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Aoun M, Siegel C, Windham G, Williams W, Nelson R. Application of reflectance spectroscopy to identify maize genotypes and aflatoxin levels in single kernels. WORLD MYCOTOXIN J 2022. [DOI: 10.3920/wmj2021.2750] [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: 11/19/2022]
Abstract
Spectroscopy is a rapid, non-destructive, and low-cost analytical technique that has the potential to complement more resource-intensive analytical methods. We explored the use of spectral methods to differentiate maize genotypes and assess aflatoxin (AF) contamination in maize kernels. We compared the performance of two instruments: a research-grade ultraviolet-visible-near infrared (UV-Vis-NIR) spectrometer that measures reflectance from 304 -1,085 nm, and a miniaturised NIR spectrometer that measures reflectance from 740-1,070 nm. Both systems were used to predict AF levels in maize kernels from a single genotype and across 10 genotypes, and to predict genotype for the latter. A partial least square discriminant analysis model was trained on 70% of the kernels and tested on the remaining 30%. The classification accuracy for 10 maize genotypes was 71-72% using the UV-Vis-NIR instrument on 1,170 kernels, and 65-66% using the NIR device on 740 kernels. The classification accuracy for 247 AF-contaminated kernels of a single genotype using the UV-Vis-NIR instrument was 71, 82, and 92% for AF thresholds of 20, 100, and 1000 μg/kg, respectively. Using the same spectrometer on 872 kernels from 10 genotypes, AF classification accuracy was 67, 90, and 95% in validation sets for AF thresholds of 20, 100, and 1000 μg/kg, respectively. The UV-Vis-NIR instrument and the NIR device had similar classification accuracies for AF thresholds of 100 and 1000 μg/kg, whereas the NIR device had higher accuracy for the AF threshold of 20 μg/kg. Reflectance spectroscopy outperformed visual sorting and the bright greenish yellow fluorescence test in identifying AF levels. Applying spectral analysis to estimate mycotoxin levels and to identify maize genotypes could contribute to regional toxin surveillance and action efforts. Further, using AF-associated spectral features for grain sorting can reduce AF exposure.
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Affiliation(s)
- M. Aoun
- School of Integrative Plant Science, Cornell University, Ithaca, NY 14853, USA
- Department of Entomology and Plant Pathology, Oklahoma State University, Stillwater, OK 74078, USA
| | - C. Siegel
- School of Integrative Plant Science, Cornell University, Ithaca, NY 14853, USA
| | - G.L. Windham
- USDA, Agricultural Research Service, Corn Host Plant Resistance Research Unit, Mississippi State, MS 39762, USA
| | - W.P. Williams
- USDA, Agricultural Research Service, Corn Host Plant Resistance Research Unit, Mississippi State, MS 39762, USA
| | - R.J. Nelson
- School of Integrative Plant Science, Cornell University, Ithaca, NY 14853, USA
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Siegel C, Stamm B, Vega J, Sevim E, Lockshin M, Sammaritano L, Barbhaiya M. AB0556 CHARACTERISTICS OF PATIENTS DIAGNOSED WITH UNDIFFERENTIATED CONNECTIVE TISSUE DISEASE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatients with undifferentiated connective tissue disease (UCTD) struggle with physical symptoms as well as diagnostic uncertainty.1 UCTD diagnosis requires exclusion of other connective tissue diseases (CTD). Prior studies use variable definitions of UCTD that do not account for updated classification criteria thus limiting generalizability.ObjectivesWe identified characteristics associated with rheumatologist-diagnosed UCTD, applied strict exclusion criteria, and compared UCTD patients to those with criteria-defined CTD.MethodsWe recruited patients ≥18 years old seen between 2018-2022 who had rheumatologist-diagnosed UCTD with positive ANA and ≥1 sign/symptom of a CTD. We reviewed medical records to identify those who fulfilled ACR/EULAR-endorsed classification criteria for SLE, RA, SSc, Primary Sjögren’s, Idiopathic Inflammatory Myopathy, and 2006 Revised Sapporo Criteria for APS. We compared sociodemographic, clinical, serologic, and treatment variables between UCTD and CTD using chi-square, Fisher’s exact, and t-tests.ResultsOf 89 patients with rheumatologist-diagnosed UCTD (mean age 49.0 ± 13.7 years, 97.8% female, 66.3% White), 59 (66.3%) had UCTD and 30 (33.7%) had criteria-defined CTD (27 SLE, 3 SLE and RA, 1 RA, and 1 APS).Patients in both groups had similar non-criteria manifestations, most commonly arthralgia (89.8% UCTD vs. 83.3% CTD, p=0.50) and fatigue (55.9% UCTD vs. 73.3% CTD, p=0.17). Compared to patients with CTD, those with UCTD were less likely to have nonerosive arthritis (27.1% vs. 56.7%, p=0.01) (Table 1).Table 1.Characteristics of Patients with UCTD or Criteria-Defined CTDUCTD1 (n=57), N (%)CTD2 (n=32), N (%)p-valuesClinical3,4•,4nicalN (%))cs of Pa16 (27.1)17 (56.7)0.01•.0156.7) (%))cs of Patients with UCTD or Criteria31 (52.5)18 (60.0)0.65•.6560.0) (%))cs of Patient7 (11.9)4 (13.3)1.0•.013.3)) (%))cs of Patients with UCTD or Criteria-Defined C27 (45.8)14 (46.7)1.0•.0(46.7) (%))cs of Patien24 (40.7)11 (36.7)0.82Serology3•erology) (%))cs of Patients with UCTD or Criteria-Defined CTDth19 (32.2)19 (63.3)<0.01•0.013.3) (%))cs of Patien9 (15.3)13 (4.3)<0.01•0.01.3)) (%))22 (37.3)25 (83.3)<0.01•0.013.3) (%))cs of Patients w10 (16.9)6 (20.0))0.77•.770.0)) (%))cs of Patients with UCTD or Criteria-D6 (10.2)2 (6.7)0.71•.71.7))) (%))cs of Patients with UCTD or Criteria-Defined CTDther CTDs. Our fi18 (30.5)10 (33.3)0.81•.8133.3) (%))cs11 (18.6)6 (20.0)1.01. Do not fulfill ACR/EULAR classification criteria for SLE, RA, SSc, PSS, IIM, APS.2. Diagnosed with UCTD and fulfill ≥1 set of listed CTD classification criteria.3. Defined per listed classification criteria4. Criteria with n≤5: fever, proteinuria/cellular casts, pulmonary hypertension, interstitial lung disease, dysphagia/esophageal dysmotilityPatients with UCTD were less likely than those with CTD to have any hematologic manifestation (lymphopenia, leukopenia, thrombocytopenia, or hemolytic anemia) (p=0.02), anti-dsDNA or anti-Smith antibodies (p<0.01), or hypocomplementemia (p<0.01). The frequency of RA, Sjogren’s, and APS-related serologies did not differ between groups (Table 1).Compared to those with CTD, UCTD patients were less likely to have ever received systemic corticosteroids (71.2% vs. 96.7%, p<0.01); ever use of any disease-modifying antirheumatic drug (DMARD) was similar (35.6% vs. 46.7%, p=0.36).ConclusionAmong patients diagnosed with UCTD, 66.3% met a stringent definition. Compared to those with criteria-defined CTD, UCTD patients had lower frequency of arthritis, hematologic abnormalities, SLE-specific antibodies, and hypocomplementemia. While use of DMARDs did not differ, UCTD patients were less likely to use systemic corticosteroids.Rheumatologists diagnose UCTD even when criteria are met for other CTDs. Our findings suggest UCTD is nonetheless a distinct clinical entity; more rigorous characterization will enable generalizable prognostic and therapy trials.References[1]Siegel CH, et al. J Clin Rheumatol 2021 Mar 5. doi: 0.1097/RHU. 0000000000001714Disclosure of InterestsNone declared
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Siegel C, Bass A, Jannat-Khah D, Bruce O, Olmscheid J, Ghosh N, Sattui SE, Schwartzman M, Zisa D, Lakhanpal A, Yip K, Yue L, Aizer J, Berman J. AB1388 CHARACTERISTICS ASSOCIATED WITH MYCHART ACTIVATION AND REASONS FOR NON-USE AMONG RHEUMATOLOGY CLINIC PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundElectronic patient portals, such as MyChart by Epic, allow patients to view their medical records, request medication refills, and communicate with their health care providers. Factors associated with portal use include being younger, female, White, having private insurance, and having chronic illness.1The Hospital for Special Surgery (HSS) rheumatology clinic serves primarily patients with public insurance (Medicaid, which insures low-income adults, and Medicare, which insures adults >65 years old and those with eligible chronic illness/disability). These patients may be at increased risk for poor health outcomes due to clinical and socioeconomic factors and they are less likely to use MyChart than patients seen in HSS private practices. Increased MyChart use may benefit this high-risk group and improve health equity.ObjectivesThis study aims to identify characteristics associated with MyChart activation and reasons for its underutilization among patients seen in the HSS rheumatology clinic.MethodsWe identified all patients aged ≥ 18 years seen in the HSS rheumatology clinic at least twice between January 15, 2019 and January 14, 2021, with at least one visit occurring between July 15, 2020 and January 14, 2021. MyChart status (active vs. inactive) and sociodemographic and clinical variables were extracted from the electronic health record (EHR). We used chi-square tests and t-tests to compare characteristics between patients with and without active MyChart; p-value <0.05 was considered significant (Table 1). In addition, 10 rheumatology fellows were prompted on 3 occasions over 6 weeks to informally survey their own clinic patients with inactive MyChart accounts by asking: “What is your primary reason for not using MyChart?”.Table 1.Baseline Characteristics of Hospital for Special Surgery Rheumatology Clinic Patients Stratified by MyChart Activation StatusMyChart Active (N=726)MyChart Inactive (N=501)p-valueAge, yrs - Mean (SD)50.3 (15.6)60.0 (15.3)<0.01Female - N (%)601 (82.8)412 (82.2)0.80Race - N (%)0.37•White/Caucasian275 (37.9)184 (36.7)•Black/African American185 (25.5)135 (27.0)•Asian58 (8.0)25 (5.0)•Other189 (26.0)145 (28.9)•Unknown18 (2.5)11 (2.2)Ethnicity - N (%)0.27•Hispanic/Latino294 (40.5)226 (45.1)•Not Hispanic/Latino422 (58.1)268 (53.5)•Unknown10 (1.4)7 (1.4)Preferred language - N (%)<0.01•English611 (84.2)332 (66.3)•Spanish72 (9.9)134 (26.8)•Other43 (5.9)35 (7.0)Needs interpreter - N (%)106 (14.6)156 (31.1)<0.01ResultsThere were 1,227 patients included (93.2% with Medicaid and/or Medicare insurance). Compared to patients with inactive MyChart (42.9%), those with active MyChart (57.1%) were younger (50.3 ± 15.6 vs. 60.0 ± 15.3 years, p<0.01). The majority of patients in both groups was female. There was no significant difference in race or ethnicity between groups. Patients without active MyChart were less likely to identify English as their preferred language and more likely to require an interpreter for clinic visits (Table 1).The rheumatology fellows collectively asked 16 clinic patients with inactive MyChart their primary reason for non-use. The most commonly cited reason was difficulty using the technology (n=8; 50.0%); others included visual impairment (n=2; 12.5%), preference for using the telephone (n=2; 12.5%), concerns about security/spam (n=2; 12.5%), not having a smart phone/computer (n=1; 6.3%), and having a language barrier (n=1; 6.3%).ConclusionIn the HSS rheumatology clinic, patients who did not have active MyChart were older and less likely to be English-speaking than those who did. The most common barrier to MyChart use reported by patients was difficulty with the technology. This pilot data suggests a need for interventions to facilitate patient-provider communication, specifically targeting older and non-English-speaking rheumatology clinic patients, with the goal of advancing patient engagement and health equity.References[1]Ancker JS, et al. J Gen Intern Med. 2011 June 7. doi: 10.1007/s11606-011-1749-y.Disclosure of InterestsCaroline Siegel: None declared, Anne Bass: None declared, Deanna Jannat-Khah Shareholder of: AstraZeneca, Walgreens, Cytodyn, Omar Bruce: None declared, Justin Olmscheid: None declared, Nilasha Ghosh: None declared, Sebastian E. Sattui Grant/research support from: AstraZeneca, Monica Schwartzman: None declared, Diane Zisa: None declared, Amit Lakhanpal: None declared, Kevin Yip: None declared, Linda Yue: None declared, Juliet Aizer Grant/research support from: Pfizer and Lilly, Jessica Berman: None declared
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Siegel C, Sevim E, Stamm B, Vega J, Kleinman J, Barnhill J, Lockshin M, Sammaritano L, Barbhaiya M. POS0715 QUANTIFYING THE PSYCHOSOCIAL IMPACT OF UNDIFFERENTIATED CONNECTIVE TISSUE DISEASE (UCTD). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Only half of patients diagnosed with SLE fulfill classification criteria; the rest have “SLE-like” illnesses such as UCTD. SLE patients are known to experience impaired health-related quality of life (HRQoL) and significant anxiety, depression, and fatigue,1 yet the psychosocial aspects of UCTD are less established. In a qualitative study, we found that most UCTD patients had engaged in psychotherapy and felt additional support was needed.2Objectives:Using multiple validated instruments, this study aims to quantify the psychosocial impact of UCTD.Methods:The Hospital for Special Surgery UCTD and Overlap Registry includes UCTD patients aged ≥ 18 years with ANA ≥ 1:80 and ≥ 1 sign or symptom of rheumatic disease who do not fulfill classification criteria for a defined CTD. We administered the 36-Item Short Form Health Survey (SF-36), General Anxiety Disorder-7 (GAD-7), Beck Depression Inventory (BDI), and Fatigue Severity Scale (FSS) to all patients to assess HRQoL, anxiety, depression, and fatigue. Instruments were scored based on established algorithms and results were summarized using predefined scales and severity thresholds.Results:The composite questionnaire was administered to 85 UCTD patients and completed by 75 (97.3% female, 60% white, mean age ± SD 48.8 ± 13.6 years). The SF-36 Physical Component Summary mean score was 37.8 and Mental Component Summary mean score was 41.1. Across the 8 SF-36 subscales, mean scores were lowest for role limitations due to physical health (39.3) and vitality (39.7) and highest for physical functioning (67.2), role limitations due to emotional health (67.1), and mental health (67.1). Approximately half of UCTD patients reported anxiety (GAD-7 ≥ 6); 20% had moderate/severe anxiety (GAD-7 ≥ 10). The prevalence of depression (BDI ≥ 14) was 26.7%; 13.3% had moderate/severe depression (BDI ≥ 20). Fatigue (FSS ≥ 3) was reported by 82.8% of patients (median FSS score of 4.7) [Table 1].Table 1.Psychosocial Survey Scores of Patients with Undifferentiated
Connective Tissue Disease (n=75)36-Item Short Form Health Survey (SF-36)Range 1-100 – Mean (SD)*Physical Component Summary∘Physical functioning∘Role-Physical∘Bodily PainoGeneral Health38.2 (11.2)67.2 (26.3)39.3 (46.3)49.5 (22.1)42.9 (21.5)Mental Component Summary∘Vitality∘Social Functioning∘Role-EmotionaloMental Health41.3 (10.7)39.7 (21.7)59.3 (25.9)67.1 (41.9)67.1 (18.3)Generalized Anxiety Disorder-7 (GAD-7)Range 0-21 – N (%)**None [0-5]Mild [6-10]Moderate [11-15]Severe [16-21]38 (50.7)22 (29.3)14 (18.7)1 (1.3)Beck Depression Inventory (BDI)Range 0-63 – N (%)**Minimal [0-13]Mild [14-19]Moderate [20-28]Severe [29-63]55 (73.3)10 (13.3)7 (9.3)3 (4.0)Fatigue Severity Scale (FSS) Range 1-7 – Median (IQR)**4.7 (1.5)*Higher number indicates better health state. **Higher number indicates greater severity.Conclusion:UCTD patients have significantly impaired HRQoL and a high prevalence of anxiety, depression, and fatigue, suggesting substantial psychosocial impact of UCTD comparable to that reported in SLE.3,4 Impaired HRQoL in UCTD is driven to similar degrees by aspects of physical and mental health. In future studies, we will compare age- and sex- matched UCTD to SLE patients and longitudinally evaluate psychosocial metrics alongside clinical trajectories.References:[1]Dietz B, Katz P, Dall’Era M, et al. Major depression and adverse patient-reported outcomes in systemic lupus erythematosus: Results from a prospective longitudinal cohort. Arthritis Care Res. 2021;73(1):48-54.[2]Siegel CH, Kleinman J, Barbhaiya M, et al. The psychosocial impact of undifferentiated connective tissue disease on patient health and well-being: A qualitative study. J Clin Rheumatol. In press.[3]Gu M, Cheng Q, Wang X, et al. The impact of SLE on health-related quality of life assessed with SF-36: A systemic review and meta-analysis. Lupus. 2019;28(3):371-382.[4]Zhang L, Fu T, Yin R, Zhang Q, Shen B. Prevalence of depression and anxiety in systemic lupus erythematosus: A systematic review and meta-analysis. BMC Psychiatry. 2017;17(1).Acknowledgements:This project was supported by the Barbara Volcker Center for Women and Rheumatic Diseases and the Robin J. Sillau Memorial Research Fund for Connective Tissue Disease. Dr. Barbhaiya is supported by the Rheumatology Research Foundation Investigator Award.Disclosure of Interests:None declared
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Rogers JL, Vera E, Acquaye A, Briceno N, Jammula V, King AL, Leeper H, Quezado MM, Gonzalez Alarcon J, Boris L, Burton E, Celiku O, Choi A, Christ A, Crandon S, Grajkowska E, Leggiero N, Lollo N, Penas-Prado M, Reyes J, Siegel C, Theeler BJ, Timmer M, Wall K, Wu J, Aldape K, Gilbert MR, Armstrong TS. Living with a central nervous system (CNS) tumor: findings on long-term survivorship from the NIH Natural History Study. Neurooncol Pract 2021; 8:460-474. [PMID: 34277024 DOI: 10.1093/nop/npab022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Primary central nervous system (CNS) tumors are often associated with high symptom burden and a poor prognosis from the time of diagnosis. The purpose of this study is to describe patient-reported outcomes (PRO) data from long-term survivors (LTS; ≥5-year survival post-diagnosis). Methods Clinical/treatment/molecular characteristics and PROs (symptom burden/interference (MDASI-BT/SP), perceived cognition (Neuro-QoL), anxiety/depression (PROMIS), and general health status (EQ-5D-3L)) were collected on 248 adult LTS between 9/2016 and 8/2019. Descriptive statistics and regression analysis were used to report results. Results Participants had a median age of 47 years (19-82) and were primarily White (83%) males (51%) with high-grade tumors (59%) and few mutations. Forty-two percent of the 222 brain tumor LTS reported no moderate-to-severe symptoms, whereas 45% reported three or more; most common symptoms were fatigue (40%), difficulty remembering (29%), and drowsiness (28%). Among spine tumor LTS (n = 42), nearly half reported moderate-to-severe weakness, pain, fatigue, and numbness/tingling, with 72% experiencing activity-related interference. Severe anxiety, depression, and cognitive symptoms were reported in up to 23% of the sample. Brain tumor LTS at higher risk for severe symptoms were more likely to be young, unemployed, and have poor KPS (Karnofsky Performance Status), whereas high symptom-risk spinal cord tumor LTS had poor KPS and received any tumor treatment. Conclusions Findings indicate LTS fall into distinct cohorts with no significant symptoms or very high symptom burden, regardless of tumor grade or mutational profile. These LTS data demonstrate the need for survivorship care programs and future studies to explore the symptom trajectory of all CNS tumor patients for prevention and early interventions.
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Affiliation(s)
- James L Rogers
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alvina Acquaye
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nicole Briceno
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Varna Jammula
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amanda L King
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Heather Leeper
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Martha M Quezado
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Javier Gonzalez Alarcon
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisa Boris
- Leidos Biomedical Research, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Frederick, Maryland, USA
| | - Eric Burton
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Orieta Celiku
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Anna Choi
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexa Christ
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sonja Crandon
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ewa Grajkowska
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Nicole Lollo
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Christine Siegel
- Leidos Biomedical Research, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Frederick, Maryland, USA
| | - Brett J Theeler
- Department of Neurology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Michael Timmer
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kathleen Wall
- Leidos Biomedical Research, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Frederick, Maryland, USA
| | - Jing Wu
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kenneth Aldape
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Wu J, Yuan Y, Long Priel DA, Fink D, Peer CJ, Sissung TM, Su YT, Pang Y, Yu G, Butler MK, Mendoza TR, Vera E, Ahmad S, Bryla C, Lindsley M, Grajkowska E, Mentges K, Boris L, Antony R, Garren N, Siegel C, Lollo N, Cordova C, Aboud O, Theeler BJ, Burton EM, Penas-Prado M, Leeper H, Gonzales J, Armstrong TS, Calvo KR, Figg WD, Kuhns DB, Gallin JI, Gilbert MR. Phase I Study of Zotiraciclib in Combination with Temozolomide for Patients with Recurrent High-grade Astrocytomas. Clin Cancer Res 2021; 27:3298-3306. [PMID: 33785481 DOI: 10.1158/1078-0432.ccr-20-4730] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/03/2021] [Accepted: 03/24/2021] [Indexed: 01/31/2023]
Abstract
PURPOSE To investigate the toxicity profile and establish an optimal dosing schedule of zotiraciclib with temozolomide in patients with recurrent high-grade astrocytoma. PATIENTS AND METHODS This two-stage phase I trial determined the MTD of zotiraciclib combined with either dose-dense (Arm1) or metronomic (Arm2) temozolomide using a Bayesian Optimal Interval design; then a randomized cohort expansion compared the progression-free survival rate at 4 months (PFS4) of the two arms for an efficient determination of a temozolomide schedule to combine with zotiraciclib at MTD. Pharmacokinetic and pharmacogenomic profiling were included. Patient-reported outcome was evaluated by longitudinal symptom burden. RESULTS Fifty-three patients were enrolled. Dose-limiting toxicities were neutropenia, diarrhea, elevated liver enzymes, and fatigue. MTD of zotiraciclib was 250 mg in both arms and thus selected for the cohort expansion. Dose-dense temozolomide plus zotiraciclib (PSF4 40%) compared favorably with metronomic temozolomide (PFS4 25%). Symptom burden worsened at cycle 2 but stabilized by cycle 4 in both arms. A significant decrease in absolute neutrophil count and neutrophil reactive oxygen species production occurred 12-24 hours after an oral dose of zotiraciclib but both recovered by 72 hours. Pharmacokinetic/pharmacogenomic analyses revealed that the CYP1A2_5347T>C (rs2470890) polymorphism was associated with higher AUCinf value. CONCLUSIONS Zotiraciclib combined with temozolomide is safe in patients with recurrent high-grade astrocytomas. Zotiraciclib-induced neutropenia can be profound but mostly transient, warranting close monitoring rather than treatment discontinuation. Once validated, polymorphisms predicting drug metabolism may allow personalized dosing of zotiraciclib.
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Affiliation(s)
- Jing Wu
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland.
| | - Ying Yuan
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Debra A Long Priel
- Neutrophil Monitoring Laboratory, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Danielle Fink
- Neutrophil Monitoring Laboratory, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Cody J Peer
- Clinical Pharmacology Program, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Tristan M Sissung
- Clinical Pharmacology Program, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Yu-Ting Su
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Ying Pang
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Guangyang Yu
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Madison K Butler
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Tito R Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth Vera
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | | | - Christine Bryla
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Matthew Lindsley
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Ewa Grajkowska
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Kelly Mentges
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Lisa Boris
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Ramya Antony
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Nancy Garren
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Christine Siegel
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Nicole Lollo
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Christine Cordova
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Orwa Aboud
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Brett J Theeler
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Eric M Burton
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Heather Leeper
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Javier Gonzales
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | | | - William D Figg
- Clinical Pharmacology Program, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Douglas B Kuhns
- Neutrophil Monitoring Laboratory, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | | | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
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7
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Rowe L, Vera E, Acquaye A, Crandon S, Shah V, Bryla C, Wu J, Wall K, Siegel C, Reyes J, Penas-Prado M, Leggiero N, Cordova C, Burton E, Antony R, Boris L, Aboud O, Vyas Y, Mathen P, Gilbert M, Camphausen K, Mendoza T, Armstrong T. The prevalence of altered body image in patients with primary brain tumors: an understudied population. J Neurooncol 2020; 147:397-404. [PMID: 32096067 PMCID: PMC7136178 DOI: 10.1007/s11060-020-03433-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/12/2020] [Indexed: 11/28/2022]
Abstract
Purpose Body image (BI) is an important issue for cancer patients, as patients with BI concerns are susceptible to depression, anxiety, difficulty coping, and poor quality of life (QoL). While this concern has been documented in patients with other malignancies, no data exists of this QoL issue in patients with primary brain tumors (PBT). Methods A cross-sectional survey of 100 PBT patients was conducted on an IRB approved prospective protocol using structured questionnaires. Participants completed the body image scale (BIS), Appearance Scheme Inventory Revised (ASI-R), MD Anderson Symptom Inventory Brain Tumor (MDASI-BT), and Patient-Reported Outcomes Measurement Information System (PROMIS) Depression, Anxiety, and Psychosocial Impact Positive measures. Results The prevalence of clinically significant body image dissatisfaction (BIS ≥ 10) was 28% (95% CI 19–37%), median BIS score was 5 (range 0–27). The median ASI-R composite score was 2.9 (range 1.5–4.7). BIS was significantly correlated with the ASI-R (r = 0.53, 95% CI 0.37 to 0.65). The mean PROMIS Depression score was 48.4 (SD = 8.9), PROMIS Anxiety score was 49.4 (SD = 9.9), and PROMIS Psychosocial Illness Impact Positive score was 48.9 (SD = 9.7). BIS was significantly correlated with age, and trended with BMI and sex. The PROMIS Psychosocial Illness Impact Positive and PROMIS Anxiety scores were the most strongly related to BIS. Conclusions This study, the first to explore altered body image in PBT patients, revealed clinically significant body image dissatisfaction in nearly 1/3 of patients, similar to other malignancies. These findings underscore the potential contribution of disease and treatment-related body image concerns on psychosocial wellbeing in patients with PBT. Electronic supplementary material The online version of this article (10.1007/s11060-020-03433-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lindsay Rowe
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Elizabeth Vera
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alvina Acquaye
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sonja Crandon
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Veeraj Shah
- University of Maryland, College Park, MD, USA
| | - Christine Bryla
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jing Wu
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kathleen Wall
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine Siegel
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Leggiero
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine Cordova
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ramya Antony
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- Leidos Biomedical Research, Frederick National Laboratory for Cancer Research Sponsored By the National Cancer Institute, Frederick, MD, USA
| | - Orwa Aboud
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yamini Vyas
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter Mathen
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kevin Camphausen
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tito Mendoza
- Department of Symptom Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Terri Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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8
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Penas-Prado M, Theeler BJ, Cordeiro B, Dunkel IJ, Hau P, Mahajan A, Robinson GW, Willmarth N, Aboud O, Aldape K, Butman JA, Gajjar A, Kelly W, Rao G, Raygada M, Siegel C, Romo CG, Armstrong TS, Gilbert MR. Proceedings of the Comprehensive Oncology Network Evaluating Rare CNS Tumors (NCI-CONNECT) Adult Medulloblastoma Workshop. Neurooncol Adv 2020; 2:vdaa097. [PMID: 33005896 PMCID: PMC7518566 DOI: 10.1093/noajnl/vdaa097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Medulloblastoma (MB) is a rare brain tumor occurring more frequently in children in whom research has been primarily focused. Treatment recommendations in adults are mainly based on retrospective data and pediatric experience; however, molecular features and treatment tolerance differ between the 2 age groups. In adults, prognostic tools are suboptimal, late recurrences are typical, and long-term sequelae remain understudied. Treatment has not adapted to molecular classification advances; thus, the survival rate of adult MB has not improved. METHODS In 2017, the National Cancer Institute (NCI) received support from the Cancer Moonshot℠ to address the challenges and unmet needs of adults with rare central nervous system tumors through NCI-CONNECT, a program that creates partnerships among patients, health care professionals, researchers, and advocacy organizations. On November 25, 2019, NCI-CONNECT convened leading clinicians and scientists in a workshop to review advances in research, share scientific insights, and discuss clinical challenges in adult MB. RESULTS Working groups identified unmet needs in clinical trial design, tissue acquisition and testing, tumor modeling, and measurement of clinical outcomes. CONCLUSIONS Participants identified opportunities for collaboration; discussed plans to create a working group of clinicians, researchers, and patient advocates; and developed specific action items to expedite progress in adult MB.
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Affiliation(s)
- Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Brett J Theeler
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
- Department of Neurology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Brittany Cordeiro
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Ira J Dunkel
- Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Peter Hau
- Wilhelm Sander NeuroOncology Unit and Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Anita Mahajan
- Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Giles W Robinson
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | | | - Orwa Aboud
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
- Brain Tumor Program, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
| | - Kenneth Aldape
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - John A Butman
- Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, Maryland, USA
| | - Amar Gajjar
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - William Kelly
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Margarita Raygada
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Christine Siegel
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Carlos G Romo
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
- Brain Tumor Program, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
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9
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Vyas Y, Vera E, Bryla C, Crandon S, Wu J, Wall K, Theeler B, Siegel C, Reyes J, Penas-Prado M, Leggiero N, Cordova C, Burton E, Antony R, Boris L, Aboud O, Gilbert M, Armstrong T. HOUT-04. ASSOCIATION OF COMMON PATIENT-REPORTED IMMUNOTHERAPY SYMPTOMATIC SIDE EFFECTS AND PSEUDOPROGRESSION IN PATIENTS WITH PRIMARY CENTRAL NERVOUS SYSTEM (CNS) TUMORS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.469] [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: 11/15/2022] Open
Abstract
Abstract
BACKGROUND
Immunotherapy agents have unique symptomatic side effects; patient-reported outcomes (PROs) can help to characterize the benefits and burdens associated with therapy. Common immunotherapy-associated symptoms include pain, fatigue, shortness of breath, and irregular bowel patterns. The purpose of this study was to assess the severity of symptoms and their association with imaging changes in CNS tumor patients undergoing single agent or combination treatment with immune checkpoint inhibitors (ICIs).
METHODS
Patients completed the MDASI-BT or MDASI-SP at baseline and longitudinally (every 8 weeks), and results through cycle 4 are reported. Neuro-imaging was categorized as stable, possible ICI-related pseudoprogression, or progression by clinical team review.
RESULTS
29 Brain Tumor (BT) and 6 Spinal Tumor patients participated; the majority of which were male (62%) and white (91%), ranging 24-74yo (mean = 46). Glioblastoma was the most common diagnosis (31%) followed by medulloblastoma (16%), with 56% of patients having greater than 2 recurrences prior to the study. At baseline, both brain and spine tumor patients reported moderate to severe fatigue (Brain=4, Spine=6) and pain (Spine=5) with shortness of breath and pain worsening over time. BT patients with pseudoprogression were more likely to report increased fatigue (87%) and pain (63%) compared to those with stable (29%) or true progressive (17%) disease on imaging. BT patients with pseudoprogression also reported worsening of cognitive (43%) and neurologic (57%) symptom burden.
CONCLUSIONS
In contrast to the common pseudoprogression after chemoradiation, treatment-specific symptoms were worse with ICI-related pseudoprogression by MRI where an immunologic reaction was the likely cause of the imaging worsening. These results suggest that commonly used symptom and functional assessments to distinguish true progression from pseudoprogression may not be helpful with immunotherapy. Additional studies including those with pathologic confirmation of progression or pseudoprogression combined with outcomes measures are needed to develop more accurate determinations of disease status.
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Affiliation(s)
- Yamini Vyas
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine Bryla
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sonja Crandon
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jing Wu
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kathleen Wall
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brett Theeler
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine Siegel
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Leggiero
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine Cordova
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ramya Antony
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Orwa Aboud
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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10
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Aboud O, Gilbert M, Armstrong T, Vera E, Wu J, Wall K, Theeler B, Siegel C, Reyes J, Leggiero N, Crandon S, Cordova C, Boris L, Bryla C, Burton E, Antony R, Quezado M, Shah R, Penas-Prado M. NIMG-32. CHALLENGES OF IMAGING INTERPRETATION TO PREDICT OLIGODENDROGLIOMA GRADE. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.702] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
A recent report examining 75 Oligodendrogliomas indicated that specific imaging features may help predict grading and guide target selection for biopsy when resection is not possible. This report attempted to validate these findings in a separate sample and evaluate interrater reliability.
METHODS
Two Neuro-Oncologists, blinded to radiology report and grading reviewed diagnostic pre-radiation MRI. Imaging features and reviewer interpretations were evaluated included contrast enhancement, necrosis, calcification, and restricted diffusion; examiner concordance is reported.
RESULTS
Sixty-two patients with diagnosis of Oligodendroglioma (50 WHO grade II, 12 WHO grade III); 54 were molecularly confirmed as IDH-mutant/1p19q co-deleted based on the NOB Natural History Study. Four patients (grade III) were excluded due to lack of imaging studies. Among 58 evaluable patients, their location was frontal (n=32), temporal (n=14), parietal (n=4), occipital (n=1), and multi-lobe (n=11). Extent of resection: gross total 9, subtotal 36, biopsy 17. Partial to extensive contrast enhancement was present in 18/58 patients (6 grade II, 33%; 12 grade III, 67%); Kappa interrater agreement k= 0.37 on grade II and k=0.50 on grade III; extensive enhancement was present in 4/58 (all grade III), k= 0.70. Necrosis noted in 7/58 patients (all grade III), k=0.61. Calcification noted in 7/17 patients reviewed (all grade III), k=1.0; restriction noted in only 2/39 patients reviewed (all grade III), k=1.0.
CONCLUSIONS
THE presence of extensive enhancement, necrosis, calcification and restricted diffusion were only present in grade III with substantial agreement between readers, but there was lower agreement for partial enhancement. Image reviewers commented on the variability of enhancement intensity in normal structures between scans, likely contributing to this poor concordance. Tumor areas with extensive enhancement and/or necrosis are associated with higher grade and can guide biopsy if resection is not feasible. Discrepancies in imaging interpretation may be ameliorated by implementing a standardized imaging protocol.
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Affiliation(s)
- Orwa Aboud
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jing Wu
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kathleen Wall
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Christine Siegel
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Leggiero
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sonja Crandon
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine Cordova
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine Bryla
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ramya Antony
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Martha Quezado
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ritu Shah
- National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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11
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Wu J, Bryla C, Su YT, Grajkowska E, McCoy A, Boris L, Antony R, Garren N, Siegel C, Cordova C, Aboud O, Vera E, Lawhon T, Penas-Prado M, Theeler B, Mendoza T, Armstrong T, Yuan Y, Gilbert M. ACTR-62. PHASE I TRIAL OF TG02 PLUS DOSE-DENSE OR METRONOMIC TEMOZOLOMIDE FOR RECURRENT HIGH-GRADE ASTROCYTOMA IN ADULTS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.104] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Therapies targeting multiple survival pathways are desirable for high-grade gliomas. TG02 (Zotiraciclib), a CDK9 inhibitor, regulates transcription and metabolism of tumor cells and synergizes with temozolomide. A phase I/II trial was launched to test the TG02/temozolomide combined treatment in recurrent high-grade astrocytomas. Phase I results are reported here.
METHODS
Adults with recurrent high-grade astrocytoma, KPS≥60, adequate organ function, < 2 prior relapses were enrolled. Primary endpoint was dose limiting toxicity (DLT) in cycle1 in each arm. Bayesian optimal interval design was employed to determine the maximum tolerated dose (MTD) with the target DLT rate of 35% and the toxicity profile of the combination of TG02 (starting dose 200mg orally on days1,12,15, and 26) and temozolomide, either as a dose-dense (DD; 125mg/m2/d, 7on/7off, Arm1) or metronomic (MN; 50mg/m2/d, Arm2) dosing schedule on a 28-day cycle.
RESULTS
Thirty-eight patients were evaluable; median age 50.7, KPS 90. Of 18 evaluable patients in Arm1, at TG02 dose-level 200mg, 1/6 had a DLT: Gr3 diarrhea; at dose-level 250mg, 3/12 had DLTs: Gr4 neutropenia for over 5 days, Gr3 elevated ALT, and Gr3 fatigue. Of 20 evaluable patients in Arm2, at TG02 dose-level 200mg, 1/6 had a DLT: recurrent Gr3 neutropenia; at dose-level 250mg, 5/12 had a DLT: Gr3 elevated ALT, Gr3 fatigue, and Gr4 neutropenia; at dose-level 300mg,1 of 2 had a DLT: Gr4 febrile neutropenia, Gr4 elevated ALT, Gr4 elevated AST. TG02 dose-level of 250mg was declared as the MTD in both Arms. Using the MDASI-BT, patients with high symptom burden had increased symptoms during cycle1 but became stable as they continued treatment.
CONCLUSION
The combination of TG02 at the MTD of 250mg with DD or MN temozolomide was tolerated. Cohort expansion continues at the MTD in both arms. Objective responses have been observed, suggesting activity of this regimen and supporting continued investigation.
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Affiliation(s)
- Jing Wu
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine Bryla
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yu-Ting Su
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ewa Grajkowska
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ann McCoy
- National Cancer Institute, Bethesda, USA
| | - Lisa Boris
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ramya Antony
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Christine Siegel
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine Cordova
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Orwa Aboud
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tracy Lawhon
- Adastra Pharmaceuticals, Inc, San Diego, CA, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brett Theeler
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tito Mendoza
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Terri Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ying Yuan
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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12
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Siegel C, Raygada M, Acquaye A, Stearn S, Wall K, Crandon S, Stevens-Brown K, Wu J, Vera L, Theeler B, Reyes J, Leggiero N, Cordova C, Bryla C, Burton E, Boris L, Antony R, Ani T, Aboud O, Armstrong T, Gilbert M, Penas-Prado M. RARE-10. IMPROVING CARE FOR ADULT PATIENTS WITH RARE CNS TUMORS: THE NATIONAL CANCER INSTITUTE-COMPREHENSIVE ONCOLOGY NETWORK EVALUATING RARE CNS TUMORS (NCI-CONNECT) PROGRAM AND CLINIC. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.933] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
While rare cancers have provided insight into mechanisms of tumorigenesis and familial syndromes, patients with rare CNS tumors and providers face unique challenges, including diagnostic delays and errors, lack of standardized approaches to care/treatment, and limited social support. Scant data exists on the natural history, health status, and impact of these tumors on life quality. This report describes an innovative clinic designed to fulfill the mission of the NCI-CONNECT program: To advance our understanding and to improve approaches to care and treatment of rare CNS tumors.
METHODS
A specialized weekly clinic was established incorporating routine comprehensive analysis of tumor tissue, genetic counseling with individual pedigree assessment, group meetings with a health and wellness counselor and comprehensive clinical evaluation. Patients and caregivers both participated. Descriptive statistics report of NCI-CONNECT clinic patients from January 1-May 8, 2019 are presented.
RESULTS
33 patients and 32 caregivers have participated to date, representing 6 of the 12 rare tumors studied in NCI-CONNECT: 19 ependymomas, 9 oligodendrogliomas, 2 PXAs, 1 papillary pineal tumor, 1 medulloblastoma, 1 gliosarcoma. The median time from receiving pathologic material to appointment was 22 days, with analysis including methylation and next generation sequencing testing. All 33 patients underwent genetic counseling, most (n=26) having at least ≥ 2 first- or second-degree relatives diagnosed with cancer (Germline mutations/genetic predisposition testing underway). 44 patients attended (33 with 8 repeat visits) the health and wellness group sessions, with education on coping/wellness techniques included. During this same period, 7 patients participated in a rare CNS basket trial using nivolumab.
CONCLUSIONS
We have developed an innovative clinic model to interrogate rare CNS tumors for therapeutic targets, understand individual risk, how the patient feels and functions and conduct clinical trials. This effort has the potential to accelerate our understanding of these rare tumors and provide guidance on care.
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Affiliation(s)
- Christine Siegel
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Alvina Acquaye
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Kathleen Wall
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sonja Crandon
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Jing Wu
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Brett Theeler
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Leggiero
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine Cordova
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine Bryla
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Lisa Boris
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ramya Antony
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Orwa Aboud
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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13
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King A, Shuboni-Mulligan D, Vera E, Crandon S, Aboud O, Antony R, Boris L, Bryla C, Burton E, Cordova C, Gartland C, Grajkowska E, Penas-Prado M, Reyes J, Leggiero N, Siegel C, Theeler B, Wall K, Wu J, Gilbert M, Armstrong T. QOLP-36. THE IMPORTANCE OF SLEEP DISTURBANCE IN PRIMARY BRAIN TUMOR (PBT) PATIENTS: CLINICAL CHARACTERISTICS & CO-OCCURRENCE WITH TUMOR-RELATED & PSYCHOLOGICAL SYMPTOMS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Sleep disturbance (SD) is a common symptom reported by PBT patients and research has demonstrated a link between sleep and stress circadian pathways. SD can impact perceived severity of other symptoms and development of psychopathology. This study explored the prevalence of moderate-severe SD in PBT patients, identifying associated clinical characteristics and co-occurrence with other tumor-related and psychological symptoms. Demographic, clinical characteristics, MDASI-Brain Tumor, and PROMIS Depression and Anxiety Short-Forms were collected at study entry. Descriptive statistics, Chi-square tests, and independent t-tests were used to report results. The sample included 424 patients (58% male, 81% Caucasian) with a median age of 49 years (range 18–81) and 58% with high-grade gliomas. Most had received treatment with surgery, radiation or chemotherapy prior to study entry, with 44% reporting a past recurrence. Moderate-severe SD (³ 5 on a 0–10 scale) was reported in 19% of patients and was associated with younger age (mean difference = 5 years), poor KPS (OR 2.2), current steroid use (OR 2.4), and tumor progression on MRI (OR 2). Those with moderate-severe SD had a higher overall symptom burden (mean difference = 2.3) and reported more moderate-severe symptoms (8 vs. 2). Patients reporting moderate-severe SD also reported higher severity in affective and cognitive symptom domains and mood-interference, with fatigue (72%), drowsiness (59%), and distress (56%) the most frequently co-occurring symptoms. Patients with moderate-severe SD also had increased prevalence of moderate-severe anxiety (32%) and depression (23%), compared to 10% in those without SD. PBT patients with moderate-severe SD are more symptomatic and have higher incidence of mood disturbance, suggesting a key role for sleep in the development of tumor-related and psychological symptoms. Future work delineating specific pathways involving sleep disturbance and co-occurring symptoms will be foundational for designing targeted sleep interventions to improve symptom burden and quality of life.
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Affiliation(s)
- Amanda King
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dorela Shuboni-Mulligan
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sonja Crandon
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Orwa Aboud
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ramya Antony
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine Bryla
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine Cordova
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Carrie Gartland
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ewa Grajkowska
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Leggiero
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine Siegel
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Kathleen Wall
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jing Wu
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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14
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Vera E, Gilbert M, Aboud O, Antony R, Boris L, Bryla C, Burton E, Cordova C, Crandon S, Leggiero N, Penas-Prado M, Reyes J, Siegel C, Theeler B, Wall K, Wu J, Armstrong T. HOUT-22. EVALUATING CLINICAL IMPACT UTILIZING THE RANO-PRO COLLABORATIVE’S STANDARDIZED PRIORITY CONSTRUCTS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.487] [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: 11/13/2022] Open
Abstract
Abstract
Increasing recognition of the symptom burden and functional limitations among primary brain tumor (PBT) patients has led to proposing clinical outcomes assessments as an additional measure of a treatment’s effectiveness. The RANO-PRO Collaborative recommended core symptoms for evaluation in clinical care and research for malignant glioma are weakness, walking, seizures, communication, memory, and treatment-specific symptoms. We evaluated these symptoms using the MDASI-Brain Tumor (BT) in the PBT patient sample of the NCI-NOB Natural History Study, in relation to disease progression, by descriptive statistics, and independent- and paired-samples t-tests. The sample included 434 PBT patients (59% male, median age=50 (18–83), 82% white, 43% with a prior recurrence). In the 60% with a malignant glioma, weakness, walking, seizures, difficulty remembering, and fatigue were significantly worse in the group with progression at time of imaging compared to the group with stable disease (p< 0.05). In a subset of 114 patients with progression after study entry, reported severity in all symptoms (except seizures) significantly worsened from study entry to time of progression (-1.7< mean difference< -0.1, p< 0.02, 0.3< r< 0.5). Walking, weakness, difficulty remembering, and fatigue each had a difference greater than 1-point, the minimally important difference for MDASI-BT. No one core symptom accounted for the severity change; each was reported by 17%-35% of patients as their largest change in severity. Utilizing the symptom with the largest change increased the magnitude of the worsening and its effect size (mean difference=-2.9, r=0.5). The analysis was repeated in the larger PBT sample with similar statistical findings but with smaller mean differences. RANO-PRO Collaborative core symptoms were shown to worsen at time of progression on imaging, highlighting the importance of continual symptom assessment and validating this core symptom group. Further analysis will focus on degree of change with each core symptom and validation in other datasets.
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Affiliation(s)
- Elizabeth Vera
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Orwa Aboud
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ramya Antony
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine Bryla
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine Cordova
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sonja Crandon
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Leggiero
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine Siegel
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Kathleen Wall
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jing Wu
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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15
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Cordova C, Vera E, Aboud O, Antony R, Boris L, Bryla C, Burton E, Crandon S, Leggiero N, Reyes J, Siegel C, Theeler B, Vyas Y, Wall K, Wu J, Gilbert M, Armstrong T, Penas-Prado M. RARE-35. MRI FINDINGS AT PROGRESSION IN ADULT PATIENTS WITH MEDULLOBLASTOMA. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.958] [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: 11/12/2022] Open
Abstract
Abstract
Progression (PD) in medulloblastoma (MB) represents a diagnostic challenge due to imaging heterogeneity among/within patients. SHH (Sonic hedgehog)-MB is thought to recur mostly within the tumor bed (TB). In children, DWI restriction (DWIr) is more sensitive than contrast enhancement(CE) for first PD. Whether this is applicable to adults is unknown.
METHODS
Retrospective review of adults (age ≥18) with MB enrolled to Natural History study at NCI-NOB. Descriptive statistics of imaging at diagnosis and PD(CE, T2/FLAIR signal without CE, DWIr) and imaging patterns for each PD. RESULTS:14 adults with MB: 5 diagnosed in childhood (8–16 yrs), 9 as adults (18–45 yrs); Subtypes: 7 SHH, 3 non-WNT/non-SHH, 4 unknown. Eleven experienced ≥1 PD (6/7 SHH, 2/3 non-WNT/non-SHH, 3/4 unknown); median PD of 5 (range 1–9). Median age at first PD 31 years (range 10–46) with 5 first PDs >5 years after diagnosis. In 10 patients with available baseline MRI, 9 had CE, and 8 DWIr (2 without DWI sequences). Of 48 total PDs, the commonest patterns were: brain LMD alone (n=14), TB alone or distant brain parenchyma alone (each n=7), distant brain parenchyma with brain LMD (n=6), and TB with either distant brain parenchyma or LMD (n=3). Of the 82 PD lesions, 23% (n=14) of brain lesions lacked DWIr, and 37% (n=23) had T2/FLAIR signal without CE. PD tissue confirmation obtained at 18 time points:16 cases with confirmed recurrence had heterogeneous characteristics; in 12 with brain PD: CE in 5, T2/FLAIR without CE in 3 (unknown: 4). 2 CE lesions revealed meningioma (one- atypical meningioma- had DWIr).
CONCLUSIONS
Imaging findings in adult patients with MB are highly heterogeneous. Despite high specificity of DWIr for PD in children, it failed for 23% of brain lesions across multiple patients. Most SHH-MB had PD outside the TB, unlike what is widely accepted in the literature.
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Affiliation(s)
| | - Elizabeth Vera
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Orwa Aboud
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ramya Antony
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine Bryla
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sonja Crandon
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Leggiero
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine Siegel
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Kathleen Wall
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jing Wu
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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16
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Wu J, Yuan Y, Cordova C, Aboud O, Penas-Prado M, Theeler BJ, Bryla C, Su YT, Grajkowska E, McCoy A, Boris L, Siegel C, Antony R, Garren N, Lawhon T, Armstrong T, Gilbert MR. Phase I trial of TG02 plus dose-dense or metronomic temozolomide for recurrent anaplastic astrocytoma and glioblastoma in adults. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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
2031 Background: Therapies targeting multiple survival pathways simultaneously may be more effective for high-grade gliomas, a disease highly resistant to treatment. Our preclinical studies have shown potent anti-glioma effects of TG02 and synergy with temozolomide (TMZ) through modulation of transcription and cellular metabolism. A phase I/II trial was launched to test the combination of TG02 and TMZ in recurrent malignant gliomas and herein we report the phase I results. Methods: Adults with recurrent high-grade astrocytoma, KPS ≥ 60, normal organ function, ≤ 2 prior relapses were enrolled. The primary endpoint was dose limiting toxicity (DLT) from the start of the combined treatment to 4 weeks after in each arm. Bayesian optimal interval (BOIN) design was employed to determine the maximum tolerated dose (MTD) with the target DLT rate of 35% and the toxicity profile of the combination of TG02 (starting dose 200mg orally on days 1, 12, 15, and 26) and TMZ, either as a dose-dense (DD; 125mg/m2/d, 7on/7off, Arm 1) or metronomic (MN; 50mg/m2/d, Arm 2) dosing schedule on a 28-day cycle. Results: Forty patients were enrolled; 38 were evaluable; 70% male; overall median age 50.7; median KPS 90. Of 18 evaluable patients in Arm 1 (DD TMZ), at TG02 dose level 200mg, 1/6 had a DLT: Gr3 diarrhea. At TG02 dose level 250mg, 3/12 had DLTs: Gr4 neutropenia for over 5 days, Gr3 elevated ALT, and Gr3 fatigue. Of 20 evaluable patients in Arm 2 (MN TMZ), at TG02 dose level 200mg, 1/6 had a DLT: recurrent Gr3 neutropenia. At TG02 dose level 250mg, 5/12 had a DLT: Gr3 elevated ALT, Gr3 fatigue, and Gr4 neutropenia. At TG02 dose level 300mg,1 out of 2 had a DLT: Gr4 febrile neutropenia, Gr4 elevated ALT, Gr4 elevated AST, which resulted in hospitalization. Therefore, the TG02 dose level of 250mg was declared as the MTD in both Arm 1 and Arm 2. Conclusions: The combination of TG02 at the MTD of 250mg with DD or MN TMZ has a tolerable toxicity profile. Cohort expansion continues at the MTD in both arms to conduct pharmacokinetics and pharmacogenetics to better elucidate the toxicity profile. Objective responses have been observed, suggesting activity of this regimen and supporting continued investigation with the phase II randomized component. Clinical trial information: NCT02942264.
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Affiliation(s)
| | - Ying Yuan
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Marta Penas-Prado
- The University of Texas MD Anderson Cancer Center, Department of Neuro-Oncology, Houston, TX
| | | | - Christine Bryla
- Medical Oncology Branch, National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | | | | | | | | | | | | | | | | | | | - Mark R. Gilbert
- The University of Texas MD Anderson Cancer Center, Houston, TX
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17
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Rowe L, Vera E, Acquaye A, Crandon S, Fletcher Ruiz M, Aboud O, Boris L, Brown M, Garren N, Ji M, Levine J, Mackey M, Mathan P, Romo C, Reyes J, Siegel C, Smart D, Wu J, Gilbert M, Camphausen K, Mendoza T, Armstrong T. QOLP-06. BODY IMAGE DISTURBANCE IN PATIENTS WITH PRIMARY BRAIN TUMORS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.892] [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: 11/12/2022] Open
Affiliation(s)
- Lindsay Rowe
- Radiation Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | | | | | - Sonja Crandon
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | | | - Orwa Aboud
- National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Miranda Brown
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Nancy Garren
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Ming Ji
- Office of Information Technology, CCR, NCI, NIH, Bethesda, MD, USA
| | - Jason Levine
- Office of Information Technology, CCR, NCI, NIH, Bethesda, MD, USA
| | | | | | | | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | | | | | - Jing Wu
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Mark Gilbert
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
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18
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Acquaye A, Armstrong T, Vera E, Crandon S, Fletcher Ruiz M, Aboud O, Boris L, Brown M, Garren N, Ji M, Levine J, Romo C, Reyes J, Siegel C, Wu J, Gilbert M, Scheurer M. QOLP-14. PRELIMINARY EXAMINATION OF CONFIRMED GLIOMA RISK FACTORS AMONG EPENDYMOMA PATIENTS IN THE NEURO-ONCOLOGY BRANCH NATURAL HISTORY STUDY (NOB-NHS) AND RISK AND OUTCOMES STUDY (ROS). Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.900] [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: 11/13/2022] Open
Affiliation(s)
| | | | | | - Sonja Crandon
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | | | - Orwa Aboud
- National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Miranda Brown
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Nancy Garren
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Ming Ji
- Office of Information Technology, CCR, NCI, NIH, Bethesda, MD, USA
| | - Jason Levine
- Office of Information Technology, CCR, NCI, NIH, Bethesda, MD, USA
| | | | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | | | - Jing Wu
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Mark Gilbert
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
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19
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Schreck K, Vera E, Aboud O, Acquaye A, Boris L, Briceno N, Brown M, Chung HJ, Crandon S, Garren N, Ji M, Levine J, Patel S, Quezado M, Raffeld M, Reyes J, Romo C, Siegel C, Theeler B, Xi L, Gilbert M, Grossman S, Armstrong T, Wu J. PATH-28. THE NATURAL HISTORY OF BRAF V600E-MUTATED GLIOBLASTOMAS IN ADULTS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Karisa Schreck
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | | | - Orwa Aboud
- National Institutes of Health, Bethesda, MD, USA
| | | | - Lisa Boris
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Nicole Briceno
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Miranda Brown
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Hye-Jung Chung
- Molecular Pathology, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Sonja Crandon
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Nancy Garren
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Ming Ji
- Office of Information Technology, CCR, NCI, NIH, Bethesda, MD, USA
| | | | - Snehal Patel
- Molecular Pathology, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Martha Quezado
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | | | | | | | - Liqiang Xi
- Molecular Pathology, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Mark Gilbert
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Stuart Grossman
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | | | - Jing Wu
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
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20
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Aboud O, Raffeld M, Brown J, Sabersky A, Briceno N, Brown M, Chung HJ, Crandon S, Ji M, Levine J, Patel S, Reyes J, Siegel C, Vera E, Xi L, Nduom E, Quezado M, Ray-Chaudhury A, Lopes O, Armstrong T, Gilbert M, Theeler B. RARE-26. MUTATIONS IN MAPK PATHWAY GENES ARE CHARACTERISTIC AND CONFIRMATORY OF MULTINODULAR AND VACUOLATING NEURONAL TUMOR OF THE CEREBRUM. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.999] [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: 11/14/2022] Open
Affiliation(s)
- Orwa Aboud
- National Institutes of Health, Bethesda, MD, USA
| | | | - Joseph Brown
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | - Nicole Briceno
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Miranda Brown
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Hye-Jung Chung
- Molecular Pathology, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Sonja Crandon
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Ming Ji
- Office of Information Technology, CCR, NCI, NIH, Bethesda, MD, USA
| | - Jason Levine
- Office of Information Technology, CCR, NCI, NIH, Bethesda, MD, USA
| | - Snehal Patel
- Molecular Pathology, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | | | | | - Liqiang Xi
- Molecular Pathology, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Edjah Nduom
- Surgical Neurology Branch, NINDS, NIH, Bethesda, MD, USA
| | - Martha Quezado
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Abhik Ray-Chaudhury
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Osorio Lopes
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Mark Gilbert
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Brett Theeler
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
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Acquaye A, Vera E, Aboud O, Armstrong T, Boris L, Brown M, Crandon S, Garren N, Ji M, Levine J, Romo C, Reyes J, Siegel C, Wu J, Mackey M, Camphausen K, Mathan P, Smart D, Fletcher Ruiz M, Mendoza T, Gilbert M, Rowe L. QOLP-16. CAPTURING THE PRIMARY BRAIN TUMOR (PBT) PATIENT’S EXPERIENCE OF BODY IMAGE DISSATISFACTION: REPORT FROM THE NEURO-ONCOLOGY BRANCH-NATURAL HISTORY STUDY (NOB-NHS). Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.902] [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: 11/14/2022] Open
Affiliation(s)
| | | | - Orwa Aboud
- National Institutes of Health, Bethesda, MD, USA
| | | | - Lisa Boris
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Miranda Brown
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Sonja Crandon
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Nancy Garren
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Ming Ji
- Office of Information Technology, CCR, NCI, NIH, Bethesda, MD, USA
| | - Jason Levine
- Office of Information Technology, CCR, NCI, NIH, Bethesda, MD, USA
| | | | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | | | - Jing Wu
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | | | | | | | | | | | | | - Mark Gilbert
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Lindsay Rowe
- Radiation Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
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Giles A, Nettey L, Liechti T, Beddall M, Vera E, Park D, Wu J, Theeler B, Siegel C, Boris L, Garren N, Bryla C, McCoy A, Nduom E, Zaghloul K, Armstrong T, Roederer M, Gilbert M. IMMU-68. SINGLE-CELL PROTEOMIC ANALYSIS OF IMMUNE CELL RESPONSE TO CHECKPOINT BLOCKADE USING 30-PARAMETER FLOW CYTOMETRY. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.571] [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: 11/13/2022] Open
Affiliation(s)
- Amber Giles
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Leonard Nettey
- ImmunoTechnology Section, Vaccine Research Center, NIAID, NIH, Bethesda, MD, USA
| | - Thomas Liechti
- ImmunoTechnology Section, Vaccine Research Center, NIAID, NIH, Bethesda, MD, USA
| | - Margaret Beddall
- ImmunoTechnology Section, Vaccine Research Center, NIAID, NIH, Bethesda, MD, USA
| | | | - Deric Park
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Jing Wu
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Brett Theeler
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | | | - Lisa Boris
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Nancy Garren
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | | | - Ann McCoy
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Edjah Nduom
- Surgical Neurology Branch, NINDS, NIH, Bethesda, MD, USA
| | | | | | - Mario Roederer
- ImmunoTechnology Section, Vaccine Research Center, NIAID, NIH, Bethesda, MD, USA
| | - Mark Gilbert
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
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Boris L, Bryla C, Vera E, Aboud O, Garren N, Park D, Siegel C, Theeler B, Wu J, Armstrong T, Gilbert M. RARE-21. A DESCRIPTIVE REPORT OF PATIENTS WITH RARE CENTRAL NERVOUS SYSTEM (CNS) CANCERS ON AN NCI-CONNECT CANCER MOONSHOT IMMUNE CHECKPOINT INHIBITOR TRIAL. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.995] [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: 11/14/2022] Open
Affiliation(s)
- Lisa Boris
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | | | | | - Orwa Aboud
- National Institutes of Health, Bethesda, MD, USA
| | - Nancy Garren
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Deric Park
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | | | - Brett Theeler
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Jing Wu
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | | | - Mark Gilbert
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
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Garren N, Vera E, Aboud O, Acquaye A, Boris L, Brown M, Crandon S, Ji M, Levine J, Reyes J, Romo C, Siegel C, Wu J, Gilbert M, Armstrong T. QOLP-26. PATIENT REPORTED OUTCOMES MEASUREMENT INFORMATION SYSTEM (PROMIS) SCREENING FOR ANXIETY & DEPRESSION IN CENTRAL NERVOUS SYSTEM(CNS) CANCER: LARGE COHORT REPORT FROM THE NEURO-ONCOLOGY BRANCH NATURAL HISTORY STUDY (NOB-NHS). Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.912] [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: 11/13/2022] Open
Affiliation(s)
- Nancy Garren
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | | | - Orwa Aboud
- National Institutes of Health, Bethesda, MD, USA
| | | | - Lisa Boris
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Miranda Brown
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Sonja Crandon
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Ming Ji
- Office of Information Technology, CCR, NCI, NIH, Bethesda, MD, USA
| | - Jason Levine
- Office of Information Technology, CCR, NCI, NIH, Bethesda, MD, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | | | | | - Jing Wu
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Mark Gilbert
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
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Ruiz MF, Vera E, Acquaye A, Boris L, Brown M, Crandon S, Garren N, Ji M, Levine J, Reyes J, Siegel C, Wu J, Gilbert M, Armstrong T. HOUT-03. SCREENING FOR MOOD DISTURBANCE IN LONG-TERM CENTRAL NERVOUS SYSTEM (CNS) TUMOR SURVIVORS USING PATIENT REPORTED OUTCOMES MEASUREMENT INFORMATION SYSTEM (PROMIS): A NEURO-ONCOLOGY BRANCH NATURAL HISTORY STUDY (NOB-NHS) REPORT. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.471] [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: 11/14/2022] Open
Affiliation(s)
| | | | | | - Lisa Boris
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Miranda Brown
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Sonja Crandon
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Nancy Garren
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Ming Ji
- Office of Information Technology, CCR, NCI, NIH, Bethesda, MD, USA
| | - Jason Levine
- Office of Information Technology, CCR, NCI, NIH, Bethesda, MD, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | | | - Jing Wu
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Mark Gilbert
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
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Siegel C, Aboud O, Brown M, Chung HJ, Raffeld M, Crandon S, Ji M, Levine J, Vera E, Patel S, Reyes J, Armstrong T, Xi L, Acquaye A, Boris L, Briceno N, Garren N, Romo C, Quezado M, Wu J, Theeler B, Gilbert M. PATH-52. UTILIZING NEXT GENERATION SEQUENCING REPORTS IN CLINICAL DECISION MAKING: REPORT FROM THE NATIONAL INSTITUTES OF HEALTH (NIH) NEURO-ONCOLOGY BRANCH (NOB) NATURAL HISTORY STUDY (NHS) PRIMARY BRAIN TUMOR PANEL (PBTP). Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Orwa Aboud
- National Institutes of Health, Bethesda, MD, USA
| | - Miranda Brown
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | | | - Mark Raffeld
- National Institutes of Health, Bethesda, MD, USA
| | - Sonja Crandon
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Ming Ji
- Office of Information Technology, CCR, NCI, NIH, Bethesda, MD, USA
| | - Jason Levine
- Office of Information Technology, CCR, NCI, NIH, Bethesda, MD, USA
| | | | - Snehal Patel
- Molecular Pathology, Center for Cancer Research, NCI, Bethesda, MD, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | | | - Liqiang Xi
- National Institutes of Health, Bethesda, MD, USA
| | | | - Lisa Boris
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | - Nicole Briceno
- Neuro-Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
| | | | | | | | - Jing Wu
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
| | | | - Mark Gilbert
- Neuro-Oncology Branch, CCR, NCI, NIH, Bethesda, MD, USA
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27
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Anderson K, Holmes S, Siegel C. VIRTUAL CARE FARMS: A CREATIVE APPROACH TO ADDRESSING LONELINESS AND BUILDING COMMUNITY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1821] [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: 11/13/2022] Open
Affiliation(s)
- K Anderson
- University of Montana, School of Social Work
| | - S Holmes
- University of Maryland Baltimore
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28
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Ranjan S, Quezado M, Garren N, Boris L, Siegel C, Lopes Abath Neto O, Theeler BJ, Park DM, Nduom E, Zaghloul KA, Gilbert MR, Wu J. Clinical decision making in the era of immunotherapy for high grade-glioma: report of four cases. BMC Cancer 2018; 18:239. [PMID: 29490632 PMCID: PMC5831705 DOI: 10.1186/s12885-018-4131-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 02/14/2018] [Indexed: 01/05/2023] Open
Abstract
Background Immune checkpoint inhibitors (ICPIs) are being investigated in clinical trials for patients with glioblastoma. While these therapies hold great promise, management of the patients receiving such treatment can be complicated due to the challenges in recognizing immune-related adverse events caused by checkpoint inhibitor treatment. Brain imaging changes that are the consequence of an inflammatory response may be misinterpreted as disease progression leading to inappropriate premature cessation of treatment. The aim of this study was to, by way of a series of cases, underscore the challenges in determining the nature of contrast-enhancing masses that develop during the treatment of patients with glioblastoma treated with ICPIs. Case presentation We reviewed the clinical course and management of 4 patients on ICPIs who developed signs of tumor progression on imaging. These findings were examined in the context of Immunotherapy Response Assessment in Neuro-Oncology (iRANO) guidelines. Although all 4 patients had very similar imaging findings, 2 of the 4 patients were later found to have intense inflammatory changes (pseudoprogression) by pathologic examination. Conclusions A high index of suspicion for pseudoprogression needs to be maintained when a patient with brain tumor on immunotherapy presents with worsening in an area of a pre-existing tumor or a new lesion in brain. Our findings strongly suggest that pathological diagnosis remains the gold standard for distinguishing tumor progression from pseudoprogression in patients receiving immunotherapy. There is a large unmet need to develop reliable non-invasive imaging diagnostic techniques. Trial registration ClinicalTrials.gov NCT02311920. Registered 8 December 2014.
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Affiliation(s)
- Surabhi Ranjan
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institute of Health, Bethesda, MD, 20892, USA
| | - Martha Quezado
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Nancy Garren
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institute of Health, Bethesda, MD, 20892, USA
| | - Lisa Boris
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, MD, 21702, USA
| | - Christine Siegel
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, MD, 21702, USA
| | - Osorio Lopes Abath Neto
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Brett J Theeler
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institute of Health, Bethesda, MD, 20892, USA.,Department of Neurology and John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, 20889, USA
| | - Deric M Park
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institute of Health, Bethesda, MD, 20892, USA
| | - Edjah Nduom
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Kareem A Zaghloul
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institute of Health, Bethesda, MD, 20892, USA
| | - Jing Wu
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institute of Health, Bethesda, MD, 20892, USA.
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Vera E, Mendoza T, Crandon S, Lisa B, Garren N, Siegel C, Park DM, Sul JH, Theeler B, Wu J, Gilbert MR, Armstrong T. QLIF-31. SYMPTOM BURDEN AND HEALTH STATUS OF PATIENTS WITH RARE VERSUS COMMON BRAIN TUMORS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.840] [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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Lisa B, Vera E, Wu J, Park DM, Bryla C, Crandon S, Garren N, McCoy A, Siegel C, Theeler BJ, Sul JH, Gilbert M, Armstrong T. QLIF-03. UNUSUAL ADVERSE DRUG REACTIONS IN HIGH GRADE GLIOMA PATIENTS TREATED WITH TEMOZOLOMIDE. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.814] [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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31
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Wu J, Bryla C, McCoy A, Lisa B, Garren N, Siegel C, Grajkowska E, Theeler B, Park DM, Parrott T, Armstrong TS, Yuan Y, Gilbert MR. ACTR-69. PHASE I TRIAL OF TG02 PLUS DOSE-DENSE OR METRONOMIC TEMOZOLOMIDE FOR ADULTS WITH RECURRENT ANAPLASTIC ASTROCYTOMA AND GLIOBLASTOMA. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Siegel C, Armstrong T, Chung HJ, Crandon S, Patel S, Powers A, Quezado M, Ray-Chaudhury A, Vera E, Wu J, Xi L, Raffeld M, Gilbert M. PATH-40. STANDARDIZED MOLECULAR ANALYSIS OF PRIMARY CENTRAL NERVOUS SYSTEM (CNS) TUMORS IN A RESEARCH BASED CLINICAL PRACTICE. AN INTRODUCTION TO THE PRIMARY CNS TUMOR NEXT GENERATION SEQUENCING (NGS) PANEL. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Acquaye AA, Garren N, Vera E, Lisa B, Siegel C, Park DM, Wu J, Crandon S, Theeler BJ, Sul JH, Gilbert MR, Armstrong T. QLIF-17. ASSESSING DEPRESSION IN GLIOMA PATIENTS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.827] [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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Garren N, Acquaye AA, Vera E, Lisa B, Siegel C, Park DM, Sul JH, Theeler BJ, Wu J, Crandon S, Gilbert M, Armstrong T. QLIF-13. EVALUATION OF ANXIETY SYMPTOMS AMONG BRAIN TUMOR PATIENTS; ARE WE PROVIDING APPROPRIATE, EFFECTIVE CARE? Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.823] [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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35
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Pfister G, Schatz AK, Siegel C, Steichele E, Waschkowski W, Bücherl T. Nondestructive Testing of Materials and Components by Computerized Tomography with Fast and Thermal Reactor Neutrons. NUCL SCI ENG 2017. [DOI: 10.13182/nse92-a23905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- G. Pfister
- Universität Stuttgart, Institut für Kernenergetik und Energiesysteme Pfaffenwaldring 31, D-7000 Stuttgart 80, Federal Republic of Germany
| | - A. K. Schatz
- Universität Stuttgart, Institut für Kernenergetik und Energiesysteme Pfaffenwaldring 31, D-7000 Stuttgart 80, Federal Republic of Germany
| | - C. Siegel
- Universität Stuttgart, Institut für Kernenergetik und Energiesysteme Pfaffenwaldring 31, D-7000 Stuttgart 80, Federal Republic of Germany
| | - E. Steichele
- FRM Reaktorstation Garching der Technischen Universität München Lichtenbergstraße, D-8046 Garching, Federal Republic of Germany
| | - W. Waschkowski
- FRM Reaktorstation Garching der Technischen Universität München Lichtenbergstraße, D-8046 Garching, Federal Republic of Germany
| | - T. Bücherl
- FRM Reaktorstation Garching der Technischen Universität München Lichtenbergstraße, D-8046 Garching, Federal Republic of Germany
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Alahmadi A, Lee R, Siegel C, Gholam P. Utility of multidisciplinary tumor board (MTB) in the management of hepatocellular cancer (HCC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw371.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
A problem in optimal resource allocation is considered for n jobs with identically distributed service times admitting a monotone hazard function. If the hazard function is increasing, it is shown that the procedure of allocating the full resource individually to each job until its completion minimizes the expected completion time of the jth job. The procedure which at any instant of time equally allocated the resource among all of the remaining jobs is shown to minimize the expected total cumulative waiting time if the hazard is decreasing.
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Draper K, Siegel C, White J, Solis CM, Mishna F. Preschoolers, Parents, and Teachers (PPT): A Preventive Intervention with an At Risk Population. Int J Group Psychother 2015; 59:221-42. [DOI: 10.1521/ijgp.2009.59.2.221] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Leibfarth S, Eckert F, Welz S, Siegel C, Schmidt H, Schwenzer N, Zips D, Thorwarth D. Automatic delineation of tumor volumes by co-segmentation of combined PET/MR data. Phys Med Biol 2015; 60:5399-412. [DOI: 10.1088/0031-9155/60/14/5399] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Hallström T, Siegel C, Mörgelin M, Kraiczy P, Skerka C, Zipfel P. CspA from Borrelia burgdorferi inhibits the terminal complement pathway. Mol Immunol 2013. [DOI: 10.1016/j.molimm.2013.05.019] [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: 11/24/2022]
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Leibfarth S, Mönnich D, Welz S, Siegel C, Schwenzer N, Schmidt H, Zips D, Thorwarth D. A strategy for multimodal deformable image registration to integrate PET/MR into radiotherapy treatment planning. Acta Oncol 2013; 52:1353-9. [PMID: 23879651 DOI: 10.3109/0284186x.2013.813964] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Combined positron emission tomography (PET)/magnetic resonance imaging (MRI) is highly promising for biologically individualized radiotherapy (RT). Hence, the purpose of this work was to develop an accurate and robust registration strategy to integrate combined PET/MR data into RT treatment planning. Material and methods. Eight patient datasets consisting of an FDG PET/computed tomography (CT) and a subsequently acquired PET/MR of the head and neck (HN) region were available. Registration strategies were developed based on CT and MR data only, whereas the PET components were fused with the resulting deformation field. Following a rigid registration, deformable registration was performed with a transform parametrized by B-splines. Three different optimization metrics were investigated: global mutual information (GMI), GMI combined with a bending energy penalty (BEP) for regularization (GMI+ BEP) and localized mutual information with BEP (LMI+ BEP). Different quantitative registration quality measures were developed, including volumetric overlap and mean distance measures for structures segmented on CT and MR as well as anatomical landmark distances. Moreover, the local registration quality in the tumor region was assessed by the normalized cross correlation (NCC) of the two PET datasets. RESULTS LMI+ BEP yielded the most robust and accurate registration results. For GMI, GMI+ BEP and LMI+ BEP, mean landmark distances (standard deviations) were 23.9 mm (15.5 mm), 4.8 mm (4.0 mm) and 3.0 mm (1.0 mm), and mean NCC values (standard deviations) were 0.29 (0.29), 0.84 (0.14) and 0.88 (0.06), respectively. CONCLUSION Accurate and robust multimodal deformable image registration of CT and MR in the HN region can be performed using a B-spline parametrized transform and LMI+ BEP as optimization metric. With this strategy, biologically individualized RT based on combined PET/MRI in terms of dose painting is possible.
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Affiliation(s)
- Sara Leibfarth
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen , Tübingen , Germany
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Abstract
Multiple cell death pathways are activated in cerebral ischaemia. Much of the initial injury, especially in the core of the infarct where cerebral blood flow is severely reduced, is necrotic and secondary to severe energy failure. However, there is considerable evidence that delayed cell death continues for several days, primarily in the penumbral region. As reperfusion therapies grow in number and effectiveness, restoration of blood flow early after injury may lead to a shift towards apoptosis. It is important to elucidate what are the key mediators of apoptotic cell death after stroke, as inhibition of apoptosis may have therapeutic implications. There are two well described pathways that lead to apoptotic cell death; the caspase pathway and the more recently described caspase-independent pathway triggered by poly-ADP-ribose polymers (PARP) activation. Caspase-induced cell death is initiated by release of mitochondrial cytochrome c, formation of the cytosolic apoptosome, and activation of endonucleases leading to a multitude of small randomly cleaved DNA fragments. In contrast caspase-independent cell death is secondary to activation of apoptosis inducing factor (AIF). Mitochondrial AIF translocates to the nucleus, where it induces peripheral chromatin condensation, as well as characteristic high-molecular-weight (50 kbp) DNA fragmentation. Although caspase-independent cell death has been recognized for some time and is known to contribute to ischaemic injury, the upstream triggering events leading to activation of this pathway remain unclear. The two major theories are that ischaemia leads to nicotinamide adenine dinucleotide (NAD+) depletion and subsequent energy failure, or alternatively that cell death is directly triggered by a pro-apoptotic factor produced by activation of the DNA repair enzyme PARP. PARP activation is robust in the ischaemic brain producing variable lengths of poly-ADP-ribose (PAR) polymers as byproducts of PARP activation. PAR polymers may be directly toxic by triggering mitochondrial AIF release independently of NAD+ depletion. Recently, sex differences have been discovered that illustrate the importance of understanding these molecular pathways, especially as new therapeutics targeting apoptotic cell death are developed. Cell death in females proceeds primarily via caspase activation whereas caspase-independent mechanisms triggered by the activation of PARP predominate in the male brain. This review summarizes the current literature in an attempt to clarify the roles of NAD+ and PAR polymers in caspase-independent cell death, and discuss sex specific cell death to provide an example of the possible importance of these downstream mediators.
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Affiliation(s)
- C Siegel
- Department of Neuroscience, University of Connecticut Health Center, Farmington, 06030, USA
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Quaas A, Odem R, Narra V, Siegel C. Differentiation of adenomyomas from leiomyomas and normal myometrium on pelvic MR imaging- the role of Gadolinium enhancement. Fertil Steril 2008. [DOI: 10.1016/j.fertnstert.2008.07.406] [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: 10/21/2022]
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Thonhofer R, Siegel C, Hafner F, Gotschuli G, Brodmann M. Successful bosentan treatment of critical ischaemia induced by vasculitis in an SCLE patient. Rheumatology (Oxford) 2008; 47:1729-30. [DOI: 10.1093/rheumatology/ken354] [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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Nguyen T, Lawrence L, Ratts V, Odem R, Siegel C, Merritt D. Diagnosis and management of didelphic uterus, obstructed hemivagina and ipsilateral renal agenesis (Herlyn-Werner-Wunderlich syndrome): the Washington University experience. Fertil Steril 2007. [DOI: 10.1016/j.fertnstert.2007.07.188] [Citation(s) in RCA: 3] [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: 11/16/2022]
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Blanchard SS, Gerrek M, Siegel C, Czinn SJ. Significant morbidity associated with RSV infection in immunosuppressed children following liver transplantation: case report and discussion regarding need of routine prophylaxis. Pediatr Transplant 2006; 10:826-9. [PMID: 17032430 DOI: 10.1111/j.1399-3046.2006.00583.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Respiratory syncytial virus (RSV) is an important cause of lower respiratory tract infection in infants and young children. In immunocompromised children, RSV infection poses a serious health threat with significantly increased and prolonged virus shedding and the development of severe respiratory disease. We report two patients, eight months and 20 months of age, who were admitted with severe RSV infection two months and 10 months post-transplant respectively. Major risk factors for severe infection is the degree of immunosuppression and the age of the patient (<24 months). Based on the significant morbidity associated with RSV infection in these patients, we recommend randomized trials in larger pediatric solid organ transplant centers to evaluate the use of palivizumab prophylaxis is efficacious to prevent morbidity in patients under the age of 24 months, while we emphasize good hygienic practices to prevent RSV nosocomial infection.
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Affiliation(s)
- Samra S Blanchard
- Department of Pediatric Gastroenterology, Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
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Schwing W, Erhard P, Holloman C, Weigel K, Blankshaen S, Anderson J, Siegel C, Seaman D, Valente J, DeOreo P, Weiss M. Thrombotic Events and Pentosidine in Hemodialysis. Hemodial Int 2004. [DOI: 10.1111/j.1492-7535.2004.0085f.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Harrison G, Hopper K, Craig T, Laska E, Siegel C, Wanderling J, Dube KC, Ganev K, Giel R, an der Heiden W, Holmberg SK, Janca A, Lee PW, León CA, Malhotra S, Marsella AJ, Nakane Y, Sartorius N, Shen Y, Skoda C, Thara R, Tsirkin SJ, Varma VK, Walsh D, Wiersma D. Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br J Psychiatry 2001; 178:506-17. [PMID: 11388966 DOI: 10.1192/bjp.178.6.506] [Citation(s) in RCA: 561] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Poorly defined cohorts and weak study designs have hampered cross-cultural comparisons of course and outcome in schizophrenia. AIMS To describe long-term outcome in 18 diverse treated incidence and prevalence cohorts. To compare mortality, 15- and 25-year illness trajectory and the predictive strength of selected baseline and short-term course variables. METHODS Historic prospective study. Standardised assessments of course and outcome. RESULTS About 75% traced. About 50% of surviving cases had favourable outcomes, but there was marked heterogeneity across geographic centres. In regression models, early (2-year) course patterns were the strongest predictor of 15-year outcome, but recovery varied by location; 16% of early unremitting cases achieved late-phase recovery. CONCLUSIONS A significant proportion of treated incident cases of schizophrenia achieve favourable long-term outcome. Sociocultural conditions appear to modify long-term course. Early intervention programmes focused on social as well as pharmacological treatments may realise longer-term gains.
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Affiliation(s)
- G Harrison
- Division of Psychiatry, University of Bristol, UK.
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