102. Angiotensin System Inhibitors are Associated with Improved Survival in Locally Advanced NSCLC and Exhibit Anti-tumor Synergism with Chemotherapy in a Murine Model of NSCLC

*Patricia Thistlethwaite Invited Discussant
University of California, San Diego
La Jolla, CA 
United States
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Patricia A. Thistlethwaite M.D.-Ph.D. is a Professor of Surgery in the Division of Cardiothoracic Surgery at the University of California, San Diego. She is a magna cum laude graduate of the Harvard Medical School. She completed her general surgery training at the Massachusetts General Hospital and cardiothoracic surgery training at the University of Pittsburgh.  Dr. Thistlethwaite served as the first woman President of the Western Thoracic Surgical Association from 2018-2019.  She is the first woman Program Director in Cardiothoracic Surgery in the United States. 

Dr. Thistlethwaite’s clinical interests span the full range of thoracic surgery, including minimally-invasive lung surgery and mediastinal surgery, lung transplantation, and chest wall surgery. She has been a Castle Connolly Top Doctor and Exceptional Woman in Medicine for the past 18 years.  

Dr. Thistlethwaite is considered a leading researcher in the field of pulmonary hypertension. Her molecular biology lab has been continuously funded by NIH R01 grants for 23 years. In 2017, Dr. Thistlethwaite was awarded the Honorary Knowledge and Discovery Award (top 5% of researchers in the U.S.) from the American Health Council and invested as an honorary member of the Royal College of Physicians in London. She has spoken at invited lectures in the United States, Europe, South America, and the far East. Her research publications have included articles in Nature Medicinethe New England Journal of MedicineProceedings of the National Academy of Science, and Circulation.    

Dr. Thistlethwaite’s national recognition has led to leadership roles in the American Heart Association, Thoracic Surgery Directors Association, Fleischner Society, Women in Thoracic Surgery, and Pulmonary Vascular Research Institute. She is Managing Editor of the journal, Pulmonary Circulation. She is the author of over 140 peer-reviewed papers and book chapters.

*Michael Lanuti Abstract Presenter
Harvard University
Boston, MA 
United States
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After receiving a Bachelor of Science in Bioengineering from the University of Pennsylvania, Dr. Lanuti received his M.D. degree from the University of Pennsylvania School of Medicine. He completed his internship and residency in Surgery at the Hospital of the University of Pennsylvania and a two year research fellowship in a Thoracic Oncology Laboratory focusing on novel treatments (gene therapy) for lung cancer. He completed a Cardiothoracic Fellowship at the Massachusetts General Hospital. He has been on staff in the Division of Thoracic Surgery since 2004, and holds a parallel appointment as Associate Professor of Surgery at Harvard Medical School. He has been the Friedman-Lambert Scholar in Academic Thoracic Surgery at MGH/HMS since 2004.  He is the Director of Thoracic Oncology for the Division of Thoracic Surgery and the Thoracic Surgery liaison to the MGH Cancer Center.  Clinical interests include minimally invasive surgery for lung cancer, complex airway tumors, multimodality treatment of esophageal cancer, mediastinal tumors,  thermal ablation of lung tumors. 

Sunday, May 7, 2023: 7:30 AM - 7:45 AM
15 Minutes 
Los Angeles Convention Center 
Room: 408B 

Abstract

Objective: Several studies suggest that angiotensin system inhibitors can potentiate anti-tumor strategies in solid tumors. We investigated angiotensin system inhibitors (ASI) on outcomes in patients with locally advanced non-small cell lung cancer (NSCLC) and performed translational studies to elucidate anti-tumor mechanism in a murine model of NSCLC.

Methods: Survival outcomes of patients (N=125) diagnosed with clinical stage IIIA NSCLC treated with chemoradiotherapy followed by surgery (2009-2015) were correlated with ASI use in a single institutional cohort. To assess anti-tumor efficacy of ASI's, cell culture models of lung cancer were treated with Losartan or combination Losartan and Cisplatin in vitro and then applied to in vivo models. Mechanism was assessed with markers of endothelial-mesenchymal transition (EMT) or surrogates of other signalling pathways.

Results: In a cohort of 125 patents treated stage IIIA NSCLC, overall survival of ASI users (n=99) were compared to ASI non users (n=26). On multivariate analysis ASI use was independently associated with improved overall survival (p =0.047, HR 0.324). Further exploration at the bench with Losartan (≥0.5μM) significantly inhibited proliferation and migration of multiple human lung cancer cells in vitro including H441, H358, H1299, SW1573 and also in a syngeneic murine lung cancer cell line, TC-1. The combination of Losartan and Cisplatin significantly improved the cytotoxic effect of cisplatin (H441 p 0.043, H358 p 0.044, H1299 p 0.046, SW1573 p 0.020, TC-1 p 0.012) and significantly reduced the tumor volume of implanted subcutaneous tumors (SW1573-Nude mice, p=0.045; TC-1-C57BL/6 mice, p=0.001) in a murine flank model. Combination treatment significantly inhibited EMT and down-regulated the expression of AKT, Stat3, and PD-L1.

Conclusions: ASI use was associated with improved overall survival in a cohort of stage IIIA NSCLC . Losartan enhances the cytotoxic effect of chemotherapy in a dose dependent fashion in a murine model of NSCLC by attenuating the EMT pathway. This study suggests an important role for ASI therapy as an adjunct in the multi-modality cytotoxic treatment of lung cancer.

Presentation Duration

7 minute presentation; 7 minute discussion 

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