we analyzed primary tumor immune infiltrates from responding and nonresponding patients. At baseline, a higher ratio between active (4-1BB/OX40+) and inactive regulatory CD4+ T cells was associated with immunotherapy response. Furthermore, upon therapy, this active regulatory T-cell (Treg) population showed a profound decrease in responding patients.

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Background: Although cutaneous squamous cell carcinoma (cSCC) is common, lymph node metastases are relatively rare and are usually treated with lymph node dissection (LND). The aim of this study was to describe the clinical course and prognosis after LND for cSCC at all anatomical locations.

Methods: A retrospective search at three centres was performed to identify patients with lymph node metastases of cSCC who were treated with LND.

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Background: Neoadjuvant systemic therapy has shown promising results in the treatment of high-risk stage III melanoma; however, the effects on surgery are currently unknown. This study aims to compare the surgical outcomes, in terms of postoperative complications, postoperative morbidity, duration of surgery and textbook outcomes, of patients with high-risk stage III melanoma who received neoadjuvant systemic therapy followed by lymph node dissection with patients who received an upfront lymph node dissection.

Methods: In this retrospective cohort study, patients with high-risk stage III melanoma treated with neoadjuvant anti-PD1 and anti-CTLA4 in the OpACIN (NCT02437279) and OpACIN-neo (NCT02977052) trial between October 2014 and August 2018 were included and compared to patients who received upfront surgery in the same time period.

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Article Synopsis
  • Mucosal melanoma (MM) is a rare and aggressive cancer, with the study examining its incidence and survival trends in the Netherlands from 1990-2019, amidst advancements in treatment options for melanoma.
  • The research found that 1496 cases were diagnosed, predominantly in women and often at an advanced stage, with a consistent incidence rate and a 5-year overall survival (OS) rate of only 24%.
  • While immune and targeted therapies have improved outcomes for MM patients, they still face a worse prognosis compared to those with cutaneous melanoma (CM), highlighting the need for further research to enhance treatment effectiveness.
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Wound healing is a complex biological process subject to complications that might jeopardize the patient's postoperative care. Appropriately approaching surgical wounds after head and neck surgery positively influences the quality and speed of wound healing and increases patient comfort. A large variety of dressing materials currently exist that allow the care of different types of wounds.

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Background: Merkel cell carcinoma (MCC) is a cutaneous tumor with a high tendency to metastasize, and a significant proportion of patients have metastases at first presentation. This study aims to determine the value of baseline ultrasound (US) and  fluorodeoxyglucose-positron emission tomography/computed tomography ( FDG-PET/CT) imaging in both patients with clinically localized MCC (Stage I/II) and patients who present with palpable lymph nodes (Stage III).

Methods: This retrospective cohort included 135 MCC patients who underwent baseline US (with fine needle aspiration cytology (FNAC)) and/or FDG-PET/CT imaging between 2015 and 2021.

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Background: Neoadjuvant immune checkpoint blockade (ICB) prior to surgery may induce early pathological responses in head and neck squamous cell carcinoma (HNSCC) patients. Routine imaging parameters fail to diagnose these responses early on. Magnetic resonance (MR) diffusion-weighted imaging (DWI) has proven to be useful for detecting HNSCC tumor mass after (chemo)radiation therapy.

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Purpose: The frequency and patterns of HL in a HNRMS survivor cohort were investigated. A dose-effect relationship between the dose to the cochlea and HL was explored.

Methods: Dutch survivors treated for HNRMS between 1993 and 2017 with no relapse and at least two years after the end of treatment were eligible for inclusion.

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Talimogene laherparepvec (T-VEC) is a modified herpes simplex virus, type 1, intralesionally administered in patients with stage IIIB/C-IVM1a unresectable melanoma. When surgery is not a treatment option in the head and neck region, T-VEC can be an elegant alternative to systemic immunotherapy. Ten patients with metastatic melanoma in the head and neck region started treatment with T-VEC monotherapy at the Netherlands Cancer Institute.

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Neoadjuvant ipilimumab and nivolumab induces high pathologic response rates (pRRs) in clinical stage III nodal melanoma, and pathologic response is strongly associated with prolonged relapse-free survival (RFS). The PRADO extension cohort of the OpACIN-neo trial ( NCT02977052 ) addressed the feasibility and effect on clinical outcome of using pathologic response after neoadjuvant ipilimumab and nivolumab as a criterion for further treatment personalization. In total, 99 patients with clinical stage IIIb-d nodal melanoma were included and treated with 6 weeks of neoadjuvant ipilimumab 1 mg kg and nivolumab 3 mg kg.

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Single-agent Talimogene Laherparepvec (T-VEC) was developed for treatment of unresectable and injectable stage III-IV melanoma. Since its approval and reimbursement, studies have reported varying response rates. The purpose of this systematic review and meta-analysis was to investigate the efficacy and safety of T-VEC.

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Importance: Neoadjuvant checkpoint inhibition in patients with high-risk stage III melanoma shows high pathologic response rates associated with a durable relapse-free survival. Whether a therapeutic lymph node dissection (TLND) can be safely omitted when a major pathologic response in the largest lymph node metastasis at baseline (index lymph node; ILN) is obtained is currently being investigated. A previous small pilot study (n = 12) showed that the response in the ILN may be representative of the pathologic response in the entire TLND specimen.

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Exciting advances in melanoma systemic therapies have presented the opportunity for surgical oncologists and their multidisciplinary colleagues to test the neoadjuvant systemic treatment approach in high-risk, resectable metastatic melanomas. Here we describe the state of the science of neoadjuvant systemic therapy (NAST) for melanoma, focusing on the surgical aspects and the key role of the surgical oncologist in this treatment paradigm. This paper summarizes the past decade of developments in melanoma treatment and the current evidence for NAST in stage III melanoma specifically.

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Purpose: To investigate the utility of [F]FDG-PET as an imaging biomarker for pathological response early upon neoadjuvant immune checkpoint blockade (ICB) in patients with head and neck squamous cell carcinoma (HNSCC) before surgery.

Methods: In the IMCISION trial (NCT03003637), 32 patients with stage II‒IVb HNSCC were treated with neoadjuvant nivolumab with (n = 26) or without (n = 6) ipilimumab (weeks 1 and 3) before surgery (week 5). [F]FDG-PET/CT scans were acquired at baseline and shortly before surgery in 21 patients.

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