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Ma DN, Gao XY, Dan YB, Zhang AN, Wang WJ, Yang G, Zhu HZ. Evaluating Solid Lung Adenocarcinoma Anaplastic Lymphoma Kinase Gene Rearrangement Using Noninvasive Radiomics Biomarkers. Onco Targets Ther 2020; 13:6927-6935. [PMID: 32764984 PMCID: PMC7371989 DOI: 10.2147/ott.s257798] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/15/2020] [Indexed: 01/10/2023] Open
Abstract
Purpose To develop a radiogenomics classifier to assess anaplastic lymphoma kinase (ALK) gene rearrangement status in pretreated solid lung adenocarcinoma noninvasively. Materials and Methods This study consisted of 140 consecutive pretreated solid lung adenocarcinoma patients with complete enhanced CT scans who were tested for both EGFR mutations and ALK status. Pre-contrast CT and standard post-contrast CT radiogenomics machine learning classifiers were designed as two separate classifiers. In each classifier, dataset was randomly split into training and independent testing group on a 7:3 ratio, accordingly subjected to a 5-fold cross-validation. After normalization, best feature subsets were selected by Pearson correlation coefficient (PCC) and analysis of variance (ANOVA) or recursive feature elimination (RFE), whereupon a radiomics classifier was built with support vector machine (SVM). The discriminating performance was assessed with the area under receiver-operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results In classifier one, 98 cases were selected as training data set, 42 cases as independent testing data set. In classifier two, 87 cases were selected as training data set, 37 cases as independent testing data set. Both classifiers extracted 851 radiomics features. The top 25 pre-contrast features and top 19 post-contrast features were selected to build optimal ALK+ radiogenomics classifiers accordingly. The accuracies, AUCs, sensitivity, specificity, PPV, and NPV of pre-contrast CT classifier were 78.57%, 80.10% (CI: 0.6538–0.9222), 71.43%, 82.14%, 66.67%, and 85.19%, respectively. Those results of standard post-contrast CT classifier were 81.08%, 82.85% (CI: 0.6630–0.9567), 76.92%, 83.33%, 71.43%, and 86.96%. Conclusion Solid lung adenocarcinoma ALK+ radiogenomics classifier of standard post-contrast CT radiomics biomarkers produced superior performance compared with that of pre-contrast one, suggesting that post-contrast CT radiomics should be recommended in the context of solid lung adenocarcinoma radiogenomics AI. Standard post-contrast CT machine learning radiogenomics classifier could help precisely identify solid adenocarcinoma ALK rearrangement status, which may act as a pragmatic and cost-efficient substitute for traditional invasive ALK status test.
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Affiliation(s)
- De-Ning Ma
- Department of Colorectal Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou 310022, Zhejiang Province, People's Republic of China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou 310022, Zhejiang Province, People's Republic of China
| | - Xin-Yi Gao
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou 310022, Zhejiang Province, People's Republic of China.,Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou 310022, Zhejiang Province, People's Republic of China
| | - Yi-Bo Dan
- Department of Physics, Shanghai Key Laboratory of Magnetic Resonance, Shanghai 200062, People's Republic of China
| | - An-Ni Zhang
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou 310022, Zhejiang Province, People's Republic of China.,Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou 310022, Zhejiang Province, People's Republic of China
| | - Wei-Jun Wang
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou 310022, Zhejiang Province, People's Republic of China.,Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou 310022, Zhejiang Province, People's Republic of China
| | - Guang Yang
- Department of Physics, Shanghai Key Laboratory of Magnetic Resonance, Shanghai 200062, People's Republic of China
| | - Hong-Zhou Zhu
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou 310022, Zhejiang Province, People's Republic of China.,Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou 310022, Zhejiang Province, People's Republic of China
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Mak RH, Hermann G, Aerts HJ, Baldini EH, Chen AB, Kozono D, Rabin MS, Swanson SJ, Chen YH, Catalano P, Johnson BE, Jänne PA. Outcomes by EGFR, KRAS, and ALK Genotype After Combined Modality Therapy for Locally Advanced Non–Small-Cell Lung Cancer. JCO Precis Oncol 2018; 2:1-18. [DOI: 10.1200/po.17.00219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose In 699 patients with locally advanced non–small-cell lung cancer (NSCLC) treated with radiation therapy as part of combined modality therapy, we compared outcomes among genotyped and ungenotyped patients and by tumor genotype status ( EGFR, KRAS, and ALK). Patients and Methods Genotyping was performed in 250 patients: EGFR+ (19%), KRAS+ (32%), ALK+ (9%), and wild type (WT−/−/−; 40%). Outcomes were analyzed using the Kaplan-Meier method and Cox regression. Results With a median follow-up of 48.2 months among genotyped patients, median overall survival (OS) was significantly longer for EGFR+ and ALK+ compared with KRAS+ and WT−/−/− (55.8 months v not reached v 28.0 v 33.2 months; P = .02). There was no difference in progression-free survival (median, 15.3 v 13.7 v 13.0 v 14.5 months; P = .47) or in freedom from distant metastases by genotype (3-year estimates: 42% v 49% v 27% v 25%; P = .25). There was higher freedom from locoregional recurrence (LRR) for EGFR+ tumors and lower freedom from LRR in ALK+ tumors, compared with KRAS+ and WT−/−/− tumors (3-year: 77% v 38% v 49% v 46%). In multivariable analysis, ALK+ remained associated with increased OS (HR, 0.32; 95% CI, 0.12 to 0.87; P = .03), and EGFR+ was associated with decreased LRR (HR, 0.47; 95% CI, 0.24 to 0.92; P = .03). Analysis of post-recurrence survival demonstrated that EGFR+/ ALK+ patients treated with appropriate tyrosine kinase inhibitors had higher OS compared with other groups. Conclusion In this series of locally advanced NSCLC treated with combined modality therapy, EGFR+ and ALK+ were associated with higher OS, whereas LRR was lower in EGFR+ patients, and the risk of distant metastases was high in all subgroups. The outcomes and patterns of failure in genotypic subgroups of NSCLC from this study can inform the design of future trials integrating targeted therapies.
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Affiliation(s)
- Raymond H. Mak
- Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Yu-Hui Chen, Paul Catalano, Bruce E. Johnson, and Pasi A. Jänne, Dana-Farber Cancer Institute; Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldin, Aileen B. Chen, David Kozono, and Scott J. Swanson, Brigham and Women's Hospital; Raymond H. Mak, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Scott J. Swanson, Bruce E. Johnson, and
| | - Gretchen Hermann
- Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Yu-Hui Chen, Paul Catalano, Bruce E. Johnson, and Pasi A. Jänne, Dana-Farber Cancer Institute; Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldin, Aileen B. Chen, David Kozono, and Scott J. Swanson, Brigham and Women's Hospital; Raymond H. Mak, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Scott J. Swanson, Bruce E. Johnson, and
| | - Hugo J. Aerts
- Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Yu-Hui Chen, Paul Catalano, Bruce E. Johnson, and Pasi A. Jänne, Dana-Farber Cancer Institute; Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldin, Aileen B. Chen, David Kozono, and Scott J. Swanson, Brigham and Women's Hospital; Raymond H. Mak, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Scott J. Swanson, Bruce E. Johnson, and
| | - Elizabeth H. Baldini
- Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Yu-Hui Chen, Paul Catalano, Bruce E. Johnson, and Pasi A. Jänne, Dana-Farber Cancer Institute; Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldin, Aileen B. Chen, David Kozono, and Scott J. Swanson, Brigham and Women's Hospital; Raymond H. Mak, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Scott J. Swanson, Bruce E. Johnson, and
| | - Aileen B. Chen
- Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Yu-Hui Chen, Paul Catalano, Bruce E. Johnson, and Pasi A. Jänne, Dana-Farber Cancer Institute; Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldin, Aileen B. Chen, David Kozono, and Scott J. Swanson, Brigham and Women's Hospital; Raymond H. Mak, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Scott J. Swanson, Bruce E. Johnson, and
| | - David Kozono
- Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Yu-Hui Chen, Paul Catalano, Bruce E. Johnson, and Pasi A. Jänne, Dana-Farber Cancer Institute; Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldin, Aileen B. Chen, David Kozono, and Scott J. Swanson, Brigham and Women's Hospital; Raymond H. Mak, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Scott J. Swanson, Bruce E. Johnson, and
| | - Michael S. Rabin
- Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Yu-Hui Chen, Paul Catalano, Bruce E. Johnson, and Pasi A. Jänne, Dana-Farber Cancer Institute; Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldin, Aileen B. Chen, David Kozono, and Scott J. Swanson, Brigham and Women's Hospital; Raymond H. Mak, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Scott J. Swanson, Bruce E. Johnson, and
| | - Scott J. Swanson
- Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Yu-Hui Chen, Paul Catalano, Bruce E. Johnson, and Pasi A. Jänne, Dana-Farber Cancer Institute; Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldin, Aileen B. Chen, David Kozono, and Scott J. Swanson, Brigham and Women's Hospital; Raymond H. Mak, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Scott J. Swanson, Bruce E. Johnson, and
| | - Yu-Hui Chen
- Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Yu-Hui Chen, Paul Catalano, Bruce E. Johnson, and Pasi A. Jänne, Dana-Farber Cancer Institute; Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldin, Aileen B. Chen, David Kozono, and Scott J. Swanson, Brigham and Women's Hospital; Raymond H. Mak, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Scott J. Swanson, Bruce E. Johnson, and
| | - Paul Catalano
- Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Yu-Hui Chen, Paul Catalano, Bruce E. Johnson, and Pasi A. Jänne, Dana-Farber Cancer Institute; Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldin, Aileen B. Chen, David Kozono, and Scott J. Swanson, Brigham and Women's Hospital; Raymond H. Mak, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Scott J. Swanson, Bruce E. Johnson, and
| | - Bruce E. Johnson
- Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Yu-Hui Chen, Paul Catalano, Bruce E. Johnson, and Pasi A. Jänne, Dana-Farber Cancer Institute; Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldin, Aileen B. Chen, David Kozono, and Scott J. Swanson, Brigham and Women's Hospital; Raymond H. Mak, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Scott J. Swanson, Bruce E. Johnson, and
| | - Pasi A. Jänne
- Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Yu-Hui Chen, Paul Catalano, Bruce E. Johnson, and Pasi A. Jänne, Dana-Farber Cancer Institute; Raymond H. Mak, Gretchen Hermann, Hugo J. Aerts, Elizabeth H. Baldin, Aileen B. Chen, David Kozono, and Scott J. Swanson, Brigham and Women's Hospital; Raymond H. Mak, Hugo J. Aerts, Elizabeth H. Baldini, Aileen B. Chen, David Kozono, Michael S. Rabin, Scott J. Swanson, Bruce E. Johnson, and
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Hoeltzenbein M, Beck E, Fietz AK, Wernicke J, Zinke S, Kayser A, Padberg S, Weber-Schoendorfer C, Meister R, Schaefer C. Pregnancy Outcome After First Trimester Use of Methyldopa: A Prospective Cohort Study. Hypertension 2017; 70:201-208. [PMID: 28533329 DOI: 10.1161/hypertensionaha.117.09110] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 02/01/2017] [Accepted: 04/20/2017] [Indexed: 01/23/2023]
Abstract
Published experience on first trimester exposure to methyldopa is still limited, although it is recommended as first-line treatment for hypertensive disorders in pregnancy in most countries. The primary aim of this prospective observational cohort study was to analyze the rate of major birth defects and spontaneous abortions in women with methyldopa therapy for chronic hypertension. Outcomes of 261 pregnancies with first trimester exposure to methyldopa and 526 comparison pregnancies without chronic hypertension reported to the German Embryotox pharmacovigilance institute were evaluated. The rate of major birth defects in the exposed cohort was not significantly increased compared with the comparison cohort (3.7% versus 2.5%; adjusted odds ratio, 1.24; 95% confidence interval, 0.4-4.0). There was a tendency toward a higher rate of spontaneous abortions in exposed women. The risk of preterm birth was significantly higher, and adjusted birth weight scores were significantly lower in the methyldopa group. Head circumferences were significantly reduced in exposed boys only. There was neither evidence for an increased risk for birth defects or increase in early pregnancy loss nor evidence for growth restriction or a reduced head circumference in a sensitivity analysis comparing monotherapies with methyldopa to metoprolol. However, the significantly increased risk of preterm birth in methyldopa-treated pregnancies was confirmed. In conclusion, our study does not indicate a teratogenic risk of methyldopa. Further studies are needed to confirm its safety in the first trimester and clarify the influence of hypertension and methyldopa on preterm birth and intrauterine growth. CLINICAL TRIAL REGISTRATION URL: https://drks-neu.uniklinik-freiburg.de/drks_web/. Unique identifier: DRKS00010502.
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Affiliation(s)
- Maria Hoeltzenbein
- From the Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Germany (M.H., E.B., A.-K.F., J.W., S.Z., A.K., S.P., C.W.-S., C.S.); and Department of Mathematics, Beuth Hochschule für Technik Berlin, University of Applied Sciences, Germany (A.-K.F., R.M.).
| | - Evelin Beck
- From the Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Germany (M.H., E.B., A.-K.F., J.W., S.Z., A.K., S.P., C.W.-S., C.S.); and Department of Mathematics, Beuth Hochschule für Technik Berlin, University of Applied Sciences, Germany (A.-K.F., R.M.)
| | - Anne-Katrin Fietz
- From the Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Germany (M.H., E.B., A.-K.F., J.W., S.Z., A.K., S.P., C.W.-S., C.S.); and Department of Mathematics, Beuth Hochschule für Technik Berlin, University of Applied Sciences, Germany (A.-K.F., R.M.)
| | - Juliane Wernicke
- From the Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Germany (M.H., E.B., A.-K.F., J.W., S.Z., A.K., S.P., C.W.-S., C.S.); and Department of Mathematics, Beuth Hochschule für Technik Berlin, University of Applied Sciences, Germany (A.-K.F., R.M.)
| | - Sandra Zinke
- From the Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Germany (M.H., E.B., A.-K.F., J.W., S.Z., A.K., S.P., C.W.-S., C.S.); and Department of Mathematics, Beuth Hochschule für Technik Berlin, University of Applied Sciences, Germany (A.-K.F., R.M.)
| | - Angela Kayser
- From the Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Germany (M.H., E.B., A.-K.F., J.W., S.Z., A.K., S.P., C.W.-S., C.S.); and Department of Mathematics, Beuth Hochschule für Technik Berlin, University of Applied Sciences, Germany (A.-K.F., R.M.)
| | - Stephanie Padberg
- From the Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Germany (M.H., E.B., A.-K.F., J.W., S.Z., A.K., S.P., C.W.-S., C.S.); and Department of Mathematics, Beuth Hochschule für Technik Berlin, University of Applied Sciences, Germany (A.-K.F., R.M.)
| | - Corinna Weber-Schoendorfer
- From the Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Germany (M.H., E.B., A.-K.F., J.W., S.Z., A.K., S.P., C.W.-S., C.S.); and Department of Mathematics, Beuth Hochschule für Technik Berlin, University of Applied Sciences, Germany (A.-K.F., R.M.)
| | - Reinhard Meister
- From the Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Germany (M.H., E.B., A.-K.F., J.W., S.Z., A.K., S.P., C.W.-S., C.S.); and Department of Mathematics, Beuth Hochschule für Technik Berlin, University of Applied Sciences, Germany (A.-K.F., R.M.)
| | - Christof Schaefer
- From the Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Germany (M.H., E.B., A.-K.F., J.W., S.Z., A.K., S.P., C.W.-S., C.S.); and Department of Mathematics, Beuth Hochschule für Technik Berlin, University of Applied Sciences, Germany (A.-K.F., R.M.)
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Bianca I, Geraci G, Gulizia MM, Egidy Assenza G, Barone C, Campisi M, Alaimo A, Adorisio R, Comoglio F, Favilli S, Agnoletti G, Carmina MG, Chessa M, Sarubbi B, Mongiovì M, Russo MG, Bianca S, Canzone G, Bonvicini M, Viora E, Poli M. Consensus Document of the Italian Association of Hospital Cardiologists (ANMCO), Italian Society of Pediatric Cardiology (SICP), and Italian Society of Gynaecologists and Obstetrics (SIGO): pregnancy and congenital heart diseases. Eur Heart J Suppl 2017; 19:D256-D292. [PMID: 28751846 PMCID: PMC5526477 DOI: 10.1093/eurheartj/sux032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The success of cardiac surgery over the past 50 years has increased numbers and median age of survivors with congenital heart disease (CHD). Adults now represent two-thirds of patients with CHD; in the USA alone the number is estimated to exceed 1 million. In this population, many affected women reach reproductive age and wish to have children. While in many CHD patients pregnancy can be accomplished successfully, some special situations with complex anatomy, iatrogenic or residual pathology are associated with an increased risk of severe maternal and fetal complications. Pre-conception counselling allows women to come to truly informed choices. Risk stratification tools can also help high-risk women to eventually renounce to pregnancy and to adopt safe contraception options. Once pregnant, women identified as intermediate or high risk should receive multidisciplinary care involving a cardiologist, an obstetrician and an anesthesiologist with specific expertise in managing this peculiar medical challenge. This document is intended to provide cardiologists working in hospitals where an Obstetrics and Gynecology Department is available with a streamlined and practical tool, useful for them to select the best management strategies to deal with a woman affected by CHD who desires to plan pregnancy or is already pregnant.
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Affiliation(s)
- Innocenzo Bianca
- Pediatric Cardiology Unit, Maternity and Neonatal Department, ARNAS Garibaldi, Catania, Italy
| | - Giovanna Geraci
- Cardiology Department, PO Cervello, Az. Osp. Riuniti Villa Sofia-Cervello, Via Trabucco, 180, 90146 Palermo, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione ‘Garibaldi’, Catania, Italy
| | - Gabriele Egidy Assenza
- Pediatric Cardiology and Adult Congenital Heart Program, Azienda Ospedaliera-Universitaria Sant’Orsola-Malpighi, Bologna, Itlay
| | - Chiara Barone
- Genetics Unit, Maternity and Neonatal Department, ARNAS Garibaldi, Catania, Italy
| | - Marcello Campisi
- Pediatric Cardiology Unit, Maternity and Neonatal Department, ARNAS Garibaldi, Catania, Italy
| | - Annalisa Alaimo
- Pediatric Cardiology Department, PO Di Cristina, ARNAS Civico, Palermo, Italy
| | - Rachele Adorisio
- Pediatric Cardiology Department, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Francesca Comoglio
- SCDU 2, Dipartimento di Scienze Chirurgiche (Surgical Sciences Department), Università di Torino, Italy
| | - Silvia Favilli
- Pediatric Cardiology Department, Azienda-Ospedalliero-Universitaria Meyer, Firenze, Italy
| | - Gabriella Agnoletti
- Pediatric Cardiology Department, Ospedale Regina Margherita, Città della Salute e della Scienza, Torino, Italy
| | - Maria Gabriella Carmina
- Cardiology Department, PO Cervello, Az. Osp. Riuniti Villa Sofia-Cervello, Via Trabucco, 180, 90146 Palermo, Italy
| | - Massimo Chessa
- Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato Milanese San Donato Milanese (MI), Italy
| | - Berardo Sarubbi
- Pediatric Cardiology and Cardiology SUN, Seconda Università di Napoli, AORN dei Colli, Ospedale Monaldi, Napoli, Italy
| | - Maurizio Mongiovì
- Pediatric Cardiology Department, PO Di Cristina, ARNAS Civico, Palermo, Italy
| | - Maria Giovanna Russo
- Pediatric Cardiology and Cardiology SUN, Seconda Università di Napoli, AORN dei Colli, Ospedale Monaldi, Napoli, Italy
| | - Sebastiano Bianca
- Genetics Unit, Maternity and Neonatal Department, ARNAS Garibaldi, Catania, Italy
| | - Giuseppe Canzone
- Women and Children Health Department, Ospedale S. Cimino, Termini Imerese (PA), Italy
| | - Marco Bonvicini
- Pediatric Cardiology and Adult Congenital Heart Program, Azienda Ospedaliera-Universitaria Sant’Orsola-Malpighi, Bologna, Itlay
| | - Elsa Viora
- Echography and Prenatal Diagnosis Centre, Obstetrics and Gynaecology Department, Città della Salute e della Scienza di Torino, Italy
| | - Marco Poli
- Intensive Cardiac Therapy Department, Ospedale Sandro Pertini, Roma, Italy
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Bernicker EH, Miller RA, Cagle PT. Biomarkers for Selection of Therapy for Adenocarcinoma of the Lung. J Oncol Pract 2017; 13:221-227. [DOI: 10.1200/jop.2016.019182] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To suggest that the discovery of targetable driver mutations in many patients with advanced adenocarcinoma of the lung has completely transformed the work-up and therapeutic options for this disease would not be hyperbole. Although not curative, small-molecule tyrosine kinase inhibitors directed at oncogene-addicted tumors have led to significantly improved response rates compared with cytotoxic chemotherapy, with often manageable toxicities and better tolerance. However, the absence of reliable clinical predictors has made molecular testing essential to ensure that patients receive the proper medical management. We outline the many recent advances with regard to diagnosis and treatment of oncogene-addicted advanced nonsquamous non–small-cell lung cancer.
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Helland Å. MicroRNA-profiles in lung adenocarcinomas. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2016. [DOI: 10.1080/23808993.2016.1240011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yoshida T, Oya Y, Tanaka K, Shimizu J, Horio Y, Kuroda H, Sakao Y, Hida T, Yatabe Y. Differential Crizotinib Response Duration Among ALK Fusion Variants in ALK-Positive Non-Small-Cell Lung Cancer. J Clin Oncol 2016; 34:3383-9. [PMID: 27354483 DOI: 10.1200/jco.2015.65.8732] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Anaplastic lymphoma kinase (ALK) rearrangement-positive non-small-cell lung cancers can be effectively treated with an ALK tyrosine kinase inhibitor (TKI) such as crizotinib, but the response magnitude and duration are heterogeneous. Several ALK variants have been identified, but few studies have focused on the effects of different ALK variants on the efficacy of crizotinib. PATIENTS AND METHODS Among 55 patients treated with crizotinib as the initial ALK-TKI between January 2007 and December 2014, we identified 35 patients with tumor specimens that could be evaluated for ALK variants by reverse transcription polymerase chain reaction. We retrospectively evaluated the efficacy of crizotinib on the basis of the objective response rate and progression-free survival (PFS) according to the ALK variants. RESULTS The most frequent ALK variant was variant 1 in 19 patients (54%), followed by variant 2 in five patients (14%), variant 3a/3b in four patients (12%), and other variants in seven patients (20%). Objective response rate was 69% in all patients, whereas it was 74% and 63% in the variant 1 and non-variant 1 groups, respectively. The median PFS time was significantly longer in patients with variant 1 than in those with non-variant 1 (median PFS, 11.0 months [95% CI, 6.5 to 43.0 months] v 4.2 months [95% CI, 1.6 to 10.2 months], respectively; P < .05). Multivariable analysis identified two significant factors associated with PFS duration, ALK variant 1 (hazard ratio, 0.350; 95% CI, 0.128 to 0.929; P < .05) and advanced stage (hazard ratio, 4.646; 95% CI, 1.381 to 21.750; P < .05). CONCLUSION Our results indicate the better efficacy of crizotinib in patients with ALK variant 1 versus non-variant 1. The ALK variant status might affect the efficacy of ALK-TKIs.
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Affiliation(s)
| | - Yuko Oya
- All authors: Aichi Cancer Center Hospital, Aichi, Japan
| | - Kosuke Tanaka
- All authors: Aichi Cancer Center Hospital, Aichi, Japan
| | | | | | | | | | - Toyoaki Hida
- All authors: Aichi Cancer Center Hospital, Aichi, Japan
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Hoffman MB, Farhangian M, Feldman SR. Psoriasis during pregnancy: characteristics and important management recommendations. Expert Rev Clin Immunol 2015; 11:709-20. [DOI: 10.1586/1744666x.2015.1037742] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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