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Nizam I, Dabirrahmani D, Alva A, Choudary D. Bikini anterior hip replacements in obese patients are not associated with an increased risk of complication. Arch Orthop Trauma Surg 2022; 142:2919-2926. [PMID: 34510240 DOI: 10.1007/s00402-021-04143-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 08/22/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Direct anterior approach (DAA) arthroplasty has generated great interest because of its minimally invasive and muscle sparing nature. Obese patients are reported to be associated with greater incidence of complications in primary joint replacement. The purpose of this study was to compare patient outcomes and complication rates between obese and non-obese patients undergoing primary total hip arthroplasty (THA) through a Bikini direct anterior incision. METHODS This retrospective, single surgeon study compared the outcome of 258 obese patients and 200 non-obese patients undergoing DAA THA using a Bikini incision, over a 5-year period. The average follow-up was 3.2 years (range 1.1-5.6 years). RESULTS There was no statistically significant differences in the complication rate between the two groups. The obese group recorded 2 major (venous thromboembolism and peri-prosthetic fracture) and 2 minor complications (superficial wound infection), compared with the non-obese group, which recorded 2 major (deep-wound infection and peri-prosthetic fracture) and 1 minor complication (superficial wound infection). Patient-reported outcomes (WOMAC and Harris Hip Scores) showed significant post-operative improvements (p < 0.001) and did not differ between the two groups. CONCLUSIONS Bikini DDA THA does not increase the complication rate in obese patients and offers similar clinical improvements compared to non-obese patients.
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Affiliation(s)
- I Nizam
- Ozorthopaedics, 1356 High Street, Malvern, VIC, 3144, Australia.
| | - D Dabirrahmani
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - A Alva
- Ozorthopaedics, 1356 High Street, Malvern, VIC, 3144, Australia
| | - D Choudary
- Ozorthopaedics, 1356 High Street, Malvern, VIC, 3144, Australia
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McGregor BA, Xie W, Adib E, Stadler WM, Zakharia Y, Alva A, Michaelson MD, Gupta S, Lam ET, Farah S, Nassar AH, Wei XX, Kilbridge KL, Harshman L, Signoretti S, Sholl L, Kwiatkowski DJ, McKay RR, Choueiri TK. Biomarker-Based Phase II Study of Sapanisertib (TAK-228): An mTORC1/2 Inhibitor in Patients With Refractory Metastatic Renal Cell Carcinoma. JCO Precis Oncol 2022; 6:e2100448. [PMID: 35171658 PMCID: PMC8865529 DOI: 10.1200/po.21.00448] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/06/2021] [Accepted: 01/10/2022] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Sapanisertib is a kinase inhibitor that inhibits both mammalian target of rapamycin complex 1 (mTORC1) and mTORC2. In this multicenter, single-arm phase II trial, we evaluated the efficacy of sapanisertib in patients with treatment-refractory metastatic renal cell carcinoma (mRCC; NCT03097328). METHODS Patients with mRCC of any histology progressing through standard therapy (including prior mTOR inhibitors) had baseline biopsy and received sapanisertib 30 mg by mouth once weekly until unacceptable toxicity or disease progression. The primary end point was objective response rate by RECIST 1.1. Tissue biomarkers of mTOR pathway activation were explored. RESULTS We enrolled 38 patients with mRCC (clear cell = 28; variant histology = 10) between August 2017 and November 2019. Twenty-four (63%) had received ≥ 3 prior lines of therapy; 17 (45%) had received prior rapalog therapy. The median follow-up was 10.4 (range 1-27.4) months. Objective response rate was two of 38 (5.3%; 90% CI, 1 to 15.6); the median progression-free survival (PFS) was 2.5 months (95% CI, 1.8 to 3.7). Twelve patients (32%) developed treatment-related grade 3 adverse events, with no grade 4 or 5 toxicities. Alterations in the mTOR pathway genes were seen in 5 of 29 evaluable patients (MTOR n = 1, PTEN n = 3, and TSC1 n = 1) with no association with response or PFS. Diminished or loss of PTEN expression by immunohistochemistry was seen in 8 of 21 patients and trended toward shorter PFS compared with intact PTEN (median 1.9 v 3.7 months; hazard ratio 2.5; 95% CI, 0.9 to 6.7; P = .055). CONCLUSION Sapanisertib had minimal activity in treatment-refractory mRCC independent of mTOR pathway alterations. Additional therapeutic strategies are needed for patients with refractory mRCC.
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Affiliation(s)
| | | | - Elio Adib
- Dana-Farber Cancer Institute, Boston, MA
- Brigham and Women's Hospital, Boston, MA
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Grivas P, Loriot Y, Morales-Barrera R, Teo MY, Zakharia Y, Feyerabend S, Vogelzang NJ, Grande E, Adra N, Alva A, Necchi A, Rodriguez-Vida A, Gupta S, Josephs DH, Srinivas S, Wride K, Thomas D, Simmons A, Loehr A, Dusek RL, Nepert D, Chowdhury S. Efficacy and safety of rucaparib in previously treated, locally advanced or metastatic urothelial carcinoma from a phase 2, open-label trial (ATLAS). BMC Cancer 2021; 21:593. [PMID: 34030643 PMCID: PMC8147008 DOI: 10.1186/s12885-021-08085-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND ATLAS evaluated the efficacy and safety of the PARP inhibitor rucaparib in patients with previously treated locally advanced/unresectable or metastatic urothelial carcinoma (UC). METHODS Patients with UC were enrolled independent of tumor homologous recombination deficiency (HRD) status and received rucaparib 600 mg BID. The primary endpoint was investigator-assessed objective response rate (RECIST v1.1) in the intent-to-treat and HRD-positive (loss of genome-wide heterozygosity ≥10%) populations. Key secondary endpoints were progression-free survival (PFS) and safety. Disease control rate (DCR) was defined post-hoc as the proportion of patients with a confirmed complete or partial response (PR), or stable disease lasting ≥16 weeks. RESULTS Of 97 enrolled patients, 20 (20.6%) were HRD-positive, 30 (30.9%) HRD-negative, and 47 (48.5%) HRD-indeterminate. Among 95 evaluable patients, there were no confirmed responses. However, reductions in the sum of target lesions were observed, including 6 (6.3%) patients with unconfirmed PR. DCR was 11.6%; median PFS was 1.8 months (95% CI, 1.6-1.9). No relationship was observed between HRD status and efficacy endpoints. Median treatment duration was 1.8 months (range, 0.1-10.1). Most frequent any-grade treatment-emergent adverse events were asthenia/fatigue (57.7%), nausea (42.3%), and anemia (36.1%). Of 64 patients with data from tumor tissue samples, 10 (15.6%) had a deleterious alteration in a DNA damage repair pathway gene, including four with a deleterious BRCA1 or BRCA2 alteration. CONCLUSIONS Rucaparib did not show significant activity in unselected patients with advanced UC regardless of HRD status. The safety profile was consistent with that observed in patients with ovarian or prostate cancer. TRIAL REGISTRATION This trial was registered in ClinicalTrials.gov (NCT03397394). Date of registration: 12 January 2018. This trial was registered in EudraCT (2017-004166-10).
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Affiliation(s)
- P Grivas
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, 98109, USA.
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA.
- Seattle Cancer Care Alliance, 1144 Eastlake Avenue E, LG- 465, Seattle, WA, 98109, USA.
| | - Y Loriot
- Department of Medicine, Gustave Roussy Cancer Campus, INSERM U981, Université Paris-Saclay, 39 Rue Camille Desmoulins, 94800, Villejuif, France
| | | | - M Y Teo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Y Zakharia
- Division of Hematology, Oncology, and Blood and Marrow Transplant, University of Iowa and Holden Comprehensive Cancer Center, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - S Feyerabend
- Studienpraxis Urologie, Steinengrabenstraße 17, 72622, Nürtingen, Germany
| | - N J Vogelzang
- Division of Hematology/Oncology, Comprehensive Cancer Centers of Nevada, 3730 S Eastern Avenue, Las Vegas, NV, 89169, USA
| | - E Grande
- Department of Medical Oncology, MD Anderson Cancer Center, Calle de Arturo Soria, 270 28033, Madrid, Spain
| | - N Adra
- Department of Medicine, Indiana University Simon Cancer Center, 535 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - A Alva
- Department of Internal Medicine, University of Michigan Comprehensive Cancer Center, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - A Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - A Rodriguez-Vida
- Medical Oncology Department, Hospital del Mar, Passeig Maritim 25-29, 08003, Barcelona, Spain
| | - S Gupta
- Division of Medical Oncology, Huntsman Cancer Institute, University of Utah, 1950 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - D H Josephs
- Department of Medical Oncology, Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - S Srinivas
- Division of Medical Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA
| | - K Wride
- Clovis Oncology, Inc., 5500 Flatiron Parkway, Boulder, CO, 80301, USA
| | - D Thomas
- Clovis Oncology, Inc., 5500 Flatiron Parkway, Boulder, CO, 80301, USA
| | - A Simmons
- Clovis Oncology, Inc., 5500 Flatiron Parkway, Boulder, CO, 80301, USA
| | - A Loehr
- Clovis Oncology, Inc., 5500 Flatiron Parkway, Boulder, CO, 80301, USA
| | - R L Dusek
- Clovis Oncology, Inc., 5500 Flatiron Parkway, Boulder, CO, 80301, USA
| | - D Nepert
- Clovis Oncology, Inc., 5500 Flatiron Parkway, Boulder, CO, 80301, USA
| | - S Chowdhury
- Department of Medical Oncology, Guy's and St. Thomas' NHS Foundation Trust & Sarah Cannon Research Institute, Great Maze Pond, London, SE1 9RT, UK
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Storino J, Bradley DG, l. Basbus, Lastiri J, Specterman S, Colombo S, Alva A. P-326 Chemoradiotherapy treatment in gastroesophageal junction tumors. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.408] [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: 11/30/2022] Open
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Bamias A, Tzannis K, Harshman LC, Crabb SJ, Wong YN, Kumar Pal S, De Giorgi U, Ladoire S, Agarwal N, Yu EY, Niegisch G, Necchi A, Sternberg CN, Srinivas S, Alva A, Vaishampayan U, Cerbone L, Liontos M, Rosenberg J, Powles T, Bellmunt J, Galsky MD. Impact of contemporary patterns of chemotherapy utilization on survival in patients with advanced cancer of the urinary tract: a Retrospective International Study of Invasive/Advanced Cancer of the Urothelium (RISC). Ann Oncol 2019; 30:1841. [PMID: 31868903 PMCID: PMC8902985 DOI: 10.1093/annonc/mdz214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bamias A, Tzannis K, Harshman LC, Crabb SJ, Wong YN, Kumar Pal S, De Giorgi U, Ladoire S, Agarwal N, Yu EY, Niegisch G, Necchi A, Sternberg CN, Srinivas S, Alva A, Vaishampayan U, Cerbone L, Liontos M, Rosenberg J, Powles T, Bellmunt J, Galsky MD. Impact of contemporary patterns of chemotherapy utilization on survival in patients with advanced cancer of the urinary tract: a Retrospective International Study of Invasive/Advanced Cancer of the Urothelium (RISC). Ann Oncol 2019; 29:361-369. [PMID: 29077785 DOI: 10.1093/annonc/mdx692] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Cisplatin-based combination chemotherapy is the standard treatment of advanced urinary tract cancer (aUTC), but 50% of patients are ineligible for cisplatin according to recently published criteria. We used a multinational database to study patterns of chemotherapy utilization in patients with aUTC and determine their impact on survival. Patients and methods This was a retrospective study of patients with: UTC (bladder, renal pelvis, ureter or urethra); advanced disease (stages T4b and/or N+ and/or M+); urothelial, squamous or adenocarcinoma histology. Primary objective was overall survival (OS). Eligibility-for-cisplatin was defined by Eastern Cooperative Oncology Group performance status ≤ 1, creatinine clearance ≥ 60 ml/min, no hearing loss, no neuropathy and no heart failure. Cox regression multivariate analyses were used to establish independent associations of cisplatin versus noncisplatin-based chemotherapy on OS. Results 1794 patients treated between 2000 and 2013 at 29 centers were analyzed. Median follow-up was 29.1 months. About 1333 patients (74%) received first-line chemotherapy: the use of first-line chemotherapy was associated with longer OS: [hazard ratio (HR): 1.91, 95% confidence interval (CI): 1.67-2.20]. Type of first-line chemotherapy received was: cisplatin-based 669 (50%), carboplatin-based 399 (30%) and other 265 (20%). Cisplatin use was an independent favorable prognostic factor (HR: 1.54, 95% CI: 1.35-1.77). This benefit was independent of baseline characteristics or comorbidities but was associated with eligibility-for-cisplatin: eligible patients treated with cisplatin lived longer than those who were not (HR: 1.74, 95% CI: 1.36-2.21), while such benefit was not observed among ineligible patients. About 26% of patients who did not receive cisplatin were eligible for this agent. Median OS of ineligible patients was poor irrespective of the chemotherapy used. Conclusions The importance of applying published criteria of eligibility-for-cisplatin was confirmed in a multinational, real-world setting in aUTC. The reasons for deviations from these criteria set targets to improve adherence. Effective therapies for cisplatin-ineligible patients are needed.
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Affiliation(s)
- A Bamias
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - K Tzannis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - S J Crabb
- University of Southampton, Southampton, UK
| | - Y-N Wong
- Fox Chase Cancer Center, Philadelphia
| | - S Kumar Pal
- City of Hope Comprehensive Cancer Center, Duarte, USA
| | - U De Giorgi
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - S Ladoire
- Center Georges-François Leclerc, Dijon, France
| | | | - E Y Yu
- University of Washington, Seattle, USA
| | - G Niegisch
- Department of Urology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - A Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
| | | | - S Srinivas
- Stanford University School of Medicine, Stanford
| | - A Alva
- University of Michigan, Ann Arbor
| | | | - L Cerbone
- San Camillo Forlanini Hospital, Rome, Italy
| | - M Liontos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - J Rosenberg
- Memorial Sloan-Kettering Cancer Center, New York, USA
| | - T Powles
- Barts Health and the Royal Free NHS Trust, Queen Mary University of London, London, UK
| | - J Bellmunt
- Dana-Farber Cancer Institute, Boston, USA
| | - M D Galsky
- Mount Sinai School of Medicine, Tisch Cancer Institute, New York, USA
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Fishman M, Dutcher JP, Clark JI, Alva A, Miletello GP, Curti B, Agarwal N, Hauke R, Mahoney KM, Moon H, Treisman J, Tykodi SS, Daniels G, Morse MA, Wong MKK, Kaufman H, Gregory N, McDermott DF. Overall survival by clinical risk category for high dose interleukin-2 (HD IL-2) treated patients with metastatic renal cell cancer (mRCC): data from the PROCLAIM SM registry. J Immunother Cancer 2019; 7:84. [PMID: 30917871 PMCID: PMC6437874 DOI: 10.1186/s40425-019-0567-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/14/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Prognostic scoring systems are used to estimate the risk of mortality from metastatic renal cell carcinoma (mRCC). Outcomes from different therapies may vary within each risk group. These survival algorithms have been applied to assess outcomes in patients receiving T-cell checkpoint inhibitory immunotherapy and tyrosine kinase inhibitor therapy, but have not been applied extensively to patients receiving high dose interleukin-2 (HD IL-2) immunotherapy. METHODS Survival of 810 mRCC patients treated from 2006 to 2017 with high dose IL-2 (aldesleukin) and enrolled in the PROCLAIMSM registry data base was assessed utilizing the International Metastatic RCC Database Consortium (IMDC) risk criteria. Median follow-up is 23.4 months (mo.) (range 0.2-124 mo.). Subgroup evaluations were performed by separating patients by prior or no prior therapy, IL-2 alone, or therapy subsequent to IL-2. Some patients were in two groups. We will focus on the 356 patients who received IL-2 alone, and evaluate outcome by risk factor categories. RESULTS Among the 810 patients, 721 were treatment-naïve (89%) and 59% were intermediate risk. Overall, of the 249 patients with favorable risk, the median overall survival (OS) is 63.3 mo. and the 2-year OS is 77.6%. Of 480 patients with intermediate risk, median OS is 42.4 mo., 2-year OS 68.2%, and of 81 patients with poor risk, median OS 14 mo., 2-year OS 40.4%. Among those who received IL-2 alone (356 patients), median OS is 64.5, 57.6, and 14 months for favorable, intermediate and poor risk categories respectively. Two year survival among those treated only with HD IL-2 is 73.4, 63.7 and 39.8%, for favorable, intermediate and poor risk categories respectively. CONCLUSIONS Among mRCC patients treated with HD IL-2, all risk groups have median and 2-year survival consistent with recent reports of checkpoint or targeted therapies for mRCC. Favorable and intermediate risk (by IMDC) patients treated with HD IL-2 have longer OS compared with poor risk patients, with most durable OS observed in favorable risk patients. Favorable risk patients treated with HD IL-2 alone have a 2-year OS of 74%. These data continue to support a recommendation for HD IL-2 for patients with mRCC who meet eligibility criteria. TRIAL REGISTRATION PROCLAIM, NCT01415167 was registered with ClinicalTrials.gov on August 11, 2011, and initiated for retrospective data collection until 2006, and prospective data collection ongoing since 2011.
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Affiliation(s)
| | | | - J. I. Clark
- Loyola University Medical Center, Maywood, IL USA
| | - A. Alva
- University of Michigan, Ann Arbor, MI USA
| | | | - B. Curti
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR USA
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
| | - R. Hauke
- Nebraska Cancer Specialist, Omaha, NE USA
| | - K. M. Mahoney
- Beth Israel Deaconess Medical Center, Boston, MA USA
| | - H. Moon
- Southern California Permanente Medical Group, Pasadena, CA USA
| | - J. Treisman
- Medical College of Wisconsin, Milwaukee, WI USA
| | - S. S. Tykodi
- University of Washington and Fred Hutchinson Cancer Center, Seattle, WA USA
| | - G. Daniels
- University of California San Diego, San Diego, CA USA
| | | | | | - H. Kaufman
- Massachusetts General Hospital, Boston, MA USA
| | - N. Gregory
- Prometheus Laboratories, San Diego, CA USA
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Bazhenova L, Carvajal R, Cho B, Eaton K, Goel S, Heist R, Ingham M, Wang D, Werner T, Neuteboom S, Potvin D, Chen I, Christensen J, Chao R, Alva A. Sitravatinib demonstrates activity in patients with novel genetic alterations that inactivate CBL. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy279.396] [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: 11/14/2022] Open
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Powles T, Loriot Y, Gschwend J, Bellmunt J, Geczi L, Vulsteke C, Abdelsalam M, Gafanov R, Kyun Bae W, Revesz J, Yamamoto Y, Anido U, Su W, Fleming M, Markus M, Feng D, Poehlein C, Alva A. KEYNOTE-361: Phase 3 trial of pembrolizumab ± chemotherapy versus chemotherapy alone in advanced urothelial cancer. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/s1569-9056(18)31636-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Zhang T, Harrison M, O'Donnell P, Alva A, Hahn N, Appleman L, Cetnar J, Burke J, Fleming M, Milowsky M, Mortazavi A, Shore N, Schmidt E, Kresja C, Chen T, Bitman B, Izumi R, Hamdy A, George D. Phase 2 study of pembrolizumab alone or combined with acalabrutinib in platinum-refractory metastatic urothelial carcinoma (mUC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Powles T, Gschwend J, Loriot Y, Bellmunt J, Geczi L, Vulsteke C, Abdelsalam M, Gafanov R, Bae W, Revesz J, Yamamoto Y, Anido U, Su WP, Fleming M, Markus M, Feng D, Poehlein C, Alva A. Pembrolizumab ± chemotherapy versus chemotherapy in advanced urothelial cancer: Phase 3 KEYNOTE-361 trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Bamias A, Tzannis K, Liontos M, Harshman L, Crabb S, Wong YN, Pal S, Powles T, Bellmunt J, De Giorgi U, Ladoire S, Agarwal N, Yu E, Niegisch G, Sternberg C, Alva A, Srinivas S, Rosenberg J, Investigators R. Patterns of chemotherapy utilization in metastatic urothelial cancer (mUC): analysis from the retrospective international study of invasive/advanced cancer of the urothelium (RISC) database. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.26] [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: 11/13/2022] Open
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Udager AM, Liu TY, Skala SL, Magers MJ, McDaniel AS, Spratt DE, Feng FY, Siddiqui J, Cao X, Fields KL, Morgan TM, Palapattu GS, Weizer AZ, Chinnaiyan AM, Alva A, Montgomery JS, Tomlins SA, Jiang H, Mehra R. Frequent PD-L1 expression in primary and metastatic penile squamous cell carcinoma: potential opportunities for immunotherapeutic approaches. Ann Oncol 2016; 27:1706-12. [PMID: 27217541 DOI: 10.1093/annonc/mdw216] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/16/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Despite aggressive multimodal therapy, locally advanced and/or metastatic penile squamous cell carcinoma (SqCC) is associated with significant morbidity and mortality, indicating a need for new therapeutic options. Given the emerging clinical utility of immunotherapeutics, we sought to assess the incidence and potential clinical significance of PD-L1 expression in penile SqCC. PATIENTS AND METHODS Using an anti-PD-L1 primary antibody (clone 5H1), immunohistochemistry was carried out on whole tumor sections from 37 patients with penile SqCC treated at our institution between 2005 and 2013. PD-L1-positive tumors were defined as those with membranous staining in ≥5% of tumor cells. Association between PD-L1 expression and clinicopathologic parameters was examined using Fisher's exact test. Correlation between PD-L1 expression in primary tumors and matched metastases was assessed using the Spearman rank correlation coefficient (ρ). The difference in cancer-specific mortality between PD-L1-positive and -negative groups was examined using the log-rank test. RESULTS Twenty-three (62.2%) of 37 primary tumors were positive for PD-L1 expression, and there was strong positive correlation of PD-L1 expression in primary and metastatic samples (ρ = 0.72; 0.032 < P < 0.036). Primary tumor PD-L1 expression was significantly associated with usual type histology (P = 0.040) and regional lymph node metastasis (P = 0.024), as well as decreased cancer-specific survival (P = 0.011). CONCLUSIONS The majority of primary penile SqCC tumors express PD-L1, which is associated with high-risk clinicopathologic features and poor clinical outcome. These data provide a rational basis for further investigation of anti-PD-1 and anti-PD-L1 immunotherapeutics in patients with advanced penile SqCC.
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Affiliation(s)
- A M Udager
- Department of Pathology, University of Michigan Health System
| | - T-Y Liu
- Department of Biostatistics, University of Michigan School of Public Health
| | - S L Skala
- Department of Pathology, University of Michigan Health System
| | - M J Magers
- Department of Pathology, University of Michigan Health System
| | - A S McDaniel
- Department of Pathology, University of Michigan Health System
| | - D E Spratt
- Department of Radiation Oncology Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor
| | - F Y Feng
- Department of Radiation Oncology Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor
| | | | | | - K L Fields
- Department of Pathology, University of Michigan Health System
| | - T M Morgan
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor Internal Medicine, Division of Hematology/Oncology, University of Michigan Health System
| | - G S Palapattu
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor Internal Medicine, Division of Hematology/Oncology, University of Michigan Health System
| | - A Z Weizer
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor Internal Medicine, Division of Hematology/Oncology, University of Michigan Health System
| | - A M Chinnaiyan
- Department of Pathology, University of Michigan Health System Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor Departments of Urology Internal Medicine, Division of Hematology/Oncology, University of Michigan Health System Michigan Center for Translational Pathology
| | - A Alva
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor Howard Hughes Medical Institute, Ann Arbor, USA
| | - J S Montgomery
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor Internal Medicine, Division of Hematology/Oncology, University of Michigan Health System
| | - S A Tomlins
- Department of Pathology, University of Michigan Health System Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor Departments of Urology Internal Medicine, Division of Hematology/Oncology, University of Michigan Health System
| | - H Jiang
- Department of Biostatistics, University of Michigan School of Public Health
| | - R Mehra
- Department of Pathology, University of Michigan Health System Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor Departments of Urology
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Vanhegan IS, Alva A, Shaerf D, Baghla D. Intraoperative assessment of flexor hallucis longus tendon integrity following hallux valgus correction. Ann R Coll Surg Engl 2016; 98:520. [PMID: 27138852 DOI: 10.1308/rcsann.2016.0157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - A Alva
- London North West Healthcare NHS Trust , UK
| | - D Shaerf
- London North West Healthcare NHS Trust , UK
| | - Dps Baghla
- London North West Healthcare NHS Trust , UK
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16
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Ramos J, Casey M, Bamias A, De Giorgi U, Bellmunt J, Harshman L, Ladoire S, Wong Y, Alva A, Necchi A, Recine F, Vaishampayan U, Niegisch G, Pal S, Crabb S, Golshayan A, Srinivas S, Rosenberg J, Galsky M, Yu E. 2607 Predicting venous thromboembolism (VTE) in metastatic urothelial tract tumors (UTT). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31425-3] [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: 12/01/2022]
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17
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Karmouni T, Bensalah K, Alva A, Patard JJ, Lobel B, Guillé F. [Role of antibiotic prophylaxis in ambulatory cystoscopy]. Prog Urol 2001; 11:1239-41. [PMID: 11859658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND There has been a great deal of discussion regarding the necessity of antibiotic prophylaxis in transurethral cystoscopy. In order to clarify this complicated issue, a randomized prospective study was performed on 126 patients planned for cystoscopy. PATIENTS AND METHODS 126 patients who underwent urethrocystoscopy and did not have pyuria and bacteriuria were included and divided randomly into 2 groups: group 1 received 400 mg of norfloxacine and group 2 nothing. Urinalysis were performed on all patients 3 days after the examination. Statistical analyses were performed using Chi 2 test and the level of significance was set at 5%. RESULTS The global rate of infection was 5%. In the group 1 the incidence of infection was 3% (2/67) vs 5.1% (5/59) in group 2. There were no significant differences in the incidence in the background factor between the 2 groups of patients (p > 0.05). CONCLUSION Prophylactic administration of antibiotic before cystoscopy does not decrease the incidence of urinary tract incidence and it is not necessarily in patients with sterile urine.
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Affiliation(s)
- T Karmouni
- Service d'Urologie, CHU Pontchaillou, 2, rue Henri Le Guilloux, 35033 Rennes
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18
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Karmouni T, Rioux-Leclercq N, Bensalah K, Alva A, Patard JJ, Guillé F, Lobel B. [Primary neuroendocrine carcinoma of the bladder: diagnosis and treatment]. Prog Urol 2000; 10:590-4. [PMID: 11064903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE This rare but aggressive bladder tumour presents the morphological and immunohistochemical characteristic, common to all neuroendocrine tumours observed in other organs. This study analyzed the diagnostic criteria and therapeutic results obtained in 5 consecutive patients over a 3-year period. MATERIALS AND METHODS 5 patients (3 men and 2 women) suffering from primary small cell carcinoma of the bladder were evaluated. Histological diagnosis, treatment modalities and outcome were reviewed. RESULTS The main clinical presentation was macroscopic haematuria. All tumours were invasive at the time of diagnosis. 4 patients were treated by trans urethral resection alone, 2 of whom also received adjuvant radio-chemotherapy. One patient was treated by radical cystectomy. The 4 patients treated by conservative treatment modality had progression and a shorter survival, in contrast with patient treated by radical cystectomy. CONCLUSION The urologist must recognize this rare histological entity, which have a poor prognosis and requires multidisciplinary management. Treatment must consist of a combination of neoadjuvant or adjuvant chemotherapy and surgery to achieve the best results.
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Affiliation(s)
- T Karmouni
- Service d'Urologie, CHRU Pontchaillou, Rennes, France.
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