1
|
Safi SA, Alexander A, Neuhuber W, Haeberle L, Rehders A, Luedde T, Esposito I, Fluegen G, Knoefel WT. Defining distal splenopancreatectomy by the mesopancreas. Langenbecks Arch Surg 2024; 409:127. [PMID: 38625602 PMCID: PMC11021282 DOI: 10.1007/s00423-024-03320-0] [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: 01/16/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND The implementation of the pathologic CRM (circumferential resection margin) staging system for pancreatic head ductal adenocarcinomas (hPDAC) resulted in a dramatic increase of R1 resections at the dorsal resection margin, presumably because of the high rate of mesopancreatic fat (MP) infiltration. Therefore, mesopancreatic excision (MPE) during pancreatoduodenectomy has recently been promoted and has demonstrated better local disease control, fueling the discussion of neoadjuvant downsizing regimes in MP + patients. However, it is unknown to what extent the MP is infiltrated in patients with distal pancreatic (tail/body) carcinomas (dPDAC). It is also unknown if the MP infiltration status affects surgical margin control in distal pancreatectomy (DP). The aim of our study was to histopathologically analyze MP infiltration and elucidate the influence of resection margin clearance on recurrence and survival in patients with dPDAC. Furthermore, the results were compared to a collective receiving MPE for hPDAC. METHOD Clinicopathological and survival parameters of 295 consecutive patients who underwent surgery for PDAC (n = 63 dPDAC and n = 232 hPDAC) were evaluated. The CRM evaluation was performed in a standardized fashion and the specimens were examined according to the Leeds pathology protocol (LEEPP). The MP area was histopathologically evaluated for cancerous infiltration. RESULTS In 75.4% of dPDAC patients the MP fat was infiltrated by vital tumor cells. The rates of MP infiltration and R0CRM- resections were similar between dPDAC and hPDAC patients (p = 0.497 and 0.453 respectively). MP- infiltration status did not correlate with CRM implemented resection status in dPDAC patients (p = 0.348). In overall survival analysis, resection status and MP status remained prognostic factors for survival. In follow up analysis. surgical margin clearance in dPDAC patients was associated with a significant improvement in local recurrence rates (5.2% in R0CRM- resected vs. 33.3 in R1/R0CRM + resected, p = 0.002). CONCLUSION While resection margin status was not affected by the MP status in dPDAC patients, the high MP infiltration rate, as well as improved survival in MP- dPDAC patients after R0CRM- resection, justify mesopancreatic excision during splenopancreatectomy. Larger scale studies are urgently needed to validate our results and to study the effect on neoadjuvant treatment in dPDAC patients.
Collapse
Affiliation(s)
- S-A Safi
- Departments of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - A Alexander
- Departments of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - W Neuhuber
- Institute of Anatomy I, Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstr. 1, Erlangen, Germany
| | - L Haeberle
- Institute of Pathology, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - A Rehders
- Departments of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - T Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - I Esposito
- Institute of Pathology, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - G Fluegen
- Departments of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - W T Knoefel
- Departments of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.
| |
Collapse
|
2
|
Cruz-Lim EM, Mou B, Baker S, Arbour G, Stefanyk K, Jiang W, Liu M, Bergman A, Schellenberg D, Alexander A, Berrang T, Bang A, Chng N, Matthews Q, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Huang V, Mestrovic A, Hyde D, Lund C, Pai H, Valev B, Lefresne S, Tyldesley S, Olson R. Prospective Longitudinal Assessment of Quality of Life After Stereotactic Ablative Radiotherapy for Oligometastases: Analysis of the Population-based SABR-5 Phase II Trial. Clin Oncol (R Coll Radiol) 2024; 36:148-156. [PMID: 38087705 DOI: 10.1016/j.clon.2023.11.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/11/2023] [Accepted: 11/28/2023] [Indexed: 02/18/2024]
Abstract
AIMS To evaluate longitudinal patient-reported quality of life (QoL) in patients treated with stereotactic ablative radiotherapy (SABR) for oligometastases. MATERIALS AND METHODS The SABR-5 trial was a population-based single-arm phase II study of SABR to up to five sites of oligometastases, conducted in six regional cancer centres in British Columbia, Canada from 2016 to 2020. Prospective QoL was measured using treatment site-specific QoL questionnaires at pre-treatment baseline and at 3, 6, 9, 12, 15, 18, 21, 24, 30 and 36 months after treatment. Patients with bone metastases were assessed with the Brief Pain Inventory (BPI). Patients with liver, adrenal and abdominopelvic lymph node metastases were assessed with the Functional Assessment of Chronic Illness Therapy-Abdominal Discomfort (FACIT-AD). Patients with lung and intrathoracic lymph node metastases were assessed with the Prospective Outcomes and Support Initiative (POSI) lung questionnaire. The two one-sided test procedure was used to assess equivalence between the worst QoL score and the baseline score of individual patients. The mean QoL at all time points was used to determine the trajectory of QoL response after SABR. The proportion of patients with 'stable', 'improved' or 'worsened' QoL was determined for all time points based on standard minimal clinically important differences (MCID; BPI worst pain = 2, BPI functional interference score [FIS] = 0.5, FACIT-AD Trial Outcome Index [TOI] = 8, POSI = 3). RESULTS All enrolled patients with baseline QoL assessment and at least one follow-up assessment were analysed (n = 133). On equivalence testing, the patients' worst QoL scores were clinically different from baseline scores and met MCID (BPI worst pain mean difference: 1.8, 90% confidence interval 1.19 to 2.42]; BPI FIS mean difference: 1.68, 90% confidence interval 1.15 to 2.21; FACIT-AD TOI mean difference: -8.76, 90% confidence interval -11.29 to -6.24; POSI mean difference: -4.61, 90% confidence interval -6.09 to -3.14). However, the mean FIS transiently worsened at 9, 18 and 21 months but eventually returned to stable levels. The mean FACIT and POSI scores also worsened at 36 months, albeit with a limited number of responses (n = 4 and 8, respectively). Most patients reported stable QoL at all time points (range: BPI worst pain 71-82%, BPI FIS 45-78%, FACIT-AD TOI 50-100%, POSI 25-73%). Clinically significant stability, worsening and improvement were seen in 70%/13%/18% of patients at 3 months, 53%/28%/19% at 18 months and 63%/25%/13% at 36 months. CONCLUSIONS Transient decreases in QoL that met MCID were seen between patients' worst QoL scores and baseline scores. However, most patients experienced stable QoL relative to pre-treatment levels on long-term follow-up. Further studies are needed to characterise patients at greatest risk for decreased QoL.
Collapse
Affiliation(s)
- E M Cruz-Lim
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - B Mou
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - S Baker
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - G Arbour
- University of British Columbia, British Columbia, Canada
| | - K Stefanyk
- University of British Columbia, British Columbia, Canada
| | - W Jiang
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - M Liu
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - A Bergman
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - D Schellenberg
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - A Alexander
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - T Berrang
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - A Bang
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - N Chng
- BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - Q Matthews
- BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - H Carolan
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - F Hsu
- University of British Columbia, British Columbia, Canada; BC Cancer - Abbotsford, Abbotsford, British Columbia, Canada
| | - S Miller
- University of British Columbia, British Columbia, Canada; BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - S Atrchian
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - E Chan
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - C Ho
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - I Mohamed
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - A Lin
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - V Huang
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - A Mestrovic
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - D Hyde
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - C Lund
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - H Pai
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - B Valev
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - S Lefresne
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - S Tyldesley
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - R Olson
- University of British Columbia, British Columbia, Canada; BC Cancer - Prince George, Prince George, British Columbia, Canada.
| |
Collapse
|
3
|
Cruz-Lim EM, Mou B, Jiang W, Liu M, Bergman A, Schellenberg D, Alexander A, Berrang T, Bang A, Chng N, Matthews Q, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Huang V, Mestrovic A, Hyde D, Lund C, Pai H, Valev B, Lefresne S, Tyldesley S, Olson R, Baker S. Predictors of Quality of Life Decline in Patients with Oligometastases treated with Stereotactic Ablative Radiotherapy: Analysis of the Population-Based SABR-5 Phase II Trial. Clin Oncol (R Coll Radiol) 2024; 36:141-147. [PMID: 38296662 DOI: 10.1016/j.clon.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/15/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024]
Abstract
AIMS Most patients experience stable quality of life (QoL) after stereotactic ablative radiotherapy (SABR) treatment for oligometastases. However, a subset of patients experience clinically relevant declines in QoL on post-treatment follow-up. This study aimed to identify risk factors for QoL decline. MATERIALS AND METHODS The SABR-5 trial was a population-based single-arm phase II study of SABR to up to five sites of oligometastases. Prospective QoL was measured using treatment site-specific tools at pre-treatment baseline and 3, 6, 9, 12, 15, 18, 21, 24, 30 and 36 months after treatment. The time to persistent QoL decline was calculated as the time from SABR to the first decline in QoL score meeting minimum clinically important difference with no improvement to baseline score on subsequent assessments. Univariable and multivariable logistic regression analyses were carried out to determine factors associated with QoL decline. RESULTS One hundred and thirty-three patients were included with a median follow-up of 32 months (interquartile range 25-43). Thirty-five patients (26%) experienced a persistent decline in QoL. The median time until persistent QoL decline was not reached. The cumulative incidence of QoL decline at 2 and 3 years were 22% (95% confidence interval 14.0-29.6) and 40% (95% confidence interval 28.0-51.2), respectively. In multivariable analysis, disease progression (odds ratio 5.23, 95% confidence interval 1.59-17.47, P = 0.007) and adrenal metastases (odds ratio 9.70, 95% confidence interval 1.41-66.93, P = 0.021) were associated with a higher risk of QoL decline. Grade 3 or higher (odds ratio 3.88, 95% confidence interval 0.92-16.31, P = 0.064) and grade 2 or higher SABR-associated toxicity (odds ratio 2.24, 95% confidence interval 0.85-5.91, P = 0.10) were associated with an increased risk of QoL decline but did not reach statistical significance. CONCLUSIONS Disease progression and adrenal lesion site were associated with persistent QoL decline following SABR. The development of grade 3 or higher toxicities was also associated with an increased risk, albeit not statistically significant. Further studies are needed, focusing on the QoL impact of metastasis-directed therapies.
Collapse
Affiliation(s)
- E M Cruz-Lim
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - B Mou
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - W Jiang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - M Liu
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - A Bergman
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - D Schellenberg
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - A Alexander
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - T Berrang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - A Bang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - N Chng
- BC Cancer - Prince George, British Columbia, Canada
| | - Q Matthews
- BC Cancer - Prince George, British Columbia, Canada
| | - H Carolan
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - F Hsu
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Abbotsford, British Columbia, Canada
| | - S Miller
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Prince George, British Columbia, Canada
| | - S Atrchian
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - E Chan
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - C Ho
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - I Mohamed
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - A Lin
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - V Huang
- BC Cancer - Surrey, British Columbia, Canada
| | - A Mestrovic
- BC Cancer - Vancouver, British Columbia, Canada
| | - D Hyde
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - C Lund
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - H Pai
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - B Valev
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - S Lefresne
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - S Tyldesley
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - R Olson
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Prince George, British Columbia, Canada
| | - S Baker
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada.
| |
Collapse
|
4
|
Agostini M, Alexander A, Araujo GR, Bakalyarov AM, Balata M, Barabanov I, Baudis L, Bauer C, Belogurov S, Bettini A, Bezrukov L, Biancacci V, Bossio E, Bothe V, Brudanin V, Brugnera R, Caldwell A, Cattadori C, Chernogorov A, Comellato T, D’Andrea V, Demidova EV, Marco ND, Doroshkevich E, Fischer F, Fomina M, Gangapshev A, Garfagnini A, Gooch C, Grabmayr P, Gurentsov V, Gusev K, Hakenmüller J, Hemmer S, Hofmann W, Huang J, Hult M, Inzhechik LV, Csáthy JJ, Jochum J, Junker M, Kazalov V, Kermaïdic Y, Khushbakht H, Kihm T, Kilgus K, Kirpichnikov IV, Klimenko A, Kneißl R, Knöpfle KT, Kochetov O, Kornoukhov VN, Korošec M, Krause P, Kuzminov VV, Laubenstein M, Lindner M, Lippi I, Lubashevskiy A, Lubsandorzhiev B, Lutter G, Macolino C, Majorovits B, Maneschg W, Manzanillas L, Marshall G, Misiaszek M, Morella M, Müller Y, Nemchenok I, Pandola L, Pelczar K, Pertoldi L, Piseri P, Pullia A, Ransom C, Rauscher L, Redchuk M, Riboldi S, Rumyantseva N, Sada C, Salamida F, Schönert S, Schreiner J, Schütt M, Schütz AK, Schulz O, Schwarz M, Schwingenheuer B, Selivanenko O, Shevchik E, Shirchenko M, Shtembari L, Simgen H, Smolnikov A, Stukov D, Vasenko AA, Veresnikova A, Vignoli C, Sturm KV, Wester T, Wiesinger C, Wojcik M, Yanovich E, Zatschler B, Zhitnikov I, Zhukov SV, Zinatulina D, Zschocke A, Zsigmond AJ, Zuber K, Zuzel G. An improved limit on the neutrinoless double-electron capture of 36Ar with GERDA. Eur Phys J C Part Fields 2024; 84:34. [PMID: 38229675 PMCID: PMC10788323 DOI: 10.1140/epjc/s10052-023-12280-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/21/2023] [Indexed: 01/18/2024]
Abstract
The GERmanium Detector Array (Gerda) experiment operated enriched high-purity germanium detectors in a liquid argon cryostat, which contains 0.33% of 36 Ar, a candidate isotope for the two-neutrino double-electron capture (2ν ECEC) and therefore for the neutrinoless double-electron capture (0ν ECEC). If detected, this process would give evidence of lepton number violation and the Majorana nature of neutrinos. In the radiative 0ν ECEC of 36 Ar, a monochromatic photon is emitted with an energy of 429.88 keV, which may be detected by the Gerda germanium detectors. We searched for the 36 Ar 0ν ECEC with Gerda data, with a total live time of 4.34 year (3.08 year accumulated during Gerda Phase II and 1.26 year during Gerda Phase I). No signal was found and a 90% CL lower limit on the half-life of this process was established T 1 / 2 > 1.5 · 10 22 year. Supplementary Information The online version contains supplementary material available at 10.1140/epjc/s10052-023-12280-6.
Collapse
|
5
|
Whisenant MS, Alexander A, Woodward WA, Teshome M, Ueno NT, Williams LA. Inflammatory Breast Cancer: Understanding the Patient Experience. Cancer Nurs 2024; 47:E65-E72. [PMID: 36729801 DOI: 10.1097/ncc.0000000000001165] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Inflammatory breast cancer (IBC) is an aggressive, locally advanced cancer with a 5-year survival rate of approximately 40%. Although patients with IBC likely experience significant and variable symptom burden from diagnosis through survivorship, the description of the symptom burden in this population is limited. OBJECTIVES The purpose of this study was to describe the experience of patients with IBC and define the content domain for a patient-reported outcome measure of IBC symptom burden. METHODS Twenty patients with IBC described their experience in single qualitative interviews. Content analysis was used to define the symptom burden content domain. Relevance ratings by a panel of experts reduced the number of items for a preliminary patient-reported outcome symptom burden measure. RESULTS The mean (SD) participant age was 52.8 (12.0) years; 50.0% had distant metastatic disease, and 85.0% were currently receiving treatment. Content analysis revealed 45 symptoms, with 20 symptoms reported by greater than or equal to 20% of participants. All participants described localized disease-related symptoms. Treatment-related symptoms varied among participants based on the modalities received. CONCLUSION Patients with IBC experience symptom burden that is distinct from the symptom burden experienced by patients with non-IBC. IMPLICATIONS FOR PRACTICE Differentiating the disease-related symptoms of IBC may assist clinicians in making timely and accurate diagnoses for IBC. A disease- and treatment-specific measure of the symptom burden of IBC should be incorporated in clinical practice to allow for regular assessment and evaluation of symptom burden and implementation of evidence-based interventions for symptom management.
Collapse
Affiliation(s)
- Meagan S Whisenant
- Author Affiliations: Department of Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston (Dr Whisenant); and Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Department of Breast Medical Oncology (Drs Alexander and Ueno), Department of Radiation Oncology (Dr Woodward), Department of Breast Surgical Oncology (Dr Teshome), and Department of Symptom Research (Dr Williams), The University of Texas MD Anderson Cancer Center, Houston
| | | | | | | | | | | |
Collapse
|
6
|
Agostini M, Alexander A, Araujo GR, Bakalyarov AM, Balata M, Barabanov I, Baudis L, Bauer C, Belogurov S, Bettini A, Bezrukov L, Biancacci V, Bossio E, Bothe V, Brugnera R, Caldwell A, Calgaro S, Cattadori C, Chernogorov A, Chiu PJ, Comellato T, D'Andrea V, Demidova EV, Di Giacinto A, Di Marco N, Doroshkevich E, Fischer F, Fomina M, Gangapshev A, Garfagnini A, Gooch C, Grabmayr P, Gurentsov V, Gusev K, Hackenmüller S, Hemmer S, Hofmann W, Huang J, Hult M, Inzhechik LV, Janicskó Csáthy J, Jochum J, Junker M, Kazalov V, Kermaïdic Y, Khushbakht H, Kihm T, Kilgus K, Kirpichnikov IV, Klimenko A, Knöpfle KT, Kochetov O, Kornoukhov VN, Krause P, Kuzminov VV, Laubenstein M, Lehnert B, Lindner M, Lippi I, Lubashevskiy A, Lubsandorzhiev B, Lutter G, Macolino C, Majorovits B, Maneschg W, Manzanillas L, Marshall G, Miloradovic M, Mingazheva R, Misiaszek M, Morella M, Müller Y, Nemchenok I, Neuberger M, Pandola L, Pelczar K, Pertoldi L, Piseri P, Pullia A, Ransom C, Rauscher L, Redchuk M, Riboldi S, Rumyantseva N, Sada C, Sailer S, Salamida F, Schönert S, Schreiner J, Schütt M, Schütz AK, Schulz O, Schwarz M, Schwingenheuer B, Selivanenko O, Shevchik E, Shirchenko M, Shtembari L, Simgen H, Smolnikov A, Stukov D, Sullivan S, Vasenko AA, Veresnikova A, Vignoli C, von Sturm K, Wester T, Wiesinger C, Wojcik M, Yanovich E, Zatschler B, Zhitnikov I, Zhukov SV, Zinatulina D, Zschocke A, Zsigmond AJ, Zuber K, Zuzel G. Final Results of GERDA on the Two-Neutrino Double-β Decay Half-Life of ^{76}Ge. Phys Rev Lett 2023; 131:142501. [PMID: 37862664 DOI: 10.1103/physrevlett.131.142501] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/15/2023] [Indexed: 10/22/2023]
Abstract
We present the measurement of the two-neutrino double-β decay rate of ^{76}Ge performed with the GERDA Phase II experiment. With a subset of the entire GERDA exposure, 11.8 kg yr, the half-life of the process has been determined: T_{1/2}^{2ν}=(2.022±0.018_{stat}±0.038_{syst})×10^{21} yr. This is the most precise determination of the ^{76}Ge two-neutrino double-β decay half-life and one of the most precise measurements of a double-β decay process. The relevant nuclear matrix element can be extracted: M_{eff}^{2ν}=(0.101±0.001).
Collapse
Affiliation(s)
- M Agostini
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - A Alexander
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - G R Araujo
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - A M Bakalyarov
- National Research Centre "Kurchatov Institute," Moscow, Russia
| | - M Balata
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - I Barabanov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - L Baudis
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - C Bauer
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - S Belogurov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Institute for Theoretical and Experimental Physics, NRC "Kurchatov Institute," Moscow, Russia
| | - A Bettini
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - L Bezrukov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - V Biancacci
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - E Bossio
- Physik Department, Technische Universität München, Germany
| | - V Bothe
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - R Brugnera
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - A Caldwell
- Max-Planck-Institut für Physik, Munich, Germany
| | - S Calgaro
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | | | - A Chernogorov
- Institute for Theoretical and Experimental Physics, NRC "Kurchatov Institute," Moscow, Russia
- National Research Centre "Kurchatov Institute," Moscow, Russia
| | - P-J Chiu
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - T Comellato
- Physik Department, Technische Universität München, Germany
| | - V D'Andrea
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell'Aquila, L'Aquila, Italy
| | - E V Demidova
- Institute for Theoretical and Experimental Physics, NRC "Kurchatov Institute," Moscow, Russia
| | - A Di Giacinto
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - N Di Marco
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
| | - E Doroshkevich
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - F Fischer
- Max-Planck-Institut für Physik, Munich, Germany
| | - M Fomina
- Joint Institute for Nuclear Research, Dubna, Russia
| | - A Gangapshev
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - A Garfagnini
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - C Gooch
- Max-Planck-Institut für Physik, Munich, Germany
| | - P Grabmayr
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - V Gurentsov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - K Gusev
- Joint Institute for Nuclear Research, Dubna, Russia
- National Research Centre "Kurchatov Institute," Moscow, Russia
- Physik Department, Technische Universität München, Germany
| | | | | | - W Hofmann
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - J Huang
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - M Hult
- European Commission, JRC-Geel, Geel, Belgium
| | - L V Inzhechik
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | | | - J Jochum
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - M Junker
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - V Kazalov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - Y Kermaïdic
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - H Khushbakht
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - T Kihm
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - K Kilgus
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - I V Kirpichnikov
- Institute for Theoretical and Experimental Physics, NRC "Kurchatov Institute," Moscow, Russia
| | - A Klimenko
- Joint Institute for Nuclear Research, Dubna, Russia
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - K T Knöpfle
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - O Kochetov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - V N Kornoukhov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - P Krause
- Physik Department, Technische Universität München, Germany
| | - V V Kuzminov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - M Laubenstein
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - B Lehnert
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - M Lindner
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | | | | | - B Lubsandorzhiev
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - G Lutter
- European Commission, JRC-Geel, Geel, Belgium
| | - C Macolino
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell'Aquila, L'Aquila, Italy
| | | | - W Maneschg
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | | | - G Marshall
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - M Miloradovic
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - R Mingazheva
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - M Misiaszek
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - M Morella
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
| | - Y Müller
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - I Nemchenok
- Joint Institute for Nuclear Research, Dubna, Russia
| | - M Neuberger
- Physik Department, Technische Universität München, Germany
| | - L Pandola
- INFN Laboratori Nazionali del Sud, Catania, Italy
| | - K Pelczar
- European Commission, JRC-Geel, Geel, Belgium
| | - L Pertoldi
- Physik Department, Technische Universität München, Germany
- INFN Padova, Padua, Italy
| | - P Piseri
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - A Pullia
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - C Ransom
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - L Rauscher
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - S Riboldi
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - N Rumyantseva
- Joint Institute for Nuclear Research, Dubna, Russia
- National Research Centre "Kurchatov Institute," Moscow, Russia
| | - C Sada
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - S Sailer
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - F Salamida
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell'Aquila, L'Aquila, Italy
| | - S Schönert
- Physik Department, Technische Universität München, Germany
| | - J Schreiner
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - M Schütt
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A-K Schütz
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - O Schulz
- Max-Planck-Institut für Physik, Munich, Germany
| | - M Schwarz
- Physik Department, Technische Universität München, Germany
| | | | - O Selivanenko
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - E Shevchik
- Joint Institute for Nuclear Research, Dubna, Russia
| | - M Shirchenko
- Joint Institute for Nuclear Research, Dubna, Russia
| | - L Shtembari
- Max-Planck-Institut für Physik, Munich, Germany
| | - H Simgen
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A Smolnikov
- Joint Institute for Nuclear Research, Dubna, Russia
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - D Stukov
- National Research Centre "Kurchatov Institute," Moscow, Russia
| | - S Sullivan
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A A Vasenko
- Institute for Theoretical and Experimental Physics, NRC "Kurchatov Institute," Moscow, Russia
| | - A Veresnikova
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - C Vignoli
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - K von Sturm
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - T Wester
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - C Wiesinger
- Physik Department, Technische Universität München, Germany
| | - M Wojcik
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - E Yanovich
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - B Zatschler
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - I Zhitnikov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - S V Zhukov
- National Research Centre "Kurchatov Institute," Moscow, Russia
| | - D Zinatulina
- Joint Institute for Nuclear Research, Dubna, Russia
| | - A Zschocke
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - K Zuber
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - G Zuzel
- Institute of Physics, Jagiellonian University, Cracow, Poland
| |
Collapse
|
7
|
Agostini M, Alexander A, Araujo G, Bakalyarov AM, Balata M, Barabanov I, Baudis L, Bauer C, Belogurov S, Bettini A, Bezrukov L, Biancacci V, Bossio E, Bothe V, Brugnera R, Caldwell A, Calgaro S, Cattadori C, Chernogorov A, Chiu PJ, Comellato T, D’Andrea V, Demidova EV, Di Giacinto A, Di Marco N, Doroshkevich E, Fischer F, Fomina M, Gangapshev A, Garfagnini A, Gooch C, Grabmayr P, Gurentsov V, Gusev K, Hakenmüller J, Hemmer S, Hofmann W, Hult M, Inzhechik LV, Janicskó Csáthy J, Jochum J, Junker M, Kazalov V, Kermaïdic Y, Khushbakht H, Kihm T, Kilgus K, Kirpichnikov IV, Klimenko A, Knöpfle KT, Kochetov O, Kornoukhov VN, Krause P, Kuzminov VV, Laubenstein M, Lindner M, Lippi I, Lubashevskiy A, Lubsandorzhiev B, Lutter G, Macolino C, Majorovits B, Maneschg W, Manzanillas L, Marshall G, Misiaszek M, Morella M, Müller Y, Nemchenok I, Neuberger M, Pandola L, Pelczar K, Pertoldi L, Piseri P, Pullia A, Rauscher L, Redchuk M, Riboldi S, Rumyantseva N, Sada C, Sailer S, Salamida F, Schönert S, Schreiner J, Schütt M, Schütz AK, Schulz O, Schwarz M, Schwingenheuer B, Selivanenko O, Shevchik E, Shirchenko M, Shtembari L, Simgen H, Smolnikov A, Stukov D, Sullivan S, Vasenko AA, Veresnikova A, Vignoli C, von Sturm K, Wester T, Wiesinger C, Wojcik M, Yanovich E, Zatschler B, Zhitnikov I, Zhukov SV, Zinatulina D, Zschocke A, Zsigmond AJ, Zuber K, Zuzel G. Search for tri-nucleon decays of 76Ge in GERDA. Eur Phys J C Part Fields 2023; 83:778. [PMID: 37674593 PMCID: PMC10477131 DOI: 10.1140/epjc/s10052-023-11862-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/25/2023] [Indexed: 09/08/2023]
Abstract
We search for tri-nucleon decays of 76 Ge in the dataset from the GERmanium Detector Array (GERDA) experiment. Decays that populate excited levels of the daughter nucleus above the threshold for particle emission lead to disintegration and are not considered. The ppp-, ppn-, and pnn-decays lead to 73 Cu, 73 Zn, and 73 Ga nuclei, respectively. These nuclei are unstable and eventually proceed by the beta decay of 73 Ga to 73 Ge (stable). We search for the 73 Ga decay exploiting the fact that it dominantly populates the 66.7 keV 73 m Ga state with half-life of 0.5 s. The nnn-decays of 76 Ge that proceed via 73 m Ge are also included in our analysis. We find no signal candidate and place a limit on the sum of the decay widths of the inclusive tri-nucleon decays that corresponds to a lower lifetime limit of 1.2× 1026 yr (90% credible interval). This result improves previous limits for tri-nucleon decays by one to three orders of magnitude.
Collapse
Affiliation(s)
- M. Agostini
- Department of Physics and Astronomy, University College London, London, UK
| | - A. Alexander
- Department of Physics and Astronomy, University College London, London, UK
| | - G. Araujo
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | | | - M. Balata
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - I. Barabanov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - L. Baudis
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - C. Bauer
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - S. Belogurov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
- NRNU MEPhI, Moscow, Russia
| | - A. Bettini
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - L. Bezrukov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - V. Biancacci
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - E. Bossio
- Physik Department, Technische Universität München, Munich, Germany
| | - V. Bothe
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - R. Brugnera
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - A. Caldwell
- Max-Planck-Institut für Physik, Munich, Germany
| | - S. Calgaro
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | | | - A. Chernogorov
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | - P.-J. Chiu
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - T. Comellato
- Physik Department, Technische Universität München, Munich, Germany
| | - V. D’Andrea
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
| | - E. V. Demidova
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - A. Di Giacinto
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - N. Di Marco
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
| | - E. Doroshkevich
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - F. Fischer
- Max-Planck-Institut für Physik, Munich, Germany
| | - M. Fomina
- Joint Institute for Nuclear Research, Dubna, Russia
| | - A. Gangapshev
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - A. Garfagnini
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - C. Gooch
- Max-Planck-Institut für Physik, Munich, Germany
| | - P. Grabmayr
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - V. Gurentsov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - K. Gusev
- Joint Institute for Nuclear Research, Dubna, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
- Physik Department, Technische Universität München, Munich, Germany
| | - J. Hakenmüller
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Present Address: Duke University, Durham, NC USA
| | | | - W. Hofmann
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - M. Hult
- European Commission, JRC-Geel, Geel, Belgium
| | - L. V. Inzhechik
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Moscow Institute of Physics and Technology, Moscow, Russia
| | - J. Janicskó Csáthy
- Physik Department, Technische Universität München, Munich, Germany
- Present Address: Leibniz-Institut für Kristallzüchtung, Berlin, Germany
| | - J. Jochum
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - M. Junker
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - V. Kazalov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - Y. Kermaïdic
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - H. Khushbakht
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - T. Kihm
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - K. Kilgus
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - I. V. Kirpichnikov
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - A. Klimenko
- Joint Institute for Nuclear Research, Dubna, Russia
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Dubna State University, Dubna, Russia
| | - K. T. Knöpfle
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - O. Kochetov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - V. N. Kornoukhov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- NRNU MEPhI, Moscow, Russia
| | - P. Krause
- Physik Department, Technische Universität München, Munich, Germany
| | - V. V. Kuzminov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - M. Laubenstein
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - M. Lindner
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | | | | | - B. Lubsandorzhiev
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - G. Lutter
- European Commission, JRC-Geel, Geel, Belgium
| | - C. Macolino
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
| | | | - W. Maneschg
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | | | - G. Marshall
- Department of Physics and Astronomy, University College London, London, UK
| | - M. Misiaszek
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - M. Morella
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
| | - Y. Müller
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - I. Nemchenok
- Joint Institute for Nuclear Research, Dubna, Russia
- Dubna State University, Dubna, Russia
| | - M. Neuberger
- Physik Department, Technische Universität München, Munich, Germany
| | - L. Pandola
- INFN Laboratori Nazionali del Sud, Catania, Italy
| | - K. Pelczar
- European Commission, JRC-Geel, Geel, Belgium
| | - L. Pertoldi
- Physik Department, Technische Universität München, Munich, Germany
- INFN Padova, Padua, Italy
| | - P. Piseri
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - A. Pullia
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - L. Rauscher
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - S. Riboldi
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - N. Rumyantseva
- Joint Institute for Nuclear Research, Dubna, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | - C. Sada
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - S. Sailer
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - F. Salamida
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
| | - S. Schönert
- Physik Department, Technische Universität München, Munich, Germany
| | - J. Schreiner
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - M. Schütt
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A.-K. Schütz
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - O. Schulz
- Max-Planck-Institut für Physik, Munich, Germany
| | - M. Schwarz
- Physik Department, Technische Universität München, Munich, Germany
| | | | - O. Selivanenko
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - E. Shevchik
- Joint Institute for Nuclear Research, Dubna, Russia
| | | | | | - H. Simgen
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A. Smolnikov
- Joint Institute for Nuclear Research, Dubna, Russia
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - D. Stukov
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | - S. Sullivan
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A. A. Vasenko
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - A. Veresnikova
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - C. Vignoli
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - K. von Sturm
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - T. Wester
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | | | - M. Wojcik
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - E. Yanovich
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - B. Zatschler
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - I. Zhitnikov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - S. V. Zhukov
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | | | - A. Zschocke
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - K. Zuber
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - G. Zuzel
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | | |
Collapse
|
8
|
Jayasooriya S, Stolbrink M, Khoo EM, Sunte IT, Awuru JI, Cohen M, Lam DC, Spanevello A, Visca D, Centis R, Migliori GB, Ayuk AC, Buendia JA, Awokola BI, Del-Rio-Navarro BE, Muteti-Fana S, Lao-Araya M, Chiarella P, Badellino H, Somwe SW, Anand MP, Garcí-Corzo JR, Bekele A, Soto-Martinez ME, Ngahane BHM, Florin M, Voyi K, Tabbah K, Bakki B, Alexander A, Garba BL, Salvador EM, Fischer GB, Falade AG, ŽivkoviĆ Z, Romero-Tapia SJ, Erhabor GE, Zar H, Gemicioglu B, Brandão HV, Kurhasani X, El-Sharif N, Singh V, Ranasinghe JC, Kudagammana ST, Masjedi MR, Velásquez JN, Jain A, Cherrez-Ojeda I, Valdeavellano LFM, Gómez RM, Mesonjesi E, Morfin-Maciel BM, Ndikum AE, Mukiibi GB, Reddy BK, Yusuf O, Taright-Mahi S, Mérida-Palacio JV, Kabra SK, Nkhama E, Filho NR, Zhjegi VB, Mortimer K, Rylance S, Masekela RR. Clinical standards for the diagnosis and management of asthma in low- and middle-income countries. Int J Tuberc Lung Dis 2023; 27:658-667. [PMID: 37608484 PMCID: PMC10443788 DOI: 10.5588/ijtld.23.0203] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND: The aim of these clinical standards is to aid the diagnosis and management of asthma in low-resource settings in low- and middle-income countries (LMICs).METHODS: A panel of 52 experts in the field of asthma in LMICs participated in a two-stage Delphi process to establish and reach a consensus on the clinical standards.RESULTS: Eighteen clinical standards were defined: Standard 1, Every individual with symptoms and signs compatible with asthma should undergo a clinical assessment; Standard 2, In individuals (>6 years) with a clinical assessment supportive of a diagnosis of asthma, a hand-held spirometry measurement should be used to confirm variable expiratory airflow limitation by demonstrating an acute response to a bronchodilator; Standard 3, Pre- and post-bronchodilator spirometry should be performed in individuals (>6 years) to support diagnosis before treatment is commenced if there is diagnostic uncertainty; Standard 4, Individuals with an acute exacerbation of asthma and clinical signs of hypoxaemia or increased work of breathing should be given supplementary oxygen to maintain saturation at 94-98%; Standard 5, Inhaled short-acting beta-2 agonists (SABAs) should be used as an emergency reliever in individuals with asthma via an appropriate spacer device for metered-dose inhalers; Standard 6, Short-course oral corticosteroids should be administered in appropriate doses to individuals having moderate to severe acute asthma exacerbations (minimum 3-5 days); Standard 7, Individuals having a severe asthma exacerbation should receive emergency care, including oxygen therapy, systemic corticosteroids, inhaled bronchodilators (e.g., salbutamol with or without ipratropium bromide) and a single dose of intravenous magnesium sulphate should be considered; Standard 8, All individuals with asthma should receive education about asthma and a personalised action plan; Standard 9, Inhaled medications (excluding dry-powder devices) should be administered via an appropriate spacer device in both adults and children. Children aged 0-3 years will require the spacer to be coupled to a face mask; Standard 10, Children aged <5 years with asthma should receive a SABA as-needed at step 1 and an inhaled corticosteroid (ICS) to cover periods of wheezing due to respiratory viral infections, and SABA as-needed and daily ICS from step 2 upwards; Standard 11, Children aged 6-11 years with asthma should receive an ICS taken whenever an inhaled SABA is used; Standard 12, All adolescents aged 12-18 years and adults with asthma should receive a combination inhaler (ICS and rapid onset of action long-acting beta-agonist [LABA] such as budesonide-formoterol), where available, to be used either as-needed (for mild asthma) or as both maintenance and reliever therapy, for moderate to severe asthma; Standard 13, Inhaled SABA alone for the management of patients aged >12 years is not recommended as it is associated with increased risk of morbidity and mortality. It should only be used where there is no access to ICS.The following standards (14-18) are for settings where there is no access to inhaled medicines. Standard 14, Patients without access to corticosteroids should be provided with a single short course of emergency oral prednisolone; Standard 15, Oral SABA for symptomatic relief should be used only if no inhaled SABA is available. Adjust to the individual's lowest beneficial dose to minimise adverse effects; Standard 16, Oral leukotriene receptor antagonists (LTRA) can be used as a preventive medication and is preferable to the use of long-term oral systemic corticosteroids; Standard 17, In exceptional circumstances, when there is a high risk of mortality from exacerbations, low-dose oral prednisolone daily or on alternate days may be considered on a case-by-case basis; Standard 18. Oral theophylline should be restricted for use in situations where it is the only bronchodilator treatment option available.CONCLUSION: These first consensus-based clinical standards for asthma management in LMICs are intended to help clinicians provide the most effective care for people in resource-limited settings.
Collapse
Affiliation(s)
- S Jayasooriya
- Academic Unit of Primary Care, University of Sheffield, Sheffield
| | - M Stolbrink
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - E M Khoo
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia, International Primary Care Respiratory Group, Edinburgh, Scotland, UK
| | - I T Sunte
- Global Allergy and Airways Patient Platform, Vienna, Austria
| | - J I Awuru
- Global Allergy and Airways Patient Platform, Vienna, Austria
| | - M Cohen
- Hospital Centro Médico, Guatemala City, Guatemala, Mexico, Asociación Latinoamericana de Tórax, Montevideo, Uruguay
| | - D C Lam
- Department of Medicine, University of Hong Kong, Hong Kong, Asian Pacific Society of Respirology, Hong Kong, China
| | - A Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como
| | - D Visca
- Asociación Latinoamericana de Tórax, Montevideo, Uruguay, Department of Medicine, University of Hong Kong, Hong Kong
| | - R Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, Tradate, Italy
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, Tradate, Italy
| | - A C Ayuk
- College of Medicine, University of Nigeria, Enugu, Nigeria
| | - J A Buendia
- Affiliation Departamento de Farmacologia y Tóxicologia, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - B I Awokola
- Medical Research Council, The Gambia at the London School of Tropical Medicine, The Gambia
| | | | - S Muteti-Fana
- Department of Primary Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - M Lao-Araya
- Division of Allergy and Clinical Immunology, Chian Mai University, Chiang Mai, Thailand
| | - P Chiarella
- Health Sciences School, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - H Badellino
- Head Pediatric Respiratory Medicine Department, Clinica Regional del Este, San Francisco, Argentina
| | - S W Somwe
- Paediatrics and Child Health, University of Lusaka, Lusaka, Zambia
| | - M P Anand
- Department of Respiratory Medicine, JSS Medical College, Mysore, India
| | - J R Garcí-Corzo
- Department of Pediatrics, Universidad Industrial de Santander, Santander, Colombia
| | - A Bekele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - M E Soto-Martinez
- Department of Pediatrics, Universidad de Costa Rica, San Jose, Costa Rica
| | - B H M Ngahane
- Douala General Hospital, University of Douala, Douala, Cameroon
| | - M Florin
- Institute of Pneumology M. Nasta, Bucharest, Romania
| | - K Voyi
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - K Tabbah
- College of Medicine, Ajman University, Ajman, United Arab Emirates
| | - B Bakki
- University of Maiduguri Teaching Hospital, Maiduguri
| | - A Alexander
- Deparment of Medicine, University of Abuja, Abuja
| | - B L Garba
- Department of Paediatrics, Usmanu Danfodiyo, University Teaching Hospital, Sokoto, Nigeria
| | - E M Salvador
- Deparment of Biological Sciences, Eduardo Mondlane University, Maputo, Mozambique
| | - G B Fischer
- University of Medical Sciences, Porto Alegre, RS, Brazil
| | - A G Falade
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
| | - Zorica ŽivkoviĆ
- Dragiša Mišovic, Childrens Hsopital for Lung Disease and TB, Belgrade, Serbia
| | - S J Romero-Tapia
- Health Sciences, Academic Division, Juarez Autononous, University of Tabasco, Villahermosa, Mexico
| | - G E Erhabor
- Department of Medicine, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - H Zar
- Department of Paediatrics & Child Health & SA MRC Unit on Children & Adolescent Health, Red Cross Childrens Hospital, University of Cape Town, Cape Town, South Africa
| | - B Gemicioglu
- Department of Pulmonary Diseases, Istanbul University, Cerrahpasa, Turkey
| | - H V Brandão
- State University of Feira de Santana, Feira de Santana, BA, Brazil
| | - X Kurhasani
- UBT Higher Education Institution, Prishtina, Kosovo
| | | | - V Singh
- MJ Rajasthan Hospital, Jaipur, India
| | | | - S T Kudagammana
- Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - M R Masjedi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - J N Velásquez
- Medical School, Santander Industrial, Bucaramanga, Colombia
| | - A Jain
- Department of Community Medicine, Kasturba Medical College, Mangalore
| | | | - L F M Valdeavellano
- Asociación Latinoamericana de Tórax, Montevideo, Uruguay, Francisco Morroguín University, Guatemala City, Guatemala
| | - R M Gómez
- Faculty of Health Sciences, Catholic University of Salta, Salta, Argentina
| | - E Mesonjesi
- Department of Allergy and Clinical Immunology, University Hospital Centre "Mother Teresa", Tirana, Albania
| | | | - A E Ndikum
- The University of Yaounde 1, Yaounde, Cameroon
| | | | - B K Reddy
- Shishuka Children's Speciality Hospital, Bangalore, India
| | - O Yusuf
- The Allergy and Asthma Institute, Islamabad, Pakistan
| | - S Taright-Mahi
- Medecin Faculty, Mustapha Universitary Hospital Algiers, Algeria
| | - J V Mérida-Palacio
- Centrode Investigación de Enfermedades Alérgicas y Respiratorias SC, Mexico DF, Mexico
| | - S K Kabra
- Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - E Nkhama
- Levy Mwanawasa Medical University, School of Public Health and Environmental Sciences, Lusaka, Zambia
| | - N R Filho
- Federal University of Parana, Curitiba, PA, Brazil
| | - V B Zhjegi
- Social Medicine, Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - K Mortimer
- University of Cambridge, Cambridge, Imperial College, London, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK, Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| | - S Rylance
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | - R R Masekela
- Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| |
Collapse
|
9
|
Hao X, Shen Y, Chen N, Zhang W, Valverde E, Wu L, Chan HL, Xu Z, Yu L, Gao Y, Bado I, Michie LN, Rivas CH, Dominguez LB, Aguirre S, Pingel BC, Wu YH, Liu F, Ding Y, Edwards DG, Liu J, Alexander A, Ueno NT, Hsueh PR, Tu CY, Liu LC, Chen SH, Hung MC, Lim B, Zhang XHF. Osteoprogenitor-GMP crosstalk underpins solid tumor-induced systemic immunosuppression and persists after tumor removal. Cell Stem Cell 2023; 30:648-664.e8. [PMID: 37146584 PMCID: PMC10165729 DOI: 10.1016/j.stem.2023.04.005] [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: 02/14/2023] [Revised: 03/09/2023] [Accepted: 04/06/2023] [Indexed: 05/07/2023]
Abstract
Remote tumors disrupt the bone marrow (BM) ecosystem (BME), eliciting the overproduction of BM-derived immunosuppressive cells. However, the underlying mechanisms remain poorly understood. Herein, we characterized breast and lung cancer-induced BME shifts pre- and post-tumor removal. Remote tumors progressively lead to osteoprogenitor (OP) expansion, hematopoietic stem cell dislocation, and CD41- granulocyte-monocyte progenitor (GMP) aggregation. The tumor-entrained BME is characterized by co-localization between CD41- GMPs and OPs. OP ablation abolishes this effect and diminishes abnormal myeloid overproduction. Mechanistically, HTRA1 carried by tumor-derived small extracellular vesicles upregulates MMP-13 in OPs, which in turn induces the alterations in the hematopoietic program. Importantly, these effects persist post-surgery and continue to impair anti-tumor immunity. Conditional knockout or inhibition of MMP-13 accelerates immune reinstatement and restores the efficacies of immunotherapies. Therefore, tumor-induced systemic effects are initiated by OP-GMP crosstalk that outlasts tumor burden, and additional treatment is required to reverse these effects for optimal therapeutic efficacy.
Collapse
Affiliation(s)
- Xiaoxin Hao
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; McNair Medical Institute, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Yichao Shen
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Graduate Program in Integrative Molecular and Biomedical Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; McNair Medical Institute, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Nan Chen
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Weijie Zhang
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Elizabeth Valverde
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Ling Wu
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Hilda L Chan
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Medical Scientist Training Program, Baylor College of Medicine, Houston, TX 77030, USA
| | - Zhan Xu
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Liqun Yu
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Yang Gao
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Igor Bado
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Laura Natalee Michie
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Charlotte Helena Rivas
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Graduate Program in Cancer and Cell Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Luis Becerra Dominguez
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Graduate Program in Immunology and Microbiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Sergio Aguirre
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Graduate Program in Integrative Molecular and Biomedical Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Bradley C Pingel
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Graduate Program in Immunology and Microbiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Yi-Hsuan Wu
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Graduate Program in Cancer and Cell Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Fengshuo Liu
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Graduate Program in Cancer and Cell Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Yunfeng Ding
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - David G Edwards
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Jun Liu
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Angela Alexander
- Department of Breast Medical Oncology and Morgan Welch IBC Research Program and Clinic, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Naoto T Ueno
- Department of Breast Medical Oncology and Morgan Welch IBC Research Program and Clinic, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; University of Hawai'i Cancer Center (UHCC), 701 Ilalo Street, Honolulu, HI 96813, USA
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, China Medical University Hospital, Taichung 40402, Taiwan
| | - Chih-Yen Tu
- School of Medicine, College of Medicine, China Medical University, Taichung 406, Taiwan; Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung 40402, Taiwan
| | - Liang-Chih Liu
- School of Medicine, College of Medicine, China Medical University, Taichung 406, Taiwan; Division of Breast Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Shu-Hsia Chen
- Immunomonitoring Core, Center for Immunotherapy Research, Houston Methodist Research Institute (HMRI), Houston, TX, USA
| | - Mien-Chie Hung
- Graduate Institute of Biomedical Sciences, Research Center for Cancer Biology, and Center for Molecular Medicine, China Medical University, Taichung 40402, Taiwan
| | - Bora Lim
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Xiang H-F Zhang
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; McNair Medical Institute, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| |
Collapse
|
10
|
Agostini M, Alexander A, Araujo GR, Bakalyarov AM, Balata M, Barabanov I, Baudis L, Bauer C, Belogurov S, Bettini A, Bezrukov L, Biancacci V, Bossio E, Bothe V, Brugnera R, Caldwell A, Calgaro S, Cattadori C, Chernogorov A, Chiu PJ, Comellato T, D’Andrea V, Demidova EV, Di Giacinto A, Di Marco N, Doroshkevich E, Fischer F, Fomina M, Gangapshev A, Garfagnini A, Gooch C, Grabmayr P, Gurentsov V, Gusev K, Hakenmüller J, Hemmer S, Hofmann W, Hult M, Inzhechik LV, Csáthy JJ, Jochum J, Junker M, Kazalov V, Kermaïdic Y, Khushbakht H, Kihm T, Kilgus K, Kirpichnikov IV, Klimenko A, Knöpfle KT, Kochetov O, Kornoukhov VN, Krause P, Kuzminov VV, Laubenstein M, Lehnert B, Lindner M, Lippi I, Lubashevskiy A, Lubsandorzhiev B, Lutter G, Macolino C, Majorovits B, Maneschg W, Manzanillas L, Marshall G, Miloradovic M, Mingazheva R, Misiaszek M, Morella M, Müller Y, Nemchenok I, Neuberger M, Pandola L, Pelczar K, Pertoldi L, Piseri P, Pullia A, Rauscher L, Redchuk M, Riboldi S, Rumyantseva N, Sada C, Sailer S, Salamida F, Schönert S, Schreiner J, Schütt M, Schütz AK, Schulz O, Schwarz M, Schwingenheuer B, Selivanenko O, Shevchik E, Shirchenko M, Shtembari L, Simgen H, Smolnikov A, Stukov D, Sullivan S, Vasenko AA, Veresnikova A, Vignoli C, von Sturm K, Wegmann A, Wester T, Wiesinger C, Wojcik M, Yanovich E, Zatschler B, Zhitnikov I, Zhukov SV, Zinatulina D, Zschocke A, Zsigmond AJ, Zuber K, Zuzel G. Liquid argon light collection and veto modeling in GERDA Phase II. Eur Phys J C Part Fields 2023; 83:319. [PMID: 37122826 PMCID: PMC10126063 DOI: 10.1140/epjc/s10052-023-11354-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/24/2023] [Indexed: 05/03/2023]
Abstract
The ability to detect liquid argon scintillation light from within a densely packed high-purity germanium detector array allowed the Gerda experiment to reach an exceptionally low background rate in the search for neutrinoless double beta decay of76 Ge. Proper modeling of the light propagation throughout the experimental setup, from any origin in the liquid argon volume to its eventual detection by the novel light read-out system, provides insight into the rejection capability and is a necessary ingredient to obtain robust background predictions. In this paper, we present a model of the Gerda liquid argon veto, as obtained by Monte Carlo simulations and constrained by calibration data, and highlight its application for background decomposition.
Collapse
Affiliation(s)
- M. Agostini
- Department of Physics and Astronomy, University College London, London, UK
| | - A. Alexander
- Department of Physics and Astronomy, University College London, London, UK
| | - G. R. Araujo
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | | | - M. Balata
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - I. Barabanov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - L. Baudis
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - C. Bauer
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - S. Belogurov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
- Moscow Inst. of Physics and Technology, Dolgoprudny, Russia
| | - A. Bettini
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - L. Bezrukov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - V. Biancacci
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - E. Bossio
- Physik Department, Technische Universität München, Munich, Germany
| | - V. Bothe
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - R. Brugnera
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - A. Caldwell
- Max-Planck-Institut für Physik, Munich, Germany
| | - S. Calgaro
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | | | - A. Chernogorov
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | - P. -J. Chiu
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - T. Comellato
- Physik Department, Technische Universität München, Munich, Germany
| | - V. D’Andrea
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
| | - E. V. Demidova
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - A. Di Giacinto
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - N. Di Marco
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
| | - E. Doroshkevich
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - F. Fischer
- Max-Planck-Institut für Physik, Munich, Germany
| | - M. Fomina
- Joint Institute for Nuclear Research, Dubna, Russia
| | - A. Gangapshev
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - A. Garfagnini
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - C. Gooch
- Max-Planck-Institut für Physik, Munich, Germany
| | - P. Grabmayr
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - V. Gurentsov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - K. Gusev
- Joint Institute for Nuclear Research, Dubna, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
- Physik Department, Technische Universität München, Munich, Germany
| | - J. Hakenmüller
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Present Address: Duke University, Durham, NC USA
| | | | - W. Hofmann
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - M. Hult
- European Commission, JRC-Geel, Geel, Belgium
| | - L. V. Inzhechik
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Dubna State University, Dubna, Russia
| | - J. Janicskó Csáthy
- Physik Department, Technische Universität München, Munich, Germany
- Present Address: Leibniz-Institut für Kristallzüchtung, Berlin, Germany
| | - J. Jochum
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - M. Junker
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - V. Kazalov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - Y. Kermaïdic
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Present Address: Université Paris-Saclay, CNRS/IN2P3, IJCLab, 91405 Orsay, France
| | - H. Khushbakht
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - T. Kihm
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - K. Kilgus
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - I. V. Kirpichnikov
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - A. Klimenko
- Joint Institute for Nuclear Research, Dubna, Russia
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Dubna State University, Dubna, Russia
| | - K. T. Knöpfle
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- NRNU MEPhI, Moscow, Russia
| | - O. Kochetov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - V. N. Kornoukhov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - P. Krause
- Physik Department, Technische Universität München, Munich, Germany
| | - V. V. Kuzminov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - M. Laubenstein
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - B. Lehnert
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
- Present Address: Nuclear Science Division, Berkeley, USA
| | - M. Lindner
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | | | | | - B. Lubsandorzhiev
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - G. Lutter
- European Commission, JRC-Geel, Geel, Belgium
| | - C. Macolino
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
| | | | - W. Maneschg
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | | | - G. Marshall
- Department of Physics and Astronomy, University College London, London, UK
| | - M. Miloradovic
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - R. Mingazheva
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - M. Misiaszek
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - M. Morella
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
| | - Y. Müller
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - I. Nemchenok
- Joint Institute for Nuclear Research, Dubna, Russia
- Present Address: Université Paris-Saclay, CNRS/IN2P3, IJCLab, 91405 Orsay, France
| | - M. Neuberger
- Physik Department, Technische Universität München, Munich, Germany
| | - L. Pandola
- INFN Laboratori Nazionali del Sud, Catania, Italy
| | - K. Pelczar
- European Commission, JRC-Geel, Geel, Belgium
| | - L. Pertoldi
- Physik Department, Technische Universität München, Munich, Germany
- INFN Padova, Padua, Italy
| | - P. Piseri
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - A. Pullia
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - L. Rauscher
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - S. Riboldi
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - N. Rumyantseva
- Joint Institute for Nuclear Research, Dubna, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | - C. Sada
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - S. Sailer
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - F. Salamida
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
| | - S. Schönert
- Physik Department, Technische Universität München, Munich, Germany
| | - J. Schreiner
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - M. Schütt
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A. -K. Schütz
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - O. Schulz
- Max-Planck-Institut für Physik, Munich, Germany
| | - M. Schwarz
- Physik Department, Technische Universität München, Munich, Germany
| | | | - O. Selivanenko
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - E. Shevchik
- Joint Institute for Nuclear Research, Dubna, Russia
| | | | | | - H. Simgen
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A. Smolnikov
- Joint Institute for Nuclear Research, Dubna, Russia
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - D. Stukov
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | - S. Sullivan
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A. A. Vasenko
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - A. Veresnikova
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - C. Vignoli
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - K. von Sturm
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - A. Wegmann
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - T. Wester
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - C. Wiesinger
- Physik Department, Technische Universität München, Munich, Germany
| | - M. Wojcik
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - E. Yanovich
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - B. Zatschler
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - I. Zhitnikov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - S. V. Zhukov
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | | | - A. Zschocke
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - K. Zuber
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - G. Zuzel
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - Gerda collaboration
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
- INFN Laboratori Nazionali del Sud, Catania, Italy
- Institute of Physics, Jagiellonian University, Cracow, Poland
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
- Joint Institute for Nuclear Research, Dubna, Russia
- European Commission, JRC-Geel, Geel, Belgium
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Department of Physics and Astronomy, University College London, London, UK
- INFN Milano Bicocca, Milan, Italy
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
- Max-Planck-Institut für Physik, Munich, Germany
- Physik Department, Technische Universität München, Munich, Germany
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
- Physik-Institut, Universität Zürich, Zurich, Switzerland
- Present Address: Duke University, Durham, NC USA
- Present Address: Leibniz-Institut für Kristallzüchtung, Berlin, Germany
- Present Address: Nuclear Science Division, Berkeley, USA
- Present Address: Université Paris-Saclay, CNRS/IN2P3, IJCLab, 91405 Orsay, France
- NRNU MEPhI, Moscow, Russia
- Moscow Inst. of Physics and Technology, Dolgoprudny, Russia
- Dubna State University, Dubna, Russia
| |
Collapse
|
11
|
Lim B, Alexander A, Willey JS, Sun H, Liu S, Patel AB, Parra ER, Haymaker C, Soto LS, Serrano A, Sun B, Lima CFP, Tamegnon A, Pandurengan RK, Douse D, Lan J, Raja L, Chu R, Knafl M, Woodman SE, Zhu H, Shulze K, Fedenko K, Darbonne W, Ueno NT, Valero V. Abstract P4-08-19: Biomarker analysis: Multi-omics elucidation of Cohort 1 from a phase II study of a triple combination of Atezolizumab + cobimetinib + eribulin in patients with metastatic inflammatory breast cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-08-19] [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: 03/06/2023]
Abstract
Abstract
Background: Inflammatory breast cancer (IBC) is a rare but aggressive tumor type accounting for up to 10% of breast cancer deaths. One-third of IBCs express high PD-L1 that can be targeted by atezolizumab (Az). MEK inhibitor cobimetinib (Co) not only inhibits the RAS-MAPK pathway but can further enhance immune-mediated killing. Thus, we hypothesize that Az+Co may enhance the efficacy of chemotherapy in metastatic IBC (mIBC). We opened a trial to test this hypothesis with a comprehensive multi-omics biomarker assessment. Patients and Methods: In a single-center, open-label phase II study, cohort 1 received one cycle of Az+ Co, followed by four cycles of Az+Co+eribulin (E) to induce a maximum clinical response, followed by Az+Co maintenance. Pre and Post one cycle of Az+Co tumors were collected for immunohistochemistry (IHC), multiplex immunofluorescence (mIF), whole-exome sequencing (WES), and RNA sequencing (RNAseq). Blood was collected for circulating tumor DNA (ctDNA). Results: Seventeen patients were enrolled in cohort 1. Seven had PR, and three had SD as the best responses. Fourteen had pre, and six had pre/post tumors. The levels of PD-L1 expression at pre/post were not associated with responses. WES revealed the median tumor mutation burden at pre- was 9mt/Mb. More than 50% had TP53 and PI3K pathway mutations at pre. RTK-RAS and Notch pathways were altered in 4/9 cases. PRDM9 and DPY19L2 single-gene mutations were commonly noted in pre. No cancer-associated gene aberration, including potential biomarkers of anti-PDL1 agent response was associated with clinical outcomes. Transcriptomic gene set enrichment analysis demonstrated a greater degree of TNFa and TGFb signaling, Oxphos, angiogenesis, and epithelial-to-mesenchymal transition (EMT) processes in tumors from patients with poor response. Immune profiling by RNAseq revealed two responders to have elevated effector memory T cells, NK T cells, myeloid dendritic cells, and M1 macrophage signatures in pre-samples, but post-samples were not available. mIF confirmed a higher frequency of NK-T cells. The ctDNA analysis from serially collected blood samples is ongoing. Discussion: In this comprehensive multi-omics analysis of pre-and-post-Az+Co, we observed several novel findings, while conventional biomarkers for Az and Co did not correlate with clinical responses. EMT, Oxphos, Notch, and chronic inflammation pathways, which are not previously well reported, were observed in this IBC cohort. These markers warrant further validation to see if they carry significance as therapeutic targets in IBC.
Citation Format: Bora Lim, Angela Alexander, Jie S. Willey, Huiming Sun, Suyu Liu, Anisha B. Patel, Edwin Roger Parra, Cara Haymaker, Luisa Solis Soto, Alejandra Serrano, Baohua Sun, Cibelle Freitas Pinto Lima, Auriole Tamegnon, Renganayaki K. Pandurengan, Dzifa Douse, Jessica Lan, Luthra Raja, Randy Chu, Mark Knafl, Scott E. Woodman, Haifeng Zhu, Katja Shulze, Katherine Fedenko, Walter Darbonne, Naoto T. Ueno, Vicente Valero. Biomarker analysis: Multi-omics elucidation of Cohort 1 from a phase II study of a triple combination of Atezolizumab + cobimetinib + eribulin in patients with metastatic inflammatory breast cancer. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-08-19.
Collapse
Affiliation(s)
- Bora Lim
- 1Baylor College of Medicine, Houston, TX
| | | | | | - Huiming Sun
- 4The University of Texas MD Anderson Cancer Center
| | - Suyu Liu
- 5The University of Texas MD Anderson Cancer Center, Texas
| | | | | | | | | | | | - Baohua Sun
- 11The University of Texas MD Anderson Cancer Center
| | | | | | | | - Dzifa Douse
- 15The University of Texas MD Anderson Cancer Center
| | - Jessica Lan
- 16The University of Texas MD Anderson Cancer Center
| | - Luthra Raja
- 17The University of Texas MD Anderson Cancer Center
| | - Randy Chu
- 18The University of Texas MD Anderson Cancer Center
| | - Mark Knafl
- 19The University of Texas MD Anderson Cancer Center
| | | | - Haifeng Zhu
- 21The University of Texas MD Anderson Cancer Center
| | | | | | | | - Naoto T. Ueno
- 25The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vicente Valero
- 26Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
12
|
Iwase T, Alexander A, Chiv V, Kai M, Kida K, Parker C, Marx AN, Cohen E, Gao H, Reuben J, Wang X, Krishnamurthy S, Liu D, Shen Y, Ramirez D, Tripathy D, Booser D, Yam C, Valero V, Lim B, Ueno NT, Willey JS. Abstract P3-02-04: Phase II study of Pembrolizumab Maintenance treatment in patients with HER2-negative inflammatory breast cancer (IBC) and triple-negative breast cancer (TNBC) after response to chemotherapy. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p3-02-04] [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: 03/06/2023]
Abstract
Abstract
Accumulating physical and hematologic toxicities make the indefinite use of chemotherapy unfeasible for many patients with metastatic/recurrent HER2– IBC or TNBC. Whether maintenance immunotherapy has a role in the treatment of these patients is unclear. We conducted a single-arm phase II trial of pembrolizumab monotherapy in patients with metastatic/recurrent HER2– IBC or TNBC (regardless of their PD-L1 expression status) and report here the clinical data from this trial. Methods: Eligible patients were enrolled between 2015 and 2022 and had had a CR, a PR, or SD after a minimum of 3 cycles of chemotherapy for metastatic/recurrent disease. PD-L1 expression status was not used to determine eligibility. Patients received 200 mg of pembrolizumab every 3 weeks (q3w) until disease progression, intolerable toxicity, or 2 years. In late 2021, the study was amended to allow patients who had received ≥8 cycles of q3w therapy to transition to q6w dosing (400 mg), based on the FDA’s approval of both dosing regimens across all indications. The primary endpoint was the 4-month disease control rate (DCR); exploratory endpoints included safety and correlative biomarkers from tissue and blood to ascertain associations between clinical response and PD-L1 expression, T-cell clonality, and immune profiling. Results: Of 43 patients (median age, 54 years; range, 34-77 years), 11 had IBC (10 with triple-negative IBC and 1 with ER+ HER2– IBC), and 32 had TNBC. The 4-month DCR was 58.1% (95% CI: 43.4%-72.9%). During a median follow-up of 11.4 months, 25 patients died. The entire cohort’s median OS and PFS times were 26.0 months (95% CI: 11.0-33.5 months) and 4.8 months (95% CI: 3.0-7.1 months), respectively. The median OS times of the IBC and TNBC groups did not differ significantly, nor did those of the CR, PR, and SD groups. The median PFS times of the IBC group (2.2 months) and TNBC group (4.8 months) did not differ significantly (p = .12), but those of the CR, PR, and SD groups did (not reached, 10.3 months, and 3.4 months, respectively; p = .01). Among the 37 patients who are off study treatment, most patients (84%; n=31/37) discontinued treatment owing to disease progression rather than toxicities (n=2), and the toxicities overall were consistent with the known profile of single-agent anti-PD1. Five patients had grade 3 events; there were no grade 4 or 5 events. Three patients had irreversible endocrinopathies (thyroiditis and adrenal insufficiency) requiring hormone replacement, but only 1 patient discontinued pembrolizumab because of these events. One patient discontinued treatment because of optic neuritis requiring steroids. Four patients completed 2 years of treatment without disease progression. Conclusions: Pembrolizumab maintenance therapy achieves acceptable disease control after induction chemotherapy. The PFS in this trial compares favorably to the expected durations of response to later lines of therapy. The toxicity profile of pembrolizumab compares favorably with those of chemotherapy and ADCs, which may provide a rationale for the use of ICIs in this setting. However, whether pembrolizumab maintenance therapy is helpful in TNBC patients who have received concurrent pembrolizumab with neoadjuvant chemotherapy is unknown, as these patients were excluded from the trial. Acknowledgements: This trial was supported by Merck.
Citation Format: Toshiaki Iwase, Angela Alexander, Vivian Chiv, Megumi Kai, Kumiko Kida, Charla Parker, Angela N. Marx, Evan Cohen, Hui Gao, James Reuben, Xiaoping Wang, Savitri Krishnamurthy, Diane Liu, Yu Shen, David Ramirez, Debu Tripathy, Daniel Booser, Clinton Yam, Vicente Valero, Bora Lim, Naoto T. Ueno, Jie S. Willey. Phase II study of Pembrolizumab Maintenance treatment in patients with HER2-negative inflammatory breast cancer (IBC) and triple-negative breast cancer (TNBC) after response to chemotherapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-02-04.
Collapse
Affiliation(s)
| | | | - Vivian Chiv
- 3UT MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | - Evan Cohen
- 8University of Texas MD Anderson Cancer Center
| | - Hui Gao
- 9UT MD Anderson Cancer Center
| | | | | | | | | | - Yu Shen
- 14UT MD Anderson Cancer Center
| | | | - Debu Tripathy
- 16The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Clinton Yam
- 18Breast Medical Oncology Department, The University of Texas MD Anderson Cancer Center
| | - Vicente Valero
- 19Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bora Lim
- 20Baylor College of Medicine, Houston, TX
| | - Naoto T. Ueno
- 21The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | |
Collapse
|
13
|
Marx AN, Kai M, Fu M, Murphy HE, Willey JS, Sun H, Alexander A, Bassett RL, Whitman GJ, Le-Petross HTC, Patel M, Arun BK, Abouharb S, Thomas PS, Barcenas CH, Ibrahim NK, Valero V, Ueno NT, Layman RM, Lim B, Woodward W, Lucci A. Abstract P4-06-09: A phase 1b study of neratinib with THP in metastatic and locally advanced breast cancer, and phase II study of THP followed by AC in HER2 + primary inflammatory breast cancer (IBC), and neratinib with taxol followed by AC in HR+/HER2- IBC. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-06-09] [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: 03/06/2023]
Abstract
Abstract
Background: The pathologic complete response (pCR) rate in inflammatory breast cancer (IBC) patients is worse than in non-IBC patients; new drug combinations are warranted to improve pCR rates across all IBC molecular subtypes. Based on our preclinical data, we added neratinib to standard neoadjuvant chemotherapy in both HER2+ (synergy) and HER2-/hormone receptor (HR)+ (high frequency of ERBB2 mut) untreated IBC, as a single-center, non-randomized phase I/II trial. Patients and Method: This study enrolled three cohorts: Cohort I phase Ib (C1P1B), Cohort I Phase II (C1P2) and Cohort II (C2). In C1P1B to determine the recommended phase 2 dose (RP2D), we enrolled patients with HER2+ metastatic or locally advanced breast cancer. Patients received paclitaxel/trastuzumab/pertuzumab (THP) + neratinib x 4 cycles (up to 8 cycles per physician’s discretion). For C1P2 and C2, we enrolled Stage III – IV primary IBC patients. In C1P2, patients with HER2+ IBC received neratinib (RP2D) combined with THP x 4 cycles followed by doxorubicin/cyclophosphamide (AC) x 4 cycles. Per stage I design, 11 patients were enrolled with plan to enroll 20 more patients in Stage II if at least 6 had a pCR. In C2, patients with HER2-/HR+ IBC received neratinib 200 mg/day combined with paclitaxel x 4 cycles followed by AC x 4 cycles. Stage I design planned for enrollment of 16 patients with enrollment of 15 more patients on stage II, if at least 2 Stage I patients had pCR. In all three cohorts, patients initiated prophylactic anti-diarrheal medication (loperamide & budesonide) with the first dose of neratinib. Results: From 2018 to 2022, thirty-four patients were enrolled and treated (n=4 C1P1B, n=14 C1P2, n=16 C2). In C1P1B, observed DLTs (dose limiting toxicities) were Grade (Gr) 2 Diarrhea, n=2 (50%); Gr3 diarrhea, n=2 (50%); 2 patients had a serious adverse event (SAE); 3 patients (55%) had Gr2 nausea. The RP2D was established at 80 mg/day (dose level 0). For patients in C1P2, the most frequently occurring adverse events (AEs) included Gr2 Alopecia, n=14 (100%); Gr2&3 Diarrhea, n=14 (100%); Gr2/3 Nausea, n=12 (86%); Gr2/3 Anemia, n=7 (50%); Gr2/3 Fatigue, n=8 (57%); Gr2/3 Hypokalemia, n=6 (57%); and Gr2/3 Neutrophil count decreased, n= 7 (50%). 6 patients had an SAE. Of the first 11 patients, 5 (46%) had pCR, 1 (9%) RCB-1, 1 (9%) RCB-II and 1 (9%) RCB-III. Three patients stopped study treatment for toxicity (27%), were non-evaluable and replaced. Of these, one had RCB-III (33.3%), one progression of disease (PD) (33.3%), and one came off study for toxicity (33.3%). Rather than replacing additional non-evaluable patients, the study was closed to new patient accrual. In C2, the most frequently occurring AEs were Gr2 diarrhea, n=7(44%); Gr3 diarrhea, n=8 (50%); Gr2 alopecia, n=14 (88%); Gr2/3 Anemia, n=10 (63%); Gr2/3 Nausea, n=7 (44%); Gr2/3 Neutropenia, n= 7 (44%). 3 patients had an SAE. Of 16 patients in this cohort, 1 had pCR (6%), 5 RCB-II (31%), 4 RCB-III (25%), 3 came off study for toxicity (19%) and 3 had PD (19%). C2 also closed to new patient accrual given the high toxicity profile. Conclusion: The addition of neratinib did not improve the pCR rate in HER2+ or HER2-/HR+ subtypes of IBC, and increased toxicities were observed. The trial closed to new patient entry March 2022. However, some patients achieved significant response. Biomarker analysis is ongoing. Evaluable participants will continue long-term follow-up per protocol. Acknowledgments: This study is supported by PUMA Biotechnology.
Citation Format: Angela N. Marx, Megumi Kai, Min Fu, Hope E. Murphy, Jie S. Willey, Huiming Sun, Angela Alexander, Roland L. Bassett, Gary J. Whitman, H. T. Carisa Le-Petross, Miral Patel, Banu K. Arun, Sausan Abouharb, Parijatham S. Thomas, Carlos H. Barcenas, Nuhad K. Ibrahim, Vicente Valero, Naoto T. Ueno, Rachel M. Layman, Bora Lim, Wendy Woodward, Anthony Lucci. A phase 1b study of neratinib with THP in metastatic and locally advanced breast cancer, and phase II study of THP followed by AC in HER2 + primary inflammatory breast cancer (IBC), and neratinib with taxol followed by AC in HR+/HER2- IBC [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-06-09.
Collapse
Affiliation(s)
| | | | - Min Fu
- 3MD Anderson Cancer Center
| | | | | | - Huiming Sun
- 6The University of Texas MD Anderson Cancer Center
| | | | | | | | | | - Miral Patel
- 11University of Texas MD Anderson Cancer Center
| | | | | | | | | | | | - Vicente Valero
- 17Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Naoto T. Ueno
- 18The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Bora Lim
- 20Baylor College of Medicine, Houston, TX
| | | | | |
Collapse
|
14
|
Meshram S, Gupta S, Alexander A, Agrawal S, Lanjewar N, Meshram K, Patel A, More A, Yadav R, Muley S, Shamkuwar C, Singh A. Sleep quality in COVID-19 patients and its association with severity of COVID. Sleep Med 2022. [PMCID: PMC9300259 DOI: 10.1016/j.sleep.2022.05.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
15
|
Bondarenko AS, Aviles J, Alexander A, Korepanov A, Mendoza R. Tomographic and centroid reconstructions of plasma emission on C-2W via enhanced 300-channel bolometry system. Rev Sci Instrum 2022; 93:103517. [PMID: 36319330 DOI: 10.1063/5.0101656] [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] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
The C-2W experimental device at TAE Technologies utilizes neutral beam injection and edge biasing to sustain long-lived, stable field reversed configuration (FRC) plasma. An ongoing effort is under way to optimize the electrode biasing system, which provides boundary control to stabilize the FRC. To this end, tomography offers a powerful and non-invasive technique as tomographic reconstruction of the FRC emission profile provides an important assessment of global stability. Recently, a new signal acquisition system was implemented on a bolometer array dedicated to tomography on C-2W, significantly enhancing the signal-to-noise of the collected data. The array consists of 300 simultaneously digitized photodiode channels that respond to a broad range of wavelengths, from soft x-ray to near-infrared, as well as energetic particles, yielding 180 unique lines of sight that intersect a toroidal plane of the FRC near the mid-plane. Utilizing the collected photo-signals from a set of plasma discharges in which the electrode biasing was intentionally terminated mid-shot, time-resolved reconstruction of the plasma emissivity is achieved via pixel-based 1D and 2D tomographic algorithms, revealing sharply annular profiles with a clear magnetohydrodynamic (MHD) mode structure. In addition, reconstruction of the plasma center-of-emission trajectories via a centroid algorithm applied to the same set of discharges demonstrates a cyclical plasma wobble. Crucially, both the tomography reconstruction and centroid reconstruction indicate an n = 1 toroidal mode that reverses from the electron diamagnetic direction to the ion diamagnetic direction and grows in amplitude after bias termination, qualitatively consistent with the expected stabilizing effect of electrodes.
Collapse
Affiliation(s)
- A S Bondarenko
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| | - J Aviles
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| | - A Alexander
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| | - A Korepanov
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| | - R Mendoza
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| |
Collapse
|
16
|
Wahood W, Hallak H, Mushannen T, Alexander A, Brinjikji W. Abstract No. 565 Trends in utilization of endotracheal anesthesia for mechanical thrombectomy in acute ischemic stroke in the United States. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.547] [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] Open
|
17
|
Kundapur V, Mayer M, Auer RN, Alexander A, Weibe S, Pushie MJ, Cranmer-Sargison G. Is Mini Beam Ready for Human Trials? Results of Randomized Study of Treating De-Novo Brain Tumors in Canines Using Linear Accelerator Generated Mini Beams. Radiat Res 2022; 198:162-171. [PMID: 35536992 DOI: 10.1667/rade-21-00093.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 04/22/2022] [Indexed: 11/03/2022]
Abstract
The main challenge in treating malignant brain neoplasms lies in eradicating the tumor while minimizing treatment-related damage. Conventional radiation treatments are associated with considerable side effects. Synchrotron generated micro-beam radiation (SMBRT) has shown to preserve brain architecture while killing tumor cells, however physical characteristics and limited facility access restrict its use. We have created a new clinical device which produces mini beams on a linear accelerator, to provide a new type of treatment called mini-beam radiation therapy (MBRT). The objective of this study is to compare the treatment outcomes of linear accelerator based MBRT versus standard radiation treatment (SRT), to evaluate the tumor response and the treatment-related changes in the normal brain with respect to each treatment type. Pet dogs with de-novo brain tumors were accrued for treatment. Dogs were randomized between standard fractionated stereotactic (9 Gy in 3 fractions) radiation treatment vs. a single fraction of MBRT (26 Gy mean dose). Dogs were monitored after treatment for clinical assessment and imaging. When the dogs were euthanized, a veterinary pathologist assessed the radiation changes and tumor response. We accrued 16 dogs, 8 dogs in each treatment arm. In the MBRT arm, 71% dogs achieved complete pathological remission. The radiation-related changes were all confined to the target region. Structural damage was not observed in the beam path outside of the target region. In contrast, none of the dogs in control group achieved remission and the treatment related damage was more extensive. Therapeutic superiority was observed with MBRT, including both tumor control and the normal structural preservation. The MBRT findings are suggestive of an immune related mechanism which is absent in standard treatment. These findings together with the widespread availability of clinical linear accelerators make MBRT a promising research topic to explore further treatment and clinical trial opportunities.
Collapse
Affiliation(s)
- V Kundapur
- Radiation Oncology, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
| | - M Mayer
- Veterinary Radiation Oncology, Department of Small Animal clinical Sciences, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - R N Auer
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - A Alexander
- Radiation Physics, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
| | - S Weibe
- Department of Clinical Imaging, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - M J Pushie
- Department of Surgery, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - G Cranmer-Sargison
- Radiation Physics, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
| |
Collapse
|
18
|
Sayed L, Valand P, Brewin M, Matthews A, Robson M, Nayaran N, Alexander A, Davies L, Scott E, Steele J, McMullen E. Determining the appropriate use of Technology Enabled Care Services (TECS) to manage upper limb trauma injuries during the COVID-19 pandemic: A multicentre retrospective observational study. J Plast Reconstr Aesthet Surg 2022; 75:2127-2134. [PMID: 35367161 PMCID: PMC8855640 DOI: 10.1016/j.bjps.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 02/14/2022] [Indexed: 10/25/2022]
|
19
|
Verma VS, Badwaik HR, Vaishnav Y, Alexander A, A A. Synthesis, Characterization, Molecular Modelling and Biological Evaluation of Substituted Benzo (h) Chromene-3-Carboxylate Derivatives as a Potential Agent for the Treatment of Hyperlipidemia. Indian J Pharm Sci 2022. [DOI: 10.36468/pharmaceutical-sciences.939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
20
|
Ueno NT, Alexander A. "Why and What" for the optimal management of inflammatory breast cancer. Chin Clin Oncol 2021; 10:54. [PMID: 34930010 DOI: 10.21037/cco-21-158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/22/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Naoto T Ueno
- Professor of Medicine, Nylene Eckles Distinguished Professor in Breast Cancer Research, Executive Director of Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Angela Alexander
- Sr. Clinical Studies Coordinator, Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
21
|
Nilanon T, Nocera LP, Martin AS, Kolatkar A, May M, Hasnain Z, Ueno NT, Yennu S, Alexander A, Mejia AE, Boles RW, Li M, Lee JSH, Hanlon SE, Cozzens Philips FA, Quinn DI, Newton PK, Broderick J, Shahabi C, Kuhn P, Nieva JJ. Use of Wearable Activity Tracker in Patients With Cancer Undergoing Chemotherapy: Toward Evaluating Risk of Unplanned Health Care Encounters. JCO Clin Cancer Inform 2021; 4:839-853. [PMID: 32970482 PMCID: PMC7531613 DOI: 10.1200/cci.20.00023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Unplanned health care encounters (UHEs) such as emergency room visits can occur commonly during cancer chemotherapy treatments. Patients at an increased risk of UHEs are typically identified by clinicians using performance status (PS) assessments based on a descriptive scale, such as the Eastern Cooperative Oncology Group (ECOG) scale. Such assessments can be bias prone, resulting in PS score disagreements between assessors. We therefore propose to evaluate PS using physical activity measurements (eg, energy expenditure) from wearable activity trackers. Specifically, we examined the feasibility of using a wristband (band) and a smartphone app for PS assessments. METHODS We conducted an observational study on a cohort of patients with solid tumor receiving highly emetogenic chemotherapy. Patients were instructed to wear the band for a 60-day activity-tracking period. During clinic visits, we obtained ECOG scores assessed by physicians, coordinators, and patients themselves. UHEs occurring during the activity-tracking period plus a 90-day follow-up period were later compiled. We defined our primary outcome as the percentage of patients adherent to band-wear ≥ 80% of 10 am to 8 pm for ≥ 80% of the activity-tracking period. In an exploratory analysis, we computed hourly metabolic equivalent of task (MET) and counted 10 am to 8 pm hours with > 1.5 METs as nonsedentary physical activity hours. RESULTS Forty-one patients completed the study (56.1% female; 61.0% age 40-60 years); 68% were adherent to band-wear. ECOG score disagreement between assessors ranged from 35.3% to 50.0%. In our exploratory analysis, lower average METs and nonsedentary hours, but not higher ECOG scores, were associated with higher 150-day UHEs. CONCLUSION The use of a wearable activity tracker is generally feasible in a similar population of patients with cancer. A larger randomized controlled trial should be conducted to confirm the association between lower nonsedentary hours and higher UHEs.
Collapse
Affiliation(s)
- Tanachat Nilanon
- Department of Computer Science, University of Southern California, Los Angeles, CA.,Integrated Media Systems Center, University of Southern California, Los Angeles, CA
| | - Luciano P Nocera
- Integrated Media Systems Center, University of Southern California, Los Angeles, CA
| | - Alexander S Martin
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Anand Kolatkar
- Bridge Institute, University of Southern California, Los Angeles, CA.,Department of Biological Sciences, University of Southern California, Los Angeles, CA
| | - Marcella May
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA
| | - Zaki Hasnain
- Department of Aerospace & Mechanical Engineering, University of Southern California, Los Angeles, CA
| | - Naoto T Ueno
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sriram Yennu
- Department of Palliative, Rehabilitation, & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Angela Alexander
- Department of Experimental Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aaron E Mejia
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Roger Wilson Boles
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Ming Li
- Keck School of Medicine, University of Southern California, Los Angeles, CA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Jerry S H Lee
- Center for Strategic Scientific Initiatives, National Cancer Institute, Bethesda, MD
| | - Sean E Hanlon
- Center for Strategic Scientific Initiatives, National Cancer Institute, Bethesda, MD
| | | | - David I Quinn
- Keck School of Medicine, University of Southern California, Los Angeles, CA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.,Division of Medical Oncology, University of Southern California, Los Angeles, CA
| | - Paul K Newton
- Department of Aerospace & Mechanical Engineering, University of Southern California, Los Angeles, CA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.,Department of Mathematics, University of Southern California, Los Angeles, CA
| | - Joan Broderick
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA
| | - Cyrus Shahabi
- Department of Computer Science, University of Southern California, Los Angeles, CA.,Integrated Media Systems Center, University of Southern California, Los Angeles, CA
| | - Peter Kuhn
- Keck School of Medicine, University of Southern California, Los Angeles, CA.,Department of Biological Sciences, University of Southern California, Los Angeles, CA.,Department of Aerospace & Mechanical Engineering, University of Southern California, Los Angeles, CA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.,Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
| | - Jorge J Nieva
- Keck School of Medicine, University of Southern California, Los Angeles, CA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.,Division of Medical Oncology, University of Southern California, Los Angeles, CA
| |
Collapse
|
22
|
Prabhu JS, Patil S, Rajarajan S, Ce A, Nair M, Alexander A, Ramesh R, Bs S, Sridhar T. Triple-negative breast cancers with expression of glucocorticoid receptor in immune cells show better prognosis. Ann Oncol 2021; 32. [PMID: 34220400 DOI: 10.1016/j.annonc.2021.03.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Glucocorticoid receptor (GR) is shown to have variable frequency of expression in invasive tumors of the breast. Investigation of additional nuclear receptors like GR in receptor negative tumors like triple negative breast cancer (TNBC) may have prognostic and therapeutic significance. Methods Expression of GR was evaluated by immunohistochemistry in 175 tumors of invasive breast cancer with long term follow up. GR Expression was separately evaluated in invasive tumor cells, stromal cells and tumor infiltrating lymphocytes (TIL's). Staining pattern was categorised as positive when more than 1% of the cells stained in each subpopulation of cells. Disease free survival was analysed between GR positive and negative status by Kaplan Meier analysis. Results Of the 175 tumors, 121 (70%) were ER positive, 53 (30%) were ER negative and 29% (51) were triple negative. 74% (130/175) tumors showed expression of GR in invasive tumor cells while (84%) 147/175 had expression in TIL's. No significant difference in distribution of GR was noted between ER positive and ER negative tumors (78% vs 66%, p-0.1). Of the TNBC's 54% (28/51) and 70% (36/51) showed expression of GR in invasive tumor and TIL's respectively. Overall, GR positive tumors had significant better survival than GR negative tumors (mean survival time of 85 vs 59 months respectively, p-0.04) Contrary to the reports that GR expression in TIL's are associated with immunosuppressive activity in model systems, TNBC's with increased expression of GR in immune cells were associated with better survival (Mean survival time 74 vs 41 months, log rank test- p-0.03). TNBC tumors which were GR negative had higher lymph node metastases (p-0.04) and none of the other clinical features like age, menopausal state, tumor size and grade were different between GR positive and negative tumors within TNBC. Conclusions Glucocorticoids (GC) are often used to alleviate the adverse symptoms during chemotherapy. Determining the GR status is of importance due to the pro cell survival effect of the glucocorticoids mediated through GR during chemotherapy. Though GC mediated effects on chemotherapy are controversial, our results indicate favourable effects in TNBC.
Collapse
Affiliation(s)
- J S Prabhu
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - S Patil
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - S Rajarajan
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - A Ce
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - M Nair
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - A Alexander
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - R Ramesh
- Department of Surgical Oncology, St Johns Medical College Hospital, Bangalore, India
| | - S Bs
- Department of Surgical Oncology, Shankara Cancer Hospital & Research Centre, Bangalore, India
| | - T Sridhar
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| |
Collapse
|
23
|
Lokesh PK, Chowdhary S, Pol SA, Rajeswari M, Saxena SK, Alexander A. Quantification of biomaterial dispersion during otologic procedures and role of barrier drapes in Covid 2019 era - a laboratory model. J Laryngol Otol 2020; 134:1-6. [PMID: 33143756 PMCID: PMC7684199 DOI: 10.1017/s002221512000239x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Aerosol generation during temporal bone surgery caries the risk of viral transmission. Steps to mitigate this problem are of particular importance during the coronavirus disease 2019 pandemic. OBJECTIVE To quantify the effect of barrier draping on particulate material dispersion during temporal bone surgery. METHODS The study involved a cadaveric model in a simulated operating theatre environment. Particle density and particle count for particles sized 1-10 μ were measured in a simulated operating theatre environment while drilling on a cadaveric temporal bone. The effect of barrier draping to decrease dispersion was recorded and analysed. RESULTS Barrier draping decreased counts of particles smaller than 5 μ by a factor of 80 in the operating theatre environment. Both particle density and particle count showed a statistically significant reduction with barrier draping (p = 0.027). CONCLUSION Simple barrier drapes were effective in decreasing particle density and particle count in the operating theatre model and can prevent infection in operating theatre personnel.
Collapse
Affiliation(s)
- P K Lokesh
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| | - S Chowdhary
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| | - S A Pol
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| | - M Rajeswari
- Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| | - S K Saxena
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| | - A Alexander
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| |
Collapse
|
24
|
Alexander A, Serena G, González J, DeFaria W, Ciancio G. Renal transplantation using vascular conduit reconstruction in deceased kidneys with multiple renal arteries and short renal veins. Actas Urol Esp 2020; 44:623-629. [PMID: 32534829 DOI: 10.1016/j.acuro.2020.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/24/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transplantation of kidneys with vascular anatomical variants remains a challenge. Due to its varying success in regard to graft function after transplantation, these organs have been frequently discarded assuming in advance an unaffordable rate of vascular complications. PATIENTS AND METHODS We performed three kidney transplants using organs from deceased donors harboring vascular variants (multiple arteries and short veins), including an unsplittable horseshoe kidney. Different grafts harvested from the same donor aorta, common iliac artery, and inferior vena cava, were used to reconstruct the initial vascular configuration by creating single arterial and venous conduits aimed to simplify the vascular anastomoses in the recipient. RESULTS No post-operative complications were recorded. Warm ischemia times remained comparable to single artery renal allografts. No delayed graft function was noted in any case, and every patient regained normal renal function after transplantation. CONCLUSIONS Vascular reconstruction using arterial and venous grafts harvested from the same deceased donor may result a helpful tool to simplify vascular anastomoses during transplantation surgery, thus avoiding their discard in advance, minimizing perioperative complications, and enabling normal graft function rates in the long-term follow-up. The successful outcome obtained by using this approach would help to expand the donor criteria for the inclusion of organs containing vascular anatomical variants.
Collapse
|
25
|
Kundapur V, Mayer M, Auer R, Pushie J, Alexander A, Sheldon W. Is Microbeam Radiation Treatment Ready For Prime Time? Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
26
|
Shippy S, Allgood H, Messenger K, Gatson B, Alexander A, Wellehan J, Johnson A. Pharmacodynamics and pharmacokinetics of intramuscular alfaxalone in central bearded dragons (Pogona vitticeps): effect of injection site. Vet Anaesth Analg 2020. [DOI: 10.1016/j.vaa.2020.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
27
|
Langran C, Alexander A, Donyai P. Longitudinal Evaluation of the Healthy Living Assessment as an Experiential Learning Activity Provided On-Campus. Am J Pharm Educ 2020; 84:7026. [PMID: 32313273 PMCID: PMC7159011 DOI: 10.5688/ajpe7026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/07/2019] [Indexed: 06/11/2023]
Abstract
Objective. To implement and evaluate the effectiveness of healthy living assessments (HLA) conducted on campus by undergraduate pharmacy students. Methods. Because of a shortage of workplace-based placements for undergraduate pharmacy students, a program was developed for students to conduct HLAs on campus for volunteer patients. Pharmacy students underwent training and completed a competency assessment before being approved to conduct HLAs. Staff members and students were recruited to serve as participants. Following the HLA, pharmacy students completed a quantitative and qualitative questionnaires to assess their perceived educational gains and opinions about the experience. Participants who underwent an HLA were asked to complete a questionnaire about the quality of the service they received. Results. From 2011-2019, 896 HLAs were conducted by 764 undergraduate pharmacy students. The students reported that completing an HLA improved their clinical knowledge, counselling skills, professionalism, and confidence when talking to participants. They believed the HLA delivered an authentic learning experience, similar to that achieved during workplace-based placements. The HLA service was rated as good or outstanding by 99% of the participants, and the majority stated that they intended to make lifestyle changes as a result of attending the HLA. Conclusion. Conducting healthy living assessments provided undergraduate pharmacy students a valuable, quality-assured opportunity for experiential learning. The HLAs were well received by participants as they informed them about their current health status and gave them useful advice about making health improvements.
Collapse
Affiliation(s)
- Catherine Langran
- University of Reading, School of Pharmacy, Reading, Berkshire, United Kingdom
| | - Angela Alexander
- University of Reading, School of Pharmacy, Reading, Berkshire, United Kingdom
| | - Parastou Donyai
- University of Reading, School of Pharmacy, Reading, Berkshire, United Kingdom
| |
Collapse
|
28
|
Alexander A, Fujii T, Stauder MC, Woodward WA, Reuben JM, Shen Y, Liu D, Reddy SM, Valero V, Gilchrist SC, Lim B, Lucci A, Ueno NT, Barcenas CH. Abstract OT1-02-02: A pilot study to examine the feasibility of measuring CTC and inflammatory biomarker changes resulting from atorvastatin as adjuvant therapy in TNBC and TN-IBC patients with residual disease after neoadjuvant chemotherapy. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-ot1-02-02] [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: Patients who have TNBC or triple negative-IBC (TN-IBC) and do not achieve pathological complete response after neoadjuvant chemotherapy are at significant risk for distant relapse and death from recurrent disease. Apart from capecitabine, there are no proven adjuvant therapies that may improve these poor outcomes of patients with chemo-resistant tumors. Therefore, there is an unmet need for effective systemic therapy for this subset of patients with TNBC. Epidemiological evidence reveals that statin use after diagnosis is associated with improved breast cancer relapse-free survival and decreased mortality. However, direct evidence of in vivo mechanisms explaining this association are lacking. Preclinical studies using statins in breast cancer reveal pathways that statins can inhibit proliferation, stem cell self-renewal and metastatic potential.
Trial Design: This is a pilot study designed in 2 phases to assess feasibility of completion while providing a signal of efficacy in biomarker changes. In the first phase, we will follow the initial 30 patients who meet eligibility for atorvastatin treatment for the 2-year treatment window, or until disease recurrence. We will collect blood samples prior to, and during atorvastatin treatment for circulating tumor cells (CTCs), cytokine and inflammatory biomarker analyses. We defined a positive outcome as CTCs remaining non-detected at 6 months when baseline CTC is undetected, or a reduction in the number of CTCs at 6 months compared to baseline. If we observe a positive outcome among the initial 30 patients, then we will open the second phase of this study for an additional 50 patients. Here we will follow both patient cohorts who receive and not receive atorvastatin treatment to collect longitudinal data on biomarkers as a function of the natural history of TNBC to better understand the activity of atorvastatin.
Trial Eligibility: Patients with stage II-III TNBC who have residual cancer burden (RCB)-II or RCB-III or stage 3 TN-IBC with any amount of residual disease, and are not taking a statin or any other anti-lipidemic agent are candidates for the study. Patients must have adequate hematologic, organ, and cardiac function and must have recovered from the acute effects of any prior treatments. Baseline lipid profile will be assessed by a cardiologist to determine the patients’ eligibility to take atorvastatin based on current ACC/AHA guideline, and to select between moderate (20mg) or high intensity treatment (40mg).
Specific Aims: The primary objective is to determine the proportion of patients with undetectable CTCs at 6 months with and without atorvastatin therapy. Secondary objectives include correlation of baseline lipid profiles/lipid profile changes with 2 year-relapse free survival (RFS), CTC counts and inflammatory biomarkers.
Statistical Methods: The total estimated enrollment is 80 patients, including at least 5 treated with adjuvant capecitabine and at least 5 without adjuvant capecitabine. The study overall is powered with the assumption that 48 patients will receive atorvastatin and 32 will not, and this will allow us to estimate the percent of patients with negative CTCs at 6 months with a standard error not larger than 7% and 9%, respectively. All other analyses including inflammatory biomarkers and RFS differences between groups are exploratory and considered hypothesis-generating rather than conclusive.
Citation Format: Angela Alexander, Takeo Fujii, Michael C Stauder, Wendy A Woodward, James M Reuben, Yu Shen, Diane Liu, Sangeetha M Reddy, Vicente Valero, Susan C Gilchrist, Bora Lim, Anthony Lucci, Naoto T Ueno, Carlos H Barcenas. A pilot study to examine the feasibility of measuring CTC and inflammatory biomarker changes resulting from atorvastatin as adjuvant therapy in TNBC and TN-IBC patients with residual disease after neoadjuvant chemotherapy [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 OT1-02-02.
Collapse
Affiliation(s)
| | - Takeo Fujii
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - James M Reuben
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yu Shen
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Diane Liu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Vicente Valero
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Bora Lim
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anthony Lucci
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naoto T Ueno
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | |
Collapse
|
29
|
Whisenant M, Alexander A, Williams LA, Woodward W, El-Zein R, Ueno NT. Abstract P6-15-06: Establishing the content domain for a patient-reported outcomes measure to evaluate the unique symptom burden of inflammatory breast cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p6-15-06] [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: Inflammatory breast cancer (IBC) is an aggressive, locally advanced breast cancer with a poor prognosis including a median survival of less than 4 years and a 5-year survival rate of around 60-70%. Symptom monitoring and management has demonstrated improved cancer patient outcomes, including quality of life, resource utilization, ability to continue treatment, and disease-free survival. The use of disease-specific patient-reported outcomes (PROs) is critical for facilitating individualized symptom monitoring and management. While women with IBC likely experience significant and variable symptom burden from diagnosis through treatment and survivorship that may remain under-reported and unmanaged, there is limited description of the symptom burden in this population and no disease-specific valid and reliable instrument for measuring symptom burden in IBC. In addition, because the diagnosis of IBC is based on clinical criteria as opposed to molecular or pathological diagnostic criteria, attention to defining the disease-related symptoms may assist clinicians in making timely and accurate diagnoses. The purpose of this study was to describe the patient experience of IBC and define the content domain for a PRO measure of IBC symptom burden, using patient input to ensure content validity. Methods: This descriptive study is the first stage in development of a PRO IBC symptom burden measure. Twenty patients with IBC across the disease continuum described their experience in single qualitative interviews. Content analysis was used to describe their experience and define the symptom burden content domain. Results: Mean patient age was 52.8 years (range, 30-73 years); 50% with locally advanced and 50% with metastatic disease, with 85% receiving treatment at the time of the interview. Content analysis found 51 symptoms related to both disease and treatment, with 24 symptoms reported at least 20% of participants. Participants reported, on average, 13.1 symptoms (range, 3-23 symptoms). All participants described localized disease-related symptoms that were present at diagnosis, which included breast rash (40% of participants), changes in the texture of the breast (55%), nipple changes (25%), breast pain (40%), breast discoloration (70%), breast lump (55%), breast warmth (10%), and breast swelling (50%). Treatment-related symptoms varied among participants based on modalities received. Patients volunteered ways in which symptoms impacted daily activities and relationships and how symptoms were managed. Conclusions: We have completed our pilot study. Patients with IBC experience numerous symptoms related to disease and treatment, including many localized disease-related symptoms with various treatments resulting in unique symptom burden. Symptoms may result in interference with daily activities, relationships, life plans, treatment adherence, and mood. Well-designed PROs are essential for accurate symptom assessment and management to maintain patient functioning. The content domain for a PRO symptom-burden measure of IBC encompasses the severity and activity interference of common symptoms of IBC and its treatment.
Citation Format: Meagan Whisenant, Angela Alexander, Loretta A. Williams, Wendy Woodward, Randa El-Zein, Naoto Tada Ueno. Establishing the content domain for a patient-reported outcomes measure to evaluate the unique symptom burden of inflammatory breast cancer [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 P6-15-06.
Collapse
Affiliation(s)
| | | | | | - Wendy Woodward
- 1The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Naoto Tada Ueno
- 1The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
30
|
Gao H, Kida K, Cohen EN, Alexander A, Lim B, Parker C, Tin S, Valero V, Tripathy D, Reuben A, Ueno NT, Reuben JM. Abstract P3-09-12: Peripheral T cell clonality and exhaustion as novel biomarkers for anti-PD-1 (pembrolizumab) maintenance therapy in patients with metastatic inflammatory breast cancer (mIBC) and non-IBC triple negative breast cancer (mTNBC). Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p3-09-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Inflammatory breast cancer (IBC) and triple negative breast cancer (TNBC) are more aggressive than other breast cancer subtypes, and up until recently lacked therapy options that maintain acceptable quality of life. While chemotherapy is a treatment option for all subtypes of breast cancer, it is used long-term as maintenance therapy for metastatic TNBC (mTNBC) and often produces cumulative toxicity resulting in discontinuation of treatment. Moreover, responses are rarely durable after discontinuation of chemotherapy. Immune checkpoint blockade has the potential to maintain therapy. To determine factors associated with response to anti-PD-1 therapy (pembrolizumab), we performed minimally invasive blood-based analyses of T-cell repertoire and phenotype to evaluate their association with progression-free survival (PFS) in 15 patients with metastatic IBC (mIBC) or mTNBC.
Materials and Methods: Fifteen patients with mIBC (n=6) or mTNBC (n=9) were enrolled on an ongoing phase II study to receive pembrolizumab as maintenance therapy after achieving a clinical response or stable disease to systemic chemotherapy for metastatic disease. We performed analyses of T-cell repertoire and phenotype on peripheral blood mononuclear cells (PBMC) from samples obtained post induction therapy but before initiation of pembrolizumab (baseline) therapy. Expression of T-cell exhaustion markers 2B4, CTLA4, BTLA, Lag3, PD-1, and Tim3 was evaluated on PBMC by flow cytometry. T-cell receptor (TCR) beta chain CDR3 DNA sequencing by ImmunoSEQ and richness (diversity) and clonality (reactivity) were evaluated. Patients were followed through 5 months of treatment with pembrolizumab to evaluate the association between T-cell repertoire and phenotype with PFS.
Results: Seven patients had stable disease (SD) and 8 had progressive disease (PD) by 5 months. The median follow-up was 14.2 months (range: 4.5 to 27.7 months). Among the patients who progressed within 5 months, the earliest and the latest time to progression was at 1.38 months and 4.82 months, respectively. CTLA4 expression in CD4+ T cells at baseline was significantly higher in patients with PD than in patients with SD (p = 0.040). Patients with a low percentage of CD4+ T cells expressing exhaustion markers (CTLA4, Tim3, and 2B4) at baseline were more likely to have SD (chi-square p = 0.041) and significantly longer median PFS than patients with PD (median time to progression was not reached in SD vs. 4.1 months in PD, p = 0.018). Additionally, patients with high clonality and low CD4+ T exhaustion markers were more likely to have SD (chi-square p = 0.041) and a longer median time to progression (median time to progression was not reached in SD vs. 4.1 months in PD, p = 0.015).
Conclusions: Baseline T-cell clonality and T-cell exhaustion markers have significant translational relevance and can help to explain variable responses to immune checkpoint blockade. Our data suggest that T-cell reactivity at baseline, and a lower percentage of CD4+ T cells expressing CTLA4/Tim3/2B4 were favorable prognostic factors for pembrolizumab maintenance therapy. This proof-of-concept provides compelling data that T-cell clonality and phenotyping of T-cell exhaustion markers can be useful and should be applied to future trials with immune checkpoint inhibitors.
Citation Format: Hui Gao, Kumiko Kida, Evan N Cohen, Angela Alexander, Bora Lim, Charla Parker, Sanda Tin, Vicente Valero, Debu Tripathy, Alexandre Reuben, Naoto T Ueno, James M Reuben. Peripheral T cell clonality and exhaustion as novel biomarkers for anti-PD-1 (pembrolizumab) maintenance therapy in patients with metastatic inflammatory breast cancer (mIBC) and non-IBC triple negative breast cancer (mTNBC) [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 P3-09-12.
Collapse
Affiliation(s)
- Hui Gao
- UT MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Bora Lim
- UT MD Anderson Cancer Center, Houston, TX
| | | | - Sanda Tin
- UT MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | |
Collapse
|
31
|
Tan H, Hannon C, Gopalan A, Alexander A, Patel J, Bergeon D, Andreoli L, Jarski R, McKeown T, Gunaga S. 204 Screening for Balance and Vision Symptoms in Triage to Enhance Identification of Strokes in the Emergency Department. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.372] [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: 10/25/2022]
|
32
|
Ge L, Alexander A, Rydelek S, Carrion R, Barrera E, Perito P, Hakky T. 029 Biomechanical Effects of Rear Tip Extenders on Inflatable Penile Implants: A Cadaveric Study. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
33
|
Alexander A, Marx AN, Reddy SM, Reuben JM, Le-Petross HC, Lane D, Huang ML, Krishnamurthy S, Gong Y, Gombos DS, Patel N, Tung CI, Allen RC, Kandl TJ, Wu J, Liu S, Patel AB, Futreal A, Wistuba I, Layman RM, Valero V, Tripathy D, Ueno NT, Lim B. Abstract OT3-05-04: Phase II study of atezolizumab, cobimetinib, and eribulin in patients with recurrent or metastatic inflammatory breast cancer (IBC). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-05-04] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: IBCs that do not completely respond to chemotherapy often have dysregulated immune pathways, and novel therapies are needed to improve outcomes in recurrent/metastatic disease. One-third of IBCs express the atezolizumab target PD-L1, and cobimetinib increases PD-L1 expression; thus, we hypothesize that atezolizumab and cobimetinib may act synergistically in IBC. The FDA-approved agent eribulin is active in IBC and has anti-stem cell activity and can reverse the IBC phenotype of epithelial-to-mesenchymal transition. Hence the use of eribulin as a chemotherapy backbone in combination with other novel agents is well justified.
Trial Design: This single-arm, open-label trial is enrolling patients with recurrent IBC or de novo metastatic IBC that has progressed on at least 1 line of standard chemotherapy. During a 4-week pharmacodynamic window, patients have an upfront biopsy, receive atezolizumab and cobimetinib treatment for 4 weeks, and have a second biopsy. Triple-combination treatment then commences, with standard eribulin dosing. After 4 cycles of eribulin, patients receive maintenance targeted therapy until disease progression or intolerable toxicity.
Eligibility Criteria: Patients with metastatic IBC of any molecular subtype must have measurable disease (per RECIST 1.1) amenable to biopsy. Patients with HER2+ disease must have received both pertuzumab and T-DM1. Patients with treated stable brain metastases are allowed. Patients must have recovered from the acute effects of any prior therapies and have adequate hematologic, organ, and cardiac function. Patients with autoimmune diseases or a history of pneumonitis are ineligible.
Specific Aims: The primary objective is to determine the overall response rate (ORR) of the combination therapy. Secondary objectives include determining the safety and tolerability, clinical benefit rate, response duration, progression-free survival, 2-year overall survival rate and predictive biomarker analyses.
Statistical Methods: The trial will enroll up to 9 patients in its phase I/safety lead-in portion and up to 33 patients total. A Bayesian optimal interval design is used to efficiently determine the maximum tolerated cobimetinib dose in phase I. Patients start cobimetinib at the FDA-approved dose of 60 mg/day with a target toxicity rate is 0.3. Phase II will enroll 24 patients to determine the efficacy of the triple-combination therapy. The historical ORR in metastatic IBC is 10%; our sample size provides 80% power to detect an ORR improvement to 25%.
Accrual: The trial has enrolled 7 patients since its start in August 2017.
Citation Format: Alexander A, Marx AN, Reddy SM, Reuben JM, Le-Petross HC, Lane D, Huang ML, Krishnamurthy S, Gong Y, Gombos DS, Patel N, Tung CI, Allen RC, Kandl TJ, Wu J, Liu S, Patel AB, Futreal A, Wistuba I, Layman RM, Valero V, Tripathy D, Ueno NT, Lim B. Phase II study of atezolizumab, cobimetinib, and eribulin in patients with recurrent or metastatic inflammatory breast cancer (IBC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-05-04.
Collapse
Affiliation(s)
- A Alexander
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - AN Marx
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - SM Reddy
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - JM Reuben
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - HC Le-Petross
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - D Lane
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - ML Huang
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Y Gong
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - DS Gombos
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - N Patel
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - CI Tung
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - RC Allen
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - TJ Kandl
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - J Wu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - S Liu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - AB Patel
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - A Futreal
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - I Wistuba
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - RM Layman
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - V Valero
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - D Tripathy
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - NT Ueno
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - B Lim
- University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
34
|
Mahmood J, Alexander A, Samanta S, Soman S, Shukla H, Davila E, Carrier F, Jackson I, Vujaskovic Z. Radiation Therapy in Combination with Hyperthermia and Immunotherapy Inhibit Pancreatic Tumor Growth and Modulate Tumor Microenvironment in Mice. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.625] [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: 10/28/2022]
|
35
|
Rajarajan S, Prabhu J, Korlimarla A, Nair M, Alexander A, Kaluve R, Ps H, Raja U, Ramesh R, Patil S, Bs S, Ts S. MicroRNA based immune response signature identifies poor prognostic subgroup within ER negative breast cancers. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy428.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
36
|
Chen X, Low KH, Alexander A, Jiang Y, Karakas C, Hess KR, Carey JPW, Bui TN, Vijayaraghavan S, Evans KW, Yi M, Ellis DC, Cheung KL, Ellis IO, Fu S, Meric-Bernstam F, Hunt KK, Keyomarsi K. Cyclin E Overexpression Sensitizes Triple-Negative Breast Cancer to Wee1 Kinase Inhibition. Clin Cancer Res 2018; 24:6594-6610. [PMID: 30181387 DOI: 10.1158/1078-0432.ccr-18-1446] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/21/2018] [Accepted: 08/29/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Poor prognosis in triple-negative breast cancer (TNBC) is due to an aggressive phenotype and lack of biomarker-driven targeted therapies. Overexpression of cyclin E and phosphorylated-CDK2 are correlated with poor survival in patients with TNBC, and the absence of CDK2 desensitizes cells to inhibition of Wee1 kinase, a key cell-cycle regulator. We hypothesize that cyclin E expression can predict response to therapies, which include the Wee1 kinase inhibitor, AZD1775. EXPERIMENTAL DESIGN Mono- and combination therapies with AZD1775 were evaluated in TNBC cell lines and multiple patient-derived xenograft (PDX) models with different cyclin E expression profiles. The mechanism(s) of cyclin E-mediated replicative stress were investigated following cyclin E induction or CRISPR/Cas9 knockout by a number of assays in multiple cell lines. RESULTS Cyclin E overexpression (i) is enriched in TNBCs with high recurrence rates, (ii) sensitizes TNBC cell lines and PDX models to AZD1775, (iii) leads to CDK2-dependent activation of DNA replication stress pathways, and (iv) increases Wee1 kinase activity. Moreover, treatment of cells with either CDK2 inhibitors or carboplatin leads to transient transcriptional induction of cyclin E (in cyclin E-low tumors) and result in DNA replicative stress. Such drug-mediated cyclin E induction in TNBC cells and PDX models sensitizes them to AZD1775 in a sequential treatment combination strategy.Conclusions: Cyclin E is a potential biomarker of response (i) for AZD1775 as monotherapy in cyclin E-high TNBC tumors and (ii) for sequential combination therapy with CDK2 inhibitor or carboplatin followed by AZD1775 in cyclin E-low TNBC tumors.
Collapse
Affiliation(s)
- Xian Chen
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Kwang-Huei Low
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Angela Alexander
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yufeng Jiang
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cansu Karakas
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kenneth R Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason P W Carey
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tuyen N Bui
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Smruthi Vijayaraghavan
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kurt W Evans
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Min Yi
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - D Christian Ellis
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Ian O Ellis
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Siqing Fu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Khandan Keyomarsi
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| |
Collapse
|
37
|
Martin AS, Boles RW, Nocera L, Kolatkar A, May M, Hasnain Z, Ueno NT, Yennu S, Alexander A, Mejia A, Li M, Cozzens Philips FA, Newton PK, Broderick J, Shahabi C, Kuhn P, Nieva JJ. Objective metrics of patient activity: Use of wearable trackers and patient reported outcomes in predicting unexpected healthcare events in cancer patients undergoing highly emetogenic chemotherapy. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.6519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Marcella May
- University of Southern California, Los Angeles, CA
| | - Zaki Hasnain
- University of Southern California, Los Angeles, CA
| | - Naoto T. Ueno
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sriram Yennu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Aaron Mejia
- University of Southern California, Los Angeles, CA
| | | | | | | | | | | | - Peter Kuhn
- University of Southern California, Los Angeles, CA
| | | |
Collapse
|
38
|
Alexander A, Arnold TL, Bishnoi S, Ballinger C, Shaitelman SF, Schaverien MV, Cohen L, Dev M, Ueno NT. Survivorship and Advocacy in Inflammatory Breast Cancer. J Cancer 2018; 9:1430-1436. [PMID: 29721053 PMCID: PMC5929088 DOI: 10.7150/jca.21281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 03/04/2018] [Indexed: 01/30/2023] Open
Abstract
In February 2017, the Morgan Welch Inflammatory Breast Cancer (IBC) Research Program and Clinic hosted a scientific conference in Houston to commemorate the tenth anniversary of the opening of the first IBC-dedicated clinic in the world. Attendees included basic science researchers, clinicians who treat IBC, as well as patients and their caregivers. Several US-based and international IBC-focused nonprofit organizations were also represented. In this third paper from the conference, we report on the breakout session regarding survivorship and advocacy issues related to IBC, sharing an overview of the educational content presented and discussions regarding the future of IBC advocacy. Panelists focused on lymphedema research and clinical solutions, integrative medicine, and social work, with time provided for questions in small groups. IBC nonprofits that are leading advocacy efforts were introduced, and ways to become involved in these initiatives were discussed. Priorities for future advocacy and clinical care needs were also highlighted. In addition to summarizing these topics, we provide a suggested integrated IBC-specific plan of care that could be provided to the patient at the beginning of care and referred to throughout treatment and follow-up.
Collapse
Affiliation(s)
- Angela Alexander
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston TX.,Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston TX
| | | | - Sandra Bishnoi
- Rice 360 Program, Rice University, Houston TX.,Metastatic Breast Cancer Network
| | | | - Simona F Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston TX
| | - Mark V Schaverien
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston TX
| | - Lorenzo Cohen
- Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston TX
| | - Mary Dev
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston TX
| | - Naoto T Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston TX.,Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston TX
| |
Collapse
|
39
|
Parsons C, Tayoun AM, Benado BD, Ragusa G, Dorvil RF, Rourke EA, O' Connor K, Reed IG, Alexander A, Willetts L, Habibian M, Adams BD. The role of long noncoding RNAs in cancer metastasis. ACTA ACUST UNITED AC 2018. [DOI: 10.20517/2394-4722.2018.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
40
|
Ueno NT, Espinosa Fernandez JR, Cristofanilli M, Overmoyer B, Rea D, Berdichevski F, El-Shinawi M, Bellon J, Le-Petross HT, Lucci A, Babiera G, DeSnyder SM, Teshome M, Chang E, Lim B, Krishnamurthy S, Stauder MC, Parmar S, Mohamed MM, Alexander A, Valero V, Woodward WA. International Consensus on the Clinical Management of Inflammatory Breast Cancer from the Morgan Welch Inflammatory Breast Cancer Research Program 10th Anniversary Conference. J Cancer 2018; 9:1437-1447. [PMID: 29721054 PMCID: PMC5929089 DOI: 10.7150/jca.23969] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/29/2018] [Indexed: 01/17/2023] Open
Abstract
National and international experts in inflammatory breast cancer (IBC) from high-volume centers treating IBC recently convened at the 10th Anniversary Conference of the Morgan Welch Inflammatory Breast Cancer Research Program at The University of Texas MD Anderson Cancer Center in Houston Texas. A consensus on the clinical management of patients with IBC was discussed, summarized, and subsequently reviewed. All participants at the conference (patients, advocates, researchers, trainees, and clinicians) were queried using the MDRing electronic survey on key management issues. A summary of the expert consensus and participant voting is presented. Bilateral breast and nodal evaluation, breast magnetic resonance imaging, positron emission tomography/computed tomography, and medical photographs were endorsed as optimal. Neoadjuvant systemic therapy, modified radical mastectomy and level I and II ipsilateral axillary node dissection, post-mastectomy radiotherapy, adjuvant targeted therapy and hormonal therapy as indicated, and delayed reconstruction were agreed-upon fundamental premises of standard non-protocol-based treatment for IBC. Consideration for local-regional therapy in de novo stage IV IBC was endorsed to provide local control whenever feasible. Variation across centers and special circumstances were discussed.
Collapse
Affiliation(s)
- Naoto T Ueno
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jose Rodrigo Espinosa Fernandez
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Massimo Cristofanilli
- Department of Medicine, Division of Hematology and Oncology, Robert H Lurie Comprehensive Cancer Center, Northwestern University, Evanston, Illinois, USA
| | - Beth Overmoyer
- Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Dan Rea
- School of Cancer Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Fedor Berdichevski
- School of Cancer Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Mohamad El-Shinawi
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Jennifer Bellon
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Huong T Le-Petross
- Department of Zoology, Faculty of Science, Cairo University, Giza, Egypt
| | - Anthony Lucci
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gildy Babiera
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah M DeSnyder
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mediget Teshome
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Edward Chang
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bora Lim
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Savitri Krishnamurthy
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael C Stauder
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Simrit Parmar
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mona M Mohamed
- Department of Zoology, Faculty of Science, Cairo University, Giza, Egypt
| | - Angela Alexander
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vicente Valero
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wendy A Woodward
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
41
|
Alexander A, Willey J, Sun H, Parker CA, Marx AN, Wood AL, Reddy SM, Reuben JM, Bassett RL, Le-Petross HT, Krishnamurthy S, Gong Y, Woodward WA, Valero V, Ueno NT, Lim B. Abstract OT1-02-05: A single arm phase II study of adjuvant anti-PD1 (pembrolizumab) in combination with hormonal therapy in patients with hormone receptor (HR)-positive localized inflammatory breast cancer (IBC) who did not achieve a pathological complete response (pCR) to neoadjuvant chemotherapy. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot1-02-05] [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: The pCR rate to conventional chemotherapy in hormone receptor positive IBC has historically been low (7.4% for HR+ HER2-, and 30% for HR+ HER2+), and despite the use of adjuvant endocrine therapy, the recurrence rate is still as high as 40%. To date, no targeted agent is proven to improve the efficacy of adjuvant endocrine therapy within the IBC population to improve this poor disease free survival (DFS). One plausible reason for the poor efficacy of endocrine therapy is a suppressed immune system, which allows tumor cells to avoid detection despite expression of potential immunogenic surface antigens.
Trial Design: This is a single arm trial that will enroll stage III HR+ IBC patients who have completed neoadjuvant therapy but had residual disease at mastectomy. Enrollment should be before or within 2 months of beginning endocrine therapy. Monitoring of DFS will be done with radiological imaging every 3 cycles (starting at cycle 4) as clinically indicated, per standard of care. Pembrolizumab is given on day 1 of each 21 day cycle for up to 2 years if the disease is controlled, and hormonal therapy will be administered per standard of care.
Eligibility Criteria: Clinical stage 3 IBC ER+/PR+ and HER2 negative patients who completed neoadjuvant chemotherapy and surgery with evidence of residual cancer in the breast or lymph nodes, but be clinically disease-free with good performance status at the start of study. Patients also must have adequate hematologic and organ function, and have recovered from the acute effects from prior treatments.
Specific Aims: The primary objective is to determine the disease free survival (DFS) at 2 years of patients with adjuvant therapy using Pembrolizumab in combination with standard adjuvant hormonal therapy. The secondary objective is to determine the safety and toxicity profile of this combination.
Statistical Methods: With a sample size of 37 patients, assuming that 80% are alive (20% increase from historical data) and disease-free at 2 years, and all patients are followed for >2 years after enrollment with no dropout, a 95% confidence interval around the 2-year estimate of DFS will be generated. DFS will then be compared with the historical control rate of 60% by year 2 using a one-sided exponential MLE test.
Accrual: To date we have enrolled 3 patients since activation in January 2017, and the target enrollment is 37 patients.
Contact information: For more information or to refer a patient, please contact study coordinator, Angela Alexander - aalexand@mdanderson.org
Citation Format: Alexander A, Willey J, Sun H, Parker CA, Marx AN, Wood AL, Reddy SM, Reuben JM, Bassett RL, Le-Petross HT, Krishnamurthy S, Gong Y, Woodward WA, Valero V, Ueno NT, Lim B. A single arm phase II study of adjuvant anti-PD1 (pembrolizumab) in combination with hormonal therapy in patients with hormone receptor (HR)-positive localized inflammatory breast cancer (IBC) who did not achieve a pathological complete response (pCR) to neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT1-02-05.
Collapse
Affiliation(s)
- A Alexander
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - J Willey
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - H Sun
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - CA Parker
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - AN Marx
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - AL Wood
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - SM Reddy
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - JM Reuben
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - RL Bassett
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - HT Le-Petross
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Y Gong
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - WA Woodward
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - V Valero
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - NT Ueno
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - B Lim
- University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
42
|
Alexander A, Kaluve R, Prabhu JS, Korlimarla A, BS S, Manjunath S, Patil S, KS G, Sridhar TS. Abstract P4-10-12: Treatment decision making, and strategies for coping with financial stress in Indian women diagnosed with breast cancer and their families. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-10-12] [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
Introduction: In spite of rapid urbanization and modernization the family remains central in the socio-cultural structure of India. The individuals are enmeshed into this unit and tend to be interlinked financially, emotionally and socially. The head of this family unit tends to be a male more often than not. As is well known, despite recent attempts by the governments at the state and centre at providing health coverage for cancer through regional cancer centres, a majority have to raise the money for cancer care by themselves. We have examined the role of the family in treatment decision making and in the strategies employed to raise the money and cope with the financial stress imposed by a diagnosis of breast cancer.
Method: 378 women with breast cancer were enrolled into a longitudinal study at first diagnosis between the years 2008-2012, at two tertiary care hospitals in Bangalore, India. The median follow up as of May 31st 2017 is 78 months with only 2% loss to follow-up over the past 8 years. Follow-up was maintained by frequent meetings between a counselling psychologist (AA) and the patient and/or a family member. The frequency of meetings was monthly during the initial treatment and then quarterly over the next 5 years. Information on demographics was collected during the treatment phase and information on the psychosocial aspects was collected in non-structured interactions subsequently. This information included details of support structure, decision making, and financial arrangements.
Results: This is a predominantly urban cohort with 80% being urban. The median age of patients at first diagnosis was 55 years. Almost all of our patients (99%) had the support of one or more family members. We analysed the pattern of decision making for treatment and in half of all cases either the husband or the son were the decision makers. In an additional 15% daughters and other relatives were the primary decision makers. Approximately a third of women made the decision concerning treatment themselves, and these women tended to be college educated (51% vs 16%) and employed (53% vs 12%).
30% of the patients met the costs incurred through medical insurance plans purchased by the family. Another quarter of patients were able to meet the costs from their savings. 45% had difficulty in finding the money for treatment and 15% took personal loans while 30% had to sell land/gold ornaments or take loans against assets of these sorts. Only (3%) discontinued the treatment due to financial difficulties. As in the case of decision making those who had the financial resources tended to be more educated (41% vs 11%), and were employed (31% vs 21%).
Conclusion: The data from a predominantly urban cohort of breast cancer enrolled between 2008-2012, supports the general belief that in India the family remains the fulcrum of an individual during crises, and not surprisingly education and employment lead to both psychological and economic emancipation of women.
Citation Format: Alexander A, Kaluve R, Prabhu JS, Korlimarla A, BS S, Manjunath S, Patil S, KS G, Sridhar TS. Treatment decision making, and strategies for coping with financial stress in Indian women diagnosed with breast cancer and their families [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-12.
Collapse
Affiliation(s)
- A Alexander
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - R Kaluve
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - JS Prabhu
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - A Korlimarla
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - S BS
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - S Manjunath
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - S Patil
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - G KS
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - TS Sridhar
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| |
Collapse
|
43
|
Thulborn KR, Atkinson IC, Alexander A, Singal M, Amin-Hanjani S, Du X, Alaraj A, Charbel FT. Comparison of Blood Oxygenation Level-Dependent fMRI and Provocative DSC Perfusion MR Imaging for Monitoring Cerebrovascular Reserve in Intracranial Chronic Cerebrovascular Disease. AJNR Am J Neuroradiol 2018; 39:448-453. [PMID: 29371256 DOI: 10.3174/ajnr.a5515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/07/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Loss of hemodynamic reserve in intracranial cerebrovascular disease reduces blood oxygenation level-dependent activation by fMRI and increases asymmetry in MTT measured by provocative DSC perfusion MR imaging before and after vasodilation with intravenous acetazolamide. The concordance for detecting hemodynamic reserve integrity has been compared. MATERIALS AND METHODS Patients (n = 40) with intracranial cerebrovascular disease and technically adequate DSA, fMRI and provocative DSC perfusion studies were retrospectively grouped into single vessels proximal to and distal from the circle of Willis, multiple vessels, and Moyamoya disease. The vascular territories were classified as having compromised hemodynamic reserve if the expected fMRI blood oxygenation level-dependent activation was absent or if MTT showed increased asymmetry following vasodilation. Concordance was examined in compromised and uncompromised vascular territories of each group with the Fischer exact test and proportions of agreement. RESULTS Extensive leptomeningeal collateral circulation was present in all cases. Decreased concordance between the methods was found in vascular territories with stenosis distal to but not proximal to the circle of Willis. Multivessel and Moyamoya diseases also showed low concordance. A model of multiple temporally displaced arterial inputs from leptomeningeal collateral flow demonstrated that the resultant lengthening MTT mimicked compromised hemodynamic reserve despite being sufficient to support blood oxygenation level-dependent contrast. CONCLUSIONS Decreased concordance between the 2 methods for assessment of hemodynamic reserve for vascular disease distal to the circle of Willis is posited to be due to well-developed leptomeningeal collateral circulation providing multiple temporally displaced arterial input functions that bias the perfusion analysis toward hemodynamic reserve compromise while blood oxygenation level-dependent activation remains detectable.
Collapse
Affiliation(s)
- K R Thulborn
- From the Center for Magnetic Resonance Research (K.R.T., I.C.A., A.Alexander, M.S.)
| | - I C Atkinson
- From the Center for Magnetic Resonance Research (K.R.T., I.C.A., A.Alexander, M.S.)
| | - A Alexander
- From the Center for Magnetic Resonance Research (K.R.T., I.C.A., A.Alexander, M.S.)
| | - M Singal
- From the Center for Magnetic Resonance Research (K.R.T., I.C.A., A.Alexander, M.S.)
| | - S Amin-Hanjani
- Department of Neurological Surgery (S.A.-H., X.D., A.Alaraj, F.T.C.), University of Illinois Medical Center, Chicago, Illinois
| | - X Du
- Department of Neurological Surgery (S.A.-H., X.D., A.Alaraj, F.T.C.), University of Illinois Medical Center, Chicago, Illinois
| | - A Alaraj
- Department of Neurological Surgery (S.A.-H., X.D., A.Alaraj, F.T.C.), University of Illinois Medical Center, Chicago, Illinois
| | - F T Charbel
- Department of Neurological Surgery (S.A.-H., X.D., A.Alaraj, F.T.C.), University of Illinois Medical Center, Chicago, Illinois
| |
Collapse
|
44
|
Teoh T, Mill C, Wong T, Baerg I, Alexander A, Hildebrand KJ, Dean J, Kuzeljevic B, Chan ES. Impact of supervised epinephrine autoinjector administration during food challenges on parent confidence. Ann Allergy Asthma Immunol 2017; 116:467-9. [PMID: 27153741 DOI: 10.1016/j.anai.2016.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/19/2016] [Accepted: 02/29/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Timothy Teoh
- Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital Allergy Clinic, Vancouver, British Columbia, Canada
| | - Christopher Mill
- Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital Allergy Clinic, Vancouver, British Columbia, Canada
| | - Tiffany Wong
- Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital Allergy Clinic, Vancouver, British Columbia, Canada
| | - Ingrid Baerg
- Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital Allergy Clinic, Vancouver, British Columbia, Canada
| | - Angela Alexander
- Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital Allergy Clinic, Vancouver, British Columbia, Canada
| | - Kyla J Hildebrand
- Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital Allergy Clinic, Vancouver, British Columbia, Canada
| | - John Dean
- Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital Allergy Clinic, Vancouver, British Columbia, Canada
| | - Boris Kuzeljevic
- Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital Allergy Clinic, Vancouver, British Columbia, Canada
| | - Edmond S Chan
- Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital Allergy Clinic, Vancouver, British Columbia, Canada.
| |
Collapse
|
45
|
Woodward WA, Cristofanilli M, Merajver SD, Van Laere S, Pusztai L, Bertucci F, Berditchevski F, Polyak K, Overmoyer B, Devi GR, Sterneck E, Schneider R, Debeb BG, Wang X, van Golen KL, El-Zein R, Rahal OM, Alexander A, Reuben JM, Krishnamurthy S, Lucci A, Ueno NT. Scientific Summary from the Morgan Welch MD Anderson Cancer Center Inflammatory Breast Cancer (IBC) Program 10 th Anniversary Conference. J Cancer 2017; 8:3607-3614. [PMID: 29667990 PMCID: PMC5687177 DOI: 10.7150/jca.21200] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/28/2017] [Indexed: 02/01/2023] Open
Abstract
In 2006, a remarkable collaboration between University of Texas MD Anderson Cancer Center clinicians and Texas and New Mexico State legislators led to the formation of a dedicated IBC Research Program and Clinic at MD Anderson. This initiative provided funding and infrastructure to foster coordination of an IBC World Consortium of national and international experts, and launch the first ever IBC international conference in 2008, which brought together experts from around the world to facilitate collaborations and accelerate progress. Indeed great progress has been made since then. National and international experts in IBC convened at the 10th Anniversary Conference of the MD Anderson IBC Clinic and Research Program and presented the most extensive sequencing analysis to date comparing IBC to non-IBC, gene- and protein-based immunoprofiling of IBC versus non-IBC patients, and converging lines of evidence on the specific role of the microenvironment in IBC. Novel models, unique metabolic mechanisms, and prominent survival pathways have been identified and were presented. Multiple clinical trials based on the work of the last decade are in progress or in development. The important challenges ahead were discussed. This progress and a coordinated summary of these works are presented herein.
Collapse
Affiliation(s)
- Wendy A Woodward
- MD Anderson Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Massimo Cristofanilli
- Developmental Therapeutics Program of Division of Hematology Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Sofia D Merajver
- Program in Cellular and Molecular Biology, University of Michigan Medical School, Ann Arbor, MI.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI.,University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, 48109, USA. The Office for Health Equity and Inclusion, University of Michigan, Ann Arbor, MI.,Program in Cancer Biology, University of Michigan Medical School, Ann Arbor, MI
| | - Steven Van Laere
- Center for Oncological Research (CORE), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp Belgium
| | - Lajos Pusztai
- Breast Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Francois Bertucci
- Department of Medical Oncology, Institute Paoli-Calmettes, Marseille, France
| | - Fedor Berditchevski
- School of Cancer Sciences of the University of Birmingham, Birmingham, United Kingdom
| | - Kornelia Polyak
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA.,BBS Program, Harvard Medical School, Boston, MA.,Broad Institute, Cambridge, MA
| | - Beth Overmoyer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Gayathri R Devi
- Department of Surgery, Division of Surgical Sciences, Duke University Medical Sciences, Durham, NC.,Women's Cancer Program, Duke Cancer Institute, Durham, NC
| | - Esta Sterneck
- Laboratory of Cell and Developmental Signaling, Center for Cancer Research, National Cancer Institute, Frederick, MD
| | - Robert Schneider
- Department of Microbiology, New York University School of Medicine, New York, NY.,Perlmutter Cancer Center, New York University School of Medicine, New York, NY
| | - Bisrat G Debeb
- MD Anderson Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xiaoping Wang
- MD Anderson Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kenneth L van Golen
- Department of Biological Sciences and The Center for Translational Cancer Research, The University of Delaware, Newark, DE
| | - Randa El-Zein
- Department of Radiology, Houston Methodist Research Institute, Houston, TX.,Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Omar M Rahal
- MD Anderson Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Angela Alexander
- MD Anderson Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James M Reuben
- MD Anderson Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Savitri Krishnamurthy
- MD Anderson Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anthony Lucci
- MD Anderson Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naoto T Ueno
- MD Anderson Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
46
|
Alexander A, Karakas C, Chen X, Carey JPW, Yi M, Bondy M, Thompson P, Cheung KL, Ellis IO, Gong Y, Krishnamurthy S, Alvarez RH, Ueno NT, Hunt KK, Keyomarsi K. Cyclin E overexpression as a biomarker for combination treatment strategies in inflammatory breast cancer. Oncotarget 2017; 8:14897-14911. [PMID: 28107181 PMCID: PMC5362453 DOI: 10.18632/oncotarget.14689] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/26/2016] [Indexed: 12/18/2022] Open
Abstract
Inflammatory breast cancer (IBC) is a virulent form of breast cancer, and novel treatment strategies are urgently needed. Immunohistochemical analysis of tumors from women with a clinical diagnosis of IBC (n = 147) and those with non-IBC breast cancer (n = 2510) revealed that, whereas in non-IBC cases cytoplasmic cyclin E was highly correlated with poor prognosis (P < 0.001), in IBC cases both nuclear and cytoplasmic cyclin E were indicative of poor prognosis. These results underscored the utility of the cyclin E/CDK2 complex as a novel target for treatment. Because IBC cell lines were highly sensitive to the CDK2 inhibitors dinaciclib and meriolin 5, we developed a high-throughput survival assay (HTSA) to design novel sequential combination strategies based on the presence of cyclin E and CDK2. Using a 14-cell-line panel, we found that dinaciclib potentiated the activity of DNA-damaging chemotherapies treated in a sequence of dinaciclib followed by chemotherapy, whereas this was not true for paclitaxel. We also identified a signature of DNA repair–related genes that are downregulated by dinaciclib, suggesting that global DNA repair is inhibited and that prolonged DNA damage leads to apoptosis. Taken together, our findings argue that CDK2-targeted combinations may be viable strategies in IBC worthy of future clinical investigation.
Collapse
Affiliation(s)
- Angela Alexander
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Houston, Texas, USA
| | - Cansu Karakas
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xian Chen
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jason P W Carey
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Min Yi
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Melissa Bondy
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Patricia Thompson
- Department of Pathology, Stony Brook School of Medicine, Stony Brook, New York, USA
| | | | - Ian O Ellis
- University of Nottingham, School of Medicine, Nottingham, UK
| | - Yun Gong
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Savitri Krishnamurthy
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Houston, Texas, USA
| | - Ricardo H Alvarez
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Houston, Texas, USA.,Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naoto T Ueno
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Houston, Texas, USA.,Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kelly K Hunt
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Khandan Keyomarsi
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
47
|
Einstein N, Okubanjo O, Alexander A, Putman M, Watts H. 158 Caring for a Critically Ill Simulated Left Ventricular Assist Device Patient With or Without a Cognitive Aid Improves Physician Comfort. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.185] [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]
|
48
|
Mahmood J, Jackson I, Pavlovic R, Zhang A, Connors C, Alexander A, Kaytor M, Vujaskovic Z. Treatment With Nano-Genistein for the Prevention of Radiation-Induced Erectile Dysfunction. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
49
|
Francis AM, Alexander A, Liu Y, Vijayaraghavan S, Low KH, Yang D, Bui T, Somaiah N, Ravi V, Keyomarsi K, Hunt KK. CDK4/6 Inhibitors Sensitize Rb-positive Sarcoma Cells to Wee1 Kinase Inhibition through Reversible Cell-Cycle Arrest. Mol Cancer Ther 2017; 16:1751-1764. [PMID: 28619757 PMCID: PMC5975955 DOI: 10.1158/1535-7163.mct-17-0040] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [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: 01/12/2017] [Revised: 05/15/2017] [Accepted: 06/09/2017] [Indexed: 12/29/2022]
Abstract
Research into the biology of soft tissue sarcomas has uncovered very few effective treatment strategies that improve upon the current standard of care which usually involves surgery, radiation, and chemotherapy. Many patients with large (>5 cm), high-grade sarcomas develop recurrence, and at that point have limited treatment options available. One challenge is the heterogeneity of genetic drivers of sarcomas, and many of these are not validated targets. Even when such genes are tractable targets, the rarity of each subtype of sarcoma makes advances in research slow. Here we describe the development of a synergistic combination treatment strategy that may be applicable in both soft tissue sarcomas as well as sarcomas of bone that takes advantage of targeting the cell cycle. We show that Rb-positive cell lines treated with the CDK4/6 inhibitor palbociclib reversibly arrest in the G1 phase of the cell cycle, and upon drug removal cells progress through the cell cycle as expected within 6-24 hours. Using a long-term high-throughput assay that allows us to examine drugs in different sequences or concurrently, we found that palbociclib-induced cell-cycle arrest poises Rb-positive sarcoma cells (SK-LMS1 and HT-1080) to be more sensitive to agents that work preferentially in S-G2 phase such as doxorubicin and Wee1 kinase inhibitors (AZD1775). The synergy between palbociclib and AZD1775 was also validated in vivo using SK-LMS1 xenografts as well as Rb-positive patient-derived xenografts (PDX) developed from leiomyosarcoma patients. This work provides the necessary preclinical data in support of a clinical trial utilizing this treatment strategy. Mol Cancer Ther; 16(9); 1751-64. ©2017 AACR.
Collapse
Affiliation(s)
- Ashleigh M Francis
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Angela Alexander
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yanna Liu
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Smruthi Vijayaraghavan
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kwang Hui Low
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dong Yang
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tuyen Bui
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neeta Somaiah
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Khandan Keyomarsi
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| |
Collapse
|
50
|
Nair M, Prabhu J, Remacle J, S H, Korlimarla A, Kaluve R, Alexander A, Patil S, S S, Srinivas S. Examination of the role of integrin β3 in chemoresistance by analysis of residual NACT tumor specimens and knock-in experiments. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx140.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|