1
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Callegari M, Danziger-Isakov LA, Rose A, Kaul D, Shaffer K, Chong PP, Florescu D, German K, Avery R, Nguyen MH, Wildfeuer B, Michaels MG, Green M, Guo K, Zhao L, Daud A, Ison MG. Presentation, anagement, and outcomes of norovirus in adult and pediatric solid organ and hematopoietic stem cell transplant recipients: A multicenter, retrospective study. Transpl Infect Dis 2024:e14270. [PMID: 38526183 DOI: 10.1111/tid.14270] [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: 11/18/2023] [Revised: 01/20/2024] [Accepted: 03/05/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Norovirus (NoV) can cause chronic relapsing and remitting diarrhea in immunocompromised patients. Few multicenter studies have described the clinical course, outcomes, and complications of chronic NoV in transplant recipients. METHODS A multicenter retrospective study of adult and pediatric SOT and HSCT recipients diagnosed with NoV between November 1, 2017, and February 28, 2021. Data were obtained from electronic medical records (EMR) and entered into a central REDCap database. Descriptive statistics were calculated. RESULTS A total of 280 NoV+ patients were identified across eight sites. The majority were adults (74.1%) and SOT recipients (91.4%). Initial diagnosis of NoV occurred a median of 36 months post-Tx (IQR [15.0, 90.0]). Most NoV cases had >3 diarrheal episodes daily (66.0%), nausea and vomiting (60.1%). Duration of diarrhea varied greatly (median = 10 days, mean = 85.9 days, range (1, 2100)). 71.3% were hospitalized. Adjustment of immunosuppression, including reduction and discontinuation of mToR inhibitor, CNI, and/or MMF, was the most common management intervention for NoV. Other therapies resulted only in temporary improvement. Four patients died within 30 days and three others died by 180 days postdiagnosis. Clinically significant renal dysfunction was observed in 12.5% by 30 days and 21.4% by 180 days post-NoV diagnosis. CONCLUSION In HSCT and SOT patients, NoV frequently resulted in severe symptoms, prolonged diarrhea (30% persistent with diarrhea for >30 days), and clinically significant renal dysfunction (up to 21% of patients). Utilized therapies did not reliably result in the resolution of infection demonstrating the need for more effective treatment.
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Affiliation(s)
- Michelle Callegari
- Divisions of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lara A Danziger-Isakov
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Anne Rose
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Daniel Kaul
- Division of Infectious Disease, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kelly Shaffer
- Division of Infectious Disease, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Pearlie P Chong
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Diana Florescu
- Infectious Diseases Division, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kaci German
- Infectious Diseases Division, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Robin Avery
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - M Hong Nguyen
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brett Wildfeuer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marian G Michaels
- Department of Pediatrics, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael Green
- Department of Pediatrics, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kexin Guo
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amna Daud
- Divisions of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael G Ison
- Respiratory Diseases Branch, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
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2
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Keefer L, Daud A, Ison M. Approach to patient reported outcome measures selection and implementation in a chronic norovirus clinical efficacy trial for patients after solid organ transplant. Transpl Infect Dis 2023; 25:e14099. [PMID: 37436814 DOI: 10.1111/tid.14099] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 06/15/2023] [Accepted: 06/23/2023] [Indexed: 07/13/2023]
Abstract
Norovirus is the second most common cause of diarrhea among solid organ transplant recipients. There are currently no approved therapies for Norovirus, which can substantially impact quality of life, particularly in an immunocompromised patient population. In order to establish clinical efficacy and support any medication claims related to a patient's symptoms or function, the Food and Drug Administration requires that a trial's primary endpoints be derived from patient reported outcome measures- an outcome that comes directly from the patient, without interpretation of the patient's response by a clinician or anyone else. In this paper, we describe our study team's approach to the definition, selection, measurement and evaluation of patient reported outcome measures as part of establishing clinical efficacy of Nitazoxanide for acute and chronic Norovirus in solid organ transplant recipients. We specifically describe our approach to measuring the primary efficacy endpoint- days to cessation of vomiting and diarrhea after randomization through 160 days, measured through daily symptom diaries as well as the impact of treatment on exploratory efficacy endpoints, particularly change in the impact of norovirus on psychological function and quality of life.
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Affiliation(s)
- Laurie Keefer
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amna Daud
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Ison
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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3
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Thuluvath AJ, Siddiqui O, Lai JC, Peipert J, Levitsky J, Daud A, Mazumder NR, Flores AM, Borja-Cacho D, Caicedo JC, Loftus C, Wong R, Mroczek D, Ladner DP. Personality Traits in Patients With Cirrhosis Are Different From Those of the General Population and Impact Likelihood of Liver Transplantation. Transplantation 2023; 107:420-428. [PMID: 36173424 PMCID: PMC10294608 DOI: 10.1097/tp.0000000000004304] [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] [Indexed: 01/28/2023]
Abstract
BACKGROUND Personality traits influence clinical outcomes in chronic diseases, but their impact in cirrhosis is unknown. We studied the personality of patients with cirrhosis undergoing liver transplant (LT) evaluation and determined their correlation to clinical outcomes. METHODS A multicenter' prospective study of adult patients undergoing LT evaluation was performed from January 2018 to October 2019. The "Big Five" personality traits of conscientiousness, extraversion, openness, neuroticism, and agreeableness plus agency were assessed with the Midlife Development Inventory Personality Scale and compared with the general population. Frailty was assessed with the Liver Frailty Index. RESULTS Two hundred sixty-three LT candidates were enrolled. Twenty-four percent had hepatitis C virus, 25% nonalcoholic steatohepatitis, and 25% ethyl alcohol (mean model for end-stage liver disease = 15.7). Compared with the general population, LT candidates had higher openness (3.1 versus 2.9; P < 0.001), extraversion (3.2 versus 3.1; P < 0.001), agreeableness (3.5 versus 3.4; P = 0.04), agency (2.9 versus 2.6; P < 0.001), neuroticism (2.2 versus 2.1; P = 0.001), and lower conscientiousness (3.3 versus 3.4; P = 0.007). Patients with higher conscientiousness were more likely to receive an LT (HR = 2.76; P = 0.003). CONCLUSIONS Personality traits in LT candidates differ significantly from the general population, with higher conscientiousness associated with a higher likelihood of receiving a transplant.
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Affiliation(s)
- Avesh J. Thuluvath
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
- Division of Hepatology, Department of Medicine, Northwestern Medicine, Chicago, IL
| | - Osama Siddiqui
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jennifer C. Lai
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, CA
| | - John Peipert
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Josh Levitsky
- Division of Hepatology, Department of Medicine, Northwestern Medicine, Chicago, IL
| | - Amna Daud
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Nikhilesh R. Mazumder
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
- Division of Hepatology, Department of Medicine, Northwestern Medicine, Chicago, IL
| | - Anne-Marie Flores
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Daniel Borja-Cacho
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
- Division of Transplant, Department of Surgery, Northwestern Medicine, Chicago, IL
| | - Juan C. Caicedo
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
- Division of Transplant, Department of Surgery, Northwestern Medicine, Chicago, IL
| | - Corinne Loftus
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Randi Wong
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, CA
| | - Dan Mroczek
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Psychology, Weinberg College of Arts & Sciences, Northwestern University, Evanston, IL
| | - Daniela P. Ladner
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Division of Transplant, Department of Surgery, Northwestern Medicine, Chicago, IL
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4
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Li Y, Flavell RR, Juarez R, Chow M, Wu C, Tsai K, Daud A, Behr SC. Retrospective study of the incidence of sarcoidosis-like reaction in patients treated with immunotherapy. Clin Radiol 2023; 78:e131-e136. [PMID: 36344282 DOI: 10.1016/j.crad.2022.09.127] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/06/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
AIM To assess the frequency of radiographically evident drug-induced sarcoidosis-like reaction (DISR) in patients treated with anti-cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) therapy, anti-programmed cell death protein 1 (PD-1) therapy, or a combination of both in a single centre. MATERIALS AND METHODS The images and medical records of 457 patients with metastatic melanoma or head and neck cancer treated with either anti-CTLA-4 therapy, anti-PD-1 therapy, or a combination of both at University of California medical centre were reviewed retrospectively and the incidence of radiological manifestations of DISR was assessed among these treatment groups. RESULTS Radiological manifestations of DISR were found in 19/457 patients (4.1%). The mean interval from the initiation of immunotherapy to development of DISR was 5.5 months (range 2.3-13.5 months). Mean interval from radiological detection of DISR to imaging evidence of resolution was 5.8 months (range 1.6-18.3 months). Three patients out of 81 (3.7%), 11/297 (3.7%), and 5/79 (6.3%) developed sarcoidosis-like reaction after treatment with anti-CTLA-4 antibody, anti-PD-1 antibody, and a combination of both, respectively. Most patients with DISR were asymptomatic and did not require systemic therapy. Most patients did not demonstrate concomitant increased maximum standardised uptake value (SUVmax) in other organs on their integrated 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET)/computed tomography (CT). CONCLUSIONS In the present retrospective study of patients treated with immune checkpoint inhibitors (ICIs), DISR occurred in approximately 3.7% of patients treated with either anti-CTLA-4 or anti-PD-1 antibody and 6.3% of patients treated with a combination of both.
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Affiliation(s)
- Y Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, USA
| | - R R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, USA
| | - R Juarez
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, USA
| | - M Chow
- Department of Medicine, University of California, San Francisco, 1825 5(th) St, San Francisco, CA 94143, USA
| | - C Wu
- Department of Medicine, University of California, San Francisco, 1825 5(th) St, San Francisco, CA 94143, USA
| | - K Tsai
- Department of Medicine, University of California, San Francisco, 1825 5(th) St, San Francisco, CA 94143, USA
| | - A Daud
- Department of Medicine, University of California, San Francisco, 1825 5(th) St, San Francisco, CA 94143, USA
| | - S C Behr
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, USA.
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5
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Lebbe C, Long G, Robert C, Hamid O, Atkinson V, Shoushtari A, Daud A, Bechter O, Schadendorf D, Sullivan R, Dummer R, Grob J, Lewis N, Fan L, Basu S, Caponigro G, Cooke V, Lau A, Amaria R. LBA40 Phase II study of multiple LXH254 drug combinations in patients (pts) with unresectable/metastatic, BRAF V600- or NRAS-mutant melanoma. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.038] [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: 11/01/2022] Open
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6
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Bushara O, Alhalel J, Sanders J, Azad H, Cerri T, Zafer S, Guo K, Zhao L, Daud A, Borja-Cacho D, Caicedo-Ramirez JC. Single Center Experience with Incidence, Impact and Predictors of Biliary Complications in Donation After Circulatory Death Liver Transplantation. Prog Transplant 2022; 32:252-260. [PMID: 35702045 DOI: 10.1177/15269248221107039] [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] [Indexed: 11/16/2022]
Abstract
Introduction: Utilizing allografts from donors after cardiac death (DCD) has improved organ availability, and DCD livers comprise a growing proportion of transplantations. However, it has been suggested that DCD transplantations have worse outcomes. Research Questions: We aimed to characterize outcomes in a large cohort of DCD transplantations, identify trends in outcomes over time, and identify factors associated with the development of biliary complications. Design: We conducted an observational retrospective cohort study of patients receiving DCD liver allografts within a large academic teaching hospital with a high transplantation volume. Consecutive patients who underwent Type III DCD liver transplantation from 2006-2016 were included in our cohort. Re-transplantations and multi-organ transplant recipients were excluded. Results: Ninety-six type III DCD transplantations occurred between 2006-2016. We report a 1one-year patient survival of 90.6% (87) and a 5five-year patient survival of 69.8% (67). Twenty-nine (30.2%) patients experienced any biliary complication in the first year following discharge, with 17 (17.7%) experiencing ischemic cholangiopathy. Five-year patient (P = 0.04) and graft (P = 0.005) survival improved over time. Post-operative biliary complications experienced during index admission and prior to discharge were found to be associated with the development of biliary complications (P = 0.005) and ischemic cholangiopathy (P = 0.01) following discharge. Conclusion: Our data suggested that outcomes using DCD allografts have improved, however biliary complications remain a significant issue in DCD transplantation. Patients who experienced post-operative biliary complications during index admission may require more frequent screening to allow the initiation of earlier treatment for biliary complications.
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Affiliation(s)
- Omar Bushara
- 12244Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jonathan Alhalel
- 12244Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jes Sanders
- Department of Surgery, 12244Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hooman Azad
- 12244Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Thomas Cerri
- 97174Rosalind Franklin Medical School, Chicago, IL, USA
| | - Salmaan Zafer
- 97174Rosalind Franklin Medical School, Chicago, IL, USA
| | - Kexin Guo
- Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
| | - Lihui Zhao
- Department of Preventive Medicine, 12244Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amna Daud
- 209825Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
| | - Daniel Borja-Cacho
- 209825Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
| | - Juan C Caicedo-Ramirez
- 209825Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
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7
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Ison MG, Tan M, Daud A, Huang P, Jiang JX. Quantitative norovirus viral load is not affected by home storage of stool. Transpl Infect Dis 2022; 24:e13826. [PMID: 35334150 PMCID: PMC9233081 DOI: 10.1111/tid.13826] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 11/30/2022]
Abstract
In preparation of a clinical trial of norovirus treatment, there were concerns raised by FDA about risk of self‐storage of stool from patients infected with norovirus affecting quantitative assessments of norovirus RNA. Specifically, most home freezers are frost‐free and may expose the samples to multiple rounds of freeze‐thaw. Stool samples collected by the study team were stored at different lengths in a frost‐free freezer and at −80°C. Quantitative PCRs of norovirus were performed on all samples using the same assay. By all measures, there was no significant change in measured viral load with home storage.
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Affiliation(s)
- Michael G Ison
- Divisions of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Divisions of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ming Tan
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amna Daud
- Divisions of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Pengwei Huang
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jason Xi Jiang
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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8
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Campbell PT, Kosirog M, Aghaulor B, Gregory D, Pine S, Daud A, Das A, Finn DJ, Levitsky J, Holl JL, Lloyd-Jones DM, VanWagner LB. Comanagement With Nephrologist Care Is Associated With Fewer Cardiovascular Events Among Liver Transplant Recipients With Chronic Kidney Disease. Transplant Direct 2021; 7:e766. [PMID: 34557583 PMCID: PMC8454906 DOI: 10.1097/txd.0000000000001220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/06/2021] [Accepted: 07/15/2021] [Indexed: 01/13/2023] Open
Abstract
Chronic kidney disease (CKD) is associated with cardiovascular (CV) events, a leading complication in liver transplant recipients (LTRs). Timely subspecialty care is associated with improved clinical outcomes in patients with CKD. This study sought to assess associations between nephrology comanagement and CV events among LTRs at risk for or with CKD. METHODS LTRs with CKD plus those at risk were identified in an inception cohort at a single tertiary care network between 2010 and 2016, using electronic health record data and manual chart review. CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m2 or International Classification of Diseases 9th or 10th revision code for CKD and at-risk CKD as estimated glomerular filtration rate 60-89 mL/min/1.73 m2. Cox proportional hazard models assessed the association between nephrology comanagement and CV events among LTRs with or at risk for CKD. RESULTS Among 602 LTRs followed for up to 6 y posttransplant, prevalence of CKD plus those at risk increased yearly (71% in year 1, 86% in year 6) (P < 0.0001). Rates of nephrology comanagement decreased yearly posttransplant (35% in year 1, 28% in year 6). In multivariable models, nephrology comanagement was associated with lower CV events (adjusted hazard ratio, 0.57; 95% confidence interval, 0.33-0.99). CONCLUSIONS Among LTRs with CKD, nephrology comanagement may be associated with lower CV events. A prospective study is needed to identify the reasons for improved outcomes and barriers to nephrology referral.
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Affiliation(s)
- Patrick T. Campbell
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, IL
| | - Megan Kosirog
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, IL
| | - Blessing Aghaulor
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, IL
| | - Dyanna Gregory
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, IL
| | - Stewart Pine
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, IL
| | - Amna Daud
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Arighno Das
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, IL
| | - Daniel J. Finn
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, IL
| | - Josh Levitsky
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, IL
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jane L. Holl
- Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL
- Biological Sciences Division, Department of Neurology, University of Chicago, Chicago, IL
| | - Donald M. Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lisa B. VanWagner
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, IL
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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9
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Mazumder NR, Simpson D, Atiemo K, Jackson K, Zhao L, Daud A, Kho A, Gabra LG, Caicedo JC, Levitsky J, Ladner DP. Black Patients With Cirrhosis Have Higher Mortality and Lower Transplant Rates: Results From a Metropolitan Cohort Study. Hepatology 2021; 74:926-936. [PMID: 34128254 DOI: 10.1002/hep.31742] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/30/2020] [Accepted: 01/19/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS Estimates of racial disparity in cirrhosis have been limited by lack of large-scale, longitudinal data, which track patients from diagnosis to death and/or transplant. APPROACH AND RESULTS We analyzed a large, metropolitan, population-based electronic health record data set from seven large health systems linked to the state death registry and the national transplant database. Multivariate competing risk analyses, adjusted for sex, age, insurance status, Elixhauser score, etiology of cirrhosis, HCC, portal hypertensive complication, and Model for End-Stage Liver Disease-Sodium (MELD-Na), examined the relationship between race, transplant, and cause of death as defined by blinded death certificate review. During the study period, 11,277 patients met inclusion criteria, of whom 2,498 (22.2%) identified as Black. Compared to White patients, Black patients had similar age, sex, MELD-Na, and proportion of alcohol-associated liver disease, but higher comorbidity burden, lower rates of private insurance, and lower rates of portal hypertensive complications. Compared to White patients, Black patients had the highest rate all-cause mortality and non-liver-related death and were less likely to be listed or transplanted (P < 0.001 for all). In multivariate competing risk analysis, Black patients had a 26% increased hazard of liver-related death (subdistribution HR, 1.26; 95% CI, [1.15-1.38]; P < 0.001). CONCLUSIONS Black patients with cirrhosis have discordant outcomes. Further research is needed to determine how to address these real disparities in the field of hepatology.
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Affiliation(s)
- Nikhilesh R Mazumder
- Department of Gastroenterology and HepatologyNorthwestern University Feinberg School of MedicineChicagoIL.,Comprehensive Transplant CenterNorthwestern University Feinberg School of MedicineNorthwestern University Transplant Outcomes Research Collaborative (NUTORC)ChicagoIL
| | - Dinee Simpson
- Comprehensive Transplant CenterNorthwestern University Feinberg School of MedicineNorthwestern University Transplant Outcomes Research Collaborative (NUTORC)ChicagoIL.,Division of TransplantDepartment of SurgeryNorthwestern MedicineChicagoIL
| | - Kofi Atiemo
- Comprehensive Transplant CenterNorthwestern University Feinberg School of MedicineNorthwestern University Transplant Outcomes Research Collaborative (NUTORC)ChicagoIL.,Tulane Abdominal Transplant InstituteDepartment of SurgeryTulane University School of MedicineNew OrleansLA
| | - Kathryn Jackson
- Institute for Public Health and Medicine-Center for Health Information PartnershipsNorthwestern University, Feinberg School of MedicineChicagoIL
| | - Lihui Zhao
- Comprehensive Transplant CenterNorthwestern University Feinberg School of MedicineNorthwestern University Transplant Outcomes Research Collaborative (NUTORC)ChicagoIL.,Department of Preventative MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Amna Daud
- Comprehensive Transplant CenterNorthwestern University Feinberg School of MedicineNorthwestern University Transplant Outcomes Research Collaborative (NUTORC)ChicagoIL
| | - Abel Kho
- Comprehensive Transplant CenterNorthwestern University Feinberg School of MedicineNorthwestern University Transplant Outcomes Research Collaborative (NUTORC)ChicagoIL.,Institute for Public Health and Medicine-Center for Health Information PartnershipsNorthwestern University, Feinberg School of MedicineChicagoIL
| | - Lauren G Gabra
- Feinberg School of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Juan C Caicedo
- Comprehensive Transplant CenterNorthwestern University Feinberg School of MedicineNorthwestern University Transplant Outcomes Research Collaborative (NUTORC)ChicagoIL.,Division of TransplantDepartment of SurgeryNorthwestern MedicineChicagoIL
| | - Josh Levitsky
- Department of Gastroenterology and HepatologyNorthwestern University Feinberg School of MedicineChicagoIL.,Comprehensive Transplant CenterNorthwestern University Feinberg School of MedicineNorthwestern University Transplant Outcomes Research Collaborative (NUTORC)ChicagoIL
| | - Daniela P Ladner
- Comprehensive Transplant CenterNorthwestern University Feinberg School of MedicineNorthwestern University Transplant Outcomes Research Collaborative (NUTORC)ChicagoIL.,Division of TransplantDepartment of SurgeryNorthwestern MedicineChicagoIL
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10
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VanWagner LB, Gordon E, Adamski L, Kosirog M, Daud A, Finn DJ, Lloyd-Jones DM, Holl JL. Liver Transplant Recipient, Caregiver, and Provider Perceptions of Cardiovascular Disease and Related Risk Factors After Transplant. Liver Transpl 2021; 27:668-683. [PMID: 33314702 PMCID: PMC8822904 DOI: 10.1002/lt.25973] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/06/2020] [Accepted: 12/02/2020] [Indexed: 12/12/2022]
Abstract
Liver transplant recipients (LTRs) are at high risk for cardiovascular disease (CVD). We sought to characterize LTR, informal caregiver, and health care provider perceptions about CVD care after liver transplantation (LT) to inform the design of solutions to improve care. Participants included adult LTRs, their caregivers, and multispecialty health care providers recruited from an urban tertiary care network who participated in 90-minute focus groups and completed a brief survey. Focus group transcripts were analyzed using thematic analysis, and survey data were analyzed using descriptive statistics. A total of 17 LTRs, 9 caregivers, and 22 providers participated in 7 separate focus groups. Most (93.3%) LTRs and caregivers were unaware of the risk of CVD after LT. Although 54.5% of providers were confident discussing CVD risk factors with LTRs, only 36.3% were confident managing CVD risk factors in LTRs, and only 13.6% felt that CVD risk factors in their LTR patients were well controlled. Barriers to CVD care for LTRs included (1) lack of awareness of CVD risk after LT, (2) lack of confidence in an ability to provide proper CVD care to LTRs, (3) reluctance to provide CVD care without transplant provider review, and (4) complexity of communication with the multidisciplinary LTR care team about CVD care. Participant recommendations included improved education for LTRs and caregivers about CVD risk factors, electronic health record alerts for providers, clearly defined CVD care provider roles, increased use of the transplant pharmacist, and multidisciplinary provider meetings to discuss care plans for LTRs. Multiple barriers to CVD care after LT were identified, and targeted recommendations were proposed by participants. Transplant centers should integrate participants' recommendations when designing interventions to optimize CVD care for LTRs.
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Affiliation(s)
- Lisa B. VanWagner
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL;,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elisa Gordon
- Department of Surgery, Division of Transplant, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lindsay Adamski
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Megan Kosirog
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Amna Daud
- Department of Surgery, Division of Transplant, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Daniel J. Finn
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Donald M. Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL;,Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jane L. Holl
- Center for Healthcare Delivery Science and Innovation and Department of Neurology, Biological Sciences Division, University of Chicago, Chicago, IL
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11
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Daud A, Kesete B, Sriranjan S, Britton E, Steel C, Lewin J. Evaluation of efficiency and quality of the multi-disciplinary team handover process in a mother and baby inpatient setting. Eur Psychiatry 2021. [PMCID: PMC9475588 DOI: 10.1192/j.eurpsy.2021.1339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction At Coombe Wood Mother and Baby unit (MBU) there are daily multi-disciplinary team (MDT) handover meetings and a weekly MDT ward round attended by 7-8 team members. There are concerns that the handover is too time consuming, utilising time which could be spent on other clinical duties, and concerns regarding the relevance of information that is handed over. Objectives To perform a service evaluation to determine the efficiency and quality of MDT handover meetings in an MBU setting. Methods Data was collected from September to October 2020. A checklist was designed listing information felt to be relevant to handover and contained the following data points – ‘current situation’, ‘mental health’, ‘level of observations’, ‘risk’, ‘physical health’, ‘baby care’, ‘baby supervision levels’ and ‘tasks and responsibilities’. The start and stop times of each MDT handover meeting were noted and a record was made as to whether these topics were discussed. Results Mean meeting duration was 32.2 minutes (range: 13 – 45 minutes) and amounted to 2.68 hours spent in MDT handover over a 5-day working week. This equates to 21.4 person-hours (based on 8 staff) a week. 928 data points were generated. 50.7% (468) data points were recorded and commonly omitted data points were – ‘tasks and responsibilities’, ‘risk’, ‘level of observations’ and ‘physical health’. On all occasions, ‘current situation’, ‘mental health’ and ‘baby care’ were handed over. Conclusions The results of this service evaluation provide compelling evidence for a wider improvement project. Involving MDT staff in designing interventions will make handover meetings more meaningful.
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12
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VanWagner LB, Aghaulor B, Hussain T, Kosirog M, Campbell P, Pine S, Daud A, Finn DJ, Levitsky J, Lloyd-Jones DM, Holl JL. When evidence is lacking: a mixed-methods approach for the development of practice guidance in liver transplantation. Gastroenterol Rep (Oxf) 2020; 9:22-30. [PMID: 33747523 PMCID: PMC7962731 DOI: 10.1093/gastro/goaa068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/22/2020] [Indexed: 11/13/2022] Open
Abstract
Background Most interventions for conditions with a small cohort size, such as transplantation, are unlikely to be part of a clinical trial. When condition-specific evidence is lacking, expert consensus can offer more precise guidance to improve care. Management of cardiovascular risk in liver-transplant recipients is one example for which clinicians have, to date, adapted evidence-based guidelines from studies in the general population. However, even when consensus is achieved, implementation of practice guidance is often inadequate and protracted. We report on a novel mixed-methods approach, the Northwestern Method©, for the development of clinical-practice guidance when condition-specific evidence is lacking. We illustrate the method through the development of practice guidance for managing cardiovascular risk in liver-transplant recipients. Methods The Northwestern Method© consists of (i) adaptation of relevant, existing, evidence-based clinical-practice guidelines for the target population; (ii) consensus by experts of the proposed practice guidance; (iii) identification of barriers to guidance adherence in current practice; and (iv) recommendation for implementation and dissemination of the practice guidance. The method is based on an iterative, user-centered approach in which the needs, wants, and limitations of all end users, including patients, are attended to at each stage of the design and development process. Conclusions The Northwestern Method© for clinical-practice-guidance development uses a mixed-methods approach to bring together broad representation from multiple disciplines and practice settings to develop consensus considering the unique needs and preferences of patients, caregivers, and practitioners who are directly impacted by clinical-practice-guidance recommendations. We hypothesize that a priori involvement of end users in the guidance-development process will lead to sustainable implementation of guidance statements into clinical practice.
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Affiliation(s)
- Lisa B VanWagner
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Blessing Aghaulor
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tasmeen Hussain
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Megan Kosirog
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Patrick Campbell
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stewart Pine
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amna Daud
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel J Finn
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Josh Levitsky
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Donald M Lloyd-Jones
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jane L Holl
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Healthcare Delivery Science and Innovation and Department of Neurology, Biological Sciences Division, University of Chicago, Chicago, IL, USA
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13
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Mazumder NR, Celaj S, Atiemo K, Daud A, Jackson KL, Kho A, Levitsky J, Ladner DP. Liver-related mortality is similar among men and women with cirrhosis. J Hepatol 2020; 73:1072-1081. [PMID: 32344052 PMCID: PMC7572539 DOI: 10.1016/j.jhep.2020.04.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/08/2020] [Accepted: 04/13/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Sex-based differences are known to significantly contribute to outcomes in patients with chronic liver diseases; however, the role of patient sex in cirrhosis is unclear. We aimed to study the relationship between patient sex and cirrhosis. METHODS We analyzed a cohort of 20,045 patients with cirrhosis using a Chicago-wide electronic health record database that was linked with the United Network for Organ Sharing and cause of death data from the state death registry. Adjusted Cox survival analyses and competing risk analyses were performed to obtain subdistribution hazard ratios (HRs) for liver-related cause of death. RESULTS Female and male patients had similar age, racial distribution, insurance status, and comorbidity status by Elixhauser score. Females had higher rates of cholestatic liver disease (17.1% vs. 6.2%, p <0.001) and non-alcoholic steatohepatitis (29.8% vs. 21.2%, p <0.001) than males. They were less likely to have portal hypertensive complications and had lower peak MELD-Na scores during follow-up. Female sex was associated with a decreased hazard of all-cause mortality (adjusted HR 0.85; 95% CI 0.80-0.90). This effect was attenuated when liver-related mortality was examined (subdistribution HR 0.93; 95% CI 0.87-1.00). No significant difference was noted for women who were 'ever-listed' in competing risk analyses for either all-cause mortality (subdistribution HR 1.09; 95% CI 0.88-1.35) or liver-related death (subdistribution HR 1.12; 95% CI 0.87-1.43), despite lower rates of listing (7.5% vs. 9.8%; p <0.001) and transplant (3.5% vs. 5.2%; p <0.001). CONCLUSIONS In this longitudinal study of patients with cirrhosis, female sex was associated with a survival advantage likely driven by lower rates of non-liver-related death. Women were not at an increased risk of liver-related death despite lower rates of listing and transplantation. LAY SUMMARY Patient sex is an important contributor in many chronic diseases, including cirrhosis. Prior studies have suggested that female sex is associated with worse outcomes. We analyzed a cohort of 20,045 patients with cirrhosis using a Chicago-wide electronic health record database. Using multivariate competing risk analyses, we found that female sex in cirrhosis is actually associated with a lower risk of all-cause mortality and has no association with liver-related mortality. Our findings are novel because we show that women with cirrhosis have a similar risk of liver-related death as their male counterparts, despite lower rates of listing and transplantation.
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Affiliation(s)
- Nikhilesh R Mazumder
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Stela Celaj
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kofi Atiemo
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Amna Daud
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kathryn L Jackson
- Center for Health Information Partnerships, Institute for Public Health and Medicine, Chicago, IL
| | - Abel Kho
- Center for Health Information Partnerships, Institute for Public Health and Medicine, Chicago, IL
| | - Josh Levitsky
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL; Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Daniela P Ladner
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies, Institute for Public Health and Medicine, Chicago, IL.
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Kaundinya T, Mazumder N, Atiemo K, Spellman A, Daud A, Curtis LM, Ladner DP. Health Literacy Gaps in Online Resources for Cirrhotic Patients. ACTA ACUST UNITED AC 2020; 10:1-6. [PMID: 32879644 DOI: 10.14740/jcs401] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background The average readability level in the USA is a sixth grade level and for patients with chronic disease it is lower. Cirrhosis is a prevalent chronic disease that requires complex knowledge and instructions to manage. No research has been done about the understandability of online educational content for cirrhotic patients. Patients can find online materials curated by both general health platforms and high-volume liver transplant centers, and thus these materials were analyzed. Methods After determining exclusion criteria, the websites of the top 20 general health platform results and the websites of the top 20 high-volume hepatology centers were analyzed. Readability was assessed using the Patient Education Materials Assessment Tool (Audiovisual Materials) (PEMAT-A/V), Flesch-Kincaid Grade Level tests, word counts, sentence counts, words per sentence, and time for an average sixth grader to read. Results The mean grade level readabilities were 12.3 and 11.3 for the general resources and the transplant center resources, respectively. The online resources ranged from 9 to 389 sentences requiring an average of 9.8 min to read. The mean PEMAT-A/V scores were 70.05% for the general resources and 72.45% for the transplant center resources. There was a statistically significant difference in the Flesch-Kincaid grade level, sentence number, words per sentence, word count, and time for an average sixth grader to read the general resources and transplant center resources (P < 0.05). Conclusions The online resources both from health platforms and hepatology centers available to patients with cirrhosis are too long and complex and underscore the need for simpler and shorter resources.
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Affiliation(s)
- Trisha Kaundinya
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nikhilesh Mazumder
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Division of Gastroenterology, Northwestern Medicine, Chicago, IL, USA
| | - Kofi Atiemo
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Division of Transplant, Department of Surgery, Tulane University, New Orleans, LA, USA
| | - Ari Spellman
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,University of Michigan Medical School, Ann Arbor, MI, USA
| | - Amna Daud
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Laura Marie Curtis
- Health Literacy and Learning Program (HeLP), Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Chicago, IL, USA
| | - Daniela Patricia Ladner
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Division of Transplantation, Northwestern Medicine, Chicago, IL, USA
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15
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Mazumder NR, Atiemo K, Daud A, Kho A, Abecassis M, Levitsky J, Ladner DP. Patients With Persistently Low MELD-Na Scores Continue to Be at Risk of Liver-related Death. Transplantation 2020; 104:1413-1418. [PMID: 31644488 PMCID: PMC7192363 DOI: 10.1097/tp.0000000000002997] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND The vast majority of patients with cirrhosis have low Model for End-Stage Liver Disease-Sodium (MELD-Na) scores; however, the ability for the MELD-Na score to predict patient outcomes at low scores is unclear. METHODS Adult patients in a multicenter, Chicago-wide database of medical records with International Classification of Disease, Ninth Edition codes of cirrhosis and without a history of hepatocellular carcinoma were included. Records were linked with the state death registry, and death certificates were manually reviewed. Deaths were classified as "liver-related," "non-liver-related," and "non-descript" as adjudicated by a panel comprised of a transplant surgeon, a hepatologist, and an internist. A sensitivity analysis was performed where patients with hepatocellular carcinoma were included. RESULTS Among 7922 identified patients, 3999 patients had MELD-Na scores that were never higher than 15. In total, 2137 (27%) patients died during the study period with higher mortality rates for the patients in the high MELD-Na group (19.4 (41.6%) versus 4.1 (12.6%) per 100 person-y, P < 0.001). The high MELD-Na group died of a liver-related cause in 1142 out of 1632 (70%) as compared to 240 out of 505 (47.5%) deaths in the low MELD-Na group. There was no difference in the distribution of subcategory of liver-related death between low and high MELD-Na groups. Among subclassification of liver-related deaths, the most common cause of death was "Infectious" in both groups. CONCLUSIONS Despite persistently low MELD-Na scores, patients with cirrhosis still experience high rates of liver-related mortality.
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Affiliation(s)
- Nikhilesh R Mazumder
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, IL
| | - Kofi Atiemo
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Amna Daud
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Abel Kho
- Center for Health Information Partnerships, Institute for Public Health and Medicine, Chicago, Northwestern University, Chicago, IL
| | - Michael Abecassis
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Josh Levitsky
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, IL
| | - Daniela P Ladner
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Chicago, IL
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16
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Craig-Schapiro R, Krepostman N, Ravi M, Mazumder N, Daud A, Ladner DP. Neuropraxia: An Underappreciated Morbidity of Liver Transplantation. J Surg Res 2020; 255:188-194. [PMID: 32563759 DOI: 10.1016/j.jss.2020.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/20/2019] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Peripheral nerve injuries can be devastating complications of surgery, potentially resulting in severe functional disability and decreased quality of life. Long surgeries with considerable tissue manipulation, for example, liver transplantation, may present increased risk; however, neuropraxia in transplantation has not been well investigated. MATERIALS AND METHODS This is a retrospective study of all adult patients undergoing liver transplantation at a large academic center between January 2013 and December 2015. Descriptive analyses, logistic regressions, and forward selection procedures were used to determine the odds of developing neuropraxia and associated factors. RESULTS Of the 283 liver recipients, the mean age was 55.8 y, 35.1% were female, 65.6% were Caucasian, 8.9% were African American, 16.7% were Hispanic, and mean model for end-stage liver disease sodium score at transplant was 24.2 ± 10.9. The underlying etiology was alcohol (26.2%), hepatitis C (34.8%), nonalcoholic steatohepatitis (13.1%), and other (14.2%). The incidence of neuropraxia after liver transplantation was 8.3% (n = 25), with 60% (n = 16) upper extremities, 82% left sided, and 84% male. There was no difference in age, race, body mass index, hypertension, diabetes, hyperlipidemia, or smoking in those with neuropraxia versus those without. In multivariate analysis, neuropraxia was significantly associated with male gender, lower model for end-stage liver disease score, and longer duration of surgery (P < 0.05). Symptoms lasted median 5 d, with a wide range up to 187 d. Neuropraxia-specific treatment (physical therapy or medications) was required in 32% (n = 9). CONCLUSIONS Peripheral nerve injuries are an unexplored complication of liver transplantation. Although transient, a high number (8.2%) of patients developed neuropraxia, negatively affecting their ability for recovery. Exploration of mechanisms for minimizing risk and intraoperative detection and prevention should be considered to mitigate this complication.
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Affiliation(s)
- Rebecca Craig-Schapiro
- Division of Transplantation, Department of Surgery, Weill Cornell Medical Center, New York, New York
| | - Nicolas Krepostman
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mohan Ravi
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Nikhilesh Mazumder
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amna Daud
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Daniela P Ladner
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Transplantation, Department of Surgery, Northwestern Medicine, Chicago, Illinois.
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VanWagner LB, Holl JL, Montag S, Gregory D, Connolly S, Kosirog M, Campbell P, Pine S, Daud A, Finn D, Ladner D, Skaro AI, Levitsky J, Lloyd-Jones DM. Blood pressure control according to clinical practice guidelines is associated with decreased mortality and cardiovascular events among liver transplant recipients. Am J Transplant 2020; 20:797-807. [PMID: 31730286 PMCID: PMC7042060 DOI: 10.1111/ajt.15706] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 07/18/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 01/25/2023]
Abstract
Data for liver transplant recipients (LTRs) regarding the benefit of care concordant with clinical practice guidelines for management of blood pressure (BP) are sparse. This paper reports on clinician adherence with BP clinical practice guideline recommendations and whether BP control is associated with mortality and cardiovascular events (CVEs) among LTRs. We conducted a longitudinal cohort study of adult LTRs who survived to hospital discharge at a large tertiary care network between 2010 and 2016. The primary exposure was a BP of <140/<90 mm Hg within year 1 of LT. Among 602 LTRs (mean age 56.7 years, 64% men), 92% had hypertension and 38% had new onset hypertension. Less than 30% of LTRs achieved a BP of <140/<90 mm Hg over a mean of 43.2 months. In multivariable models, adjusted for key confounders, BP control post-LT compared with lack of control was associated with a significantly lower hazard of mortality (hazard ratio [HR] 0.48, 95% confidence interval [CI] 0.39, 0.87) and of CVEs (HR 0.65, 95% CI 0.43, 0.97). The association between BP control of <140/<90 mm Hg with improved survival and decreased CVEs in LTRs suggests that efforts to improve clinician adherence to BP clinical practice recommendations should be intensified.
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Affiliation(s)
- Lisa B. VanWagner
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jane L. Holl
- Center for Healthcare Delivery Science and Innovation and Department of Neurology, biological Sciences Division, University of Chicago, Chicago, Illinois
| | - Samantha Montag
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dyanna Gregory
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sean Connolly
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Megan Kosirog
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patrick Campbell
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stewart Pine
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amna Daud
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dan Finn
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniela Ladner
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anton I. Skaro
- Department of Surgery, Division of General Surgery and Multi-Organ Transplant, University of Western Ontario Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Josh Levitsky
- Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Donald M. Lloyd-Jones
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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18
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Eggermont A, Carlino M, Hauschild A, Ascierto P, Arance A, Daud A, O’Day S, Taylor M, Smith A, Rodgers A, Moreno BH, Diede S, Kluger H. Pembrolizumab (pembro) plus lenvatinib (len) for first-line treatment of patients (pts) with advanced melanoma: Phase III LEAP-003 study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz255.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ho B, Bhagat H, Schwartz JJ, Atiemo K, Daud A, Kang R, Montag SE, Zhao L, Lee E, Skaro AI, Ladner DP. Real-World Study of Once-Daily, Extended-Release Tacrolimus Versus Twice-Daily, Immediate-Release Tacrolimus in Kidney Transplantation: Clinical Outcomes and Healthcare Resource Utilization. Adv Ther 2019; 36:1465-1479. [PMID: 30941724 PMCID: PMC6824361 DOI: 10.1007/s12325-019-00904-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Real-world data with extended-release tacrolimus (ER-T) are lacking in the USA. This study examined clinical outcomes and healthcare resource utilization in kidney transplant patients receiving ER-T in clinical practice. METHODS This was a retrospective, single-center analysis (February-June 2016) using data from Northwestern University's Enterprise Data Warehouse. Adult patients receiving a kidney transplant in the preceding 4 years, treated de novo or converted to ER-T from immediate-release tacrolimus (IR-T) within 10 days post-transplantation, and maintained on ER-T (at least 3 months) were included. Patients were matched for demographic and clinical characteristics with IR-T-treated control patients. Endpoints included clinical outcomes and healthcare resource utilization up to 1 year post-transplantation. RESULTS A total of 19 ER-T-treated patients were matched with 55 IR-T-treated patients. No ER-T-treated patients experienced biopsy-confirmed acute rejection (BCAR) or graft failure versus 3 (5.5%) and 3 (5.5%) IR-T-treated patients, respectively. Mean estimated glomerular filtration rate (eGFR), the number of all-cause outpatient visits, readmissions, and all-cause hospitalization days were comparable between groups. Tacrolimus trough levels, days to target level (6-10 ng/mL), and number of required dose adjustments were also similar. CONCLUSION Real-world clinical outcomes and healthcare resource utilization were similar with ER-T and IR-T. Larger studies will need to investigate the trend toward fewer BCAR events, and increased graft survival with ER-T. FUNDING Astellas Pharma Global Development, Inc. Plain language summary available for this article.
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Affiliation(s)
- Bing Ho
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University, 676 N. St. Clair Street, 19th Floor, Chicago, IL, 60611, USA
| | - Hardik Bhagat
- Medical Affairs, Americas, Astellas Pharma Global Development, Inc., 1 Astellas Way, Northbrook, IL, 60062, USA
| | - Jason J Schwartz
- Medical Affairs, Americas, Astellas Pharma Global Development, Inc., 1 Astellas Way, Northbrook, IL, 60062, USA
| | - Kofi Atiemo
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University, 676 N. St. Clair Street, 19th Floor, Chicago, IL, 60611, USA
| | - Amna Daud
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University, 676 N. St. Clair Street, 19th Floor, Chicago, IL, 60611, USA
| | - Raymond Kang
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University, 676 N. St. Clair Street, 19th Floor, Chicago, IL, 60611, USA
| | - Samantha E Montag
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University, 676 N. St. Clair Street, 19th Floor, Chicago, IL, 60611, USA
- Department of Preventive Medicine, Northwestern University, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Lihui Zhao
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University, 676 N. St. Clair Street, 19th Floor, Chicago, IL, 60611, USA
- Department of Preventive Medicine, Northwestern University, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Edward Lee
- Medical Affairs, Americas, Astellas Pharma Global Development, Inc., 1 Astellas Way, Northbrook, IL, 60062, USA
| | - Anton I Skaro
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, St. Joseph's Hospital, 268 Grosvenor Street, Rm. E3-117, London, ON, N6A 4V2, Canada
| | - Daniela P Ladner
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University, 676 N. St. Clair Street, 19th Floor, Chicago, IL, 60611, USA.
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Hamid O, Robert C, Daud A, Hodi FS, Hwu WJ, Kefford R, Wolchok JD, Hersey P, Joseph R, Weber JS, Dronca R, Mitchell TC, Patnaik A, Zarour HM, Joshua AM, Zhao Q, Jensen E, Ahsan S, Ibrahim N, Ribas A. Five-year survival outcomes for patients with advanced melanoma treated with pembrolizumab in KEYNOTE-001. Ann Oncol 2019; 30:582-588. [PMID: 30715153 PMCID: PMC6503622 DOI: 10.1093/annonc/mdz011] [Citation(s) in RCA: 562] [Impact Index Per Article: 112.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pembrolizumab demonstrated robust antitumor activity and safety in the phase Ib KEYNOTE-001 study (NCT01295827) of advanced melanoma. Five-year outcomes in all patients and treatment-naive patients are reported herein. Patients whose disease progressed following initial response and who received a second course of pembrolizumab were also analyzed. PATIENTS AND METHODS Patients aged ≥18 years with previously treated or treatment-naive advanced/metastatic melanoma received pembrolizumab 2 mg/kg every 3 weeks, 10 mg/kg every 3 weeks, or 10 mg/kg every 2 weeks until disease progression, intolerable toxicity, or patient/investigator decision to withdraw. Kaplan-Meier estimates of overall survival (OS) and progression-free survival (PFS) were calculated. Objective response rate and PFS were based on immune-related response criteria by investigator assessment (data cut-off, September 1, 2017). RESULTS KEYNOTE-001 enrolled 655 patients with melanoma; median follow-up was 55 months. Estimated 5-year OS was 34% in all patients and 41% in treatment-naive patients; median OS was 23.8 months (95% CI, 20.2-30.4) and 38.6 months (95% CI, 27.2-not reached), respectively. Estimated 5-year PFS rates were 21% in all patients and 29% in treatment-naive patients; median PFS was 8.3 months (95% CI, 5.8-11.1) and 16.9 months (95% CI, 9.3-35.5), respectively. Median response duration was not reached; 73% of all responses and 82% of treatment-naive responses were ongoing at data cut-off; the longest response was ongoing at 66 months. Four patients [all with prior response of complete response (CR)] whose disease progressed during observation subsequently received second-course pembrolizumab. One patient each achieved CR and partial response (after data cut-off). Treatment-related AEs (TRAEs) occurred in 86% of patients and resulted in study discontinuation in 7.8%; 17% experienced grade 3/4 TRAE. CONCLUSIONS This 5-year analysis of KEYNOTE-001 represents the longest follow-up for pembrolizumab to date and confirms the durable antitumor activity and tolerability of pembrolizumab in advanced melanoma. CLINICAL TRIAL REGISTRY ClinicalTrials.gov, NCT01295827.
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Affiliation(s)
- O Hamid
- Medical Oncology, The Angeles Clinic and Research Institute, Los Angeles, USA.
| | - C Robert
- Department of Dermatology, Gustave Roussy, Villejuif; Department of Medicine, University of Paris-Sud, Paris, France
| | - A Daud
- Department of Medicine, University of California, San Francisco, San Francisco
| | - F S Hodi
- Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - W J Hwu
- Department of Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - R Kefford
- Medical Oncology, Westmead Hospital, Westmead; Medical Oncology, Melanoma Institute Australia, Sydney; Medical Oncology, Macquarie University, Macquarie Park; Medical Oncology, University of Sydney, Sydney, Australia
| | - J D Wolchok
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - P Hersey
- Medical Oncology, University of Sydney, Sydney, Australia; Department of Medicine, Centenary Institute, Sydney, Australia
| | - R Joseph
- Medical Oncology, Mayo Clinic Cancer Center-Florida, Jacksonville
| | - J S Weber
- Department of Medicine, Perlmutter Cancer Center, NYU Langone Health, New York
| | - R Dronca
- Medical Oncology, Mayo Clinic Cancer Center-Florida, Jacksonville
| | - T C Mitchell
- Division of Hematology Oncology, Abramson Cancer Center, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
| | - A Patnaik
- Medical Oncology, South Texas Accelerated Research Therapeutics, San Antonio
| | - H M Zarour
- Department of Immunology, University of Pittsburgh Cancer Institute, Pittsburgh, USA
| | - A M Joshua
- Medical Oncology, Melanoma Institute Australia, Sydney; Medical Oncology, University of Sydney, Sydney, Australia; Kinghorn Cancer Centre, St. Vincent's Hospital, Medical Oncology, Garvan Institute of Medical Research, Sydney; Medical Oncology, University of New South Wales, Sydney, Australia
| | - Q Zhao
- Merck & Co., Inc., Kenilworth
| | | | - S Ahsan
- Merck & Co., Inc., Kenilworth
| | | | - A Ribas
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA
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Hamid O, Ribas A, Daud A, Butler M, Carlino M, Hwu WJ, Long G, Ancell K, Hodi F, Khushalani N, Blank C, Loquai C, Lin J, Diede S, Robert C. Efficacy of pembrolizumab (Pembro) in patients (Pts) with advanced melanoma with stable brain metastases (BM) at baseline: A pooled retrospective analysis. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy289.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Guo J, Carvajal RD, Dummer R, Hauschild A, Daud A, Bastian BC, Markovic SN, Queirolo P, Arance A, Berking C, Camargo V, Herchenhorn D, Petrella TM, Schadendorf D, Sharfman W, Testori A, Novick S, Hertle S, Nourry C, Chen Q, Hodi FS. Efficacy and safety of nilotinib in patients with KIT-mutated metastatic or inoperable melanoma: final results from the global, single-arm, phase II TEAM trial. Ann Oncol 2018; 28:1380-1387. [PMID: 28327988 PMCID: PMC5452069 DOI: 10.1093/annonc/mdx079] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [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] [Indexed: 01/27/2023] Open
Abstract
Background The single-arm, phase II Tasigna Efficacy in Advanced Melanoma (TEAM) trial evaluated the KIT-selective tyrosine kinase inhibitor nilotinib in patients with KIT-mutated advanced melanoma without prior KIT inhibitor treatment. Patients and methods Forty-two patients with KIT-mutated advanced melanoma were enrolled and treated with nilotinib 400 mg twice daily. TEAM originally included a comparator arm of dacarbazine (DTIC)-treated patients; the design was amended to a single-arm trial due to an observed low number of KIT-mutated melanomas. Thirteen patients were randomized to DTIC before the protocol amendment removing this study arm. The primary endpoint was objective response rate (ORR), determined according to Response Evaluation Criteria In Solid Tumors. Results ORR was 26.2% (n = 11/42; 95% CI, 13.9%–42.0%), sufficient to reject the null hypothesis (ORR ≤10%). All observed responses were partial responses (PRs; median response duration, 7.1 months). Twenty patients (47.6%) had stable disease and 10 (23.8%) had progressive disease; 1 (2.4%) response was unknown. Ten of the 11 responding patients had exon 11 mutations, four with an L576P mutation. The median progression-free survival and overall survival were 4.2 and 18.0 months, respectively. Three of the 13 patients on DTIC achieved a PR, and another patient had a PR following switch to nilotinib. Conclusion Nilotinib activity in patients with advanced KIT-mutated melanoma was similar to historical data from imatinib-treated patients. DTIC treatment showed potential activity, although the low patient number limits interpretation. Similar to previously reported results with imatinib, nilotinib showed greater activity among patients with an exon 11 mutation, including L576P, suggesting that nilotinib may be an effective treatment option for patients with specific KIT mutations. Clinical Trial Registration ClinicalTrials.gov, NCT01028222.
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Affiliation(s)
- J Guo
- Department of Renal Cancer & Melanona, Peking University Cancer Hospital & Institute, Beijing, China
| | - R D Carvajal
- Division of Hematology/Oncology, Columbia University Medical Center, New York, USA
| | - R Dummer
- Skin Cancer Center, University Hospital of Zurich, Zurich, Switzerland
| | - A Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - A Daud
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco
| | - B C Bastian
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco
| | - S N Markovic
- Department of Hematology/Oncology, Mayo Clinic Cancer Center, Rochester, USA
| | - P Queirolo
- Department of Medical Oncology, National Research Institute for Cancer, Genova, Italy
| | - A Arance
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - C Berking
- Department of Dermatology & Allergology, University Hospital Munich (LMU), Munich, Germany
| | - V Camargo
- Department of Medical Oncology, Cancer Institute of São Paulo, São Paulo
| | - D Herchenhorn
- Department of Clinical Oncology, National Institute of Cancer, Rio de Janeiro, Brazil
| | - T M Petrella
- Department of Medical Oncology, Sunnybrook Health Sciences Center, Toronto, Canada
| | - D Schadendorf
- Department of Dermatology, Essen University Hospital, Essen, Germany
| | - W Sharfman
- Department of Oncology & Dermatology, Sidney Kimmel Comprehensive Cancer Center/Johns Hopkins Medicine, Lutherville, USA
| | - A Testori
- Melanoma and Muscle Cutaneous Sarcoma Division, European Institute of Oncology, Milano, Italy
| | - S Novick
- Oncology Business Unit, Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - S Hertle
- Oncology Business Unit, Novartis Pharma AG, Basel, Switzerland
| | - C Nourry
- Oncology Business Unit, Novartis Pharma AG, Basel, Switzerland
| | - Q Chen
- Oncology Business Unit, Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - F S Hodi
- Melanoma Center, Dana-Farber Cancer Institute, Boston, USA
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Andtbacka R, Ross M, Agarwala S, Taylor M, Vetto J, Neves R, Daud A, Khong H, Ungerleider R, Tanaka M, Grossmann K. Subgroup analysis of a phase II multicenter trial of HF10, oncolytic virus immunotherapy, and ipilimumab combination treatment in unresectable or metastatic melanoma patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Xu W, Frederickson J, Callahan J, Ribas A, Gonzalez R, Pavlick A, Hamid O, Gajewski T, Puzanov I, Daud A, Colburn D, Choong N, Wongchenko M, Hicks R, McArthur G. Prognostic impact of early complete metabolic response on FDG-PET, in BRAF V600 mutant metastatic melanoma patients treated with combination vemurafenib & cobimetinib. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx377.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Daud A, Puzanov I, Dummer R, Schadendorf D, Hamid O, Robert C, Hodi F, Schachter J, Sosman J, Pavlick A, Gonzalez R, Blank C, Cranmer L, O’Day S, Salama A, Margolin K, Yang J, Homet Moreno B, Ibrahim N, Ribas A. Analysis of response and survival in patients (pts) with ipilimumab (ipi)-refractory melanoma treated with pembrolizumab (pembro) in KEYNOTE-002. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx377.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Powderly J, Patel M, Lee J, Brody J, Meric-Bernstam F, Hamilton E, Ponce Aix S, Garcia-Corbacho J, Bang YJ, Ahn MJ, Rha S, Kim KP, Gil Martin M, Wang H, Lazorchak A, Wyant T, Ma A, Agarwal S, Tuck D, Daud A. CA-170, a first in class oral small molecule dual inhibitor of immune checkpoints PD-L1 and VISTA, demonstrates tumor growth inhibition in pre-clinical models and promotes T cell activation in Phase 1 study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx376.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Olszanski A, Gonzalez R, Corrie P, Pavlick A, Middleton M, Lorigan P, Plummer R, Skaria S, Herbert C, Gore M, Agarwala S, Daud A, Zhang S, Bahamon B, Rangachari L, Hoberman E, Kneissl M, Rasco D. Phase I study of the investigational, oral pan-RAF kinase inhibitor TAK-580 (MLN2480) in patients with advanced solid tumors (ST) or melanoma (MEL): Final analysis. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx367.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Affiliation(s)
- A Daud
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei
| | - S Johar
- Department of Medicine, Division of Cardiology, RIPAS Hospital, Bandar Seri Begawan, Brunei
| | - K C Lim
- Department of Radiology, RIPAS Hospital, Bandar Seri Begawan, Brunei
| | - V H Chong
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei
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Andtbacka R, Ross M, Agarwala S, Taylor M, Vetto J, Neves R, Daud A, Khong H, Ungerleider R, Welden S, Tanaka M, Grossmann K. Tumor response from phase II study of combination treatment with intratumoral HF10, a replication-competent HSV-1 oncolytic virus, and ipilimumab in patients with stage IIIB, IIIC, or IV unresectable or metastatic melanoma. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw379.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hamid O, Puzanov I, Dummer R, Schachter J, Daud A, Schadendorf D, Blank C, Cranmer L, Robert C, Pavlick A, Gonzalez R, Hodi F, Ascierto P, Salama A, Margolin K, Gangadhar T, Wei Z, Ebbinghaus S, Ibrahim N, Ribas A. Final overall survival for KEYNOTE-002: pembrolizumab (pembro) versus investigator-choice chemotherapy (chemo) for ipilimumab (ipi)-refractory melanoma. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw379.02] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Yap LB, Nguyen STB, Qadir F, Ma SK, Muhammad Z, Koh KW, Ali Z, Tay GS, Daud A, Said A, Sahat N, Rebo R, Tamin SS, Hussin A, Kaur S, Omar R. A comparison of long-term outcomes between narrow and broad QRS complex patients treated with cardiac resynchronization therapy. Acta Cardiol 2016; 71:323-330. [PMID: 27594128 DOI: 10.2143/ac.71.3.3152093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Thomas S, Aggarwal R, Jahan T, Ryan C, Troung T, Cripps AM, Raha P, Thurn KT, Chen S, Grabowsky JA, Park J, Hwang J, Daud A, Munster PN. A phase I trial of panobinostat and epirubicin in solid tumors with a dose expansion in patients with sarcoma. Ann Oncol 2016; 27:947-52. [PMID: 26903311 DOI: 10.1093/annonc/mdw044] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 09/14/2015] [Accepted: 01/27/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Treatment options for sarcoma are limited. Histone deacetylase inhibitors increase the efficacy of topoisomerase II inhibitors by promoting access to chromatin and by down-regulating DNA repair. Thus, combined panobinostat and epirubicin therapy was evaluated to treat refractory sarcoma. PATIENTS AND METHODS Patients with advanced solid tumors were enrolled in a 3 + 3 dose-escalation phase I trial of panobinostat given on days 1, 3, and 5 followed by 75 mg/m(2) of epirubicin on day 5 in 21-day cycles, with a dose expansion at maximum tolerated dose (MTD) in 20 sarcoma patients. Peripheral blood mononucleocyte histone acetylation was also evaluated. RESULTS Forty patients received 20-60 mg panobinostat. Dose-limiting toxicities included thrombocytopenia, febrile neutropenia, and fatigue at 60 mg, defining a panobinostat MTD at 50 mg. Four responses were seen in 37 assessable patients, all after progression on prior topoisomerase II inhibitors. For those with sarcoma, 12 of 20 derived clinical benefit (1 partial response and 11 stable disease, median overall survival 8.3 months), including 8 of 14 previously progressed on topoisomerase II therapy. Treatment benefits correlated with increased histone acetylation and decreased neutrophil count on day 5. CONCLUSIONS Panobinostat and epirubicin treatment is well tolerated and may reverse anthracycline resistance. Changes in histone acetylation and associated decrease in neutrophil count correlated with clinical benefit and warrant investigation as predictive biomarkers. CLINICAL TRIAL This trial is registered at www.Clinicaltrials.gov, Identifier: NCT00878904.
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Affiliation(s)
- S Thomas
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - R Aggarwal
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - T Jahan
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - C Ryan
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - T Troung
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - A M Cripps
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - P Raha
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - K T Thurn
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - S Chen
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - J A Grabowsky
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - J Park
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - J Hwang
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - A Daud
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - P N Munster
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
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McElroy LM, Woods DM, Yanes AF, Skaro AI, Daud A, Curtis T, Wymore E, Holl JL, Abecassis MM, Ladner DP. Applying the WHO conceptual framework for the International Classification for Patient Safety to a surgical population. Int J Qual Health Care 2016; 28:166-74. [PMID: 26803539 DOI: 10.1093/intqhc/mzw001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Efforts to improve patient safety are challenged by the lack of universally agreed upon terms. The International Classification for Patient Safety (ICPS) was developed by the World Health Organization for this purpose. This study aimed to test the applicability of the ICPS to a surgical population. DESIGN A web-based safety debriefing was sent to clinicians involved in surgical care of abdominal organ transplant patients. A multidisciplinary team of patient safety experts, surgeons and researchers used the data to develop a system of classification based on the ICPS. Disagreements were reconciled via consensus, and a codebook was developed for future use by researchers. RESULTS A total of 320 debriefing responses were used for the initial review and codebook development. In total, the 320 debriefing responses contained 227 patient safety incidents (range: 0-7 per debriefing) and 156 contributing factors/hazards (0-5 per response). The most common severity classification was 'reportable circumstance,' followed by 'near miss.' The most common incident types were 'resources/organizational management,' followed by 'medical device/equipment.' Several aspects of surgical care were encompassed by more than one classification, including operating room scheduling, delays in care, trainee-related incidents, interruptions and handoffs. CONCLUSIONS This study demonstrates that a framework for patient safety can be applied to facilitate the organization and analysis of surgical safety data. Several unique aspects of surgical care require consideration, and by using a standardized framework for describing concepts, research findings can be compared and disseminated across surgical specialties. The codebook is intended for use as a framework for other specialties and institutions.
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Affiliation(s)
- L M McElroy
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - D M Woods
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A F Yanes
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A I Skaro
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A Daud
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - T Curtis
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - E Wymore
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J L Holl
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - M M Abecassis
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - D P Ladner
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Bhatia S, Iyer J, Ibrani D, Blom A, Byrd D, Parvathaneni U, Diep T, Le M, Pierce R, Heller R, Daud A, Nghiem P. 504 Intratumoral delivery of Interleukin-12 DNA via in vivo electroporation leads to regression of injected and non-injected tumors in Merkel cell carcinoma: Final Results of a phase 2 study. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30306-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Middleton MR, Friedlander P, Hamid O, Daud A, Plummer R, Falotico N, Chyla B, Jiang F, McKeegan E, Mostafa NM, Zhu M, Qian J, McKee M, Luo Y, Giranda VL, McArthur GA. Randomized phase II study evaluating veliparib (ABT-888) with temozolomide in patients with metastatic melanoma. Ann Oncol 2015. [PMID: 26202595 DOI: 10.1093/annonc/mdv308] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Veliparib (ABT-888) is a potent, orally bioavailable, small-molecule inhibitor of the DNA repair enzymes poly ADP-ribose polymerase-1 and -2. Veliparib enhances the efficacy of temozolomide (TMZ) and other cytotoxic agents in preclinical tumor models. PATIENTS AND METHODS In this multicenter, double-blind trial, adults with unresectable stage III or IV metastatic melanoma were randomized 1:1:1 to TMZ plus veliparib 20 or 40 mg, or placebo twice daily. Efficacy end points included progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). RESULTS Patients (N = 346) were randomized between February 2009 and January 2010. Median [95% confidence interval (CI)] PFS was 3.7 (3.0-5.5), 3.6 (1.9-4.1), and 2 (1.9-3.7) months in the 20-mg, 40-mg, and placebo arms, respectively. Median (95% CI) OS was 10.8 (9.0-13.1), 13.6 (11.4-15.9), and 12.9 (9.8-14.3) months, respectively; ORR was 10.3%, 8.7%, and 7.0%. Exploratory analyses showed patients with low ERCC1 expression had longer PFS when TMZ was combined with veliparib. Toxicities were as expected for TMZ. The frequencies of thrombocytopenia, neutropenia, and leukopenia were significantly increased in the veliparib groups. Grade 3 or 4 adverse events, mainly hematologic toxicities, were seen in 55%, 63%, and 41% of patients in the 20-mg, 40-mg, and placebo arms, respectively. CONCLUSIONS Median PFS with 20 and 40 mg veliparib almost doubled numerically compared with placebo, but the improvements did not reach statistical significance. OS was not increased with veliparib. Toxicities were similar to TMZ monotherapy, but with increased frequency.
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Affiliation(s)
- M R Middleton
- Department of Oncology, University of Oxford, Churchill Hospital, Oxford, UK
| | - P Friedlander
- Hematology and Medical Oncology, The Mount Sinai Medical Center, New York
| | - O Hamid
- Experimental Therapeutics/Immunotherapy, The Los Angeles Clinic and Research Institute, Los Angeles
| | - A Daud
- University of California San Francisco Medical Center, University of California, San Francisco, USA
| | - R Plummer
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | | | - B Chyla
- AbbVie Inc., North Chicago, USA
| | - F Jiang
- AbbVie Inc., North Chicago, USA
| | | | | | - M Zhu
- AbbVie Inc., North Chicago, USA
| | - J Qian
- AbbVie Inc., North Chicago, USA
| | - M McKee
- AbbVie Inc., North Chicago, USA
| | - Y Luo
- AbbVie Inc., North Chicago, USA
| | | | - G A McArthur
- Divisions of Cancer Medicine/Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
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Robert C, Mateus C, Hodi S, Kefford R, Hamid O, Daud A, Wolchok JD, Hwu WJ, Gangadhar TC, Patnaik A, Joshua AM, Hersey P, Weber J, Dronca R, Zarour H, Gergich K, Li XN, Lannone R, Kang SP, Ebbinghaus S, Ribas A. Traitement par anticorps anti-PD-1 : pembrolizumab (MK-3475) chez 411 patients (pts) atteints de mélanome métastatique. Ann Dermatol Venereol 2014. [DOI: 10.1016/j.annder.2014.09.084] [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: 10/24/2022]
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Menzies AM, Ashworth MT, Swann S, Kefford RF, Flaherty K, Weber J, Infante JR, Kim KB, Gonzalez R, Hamid O, Schuchter L, Cebon J, Sosman JA, Little S, Sun P, Aktan G, Ouellet D, Jin F, Long GV, Daud A. Characteristics of pyrexia in BRAFV600E/K metastatic melanoma patients treated with combined dabrafenib and trametinib in a phase I/II clinical trial. Ann Oncol 2014; 26:415-21. [PMID: 25411413 DOI: 10.1093/annonc/mdu529] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pyrexia is a frequent adverse event with combined dabrafenib and trametinib therapy (CombiDT), but little is known of its clinical associations, etiology, or appropriate management. PATIENTS AND METHODS All patients on the BRF133220 phase I/II trial of CombiDT treated at the standard dose (150/2) were included for assessment of pyrexia (n = 201). BRAF and MEK inhibitor-naïve patients (n = 117) were included for efficacy analyses. Pyrexia was defined as temperature ≥38°C (≥100.4(°)F) or related symptoms. RESULTS Fifty-nine percent of patients developed pyrexia during treatment, 24% of which had pyrexia symptoms without a recorded elevation in body temperature. Pyrexia was grade 2+ in 60% of pyrexia patients. Median time to onset of first pyrexia was 19 days, with a median duration of 9 days. Pyrexia patients had a median of two pyrexia events, but 21% had three or more events. Various pyrexia management approaches were conducted in this study. A trend was observed between dabrafenib and hydroxy-dabrafenib exposure and pyrexia. No baseline clinical characteristics predicted pyrexia, and pyrexia was not statistically significantly associated with treatment outcome. CONCLUSIONS Pyrexia is a frequent and recurrent toxicity with CombiDT treatment. No baseline features predict pyrexia, and it is not associated with clinical outcome. Dabrafenib and metabolite exposure may contribute to the etiology of pyrexia. The optimal secondary prophylaxis for pyrexia is best studied in a prospective trial.
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Affiliation(s)
- A M Menzies
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia
| | - M T Ashworth
- University of California San Francisco, San Francisco
| | - S Swann
- Clinical Statistics, GlaxoSmithKline, Collegeville, USA
| | - R F Kefford
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia Westmead Hospital, University of Sydney, Sydney Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - K Flaherty
- Massachusetts General Hospital Center, Boston
| | - J Weber
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa
| | - J R Infante
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville
| | - K B Kim
- California Pacific Medical Center, San Francisco
| | - R Gonzalez
- Department of Medical Oncology, The University of Colorado Cancer Center, Aurora
| | - O Hamid
- Department of Oncology, The Angeles Clinic and Research Institute, Santa Monica
| | - L Schuchter
- Penn Medicine, The University of Pennsylvania, Philadelphia, USA
| | - J Cebon
- Oncology Unit, Ludwig Institute for Cancer Research, Heidelberg, Australia
| | - J A Sosman
- Department of Oncology, Vanderbilt University Medical Centre, Nashville, USA
| | - S Little
- Clinical Statistics, GlaxoSmithKline, Collegeville, USA
| | - P Sun
- Clinical Statistics, GlaxoSmithKline, Collegeville, USA
| | - G Aktan
- Clinical Statistics, GlaxoSmithKline, Collegeville, USA
| | - D Ouellet
- Clinical Statistics, GlaxoSmithKline, Collegeville, USA
| | - F Jin
- Clinical Statistics, GlaxoSmithKline, Collegeville, USA
| | - G V Long
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - A Daud
- University of California San Francisco, San Francisco
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Daud A, Hamid O, Robert C, Hodi F, Wolchok J, Hwu W, Weber J, Kefford R, Hersey P, Joshua A, Joseph R, Gangadhar T, Dronca R, Patnaik A, Zarour H, Gerigich K, Lunceford J, Emancipator K, Dolled-Filhart M, Li X, Kang P, Ebbinghaus S, Ribas A. 140 Relationship between programmed death ligand 1 (PD-L1) expression and clinical outcome in patients (pts) with melanoma (MEL) treated with pembrolizumab (pembro; MK-3475). Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70266-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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McElroy LM, Daud A, Lapin B, Ross O, Woods DM, Skaro AI, Holl JL, Ladner DP. Detection of medical errors in kidney transplantation: a pilot study comparing proactive clinician debriefings to a hospital-wide incident reporting system. Surgery 2014; 156:1106-15. [PMID: 25444312 DOI: 10.1016/j.surg.2014.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 05/08/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Rates of medical errors and adverse events remain high for patients who undergo kidney transplantation; they are particularly vulnerable because of the complexity of their disease and the kidney transplantation procedure. Although institutional incident-reporting systems are used in hospitals around the country, they often fail to capture a substantial proportion of medical errors. The goal of this study was to assess the ability of a proactive, web-based clinician safety debriefing to augment the information about medical errors and adverse events obtained via traditional incident reporting systems. METHODS Debriefings were sent to all individuals listed on operating room personnel reports for kidney transplantation surgeries between April 2010 and April 2011, and incident reports were collected for the same time period. The World Health Organization International Classification for Patient Safety was used to classify all issues reported. RESULTS A total of 270 debriefings reported 334 patient safety issues (179 safety incidents, 155 contributing factors), and 57 incident reports reported 92 patient safety issues (56 safety incidents, 36 contributing factors). Compared with incident reports, more attending physicians completed the debriefings (32.0 vs 3.5%). DISCUSSION The use of a proactive, web-based debriefing to augment an incident reporting system in assessing safety risks in kidney transplantation demonstrated increased information, more perspectives of a single safety issue, and increased breadth of participants.
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Affiliation(s)
- Lisa M McElroy
- Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL; Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Amna Daud
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Brittany Lapin
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Olivia Ross
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Donna M Woods
- Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL; Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anton I Skaro
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jane L Holl
- Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL; Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Daniela P Ladner
- Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL; Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Robert C, Joshua A, Weber J, Ribas A, Hodi F, Kefford R, Daud A, Wolchok J, Hwu WJ, Gangadhar T, Patnaik A, Hersey P, Dronca R, Zarour H, Ge Y, Lindia J, Giannotti M, Ebbinghaus S, Kang S, Hamid O. Pembrolizumab (Pembro; Mk-3475) for Advanced Melanoma (Mel): Randomized Comparison of Two Dosing Schedules. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.42] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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41
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McElroy LM, Daud A, Davis AE, Lapin B, Baker T, Abecassis MM, Levitsky J, Holl JL, Ladner DP. A meta-analysis of complications following deceased donor liver transplant. Am J Surg 2014; 208:605-18. [PMID: 25118164 DOI: 10.1016/j.amjsurg.2014.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/14/2014] [Accepted: 06/09/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Liver transplantation is a complex surgery associated with high rates of postoperative complications. While national outcomes data are available, national rates of most complications are unknown. DATA SOURCES A systematic review of the literature reporting rates of postoperative complications between 2002 and 2012 was performed. A cohort of 29,227 deceased donor liver transplant recipients from 74 studies was used to calculate pooled incidences for 17 major postoperative complications. CONCLUSIONS This is the first comprehensive review of postoperative complications after liver transplantation and can serve as a guide for transplant and nontransplant clinicians. Efforts to collect national data on complications, such as through the National Surgical Quality Improvement Program, would improve the ability to provide patients with informed consent, serve as a tool for individual center performance monitoring, and provide a central source against which to measure interventions aimed at improving patient care.
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Affiliation(s)
- Lisa M McElroy
- Center for Healthcare Studies, Institute for Public Health and Medicine, Chicago, IL, USA; Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL, USA.
| | - Amna Daud
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL, USA
| | - Ashley E Davis
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL, USA
| | - Brittany Lapin
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL, USA
| | - Talia Baker
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL, USA
| | - Michael M Abecassis
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL, USA
| | - Josh Levitsky
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL, USA
| | - Jane L Holl
- Center for Healthcare Studies, Institute for Public Health and Medicine, Chicago, IL, USA
| | - Daniela P Ladner
- Center for Healthcare Studies, Institute for Public Health and Medicine, Chicago, IL, USA; Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL, USA
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Grippo JF, Zhang W, Heinzmann D, Yang KH, Wong J, Joe AK, Munster P, Sarapa N, Daud A. A phase I, randomized, open-label study of the multiple-dose pharmacokinetics of vemurafenib in patients with BRAF V600E mutation-positive metastatic melanoma. Cancer Chemother Pharmacol 2013; 73:103-11. [DOI: 10.1007/s00280-013-2324-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 10/11/2013] [Indexed: 10/26/2022]
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Ladner DP, Alonso EM, Butt Z, Caicedo JC, Cella D, Daud A, Friedewald JJ, Gordon EJ, Hazen GB, Ho BT, Hoke KR, Holl JL, Ison MG, Kang R, Mehrotra S, Preczewski LB, Ross OA, Sharaf PH, Skaro AI, Wang E, Wolf MS, Woods DM, Abecassis MM. NUTORC-a transdisciplinary health services and outcomes research team in transplantation. Transl Behav Med 2012; 2:446-458. [PMID: 23667403 PMCID: PMC3647618 DOI: 10.1007/s13142-012-0176-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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] [Indexed: 12/15/2022] Open
Abstract
The field of solid organ transplantation has historically concentrated research efforts on basic science and translational studies. However, there has been increasing interest in health services and outcomes research. The aim was to build an effective and sustainable, inter- and transdisciplinary health services and outcomes research team (NUTORC), that leveraged institutional strengths in social science, engineering, and management disciplines, coupled with an international recognized transplant program. In 2008, leading methodological experts across the university were identified and intramural funding was obtained for the NUTORC initiative. Inter- and transdisciplinary collaborative teams were created across departments and schools within the university. Within 3 years, NUTORC became fiscally sustainable, yielding more than tenfold return of the initial investment. Academic productivity included funding for 39 grants, publication of 60 manuscripts, and 166 national presentations. Sustainable educational opportunities for students were created. Inter- and transdisciplinary health services and outcomes research in transplant can be innovative and sustainable.
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Affiliation(s)
- Daniela P. Ladner
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
- />Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Estella M. Alonso
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Zeeshan Butt
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Juan Carlos Caicedo
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - David Cella
- />Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Amna Daud
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - John J. Friedewald
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Division of Nephrology, Department of Medicine, Northwestern University, Chicago, IL USA
| | - Elisa J. Gordon
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Gordon B. Hazen
- />Department of Industrial Engineering and Management Sciences, McCormick School of Engineering, Northwestern University, Chicago, IL USA
| | - Bing T. Ho
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Division of Nephrology, Department of Medicine, Northwestern University, Chicago, IL USA
| | - Kathleen R. Hoke
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Jane L. Holl
- />Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Michael G. Ison
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Division of Infectious Diseases, Department of Medicine, Northwestern University, Chicago, IL USA
| | - Raymond Kang
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Sanjay Mehrotra
- />Department of Industrial Engineering and Management Sciences, McCormick School of Engineering, Northwestern University, Chicago, IL USA
| | - Luke B. Preczewski
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
| | - Olivia A. Ross
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Pamela H. Sharaf
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Anton I. Skaro
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Edward Wang
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
| | - Michael S. Wolf
- />Division of General Internal Medicine, Department of Medicine, Northwestern University, Chicago, IL USA
| | - Donna M. Woods
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Michael M. Abecassis
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
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Munster P, van der Noll R, Voest E, Specht J, Werner T, Dees E, Tan A, Daud A, Schellens J, Lolkema M, Griffin M, Agarwal N, Falchook G, Kleha J, Durante M, Smith D, Adams L, Greshock J, Morris S, Kurzrock R. PI3K Kinase Inhibitor GSK2126458 (GSK458): Clinical Activity in Select Patient (PT) Populations Defined by Predictive Markers (STUDY P3K112826). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33038-6] [Citation(s) in RCA: 3] [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: 10/25/2022] Open
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Gonzalez R, Ribas A, Daud A, Pavlick A, Gajewski T, Puzanov I, Teng M, Chan I, Choong N, McArthur G. Phase IB Study of Vemurafenib in Combination with the Mek Inhibitor, GDC-0973, in Patients (PTS) with Unresectable or Metastatic BRAFV600 Mutated Melanoma (BRIM7). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)34336-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Munster PN, van der Noll R, Voest EE, Dees EC, Tan AR, Specht JM, Falchook GS, Daud A, Lolkema MP, Grilley-Olson JE, Yu EY, Fu S, Bergsland EK, Kleha J, Peng S, Smith DA, Lampkin TA, Schellens JHM, Morris SR, Kurzrock R. Phase I first-in-human study of the PI3 kinase inhibitor GSK2126458 (GSK458) in patients with advanced solid tumors (study P3K112826). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [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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Gordon MS, Vogelzang NJ, Schoffski P, Daud A, Spira AI, O'Keeffe BA, Rafferty T, Lee Y, Berger R, Shapiro G. Activity of cabozantinib (XL184) in soft tissue and bone: Results of a phase II randomized discontinuation trial (RDT) in patients (pts) with advanced solid tumors. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [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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Moore AP, Thomas S, Ryan CJ, Jahan TM, DuBois SG, Chan JK, Thurn KT, Collisson EA, Reinert A, Daud A, Munster PN. A phase I trial of the histone deacetylase inhibitor panobinostat (LBH589) and epirubicin in patients with solid tumor malignancies. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3036] [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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Cha E, Daud A, McNeel DG, Heller R, Fong L. Systemic immune responses induced by intratumoral plasmid IL-12 electroporation in patients with melanoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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