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Upadhyay R, Dhakal A, Karivedu V, Wheeler C, Hoyd R, Bhateja P, Bonomi M, Valentin S, Gamez ME, Konieczkowski DJ, Baliga S, Grecula JC, Blakaj DM, Gogineni E, Mitchell DL, Denko N, Jhawar SR, Spakowicz D. Comparative Analysis of Tumor Microbiome, Molecular Profile and Immune Cell Abundance by HPV Status in Head and Neck Cancers and Their Impact on Survival. Int J Radiat Oncol Biol Phys 2023; 117:e264. [PMID: 37785006 DOI: 10.1016/j.ijrobp.2023.06.1221] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Traditional clinical and molecular prognostic factors offer valuable insight into the heterogeneous natural history and treatment response of head and neck squamous cell carcinoma (HNSCC) yet fail to explain the full spectrum of observed variability. The tumor microenvironment (TME), comprising microbiome and immune cells can impact treatment response and prognosis. We analyzed The Cancer Genome Atlas (TCGA) to evaluate the association of specific microbes and genes in TME with survival and their differential expression in HPV positive (+) and HPV negative (-) HNSCC. MATERIALS/METHODS HNSCC RNA sequencing (RNAseq) samples from TCGA were processed through the Exogenous sequencing in Tumors and Immune Cells (ExoTIC) pipeline to identify gene expression and microbial presence. HPV status was assessed by detection of papillomaviridae family of microbes. Clinical data from TCGA was extracted to compare overall survival (OS) and control for competing variables using Cox proportional hazards regression. Difference in immune cell abundance was evaluated by Kruskal-Wallis test. All statistical analysis was performed using R. RESULTS A total of 498 RNAseq samples from TCGA were analyzed. Oral cavity, oropharynx, hypopharynx, and larynx tumors comprised 21.6%, 15%, 1.8%, and 22.2% of specimens, respectively. HPV was detected in 111 patients (22%), most commonly Alpha papillomavirus 9 (90.1%). Of the 5838 enriched microbes, 330 were significantly associated with OS after controlling for tumor stage, smoking, and age. Specifically, the presence of Alpha papillomavirus 9 was associated with significantly improved OS [adjusted HR = 0.60 (95% CI 0.40 - 0.89, p = 0.01)]. Microbial species found in more abundance in HPV- tumors included Citrobacter farmeri, Thermoanaerobacter kivui and Yersinia pestis which are gram negative anaerobes. Genes related to cellular transport and DNA repair were enriched while genes related to proliferation (e.g., SAGE1) were depleted in HPV+ samples. HPV- tumors had a significantly higher number of M0 (p < 0.001) and M2 macrophages (p = 0.035) while HPV+ tumors had more T regulatory cells (p < 0.001) and CD8+ T-cells (p < 0.001). CONCLUSION Tumor microenvironment was significantly associated with survival for HNSCC patients, with particular microbes such as Alpha papillomavirus 9 correlating with improved OS. Greater abundance of certain anaerobic microbes was seen in HPV- tumors. These findings suggest TME can be used to predict patient outcomes and potentially guide personalized treatment approaches. We found an abundance of M0 and M2 macrophages in HPV- tumors, which are considered pro-tumorigenic, while anti-tumor M1 macrophages were similar in the two groups. This may help identify mechanism of resistance to immunotherapies and tailor novel immunotherapy combinations in specific patient subgroups. With further prospective research and external validation these findings have the potential to significantly impact the way we treat HNSCC in the future.
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Affiliation(s)
| | - A Dhakal
- The Ohio State University College of Medicine, Columbus, OH
| | - V Karivedu
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - C Wheeler
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - R Hoyd
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - P Bhateja
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - M Bonomi
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - S Valentin
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - M E Gamez
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | - S Baliga
- Ohio State University, Columbus, OH
| | - J C Grecula
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - D M Blakaj
- James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - E Gogineni
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - D L Mitchell
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - N Denko
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - S R Jhawar
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - D Spakowicz
- The Ohio State University Wexner Medical Center, Columbus, OH
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Quick A, Diaz Pardo D, Miller E, Arnett A, Pitter K, Kim J, Flora L, Williams N, Hoyd R, Wheeler C, Mo X, Chambers L, Spakowicz D, Arthur E. Vaginal Microbiome as a Biomarker of Vaginal Health and Patient-Reported Outcomes in Women Receiving Pelvic Radiation. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1706] [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: 10/31/2022]
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Presley C, Grogan M, Hoyd R, Compston A, Hock K, Knauss B, Redder E, Arrato N, Lo S, Benedict J, Janse S, Hayes S, Williams N, Wheeler C, Carbone D, Paskett E, Andersen B, Spakowicz D. Resiliency among Older Adults Receiving Lung Cancer Treatment (ROAR-LCT, NCT04229381): The feasibility of a novel supportive care intervention with collection of longitudinal gut microbiome specimens and activity tracking during the COVID-19 Pandemic. J Geriatr Oncol 2022. [DOI: 10.1016/s1879-4068(22)00320-4] [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: 11/07/2022]
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Garfield SF, Wheeler C, Etkind M, Ogunleye D, Williams M, Boucher C, Taylor A, Norton J, Lloyd J, Grimes T, Kelly D, Franklin BD. Providing pharmacy support to housebound patients: learning from the COVID-19 pandemic. International Journal of Pharmacy Practice 2022. [PMCID: PMC9383631 DOI: 10.1093/ijpp/riac019.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Introduction Housebound patients may face challenges to their medicines management due to reduced household mobility and potential lack of access to healthcare services. Previous literature has explored the medication-related needs of housebound patients from pharmacists’ perspectives (1-2). However little work has focussed on the patient/family perspective. In this study, we used data obtained from those staying at home as much as possible during the COVID-19 pandemic to fill this gap. Aim To explore home medicine practices and safety for people who were housebound during the COVID19 pandemic and to create guidance, from the patient/family perspective, for enabling pharmacists to facilitate safe medicine practices for this population. Methods Interviews were carried out with people who were taking at least one long term medication and met the criteria for ‘shielding’ and/or were over 70 years of age during the first wave of the COVID-19 pandemic in the UK and/or their family carers. Respondents were recruited through patient and public involvement representatives, the research team’s networks, and support groups. Potential participants were approached via personal contact and social media. Interviews were conducted by telephone or video conferencing and participants asked about their medicines management while staying at home. Inductive thematic analysis was carried out. Patient and public involvement representatives were involved in the data analysis alongside the researchers. Results Fifty people were interviewed (16 males, 34 females; mean age 68 years, range 26–93 years). Interview data suggested diversity of experiences of medicines management while staying at home. Some respondents reported no or little change, others an initial crisis followed by re-stabilisation, and others that the pandemic was a tipping point, exacerbating underlying challenges and having negative effects on their health and wellbeing. Medicine safety issues reported included omitted doses and less-effective formulations being used. Participants also described experiencing high levels of anxiety related to obtaining medicines, monitoring medicines and feeling at risk of contracting COVID-19 while accessing medicine-related healthcare services. Key factors identified as facilitating a smooth transition included patients’ own agency, support from family, friends and community, good communication with pharmacy staff, continuity of pharmacy services and synchronisation of medicines supply so that a maximum of one collection/delivery was required each month. Conclusion The study findings that we have presented relate to the UK only; this may limit the generalisability of our findings to other countries. Findings from Ireland are in the process of being analysed and will provide a basis of comparison. In addition, more females took part than males, despite efforts to address this. However, our findings suggest pharmacy staff can support medicines management for people who are housebound by synchronisation of medicines supply, delivering medicines where possible, developing/raising awareness of alternative means of communication, providing continuity of pharmacy services and signposting any community support available. References (1) Kayyali R, Funnell G, Harrap N, Patel A. Can community pharmacy successfully bridge the gap in care for housebound patients? Research in Social and Administrative Pharmacy 2019;15:425-439. (2) Latif A, Mandane B, Anderson E, Barraclough C, Travis S. Optimizing medicine use for people who are homebound: an evaluation of a pilot domiciliary Medicine Use Review (dMUR) service in England. Integr Pharm Res Pract 2018;7:33-40.
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Affiliation(s)
- S F Garfield
- UCL School of Pharmacy, UCL, London, UK
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College, London, UK
| | - C Wheeler
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College, London, UK
| | - M Etkind
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
| | - D Ogunleye
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
| | - M Williams
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
| | - C Boucher
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College, London, UK
| | - A Taylor
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College, London, UK
| | - J Norton
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College, London, UK
| | - J Lloyd
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College, London, UK
| | - T Grimes
- The School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Republic of Ireland
| | - D Kelly
- Health Research Institute, University of Limerick
| | - B D Franklin
- UCL School of Pharmacy, UCL, London, UK
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College, London, UK
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Morgan R, Clamp A, Ryder W, Wheeler C, Buckley E, Truelove J, Murphy A, Hasan J, Mitchell C, Burghel G, White D, Price M, Bhaskar S, Shaw J, Dive C, Wallace A, O'Connor J, Rothwell D, Edmondson R, Jayson G. 731P Multi-maintenance olaparib in relapsed, platinum-sensitive BRCA-mutant high-grade serous ovarian carcinoma (MOLTO): A phase II feasibility study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1174] [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] Open
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Werhahn SM, Dathe H, Rottmann T, Franke T, Wheeler C, Fili M, Hasenfuss G, Seidler T. 1106Validity of activity data collected by mobile Apple devices - Testing a new telemedical care concept for patients after hospitalization for heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1106] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S M Werhahn
- Universitätsmedizin Göttingen, Kardiologie, Göttingen, Germany
| | - H Dathe
- Universitätsmedizin Göttingen, Institut für Medizinische Informatik, Göttingen, Germany
| | - T Rottmann
- Universitätsmedizin Göttingen, Institut für Medizinische Informatik, Göttingen, Germany
| | - T Franke
- Universitätsmedizin Göttingen, Institut für Medizinische Informatik, Göttingen, Germany
| | | | - M Fili
- Medopad Ltd, London, United Kingdom
| | - G Hasenfuss
- Universitätsmedizin Göttingen, Kardiologie, Göttingen, Germany
| | - T Seidler
- Universitätsmedizin Göttingen, Kardiologie, Göttingen, Germany
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Bijsmans ES, Jepson RE, Wheeler C, Syme HM, Elliott J. Plasma N-Terminal Probrain Natriuretic Peptide, Vascular Endothelial Growth Factor, and Cardiac Troponin I as Novel Biomarkers of Hypertensive Disease and Target Organ Damage in Cats. J Vet Intern Med 2017; 31:650-660. [PMID: 28387019 PMCID: PMC5435049 DOI: 10.1111/jvim.14655] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 06/20/2016] [Revised: 10/06/2016] [Accepted: 12/12/2016] [Indexed: 12/22/2022] Open
Abstract
Background In the absence of ocular target organ damage (ocular‐TOD), diagnosis of hypertension is challenging in cats. Biomarkers would provide additional support for the diagnosis of hypertension. Hypothesis Vascular endothelial growth factor (VEGF), N‐terminal probrain natriuretic peptide (NT‐proBNP), cardiac troponin I (cTnI), and urine protein‐to‐creatinine ratio (UPC) are predictors of systemic hypertension, will be increased in cats with hypertension with or without ocular‐TOD, and will decrease with antihypertensive treatment. Methods Plasma VEGF, NT‐proBNP, and cTnI concentrations and UPC were determined in healthy geriatric cats, normotensive cats with chronic kidney disease (CKD), hypertensive cats with evidence of hypertensive retinopathy (HT‐ocular‐TOD), and hypertensive cats without hypertensive ocular‐TOD (HT‐noTOD). Comparisons among groups were performed. Multivariable binary logistic regression models were built to identify independent biomarkers of hypertension and ocular‐TOD. Receiver operator characteristic (ROC) curves were drawn to assess clinical use. Results Cats with HT‐ocular‐TOD had significantly higher VEGF than all other groups (P < .05) and significantly higher NT‐proBNP than healthy cats (P < .001). Healthy cats had significantly lower cTnI than all other groups (P < .05). No differences were found among groups for UPC (P = .08). Cardiac troponin I and VEGF were independent predictors of hypertension (P < .05), but none of the biomarkers were independent predictors of ocular‐TOD. N‐terminal probrain natriuretic peptide concentrations decreased with antihypertensive treatment (P < .001). The ROC curves indicated that none of the biomarkers met the criteria to function as diagnostic tests for the diagnosis of hypertension or associated ocular‐TOD. Conclusions and Clinical Significance Despite statistical significance and changes with ocular‐TOD, antihypertensive treatment, or both, VEGF, NT‐proBNP, and cTnI did not function as useful diagnostic tests for hypertension. Persistently increased systolic blood pressure (SBP) measurements in combination with fundoscopy remains the preferred method for diagnosis of feline hypertension.
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Affiliation(s)
- E S Bijsmans
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London, UK
| | - R E Jepson
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - C Wheeler
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London, UK
| | - H M Syme
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - J Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London, UK
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Huguelet PS, Browner-Elhanan KJ, Fleming N, Karjane NW, Loveless M, Sheeder J, Talib HJ, Wheeler C, Kaul P. Does the North American Society for Pediatric and Adolescent Gynecology Short Curriculum Increase Resident Knowledge in Pediatric and Adolescent Gynecology? J Pediatr Adolesc Gynecol 2016; 29:623-627. [PMID: 27216709 DOI: 10.1016/j.jpag.2016.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/18/2016] [Accepted: 05/06/2016] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To determine if the North American Society for Pediatric and Adolescent Gynecology (NASPAG) Short Curriculum improves self-reported knowledge in pediatric and adolescent gynecology (PAG) among obstetrics and gynecology (Ob/Gyn) residents, at programs without PAG-trained faculty. DESIGN Prospective, cross-sectional exposure to the NASPAG short curriculum with a follow-up questionnaire. SETTING Ob/Gyn residency training programs without PAG faculty. PARTICIPANTS Ob/Gyn residents in training from February 2015 to June 2015. INTERVENTIONS Exposure to the NASPAG Short Curriculum. MAIN OUTCOME MEASURES Improvement in self-perceived knowledge after completion of curriculum. RESULTS Two hundred twenty-seven residents met inclusion criteria; 34 completed the study (15% response). Less than 50% of residents reported adequate knowledge in the areas of prepubertal vaginal bleeding, vulvovaginitis, precocious and delayed puberty, Home environment, Education and Employment, Eating, peer-related Activities, Drugs, Sexuality, Suicide/depression, Safety from injury and violence (HEEADSSS) interview, pelvic pain, and bleeding management in teens with developmental delay. After completion of the curriculum, self-reported knowledge improved in 8 of 10 learning objectives, with no significant improvement in bleeding disorders or Müllerian anomalies. There was no association between pretest knowledge and level of residency training, type of residency program, previous exposure to PAG lectures, and previous exposure to patients with PAG complaints. CONCLUSION Significant deficiencies exist regarding self-reported knowledge of core PAG topics among Ob/Gyn residents at programs without PAG-trained faculty. Use of the NASPAG Short Curriculum by residents without access to PAG-trained faculty resulted in improved self-reported knowledge in PAG.
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Affiliation(s)
- P S Huguelet
- Pediatric and Adolescent Gynecology, Children's Hospital Colorado, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado.
| | - K J Browner-Elhanan
- Division of Adolescent Medicine, Children's Hospital, Memorial University Medical Center, Savannah, Georgia
| | - N Fleming
- Pediatric and Adolescent Gynecology, Children's Hospital of Eastern Ontario, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - N W Karjane
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia
| | - M Loveless
- Pediatric and Adolescent Gynecology, Kosair Children's Hospital, Louisville, Kentucky
| | - J Sheeder
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - H J Talib
- Division of Adolescent Medicine, Children's Hospital at Montefiore, Albert Einstein College of Medicine, The Bronx, New York City, New York
| | - C Wheeler
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - P Kaul
- Division of Adolescent Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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Lewis M, McAndrew M, Wheeler C, Workman N, Agashe P, Koopmann J, Uddin E, Zou L, Stark R, Anson J, Cope A, Vyse T. THU0249 Functional Clusters of Autoantibodies Targeting TLR and Smad Pathways Define New Subgroups in Systemic Lupus Erythematosus. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.6111] [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: 11/04/2022]
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Campian J, Gladstone D, Ambady P, Ye X, King K, Borrello I, Petrik S, Golightly M, Holdhoff M, Grossman S, Bhardwaj R, Chakravadhanula M, Ozols V, Georges J, Carlson E, Hampton C, Decker W, Chiba Y, Hashimoto N, Kagawa N, Hirayama R, Tsuboi A, Oji Y, Oka Y, Sugiyama H, Yoshimine T, Choi B, Gedeon P, Herndon J, Sanchez-Perez L, Mitchell D, Bigner D, Sampson J, Choi YA, Pandya H, Gibo DM, Debinski W, Cloughesy TF, Liau LM, Chiocca EA, Jolly DJ, Robbins JM, Ostertag D, Ibanez CE, Gruber HE, Kasahara N, Vogelbaum MA, Kesari S, Mikkelsen T, Kalkanis S, Landolfi J, Bloomfield S, Foltz G, Pertschuk D, Everson R, Jin R, Safaee M, Lisiero D, Odesa S, Liau L, Prins R, Gholamin S, Mitra SS, Richard CE, Achrol A, Kahn SA, Volkmer AK, Volkmer JP, Willingham S, Kong D, Shin JJ, Monje-Deisseroth M, Cho YJ, Weissman I, Cheshier SH, Kanemura Y, Sumida M, Yoshioka E, Yamamoto A, Kanematsu D, Takada A, Nonaka M, Nakajima S, Goto S, Kamigaki T, Takahara M, Maekawa R, Shofuda T, Moriuchi S, Yamasaki M, Kebudi R, Cakir FB, Gorgun O, Agaoglu FY, Darendeliler E, Lin Y, Wang Y, Qiu X, Jiang T, Lin Y, Wang Y, Jiang T, Zhang G, Wang J, Okada H, Butterfield L, Hamilton R, Drappatz J, Engh J, Amankulor N, Lively M, Chan M, Salazar A, Potter D, Shaw E, Lieberman F, Pandya H, Choi Y, Park J, Phuphanich S, Wheeler C, Rudnick J, Hu J, Mazer M, Wang H, Nuno M, Guevarra A, Sanchez C, Fan X, Ji J, Chu R, Bender J, Hawkins E, Black K, Yu J, Reap E, Archer G, Sanchez-Perez L, Norberg P, Schmittling R, Nair S, Cui X, Snyder D, Chandramohan V, Choi B, Kuan CT, Mitchell D, Bigner D, Yan H, Sampson J, Reardon D, Li G, Recht L, Fink K, Nabors L, Tran D, Desjardins A, Chandramouli N, Duic JP, Groves M, Clarke A, Hawthorne T, Green J, Yellin M, Sampson J, Rigakos G, Spyri O, Nomikos P, Stavridi F, Grossi I, Theodorakopoulou I, Assi A, Kouvatseas G, Papadopoulou E, Nasioulas G, Labropoulos S, Razis E, Rudnick J, Ravi A, Sanchez C, Tang DN, Hu J, Yu J, Sharma P, Black K, Sengupta S, Sampath P, Soto H, Erickson K, Malone C, Hickey M, Ha E, Young E, Ellingson B, Prins R, Liau L, Kruse C, Sul J, Hilf N, Kutscher S, Schoor O, Lindner J, Reinhardt C, Kreisl T, Iwamoto F, Fine H, Singh-Jasuja H, Teijeira L, Gil-Arnaiz I, Hernandez-Marin B, Martinez-Aguillo M, Sanchez SDLC, Viudez A, Hernandez-Garcia I, Lecumberri MJ, Grandez R, de Lascoiti AF, Garcia RV, Thomas A, Fisher J, Baron U, Olek S, Rhodes H, Gui J, Hampton T, Tafe L, Tsongalis G, Lefferts J, Wishart H, Kleen J, Miller M, Ernstoff M, Fadul C, Vlahovic G, Desjardins A, Peters K, Ranjan T, Herndon J, Friedman A, Friedman H, Bigner D, Archer G, Lally-Goss D, Sampson J, Wainwright D, Dey M, Chang A, Cheng Y, Han Y, Lesniak M, Weller M, Kaulich K, Hentschel B, Felsberg J, Gramatzki D, Pietsch T, Simon M, Westphal M, Schackert G, Tonn JC, Loeffler M, Reifenberger G, Yu J, Rudnick J, Hu J, Phuphanich S, Mazer M, Wang H, Xu M, Nuno M, Patil C, Chu R, Black K, Wheeler C. IMMUNOTHERAPY/BIOLOGICAL THERAPIES. Neuro Oncol 2013; 15:iii68-iii74. [PMCID: PMC3823893 DOI: 10.1093/neuonc/not178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
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Lindsay JO, Chipperfield R, Giles A, Wheeler C, Orchard T. A UK retrospective observational study of clinical outcomes and healthcare resource utilisation of infliximab treatment in Crohn's disease. Aliment Pharmacol Ther 2013; 38:52-61. [PMID: 23701393 DOI: 10.1111/apt.12339] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 01/05/2013] [Accepted: 04/30/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Crohn's disease (CD) places a substantial burden on healthcare systems, with the majority of costs arising from hospitalisation and surgery. AIM To evaluate the 'real-world' clinical effectiveness, impact on healthcare utilisation and cost of infliximab for the treatment of CD in UK practice. METHODS A non-interventional, retrospective analysis of medical records from patients with CD treated with infliximab at 18 hospital centres across the UK. The primary objective was to compare cumulative clinical outcomes and healthcare resource utilisation for the 0- to 24-month post-infliximab period with the 12 months preceding infliximab treatment. Predefined outcomes included the number of elective surgical procedures, hospitalisations and healthcare provider consultations. Costs associated with healthcare utilisation were collected from the perspective of the UK National Health Service (NHS). RESULTS The study involved 380 patients. Infliximab significantly reduced the mean number of elective (from 0.18 to 0.11; P = 0.0035) and non-elective (from 0.46 to 0.29; P < 0.0001) hospitalisations, and the number of consultations with gastroenterologists, gastrointestinal surgeons and radiologists (from 4.0 to 3.5, from 0.7 to 0.5 and from 0.5 to 0.2, respectively; all P < 0.001); all decreases were associated with significant cost reductions. The mean number of elective surgical procedures (including correction of severe anal fistulae and abscess drainage) was significantly reduced. CONCLUSIONS The observed reductions in numbers of hospitalisations, surgical procedures and consultations with healthcare professionals are key indicators of the clinical effectiveness of infliximab for the treatment of CD. These benefits result in overall decreases in healthcare resource utilisation, which translate into cost savings for the NHS.
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Affiliation(s)
- J O Lindsay
- Digestive Diseases Clinical Academic Unit, Barts Health NHS Trust and Barts and the London School of Medicine, Queen Mary University of London, London, UK.
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McAndrew M, Wheeler C, Koopmann J, Uddin E, Lewis M, Vyse T. SAT0528 Novel Autoantibody Biomarkers for the Improved Diagnosis of Systemic Lupus Erythematosus. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gore M, Bellmunt J, Eisen T, Escudier B, Mickisch G, Patard J, Porta C, Ravaud A, Schmidinger M, Schöffski P, Sternberg C, Szczylik C, De Nigris E, Wheeler C, Kirpekar S. Evaluation of treatment options for patients with advanced renal cell carcinoma: Assessment of appropriateness, using the validated semi-quantitative RAND corporation/University of California, Los Angeles methodology. Eur J Cancer 2012; 48:1038-47. [DOI: 10.1016/j.ejca.2012.02.058] [Citation(s) in RCA: 15] [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] [Received: 02/15/2012] [Accepted: 02/19/2012] [Indexed: 12/18/2022]
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Loharikar A, Newton A, Rowley P, Wheeler C, Bruno T, Barillas H, Pruckler J, Theobald L, Lance S, Brown JM, Barzilay EJ, Arvelo W, Mintz E, Fagan R. Typhoid Fever Outbreak Associated With Frozen Mamey Pulp Imported From Guatemala to the Western United States, 2010. Clin Infect Dis 2012; 55:61-6. [DOI: 10.1093/cid/cis296] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hickey MJ, Malone CK, Erickson KL, Gerschenson LE, Lin AH, Inagaki A, Hiraoka K, Kasahara N, Mueller B, Kruse CA, Kong S, Tyler B, Zhou J, Carter BS, Brem H, Junghans RP, Sampath P, Lai RK, Recht LD, Reardon DA, Paleologos N, Groves M, Rosenfeld MR, Davis T, Green J, Heimberger A, Sampson J, Hashimoto N, Tsuboi A, Chiba Y, Kijima N, Oka Y, Kinoshita M, Kagawa N, Fujimoto Y, Sugiyama H, Yoshimine T, Birks SM, Burnet M, Pilkington GJ, Yu JS, Wheeler CJ, Rudnick J, Mazer M, Wang HQ, Nuno MA, Richardson JE, Fan X, Ji J, Chu RM, Bender JG, Hawkins EW, Black KL, Phuphanich S, Pollack IF, Jakacki RI, Butterfield LH, Okada H, Hunt MA, Pluhar GE, Andersen BM, Gallardo JL, Seiler CO, SantaCruz KS, Ohlfest JR, Bauer DF, Lamb LS, Harmon DK, Zheng X, Romeo AK, Gillespie GY, Parker JN, Markert JM, Jacobs VL, Landry RP, De Leo JA, Bromberg JE, Doorduijn J, Baars JW, van Imhoff GW, Enting R, van den Bent MJ, Murphy KA, Bedi J, Epstein A, Ohlfest JR, Olin M, Andersen B, Swier L, Ohlfest J, Litterman AJ, Zellmer DM, Ohlfest JR, Chiocca EA, Aguilar LK, Aguilar-Cordova E, Manzanera AG, Harney KR, Portnow J, Badie B, Lesniak M, Bell S, Ray-Chaudhuri A, Kaur B, Hardcastle J, Cavaliere R, McGregor J, Lo S, Chakarvarti A, Grecula J, Newton H, Trask TW, Baskin DS, New PZ, Zeng J, See AP, Phallen J, Belcaid Z, Durham N, Meyer C, Albesiano E, Pradilla G, Ford E, Hammers H, Tyler B, Brem H, Tran PT, Pardoll D, Drake CG, Lim M, Ghazi A, Ashoori A, Hanley P, Salsman V, Schaffer DR, Grada Z, Kew Y, Powell SZ, Grossman R, Scheurer ME, Leen AM, Rooney CM, Bollard CM, Heslop HE, Gottschalk S, Ahmed N, Hu J, Patil C, Nuno M, Wheeler C, Rudnick J, Phuphanich S, Mazer M, Wang HQ, Chu R, Black K, Yu J, Marabelle A, Kohrt H, Brody J, Luong R, Tse V, Levy R, Li YM, Jun H, Shahryar M, Daniel VA, Walter HA, Thaipisuttikul I, Avila E, Mitchell DA, Archer GE, Friedman HS, Herndon JE, Bigner DD, Sampson JH, Johnson LA, Archer GE, Nair SK, Schmittling R, Reap E, Sampson JH, Mitchell DA, Li YM, Shahryar M, Jun H, Daniel VA, Walter HA, Knisely JP, Kluger H, Flanigan J, Sznol M, Yu JB, Chiang VL, Prins RM, Kim W, Soto H, Lisiero DN, Lisiero DN, Liau LM. IMMUNOTHERAPY. Neuro Oncol 2011; 13:iii34-iii40. [PMCID: PMC3199174 DOI: 10.1093/neuonc/nor151] [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: 09/21/2023] Open
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Gore M, Bellmunt J, Eisen T, Mickisch G, Patard J, Porta C, Ravaud A, Schmidinger M, Sternberg C, Szczylik C, De Nigris E, Kirpekar S, Wheeler C. 7114 POSTER DISCUSSION Appropriateness of Treatment Options for the Management of Patients With Advanced Renal Cell Carcinoma (RCC) Using the Validated Semi Quantitative RAND Corporation/University of California, Los Angeles (RAND/UCLA) Methodology. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72029-9] [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: 10/17/2022]
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Wheeler C, Said H, Prucz R, Rohrich R, Mathes D. Erratum. Aesthet Surg J 2011. [DOI: 10.1177/1090820x11415828] [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] Open
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Martin SI, Dodson B, Wheeler C, Davis J, Pesavento T, Bumgardner GL. Monitoring infection with Epstein-Barr virus among seromismatch adult renal transplant recipients. Am J Transplant 2011; 11:1058-63. [PMID: 21449943 DOI: 10.1111/j.1600-6143.2011.03478.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Patients who undergo Epstein-Barr virus (EBV) seromismatch (D+/R-) transplants have a higher risk for the development of post-transplant lymphoproliferative disorder (PTLD). Adult renal transplant recipients at a single institution were prospectively monitored for EBV during the first year post-transplant. Over a 2-year period, 34 patients (7.78%) were identified as being EBV D+/R-recipients. Patients who developed symptoms or had persistent viremia were pre-emptively administered rituximab. Six recipients were discharged without monitoring on the protocol. Of those six, three (50%) developed PTLD and all three lost their grafts. Twenty (60.6%) of the 34 recipients developed viremia during the first year post-transplant. Of the recipients who became viremic, six (30%) received rituximab. None of the six who received rituximab-developed PTLD. We found that recipients who were not monitored on the protocol were more likely to have PTLD and graft loss compared to those who were (p = 0.008). Post-transplant monitoring of adults who undergo EBV D+/R-kidney transplants for viremia and symptoms associated with EBV infection may prompt intervention which reduces the incidence of PTLD within the first year. Use of rituximab in preventing PTLD among patients with primary EBV infection requires further prospective study to determine its overall safety and efficacy.
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Affiliation(s)
- S I Martin
- Division of Infectious Diseases and The Comprehensive Transplant Center, The Ohio State University Medical Center, Columbus, OH, USA.
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Phuphanich S, Rudnick J, Mazer M, Wang HQ, Serrano N, Richardson J, Wheeler C, Singh M, Black K, Yu J. Immune response correlation with progression-free survival in glioblastoma following dendritic cell immunotherapy (ICT-107). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.2097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Miller W, Wheeler C, Panoskaltsis-Mortari A, Kirk A, Larsen C, Blazar B, Kean L. Prevention Of Acute GvHD During MHC Haploidentical HSCT: Evaluating The Efficacy Of T-Cell Costimulation Blockade Using A Novel Rhesus Macaque Transplant Model. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.054] [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: 10/19/2022]
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Phuphanich S, Rudnick J, Chu R, Mazer M, Wang H, Serrano N, Francisco M, Wheeler C, Singh M, Yu JS. A phase I trial of tumor-associated antigen-pulsed dendritic cell immunotherapy for patients with brain stem glioma and glioblastoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.2032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2032 Background: Previous immunotherapy trials for malignant glioma (Yu, J.,et al, Cancer Res. 2001;61:842–7 and 2004;64;4973–9) have demonstrated efficacy in generating a tumor specific immune response. Here we set out to determine feasibility and immunogenecity of dendritic vaccination with specific glioma-associated antigens. Methods: The goal of this study is to use tumor associated antigens (TAA) known to be expressed on gliomas and pulse dendritic cells with these antigens in an MHC compatible fashion using epitopes of HER-2, TRP-2, gp100, MAGE-1, IL13R alpha, and AIM-3. In this phase I trial, HLA-A1 and/or HLA-A2-positive patients with newly diagnosed or recurrent glioblastoma were eligible. Leukapheresis was used to isolate mononuclear cells which were differentiated into dendritic cells in culture, pulsed with tumor peptide, and then administered intradermally three times at 2-week intervals. Results: Twenty patients, 15 males and five females, were enrolled between November 2006 and December 2008 with one screen failure. The median patient age was 47 years (range: 26–65) and patients had a median Karnofsky performance status of 90% (range: 90–100). There were 16 newly diagnosed and three recurrent glioblastoma multiforme (GBM) patients, who underwent surgery prior to vaccination. Our data on 19 patients and 54 courses of dendritic cell vaccines demonstrate zero grade 3 /4 toxicities that were attributable to the vaccination. Thirteen patients continue to have stable disease (ranging from 15 to 115 weeks), six patients have demonstrated tumor progression. Median survival from surgery was 60 weeks (ranging from 26 to 115 weeks). Of 15 patients tested to date, six patients demonstrated an antigen-specific cytotoxic T-cell response to at least one antigen after vaccination. Only 17% of CTL responders (1/6) demonstrated tumor progression compared to 56% (5/9) of nonresponders to date. Conclusions: This phase I study demonstrated the feasibility, safety, and bioactivity of a TAA-pulsed dendritic cell vaccine for patients with glioblastoma progression free survival correlated with CTL response. [Table: see text]
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Affiliation(s)
- S. Phuphanich
- Cedars-Sinai Medical Center, Los Angeles, CA; Immunocellular Therapeutics Ltd., Woodland Hills, CA
| | - J. Rudnick
- Cedars-Sinai Medical Center, Los Angeles, CA; Immunocellular Therapeutics Ltd., Woodland Hills, CA
| | - R. Chu
- Cedars-Sinai Medical Center, Los Angeles, CA; Immunocellular Therapeutics Ltd., Woodland Hills, CA
| | - M. Mazer
- Cedars-Sinai Medical Center, Los Angeles, CA; Immunocellular Therapeutics Ltd., Woodland Hills, CA
| | - H. Wang
- Cedars-Sinai Medical Center, Los Angeles, CA; Immunocellular Therapeutics Ltd., Woodland Hills, CA
| | - N. Serrano
- Cedars-Sinai Medical Center, Los Angeles, CA; Immunocellular Therapeutics Ltd., Woodland Hills, CA
| | - M. Francisco
- Cedars-Sinai Medical Center, Los Angeles, CA; Immunocellular Therapeutics Ltd., Woodland Hills, CA
| | - C. Wheeler
- Cedars-Sinai Medical Center, Los Angeles, CA; Immunocellular Therapeutics Ltd., Woodland Hills, CA
| | - M. Singh
- Cedars-Sinai Medical Center, Los Angeles, CA; Immunocellular Therapeutics Ltd., Woodland Hills, CA
| | - J. S. Yu
- Cedars-Sinai Medical Center, Los Angeles, CA; Immunocellular Therapeutics Ltd., Woodland Hills, CA
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Rudnick JD, Phuphanich S, Chu R, Mazer M, Wang H, Serrano N, Francisco M, Black KL, Wheeler C, Yu J. A phase I trial of surgical resection with biodegradable carmustine (BCNU) wafer placement followed by vaccination with dendritic cells pulsed with tumor lysate for patients with malignant glioma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.2033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2033 Background: Our prior immunotherapy trials demonstrated efficacy in generating a tumor specific immune response in malignant glioma and the potential for high tumor-specific toxicity and sustained tumoricidal activity. Immunotherapy may synergize with chemotherapy and biodegradable carmustine (BCNU) wafers extend overall survival from 11.6 to 13.9 months. Methods: We exploited this synergistic effect to maintain a cytotoxic environment around the tumor milieu. Patients with high-grade glioma were eligible after maximal resection with biodegradable carmustine (BCNU) wafer placement. Screening leukapheresis is used to isolate mononuclear cells which are differentiated into dendritic cells, pulsed with tumor lysate, and then 3 intradermal vaccines are administered at 2-week intervals. Patients continued systemic chemotherapy after vaccine or at progression. Results: Eighteen patients have been enrolled (7 Male, 11 Female) between April 2007 and February 2009 with one screen failure and two patients with clinical progression prior to vaccination. The median patient age was 57 years (26 to 74 ) and median Karnofsky performance status was 90% (80–100). The histology included 3 newly diagnosed glioblastoma multiforme (GBM), 8 recurrent GBM, 2 newly diagnosed anaplastic astrocytoma (AA), and 2 recurrent AA. 15 patients were successfully treated by vaccine injections with 12 patients receiving vaccine every 2 weeks x 3 followed by adjuvant chemotherapy. Our preliminary data on 15 patients and 39 courses of Dendritic Cell vaccines demonstrate one grade 3 toxicity of fever/chest pain. A stable disease interval of 13 to 90 weeks was observed for patients who received vaccine. The 3 newly diagnosed GBM patients have stable disease (18 to 71 weeks). In the recurrent GBM cohort 7/8 patients had progression within 6 months from the post-vaccination MRI. Conclusions: This phase I study demonstrates the safety, feasibility of dendritic cell vaccination with biodegradable carmustine (BCNU) wafers with one grade 3 AE. Immunological data is pending to determine potential synergy of dendritic cell vaccination with intracranial chemotherapy. No significant financial relationships to disclose.
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Affiliation(s)
| | | | - R. Chu
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - M. Mazer
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - H. Wang
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - N. Serrano
- Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - K. L. Black
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - C. Wheeler
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - J. Yu
- Cedars-Sinai Medical Center, Los Angeles, CA
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Wheeler C, Vugia DJ, Thomas G, Beach MJ, Carnes S, Maier T, Gorman J, Xiao L, Arrowood MJ, Gilliss D, Werner SB. Outbreak of cryptosporidiosis at a California waterpark: employee and patron roles and the long road towards prevention. Epidemiol Infect 2007; 135:302-10. [PMID: 17291365 PMCID: PMC2870568 DOI: 10.1017/s0950268806006777] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2006] [Indexed: 11/06/2022] Open
Abstract
In August-September 2004, a cryptosporidiosis outbreak affected >250 persons who visited a California waterpark. Employees and patrons of the waterpark were affected, and three employees and 16 patrons admitted to going into recreational water while ill with diarrhoea. The median illness onset date for waterpark employees was 8 days earlier than that for patrons. A case-control study determined that getting water in one's mouth on the waterpark's waterslides was associated with illness (adjusted odds ratio 7.4, 95% confidence interval 1.7-32.2). Laboratory studies identified Cryptosporidium oocysts in sand and backwash from the waterslides' filter, and environmental investigations uncovered inadequate water-quality record keeping and a design flaw in one of the filtration systems. Occurring more than a decade after the first reported outbreaks of cryptosporidiosis in swimming pools, this outbreak demonstrates that messages about healthy swimming practices have not been adopted by pool operators and the public.
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Affiliation(s)
- C Wheeler
- Epidemic Intelligence Service assigned to the California Department of Health Services, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Bowler RP, Hokanson J, Taylor M, Levy S, Canaham EM, Regan E, Wheeler C, Nicks M, Chan E, Crapo JD. Extracellular superoxide dismutase (EC-SOD) as a protective factor for risk of chronic obstructive pulmonary disease. Eur Respir Rev 2006. [DOI: 10.1183/09059180.00010117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Holden SN, Eckhardt SG, Basser R, de Boer R, Rischin D, Green M, Rosenthal MA, Wheeler C, Barge A, Hurwitz HI. Clinical evaluation of ZD6474, an orally active inhibitor of VEGF and EGF receptor signaling, in patients with solid, malignant tumors. Ann Oncol 2005; 16:1391-7. [PMID: 15905307 DOI: 10.1093/annonc/mdi247] [Citation(s) in RCA: 259] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND ZD6474 selectively inhibits the tyrosine kinase activity of vascular endothelial growth factor receptor and epidermal growth factor receptor. The safety, tolerability and pharmacokinetics of ZD6474 were assessed in a phase I dose-escalation study of patients with advanced solid tumors. PATIENTS AND METHODS Adult patients with tumors refractory to standard treatments received once-daily oral ZD6474 (50-600 mg) in 28-day cycles, until disease progression or unacceptable toxicity was observed. RESULTS Seventy-seven patients were treated at doses of 50 mg (n=9), 100 mg (n=19), 200 mg (n=8), 300 mg (n=25), 500 mg (n=8), and 600 mg (n=8). Adverse events were generally mild, and the most common dose-limiting toxicities (DLT) were diarrhea (n=4), hypertension (n=4), and rash (n=3). The incidence of most adverse events appeared to be dose-dependant. In the 500 mg/day cohort, 3/8 patients experienced DLT and this dose was therefore considered to exceed the maximum tolerated dose. Pharmacokinetic analysis confirmed that ZD6474 was suitable for once-daily oral dosing. CONCLUSIONS Once-daily oral dosing of ZD6474 at 300 mg/day is generally well tolerated in patients with advanced solid tumors, and this dose is being investigated in phase II trials.
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Affiliation(s)
- S N Holden
- University of Colorado Cancer Center, Aurora, CO, USA.
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Lambert N, Plumb J, Looise B, Johnson IT, Harvey I, Wheeler C, Robinson M, Rolfe P. Using smart card technology to monitor the eating habits of children in a school cafeteria: 1. Developing and validating the methodology. J Hum Nutr Diet 2005; 18:243-54. [PMID: 16011560 DOI: 10.1111/j.1365-277x.2005.00617.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the study was to test the feasibility of using smart card technology to track the eating behaviours of nearly a thousand children in a school cafeteria. METHODS Within a large boys' school a smart card based system was developed that was capable of providing a full electronic audit of all the individual transactions that occurred within the cafeteria. This dataset was interfaced to an electronic version of the McCance and Widdowson composition of foods dataset. The accuracy of the smart card generated data and the influence of portion size and wastage were determined empirically during two 5-day trials. RESULTS The smart card system created succeeded in generating precise data on the food choices made by hundreds of children over an indefinite time period. The data was expanded to include a full nutrient analysis of all the foods chosen. The accuracy of this information was only constrained by the limitations facing all food composition research, e.g. variations in recipes, portion sizes, cooking practices, etc. Although technically possible to introduce wastage correction factors into the software, thereby providing information upon foods consumed, this was not seen as universally practical. CONCLUSION The study demonstrated the power of smart card technology for monitoring food/nutrient choice over limitless time in environments such as school cafeterias. The strengths, limitations and applications of such technology are discussed.
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Affiliation(s)
- N Lambert
- Institute of Food Research, Norwich Research Park, Colney, Norwich, UK.
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Lambert N, Plumb J, Looise B, Johnson IT, Harvey I, Wheeler C, Robinson M, Rolfe P. Using smart card technology to monitor the eating habits of children in a school cafeteria: 3. The nutritional significance of beverage and dessert choices. J Hum Nutr Diet 2005; 18:271-9. [PMID: 16011563 DOI: 10.1111/j.1365-277x.2005.00619.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 12/23/2022]
Abstract
OBJECTIVE The consumption patterns of beverages and desserts features highly in the current debate surrounding children's nutrition. The aim of this study was to continuously monitor the choice of beverages and desserts made by nearly 1000 children in a school cafeteria. METHODS A newly developed smart card system was used to monitor the food choices of diners (7-16-year-old boys) in a school cafeteria over 89 days. A wide variety of beverages and desserts were on offer daily. RESULTS Despite coming from an affluent, well-educated demographic group, the boys' choices of beverages and desserts mirrored those of children in general. Buns and cookies were over 10 times more popular than fresh fruits and yogurts. Sugary soft-drinks were over 20 times more popular than fresh fruit drinks and milk combined. Appropriate choices could, over a month, reduce intake of added sugar by over 800 g and fat by over 200 g. CONCLUSION The smart card system was very effective at monitoring total product choices for nearly 1000 diners. In agreement with a recent national school meal survey, where choice is extensive, children show a preference for products high in fat and/or sugar. The consequences of these preferences are discussed.
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Affiliation(s)
- N Lambert
- Institute of Food Research, Norwich Research Park, Colney, Norwich, UK.
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Lambert N, Plumb J, Looise B, Johnson IT, Harvey I, Wheeler C, Robinson M, Rolfe P. Using smart card technology to monitor the eating habits of children in a school cafeteria: 2. The nutrient contents of all meals chosen by a group of 8- to 11-year-old boys over 78 days. J Hum Nutr Diet 2005; 18:255-65; quiz 267-9. [PMID: 16011561 DOI: 10.1111/j.1365-277x.2005.00618.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the study was to test the abilities of the newly created smart card system to track the nutrient contents of foods chosen over several months by individual diners in a school cafeteria. METHODS From the food choice and composition of food data sets, an Access database was created encompassing 30 diners (aged 8-11 years), 78 days and eight nutrients. Data were available for a total of 1909 meals. RESULTS Based upon population mean values the cohort were clearly choosing meals containing higher than the recommended maximum amounts for sugar and lower than the recommended minimum amounts of fibre, iron and vitamin A. Protein and vitamin C contents of meals chosen were well above minimum requirements. Over the 1909 meals, nutrient requirements were met 41% of the time. CONCLUSIONS The system created was very effective at continually monitoring food choices of individual diners over limitless time. The data generated raised questions on the common practice of presenting nutrient intakes as population mean values calculated over a few days. The impact of heavily fortified foods on such studies in general is discussed.
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Affiliation(s)
- N Lambert
- Institute of Food Research, Norwich Research Park, Colney, Norwich, UK.
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Fallone CA, Barkun AN, Mayrand S, Wakil G, Friedman G, Szilagyi A, Wheeler C, Ross D. There is no difference in the disease severity of gastro-oesophageal reflux disease between patients infected and not infected with Helicobacter pylori. Aliment Pharmacol Ther 2004; 20:761-8. [PMID: 15379836 DOI: 10.1111/j.1365-2036.2004.02171.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The role of Helicobacter pylori in gastro-oesophageal reflux disease (GERD) is controversial. AIM To compare the severity of GERD in infected vs. non-infected patients, as part of an ongoing randomized controlled trial that examines the impact of H. pylori eradication on GERD-related outcomes. METHODS Consecutive GERD patients underwent urea breath testing and completed validated GERD symptom severity, and quality of life questionnaires as well as, 24-h pH-metry. These parameters, as well as demographics and endoscopic findings were assessed in double-blinded fashion and compared between H. pylori-infected and non-infected subjects. RESULTS Helicobacter pylori-infected GERD patients (n=50) were significantly older and less educated than non-infected patients (n=51). They also used proton pump inhibitors less often but had no difference in symptoms (as measured with both the Spechler's Activity Index and the Gastrointestinal Symptom Rating Scale), quality of life, endoscopic findings or 24-h pH-metry findings. CONCLUSION This prospective, double-blind study demonstrates, using excellent GERD quantifying measures including validated symptom severity scores, endoscopy, and 24-h pH-metry, that there exist no clinically significant differences in clinical or laboratory-related GERD manifestations between H. pylori-infected and non-infected GERD patients.
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Affiliation(s)
- C A Fallone
- Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada.
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Ward E, Hedlund L, Kurylo W, Viglianti B, Wheeler C, Anscher M, Dewhirst M, Marks L, Vujaskovic Z. Hyperpolarized helium MRI assessment of the spatial heterogeneity in lung function with potential relationship to radiation response. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.06.180] [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: 11/27/2022]
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Heymach JV, Dong RP, Dimery I, Wheeler C, Fidias P, Lu C, Johnson B, Herbst R. ZD6474, a novel antiangiogenic agent, in combination with docetaxel in patients with NSCLC: Results of the run-in phase of a two-part, randomized phase II study. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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)
- J. V. Heymach
- Dana-Farber Cancer Institute, Boston, MA; AstraZeneca, Wilmington, DE; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - R.-P. Dong
- Dana-Farber Cancer Institute, Boston, MA; AstraZeneca, Wilmington, DE; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - I. Dimery
- Dana-Farber Cancer Institute, Boston, MA; AstraZeneca, Wilmington, DE; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - C. Wheeler
- Dana-Farber Cancer Institute, Boston, MA; AstraZeneca, Wilmington, DE; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - P. Fidias
- Dana-Farber Cancer Institute, Boston, MA; AstraZeneca, Wilmington, DE; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - C. Lu
- Dana-Farber Cancer Institute, Boston, MA; AstraZeneca, Wilmington, DE; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - B. Johnson
- Dana-Farber Cancer Institute, Boston, MA; AstraZeneca, Wilmington, DE; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - R. Herbst
- Dana-Farber Cancer Institute, Boston, MA; AstraZeneca, Wilmington, DE; University of Texas M. D. Anderson Cancer Center, Houston, TX
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Oliver R, Wheeler C, Langmuir P, Melezinek I, Stone A. Evaluation of the role of body-surface-area dose adjustment of ZD6126, a novel vascular-targeting agent. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3065] [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)
- R. Oliver
- AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Boston, MA
| | - C. Wheeler
- AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Boston, MA
| | - P. Langmuir
- AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Boston, MA
| | - I. Melezinek
- AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Boston, MA
| | - A. Stone
- AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Boston, MA
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Medinger M, Mross K, Zirrgiebel U, Strecker R, Wheeler C, Clack G, Lewis J, Puchalski TA, Unger C, Drevs J. Phase I dose-escalation study of the highly potent VEGF receptor kinase inhibitor, AZD2171, in patients with advanced cancers with liver metastases. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Medinger
- Albert-Ludwigs University Freiburg, Freiburg, Germany; ProQinase GmbH, Freiburg, Germany; AstraZeneca, Boston, MA; AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Wilmington, DE
| | - K. Mross
- Albert-Ludwigs University Freiburg, Freiburg, Germany; ProQinase GmbH, Freiburg, Germany; AstraZeneca, Boston, MA; AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Wilmington, DE
| | - U. Zirrgiebel
- Albert-Ludwigs University Freiburg, Freiburg, Germany; ProQinase GmbH, Freiburg, Germany; AstraZeneca, Boston, MA; AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Wilmington, DE
| | - R. Strecker
- Albert-Ludwigs University Freiburg, Freiburg, Germany; ProQinase GmbH, Freiburg, Germany; AstraZeneca, Boston, MA; AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Wilmington, DE
| | - C. Wheeler
- Albert-Ludwigs University Freiburg, Freiburg, Germany; ProQinase GmbH, Freiburg, Germany; AstraZeneca, Boston, MA; AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Wilmington, DE
| | - G. Clack
- Albert-Ludwigs University Freiburg, Freiburg, Germany; ProQinase GmbH, Freiburg, Germany; AstraZeneca, Boston, MA; AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Wilmington, DE
| | - J. Lewis
- Albert-Ludwigs University Freiburg, Freiburg, Germany; ProQinase GmbH, Freiburg, Germany; AstraZeneca, Boston, MA; AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Wilmington, DE
| | - T. A. Puchalski
- Albert-Ludwigs University Freiburg, Freiburg, Germany; ProQinase GmbH, Freiburg, Germany; AstraZeneca, Boston, MA; AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Wilmington, DE
| | - C. Unger
- Albert-Ludwigs University Freiburg, Freiburg, Germany; ProQinase GmbH, Freiburg, Germany; AstraZeneca, Boston, MA; AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Wilmington, DE
| | - J. Drevs
- Albert-Ludwigs University Freiburg, Freiburg, Germany; ProQinase GmbH, Freiburg, Germany; AstraZeneca, Boston, MA; AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Wilmington, DE
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37
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Elias AD, Ibrahim J, Richardson P, Avigan D, Joyce R, Reich E, McCauley M, Wheeler C, Frei E. The impact of induction duration and the number of high-dose cycles on the long-term survival of women with metastatic breast cancer treated with high-dose chemotherapy with stem cell rescue: an analysis of sequential phase I/II trials from the Dana-Farber/Beth Israel STAMP program. Biol Blood Marrow Transplant 2002; 8:198-205. [PMID: 12017145 DOI: 10.1053/bbmt.2002.v8.pm12017145] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although high-dose chemotherapy (HDC) with stem cell rescue for the treatment of women with metastatic breast cancer (MBC) is currently a controversial strategy, we report the long-term outcomes of women undergoing high-dose therapy for MBC over the past 12 years while participating in a sequence of research studies transitioning between a single to a double intensification approach. Univariate and multivariate analyses provide a framework to understand the prognostic factors important for event-free and overall survival. Between May 1988 and April 1998, we enrolled 188 women with MBC into 3 trials of previously reported sequential transplantation strategies. Trial I (long induction/single transplantation) accepted 62 women in partial or complete response to an unspecified induction therapy and treated them with high-dose CTCb (cyclophosphamide, thiotepa, and carboplatin) supported by marrow or peripheral blood progenitor cells (PBPC). Trial II (long induction/double transplantation) accepted 68 women in partial or complete response to an unspecified induction therapy, and mobilized stem cells with 2 cycles of AF (doxorubicin and 5-fluorouracil) with granulocyte colony-stimulating factor (G-CSF). These women then received 1 cycle of high-dose single-agent melphalan followed 3 to 5 weeks later by CTCb, each with marrow or PBPC support. Trial III (short induction/double transplantation) enrolled 58 women prior to chemotherapy treatment for metastatic disease. Induction/mobilization consisted of 2 cycles given 14 days apart of doxorubicin and G-CSF. In contrast to trials I and II, patients with stable disease or better response to induction were eligible to proceed ahead with 2 cycles of HDC, 1 being CTCb and the other being dose escalated paclitaxel together with high-dose melphalan (TxM). These 2 HDC regimens were administered 5 weeks apart. TxM was given first in 32 patients and CTCb was given first in 26 patients. The median follow-up periods for trials I, II, and III were 98, 62, and 39 months from the initiation of induction chemotherapy and 92, 55, and 36 months from last high-dose therapy, respectively. The patient characteristics upon entry into these trials were similar. Important differences were that only those patients achieving a partial response or better to induction therapy were enrolled and analyzed for trials I and II, but all patients were analyzed on an intent-to-treat basis for trial III, including those who did not receive intensification. The median event-free survival (EFS) times from induction chemotherapy were 13, 19, and 27 months for trials I, II, and III, respectively (III versus I + II, P = .0004; III versus I, P = .0005; III versus II, P = .005; II versus I, P = .25). The median overall survival (OS) times from induction chemotherapy were 30, 29, and 57 months for trials I, II, and III, respectively (III versus I + II, P = .002; III versus I, P = .003; III versus II, P = .009; II versus I, P = .47). By multivariate Cox regression, participation in the short induction/double transplantation trial III and having no prior adjuvant chemotherapy remained favorable prognostic factors for both EFS and OS. The presence of visceral disease shortened EFS, and hormone sensitivity was of borderline significance. No substantive differences in the characteristics of the patient populations between the 3 trials appeared to interact with outcomes. In conclusion, we found that single transplantation in responding patients after long induction achieves a small cohort of long-term survivors, similar to the results reported by other transplantation centers. Adding a cycle of single-agent high-dose melphalan in this context delayed median time to relapse but did not affect long-term EFS or OS. The double transplantation approach using CTCb and TxM early in the course of treatment was associated with the best EFS and overall survival and was safe, feasible, and tolerable. Treatment duration was only 14 weeks, and this treatment option eliminated lengthy induction chemotherapy. Although selection biases may have in part contributed to this effect, a randomized comparison of standard therapy versus short induction/double transplantation is warranted.
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Affiliation(s)
- A D Elias
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
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D'Souza S, Rosseels V, Denis O, Tanghe A, De Smet N, Jurion F, Palfliet K, Castiglioni N, Vanonckelen A, Wheeler C, Huygen K. Improved tuberculosis DNA vaccines by formulation in cationic lipids. Infect Immun 2002; 70:3681-8. [PMID: 12065510 PMCID: PMC128113 DOI: 10.1128/iai.70.7.3681-3688.2002] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [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: 01/15/2023] Open
Abstract
Mice were vaccinated with plasmid DNA (pDNA) encoding antigen 85A (Ag85A), Ag85B, or PstS-3 from Mycobacterium tuberculosis either in saline or formulated for intramuscular injections in VC1052:DPyPE (aminopropyl-dimethyl-myristoleyloxy-propanaminium bromide-diphytanoylphosphatidyl-ethanolamine) (Vaxfectin; Vical, Inc., San Diego, Calif.) or for intranasal instillations in GAP-DLRIE:DOPE (aminopropyl-dimethyl-bis-dodecyloxy-propanaminium bromide-dioleoylphosphatidyl-ethanolamine). These two novel cationic and neutral colipid formulations were previously reported to be effective adjuvants for pDNA-induced antibody responses. The levels of Ag85-specific total immunoglobulin G (IgG) and IgG isotypes were all increased 3- to 10-fold by formulation of pDNA in Vaxfectin. The level of production of splenic T-cell-derived Th1-type cytokines (interleukin-2 and gamma interferon) in response to purified Ag85 and to synthetic peptides spanning the entire Ag85A protein was also significantly higher in animals vaccinated with pDNA formulated in Vaxfectin. Cytolytic T-lymphocyte responses generated by pDNA encoding phosphate-binding protein PstS-3 in Vaxfectin were better sustained over time than were those generated by PstS-3 DNA in saline. Intranasal immunization with Ag85A DNA in saline was completely ineffective, whereas administration in GAP-DLRIE:DOPE induced a positive Th1-type cytokine response; however, the extent of the latter response was clearly lower than that obtained following intramuscular immunization with the same DNA dose. Combined intramuscular and intranasal administrations in cationic lipids resulted in stronger immune responses in the spleen and, more importantly, in the lungs as well. Finally, formulation in Vaxfectin increased the protective efficacy of the Ag85B DNA vaccine, as measured by reduced relative light unit counts and CFU counts in the spleen and lungs from mice challenged with bioluminescent M. tuberculosis H37Rv. These results may be of importance for future clinical use of DNA vaccines in humans.
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MESH Headings
- ATP-Binding Cassette Transporters/genetics
- ATP-Binding Cassette Transporters/immunology
- Acyltransferases
- Adjuvants, Immunologic
- Administration, Intranasal
- Animals
- Antibodies, Bacterial/biosynthesis
- Antigens, Bacterial/genetics
- Antigens, Bacterial/immunology
- BCG Vaccine/immunology
- Bacterial Proteins/genetics
- Bacterial Proteins/immunology
- Cations
- Injections, Intramuscular
- Interferon-gamma/biosynthesis
- Interleukin-2/biosynthesis
- Lipids
- Lung/immunology
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Phosphatidylethanolamines/immunology
- Spleen/immunology
- T-Lymphocytes, Cytotoxic/immunology
- Th1 Cells/immunology
- Tuberculosis/prevention & control
- Vaccination
- Vaccines, DNA/immunology
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Affiliation(s)
- S D'Souza
- Mycobacterial Immunology, Pasteur Institute of Brussels, B1180 Brussels, Belgium
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Barnfield C, Brew R, Tilling R, Rae A, Wheeler C, Klavinskis LS. The cellular basis of immune induction at mucosal surfaces by DNA vaccination. Dev Biol (Basel) 2002; 104:159-64. [PMID: 11713815] [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] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The nasal mucosa provides a simple, non-invasive route to deliver DNA encoding the gene of interest to stimulate mucosal and systemic immune responses. However, unlike the intradermal or intramuscular routes for plasmid DNA (pDNA) delivery, immune responsiveness to antigen exposure at the respiratory mucosa is tightly regulated, consistent with the balance between active immunity and non-responsiveness to pathogenic or inert environmental antigens. We have characterised the antigen presenting cell types, their distribution and activation status following nasal vaccination with pDNA-cytofectin complexes encoding model antigens. We demonstrate that nasal immunisation is associated with expression of the encoded protein in a small population of dendritic cells and macrophages at the site of pDNA delivery, in the draining lymph nodes (LN) and in the spleen. Antigen expression by nasal dendritic cells was associated with up-regulation of surface MHC class II and CD86 expression and functional activation of T-lymphocytes. The results highlight the potential of intranasal vaccination with pDNA, provided the activation / costimulatory requirements for an active immune response are achieved.
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Affiliation(s)
- C Barnfield
- Peter Gorer Department of Immunobiology, Guy's Hospital, GKT, London, UK
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40
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Elias AD, Richardson P, Avigan D, Ibrahim J, Joyce R, McDermott D, Levine J, Warren D, McCauley M, Wheeler C, Frei E. A short course of induction chemotherapy followed by two cycles of high-dose chemotherapy with stem cell rescue for chemotherapy naive metastatic breast cancer: sequential phase I/II studies. Bone Marrow Transplant 2001; 28:447-54. [PMID: 11593317 DOI: 10.1038/sj.bmt.1703148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2000] [Accepted: 05/15/2001] [Indexed: 11/09/2022]
Abstract
Two cycles of high-dose chemotherapy with stem cell support (HDC) may increase the total dose delivered and dose intensity. A brief induction phase and different non-cross-resistant agents for each HDC cycle were used to avoid drug resistance. Twenty-six women with metastatic BC had induction and stem cell mobilization with two cycles of doxorubicin/G-CSF given every 14 days. Patients with stable disease or better after induction received HD CTCb followed by HD melphalan and dose-escalated paclitaxel. At 475 mg/m(2) of paclitaxel by 24-h infusion, dose-limiting transient peripheral sensory neuropathy was encountered. No toxic deaths occurred. Complete and near complete response after completion of therapy was achieved in 22 (85%) of 26 patients. The median EFS was 38 months. The median OS has not yet been reached. At a median follow-up of 33 (25-43) months, actuarial EFS and OS were 54% (95% confidence interval (CI), 39-69%) and 69% (95% CI, 56-79%), respectively. This double transplant approach lasts only 14 weeks and is feasible, safe, and tolerable. Whilst selection biases may in part contribute to favorable EFS and OS, a randomized comparison of standard therapy vs double transplant in both metastatic and locally advanced breast cancer is warranted.
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Affiliation(s)
- A D Elias
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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41
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Tanghe A, D'Souza S, Rosseels V, Denis O, Ottenhoff TH, Dalemans W, Wheeler C, Huygen K. Improved immunogenicity and protective efficacy of a tuberculosis DNA vaccine encoding Ag85 by protein boosting. Infect Immun 2001; 69:3041-7. [PMID: 11292722 PMCID: PMC98258 DOI: 10.1128/iai.69.5.3041-3047.2001] [Citation(s) in RCA: 152] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
C57BL/6 mice were vaccinated with plasmid DNA encoding Ag85 from Mycobacterium tuberculosis, with Ag85 protein in adjuvant, or with a combined DNA prime-protein boost regimen. While DNA immunization, as previously described, induced robust Th1-type cytokine responses, protein-in-adjuvant vaccination elicited very poor cytokine responses, which were 10-fold lower than those observed with DNA immunization alone. Injection of Ag85 DNA-primed mice with 30 to 100 microg of purified Ag85 protein in adjuvant increased the interleukin-2 and gamma interferon (IFN-gamma) response in spleen two- to fourfold. Further, intracellular cytokine analysis by flow cytometry also showed an increase in IFN-gamma-producing CD4(+) T cells in DNA-primed-protein-boosted animals, compared to those that received only the DNA vaccination. Moreover, these responses appeared to be better sustained over time. Antibodies were readily produced by all three methods of immunization but were exclusively of the immunoglobulin G1 (IgG1) isotype following protein immunization in adjuvant and preferentially of the IgG2a isotype following DNA and DNA prime-protein boost vaccination. Finally, protein boosting increased the protective efficacy of the DNA vaccine against an intravenous M. tuberculosis H37Rv challenge infection, as measured by CFU or relative light unit counts in lungs 1 and 2 months after infection. The capacity of exogenously given protein to boost the DNA-primed vaccination effect underlines the dominant role of Th1-type CD4(+) helper T cells in mediating protection.
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Affiliation(s)
- A Tanghe
- Pasteur Institute of Brussels, Mycobacterial Immunology, B1180 Brussels, Belgium
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Wheeler C, Khurshid A, Ibrahim J, Elias A, Mauch P, Ault K, Antin J. Incidence of post transplant myelodysplasia/acute leukemia in non-Hodgkin's lymphoma patients compared with Hodgkin's disease patients undergoing autologous transplantation following cyclophosphamide, carmustine, and etoposide (CBV). Leuk Lymphoma 2001; 40:499-509. [PMID: 11426523 DOI: 10.3109/10428190109097649] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Secondary malignancies, particularly myelodysplasia (MDS), are serious events following high dose therapy with autologous stem cell support. We observed a higher frequency of secondary malignancies in patients with Hodgkin's disease (HD) than in patients with non-Hodgkin's lymphoma (NHL) undergoing high dose therapy with the same non-TBI conditioning regimen. Three hundred patients with Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) were treated with cyclophosphamide, carmustine and etoposide and autologous stem cell support from 1986 through 1994. Median follow up of survivors is 3.9 years. Five-year survival is 51% for HD and 48% for NHL. Eleven patients developed second malignancies (9/150 treated for HD vs. 2/150 treated for NHL) a median of 2.4 years from transplantation and 5.2 years from initial diagnosis. Six patients had myelodysplasia or acute leukemia (MDS/AML) and 5 had lymphomas or solid tumors. Actuarial risk of MDS/AML at five years for patients transplanted for non-Hodgkin's lymphoma is 3% (95% CI 0.6-9.6%). HD patients had significantly different pretreatment characteristics than patients with NHL. A Cox model showed that greater number of prior relapses and prior radiation therapy were significant risk factors for the development of MDS/AML. These data suggest that CBV is associated with a lower risk of secondary MDS/AML than TBI containing regimens and that much of the risk is associated with the pre-transplantation therapy. The use of autotransplantation early in the course of therapy for relapsed lymphoma might prevent some cases of MDS/AML.
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Affiliation(s)
- C Wheeler
- Beth Israel Deaconess Medical Center, Division of Hematology/Oncology, Farber Cancer Institute, MA, USA
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43
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Wheeler C, Berkley S. Initial lessons from public-private partnerships in drug and vaccine development. Bull World Health Organ 2001; 79:728-34. [PMID: 11545329 PMCID: PMC2566495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
In recent years, venture capital approaches have delivered impressive results in identifying and funding promising health discoveries and bringing them to market. This success has inspired public sector experiments with "social venture capital" approaches to address the dearth of affordable treatment and prevention for diseases of the developing world. Employing the same focus on well-defined and measurable objectives, and the same type of connections to pool and deploy resources as their for-profit counterparts, social venture capitalists seek to use the tools and incentives of capitalism to solve one of its biggest failures: the lack of drugs and vaccines for diseases endemic to low-income populations. As part of a larger trend of partnerships emerging in health product donation and distribution, public-private partnerships for pharmaceutical development have led research and development (R&D) efforts to generate more accessible and efficacious products for diseases such as malaria, tuberculosis, and AIDS. In this article, three R&D-focused partnerships are explored: the International AIDS Vaccine Initiative; the Medicines for Malaria Venture; and the newly formed Global Alliance for TB Drug Development. The article highlights key elements essential to the success of these ventures.
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Affiliation(s)
- C Wheeler
- Global Alliance for TB Drug Development, New York, USA.
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Abstract
This paper focuses on the marketing of alcohol to young people in the United Kingdom, but the lessons that emerge have international significance. Alcohol is a global enterprise and recent consolidation means that it is controlled by a decreasing number of expanding multi-nationals. Alcohol companies are able to allocate significant resources to researching consumer preferences, developing new products and promoting them on an international level. Recent years have seen a growth in the value that youth culture attaches to brand labels and symbols and a move away from the healthy-living ethos. The alcohol industry's response to these trends has been to design alcoholic beverages that appeal to young people, using well-informed and precisely targeted marketing strategies. This has led to growing concerns about the implications for public health and a demand for tighter controls to regulate alcohol marketing practices. In the United Kingdom, controls on alcohol are piecemeal and reactive and the current system of voluntary regulation appears ineffective. This paper argues for more research to establish current industry practice and inform the development of a comprehensive regulatory structure and system of monitoring.
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Affiliation(s)
- M C Jackson
- Centre for Social Marketing, University of Strathclyde, 173 Cathedral Street, Glasgow G4 0RQ, Scotland, UK
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45
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Stiff P, Gingrich R, Luger S, Wyres MR, Brown RA, LeMaistre CF, Perry J, Schenkein DP, List A, Mason JR, Bensinger W, Wheeler C, Freter C, Emmanouilides C. A randomized phase 2 study of PBPC mobilization by stem cell factor and filgrastim in heavily pretreated patients with Hodgkin's disease or non-Hodgkin's lymphoma. Bone Marrow Transplant 2000; 26:471-81. [PMID: 11019835 DOI: 10.1038/sj.bmt.1702531] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This randomized, controlled study compared the ability to mobilize and collect an optimal target yield of 5 x 10(6) CD34+ cells/kg using stem cell factor (SCF; 20 microg/kg/day) plus filgrastim (G-CSF; 10 microg/kg/day) vs filgrastim alone (10 microg/kg/day) in 102 patients diagnosed with non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD), who were prospectively defined as being heavily pretreated. Leukapheresis began on day 5 of cytokine administration and continued daily until the target yield was reached, or until a maximum of five leukaphereses had been performed. Compared with the filgrastim-alone group (n = 54), the SCF plus filgrastim group (n = 48) showed an increase in the proportion of patients reaching the target yield within five leukaphereses (44% vs 17%, P = 0.002); reduction in the number of leukaphereses required to reach the target yield (P = 0.003); reduction in the proportion of patients failing to reach a minimum yield of 1 x 10(6) CD34+ cells/kg to proceed to transplant (16% vs 26%, P = NS); increase in the median yield of CD34+ cells per leukapheresis (0.73 x 10(6)/kg vs 0.48 x 10(6)/kg, P = 0.04); and an increase in the median total CD34+ cells collected within five leukaphereses (3.6 x 10(6)/kg vs 2.4 x 10(6)/kg, P = 0.05). All patients receiving SCF were premedicated (antihistamines and albuterol), and treatment was generally well tolerated. Five patients experienced severe mast cell-mediated reactions, none of which were life-threatening. In this study of heavily pretreated lymphoma patients, SCF plus filgrastim was more effective than filgrastim alone for mobilizing PBPC for harvesting and transplantation after high-dose chemotherapy.
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Affiliation(s)
- P Stiff
- Loyola University, Maywood, IL, USA
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46
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Frei E, Ara G, Teicher B, Bunnell C, Richardson P, Wheeler C, Tew K, Elias A. Double high-dose chemotherapy with stem cell rescue (HD-SCR) in patients with breast cancer - effect of sequence. Cancer Chemother Pharmacol 2000; 45:239-46. [PMID: 10663642 DOI: 10.1007/s002800050035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION A preliminary analysis of our double high-dose chemotherapy with stem cell rescue (HD-SCR) clinical trial for breast cancer, and preclinical cross-resistant studies, suggested that melphalan (M) adversely affected response to subsequent chemotherapy, i.e., that the sequence of alkylating agents (AAs) might affect response. We, therefore, constructed and examined preclinical models to determine whether prior exposure to M, in fact, adversely affected response to other therapy. PURPOSE The purpose of the study was to determine whether the sequence of AAs, specifically the prior use of M, adversely affected response to subsequent treatment. METHODS The methods employed were the following: (1) Human tumor cell lines rendered resistant by in vitro sequential exposure to five different AAs were developed. The resistant cell lines were examined for cross-resistance to alkylating and other agents. (2) In vivo studies in the p388 mouse leukemia for resistance and cross-resistance among the AAs. (3) In vivo studies of the effect of sequence of AAs on response in mice bearing EMT6 breast cancer. (4) The double transplant model was developed in the mouse and the sequence of high-dose AAs was studied. (5) Biochemical and reverse transcriptase-polymerase chain reaction (RT-PCR) studies of the various resistant tumor cell lines. RESULTS (1) The in vitro human tumor cells resistant to M were cross-resistant in 57% of tests to other AAs. In contrast, resistance for other AAs crossed to other agents in only 10 to 20% of tests. (2) The in vivo studies of p388 indicated that resistance to M commonly crossed to other AAs and many non-AAs. (3) The results for the mouse breast cancer (EMT6) studies of the sequence of AAs again indicated that M employed first markedly reduced responsiveness to subsequent treatment, particularly with AAs. (4) The double transplant model: again, M first markedly reduced response to other agents. (5) The in vitro resistant human tumor cell lines, particularly the breast cancer cell line MCF7, were found to contain high concentrations of glutathione S1 transferase gamma, which is consistent with that mechanism being responsible for resistance. CONCLUSION The sequence of alkylating agent treatment may substantially influence response. Melphalan, particularly, produces resistance that commonly crosses to the other AAs. Mechanistic studies indicate significant changes in glutathione S1 transferase, a known mechanism for broadly based resistance to AAs.
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Affiliation(s)
- E Frei
- Dana Farber Cancer Institute, Department of Adult Oncology, 44 Binney Street, Boston, Massachusetts 02115, Harvard Medical School, Boston, Massachusetts 02115, USA
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Frei E, Richardson P, Avigan D, Bunnell C, Wheeler C, Elias A. The interval between courses of high-dose chemotherapy with stem cell rescue: therapeutic hypotheses. Bone Marrow Transplant 1999; 24:939-45. [PMID: 10556951 DOI: 10.1038/sj.bmt.1702012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The interval between courses of chemotherapy have classically been kept to a minimum in order to maximize dose intensity. Certain clinical observations suggest that longer intervals, particularly in the high-dose setting, may be more effective. This is based in part on the evidence that resistance is reversible over time and that the interval should be sufficient to allow for such a reversal. Clinical evidence for such reversibility include the following. In metastatic breast cancer, double or double high-dose stem cell rescue (HD-SCR) studies involving a minimal interval, have not, at least as yet, been shown to be superior to single HD-SCR. In Hodgkin's disease, response after relapse correlates directly with duration of time to relapse. In a comparative study of metastatic breast cancer, early HD-SCR preceded by daunorubicin induction was inferior to delayed HD-SCR. The latter was not preceded by induction chemotherapy. In a comparative study of childhood ALL, patients randomized to delayed (4 month interval) intensification had a significantly superior survival as compared to patients randomized to immediate (1 month interval) intensification. Taken together, these clinical observations indicate that resistance is reversible and that optimization of the interval must take this into account. Cytokinetic modeling of those clinical studies also found that delayed HD-SCR could result in a superior effect. Cytokinetic models of minimal residual tumor which were also examined included the Skipper exponential model, the Norton-Simon model which emphasizes the Gompertzian effect, the clonal evolution model, and the Retsky-Demisheli model which derives from a bimodal relapse pattern above. Biological and clinical data have resulted in a clinical protocol in the CALGB wherein patients with metastatic breast cancer are randomly allocated to (1) a single HD-SCR arm; (2) a double HD-SCR with a 5-week interval; and (3) a double HD-SCR arm with a 16 week interval.
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Affiliation(s)
- E Frei
- Dana Farber Cancer Institute, Department of Adult Oncology, Boston, MA 02115, USA
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Shwartz M, Gastfriend D, Mulvey K, Baker G, Woods D, Wheeler C, Zaremba N, Plough A. The Boston Target Cities program: overview and evaluation results. J Psychoactive Drugs 1999; 31:265-72. [PMID: 10533973 DOI: 10.1080/02791072.1999.10471756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- M Shwartz
- School of Management, Boston University, Massachusetts 02215, USA
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Wheeler C, Lundström J. NXY-059: Pharmacokinetics in rats and dogs. J Stroke Cerebrovasc Dis 1999. [DOI: 10.1016/s1052-3057(99)80134-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Elias A, Ibrahim J, Skarin AT, Wheeler C, McCauley M, Ayash L, Richardson P, Schnipper L, Antman KH, Frei E. Dose-intensive therapy for limited-stage small-cell lung cancer: long-term outcome. J Clin Oncol 1999; 17:1175. [PMID: 10561176 DOI: 10.1200/jco.1999.17.4.1175] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine progression-free survival (PFS) and overall long-term survival for limited-stage small-cell lung cancer (SCLC) patients aged 60 years or younger who respond to first-line chemotherapy followed by high-dose combination alkylating agents (cyclophosphamide 5,625 mg/m(2), cisplatin 165 mg/m(2), and carmustine 480 mg/m(2)) with hematologic stem-cell support and chest and prophylactic cranial radiotherapy. PATIENTS AND METHODS Patients were selected on the basis of their continued response to first-line therapy, their relative lack of significant comorbidity, and their ability to obtain financial clearance. RESULTS Of 36 patients with stage III SCLC, nine patients (25%) had achieved a complete response (CR), 20 had achieved a near-CR, and seven had achieved a partial response before undergoing high-dose therapy. Toxicity included three deaths (8%). For all patients, the median PFS was 21 months. The 2- and 5-year survival rates after dose intensification were 53% (95% confidence interval [CI], 39% to 72%), and 41% (95% CI, 28% to 61%). Of the 29 patients who were in or near CR before undergoing high-dose therapy, 14 remain continuously progression-free a median of 61 months (range, 40 to 139 months) after high-dose therapy. Actuarial 2- and 5-year PFS rates were 57% (95% CI, 41% to 79%) and 53% (95% CI, 38% to 76%). By multivariate analysis, short intensive induction chemotherapy was associated with favorable outcome (P <.05). CONCLUSION Use of high-dose systemic therapy with intensive local-regional radiotherapy was associated with manageable treatment-related morbidity and mortality. Patients who were in or near CR before intensification are enjoying an unmaintained 5-year PFS rate of 53%. Late complications were infrequent, and most patients returned to full-time work and activity. A randomized comparison of this approach and conventional-dose therapy should define the use of dose intensification with hematopoietic support in patients with responding limited-stage SCLC.
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Affiliation(s)
- A Elias
- Department of Medicine, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, MA 02115, USA.
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