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Orji R, Morgans A, Jahangir E, Markson F, Ilelaboye A, Tan A, Okwuosa TM. Androgen Deprivation Therapy/Androgen Receptor Signaling Inhibitor Treatments for Prostate Cancer: Pathophysiology and Review of Effects on Cardiovascular Disease. South Med J 2024; 117:245-253. [PMID: 38701845 DOI: 10.14423/smj.0000000000001687] [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: 05/05/2024]
Abstract
Androgen deprivation therapy is the cornerstone of systemic management for prostate cancer but is associated with multiple adverse effects that must be considered during treatment. These effects occur because of the profound hypogonadism that is induced from lack of testosterone or due to the medications used in the treatment or in combination with androgen receptor signaling inhibitors. This article critically reviews the associations between androgen deprivation therapy, androgen receptor signaling inhibitors, and cardiovascular complications such as prolonged QT interval, atrial fibrillation, heart failure, atherosclerosis, coronary heart disease, venous thromboembolism, and peripheral arterial occlusive disease. These unfavorable outcomes reinforce the need for regular cardiovascular screening of patients undergoing androgen deprivation for the management of prostate cancer.
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Affiliation(s)
| | - Alicia Morgans
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Eiman Jahangir
- Division of Cardiovascular Medicine, Section of Cardio-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Favor Markson
- Department of Internal Medicine, Lincoln Medical Center, Bronx, New York
| | - Ayodeji Ilelaboye
- Department of Internal Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Alan Tan
- Division of Hematology-Oncology, Rush University Medical Center, Chicago, Illinois
| | - Tochukwu M Okwuosa
- Division of Cardiovascular Medicine, Section of Cardio-Oncology, Rush University Medical Center, Chicago, Illinois
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James ND, Tannock I, N'Dow J, Feng F, Gillessen S, Ali SA, Trujillo B, Al-Lazikani B, Attard G, Bray F, Compérat E, Eeles R, Fatiregun O, Grist E, Halabi S, Haran Á, Herchenhorn D, Hofman MS, Jalloh M, Loeb S, MacNair A, Mahal B, Mendes L, Moghul M, Moore C, Morgans A, Morris M, Murphy D, Murthy V, Nguyen PL, Padhani A, Parker C, Rush H, Sculpher M, Soule H, Sydes MR, Tilki D, Tunariu N, Villanti P, Xie LP. The Lancet Commission on prostate cancer: planning for the surge in cases. Lancet 2024; 403:1683-1722. [PMID: 38583453 DOI: 10.1016/s0140-6736(24)00651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/28/2023] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Nicholas D James
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
| | - Ian Tannock
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Felix Feng
- University of California, San Francisco, USA
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Syed Adnan Ali
- University of Manchester, Manchester, UK; The Christie Hospital, Manchester, UK
| | | | | | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Eva Compérat
- Tenon Hospital, Sorbonne University, Paris; AKH Medical University, Vienna, Austria
| | - Ros Eeles
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | | | - Áine Haran
- The Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | | | | | - Stacy Loeb
- New York University, New York, NY, USA; Manhattan Veterans Affairs, New York, NY, USA
| | | | | | | | - Masood Moghul
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Michael Morris
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Declan Murphy
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | | | | | | | | | | | - Howard Soule
- Prostate Cancer Foundation, Santa Monica, CA, USA
| | | | - Derya Tilki
- Martini-Klinik Prostate Cancer Center and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Türkiye
| | - Nina Tunariu
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Li-Ping Xie
- First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Partridge AH, Morgans A, Knelson LP, Recklitis C, Nekhlyudov L, Chi SN, Kenney LB, Diller L, Vrooman LM. Correction to: Cancer survivorship programs at the Dana-Farber Cancer Institute. J Cancer Surviv 2024:10.1007/s11764-024-01588-1. [PMID: 38607516 DOI: 10.1007/s11764-024-01588-1] [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: 04/13/2024]
Affiliation(s)
- Ann H Partridge
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
- Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Alicia Morgans
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lauren P Knelson
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Christopher Recklitis
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | - Larissa Nekhlyudov
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Susan N Chi
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | - Lisa B Kenney
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | - Lisa Diller
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | - Lynda M Vrooman
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
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Partridge AH, Morgans A, Knelson LP, Recklitis C, Nekhlyudov L, Chi SN, Kenney LB, Diller L, Vrooman LM. Cancer survivorship programs at the Dana-Farber Cancer Institute. J Cancer Surviv 2024; 18:34-41. [PMID: 38294603 PMCID: PMC11003887 DOI: 10.1007/s11764-023-01525-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE We sought to present the current status of survivorship programs at Dana-Farber Cancer Institute which include the David B. Perini, Jr. Quality of Life Clinic for survivors of childhood cancer, Stop and Shop Neuro-Oncology Outcomes Clinic for pediatric brain tumor survivors, and Adult Survivorship Program for adult cancer survivors including those diagnosed as adults (age 18 years and older) and adult survivors of childhood cancer, in an effort to share best practices as well as challenges. METHODS Description of programs and discussion. RESULTS Our institutional programs are detailed regarding their history and the multidisciplinary approach and both consultative and long-term care delivery models for pediatric and adult cancer survivors, with the goal of meeting the spectrum of survivorship care needs, from diagnosis and management of long-term effects of cancer-directed therapy and surveillance for subsequent cancer, to healthy lifestyle promotion and psychosocial support. Program investigators conduct research to understand the risks and unmet needs of cancer survivors, and to develop and test interventions to improve care delivery and medical and psychosocial outcomes. There are also educational initiatives detailed. CONCLUSIONS Survivorship programs at Dana-Farber are designed to optimize care and outcomes for cancer survivors including conducting quality improvement initiatives and research to further understand and meet the clinical needs of the large, heterogenous, and growing population cancer survivors into the future. IMPLICATIONS FOR CANCER SURVIVORS Programs like ours as well as those ongoing and planned aim to improve the comprehensive care of diverse cancer survivors.
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Affiliation(s)
- Ann H Partridge
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
- Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Alicia Morgans
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lauren P Knelson
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Christopher Recklitis
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | - Larissa Nekhlyudov
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Susan N Chi
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | - Lisa B Kenney
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | - Lisa Diller
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | - Lynda M Vrooman
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
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Morgans A. Expanding Treatment Options for Older Adults With Prostate Cancer. JAMA Oncol 2023; 9:1638-1639. [PMID: 37883113 DOI: 10.1001/jamaoncol.2023.4172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Affiliation(s)
- Alicia Morgans
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
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Rencsok EM, Slopen N, Autio K, Morgans A, McSwain L, Barata P, Cheng HH, Dreicer R, Heath E, McKay RR, Pomerantz M, Rathkopf D, Tagawa S, Whang YE, Ragin C, Odedina FT, George DJ, Kantoff PW, Vinson J, Villanti P, Haneuse S, Mucci LA. Quality of life in the year after new diagnosis with advanced prostate cancer for Black and White individuals living in the US. Qual Life Res 2023; 32:3209-3221. [PMID: 37410340 PMCID: PMC10711502 DOI: 10.1007/s11136-023-03468-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE To assess differences in baseline and longitudinal quality of life among Black and White individuals in the US with advanced prostate cancer. METHODS Secondary analysis of data from the International Registry for Men with Advanced Prostate Cancer (IRONMAN) including US participants newly diagnosed with advanced prostate cancer and identifying their race as Black or White from 2017 to 2023. Participants completed the EORTC QLQ-C30 Quality of Life (QoL) Survey at study enrollment and every 3 months thereafter for up to 1 year of follow-up reporting 15 scale scores ranging from 0 to 100 (higher functioning and lower symptom scores represent better quality of life). Linear mixed effects models with race and month of questionnaire completion were fit for each scale, and model coefficients were used to assess differences in baseline and longitudinal QoL by race. RESULTS Eight hundred and seventy-nine participants were included (20% identifying as Black) at 38 US sites. Compared to White participants at baseline, Black participants had worse constipation (mean 6.3 percentage points higher; 95% CI 2.9-9.8), financial insecurity (5.7 (1.4-10.0)), and pain (5.1 (0.9-9.3)). QoL decreased over time similarly by race; most notably, role functioning decreased by 0.7 percentage points (95% CI -0.8, -0.5) per month. CONCLUSION There are notable differences in quality of life at new diagnosis of advanced prostate cancer for Black and White individuals, and quality of life declines similarly in the first year for both groups. Interventions that address specific aspects of quality of life in these patients could meaningfully improve the overall survivorship experience.
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Affiliation(s)
- Emily M Rencsok
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, MA, USA.
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Karen Autio
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Pedro Barata
- Section of Hematology and Oncology, Tulane University School of Medicine, New Orleans, LA, USA
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Heather H Cheng
- Division of Medical Oncology, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Robert Dreicer
- University of Virginia Cancer Center, Charlottesville, VA, USA
| | | | - Rana R McKay
- Department of Oncology, University of California San Diego Moores Cancer Center, La Jolla, CA, USA
| | | | - Dana Rathkopf
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Scott Tagawa
- Division of Hematology and Medical Oncology, Weill Cornell Medical Center, New York, NY, USA
| | - Young E Whang
- Department of Medicine, Division of Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Camille Ragin
- Fox Chase Cancer Center, Philadelphia, PA, USA
- African-Caribbean Cancer Consortium, Philadelphia, PA, USA
| | - Folakemi T Odedina
- Mayo Clinic Comprehensive Cancer Center, Jacksonville, FL, USA
- Prostate Cancer Transatlantic Consortium (CaPTC), Jacksonville, FL, USA
| | | | - Philip W Kantoff
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Convergent Therapeutics, Cambridge, MA, USA
| | - Jacob Vinson
- Prostate Cancer Clinical Trials Consortium (PCCTC), New York, NY, USA
| | | | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lorelei A Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Knelson LP, Rosenberg S, Snow C, Rigby K, Lynch J, Sella T, Morgans A, Partridge AH. Survivorship Navigation for Young Women With Early-Stage Breast Cancer. Clin Breast Cancer 2023; 23:746-751.e1. [PMID: 37625925 DOI: 10.1016/j.clbc.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/20/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Young women treated for breast cancer experience unique concerns in follow-up. We developed a program to direct young breast cancer survivors to a dedicated survivorship visit and evaluated their experience. MATERIALS AND METHODS Early-stage breast cancer patients diagnosed under age 45 within 1 year of completing breast surgery, chemotherapy and/or radiation therapy were systematically referred for a survivorship visit. Patients completed a one-time, post-visit survey about their experience. RESULTS Sixty-nine out of 89 (78%) eligible patients attended a survivorship visit, and 40 of those 69 (58%) completed the post-visit survey. Most respondents learned about the survivorship clinic after completing treatment (30/40; 75%) and reported the survivorship visit occurred at an appropriate time in their follow-up care (26/40; 65%). Of the 34 respondents who reported receiving a treatment summary and survivorship care plan, 30 indicated it would be helpful when visiting their primary care provider (88.2%). Participants reported gaining valuable knowledge about cancer treatment (28/38; 73.7%), side effects (32/39; 82.1%), and cancer surveillance (30/40; 75%), and discussed emotional health (32/40; 80%), exercise (38/40; 95%), and ongoing cancer surveillance (32/37; 86.5%). Several reported intentions to make changes to their follow-up oncology care (8/20; 40%), exercise routines (16/30; 53.3%), and emotional health care (15/22; 68.2%). DISCUSSION Survivorship visit navigation is feasible for young breast cancer patients. These visits can influence knowledge gained and intended future health plans and behaviors. Systematic approaches to survivorship care may improve the physical and mental health of cancer survivors. Future health care delivery research focused on survivorship is warranted.
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Affiliation(s)
| | - Shoshana Rosenberg
- Weill Cornell Medicine, Sandra and Edward Meyer Cancer Center, New York, NY
| | - Craig Snow
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Tal Sella
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - Alicia Morgans
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - Ann H Partridge
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA.
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Moey MYY, Hennessy C, French B, Warner JL, Tucker MD, Hausrath DJ, Shah DP, DeCara JM, Bakouny Z, Labaki C, Choueiri TK, Dent S, Akhter N, Ismail-Khan R, Tachiki L, Slosky D, Polonsky TS, Awosika JA, Crago A, Wise-Draper T, Balanchivadze N, Hwang C, Fecher LA, Gomez CG, Hayes-Lattin B, Glover MJ, Shah SA, Gopalakrishnan D, Griffiths EA, Kwon DH, Koshkin VS, Mahmood S, Bashir B, Nonato T, Razavi P, McKay RR, Nagaraj G, Oligino E, Puc M, Tregubenko P, Wulff-Burchfield EM, Xie Z, Halfdanarson TR, Farmakiotis D, Klein EJ, Robilotti EV, Riely GJ, Durand JB, Hayek SS, Kondapalli L, Berg S, O'Connor TE, Bilen MA, Castellano C, Accordino MK, Sibel B, Weissmann LB, Jani C, Flora DB, Rudski L, Dutra MS, Nathaniel B, Ruíz-García E, Vilar-Compte D, Gupta S, Morgans A, Nohria A. COVID-19 severity and cardiovascular outcomes in SARS-CoV-2-infected patients with cancer and cardiovascular disease. Transl Oncol 2023; 34:101709. [PMID: 37302348 PMCID: PMC10235676 DOI: 10.1016/j.tranon.2023.101709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 05/20/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023] Open
Abstract
Background Data regarding outcomes among patients with cancer and co-morbid cardiovascular disease (CVD)/cardiovascular risk factors (CVRF) after SARS-CoV-2 infection are limited. Objectives To compare Coronavirus disease 2019 (COVID-19) related complications among cancer patients with and without co-morbid CVD/CVRF. Methods Retrospective cohort study of patients with cancer and laboratory-confirmed SARS-CoV-2, reported to the COVID-19 and Cancer Consortium (CCC19) registry from 03/17/2020 to 12/31/2021. CVD/CVRF was defined as established CVD or no established CVD, male ≥ 55 or female ≥ 60 years, and one additional CVRF. The primary endpoint was an ordinal COVID-19 severity outcome including need for hospitalization, supplemental oxygen, intensive care unit (ICU), mechanical ventilation, ICU or mechanical ventilation plus vasopressors, and death. Secondary endpoints included incident adverse CV events. Ordinal logistic regression models estimated associations of CVD/CVRF with COVID-19 severity. Effect modification by recent cancer therapy was evaluated. Results Among 10,876 SARS-CoV-2 infected patients with cancer (median age 65 [IQR 54-74] years, 53% female, 52% White), 6253 patients (57%) had co-morbid CVD/CVRF. Co-morbid CVD/CVRF was associated with higher COVID-19 severity (adjusted OR: 1.25 [95% CI 1.11-1.40]). Adverse CV events were significantly higher in patients with CVD/CVRF (all p<0.001). CVD/CVRF was associated with worse COVID-19 severity in patients who had not received recent cancer therapy, but not in those undergoing active cancer therapy (OR 1.51 [95% CI 1.31-1.74] vs. OR 1.04 [95% CI 0.90-1.20], pinteraction <0.001). Conclusions Co-morbid CVD/CVRF is associated with higher COVID-19 severity among patients with cancer, particularly those not receiving active cancer therapy. While infrequent, COVID-19 related CV complications were higher in patients with comorbid CVD/CVRF. (COVID-19 and Cancer Consortium Registry [CCC19]; NCT04354701).
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Affiliation(s)
- Melissa Y Y Moey
- Department of Cardiovascular Disease, Vidant Medical Center/East Carolina University, Greenville, NC, United States
| | - Cassandra Hennessy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jeremy L Warner
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, United States; Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, United States
| | - Matthew D Tucker
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, United States
| | - Daniel J Hausrath
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, United States
| | - Dimpy P Shah
- Mays Cancer Center at UTHealth San Antonio MD Anderson, San Antonio, TX, United States
| | - Jeanne M DeCara
- Section of Cardiology, University of Chicago Medical Center, Chicago, IL, United States
| | - Ziad Bakouny
- Dana-Farber Cancer Institute, Boston, MA, United States
| | - Chris Labaki
- Dana-Farber Cancer Institute, Boston, MA, United States
| | | | - Susan Dent
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Nausheen Akhter
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Roohi Ismail-Khan
- Cardio-Oncology Program, Division of Cardiovascular Medicine, University of South Florida Morsani College of Medicine and Moffitt Cancer Center, Tampa, FL, United States
| | - Lisa Tachiki
- University of Washington, Seattle, WA, United States; Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - David Slosky
- Cardio-Oncology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Tamar S Polonsky
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Joy A Awosika
- University of Cincinnati Cancer Center, Cincinnati, OH, United States
| | - Audrey Crago
- University of Cincinnati Cancer Center, Cincinnati, OH, United States
| | | | - Nino Balanchivadze
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, MI, United States
| | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, MI, United States
| | - Leslie A Fecher
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, United States
| | | | - Brandon Hayes-Lattin
- Division of Hematology and Medical Oncology, Knight Cancer Institute at Oregon Health and Science University, Portland, OR, United States
| | - Michael J Glover
- Stanford Cancer Institute at Stanford University, Stanford, CA, United States
| | - Sumit A Shah
- Stanford Cancer Institute at Stanford University, Stanford, CA, United States
| | - Dharmesh Gopalakrishnan
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Elizabeth A Griffiths
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Daniel H Kwon
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, CA, United States
| | - Vadim S Koshkin
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, CA, United States
| | - Sana Mahmood
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Babar Bashir
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Taylor Nonato
- Moores Cancer Center, University of California San Diego, La Jolla, CA, United States
| | - Pedram Razavi
- Moores Cancer Center, University of California San Diego, La Jolla, CA, United States
| | - Rana R McKay
- Moores Cancer Center, University of California San Diego, La Jolla, CA, United States
| | - Gayathri Nagaraj
- Division of Medical Oncology and Hematology, Loma Linda University, Loma Linda, CA, United States
| | - Eric Oligino
- Cardio-Oncology, Hartford HealthCare Cancer, Hartford, CT, United States
| | | | - Polina Tregubenko
- The University of Kansas Health System, Kansas City, KS, United States
| | | | - Zhuoer Xie
- Mayo Clinic, Rochester, MN, United States
| | | | | | - Elizabeth J Klein
- Brown University and Lifespan Cancer Institute, Providence, RI, United States
| | | | - Gregory J Riely
- Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | | | - Salim S Hayek
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, United States
| | - Lavanya Kondapalli
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Stephanie Berg
- Loyola University Medical Center, Chicago, IL, United States
| | | | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Emory University, Atlanta, GA, United States
| | - Cecilia Castellano
- Winship Cancer Institute of Emory University, Emory University, Atlanta, GA, United States
| | - Melissa K Accordino
- Herbert Irving Comprehensive Cancer Center at Columbia University, New York, NY, United States
| | - Blau Sibel
- Northwest Medical Specialties, Tacoma, WA, United States
| | | | - Chinmay Jani
- Mount Auburn Hospital, Cambridge, MA, United States
| | | | - Lawrence Rudski
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Miriam Santos Dutra
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | | | | | | | | | - Alicia Morgans
- Dana-Farber Cancer Institute, Boston, MA, United States.
| | - Anju Nohria
- Cardiovascular Division, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA, United States.
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Morgans A. Prostate Cancer Survivorship Today: Support that Spans the Journey. Eur Urol Focus 2023; 9:403-404. [PMID: 37271699 DOI: 10.1016/j.euf.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Alicia Morgans
- Associate Professor of Medicine, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, USA.
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10
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Gong F, Loeb S, Siu K, Myrie A, Orstad S, Kenfield SA, Morgans A, Thakker S, Robbins R, Carter P, Jean-Louis G, Nolasco TS, Byrne N, Gupta N. Sleep disturbances are underappreciated in prostate cancer survivorship. Prostate Cancer Prostatic Dis 2023; 26:210-212. [PMID: 36543892 DOI: 10.1038/s41391-022-00630-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The prevalence of sleep disturbances among prostate cancer (PCa) survivors, and extent of urologist involvement in sleep care are not well-studied. METHODS PCa survivors (n = 167) and urologists (n = 145) were surveyed about sleep disturbances and survivorship care practices. RESULTS Most PCa survivors had sleep disturbances, including 50.9% with poor sleep quality, 18.0% with clinical/severe insomnia, and 36.5% at high-risk for sleep apnea. Few urologists routinely screened for sleep disturbances, as recommended in national cancer survivorship guidelines. CONCLUSIONS Optimal PCa survivorship care should incorporate screening for sleep disturbances, addressing comorbid factors affecting sleep and referring to sleep medicine when appropriate.
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Affiliation(s)
- Fred Gong
- From SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Stacy Loeb
- New York University Langone Health, New York, NY, USA
- Manhattan Veterans Affairs, New York, NY, USA
| | - Katherine Siu
- New York University Langone Health, New York, NY, USA
- Manhattan Veterans Affairs, New York, NY, USA
| | | | - Stephanie Orstad
- New York University Langone Health, New York, NY, USA
- Manhattan Veterans Affairs, New York, NY, USA
| | | | - Alicia Morgans
- Dana- Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Rebecca Robbins
- Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Patricia Carter
- The Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | | | - Tatiana Sanchez Nolasco
- New York University Langone Health, New York, NY, USA
- Manhattan Veterans Affairs, New York, NY, USA
| | - Nataliya Byrne
- New York University Langone Health, New York, NY, USA
- Manhattan Veterans Affairs, New York, NY, USA
| | - Natasha Gupta
- New York University Langone Health, New York, NY, USA
- Manhattan Veterans Affairs, New York, NY, USA
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11
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VanderWeele DJ, Kocherginsky M, Munir S, Martone B, Sagar V, Morgans A, Stadler WM, Abdulkadir S, Hussain M. A Phase II Study of sEphB4-HSA in Metastatic Castration-Resistant Prostate Cancer. Clin Genitourin Cancer 2022; 20:575-580. [PMID: 36210299 DOI: 10.1016/j.clgc.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/06/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Ephrin receptors and their membrane-localized ligands induce bidirectional signaling and facilitate tumor-stroma interactions. Blocking the EphB4-EphrinB2 pathway, which can be accomplished by soluble EphB4 conjugated to human serum albumin (sEphB4-HSA), promotes cell death in preclinical models of aggressive prostate cancer. We hypothesized that targeting the EphB4-EphrinB2 pathway may serve as a therapeutic target in the treatment of metastatic castration resistant prostate cancer (mCRPC). PATIENTS AND METHODS We conducted a single arm, phase II trial in patients with progressive mCRPC who had received no more than 3 prior therapies for mCRPC. sEphB4-HSA 1000 mg IV was administered every 2 weeks, extending to 3 weeks starting from cycle 7. The primary endpoint was confirmed prostate specific antigen (PSA) response rate. We employed a Simon 2-stage Minimax design with 15 patients in the first stage and 10 additional patients in the second stage. RESULTS Fourteen eligible patients enrolled in the study with median age of 73.5 years (range: 52-83) and median baseline PSA of 65.11 ng/mL (range: 7.77-2850 ng/mL). Most patients received 3 prior therapies for mCRPC. The median treatment duration with sEphB4-HSA was 6.5 weeks (range: 2-35 weeks). Three patients experienced a serious adverse event potentially related to therapy, including 1 patient with a grade 5 event (cerebral vascular accident) possibly related to the study drug. No patient had a confirmed PSA response, and the study was stopped for futility. Thirteen patients had PSA progression. The median time to PSA progression was 28 days (90% CI: 28-42 days), and median time to radiologic progression was 55 days (90% CI: 54-72 days). Of 3 patients with measurable disease, 2 had stable disease and one had progressive disease. CONCLUSION In patients with mCRPC who progressed on prior second generation AR-targeted therapy, sEphB4-HSA monotherapy had no discernable anti-tumor activity.
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Affiliation(s)
- David J VanderWeele
- Robert H. Lurie Comprehensive Cancer Center at Northwestern University, Chicago, IL; Division of Hematology Oncology, Department of Medicine, Northwestern University, Chicago, IL
| | - Masha Kocherginsky
- Robert H. Lurie Comprehensive Cancer Center at Northwestern University, Chicago, IL; Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Sabah Munir
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Brenda Martone
- Division of Hematology Oncology, Department of Medicine, Northwestern University, Chicago, IL
| | - Vinay Sagar
- Department of Urology, Northwestern University, Chicago, IL
| | - Alicia Morgans
- Robert H. Lurie Comprehensive Cancer Center at Northwestern University, Chicago, IL; Division of Hematology Oncology, Department of Medicine, Northwestern University, Chicago, IL
| | | | - Sarki Abdulkadir
- Robert H. Lurie Comprehensive Cancer Center at Northwestern University, Chicago, IL; Department of Urology, Northwestern University, Chicago, IL
| | - Maha Hussain
- Robert H. Lurie Comprehensive Cancer Center at Northwestern University, Chicago, IL; Division of Hematology Oncology, Department of Medicine, Northwestern University, Chicago, IL.
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12
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Samora NL, Wallis CJD, Huang L, Tallman JE, Zhao Z, Hoffman K, Morgans A, Cooperberg M, Goodman M, Greenfield S, Hamilton AS, Hashibe M, Kaplan S, O'Neil B, Paddock LE, Stroup A, Wu X, Koyama T, Penson DF, Barocas DA. Association between body mass index and localized prostate cancer management and disease-specific quality of life. BJUI Compass 2022; 4:223-233. [PMID: 36816144 PMCID: PMC9931544 DOI: 10.1002/bco2.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/08/2022] [Accepted: 09/28/2022] [Indexed: 02/17/2023] Open
Abstract
Purpose The purpose of this work is to describe the association between body mass index (BMI) and (1) management option for localized prostate cancer (PCa) and (2) disease-specific quality of life (ds-QoL) after treatment or active surveillance. Subjects/patients and methods We analysed data from men with localized PCa managed with radical prostatectomy (RP), radiation therapy (RT), or active surveillance (AS) in a prospective, population-based cohort study. We evaluated the association between BMI and management option with multivariable multinomial logistic regression analysis. The association between BMI and ds-QoL was assessed using multivariable longitudinal linear regression. Regression models were adjusted for baseline domain scores, demographics, and clinicopathologic characteristics. Results A total of 2378 men were included (medians [quartiles]: age 64 [59-69] years; BMI 27 kg/m2; 77% were non-Hispanic white); 29% were obese (BMI ≥ 30). Accounting for demographic and clinicopathologic features, BMI ≥ 28 kg/m2 was inversely associated with the likelihood of receiving RP (compared with RT) and became statistically significant at BMI ≥ 33 kg/m2 (maximum adjusted relative risk ratio = 0.80, 95% CI 0.67 to 0.95, p = 0.013 for BMI ≥ 33 vs. 25). Conversely, BMI was not significantly associated with the likelihood of receiving AS compared with RT. After stratification by management option, obese men who underwent definitive treatment were not found to have clinically worse ds-QoL. Obese men initially on AS appeared to have worse urinary incontinence than nonobese men, but this was not significant on an as-treated sensitivity analysis. Conclusions Among men with localized PCa, those with BMI ≥ 33 kg/m2 were less likely to receive surgery than radiation. Obesity was not associated with ds-QoL in men undergoing definitive treatment, nor in men who remained on AS.
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Affiliation(s)
| | | | - Li‐Ching Huang
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Jacob E. Tallman
- Department of UrologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Zhiguo Zhao
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Karen Hoffman
- Department of Radiation OncologyThe University of Texas MD Anderson CenterHoustonTexasUSA
| | - Alicia Morgans
- Dana Farber Cancer InstituteHarvard Medical SchoolBostonMassachusettsUSA
| | | | - Michael Goodman
- Department of EpidemiologyEmory University Rollins School of Public HealthAtlantaGeorgiaUSA
| | - Sheldon Greenfield
- Department of MedicineUniversity of California IrvineIrvineCaliforniaUSA
| | - Ann S. Hamilton
- Department of Population and Public Health SciencesKeck School of Medicine at the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Mia Hashibe
- Department of Family and Preventative MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Sherrie Kaplan
- Department of MedicineUniversity of California IrvineIrvineCaliforniaUSA
| | - Brock O'Neil
- Department of UrologyUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Lisa E. Paddock
- Department of EpidemiologyRutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
| | - Antoinette Stroup
- Department of EpidemiologyRutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
| | - Xiao‐Cheng Wu
- Department of EpidemiologyLouisiana State University New Orleans School of Public HealthNew OrleansLouisianaUSA
| | - Tatsuki Koyama
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - David F. Penson
- Department of UrologyVanderbilt University Medical CenterNashvilleTennesseeUSA
- Geriatric Research Education and Clinical CenterVeterans Affairs Tennessee Valley Healthcare SystemNashvilleTennesseeUSA
| | - Daniel A. Barocas
- Department of UrologyVanderbilt University Medical CenterNashvilleTennesseeUSA
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13
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Cheung YMM, Morgans A, Hamnvik OPR. Bone Health and Denosumab Discontinuation in Oncology Populations. Oncologist 2022; 27:998-1003. [PMID: 36250799 PMCID: PMC9732234 DOI: 10.1093/oncolo/oyac213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/12/2022] [Indexed: 01/05/2023] Open
Abstract
Managing bone health after denosumab cessation is a commonly encountered challenge. Although the “rebound phenomenon” is generally recognized by endocrinologists in the context of osteoporosis, it is not as widely understood in the context of bone metastases and cancer. This commentary reviews the evidence on the efficacy and safety of various bone health agents in mitigating the “rebound phenomenon” in cancer populations.
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Affiliation(s)
- Yee-Ming Melody Cheung
- Corresponding author: Ole-Petter Riksfjord Hamnvik, MBBCh, BAO, MMSc, Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women’s Hospital, 221 Longwood Ave, RFB-2, Boston, MA 02115, USA.
| | - Alicia Morgans
- Department of Medical Oncology, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA, USA
| | - Ole-Petter Riksfjord Hamnvik
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA, USA
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Herriges MJ, Shenhav-Goldberg R, Peck JI, Bhanvadia SK, Morgans A, Chino F, Chandrasekar T, Shapiro O, Jacob JM, Basnet A, Bratslavsky G, Goldberg H. Financial Toxicity and Its Association With Prostate and Colon Cancer Screening. J Natl Compr Canc Netw 2022; 20:981-988. [PMID: 36075394 DOI: 10.6004/jnccn.2022.7036] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The term "financial toxicity" or "hardship" is a patient-reported outcome that results from the material costs of cancer care, the psychological impacts of these costs, and the coping strategies that patients use to deal with the strain that includes delaying or forgoing care. However, little is known about the impact of financial toxicity on cancer screening. We examined the effects of financial toxicity on the use of screening tests for prostate and colon cancer. We hypothesized that greater financial hardship would show an association with decreased prevalence of cancer screening. METHODS This cross-sectional survey-based US study included men and women aged ≥50 years from the National Health Interview Survey database from January through December 2018. A financial hardship score (FHS) between 0 and 10 was formulated by summarizing the responses from 10 financial toxicity dichotomic questions (yes or no), with a higher score associated with greater financial hardship. Primary outcomes were self-reported occurrence of prostate-specific antigen (PSA) blood testing and colonoscopy for prostate and colon cancer screening, respectively. RESULTS Overall, 13,439 individual responses were collected. A total of 9,277 (69.03%) people had undergone colonoscopies, and 3,455 (70.94%) men had a PSA test. White, married, working men were more likely to undergo PSA testing and colonoscopy. Individuals who had not had a PSA test or colonoscopy had higher mean FHSs than those who underwent these tests (0.70 and 0.79 vs 0.47 and 0.61, respectively; P≤.001 for both). Multivariable logistic regression models demonstrated that a higher FHS was associated with a decreased odds ratio for having a PSA test (0.916; 95% CI, 0.867-0.967; P=.002) and colonoscopy (0.969; 95% CI, 0.941-0.998; P=.039). CONCLUSIONS Greater financial hardship is suggested to be associated with a decreased probability of having prostate and colon cancer screening. Healthcare professionals should be aware that financial toxicity can impact not only cancer treatment but also cancer screening.
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Affiliation(s)
- Michael J Herriges
- Pediatrics Department, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | | | - Juliet I Peck
- Performing Arts Medicine Department, Shenandoah University, Winchester, Virginia
| | - Sumeet K Bhanvadia
- USC Norris Cancer Center, Keck Medical Center, University of Southern California, Los Angeles, California
| | - Alicia Morgans
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Fumiko Chino
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | | | | | - Alina Basnet
- Hematology/Oncology Department, State University of New York Upstate Medical University, Syracuse, New York
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15
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Beer TM, Shore N, Morgans A, Winters‐Stone K, Wefel JS, George DJ. Functional impact of androgen‐targeted therapy on patients with castration‐resistant prostate cancer. BJUI Compass 2022; 3:424-433. [PMID: 36267196 PMCID: PMC9579880 DOI: 10.1002/bco2.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/10/2021] [Revised: 05/25/2022] [Accepted: 06/12/2022] [Indexed: 12/05/2022] Open
Abstract
Context Second‐generation androgen receptor inhibitors (ARIs) extend metastasis‐free survival, prolong overall survival, and delay symptoms when added to androgen deprivation therapy for the treatment of castration‐sensitive or castration‐resistant prostate cancer (CRPC). However, ARIs may adversely impact physical and cognitive function, thereby decreasing quality of life and prognosis. Objective To evaluate the evidence regarding the potential effects of ARIs on physical and cognitive function and to contextualize how drug‐related adverse effects may influence treatment decisions in CRPC. Evidence acquisition We performed a literature search using MEDLINE from January 1998 to June 2020 using terms relating to prostate cancer, androgen deprivation, and physical and cognitive function. We selected 61 publications for analysis. Evidence synthesis Treatment‐induced deterioration in physical and cognitive function may impair the independence and well‐being of patients with CRPC. Patient‐reported outcomes from clinical trials of ARIs provide quantitative evidence of their impact on these domains, which appears to vary between ARIs, reflecting the different adverse event profiles of these agents. Thus, the risk of physical or cognitive dysfunction may be managed or mitigated by appropriate selection of treatment options. Studies in patients with CRPC have assessed the cognitive effects of ARIs with validated instruments, whereas quantitative analysis of the impact on physical function has been limited. Conclusion Several validated instruments utilized for the assessment of physical and cognitive function in clinical studies have been adapted for clinical practice; however, consensus on the standardization of these assessments is required. Future clinical studies employing validated tools may generate data on the impact of ARIs and guide treatment decisions for patients with CRPC. Patient summary We review the hormonal therapies used to treat men with prostate cancer and the effects they have on physical and cognitive function. We discuss how to measure these effects and how this may assist when choosing treatment.
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Affiliation(s)
- Tomasz M. Beer
- Oregon Health and Science University Knight Cancer Institute Portland Oregon USA
| | - Neal Shore
- Carolina Urologic Research Center Myrtle Beach South Carolina USA
| | | | - Kerri Winters‐Stone
- Oregon Health and Science University Knight Cancer Institute Portland Oregon USA
| | - Jeffrey S. Wefel
- The University of Texas MD Anderson Cancer Center Houston Texas USA
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16
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Panzone J, Welch C, Morgans A, Bhanvadia SK, Mossanen M, Goldberg RS, Chandrasekar T, Pinkhasov R, Shapiro O, Jacob JM, Basnet A, Bratslavsky G, Goldberg H. Association of Race With Cancer-Related Financial Toxicity. JCO Oncol Pract 2021; 18:e271-e283. [PMID: 34752150 DOI: 10.1200/op.21.00440] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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
PURPOSE We investigated the association between race and FT among previous patients with cancer. Studies show that patients with cancer experience financial toxicity (FT) because of their cancer treatment. METHODS Data on individuals with a cancer history were collected in this cross-sectional study during 2012, 2014, and 2017, from the US Health Information National Trends Survey. This survey is conducted by mail with monetary compensation as an incentive. We specifically assessed responses to two questions: Has cancer hurt you financially? Have you been denied health insurance because of cancer? Multivariable logistic regression analyses were used to assess the associations between these questions and race. RESULTS Of 10,592 individuals participating, 1,328 men and women (12.5%) with a cancer history were assessed. Compared with Blacks, Whites were found to have a higher rate of insurance (95.4% v 90.0%), were more likely to receive cancer treatment (93.9% v 85%), and had a higher rate of surgical treatment than Blacks (77% v 60%), Hispanics (55%), and others (77%, 60%, 55%, and 74.2%, respectively, P < .001). On multivariable analysis, Blacks were more than five times as likely to be denied insurance (odds ratio, 5.003; 95% CI, 2.451 to 10.213; P < .001) and more than twice as likely to report being hurt financially because of cancer (odds ratio, 2.448; 95% CI, 1.520 to 3.941; P < .001) than Whites. Of all cancer groups analyzed (genitourinary, gynecologic, gastrointestinal, and breast), genitourinary malignancies were the only group in which the rate of reporting being hurt financially varied in a statistically significant manner (Whites 36.7%, Hispanics 62.5%, and Blacks 59.3%, P = .004). CONCLUSION Our data suggest that race is significantly associated with FT because of cancer. Awareness of racial inequality with regards to FT should be raised among health care workers.
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Affiliation(s)
- John Panzone
- Urology Department, SUNY Upstate Medical University, Syracuse, NY.,Le Moyne College, Syracuse, NY
| | - Christopher Welch
- Urology Department, SUNY Upstate Medical University, Syracuse, NY.,Hamilton College, Clinton, NY
| | - Alicia Morgans
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sumeet K Bhanvadia
- USC Norris Cancer Center, Keck Medical Center, University of Southern California, Los Angeles, CA
| | - Matthew Mossanen
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Ruben Pinkhasov
- Urology Department, SUNY Upstate Medical University, Syracuse, NY
| | - Oleg Shapiro
- Urology Department, SUNY Upstate Medical University, Syracuse, NY
| | - Joseph M Jacob
- Urology Department, SUNY Upstate Medical University, Syracuse, NY
| | - Alina Basnet
- Hematology/Oncology Department, SUNY Upstate Medical University, Syracuse, NY
| | | | - Hanan Goldberg
- Urology Department, SUNY Upstate Medical University, Syracuse, NY
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17
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Tehrani DM, Wang X, Rafique AM, Hayek SS, Herrmann J, Neilan TG, Desai P, Morgans A, Lopez-Mattei J, Parikh RV, Yang EH. Impact of cancer and cardiovascular disease on in-hospital outcomes of COVID-19 patients: results from the american heart association COVID-19 cardiovascular disease registry. Cardiooncology 2021; 7:28. [PMID: 34372948 PMCID: PMC8352751 DOI: 10.1186/s40959-021-00113-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/14/2021] [Indexed: 12/11/2022]
Abstract
Background While pre-existing cardiovascular disease (CVD) appears to be associated with poor outcomes in patients with Coronavirus Disease 2019 (COVID-19), data on patients with CVD and concomitant cancer is limited. The purpose of this study is to evaluate the effect of underlying CVD and CVD risk factors with cancer history on in-hospital mortality in those with COVID-19. Methods Data from symptomatic adults hospitalized with COVID-19 at 86 hospitals in the US enrolled in the American Heart Association’s COVID-19 CVD Registry was analyzed. The primary exposure was cancer history. The primary outcome was in-hospital death. Multivariable logistic regression models were adjusted for demographics, CVD risk factors, and CVD. Interaction between history of cancer with concomitant CVD and CVD risk factors were tested. Results Among 8222 patients, 892 (10.8%) had a history of cancer and 1501 (18.3%) died. Cancer history had significant interaction with CVD risk factors of age, body mass index (BMI), and smoking history, but not underlying CVD itself. History of cancer was significantly associated with increased in-hospital death (among average age and BMI patients, adjusted odds ratio [aOR] = 3.60, 95% confidence interval [CI]: 2.07–6.24; p < 0.0001 in those with a smoking history and aOR = 1.33, 95%CI: 1.01—1.76; p = 0.04 in non-smokers). Among the cancer subgroup, prior use of chemotherapy within 2 weeks of admission was associated with in-hospital death (aOR = 1.72, 95%CI: 1.05–2.80; p = 0.03). Underlying CVD demonstrated a numerical but statistically nonsignificant trend toward increased mortality (aOR = 1.18, 95% CI: 0.99—1.41; p = 0.07). Conclusion Among hospitalized COVID-19 patients, cancer history was a predictor of in-hospital mortality. Notably, among cancer patients, recent use of chemotherapy, but not underlying CVD itself, was associated with worse survival. These findings have important implications in cancer therapy considerations and vaccine distribution in cancer patients with and without underlying CVD and CVD risk factors.
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Affiliation(s)
- David M Tehrani
- Division of Cardiology, Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA
| | - Xiaoyan Wang
- Division of General Internal Medicine and Health Service Research, Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA
| | - Asim M Rafique
- Division of Cardiology, Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA
| | - Salim S Hayek
- Division of Cardiology, Department of Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Tomas G Neilan
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Pooja Desai
- Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA
| | - Alicia Morgans
- Division of Hematology and Oncology, Department of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Juan Lopez-Mattei
- Division of Cardiology, Department of Medicine, Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rushi V Parikh
- Division of Cardiology, Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA
| | - Eric H Yang
- Division of Cardiology, Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA. .,UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles Health System, Los Angeles, CA, USA.
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18
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Polineni P, Ashack L, Kalapurakal J, Morgans A, VanderWeele D, Kundu S, Hussain M, Meeks J, Sachdev S. Trimodality Treatment for Muscle-Invasive Bladder Cancer: An Institutional Experience. Adv Radiat Oncol 2021; 6:100718. [PMID: 34286164 PMCID: PMC8273199 DOI: 10.1016/j.adro.2021.100718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/06/2020] [Revised: 04/07/2021] [Accepted: 04/27/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose As an alternative to radical cystectomy, tri-modality treatment (TMT) is an effective treatment approach for selected patients with muscle-invasive bladder cancer (MIBC). The purpose of this report is to contribute to the literature by summarizing institutional outcomes of a bladder-preserving TMT approach for patients with MIBC. Methods and Materials Patients treated with TMT for MIBC from 1998 to 2019 were identified. Patient, disease, and treatment factors were recorded. Overall survival (OS), disease-free survival (DFS), and bladder-preserved DFS were estimated with the Kaplan-Meier method. Prognostic factors were evaluated with Cox proportional hazards regression. Results Thirty-two patients treated with TMT to a median dose of 64.8 Gy for T2 (78%), T3 (19%), and T4 (3%) disease were followed for a median of 19 months (mean, 36; range, 6-213); 31% had associated carcinoma in situ; 25% had associated hydronephrosis. Cisplatin was the most commonly used chemotherapeutic agent. OS rates were 84% at 1 year and 61% at 5 years. DFS rates were 84% and 61% and bladder-preserved DFS rates were 84% and 60% at 1 year and 5 years, respectively. Salvage cystectomy rates at 1 year and 5 years were 4% and 9%, respectively. Four patients had locally invasive recurrences at 8, 11, 34, and 37 months after initial MIBC diagnosis, 2 of whom underwent salvage radical cystectomy. Ten (31%) patients developed distant disease at a median of 13 months after diagnosis. Unlike local recurrence, distant recurrences were associated with worse OS and hazard ratios of 3.4 (P = 0.039). Conclusions OS and DFS were comparable to those of published data. Our outcomes support TMT as an effective option for carefully selected patients with MIBC.
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Affiliation(s)
| | | | | | | | | | - Shilajit Kundu
- Urology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Joshua Meeks
- Urology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Tehrani D, Wang X, Rafique AM, Hayek SS, Herrmann J, Neilan TG, Desai P, Morgans A, Lopez-mattei J, Parikh RV, Yang EH. Impact of Cancer and Cardiovascular Disease on In-Hospital Outcomes of COVID-19 Patients: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry.. [PMID: 34127966 PMCID: PMC8202433 DOI: 10.21203/rs.3.rs-600795/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: While pre-existing cardiovascular disease (CVD) appears to be associated with poor outcomes in patients with Coronavirus Disease 2019 (COVID-19), data on patients with CVD and concomitant cancer is limited. Evaluate the effect of underlying CVD and CVD risk factors with cancer history on in-hospital mortality in those with COVID-19. Methods: Data from symptomatic adults hospitalized with COVID-19 at 86 hospitals in the US enrolled in the American Heart Association’s COVID-19 CVD Registry was analyzed. The primary exposure was cancer history. The primary outcome was in-hospital death. Multivariable logistic regression models were adjusted for demographics, CVD risk factors, and CVD. Interaction between history of cancer with concomitant CVD and CVD risk factors were tested. Results: Among 8222 patients, 892 (10.8%) had a history of cancer and 1501 (18.3%) died. Cancer history had significant interaction with CVD risk factors of age, body mass index (BMI), and smoking history, but not underlying CVD itself. History of cancer was significantly associated with increased in-hospital death (among average age and BMI patients, adjusted odds ratio [aOR]=3.60, 95% confidence interval [CI]: 2.07–6.24; p<0.0001 in those with a smoking history and aOR=1.33, 95%CI: 1.01 – 1.76; p=0.04 in non-smokers). Among the cancer subgroup, prior use of chemotherapy within 2 weeks of admission was associated with in-hospital death (aOR=1.72, 95%CI: 1.05–2.80; p=0.03). Underlying CVD demonstrated a numerical but statistically nonsignificant trend toward increased mortality (aOR=1.18, 95% CI: 0.99 – 1.41; p=0.07). Conclusion: Among hospitalized COVID-19 patients, cancer history was a predictor of in-hospital mortality. Notably, among cancer patients, recent use of chemotherapy, but not underlying CVD itself, was associated with worse survival. These findings have important implications in cancer therapy considerations and vaccine distribution in cancer patients with and without underlying CVD and CVD risk factors.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Juan Lopez-Mattei
- MD Anderson Division of Radiation Oncology: The University of Texas MD Anderson Cancer Center Division of Radiation Oncology
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Tehrani D, Rafique A, Wang X, Desai P, Morgans A, Herrmann J, Lopez-Mattei J, Neilan T, Hayek S, Parikh R, Yang E. IN-HOSPITAL OUTCOMES AMONG COVID-19 PATIENTS WITH CANCER AND CARDIOVASCULAR DISEASE. J Am Coll Cardiol 2021. [PMCID: PMC8091257 DOI: 10.1016/s0735-1097(21)04419-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Okwuosa TM, Morgans A, Rhee JW, Reding KW, Maliski S, Plana JC, Volgman AS, Moseley KF, Porter CB, Ismail-Khan R. Impact of Hormonal Therapies for Treatment of Hormone-Dependent Cancers (Breast and Prostate) on the Cardiovascular System: Effects and Modifications: A Scientific Statement From the American Heart Association. Circ Genom Precis Med 2021; 14:e000082. [PMID: 33896190 DOI: 10.1161/hcg.0000000000000082] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cardiovascular disease and cancer are the leading causes of death in the United States, and hormone-dependent cancers (breast and prostate cancer) are the most common noncutaneous malignancies in women and men, respectively. The hormonal (endocrine-related) therapies that serve as a backbone for treatment of both cancers improve survival but also increase cardiovascular morbidity and mortality among survivors. This consensus statement describes the risks associated with specific hormonal therapies used to treat breast and prostate cancer and provides an evidence-based approach to prevent and detect adverse cardiovascular outcomes. Areas of uncertainty are highlighted, including the cardiovascular effects of different durations of hormonal therapy, the cardiovascular risks associated with combinations of newer generations of more intensive hormonal treatments, and the specific cardiovascular risks that affect individuals of various races/ethnicities. Finally, there is an emphasis on the use of a multidisciplinary approach to the implementation of lifestyle and pharmacological strategies for management and risk reduction both during and after active treatment.
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de Wit R, Freedland S, Oudard S, Marinov G, Capart P, Combest A, Peterson R, Ozatilgan A, Morgans A. 627P Real-world evidence (RWE) for patients (pts) with metastatic castration-resistant prostate cancer (mCRPC) treated with cabazitaxel (CBZ): Comparison with the randomized clinical study CARD. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.886] [Citation(s) in RCA: 1] [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: 11/29/2022] Open
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Narayan V, Harrison M, Cheng H, Kenfield S, Aggarwal R, Kwon D, McKay R, Hauger R, Hart N, Conzen S, Borno H, Jim H, Dicker A, Dorff T, Moslehi J, Mucci L, Parsons JK, Saad F, Soule H, Morgans A, Ryan CJ. Improving research for prostate cancer survivorship: A statement from the Survivorship Research in Prostate Cancer (SuRECaP) working group. Urol Oncol 2020; 38:83-93. [DOI: 10.1016/j.urolonc.2019.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/16/2019] [Accepted: 10/08/2019] [Indexed: 12/26/2022]
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Boettcher AN, Usman A, Morgans A, VanderWeele DJ, Sosman J, Wu JD. Past, Current, and Future of Immunotherapies for Prostate Cancer. Front Oncol 2019; 9:884. [PMID: 31572678 PMCID: PMC6749031 DOI: 10.3389/fonc.2019.00884] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 08/27/2019] [Indexed: 12/22/2022] Open
Abstract
Prostate cancer (PCa) is the most common cancer in men, and the second leading cause of cancer related death in men in Western countries. The standard therapy for metastatic PCa is androgen suppression therapy (AST). Men undergoing AST eventually develop metastatic castration-resistant prostate cancer (mCRPC), of which there are limited treatment options available. Immunotherapy has presented substantial benefits for many types of cancer, but only a marginal benefit for mCRPC, at least in part, due to the immunosuppressive tumor microenvironment (TME). Current clinical trials are investigating monotherapies or combination therapies involving adoptive cellular therapy, viral, DNA vaccines, oncolytic viruses, and immune checkpoint inhibitors (ICI). Immunotherapies are also being combined with chemotherapy, radiation, and AST. Additionally, preclinical investigations show promise with the recent description of alternative ways to circumvent the immunosuppressive nature of the prostate tumor microenvironment, including harnessing the immune stimulatory NKG2D pathway, inhibiting myeloid derived suppressor cells, and utilizing immunomodulatory oncolytic viruses. Herein we provide an overview of recent preclinical and clinical developments in cancer immunotherapies and discuss the perspectives for future immunotherapies in PCa.
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Affiliation(s)
- Adeline N Boettcher
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Ahmed Usman
- Department of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Alicia Morgans
- Department of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - David J VanderWeele
- Department of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jeffrey Sosman
- Department of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jennifer D Wu
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Department of Microbiology and Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Gupta S, Albertson D, Gaston D, Heilbrun ME, Agarwal N, Boucher K, Parnell TJ, Liu T, Morgans A, Madison R, Gowen K, Miller VA, Ross JS, Ali SM, Millis SZ. Comprehensive Genomic Sequencing of Urothelial Tumors Identifies Rare SMARCB1 (INI-1)–Deficient Carcinomas of the Urinary System. Clin Genitourin Cancer 2018; 16:e373-e382. [DOI: 10.1016/j.clgc.2017.09.001] [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] [Received: 06/27/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 01/22/2023]
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Pezaro C, Omlin A, Mastris K, Attard G, Beer T, Chi K, Chowdhury S, Davis I, Drake C, de Bono J, Efstathiou E, Gravis G, Higano C, Hussain M, James N, Logothetis C, Morgans A, Parker C, Ryan C, Saad F, Sartor O, Small E, Sternberg C, Sweeney C, Tannock I, Tombal B, Gillessen S. Precision, complexity and stigma in advanced prostate cancer terminology: it is time to move away from ‘castration-resistant’ prostate cancer. Ann Oncol 2017; 28:1692-1694. [DOI: 10.1093/annonc/mdx312] [Citation(s) in RCA: 4] [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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Kanz BA, Pollack MH, Johnpulle R, Puzanov I, Horn L, Morgans A, Sosman JA, Rapisuwon S, Conry RM, Eroglu Z, Johnson DB. Safety and efficacy of anti-PD-1 in patients with baseline cardiac, renal, or hepatic dysfunction. J Immunother Cancer 2016; 4:60. [PMID: 27777770 PMCID: PMC5067899 DOI: 10.1186/s40425-016-0166-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 09/13/2016] [Indexed: 12/26/2022] Open
Abstract
Background Anti-PD-1 therapy is increasingly used in various advanced malignancies. Patients with baseline organ dysfunction are largely excluded from clinical trials. Therefore it is unclear whether anti-PD-1 therapy is safe or effective in this setting. Further, these patients are often not candidates for other anti-cancer therapies, highlighting their need for active treatment options. Methods We performed a retrospective analysis of patients from multiple centers with advanced solid tumors and baseline organ dysfunction who received anti-PD-1 therapy. Organ dysfunction was defined as cardiac (left ventricular ejection fraction ≤45 %), renal (creatinine ≥2 mg/dL or GFR ≤30 ml/min) or hepatic dysfunction (evidence of cirrhosis on imaging or AST, ALT or bilirubin ≥3x ULN). We assessed change in organ dysfunction, immune related adverse events (irAEs), response rate, progression free survival (PFS) and overall survival (OS). Results We identified 27 patients eligible for inclusion with the following diseases: renal cell carcinoma (n = 8), melanoma (10), non-small cell lung cancer (3), small cell lung cancer (2) and urothelial bladder cancer (4). Baseline organ dysfunction included renal dysfunction (n = 17), hepatic dysfunction (7), cardiac dysfunction (11), including >1 organ dysfunction (8). Worsening organ dysfunction requiring hospitalization or dose delays occurred in 8 patients (30 %) although in most cases this was thought not-drug related and resolved with supportive care. Grade 3 irAEs occurred in 2 pts (7 %; hepatitis and colitis). Thirteen of 27 patients had ongoing treatment benefit (objective response or stable disease) at data collection (48 %). Eleven patients had primary progressive disease (41 %), 11 had stable disease (41 %), 4 had partial responses (15 %), and one had a complete response (4 %). Overall, median PFS was 168 days. Median OS was not reached. Conclusions In our experience, anti-PD-1 agents in this group of patients with cardiac, hepatic or renal dysfunction were associated with tolerable irAEs and infrequent manageable worsening of organ dysfunction. Further, objective responses and prolonged PFS were observed in a number of patients. Thus, patients with baseline organ dysfunction may be considered for anti-PD-1 therapy with appropriate clinical monitoring.
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Affiliation(s)
- Bridgette A Kanz
- Departments of Pharmaceutical Services, Vanderbilt Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN 37232 USA
| | - Megan H Pollack
- Departments of Pharmaceutical Services, Vanderbilt Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN 37232 USA
| | - Romany Johnpulle
- Departments of Medicine, Vanderbilt Ingram Cancer Center, 777 PRB, 2220 Pierce Ave., Nashville, TN 37232 USA
| | - Igor Puzanov
- Department of Medicine, Roswell Park Cancer Institute, Elm @ Carlton Streets, Buffalo, NY 14263 USA
| | - Leora Horn
- Departments of Medicine, Vanderbilt Ingram Cancer Center, 777 PRB, 2220 Pierce Ave., Nashville, TN 37232 USA
| | - Alicia Morgans
- Departments of Medicine, Vanderbilt Ingram Cancer Center, 777 PRB, 2220 Pierce Ave., Nashville, TN 37232 USA
| | - Jeffrey A Sosman
- Departments of Medicine, Vanderbilt Ingram Cancer Center, 777 PRB, 2220 Pierce Ave., Nashville, TN 37232 USA
| | - Suthee Rapisuwon
- Department of Oncology, Georgetown Lombardi Cancer Center, 3970 Reservoir Road NW, Washington, DC 20007 USA
| | - R Martin Conry
- Department of Medicine, University of Alabama at Birmingham, 1824 6th Avenue S, Birmingham, AL 35233 USA
| | - Zeynep Eroglu
- Department of Cutaneous Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612 USA
| | - Douglas B Johnson
- Departments of Medicine, Vanderbilt Ingram Cancer Center, 777 PRB, 2220 Pierce Ave., Nashville, TN 37232 USA
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Guan J, Khambhati J, Jones LW, Morgans A, Allaf M, Penson DF, Moslehi J. Cardiology Patient Page. ABCDE Steps for Heart and Vascular Wellness Following a Prostate Cancer Diagnosis. Circulation 2016; 132:e218-20. [PMID: 26527696 DOI: 10.1161/circulationaha.115.012521] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jian Guan
- From the Cardiovascular Division (J.G., J.K., J.M.), Cardio-Oncology Program (J.G., J.K., A.M., D.F.P., J.M.), Vanderbilt-Ingram Cancer Center (A.M., J.M.), Department of Urologic Surgery (D.F.P.), Vanderbilt University School of Medicine, Nashville, TN; Memorial Sloan Kettering Cancer Center, New York (L.W.J.); Department of Urologic Surgery, Johns Hopkins Hospital, Baltimore, MD (M.A.)
| | - Jay Khambhati
- From the Cardiovascular Division (J.G., J.K., J.M.), Cardio-Oncology Program (J.G., J.K., A.M., D.F.P., J.M.), Vanderbilt-Ingram Cancer Center (A.M., J.M.), Department of Urologic Surgery (D.F.P.), Vanderbilt University School of Medicine, Nashville, TN; Memorial Sloan Kettering Cancer Center, New York (L.W.J.); Department of Urologic Surgery, Johns Hopkins Hospital, Baltimore, MD (M.A.)
| | - Lee W Jones
- From the Cardiovascular Division (J.G., J.K., J.M.), Cardio-Oncology Program (J.G., J.K., A.M., D.F.P., J.M.), Vanderbilt-Ingram Cancer Center (A.M., J.M.), Department of Urologic Surgery (D.F.P.), Vanderbilt University School of Medicine, Nashville, TN; Memorial Sloan Kettering Cancer Center, New York (L.W.J.); Department of Urologic Surgery, Johns Hopkins Hospital, Baltimore, MD (M.A.)
| | - Alicia Morgans
- From the Cardiovascular Division (J.G., J.K., J.M.), Cardio-Oncology Program (J.G., J.K., A.M., D.F.P., J.M.), Vanderbilt-Ingram Cancer Center (A.M., J.M.), Department of Urologic Surgery (D.F.P.), Vanderbilt University School of Medicine, Nashville, TN; Memorial Sloan Kettering Cancer Center, New York (L.W.J.); Department of Urologic Surgery, Johns Hopkins Hospital, Baltimore, MD (M.A.)
| | - Mohamad Allaf
- From the Cardiovascular Division (J.G., J.K., J.M.), Cardio-Oncology Program (J.G., J.K., A.M., D.F.P., J.M.), Vanderbilt-Ingram Cancer Center (A.M., J.M.), Department of Urologic Surgery (D.F.P.), Vanderbilt University School of Medicine, Nashville, TN; Memorial Sloan Kettering Cancer Center, New York (L.W.J.); Department of Urologic Surgery, Johns Hopkins Hospital, Baltimore, MD (M.A.)
| | - David F Penson
- From the Cardiovascular Division (J.G., J.K., J.M.), Cardio-Oncology Program (J.G., J.K., A.M., D.F.P., J.M.), Vanderbilt-Ingram Cancer Center (A.M., J.M.), Department of Urologic Surgery (D.F.P.), Vanderbilt University School of Medicine, Nashville, TN; Memorial Sloan Kettering Cancer Center, New York (L.W.J.); Department of Urologic Surgery, Johns Hopkins Hospital, Baltimore, MD (M.A.)
| | - Javid Moslehi
- From the Cardiovascular Division (J.G., J.K., J.M.), Cardio-Oncology Program (J.G., J.K., A.M., D.F.P., J.M.), Vanderbilt-Ingram Cancer Center (A.M., J.M.), Department of Urologic Surgery (D.F.P.), Vanderbilt University School of Medicine, Nashville, TN; Memorial Sloan Kettering Cancer Center, New York (L.W.J.); Department of Urologic Surgery, Johns Hopkins Hospital, Baltimore, MD (M.A.).
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Van Bommel A, Morgans A, Tombal B, De Reijke T, Stowell C, Penson D. 2522 Development of a standardized set of patient-centered outcomes for advanced prostate cancer: An international effort for a unified approach. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31341-7] [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: 10/22/2022]
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Hoffman K, Alvarez J, Barocas D, Koyama T, Morgans A, Phillips S, Resnick M, Penson D. MP27-11 DISTINCT SIDE EFFECT PROFILES AFTER CONTEMPORARY TREATMENT OF LOCALIZED PROSTATE CANCER. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Barocas DA, Chen V, Cooperberg M, Goodman M, Graff JJ, Greenfield S, Hamilton A, Hoffman K, Kaplan S, Koyama T, Morgans A, Paddock LE, Phillips S, Resnick MJ, Stroup A, Wu XC, Penson DF. Using a population-based observational cohort study to address difficult comparative effectiveness research questions: the CEASAR study. J Comp Eff Res 2014; 2:445-60. [PMID: 24236685 DOI: 10.2217/cer.13.34] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND While randomized controlled trials represent the highest level of evidence we can generate in comparative effectiveness research, there are clinical scenarios where this type of study design is not feasible. The Comparative Effectiveness Analyses of Surgery and Radiation in localized prostate cancer (CEASAR) study is an observational study designed to compare the effectiveness and harms of different treatments for localized prostate cancer, a clinical scenario in which randomized controlled trials have been difficult to execute and, when completed, have been difficult to generalize to the population at large. METHODS CEASAR employs a population-based, prospective cohort study design, using tumor registries as cohort inception tools. The primary outcome is quality of life after treatment, measured by validated instruments. Risk adjustment is facilitated by capture of traditional and nontraditional confounders before treatment and by propensity score analysis. RESULTS We have accrued a diverse, representative cohort of 3691 men in the USA with clinically localized prostate cancer. Half of the men invited to participate enrolled, and 86% of patients who enrolled have completed the 6-month survey. CONCLUSION Challenging comparative effectiveness research questions can be addressed using well-designed observational studies. The CEASAR study provides an opportunity to determine what treatments work best, for which patients, and in whose hands.
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Resnick M, Barocas D, Morgans A, Phillips S, Fan KH, Koyama T, Albertsen P, Chen V, Cooperberg M, Graff J, Greenfield S, Hamilton A, Hoffman K, Hoffman R, Kaplan S, Stanford J, Stroup A, Wu XC, Penson D. 449 THE BURDEN OF PRE-TREATMENT URINARY, SEXUAL, AND BOWEL DYSFUNCTION ACROSS TWO DECADES OF PROSTATE CANCER: RESULTS FROM PCOS AND CEASAR. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1839] [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: 11/28/2022]
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Resnick M, Fan KH, Koyama T, Keegan K, Barocas D, Morgans A, Hamilton A, Stroup A, Albertsen P, Hoffman R, Penson D. 448 LONG TERM TREATMENT REGRET AMONG MEN TREATED WITH RADICAL PROSTATECTOMY OR EXTERNAL BEAM RADIATION THERAPY FOR LOCALIZED PROSTATE CANCER: RESULTS FROM THE PROSTATE CANCER OUTCOMES STUDY. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1838] [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: 10/27/2022]
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Barocas D, Resnick M, Morgans A, Phillips S, Chen V, Cooperberg M, Graff J, Greenfield S, Hamilton A, Hoffman K, Kaplan S, Koyama T, Stroup A, Wu XC, Penson D. 57 ASSOCIATION BETWEEN RACE AND PARTICIPATORY DECISION MAKING (PDM) IN TREATMENT DECISIONS FOR PROSTATE CANCER (PC) MANAGEMENT. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1433] [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: 10/27/2022]
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Stalker TJ, Wu J, Morgans A, Traxler EA, Wang L, Chatterjee MS, Lee D, Quertermous T, Hall RA, Hammer DA, Diamond SL, Brass LF. Endothelial cell specific adhesion molecule (ESAM) localizes to platelet-platelet contacts and regulates thrombus formation in vivo. J Thromb Haemost 2009; 7:1886-96. [PMID: 19740102 PMCID: PMC4441405 DOI: 10.1111/j.1538-7836.2009.03606.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND In resting platelets, endothelial cell specific adhesion molecule (ESAM) is located in alpha granules, increasing its cell surface expression following platelet activation. However, the function of ESAM on platelets is unknown. OBJECTIVE To determine whether ESAM has a role in thrombus formation. METHODS AND RESULTS We found that following platelet activation ESAM localizes to the junctions between adjacent platelets, suggesting a role for this protein in contact-dependent events that regulate thrombus formation. To test this hypothesis we examined the effect of ESAM deletion on platelet function. In vivo, ESAM(-/-) mice achieved more stable hemostasis than wild-type mice following tail transection, and developed larger thrombi following laser injury of cremaster muscle arterioles. In vitro, ESAM(-/-) platelets aggregated at lower concentrations of G protein-dependent agonists than wild-type platelets, and were more resistant to disaggregation. In contrast, agonist-induced calcium mobilization, alpha(IIb)beta(3) activation, alpha-granule secretion and platelet spreading, were normal in ESAM-deficient platelets. To understand the molecular mechanism by which ESAM regulates platelet activity, we utilized a PDZ domain array to identify the scaffold protein NHERF-1 as an ESAM binding protein, and further demonstrated that it associates with ESAM in both resting and activated platelets. CONCLUSIONS These findings support a model in which ESAM localizes to platelet contacts following platelet activation in order to limit thrombus growth and stability so that the optimal hemostatic response occurs following vascular injury.
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Affiliation(s)
- T J Stalker
- Department of Medicine, The Institute for Medicine and Engineering, University of Pennsylvania, Philadelphia, PA 19104, USA
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Salmon P, Moghanaki D, Mick R, Furth EE, Behbehani A, Morgans A, Drebin J, Rosato EF, Whittington R, Giantonio BJ. Number and percentage of pathologically involved lymph nodes (pLN) in patients (pts) with pancreatic adenocarcinoma (PA) predicts for overall survival (OS) in pts treated with postoperative adjuvant chemoradiotherapy (CRT). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15509] [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
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Morgans A, Moghanaki D, Mick R, Furth EE, Salmon P, Behbehani A, Drebin J, Rosato EF, Whittington R, Giantonio BJ. Survival following resection of pancreatic cancers may not be affected by length of hospital stay or delay to initiating adjuvant chemoradiation (CRT). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4639] [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
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Haynes JC, Moghanaki D, Morgans A, Salmon P, Furth EE, Giantonio BJ, Drebin J, Rosato EF, Whittington R, Metz JM. Survival following partial pancreatectomy and radiation for ampullary adenocarcinoma. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15614] [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
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Moghanaki D, Behbehani A, Morgans A, Salmon P, Furth EE, Sun W, Giantonio BJ, Metz JM, Rosato EF, Whittington R. Outcomes with postoperative chemoradiation (CRT) in patients (pts) with gross residual disease (R2) following surgical resection of pancreatic adenocarcinoma (PA). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15628] [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
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Woulfe D, Jiang H, Morgans A, Monks R, Birnbaum M, Brass LF. Defects in secretion, aggregation, and thrombus formation in platelets from mice lacking Akt2. J Clin Invest 2004; 113:441-50. [PMID: 14755341 PMCID: PMC324545 DOI: 10.1172/jci20267] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2003] [Accepted: 12/02/2003] [Indexed: 12/14/2022] Open
Abstract
Prior studies have shown that PI3Ks play a necessary but incompletely defined role in platelet activation. One potential effector for PI3K is the serine/threonine kinase, Akt, whose contribution to platelet activation was explored here. Two isoforms of Akt were detected in mouse platelets, with expression of Akt2 being greater than Akt1. Deletion of the gene encoding Akt2 impaired platelet aggregation, fibrinogen binding, and granule secretion, especially in response to low concentrations of agonists that activate the G(q)-coupled receptors for thrombin and thromboxane A(2). Loss of Akt2 also impaired arterial thrombus formation and stability in vivo, despite having little effect on platelet responses to collagen and ADP. In contrast, reducing Akt1 expression had no effect except when Akt2 was also deleted. Activation of Akt by thrombin was abolished by deletion of Galpha(q) but was relatively unaffected by deletion of Galpha(i2), which abolished Akt activation by ADP. From these results we conclude that Akt2 is a necessary component of PI3K-dependent signaling downstream of G(q)-coupled receptors, promoting thrombus growth and stability in part by supporting secretion. The contribution of Akt1 is less evident except in the setting in which Akt2 is absent.
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Affiliation(s)
- Donna Woulfe
- Department of Medicine, University of Pennsylvania, Philadelphia, USA.
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Woulfe D, Jiang H, Morgans A, Monks R, Birnbaum M, Brass LF. Defects in secretion, aggregation, and thrombus formation in platelets from mice lacking Akt2. J Clin Invest 2004. [DOI: 10.1172/jci200420267] [Citation(s) in RCA: 183] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lees C, Parra M, Missfelder-Lobos H, Morgans A, Fletcher O, Nicolaides KH. Individualized risk assessment for adverse pregnancy outcome by uterine artery Doppler at 23 weeks. Obstet Gynecol 2001; 98:369-73. [PMID: 11530114 DOI: 10.1016/s0029-7844(01)01474-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [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: 11/28/2022]
Abstract
OBJECTIVE To provide individualized risk prediction of severe adverse pregnancy outcome based on uterine artery Doppler screening at 23 weeks. METHODS Color Doppler assessment of the uterine arteries was carried out in 5121 women attending for routine care at 23 weeks in two inner-city obstetric units. The mean uterine artery pulsatility index (PI) was calculated, and the likelihood ratios in relation to PI were generated for severe adverse outcome. This was defined as fetal death, placental abruption, and delivery before 34 weeks associated with preeclampsia and birth weight less than the 10th centile. RESULTS The likelihood of severe adverse pregnancy outcome increased quadratically with mean uterine artery PI. This relationship was not affected by maternal age, ethnicity, or parity. At a mean PI of 1.45, the 95th centile for our population, the likelihood ratio for severe adverse pregnancy outcome was 5. Cigarette smoking had an additional contribution to PI in predicting severe adverse outcome, roughly doubling the risk for a given PI. CONCLUSION The individualized risk of severe adverse pregnancy outcome can be determined by uterine artery Doppler screening at 23 weeks and knowledge of cigarette smoking history. Such individualized risk would allow ultrasound resources and clinical follow-up to be tailored to the pregnant woman for the most appropriate use of antenatal care.
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Affiliation(s)
- C Lees
- Harris Birthright Unit, King's College Hospital, London, United Kingdom.
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