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Bteich F, Desai K, Zhang C, Kaur A, Levy RA, Bioh L, Wang A, Sultana S, Kaubisch A, Kinkhabwala M, Bellemare S, Fidvi S, Kanmaniraja D, Berkenblit R, Moon JY, Adedimeji A, Tow CY, Saenger Y. Immunotherapy Efficacy in Advanced Hepatocellular Carcinoma in a Diverse and Underserved Population in the United States. J Hepatocell Carcinoma 2024; 11:257-269. [PMID: 38333221 PMCID: PMC10849901 DOI: 10.2147/jhc.s436804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/07/2023] [Indexed: 02/10/2024] Open
Abstract
Background Incidence of hepatocellular cancer (HCC) in the Bronx is 61% higher than the rest of New York State. Underserved populations are not well represented in clinical trials of immune checkpoint inhibitors (ICI). Methods Demographics were tabulated for 194 patients treated with ICI at the Montefiore-Einstein Comprehensive Cancer Center (MECCC) between 2017 and 2022. Categorical variables were analyzed by Chi-squared test, and survival was analyzed using Kaplan-Meier (KM) curves. Results MECCC patients were 40.7% Hispanic and 20.6% Black, compared with 3% and 2%, respectively, in the landmark IMbrave 150 study. Median overall survival (mOS) on ICI was 9.0 months, 25.0 months for the 100 (51.5%) favorable-prognosis Child Pugh A (CPA) patients included in HCC clinical trials. Disease control rate (DCR) was 58.5% among 123 evaluable patients per mRECIST 1.1. Baseline liver function, as defined by CP and the Model for End-Stage Liver Disease-Sodium (MELD-Na), correlated with survival (p < 0.001). Hepatitis C Virus (HCV) and alcoholism were over-represented relative to National Cancer Institute (NCI) data (56.2% vs 4.7% and 38.7% vs 8.2%, respectively). HCV treatment correlated with prolonged survival in infected patients (p = 0.0017). AFP decline correlated with response (p = 0.001). Hispanic patients lived longer when clinical variables were controlled for (mOS 52 vs 23 months; p = 0.011). Conclusion In an underserved HCC population, ICI yielded a DCR of 58.5% and low rates of severe toxicity. This work highlights ICI efficacy in minority groups, a need for earlier HCC diagnosis and for studies of genetic and environmental factors in Hispanics with HCC.
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Affiliation(s)
- Fernand Bteich
- Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA
| | - Kush Desai
- Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA
| | - Chenxin Zhang
- Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Anahat Kaur
- Department of Medicine, Division of Medical Oncology, Jacobi Medical Center, Bronx, NY, USA
| | - Rachel A Levy
- Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA
| | - Lydia Bioh
- Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA
| | - Aaron Wang
- Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA
| | - Sharmin Sultana
- Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA
| | | | - Milan Kinkhabwala
- Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA
- Department of General Surgery, Division of Abdominal Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Sarah Bellemare
- Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA
- Department of General Surgery, Division of Abdominal Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Shabnam Fidvi
- Department of Radiology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Robert Berkenblit
- Department of Radiology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jee-Young Moon
- Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Clara Y Tow
- Department of Medicine, Division of Transplant Hepatology, Montefiore Medical Center, Bronx, NY, USA
| | - Yvonne Saenger
- Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA
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Taylor Z, Kjelstrom S, Buckley M, Cahn D. Overall Survival and Associations of Insurance Status Among Hispanic Men With High-Risk Prostate Cancer. Cureus 2023; 15:e45723. [PMID: 37876384 PMCID: PMC10591534 DOI: 10.7759/cureus.45723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/20/2023] [Indexed: 10/26/2023] Open
Abstract
Objectives Our objectives were to (1) determine the association between ethnicity and high-risk prostate cancer (PCa) survival and (2) determine whether this association is modified by insurance status. Methods We performed a retrospective review of the National Cancer Database (NCDB) from 2004 to 2017 of non-Hispanic White (NHW), Hispanic White (HW), or Black men with high-risk PCa. A multivariate Cox regression model was built to test the association between overall survival (OS) and race/ethnicity, insurance status, and their interaction, controlling for various socioeconomic and disease-specific variables. Results A total of 94,708 men with high-risk PCa were included in the analysis. Both HW and Black men had lower socioeconomic status characteristics and lower rates of private insurance. Race/ethnicity was significantly associated with OS in the adjusted analysis. Only Medicare demonstrated significantly worse OS. NHW (covariate-adjusted hazard ratio (aHR): 1.83, 95% CI: 1.45-2.32) and Black (aHR: 1.71, 05% CI: 1.34-2.19) men demonstrated significantly worse survival when compared to HW men. Subgroup analysis demonstrated significant differences occurring among HW men with private insurance/managed care when compared to those not insured, Medicaid, Medicare, and other government insurance types. Conclusion Despite socioeconomic and demographic disadvantages, HW men demonstrate improved OS compared to NHW men. Furthermore, HW men demonstrated improved OS compared to NHW men within nearly each insurance status type. This finding is likely the result of a complex multifactorial web and as such serves as an interesting hypothesis-generating study.
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Affiliation(s)
| | | | - Meghan Buckley
- Statistics, Lankenau Institute for Medical Research, Wynnewood, USA
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Cardona S, Calixte R, Rivera A, Islam JY, Vidot DC, Camacho-Rivera M. Perceptions and Patterns of Cigarette and E-Cigarette Use among Hispanics: A Heterogeneity Analysis of the 2017-2019 Health Information National Trends Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6378. [PMID: 34204687 PMCID: PMC8296202 DOI: 10.3390/ijerph18126378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 12/19/2022]
Abstract
There are documented disparities in smoking behaviors among Hispanic adults in the U.S., but little is known about patterns of e-cigarette use. Using data from the HINTS 5 cycle 1-3, we examined cigarette and e-cigarette history and current use, as well as perceptions of the dangers of e-cigarette use relative to cigarette use. Primary predictors were Hispanic ethnic group, gender, age, education, income, and English language proficiency. Binary outcomes were modeled using the logit link, and multinomial outcome variables were modeled using generalized logit model. Fifty-three percent of participants were Mexican, 8% Puerto Rican, 4% were Cuban, and 35% identified as other Hispanics. Of the 1618 respondents, 23% were former cigarette smokers and 10% were current cigarette smokers. Twenty percent reported history of electronic cigarettes and 4% reported current use. In multivariable models, Hispanic women were significantly less likely to report ever being smokers compared to Hispanic men (aOR = 0.61, 95% CI = 0.42, 0.88). Puerto Ricans were 2.4 times as likely to report being current smokers (95% CI = 1.11, 5.11) compared to Mexicans. Among Hispanics, significant differences in e-cigarette and cigarette use behaviors emerged by gender, age, ethnicity, and cancer history, with implications for tailoring smoking prevention and cessation messages.
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Affiliation(s)
- Stephanie Cardona
- Department of Community Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA;
| | - Rose Calixte
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA;
| | - Argelis Rivera
- Department of Medicine, Mount Sinai Icahn School of Medicine, New York, NY 10009, USA;
| | - Jessica Yasmine Islam
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA;
| | - Denise Christina Vidot
- Sylvester Comprehensive Cancer Center, School of Nursing and Health Studies, University of Miami, Miami, FL 33146, USA;
| | - Marlene Camacho-Rivera
- Department of Community Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA;
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