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Liu B, Lam V, Pachman D, Ruddy K, Burke O, Lingamaneni P, Yu Y, Jiang G, Cheville A, Leventakos K. 50P Patient-reported outcomes in non-small cell lung cancer patients receiving immunotherapy monotherapy: Analysis from enhanced, EHR-facilitated cancer symptom control (E2C2) pragmatic clinical trial. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00304-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Lam V, Hu KM. Management of COVID-19 Infection in Pregnancy. Emerg Med Clin North Am 2022; 41:307-322. [PMID: 37024166 PMCID: PMC9755010 DOI: 10.1016/j.emc.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Although the majority of pregnant patients who contract severe acute respiratory syndrome coronavirus 2 will have a mild course of illness, pregnant patients with coronavirus disease-2019 are more likely than their nonpregnant counterparts to develop a severe illness with an increased risk of poor maternal and fetal outcomes. Although the extent of research in this specific patient population remains limited, there are tenets of care with which physicians and other providers must be familiar to increase the chances of better outcomes for the two patients in their care.
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Scott S, Hu C, Smith K, Anagnostou V, Lee J, Spicer J, Illei P, Prophet E, Rosner S, Ettinger D, Feliciano J, Hann C, Lam V, Levy B, Murray J, Brahmer J, Forde P, Marrone K. EP02.04-007 Phase 2 Trial of Neoadjuvant KRASG12C Directed Therapy with Adagrasib (MRTX849) With or Without Nivolumab in Resectable NSCLC (Neo-KAN). J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rosner S, Zaidi N, Wang H, Smith K, Nauroth J, Guo M, Fitzpatrick P, Riemer J, Barnes A, Wenga P, Feliciano J, Hann C, Lam V, Murray J, Scott S, Anagnostou V, Levy B, Forde P, Brahmer J, Jaffee E, Marrone K. EP08.01-086 Pooled Mutant KRAS-Targeted Peptide Vaccine with Nivolumab and Ipilimumab in Advanced KRAS Mutated Non-Small Cell Lung Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Wong ML, Shi Y, Smith AK, Miaskowski C, Boscardin WJ, Cohen HJ, Lam V, Mazor M, Metzger L, Presley CJ, Williams GR, Loh KP, Ursem CJ, Friedlander TW, Blakely CM, Gubens MA, Allen G, Shumay D, Walter LC. Changes in older adults' life space during lung cancer treatment: A mixed methods cohort study. J Am Geriatr Soc 2022; 70:136-149. [PMID: 34611887 PMCID: PMC8742783 DOI: 10.1111/jgs.17474] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/11/2021] [Accepted: 08/20/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Maintenance of function during cancer treatment is important to older adults. Characteristics associated with pretreatment life-space mobility and changes during non-small cell lung cancer (NSCLC) treatment remain unknown. METHODS This mixed methods cohort study recruited adults age ≥65 with advanced NSCLC starting palliative chemotherapy, immunotherapy, and/or targeted therapy from a Comprehensive Cancer Center, Veterans Affairs, and safety-net clinic. Patients completed geriatric assessments including Life-Space Assessment (LSA) pretreatment and at 1, 2, 4, and 6 months after treatment initiation. LSA scores range from 0 to 120 (greater mobility); LSA <60 is considered restricted. We used mixed-effects models to examine pretreatment LSA, change from 0 to 1 month, and change from 1 to 6 months. A subgroup participated in semistructured interviews pretreatment and at 2 and 6 months to understand the patient experience of life-space change. For each interview participant, we created joint displays of longitudinal LSA scores juxtaposed with illustrative quotes. RESULTS Among 93 patients, median age was 73 (range 65-94). Mean pretreatment LSA score was 67.1. On average, LSA declined 10.1 points from pretreatment to 1 month and remained stable at 6 months. Pretreatment LSA score was associated with several demographic, clinical, geriatric assessment, and symptom characteristics. LSA decline at 1 month was greater among patients with high anxiety (slope = -12.6 vs. -2.3, p = 0.048). Pretreatment body mass index <21 kg/m2 was associated with LSA improvement from 1 to 6 months (slope = 4.1 vs. -0.04, p = 0.003). Joint displays illustrated the impact of different life-space trajectories on patients' lives in their words. CONCLUSION Older adults with NSCLC have low pretreatment life space with many developing restricted life space during treatment. Incorporating life-space assessments into clinical cancer care may help older adults concretely visualize how treatment might impact their daily function to allow for informed decision making and identify early changes in mobility to implement supportive interventions.
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Melese ES, Franks E, Cederberg RA, Harbourne BT, Shi R, Wadsworth BJ, Collier JL, Halvorsen EC, Johnson F, Luu J, Oh MH, Lam V, Krystal G, Hoover SB, Raffeld M, Simpson RM, Unni AM, Lam WL, Lam S, Abraham N, Bennewith KL, Lockwood WW. CCL5 production in lung cancer cells leads to an altered immune microenvironment and promotes tumor development. Oncoimmunology 2021; 11:2010905. [PMID: 35481284 PMCID: PMC9038050 DOI: 10.1080/2162402x.2021.2010905] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Current immunotherapies for lung cancer are only effective in a subset of patients. Identifying tumor-derived factors that facilitate immunosuppression offers the opportunity to develop novel strategies to supplement and improve current therapeutics. We sought to determine whether expression of driver oncogenes in lung cancer cells affects cytokine secretion, alters the local immune environment, and influences lung tumor progression. We demonstrate that oncogenic EGFR and KRAS mutations, which are early events in lung tumourigenesis, can drive cytokine and chemokine production by cancer cells. One of the most prominent changes was in CCL5, which was rapidly induced by KRASG12V or EGFRL858R expression, through MAPK activation. Immunocompetent mice implanted with syngeneic KRAS-mutant lung cancer cells deficient in CCL5 have decreased regulatory T cells (Tregs), evidence of T cell exhaustion, and reduced lung tumor burden, indicating tumor-cell CCL5 production contributes to an immune suppressive environment in the lungs. Furthermore, high CCL5 expression correlates with poor prognosis, immunosuppressive regulatory T cells, and alteration to CD8 effector function in lung adenocarcinoma patients. Our data support targeting CCL5 or CCL5 receptors on immune suppressive cells to prevent formation of an immune suppressive tumor microenvironment that promotes lung cancer progression and immunotherapy insensitivity.
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Beyer A, Lam V, Fagel B, Dong S, Hebert C, Wallace C, Theyyunni N, Tucker R, Cover M, Kessler R, Cranford JA, Huang R, Majkrzak AA, Seleno NR, Fung CM. Undifferentiated Dyspnea with Point-of-Care Ultrasound, Primary Emergency Physician Compared with a Dedicated Emergency Department Ultrasound Team. J Emerg Med 2021; 61:278-292. [PMID: 34348868 DOI: 10.1016/j.jemermed.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/07/2021] [Accepted: 03/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Emergency physicians (EPs) perform critical actions while operating with diagnostic uncertainty. Point-of-care ultrasound (POCUS) is useful in evaluation of dyspneic patients. In prior studies, POCUS is often performed by ultrasound (US) teams without patient care responsibilities. OBJECTIVES This study evaluates the effectiveness of POCUS in narrowing diagnostic uncertainty in dyspneic patients when performed by treating EPs vs. separate US teams. METHODS This multicenter, prospective noninferiority cohort study investigated the effect of a POCUS performing team in patient encounters for dyspnea. Before-and-after surveys assessing medical decision-making were administered to attending physicians. Primary outcome was change in most likely diagnosis after POCUS. This was assessed for noninferiority between encounters where the primary or US team performed POCUS. Secondary outcomes included change in differential diagnosis, confidence in diagnosis, interventions considered, and image quality. RESULTS There were 156 patient encounters analyzed. In the primary team group, most likely diagnosis changed in 40% (95% confidence interval 28-52%) of encounters vs. 32% (95% confidence interval 22-41%) in the US team group. This was noninferior using an a priori specified margin of 20% (p < .0001). Post-POCUS differential decreased by a mean 1.8 diagnoses and was equivalent within a margin of 0.5 diagnoses between performing teams (p = 0.034). Other outcomes were similar between groups. CONCLUSION POCUS performed by primary teams was noninferior to POCUS performed by US teams for changing the most likely diagnosis, and equivalent when considering mean reduction in number of diagnoses. POCUS performed by treating EPs reduces cognitive burden in dyspneic patients.
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Chan WL, Choi HCW, Ho PPY, Lau JKS, Tse RPY, Au J, Lam V, Liu R, Ho I, Wong C, Cheung B, Lam E, Chow D, Lam KO, Yuen KK, Kwong DLW. Immune-Related Endocrine Dysfunctions in Combined Modalities of Treatment: Real-World Data. Cancers (Basel) 2021; 13:cancers13153797. [PMID: 34359698 PMCID: PMC8345182 DOI: 10.3390/cancers13153797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/16/2021] [Accepted: 07/25/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary Immune-checkpoint inhibitors (ICI) have been increasingly used in the management of various types of cancers. More studies and guidelines also recommended the combination of ICI with other anti-cancer agents to improve the efficacy and treatment outcome. This retrospective study showed that the combination of ICI and targeted agents increased the risk of immune-related endocrine dysfunction and hypothyroidism. Moreover, older patients on ICI had a higher risk of immune-related diabetes mellitus. ICI is safe and well-tolerated regardless of age, but close monitoring of fasting glucose is essential in older populations. Abstract The number of immune-related endocrine dysfunctions (irEDs) has concurrently increased with the widespread use of immunotherapy in clinical practice and further expansion of the approved indications for immune checkpoint inhibitor (ICI) in cancer management. A retrospective analysis was conducted on consecutive patients ≥18 years of age with advanced solid malignancies who had received at least one dose of anti-programmed cell death protein 1 (anti-PD-1) and/or anti-CTLA4 antibodies between January 2014 and December 2019 at a university hospital in Hong Kong. Patients were reviewed up to two months after the last administration of an ICI. The types, onset times and grades of irEDs, including hypothyroidism, hyperthyroidism, adrenal insufficiency and immune-related diabetes mellitus, were recorded. Factors associated with irEDs were identified using multivariate analysis. A total of 953 patients (male: 603, 64.0%; median age: 62.0 years) were included. Of these, 580 patients (60.9%) used ICI-alone, 132 (13.9%) used dual-ICI, 187 (19.6%) used an ICI combined with chemotherapy (chemo + ICI), and 54 (5.70%) used immunotherapy with a targeted agent (targeted + ICI). A significantly higher proportion of patients using targeted + ICI had irEDs and hypothyroidism; in contrast, a higher proportion of patients using dual-ICI had adrenal insufficiency. There was no significant difference in the incidence of irED between the younger (<65 years) and older (≥65 years) patients. Using logistic regression, only treatment type was significantly associated with irEDs. Notably, older patients had a higher risk of having immune-related diabetes mellitus. This large, real-world cohort demonstrates that targeted + ICI has a higher risk of overall irED and hypothyroidism. Immunotherapy is safe and well-tolerated regardless of age, but close monitoring of fasting glucose is essential in older populations.
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Evans CJ, Olson JM, Mondal BC, Kandimalla P, Abbasi A, Abdusamad MM, Acosta O, Ainsworth JA, Akram HM, Albert RB, Alegria-Leal E, Alexander KY, Ayala AC, Balashova NS, Barber RM, Bassi H, Bennion SP, Beyder M, Bhatt KV, Bhoot C, Bradshaw AW, Brannigan TG, Cao B, Cashell YY, Chai T, Chan AW, Chan C, Chang I, Chang J, Chang MT, Chang PW, Chang S, Chari N, Chassiakos AJ, Chen IE, Chen VK, Chen Z, Cheng MR, Chiang M, Chiu V, Choi S, Chung JH, Contreras L, Corona E, Cruz CJ, Cruz RL, Dang JM, Dasari SP, De La Fuente JRO, Del Rio OMA, Dennis ER, Dertsakyan PS, Dey I, Distler RS, Dong Z, Dorman LC, Douglass MA, Ehresman AB, Fu IH, Fua A, Full SM, Ghaffari-Rafi A, Ghani AA, Giap B, Gill S, Gill ZS, Gills NJ, Godavarthi S, Golnazarian T, Goyal R, Gray R, Grunfeld AM, Gu KM, Gutierrez NC, Ha AN, Hamid I, Hanson A, Hao C, He C, He M, Hedtke JP, Hernandez YK, Hlaing H, Hobby FA, Hoi K, Hope AC, Hosseinian SM, Hsu A, Hsueh J, Hu E, Hu SS, Huang S, Huang W, Huynh M, Javier C, Jeon NE, Ji S, Johal J, John A, Johnson L, Kadakia S, Kakade N, Kamel S, Kaur R, Khatra JS, Kho JA, Kim C, Kim EJK, Kim HJ, Kim HW, Kim JH, Kim SA, Kim WK, Kit B, La C, Lai J, Lam V, Le NK, Lee CJ, Lee D, Lee DY, Lee J, Lee J, Lee J, Lee JY, Lee S, Lee TC, Lee V, Li AJ, Li J, Libro AM, Lien IC, Lim M, Lin JM, Liu CY, Liu SC, Louie I, Lu SW, Luo WY, Luu T, Madrigal JT, Mai Y, Miya DI, Mohammadi M, Mohanta S, Mokwena T, Montoya T, Mould DL, Murata MR, Muthaiya J, Naicker S, Neebe MR, Ngo A, Ngo DQ, Ngo JA, Nguyen AT, Nguyen HCX, Nguyen RH, Nguyen TTT, Nguyen VT, Nishida K, Oh SK, Omi KM, Onglatco MC, Almazan GO, Paguntalan J, Panchal M, Pang S, Parikh HB, Patel PD, Patel TH, Petersen JE, Pham S, Phan-Everson TM, Pokhriyal M, Popovich DW, Quaal AT, Querubin K, Resendiz A, Riabkova N, Rong F, Salarkia S, Sama N, Sang E, Sanville DA, Schoen ER, Shen Z, Siangchin K, Sibal G, Sin G, Sjarif J, Smith CJ, Soeboer AN, Sosa C, Spitters D, Stender B, Su CC, Summapund J, Sun BJ, Sutanto C, Tan JS, Tan NL, Tangmatitam P, Trac CK, Tran C, Tran D, Tran D, Tran V, Truong PA, Tsai BL, Tsai PH, Tsui CK, Uriu JK, Venkatesh S, Vo M, Vo NT, Vo P, Voros TC, Wan Y, Wang E, Wang J, Wang MK, Wang Y, Wei S, Wilson MN, Wong D, Wu E, Xing H, Xu JP, Yaftaly S, Yan K, Yang E, Yang R, Yao T, Yeo P, Yip V, Yogi P, Young GC, Yung MM, Zai A, Zhang C, Zhang XX, Zhao Z, Zhou R, Zhou Z, Abutouk M, Aguirre B, Ao C, Baranoff A, Beniwal A, Cai Z, Chan R, Chien KC, Chaudhary U, Chin P, Chowdhury P, Dalie J, Du EY, Estrada A, Feng E, Ghaly M, Graf R, Hernandez E, Herrera K, Ho VW, Honeychurch K, Hou Y, Huang JM, Ishii M, James N, Jang GE, Jin D, Juarez J, Kesaf AE, Khalsa SK, Kim H, Kovsky J, Kuang CL, Kumar S, Lam G, Lee C, Lee G, Li L, Lin J, Liu J, Ly J, Ma A, Markovic H, Medina C, Mungcal J, Naranbaatar B, Patel K, Petersen L, Phan A, Phung M, Priasti N, Ruano N, Salim T, Schnell K, Shah P, Shen J, Stutzman N, Sukhina A, Tian R, Vega-Loza A, Wang J, Wang J, Watanabe R, Wei B, Xie L, Ye J, Zhao J, Zimmerman J, Bracken C, Capili J, Char A, Chen M, Huang P, Ji S, Kim E, Kim K, Ko J, Laput SLG, Law S, Lee SK, Lee O, Lim D, Lin E, Marik K, Mytych J, O'Laughlin A, Pak J, Park C, Ryu R, Shinde A, Sosa M, Waite N, Williams M, Wong R, Woo J, Woo J, Yepuri V, Yim D, Huynh D, Wijiewarnasurya D, Shapiro C, Levis-Fitzgerald M, Jaworski L, Lopatto D, Clark IE, Johnson T, Banerjee U. A functional genomics screen identifying blood cell development genes in Drosophila by undergraduates participating in a course-based research experience. G3-GENES GENOMES GENETICS 2021; 11:6127131. [PMID: 33561251 PMCID: PMC8022729 DOI: 10.1093/g3journal/jkaa028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/06/2020] [Indexed: 11/13/2022]
Abstract
Undergraduate students participating in the UCLA Undergraduate Research Consortium for Functional Genomics (URCFG) have conducted a two-phased screen using RNA interference (RNAi) in combination with fluorescent reporter proteins to identify genes important for hematopoiesis in Drosophila. This screen disrupted the function of approximately 3500 genes and identified 137 candidate genes for which loss of function leads to observable changes in the hematopoietic development. Targeting RNAi to maturing, progenitor, and regulatory cell types identified key subsets that either limit or promote blood cell maturation. Bioinformatic analysis reveals gene enrichment in several previously uncharacterized areas, including RNA processing and export and vesicular trafficking. Lastly, the participation of students in this course-based undergraduate research experience (CURE) correlated with increased learning gains across several areas, as well as increased STEM retention, indicating that authentic, student-driven research in the form of a CURE represents an impactful and enriching pedagogical approach.
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Elisia I, Hay M, Cho B, Yeung M, Kowalski S, Wong J, Lam V, Larsen M, Krystal G. Low carbohydrate diets containing soy protein and fish oil slow the growth of established NNK-induced lung tumors. Carcinogenesis 2021; 41:1083-1093. [PMID: 32215551 DOI: 10.1093/carcin/bgaa028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/03/2020] [Accepted: 03/23/2020] [Indexed: 12/13/2022] Open
Abstract
We recently found that a diet composed of 15% of total calories as carbohydrate (CHO), primarily as amylose, 35% soy protein and 50% fat, primarily as fish oil (FO) (15%Amylose/Soy/FO) was highly effective at preventing lung nodule formation in a nicotine-derived nitrosamine ketone (NNK)-induced lung cancer model. We asked herein whether adopting such a diet once cancers are established might also be beneficial. To test this, NNK-induced lung nodules were established in mice on a Western diet and the mice were then either kept on a Western diet or switched to various low CHO diets. Since we previously found that sedentary mice develop more lung nodules than active mice, we also compared the effect of exercise in this cancer progression model. We found that switching to a 15%Amylose/Soy/FO diet reduced lung nodules and slowed tumor growth with both 'active' and 'sedentary' mice. Ki67, cleaved caspase 3 and Terminal Deoxynucleotidyl Transferase-Mediated dUTP Nick End Labeling assays suggested that the efficacy of the 15%Amylose/Soy/FO in lowering tumor nodule count and size was not due to a reduction in tumor cell proliferation, but to an increase in apoptosis. The 15%Amylose/Soy/FO diet also significantly lowered liver fatty acid synthase and 6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3 expression, pointing to a global metabolic switch from glycolysis to fatty acid oxidation. Mice fed the 15%Amylose/Soy/FO diet also had significantly reduced plasma levels of interleukin (IL)-1β, IL-6 and tumor necrosis factor α. These results suggest that the 15%Amylose/Soy/FO diet may slow tumor growth by suppressing proinflammatory cytokines, inducing a metabolic switch away from glycolysis and inducing apoptosis in tumors.
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Loh KP, Lam V, Webber K, Padam S, Sedrak MS, Musinipally V, Grogan M, Presley CJ, Grandi J, Sanapala C, Castillo DA, DiGiovanni G, Mohile SG, Walter LC, Wong ML. Characteristics Associated With Functional Changes During Systemic Cancer Treatments: A Systematic Review Focused on Older Adults. J Natl Compr Canc Netw 2021; 19:1055-1062. [PMID: 33857918 DOI: 10.6004/jnccn.2020.7684] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/12/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Maintaining functional status is important to older adults with cancer, but data are limited on how systemic treatments affect functional status. We systematically reviewed changes in functional status during systemic cancer treatments and identified characteristics associated with functional decline and improvement. METHODS We searched PubMed, Embase, Web of Science, and Cochrane Register of Controlled Trials for articles examining characteristics associated with functional changes in older adults during systemic cancer treatment published in English between database inception and January 11, 2019 (PROSPERO CRD42019123125). Findings were summarized with descriptive statistics. Study characteristics between older adult-specific and non-older adult-specific studies were compared using the Fisher exact test. RESULTS We screened 15,244 titles/abstracts and 519 full texts. The final analysis included 44 studies, which enrolled >8,400 patients; 39% of studies focused on older adults (1 study enrolled adults aged ≥60 years, 10 enrolled adults aged ≥65 years, and 6 enrolled adults aged ≥70 years). Almost all studies (98%) used patient-reported outcomes to measure functional status; only 20% used physical performance tests. Reporting of functional change was heterogeneous, with 48% reporting change scores. Older adult-specific studies were more likely to analyze functional change dichotomously (29% vs 4%; P=.008). Functional decline ranged widely, from 6% to 90%. The most common patient characteristics associated with functional decline were older age (n=7 studies), worse performance status (n=4), progressive disease status (n=4), pain (n=4), anemia (n=4), and worse nutritional status (n=4). Twelve studies examined functional improvement and identified 11 unique associated characteristics. CONCLUSIONS Functional decline is increasingly recognized as an important outcome in older adults with cancer, but definitions and analyses are heterogeneous, leading to a wide range of prevalence. To identify patients at highest risk of functional decline during systemic cancer treatments, trials need to routinely analyze functional outcomes and measure characteristics associated with decline (eg, nutrition).
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Hsu M, Murray J, Zhang J, Barasa D, Turner M, Forde P, Ettinger D, Lam V, Marrone K, Levy B, Hann C, Brahmer J, Feliciano J, Naidoo J. MA07.05 Survivors from Anti-PD-(L)1 Immunotherapy in NSCLC: Clinical Features, Survival Outcomes and Long-term Toxicities. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pushie M, Hollings A, Reinhardt J, Webb S, Lam V, Takechi R, Mamo J, Paterson P, Kelly M, George G, Pickering I, Hackett M. Sample preparation with sucrose cryoprotection dramatically alters Zn distribution in the rodent hippocampus, as revealed by elemental mapping. JOURNAL OF ANALYTICAL ATOMIC SPECTROMETRY 2020; 35:2498-2508. [PMID: 33795908 PMCID: PMC8009441 DOI: 10.1039/d0ja00323a] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Transition metal ions (Fe, Mn, Cu, Zn) are essential for healthy brain function, but altered concentration, distribution, or chemical form of the metal ions has been implicated in numerous brain pathologies. Currently, it is not possible to image the cellular or sub-cellular distribution of metal ions in vivo and therefore, studying brain-metal homeostasis largely relies on ex vivo in situ elemental mapping. Sample preparation methods that accurately preserve the in vivo elemental distribution are essential if one wishes to translate the knowledge of elemental distributions measured ex vivo toward increased understanding of chemical and physiological pathways of brain disease. The choice of sample preparation is particularly important for metal ions that exist in a labile or mobile form, for which the in vivo distribution could be easily distorted by inappropriate sample preparation. One of the most widely studied brain structures, the hippocampus, contains a large pool of labile and mobile Zn. Herein, we describe how sucrose cryoprotection, the gold standard method of preparing tissues for immuno-histochemistry or immuno-fluorescence, which is also often used as a sample preparation method for elemental mapping studies, drastically alters hippocampal Zn distribution. Based on the results of this study, in combination with a comparison against the strong body of published literature that has used either rapid plunge freezing of brain tissue, or sucrose cryo-protection, we strongly urge investigators in the future to cease using sucrose cryoprotection as a method of sample preparation for elemental mapping, especially if Zn is an analyte of interest.
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Lam V, Theyyunni N. Septic arthritis due to non-tuberculous mycobacterium without effusion. Am J Emerg Med 2020; 43:287.e5-287.e7. [PMID: 33010992 DOI: 10.1016/j.ajem.2020.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 11/19/2022] Open
Abstract
Septic arthritis is an important but difficult to make diagnosis that leads to significant morbidity and mortality. Joint effusion is generally accepted to be a highly sensitive finding in septic arthritis; however, final diagnosis requires synovial fluid studies. Without a significant joint effusion, it is difficult to obtain synovial fluid. In this case report, we describe the presentation and diagnosis of septic arthritis in the first MTP due to mycobacterium chelonae in a 69 year old man with a history of gout and immunosuppression due to a heart transplant. There was notably no significant effusion in the joint on clinical examination or bedside ultrasound. As the patient was immunosuppressed, arthrocentesis was performed under ultrasound guidance. A needle was clearly visualized in the joint; however, minimal synovial fluid was obtained. The fluid grew Mycobacterium chelonae in culture. Subsequent joint washout revealed purulent synovial fluid that grew out the same bacteria. This case emphasizes the importance of obtaining synovial fluid to evaluate for septic arthritis, even when joint effusion is absent. Ultrasound guidance can facilitate this.
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Hannigan B, Ye W, Mehrotra M, Lam V, Bolivar A, Zalles S, Barkoh BA, Duose D, Hu PC, Broaddus R, Stewart J, Heymach J, Medeiros LJ, Wistuba I, Luthra R, Roy-Chowdhuri S. Liquid biopsy assay for lung carcinoma using centrifuged supernatants from fine-needle aspiration specimens. Ann Oncol 2020; 30:963-969. [PMID: 30887015 DOI: 10.1093/annonc/mdz102] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Tumor mutation profiling is standard-of-care in lung carcinoma patients. However, comprehensive molecular profiling of small specimens, including core needle biopsy (CNB) and fine-needle aspiration (FNA) specimens, may often be inadequate due to limited tissue. Centrifuged FNA supernatants, which are typically discarded, have emerged recently as a novel liquid-based biopsy for molecular testing. In this study, we evaluate the use of lung carcinoma FNA supernatants for detecting clinically relevant mutations. METHODS Supernatants from lung carcinoma FNA samples (n = 150) were evaluated. Samples were further analyzed using next-generation sequencing (NGS) and ultrasensitive droplet digital PCR (ddPCR). Mutation profiles in a subset of samples were compared with results derived from paired tissue samples from the same patient (n = 67) and available plasma liquid biopsy assay (n = 45). RESULTS All 150 samples yielded adequate DNA and NGS were carried out successfully on 104 (90%) of 116 selected samples. Somatic mutations were detected in 82% of the samples and in 50% of these patients a clinically relevant mutation was identified that would qualify them for targeted therapy or a clinical trial. There was high overall concordance between the mutation profiles of supernatants and the corresponding tissue samples, with 100% concordance with concurrent FNA and 96% with concurrent CNB samples. Comparison of actionable driver mutations detected in supernatant versus plasma samples showed 84% concordance. CONCLUSIONS FNA supernatants can provide a valuable specimen source for genotyping lung carcinoma especially in patients with insufficient tumor tissue, thereby reducing multigene mutation profiling failure rates, improving turnaround times, and avoiding repeat biopsies.
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Abstract
There are approximately 350,000 out-of-hospital cardiac arrests and 200,000 in-hospital cardiac arrests annually in the United States, with survival rates of approximately 5% to 10% and 24%, respectively. The critical factors that have an impact on cardiac arrest survival include prompt recognition and activation of prehospital care, early cardiopulmonary resuscitation, and rapid defibrillation. Advanced life support protocols are continually refined to optimize intracardiac arrest management and improve survival with favorable neurologic outcome. This article focuses on current treatment recommendations for adult nontraumatic cardiac arrest, with emphasis on the latest evidence and controversies regarding intracardiac arrest management.
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Elisia I, Cho B, Hay M, Yeung M, Kowalski S, Wong J, Lam V, Krystal G. The Effect of Low Carbohydrate Diets on Preventing and Treating Carcinogen-Induced Lung Cancer in Mice. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa044_022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
Since cancer cells typically rely more on glycolysis than normal cells, we hypothesized that lowering carbohydrate intake may reduce cancer risk. We aimed to investigate the efficacy of low-carbohydrate (CHO) diets in preventing and treating a tobacco-specific carcinogen-induced lung cancer in female A/J mice.
Methods
We evaluated the role of different types of CHO (easily digestible vs resistant), protein (casein vs. soy) and fat (fish vs. coconut vs. a mixture of oils) in modulating 4-(N-methyl-N-nitrosamino)-1-(3- pyridyl)-1-butanone (NNK)-induced lung nodule formation in these mice. To assess the efficacy of these diets in preventing NNK-induced lung nodule formation, we put these mice in the different diets for 2 weeks, intraperitoneally-injected NNK once a week for two weeks to initiate lung nodule formation. After 5 months, the lung nodules in these mice were counted.
Results
The lowering of easily digestible CHO significantly reduced constitutive blood glucose levels and lung nodule formation in the mice. Interestingly, diets low in easily digestible starch, high in fish oil (FO) and soy protein (15%Amylose/Soy/FO) were the most effective at preventing the formation of NNK-induced lung nodules. To determine if this 15%Amylose/Soy/FO is also effective at slowing tumor progression, we fed NNK-injected A/J mice a Western diet until tumors were established (5 months post NNK) and then either switched them to the 15%Amylose/Soy/FO or kept them on the Western diet for 5 additional months. The 15%Amylose/Soy/FO diet prevented the formation of additional lung tumor nodules and reduced the size of the tumors, although no significant difference was observed in tumor stage. The reduction in size of the lung tumors on the 15%Amylose/Soy/FO diet was not due to a lower tumor proliferation (Ki67 index) but an increase in apoptosis, as determined by TUNEL assays.
Conclusions
We conclude that a diet change that lowers glucose intake, incorporates FO and soy protein may be effective not only in preventing lung cancer formation but also in slowing the growth of established lung tumors.
Funding Sources
Lotte & John Hecht Memorial Foundation.
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Elisia I, Hay M, Li M, Cho B, Lam V, Mohn W, Leung H, Krystal G. The Effect of Diet on the Microbiome Composition and Incidence of NNK-Induced Lung Cancer. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa062_014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Since lowering carbohydrate (CHO) intake has been hypothesized to reduce cancer risk, we investigated whether low-CHO diets could prevent lung cancer in A/J mice, induced by the tobacco-specific carcinogen, 4-(N-methyl-N-nitrosamino)-1-(3- pyridyl)-1-butanone (NNK), and, if so if this corresponded to changes in gut microbiome composition.
Methods
We compared the effect of different quantities and types of CHO (easily digestible vs resistant), protein (casein vs. soy) and fat (fish vs. coconut vs. a mixture of oils) in modulating lung nodule formation and gut microbiome composition in A/J mice. Mice were fed either the Western diet or the low CHO diets, composed of different types of CHO, protein and fat for two weeks before injections with NNK to initiate lung formation. After 20 weeks, their feces were collected for amplification and sequencing of the bacterial 16S RNA gene V4 regions and the lung nodules were counted.
Results
Diets low in easily digestible starch, high in fish oil and soy protein were the most effective at preventing the formation of NNK-induced lung nodules. Changing protein, CHO and fat type in the diets all resulted in significant differences in the fecal microbiome composition of the NNK-injected mice. We also found a reduced abundance of the Streptococacceae and Clostridiaceae families in mice with low lung nodule numbers.
Conclusions
We suggest that it is possible that the diets reduced lung nodule formation, at least in part, via alterations in the microbiomes of the mice.
Funding Sources
Lotte & John Hecht Memorial Foundation.
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Lam V, Loh KP, Webber KR, Padam S, Sedrak MS, Musinipally V, Grogan M, Presley CJ, Grandi J, Sanapala C, Digiovanni G, Castillo D, Walter LC, Wong ML. Patient factors associated with changes in functional status during systemic cancer therapy in older adults: A systematic review. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e24022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e24022 Background: Maintaining function and preventing functional decline during cancer treatment is critically important to older adults. This systematic review characterized and identified patient factors associated with functional change during systemic cancer therapy in older adults. Methods: Following PRISMA guidelines, we searched PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials for articles examining changes in function during systemic cancer treatment published in English through 1/11/19. Studies were eligible if they included adults age >65 and analyzed associations between patient factors and change in function. At least two independent investigators reviewed each article with discrepancies resolved by consensus. Major findings were summarized; no meta-analysis was planned a priori given the heterogeneity in studies. Results: We screened 15,244 titles/abstracts and 519 full texts. The final analysis included 69 studies, which enrolled > 11,000 patients with cancer. Most studies enrolled adults of all ages; 20% included only adults age >65 and 13% only adults age >70. A quarter of studies enrolled patients with lung cancer while 22% included all solid tumors and hematologic malignancies. The majority of studies evaluated function during chemotherapy (96%) with 9% including targeted therapy and 4% immunotherapy. Function was primarily measured with patient-reported outcomes (93% of studies). Reporting of functional change was heterogeneous with many reporting change scores or means at multiple time points. Among studies that reported the percentage of patients who developed functional decline, results ranged widely from 6% to 90%. Functional improvement occurred among 2% to 57% of patients. The most common patient factors associated with functional decline during systemic cancer therapy were older age (n = 8 studies), fatigue (n = 8), worse baseline performance status (n = 8) and physical activity (n = 5), and anemia (n = 5). Only 10 studies examined factors associated with functional recovery, identifying 12 unique patient factors. Conclusions: Among older adults with cancer, functional changes during systemic cancer therapy are common. Interventions to target modifiable patient factors associated with functional decline are needed to help patients maintain or improve function during treatment. Additionally, evaluating both functional decline and improvement is necessary to better characterize functional trajectories during systemic cancer therapy.
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Franks E, Melese E, Harbourne B, Halvorsen L, Cederberg R, Collier J, Firmino N, Luu J, Unni A, Oh MH, Lam V, Krystal G, Abraham N, Bennewith K, Lockwood W. Abstract A38: Oncogenes drive production of immunosuppressive cytokines to facilitate lung cancer progression. Cancer Immunol Res 2020. [DOI: 10.1158/2326-6074.tumimm18-a38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Lung cancer development is driven by the expression of mutant oncogenes, with EGFR and KRAS being the most frequent mutations in lung adenocarcinoma. However, these mutations alone are not sufficient for tumorigenesis, and additional factors influence tumor development and progression, including the balance of antitumor immune effector cells and protumorigenic immune suppressor cells within the tumor environment. We hypothesized that oncogene signaling regulates the production of cytokines by tumor cells in order to modulate the immune microenviroment and promote lung tumor development. We used CIBERSORT to quantify 22 immune cell types in over 300 human lung adenocarcinomas (LUAD) and 100 matched normal lung tissues. Cells associated with inflammatory or antitumor response, macrophages (M1, M0), T follicular helper cells, and plasma cells, were enriched in LUAD compared to normal lung tissue. Additionally, immunosuppressive regulatory T cells (Tregs) were significantly enriched in LUAD tumors, even at the early stages. To identify cytokines that could be induced by oncogenic signaling early in lung tumorigenesis, we used normal cells expressing doxycycline-inducible mutant KRASG12V mutant EGFRL858R or wild-type EGFR and analyzed cytokine production with a multiplex assay (LUMINEX). Induction of oncogenic signaling in normal cells rapidly increased production of cytokines CCL5 and CCL2. These are capable of recruiting a variety of cells types, including Tregs. In KRAS mutant lung cancer cells, disruption of oncogene signaling with a MEK inhibitor (trametinib) decreased CCL5 production. We used transgenic mice that spontaneously develop lung tumors in response to tetracycline-inducible expression of mutant EGFRDelEx19 or mutant KRASG12V in type II alveolar cells to investigate immune cell populations that may change in response to oncogene-driven lung tumorigenesis. We found that Tregs were increased in the lungs of tumor-bearing mice. These Tregs express the CCL5 receptor, CCR5. Several cytokines were elevated in bronchioalveolar lavage fluid or in lung lysates of tumor-bearing mice, including IL-12(p40), CXCL1, CCL2, CCL3 and CCL5. Murine Lewis lung carcinoma (LLC) cells harbor a KRAS mutation and express high levels of CCL5. We are currently investigating the effects of disrupting oncogene signaling or CCL5 expression in LLC cells on cytokine production and immune cell recruitment in vivo using syngeneic implantation of the cells into mice. Our data suggest that oncogenic signaling regulates expression of cytokines in lung tumor cells. Targeted inhibition of cytokines directly or indirectly through oncogenic signaling may represent therapeutic strategies to block the recruitment of immune-suppressive cells to the tumor microenvironment, thereby enhancing the antitumor immune response.
Citation Format: Elizabeth Franks, Etienne Melese, Bryant Harbourne, Liz Halvorsen, Rachel Cederberg, Jenna Collier, Natalie Firmino, Jennifer Luu, Arun Unni, Min Hee Oh, Vivian Lam, Gerry Krystal, Ninan Abraham, Kevin Bennewith, William Lockwood. Oncogenes drive production of immunosuppressive cytokines to facilitate lung cancer progression [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2018 Nov 27-30; Miami Beach, FL. Philadelphia (PA): AACR; Cancer Immunol Res 2020;8(4 Suppl):Abstract nr A38.
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Tsilimigras DI, Moris D, Hyer JM, Bagante F, Sahara K, Moro A, Paredes AZ, Mehta R, Ratti F, Marques HP, Silva S, Soubrane O, Lam V, Poultsides GA, Popescu I, Alexandrescu S, Martel G, Workneh A, Guglielmi A, Hugh T, Aldrighetti L, Endo I, Sasaki K, Rodarte AI, Aucejo FN, Pawlik TM. Hepatocellular carcinoma tumour burden score to stratify prognosis after resection. Br J Surg 2020; 107:854-864. [PMID: 32057105 DOI: 10.1002/bjs.11464] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/23/2019] [Accepted: 11/15/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Although the Barcelona Clinic Liver Cancer (BCLC) staging system has been largely adopted in clinical practice, recent studies have emphasized the need for further refinement and subclassification of this system. METHODS Patients who underwent hepatectomy with curative intent for BCLC-0, -A or -B hepatocellular carcinoma (HCC) between 2000 and 2017 were identified using a multi-institutional database. The tumour burden score (TBS) was calculated, and overall survival (OS) was examined in relation to TBS and BCLC stage. RESULTS Among 1053 patients, 63 (6·0 per cent) had BCLC-0, 826 (78·4 per cent) BCLC-A and 164 (15·6 per cent) had BCLC-B HCC. OS worsened incrementally with higher TBS (5-year OS 77·9, 61 and 39 per cent for low, medium and high TBS respectively; P < 0·001). No differences in OS were noted among patients with similar TBS, irrespective of BCLC stage (61·6 versus 58·9 per cent for BCLC-A/medium TBS versus BCLC-B/medium TBS, P = 0·930; 45 versus 13 per cent for BCLC-A/high TBS versus BCLC-B/high TBS, P = 0·175). Patients with BCLC-B HCC and a medium TBS had better OS than those with BCLC-A disease and a high TBS (58·9 versus 45 per cent; P = 0·005). On multivariable analysis, TBS remained associated with OS among patients with BCLC-A (medium TBS: hazard ratio (HR) 2·07, 95 per cent c.i. 1·42 to 3·02, P < 0·001; high TBS: HR 4·05, 2·40 to 6·82, P < 0·001) and BCLC-B (high TBS: HR 3·85, 2·03 to 7·30; P < 0·001) HCC. TBS could also stratify prognosis among patients in an external validation cohort (5-year OS 79, 51·2 and 28 per cent for low, medium and high TBS respectively; P = 0·010). CONCLUSION The prognosis of patients with HCC varied according to the BCLC stage but was largely dependent on the TBS.
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Hussain T, Lam V, Farhad M, Lee S, Stephenson JA, Kockelbergh R, Rajesh A. Can subcentimetre ultrasound detected angiomyolipomas be safely disregarded? Clin Radiol 2020; 75:287-292. [PMID: 31916983 DOI: 10.1016/j.crad.2019.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/04/2019] [Indexed: 01/20/2023]
Abstract
AIM To optimise follow-up by dismissing lesions on baseline ultrasound (US) if renal lesions conform to US criteria of an angiomyolipoma (AML). METHOD AND MATERIALS The present study was a 10-year retrospective review of patients who were found to have incidental hyperechoic renal lesions on US to ascertain the outcome from subsequent imaging, clinical encounters, and cancer registrations. Exclusions included renal calculi, tuberous sclerosis, Von-Hippel-Lindau, or a known cancer. RESULTS After excluding 39 patients, 1,493 patients were identified. One hundred and sixty had more than one lesion with 87 patients having bilateral lesions. Regardless of indication, 889 patients had subsequent imaging within 5 years (59.5%). The average size of all AMLs was 13.2 mm. In the group with lesions that were <10 mm (807), 438 had imaging follow-up with an average follow-up time of 1.5 years. Mean lesion size in this group was 7 mm, with an average increase of <0.5 mm on follow-up. No lesions were found to be malignant on subsequent imaging nor did any of these patients have a subsequent renal cancer diagnosis registered at local multidisciplinary team meetings. CONCLUSION No incidental subcentimetre hyperechoic renal lesion with imaging characteristics of an AML demonstrated significant growth or developed into a malignancy on follow-up.
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Aoki T, Chong LC, Takata K, Milne K, Hav M, Colombo A, Chavez EA, Nissen M, Wang X, Miyata-Takata T, Lam V, Viganò E, Woolcock BW, Telenius A, Li MY, Healy S, Ghesquiere C, Kos D, Goodyear T, Veldman J, Zhang AW, Kim J, Saberi S, Ding J, Farinha P, Weng AP, Savage KJ, Scott DW, Krystal G, Nelson BH, Mottok A, Merchant A, Shah SP, Steidl C. Single-Cell Transcriptome Analysis Reveals Disease-Defining T-cell Subsets in the Tumor Microenvironment of Classic Hodgkin Lymphoma. Cancer Discov 2019; 10:406-421. [PMID: 31857391 DOI: 10.1158/2159-8290.cd-19-0680] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/13/2019] [Accepted: 12/13/2019] [Indexed: 12/22/2022]
Abstract
Hodgkin lymphoma is characterized by an extensively dominant tumor microenvironment (TME) composed of different types of noncancerous immune cells with rare malignant cells. Characterization of the cellular components and their spatial relationship is crucial to understanding cross-talk and therapeutic targeting in the TME. We performed single-cell RNA sequencing of more than 127,000 cells from 22 Hodgkin lymphoma tissue specimens and 5 reactive lymph nodes, profiling for the first time the phenotype of the Hodgkin lymphoma-specific immune microenvironment at single-cell resolution. Single-cell expression profiling identified a novel Hodgkin lymphoma-associated subset of T cells with prominent expression of the inhibitory receptor LAG3, and functional analyses established this LAG3+ T-cell population as a mediator of immunosuppression. Multiplexed spatial assessment of immune cells in the microenvironment also revealed increased LAG3+ T cells in the direct vicinity of MHC class II-deficient tumor cells. Our findings provide novel insights into TME biology and suggest new approaches to immune-checkpoint targeting in Hodgkin lymphoma. SIGNIFICANCE: We provide detailed functional and spatial characteristics of immune cells in classic Hodgkin lymphoma at single-cell resolution. Specifically, we identified a regulatory T-cell-like immunosuppressive subset of LAG3+ T cells contributing to the immune-escape phenotype. Our insights aid in the development of novel biomarkers and combination treatment strategies targeting immune checkpoints.See related commentary by Fisher and Oh, p. 342.This article is highlighted in the In This Issue feature, p. 327.
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Wong ML, Smith AK, Miaskowski C, Musinipally V, Cohen HJ, Lam V, Mazor M, Ursem CJ, Loh KP, Cohen J, Shumay D, Levin AO, Dixit N, Grandi J, Walter LC. Mixed methods comparison of functional decline during chemotherapy, immunotherapy (IO), and/or targeted therapy in older adults with non-small cell lung cancer (NSCLC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.31_suppl.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
92 Background: Functional decline during NSCLC treatment is critically important to older adults. Yet, data on functional decline—particularly during chemoIO, IO, and targeted therapy—remain limited. Additionally, the best measures to capture functional decline from the patient’s perspective remain unknown. Methods: We conducted a multisite, mixed methods prospective cohort study to characterize function during systemic NSCLC treatment and compare quantitative measures with gold standard qualitative descriptions of patients’ lived experience. Prior to and at 2 months after treatment initiation, 69 adults age >65 with advanced NSCLC starting chemo, IO, and/or targeted therapy underwent geriatric assessments including instrumental activities of daily living (IADL), EORTC QLQ-C30 Physical Functioning (PF), and Life-Space Assessment (LSA). LSA measures where a person goes in their environment, how frequently, and how independently. Pretreatment functional impairment and decline at 2 months were assessed. In a qualitative substudy, 16 purposively sampled patients with diverse pretreatment function completed two semi-structured interviews (pretreatment, 2 months) to explore treatment effects on daily functioning. Grounded theory was used to code for functional decline. Using the qualitative patient experience as the gold standard, sensitivity and specificity were calculated for each functional measure. Results: Mean age was 75 (range 65-94). NSCLC treatment included IO (36%), targeted therapy (28%), chemoIO (23%), and chemo (13%). Pretreatment functional impairment was common and ~25% of patients experienced functional decline on quantitative measures at 2 months (Table). Qualitatively, 50% described functional decline at 2 months. LSA had the highest sensitivity (71%) and similar specificity (88%) as IADL and PF. Conclusions: Functional decline during NSCLC treatment is common. LSA provides a sensitive and specific patient-centered measure of function. [Table: see text]
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Kotwal AA, Presley CJ, Loh KP, Huang LW, Lam V, Wong ML. Geriatric oncology research at the 2019 American Geriatrics Society (AGS) annual meeting: Joint perspectives from the Young International Society of Geriatric Oncology (SIOG) and AGS Cancer and Aging Special Interest Group. J Geriatr Oncol 2019; 10:994-997. [PMID: 31272896 PMCID: PMC6814544 DOI: 10.1016/j.jgo.2019.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 06/15/2019] [Indexed: 01/30/2023]
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