1
|
Islam KM, Anggondowati T, Deviany PE, Ryan JE, Fetrick A, Bagenda D, Copur MS, Tolentino A, Vaziri I, McKean HA, Dunder S, Gray JE, Huang C, Ganti AK. Patient preferences of chemotherapy treatment options and tolerance of chemotherapy side effects in advanced stage lung cancer. BMC Cancer 2019; 19:835. [PMID: 31455252 PMCID: PMC6712837 DOI: 10.1186/s12885-019-6054-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 08/19/2019] [Indexed: 11/18/2022] Open
Abstract
Background In the U.S., lung cancer accounts for 14% of cancer diagnoses and 28% of cancer deaths annually. Since no cure exists for advanced lung cancer, the main treatment goal is to prolong survival. Chemotherapy regimens produce side effects with different profiles. Coupling this with individual patient’s preferred side effects could result in patient-centered choices leading to better treatment outcomes. There are apparently no previous studies of or tools for assessing and utilizing patient chemotherapy preferences in clinical settings. The long-term goal of the study was to facilitate patients’ treatment choices for advanced-stage lung cancer. A primary aim was to determine how preferences for chemotherapy side effects relate to chemotherapy choices. Methods An observational, longitudinal, open cohort study of patients with advanced-stage non-small cell lung cancer (NSCLC) was conducted. Data sources included patient medical records and from one to three interviews per subject. Data were analyzed using Chi-square, Fisher’s Exact and McNamara’s test, and logistic regression. Results Patients identified the top three chemotherapy side effects that they would most like to avoid: shortness of breath, bleeding, and fatigue. These side effects were similar between first and last interviews, although the rank order changed after patients experienced chemotherapy. Conclusions Patients ranked drug side effects that they would most like to avoid. Patient-centered clinical care and patient-centered outcomes research are feasible and may be enhanced by stakeholder commitment. The study results are limited to patients with advanced NSCLC. Most of the subjects were White, since patients were drawn from the U.S. Midwest, a predominantly White population.
Collapse
Affiliation(s)
- K M Islam
- Medical College of Augusta, Augusta University, 1120 15th Street, CJ 2326, Augusta, GA, 30912, USA.
| | - T Anggondowati
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, Omaha, NE, USA
| | - P E Deviany
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, Omaha, NE, USA
| | - J E Ryan
- Nebraska Cancer Coalition, Lincoln, NE, USA
| | - A Fetrick
- Department of Health Services Research and Administration, University of Nebraska Medical Center College of Public Health, Omaha, NE, USA
| | - D Bagenda
- Department of Anesthesiology, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
| | - M S Copur
- Marry Lanning Healthcare System, Hastings, NE, USA
| | - A Tolentino
- Avera Cancer Institute, Sioux Falls, SD, USA.,Saint Luke's Hospital of Kansas City, Kansas City, MO, USA
| | - I Vaziri
- Callahan Cancer Center, North Platte, NE, USA
| | - H A McKean
- Avera Cancer Institute, Sioux Falls, SD, USA
| | - S Dunder
- Southeast Nebraska Cancer Center, Lincoln, NE, USA
| | - J E Gray
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - C Huang
- Department of Veterans Affairs Medical Center, Kansas City, MO, USA
| | - A K Ganti
- Veterans Administration Health Care Systems Medical Center, Omaha, NE, USA.,Department of Internal Medicine, School of Medicine, University of Nebraska Medical Center Division of Oncology-Hematology, Omaha, NE, USA
| |
Collapse
|
2
|
Ganti AK, Ray J, Mooney KL, Zambrano E, Hillard PJA, Fok W. Unusual Cause of Pediatric Vaginal Bleeding: Infantile Capillary Hemangioma of the Cervix. J Pediatr Adolesc Gynecol 2019; 32:80-82. [PMID: 30107231 DOI: 10.1016/j.jpag.2018.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The differential diagnosis for pediatric prepubertal vaginal bleeding is wide. Rare etiologies include vascular malformations and tumors, such as infantile hemangiomas (IHs), which validate the usefulness of exam under anesthesia, vaginoscopy, and tissue diagnosis. CASE We report a case of an IH in a 6-year-old girl causing vaginal bleeding requiring transfusion. Vaginoscopy revealed a cervical IH of less than 1 cm. Expectant management and oral propranolol were successful management options. SUMMARY AND CONCLUSION Rare, even small soft tissue tumors such as IH can lead to impressive blood loss via vaginal bleeding. Accurate tissue diagnosis and a multidisciplinary approach are essential to planning safe, effective treatment, and follow-up.
Collapse
Affiliation(s)
- A K Ganti
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
| | - J Ray
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
| | - K L Mooney
- Department of Pathology, Stanford University, Stanford, California
| | - E Zambrano
- Department of Pathology, Stanford University, Stanford, California
| | - P J A Hillard
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California.
| | - W Fok
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
| |
Collapse
|
3
|
Lakshmanan I, Rachagani S, Hauke R, Krishn SR, Paknikar S, Seshacharyulu P, Karmakar S, Nimmakayala RK, Kaushik G, Johansson SL, Carey GB, Ponnusamy MP, Kaur S, Batra SK, Ganti AK. MUC5AC interactions with integrin β4 enhances the migration of lung cancer cells through FAK signaling. Oncogene 2016; 35:4112-21. [PMID: 26751774 DOI: 10.1038/onc.2015.478] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/29/2015] [Accepted: 11/10/2015] [Indexed: 01/07/2023]
Abstract
MUC5AC is a secretory mucin aberrantly expressed in various cancers. In lung cancer, MUC5AC is overexpressed in both primary and metastatic lesions; however, its functional role is not well understood. The present study was aimed at evaluating mechanistic role of MUC5AC on metastasis of lung cancer cells. Clinically, the overexpression of MUC5AC was observed in lung cancer patient tissues and was associated with poor survival. In addition, the overexpression of Muc5ac was also observed in genetically engineered mouse lung adenocarcinoma tissues (Kras(G12D); Trp53(R172H/+); AdCre) in comparison with normal lung tissues. Our functional studies showed that MUC5AC knockdown resulted in significantly decreased migration in two lung cancer cell lines (A549 and H1437) as compared with scramble cells. Expression of integrins (α5, β1, β3, β4 and β5) was decreased in MUC5AC knockdown cells. As both integrins and MUC5AC have a von Willebrand factor domain, we assessed for possible interaction of MUC5AC and integrins in lung cancer cells. MUC5AC strongly interacted only with integrin β4. The co-localization of MUC5AC and integrin β4 was observed both in A549 lung cancer cells as well as genetically engineered mouse adenocarcinoma tissues. Activated integrins recruit focal adhesion kinase (FAK) that mediates metastatic downstream signaling pathways. Phosphorylation of FAK (Y397) was decreased in MUC5AC knockdown cells. MUC5AC/integrin β4/FAK-mediated lung cancer cell migration was confirmed through experiments utilizing a phosphorylation (Y397)-specific FAK inhibitor. In conclusion, overexpression of MUC5AC is a poor prognostic marker in lung cancer. MUC5AC interacts with integrin β4 that mediates phosphorylation of FAK at Y397 leading to lung cancer cell migration.
Collapse
Affiliation(s)
- I Lakshmanan
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA
| | - S Rachagani
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA
| | - R Hauke
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA
| | - S R Krishn
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA
| | - S Paknikar
- Division of Oncology-Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - P Seshacharyulu
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA
| | - S Karmakar
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA
| | - R K Nimmakayala
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA
| | - G Kaushik
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA
| | - S L Johansson
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA.,Eppley Institute for Research in Cancer and Allied Diseases, Fred & Pamela Buffett Cancer Center University of Nebraska Medical Center, Omaha, NE, USA
| | - G B Carey
- Section of Hematology-Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - M P Ponnusamy
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA.,Eppley Institute for Research in Cancer and Allied Diseases, Fred & Pamela Buffett Cancer Center University of Nebraska Medical Center, Omaha, NE, USA
| | - S Kaur
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA
| | - S K Batra
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA.,Eppley Institute for Research in Cancer and Allied Diseases, Fred & Pamela Buffett Cancer Center University of Nebraska Medical Center, Omaha, NE, USA
| | - A K Ganti
- Division of Oncology-Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Internal Medicine, VA Nebraska Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
4
|
Vaz AP, Ponnusamy MP, Rachagani S, Dey P, Ganti AK, Batra SK. Novel role of pancreatic differentiation 2 in facilitating self-renewal and drug resistance of pancreatic cancer stem cells. Br J Cancer 2014; 111:486-96. [PMID: 25003666 PMCID: PMC4119968 DOI: 10.1038/bjc.2014.152] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 02/27/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cancer stem cells (CSCs) contribute towards disease aggressiveness and drug resistance. Specific identification of CSC maintenance genes and targeting can improve the efficiency of currently available treatment modalities. Pancreatic differentiation 2 (PD2) has a major role in the self-renewal of mouse embryonic stem cells. In the present study, we investigated the role of PD2 in pancreatic CSCs. METHODS Characterisation of CSCs and non-CSCs from mouse models, pancreatic cancer cells and human tissues by CSC and self-renewal marker analysis using confocal assay. Effect of PD2 knockdown in CSCs (after gemcitabine treatment) was studied by immunoblot and apoptosis assays. RESULTS A subpopulation of cells displayed PD2 overexpression in mouse (Kras(G12D); Pdx1-Cre and Kras(G12D); Trp53(R172H/+); Pdx1-Cre) and human pancreatic tumours, which co-express CSC markers. Cancer stem cells exhibited elevated expression of PD2 and self-renewal markers, such as Oct3/4, Shh and β-catenin. Gemcitabine treatment maintained the CSC population with simultaneous maintenance of PD2 and CSC marker expression. Knockdown of PD2 in CSCs resulted in reduced viability of cells and enhanced apoptosis along with abrogated expression of CD133 and MDR2. CONCLUSIONS Our results suggest that PD2 is a novel CSC maintenance protein, loss of which renders the CSCs more susceptible to drug-induced cell death.
Collapse
Affiliation(s)
- A P Vaz
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA
| | - M P Ponnusamy
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA
| | - S Rachagani
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA
| | - P Dey
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA
| | - A K Ganti
- 1] Department of Internal Medicine, VA Nebraska Western Iowa Health Care System, University of Nebraska Medical Center, Omaha, NE, USA [2] Division of Oncology-Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - S K Batra
- 1] Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA [2] Buffet Cancer Center, Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
5
|
Marr AS, Loberiza FR, Kessinger MA, McGarry J, Ganti AK. Compliance with ASCO guidelines in the treatment of stage IV non-small cell lung cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e16614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
6
|
Tiwana J, Ortman S, Davies T, Gonsalves W, Tashi T, Krishnamurthy J, Thota R, Abu Hazeem M, Ganta A, Sama AR, Aldoss IT, Ganti AK, Silberstein PT, Subbiah S. Long-standing diabetes and its effects on outcomes in colon cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
7
|
Tashi T, Aldoss IT, Gonsalves W, Ganti AK, Silberstein PT, Townley P, Subbiah S. Surgical resection in early limited-stage small cell lung cancer: Time to rethink? A retrospective analysis of the VA Central Cancer Registry. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
8
|
Edmonds RJ, Subbiah S, Ganti AK, Silberstein PT. Epidemiologic differences among colon cancer patients diagnosed before age 85 those diagnosed after age 85. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
9
|
Wilkes A, Tashi T, Wolpert J, Goshgarian A, Gonsalves W, Thota R, Krishnamurthy J, Aldoss IT, Sama AR, Townley P, Didwaniya N, Ganti AK, Silberstein PT, Subbiah S. Primary non-Hodgkin lymphoma of the colon: A Veterans Affairs Central Cancer Registry analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
10
|
Gonsalves W, Tashi T, Davies T, Ortman S, Thota R, Krishnamurthy J, Aldoss IT, Kalaiah M, Ganta A, Didwaniya N, Eberle C, Ganti AK, Subbiah S, Silberstein PT. Aggressiveness of end-of-life care before and after the utilization of a palliative care service. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
11
|
Ganti AK, Shostrom V, Islam KM, Marr AS, Smith L, Kessinger MA. Early-stage non-small cell lung cancer: A SEER database analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e17501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
12
|
Abstract
Laboratory data suggest an association between statins and risk of brain metastasis (BM) in patients diagnosed with lung cancer. Our retrospective cohort included 252 patients diagnosed with lung cancer and 55 (22%) patients subsequently developed BM. The risk of BM was significantly higher in younger patients (p < .0007). The multivariable Cox model did not show a significant association between statin use and BM from lung cancer (Hazard-Ratio (HR) = 1.20, 95% confidence interval (CI): 0.68-2.13). Future studies should focus on late stage NSCLC and examine the incidence of BM among statin users at the time of death.
Collapse
Affiliation(s)
- D Leigh
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
| | | | | | | | | |
Collapse
|
13
|
Ganti AK, Loberiza Jr. FR, Kessinger A. Effect of age on chemotherapy-induced hematologic toxicity. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
14
|
Loberiza FR, Armitage JO, Bierman PJ, Bociek RG, Darrington DL, Ganti AK, Vose JM, Weisenburger DD. 25-year survival trends of patients with lymphoma by race/ethnicity as reported to the Nebraska Lymphoma Study Group (NLSG). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.6547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
15
|
Azim HA, Ganti AK, Elattar I, Azim H, Loberiza FR. Triplets vs. doublets in the management of advanced non-small cell lung cancer (NSCLC) using third generation chemotherapeutic agents: A meta-analysis. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7580 Background: A platinum-based doublet is the current standard of care in the management of NSCLC. Addition of a third agent to the doublet has not shown to improve outcomes in a previous meta-analysis. Since one of the reasons for this may have been the inclusion of trials utilizing agents inferior to the currently used, we conducted a meta-analysis to evaluate the benefit of adding a third generation cytotoxic chemotherapeutic agent to a platinum doublet in terms of response rate, survival, and toxicity in patients with advanced NSCLC. Methods: Randomized controlled trials for advanced NSCLC, published as full papers in English, comparing doublets to triplets restricted to platinum salts and third-generation cytotoxic chemotherapeutic agents (vinorelbine, gemcitabine, docetaxel, paclitaxel) were analyzed. A Medline search was performed using the search terms “lung cancer” and “randomized trials”. Manual searches were also performed in the Journal of Clinical Oncology and Annals of Oncology. Pooled odds ratios (ORs) for the objective response and toxicity rates were calculated using the Mantel-Haenszel estimate. Pooled median ratios for median survival were calculated using the weighted sum of the log-ratio of median ratios of individual study. Results: Eight trials (2,107 patients) published between 2000 and 2006 were eligible. Patients receiving triplet therapy had a significantly increased response rate (OR 1.86; 95% CI, 1.53 –2.26; P<0.001) and median survival (41.9 weeks vs. 37.05 weeks; OR: 1.14, 95% CI: 1.00–1.31; P=0.047), at the expense of higher grade III/IV hematological and neurological toxicity (P<0.001) ( Table ). Conclusions: The addition of a third-generation cytotoxic agent to a platinum-based doublet was associated with improved response rate and survival, but with increased hematological and neurological toxicity. Thus, triplet therapy may be considered in selected good performance status patients with advanced NSCLC. No significant financial relationships to disclose. [Table: see text]
Collapse
Affiliation(s)
- H. A. Azim
- National Cancer Institute-Cairo University, Cairo, Egypt; University of Nebraska Medical Center, Omha, NE; Cairo University Hospital, Cairo, Egypt
| | - A. K. Ganti
- National Cancer Institute-Cairo University, Cairo, Egypt; University of Nebraska Medical Center, Omha, NE; Cairo University Hospital, Cairo, Egypt
| | - I. Elattar
- National Cancer Institute-Cairo University, Cairo, Egypt; University of Nebraska Medical Center, Omha, NE; Cairo University Hospital, Cairo, Egypt
| | - H. Azim
- National Cancer Institute-Cairo University, Cairo, Egypt; University of Nebraska Medical Center, Omha, NE; Cairo University Hospital, Cairo, Egypt
| | - F. R. Loberiza
- National Cancer Institute-Cairo University, Cairo, Egypt; University of Nebraska Medical Center, Omha, NE; Cairo University Hospital, Cairo, Egypt
| |
Collapse
|
16
|
Loberiza FR, Ganti AK, Armitage JO, Bierman PJ, Bociek RG, Devetten MP, Maness LJ, Vose JM, Lee S. Advance care planning (ACP) prior to hematopoeitic stem cell transplantation (HSCT) in patients with cancer is associated with improved survival. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.9026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9026 Background: HSCT carries an increased risk of mortality. Thus, patients are encouraged to have ACP. However, discussions about ACP is not a casual process since it may elicit undue anxiety to the patients and their families. Anecdotally, pts fear that discussion of the possibility of death is inconsistent with hoping for the best outcome. We therefore compared the outcomes of pts with or without ACP who received HSCT for cancer. Methods: ACP was defined as having living will, power of attorney for health care, or life-support instructions conducted prior to transplant. ACP were reviewed in pts who were at least 19 yo and received first allogeneic or autologous HSCT for cancer between 2001 and 2003. Pts were classified into: 1) No ACP, 2) ACP prior to cancer dx, 3) ACP after cancer dx but prior to HSCT. Multivariate analysis (MVA) was done to evaluate the relative risk of mortality at 1 year according to ACP while adjusting for other prognostic factors. Results: 343 pts were included in the study: 172 (50%) did not have ACP, while 171 (50%) pts had ACP. Of those with ACP, 127 pts (74%) were available for review. Characteristics were similar between pts with and without reviewable ACP. 28 pts had ACP prior to cancer dx, 87 had ACP prior to HSCT, while 12 had ACP after HSCT. 64% of pts with ACP had both power of attorney and a living will, 16% had a living will alone and 19% had power of attorney alone. Older pts (p <0.001) and Caucasians (p = 0.04) were more likely to have ACP. MVA were confined to the 172 pts with no ACP and 115 who had ACP before HSCT and showed that pts with ACP prior to HSCT had a significantly lower risk of mortality (see table ). Conclusions: Despite a diagnosis of cancer and hospitalization for HSCT, only 50% of patients had engaged in ACP. ACP at any time before HSCT was associated with higher one-year survival. Engagement in ACP is not necessarily inconsistent with hoping for the best outcome in HSCT. Further study is warranted to explore the reasons for engaging or not in ACP. No significant financial relationships to disclose. [Table: see text]
Collapse
Affiliation(s)
- F. R. Loberiza
- Univ of Nebraska Medcl Ctr, Omaha, NE; Dana-Farber Cancer Institute, Boston, MA
| | - A. K. Ganti
- Univ of Nebraska Medcl Ctr, Omaha, NE; Dana-Farber Cancer Institute, Boston, MA
| | - J. O. Armitage
- Univ of Nebraska Medcl Ctr, Omaha, NE; Dana-Farber Cancer Institute, Boston, MA
| | - P. J. Bierman
- Univ of Nebraska Medcl Ctr, Omaha, NE; Dana-Farber Cancer Institute, Boston, MA
| | - R. G. Bociek
- Univ of Nebraska Medcl Ctr, Omaha, NE; Dana-Farber Cancer Institute, Boston, MA
| | - M. P. Devetten
- Univ of Nebraska Medcl Ctr, Omaha, NE; Dana-Farber Cancer Institute, Boston, MA
| | - L. J. Maness
- Univ of Nebraska Medcl Ctr, Omaha, NE; Dana-Farber Cancer Institute, Boston, MA
| | - J. M. Vose
- Univ of Nebraska Medcl Ctr, Omaha, NE; Dana-Farber Cancer Institute, Boston, MA
| | - S. Lee
- Univ of Nebraska Medcl Ctr, Omaha, NE; Dana-Farber Cancer Institute, Boston, MA
| |
Collapse
|
17
|
Ganti AK, Parr A, Nguyen D, Grem JL. Gene expression profile of enzymes involved in gemcitabine (Gem) metabolism in bone marrow mononuclear cells as predictors of myelosuppression. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.2007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2007 Background: The dose-limiting toxicity of gemcitabine (Gem) is hematologic toxicity (heme tox), and there is wide intra-patient variability in the degree of heme tox. This study was done to assess the possible impact of gene expression of enzymes involved in Gem metabolism or mechanism of action on heme tox. Methods: Pre-therapy mononuclear cells were isolated from bone marrow aspirates collected from 71 consenting patients with various advanced malignancies enrolled in an IRB-approved phase I trial in which single agent Gem was given over 30 min weekly for 2 of 3 weeks during cycle 1 at doses ranging from 750–1,560 mg/m2. Gene expression of deoxycytidine kinase (DCK), an activating enzyme, cytidine deaminase (CD) and deoxycytidylate deaminase (DCD), deactivating enzymes, and ribonucleotide reductase M2 (RNR), which is inhibited by Gem diphosphate, was measured by real-time RT-PCR. Target gene expression was relative to beta-actin. Heme tox was calculated as the % decrease in white blood cells (WBC), neutrophils (ANC) and platelets (PLT) from baseline. Results: 71 patients (26 females, 35 males) with a median age of 56 years (range: 20–75) were included in the analysis. The median (25th %, 75th %) gene expression was as follows (x10e3/beta-actin): DCK, 0.34 (0.19, 0.64); CD, 1.88 (1.33, 2.92); DCD, 2.48 (1.15, 7.78); and RNR, 0.39 (0.19, 0.80). A strong linear correlation was noted only between RNR & DCD gene expression (Pearson r = 0.89). When gene expression was categorized as above or below the median value, only CD appeared to influence heme tox (mean ± std dev) ( Table ). T-test p value is shown. Conclusions: Gem is rapidly metabolized to its inactive metabolite by CD. Subjects with a higher relative gene expression of CD tended to have a lesser degree of heme tox following Gem. Correlation with Gem pharmacokinetics in these subjects is planned. [Table: see text] No significant financial relationships to disclose.
Collapse
Affiliation(s)
- A. K. Ganti
- University of Nebraska Medical Center, Omaha, NE; National Cancer Institute, Bethesda, MD
| | - A. Parr
- University of Nebraska Medical Center, Omaha, NE; National Cancer Institute, Bethesda, MD
| | - D. Nguyen
- University of Nebraska Medical Center, Omaha, NE; National Cancer Institute, Bethesda, MD
| | - J. L. Grem
- University of Nebraska Medical Center, Omaha, NE; National Cancer Institute, Bethesda, MD
| |
Collapse
|
18
|
Loberiza FR, Villanueva MH, Devetten M, Ganti AK, Maness LJ, Bierman PJ, Bociek RG, Armitage JO, Vose JM. Effect of follow-up provider source on outcomes of patients with hematologic malignancies receiving hematopoietic stem cell transplantation. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6112 Background: Studies have shown that involvement of trained physicians is associated with favorable outcomes of patients receiving hematopoietic stem cell transplantation (HSCT). At the University of Nebraska Medical Center (UNMC), most patients are shifted back to the care of their referring physicians in the first 100 days. We evaluated whether the practice of shifting care of patients from specialists to primary care providers (PCP), referred to as patient care oscillation, in HSCT results in optimal outcomes. Methods: Data from 666 patients who underwent HSCT for malignant hematologic disorders between 2000 and 2003 were analyzed. Cox proportional hazards regression analyses were done to compare the relative risk of relapse/progression and mortality at 100-days and 1-year between patients whose care remained with specialists (transplant MDs at UNMC or community oncologist) versus those who were transferred back to the care of referring PCPs while adjusting for patient and disease factors. Results: Rate of patient care oscillation varies according to type of transplant. In allo-HSCT, 50% of patients received follow-up care from PCPs, 30% from community oncologists, while 20% remain at UNMC for follow-up. In auto-HSCT, 70% of patients received follow-up care from PCPs, 20% from community oncologists, while 10% remain at UNMC for follow-up with transplanting physicians. Outcomes after HSCT according to type of transplant is shown in the table. Conclusions: These preliminary findings suggest that in both allogeneic and autologous HSCT, the risk of disease progression/relapse and mortality may be independent of the type of follow-up care provider. However, further studies are needed to determine whether the practice of shifting the care of HSCT patients results in similar medical care utilization, post-transplant complications, re-hospitalizations and patient satisfaction. Patients likely to benefit from specialized versus primary care should be identified. [Table: see text] No significant financial relationships to disclose.
Collapse
Affiliation(s)
| | | | - M. Devetten
- University of Nebraska Medical Center, Omaha, NE
| | - A. K. Ganti
- University of Nebraska Medical Center, Omaha, NE
| | - L. J. Maness
- University of Nebraska Medical Center, Omaha, NE
| | | | - R. G. Bociek
- University of Nebraska Medical Center, Omaha, NE
| | | | - J. M. Vose
- University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
19
|
Ganti AK, Weisenburger DD, Smith LM, Hans CP, Bociek RG, Bierman PJ, Vose JM, Armitage JO. Patients with grade 3 follicular lymphoma have prolonged relapse-free survival following anthracycline-based chemotherapy: the Nebraska Lymphoma Study Group Experience. Ann Oncol 2006; 17:920-7. [PMID: 16524969 DOI: 10.1093/annonc/mdl039] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The aim of the study was to determine the outcome and clinical features predictive of survival in patients with follicular lymphoma (FL) treated aggressively and to determine the rate of disease-specific mortality in patients with grade 3 FL (FL3). MATERIALS AND METHODS Four hundred and twenty-one patients with FL who were treated with various anthracycline-based chemotherapy regimens were included in this retrospective study. RESULTS Patients with FL3 and a diffuse component of >50% had the worst outcome, with a hazard ratio of dying of 2.2 (95% CI 1.4-3.4) compared with patients with FL1 or FL2, and a ratio of 1.6 (95% CI 1.02-2.5) compared with FL3 with a diffuse component of < or =50% by multivariate analysis (P = 0.0026). Patients with FL3a had an outcome similar to those with FL3b. In patients with FL3 and a diffuse component of < or =50%, the overall and event-free survival curves showed a plateau for patients younger than 60 years of age. However, there were no differences in the cumulative incidence of relapse/progression or lymphoma-specific/treatment-related mortality between the two age groups. CONCLUSIONS Less than half of the patients with FL3 and a diffuse component of < or =50% treated with anthracycline-based combination chemotherapy will relapse and relapses are uncommon after 6 years. Older patients should be offered the same aggressive chemotherapy as younger patients.
Collapse
Affiliation(s)
- A K Ganti
- Department of Internal Medicine, Division of Oncology/Hematology, University of Nebraska Medical Center, Omaha, USA
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Ganti AK, Sahmoun AE, Panwalkar AW, Tendulkar K, Potti A. Effect of hormone replacement therapy on survival in women with lung cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. K. Ganti
- Univ of Nebraska Medcl Ctr, Omaha, NE; Univ of North Dakota Sch of Medicine, Fargo, ND; Duke Univ Medcl Ctr, Durham, NC
| | - A. E. Sahmoun
- Univ of Nebraska Medcl Ctr, Omaha, NE; Univ of North Dakota Sch of Medicine, Fargo, ND; Duke Univ Medcl Ctr, Durham, NC
| | - A. W. Panwalkar
- Univ of Nebraska Medcl Ctr, Omaha, NE; Univ of North Dakota Sch of Medicine, Fargo, ND; Duke Univ Medcl Ctr, Durham, NC
| | - K. Tendulkar
- Univ of Nebraska Medcl Ctr, Omaha, NE; Univ of North Dakota Sch of Medicine, Fargo, ND; Duke Univ Medcl Ctr, Durham, NC
| | - A. Potti
- Univ of Nebraska Medcl Ctr, Omaha, NE; Univ of North Dakota Sch of Medicine, Fargo, ND; Duke Univ Medcl Ctr, Durham, NC
| |
Collapse
|
21
|
Affiliation(s)
- A K Ganti
- Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | | |
Collapse
|
22
|
Sahmoun AE, Ganti AK, Panwalkar AW, Tendulkar K, Potti A. Impact of smoking on anatomical distribution and survival in women with lung cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.9704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. E. Sahmoun
- Univ of North Dakota Sch of Medicine, Fargo, ND; Univ of Nebraska Medcl Ctr, Omaha, NE; Duke Univ Medcl Ctr, Durham, NC
| | - A. K. Ganti
- Univ of North Dakota Sch of Medicine, Fargo, ND; Univ of Nebraska Medcl Ctr, Omaha, NE; Duke Univ Medcl Ctr, Durham, NC
| | - A. W. Panwalkar
- Univ of North Dakota Sch of Medicine, Fargo, ND; Univ of Nebraska Medcl Ctr, Omaha, NE; Duke Univ Medcl Ctr, Durham, NC
| | - K. Tendulkar
- Univ of North Dakota Sch of Medicine, Fargo, ND; Univ of Nebraska Medcl Ctr, Omaha, NE; Duke Univ Medcl Ctr, Durham, NC
| | - A. Potti
- Univ of North Dakota Sch of Medicine, Fargo, ND; Univ of Nebraska Medcl Ctr, Omaha, NE; Duke Univ Medcl Ctr, Durham, NC
| |
Collapse
|
23
|
Abstract
BACKGROUND Patients with mantle cell lymphoma (MCL) have in general, lower response rates and overall survival (OS) than those with other B-cell non-Hodgkin's lymphomas. The role of hematopoietic stem cell transplantation (HSCT) in MCL is unclear. Hence we decided to study the clinical course of patients who received autologous and allogeneic HSCT for MCL. METHODS Ninety-seven patients, (80 patients-autologous; 17 patients-allogeneic) who received a HSCT for mantle cell lymphoma were included in the study. RESULTS The complete response rates at day 100 between the two groups were similar (73% vs. 62%). Day-100 mortality was higher in the allogeneic HSCT group (19% vs. 0%) (P < 0.01). The estimated 5-year relapse rates, 5-year event-free survival (EFS) and 5-year OS among the allogeneic HSCT patients were 21%, 44% and 49%, respectively, similar to 56%, 39% and 47% in the autologous group. Ten patients received HyperCVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone + high-dose methotrexate and cytarabine) +/- rituximab prior to transplant. There have been no relapses or deaths amongst these patients at a median follow-up of 16 months. CONCLUSIONS Patients treated with allogeneic HSCT had a lower relapse rate, but similar EFS and OS to autologous HSCT. Treatment of MCL with HyperCVAD +/- rituximab followed by HSCT seems promising.
Collapse
Affiliation(s)
- A K Ganti
- Department of Internal Medicine, Division of Oncology/Hematology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | | | | | | | | | | |
Collapse
|
24
|
Potti A, Ganti AK, Koch M, Kargas S. Effect of pesticide exposure on HER-2/ neu and CD117 overexpression in patients with extensive stage small cell lung carcinoma (ESSCLC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.9629a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. Potti
- Duke University Medical Center, Durham, NC; University of Nebraska Medical Center, Omaha, NE; University of North Dakota School of Medicine, Fargo, ND; IMPATH Laboratories, Los Angeles, CA
| | - A. K. Ganti
- Duke University Medical Center, Durham, NC; University of Nebraska Medical Center, Omaha, NE; University of North Dakota School of Medicine, Fargo, ND; IMPATH Laboratories, Los Angeles, CA
| | - M. Koch
- Duke University Medical Center, Durham, NC; University of Nebraska Medical Center, Omaha, NE; University of North Dakota School of Medicine, Fargo, ND; IMPATH Laboratories, Los Angeles, CA
| | - S. Kargas
- Duke University Medical Center, Durham, NC; University of Nebraska Medical Center, Omaha, NE; University of North Dakota School of Medicine, Fargo, ND; IMPATH Laboratories, Los Angeles, CA
| |
Collapse
|
25
|
Tendulkar K, Ganti AK, Koka V, Koch M, Potti A. HER-2/ neu overexpression and its effect on survival in solid tumors. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.9559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- K. Tendulkar
- University of North Dakota School of Medicine, Fargo, ND; University of Nebraska Medical Center, Omaha, NE; Duke University Medical Center, Durham, NC
| | - A. K. Ganti
- University of North Dakota School of Medicine, Fargo, ND; University of Nebraska Medical Center, Omaha, NE; Duke University Medical Center, Durham, NC
| | - V. Koka
- University of North Dakota School of Medicine, Fargo, ND; University of Nebraska Medical Center, Omaha, NE; Duke University Medical Center, Durham, NC
| | - M. Koch
- University of North Dakota School of Medicine, Fargo, ND; University of Nebraska Medical Center, Omaha, NE; Duke University Medical Center, Durham, NC
| | - A. Potti
- University of North Dakota School of Medicine, Fargo, ND; University of Nebraska Medical Center, Omaha, NE; Duke University Medical Center, Durham, NC
| |
Collapse
|
26
|
Abstract
Abciximab (c7E3 Fab) inhibits platelet aggregation and is used to prevent complications of percutaneous coronary intervention. Thrombocytopenia is an often-cited complication of abciximab. Pseudothrombocytopenia is due to ethylenediaminetetraacetate (EDTA)-activated platelet agglutination, resulting in a spuriously low platelet count. We have looked at both "true" and pseudothrombocytopenia after infusion of abciximab. Sixty-six patients receiving their first exposure to abciximab after an unstable coronary event/revascularization were eligible. All the patients received a bolus of c7E3 Fab followed by a continuous infusion. Platelets were monitored in all patients at 2, 4, 12, 24, and 48 h, and more frequently if required. The incidence of thrombocytopenia and acute severe thrombocytopenia (platelet count < or =20,000/microl) was evaluated. A peripheral blood smear was performed on all patients showing thrombocytopenia to evaluate for pseudothrombocytopenia. Seventeen (25.6%) developed thrombocytopenia and nine (13.6%) developed acute severe thrombocytopenia. However, 18 of these patients had pseudothrombocytopenia. The onset of true thrombocytopenia was at 4 h after the infusion, while pseudothrombocytopenia occurred at anytime during the first 24 h. Only two (3.03%) patients required platelet transfusions. No life-threatening hemorrhagic complications were recognized. Five of six subjects with true thrombocytopenia had positive laboratory findings of disseminated intravascular coagulation; however, none had an adverse outcome. Acute severe thrombocytopenia was noted to be a relatively benign adverse effect of abciximab. There is an increasing incidence of pseudothrombocytopenia in this subgroup of patients. It would be worthwhile examining a peripheral blood smear or collecting blood for platelet counts in a heparin-coated tube in order to exclude this phenomenon and thereby prevent inappropriate discontinuation of this drug.
Collapse
Affiliation(s)
- D A Schell
- Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, 1919 N Elm Street, Fargo, ND 58102, USA
| | | | | | | |
Collapse
|
27
|
Potti A, Ganti AK, Koch M, Mehdi SA, Levitt R. Identification of HER-2/neu overexpression and the clinical course of lung carcinoma in non-smokers with chronic lymphocytic leukemia. Lung Cancer 2001; 34:227-32. [PMID: 11679181 DOI: 10.1016/s0169-5002(01)00241-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Patients with CLL have an excess risk of developing second primary malignancies. The etiology of this excess risk is unclear, and has been thought to be related to smoking. HER-2/neu overexpression has evolved as a prognostic/predictive factor in some solid tumors. We reviewed our experience with non-smokers who had CLL and subsequently developed lung carcinoma, in an effort to better understand the clinical course of these patients, and to evaluate the role of HER-2/neu overexpression. We reviewed the records of all patients who had a diagnosis of both CLL and lung carcinoma between 1986 and 2000. HER-2/neu overexpression was estimated by immunohistochemistry (IHC) using the Hercep test (DAKO). An IHC score of 2+ or greater was considered positive. Overall survival was calculated from the date of diagnosis of lung carcinoma by the Kaplan-Meier product limit method. Fourteen non-smokers in whom a diagnosis of CLL was made at least 6 months prior to the diagnosis of lung carcinoma were identified. The median age for diagnosis of CLL in this group was 67 years while that for lung carcinoma was 70 years. The lung carcinomas included 10 non-small cell (NSCLC) and four small cell (SCLC) carcinomas. Nine specimens (six NSCLC and three SCLC) showed HER-2/neu overexpression. Interestingly, 90% of patients with advanced stage cancer (stage IIIB/IV NSCLC or extensive SCLC) overexpressed HER-2/neu. The presence of CLL did not alter outcome in patients with early stage lung cancer. However, after adjustment for age and performance status, patients with advanced stage NSCLC and CLL had a worse than expected outcome. HER-2/neu overexpression (independent of smoking) may be involved in the development/progression of lung cancer in patients with CLL, and has an associated worse outcome. It is appropriate to consider heightened surveillance of CLL patients for lung carcinoma.
Collapse
Affiliation(s)
- A Potti
- Department of Medicine, University of North Dakota School of Medicine, Fargo, ND 58102, USA.
| | | | | | | | | |
Collapse
|