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Mapuskar KA, Pulliam CF, Tomanek-Chalkley A, Rastogi P, Wen H, Dayal S, Griffin BR, Zepeda-Orozco D, Sindler AL, Anderson CM, Beardsley R, Kennedy EP, Spitz DR, Allen BG. The antioxidant and anti-inflammatory activities of avasopasem manganese in age-associated, cisplatin-induced renal injury. Redox Biol 2024; 70:103022. [PMID: 38215546 PMCID: PMC10821164 DOI: 10.1016/j.redox.2023.103022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024] Open
Abstract
PURPOSE Cisplatin contributes to acute kidney injury (AKI) and chronic kidney disease (CKD) that occurs with greater frequency and severity in older patients. Age-associated cisplatin sensitivity in human fibroblasts involves increased mitochondrial superoxide produced by older donor cells. EXPERIMENTAL DESIGN Young and old C57BL/6 J murine models of cisplatin-induced AKI and CKD were treated with the SOD mimetic avasopasem manganese to investigate the potential antioxidant and anti-inflammatory effects. Adverse event reporting from a phase 2 and a phase 3 randomized clinical trial (NCT02508389 and NCT03689712) conducted in patients treated with cisplatin and AVA was determined to have established the incidence and severity of AKI. RESULTS Cisplatin-induced AKI and CKD occurred in all mice, however, was more pronounced in older mice. AVA reduced cisplatin-induced mortality, AKI, and CKD, in older animals. AVA also alleviated cisplatin-induced alterations in mitochondrial electron transport chain (ETC) complex activities and NADPH Oxidase 4 (NOX4) and inhibited the increased levels of the inflammation markers, TNFα, IL1, ICAM-1, and VCAM-1. Analysis of age-stratified subjects treated with cisplatin from clinical trials (NCT02508389, NCT03689712) also supported that the incidence of AKI increased with age and AVA reduced age-associated therapy-induced adverse events (AE), including hypomagnesemia, increased creatinine, and AKI. CONCLUSIONS Older mice and humans are more susceptible to cisplatin-induced kidney injury, and treatment with AVA mitigates age-associated damage. Mitochondrial ETC and NOX4 activities represent sources of superoxide production contributing to cisplatin-induced kidney injury, and pro-inflammatory cytokine production and endothelial dysfunction may also be increased by superoxide formation.
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Affiliation(s)
- Kranti A Mapuskar
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Iowa City, IA, 52242, USA
| | - Casey F Pulliam
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Iowa City, IA, 52242, USA
| | - Ann Tomanek-Chalkley
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Iowa City, IA, 52242, USA
| | | | | | - Sanjana Dayal
- Internal Medicine, Iowa City, IA, 52242, USA; The University of Iowa, Iowa City VA Healthcare System, Iowa City, IA, 52242, USA
| | - Benjamin R Griffin
- Internal Medicine, Iowa City, IA, 52242, USA; Division of Nephrology, Iowa City, IA, 52242, USA
| | - Diana Zepeda-Orozco
- Pediatric Nephrology and Hypertension at Nationwide Children's Hospital, Columbus, OH, USA; Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics at the Ohio State University, Columbus, OH, USA
| | - Amy L Sindler
- Health and Human Physiology, University of Iowa, USA
| | - Carryn M Anderson
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Iowa City, IA, 52242, USA
| | | | | | - Douglas R Spitz
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Iowa City, IA, 52242, USA
| | - Bryan G Allen
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Iowa City, IA, 52242, USA.
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Sonis ST, Anderson CM. Avasopasem for the treatment of radiotherapy-induced severe oral mucositis. Expert Opin Investig Drugs 2023. [PMID: 37365149 DOI: 10.1080/13543784.2023.2230117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/16/2023] [Accepted: 06/23/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Oral mucositis (OM) remains a significant, highly symptomatic, disruptive side effect of radiation and concomitant chemoradiation therapy used for the treatment of squamous cell cancers of the head and neck. Despite its clinical and economic burden, implementation of an effective intervention has been elusive. AREAS COVERED Increased understanding of the complexity of the biological basis for its pathogenesis has yielded potential druggable targets of such as the mitigation of superoxide formation and oxidative stress. Avasopasem manganese is a selective superoxide dismutase mimetic being developed by Galera Therapeutics, which recently submitted a New Drug Application (NDA) to the FDA for a severe OM indication. This review describes the preclinical and clinical studies which led to, and supported the NDA, and assesses the potential utility of avasopasem clinically. EXPERT OPINION Avasopasem manganese appears to effectively mitigate severe OM associated with concomitant chemoradiation used in the treatment of head and neck cancers, as well as cisplatin-associated renal toxicity in the absence of impairing tumor response.
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Affiliation(s)
- Stephen T Sonis
- Divisions of Oral Medicine, Brigham and Women's Hospital and the Dana-Farber Cancer Institute, Boston, MA, USA
- Biomodels, LLC and Primary Endpoint Solutions, LLC, Waltham, MA, USA
| | - Carryn M Anderson
- Department of Radiation Oncology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Dunkerley DAP, Hyer DE, Snyder JE, St-Aubin JJ, Anderson CM, Caster JM, Smith MC, Buatti JM, Yaddanapudi S. Clinical Implementational and Site-Specific Workflows for a 1.5T MR-Linac. J Clin Med 2022; 11:jcm11061662. [PMID: 35329988 PMCID: PMC8954784 DOI: 10.3390/jcm11061662] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/21/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 01/27/2023] Open
Abstract
MR-guided adaptive radiotherapy (MRgART) provides opportunities to benefit patients through enhanced use of advanced imaging during treatment for many patients with various cancer treatment sites. This novel technology presents many new challenges which vary based on anatomic treatment location, technique, and potential changes of both tumor and normal tissue during treatment. When introducing new treatment sites, considerations regarding appropriate patient selection, treatment planning, immobilization, and plan-adaption criteria must be thoroughly explored to ensure adequate treatments are performed. This paper presents an institution’s experience in developing a MRgART program for a 1.5T MR-linac for the first 234 patients. The paper suggests practical treatment workflows and considerations for treating with MRgART at different anatomical sites, including imaging guidelines, patient immobilization, adaptive workflows, and utilization of bolus.
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Safran HP, Winter K, Ilson DH, Wigle D, DiPetrillo T, Haddock MG, Hong TS, Leichman LP, Rajdev L, Resnick M, Kachnic LA, Seaward S, Mamon H, Diaz Pardo DA, Anderson CM, Shen X, Sharma AK, Katz AW, Salo J, Leonard KL, Moughan J, Crane CH. Trastuzumab with trimodality treatment for oesophageal adenocarcinoma with HER2 overexpression (NRG Oncology/RTOG 1010): a multicentre, randomised, phase 3 trial. Lancet Oncol 2022; 23:259-269. [PMID: 35038433 PMCID: PMC8903071 DOI: 10.1016/s1470-2045(21)00718-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Trastuzumab is a monoclonal antibody against HER2 (also known as ERBB2). The primary objective of the NRG Oncology/RTOG-1010 trial was to establish whether trastuzumab improves disease-free survival when combined with trimodality treatment (paclitaxel plus carboplatin and radiotherapy, followed by surgery) for patients with untreated HER2-overexpressing oesophageal adenocarcinoma. METHODS NRG Oncology/RTOG-1010 was an open label, randomised, phase 3 trial for which patients were accrued from 111 NRG-affiliated institutions in the USA. Eligible patients were adults (aged ≥18 years) with newly diagnosed pathologically confirmed oesophageal adenocarcinoma, American Joint Committee on Cancer 7th edition T1N1-2 or T2-3N0-2 stage disease, and a Zubrod performance status of 0-2. Patients were stratified by adenopathy (no vs yes [coeliac absent] vs yes [coeliac present ≤2 cm]) and randomly assigned (1:1) to receive weekly intravenous paclitaxel (50 mg/m2 intravenously over 1 h) and carboplatin (area under the curve 2, intravenously over 30-60 min) for 6 weeks with radiotherapy 50·4 Gy in 28 fractions (chemoradiotherapy) followed by surgery, with or without intravenous trastuzumab (4 mg/kg in week one, 2 mg/kg per week for 5 weeks during chemoradiotherapy, 6 mg/kg once presurgery, and 6 mg/kg every 3 weeks for 13 treatments starting 21-56 days after surgery). The primary endpoint, disease-free survival, was defined as the time from randomisation to death or first of locoregional disease persistence or recurrence, distant metastases, or second primary malignancy. Analyses were done by modified intention to treat. This study is registered with Clinicaltrials.gov, NCT01196390; it is now closed and in follow-up. FINDINGS 606 patients were entered for HER2 assessment from Dec 30, 2010 to Nov 10, 2015, and 203 eligible patients who were HER2-positive were enrolled and randomly assigned to chemoradiotherapy plus trastuzumab (n=102) or chemoradiotherapy alone (n=101). Median duration of follow-up was 2·8 years (IQR 1·4-5·7). Median disease-free survival was 19·6 months (95% CI 13·5-26·2) with chemoradiotherapy plus trastuzumab compared with 14·2 months (10·5-23·0) for chemoradiotherapy alone (hazard ratio 0·99 [95% CI 0·71-1·39], log-rank p=0·97). Grade 3 treatment-related adverse events occurred in 41 (43%) of 95 patients in the chemoradiotherapy plus trastuzumab group versus 52 (54%) of 96 in the chemoradiotherapy group and grade 4 events occurred in 20 (21%) versus 21 (22%). The most common grade 3 or worse treatment-related adverse events for both groups were haematological (53 [56%] of 95 patients in the chemoradiotherapy plus trastuzumab group vs 55 [57%] of 96 patients in the chemotherapy group) or gastrointestinal disorders (28 [29%] vs 20 [21 %]). 34 (36%) of 95 patients in the chemoradiotherapy plus trastuzumab group and 27 (28%) of 96 patients in the chemoradiotherapy only group had treatment-related serious adverse events. There were eight treatment-related deaths: five (5%) of 95 patients in the chemoradiotherapy plus trastuzumab group (bronchopleural fistula, oesophageal anastomotic leak, lung infection, sudden death, and death not otherwise specified), and three (3%) of 96 in the chemoradiotherapy group (two multiorgan failure and one sepsis). INTERPRETATION The addition of trastuzumab to neoadjuvant chemoradiotherapy for HER2-overexpressing oesophageal cancer was not effective. Trastuzumab did not lead to increased toxicities, suggesting that future studies combining it with or using other agents targeting HER2 in oesophageal cancer are warranted. FUNDING National Cancer Institute and Genentech.
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Mapuskar KA, Steinbach EJ, Zaher A, Riley DP, Beardsley RA, Keene JL, Holmlund JT, Anderson CM, Zepeda-Orozco D, Buatti JM, Spitz DR, Allen BG. Mitochondrial Superoxide Dismutase in Cisplatin-Induced Kidney Injury. Antioxidants (Basel) 2021; 10:antiox10091329. [PMID: 34572961 PMCID: PMC8469643 DOI: 10.3390/antiox10091329] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
Cisplatin is a chemotherapy agent commonly used to treat a wide variety of cancers. Despite the potential for both severe acute and chronic side effects, it remains a preferred therapeutic option for many malignancies due to its potent anti-tumor activity. Common cisplatin-associated side-effects include acute kidney injury (AKI) and chronic kidney disease (CKD). These renal injuries may cause delays and potentially cessation of cisplatin therapy and have long-term effects on renal function reserve. Thus, developing mechanism-based interventional strategies that minimize cisplatin-associated kidney injury without reducing efficacy would be of great benefit. In addition to its action of cross-linking DNA, cisplatin has been shown to affect mitochondrial metabolism, resulting in mitochondrially derived reactive oxygen species (ROS). Increased ROS formation in renal proximal convoluted tubule cells is associated with cisplatin-induced AKI and CKD. We review the mechanisms by which cisplatin may induce AKI and CKD and discuss the potential of mitochondrial superoxide dismutase mimetics to prevent platinum-associated nephrotoxicity.
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Affiliation(s)
- Kranti A. Mapuskar
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, IA 52242, USA; (K.A.M.); (E.J.S.); (C.M.A.); (J.M.B.); (D.R.S.)
| | - Emily J. Steinbach
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, IA 52242, USA; (K.A.M.); (E.J.S.); (C.M.A.); (J.M.B.); (D.R.S.)
| | - Amira Zaher
- Biomedical Science Program, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA;
| | - Dennis P. Riley
- Galera Therapeutics, Inc., Malvern, PA 19355, USA; (D.P.R.); (R.A.B.); (J.L.K.); (J.T.H.)
| | - Robert A. Beardsley
- Galera Therapeutics, Inc., Malvern, PA 19355, USA; (D.P.R.); (R.A.B.); (J.L.K.); (J.T.H.)
| | - Jeffery L. Keene
- Galera Therapeutics, Inc., Malvern, PA 19355, USA; (D.P.R.); (R.A.B.); (J.L.K.); (J.T.H.)
| | - Jon T. Holmlund
- Galera Therapeutics, Inc., Malvern, PA 19355, USA; (D.P.R.); (R.A.B.); (J.L.K.); (J.T.H.)
| | - Carryn M. Anderson
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, IA 52242, USA; (K.A.M.); (E.J.S.); (C.M.A.); (J.M.B.); (D.R.S.)
| | - Diana Zepeda-Orozco
- Center for Clinical and Translational Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205, USA;
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Division of Nephrology, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - John M. Buatti
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, IA 52242, USA; (K.A.M.); (E.J.S.); (C.M.A.); (J.M.B.); (D.R.S.)
| | - Douglas R. Spitz
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, IA 52242, USA; (K.A.M.); (E.J.S.); (C.M.A.); (J.M.B.); (D.R.S.)
| | - Bryan G. Allen
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, IA 52242, USA; (K.A.M.); (E.J.S.); (C.M.A.); (J.M.B.); (D.R.S.)
- Correspondence: ; Tel.: +1-319-335-8019; Fax: +1-319-335-8039
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Ma DC, Anderson CM, Rodman SN, Buranasudja V, McCormick ML, Davis A, Loth E, Bodeker KL, Ahmann L, Parkhurst JR, Sun W, Follmer KR, Simons AL, Buatt JM, Spitz DR, Fath MA, Allen BG. Ketogenic Diet with Concurrent Chemoradiation in Head and Neck Squamous Cell Carcinoma: Preclinical and Phase 1 Trial Results. Radiat Res 2021; 196:213-224. [PMID: 34087943 DOI: 10.1667/rade-20-00150.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 05/06/2021] [Indexed: 11/03/2022]
Abstract
Ketogenic diets (KD) are high in fat and low in carbohydrates, forcing cells to utilize mitochondrial fatty acid oxidation for energy production. Since cancer cells demonstrate increased mitochondrial oxidative stress relative to normal cells, we hypothesized that a KD may selectively enhance metabolic oxidative stress in head and neck cancer cells, sensitizing them to radiation and platinum-based chemotherapy without causing increased toxicity in surrounding normal tissues. This hypothesis was tested in preclinical murine xenografts and in a phase 1 clinical trial (NCT01975766). In this study, mice bearing human head and neck cancer xenografts (FaDu) were fed either standard mouse chow or KetoCal® KD (90% fat, 8% carbohydrate, 2% protein) and exposed to ionizing radiation. Tumors were harvested from mice to test for glutathione, a biomarker of oxidative stress. In parallel, patients with locally advanced head and neck cancer were enrolled in a phase 1 clinical trial where they consumed KD and received radiation with concurrent platinum-based chemotherapy. Subjects consumed KetoCal KD via percutaneous endoscopic gastrostomy (PEG) tube and were also allowed to orally consume water, sugar-free drinks, and foods approved by a dietitian. Oxidative stress markers including protein carbonyls and total glutathione were assessed in patient blood samples both pre-KD and while consuming the KD. Mice bearing FaDu xenografts that received radiation and KD demonstrated a slight improvement in tumor growth rate and survival compared to mice that received radiation alone; however a variation in responses was seen dependent on the fatty acid composition of the diet. In the phase 1 clinical trial, a total of twelve patients were enrolled in the study. Four patients completed five weeks of the KD as per protocol (with variance in compliance). Eight patients did not tolerate the diet with concurrent radiation and platinum-chemotherapy (5 were patient decision and 3 were removed from study due to toxicity). The median number of days consuming a KD in patients who did not complete the study was 5.5 (range: 2-8 days). Reasons for discontinuation included "stress of diet compliance" (1 patient), grade 2 nausea (3 patients), and grade 3 fatigue (1 patient). Three patients were removed from the trial due to dose-limiting toxicities including: grade 4 hyperuricemia (2 patients) and grade 3 acute pancreatitis (1 patient). Median weight loss was 2.95% for the KD-tolerant group and 7.92% for patients who did not tolerate the diet. In conclusion, the ketogenic diet shows promise as a treatment combined with radiation in preclinical mouse head and neck cancer xenografts. A phase 1 clinical trial evaluating the safety and tolerability of KD demonstrated difficulty with diet compliance when combined with standard-of care-radiation therapy and cisplatin chemotherapy.
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Affiliation(s)
- Daniel C Ma
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, Iowa 52246
| | - Carryn M Anderson
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, Iowa 52246.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa 52246
| | - Samuel N Rodman
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, Iowa 52246
| | - Visarut Buranasudja
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, Iowa 52246
| | - Michael L McCormick
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, Iowa 52246
| | - Andrew Davis
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, Iowa 52246
| | - Elizabeth Loth
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, Iowa 52246
| | - Kellie L Bodeker
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, Iowa 52246.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa 52246
| | - Logan Ahmann
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, Iowa 52246
| | - Jessica R Parkhurst
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, Iowa 52246
| | - Wenqing Sun
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, Iowa 52246
| | - Kayla R Follmer
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, Iowa 52246
| | - Andrean L Simons
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, Iowa 52246.,Department of Pathology, University of Iowa, Iowa City, Iowa 52246.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa 52246
| | - John M Buatt
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, Iowa 52246.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa 52246
| | - Douglas R Spitz
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, Iowa 52246.,Department of Pathology, University of Iowa, Iowa City, Iowa 52246.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa 52246
| | - Melissa A Fath
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, Iowa 52246.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa 52246
| | - Bryan G Allen
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, Iowa 52246.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa 52246
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Sullivan CB, Al-Qurayshi Z, Anderson CM, Seaman AT, Pagedar NA. Factors Associated With the Choice of Radiation Therapy Treatment Facility in Head and Neck Cancer. Laryngoscope 2020; 131:1019-1025. [PMID: 32846018 DOI: 10.1002/lary.29033] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/15/2020] [Accepted: 07/29/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To analyze the clinicodemographic characteristics and treatment outcomes of patients receiving postoperative radiation therapy (PORT) at a different treatment facility rather than the initial surgical facility for head and neck cancer. STUDY DESIGN Retrospective cohort analysis. METHODS Utilizing the National Cancer Data Base, 2004 to 2015, patients with a diagnosis of oral cavity/oropharyngeal, hypopharyngeal, and laryngeal squamous cell carcinoma were studied. Multivariate analysis was completed with multivariate regression and Cox proportional hazard model, and survival outcomes were examined using Kaplan-Meier analysis. RESULTS A total of 15,181 patients who had surgery for a head and neck cancer at an academic/research center were included in the study population. Of the study population, 4,890 (32.2%) patients completed PORT at a different treatment facility. Treatment at a different facility was more common among patients who were ≥65 years old, white, Medicare recipients, those with a greater distance between residence and surgical treatment facility, and with lower income within area of residence (each P < .05). Overall survival was worse in patients completing PORT at a different treatment facility versus at the institution where surgery was completed (61.9% vs. 66.4%; P = .002). CONCLUSIONS PORT at a different facility was more common in older individuals, Medicare recipients, those with greater distance to travel, and lower-income individuals. Completing PORT outside the hospital where surgery was performed was associated with inferior survival outcomes among head and neck cancer patients. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1019-1025, 2021.
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Affiliation(s)
- Christopher B Sullivan
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Zaid Al-Qurayshi
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Carryn M Anderson
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Aaron T Seaman
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Nitin A Pagedar
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
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Callaghan CM, Seyedin SN, Mohiuddin IH, Hawkes KL, Petronek MS, Anderson CM, Buatti JM, Milhem MM, Monga V, Allen BG. The Effect of Concurrent Stereotactic Body Radiation and Anti-PD-1 Therapy for Recurrent Metastatic Sarcoma. Radiat Res 2020; 194:124-132. [PMID: 32845986 PMCID: PMC10443123 DOI: 10.1667/rade-20-00017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 01/03/2020] [Accepted: 04/29/2020] [Indexed: 11/03/2022]
Abstract
Patients diagnosed with metastatic sarcoma have limited options for achieving both local and distant tumor control. While SBRT can achieve local control, distant response rates remain low. There is limited evidence demonstrating the safety and efficacy for combining SBRT with concurrent PD-1 checkpoint blockade in metastatic sarcoma. In this prospective case-series, we examined five patients with metastatic sarcoma on pembrolizumab treated concurrently with SBRT from July 1, 2016-October 30, 2018. Acute and chronic toxicity were recorded using Common Terminology Criteria for Adverse Events (CTCAE, version 5.0). SBRT-treated tumor control was assessed using Response Evaluation Criteria in Solid Tumors (RECIST version 1.1). With median follow-up of 14.9 months, three patients with undifferentiated pleomorphic sarcoma, one with intimal, and one with chondroblastic osteosarcoma received SBRT with concurrent pembrolizumab to 10 sites of metastatic disease. No grade 5 toxicities were observed. There was a single incidence of transient grade 4 lymphopenia which resolved without intervention. Grade 3 toxicities included anemia, thrombocytopenia, lymphopenia and colitis. One tumor demonstrated local progression after SBRT, and all others remained stable or with response. In conclusion, combining SBRT with PD-1 inhibition appeared to be safe in this patient population. Expected high rates of treated-tumor local control after SBRT were observed. Two of five patients demonstrated either enhanced local tumor regression, or possible abscopal effect.
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Affiliation(s)
| | - Steven N. Seyedin
- Department of Radiation Oncology, The University of Iowa, Iowa City, Iowa 52242
| | - Imran H. Mohiuddin
- Department of Radiation Oncology, The University of Iowa, Iowa City, Iowa 52242
| | - Kelli L. Hawkes
- Department of Radiation Oncology, The University of Iowa, Iowa City, Iowa 52242
| | - Michael S. Petronek
- Department of Radiation Oncology, The University of Iowa, Iowa City, Iowa 52242
| | - Carryn M. Anderson
- Department of Radiation Oncology, The University of Iowa, Iowa City, Iowa 52242
| | - John M. Buatti
- Department of Radiation Oncology, The University of Iowa, Iowa City, Iowa 52242
| | - Mohammed M. Milhem
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Holden Comprehensive Cancer Center, Department of Internal Medicine, The University of Iowa, Iowa City, Iowa 52242
| | - Varun Monga
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Holden Comprehensive Cancer Center, Department of Internal Medicine, The University of Iowa, Iowa City, Iowa 52242
| | - Bryan G. Allen
- Department of Radiation Oncology, The University of Iowa, Iowa City, Iowa 52242
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Chua ML, Ma DJ, Anderson CM, Karam SD, Margalit DN, Kimple RJ. Follow-Up and Management of Patients With Head and Neck Cancer During the 2019 Novel Coronavirus (SARS-CoV-2) Disease Pandemic. Adv Radiat Oncol 2020; 5:631-636. [PMID: 32426556 PMCID: PMC7227497 DOI: 10.1016/j.adro.2020.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Melvin L.K. Chua
- Divisions of Radiation Oncology and Medical Sciences, National Cancer Centre Singapore and Oncology Academic Programme, Duke-NUS Medical School, Singapore
| | - Daniel J. Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Carryn M. Anderson
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Sana D. Karam
- Department of Radiation Oncology, University of Colorado Anschutz Cancer Center, Aurora, Colorado
| | - Danielle N. Margalit
- Department of Radiation Oncology, Dana-Farber/Brigham & Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Randall J. Kimple
- Department of Human Oncology, UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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10
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Holmlund J, Brill JM, Fairbanks R, Saunders D, Sonis ST, Downs M, Anderson CM. ROMAN: Reduction in oral mucositis with avasopasem manganese (GC4419)–Phase III trial in patients receiving chemoradiotherapy for locally advanced, nonmetastatic head and neck cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.tps6596] [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
TPS6596 Background: Approximately 70% of patients receiving intensity-modulated radiotherapy (IMRT) plus cisplatin for locally advanced head and neck cancer (HNC) develop SOM, defined as WHO Grade 3 or 4, which limits patients' ability to eat solids (Gr 3) or liquids (Gr 4, requiring enteral nutrition). An RT-induced burst of superoxide initiates oral mucositis (OM) development. GC4419, a superoxide dismutase mimetic, interrupts this process by converting superoxide to H2O2. It showed promising reduction of SOM in a published open-label Phase 1b/2a trial (IJROBP 1 Feb 2018). In a subsequent randomized, double-blind placebo-controlled trial in 223 patients receiving IMRT/cisplatin for HNC (ASCO 2018), 90 mg of GC4419 administered M-F prior to IMRT demonstrated statistically significant reduction in SOM duration (p=0.024, median 1.5 days @ 90 mg vs. 19 days placebo) and meaningful reductions @ 90 mg in SOM incidence (43% vs. 65%) and severity (incidence of Grade 4, 16% vs. 30%). The safety results were acceptable and consistent with the known toxicities of IMRT/cisplatin. Methods: 335 patients at multiple centers in the U.S. and Canada with locally-advanced, nonmetastatic head and neck cancer (oral cavity/oropharyngeal) receiving 70 Gy IMRT (>50 Gy to > 2 oral sites) plus cisplatin (40 mg/m2 qwk x 6-7, or 100 mg/m2 q3wk x 3) are being randomized (double-blinded) 3:2 to 90 mg of GC4419 or placebo, M-F before each RT fraction. Enrollment is stratified by cisplatin schedule and treatment setting (definitive vs. post-op). OM by the WHO scale will be assessed twice weekly during RT & weekly for 2 weeks post RT. The primary efficacy endpoint is incidence of SOM through the end of IMRT. Secondary efficacy endpoints include severity (incidence of Grade 4 OM through the end of IMRT), & days of SOM (days from first to last SOM for all patients, with patients never developing SOM having 0 days of SOM by definition). Days of SOM for the subset developing SOM will be analyzed descriptively. Patients will be followed for one year post IMRT for tumor progression/recurrence and for two years for survival. Clinical trial information: NCT03689712 .
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Affiliation(s)
| | | | | | - Deborah Saunders
- Northeast Cancer Centre, Health Sciences North, Sudbury, ON, Canada
| | | | - Matt Downs
- Statistics Collaborative, Inc., Wasnington, DC
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11
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Safran H, Winter KA, Wigle DA, DiPetrillo TA, Haddock MG, Hong TS, Leichman LP, Rajdev L, Resnick MB, Kachnic LA, Seaward SA, Mamon HJ, Diaz Pardo DA, Anderson CM, Shen X, Sharma AK, Katz AW, Salo JC, Leonard KL, Crane CH. Trastuzumab with trimodality treatment for esophageal adenocarcinoma with HER2 overexpression: NRG Oncology/RTOG 1010. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4500] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
4500 Background: Trastuzumab is a monoclonal antibody against human epidermal growth factor receptor 2 (HER2). The primary objective of RTOG 1010 was to determine if trastuzumab increases disease-free survival (DFS) when combined with trimodality treatment for patients with HER2 overexpressing esophageal adenocarcinoma. Methods: This open label, randomized phase III trial included patients with newly diagnosed stage T1N1-2, T2-3N0-2 adenocarcinoma of the esophagus involving the mid, distal, or esophagogastric junction and up to 5cm of the stomach. All patients received chemotherapy (C) of paclitaxel, 50mg/m2 and carboplatin AUC = 2, weekly for 6 weeks, with radiation (XRT: 3D-CRT or IMRT, 50.4 Gy in 28 fractions) followed by surgery. Patients were randomized 1:1 to receive weekly trastuzumab 4mg/kg week 1 then 2mg/kg/weekly x 5 during CXRT then 6 mg/kg for 1 dose prior to surgery and 6mg/kg every 3 weeks for 13 treatments after surgery. HER2 status was determined by IHC and gene amplification by FISH. With a 2-sided alpha of 0.05, 162 DFS events provide 90% power to detect a signal for an increase in median DFS from 15 to 25 months. DFS and overall survival (OS) were estimated by the Kaplan-Meier method. and arms were compared using the log rank test. The Cox proportional hazards model was used to analyze treatment effect. Results: 571 patients were entered for assessment of HER2 expression, 203 HER2+ patients randomized. The median follow-up for alive patients is 5.0 years. The estimated 2, 3, and 4-year DFS (95% CI) for the CXRT +trastuzumab arm were 41.8% (31.8%, 51.7%), 34.3% (24.7%, 43.9%), and 33.1% (23.6%, 42.7%), respectively, and for the CXRT arm were 40.0% (30.0%, 49.9%), 33.4% (23.8%, 43.0%), and 30.1% (20.7%, 39.4%), respectively; log-rank p = 0.85. The median DFS time is 19.6 months (13.5-26.2) for the CXRT +trastuzumab arm compared to 14.2 months (10.5-23.0) for the CXRT arm. The hazard ratio (95% CI) comparing the DFS of CXRT+trastuzumab arm to the CXRT arm was 0.97 (0.69, 1.36). The median OS time was 38.5 months (26.2-70.4) for the CXRT+trastuzumab arm compared to 38.9 months (29.0-64.5) for the CXRT arm, hazard ratio (95% CI): 1.01 (0.69, 1.47). There was no statistically significant increase in treatment-related toxicities with the addition of trastuzumab including no increase in cardiac events. Conclusions: The addition of trastuzumab to trimodality treatment did not improve DFS for patients with HER2 overexpressing esophageal adenocarcinoma. Supported by NCI grants U10CA180868, UG1CA189867, U10CA180822 and Genentech. Clinical trial information: NCT01196390 .
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Affiliation(s)
- Howard Safran
- Brown University Oncology Research Group, Providence, RI
| | - Kathryn A. Winter
- Statistical Center, Radiation Therapy Oncology Group, Philadelphia, PA
| | | | | | | | - Theodore S. Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | | | - Lakshmi Rajdev
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | | | | | | | | | | | | | - Xinglei Shen
- University of Kansas Cancer Center, Westwood, KS
| | | | - Alan W. Katz
- University of Rochester, James P. Wilmot Cancer Institute, Rochester, NY
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12
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Steinbach EJ, Monga V, Furqan M, Laux DE, Zepeda-Orozco D, Jetton JG, Saunders D, Dunlap N, Curtis A, Fairbanks R, Bell S, Anderson CM, Beardsley RA, Holmlund J, Spitz D, Allen BG. Effects of GC4419 (avasopasem manganese) on chronic kidney disease in head and neck cancer patients treated with radiation and cisplatin. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.12071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12071 Background: Nephrotoxicity is a major complication of platinum-based chemotherapy and ranges in incidence from 31-68%. The effects of platinum-based chemotherapeutics on long-term renal outcomes (chronic kidney disease, CKD) profoundly affect morbidity and mortality. Concurrent chemoradiotherapy (CRT) including cisplatin is standard for locally advanced squamous cell head and neck cancer (HNC) but is accompanied by the risk of CKD. In a randomized, multi-center, placebo-controlled Phase 2b trial ( NCT02508389 ) of GC4419 (avasopasem manganese) in HNC patients receiving CRT, avasopasem reduced the duration, incidence, and severity of severe oral mucositis (Anderson et al, JCO 2019). Avasopasem did not appear to alter the safety profile of CRT in that trial, including incidence of adverse events of kidney injury or azotemia. Methods: Pre- and post-treatment markers of kidney function including blood urea nitrogen (BUN), serum creatinine (sCr), and estimated glomerular filtration rate (eGFR) were retrospectively evaluated for a subset of 52 of the trial patients who received 3 cycles x 100 mg/m2 cisplatin plus placebo or 30 or 90 mg of avasopasem intravenously prior to RT, and 7 comparator patients who received the same CRT outside the study. Kidney function was evaluated between 3- and 24-months post-completion of cisplatin-radiation therapy by two-way analysis of variance (ANOVA) as defined by the Kidney Disease Improving Global Outcomes (KDIGO) CKD staging. Results: Baseline patient characteristics were skewed towards a male population but were balanced across all treatment arms with regards to baseline kidney function (comparator + placebo, n = 19; 30 mg GC4419, n = 18; 90 mg GC4419, n = 15). Treatment with 90 mg GC4419 demonstrated normal BUN values (10-20 mg/dL) at 3, 6, and 18 months and normal sCr values (0.6-1.2 mg/dL) between 3 and 24 months as compared to the placebo arm + comparator group, which exhibited statistically elevated BUN and sCr (p < 0.05). Treatment with 90 mg GC4419 also demonstrated significantly higher eGFR between 3 and 24 months post-chemoradiation (p < 0.05) compared to the placebo arm + comparator group. 90 mg GC4419 treatment significantly reduced the incidence of CKD compared to the placebo arm and comparator group, as determined by fold change in sCr values and eGFR measurements < 60 mL/min (stage G3a/b, G4, or G5 CKD). Conclusions: Avasopasem has the potential to reduce the incidence and severity of CKD in patients receiving cisplatin therapy. Clinical trial information: NCT02508389 .
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Affiliation(s)
| | - Varun Monga
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | | | | | - Jennifer G. Jetton
- University of Iowa Stead Family Children's Hospital, Division of Nephrology, Dialysis, and Transplantation, Iowa City, IA
| | - Deborah Saunders
- Northeast Cancer Centre, Health Sciences North, Sudbury, ON, Canada
| | - Neal Dunlap
- University of Louisville, James Graham Brown Cancer Center, Louisville, KY
| | | | | | | | | | | | | | - Douglas Spitz
- University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City, IA
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13
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Ulrich EJ, Menda Y, Boles Ponto LL, Anderson CM, Smith BJ, Sunderland JJ, Graham MM, Buatti JM, Beichel RR. FLT PET Radiomics for Response Prediction to Chemoradiation Therapy in Head and Neck Squamous Cell Cancer. ACTA ACUST UNITED AC 2020; 5:161-169. [PMID: 30854454 PMCID: PMC6403029 DOI: 10.18383/j.tom.2018.00038] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Radiomics is an image analysis approach for extracting large amounts of quantitative information from medical images using a variety of computational methods. Our goal was to evaluate the utility of radiomic feature analysis from 18F-fluorothymidine positron emission tomography (FLT PET) obtained at baseline in prediction of treatment response in patients with head and neck cancer. Thirty patients with advanced-stage oropharyngeal or laryngeal cancer, treated with definitive chemoradiation therapy, underwent FLT PET imaging before treatment. In total, 377 radiomic features of FLT uptake and feature variants were extracted from volumes of interest; these features variants were defined by either the primary tumor or the total lesion burden, which consisted of the primary tumor and all FLT-avid nodes. Feature variants included normalized measurements of uptake, which were calculated by dividing lesion uptake values by the mean uptake value in the bone marrow. Feature reduction was performed using clustering to remove redundancy, leaving 172 representative features. Effects of these features on progression-free survival were modeled with Cox regression and P-values corrected for multiple comparisons. In total, 9 features were considered significant. Our results suggest that smaller, more homogenous lesions at baseline were associated with better prognosis. In addition, features extracted from total lesion burden had a higher concordance index than primary tumor features for 8 of the 9 significant features. Furthermore, total lesion burden features showed lower interobserver variability.
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Affiliation(s)
- Ethan J Ulrich
- Departments of Electrical and Computer Engineering.,Biomedical Engineering
| | | | | | | | | | | | | | | | - Reinhard R Beichel
- Departments of Electrical and Computer Engineering.,Internal Medicine, University of Iowa, Iowa City, IA
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14
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Anderson CM, Kimple RJ, Lin A, Karam SD, Margalit DN, Chua MLK. De-Escalation Strategies in HPV-Associated Oropharynx Cancer-Are we Putting the Cart Before the Horse? Int J Radiat Oncol Biol Phys 2019; 104:705-709. [PMID: 31204653 DOI: 10.1016/j.ijrobp.2019.02.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 02/22/2019] [Accepted: 02/23/2019] [Indexed: 01/09/2023]
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15
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Anderson CM, Lee CM, Saunders DP, Curtis A, Dunlap N, Nangia C, Lee AS, Gordon SM, Kovoor P, Arevalo-Araujo R, Bar-Ad V, Peddada A, Colvett K, Miller D, Jain AK, Wheeler J, Blakaj D, Bonomi M, Agarwala SS, Garg M, Worden F, Holmlund J, Brill JM, Downs M, Sonis ST, Katz S, Buatti JM. Phase IIb, Randomized, Double-Blind Trial of GC4419 Versus Placebo to Reduce Severe Oral Mucositis Due to Concurrent Radiotherapy and Cisplatin For Head and Neck Cancer. J Clin Oncol 2019; 37:3256-3265. [PMID: 31618127 PMCID: PMC6881100 DOI: 10.1200/jco.19.01507] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Oral mucositis (OM) remains a common, debilitating toxicity of radiation therapy (RT) for head and neck cancer. The goal of this phase IIb, multi-institutional, randomized, double-blind trial was to compare the efficacy and safety of GC4419, a superoxide dismutase mimetic, with placebo to reduce the duration, incidence, and severity of severe OM (SOM). PATIENTS AND METHODS A total of 223 patients (from 44 institutions) with locally advanced oral cavity or oropharynx cancer planned to be treated with definitive or postoperative intensity-modulated RT (IMRT; 60 to 72 Gy [≥ 50 Gy to two or more oral sites]) plus cisplatin (weekly or every 3 weeks) were randomly assigned to receive 30 mg (n = 73) or 90 mg (n = 76) of GC4419 or to receive placebo (n = 74) by 60-minute intravenous administration before each IMRT fraction. WHO grade of OM was assessed biweekly during IMRT and then weekly for up to 8 weeks after IMRT. The primary endpoint was duration of SOM tested for each active dose level versus placebo (intent-to-treat population, two-sided α of .05). The National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.03, was used for adverse event grading. RESULTS Baseline patient and tumor characteristics as well as treatment delivery were balanced. With 90 mg GC4419 versus placebo, SOM duration was significantly reduced (P = .024; median, 1.5 v 19 days). SOM incidence (43% v 65%; P = .009) and severity (grade 4 incidence, 16% v 30%; P = .045) also were improved. Intermediate improvements were seen with the 30-mg dose. Safety was comparable across arms, with no significant GC4419-specific toxicity nor increase of known toxicities of IMRT plus cisplatin. The 2-year follow-up for tumor outcomes is ongoing. CONCLUSION GC4419 at a dose of 90 mg produced a significant, clinically meaningful reduction of SOM duration, incidence, and severity with acceptable safety. A phase III trial (ROMAN; ClinicalTrials.gov identifier: NCT03689712) has begun.
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Affiliation(s)
| | | | - Deborah P Saunders
- North East Cancer Centre, Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | | | - Neal Dunlap
- University of Louisville/James Graham Brown Cancer Center, Louisville, KY
| | | | | | | | | | | | | | | | - Kyle Colvett
- Mountain States Health Alliance, Johnson City, TN
| | | | - Anshu K Jain
- Ashland-Bellefonte Cancer Center, Ashland, KY.,Yale School of Medicine, New Haven, CT
| | | | - Dukagjin Blakaj
- James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - Marcelo Bonomi
- James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | | | | | | | | | | | - Matt Downs
- Statistics Collaborative, Washington, DC
| | | | | | - John M Buatti
- University of Iowa Hospitals and Clinics, Iowa City, IA
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16
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Affiliation(s)
- Beth M Beadle
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Carryn M Anderson
- Department of Radiation Oncology, University of Iowa Hospital and Clinics, Iowa City, Iowa.
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17
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Holmlund J, Brill JM, Lee CM, Saunders D, Sonis ST, Downs M, Anderson CM. Roman: Reduction in oral mucositis with avasopasem manganese (GC4419)—Phase 3 trial in patients receiving chemoradiotherapy for locally-advanced, non-metastatic head and neck cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps6096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS6096 Background: Approximately 70% of patients receiving intensity-modulated radiotherapy (IMRT) plus cisplatin for locally advanced head and neck cancer (HNC) develop SOM, defined as WHO Grade 3 or 4, which limits patients' ability to eat solids (Gr 3) or liquids (Gr 4, requiring enteral nutrition). An RT-induced burst of superoxide initiates oral mucositis (OM) development. GC4419, a superoxide dismutase mimetic, interrupts this process by converting superoxide to H2O2. It showed promising reduction of SOM in a published open-label Phase 1b/2a trial (IJROBP 1 Feb 2018). In a subsequent randomized, double-blind placebo-controlled trial in 223 patients receiving IMRT/cisplatin for HNC (ASCO 2018), 90 mg of GC4419 administered M-F prior to IMRT demonstrated statistically significant reduction in SOM duration (p=0.024, median 1.5 days @ 90 mg vs 19 days placebo) and meaningful reductions @ 90 mg in SOM incidence (43% vs 65%) and severity (incidence of Grade 4, 16% vs 30%). The safety profile was acceptable and consistent with the known toxicities of IMRT/cisplatin. Methods: 335 patients at multiple centers in the U.S. and Canada with locally-advanced, nonmetastatic head and neck cancer (oral cavity/oropharyngeal) receiving 70 Gy IMRT (>50 Gy to > 2 oral sites) plus cisplatin (40 mg/m2 qwk x 6-7, or 100 mg/m2 q3wk x 3) are being randomized (double-blinded) 3:2 to 90 mg of GC4419 or placebo, M-F before each RT fraction. Enrollment is stratified by cisplatin schedule and treatment setting (definitive vs post-op). OM by the WHO scale will be assessed twice weekly during RT & weekly for 2 weeks post RT. The primary efficacy endpoint is incidence of SOM through the end of IMRT. Secondary efficacy endpoints include severity (incidence of Grade 4 OM through the end of IMRT), & days of SOM (days from first to last SOM for all patients, with patients never developing SOM having 0 days of SOM by definition). Days of SOM for the subset developing SOM will be analyzed descriptively. Patients will be followed for one year post IMRT for tumor progression/recurrence and for two years for survival. Supported by Galera Therapeutics, Inc. Clinical trial information: NCT03689712.
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Affiliation(s)
| | | | | | - Deborah Saunders
- Northeast Cancer Centre of Health Sciences North, Sudbury, ON, Canada
| | | | - Matt Downs
- Statistics Collaborative, Inc., Wasnington, DC
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18
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Furqan M, Snyders TP, Saqlain MU, Mott SL, Laux D, Snow A, Anderson CM, Watkins JM, Clamon GH. Comparing high-dose cisplatin with cisplatin-based combination chemotherapy in definitive concurrent chemoradiation setting for locally advanced head and neck squamous cell carcinoma (LAHNSCC). Cancer Med 2019; 8:2730-2739. [PMID: 30968604 PMCID: PMC6558467 DOI: 10.1002/cam4.2139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND High-dose cisplatin (Cis) is a preferred systemic agent for concurrent chemoradiation (CRT) in locally advanced head and neck squamous cell cancer (LAHNSCC) patients. As some patients are unable to tolerate Cis, this study compares the toxicity and efficacy of weekly cisplatin-paclitaxel (CP) regimen with Cis. METHODS Patients with LAHNSCC receiving definitive chemoradiation either with Cis (Cisplatin-100 mg/m2 q3w x 3) or CP (Cisplatin-20 mg/m2 ; Paclitaxel-30 mg/m2 qw x7) were included. RESULTS Cis and CP groups were comprised of 114 and 111 subjects, respectively. Complete response for Cis versus CP groups was 88% versus 88%, respectively. Median follow-up for the study was 58.5 months. After adjusting for potential treatment selection bias, no significant differences were evident between Cis and CP groups for overall survival (hazard ratios [HR] 0.85, 95% CI 0.59-1.21, P = 0.36), progression free survival (HR 0.88, 95% CI 0.62-1.24, P = 0.46), locoregional control (HR 0.77, 95% CI 0.52-1.15, P = 0.21), and distant control (HR 0.87, 95% CI 0.61-1.23, P = 0.42). Patients in the CP group had less acute and chronic toxicities. CONCLUSIONS Weekly CP regimen can serve as an alternative systemic therapy with radiation in patients with LAHNSCC who are not fit for Cis.
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Affiliation(s)
- Muhammad Furqan
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Travis P Snyders
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Mohammed U Saqlain
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Sarah L Mott
- Biostatistics Core, Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Douglas Laux
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Anthony Snow
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Carryn M Anderson
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - John M Watkins
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Gerald H Clamon
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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19
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Holmlund JT, Anderson CM, Sonis ST, Beardsley R, Riley D, Brill JM, Brookes M, Terry K, Sorensen JM. CLO19-037: Reducing the Duration, Incidence and Severity of Mucosal Injury Due to Cancer Radiation therapy (RT); Positive Randomized Phase 2b Trial Results With GC4419 (Avasopasem Manganese), a Small Molecule Superoxide (SO) Dismutase (SOD) Mimetic. J Natl Compr Canc Netw 2019. [DOI: 10.6004/jnccn.2018.7136] [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: 11/17/2022]
Abstract
Introduction: RT-induced SO contributes to initiation of mucosal injury; eg, oral mucositis (OM) and esophagitis. GC4419 specifically mimics SOD’s dismutation of SO to hydrogen peroxide (H2O2), interdicting OM initiation. GC4419 reduced RT-severe OM (SOM) in a hamster cheek pouch model, and protected mucosa and other normal tissues from radiation-induced injury in other animal models. In a published phase 1b/2a open-label trial (Anderson et al, IJROBP, 1 Feb 2018), GC4419 attenuated SOM in patients (Pts) receiving intensity-modulated RT (IMRT) plus concurrent cisplatin (CDDP) for locally advanced head & neck cancer (HNC). Objectives: Determine whether GC4419 reduces duration, incidence, & severity of SOM. Methods: Pts with locally advanced oral cavity or oropharyngeal cancer; definitive or postoperative intensity-modulated (IM)RT (approximately 70 Gy [>50 Gy to > 2 oral sites]) plus CDDP (weekly or q3wk) were randomized (stratification: tumor HPV status, CDDP schedule) to 30 or 90 mg of GC4419, or placebo (PBO), 60-minute IV infusion, M–F, ending <60 minutes before IMRT delivered in 35 fractions over 7 weeks. WHO grade OM was assessed by trained evaluators biw during IMRT & qwk for up to 8 wks after IMRT. Primary endpoint: duration of SOM. Efficacy was tested for each active dose vs PBO (ITT population) by a sequential, conditional approach (2-sided alpha, 0.05). Results: 223 pts (44 sites): 90 mg (n=76), 30 mg (n=73), or PBO (n=74). Baseline patient and tumor characteristics and treatment delivery were balanced. Efficacy: At 90 mg GC4419 vs PBO, duration of SOM was significantly reduced (median, 1.5 vs 19 d; P=.024). SOM incidence (43% vs 65%; P=.009), and grade 4 incidence (16% vs 30%; P=.045) also improved. There were intermediate improvements with 30 mg. Safety was comparable across arms; no significant GC4419-specific toxicity; other known toxicities of IMRT/CDDP were not increased. Conclusions: GC4419 demonstrated a significant, clinically meaningful reduction of SOM duration, and dose-dependent improvements in other SOM parameters, with acceptable safety. A confirmatory phase 3 trial (NCT03689712) is in progress. Clinical trials to reduce RT-related esophagitis are also planned.
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Mapuskar KA, Anderson CM, Spitz DR, Batinic-Haberle I, Allen BG, E Oberley-Deegan R. Utilizing Superoxide Dismutase Mimetics to Enhance Radiation Therapy Response While Protecting Normal Tissues. Semin Radiat Oncol 2019; 29:72-80. [PMID: 30573187 DOI: 10.1016/j.semradonc.2018.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Symptomatic normal tissue injury is a common side effect following definitive therapeutic radiation and chemotherapy treatment for a variety of malignancies. These cancer therapy related toxicities may occur acutely during treatment resulting in reduced or missed therapy agent administration or after the completion of therapy resulting in significant chronic morbidities that significantly diminish patient quality of life. Radiation and chemotherapy induce the formation of reactive oxygen species (ROS) both in normal tissues and tumor cells. One type of ROS common to both chemotherapy and radiation therapy is the formation of superoxide (O2•-). Fortunately, due to metabolic differences between cancer and normal cell metabolism, as well as improved targeting techniques, ROS generation following radiation and chemotherapy is generally greater in cancer cells compared to normal tissues. However, the levels of ROS generated in normal tissues are capable of inducing significant toxicity. Thus, several groups are focusing on metabolism-based approaches to mitigate normal tissue effects occurring both during and following cancer therapy. This review will summarize the most current preclinical and clinical data available demonstrating the efficacy of small molecule, superoxide dismutase mimetics in minimizing radiation and chemotherapy-induced normal tissue injury, resulting in enhanced patient outcomes.
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Affiliation(s)
- Kranti A Mapuskar
- From the Free Radical and Radiation Biology Program, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA.; Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Carryn M Anderson
- Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Douglas R Spitz
- From the Free Radical and Radiation Biology Program, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA.; Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Ines Batinic-Haberle
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC
| | - Bryan G Allen
- From the Free Radical and Radiation Biology Program, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA.; Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA..
| | - Rebecca E Oberley-Deegan
- Department of Biochemistry and Molecular Biology, College of Medicine, Nebraska Medical Center, Omaha, NE..
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Anderson CM, Lee CM, Saunders D, Curtis A, Dunlap N, Nangia CS, Lee AS, Holmlund J, Brill JM, Sonis ST, Buatti JM. Results of a randomized, placebo (PBO) controlled, double-blind P2b trial of GC4419 (avisopasem manganese) to reduce duration, incidence and severity and delay onset of severe radiation-related oral mucositis (SOM) in patients (pts) with locally advanced squamous cell cancer of the oral cavity (OC) or oropharynx (OP). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.6006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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)
| | | | - Deborah Saunders
- Northeast Cancer Centre of Health Sciences North, Sudbury, ON, Canada
| | - Amarinthia Curtis
- Spartanburg Medical Center, Gibbs Cancer Center, Spartanburg, SC, US
| | - Neal Dunlap
- University of Louisville, James Graham Brown Cancer Center, Louisville, KY
| | - Chaitali Singh Nangia
- University of California Irvine Health Chao Family Comprehensive Cancer Center, Orange, CA
| | | | | | | | | | - John Michael Buatti
- University of Iowa Hospitals and Clinics, Department of Radiation Oncology, Iowa City, IA
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22
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Anderson CM, Sonis ST, Lee CM, Adkins D, Allen BG, Sun W, Agarwala SS, Venigalla ML, Chen Y, Zhen W, Mould DR, Holmlund JT, Brill JM, Buatti JM. Phase 1b/2a Trial of the Superoxide Dismutase Mimetic GC4419 to Reduce Chemoradiotherapy-Induced Oral Mucositis in Patients With Oral Cavity or Oropharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2017; 100:427-435. [PMID: 29174131 DOI: 10.1016/j.ijrobp.2017.10.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/26/2017] [Accepted: 10/10/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE To assess the safety of the superoxide dismutase mimetic GC4419 in combination with radiation and concurrent cisplatin for patients with oral cavity or oropharyngeal cancer (OCC) and to assess the potential of GC4419 to reduce severe oral mucositis (OM). PATIENTS AND METHODS Patients with locally advanced OCC treated with definitive or postoperative intensity modulated radiation therapy (IMRT) plus cisplatin received GC4419 by 60-minute intravenous infusion, ending <60 minutes before IMRT, Monday through Friday for 3 to 7 weeks, in a dose and duration escalation study. Oral mucositis was assessed twice weekly during and weekly after IMRT. RESULTS A total of 46 patients received GC4419 in 11 separate dosing and duration cohorts: dose escalation occurred in 5 cohorts receiving 15 to 112 mg/d over 3 weeks (n=20), duration escalation in 3 cohorts receiving 112 mg/d over 4 to 6 weeks (n=12), and then 3 additional cohorts receiving 30 or 90 mg/d over 6 to 7 weeks (n=14). A maximum tolerated dose was not reached. One dose-limiting toxicity (grade 3 gastroenteritis and vomiting with hyponatremia) occurred in each of 2 separate cohorts at 112 mg. Nausea/vomiting and facial paresthesia during infusion seemed to be GC4419 dose-related. Severe OM occurred through 60 Gy in 4 of 14 patients (29%) dosed for 6 to 7 weeks, with median duration of only 2.5 days. CONCLUSIONS The safety of GC4419 concurrently with chemoradiation for OCC was acceptable. Toxicities included nausea/vomiting and paresthesia. Doses of 30 and 90 mg/d administered for 7 weeks were selected for further study. In an exploratory analysis, severe OM seemed less frequent and briefer than expected.
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Affiliation(s)
- Carryn M Anderson
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | - Stephen T Sonis
- Biomodels and Division of Oral Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Douglas Adkins
- Section of Medical Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Bryan G Allen
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Wenqing Sun
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Sanjiv S Agarwala
- Department of Medical Oncology, St. Luke's University Hospital and Temple University, Easton, Pennsylvania
| | | | - Yuhchyau Chen
- Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, New York
| | - Weining Zhen
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Diane R Mould
- Projections Research Inc., Phoenixville, Pennsylvania
| | | | | | - John M Buatti
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Jennings DE, Flasar FM, Kunde VG, Nixon CA, Segura ME, Romani PN, Gorius N, Albright S, Brasunas JC, Carlson RC, Mamoutkine AA, Guandique E, Kaelberer MS, Aslam S, Achterberg RK, Bjoraker GL, Anderson CM, Cottini V, Pearl JC, Smith MD, Hesman BE, Barney RD, Calcutt S, Vellacott TJ, Spilker LJ, Edgington SG, Brooks SM, Ade P, Schinder PJ, Coustenis A, Courtin R, Michel G, Fettig R, Pilorz S, Ferrari C. Composite infrared spectrometer (CIRS) on Cassini: publisher's note. Appl Opt 2017; 56:5897. [PMID: 29047908 DOI: 10.1364/ao.56.005897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Indexed: 06/07/2023]
Abstract
This publisher's note renumbers the reference list in Appl. Opt.56, 5274 (2017)APOPAI0003-693510.1364/AO.56.005274.
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Andresen NS, Buatti JM, Tewfik HH, Pagedar NA, Anderson CM, Watkins JM. Radioiodine Ablation following Thyroidectomy for Differentiated Thyroid Cancer: Literature Review of Utility, Dose, and Toxicity. Eur Thyroid J 2017; 6:187-196. [PMID: 28868259 PMCID: PMC5567113 DOI: 10.1159/000468927] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/03/2017] [Indexed: 11/19/2022] Open
Abstract
Management recommendations for differentiated thyroid cancer are evolving. Total thyroidectomy is the backbone of curative-intent therapy, with radioiodine ablation (RAI) of the thyroid remnant routinely performed, in order to facilitate serologic surveillance and reduce recurrence risk. Several single-institution series have identified patient subsets for whom recurrence risk is sufficiently low that RAI may not be indicated. Further, the appropriate dose of RAI specific to variable clinicopathologic presentations remains poorly defined. While recent randomized trials demonstrated equivalent thyroid remnant ablation rates between low- and high-dose RAI, long-term oncologic endpoints remain unreported. While RAI may be employed to facilitate surveillance following total thyroidectomy, cancer recurrence risk reduction is not demonstrated in favorable-risk patients with tumor size ≤1 cm without high-risk pathologic features. When RAI is indicated, in patients without macroscopic residual disease or metastasis, the evidence suggests that the rate of successful remnant ablation following total thyroidectomy is equivalent between doses of 30-50 mCi and doses ≥100 mCi, with fewer acute side effects; however, in the setting of subtotal thyroidectomy or when preablation diagnostic scan uptake is >2%, higher doses are associated with improved ablation rates. Historical series demonstrate conflicting findings of long-term cancer control rates between dose levels; long-term results from modern series have yet to be reported. For high-risk patients, including those with positive surgical margins, gross extrathyroidal extension, lymph node involvement, subtotal thyroidectomy, or >5% uptake, higher-dose RAI therapy appears to provide superior rates of ablation and cancer control.
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Affiliation(s)
| | - John M. Buatti
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, USA
| | | | - Nitin A. Pagedar
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Carryn M. Anderson
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, USA
| | - John M. Watkins
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, USA
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Jennings DE, Flasar FM, Kunde VG, Nixon CA, Segura ME, Romani PN, Gorius N, Albright S, Brasunas JC, Carlson RC, Mamoutkine AA, Guandique E, Kaelberer MS, Aslam S, Achterberg RK, Bjoraker GL, Anderson CM, Cottini V, Pearl JC, Smith MD, Hesman BE, Barney RD, Calcutt S, Vellacott TJ, Spilker LJ, Edgington SG, Brooks SM, Ade P, Schinder PJ, Coustenis A, Courtin R, Michel G, Fettig R, Pilorz S, Ferrari C. Composite infrared spectrometer (CIRS) on Cassini. Appl Opt 2017; 56:5274-5294. [PMID: 29047582 DOI: 10.1364/ao.56.005274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/25/2017] [Indexed: 06/07/2023]
Abstract
The Cassini spacecraft orbiting Saturn carries the composite infrared spectrometer (CIRS) designed to study thermal emission from Saturn and its rings and moons. CIRS, a Fourier transform spectrometer, is an indispensable part of the payload providing unique measurements and important synergies with the other instruments. It takes full advantage of Cassini's 13-year-long mission and surpasses the capabilities of previous spectrometers on Voyager 1 and 2. The instrument, consisting of two interferometers sharing a telescope and a scan mechanism, covers over a factor of 100 in wavelength in the mid and far infrared. It is used to study temperature, composition, structure, and dynamics of the atmospheres of Jupiter, Saturn, and Titan, the rings of Saturn, and surfaces of the icy moons. CIRS has returned a large volume of scientific results, the culmination of over 30 years of instrument development, operation, data calibration, and analysis. As Cassini and CIRS reach the end of their mission in 2017, we expect that archived spectra will be used by scientists for many years to come.
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Eppsteiner RW, Fowlkes JW, Anderson CM, Robinson RA, Pagedar NA. Aggressive Salivary Malignancies at Early Stage: Outcomes and Implications for Treatment. Ann Otol Rhinol Laryngol 2017; 126:525-529. [PMID: 28474964 DOI: 10.1177/0003489417702655] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Few studies have examined whether the use of adjuvant treatment impacts survival for early stage high-grade salivary tumors. METHODS A retrospective review of the SEER database between 1973 and 2012 was performed. Patients with high-grade major salivary gland tumors including salivary duct carcinoma, carcinoma ex-pleomorphic adenoma, high-grade mucoepidermoid carcinoma, or adenocarcinoma, NOS were identified. Only stage I-II tumors were included. The impact of radiation status on observed and relative survival was examined. RESULTS Five hundred seventy-four patients with high-grade, early stage salivary tumors met inclusion criteria. Sixty-seven percent of patients received radiation therapy. There was no difference in observed or relative survival based on having received radiation. CONCLUSIONS Adjuvant radiation is indicated for advanced stage tumors or early stage tumors with adverse features. For early stage tumors without adverse features, there was no survival benefit from radiation therapy. Adjuvant radiation should be decided on a case-by-case basis for these patients.
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Affiliation(s)
- Robert W Eppsteiner
- 1 Departments of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jonathan W Fowlkes
- 1 Departments of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Carryn M Anderson
- 2 Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Robert A Robinson
- 3 Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Nitin A Pagedar
- 1 Departments of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Marquardt M, Anderson CM, Mott SL, Furqan M, Clamon GH, Parekh K, Allen BG, Buatti JM, Watkins JM. Cisplatin/5-fluorouracil (CF) versus carboplatin/paclitaxel (CT) chemoradiotherapy (CRT) for locoregionally advanced esophageal cancer (LAEC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.140] [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
140 Background: Disease control and survival outcomes for LAEC are poor despite multimodality treatment with CRT with or without esophagectomy. Without comparative trial data, oncologists select a chemotherapy regimen based on clinical experience and toxicity profile. The present investigation compares LAEC progression free survival (PFS) and overall survival (OS) for CF versus CT. Methods: A retrospective analysis was performed for patients with LAEC from 2003-2012, treated with curative-intent neoadjuvant or definitive concurrent CRT with either CF or CT. Chi-squared tests, Fisher’s exact tests, and t-tests were used to identify significant differences between treatment groups. The Kaplan-Meier method was used to estimate PFS and OS. Results: Of 149 patients with non-metastatic LAEC, 82 met inclusion criteria (n=38 CF, n=44 CT), with 63, 2, and 2 excluded for non-CF/CT CRT, missing data, and <1 month follow-up, respectively. Treatment groups were well balanced, excepting fewer females, lower prior cancer rate, and longer follow-up for the CF group (Table 1). At a median follow-up of 22.7 months (range, 1.8-132.1, median follow-up 58.6 for survivors), 48 patients experienced recurrence (22 CF, 26 CT), and 63 patients died (29 CF, 34 CT). No differences in PFS or OS were demonstrated between treatment groups (Table 1). Conclusions: The present study failed to detect a disease control or survival difference between CF and CT as a component of CRT in neoadjuvant or definitive settings for LAEC. Until randomized trial data are available, oncologists may elect CF or CT based on clinical situations and anticipated sequelae. [Table: see text]
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Affiliation(s)
| | | | - Sarah L Mott
- University of Iowa Hospitals and Clinics, Department of Radiation Oncology, Iowa City, IA
| | | | | | - Kalpaj Parekh
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | - John Michael Buatti
- University of Iowa Hospitals and Clinics, Department of Radiation Oncology, Iowa City, IA
| | - John Morgan Watkins
- University of Iowa Hospital and Clinics, Department of Radiation Oncology, Iowa City, IA
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Dooley SA, Anderson CM. Definitive IMRT for Stage III Thymic Carcinoma: A Brief Report and Literature Review. Front Oncol 2016; 6:219. [PMID: 27822456 PMCID: PMC5075761 DOI: 10.3389/fonc.2016.00219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 10/03/2016] [Indexed: 11/24/2022] Open
Abstract
Introduction Thymic carcinoma is a rare malignancy often presenting at an advanced stage. Radiation therapy and chemotherapy are often the only treatment options available to physicians. Methods A 70-year-old man presented with an unresectable stage III thymic tumor and was treated with 45 Gy in 25 fractions followed by a boost of 21.6 Gy in 12 fractions. He was also treated with bortezomib for multiple myeloma unrelated to his primary malignancy. Results The patient made a full recovery following the radiation regimen and remained disease free 4 years after the treatment. Conclusion Exclusive treatment with intensity-modulated radiation therapy provides a viable treatment option for patients presenting with advanced stage thymic carcinoma.
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Affiliation(s)
- Sarah A Dooley
- Carver College of Medicine, University of Iowa , Iowa City, IA , USA
| | - Carryn M Anderson
- Department of Radiation Oncology, University of Iowa Hospital and Clinics , Iowa City, IA , USA
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Affiliation(s)
| | | | - C M Anderson
- Department of Pædiatrics and Child Health, The Children's Hospital, Birmingham, B16 8ET
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Furqan M, Saqlain MU, Mott SL, Patel R, Laux DE, Zhang J, Abushahin LI, Anderson CM, Watkins J, Snow AN, Sun W, Clamon GH. Retrospective comparison between high-dose cisplatin and less-intensive weekly cisplatin/paclitaxel concurrently with radiation for locally advanced head and neck cancer (LAHNC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e17535] [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)
| | | | - Sarah L Mott
- University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City, IA
| | - Ravi Patel
- University of Iowa Hospsital and Clinics, Iowa City, IA
| | | | - Jun Zhang
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Department of Internal Medicine, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA
| | | | | | - John Watkins
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | - Wenqing Sun
- University of Iowa Hospitals and Clinics, Iowa City, IA
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Anderson CM, Allen BG, Sun W, Agarwala SS, Lee CM, Venigalla ML, Greenberg L, Adkins D, Chen Y, Zhen W, Mould DR, Holmlund J, Brill JM, Sonis ST, Buatti JM. Phase Ib trial of superoxide (SO) dismutase (SOD) mimetic GC4419 to reduce chemoradiotherapy (CRT)-induced oral mucositis (OM) in patients (pts) with oral cavity or oropharyngeal carcinoma (OCC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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)
| | | | - Wenqing Sun
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | | | | | | | - Douglas Adkins
- Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO
| | - Yuhchyau Chen
- University of Rochester Medical Center, Rochester, NY
| | - Weining Zhen
- University of Nebraska Medical Center, Omaha, NE
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Lyons-Ruth K, Pechtel P, Yoon SA, Anderson CM, Teicher MH. Disorganized attachment in infancy predicts greater amygdala volume in adulthood. Behav Brain Res 2016; 308:83-93. [PMID: 27060720 DOI: 10.1016/j.bbr.2016.03.050] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/09/2016] [Accepted: 03/28/2016] [Indexed: 02/07/2023]
Abstract
Early life stress in rodents is associated with increased amygdala volume in adulthood. In humans, the amygdala develops rapidly during the first two years of life. Thus, disturbed care during this period may be particularly important to amygdala development. In the context of a 30-year longitudinal study of impoverished, highly stressed families, we assessed whether disorganization of the attachment relationship in infancy was related to amygdala volume in adulthood. Amygdala volumes were assessed among 18 low-income young adults (8M/10F, 29.33±0.49years) first observed in infancy (8.5±5.6months) and followed longitudinally to age 29. In infancy (18.58±1.02mos), both disorganized infant attachment behavior and disrupted maternal communication were assessed in the standard Strange Situation Procedure (SSP). Increased left amygdala volume in adulthood was associated with both maternal and infant components of disorganized attachment interactions at 18 months of age (overall r=0.679, p<0.004). Later stressors, including childhood maltreatment and attachment disturbance in adolescence, were not significantly related to left amygdala volume. Left amygdala volume was further associated with dissociation and limbic irritability in adulthood. Finally, left amygdala volume mediated the prediction from attachment disturbance in infancy to limbic irritability in adulthood. Results point to the likely importance of quality of early care for amygdala development in human children as well as in rodents. The long-term prediction found here suggests that the first two years of life may be an early sensitive period for amygdala development during which clinical intervention could have particularly important consequences for later child outcomes.
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Affiliation(s)
- K Lyons-Ruth
- Biobehavioral Family Studies Research Program, Cambridge Hospital, United States; Department of Psychiatry, Harvard Medical School, United States.
| | - P Pechtel
- Center for Depression, Anxiety and Stress Research, McLean Hospital, United States; Department of Psychiatry, Harvard Medical School, United States
| | - S A Yoon
- Behavioral and Cognitive Neuroscience Program, Department of Psychology, The Graduate Center of the City University of New York, United States
| | - C M Anderson
- Developmental Biopsychiatry Research Program, McLean Hospital, United States; Brain Imaging Center, McLean Hospital, United States; Department of Psychiatry, Harvard Medical School, United States
| | - M H Teicher
- Developmental Biopsychiatry Research Program, McLean Hospital, United States; Department of Psychiatry, Harvard Medical School, United States
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Karnell LH, Sperry SM, Anderson CM, Pagedar NA. Influence of body composition on survival in patients with head and neck cancer. Head Neck 2015; 38 Suppl 1:E261-7. [PMID: 25545073 DOI: 10.1002/hed.23983] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Recent evidence has suggested links between obesity and outcomes for various types of cancer. This study investigates the impact that body composition has on survival in patients with head and neck cancer. METHODS Data prospectively collected from 578 patients were analyzed using Cox regression models to determine independent associations that pretreatment body mass index (BMI) and 3-month weight change have on observed survival. RESULTS Higher BMIs were associated with better survival (p < .001). Five-year rates ranged from 33.8% for underweight to 75.3% for overweight/obese patients. Patients with stable weight had the highest 5-year rate (72.6%; p = .019), whereas patients who gained ≥5% had worse survival (45.8%) than those who lost ≥5% (65.8%). BMI independently predicted survival, whereas weight change was not an independent predictor. CONCLUSION This demonstrated association between BMI and survival provides useful information when offering prognoses and investigating optimal treatments © 2015 Wiley Periodicals, Inc. Head Neck 38: E261-E267, 2016.
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Affiliation(s)
- Lucy Hynds Karnell
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa College of Medicine, Iowa City, Iowa
| | - Steven M Sperry
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa College of Medicine, Iowa City, Iowa
| | - Carryn M Anderson
- Department of Radiation Oncology, University of Iowa College of Medicine, Iowa City, Iowa
| | - Nitin A Pagedar
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa College of Medicine, Iowa City, Iowa
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Alexander SPH, Benson HE, Faccenda E, Pawson AJ, Sharman JL, McGrath JC, Catterall WA, Spedding M, Peters JA, Harmar AJ, Abul-Hasn N, Anderson CM, Anderson CMH, Araiksinen MS, Arita M, Arthofer E, Barker EL, Barratt C, Barnes NM, Bathgate R, Beart PM, Belelli D, Bennett AJ, Birdsall NJM, Boison D, Bonner TI, Brailsford L, Bröer S, Brown P, Calo G, Carter WG, Catterall WA, Chan SLF, Chao MV, Chiang N, Christopoulos A, Chun JJ, Cidlowski J, Clapham DE, Cockcroft S, Connor MA, Cox HM, Cuthbert A, Dautzenberg FM, Davenport AP, Dawson PA, Dent G, Dijksterhuis JP, Dollery CT, Dolphin AC, Donowitz M, Dubocovich ML, Eiden L, Eidne K, Evans BA, Fabbro D, Fahlke C, Farndale R, Fitzgerald GA, Fong TM, Fowler CJ, Fry JR, Funk CD, Futerman AH, Ganapathy V, Gaisnier B, Gershengorn MA, Goldin A, Goldman ID, Gundlach AL, Hagenbuch B, Hales TG, Hammond JR, Hamon M, Hancox JC, Hauger RL, Hay DL, Hobbs AJ, Hollenberg MD, Holliday ND, Hoyer D, Hynes NA, Inui KI, Ishii S, Jacobson KA, Jarvis GE, Jarvis MF, Jensen R, Jones CE, Jones RL, Kaibuchi K, Kanai Y, Kennedy C, Kerr ID, Khan AA, Klienz MJ, Kukkonen JP, Lapoint JY, Leurs R, Lingueglia E, Lippiat J, Lolait SJ, Lummis SCR, Lynch JW, MacEwan D, Maguire JJ, Marshall IL, May JM, McArdle CA, McGrath JC, Michel MC, Millar NS, Miller LJ, Mitolo V, Monk PN, Moore PK, Moorhouse AJ, Mouillac B, Murphy PM, Neubig RR, Neumaier J, Niesler B, Obaidat A, Offermanns S, Ohlstein E, Panaro MA, Parsons S, Pwrtwee RG, Petersen J, Pin JP, Poyner DR, Prigent S, Prossnitz ER, Pyne NJ, Pyne S, Quigley JG, Ramachandran R, Richelson EL, Roberts RE, Roskoski R, Ross RA, Roth M, Rudnick G, Ryan RM, Said SI, Schild L, Sanger GJ, Scholich K, Schousboe A, Schulte G, Schulz S, Serhan CN, Sexton PM, Sibley DR, Siegel JM, Singh G, Sitsapesan R, Smart TG, Smith DM, Soga T, Stahl A, Stewart G, Stoddart LA, Summers RJ, Thorens B, Thwaites DT, Toll L, Traynor JR, Usdin TB, Vandenberg RJ, Villalon C, Vore M, Waldman SA, Ward DT, Willars GB, Wonnacott SJ, Wright E, Ye RD, Yonezawa A, Zimmermann M. The Concise Guide to PHARMACOLOGY 2013/14: overview. Br J Pharmacol 2014; 170:1449-58. [PMID: 24528237 DOI: 10.1111/bph.12444] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The Concise Guide to PHARMACOLOGY 2013/14 provides concise overviews of the key properties of over 2000 human drug targets with their pharmacology, plus links to an open access knowledgebase of drug targets and their ligands (www.guidetopharmacology.org), which provides more detailed views of target and ligand properties from the IUPHAR database. The full contents can be found at http://onlinelibrary.wiley.com/doi/10.1111/bph.12444/full. This compilation of the major pharmacological targets is divided into seven areas of focus: G protein-coupled receptors, ligand-gated ion channels, ion channels, catalytic receptors, nuclear hormone receptors, transporters and enzymes. These are presented with nomenclature guidance and summary information on the best available pharmacological tools, alongside key references and suggestions for further reading. A new landscape format has easy to use tables comparing related targets. It is a condensed version of material contemporary to late 2013, which is presented in greater detail and constantly updated on the website www.guidetopharmacology.org, superseding data presented in previous Guides to Receptors & Channels. It is produced in conjunction with NC-IUPHAR and provides the official IUPHAR classification and nomenclature for human drug targets, where appropriate. It consolidates information previously curated and displayed separately in IUPHAR-DB and GRAC and provides a permanent, citable, point-in-time record that will survive database updates.
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Affiliation(s)
- Stephen P H Alexander
- School of Life Sciences, University of Nottingham Medical School, Nottingham, NG7 2UH, UK
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Anderson CM, Sun W, Buatti JM, Maley JE, Policeni B, Mott SL, Bayouth JE. Interobserver and intermodality variability in GTV delineation on simulation CT, FDG-PET, and MR Images of Head and Neck Cancer. Jacobs J Radiat Oncol 2014; 1:006. [PMID: 25568889 PMCID: PMC4283948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To compare the interobserver and intermodality differences in image-based identification of head and neck primary site gross tumor volumes (GTV). Modalities compared include: contrast-enhanced CT, F-18 fluorodeoxyglucose positron emission tomography (PET/CT) and contrast-enhanced MRI. METHODS AND MATERIALS Fourteen patients were simulated after immobilization for all 3 imaging modalities (CT, PET/CT, MRI). Three radiation oncologists (RO) contoured GTVs as seen on each modality. The GTV was contoured first on the contrast-enhanced CT (considered the standard), then on PET/CT, and finally on post-contrast T1 MRI. Interobserver and intermodality variability were analyzed by volume, intersection, union, and volume overlap ratio (VOR). RESULTS Analysis of RO contours revealed the average volume for CT-, PET/CT-, and MRI-derived GTVs were 45cc, 35cc and 49cc, respectively. In 93% of cases PET/CT-derived GTVs had the smallest volume and in 57% of cases MRI-derived GTVs had the largest volume. CT showed the largest variation in target definition (standard deviation amongst observers 35%) compared to PET/CT (28%) and MRI (27%). The VOR was largest (indicating greatest interobserver agreement) in PET/CT (46%), followed by MRI (36%), followed by CT (34%). For each observer, the least agreement in GTV definition occurred between MRI & PET/CT (average VOR = 41%), compared to CT & PET/CT (48%) and CT & MRI (47%). CONCLUSIONS A nonsignificant interobserver difference in GTVs for each modality was seen. Among three modalities, CT was least consistent, while PET/CT-derived GTVs had the smallest volumes and were most consistent. MRI combined with PET/CT provided the least agreement in GTVs generated. The significance of these differences for head & neck cancer is important to explore as we move to volume-based treatment planning based on multi-modality imaging as a standard method for treatment delivery.
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Affiliation(s)
- Carryn M. Anderson
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Wenqing Sun
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - John M. Buatti
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Joan E. Maley
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Bruno Policeni
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Sarah L. Mott
- Department of Biostatistics, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - John E. Bayouth
- Department of Human Oncology, University of Wisconsin, Madison, Wisconsin, USA
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Allen BG, Bhatia SK, Anderson CM, Eichenberger-Gilmore JM, Sibenaller ZA, Mapuskar KA, Schoenfeld JD, Buatti JM, Spitz DR, Fath MA. Ketogenic diets as an adjuvant cancer therapy: History and potential mechanism. Redox Biol 2014; 2:963-70. [PMID: 25460731 PMCID: PMC4215472 DOI: 10.1016/j.redox.2014.08.002] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [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: 06/12/2014] [Revised: 07/30/2014] [Accepted: 08/04/2014] [Indexed: 12/19/2022] Open
Abstract
Cancer cells, relative to normal cells, demonstrate significant alterations in metabolism that are proposed to result in increased steady-state levels of mitochondrial-derived reactive oxygen species (ROS) such as O2•−and H2O2. It has also been proposed that cancer cells increase glucose and hydroperoxide metabolism to compensate for increased levels of ROS. Given this theoretical construct, it is reasonable to propose that forcing cancer cells to use mitochondrial oxidative metabolism by feeding ketogenic diets that are high in fats and low in glucose and other carbohydrates, would selectively cause metabolic oxidative stress in cancer versus normal cells. Increased metabolic oxidative stress in cancer cells would in turn be predicted to selectively sensitize cancer cells to conventional radiation and chemotherapies. This review summarizes the evidence supporting the hypothesis that ketogenic diets may be safely used as an adjuvant therapy to conventional radiation and chemotherapies and discusses the proposed mechanisms by which ketogenic diets may enhance cancer cell therapeutic responses.
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Affiliation(s)
- Bryan G Allen
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA.
| | - Sudershan K Bhatia
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA
| | - Carryn M Anderson
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA
| | - Julie M Eichenberger-Gilmore
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA
| | - Zita A Sibenaller
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA
| | - Kranti A Mapuskar
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA
| | - Joshua D Schoenfeld
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA
| | - John M Buatti
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA
| | - Douglas R Spitz
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA
| | - Melissa A Fath
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA
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Hoover AC, Milhem MM, Anderson CM, Sun W, Smith BJ, Hoffman HT, Buatti JM. Efficacy of nelfinavir as monotherapy in refractory adenoid cystic carcinoma: Results of a phase II clinical trial. Head Neck 2014; 37:722-6. [PMID: 24596143 DOI: 10.1002/hed.23664] [Citation(s) in RCA: 23] [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] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 12/20/2013] [Accepted: 03/02/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Adenoid cystic carcinomas (ACCs) are malignant salivary gland tumors noteworthy for high rates of late failure with limited salvage therapy options. We have previously shown increased Akt signaling is common in ACC and the human immunodeficiency virus (HIV) protease inhibitor nelfinavir (NFV) inhibits in vitro tumor growth by suppressing Akt signaling. This phase II trial was conducted to determine progression-free survival in response to NFV in patients with recurrent/endstage ACC who have failed standard therapies. METHODS Eligible patients had recurrent or end-stage ACC and measureable disease per Response Evaluation Criteria in Solid Tumors (RECIST) criteria. NFV was provided at 1250 mg twice daily. RESULTS Among 15 trial participants, median progression-free survival was 5.5 months (lower 95% bound 4.4 months). No patient achieved a RECIST partial or complete response to therapy. CONCLUSION NFV monotherapy does not result in a meaningful improvement in clinical outcomes among patients with recurrent ACC.
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Affiliation(s)
- Andrew C Hoover
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Hoover AC, Anderson CM, Hoffman HT, de Magalhaes Silverman M, Syrbu SI, Smith MC. Laryngeal chloroma heralding relapse of acute myeloid leukemia. J Clin Oncol 2014; 32:e18-21. [PMID: 24419134 DOI: 10.1200/jco.2012.47.0047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Marquardt M, Anderson CM, Steen S, Hoover A, Karnell L, Funk G, Menda Y, Graham M, Buatti J. Accuracy of 3 Month Posttherapy FDG PET/CT in Resected Oral Cavity Cancer Patients Who Received Adjuvant Radiation. Pract Radiat Oncol 2013; 3:S24. [PMID: 24674525 DOI: 10.1016/j.prro.2013.01.085] [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: 11/18/2022]
Affiliation(s)
| | | | - S Steen
- University of Iowa, Iowa City, IA
| | - A Hoover
- University of Iowa, Iowa City, IA
| | | | - G Funk
- University of Iowa, Iowa City, IA
| | - Y Menda
- University of Iowa, Iowa City, IA
| | - M Graham
- University of Iowa, Iowa City, IA
| | - J Buatti
- University of Iowa, Iowa City, IA
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de la Garza GO, Ismail AF, Anderson CM, Wilke WW, Milhem MM, Hoffman HT, Buatti JM. Nelfinavir treatment of adenoid cystic carcinoma: A case report. Pract Radiat Oncol 2011; 2:e129-e132. [PMID: 24674175 DOI: 10.1016/j.prro.2011.09.003] [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] [Received: 07/07/2011] [Revised: 09/19/2011] [Accepted: 09/20/2011] [Indexed: 11/29/2022]
Affiliation(s)
- Gabriel O de la Garza
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa
| | - Ameera F Ismail
- Department of Radiology, University of Iowa, Iowa City, Iowa
| | - Carryn M Anderson
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa
| | - Werner W Wilke
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa
| | - Mohammed M Milhem
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa.
| | - Henry T Hoffman
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa
| | - John M Buatti
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa
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Breitbach EK, Maltz JS, Gangadharan B, Bani-Hashemi A, Anderson CM, Bhatia SK, Stiles J, Edwards DS, Flynn RT. Image quality improvement in megavoltage cone beam CT using an imaging beam line and a sintered pixelated array system. Med Phys 2011; 38:5969-79. [DOI: 10.1118/1.3651470] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Halgren C, Kjaergaard S, Bak M, Hansen C, El-Schich Z, Anderson CM, Henriksen KF, Hjalgrim H, Kirchhoff M, Bijlsma EK, Nielsen M, den Hollander NS, Ruivenkamp CAL, Isidor B, Le Caignec C, Zannolli R, Mucciolo M, Renieri A, Mari F, Anderlid BM, Andrieux J, Dieux A, Tommerup N, Bache I. Corpus callosum abnormalities, intellectual disability, speech impairment, and autism in patients with haploinsufficiency of ARID1B. Clin Genet 2011; 82:248-55. [PMID: 21801163 PMCID: PMC3464360 DOI: 10.1111/j.1399-0004.2011.01755.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Corpus callosum abnormalities are common brain malformations with a wide clinical spectrum ranging from severe intellectual disability to normal cognitive function. The etiology is expected to be genetic in as much as 30–50% of the cases, but the underlying genetic cause remains unknown in the majority of cases. By next-generation mate-pair sequencing we mapped the chromosomal breakpoints of a patient with a de novo balanced translocation, t(1;6)(p31;q25), agenesis of corpus callosum (CC), intellectual disability, severe speech impairment, and autism. The chromosome 6 breakpoint truncated ARID1B which was also truncated in a recently published translocation patient with a similar phenotype. Quantitative polymerase chain reaction (Q-PCR) data showed that a primer set proximal to the translocation showed increased expression of ARID1B, whereas primer sets spanning or distal to the translocation showed decreased expression in the patient relative to a non-related control set. Phenotype–genotype comparison of the translocation patient to seven unpublished patients with various sized deletions encompassing ARID1B confirms that haploinsufficiency of ARID1B is associated with CC abnormalities, intellectual disability, severe speech impairment, and autism. Our findings emphasize that ARID1B is important in human brain development and function in general, and in the development of CC and in speech development in particular.
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Affiliation(s)
- C Halgren
- Wilhelm Johannsen Centre for Functional Genome Research, Department of Cellular and Molecular Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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Shram MJ, Schoedel KA, Bartlett C, Shazer RL, Anderson CM, Sellers EM. Evaluation of the Abuse Potential of Lorcaserin, a Serotonin 2C (5-HT2C) Receptor Agonist, in Recreational Polydrug Users. Clin Pharmacol Ther 2011; 89:683-92. [DOI: 10.1038/clpt.2011.20] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Telephone based tobacco cessation services, or quitlines, have become central components of many comprehensive tobacco control programmes. This paper provides an overview of their history, noting milestones in the growth of quitlines. Key factors in their worldwide adoption were solid evidence from clinical trials with large community samples and strong backing from public health officials. Quitlines are now available throughout most of North America, Europe, Australia and in many other locations around the world. The paper also offers several recommendations for future directions in quitline practice and research. Benchmarks should be established for key areas of quitline implementation, such as accessibility, quality and cost efficiency. Advances in pharmacotherapy, telephony and web based applications should be investigated for opportunities to expand service offerings. Research and development are needed to determine how best to serve a diverse clientele in the most cost effective manner. Funding should be expanded and diversified to enable quitlines to serve much larger numbers of users. Healthcare providers should be targeted for quitline promotion, to engage them in a broad effort to increase the number of patients receiving cessation messages from clinicians. The goal of quitline promotion should expand to include an increase in unaided quit attempts in the population. Early research findings were quickly adopted in quitline practice, and future research to answer questions that have arisen through the implementation of quitlines will probably also find quick adoption.
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Affiliation(s)
- C M Anderson
- University of California, San Diego, La Jolla, CA 92093-0905, USA.
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Abstract
A flock of approximately 15,000 ring-necked pheasants (Phasianus colchicus) was evaluated for a sudden increase in mortality and acute neurological signs after having been previously diagnosed 3 wk earlier with a chronic respiratory disease of undetermined etiology. Approximately 25 live birds were displaying neurological signs including circling, ataxia, and obtunded behavior and 50 birds were dead. Three birds with neurological signs were submitted for evaluation. Extensive subcutaneous hemorrhage over the head and penetrating puncture wounds through the skull and into the brain were found. Trauma from a wild predatory mammal, most likely the long-tailed weasel (Mustela frenata) that had invaded the pheasant house and expressed surplus killing behavior was determined to be the cause of the acute neurological signs and mortality. The relationship of the chronic respiratory disease to the predation episode was not determined but it is possible that pheasants with severe respiratory disease may have had increased susceptibility to predation.
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Affiliation(s)
- M P Martin
- University of California at Davis, School of Veterinary Medicine, Department of Population Health and Reproduction, 1 Shields Avenue, 1114 Tupper Hall, Davis, CA 95616, USA
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Carroll AK, Clevenger WR, Szabo T, Ackermann LE, Pei Y, Ghosh SS, Glasco S, Nazarbaghi R, Davis RE, Anderson CM. Ectopic expression of the human adenine nucleotide translocase, isoform 3 (ANT-3). Characterization of ligand binding properties. Mitochondrion 2005; 5:1-13. [PMID: 16060289 DOI: 10.1016/j.mito.2004.06.004] [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: 10/26/2022]
Abstract
The adenine nucleotide translocase (ANT) is a key component in maintaining cellular energy homeostasis, and has also been implicated in formation of the mitochondrial permeability transition pore. Human ANT-3 was cloned from a human heart cDNA library and expressed as a histidine-tagged fusion protein in the mitochondria of the Trichoplusia ni. cell line. Overexpression resulted in a concomitant decrease in the endogenous ANT content, allowing for the characterization of binding of known ANT ligands to the human protein. Binding affinities for bongkrekic acid (BKA), ADP, and atractyloside (ATR) were measured in mitochondria from the human ANT-3 expressing cell line, and compared to similar preparations from bovine heart mitochondria by use of a novel radioiodinated derivative of ATR. Binding to ANT-3 by the high affinity inhibitors BKA and ATR, as well as the lower affinity natural ligand ADP, was similar to that measured in bovine heart mitochondria, and to that previously reported for mammalian heart mitochondria. Characterizations such as these of human ANT isoforms may lead to drug development for enhanced mitochondrial function and cellular viability.
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Rotondi AJ, Haas GL, Anderson CM, Newhill CE, Spring MB, Ganguli R, Gardner WB, Rosenstock JB. A Clinical Trial to Test the Feasibility of a Telehealth Psychoeducational Intervention for Persons With Schizophrenia and Their Families: Intervention and 3-Month Findings. Rehabil Psychol 2005; 50:325-336. [PMID: 26321774 DOI: 10.1037/0090-5550.50.4.325] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the feasibility of a telehealth psychoeducation intervention for persons with schizophrenia and their family members. STUDY DESIGN Randomized controlled trial. PARTICIPANTS 30 persons with schizophrenia and 21 family members or other informal support persons. INTERVENTIONS Web-based psychoeducation program that provided online group therapy and education. MAIN OUTCOME MEASURES Measures for persons with schizophrenia included perceived stress and perceived social support; for family members, they included disease-related distress and perceived social support. RESULTS At 3 months, participants with schizophrenia in the intervention group reported lower perceived stress (p = .04) and showed a trend for a higher perceived level of social support (p = .06). CONCLUSIONS The findings demonstrate the feasibility and impact of providing telehealth-based psychosocial treatments, including online therapy groups, to persons with schizophrenia and their families.
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Affiliation(s)
- A J Rotondi
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, and Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh
| | - G L Haas
- Department of Psychiatry, University of Pittsburgh
| | - C M Anderson
- Department of Psychiatry and Department of Social Work, University of Pittsburgh
| | - C E Newhill
- Department of Social Work, University of Pittsburgh
| | - M B Spring
- Department of Information Sciences, University of Pittsburgh
| | - R Ganguli
- Department of Psychiatry, University of Pittsburgh
| | - W B Gardner
- Children's Research Institute, Columbus, Ohio, and Department of Pediatrics, Ohio State University
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Anderson CM, Kaufman MJ, Lowen SB, Rohan M, Renshaw PF, Teicher MH. Brain T2 relaxation times correlate with regional cerebral blood volume. MAGMA 2004; 18:3-6. [PMID: 15592693 DOI: 10.1007/s10334-004-0076-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2004] [Revised: 10/01/2004] [Accepted: 10/07/2004] [Indexed: 11/30/2022]
Abstract
We previously reported cerebellar and putaminal transverse relaxation time (T2) differences in children with ADHD and in adults with childhood trauma. As brain T2 can be altered by deoxyhemoglobin concentration ([dHb]) and because [dHb] is proportional to regional cerebral blood volume (rCBV), at steady state we attributed those differences to rCBV changes. Studies in other species have established a correlation between T2 and rCBV; however this has yet to be demonstrated in human brain. Echo planar imaging (EPI) T2 relaxometry and dynamic susceptibility-contrast (DSC) MRI were used to measure T2 and rCBV in 11 healthy adults. Significant T2-rCBV correlations were observed in both cerebellar vermis and putamen (r = 0.759,p = 0.007;r = 0.782,p = 0.004, respectively). These correlations predict 9 +/- 3% and 10 +/- 3% rCBV changes, respectively, for each 1-msec change in T2. Consequently, brain T2 measurements may be useful for estimating steady-state rCBV.
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Affiliation(s)
- C M Anderson
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Henderson CL, Anderson CM, Sorrells DL, Wilson BJ, Dick EJ, DiGeronimo RJ. The use of a hemoglobin-based oxygen-carrying solution (HBOC-201) for extracorporeal membrane oxygenation in a porcine model with acute respiratory distress syndrome. Pediatr Crit Care Med 2004; 5:384-90. [PMID: 15215011 DOI: 10.1097/01.pcc.0000123544.46047.ba] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 11/25/2022]
Abstract
OBJECTIVE To evaluate whether hemoglobin-based oxygen-carrying solution (HBOC)-201 (Biopure) is an effective alternative to donor blood for extracorporeal membrane oxygenation support in a porcine model of acute respiratory distress syndrome (ARDS). DESIGN Randomized animal clinical trial. SETTING Animal surgical research laboratory. SUBJECTS Immature Yorkshire swine were assigned to one of three groups: 1, noninjured animals, donor porcine blood primed circuit; 2, ARDS-injured, HBOC-201 primed circuit; or 3, ARDS-injured, donor blood primed. INTERVENTIONS ARDS injury was induced in groups 2 and 3 with oleic acid infusion before bypass. All animals were placed on full venoarterial extracorporeal membrane oxygenation support for 8 hrs. MEASUREMENTS AND MAIN RESULTS Physiologic variables and laboratory samples were measured at baseline and hourly for 8 hrs. Data analysis consisted of repeated-measures analysis of variance with post hoc analysis. We found that 100% of animals survived on extracorporeal membrane oxygenation for the duration of the study period. HBOC-supported animals had comparable oxygen delivery to both donor blood groups. Mean pulmonary artery pressure, heart rate, and lactate concentrations were higher in the injury groups. Blood pressure was mildly increased in HBOC animals (p <.05 vs. control animals). Methemoglobin concentrations in the HBOC group were elevated and increased over time on extracorporeal membrane oxygenation (p <.001). CONCLUSIONS HBOC-201 appears to be an effective alternative circuit-priming agent for use during extracorporeal membrane oxygenation. HBOC offers the advantages of rapid availability and diminished donor blood cell exposure. The efficacy of HBOC in longer duration bypass, and its associated methemoglobinemia, need to be further investigated.
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Affiliation(s)
- C L Henderson
- Department of Pediatrics, Wilford USAF Hall Medical Center, Lackland AFB, TX, USA.
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Abstract
The responses of motion mechanisms depend not only on the direction of a stimulus, but also on its contrast, coherence and speed. We examined how contrast, coherence and directional selectivity interact by measuring directional tuning psychophysically across a wide range of coherence and contrast levels. We fit data with a simple model that estimated directional tuning bandwidth using contrast and coherence gain parameters that were based on neurophysiological estimates. This model estimated a bandwidth of approximately 90 degrees for directionally selective mechanisms. Bandwidth was invariant across a wide range of contrasts and coherences, as predicted by models of contrast normalization.
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Affiliation(s)
- I Fine
- Department of Psychology, UC San Diego, La Jolla, CA, USA.
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