There is increasing interest in considering brain tumors as tissues with underlying morphological and molecular organization that can be approached in much the same way as, for example, the subventricular zone of mammalian brain. Towards this end, we have interrogated sections of primary human glioma for antigens relevant for immunotherapy targeting such as IL13Ralpha2 (expressed on tumor cells but not normal brain tissues), and for receptors and signaling molecules relevant to tumor biology (for example HER2, EGFR). Examination of large (centimeter)-scale highresolution (1 um/pixel) images provides evidence for variation in gene expression patterns associated with tumor structure (such as pseudopalisading necrosis) and suggestions of reciprocal spatial expression patterns for some of these antigens. This information will contribute to the design of more effective immunotherapies as well as to our understanding of glioma origins, progression and dissemination. IR-002. TESTING AND ANALYSIS OF FLUORESCENT MARKERS PANEL FOR T-CELLS' MULTIFUNCTIONALITY IN GLIOBLASTOMA MULTIFORME PATIENTS IR-003. CCR41 REGULATORY T CELLS ACCUMULATE WITHIN THE BRAIN TUMOR IN AN EXPERIMENTAL MODEL OF GBMAlan Chang, Derek Wainwright, Mahua Dey, Yu Han, and Maciej Lesniak; University of Chicago, Chicago, IL, USA Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor in adults. One hallmark of GBM is the accumulation of infiltrating regulatory T cells (Tregs), a highly immunosuppressive T cell subset that suppresses T cell-mediated GBM rejection. Previous work has demonstrated that the Treg-recruiting chemokine, CCL22, is expressed by patient-resected GBM. Importantly, the number of Tregs expressing CCR4, the cognate chemokine receptor for CCL22, is increased in the peripheral blood of GBM patients. To investigate the therapeutic potential of targeting the CCL22-CCR4 axis in brain tumors, we systematically-analyzed the level of CCR4-expressing Tregs as well as the mRNA expression level of CCL22 and an additional CCR4-specific chemokine, CCL17. Using the orthotopic GL261 cell-based model, we found a progressive accumulation of CCR4+ Tregs in the brain tumor. Coincidently, the expression of the Treg-recruiting chemokines, CCL17 and CCL22, was predominantly localized to the tumor-infiltrating leukocytes, rather than the tumor tissue itself. Interestingly, CCL17, but not CCL22, was also expressed by both tumor and non-tumor cells in the brain. These results implicate the chemokine receptor CCR4 as a therapeutic target for further investigation as a potential strategy to target Treg trafficking to GBM.
Respecting the preference for a place of care is essential for advance care planning in patients with advanced cancer. This retrospective study included adult patients with cancer referred to an inpatient palliative care consultation team at a tertiary acute care hospital in South Korea between April 2019 and December 2020. Patients’ preference for place of care and demographic and clinical factors were recorded, and the actual discharge locations were categorized as home or non-home. Patients discharged home but with unintended hospital visits within 2 months were also investigated. Of the 891 patients referred to the palliative care consultation team, 210 (23.6%) preferred to be discharged home. Among them, 113 (53.8%) were discharged home. No significant differences were found between patients who preferred home discharge and those who did not. Home discharge was higher among female patients (p = 0.04) and lower in those with poor oral intake (p < 0.001) or dyspnea (p = 0.02). Of the 113 patients discharged home, 37 (32.8%) had unintended hospital visits within 2 months. Approximately one-quarter of hospitalized patients with advanced cancer preferred to be discharged home, but only half of them received the home discharge. To meet patients’ preferences for end-of-life care, individual care planning considering relevant factors is necessary.
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