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Aupperle RL, Kuplicki R, Tsuchiyagaito A, Akeman E, Sturycz-Taylor CA, DeVille D, Lasswell T, Misaki M, Berg H, McDermott TJ, Touthang J, Ballard ED, Cha C, Schacter DL, Paulus MP. Ventromedial prefrontal cortex activation and neurofeedback modulation during episodic future thinking for individuals with suicidal thoughts and behaviors. Behav Res Ther 2024; 176:104522. [PMID: 38547724 DOI: 10.1016/j.brat.2024.104522] [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: 09/29/2023] [Revised: 01/30/2024] [Accepted: 03/14/2024] [Indexed: 04/08/2024]
Abstract
Individuals experiencing suicidal thoughts and behaviors (STBs) show less specificity and positivity during episodic future thinking (EFT). Here, we present findings from two studies aiming to (1) further our understanding of how STBs may relate to neural responsivity during EFT and (2) examine the feasibility of modulating EFT-related activation using real-time fMRI neurofeedback (rtfMRI-nf). Study 1 involved 30 individuals with major depressive disorder (MDD; half with STBs) who performed an EFT task during fMRI, for which they imagined personally-relevant future positive, negative, or neutral events. Positive EFT elicited greater ventromedial prefrontal cortex (vmPFC) activation compared to negative EFT. Importantly, the MDD + STB group exhibited reduced vmPFC activation across all EFT conditions compared to MDD-STB; although EFT fluency and subjective experience remained consistent across groups. Study 2 included rtfMRI-nf focused on vmPFC modulation during positive EFT for six participants with MDD + STBs. Results support the feasibility and acceptability of the rtfMRI-nf protocol and quantitative and qualitative observations are provided to help inform future, larger studies aiming to examine similar neurofeedback protocols. Results implicate vmPFC blunting as a promising treatment target for MDD + STBs and suggest rtfMRI-nf as one potential technique to explore for enhancing vmPFC engagement.
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Affiliation(s)
- R L Aupperle
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA; School of Community Medicine, 1215 South Boulder Ave W., The University of Tulsa, Tulsa, OK, 74119, USA.
| | - R Kuplicki
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - A Tsuchiyagaito
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - E Akeman
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - C A Sturycz-Taylor
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - D DeVille
- Department of Psychiatry, University of California San Diego, 4510 Executive Drive, San Diego, CA, 92121, USA
| | - T Lasswell
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - M Misaki
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - H Berg
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - T J McDermott
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - J Touthang
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA
| | - E D Ballard
- Experimental Therapeutics and Pathophysiological Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - C Cha
- Department of Psychology, Columbia University, 428 Horace Mann, New York, NY, 10027, USA
| | - D L Schacter
- Department of Psychology, Harvard University, 33 Kirkland St., William James Hall, Cambridge, MA, 02138, USA
| | - M P Paulus
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74008, USA; School of Community Medicine, 1215 South Boulder Ave W., The University of Tulsa, Tulsa, OK, 74119, USA
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Alaparthi S, Cha C. Improving Survival with Medicaid Expansion in Early Hepatocellular Carcinoma: A Step in the Right Direction. Ann Surg Oncol 2023; 30:4562-4563. [PMID: 37162642 DOI: 10.1245/s10434-023-13622-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/26/2023] [Indexed: 05/11/2023]
Affiliation(s)
- S Alaparthi
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA
| | - C Cha
- Department of Surgery, Hartford Healthcare, Saint Vincent's Medical Center, Bridgeport, USA.
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Solsky I, Moaven O, Valenzuela CD, Lundy M, Stauffer JA, Del Piccolo NR, Cheung T, Corvera CU, Wisneski AD, Cha C, Zarandi NP, Dourado J, Russell G, Levine EA, Votanopoulos KI, Shen P. ASO Visual Abstract: Survival Outcomes of Optimally Treated Colorectal Metastases-The Importance of R0 Status in Surgical Treatment of Hepatic and Peritoneal Surface Disease. Ann Surg Oncol 2023; 30:4274-4275. [PMID: 37020096 DOI: 10.1245/s10434-023-13392-9] [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: 04/07/2023]
Affiliation(s)
- Ian Solsky
- Division of Surgical Oncology, Department of General Surgery, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | | | - Cristian D Valenzuela
- Division of Surgical Oncology, Department of General Surgery, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Megan Lundy
- Division of Surgical Oncology, Department of General Surgery, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | | | | | - Tanto Cheung
- Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | | | | | | | - Nima Pourhabibi Zarandi
- Division of Surgical Oncology, Department of General Surgery, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Justin Dourado
- Division of Surgical Oncology, Department of General Surgery, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Gregory Russell
- Division of Surgical Oncology, Department of General Surgery, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Division of Surgical Oncology, Department of General Surgery, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Konstantinos I Votanopoulos
- Division of Surgical Oncology, Department of General Surgery, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Perry Shen
- Division of Surgical Oncology, Department of General Surgery, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA.
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Solsky I, Moaven O, Valenzuela CD, Lundy M, Stauffer JA, Del Piccolo NR, Cheung T, Corvera CU, Wisneski AD, Cha C, Zarandi NP, Dourado J, Russell G, Levine EA, Votanopoulos KI, Shen P. Survival Outcomes of Optimally Treated Colorectal Metastases: The Importance of R0 Status in Surgical Treatment of Hepatic and Peritoneal Surface Disease. Ann Surg Oncol 2023:10.1245/s10434-023-13174-3. [PMID: 36754944 DOI: 10.1245/s10434-023-13174-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/18/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Although colorectal hepatic metastases (HM) and peritoneal surface disease (PSD) are distinct biologic diseases, they may have similar long-term survival when optimally treated with surgery. METHODS This study retrospectively reviewed prospectively managed databases. Patients undergoing R0 or R1 resections were analyzed with descriptive statistics, the Kaplan-Meier method, and Cox regression. Survival was compared over time for the following periods: 1993-2006, 2007-2012, and 2013-2020. RESULTS The study enrolled 783 HM patients undergoing liver resection and 204 PSD patients undergoing cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC). Compared with PSD patients, HM patients more often had R0 resections (90.3% vs. 32.4%), less often had pre-procedure chemotherapy (52.4% vs. 92.1%), and less often were functionally independent (79.7% vs. 95.6%). The 5-year overall survival for HM was 40.9%, with a median survival period of 45.8 months versus 25.8% and 33.4 months, respectively, for PSD (p < 0.05). When stratified by resection status, R0 HM and R0 PSD did not differ significantly in median survival (49.0 vs. 45.4 months; p = 0.83). The median survival after R1 resection also was similar between HM and PSD (32.6 vs. 26.9 months; p = 0.59). Survival between the two groups again was similar over time when stratified by resection status. The predictors of survival for HM patients were R0 resection, number of lesions, intraoperative transfusion, age, and adjuvant chemotherapy. For the PSD patients, the predictors were peritoneal cancer index (PCI) score, estimated blood loss (EBL), and female gender. CONCLUSION The study showed that R0 resections are associated with improved outcomes and that median survival is similar between HM and PSD patients when it is achieved. Surveillance and treatment strategies that facilitate R0 resections are needed to improve results, particularly for PSD.
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Affiliation(s)
- Ian Solsky
- Department of General Surgery, Division of Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | | | - Cristian D Valenzuela
- Department of General Surgery, Division of Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Megan Lundy
- Department of General Surgery, Division of Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | | | | | - Tanto Cheung
- University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | | | | | | | - Nima Pourhabibi Zarandi
- Department of General Surgery, Division of Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Justin Dourado
- Department of General Surgery, Division of Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Gregory Russell
- Department of General Surgery, Division of Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Department of General Surgery, Division of Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Konstantinos I Votanopoulos
- Department of General Surgery, Division of Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Perry Shen
- Department of General Surgery, Division of Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA.
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Valenzuela CD, Moaven O, Gawdi R, Stauffer JA, Del Piccolo NR, Cheung TT, Corvera CU, Wisneski AD, Cha C, Pourhabibi Zarandi N, Dourado J, Perry KC, Russell G, Shen P. Outcomes after repeat hepatectomy for colorectal liver metastases from the colorectal liver operative metastasis international collaborative (COLOMIC). J Surg Oncol 2022; 126:1242-1252. [PMID: 35969175 PMCID: PMC9613625 DOI: 10.1002/jso.27056] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 07/17/2022] [Accepted: 07/28/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Resection of colorectal liver metastasis (CLM) is beneficial when feasible. However, the benefit of second hepatectomy for hepatic recurrence in CLM remains unclear. METHODS The Colorectal Liver Operative Metastasis International Collaborative retrospectively examined 1004 CLM cases from 2000 to 2018 from a total of 953 patients. Hepatic recurrence after initial hepatectomy was identified in 218 patients. Kaplan-Meier analysis was performed for overall survival (OS) and recurrence-free survival (RFS). Propensity score matching (PSM) was performed to offset selection bias. Cox proportional-hazards regression was performed to identify risk factors associated with OS. RESULTS A total of 51 patients underwent second hepatectomy. Unadjusted median OS was 60.1 months in repeat-hepatectomy versus 38.3 months in the single-hepatectomy group (p = 0.015). In the PSM population, median OS remained significantly better in the repeat-hepatectomy group (60.1 vs. 33.1 months; p = 0.0023); median RFS was 12.4 months for the repeat-hepatectomy group, versus 9.8 months in the single-hepatectomy group (p = 0.0050). Repeat hepatectomy was associated with lower risk of death (hazard ratio: 0.283; p = 0.000012). Obesity, tobacco use, and high intraoperative blood loss were associated with significant risk of death (p < 0.05). CONCLUSION In CLM with hepatic recurrence, second hepatectomy was beneficial for OS. With PSM, the OS benefit of performing a second hepatectomy remained significant.
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Affiliation(s)
- Cristian D. Valenzuela
- Division of Surgical Oncology, Comprehensive Cancer CenterAtrium Health Wake Forest Baptist Medical CenterWinston‐SalemNorth CarolinaUSA
| | - Omeed Moaven
- Division of Surgical Oncology, Comprehensive Cancer CenterAtrium Health Wake Forest Baptist Medical CenterWinston‐SalemNorth CarolinaUSA
| | - Rohin Gawdi
- Division of Surgical Oncology, Comprehensive Cancer CenterAtrium Health Wake Forest Baptist Medical CenterWinston‐SalemNorth CarolinaUSA
| | - John A. Stauffer
- Department of Surgical OncologyMayo Clinic in FloridaJacksonvilleFloridaUSA
| | | | - Tan To Cheung
- Department of SurgeryUniversity of Hong KongHong KongChina
| | - Carlos U. Corvera
- Department of Hepatobiliary & Pancreatic SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Andrew D. Wisneski
- Department of Hepatobiliary & Pancreatic SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Charles Cha
- Department of SurgeryYale School of MedicineNew HavenConnecticutUSA
| | - Nima Pourhabibi Zarandi
- Division of Surgical Oncology, Comprehensive Cancer CenterAtrium Health Wake Forest Baptist Medical CenterWinston‐SalemNorth CarolinaUSA
| | - Justin Dourado
- Division of Surgical Oncology, Comprehensive Cancer CenterAtrium Health Wake Forest Baptist Medical CenterWinston‐SalemNorth CarolinaUSA
| | - Kathleen C. Perry
- Division of Surgical Oncology, Comprehensive Cancer CenterAtrium Health Wake Forest Baptist Medical CenterWinston‐SalemNorth CarolinaUSA
| | - Gregory Russell
- Department of Biostatistical SciencesWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Perry Shen
- Division of Surgical Oncology, Comprehensive Cancer CenterAtrium Health Wake Forest Baptist Medical CenterWinston‐SalemNorth CarolinaUSA
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6
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Valenzuela CD, Moaven O, Gawdi R, Stauffer JA, Del Piccolo NR, Cheung TT, Corvera CU, Wisneski AD, Cha C, Mangieri CW, Zarandi NP, Dourado J, Perry KC, Russell G, Shen P. Association of primary tumor laterality with surgical outcomes for colorectal liver metastases: results from the Colorectal Liver Operative Metastasis International Collaborative (COLOMIC). HPB (Oxford) 2022; 24:1351-1361. [PMID: 35289279 PMCID: PMC9356971 DOI: 10.1016/j.hpb.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/01/2022] [Accepted: 02/16/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Primary laterality of colorectal cancer is thought to be associated with differences in outcomes. Liver metastasis is the most common site of solitary colorectal cancer spread. However, how primary colorectal cancer laterality affects outcomes in colorectal liver metastasis remains unclear. METHODS The Colorectal Liver Operative Metastasis International Collaborative (COLOMIC) of operative hepatectomy cases for colorectal liver metastasis was compiled from five participating institutions. This included consecutive cases from 2000 to 2018 at all sites. A total of 884 patients were included in this study. Univariate, multivariate, and Kaplan-Meier analyses were performed. RESULTS Patients with left-sided versus right-sided cancers had significantly better overall survival: 49.4 vs. 41.8 months (p < 0.05). Patients with KRAS mutations had significantly worse median overall survival compared to KRAS wild-type (43.6 vs 56.1 months; p < 0.001). In left-sided cancers, KRAS mutations were associated with significantly worse median overall survival compared to KRAS wild-type cancers (43.6 vs 56.6 months; p < 0.01). This association was absent in patients with right-sided primary tumors. Multivariate Cox regression analysis revealed different variable sets (non-overlapping) were associated with overall survival, when comparing left-sided and right-sided cancers. CONCLUSION Understanding how primary tumor laterality and related biological aspects affect long-term outcomes can potentially inform treatment decisions for patients with colorectal liver metastases.
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Affiliation(s)
- Cristian D Valenzuela
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Omeed Moaven
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA; Department of Surgical Oncology, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Rohin Gawdi
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - John A Stauffer
- Department of Surgical Oncology, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Nico R Del Piccolo
- Department of Surgical Oncology, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Tan To Cheung
- Department of Surgery, University of Hong Kong, Hong Kong, China
| | - Carlos U Corvera
- Department of Hepatobiliary & Pancreatic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Andrew D Wisneski
- Department of Hepatobiliary & Pancreatic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Charles Cha
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Christopher W Mangieri
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Nima P Zarandi
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Justin Dourado
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Kathleen C Perry
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Gregory Russell
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Perry Shen
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
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Gawdi R, Valenzuela CD, Moaven O, Stauffer JA, Del Piccolo NR, Cheung T, Corvera CU, Wisneski AD, Cha C, Shen P, Russell G, Zarandi N, Dourado J. Perioperative chemotherapy for resectable colorectal liver metastases: Analysis from the Colorectal Operative Liver Metastases International Collaborative (COLOMIC). J Surg Oncol 2022; 126:339-347. [DOI: 10.1002/jso.26893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/03/2022] [Indexed: 01/08/2023]
Affiliation(s)
- Rohin Gawdi
- Department of Surgical Oncology Comprehensive Cancer Center, Wake Forest Baptist Medical Center Winston‐Salem North Carolina USA
| | - Cristian D. Valenzuela
- Department of Surgical Oncology Comprehensive Cancer Center, Wake Forest Baptist Medical Center Winston‐Salem North Carolina USA
| | - Omeed Moaven
- Department of Surgery Mayo Clinic Jacksonville Florida USA
| | | | | | - Tanto Cheung
- Department of Surgery University of Hong Kong, Hong Kong Special Administrative Region Hong Kong China
| | - Carlos U. Corvera
- Department of Surgery University of California San Francisco San Francisco California USA
| | - Andrew D. Wisneski
- Department of Surgery University of California San Francisco San Francisco California USA
| | - Charles Cha
- Yale Department of Surgery New Haven Connecticut USA
| | - Perry Shen
- Department of Surgical Oncology Comprehensive Cancer Center, Wake Forest Baptist Medical Center Winston‐Salem North Carolina USA
| | - Greg Russell
- Department of Biostatistical Sciences Wake Forest School of Medicine Winston‐Salem North Carolina USA
| | - Nima Zarandi
- Department of Surgical Oncology Comprehensive Cancer Center, Wake Forest Baptist Medical Center Winston‐Salem North Carolina USA
| | - Justin Dourado
- Department of Surgical Oncology Comprehensive Cancer Center, Wake Forest Baptist Medical Center Winston‐Salem North Carolina USA
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Guo X, Jessel S, Qu R, Kluger Y, Chen TM, Hollander L, Safirstein R, Nelson B, Cha C, Bosenberg M, Jilaveanu LB, Rimm D, Rothlin CV, Kluger HM, Desir GV. Inhibition of renalase drives tumour rejection by promoting T cell activation. Eur J Cancer 2022; 165:81-96. [PMID: 35219026 PMCID: PMC8940682 DOI: 10.1016/j.ejca.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/30/2021] [Accepted: 01/10/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Although programmed cell death protein 1 (PD-1) inhibitors have revolutionised treatment for advanced melanoma, not all patients respond. We previously showed that inhibition of the flavoprotein renalase (RNLS) in preclinical melanoma models decreases tumour growth. We hypothesised that RNLS inhibition promotes tumour rejection by effects on the tumour microenvironment (TME). METHODS We used two distinct murine melanoma models, studied in RNLS knockout (KO) or wild-type (WT) mice. WT mice were treated with the anti-RNLS antibody, m28, with or without anti-PD-1. 10X single-cell RNA-sequencing was used to identify transcriptional differences between treatment groups, and tumour cell content was interrogated by flow cytometry. Samples from patients treated with immunotherapy were examined for RNLS expression by quantitative immunofluorescence. RESULTS RNLS KO mice injected with wild-type melanoma cells reject their tumours, supporting the importance of RNLS in cells in the TME. This effect was blunted by anti-cluster of differentiation 3. However, MØ-specific RNLS ablation was insufficient to abrogate tumour formation. Anti-RNLS antibody treatment of melanoma-bearing mice resulted in enhanced T cell infiltration and activation and resulted in immune memory on rechallenging mice with injection of melanoma cells. At the single-cell level, treatment with anti-RNLS antibodies resulted in increased tumour density of MØ, neutrophils and lymphocytes and increased expression of IFNγ and granzyme B in natural killer cells and T cells. Intratumoural Forkhead Box P3 + CD4 cells were decreased. In two distinct murine melanoma models, we showed that melanoma-bearing mice treated with anti-RNLS antibodies plus anti-PD-1 had superior tumour shrinkage and survival than with either treatment alone. Importantly, in pretreatment samples from patients treated with PD-1 inhibitors, high RNLS expression was associated with decreased survival (log-rank P = 0.006), independent of other prognostic variables. CONCLUSIONS RNLS KO results in melanoma tumour regression in a T-cell-dependent fashion. Anti-RNLS antibodies enhance anti-PD-1 activity in two distinct aggressive murine melanoma models resistant to PD-1 inhibitors, supporting the development of anti-RNLS antibodies with PD-1 inhibitors as a novel approach for melanomas poorly responsive to anti-PD-1.
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Affiliation(s)
- Xiaojia Guo
- Department of Medicine Section of Nephrology, Yale University, New Haven, CT, USA
| | - Shlomit Jessel
- Department of Medicine Section of Medical Oncology, Yale University, New Haven, CT, USA
| | - Rihao Qu
- Department of Medicine Pathology, Yale University, New Haven, CT, USA
| | - Yuval Kluger
- Department of Medicine Pathology, Yale University, New Haven, CT, USA
| | - Tian-Min Chen
- Department of Medicine Section of Nephrology, Yale University, New Haven, CT, USA
| | - Lindsay Hollander
- Department of Medicine Section of Nephrology, Yale University, New Haven, CT, USA
| | - Robert Safirstein
- Department of Medicine Section of Nephrology, Yale University, New Haven, CT, USA; Department of Medicine VACHS, Yale University, New Haven, CT, USA
| | - Bryce Nelson
- Department of Medicine Pharmacology, Yale University, New Haven, CT, USA
| | - Charles Cha
- Department of Medicine Surgery, Yale University, New Haven, CT, USA
| | - Marcus Bosenberg
- Department of Medicine Section of Medical Oncology, Yale University, New Haven, CT, USA
| | - Lucia B Jilaveanu
- Department of Medicine Section of Medical Oncology, Yale University, New Haven, CT, USA
| | - David Rimm
- Department of Medicine Pathology, Yale University, New Haven, CT, USA
| | - Carla V Rothlin
- Department of Medicine Immunology, Yale University, New Haven, CT, USA
| | - Harriet M Kluger
- Department of Medicine Section of Medical Oncology, Yale University, New Haven, CT, USA
| | - Gary V Desir
- Department of Medicine Section of Nephrology, Yale University, New Haven, CT, USA; Department of Medicine VACHS, Yale University, New Haven, CT, USA; Department of Medicine Yale School of Medicine, Yale University, New Haven, CT, USA.
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9
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Safdar B, Wang M, Guo X, Cha C, Chun HJ, Deng Y, Dziura J, El-Khoury JM, Gorelick F, Ko AI, Lee AI, Safirstein R, Simonov M, Zhou B, Desir GV. Association of renalase with clinical outcomes in hospitalized patients with COVID-19. PLoS One 2022; 17:e0264178. [PMID: 35259186 PMCID: PMC8903289 DOI: 10.1371/journal.pone.0264178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/04/2022] [Indexed: 12/27/2022] Open
Abstract
Renalase is a secreted flavoprotein with anti-inflammatory and pro-cell survival properties. COVID-19 is associated with disordered inflammation and apoptosis. We hypothesized that blood renalase levels would correspond to severe COVID-19 and survival. In this retrospective cohort study, clinicopathologic data and blood samples were collected from hospitalized COVID-19 subjects (March—June 2020) at a single institution tertiary hospital. Plasma renalase and cytokine levels were measured and clinical data abstracted from health records. Of 3,450 COVID-19 patients, 458 patients were enrolled. Patients were excluded if <18 years, or opted out of research. The primary composite outcome was intubation or death within 180 days. Secondary outcomes included mortality alone, intensive care unit admission, use of vasopressors, and CPR. Enrolled patients had mean age 64 years (SD±17), were 53% males, and 48% non-whites. Mean renalase levels was 14,108·4 ng/ml (SD±8,137 ng/ml). Compared to patients with high renalase, those with low renalase (< 8,922 ng/ml) were more likely to present with hypoxia, increased ICU admission (54% vs. 33%, p < 0.001), and cardiopulmonary resuscitation (10% vs. 4%, p = 0·023). In Cox proportional hazard model, every 1000 ng/ml increase in renalase decreased the risk of death or intubation by 5% (HR 0·95; 95% CI 0·91–0·98) and increased survival alone by 6% (HR 0·95; CI 0·90–0·98), after adjusting for socio-demographics, initial disease severity, comorbidities and inflammation. Patients with high renalase-low IL-6 levels had the best survival compared to other groups (p = 0·04). Renalase was independently associated with reduced intubation and mortality in hospitalized COVID-19 patients. Future studies should assess the pathophysiological relevance of renalase in COVID-19 disease.
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Affiliation(s)
- Basmah Safdar
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
| | - Melinda Wang
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Cell Biology, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Xiaojia Guo
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- VA CT HealthCare, West Haven, Connecticut, United States of America
| | - Charles Cha
- Department of Surgery, Hartford HealthCare, Hartford, Connecticut, United States of America
| | - Hyung J. Chun
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Yanhong Deng
- Yale Center of Analytics Sciences, New Haven, Connecticut, United States of America
| | - James Dziura
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Yale Center of Analytics Sciences, New Haven, Connecticut, United States of America
| | - Joe M. El-Khoury
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Fred Gorelick
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Cell Biology, Yale School of Medicine, New Haven, Connecticut, United States of America
- Yale Center of Analytics Sciences, New Haven, Connecticut, United States of America
| | - Albert I. Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Alfred I. Lee
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Robert Safirstein
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- VA CT HealthCare, West Haven, Connecticut, United States of America
| | - Michael Simonov
- Yale Center of Analytics Sciences, New Haven, Connecticut, United States of America
| | - Bin Zhou
- Yale Center of Analytics Sciences, New Haven, Connecticut, United States of America
| | - Gary V. Desir
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- VA CT HealthCare, West Haven, Connecticut, United States of America
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Gawdi R, Valenzuela CD, Moaven O, Stauffer JA, Del Piccolo NR, Cheung TT, Corvera CU, Wisneski AD, Cha C, Shen P. Neoadjuvant vs Adjuvant Chemotherapy for Resectable Colorectal Liver Metastases: Results From an International Multicenter Collaborative. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tempero MA, Malafa MP, Chiorean EG, Czito B, Scaife C, Narang AK, Fountzilas C, Wolpin BM, Al-Hawary M, Asbun H, Behrman SW, Benson AB, Binder E, Cardin DB, Cha C, Chung V, Dillhoff M, Dotan E, Ferrone CR, Fisher G, Hardacre J, Hawkins WG, Ko AH, LoConte N, Lowy AM, Moravek C, Nakakura EK, O'Reilly EM, Obando J, Reddy S, Thayer S, Wolff RA, Burns JL, Zuccarino-Catania G. Pancreatic Adenocarcinoma, Version 1.2019. J Natl Compr Canc Netw 2020; 17:202-210. [PMID: 30865919 DOI: 10.6004/jnccn.2019.0014] [Citation(s) in RCA: 241] [Impact Index Per Article: 60.3] [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]
Abstract
The NCCN Guidelines for Pancreatic Adenocarcinoma discuss the diagnosis and management of adenocarcinomas of the exocrine pancreas and are intended to assist with clinical decision-making. These NCCN Guidelines Insights discuss important updates to the 2019 version of the guidelines, focusing on postoperative adjuvant treatment of patients with pancreatic cancers.
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Affiliation(s)
| | | | | | | | | | - Amol K Narang
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - Stephen W Behrman
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Al B Benson
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Ellen Binder
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | - Mary Dillhoff
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | - Jeffrey Hardacre
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - William G Hawkins
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Andrew H Ko
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | | | | | - Sushanth Reddy
- University of Alabama at Birmingham Comprehensive Cancer Center
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12
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Wang M, Guo X, Chun HJ, Lee AI, Cha C, Gorelick F, Desir GV. Decreased plasma levels of the survival factor renalase are associated with worse outcomes in COVID-19. medRxiv 2020. [PMID: 32577678 DOI: 10.1101/2020.06.02.20120865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Renalase (RNLS), a novel secreted plasma flavoprotein, has anti-inflammatory effects in a variety of disease processes. Severe COVID-19 disease is associated with disordered inflammatory responses. We hypothesized that reduced plasma RNLS levels could be a marker of COVID-19 disease severity. METHODS Plasma was collected from 51 hospitalized COVID-19 patients and 15 uninfected non-hospitalized controls. Plasma RNLS and cytokine levels were measured and sociodemographic and clinical data were collected from chart review. Data were analyzed using nonparametric analyses and Kaplan Meir curve log rank analysis. RESULTS Plasma RNLs levels were negatively correlated with inflammatory markers, including IL-1b, IL-6, and TNFa (p = 0.04, p = 0.03, p = 0.01, respectively). Patients with COVID-19 disease had lower levels of RNLS than controls. Lower levels of RNLS were associated with more severe disease among COVID-19 patients. Low RNLS was also associated with worse survival among COVID-19 patients (HR = 4.54; 95% CI: 1.06-19.43; p = 0.005). CONCLUSION Low plasma RNLS levels are associated with severe COVID-19 disease and may be a useful additional biomarker when identifying patients with severe COVID-19 disease. Given RNLS anti-inflammatory properties and negative correlation with inflammatory markers, these findings also suggest evidence of a potential pathophysiological mechanism for severe COVID-19 disease.
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13
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Kurbatov V, Resio BJ, Cama CA, Heller DR, Cha C, Zhang Y, Lu J, Khan SA. Liver-first approach to stage IV colon cancer with synchronous isolated liver metastases. J Gastrointest Oncol 2020; 11:76-83. [PMID: 32175108 DOI: 10.21037/jgo.2020.01.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The only possibility for cure in patients with colon adenocarcinoma (CAC) with isolated liver metastases (ILM) is resection of both primary and metastatic tumors. Little is known about the implication of the sequence in which a colectomy and hepatectomy are performed on outcomes. This study analyzes whether resection sequence impacts clinical outcomes. Methods The National Cancer Database was queried for CAC cases with hepatic metastases from 2010-2015 with exclusion of extrahepatic metastases. We compared patients treated with a liver-first approach (LFA) to those treated with a colectomy-first or simultaneous approach using Kaplan Meier and multivariable Cox proportional hazards analysis. Results In 21,788 CAC patients identified, the LFA was uncommon (2%), but was associated with higher rates of completion resection of remaining tumor (41% vs. 22%, P<0.001). Patients selected for LFA were younger, less comorbid, and more commonly received upfront chemotherapy (P<0.05). The LFA was associated with increased median survival [34 months, 95% CI (30.5-39.6 months) vs. 24 months, 95% CI (23.7-24.6 months), logrank P<0.001] and decreased risk of death [HR 0.783; 95% CI (0.67-0.89), P=0.001]. Conclusions The LFA to CAC with synchronous ILM is uncommon but is associated with greater likelihood of receiving chemotherapy prior to surgery and increased survival in selected candidates.
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Affiliation(s)
- Vadim Kurbatov
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Benjamin J Resio
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Cara A Cama
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | | | - Charles Cha
- Section of Surgical Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Yawei Zhang
- Section of Surgical Outcomes and Epidemiology, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Jun Lu
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
| | - Sajid A Khan
- Section of Surgical Oncology, Yale School of Medicine, New Haven, CT, USA
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Klemen ND, Wang M, Rubinstein JC, Olino K, Clune J, Ariyan S, Cha C, Weiss SA, Kluger HM, Sznol M. Survival after checkpoint inhibitors for metastatic acral, mucosal and uveal melanoma. J Immunother Cancer 2020; 8:e000341. [PMID: 32209601 PMCID: PMC7103823 DOI: 10.1136/jitc-2019-000341] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Checkpoint inhibitors (CPIs) are thought to be effective against cutaneous melanoma in part because of the large burden of somatic mutations (neoantigens) generated from exposure to ultraviolet radiation. However, rare melanoma subtypes arising from acral skin, mucosal surfaces, and the uveal tract are largely sun-shielded. Genomic studies show these sun-shielded melanomas have a paucity of neoantigens and unique biology; they are thought to be largely resistant to immunotherapy. It has not been definitively shown that CPI improves survival in metastatic sun-shielded melanoma. METHODS We reviewed a single institutional experience using antibodies against CTLA-4, PD-1 and/or PD-L1 to treat patients with metastatic melanoma. Primary tumor histology was categorized as cutaneous, unknown, acral, mucosal, or uveal. We studied demographic data, treatment characteristics, and overall survival (OS) after CPI. RESULTS We treated 428 patients with metastatic melanoma from 2007 to 2019. Primary tumors were cutaneous in 283 (66%), unknown in 55 (13%), acral in 22 (5%), mucosal in 38 (9%), and uveal in 30 (7%). Patients with metastatic disease from cutaneous primary tumors had median OS after CPI of 45 months compared with 17 months for acral (p=0.047), 18 months for mucosal (p=0.003), and 12 months for uveal (p<0.001). For all patients with sun-shielded melanoma (n=90), first treatment with anti-PD-1 or anti-PD-L1 was followed by a median OS of 9 months compared with 18 months after anti-CTLA-4 (p=0.010) and 20 months after combination therapy (p=0.003). There were 21 patients who achieved actual 3-year survival; 20 received both anti-CTLA-4 and anti-PD-1, either sequentially or in combination. Over 80% of 3-year survivors with progressive disease were treated with local therapy after CPI. CONCLUSIONS Long survival in patients with metastatic melanoma from acral, mucosal, and uveal primary tumors was associated with receipt of both anti-CTLA-4 and anti-PD-1 antibodies. Complete responses were rare, and local therapy was frequently employed to control disease progression. While sun-shielded melanomas exhibit worse outcomes after CPI than cutaneous melanomas, with an aggressive multidisciplinary approach, 5-year survival is still possible for 25%-32% of these patients.
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Affiliation(s)
| | - Melinda Wang
- Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jill C Rubinstein
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kelly Olino
- Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - James Clune
- Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Stephan Ariyan
- Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Charles Cha
- Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sarah A Weiss
- Medical Oncology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Harriet M Kluger
- Medical Oncology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mario Sznol
- Medical Oncology, Yale University School of Medicine, New Haven, Connecticut, USA
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Uhlig J, Nie J, Stein S, Cha C, Kim K. 3:09 PM Abstract No. 33 Comparison of radiofrequency ablation and stereotactic radiotherapy for primary treatment of intrahepatic cholangiocellular carcinoma: results from the National Cancer Database. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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16
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Chang J, Guo X, Rao V, Gromisch E, Chung S, Kluger H, Cha C, Gorelick F, Testani J, Safirstein R, Crowley S, Peixoto A, Desir G. Identification of Two Forms of Human Plasma Renalase, and Their Association With All-Cause Mortality. Kidney Int Rep 2020; 5:362-368. [PMID: 32154458 PMCID: PMC7056858 DOI: 10.1016/j.ekir.2019.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/15/2019] [Accepted: 12/06/2019] [Indexed: 01/13/2023] Open
Affiliation(s)
- J. Chang
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Health System, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - X. Guo
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - V. Rao
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - E.S. Gromisch
- Veterans Affairs Connecticut Health System, University of Connecticut School of Medicine, Farmington, Connecticut, USA
- Department of Neurology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health of New England, Hartford, Connecticut, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
- Department of Medical Sciences, Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | - S. Chung
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - H.M. Kluger
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut, USA
| | - C. Cha
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - F. Gorelick
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Health System, University of Connecticut School of Medicine, Farmington, Connecticut, USA
- Department of Cell Biology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - J. Testani
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - R. Safirstein
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Health System, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - S. Crowley
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Health System, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - A.J. Peixoto
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - G.V. Desir
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Health System, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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Uhlig J, Nie J, Stein S, Cha C, Kim K. Abstract No. 497 Comparison of radiofrequency ablation and stereotactic radiotherapy for primary treatment of low- and intermediate-stage hepatocellular carcinoma: results from the National Cancer Database. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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18
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Rubinstein JC, Khan SA, Christison-Lagay ER, Cha C. APC mutational patterns in gastric adenocarcinoma are enriched for missense variants with associated decreased survival. Genes Chromosomes Cancer 2020; 59:64-68. [PMID: 31353684 DOI: 10.1002/gcc.22792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/16/2019] [Accepted: 07/22/2019] [Indexed: 01/24/2023] Open
Abstract
Adenomatous polyposis coli (APC) mutations are causally associated with familial adenomatous polyposis (FAP) and are recurrent somatic events across numerous tumor types, including gastric adenocarcinoma. Severity of disease in FAP correlates with specific APC mutations, but the impact of given mutations on phenotype in gastric cancer is not well studied. Sequencing data from the Genomic Data Commons (GDC) demonstrate an APC mutational pattern in gastric cancer that differs dramatically from that seen in colon cancer. Exome sequencing data from APC-mutant colon and gastric adenocarcinomas in GDC was filtered for single nucleotide variants (SNVs) using MuTect2 Variant Aggregation and Masking pipeline, Somatic Aggregation Workflow. APC mutations were found in 57/441 gastric (12.9%) and 309/433 colon adenocarcinomas (71.4%). There was a significant difference in the proportion of stopgain, frameshift, and missense mutations between tumor types(P < .00001). Colon tumors were predominated by frameshift and stopgains, comprising 47.7% and 35.7%, respectively. In contrast, 47.1% of gastric mutations were missense. Gastric tumors harboring missense mutations showed decreased overall survival relative to other mutational subtypes(P = .008). In the gastric samples, 25.9% of frameshift and stopgain mutations are in the 3' portion of the gene, compared to 1.4% of colon samples. APC mutations demonstrate different distributions in gastric and colon adenocarcinoma, with a shift toward missense variants in gastric tumors and worse survival in gastric tumors harboring them. As different mutations confer variable degrees of protein dysfunction and resultant clinical manifestation, expanded investigation of specific mutational patterns will prove integral to future-risk stratification strategies.
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Affiliation(s)
- Jill C Rubinstein
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sajid A Khan
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | | | - Charles Cha
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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Cha C, Kim D, Lee J, Park S, Bae S, Kim J, Ahn S, Park H, Park S, Kim S, Cho Y, Jeong J. De-escalating axillary surgery according to neoadjuvant single or dual HER2 blockade in clinically node-positive, HER2-positive breast cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz417.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Bae S, Park S, Cha C, Lee J, Kim D, Ahn S, Jeong J. The prognostic value of neutrophil to lymphocyte ratio (NLR) and 18F-FDG PET SUV in breast cancer patients underwent neoadjuvant chemotherapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz417.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Park S, Min E, Bae S, Cha C, Kim D, Lee J, Cha Y, Jeong J, Ahn S. Comparison of standard uptake value of 18F-FDG-PET-CT with tumour-infiltrating lymphocytes in breast cancer ≥1cm. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz416.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Klemen ND, Wang M, Feingold PL, Cooper K, Pavri SN, Han D, Detterbeck FC, Boffa DJ, Khan SA, Olino K, Clune J, Ariyan S, Salem RR, Weiss SA, Kluger HM, Sznol M, Cha C. Patterns of failure after immunotherapy with checkpoint inhibitors predict durable progression-free survival after local therapy for metastatic melanoma. J Immunother Cancer 2019; 7:196. [PMID: 31340861 PMCID: PMC6657062 DOI: 10.1186/s40425-019-0672-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [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: 04/03/2019] [Accepted: 07/09/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Checkpoint inhibitors (CPI) have revolutionized the treatment of metastatic melanoma, but most patients treated with CPI eventually develop progressive disease. Local therapy including surgery, ablation or stereotactic body radiotherapy (SBRT) may be useful to manage limited progression, but criteria for patient selection have not been established. Previous work has suggested progression-free survival (PFS) after local therapy is associated with patterns of immunotherapy failure, but this has not been studied in patients treated with CPI. METHODS We analyzed clinical data from patients with metastatic melanoma who were treated with antibodies against CTLA-4, PD-1 or PD-L1, either as single-agent or combination therapy, and identified those who had disease progression in 1 to 3 sites managed with local therapy. Patterns of CPI failure were designated by independent radiological review as growth of established metastases or appearance of new metastases. Local therapy for diagnosis, palliation or CNS metastases was excluded. RESULTS Four hundred twenty-eight patients with metastatic melanoma received treatment with CPI from 2007 to 2018. Seventy-seven have ongoing complete responses while 69 died within 6 months of starting CPI; of the remaining 282 patients, 52 (18%) were treated with local therapy meeting our inclusion criteria. Local therapy to achieve no evidence of disease (NED) was associated with three-year progression-free survival (PFS) of 31% and five-year disease-specific survival (DSS) of 60%. Stratified by patterns of failure, patients with progression in established tumors had three-year PFS of 70%, while those with new metastases had three-year PFS of 6% (P = 0.001). Five-year DSS after local therapy was 93% versus 31%, respectively (P = 0.046). CONCLUSIONS Local therapy for oligoprogression after CPI can result in durable PFS in selected patients. We observed that patterns of failure seen during or after CPI treatment are strongly associated with PFS after local therapy, and may represent a useful criterion for patient selection. This experience suggests there may be an increased role for local therapy in patients being treated with immunotherapy.
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Affiliation(s)
- Nicholas D Klemen
- Section of Surgical Oncology, Yale School of Medicine, 20 Park Street, New Haven, CT, 06519, USA
| | - Melinda Wang
- Section of Surgical Oncology, Yale School of Medicine, 20 Park Street, New Haven, CT, 06519, USA
| | - Paul L Feingold
- Section of Surgical Oncology, Yale School of Medicine, 20 Park Street, New Haven, CT, 06519, USA
| | - Kirsten Cooper
- Department of Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Sabrina N Pavri
- Orlando Health Aesthetic and Reconstructive Surgery Institute, Orlando, FL, USA
| | - Dale Han
- Division of Surgical Oncology, Oregon Health and Science University, Portland, OR, USA
| | - Frank C Detterbeck
- Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Daniel J Boffa
- Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Sajid A Khan
- Section of Surgical Oncology, Yale School of Medicine, 20 Park Street, New Haven, CT, 06519, USA
| | - Kelly Olino
- Section of Surgical Oncology, Yale School of Medicine, 20 Park Street, New Haven, CT, 06519, USA
| | - James Clune
- Section of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Stephan Ariyan
- Section of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Ronald R Salem
- Section of Surgical Oncology, Yale School of Medicine, 20 Park Street, New Haven, CT, 06519, USA
| | - Sarah A Weiss
- Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Harriet M Kluger
- Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Mario Sznol
- Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Charles Cha
- Section of Surgical Oncology, Yale School of Medicine, 20 Park Street, New Haven, CT, 06519, USA.
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Uhlig J, Sellers C, Khan SA, Cha C, Kevin Kim HS. Impact of hospital volume and type on survival in hepatocellular carcinoma: Results from the National Cancer Database. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.417] [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
417 Background: To assess the impact of hospital volume and type on survival in patients with hepatocellular carcinoma (HCC). Methods: Patients with histopathological or imaging-based diagnosis of HCC were identified from the 2003-2015 National Cancer Database (NCDB). First-line treatment was stratified as liver transplant, surgical resection, interventional oncology (IO) and chemotherapy. Hospital volume was stratified as high (ranking among top 10% in case numbers) and low volume, separately for each treatment modality. Hospital type was categorized as academic and non-academic. Overall survival was assessed using multivariable Cox proportional hazards models. Results: A total of 63,877 patients were included (transplant n = 10,596, surgical resection n = 11,132, IO n = 12,286, chemotherapy n = 29,863). Of 1,261 hospitals systems which treated HCC, 226 (17.9%) were academic centers and 1,035 (82.1 %) were non-academic centers. Mean number of cases treated annually was higher in academic centers (55.2; 34.6; 40.7; 79.9) versus non-academic centers (10.7; 6.25; 6.6; 11.9 for transplant; surgical resection; IO and chemotherapy; p < 0.001, respectively). Young African American patients and those with private insurance, high income and education were more likely to receive treatment at academic centers. Geographical difference were evident among US regions, with highest proportion of HCC treated at academic centers in New England states (83.6%) and lowest in South Atlantic states (48.6%). Overall survival was superior for academic versus non-academic centers (HR = 0.89, 95% CI: 0.87-0.91, p < 0.001) and high versus low volume centers (HR = 0.79, 95% CI: 0.77-0.81, p < 0.001), after multivariable adjustment for potential confounders. These effects were evident among all HCC treatment modalities. Conclusions: HCC treatment in academic centers shows distinct patterns according to patient demographics and US geography. Among all treatment modalities, both academic setting and hospital volume independently affected HCC outcomes, with highest patient survival observed in high-volume academic centers.
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Affiliation(s)
- Johannes Uhlig
- Section of Interventional Radiology, New Haven School of Medicine, New Haven, CT
| | | | | | - Charles Cha
- Department of Surgical Oncology, Yale University School of Medicine, New Haven, CT
| | - Hyun S. Kevin Kim
- Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, and Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA
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Uhlig J, Sellers CM, Cha C, Khan SA, Lacy J, Stein SM, Kim HS. Intrahepatic Cholangiocarcinoma: Socioeconomic Discrepancies, Contemporary Treatment Approaches and Survival Trends from the National Cancer Database. Ann Surg Oncol 2019; 26:1993-2000. [PMID: 30693451 DOI: 10.1245/s10434-019-07175-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate socioeconomic discrepancies in current treatment approaches and survival trends among patients with intrahepatic cholangiocarcinoma (ICC). METHODS The 2004-2015 National Cancer Database was retrospectively analyzed for histopathologically proven ICC. Treatment predictors were evaluated using multinomial logistic regression and overall survival via multivariable Cox models. RESULTS Overall, 12,837 ICC patients were included. Multiple factors influenced treatment allocation, including age, education, comorbidities, cancer stage, grade, treatment center, and US state region (multivariable p < 0.05). The highest surgery rates were observed in the Middle Atlantic (28.7%) and lowest rates were observed in the Mountain States (18.4%). Decreased ICC treatment likelihood was observed for male African Americans with Medicaid insurance and those with low income (multivariable p < 0.05). Socioeconomic treatment discrepancies translated into decreased overall survival for patients of male sex (vs. female; hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.16-1.26, p < 0.001), with low income (< $37,999 vs. ≥ $63,000 annually; HR 1.07, 95% CI 1.01-1.14, p = 0.032), and with Medicaid insurance (vs. private insurance; HR 1.13, 95% CI 1.04-1.23, p = 0.006). Both surgical and non-surgical ICC management showed increased survival compared with no treatment, with the longest survival for surgery (5-year overall survival for surgery, 33.5%; interventional oncology, 11.8%; radiation oncology/chemotherapy, 4.4%; no treatment, 3.3%). Among non-surgically treated patients, interventional oncology yielded the longest survival versus radiation oncology/chemotherapy (HR 0.73, 95% CI 0.65-0.82, p < 0.001). CONCLUSIONS ICC treatment allocation and outcome demonstrated a marked variation depending on socioeconomic status, demography, cancer factors, and US geography. Healthcare providers should address these discrepancies by providing surgery and interventional oncology as first-line treatment to all eligible patients, with special attention to the vulnerable populations identified in this study.
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Affiliation(s)
- Johannes Uhlig
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.,Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Cortlandt M Sellers
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Charles Cha
- Division of Surgical Oncology, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.,Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Sajid A Khan
- Division of Surgical Oncology, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.,Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Jill Lacy
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA.,Division of Medical Oncology, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Stacey M Stein
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA.,Division of Medical Oncology, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Hyun S Kim
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA. .,Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA. .,Division of Medical Oncology, Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
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Heller DR, Jean RA, Chiu AS, Feder SI, Kurbatov V, Cha C, Khan SA. Regional Differences in Palliative Care Utilization Among Geriatric Colorectal Cancer Patients Needing Emergent Surgery. J Gastrointest Surg 2019; 23:153-162. [PMID: 30328071 PMCID: PMC6751557 DOI: 10.1007/s11605-018-3929-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/10/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The benefits of palliative care (PC) in critical illness are validated across a range of diseases, yet it remains underutilized in surgical patients. This study analyzed patient and hospital factors predictive of PC utilization for elderly patients with colorectal cancer (CRC) requiring emergent surgery. METHODS The National Inpatient Sample was queried for patients aged ≥ 65 years admitted emergently with CRC from 2009 to 2014. Patients undergoing colectomy, enterectomy, or ostomy formation were included and stratified according to documentation of PC consultation during admission. Chi-squared testing identified unadjusted group differences, and multivariable logistic regression identified predictors of PC. RESULTS Of 86,573 discharges meeting inclusion criteria, only 3598 (4.2%) had PC consultation. Colectomy (86.6%) and ostomy formation (30.4%) accounted for the operative majority. PC frequency increased over time (2.9% in 2009 to 6.2% in 2014, P < 0.001) and was nearly twice as likely to occur in the West compared with the Northeast (5.7 vs. 3.3%, P < 0.001) and in not-for-profit compared with proprietary hospitals (4.5 vs. 2.3%, P < 0.001). PC patients were more likely to have metastases (60.1 vs. 39.9%, P < 0.001) and die during admission (41.5 vs. 6.4%, P < 0.001). On multivariable logistic regression, PC predictors (P < 0.05) included region outside the Northeast, increasing age, more recent year, and metastatic disease. CONCLUSIONS In the USA, PC consultation for geriatric patients with surgically managed complicated CRC is low. Regional variation appears to play an important role. With mounting evidence that PC improves quality of life and outcomes, understanding the barriers associated with its provision to surgical patients is paramount.
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Affiliation(s)
- Danielle R Heller
- Department of Surgery, Yale School of Medicine, P.O. Box 208062, New Haven, CT, 06520-8062, USA
| | - Raymond A Jean
- Department of Surgery, Yale School of Medicine, P.O. Box 208062, New Haven, CT, 06520-8062, USA
- National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, P.O. Box 208088, New Haven, CT, 06520-8088, USA
| | - Alexander S Chiu
- Department of Surgery, Yale School of Medicine, P.O. Box 208062, New Haven, CT, 06520-8062, USA
| | - Shelli I Feder
- National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, P.O. Box 208088, New Haven, CT, 06520-8088, USA
- US Department of Veterans Affairs, 950 Campbell Ave, West Haven, CT, 06516, USA
| | - Vadim Kurbatov
- Department of Surgery, Yale School of Medicine, P.O. Box 208062, New Haven, CT, 06520-8062, USA
| | - Charles Cha
- Section of Surgical Oncology, Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520-8062, USA
| | - Sajid A Khan
- Section of Surgical Oncology, Department of Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT, 06520-8062, USA.
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Cha C, Bae S, Yoon CI, Park S, Kim Y, Ahn S, Lee K, Jeong J. Genomic spectrum of Asian breast cancer based on targeted next-generation sequencing in 150 consecutive primary breast cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lee D, Park S, Cha C, Yoon CI, Bae S, Ahn S, Jeong J. Lymphocyte-predominant breast cancer has a significant lower mean of absolute neutrophil counts compared to non-lymphocyte-predominant breast cancer: Analyses with 576 cases. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tempero MA, Malafa MP, Al-Hawary M, Asbun H, Bain A, Behrman SW, Benson AB, Binder E, Cardin DB, Cha C, Chiorean EG, Chung V, Czito B, Dillhoff M, Dotan E, Ferrone CR, Hardacre J, Hawkins WG, Herman J, Ko AH, Komanduri S, Koong A, LoConte N, Lowy AM, Moravek C, Nakakura EK, O'Reilly EM, Obando J, Reddy S, Scaife C, Thayer S, Weekes CD, Wolff RA, Wolpin BM, Burns J, Darlow S. Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2018; 15:1028-1061. [PMID: 28784865 DOI: 10.6004/jnccn.2017.0131] [Citation(s) in RCA: 658] [Impact Index Per Article: 109.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Ductal adenocarcinoma and its variants account for most pancreatic malignancies. High-quality multiphase imaging can help to preoperatively distinguish between patients eligible for resection with curative intent and those with unresectable disease. Systemic therapy is used in the neoadjuvant or adjuvant pancreatic cancer setting, as well as in the management of locally advanced unresectable and metastatic disease. Clinical trials are critical for making progress in treatment of pancreatic cancer. The NCCN Guidelines for Pancreatic Adenocarcinoma focus on diagnosis and treatment with systemic therapy, radiation therapy, and surgical resection.
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Abstract
AIM The aim of this article is to describe our experience in operating a capacity-building programme, the Korea International Cooperation Project, for global nursing leaders from developing countries, held during the International Council of Nurses (ICN) Conference in 2015 in Seoul, Korea. BACKGROUND Globalization points to the importance of global leadership among nursing leaders. In accordance with the theme of 'Global Citizen, Global Nursing' at the ICN conference in 2015, a capacity-building programme for nursing leaders of developing countries was implemented. INTRODUCTION The global nursing leadership programme shared experiences during the preparation and operation of the conference. To prepare the programme, this paper describes selecting participants, working with invitation lists from 30 countries, and recruiting and training volunteers. The operation of the programme, orientation, organizing tailored programmes for participant groups, addressing unexpected issues and evaluating the programme are described. IMPLICATIONS FOR NURSING POLICY ICN could implement capacity-building programmes for nursing leaders of developing countries during its ICN conference for the nursing society. A programme tailored for each continent with similar sociocultural backgrounds and health issues would provide chances for collaboration and networking. A policy to compile global nursing indicators should be developed. This would allow nursing leaders to learn about the strengths and weaknesses of global nursing and provide evidence for collaboration. CONCLUSION The programme was successful in introducing and broadening global perspectives of participants on health and education as well as building a network among leaders and next-generation leaders in participating countries for future cooperation and collaboration.
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Affiliation(s)
- S Shin
- Department of Nursing, Sahmyook University, Nowon-gu, Korea
| | - J Han
- Center for Nursing Workforce Employment Education, Korean Nurses Association, Jung-gu, Korea
| | - C Cha
- College of Nursing, Ewha Womans University, Seoul, Korea
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Hollander L, Guo X, Velazquez H, Chang J, Safirstein R, Kluger H, Cha C, Desir GV. Renalase Expression by Melanoma and Tumor-Associated Macrophages Promotes Tumor Growth through a STAT3-Mediated Mechanism. Cancer Res 2016; 76:3884-94. [PMID: 27197188 DOI: 10.1158/0008-5472.can-15-1524] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 04/05/2016] [Indexed: 12/12/2022]
Abstract
To sustain their proliferation, cancer cells overcome negative-acting signals that restrain their growth and promote senescence and cell death. Renalase (RNLS) is a secreted flavoprotein that functions as a survival factor after ischemic and toxic injury, signaling through the plasma calcium channel PMCA4b to activate the PI3K/AKT and MAPK pathways. We show that RNLS expression is increased markedly in primary melanomas and CD163(+) tumor-associated macrophages (TAM). In clinical specimens, RNLS expression in the tumor correlated inversely with disease-specific survival, suggesting a pathogenic role for RNLS. Attenuation of RNLS by RNAi, blocking antibodies, or an RNLS-derived inhibitory peptide decreased melanoma cell survival, and anti-RNLS therapy blocked tumor growth in vivo in murine xenograft assays. Mechanistic investigations showed that increased apoptosis in tumor cells was temporally related to p38 MAPK-mediated Bax activation and that increased cell growth arrest was associated with elevated expression of the cell-cycle inhibitor p21. Overall, our results established a role for the secreted flavoprotein RNLS in promoting melanoma cell growth and CD163(+) TAM in the tumor microenvironment, with potential therapeutic implications for the management of melanoma. Cancer Res; 76(13); 3884-94. ©2016 AACR.
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Affiliation(s)
- Lindsay Hollander
- Department of Medicine, Yale University, New Haven, Connecticut. Yale School of Medicine, Yale University, New Haven, Connecticut. University of Connecticut, Farmington, Connecticut
| | - Xiaojia Guo
- Department of Medicine, Yale University, New Haven, Connecticut. Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Heino Velazquez
- Department of Medicine, Yale University, New Haven, Connecticut. Yale School of Medicine, Yale University, New Haven, Connecticut. VA Connecticut Health Care System, Yale University, New Haven, Connecticut
| | - John Chang
- Department of Medicine, Yale University, New Haven, Connecticut. VA Connecticut Health Care System, Yale University, New Haven, Connecticut
| | - Robert Safirstein
- Department of Medicine, Yale University, New Haven, Connecticut. Yale School of Medicine, Yale University, New Haven, Connecticut. VA Connecticut Health Care System, Yale University, New Haven, Connecticut
| | - Harriet Kluger
- Department of Medical Oncology, Yale University, New Haven, Connecticut. Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Charles Cha
- Yale School of Medicine, Yale University, New Haven, Connecticut. VA Connecticut Health Care System, Yale University, New Haven, Connecticut. Department of Surgery, Yale University, New Haven, Connecticut
| | - Gary V Desir
- Department of Medicine, Yale University, New Haven, Connecticut. Yale School of Medicine, Yale University, New Haven, Connecticut. VA Connecticut Health Care System, Yale University, New Haven, Connecticut.
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Guo X, Hollander L, MacPherson D, Wang L, Velazquez H, Chang J, Safirstein R, Cha C, Gorelick F, Desir GV. Inhibition of renalase expression and signaling has antitumor activity in pancreatic cancer. Sci Rep 2016; 6:22996. [PMID: 26972355 PMCID: PMC4789641 DOI: 10.1038/srep22996] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/26/2016] [Indexed: 01/05/2023] Open
Abstract
An essential feature of cancer is dysregulation of cell senescence and death. Renalase, a recently discovered secreted flavoprotein, provides cytoprotection against ischemic and toxic cellular injury by signaling through the PI3K-AKT and MAPK pathways. Here we show that renalase expression is increased in pancreatic cancer tissue and that it functions as a growth factor. In a cohort of patients with pancreatic ductal adenocarcinoma, overall survival was inversely correlated with renalase expression in the tumor mass, suggesting a pathogenic role for renalase. Inhibition of renalase signaling using siRNA or inhibitory anti-renalase antibodies decreased the viability of cultured pancreatic ductal adenocarcinoma cells. In two xenograft mouse models, either the renalase monoclonal antibody m28-RNLS or shRNA knockdown of renalase inhibited pancreatic ductal adenocarcinoma growth. Inhibition of renalase caused tumor cell apoptosis and cell cycle arrest. These results reveal a previously unrecognized role for the renalase in cancer: its expression may serve as a prognostic maker and its inhibition may provide an attractive therapeutic target in pancreatic cancer.
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Affiliation(s)
- Xiaojia Guo
- Department of Medicine, VACHS, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Lindsay Hollander
- Department of Medicine, VACHS, Yale University School of Medicine, New Haven, CT 06520, USA.,Department of Surgery, University of Connecticut, Farmington, CT 06032, USA
| | - Douglas MacPherson
- Department of Medicine, VACHS, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Ling Wang
- Renal Division, Renji hospital, Shanghai Jiaotong Univ School of Medicine, Shanghai, China
| | - Heino Velazquez
- Department of Medicine, VACHS, Yale University School of Medicine, New Haven, CT 06520, USA
| | - John Chang
- Department of Medicine, VACHS, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Robert Safirstein
- Department of Medicine, VACHS, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Charles Cha
- Department of Surgery, VACHS, Yale University, New Haven, CT 06520, USA
| | - Fred Gorelick
- Department of Medicine, VACHS, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Gary V Desir
- Department of Medicine, VACHS, Yale University School of Medicine, New Haven, CT 06520, USA
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Stein S, James ES, Cong X, Deng Y, Salem RR, Cha C, Chang BW, Hochster HS, Doddamane I, Boustani A, Patel V, Kortmansky JS, Li J, Staugaard C, Lacy J. Final analysis of a phase II study of modified FOLFIRINOX in locally advanced and metastatic pancreatic cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.395] [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
395 Background: Toxicities associated with FOLFIRINOX have prompted use of modifications, despite absence of prospective data validating comparable efficacy and improved tolerability. To determine the impact of attenuated doses of irinotecan and bolus 5FU on efficacy and tolerability, we conducted a prospective phase II study of modified FOLFIRINOX in advanced PC. The efficacy of a FOLFIRINOX regimen has not been previously examined in locally advanced PC (LAPC). Previous studies in LAPC have compared chemo vs chemoRT with median OS in the 9-12 mo range (Loehrer et al, Chauffert et al, Hammel et al). Methods: Previously untreated pts with MPC or LAPC received modified FOLFIRINOX with pegylated filgrastim. Irinotecan and bolus FU were reduced by 25%. AEs were compared to historical control (Conroy et al NEJM 2011). Objective RR in MPC was compared to historical control. PFS and OS were calculated for both cohorts. Results: 31 and 44 pts with LAPC and MPC enrolled. Treatment-related grade 3 and 4 AEs were diarrhea (16.2%), neutropenia (12.2%), fatigue (12.2%), thrombocytopenia (9.5%), anemia (5.4%). Neutropenia (p < 0.0001), vomiting (p = 0.001), and fatigue (p = 0.01) were significantly decreased compared to historical control patients. In MPC, the RR (35.1%) was similar to the historical control group (36.3%; p 0.82); median PFS and OS were 6.1 months (95% CI, 5.19 to 8.31) and10.2 months (95% CI, 7.65 to 14.32) respectively. In LAPC, the RR was 17.2% and median PFS and OS were 17.8 mo (95% CI, 11.0 to 23.9) and 26.6 mo (95% CI, 16.7, NA) respectively. 13 pts went on to surgical resection with 10 now alive and 6 without recurrence. We found no significant association between early metabolic response by FDG-PET imaging and PFS and OS. Conclusions: In this first prospective study of modified FOLFIRINOX, the regimen was well tolerated and associated with decreased incidence of AEs compared to historical control of standard FOLFIRINOX. In MPC pts, the efficacy of the modified regimen appear uncompromised. In this first prospective study of a FOLFIRINOX regimen in LAPC, the PFS and OS surpasses that of previously studied regimens in LAPC. Clinical trial information: NCT01523457.
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Affiliation(s)
- Stacey Stein
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT
| | | | - Xiangyu Cong
- Yale Center for Analytical Sciences, New Haven, CT
| | - Yanhong Deng
- Yale Center for Analytical Sciences, New Haven, CT
| | - Ronald R Salem
- Department of Surgical Oncology, Yale University School of Medicine, New Haven, CT
| | - Charles Cha
- Department of Surgical Oncology, Yale University School of Medicine, New Haven, CT
| | | | - Howard S. Hochster
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT
| | | | | | | | | | - Jia Li
- Yale School of Medicine, New Haven, CT
| | | | - Jill Lacy
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT
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Stein S, Cong X, Yao X, Hahn C, Li J, Kortmansky JS, Chang BW, Cha C, Salem RR, Hochster HS, Lacy J. Phase II study of Yale modified FOLFIRINOX (mFOLFIRINOX) in locally advanced pancreatic cancer (LAPC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e15274] [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)
- Stacey Stein
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT
| | - Xiangyu Cong
- Yale Center for Analytical Sciences, New Haven, CT
| | - Xiaopan Yao
- Yale Center for Analytical Sciences, New Haven, CT
| | | | - Jia Li
- Yale School of Medicine, New Haven, CT
| | | | | | - Charles Cha
- Department of Surgical Oncology, Yale University School of Medicine, New Haven, CT
| | - Ronald R Salem
- Department of Surgical Oncology, Yale University School of Medicine, New Haven, CT
| | - Howard S. Hochster
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT
| | - Jill Lacy
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT
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DeLuzio MR, Moores C, Dhamija A, Wang Z, Cha C, Boffa DJ, Detterbeck FC, Kim AW. Resection of oligometastatic lung cancer to the pancreas may yield a survival benefit in select patients--a systematic review. Pancreatology 2015; 15:456-462. [PMID: 25900320 DOI: 10.1016/j.pan.2015.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/12/2015] [Accepted: 03/23/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To conduct a systematic review of the existing literature regarding surgical therapy for oligometastatic lung cancer to the pancreas. METHODS Data was collected on patients with singular pancreatic metastases from lung cancer from papers published between January 1970 and June 2014. This was performed following the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines. Kaplan-Meier and Cox Regression analyses were then used to determine and compare survival. RESULTS There were 27 papers that fulfilled the search criteria, from which data on 32 patients was collected. Non-small cell lung cancer (NSCLC) was the most prevalent type of primary lung malignancy, and metachronous presentations of metastases were most common. Lesions were most frequently located in the pancreatic head and consequently the most common curative intent metastasectomy was pancreaticoduodenectomy. There was a statistically significant survival benefit for patients whose metastasis were discovered incidentally by surveillance CT as opposed to those whose metastasis were discovered during a work up for new somatic complaints (p = 0.024). The overall median survival for patients undergoing curative intent resection was 29 months, with 2-year and 5-year survivals of 65% and 21% respectively. Palliative surgery or medical only management was associated with a median survival of 8 months and 2-year and 5-year survivals of 25% and 8% respectively. CONCLUSIONS Curative intent resection of isolated pancreatic metastasis from lung cancer may be beneficial in a select group of patients.
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Affiliation(s)
- Matthew R DeLuzio
- Department of Surgery, Yale-New Haven Hospital, New Haven, CT 06520, USA
| | - Craig Moores
- Department of Surgery, Yale-New Haven Hospital, New Haven, CT 06520, USA
| | - Ankit Dhamija
- Department of Surgery, Morristown Medical Center, Morristown, NJ 07960, USA
| | - Zuoheng Wang
- Division of Biostatistics, Yale School of Public Health, New Haven, CT 06520, USA
| | - Charles Cha
- Section of Surgical Oncology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Daniel J Boffa
- Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT 06520, USA
| | - Frank C Detterbeck
- Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT 06520, USA
| | - Anthony W Kim
- Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT 06520, USA.
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James ES, Cong X, Yao X, Hahn C, Kaley K, Li J, Kortmansky JS, Fischbach NA, Cha C, Salem RR, Stein S, Hochster HS, Lacy J. Final analysis of a phase II study of Yale-modified FOLFIRINOX (mFOLFIRINOX) in metastatic pancreatic cancer (MPC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
395 Background: Although FOLFIRINOX is superior to gemcitabine in MPC, the regimen is associated with significant toxicities (Conroy et al. N Engl J Med 2011;364:1817). In our prior retrospective analysis, efficacy was not compromised by dose attenuations of FOLFIRINOX (Gunturu et al. Med Oncol 2013;30:361). Based on this analysis, a prospective phase II open label study to evaluate the efficacy and tolerability of mFOLFIRINOX in pts with locally advanced (LAPC) and MPC was conducted. Herein, we report the final analysis of the toxicity in LAPC and MPC, and the efficacy in MPC. Methods: Previously untreated pts with MPC or LAPC received mFOLFIRINOX every two wks with 25% dose reductions of irinotecan & bolus 5FU until progression, unacceptable toxicity, or surgical resection. All pts received prophylactic pegfilgrastim. CAT scans were obtained every 4 cycles for response assessment by RECIST. Toxicities in the entire cohort, and response rate (RR) & pt characteristics in the MPC cohort were compared to historical data reported by Conroy. PFS was determined for MPC cohort. Results: 31 pts with LAPC and 43 pts with MPC with ECOG PS 0/1 were enrolled between 11/11 and 01/14. Characteristics of evaluable (37/43) MPC pts were: med age, 61 yrs (range 50-76); male, 21; ECOG PS 0, 17; med # metastatic sites, 2; peritoneal disease, 14; biliary stent, 9; med # of cycles 10 (range 4-31). Grade 3/4 toxicities in entire cohort were: vomiting & peripheral neuropathy, 2.7%; ALT elevated, thromboembolism and febrile neutropenia, 4.1%; anemia, 5.4%; diarrhea,16.2% (no grade 4 diarrhea reported); neutropenia & fatigue, 12.2%; thrombocytopenia, 9.5%. Neutropenia (p<0.0001), vomiting (p=0.0014), and fatigue (0.0194) were significantly decreased compared to historical data. RR in 37 pts with MPC was 35.1% (0 CR, 13 PR, 19 SD, 5 PD) and similar to historical data (36.9%; p 0.86). PFS in MPC pts was 6.11 mo with 95% CI (5.29, 8.31). Conclusions: mFOLFIRINOX with prophylactic pegfilgrastim in pts with MPC is associated with improved tolerability compared to full dose FOLFIRINOX, while RR and PFS in pts with MPC is similar to that reported by Conroy et all using full dose FOLFIRINOX. MPC pts are in follow-up for OS. Follow up for LAPC patients is ongoing. Clinical trial information: NCT01523457.
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Affiliation(s)
| | - Xiangyu Cong
- Yale Center for Analytical Sciences, New Haven, CT
| | - Xiaopan Yao
- Yale Center for Analytical Sciences, New Haven, CT
| | | | | | - Jia Li
- Yale School of Medicine, New Haven, CT
| | | | | | - Charles Cha
- Department of Surgical Oncology, Yale University School of Medicine, New Haven, CT
| | - Ronald R Salem
- Department of Surgical Oncology, Yale University School of Medicine, New Haven, CT
| | - Stacey Stein
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT
| | - Howard S. Hochster
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT
| | - Jill Lacy
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT
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Gould Rothberg BE, Deminie C, Lazowski H, Gibson JA, Cha C, Lacy J, Hochster HS, Salem RR. The Yale Gastrointestinal Cancer Biorepository: A comprehensive biospecimen and data resource for studying determinants of pancreatic ductal adenocarcinoma prognosis following curative-intent pancreaticoduodenectomy. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.272] [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
272 Background: Although surgical resection can be curative for pancreatic ductal adenocarcinoma (PDAC), only 20% of patients qualify and, of these, only 20% survive for 5 or more years. Because tumor biology, germline genetics, environmental exposures and lifestyle factors all contribute, we designed the Yale Gastrointestinal (GI) Cancer Biorepository to partner biospecimen science best practices with comprehensive clinico-epidemiologic annotations evaluate determinants of outcome for PDAC and other GI cancers. Methods: Adult patients presenting to Yale GI Oncology Clinics with incident cancers who consent are interviewed using a validated instrument to capture demographics, medical comorbidities, family history of cancer, employment history and lifestyle choices including tobacco, alcohol, diet and physical activity. Buffy coat and 20 mL of plasma are collected pre-operatively. Surgical Pathology provides three 3 mm tissue cores to be stored in RNALater at -190°C in addition to formalin-fixed tissue blocks with time to fixation at ≤30 minutes. Confirmatory touch-preparations are required for all RNALater-preserved specimens. Periodic medical record abstraction documents recurrence, progression, treatment and vital status. Quality-of-life and lifestyle reassessments occur at 6 and 12 months post-diagnosis then annually thereafter. Results: Since our March 2012 launch, we consented 388 individuals including 57 PDAC patients undergoing pancreaticoduodenectomy with 16 (28%) having received FOLFIRINOX-based neoadjuvant therapy prior to surgery. Median follow-up is 7.9 months with 11 PDAC recurrences and 7 PDAC-related deaths confirmed. Receipt of neoadjuvant therapy trended towards downstaged cancers upon resection (p=0.08). Women (n=20) were more likely to be older (p=0.02) and trended towards less advanced cancers (p=0.06) but smoked, used aspirin similarly and have BMIs comparable with men (n=37). Exome and transcriptome analysis of tumor and germline are ongoing. Conclusions: Determinants of early-stage PDAC prognosis will emerge as this cohort matures.
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Affiliation(s)
| | - Carol Deminie
- Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | | | - Joanna A Gibson
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Charles Cha
- Department of Surgical Oncology, Yale University School of Medicine, New Haven, CT
| | - Jill Lacy
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT
| | - Howard S. Hochster
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT
| | - Ronald R Salem
- Department of Surgical Oncology, Yale University School of Medicine, New Haven, CT
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Abstract
BACKGROUND Of elders with mild cognitive impairment, around half recover their cognitive function at some point in time. However, very little is known about the factors that influence their cognitive change towards recovery. AIM This study evaluated the role of depression, instrumental activity of daily living and sleep quality as they affect cognition recovery among community-dwelling elders. METHODS The study follows a longitudinal comparative research design using secondary data analysis. Community-dwelling elders with mild cognitive impairment were assessed twice with a 1-year interval to assess their levels of cognition. Adult participants were drawn from those who visited a community health centre, were aged 65 or over and who were assessed as having MCI. RESULTS Those with mild cognitive impairment when compared with the normal cognition group were more likely to be younger, have more education, living with their spouses and had better cognitive function at baseline assessment than other participants. Predictors for cognitive recovery among elders with mild cognitive impairment were age, depression and cognitive function at baseline assessment. LIMITATIONS Participants included only those who visit a community health centre in an urban area of Korea, so the findings may not be applicable to other elders with less mobility or who live in rural areas. IMPLICATIONS FOR NURSING AND HEALTH POLICY With the understanding that cognitive function and depression predict the recovery of mild cognitive function, nurses might be able to identify and target those older adults who are likely to achieve recovery of cognitive function. Additionally, health policy options, as suggested by the study as having the potential to improve mild cognitive impairment recovery, could include public education strategies.
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Affiliation(s)
- Y Kang
- Division of Nursing Science, College of Health Sciences, Ewha Womans University, Seoul
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James ES, Yao X, Cong X, Li J, Hahn C, Kaley K, Kortmansky JS, Fischbach NA, Chang BW, Salem RR, Cha C, Stein S, Hochster HS, Lacy J. Interim analysis of a phase II study of dose-modified FOLFIRINOX (mFOLFIRINOX) in locally advanced (LAPC) and metastatic pancreatic cancer (MPC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15226] [Citation(s) in RCA: 3] [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)
| | - Xiaopan Yao
- Yale Center for Analytical Sciences, New Haven, CT
| | - Xiangyu Cong
- Yale Center for Analytical Sciences, New Haven, CT
| | - Jia Li
- VA Connecticut Healthcare System, Yale Cancer Center, West Haven, CT
| | | | | | | | | | | | - Ronald R Salem
- Department of Surgical Oncology, Yale University School of Medicine, New Haven, CT
| | - Charles Cha
- Department of Surgical Oncology, Yale University School of Medicine, New Haven, CT
| | - Stacey Stein
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT
| | - Howard S. Hochster
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT
| | - Jill Lacy
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT
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Hollander L, Guo X, Salem R, Cha C. The Novel Tumor Angiogenic Factor, Adrenomedullin-2 (ADM2) Predicts Survival in Pancreatic Adenocarcinoma. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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James ES, Yao X, Cong X, Stein S, Kaley K, Hahn C, Cha C, Salem RR, Hochster HS, Lacy J. Interim analysis of a phase II study of dose-modified FOLFIRINOX (mFOLFIRINOX) in locally advanced (LAPC) and metastatic pancreatic cancer (MPC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
256 Background: Although FOLFIRINOX is superior to gemcitabine in MPC, the regimen is associated with significant toxicities (Conroy et al. N Engl J Med 2011;364:1817). In our prior retrospective analysis, efficacy was not compromised by dose attenuations of FOLFIRINOX (Gunturu et al. Med Oncol 2013;30:361). Based on this analysis, we are conducting a prospective phase II open label study to evaluate the efficacy & tolerability of mFOLFIRINOX in pts with advanced pancreatic cancer (PC). Methods: Previously untreated pts with MPC or LAPC received mFOLFIRINOX with 25% dose reductions of irinotecan & bolus 5-FU given every two wks until progression, unacceptable toxicity, or surgical resection. All pts received prophylactic pegfilgrastim. FDG-PET scans were obtained at baseline & after 2 cycles. CAT scans were obtained after every 4 cycles. Toxicities & response rate (RR) were compared to historical data reported by Conroy. Results: 53 pts with ECOG PS ≤1 have been enrolled to date between 11/11 and 08/13, Pt characteristics: LAPC 22; MPC 31; median age 62 yrs (range 46-86); male 30. Median # of cycles was 8 (range 1-21). Grade 3/4 toxicities were: anemia, febrile neutropenia (FN) & peripheral sensory neuropathy (PSN) – 3.8% each; ALT increased & thromboembolism – 5.7% each; diarrhea 7.5%; fatigue 11.3%; neutropenia 17%; thrombopenia 11.3% & vomiting 1.9%. Anemia ( p< 0.04), FN (p<0.04), PSN (p<0.04) and vomiting (p<0.02) were significantly decreased compared to historical data (Conroy). Response by RECIST (CR+PR) in 26 evaluable pts with MPC was 29% (0 CR, 9 PR, 14 SD, 3 PD) & similar to historical data (31.6%; p 0.85). 6/13 evaluable pts with LAPC underwent resection (46%).13/36 pts evaluable for PET response had a >50% decrease in SUV(max)(36%). Evaluation for OS & PFS is ongoing. Conclusions: Findings from our interim analysis suggests that mFOLFIRINOX, given along with prophylactic pegfilgrastim is associated with a similar RR and improved tolerability compared to full dose FOLFIRINOX in advanced PC. In pts with LAPC, neoadjuvant FOLFIRINOX appears to have substantial activity with 46% of evaluable pts undergoing resection. Accrual will continue to reach a goal of 70 pts. Clinical trial information: NCT01523457.
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Affiliation(s)
| | - Xiaopan Yao
- Yale Center for Analytical Sciences, New Haven, CT
| | - Xiangyu Cong
- Yale Center for Analytical Sciences, New Haven, CT
| | - Stacey Stein
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT
| | | | - Carol Hahn
- Yale University School of Medicine, New Haven, CT
| | - Charles Cha
- Department of Surgical Oncology, Yale University School of Medicine, New Haven, CT
| | - Ronald R Salem
- Department of Surgical Oncology, Yale University School of Medicine, New Haven, CT
| | - Howard S. Hochster
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT
| | - Jill Lacy
- Department of Medical Oncology, Yale University School of Medicine, New Haven, CT
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Nicholson A, Bishop J, Lannin D, Killelea B, Guo X, Cha C, Dixon JM. Triple-negative breast cancer: molecular characterization and targeted therapies. Breast Cancer Management 2013. [DOI: 10.2217/bmt.13.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
SUMMARY Triple-negative breast cancer is an aggressive subtype of breast cancer that does not have targeted therapies available. Recent research has focused on extensive molecular characterization in order to identify therapeutic targets. The Cancer Genome Atlas Network recently published one of the most extensive molecular reviews to date and identified modules of related mutations, some of which have been targeted in clinical trials. Due to tumor heterogeneity, it is unlikely that a single therapy will be effective. Identification of molecular targets and tailored treatments based on the molecular alterations in individual cancers hold the best promise for improving the outcomes of this aggressive breast cancer.
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Affiliation(s)
- Allen Nicholson
- Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA
| | - Jennifer Bishop
- Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA
| | - Donald Lannin
- Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA
| | - Brigid Killelea
- Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA
| | - Xiaojia Guo
- Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA
| | - Charles Cha
- Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA
| | - J Michael Dixon
- Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA
- Breakthrough Research Unit, Western General Hospital, Edinburgh, UK
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Kornreich DA, Cha C, Kaley K, Saif MW. Allergic contact dermatitis associated with Biosyn suture in a patient with gastroesophageal junction cancer. Cutan Ocul Toxicol 2012; 32:166-7. [DOI: 10.3109/15569527.2012.676120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Guo X, Schmitz J, Uchio E, Kenney B, Kulkarni S, Cha C. Abstract 5149: Intermedin stimulates cell growth, migration, and angiogenesis in human colorectal adenocarcinoma and hepatocellular carcinoma. Cancer Res 2011. [DOI: 10.1158/1538-7445.am2011-5149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Intermedin (IMD) functions as an angiogenic factor in a rat ischemic model and human endothelial cells. In our search for anti-angiogenic therapy for solid tumors, we analyzed the expression and possible role of IMD in tumor angiogenesis. IMD was expressed in human colorectal adenocarcinoma (CRC) and hepatocellular carcinoma (HCC). The IMD expression was significantly higher in stage I than stage 0 of both colon and liver tumors (stage I/0 ratio of mRNA level is 7.7 ± 0.4 and 3.2 ± 0.3, respectively). IMD was widely expressed in colon and liver tumor lines. Immunohistochemistry showed that the tumor regions were significantly more immunoreactive for IMD than adjacent benign regions of CRC and HCC specimens. Inhibition of IMD expression by RNA interference reduced cell proliferation by 29.7 ± 6.7% (n = 3, p = 0.047) and impaired cell invasion by 27.8 ± 3.6% (n = 3, p = 0.016) in a HCC cell line SK-Hep-1. Addition of IMD peptide for 5 minutes to serum starved SK-Hep-1 cells increased the phosphorylation level of p44 and p42 MAP Kinase (Erk1/2), suggesting that IMD regulates Sk-Hep-1 cell growth, at least partly, through activating Erk1/2 signaling pathway. Similarly, IMD knockdown in a CRC cell line HCT116 reduced cell growth by 35.0 ± 1.4 % (n = 3, p = 0.018). Conditioned medium from IMD siRNA-transfected SK-Hep-1 cells reduced endothelial cell tube formation by 31.6 ± 6.8%. Conversely, over-expression of IMD in CRC RKO cells increased cell growth and induced cell migration significantly. Furthermore, treatment with RKO/IMD conditioned medium increased endothelial cell tube formation by 14. 7 ± 0.8% (n=4, p = 0.049). Thus, IMD stimulated HCC and CRC cell growth, migration, and invasion, indicating a role for IMD in tumor angiogenesis.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 5149. doi:10.1158/1538-7445.AM2011-5149
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Affiliation(s)
| | - John Schmitz
- 2VACT Healthcare Comprehensive Cancer Center, West Haven, CT
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Uchio EM, Garg R, Li Y, Cha C, Schmitz J, Hwang J. QS96. Aging Effects on The Von Hippel Lindau (VHL) Tumor Suppressor Pathway in The Development of Renal Carcinoma. J Surg Res 2008. [DOI: 10.1016/j.jss.2007.12.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Affiliation(s)
- Robert A Kozol
- Department of Surgery, University of Connecticut School of Medicine, 236 Farmington Ave, Farmington, CT 06030, USA
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Westvik TS, Krause LK, Pradhan S, Westvik HH, Maloney SP, Rutland R, Kudo FA, Muto A, Leite JOM, Cha C, Gusberg RJ, Dardik A. Malnutrition after vascular surgery: are patients with chronic renal failure at increased risk? Am J Surg 2006; 192:e22-7. [PMID: 17071176 DOI: 10.1016/j.amjsurg.2006.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Revised: 07/31/2006] [Accepted: 07/31/2006] [Indexed: 11/15/2022]
Abstract
BACKGROUND The deleterious effects of perioperative malnutrition on recovery after general surgery are established. Since the effects of perioperative malnutrition on recovery after vascular surgery are not known, we examined the effects of nutritional status, and risk factors predictive of malnutrition, on outcome after vascular surgery. METHODS The records of all open index vascular cases (abdominal aortic aneurysm [AAA] repair, carotid endarterectomy [CEA], lower extremity bypass) performed at the Veterans Affairs (VA) Connecticut between July 2004 and June 2005 were reviewed. The primary outcome was mortality; secondary outcomes included infection and nutritional risk index (NRI) scores. RESULTS Sixty-eight open vascular cases were performed during the study period. Nutritional depletion developed in 55% of patients and was more likely in patients undergoing AAA (85%) or bypass (77%) than CEA (30%; P = .0005). Patients who developed malnutrition had similar mortality as patients who did not develop postoperative malnutrition (6.1% vs. 3.7%; P = .68); however, malnourished patients had higher rates of postoperative infection (24.2% vs. 3.7%; P = .03). Chronic renal failure was the only patient-associated risk factor predictive of postoperative nutritional depletion (odds ratio 5.9, confidence interval 1.0 to 33.6; P = .04). CONCLUSIONS Patients undergoing major open vascular surgery have high rates of postoperative malnutrition, with patients undergoing AAA repair having the highest rates of postoperative malnutrition and infection. Patients with chronic renal failure undergoing vascular surgery are associated with increased risk for postoperative malnutrition and may be a group to target for perioperative risk factor modification and nutritional supplementation.
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Affiliation(s)
- Tormod S Westvik
- Department of Surgery, Veterans Affairs Connecticut Health Care Systems, West Haven, CT 06516, USA
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Weiss JS, Dumas P, Cha C, Gusberg RJ, Dardik A. Safety of Carotid Endarterectomy in a High-Risk Population: Lessons from the VA and Connecticut. J Am Coll Surg 2006; 203:277-82. [PMID: 16931298 DOI: 10.1016/j.jamcollsurg.2006.05.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Revised: 05/11/2006] [Accepted: 05/12/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND The safety and efficacy of carotid endarterectomy (CEA) have been demonstrated in randomized trials, but these studies excluded patients thought to be at higher risk for poor outcomes. We sought to determine whether patients undergoing CEA in Veteran Affairs Hospitals (VA) were at higher risk and had different outcomes, compared with patients in nonfederal hospitals. STUDY DESIGN Records of all CEA performed in the VA Connecticut Healthcare System between October 1997 and September 2002 were examined and compared with CEA performed in all nonfederal Connecticut hospitals (CT). RESULTS There were 7,089 CEAs performed (VA, 140; CT, 6,949). VA patients had increased comorbidity scores and symptomatic presentation (39% versus 14%; p < 0.0001). Perioperative mortality rates were 1.4% (VA) and 0.3% (CT) (p = 0.06). Perioperative stroke (VA, 1.4% versus CT, 0.9%; p = 0.15) and cardiac complication (VA, 2.9% versus CT, 2.1%; p = 0.54) rates were similar. Multivariate analysis demonstrated that perioperative mortality correlated with symptomatic presentation (odds ratio 11.7, p < 0.0001), but not performance, in a VA hospital (p = 0.23); patients treated at the VA were also not at higher risk for stroke (p = 0.94) or cardiac complications (p = 0.90). CONCLUSIONS Despite increased severity of illness and symptomatic presentation, VA patients had similar perioperative outcomes compared with patients undergoing CEA in nonfederal hospitals in the state of Connecticut. These results suggest not only that patients undergoing vascular surgery at the VA may form a higher-risk population compared with patients receiving care in non-VA hospitals, but that these high-risk patients can undergo CEA safely.
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Affiliation(s)
- Jeffrey S Weiss
- Department of Surgery, VA Connecticut Healthcare Systems, West Haven, CT, USA
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Cha C, Mulkeen AL, Yoo PS, Silva T, Schmitz JC, Chu E, Uchio E. Post-transcriptional Regulation of VEGF: Potential for novel therapies. J Am Coll Surg 2006. [DOI: 10.1016/j.jamcollsurg.2006.05.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mulkeen AL, Silva T, Yoo PS, Schmitz JC, Uchio E, Chu E, Cha C. Cholesteryl oligoarginine delivering vascular endothelial growth factor siRNA effectively inhibits tumor growth in colon adenocarcinoma. Mol Ther 2006; 141:367-74; discussion 374. [PMID: 16618894 DOI: 10.1001/archsurg.141.4.367] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Vascular endothelial growth factor (VEGF) is a multifunctional angiogenic growth factor that is a primary stimulant of the development and maintenance of a vascular network in the vascularization of solid tumors. It has been reported that a blockade of VEGF-mediated angiogenesis is a powerful method for tumor regression. RNA interference represents a naturally occurring biological strategy for inhibition of gene expression. In mammalian systems, however, the in vivo application of small interfering RNA (siRNA) is severely limited by the instability and poor bioavailability of unmodified siRNA molecules. In this study, we tested the hypothesis that a hydrophobically modified protein transduction domain, cholesteryl oligo-d-arginine (Chol-R9), may stabilize and enhance tumor regression efficacy of the VEGF-targeting siRNA. The noncovalent complexation of a synthetic siRNA with Chol-R9 efficiently delivered siRNA into cells in vitro. Moreover, in a mouse model bearing a subcutaneous tumor, the local administration of complexed VEGF-targeting siRNA, but not of scrambled siRNA, led to the regression of the tumor. Hence, we propose a novel and simple system for the local in vivo application of siRNA through Chol-R9 for cancer therapy.
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Affiliation(s)
- Abby L Mulkeen
- Department of Surgery, Yale Cancer Center, New Haven, Conn., USA
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Abstract
Esophageal and gastric cancers are both common and deadly. Patients present most often after disease progression and survival is therefore poor. Due to demographic variability and recent changes in disease incidence, much emphasis has been placed on studying risk factors for both esophageal and gastric cancers. However, with increasing understanding of these diseases, low survival rates persist and continued intensive studies are necessary to optimize treatment plans. This review article discusses updates in the evolving epidemiology, clinical presentation, risk factors, and diagnostic and treatment modalities of esophageal and gastric cancers.
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Affiliation(s)
- Amy Gallo
- Department of Surgery, Yale University School of Medicine, 333 Cedar St., FMB 121, New Haven, CT 06520, USA
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