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Patel R, Negassa A, Tolu SS, Acuna-Villaorduna A, Goel S. Effectiveness of Biologic Agents Among Hispanic Patients With Metastatic Colorectal Cancer. Clin Colorectal Cancer 2024; 23:14-21.e1. [PMID: 37919185 PMCID: PMC10922547 DOI: 10.1016/j.clcc.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/26/2023] [Accepted: 10/01/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Randomized clinical trials have defined the survival advantage with the addition of biologic drugs to chemotherapy in patients with metastatic colorectal cancer (mCRC). Under representation of Hispanics contributes to poorly defined outcomes in this group. We aim to determine whether the real-world benefit of biologics extends to Hispanics using a comparative effectiveness research approach. METHODS This retrospective cohort study included all treatment centers contributing to SEER registry with available claims in the SEER-Medicare linked database (2001-2011) and 2 hospitals (2004-2016) catering to minorities. Metastatic CRC patients were classified as receiving chemotherapy or biochemotherapy (CT plus biologics; if initiated within 3 months of chemotherapy). The primary outcome was overall survival (OS) among the Hispanic patients calculated from time of administration of first dose of chemotherapy to death or last follow-up. A weighted Cox regression model was used to assess differences in survival. RESULTS We identified 182 Hispanic patients with mCRC from the Patient Entitlement and Diagnosis Summary (PEDSF) file (n = 101) and hospital database (n = 81). Overall, 52% were women and 72% received biologics. The median OS was 11.3 and 17.0 months in chemotherapy and biochemotherapy group, respectively. Biochemotherapy offered a survival benefit compared with chemotherapy alone, with an average hazard rate reduction of 39% (95% CI 6%-60%, p = .0236) using inverse probability of treatment weighting (IPTW) based analysis. CONCLUSION In this cohort of Hispanic patients with mCRC, biochemotherapy was associated with longer survival. Clinicians may offer biochemotherapy therapy to all patients regardless of race/ethnicity to maximize clinical benefit.
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Affiliation(s)
- Riya Patel
- Department of Medical Oncology, The State University of New York, University at Buffalo, Buffalo, NY; Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Abdissa Negassa
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Seda S Tolu
- Department of Medical Oncology, Columbia University, New York, NY
| | - Ana Acuna-Villaorduna
- Department of Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sanjay Goel
- Department of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
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Rahman S, Patel R, Liu J, Gaba A, Maitra R, Acuna-Villaorduna A, Kim M, Goel S. Effect of Medicaid Expansion in Reducing Racial Disparities in Early Onset Colorectal Cancer. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01756-6. [PMID: 37707661 DOI: 10.1007/s40615-023-01756-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND The burden of early onset colorectal cancer (EOCRC) falls disproportionately on minorities and individuals in specific geographic regions. While these disparities are likely multi-factorial, access to high-quality health care plays a significant role. We sought to determine if Medicaid expansion is associated with reducing racial disparities in EOCRC detection in Hispanics and non-Hispanic Blacks (NHB), compared to non-Hispanic Whites (NHW). METHODS Analysis of data from National Cancer Database was undertaken to compare incidence of EOCRC among those aged 40-49 between Medicaid expansion states (ES) and non-expansion states (NES) by racial/ethnic groups. Data was classified by race (NHW, NHB, or Hispanic), state of residence (ES or NES), and time (pre- or post-expansion). The primary outcome was change in incidence rate of EOCRC among racial/ethnic groups, according to whether patients resided in Medicaid expansion or non-expansion states. RESULTS Among Hispanics, the ES showed a significant increase in EOCRC incidence post expansion as compared to NES (p = 0.03). The rate of increase in annual incidence of EOCRC among Hispanics was 4.3% per year (pre-expansion) and 9.8% (post-expansion) for ES; and 6.4% (pre-expansion) and 1% (post-expansion) in NES. However, no difference was noted among NHB (p = 0.33) and NHW (p = 0.94). CONCLUSIONS Medicaid expansion has improved detection rates of EOCRC in ES especially in Hispanic population. This is the first study to demonstrate the effect of Medicaid expansion on the incidence of EOCRC. Based on our study findings we suggest that racial and ethnic disparities should be considered in the earlier CRC screening debates.
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Affiliation(s)
- Shafia Rahman
- Department of Medical Oncology, Ohio State University, Columbus, OH, USA
| | - Riya Patel
- Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Jianyou Liu
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Anu Gaba
- Department of Medical Oncology, Sanford Health, Fargo, ND, USA
| | - Radhashree Maitra
- Department of Medical Oncology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Biology, Yeshiva University, New York, NY, USA
| | | | - Mimi Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sanjay Goel
- Department of Medical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, 08903, New Brunswick, NJ, USA.
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Hsieh RW, Lee M, Johnson D, Zhang C, Moon JY, Hsu D, Acuna-Villaorduna A, Kuang C. Association of patient and disease characteristics with outcomes of regorafenib in patients with metastatic colorectal cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.135] [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] [Indexed: 01/25/2023] Open
Abstract
135 Background: Regorafenib (rego) is a multikinase inhibitor approved for use in metastatic colorectal cancer (mCRC). No predictive biomarkers have been identified for rego. We conducted a real-world multi-institutional retrospective study to identify the patient and tumor characteristics associated with outcomes of rego in mCRC patients. Methods: Patients from University of Pittsburgh Medical Center and Montefiore Medical Center who received rego for mCRC were included. Patient characteristics, tumor pathology and molecular profiles, treatment history, and response to rego were collected. Primary and secondary outcomes were best objective response and progression free survival (PFS) on rego, respectively. Univariate and multivariate analyses were conducted using Fisher’s exact test, Mann-Whitney U test, Firth logistic regression and Cox proportional-hazards model. Results: 76 patients were included (median age 64, 42% females, 84% whites). Rego yielded a disease control rate of 32% (including 2 complete responses) and a median PFS of 3.6 months. Tumors with high microsatellite instability (MSI-H) had a significantly lower odds of progression of disease (POD) as best objective response (p = 0.01) and a significantly longer median PFS (p = 0.022) compared with tumors with microsatellite stability (MSS) in multivariable models (Table). 75% of MSI-H mCRC patients had not received immunotherapy (IO) prior to rego. Presence of peritoneal carcinomatosis and older age were associated with higher odds of POD (p = 0.093) and a significantly shorter PFS (p = 0.029), respectively. Compared to Whites, Black patients had a numerically higher odds of POD and shorter PFS. Sex, smoking, alcohol, sidedness of CRC, previous treatments, organs involved, and KRAS mutation were not associated with treatment response or PFS. Conclusions: Our study showed that MSI-H mCRC was associated with significantly better response to rego and PFS, even in the absence of prior IO. Other predicting factors for worse outcomes of rego included older age, and potentially peritoneal carcinomatosis and Black race. None of the mutations was found associated with treatment outcomes, with the limitation of lack of comprehensive molecular testing in many patients. Studies to further examine potential biomarkers such as MCL-1 and FBW7 mutations and correlation to clinical outcomes are ongoing. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Dennis Hsu
- University of Pittsburgh Medical Center, Pittsburgh, PA
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4
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Vikash S, Bteich F, Jiang J, Kanmaniraja D, Acuna-Villaorduna A, Saenger YM, Goel S, Kaubisch A. Malignant portal vein tumor thrombosis (PVTT) in patients with hepatocellular (HCC) carcinoma: Insights from a Western single-institutional cohort. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.552] [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] [Indexed: 01/26/2023] Open
Abstract
552 Background: Macrovascular tumor invasion in the portal vein system is associated with poor survival and response to therapy. The Japanese portal vein invasion (Vp) classification is based on anatomical location of the thrombus and has been reported to predict prognosis in Asian cohorts of patients. Systemic treatment (ST) options have been increasing over the last decade, coupled with a refinement of radiation (RT) delivery and surgical techniques. Modern literature about HCC and PVTT is scarce in the West. Aim of this study was to characterize outcomes of PVTT patients stratified by Vp categories and by treatment strategies in a Western cohort of HCC patients. Methods: A total of 837 patients with HCC, treated at our tertiary referral center between 2010 and 2022, were retrospectively reviewed. 136 (16.3%) patients with PVTT at the time of diagnosis were identified. PVTT was diagnosed by contrast-enhanced computed tomography or magnetic resonance imaging. The extent of portal tumor-in-vein burden was characterized according to the Liver Cancer Study Group of Japan classification. Treatment modalities were delineated. Median OS was calculated for each group. Cox proportional hazard was used to compare OS between groups. Results: Etiology of liver disease was chronic hepatitis B in 18 (13%) patients, chronic hepatitis C in 79 (57%), alcohol in 53 (39%) and NASH in 10 (7%). Our group comprised 8 Vp1, 16 Vp2, 53 Vp3 and 59 Vp4 patients. 42% were in class Child-Pugh A, 42% B and 16% C. 14 (10%) patients underwent surgical resection of their tumor, 31 (23%) received radiation therapy, 90 (68%) were treated with systemic therapy, while 27 (23%) only received best supportive care (BSC). Median OS was 7.2 months in all comers; 16.0, 3.6, and 1.9 months when stratified by Child-Pugh class A, B, C respectively. Patients lived longer when they had more limited PVTT extent (Table). There was a trend towards worse OS in patients with Vp4 tumors compared to more peripheral thrombi (median OS 4.7 vs 12.8 mo, p=0.055). Patients treated with both ST and RT had a better OS than those treated with either alone (median OS 17.7 vs 5.7 mo, p=0.022). Median OS by treatment type is shown in Table. Conclusions: This retrospective study confirms an association between the extent of PVTT and OS in a Western HCC cohort. Patients with adequate hepatic reserve may benefit from more aggressive multi-modality treatment approaches. OS by PVTT extent and treatment modality.[Table: see text]
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Affiliation(s)
- Sindhu Vikash
- Albert Einstein College of Medicine - Jacobi Medical Center, Department of Medicine, Bronx, NY
| | - Fernand Bteich
- Albert Einstein College of Medicine - Montefiore Medical Center, Department of Medical Oncology, Bronx, NY
| | - Julie Jiang
- Albert Einstein College of Medicine - Montefiore Medical Center, Department of Radiation Oncology, Bronx, NY
| | - Devaraju Kanmaniraja
- Albert Einstein College of Medicine - Montefiore Medical Center, Department of Radiology, Bronx, NY
| | - Ana Acuna-Villaorduna
- Albert Einstein College of Medicine - Montefiore Medical Center, Department of Medical Oncology, Bronx, NY
| | - Yvonne M. Saenger
- Albert Einstein College of Medicine - Montefiore Medical Center, Department of Medical Oncology, Bronx, NY
| | - Sanjay Goel
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Andreas Kaubisch
- Albert Einstein College of Medicine - Montefiore Medical Center, Department of Medical Oncology, Bronx, NY
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Acuna-Villaorduna A, Shankar V, Wysota M, Jirgal A, Kabarriti R, Bellemare S, Goldman I, Kaubisch A, Aparo S, Goel S, Chuy J. Induction Chemotherapy With FOLFIRINOX Followed by Chemoradiation With Gemcitabine in Patients With Borderline-Resectable Pancreatic Ductal Adenocarcinoma. Cancer Control 2022; 29:10732748221134411. [PMID: 36221952 PMCID: PMC9558866 DOI: 10.1177/10732748221134411] [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] [Indexed: 11/25/2022] Open
Abstract
Introduction Perioperative therapy is standard for patients with borderline-resectable
pancreatic ductal adenocarcinoma (BR-PDAC); however, an optimal neoadjuvant
regimen is lacking. We assessed the efficacy of FOLFIRINOX chemotherapy
followed by gemcitabine-based chemoradiation as preoperative therapy. Methods Patients received 4 cycles of FOLFIRINOX, followed by 6-weekly gemcitabine
with concomitant intensity-modulated radiation. The primary endpoint was the
R0 resection rate. Secondary outcomes included resection rate,
overall-response, overall survival (OS), progression-free survival (PFS),
and tolerability. The trial was terminated early due to slow accrual. A
Simon’s optimal two-stage phase II trial single arm design was used. The
primary hypothesis of treatment efficacy was tested using a multistage group
sequential inference procedure. The secondary failure time analysis
endpoints were assessed using the Kaplan-Meier procedure and the Cox
regression model. Results A total of 22 patients enrolled in the study, 18 (81.8%) completed
neoadjuvant treatment. The bias corrected R0 rate was 55.6% (90% CI: 33.3,
68.3; P value = .16) among patients that received at least
1 cycle of FOLFIRINOX and was 80% among patients that underwent surgery. The
median OS was 35.1 months. The median PFS among patients that underwent
surgery was 34 months. Conclusion An R0 resection rate of 55.6% is favorable. Neoadjuvant FOLFIRINOX followed
by concomitant Gemcitabine with radiation was well-tolerated.
NCT01897454
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Affiliation(s)
- Ana Acuna-Villaorduna
- Department of Medical Oncology,
Montefiore
Medical Center, Bronx, NY, USA,Department of Medical Oncology,
Albert
Einstein College of Medicine, Bronx,
NY, USA
| | - Viswanathan Shankar
- Department of Epidemiology &
Population Health, Albert Einstein College of
Medicine, Bronx, NY, USA
| | - Michael Wysota
- Department of Medical Oncology,
Montefiore
Medical Center, Bronx, NY, USA,Department of Medical Oncology,
Albert
Einstein College of Medicine, Bronx,
NY, USA
| | - Amanda Jirgal
- Department of Medical Oncology,
Montefiore
Medical Center, Bronx, NY, USA
| | - Rafi Kabarriti
- Department of Radiation Oncology,
Montefiore
Medical Center, Bronx, NY, USA,Department of Radiation Oncology,
Albert
Einstein College of Medicine, Bronx,
NY, USA
| | - Sarah Bellemare
- Department of Surgery,
Montefiore
Medical Center, Bronx, NY, USA,Department of Surgery,
Albert
Einstein College of Medicine, Bronx,
NY, USA
| | - Inessa Goldman
- Department of Radiology,
Montefiore
Medical Center, Bronx, NY, USA,Department of Radiology,
Albert
Einstein College of Medicine, Bronx,
NY, USA
| | - Andreas Kaubisch
- Department of Medical Oncology,
Montefiore
Medical Center, Bronx, NY, USA,Department of Medical Oncology,
Albert
Einstein College of Medicine, Bronx,
NY, USA
| | - Santiago Aparo
- Department of Medical Oncology,
Montefiore
Medical Center, Bronx, NY, USA,Department of Medical Oncology,
Albert
Einstein College of Medicine, Bronx,
NY, USA
| | - Sanjay Goel
- Department of Medical Oncology,
Montefiore
Medical Center, Bronx, NY, USA,Department of Medical Oncology,
Albert
Einstein College of Medicine, Bronx,
NY, USA,Sanjay Goel, MD, MS, Professor of Medicine,
Department of Medical Oncology, Albert Einstein College of Medicine, Montefiore
Medical Center, 1695 Eastchester Road, Bronx NY 10461, USA.
; Jennifer Chuy, MD, Assistant
Professor of Medicine, Department of Medical Oncology, Albert Einstein College
of Medicine, Montefiore Medical Center, 1695 Eastchester Road, Bronx NY 10461,
USA.
| | - Jennifer Chuy
- Department of Medical Oncology,
Montefiore
Medical Center, Bronx, NY, USA,Department of Medical Oncology,
Albert
Einstein College of Medicine, Bronx,
NY, USA,Sanjay Goel, MD, MS, Professor of Medicine,
Department of Medical Oncology, Albert Einstein College of Medicine, Montefiore
Medical Center, 1695 Eastchester Road, Bronx NY 10461, USA.
; Jennifer Chuy, MD, Assistant
Professor of Medicine, Department of Medical Oncology, Albert Einstein College
of Medicine, Montefiore Medical Center, 1695 Eastchester Road, Bronx NY 10461,
USA.
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6
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Hammami MB, Ghalib MH, Maitra R, Acuna-Villaorduna A, Goel S. Clinical characteristics, outcomes and survival of patients with metastatic colorectal cancer on phase I trials: A single center experience from 1999 to 2022. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e15593] [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] [Indexed: 11/20/2022] Open
Abstract
e15593 Background: Metastatic colorectal cancer (mCRC) is a leading cause of cancer mortality. Few treatment options exist for patients who fail to respond to standard therapeutic agents. For patients with good performance status, phase I studies offer a valuable treatment option with a chance of clinical benefit. In this study, we report clinical characteristics, outcomes and survival of patients enrolled in phase I clinical trials at our institution. Methods: Medical records of patients with mCRC enrolled in phase I clinical trials between January 1999 to January 2022 at our institution were reviewed. Patient demographics, clinical characteristics, laboratory values, toxicities and survival time were analyzed. Overall survival (OS) was calculated as date of diagnosis of metastatic disease to death or last follow up. Phase 1 specific OS was analyzed from date of entry to first phase I trial to death. Results: 212 enrollments corresponding to 174 unique patients enrolled in 50 phase 1 clinical trials were reviewed. 53% (n = 112) were females with a median age of 60 years old [range 29-83]. 95% (n = 201) had an ECOG score of 0-1. The clinical benefit rate (stable disease plus partial response) was 35% and ORR was 4.3%. The median OS was 149 weeks, and the phase I OS was 23 weeks. Majority of the patients (53%, n = 110) received 3 or more lines of chemotherapy prior to phase I trial. In a univariable (UVA) model, the factors associated with better clinical outcome were WBC < 10.8 (P < 0.001), Hb > 12 (p = 0.011), ECOG score 0 or 1 (p = 0.005), baseline AST < 50 (p = 0.006), baseline albumin > 3.5 (p < 0.001), baseline LDH < 305 (p < 0.001). Conclusions: Phase I trials offer a reasonable option for patients with metastatic CRC. Our experience sheds light on the potential for improved outcomes in terms of survival. The survival of patients is at par with those used in late-stage disease including regorafenib and trifluridine/tipiracil. As expected, normal baseline lab parameters and better PS affect survival. Further modeling will be continued.
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Affiliation(s)
- M Bakri Hammami
- Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | | | | | | | - Sanjay Goel
- Rutgers Robert Wood Johnson Medical School, Bronx, NY
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7
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Brodsky M, Wei JX, Castagna F, Jou E, Shusterman M, Goel S, Acuna-Villaorduna A. Access to care in patients with pancreatic adenocarcinoma by race/ethnicity in an academic center in the Bronx, NY. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e16280] [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] [Indexed: 11/20/2022] Open
Abstract
e16280 Background: Racial disparities in the overall survival (OS) of patients with pancreatic adenocarcinoma (PDAC) have been previously reported. Large population datasets suggest that Non-Hispanic Blacks (NHB) have decreased OS when compared to non-Hispanic Whites (NHW), and Hispanics. It is unclear whether this is related to biologic features or differences in access to care. This study was aimed to compare time to treatment in a racially-diverse cohort of patients with PDAC in an academic center in the Bronx, NY. Methods: Patients diagnosed with PDAC between 2015 and 2021, available race/ethnicity (NHW, NHB or Hispanic) who received treatment at Montefiore Medical Center were identified. Data including demographics (age, gender, BMI), clinical features (date of diagnosis, presentation [localized/metastatic], tumor location, grade), first-treatment received (surgery or chemotherapy) and outcomes (vital status, date of death) were collected manually. Time to first treatment was compared between racial/ethnic groups using the Kruskal-Wallis test. Results: Of 226 patients diagnosed with PDAC, there were 46 (20.4%), 77 (34.1%) and 103 (45.6%) NHW, NHB and Hispanics respectively. The frequency of metastatic disease was higher in Hispanics and NHB compared to NHW (42.7% vs. 46.7% vs. 22.2%, p = 0.02). Median time to first treatment did not differ significantly among racial/ethnic groups in the overall cohort and stratified by disease presentation. Conclusions: There were no differences in access to care among racial/ethnic groups in this cohort. A higher frequency of metastatic disease at presentation among NHB and Hispanics might be explained by more aggressive biology. Further evaluation of the molecular profile in this cohort is warranted.[Table: see text]
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Affiliation(s)
| | - John X Wei
- Montefiore Medical Center, The Bronx, NY
| | | | - Erin Jou
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Michael Shusterman
- Perlmutter Cancer Center at NYU Langone Hospital—Long Island, Mineola, NY
| | - Sanjay Goel
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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8
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Patel R, Shah N, Thakkar A, Rahman S, Acuna-Villaorduna A, Shah UA, Herrera DA, Slasky S, Gritsman K, Goldfinger M, Kornblum N, Shastri A, Mantzaris I, Bachier-Rodriguez L, Braunschweig I, Verma A, McNeill K, Ye BH, Janakiram M, Sica RA. Allogeneic Stem Cell Transplantation Improves Survival in North American Adult T-Cell Leukemia and Lymphoma (NA-ATLL) with CNS Involvement with Minimal Graft Versus Host Disease (GVHD). Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00697-2] [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: 10/18/2022]
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9
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Kogure Y, Kameda T, Koya J, Yoshimitsu M, Nosaka K, Yasunaga JI, Imaizumi Y, Watanabe M, Saito Y, Ito Y, McClure MB, Tabata M, Shingaki S, Yoshifuji K, Chiba K, Okada A, Kakiuchi N, Nannya Y, Kamiunten A, Tahira Y, Akizuki K, Sekine M, Shide K, Hidaka T, Kubuki Y, Kitanaka A, Hidaka M, Nakano N, Utsunomiya A, Sica RA, Acuna-Villaorduna A, Janakiram M, Shah U, Ramos JC, Shibata T, Takeuchi K, Takaori-Kondo A, Miyazaki Y, Matsuoka M, Ishitsuka K, Shiraishi Y, Miyano S, Ogawa S, Ye BH, Shimoda K, Kataoka K. Whole-genome landscape of adult T-cell leukemia/lymphoma. Blood 2022; 139:967-982. [PMID: 34695199 PMCID: PMC8854674 DOI: 10.1182/blood.2021013568] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/11/2021] [Indexed: 11/20/2022] Open
Abstract
Adult T-cell leukemia/lymphoma (ATL) is an aggressive neoplasm immunophenotypically resembling regulatory T cells, associated with human T-cell leukemia virus type-1. Here, we performed whole-genome sequencing (WGS) of 150 ATL cases to reveal the overarching landscape of genetic alterations in ATL. We discovered frequent (33%) loss-of-function alterations preferentially targeting the CIC long isoform, which were overlooked by previous exome-centric studies of various cancer types. Long but not short isoform-specific inactivation of Cic selectively increased CD4+CD25+Foxp3+ T cells in vivo. We also found recurrent (13%) 3'-truncations of REL, which induce transcriptional upregulation and generate gain-of-function proteins. More importantly, REL truncations are also common in diffuse large B-cell lymphoma, especially in germinal center B-cell-like subtype (12%). In the non-coding genome, we identified recurrent mutations in regulatory elements, particularly splice sites, of several driver genes. In addition, we characterized the different mutational processes operative in clustered hypermutation sites within and outside immunoglobulin/T-cell receptor genes and identified the mutational enrichment at the binding sites of host and viral transcription factors, suggesting their activities in ATL. By combining the analyses for coding and noncoding mutations, structural variations, and copy number alterations, we discovered 56 recurrently altered driver genes, including 11 novel ones. Finally, ATL cases were classified into 2 molecular groups with distinct clinical and genetic characteristics based on the driver alteration profile. Our findings not only help to improve diagnostic and therapeutic strategies in ATL, but also provide insights into T-cell biology and have implications for genome-wide cancer driver discovery.
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Affiliation(s)
- Yasunori Kogure
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
| | - Takuro Kameda
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Junji Koya
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
| | - Makoto Yoshimitsu
- Department of Hematology and Rheumatology, Kagoshima University Hospital, Kagoshima, Japan
| | - Kisato Nosaka
- Department of Hematology, Rheumatology, and Infectious Disease, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Jun-Ichirou Yasunaga
- Department of Hematology, Rheumatology, and Infectious Disease, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshitaka Imaizumi
- Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Mizuki Watanabe
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuki Saito
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
- Department of Gastroenterology, Keio University School of Medicine, Tokyo, Japan
| | - Yuta Ito
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Marni B McClure
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
| | - Mariko Tabata
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sumito Shingaki
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
| | - Kota Yoshifuji
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
- Department of Hematology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenichi Chiba
- Division of Genome Analysis Platform Development, National Cancer Center Research Institute, Tokyo, Japan
| | - Ai Okada
- Division of Genome Analysis Platform Development, National Cancer Center Research Institute, Tokyo, Japan
| | - Nobuyuki Kakiuchi
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuhito Nannya
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ayako Kamiunten
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yuki Tahira
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Keiichi Akizuki
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Masaaki Sekine
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kotaro Shide
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Tomonori Hidaka
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yoko Kubuki
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Akira Kitanaka
- Department of Laboratory Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Michihiro Hidaka
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Nobuaki Nakano
- Department of Hematology, Imamura General Hospital, Kagoshima, Japan
| | - Atae Utsunomiya
- Department of Hematology, Imamura General Hospital, Kagoshima, Japan
| | - R Alejandro Sica
- Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Ana Acuna-Villaorduna
- Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Murali Janakiram
- Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Urvi Shah
- Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Juan Carlos Ramos
- Division of Hematology/Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Tatsuhiro Shibata
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo, Japan
- Laboratory of Molecular Medicine, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Kengo Takeuchi
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
- Pathology Project for Molecular Targets, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasushi Miyazaki
- Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Masao Matsuoka
- Department of Hematology, Rheumatology, and Infectious Disease, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenji Ishitsuka
- Department of Hematology and Rheumatology, Kagoshima University Hospital, Kagoshima, Japan
| | - Yuichi Shiraishi
- Division of Genome Analysis Platform Development, National Cancer Center Research Institute, Tokyo, Japan
| | - Satoru Miyano
- M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - B Hilda Ye
- Department of Cell Biology, Albert Einstein College of Medicine, New York, NY; and
| | - Kazuya Shimoda
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Keisuke Kataoka
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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10
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Rahman S, Patel RJ, Liu J, Acuna-Villaorduna A, Kim M, Goel S. Medicaid expansion to reduce racial disparity in the incidence of early onset colorectal cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.024] [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] [Indexed: 11/20/2022] Open
Abstract
24 Background: Early onset colorectal cancer (EO-CRC, age < 50 years) is an emerging public health crisis, especially in minorities. We evaluated and compared the effects of Medicaid expansion on the incidence of EO-CRC among Hispanics, Blacks, and Whites across the United States. Methods: The National Cancer Data Base was used to collect data on newly diagnosed cases of EO-CRC (40-49 years) among the three races, across all stages, from 2010-2017. Data for 21 expansion states (ES) that expanded Medicaid in 2014, and 16 non-expansion (NES) states was analyzed, excluding the states which expanded after 2014.The yearly state-wise population of all three races was collected from the U.S Census Bureau for 2010-17. A segmented Poisson regression model with generalized estimating equations was used for statistical analysis. Results: Annual incidence (AI) of EO-CRC pre and post expansion, in ES was 6/100,000 and 9/100,000 in Hispanics; 17/100,000 and 21/100,000 in Blacks and 14/100,000 and 18/100,000 for Whites. In NES the AI, pre and post 2014 was 8/100,000 and 10/100,000 among Hispanics, 19/100,00 and 24/100,000 among Blacks and 16/100,000 and 20/100,000 among Whites. Rate of change in AI of EO-CRC among Hispanics was 4.3% per year (2010-14), and 9.8% (2014-17) for ES states; and 6.4% (2010-14), and 1% (2014-17) in NES; among blacks was 3.8 % per year (2010-14), and 1.3% (2014-17) for ES states; and 1.6% (2010-14), and 3.2% (2014-17) in NES. Among Whites, increase in AI was 4.3% per year (2010-14), and 6.3% (2014-17) for ES states; and 4.0% (2010-14), and 5.7% (2014-17) in NES. ES showed greater change in incidence after expansion compared to pre-expansion in the incidence of EO-CRC as compared to NES (p=0.03) in Hispanics, however no significant difference was noted among Blacks (p=0.33) and Whites(p=0.94). Racial groups did significantly differ with respect to the degree of change in pre and post expansion (2014) rates of incidence of EO- CRC in the ES, however, in the NES, there were significant difference between the Hispanics and Whites (p=0.01), but not between Blacks versus Whites. Conclusions: Medicaid expansion reduces racial disparities in detection of EOCRC.[Table: see text]
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Affiliation(s)
- Shafia Rahman
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, NY
| | | | - Jianyou Liu
- Department of Epidemiology and Population Heath, Albert Einstein College of Medicine, New York, NY
| | | | - Mimi Kim
- Department of Epidemiology and Population Heath, Albert Einstein College of Medicine, Bronx, NY
| | - Sanjay Goel
- Albert Einstein College of Medicine, The Bronx, NY
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Goel S, Negassa A, Acuna-Villaorduna A. Comparative Effectiveness of Biologic Agents Among Black and White Medicare Patients in the US With Metastatic Colorectal Cancer. JAMA Netw Open 2021; 4:e2136378. [PMID: 34910154 PMCID: PMC8674750 DOI: 10.1001/jamanetworkopen.2021.36378] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Randomized clinical trials have defined the survival benefit provided by the addition of biologic drugs to chemotherapy in patients with metastatic colorectal cancer (mCRC). However, Black patients may be underrepresented in trial populations, and outcomes in this group remain poorly defined. OBJECTIVE To determine whether the real-world benefit of biologic drugs in Black patients is consistent with the real-world benefit of biologic drugs in White patients using a comparative effectiveness research approach. DESIGN, SETTING, AND PARTICIPANTS Population-based retrospective comparative effectiveness analysis of a cohort of patients aged 65 years or older with mCRC diagnosed between 2004 and 2011 who had received at least 1 dose of chemotherapy and had complete Medicare claims data using the Surveillance, Epidemiology, and End Result (SEER)-Medicare linked database. Data were analyzed from August 1, 2020, to March 31, 2021. INTERVENTIONS Patient data were classified according to whether patients received chemotherapy (oxaliplatin, irinotecan, and 5-fluorouracil or capecitabine) or biochemotherapy (bevacizumab, cetuximab, panitumumab, ramucirumab, or aflibercept, started within 3 months of chemotherapy). MAIN OUTCOMES AND MEASURES Overall survival (OS) defined as the time from starting chemotherapy to death or last follow-up. A weighted Cox regression model was used to assess differences in survival. RESULTS A total of 5617 patients with mCRC were identified in the SEER-Medicare linked database, and 4542 patients were included in the main analysis. Of the 5617 patients, 3969 (70.7%) received biologic agents at any point between 2004 and 2011; biologic agent therapy was started within 3 months of chemotherapy in 2894 patients (72.9%). Among 4542 patients with data on race and ethnicity, the median age was 72 years (IQR, 68-78 years), 2365 (52.0%) were female, 3445 (75.8%) had colon as the primary site, 552 (12.2%) were Black patients, and 3990 (87.8%) were White patients. There was no difference in the receipt of 1 (76.7% and 74.8%) vs 2 or more (23.3% and 25.2%: P = .92) lines of therapy, and in the receipt of biologic agents (63.6% vs 64.3% P = .33), among White patients and Black patients, respectively. Biochemotherapy was associated with a significant survival benefit compared with chemotherapy alone in the overall population (biochemotherapy median OS, 17.9 [95% CI, 17.3-18.7] months vs chemotherapy median OS, 8.3 [95% CI, 9.1-9.9] months; P < .001). The survival benefit was similar among White patients (17.8 vs 9 months; average hazard ratio, 0.59; 95% CI, 0.55-0.64; P < .001) and Black patients (18.6 vs 9.9; average hazard ratio, 0.58; 95% CI, 0.47-0.71; P < .001). CONCLUSIONS AND RELEVANCE In this comparative effectiveness analysis of a cohort of Medicare recipients with mCRC, biochemotherapy was associated with an improvement in OS with a similar rate of reduction in mortality among Black and White patients. Clinicians may offer biochemotherapy therapy to all patients to maximize clinical benefit, factoring in clinical variables, but not their race.
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Affiliation(s)
- Sanjay Goel
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Abdissa Negassa
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Ana Acuna-Villaorduna
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Rahman S, Patel RJ, Liu J, Acuna-Villaorduna A, Kim M, Goel S. Effect of Medicaid expansion on incidence of early-onset colorectal cancer incidence among Hispanics. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.3547] [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] [Indexed: 11/20/2022] Open
Abstract
3547 Background: Early onset colorectal cancer (EO-CRC, age < 50 years) is an emerging public health crisis; especially in Hispanics. Access to healthcare is critical for timely detection and is tied to medical insurance. In 2010, the Affordable Care Act allowed for expansion of Medicaid eligibility across the country, however, states were permitted to opt out by the US Supreme Court ruling of 2012, which created an unintended experiment in the healthcare market. We evaluated the effects of Medicaid expansion on the incidence of EO-CRC among Hispanics with the hypothesis that it would lead to an increase in incidence and early detection EO-CRC. Methods: The National Cancer Data Base was used to collect data on newly diagnosed Hispanics with EO-CRC (40-49 years), across all stages, from 2010-2017. Data for 21 expansion states (ES) that expanded Medicaid in 2014, and 16 non expansion (NES) states was analyzed. The yearly state-wise Hispanic population was collected from U.S Census Bureau for 2010-17. Incidence was computed as number of new cases of CRC divided by size of the state’s Hispanic population. Segmented Poisson generalized linear mixed effects model was used to analyze rate of change in yearly incidence of EOCRC before and after 2014, in ES and NES. Results: Average annual incidence (AI) of EO-CRC in Hispanics was 6/100,000 and 8/100,000 pre and post expansion, in ES, and 8/100,000 and 9/100,000 pre and post 2014 in the NES, respectively. Increase in AI of EO-CRC was 3.6% per year (2010-14) (95% CI: -0.1% to 7.4%), and 9.8% (2014-17) (95% CI: 5.2% to 14.7%) for ES states; and 6.4% (2010-14) (95% CI: 2.1% to 10.8%), and 1% (2014-17) (95% CI: -3.8% to 6.1%) in NES. ES showed greater change in EO-CRC incidence post expansion (2014) vs. pre-expansion, as compared to NES (p=0.078) table. There was no difference in stage at diagnosis between pre- and pos- expansion periods between ES and NES. Conclusions: Increase in incidence of EO-CRC in ES is likely due to greater access to health care due to Medicaid coverage as compared to NES. Other potential factor is migration of Medicaid eligible persons from NES to ES. However we need data past 2017 to confirm the current trend.[Table: see text]
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Affiliation(s)
- Shafia Rahman
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, NY
| | | | - Jianyou Liu
- Department of Epidemiology and Population Heath, Albert Einstein College of Medicine, New York, NY
| | | | - Mimi Kim
- Department of Epidemiology and Population Heath, Albert Einstein College of Medicine, Bronx, NY
| | - Sanjay Goel
- Albert Einstein College of Medicine, The Bronx, NY
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Patel RJ, Lyudmer M, Chergui A, Tolu SS, Rao D, Kaubisch A, Chuy JW, Elrafei TN, Acuna-Villaorduna A, Goel S. Factors associated with long-term survival in patients with early-onset and standard-onset colorectal cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.141] [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] [Indexed: 11/20/2022] Open
Abstract
141 Background: Differences in incidence, clinical features, and survival between early-onset (EO) and standard-onset (SO) colorectal cancer (CRC) are well-established. Factors associated with longer survival have not been reported. We aim to determine clinical and treatment factors associated with longer survival in patients (pts) with metastatic EO and SO CRC. Methods: Pts with metastatic CRC diagnosed between 2010-2019 at two NYC hospitals were identified by tumor registry and classified as EO (diagnosis at < 50 years) or SO (diagnosis at ≥ 50 years). Median overall survival (OS) was calculated for each group using Kaplan Meier curves. Long-term survival was defined as OS > 2 years (EO-CTC median OS). Data was collected by chart review and compared between short vs long-term survivors in EO and SO CRC pts independently. Stata v15 was used for statistical analysis. Results: Of 646 pts, 144 (22.3%) had EO and 502 (77.7%) had SO. High grade tumors were more likely in EO (33.3% vs 24%, OR: 1.59, p = 0.04) than SO; whereas no differences were seen in gender, sidedness, KRAS mutation or chemotherapy. Biologics were used more frequently in EO than SO (OR = 1.7; p = 0.008]. Median OS was 2.1 and 1.9 years in EO and SO. There were 53 (36.8%) and 175 (35.1%) long-term survivors in EO and SO groups. In pts with SO, metastasectomy, irinotecan-based chemotherapy and use of biologics were significantly associated with long-term survival, whereas metastasectomy was the only associated factor in pts with EO. Conclusions: Metastatectomy was the only factor associated with longer survival in both EO and SO groups. Other clinical/pathological and treatment-related factors associated with long-term survival among SO-CRC were not associated with long-term survival among EO-CRC patients. [Table: see text]
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Affiliation(s)
| | | | | | | | - Devika Rao
- Memorial Sloan Kettering Cancer Center, Basking Ridge, NJ
| | - Andreas Kaubisch
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Jennifer W. Chuy
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Tarek N. Elrafei
- Albert Einstein College of Medicine-Jacobi Medical Center, New York, NY
| | | | - Sanjay Goel
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
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Lyudmer M, Patel RJ, Chergui A, Tolu SS, Rao D, Kaubisch A, Chuy JW, Elrafei TN, Acuna-Villaorduna A, Goel S. Racial ethnic disparities in clinical/pathological features, treatment, and survival among patients with early-onset colorectal cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.21] [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] [Indexed: 11/20/2022] Open
Abstract
21 Background: Globally, the incidence of early-onset colorectal cancer has risen. Racial disparities in colorectal cancer (CRC) are well-described, however data in EO by race/ethnicity is lacking. We aim to compare the presenting features, treatment, and survival features of patients with metastatic early-onset CRC (EO). Methods: Patients with metastatic CRC diagnosed between 2010-2019 at two NYC hospitals were identified by tumor registry (n = 646). Clinical/pathological features, treatment and survival data was collected by chart review and compared between Non-Hispanic Whites (NHW), Non-Hispanic Blacks (NHB) and Hispanics (H) using Chi-square or Fisher’s exact test. Kaplan Meier curves were plotted to compare overall survival (OS) among groups. Stata v15 was used for statistical analysis. Results: Of 646 CRC patients, 126 (21.5%) were NHW, NHB or H diagnosed with EO with a frequency ranging from 16.6% in NHW to 26.1% in H. Non statistically significant lower frequencies of male gender, low/moderate grade, left-sided tumors,and higher frequency of KRAS mutations were seen in NHB (Table). Metastectomy was performed in 20 patients (13.9%) and did not differ between groups. There was no difference in the use of chemotherapy or biologics in general (Table), but NHW were more likely to get cetuximab than NHB (OR:4.5, p = 0.02) and H (OR:4.7, p = 0.02).There were no differences in median OS (1.8 vs. 2.2 vs. 2 years, p = 0.9)or 1-year OS (72% vs 72.3% vs 70.8%) in NHW, NHB and H, respectively. A lower 5-year OS was seen in NBH (14.5%) and Hispanics (24.4%) compared to NHW (44%). Conclusions: EO-CRC is more frequently seen in minority racial/ethnic groups. Despite no differences in the use of chemotherapy or biologic treatment in general, NHB have a lower 5-year survival rate compared to NHW and H. [Table: see text]
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Affiliation(s)
| | | | | | | | - Devika Rao
- Memorial Sloan Kettering Cancer Center, Basking Ridge, NJ
| | - Andreas Kaubisch
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Jennifer W. Chuy
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Tarek N. Elrafei
- Albert Einstein College of Medicine-Jacobi Medical Center, New York, NY
| | | | - Sanjay Goel
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
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15
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Wysota M, Jirgal A, Acuna-Villaorduna A, Viswanathan S, Kaubisch A, Gadde E, Kabarriti R, Goel S, Chuy JW. A phase II trial of preoperative FOLFIRINOX followed by gemcitabine-based chemoradiotherapy in patients with borderline resectable pancreatic ductal adenocarcinoma (BR PDAC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4638] [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] [Indexed: 11/20/2022] Open
Abstract
4638 Background: Preoperative (preop) therapy is widely accepted as the standard of care for patients (pt) with BR PDAC with limited evidence for a specific regimen. This study aimed to assess the efficacy of FOLFIRINOX (FOL) chemotherapy followed by gemcitabine-based chemo-radiotherapy (RT) as preop therapy in pt with BR-PDAC. Methods: This single arm Simon two stage phase II trial in pt with BR PDAC was conducted in two phases. The first phase included 4 cycles of FOL, and the second included weekly gemcitabine (1000 mg/m2) for 6 cycles with concomitant intensity-modulated RT (50.4 Gy in 28 fractions)(Gem/RT).The primary aim was to compare R0 resection rate (H0: ≤40% vs Ha≥60%) using one-sample one-sided Z test. Secondary outcomes, including overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan-Meier method. Results: Of 22 enrolled pt, 18 (81.8%) completed preoperative treatment. Median age at diagnosis was 63.4 years and 12 (54.5%) were female. There were 10 (45.5%) Hispanics, 4 (18.2%) non-Hispanic black, and 8 (36.4%) non-Hispanic white. Tumor location was predominantly head/neck (21, 95.5%), 15 (68.1%) had T2/3, and 9 (40.9%) had N2 (clinical) disease. Fourteen (64.6%) pt, had venous involvement, 5 (22.7%) had arterial, and 3 (13.6%), both. In the first phase, 20 (90.9%) completed 4 cycles of FOL, 6 (27.3%) required dose-reduction and dose was delayed in 12 (54.5%). Stable disease (SD) was achieved in 10 (52.6%), partial response (PR) in 8 (42.1%) and disease progression (PD) in 1 (5.3%) pt. Of 21 pt that entered the second phase, 18 (85.7%) completed 6 cycles of Gem/RT, 5 (26.3%) required dose-reduction and dose was delayed in 6 (31.6%). SD was achieved in 10 (55.6%), PR in 3 (16.7%) and PD in 5 (27.8%). All pt experienced at least one grade 1 adverse event (AE) and 12 (54.5%) at least one grade 3/4 AE, of which neutropenia was the most common-11 (50%). Of the 15 (68.1%) pt who underwent surgical resection, 12 (80%) achieved R0 margins and 5 (33.3%) required vascular reconstruction. The R0 rate among pt that received >1 cycle of FOLFIRINOX was 54.5%. Adjuvant chemotherapy was offered to 6/15 pt (40%). The PFS and OS will be reported. Conclusions: An R0 resection rate of 54.5% with this limited sample size is significant at the 10% level. Neoadjuvant FOLFIRINOX followed by concomitant Gem/RT was well-tolerated. The study will be amended to include adjuvant FOL in line with the PRODIGE intergroup adjuvant study results. Clinical trial information: NCT01897454 .
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Affiliation(s)
| | | | | | | | - Andreas Kaubisch
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | | | - Rafi Kabarriti
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Sanjay Goel
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Jennifer W. Chuy
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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16
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Chergui A, Gadde E, Acuna-Villaorduna A, Kabarriti R, Goel S, Kaubisch A. Clinical characteristics and outcomes of patients with advanced hepatocellular carcinoma treated with immunotherapy: A “real world” retrospective study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16644] [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] [Indexed: 11/20/2022] Open
Abstract
e16644 Background: Advanced hepatocellular carcinoma (HCC) is an aggressive malignancy with dismal prognosis. Newer agents, including immunotherapy (IO), have been granted accelerated approval for patients previously treated or unable to tolerate sorafenib. However, information outside clinical trials is scarce. This study aims to describe clinical characteristics and outcomes of HCC patients treated with IO. Methods: HCC patients treated with IO were identified using the institutional software, Clinical Looking Glass. Data regarding demographics, clinical and treatment characteristics were collected by chart review. Neutrophil/lymphocyte ratio (NLR) and AFP were collected at IO treatment initiation and considered low if below 4 and 400, respectively. Progression-free survival (PFS) was defined as time from treatment initiation to progression of disease or death, and overall-survival (OS) as time from IO initiation to death from any cause. Disease characteristics were analyzed using descriptive statistics, PFS and OS were plotted using Kaplan-Meier curves. Results: 52 patients with a median age of 64.5 years and male predominance (38, 73.1%) were identified. There were 24 (54.5%) Hispanics, 9 (20.5%) Non-Hispanic Blacks, 7 (15.9%) Non-Hispanic White and 4 (9.1%) Asians. Cirrhosis present in 41 (83.7%), median MELD of 8 (IQ: 7-10). 37 (77.1%) patients had ECOG 0-1. Hepatitis B and C and B infection were encountered in 12 (24.5%) and 22 (44%) patients, respectively. Intravascular invasion present in 16 (34.8%) and extrahepatic metastases in 7 (14.9%). Local treatment was provided to 29 (59.2%) and radiation to 14 (28.6%). First line treatment (tx1) was Sorafenib in 29 (55.8%) and Nivolumab in 21 (40.4%). Nivolumab was second line treatment or beyond (tx2) in 31 (59.6%). Median PFS was 6.2 (3.1-10.6) months and it did not differ between tx1 and tx2 (8 vs 5.9 months, p = 0.90). Median OS was 13.2 months; there was a tendency towards higher survival rates in patients that were treated in tx2 (11.8 vs 14.3 months, 0 = 0.59) and in patients with low NLR (14.8 vs 9.2 months, p = 0.14). Median OS was higher in patients with low AFP at IO treatment initiation (15.7 vs. 9.2 months, p = 0.03). Conclusions: In this multiethnic cohort, the “real world” experience of the benefit of IO in HCC is encouraging, with a median OS exceeding one year. NLR showed potential as a possible biomarker. Expanded data may elucidate the differences if any, between use of IO as front vs. second line therapy, in PFS and OS.
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Affiliation(s)
| | | | | | - Rafi Kabarriti
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Sanjay Goel
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Andreas Kaubisch
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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Levy R, Acuna-Villaorduna A, Maitra R, Goel S. Lack of association of immune checkpoint protein expression with T stage or stage grouping in colorectal cancer (CRC): A tissue microarray (TMA) based analysis of clinical data. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e15241] [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] [Indexed: 11/20/2022] Open
Abstract
e15241 Background: Immunotherapy is a valuable therapeutic intervention in multiple cancer types. In CRC, it is currently limited to those with microsatellite instability–high expression. Thus, immunotyping of CRC patients is critical to identifying potential targets for drug development. In this study, we profiled 171 CRC patient tumor samples to assess the expression of three immune check-point regulators (HHLA2, B7H3, and PD-L1), and 3 clinically useful biomarkers (CK7, CK20, and CDX2) and their association with T stage and stage grouping. Methods: TMA was created from 171 samples of CRC diagnosed between 2000 and 2016 in a major urban cancer center. Formalin fixed paraffin embedded (FFPE) tissues were used for immunohistochemistry (IHC). Antibodies specific for IHC staining were used for HHLA2, B7H3, PD-L1, CK7, CK20, and CDX2. Each specimen was scored from 4-12, based on multiplication of tumor tissue staining value (1 if 1-25%, 2 if 26-50%, 3 if 51-75%, and 4 if 76-100% of area visualized) by the intensity (1-3X). Expression of the proteins was sub divided into two or three groups, depending on the mean expression. Association between the six proteins and pathologic features including T stage and stage grouping (based on the AJCC stage at time of diagnosis) was assessed using chi-square or Fisher Exact tests. Results: Of the 171 patients, 62 (36.3%) presented with a primary cancer that recurred at a later date, and 109 (63.7%) had metastatic disease at presentation. Twenty patients were excluded from statistical analysis due to lack of staging data. The % of tumors with positive expression was 38.1 (HHLA), 37.6 (B7H3), 54.7 (PD-L1), 20.9 (CK7), 52.5 (CK20), and 58.2 (CDX2). There was no significant association between expression of each of the 6 proteins (HHLA2, B7H3, PD-L1, CK7, CK20, and CDX2) and the T stage (T1-2, T3 or T4) or stage grouping (stage 1-2 or stage 3). Consistent with clinical expectation, the expression of CK20 was higher than CK7 (p < 0.05). Conclusions: Expression of HHLA2, B7H3, PD-L1, CK7, CK20, and CDX2 were not associated with T stage or stage grouping of CRC samples in our study. These data suggest that these proteins are expressed early in the onset of CRC. Studies to determine their predictive and prognostic implications are underway.
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Affiliation(s)
- Rachel Levy
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | | | | | - Sanjay Goel
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
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18
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Shah N, Patel RJ, Thakkar A, Rahman S, Acuna-Villaorduna A, Shah U, Herrera DA, Slasky S, Gritsman K, Goldfinger M, Kornblum NS, Shastri A, Mantzaris I, Bachier-Rodriguez L, Braunschweig I, Verma A, McNeill KA, Ye BH, Janakiram M, Sica RA. CNS involvement by North American-ATLL (NA-ATLL) is associated with discrete patterns and molecular profile involving XPO1 E571 and KLF2/PI3KCD in selected cases. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.8063] [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] [Indexed: 11/20/2022] Open
Abstract
8063 Background: Information on central nervous system (CNS) involvement with NA-ATLL is limited. In this study, we describe CNS involvement in ATLL patients at a tertiary hospital in New York City. Methods: We considered CNS involvement if one of the following criteria was met 1) cerebrospinal fluid (CSF) cytology or flow cytometry was positive 2) CNS imaging was positive for disease involvement or 3) Physical exam findings were compatible with neurologic involvement. Results: Of 94 NA-ATLL patients, 21 (22.3%) had CNS involvement by ATLL. CSF was involved in 13/21 and 5/21 patients at diagnosis and relapse respectively. At diagnosis, MRI showed CNS involvement in brain and spine in 5/21 (24%) and 3/ 21 (14%) cases respectively. At relapse, imaging revealed brain and spine involvement in 2 patients each. Neurological exam was abnormal in 7 (33%) and 3 (14%) cases at diagnosis and relapse respectively. Next generation exon targeted sequencing was performed in 9 cases. Table shows the mutations (mtn) and functional groups with frequencies. XPO1 E571K mutation was present in 2 patients with extensive CNS disease and refractory to conventional treatment with an overall survival (OS) of 2 months. To our knowledge, this is the first time that XPO1 E571K is reported in a T-Cell malignancy. We also describe here a second set of mutations with CNS involvement (KLF2 and PI3KCD) in 2 patients. Median OS was 8.5 months, Median RFS was 6.5 months in our series. In most cases, the lymphomatous phenotype appeared to have direct mass-like extension (5/21) with several cases of accompanying osteolytic spine or skull lesions, whereas cases with hematogenous involvement tends to spread to the CSF by traversing the brain blood barrier. Conclusions: In this report we describe patterns of CNS involvement in ATLL and the associated mtns. We also describe two unique cases of XPO1E571K mtn in a TCL. [Table: see text]
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Affiliation(s)
- Nishi Shah
- Montefiore Einstein Center for Cancer Care, Bronx, NY
| | | | | | | | | | - Urvi Shah
- Memorial Sloan Kettering Center, New York, NY
| | | | | | | | | | - Noah Saul Kornblum
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Aditi Shastri
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Ioannis Mantzaris
- Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY
| | | | - Ira Braunschweig
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Amit Verma
- Albert Einstein College of Medicine, Bronx, NY
| | | | | | - Murali Janakiram
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
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Goel S, Negassa A, Acuna-Villaorduna A. The comparative effectiveness of biologic agents among non-hispanic black (NHB) patients with metastatic colorectal cancer (mCRC): Preliminary results of a SEER-medicare analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19059] [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] [Indexed: 11/20/2022] Open
Abstract
e19059 Background: Biologic agents (bevacizumab, cetuximab, panitumumab) have improved the overall survival (OS) of patients with mCRC. However, clinical trials are plagued by low representation of NHB patients, and a disproportionately high (>90%) accrual of non-Hispanic whites (NHW). As a result, the real world benefit among NHB patients in unknown. Comparative effectiveness research is an approach for effectively addressing this drawback. Methods: Utilizing the SEER-Medicare linked database, we identified 5,728 patients with mCRC diagnosed between 2004 and 2011 who received chemotherapy (CT; oxaliplatin, irinotecan, 5-FU, capecitabine) alone or chemotherapy with a biologic agent (CBT). OS was examined using the Kaplan-Meier method and a weighted semi-parametric accelerated failure time model. A propensity score model approach was undertaken to further account for potential treatment selection bias. Results: Overall, 88% were NHW and 12% NHB patients. The median age at diagnosis was 73 and 70 years and exposure to biologics was 71.2% and 71.4%, respectively. NHB patients had more women, were single, had lower median incomes, better differentiated tumors, less rectal primary cancers, more right sided tumors, and a worse Charleson co morbidity index. There was no difference in the receipt of 1 (72%) vs > 2 (28%) lines of therapy. The median OS was 11 and 12 months (m) in the CT-alone group, and 21 and 22 m in CBT group, among NHW and NHB, respectively. Based on an unadjusted analysis, receipt of biologics, younger age, left sided primary, well/moderate differentiation, being married, more lines of CT, and lower prevalence of co-morbidity were associated with improved OS. We also performed multiple imputations to properly account for the missing data. Among NHW, median OS was 21 vs 11 m in the CBT and CT groups, respectively (effect 1.47, 95% CI 1.36-1.60, p = 0.0000). Among NHB, median OS was 22 vs 12 m in the CBT and CT groups, respectively (effect 1.48, 95% CI 1.23-1.88, p = 0.0000). All comparisons maintained significance when adjusted for multiple comparisons. We found no interaction between biologics and race (p = 0.8743). On subgroup analysis, those patients receiving both classes of biologics (anti EGFR and anti VEGF) had the best outcome. Conclusions: In this cohort of older patients, CBT was associated with longer survival, regardless of race. Clinicians should offer CBT therapy to all patients to maximize their clinical benefit, factoring in clinical variables, but not their race.
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Affiliation(s)
- Sanjay Goel
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
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20
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Mehta V, Goel S, Kabarriti R, Cole D, Goldfinger M, Acuna-Villaorduna A, Pradhan K, Thota R, Reissman S, Sparano JA, Gartrell BA, Smith RV, Ohri N, Garg M, Racine AD, Kalnicki S, Perez-Soler R, Halmos B, Verma A. Case Fatality Rate of Cancer Patients with COVID-19 in a New York Hospital System. Cancer Discov 2020; 10:935-941. [PMID: 32357994 PMCID: PMC7334098 DOI: 10.1158/2159-8290.cd-20-0516] [Citation(s) in RCA: 550] [Impact Index Per Article: 137.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023]
Abstract
Patients with cancer in a New York hospital system were much more vulnerable to COVID-19 death than the general population, with a case fatality rate that varied by cancer type and was 28% overall. Patients with cancer are presumed to be at increased risk from COVID-19 infection–related fatality due to underlying malignancy, treatment-related immunosuppression, or increased comorbidities. A total of 218 COVID-19–positive patients from March 18, 2020, to April 8, 2020, with a malignant diagnosis were identified. A total of 61 (28%) patients with cancer died from COVID-19 with a case fatality rate (CFR) of 37% (20/54) for hematologic malignancies and 25% (41/164) for solid malignancies. Six of 11 (55%) patients with lung cancer died from COVID-19 disease. Increased mortality was significantly associated with older age, multiple comorbidities, need for ICU support, and elevated levels of D-dimer, lactate dehydrogenase, and lactate in multivariate analysis. Age-adjusted CFRs in patients with cancer compared with noncancer patients at our institution and New York City reported a significant increase in case fatality for patients with cancer. These data suggest the need for proactive strategies to reduce likelihood of infection and improve early identification in this vulnerable patient population. Significance: COVID-19 in patients with cancer is associated with a significantly increased risk of case fatality, suggesting the need for proactive strategies to reduce likelihood of infection and improve early identification in this vulnerable patient population. This article is highlighted in the In This Issue feature, p. 890
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Affiliation(s)
- Vikas Mehta
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
| | - Sanjay Goel
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
| | - Rafi Kabarriti
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
| | - Daniel Cole
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Mendel Goldfinger
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Ana Acuna-Villaorduna
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Kith Pradhan
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Raja Thota
- Network Performance Group, Montefiore Medical Center, Bronx, New York
| | - Stan Reissman
- Network Performance Group, Montefiore Medical Center, Bronx, New York
| | - Joseph A Sparano
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Benjamin A Gartrell
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Richard V Smith
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Nitin Ohri
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Madhur Garg
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Andrew D Racine
- Department of Pediatrics, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Shalom Kalnicki
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Roman Perez-Soler
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Balazs Halmos
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
| | - Amit Verma
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
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21
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Weiner A, Acuna-Villaorduna A, Sparano J, Anampa J. Abstract P3-08-24: Racial disparities in neutrophil counts among patients with metastatic breast cancer during treatment with CDK4/6 inhibitors. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p3-08-24] [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] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Addition of cyclin-dependent kinase (CDK) 4/6 inhibitors to aromatase inhibitors or fulvestrant prolongs progression-free survival (PFS) in hormone-receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) metastatic breast cancer (MBC). Grade 3/4 neutropenia occurs in up to 65% of patients treated with CDK 4/6 inhibitors, often leading to dose delay and/or reduction. Black (B) race has been associated with neutropenia. We aimed to compare changes in neutrophil counts among patients with HR+/HER2- MBC treated with CDK4/6 inhibitors by racial groups.
Methods: Patients with HR+/HER2- MBC prescribed CDK4/6 inhibitors at Montefiore Medical Center/Albert Einstein Cancer Center were identified. Cases with unknown race were excluded. Data regarding clinical, pathological, and treatment characteristics were collected through manual chart review. Race was defined as Black (B) or Non-Black (NB). PFS was defined as the time from treatment initiation to progression of disease or death. Laboratory parameters evaluated included absolute neutrophil count (ANC) at baseline (ANC-0), at 14 days (C1D14) and during each month of treatment (ANC-2, ANC-3, etc.). Changes in ANC (Delta-ANC) from baseline were estimated at specific time-points.
Results: A total of 130 patients with a mean age of 65 years were included, of whom 60 (46.2%) were B and 70 (53.8%) were NB. There were 38 (29.2%) Hispanics. CDK4/6 inhibitors were given in combination with first-line endocrine therapy in 59 patients (45.4%), and palbociclib was the most commonly used agent (117; 90%). There were no differences in the baseline characteristics among B vs. NB. The median ANC-0 was lower in B vs. NB (3.0 vs. 3.9, p=0.02); however, there were no differences in the median ANC at C1D14 (1.3 vs. 1.3, p=0.85), C2 (1.4 vs. 1.8, p=0.07), C3 (1.5 vs. 1.6, p=0.13), C4 (1.8 vs. 1.6, p=0.36) and all other time-points when comparing B vs. NB, respectively. Rate of CDK 4/6 inhibitor dose reductions for B vs. NB was similar (19% vs. 18%, p=0.47), as well as all other side-effects including grade 3/4 neutropenia (62.7% vs 45.6%, p=0.052), grade 3/4 infection (7% vs. 3.1%, p=0.32), any-grade anemia (55.9% vs. 58%, p=0.82), and grade 3/4 thrombocytopenia (5.2% vs. 5.9%, p=0.86). Delta-ANC was significantly lower for B compared to NB at C1D14 (-1.7 vs. -2.6, p=0.02), C2 (-1.5 vs. -2.3, p=0.05) and C3 (-1.8 vs. -2.6, p=0.006). There was no difference in PFS among B vs. NB receiving CDK4/6 inhibitors plus endocrine therapy in the overall cohort (10.4 vs. 11 months, p=0.68) or as first-line treatment (15 months vs. 12.4 months, p=0.28).
Conclusions: Although blacks who received CDK4/6 inhibitors had lower baseline neutrophil counts than non-black patients, they experienced less declines in their neutrophil counts from baseline, had similar rates of grade 3/4 neutropenia and dose reductions, and had similar clinical outcomes.
Black n=60Non-Black n=70pAge, mean (SD)66 (13)63 (14)0.15BMI, mean (SD)27 (7)27 (7)0.80ANC0, median (IQ)3 (2.4-4.7)3.9 (3.1-5)0.02Median ANC C1D141.3 (0.9-1.9)1.3 (0.9-1.9)0.85Median ANC C31.5 (1-2)1.6 (1.2-1.3)0.13Δ ANC C1D14-1.7 (-2.8 to -1.1)-2.6 (-3.4 to -1.8)0.02Δ ANC C3-1.8 (-2.3 to -1.1)-2.6 (-3.4 to -1.9)0.006Median PFS (95%IC)10.4 (6.6-22.6)11 (7.8-13.3)0.68
Citation Format: Ashley Weiner, Ana Acuna-Villaorduna, Joseph Sparano, Jesus Anampa. Racial disparities in neutrophil counts among patients with metastatic breast cancer during treatment with CDK4/6 inhibitors [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-08-24.
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22
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Tolu SS, Chergui A, Rao D, Kaumaya M, Acuna-Villaorduna A, Kaubisch A, Chuy JW, Rajdev L, Elrafei TN, Goel S. The impact of biologic agents in patients with metastatic colorectal cancer by race/ethnicity. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.156] [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] [Indexed: 11/20/2022] Open
Abstract
156 Background: Biologic agents have shown to improve overall survival (OS) in patients with metastatic colorectal cancer (mCRC). However, minority racial/ethnic groups were underrepresented in clinical trials. A retrospective study in a racially-diverse population diagnosed between 2000 - 2011, done by our group, reported a survival benefit with biologics; but, a subgroup analysis suggested that it was restricted to Non-Hispanic whites (NHW) only. This study aims to compare OS in patients with mCRC treated with chemotherapy and biologic agents (CBT) among racial/ethnic groups. Methods: Patients diagnosed with mCRC between 2012-2018 and treated with CBT at 3 cancer centers in the Bronx, NY were identified. Clinical data was collected by retrospective review for demographics (age at metastasis, gender and race/ethnicity categorized as Non-hispanic Black (NHB), NHW or Hispanic), pathological/ treatment characteristics (tumor grade, primary location, chemotherapy regimen, biologic agent). Cases without available race/ethnicity were excluded. OS was measured as time from mCRC diagnosis to death (verified from the National Death Index) and was compared among racial/ethnic groups using Kaplan-Meier curves. Results: A total of 278 patients; of whom 84 (42.4%) were Hispanic, 70 (35.4%) NHB and 44 (22.2%) NHW were included. The median age at diagnosis was 60 years and did not differ among racial/ethnic groups (62.5 vs 55.5 vs 56 years, p=0.07). There was a female predominance in NHB and Hispanics. Bevacizumab was more frequently used in Hispanics and NHB compared to NHW (95.2% vs. 92.9% vs. 77.3%, p=0.003, respectively). There were no differences in the frequency of cetuximab and panitumumab use. Median OS did not differ by racial/ethnic groups (21 in NHW vs. 22.8 in Hispanics and 28.6 months in NHB, p=0.40). Conclusions: Minority groups attain a similar survival benefit from the addition of biologics compared to NHW. Population-based studies are required to confirm these results.
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Affiliation(s)
| | | | - Devika Rao
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | | | | | - Andreas Kaubisch
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Jennifer W. Chuy
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | | | - Tarek N. Elrafei
- Albert Einstein College of Medicine-Jacobi Medical Center, New York, NY
| | - Sanjay Goel
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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23
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Chergui A, Gadde E, Tolu SS, Acuna-Villaorduna A, Kabarriti R, Goel S, Kaubisch A. Clinical characteristics and outcomes of patients with advanced hepatocellular carcinoma treated with immunotherapy: A real-world retrospective study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.557] [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] [Indexed: 11/20/2022] Open
Abstract
557 Background: Advanced HCC is an aggressive malignancy with dismal prognosis. Newer agents, including immunotherapy (IT), have been granted accelerated approval. Information outside clinical trials is scarce. This study is aimed to describe the clinical characteristics and outcomes of HCC patients treated with IT. Methods: Patients with HCC treated with IT were identified using the institutional data-mining software, Clinical Looking Glass. Patient demographics, clinical, and treatment characteristics were collected. Progression-free survival (PFS) was defined as time from treatment initiation to disease progression or death, and overall-survival (OS) as time from diagnosis of advanced disease to death. PFS and OS were plotted using Kaplan-Meier curves. Results: A total of 52 patients; median age 64 years; male predominance (38, 73.1%) were identified. There were 24 (54.5%) Hispanics, 9 (20.5%) Non-Hispanic Blacks, 7 (15.9%) Non-Hispanic White and 4 (9.1%) Asians. Cirrhosis was seen in 41 (83.7%), and median MELD score was 8 (IQ: 7-10). Hepatitis B and C infection were encountered in 12 (24.5%) and 22 (44%) patients, respectively. Imaging evidence of intravascular invasion was seen in 16 (34.8%) and extrahepatic metastases in 7 (14.9%) cases. Local treatment was provided to 29 (59.2%) and radiation treatment to 14 (28.6%) patients. Nivolumab was used in all the cases, as first-line treatment in 17 (32.7%) and as ≥ second line in 35(67.3%). The median PFS was 6.2 (3.1-10.6) months and was similar in first-line and ≥ second line treatment (8 vs 5.9 months, p=0.90). The median OS was 24.2 (18-28) months; there was a tendency towards higher survival rates in patients that were treated in ≥ second line (16.8 vs 25.2 months, 0=0.07). Conclusions: In this multiethnic cohort, the “real world” experience of the benefit of IT in HCC is encouraging, with a median OS exceeding two years. Expanded data may elucidate the differences if any, between use of IT as front vs. second line therapy, in PFS and OS.
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Affiliation(s)
| | | | | | | | | | - Sanjay Goel
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Andreas Kaubisch
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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24
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Shah UA, Shah N, Qiao B, Acuna-Villaorduna A, Pradhan K, Adrianzen Herrera D, Sica RA, Shastri A, Mantzaris I, Derman O, Kornblum N, Braunschweig I, Ye BH, Verma A, Janakiram M. Epidemiology and survival trend of adult T-cell leukemia/lymphoma in the United States. Cancer 2019; 126:567-574. [PMID: 31769871 DOI: 10.1002/cncr.32556] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 04/07/2019] [Revised: 06/23/2019] [Accepted: 08/15/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Globally, 5 million to 10 million people are infected with human T-cell leukemia virus type 1, which causes adult T-cell leukemia/lymphoma (ATLL) in 2% to 5% of the carriers. ATLL is a rare but extremely aggressive malignancy that can be challenging to diagnose. Very little data exist on the incidence patterns of ATLL in the United States. METHODS ATLL cases reported to the National Program of Cancer Registries, the Surveillance, Epidemiology, and End Results (SEER) program, and the New York State Cancer Registry were used for the study. Age-adjusted incidence rates were calculated by age, race/ethnicity, sex, and year of diagnosis. The 5-year survival rate was compared among race/ethnicity groups with the SEER data. RESULTS During 2001-2015, 2148 ATLL cases were diagnosed in the United States, 18% of which were in New York State. New York State had the highest incidence rate for ATLL, with a rising trend especially among non-Hispanic blacks (NHBs), whereas the incidence was stable across the remainder of the United States. NHBs were diagnosed at a younger median age (54 years) and had a shorter overall survival (6 months). In New York City, only 22.6% of the ATLL cases diagnosed were born in North America. CONCLUSIONS This is the largest epidemiological study of ATLL in the United States and shows a rising incidence in New York City. NHBs have a younger age at presentation and poor overall survival. The rising incidence is largely due to NHBs originating from the Caribbean.
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Affiliation(s)
- Urvi A Shah
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Nishi Shah
- Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Baozhen Qiao
- New York State Cancer Registry, New York State Department of Health, Albany, New York
| | - Ana Acuna-Villaorduna
- Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Kith Pradhan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Diego Adrianzen Herrera
- Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - R Alejandro Sica
- Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Aditi Shastri
- Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Ioannis Mantzaris
- Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Olga Derman
- Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Noah Kornblum
- Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Ira Braunschweig
- Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - B Hilda Ye
- Department of Cell Biology, Albert Einstein College of Medicine, Bronx, New York
| | - Amit Verma
- Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Murali Janakiram
- Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
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25
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Xiao Z, Acuna-Villaorduna A, Mantzaris I. Brachial plexopathy following autologous hematopoietic stem cell transplant: an unrecognized complication of autologous transplantation. Leuk Lymphoma 2019; 61:243-245. [PMID: 31429613 DOI: 10.1080/10428194.2019.1654094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Zhengrui Xiao
- Department of Internal Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Ana Acuna-Villaorduna
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ioannis Mantzaris
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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Acuna-Villaorduna A, Gonzalez-Lugo J, Ye BH, Adrianzen Herrera DA, Sica RA, Shah U, Shah N, Kornblum N, Braunschweig I, Derman O, Mantzaris I, Shastri A, Wang Y, Verma A, Zalta B, Janakiram M. High prevalence of pulmonary findings in computed tomographies of HTLV-1-infected patients with and without adult-T cell leukemia/lymphoma - implications for staging. Leuk Lymphoma 2019; 60:3272-3276. [PMID: 31204876 DOI: 10.1080/10428194.2019.1627543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Lung involvement has been reported in HTLV-1 carriers and in patients with ATLL. Whether there are differences in the pattern of lung involvement between ATLL and HTLV carriers in North American patients is unknown. We aimed to compare CT pulmonary findings among patients with HTLV-1 infection with and without ATLL. Among 140 patients with HTLV-1 diagnosis, 97 had CT chest available. Of these, 72 (74.2%) had ATLL and 25 (25.8%) did not have ATLL. CT chest abnormalities were present in 90 (92.8%) participants (94.4% in ATLL; 88% in non-ATLL). Higher rates of lymphadenopathy (69.4% versus 24%, p < .01) and lower rates of bronchiectasis (25% versus 48%, p = .04) were seen in ATLL compared to non-ATLL. Our study supports that staging of lung involvement in ATLL should consider HTLV-associated pulmonary findings as not all CT chest abnormalities necessarily represent malignant infiltration.
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Affiliation(s)
| | | | - B Hilda Ye
- Yeshiva University Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | - Urvi Shah
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nishi Shah
- Montefiore Hospital and Medical Center, Bronx, NY, USA
| | - Noah Kornblum
- Department of Oncology, Montefiore Medical Center, Bronx, NY, USA
| | | | - Olga Derman
- Department of Oncology, Montefiore Medical Center, Bronx, NY, USA
| | | | - Aditi Shastri
- Department of Oncology, Montefiore Medical Center, Bronx, NY, USA
| | - Yanhua Wang
- Department of Pathology, Montefiore Medical Center, Bronx, NY, USA
| | - Amit Verma
- Department of Oncology, Montefiore Einstein Center for Cancer Care, Bronx, NY, USA
| | | | - Murali Janakiram
- Department of Oncology, Montefiore Medical Center, Bronx, NY, USA
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Shah N, Acuna-Villaorduna A, Goel S. Incidence patterns of early onset colon cancer by race and stage in the US. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18168] [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] [Indexed: 11/20/2022] Open
Abstract
e18168 Background: Several studies show that incidence of colorectal cancer is increasing among young individuals. However, information on incidence of early onset colon cancer by race and stage is lacking. Methods: We analyzed incidence of colon cancer using National Program of Cancer Registries database which covers 99% of the US population. We identified colon cancer using ICD-O-3 code 8000-9049, 9056-9139, 9141-9589, along with the variable for site from cecum to sigmoid colon for years 2001 to 2015. SEER*Stat was used to calculate age-adjusted rates, trends and annual percent change. Results: Age adjusted incidence rate for colon is 31.2 cases per 100,000 among the entire population. Incidence in the age group of 15-39 years, 40-49 years, 50-59 years, 60-69 years, 70-79 years, 80+ years is 2.4, 14.3, 39.8, 86, 165.8, 232.3 per 100,000 respectively. The distribution of colon cancer by race for age groups is listed in table. When evaluating the incidence trend in each race for early onset colon cancer, the trend shows a rise in whites for both age groups (Annual Percent Change [APC] 3.4%, 1.5% for 15-39 years, 40-49 years of age respectively, p < 0.05). The trend in blacks on the other hand shows a rise of 1.2% (p < 0.05) in 15-39 years of age and a small but statistically significant decrease in incidence in 40-49 years of 0.5% (p < 0.05). In Asian Pacific Islanders (API) and American-Indians or Alaskan Natives (AI), the trend is not significant for either age groups. In the age groups above 50 years, the trend shows a decrease in incidence of colon cancer in all races. The rise in incidence for colon cancer in 15-39 years age group appears higher in localized disease as compared to metastatic disease (6.5% vs 2.8% for localized vs distant site of disease). Conclusions: This study highlights differences in incidence of early onset colon cancer among young patients by race and stage. Although there have been more cases of early onset colon cancers in blacks, the rise in incidence is higher in whites. With colonoscopy, there has been decrease in incidence of colon cancer for patients > 50 years for all races and stages. [Table: see text]
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Affiliation(s)
- Nishi Shah
- Montefiore Einstein Center for Cancer Care, Bronx, NY
| | | | - Sanjay Goel
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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Adrianzen Herrera D, Kornblum N, Acuna-Villaorduna A, Sica RA, Shah U, Butler M, Vishnuvardhan N, Shah N, Bachier-Rodriguez L, Derman O, Shastri A, Mantzaris I, Verma AK, Braunschweig I, Janakiram M. Barriers to Allogeneic Hematopoietic Stem Cell Transplantation for Human T Cell Lymphotropic Virus 1-Associated Adult T Cell Lymphoma-Leukemia in the United States: Experience from a Large Cohort in a Major Tertiary Center. Biol Blood Marrow Transplant 2019; 25:e199-e203. [PMID: 30769194 DOI: 10.1016/j.bbmt.2019.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/04/2019] [Accepted: 02/04/2019] [Indexed: 02/09/2023]
Abstract
In the United States adult T cell lymphoma-leukemia (ATLL) carries a dismal prognosis and mainly affects immigrants from human T cell lymphotropic virus 1 endemic areas. Allogeneic hematopoietic stem cell transplant (alloHSCT) can be effective and is recommended as an upfront treatment in the National Comprehensive Cancer Network guidelines. We studied the barriers to alloHSCT in one of the largest ATLL populations in the United States. Comprehensive chart and donor registry reviews were conducted for 88 ATLL patients treated at Montefiore Medical Center from 2003 to 2018. Among 49 patients with acute and 32 with lymphomatous subtypes, 48 (59.5%) were ineligible for alloHSCT because of early mortality (52%), loss to follow-up (21%), uninsured status (15%), patient declination (10%), and frailty (2%). Among 28 HLA-typed eligible patients (34.6%), matched related donors were identified for 7 (25%). A matched unrelated donor (MUD) search yielded HLA-matched in 2 patients (9.5%), HLA mismatched in 6 (28.5%), and no options in 13 (62%). Haploidentical donors were identified for 6 patients (46%) with no unrelated options. There were no suitable donors for 7 (25%) alloHSCT-eligible patients. The main limitation for alloHSCT after donor identification was death from progressive disease (82%). AlloHSCT was performed in 10 patients (12.3%) and was associated with better relapse-free survival (26 versus 11 months, P = .04) and overall survival (47 versus 10 months, P = .03). Early mortality and progressive disease are the main barriers to alloHSCT, but poor follow-up, uninsured status, and lack of suitable donor, including haploidentical, are also substantial limitations that might disproportionally affect this vulnerable population. AlloHSCT can achieve long-term remissions, and strategies aiming to overcome these barriers are urgently needed to improve outcomes in ATLL.
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Affiliation(s)
- Diego Adrianzen Herrera
- Department of Medical Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Noah Kornblum
- Department of Medical Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Ana Acuna-Villaorduna
- Department of Medical Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - R Alejandro Sica
- Department of Medical Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Urvi Shah
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Moya Butler
- Department of Medical Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Nivetha Vishnuvardhan
- Department of Medical Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Nishi Shah
- Department of Medical Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Lizamarie Bachier-Rodriguez
- Department of Medical Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Olga Derman
- Department of Medical Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Aditi Shastri
- Department of Medical Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Ioannis Mantzaris
- Department of Medical Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Amit K Verma
- Department of Medical Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Ira Braunschweig
- Department of Medical Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Murali Janakiram
- Department of Medical Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York; Department of Medicine, Division of HOT, University of Minnesota, Minneapolis, Minnesota.
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Acuna-Villaorduna A, Tran V, Gonzalez-Lugo JD, Azimi-Nekoo E, Billett HH. Natural history and clinical outcomes in patients with portal vein thrombosis by etiology: A retrospective cohort study. Thromb Res 2019; 174:137-140. [DOI: 10.1016/j.thromres.2018.12.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/23/2018] [Accepted: 12/18/2018] [Indexed: 01/28/2023]
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Fernandez-Arias M, Acuna-Villaorduna A, Miranda JJ, Diez-Canseco F, Malaga G. Adherence to pharmacotherapy and medication-related beliefs in patients with hypertension in Lima, Peru. PLoS One 2014; 9:e112875. [PMID: 25470372 PMCID: PMC4254514 DOI: 10.1371/journal.pone.0112875] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 10/17/2014] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To characterize adherence to pharmacological medication and beliefs towards medication in a group of patients with hypertension in a large national hospital. MATERIALS AND METHODS Cross-sectional survey among patients with hypertension attending the outpatient clinic of a large national hospital. Exposure of interest was the patient's beliefs towards general medication and antihypertensive drugs, i.e. beliefs of harm, overuse, necessity and concern, measured using the Beliefs about Medication questionnaire. Main outcome was adherence measured using the Morisky Medication Adherence Scale-8. Multivariate analysis was conducted using Poisson distribution logistic regression, prevalence ratios and 95% confidence intervals were calculated. RESULTS Data from 115 participants, 67% females and mean age 62.7 years were analyzed. Low adherence was found in 57.4%. Highest scores were on the ideas of necessity and one of the most rated statements was "physicians would prescribe less medication if they spent more time with patients". Beliefs of harm about medications and concerns about antihypertensive drugs were higher in the low adherence group (p<0.01). Those who scored higher on ideas of harm were 52% less likely of being high adherents (PR 0.48; 95% CI 0.25-0.93) and those with higher scores on concerns were 41% less likely of being high adherents (PR 0.59; 95% CI 0.39-0.91). Patients whose ideas of necessity outweighed their concerns were more likely to be adherent (PR 2.65; 95% CI 1.21-5.81). CONCLUSIONS Low adherence to antihypertensive medication is common. High scores on ideas of harm, concern and a high necessity-concern differential were predictors of medication adherence.
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Affiliation(s)
- Marta Fernandez-Arias
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Global Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Ana Acuna-Villaorduna
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
- * E-mail:
| | - J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Francisco Diez-Canseco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - German Malaga
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Servicio de Medicina Interna, Hospital Nacional Cayetano Heredia, Lima, Perú
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