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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Moyers JT, Pestana RC, Roszik J, Hong DS, Naing A, Fu S, Piha-Paul S, Yap TA, Karp D, Rodon J, Livingston A, Zarzour MA, Ravi V, Patel S, Benjamin RS, Ludwig J, Herzog C, Ratan R, Somaiah N, Conley A, Gorlick R, Meric-Bernstam F, Subbiah V. Examining Stripes on a Herd of Zebras: Impact of Genomic Matching for Ultrarare Sarcomas in Phase 1 Clinical Trials (SAMBA 102). Clin Cancer Res 2023; 29:401-409. [PMID: 36288393 PMCID: PMC9843435 DOI: 10.1158/1078-0432.ccr-22-2509] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/04/2022] [Accepted: 10/24/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Recently, the Connective Tissue Oncology Society published consensus guidelines for recognizing ultrarare sarcomas (URS), defined as sarcomas with an incidence ≤1 per 1,000,000. We assessed the outcomes of 56 patients with soft tissue, and 21 with bone sarcomas, enrolled in Phase 1 trials. EXPERIMENTAL DESIGN In this Sarcoma-Matched Biomarker Analysis (SAMBA-102 study), we reviewed records from patients on Phase 1 trials at the University of Texas MD Anderson Cancer Center between January 2013 and June 2021. RESULTS Among 587 sarcomas, 106 (18.1%) were classified as URS. Fifty (47%) were male, and the median age was 44.3 years (range, 19-82). The most common subtypes were alveolar soft part sarcoma (ASPS), chordoma, dedifferentiated chondrosarcoma, and sclerosing epithelioid fibrosarcoma. Compared with common sarcomas, median OS was similar 16.1 months [95% confidence interval (CI), 13.6-17.5] versus 16.1 (95% CI, 8.2-24.0) in URS (P = 0.359). Objective response to treatment was higher in URS 13.2% (n = 14/106) compared with common sarcomas 6.9% (n = 33/481; P = 0.029). Median OS for those treated on matched trials was 27.3 months (95% CI, 1.9-52.7) compared with 13.4 months (95% CI, 6.3-20.6) for those not treated on matched trials (P = 0.291). Eight of 33 (24%) molecularly matched treatments resulted in an objective response, whereas 6 of 73 unmatched treatments (8.2%) resulted in an objective response (P = 0.024). Clinical benefit rate was 36.4% (12/33) in matched trials versus 26.0% (19/73) in unmatched trials (P = 0.279). CONCLUSIONS The results demonstrate the benefit of genomic selection in Phase 1 trials to help identify molecular subsets likely to benefit from targeted therapy.
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Affiliation(s)
- Justin T. Moyers
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Division of Hematology and Oncology, Department of Medicine, University of California, Irvine, Orange, California
| | - Roberto Carmagnani Pestana
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Centro de Oncologia e Hematologia Einstein Familia Dayan-Daycoval, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jason Roszik
- Division of Cancer Medicine, Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David S. Hong
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Aung Naing
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Siqing Fu
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sarina Piha-Paul
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Timothy A. Yap
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel Karp
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jordi Rodon
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andy Livingston
- Division of Cancer Medicine, Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maria Alejandra Zarzour
- Division of Cancer Medicine, Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vinod Ravi
- Division of Cancer Medicine, Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shreyaskumar Patel
- Division of Cancer Medicine, Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert S. Benjamin
- Division of Cancer Medicine, Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joseph Ludwig
- Division of Cancer Medicine, Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cynthia Herzog
- Division of Cancer Medicine, Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ravin Ratan
- Division of Cancer Medicine, Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neeta Somaiah
- Division of Cancer Medicine, Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anthony Conley
- Division of Cancer Medicine, Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard Gorlick
- Division of Cancer Medicine, Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Funda Meric-Bernstam
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vivek Subbiah
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Corresponding Author: Vivek Subbiah, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 455, PO Box 301402, Houston, TX 77030. E-mail:
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Dao L, Ragoonanan D, Batth I, Satelli A, Foglesong J, Wang J, Zaky W, Gill JB, Liu D, Albert A, Gordon N, Huh W, Harrison D, Herzog C, Kleinerman E, Gorlick R, Daw N, Li S. Prognostic Value of Cell-Surface Vimentin-Positive CTCs in Pediatric Sarcomas. Front Oncol 2021; 11:760267. [PMID: 34956881 PMCID: PMC8695931 DOI: 10.3389/fonc.2021.760267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite advances in care, the 5 year overall survival for patients with relapsed and or metastatic sarcoma remains as low as < 35%. Currently, there are no biomarkers available to assess disease status in patients with sarcomas and as such, disease surveillance remains reliant on serial imaging which increases the risk of secondary malignancies and heightens patient anxiety. METHODS Here, for the first time reported in the literature, we have enumerated the cell surface vimentin (CSV+) CTCs in the blood of 92 sarcoma pediatric and adolescent and young adult (AYA) patients as a possible marker of disease. RESULTS We constructed a ROC with an AUC of 0.831 resulting in a sensitivity of 85.3% and a specificity of 75%. Additionally, patients who were deemed to be CSV+ CTC positive were found to have a worse overall survival compared to those who were CSV+ CTC negative. We additionally found the use of available molecular testing increased the accuracy of our diagnostic and prognostic tests. CONCLUSIONS Our findings indicate that CSV+ CTCs have prognostic value and can possibly serve as a measure of disease burden.
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Affiliation(s)
- Long Dao
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Dristhi Ragoonanan
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Izhar Batth
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Arun Satelli
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jessica Foglesong
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jian Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Wafik Zaky
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jonathan B. Gill
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Diane Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Aisha Albert
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nancy Gordon
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Winston Huh
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Douglas Harrison
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cynthia Herzog
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Eugenie Kleinerman
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Richard Gorlick
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Najat Daw
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Shulin Li
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States,*Correspondence: Shulin Li,
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Wright KD, Yao X, London WB, Kao PC, Gore L, Hunger S, Geyer R, Cohen KJ, Allen JC, Katzenstein HM, Smith A, Boklan J, Nazemi K, Trippett T, Karajannis M, Herzog C, Destefano J, Direnzo J, Pietrantonio J, Greenspan L, Cassidy D, Schissel D, Perentesis J, Basu M, Mizuno T, Vinks AA, Prabhu SP, Chi SN, Kieran MW. A POETIC Phase II study of continuous oral everolimus in recurrent, radiographically progressive pediatric low-grade glioma. Pediatr Blood Cancer 2021; 68:e28787. [PMID: 33140540 PMCID: PMC9161236 DOI: 10.1002/pbc.28787] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND To evaluate efficacy, pharmacokinetics (PK) and pharmacodynamics of single-agent everolimus in pediatric patients with radiographically progressive low-grade glioma (LGG). METHODS Everolimus was administered at 5 mg/m2 once daily as a tablet or liquid for a planned 48-week duration or until unacceptable toxicity or disease progression. Patients with neurofibromatosis type 1 were excluded. PK and pharmacodynamic endpoints were assessed in consenting patients. RESULTS Twenty-three eligible patients (median age 9.2 years) were enrolled. All patients received prior chemotherapy (median number of prior regimens two) and/or radiotherapy (two patients). By week 48, two patients had a partial response, 10 stable disease, and 11 clinical or radiographic progression; two discontinued study prior to 1 year (toxicity: 1, physician determination: 1). With a median follow up of 1.8 years (range 0.2-6.7 years), the 2-, 3-, and 5-year progression-free survivals (PFS) were 39 ± 11%, 26 ± 11%, and 26 ± 11%, respectively; two patients died of disease. The 2-, 3-, and 5-year overall survival (OS) were all 93 ± 6%. Grade 1 and 2 toxicities predominated; two definitively related grade 3 toxicities (mucositis and neutropenia) occurred. Grade 4 elevation of liver enzymes was possibly related in one patient. Predose blood levels showed substantial variability between patients with 45.5% below and 18.2% above the target range of 5-15 ng/mL. Pharmacodynamic analysis demonstrated significant inhibition in phospho-S6, 4E-BP1, and modulation of c-Myc expression. CONCLUSION Daily oral everolimus provides a well-tolerated, alternative treatment for multiple recurrent, radiographically progressive pediatric LGG. Based on these results, everolimus is being investigated further for this patient population.
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Affiliation(s)
- Karen D. Wright
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA
| | - Xiaopan Yao
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA
| | - Wendy B. London
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA
| | - Pei-Chi Kao
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA
| | - Lia Gore
- Children’s Hospital Colorado, Aurora, CO (current affiliation Children’s Hospital of Philadelphia, Philadelphia, PA)
| | - Stephen Hunger
- Children’s Hospital Colorado, Aurora, CO (current affiliation Children’s Hospital of Philadelphia, Philadelphia, PA)
| | - Russ Geyer
- Seattle Children’s Hospital, Seattle, WA
| | - Kenneth J. Cohen
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore MD
| | | | - Howard M. Katzenstein
- Children’s Healthcare of Atlanta; Atlanta GA (current affiliation Nemours Children’s Specialty Care, Jacksonville, FL)
| | - Amy Smith
- University of Florida, Gainesville, FL (current affiliation Arnold Palmer Hospital for Children, Orlando, FL)
| | | | | | | | | | | | | | | | - Jay Pietrantonio
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA
| | - Lianne Greenspan
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA
| | - Danielle Cassidy
- Children’s Hospital Colorado, Aurora, CO (current affiliation Children’s Hospital of Philadelphia, Philadelphia, PA)
| | - Debra Schissel
- Children’s Hospital Colorado, Aurora, CO (current affiliation Children’s Hospital of Philadelphia, Philadelphia, PA)
| | - John Perentesis
- Cincinnati Children’s Hospital Medical Center, Cancer and Blood Diseases Institute and
| | - Mitali Basu
- Cincinnati Children’s Hospital Medical Center, Cancer and Blood Diseases Institute and
| | | | | | - Sanjay P. Prabhu
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA
| | - Susan N. Chi
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA
| | - Mark W. Kieran
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA
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Herzog C, Homøe P, Koch A, Niclasen J, Dammeyer J, Lous J, Kørvel-Hanquist A. Effects of early childhood otitis media and ventilation tubes on psychosocial wellbeing - A prospective cohort study within the Danish National Birth Cohort. Int J Pediatr Otorhinolaryngol 2020; 133:109961. [PMID: 32169775 DOI: 10.1016/j.ijporl.2020.109961] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Otitis Media (OM) is one of the most common infections among children in developed countries and may result in temporary conductive hearing loss (HL) if accompanied by middle ear effusion (MEE). Ventilation tube insertion (VTI) is recommended as treatment for recurrent acute OM or chronic MEE with HL. HL may lead to impaired development of psychosocial skills. However, evidence for the developmental consequences of OM and the effect of VTI is inconsistent. The objectives of this study were to investigate 1) whether OM in early childhood is associated with long-term consequences of psychosocial development and 2) if VTI prevents the possible negative consequences of OM. METHODS This study examined prospectively collected data from 52.877 children registered in the Danish National Birth Cohort (DNBC). Information about previous OM-episodes and VTI was obtained through systematic follow-up interviews at seven years, and The Strength and Difficulties Questionnaire (SDQ) containing questions about psychological wellbeing was completed. Five groups were defined based on OM-exposure and the presence of VTI. Baseline characteristics were analysed, and comparison of mean SDQ-scores for the five exposure groups was conducted. Means were adjusted for à priori defined confounding factors. RESULTS Data from 52,877 children in the DNBC showed an association between OM and poorer SDQ-scores. VTI was associated with an additional increase, i.e. worsening, of the SDQ-score for boys, and only a slight beneficial effect on the girls' outcome. The groups differed in their baseline characteristics in e.g. maternal education, socio-economic status, breastfeeding, and prematurity. CONCLUSION Significant associations between parent-reported OM in early childhood and later psychosocial health difficulties were found. VTI did not resolve this association.
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Affiliation(s)
- C Herzog
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - P Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - A Koch
- Center for Infectious Disease Epidemiology, Statens Serum Institute, Copenhagen, Denmark
| | - J Niclasen
- Steno Diabetes Center, Copenhagen, Denmark
| | - J Dammeyer
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - J Lous
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - A Kørvel-Hanquist
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark.
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Herzog C, Best D, Dolan J, Donnelly L, Patel M, Sung H. Demographic Analysis of the Current Oral and Maxillofacial Surgery Applicant/Resident Cohorts. J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.joms.2019.06.131] [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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Best D, Herzog C, Braun T, Ward B, Moe J. Lichen Planus-Associated Oral Squamous Cell Carcinoma is Associated with Increased Risk of Recurrence and Improved Survival. J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.joms.2019.06.109] [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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Area C, Yen CJ, Chevez-Barrios P, Herzog C, Kan P, Zheng W, Lin F, Chintagumpala M, Gombos D, Chen SR. Technical and anatomical factors affecting intra-arterial chemotherapy fluoroscopy time and radiation dose for intraocular retinoblastoma. J Neurointerv Surg 2019; 11:1273-1276. [PMID: 31197028 DOI: 10.1136/neurintsurg-2019-014910] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Intra-arterial chemotherapy has an increasingly prominent role in the management of retinoblastoma. One concern regarding this technique is procedural radiation exposure. OBJECTIVES To examine the effects of our institution's procedural technique on fluoroscopy parameters for patients undergoing intra-arterial chemotherapy infusions for intraocular retinoblastoma. Secondary goals included describing the effect of anatomical variations of the carotid siphon and ophthalmic artery on radiation dose. METHODS A retrospective review of pediatric patients with retinoblastoma referred to interventional neuroradiology for chemosurgery was performed. Techniques were classified as: A (1.2 Fr or 1.5 Fr microcatheter with continuous verapamil flush, advanced without guide through a 2 Fr sheath) or B (1.5 Fr or 1.7 Fr microcatheter advanced within a 4 Fr base catheter, through a 4 Fr sheath). Statistical analysis was performed to determine if there was a significant difference in fluoroscopy parameters based on technique or due to anatomical variation. RESULTS 26 patients were treated with 94 intra-arterial chemotherapy infusions. 34 procedures were performed using technique A and 60 using technique B. Mean fluoroscopy time (4.75 min), fluoroscopy dose (23.3 mGy), and dose-area product (DAP; 85.2 μGy.m2) for technique A were significantly lower (p value <0.05) than for technique B, 14.0 min., 191 mGy, and 586 μGy.cm2, respectively. CONCLUSIONS Microcatheter-only technique with continuous verapamil infusion resulted in decreased fluoroscopy times, DAP, and radiation doses at our institution for the treatment of intraocular retinoblastoma. Furthermore, our fluoroscopy times using this technique are the lowest reported in the current literature. Additionally, our anatomical analysis has demonstrated a positive correlation between increasing vessel tortuosity and fluoroscopy times.
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Affiliation(s)
- Corey Area
- Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Christopher J Yen
- Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, Texas, USA
| | | | - Cynthia Herzog
- Pediatric Hematology/Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Peter Kan
- Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Wei Zheng
- Statistics, Texas Children's Hospital, Houston, Texas, USA
| | - Frank Lin
- Hematology/Oncology, Texas Children's Hospital, Houston, Texas, USA
| | | | - Dan Gombos
- Section of Ophthalmology, Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen R Chen
- Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, Texas, USA
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Groisberg R, Hong DS, Holla V, Janku F, Piha-Paul S, Ravi V, Benjamin R, Kumar Patel S, Somaiah N, Conley A, Ali SM, Schrock AB, Ross JS, Stephens PJ, Miller VA, Sen S, Herzog C, Meric-Bernstam F, Subbiah V. Clinical genomic profiling to identify actionable alterations for investigational therapies in patients with diverse sarcomas. Oncotarget 2018; 8:39254-39267. [PMID: 28424409 PMCID: PMC5503611 DOI: 10.18632/oncotarget.16845] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 03/08/2017] [Indexed: 12/22/2022] Open
Abstract
Background There are currently no United States Food and Drug Administration approved molecularly matched therapies for sarcomas except gastrointestinal stromal tumors. Complicating this is the extreme diversity, heterogeneity, and rarity of these neoplasms. Few therapeutic options exist for relapsed and refractory sarcomas. In clinical practice many oncologists refer patients for genomic profiling hoping for guidance on treatment options after standard therapy. However, a systematic analysis of actionable mutations has yet to be completed. We analyzed genomic profiling results in patients referred to MD Anderson Cancer Center with advanced sarcomas to elucidate the frequency of potentially actionable genomic alterations in this population. Methods We reviewed charts of patients with advanced sarcoma who were referred to investigational cancer therapeutics department and had CLIA certified comprehensive genomic profiling (CGP) of 236 or 315 cancer genes in at least 50ng of DNA. Actionable alterations were defined as those identifying anti-cancer drugs on the market, in registered clinical trials, or in the Drug-Gene Interaction Database. Results Among the 102 patients analyzed median age was 45.5 years (range 8-76), M: F ratio 48:54. The most common subtypes seen in our study were leiomyosarcoma (18.6%), dedifferentiated liposarcoma (11%), osteosarcoma (11%), well-differentiated liposarcoma (7%), carcinosarcoma (6%), and rhabdomyosarcoma (6%). Ninety-five out of 102 patients (93%) had at least one genomic alteration identified with a mean of six mutations per patient. Of the 95 biopsy samples with identifiable genomic alterations, the most commonly affected genes were TP53 (31.4%), CDK4 (23.5%), MDM2 (21.6%), RB1 (18.6%), and CDKN2A/B (13.7%). Notable co-segregating amplifications included MDM2-CDK4 and FRS2-FGF. Sixteen percent of patients received targeted therapy based on CGP of which 50% had at least stable disease. Conclusions Incorporating CGP into sarcoma management may allow for more precise diagnosis and sub-classification of this diverse and rare disease, as well as personalized matching of patients to targeted therapies such as those available in basket clinical trials.
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Affiliation(s)
- Roman Groisberg
- Department of Investigational Cancer Therapeutics (A Phase I Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.,Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - David S Hong
- Department of Investigational Cancer Therapeutics (A Phase I Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Vijaykumar Holla
- Khalifa Institute for Personalized Cancer Therapy (IPCT), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Filip Janku
- Department of Investigational Cancer Therapeutics (A Phase I Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Sarina Piha-Paul
- Department of Investigational Cancer Therapeutics (A Phase I Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Robert Benjamin
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Shreyas Kumar Patel
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Neeta Somaiah
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Anthony Conley
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Siraj M Ali
- Foundation Medicine Inc, Cambridge, Massachusetts 02139, USA
| | - Alexa B Schrock
- Foundation Medicine Inc, Cambridge, Massachusetts 02139, USA
| | - Jeffrey S Ross
- Foundation Medicine Inc, Cambridge, Massachusetts 02139, USA
| | | | | | - Shiraj Sen
- Department of Investigational Cancer Therapeutics (A Phase I Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.,Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Cynthia Herzog
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics (A Phase I Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics (A Phase I Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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11
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Geoerger B, Bergeron C, Gore L, Sender L, Dunkel IJ, Herzog C, Brochez L, Cruz O, Nysom K, Berghorn E, Simsek B, Shen J, Pappo A. Phase II study of ipilimumab in adolescents with unresectable stage III or IV malignant melanoma. Eur J Cancer 2017; 86:358-363. [PMID: 29100190 DOI: 10.1016/j.ejca.2017.09.032] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Ipilimumab is approved for the treatment of advanced melanoma in adults; however, little information on the efficacy and safety of ipilimumab in younger patients is available. METHODS Patients aged 12 to <18 years with previously treated or untreated, unresectable stage III or IV malignant melanoma received ipilimumab 3 or 10 mg/kg every 3 weeks. Primary end-points were 1-year overall survival and safety. RESULTS Over a period of 3.5 years, 12 patients received ipilimumab at either 3 mg/kg (n = 4) or 10 mg/kg (n = 8). The median number of ipilimumab doses was four for 3 mg/kg and three for 10 mg/kg. At 1 year, three of four patients on 3 mg/kg and five of eight patients on 10 mg/kg were alive. Two patients on 10 mg/kg had partial response, and one on 3 mg/kg had stable disease. One patient had durable partial response at 3 years without further treatment, at time of this report. There was one grade 3/4 immune-mediated adverse reaction with 3 mg/kg and five with 10 mg/kg. There were no treatment-related deaths. The study was stopped due to slow accrual. CONCLUSIONS At >1 year follow-up, ipilimumab demonstrated activity in melanoma patients aged 12 to <18 years, with a similar safety profile as that seen in adults. Our trial highlights the difficulties of enrolling younger patients with rare diseases in clinical trials for treatments that are approved in adults, suggesting adolescents with cancer types occurring predominantly in adults should be considered for inclusion in adult trials of promising new drugs. CLINICAL TRIAL REGISTRATION NCT01696045.
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Affiliation(s)
- Birgit Geoerger
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric and Adolescent Oncology, Villejuif, France.
| | - Christophe Bergeron
- Institut D'Hematologie et D'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Lia Gore
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Leonard Sender
- University of California, Irvine School of Medicine, Orange, CA, USA
| | - Ira J Dunkel
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Cynthia Herzog
- University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Ofelia Cruz
- Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Karsten Nysom
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Jun Shen
- Bristol-Myers Squibb, Princeton, NJ, USA
| | - Alberto Pappo
- St. Jude Children's Research Hospital, Memphis, TN, USA
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12
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Baumann J, Herzog C, Spanier M, Grötzsch D, Lühl L, Witte K, Jonas A, Günther S, Förste F, Hartmann R, Huth M, Kalok D, Steigenhöfer D, Krämer M, Holz T, Dietsch R, Strüder L, Kanngießer B, Mantouvalou I. Laboratory Setup for Scanning-Free Grazing Emission X-ray Fluorescence. Anal Chem 2017; 89:1965-1971. [PMID: 28105807 DOI: 10.1021/acs.analchem.6b04449] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Grazing incidence and grazing emission X-ray fluorescence spectroscopy (GI/GE-XRF) are techniques that enable nondestructive, quantitative analysis of elemental depth profiles with a resolution in the nanometer regime. A laboratory setup for soft X-ray GEXRF measurements is presented. Reasonable measurement times could be achieved by combining a highly brilliant laser produced plasma (LPP) source with a scanning-free GEXRF setup, providing a large solid angle of detection. The detector, a pnCCD, was operated in a single photon counting mode in order to utilize its energy dispersive properties. GEXRF profiles of the Ni-Lα,β line of a nickel-carbon multilayer sample, which displays a lateral (bi)layer thickness gradient, were recorded at several positions. Simulations of theoretical profiles predicted a prominent intensity minimum at grazing emission angles between 5° and 12°, depending strongly on the bilayer thickness of the sample. This information was used to retrieve the bilayer thickness gradient. The results are in good agreement with values obtained by X-ray reflectometry, conventional X-ray fluorescence and transmission electron microscopy measurements and serve as proof-of-principle for the realized GEXRF setup. The presented work demonstrates the potential of nanometer resolved elemental depth profiling in the soft X-ray range with a laboratory source, opening, for example, the possibility of in-line or even in situ process control in semiconductor industry.
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Affiliation(s)
- J Baumann
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany.,Humboldt University of Berlin , School of Analytical Sciences Adlershof (IRIS-Building), Unter den Linden 6, D-10099 Berlin, Germany
| | - C Herzog
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany
| | - M Spanier
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany
| | - D Grötzsch
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany
| | - L Lühl
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany
| | - K Witte
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany
| | - A Jonas
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany
| | - S Günther
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany
| | - F Förste
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany
| | - R Hartmann
- PNSensor GmbH , Otto-Hahn-Ring 6, D-81739 München, Germany
| | - M Huth
- PNSensor GmbH , Otto-Hahn-Ring 6, D-81739 München, Germany
| | - D Kalok
- PNSensor GmbH , Otto-Hahn-Ring 6, D-81739 München, Germany
| | - D Steigenhöfer
- PNSensor GmbH , Otto-Hahn-Ring 6, D-81739 München, Germany
| | - M Krämer
- AXO DRESDEN GmbH , Gasanstaltstraße 8b, D-01237 Dresden, Germany
| | - T Holz
- AXO DRESDEN GmbH , Gasanstaltstraße 8b, D-01237 Dresden, Germany
| | - R Dietsch
- AXO DRESDEN GmbH , Gasanstaltstraße 8b, D-01237 Dresden, Germany
| | - L Strüder
- PNSensor GmbH , Otto-Hahn-Ring 6, D-81739 München, Germany.,University of Siegen , Department of Physics, Walter-Flex-Straße 3, D-57068 Siegen, Germany
| | - B Kanngießer
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany
| | - I Mantouvalou
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany
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13
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Freemyer B, Hamilton E, Warneke CL, Ali AM, Herzog C, Hayes-Jordan A, Austin M. Treatment outcomes in pediatric melanoma-Are there benefits to specialized care? J Pediatr Surg 2016; 51:2063-2067. [PMID: 27686483 DOI: 10.1016/j.jpedsurg.2016.09.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 09/12/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of hospital specialization on survival in pediatric melanoma. METHODS We reviewed all patients under 18years old with cutaneous melanoma evaluated at MD Anderson Cancer Center, a National Cancer Institute (NCI)-designated center, from 2000 to 2014. We compared overall survival (OS) and disease-free survival (DFS) between patients who underwent all treatments at MDACC (Group A, n=146) and those who underwent initial surgical treatment at a non-NCI center (Group B, n=58). Kaplan-Meier survival curves were compared using the log-rank test. RESULTS Group A patients had significantly better OS and DFS (both p<0.001). Five-year OS was 97% (95% CI 92%-99%) in Group A versus 88% (95% CI 74%-94%) in Group B. Group survival differences were most notable in Stage 3 and 4 patients. Group A patients presenting with stage III or IV disease had a 5-year OS rate of 91.2% (95% CI 75.1%-97.1%) compared to 80.8% (95% CI 59.8%-91.5%) in Group B. The DFS rate was 94.4% (95% CI 88.5%-97.3%) in Group A versus 77.2% (95% CI 62.5%-86.7%) in Group B. CONCLUSION Surgical treatment at a comprehensive cancer center may improve outcomes for pediatric melanoma especially for patients presenting with later stage disease. LEVEL OF EVIDENCE Case-control study: Level III.
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Affiliation(s)
- Benjamin Freemyer
- Department of Pediatric Surgery, The McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, Suite 5.258, Houston, TX 77030
| | - Emma Hamilton
- Department of Pediatric Surgery, The McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, Suite 5.258, Houston, TX 77030
| | - Carla L Warneke
- Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler, Floor 4, FCT4.600, Houston, TX 77030
| | - Ali M Ali
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX 77030
| | - Cynthia Herzog
- Department of Pediatrics, Children's Cancer Hospital at the University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 0087, Houston, TX 77030
| | - Andrea Hayes-Jordan
- Department of Pediatric Surgery, The McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, Suite 5.258, Houston, TX 77030; Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX 77030
| | - Mary Austin
- Department of Pediatric Surgery, The McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, Suite 5.258, Houston, TX 77030; Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX 77030.
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14
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Spanier M, Herzog C, Grötzsch D, Kramer F, Mantouvalou I, Lubeck J, Weser J, Streeck C, Malzer W, Beckhoff B, Kanngießer B. A flexible setup for angle-resolved X-ray fluorescence spectrometry with laboratory sources. Rev Sci Instrum 2016; 87:035108. [PMID: 27036820 DOI: 10.1063/1.4943253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 02/20/2016] [Indexed: 06/05/2023]
Abstract
X-ray fluorescence (XRF) analysis is one of the standard tools for the analysis of stratified materials and is widely applied for the investigation of electronics and coatings. The composition and thickness of the layers can be determined quantitatively and non-destructively. Recent work showed that these capabilities can be extended towards retrieving stratigraphic information like concentration depth profiles using angle-resolved XRF (ARXRF). This paper introduces an experimental sample chamber which was developed as a multi-purpose tool enabling different measurement geometries suited for transmission measurements, conventional XRF, ARXRF, etc. The chamber was specifically designed for attaching all kinds of laboratory X-ray sources for the soft and hard X-ray ranges as well as various detection systems. In detail, a setup for ARXRF using an X-ray tube with a polycapillary X-ray lens as source is presented. For such a type of setup, both the spectral and lateral characterizations of the radiation field are crucial for quantitative ARXRF measurements. The characterization is validated with the help of a stratified validation sample.
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Affiliation(s)
- M Spanier
- Institute for Optics and Atomic Physics, Technische Universität Berlin, Hardenbergstraße 36, 10623 Berlin, Germany
| | - C Herzog
- Institute for Optics and Atomic Physics, Technische Universität Berlin, Hardenbergstraße 36, 10623 Berlin, Germany
| | - D Grötzsch
- Institute for Optics and Atomic Physics, Technische Universität Berlin, Hardenbergstraße 36, 10623 Berlin, Germany
| | - F Kramer
- Institute for Optics and Atomic Physics, Technische Universität Berlin, Hardenbergstraße 36, 10623 Berlin, Germany
| | - I Mantouvalou
- Institute for Optics and Atomic Physics, Technische Universität Berlin, Hardenbergstraße 36, 10623 Berlin, Germany
| | - J Lubeck
- Physikalisch-Technische Bundesanstalt, Abbestraße 2-12, 10587 Berlin, Germany
| | - J Weser
- Physikalisch-Technische Bundesanstalt, Abbestraße 2-12, 10587 Berlin, Germany
| | - C Streeck
- Physikalisch-Technische Bundesanstalt, Abbestraße 2-12, 10587 Berlin, Germany
| | - W Malzer
- Institute for Optics and Atomic Physics, Technische Universität Berlin, Hardenbergstraße 36, 10623 Berlin, Germany
| | - B Beckhoff
- Physikalisch-Technische Bundesanstalt, Abbestraße 2-12, 10587 Berlin, Germany
| | - B Kanngießer
- Institute for Optics and Atomic Physics, Technische Universität Berlin, Hardenbergstraße 36, 10623 Berlin, Germany
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15
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Hayes-Jordan A, CLopez, Green HL, Xiao LC, Huh W, Herzog C. Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Pediatric Ovarian Tumors: A Novel Treatment Approach. Pediatr Surg Int 2016; 32:71-3. [PMID: 26500075 PMCID: PMC5098267 DOI: 10.1007/s00383-015-3814-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2015] [Indexed: 01/31/2023]
Abstract
PURPOSE Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been used in adults with ovarian carcinoma proving overall survival benefit in randomized trials, but measured in months. Diffuse peritoneal disease from pediatric type ovarian tumors is rare. We applied CRS and HIPEC to pediatric girls with diffuse peritoneal disease as part of a clinical trial. METHODS In all patients complete cytoreduction was followed by HIPEC using 100 mg/m2 of cisplatin for 90 min in a closed technique. All received neoadjuvant chemotherapy. Patients with disease outside of the abdominal cavity were excluded. RESULTS Of 101 pediatric CRS and HIPEC operations, 8 had ovarian primary tumors and multifocal peritoneal disease. There were three yolk sac tumors (germ cell, mixed teratoma), one Sertoli–Leydig, one PNET of the ovary, one choriocarcinoma, one juvenile granulosa cell tumor and one adenocarcinoma. Age ranged 4–18 years. Three of the 8 (37 %) recurred and died. The remaining 63 % are disease free 2–6 years post HIPEC. Overall survival and relapse-free survival in this cohort was 64 and 62 %, respectively [CI 0.64 (0.34, 1); 0.62 (0.37, 1)]. CONCLUSIONS This is the first report of CRS and HIPEC in pediatric ovarian tumors. HIPEC may be effective in pediatric-type ovarian tumors. More study is needed in a larger cohort.
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Affiliation(s)
- A Hayes-Jordan
- University of Texas MD Anderson Cancer Center, Department of Surgical Oncology/Pediatric Surgical Oncology, Houston, Texas, USA
| | - CLopez
- University of Texas Houston Health Sciences Center
| | - HL Green
- University of Texas MD Anderson Cancer Center, Department of Surgical Oncology/Pediatric Surgical Oncology, Houston, Texas, USA
| | - LC Xiao
- University of Texas MD Anderson Cancer Center, Department of Biostatistics
| | - W Huh
- University of Texas MD Anderson Cancer Center, Division of Pediatrics
| | - C Herzog
- University of Texas MD Anderson Cancer Center, Division of Pediatrics
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16
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Godmann L, König U, Stratis A, Cromme C, Neugebauer K, Herzog C, Korb-Pap A, Niederreiter B, Dankbar B, Redlich K, Echtermeyer F, Pap T, Bertrand J. A4.22 Syndecan-4 controls interleukin (IL)-1 receptor trafficking and IL-1 signalling in chronic destructive arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-207259.104] [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: 11/03/2022]
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17
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Corrales-Medina FF, Herzog C, Hess K, Egas-Bejar D, Hong DS, Falchook G, Anderson P, Nunez C, Huh WW, Naing A, Tsimberidou AM, Wheler J, Paul SP, Janku F, Kleinerman ES, Kurzrock R, Subbiah V. Clinical characteristics and outcomes of pediatric oncology patients with aggressive biology enrolled in phase I clinical trials designed for adults: the university of Texas MD anderson cancer center experience. Oncoscience 2015; 1:522-530. [PMID: 25587555 PMCID: PMC4278323 DOI: 10.18632/oncoscience.68] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Children (patients ≤ 18 years of age) are not usually included on pharmaceutical industry sponsored Phase I trials. Methods We reviewed the medical records of 40 patients ≤ 18 years treated in ≥ 1 phase I trial at MD Anderson. Results The median OS was 8.5 months (95% CI, 5.5-13.2 months). In the multivariate analysis, age ≥15 only predicted increased OS (P = 0.0065), and >3 prior therapies (P = 0.053) predicted decreased OS. The median PFS was 2.8 months (95% CI, 2.3-4.1 months). In the multivariate analysis, independent factors that predicted increased PFS were age ≥15 years (P < 0.001) and prior radiation therapy (P = 0.049); performance status >1 (P < 0.001) and >3 prior therapies (P = 0.002) predicted decreased PFS. RMH score ≥ 2 and MDACC score ≥ 3 were associated with decreased median OS (P = 0.029 and P = 0.031 respectively). Conclusions It is feasible to conduct phase I studies in pediatric patients based on adult protocols. In the era of targeted therapy more trials should allow pediatric patients earlier in the drug development especially if deemed safe in adults in early phase trials. Translational Relevance Most pharmaceutical industry sponsored trials exclude patients less than 18 years in phase I clinical trials. Even in the era of targeted therapy pediatric patients usually have to wait for most phases of trials to be completed in adults before being allowed to enroll in clinical trials of new therapies, even in the advanced metastatic and relapsed setting. Some investigator initiated phase 1 trials of combinations of US FDA approved agents allow patients less than 18 years. We report the preliminary analyses of the outcomes of pediatric patients enrolled in phase I studies initially designed for adults, but allowing for enrollment of patients under 18.
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Affiliation(s)
- Fernando F Corrales-Medina
- Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cynthia Herzog
- Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kenneth Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniela Egas-Bejar
- Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David S Hong
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gerald Falchook
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pete Anderson
- Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Pediatric Hematology/Oncology/BMT, Levine Children's Hospital/Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Cesar Nunez
- Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Winston W Huh
- Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aung Naing
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Apostolia M Tsimberidou
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer Wheler
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarina Piha Paul
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Filip Janku
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eugenie S Kleinerman
- Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Razelle Kurzrock
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vivek Subbiah
- Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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18
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Hayes-Jordan A, Green H, Lin H, Owusu-Agyemang P, Mejia R, Okhuysen-Cawley R, Cortes J, Fitzgerald NE, McAleer MF, Herzog C, Huh WW, Anderson P. Cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for children, adolescents, and young adults: the first 50 cases. Ann Surg Oncol 2015; 22:1726-32. [PMID: 25564159 DOI: 10.1245/s10434-014-4289-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Extensive peritoneal metastatic disease is rare in children. Although usually manifested as carcinomatosis in adults, sarcomatosis is more common in children. The authors began a pediatric hyperthermic intraperitoneal chemotherapy (HIPEC) program, and this report describes their initial results from the first 50 pediatric, adolescent, and young adult patients. METHODS A single-institution, retrospective study investigated the first 50 cytoreductive surgeries and HIPEC by one surgeon for patients 3-21 years of age. The HIPEC was added to chemotherapy and radiotherapy treatment. Demographics, outcome, and complications were recorded. RESULTS The median follow-up period for the surviving patients was 21.9 months. The most common diagnoses were desmoplastic small round cell tumor (n = 21), rhabdomyosarcoma (n = 7), mesothelioma (n = 4), and other carcinoma (n = 17). Multivariate analysis showed that patients treated with HIPEC and an incomplete cytoreduction had a greater risk for recurrence than those who had a complete cytoreduction (p = 0.0002). The patients with a higher peritoneal cancer index (PCI) (i.e., a large tumor burden) had a median overall survival (OS) time of 19.9 months relative to the patients with a lower PCI score, who had a median OS of 34 months (p = 0.049). The patients without complete cytoreduction had a median OS of 7.1 months compared with 31.4 months for the patients with complete cytoreduction (p = 0.012). No perioperative mortalities occurred. The incidence of major complications was 28 %. CONCLUSION Cytoreductive surgery and HIPEC with a programmatic approach for patients 3-21 years of age is unique. The best outcome was experienced by patients with desmoplastic small round cell tumor and those with complete cytoreduction. Complete cytoreduction for patients without disease outside the abdominal cavity at the time of surgery affords the best outcome.
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Affiliation(s)
- Andrea Hayes-Jordan
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA,
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Wheeler DC, Abdalla S, Chertow G, Parfrey P, Herzog C, Mikolasevic I, Racki S, Lukenda V, Milic S, Devcic B, Orlic L, Suttorp MM, Hoekstra T, Ocak G, Van Diepen ATN, Ott I, Mittelman M, Rabelink TJ, Krediet RT, Dekker FW, Simone S, Dell'Oglio MPS, Ciccone M, Corciulo R, Castellano G, Balestra C, Grandaliano G, Gesualdo L, Pertosa G, Nishida M, Ando M, Karasawa K, Iwamoto Y, Tsuchiya K, Nitta K, Krzanowski M, Janda K, Gajda M, Dumnicka P, Fedak D, Lis G, Ja kowski P, Litwin JA, Su owicz W, Freitas GR, Silva VB, Abensur H, Luders C, Pereira BJ, Castro MC, Oliverira RB, Moyses RM, Elias RM, Silva BC, Tekce H, Ozturk S, Aktas G, Kin Tekce B, Erdem A, Ozyasar M, Taslamacioglu Duman T, Yazici M, Kirkpantur A, Balci MM, Turkvatan A, Afsar B, Alkis M, Mandiroglu F, Voroneanu L, Siriopol D, Nistor I, Apetrii M, Hogas S, Onofriescu M, Covic A, An WS, Kim SE, Son YK, Oh YJ, Gelev S, Toshev S, Trajceska L, Selim G, Dzekova P, Shikole A, Park J, Lee JS, Shin ES, Ann SH, Kim SJ, Chung HC, Janda K, Krzanowski M, Gajda M, Dumnicka P, Fedak D, Lis G, Litwin JA, Sulowicz W, Elewa U, Bichari W, Abo-Seif K, Seferi S, Rroji M, Likaj E, Spahia N, Barbullushi M, Thereska N, Kopecky CM, Genser B, Maerz W, Wanner C, Saemann MD, Weichhart T, Sezer S, Gurlek Demirci B, Tutal E, Bal Z, Erkmen Uyar M, Ozdemir Acar FN, Macunluoglu B, Atakan A, Ari Bakir E, Georgianos P, Sarafidis PA, Stamatiadis DN, Liakopoulos V, Zebekakis PE, Papagianni A, Lasaridis AN, Eftimovska - Otovic N, Babalj-Banskolieva E, Kostadinska-Bogdanoska S, Grozdanovski R, Aono M, Sato Y, El Amrani M, Asserraji M, Benyahia M, Lee YK, Choi SR, Cho A, Kim JK, Choi MJ, Kim SJ, Yoon JW, Koo JR, Kim HJ, Noh JW, Inagaki H, Yokota N, Sato Y, Chiyotanda S, Fukami K, Fujimoto S, Kendi Celebi Z, Kutlay S, Sengul S, Nergizoglu G, Erturk S, Ates K, Vishnevskii KA, Rumyantsev AS, Zemchenkov AY, Smirnov AV, Reinhardt B, Knaup R, Esteve Simo V, Carneiro Oliveira J, Moreno Guzman F, Fulquet Nicolas M, Pou Potau M, Saurina Sole A, Duarte Gallego V, Ramirez De Arellano Serna M, Turkmen K, Demirtas L, Akbas EM, Bakirci EM, Buyuklu M, Timuroglu A, Georgianos PI, Sarafidis PA, Karpetas A, Liakopoulos V, Stamatiadis DN, Papagianni A, Lasaridis AN, Taira T, Nohtomi K, Takemura T, Chiba T, Hirano T, Chang CT, Huang CC, Chen CJ, El Amrani M, Mohamed A, Benyahia M, Kanai H, Tamura Y, Kaizu Y, Kali A, Yayar O, Erdogan B, Eser B, Ercan Z, Buyukbakkal M, Merhametsiz O, Haspulat A, Yildirim T, Bozkurt B, Ayli MD, Bal Z, Erkmen Uyar M, Gokustun D, Gurlek Demirci B, Tutal E, Sezer S, Markaki A, Grammatikopoulou M, Fragkiadakis G, Stylianou K, Venyhaki M, Chatzi V, Selim G, Stojceva-Taneva O, Tozija L, Dzekova-Vidimliski P, Trajceska L, Gelev S, Petronievic Z, Sikole A, Moyseyenko V, Nykula T, Fernandes RT, Barreto DV, Rodrigues GGC, Misael A, Branco-Martins CT, Barreto FC, Yayar O, Ercan Z, Eser B, Merhametsiz O, Haspulat A, Buyukbakkal M, Erdogan B, Yildirim T, Bozkurt B, Ayli MD. DIALYSIS CARDIOVASCULAR COMPLICATIONS 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu155] [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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Anderson P, Meyers P, Kleinerman E, Venkatakrishnan K, Hughes D, Herzog C, Huh W, Sutphin R, Vyas YM, Shen V, Warwick A, Yeager N, Oliva C, Wang B, Liu Y, Chou A. Mifamurtide in metastatic and recurrent osteosarcoma: a patient access study with pharmacokinetic, pharmacodynamic, and safety assessments. Pediatr Blood Cancer 2014; 61:238-44. [PMID: 23997016 PMCID: PMC4533988 DOI: 10.1002/pbc.24686] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 06/17/2013] [Indexed: 12/29/2022]
Abstract
PURPOSE This non-randomized, patient-access protocol, assessed both safety and efficacy outcomes following liposomal muramyl-tripeptide-phosphatidylethanolamine (L-MTP-PE; mifamurtide) in patients with high-risk, recurrent and/or metastatic osteosarcoma. METHODS Patients received mifamurtide 2 mg/m(2) intravenously twice-weekly ×12 weeks, then weekly ×24 weeks with and without chemotherapy. Serum concentration-time profiles were collected. Adverse events within 24 hours of drug administration were classified as infusion-related adverse events (IRAE); other AEs and overall survival (OS) were assessed. RESULTS The study began therapy in January 2008; the last patient completed therapy in October 2012. Two hundred five patients were enrolled; median age was 16.0 years and 146/205 (71%) had active disease. Mifamurtide serum concentrations declined rapidly in the first 30 minutes post-infusion, then in a log-linear manner 2-6 hours post-dose; t1/2 was 2 hours. There were no readily apparent relationships between age and BSA-normalized clearance, half-life, or pharmacodynamic effects, supporting the dose of 2 mg/m(2) mifamurtide across the age range. Patients reported 3,679 IRAE after 7,482 mifamurtide infusions. These were very rarely grade 3 or 4 and most commonly included chills + fever or headache + fatigue symptom clusters. One- and 2-year OS was 71.7% and 45.9%. Patients with initial metastatic disease or progression approximated by within 9 months of diagnosis (N = 40) had similar 2-year OS (39.9%) as the entire cohort (45.9%) CONCLUSIONS Mifamurtide had a manageable safety profile; PK/PD of mifamurtide in this patient access study was consistent with prior studies. Two-year OS was 45.9%. A randomized clinical trial would be required to definitively determine impact on patient outcomes.
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Affiliation(s)
- P.M. Anderson
- University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - P. Meyers
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - E. Kleinerman
- University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | | | - D.P. Hughes
- University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - C. Herzog
- University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - W. Huh
- University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | | | | | - V. Shen
- Childrens Hospital of Orange County, Orange CA USA
| | - A. Warwick
- Uniformed Services University, Bethesda MD, USA
| | - N. Yeager
- Nationwide Children’s Hospital, Ohio State University Columbus OH, USA
| | | | - B. Wang
- Millennium: The Takeda Oncology Company, Cambridge, MA, USA
| | - Y. Liu
- Millennium: The Takeda Oncology Company, Cambridge, MA, USA
| | - A. Chou
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Ferrario M, Buckel E, Astorga C, Godoy J, Aguiló J, González G, Ormazábal J, Cámbara Á, Derosas C, Herzog C, Calabrán L. Results in Laparoscopic Living Donor Nephrectomy: A Multicentric Experience. Transplant Proc 2013; 45:3716-8. [DOI: 10.1016/j.transproceed.2013.08.089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Subbiah IM, Janku F, Naing A, Fu S, Hong DS, Kaseb AO, Herzog C, Kurzrock R, Wolff RA, Wolff RA, Subbiah V. Abstract 48: Theranostic profiling of adolescents and young adults (AYA) with advanced fibrolamellar hepatocellular carcinoma identifies aberrant activation of the PI3K/AKT/MTOR signaling cascade. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Fibrolamellar hepatocellular carcinoma (FLHCC) is an extremely rare malignancy predominantly affecting adolescents and young adults without underlying chronic liver disease. Its molecular profile is poorly defined. Given limited effective therapeutic options, we characterized the molecular profiles of patients with advanced FLHCC treated with novel targeted therapies on phase I clinical trials.
Methods: Of over 3400 pts with advanced malignancies seen in the Phase I clinic, we identified 12 FLHCC pts (0.4 %). We performed single gene-PCR based testing for oncogenic mutations in KRAS, NRAS, BRAF, CKIT, EGFR, PIK3CA, MET, GNAQ, TP53, IHC for PTEN loss, ALK-1, estrogen receptor (ER) and FISH for her2/neu, cMET amplification and ALK-1 rearrangement on patients with adequate available tissue in the MD Anderson CLIA-certified lab. Additionally next-generation sequencing from FFPE sections using a targeted NGS assay in a CLIA laboratory (Foundation One, MA) was completed on two patients. Over 2000 exons of 186 cancer-related genes plus over 30 introns from 14 genes often rearranged in cancer were fully sequenced for point mutations, insertions/deletions, copy number alterations (CNAs) and select gene fusions.
Results: Abnormal expression of the tumor suppressor gene PTEN was shown in 2 of 4 (50%) tested pt's tumors. The first patient's tumor shows overt PTEN loss on IHC while the second pt's tumor showed very weak cytoplasmic staining for PTEN. Interruptions of PTEN functions result in loss of negative regulation of AKT and its downstream components including mTOR. Single gene-based PCR sequencing for oncogenic mutations and the remainder of the tests using IHC and FISH were negative. Next generation sequencing of two pts revealed a missense mutation in FBXW7-E192A in one pt. The second pt's NGS profile did not reveal any actionable mutations. E192A is a missense mutation that occurs prior to the F-box domain and the highly conserved WD40 repeat region, which plays a role in substrate recognition. Mao et al (Science 2008) have reported that FBXW7 targets mTOR for degradation and cooperates with PTEN in tumor suppression and tumor cell lines harboring mutations in FBXW7 demonstrated particular sensitivity to rapamycin. .
Conclusion: With thorough comprehensive molecular profiling, we can identify potential actionable aberrations in a subset of advanced FL-HCC patients. Herein we identified activation of the PI3K/AKT/MTOR pathway by PTEN loss and missense mutation in FBXW7. Further matching patients to these actionable aberrations is underway, thereby translating these therapeutic targets to the bedside with the development of novel targeted therapies.
Citation Format: Ishwaria M. Subbiah, Filip Janku, Aung Naing, Siqing Fu, David S. Hong, Ahmed O. Kaseb, Cynthia Herzog, Razelle Kurzrock, Robert A. Wolff, Robert A. Wolff, Vivek Subbiah. Theranostic profiling of adolescents and young adults (AYA) with advanced fibrolamellar hepatocellular carcinoma identifies aberrant activation of the PI3K/AKT/MTOR signaling cascade. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 48. doi:10.1158/1538-7445.AM2013-48
Note: This abstract was not presented at the AACR Annual Meeting 2013 because the presenter was unable to attend.
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Affiliation(s)
| | - Filip Janku
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aung Naing
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | - Siqing Fu
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | - David S. Hong
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ahmed O. Kaseb
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cynthia Herzog
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Vivek Subbiah
- 1University of Texas MD Anderson Cancer Center, Houston, TX
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Louis C, Ramos C, Kalra M, Glisson B, Liu H, Herzog C, Gee A, Heslop H, Brenner M, Rooney C, Gottschalk S. A Phase II study of carboplatin and docetaxel followed by epstein-barr virus specific cytotoxic T Lymphocytes for refractory/relapsed EBV-positive nasopharyngeal carcinoma. Cytotherapy 2013. [DOI: 10.1016/j.jcyt.2013.01.030] [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: 10/27/2022]
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Macy ME, Duncan T, Whitlock J, Hunger SP, Boklan J, Narendren A, Herzog C, Arceci RJ, Bagatell R, Trippett T, Christians U, Rolla K, Ivy SP, Gore L. A multi-center phase Ib study of oxaliplatin (NSC#266046) in combination with fluorouracil and leucovorin in pediatric patients with advanced solid tumors. Pediatr Blood Cancer 2013; 60:230-6. [PMID: 23024067 PMCID: PMC3522763 DOI: 10.1002/pbc.24278] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 07/11/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Platinum agents have been used for a variety of cancers, including pivotal use in pediatric tumors for many years. Oxaliplatin, a third generation platinum, has a different side effect profile and may provide improved activity in pediatric cancers. PROCEDURE Patients 21 years or younger with progressive or refractory malignant solid tumors, including tumors of the central nervous system were enrolled on this multi-center open label, non-randomized Phase 1 dose escalation study. The study used a standard 3 + 3 dose escalation design with 2 dose levels (85 and 100 mg/m(2) ) with an expansion cohort of 15 additional patients at the recommended dose. Patients received oxaliplatin at the assigned dose level and 5-fluorouracil (5-FU) bolus 400 mg/m(2) followed by a 46-hour 5-FU infusion of 2,400 mg/m(2) every 14 days. The leucovorin dose was fixed at 400 mg/m(2) for all cohorts. RESULTS Thirty-one evaluable patients were enrolled, 8 at 85 mg/m(2) and 23 at 100 mg/m(2) for a total of 121 courses. The median age was 12 years (range 2-19 years). The main toxicities were hematologic, primarily neutrophils and platelets. The most common non-hematologic toxicities were gastrointestinal. Stable disease was noted in 11 patients (54% of evaluable patients) and 1 confirmed partial response in a patient with osteosarcoma. CONCLUSIONS The maximum planned dose of oxaliplatin at 100 mg/m(2) per dose in combination with 5-FU and leucovorin was safe and well tolerated and in this patient population. This combination demonstrated modest activity in patients with refractory or relapsed solid tumor and warrants further study. Pediatr Blood Cancer 2013;60:230-236. © 2012 Wiley Periodicals, Inc.
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Affiliation(s)
- Margaret E. Macy
- University of Colorado Anschutz Medical Campus, Aurora CO,Children’s Hospital Colorado, Aurora CO,on behalf of the Pediatric Oncology Experimental Therapeutics Investigators’ Consortium (POETIC)
| | - Tracey Duncan
- University of Colorado Anschutz Medical Campus, Aurora CO,Children’s Hospital Colorado, Aurora CO,on behalf of the Pediatric Oncology Experimental Therapeutics Investigators’ Consortium (POETIC)
| | - James Whitlock
- Vanderbilt University Medical Center, Nashville TN,on behalf of the Pediatric Oncology Experimental Therapeutics Investigators’ Consortium (POETIC)
| | - Stephen P. Hunger
- University of Colorado Anschutz Medical Campus, Aurora CO,Children’s Hospital Colorado, Aurora CO,University of Florida Shands Cancer Center, Gainesville FL,on behalf of the Pediatric Oncology Experimental Therapeutics Investigators’ Consortium (POETIC)
| | - Jessica Boklan
- Phoenix Children’s Hospital, Phoenix AZ,on behalf of the Pediatric Oncology Experimental Therapeutics Investigators’ Consortium (POETIC)
| | - Aru Narendren
- University of Calgary and Alberta Children’s Hospital, Calgary AB,on behalf of the Pediatric Oncology Experimental Therapeutics Investigators’ Consortium (POETIC)
| | - Cynthia Herzog
- MD Anderson Cancer Center, Houston TX,on behalf of the Pediatric Oncology Experimental Therapeutics Investigators’ Consortium (POETIC)
| | - Robert J. Arceci
- Johns Hopkins Medical Center and Sidney Kimmel Cancer Center, Baltimore MD,on behalf of the Pediatric Oncology Experimental Therapeutics Investigators’ Consortium (POETIC)
| | - Rochelle Bagatell
- University of Arizona Cancer Center, Tucson AZ,on behalf of the Pediatric Oncology Experimental Therapeutics Investigators’ Consortium (POETIC)
| | - Tanya Trippett
- Memorial Sloan-Kettering Cancer Center, New York, NY,on behalf of the Pediatric Oncology Experimental Therapeutics Investigators’ Consortium (POETIC)
| | - Uwe Christians
- University of Colorado Anschutz Medical Campus, Aurora CO
| | - Katherine Rolla
- Memorial Sloan-Kettering Cancer Center, New York, NY,on behalf of the Pediatric Oncology Experimental Therapeutics Investigators’ Consortium (POETIC)
| | - S. Percy Ivy
- Investigational Drug Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville MD
| | - Lia Gore
- University of Colorado Anschutz Medical Campus, Aurora CO,Children’s Hospital Colorado, Aurora CO,on behalf of the Pediatric Oncology Experimental Therapeutics Investigators’ Consortium (POETIC)
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Herzog C, Peter M, Pritsch K, Günthardt-Goerg MS, Egli S. Drought and air warming affects abundance and exoenzyme profiles of Cenococcum geophilum associated with Quercus robur, Q. petraea and Q. pubescens. Plant Biol (Stuttg) 2013; 15 Suppl 1:230-237. [PMID: 22686410 DOI: 10.1111/j.1438-8677.2012.00614.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The present study aimed to elucidate the influence of drought and elevated temperature on relative abundance and functioning of the ectomycorrhizal fungus Cenococcum geophilum on three oak species differing in adaptation to a warm and dry climate. The experiment QUERCO comprised three Quercus species (Q. robur, Q. petraea, Q. pubescens) grown for 3 years under four treatments: elevated air temperature, drought, a combination of the two, and control. Fine root samples were analysed for relative abundance and potential extracellular enzyme activities of ectomycorrhizae of C. geophilum, a fungal species known to be drought resistant. The relative abundance of C. geophilum on the roots of the oak species was significantly increased by temperature, decreased by drought, but unchanged in the combined treatment compared to the control. Although the extent of treatment effects differed among oak species, no significant influence of tree species on relative abundance of C. geophilum was detected. Exoenzyme activities of C. geophilum on Q. robur and Q. petraea (but not Q. pubescens) significantly increased in the combined treatment, but for all oak species were reduced under drought and air warming alone compared to the control. There was a significant negative correlation between abundance of C. geophilum and its leucine aminopeptidase activity. As this enzyme is not frequent among ectomycorrhizal fungi, this emphasises the functional importance of C. geophilum in the ectomycorrhizal community. Our results indicate that increased temperature and drought will influence the relative abundance and enzyme activity of C. geophilum. However, both the Quercus species and C. geophilum tolerated warming and strong drought.
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Affiliation(s)
- C Herzog
- Swiss Federal Research Institute WSL, Zürcherstrasse 111, Birmensdorf, Switzerland.
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Kerl JM, Bauer RW, Herzog C, Schoepf UJ, Vogl TJ. Detektion signifikanter Koronararterienstenosen mit 64-Teilen CT- Ein Interobserververgleich auf patienten- und segmentbasierter Ebene von Radiologen mit verschiedenen Erfahrungsleveln. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kerl JM, Bauer RW, Schell B, Schoepf UJ, Vogl TJ, Herzog C. Ein Verbesserter Referenzstandart zur Beurteilung von Koronararterienstenosen: Ein Vergleich zwischen CT und konventioneller Koronarangiographie. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mahajan A, Anderson P, McAleer M, Sulman E, Pinnix C, Woo S, Herzog C, Hayes-Jordan A. Multidisciplinary Management with Whole Abdominal IMRT of Desmoplastic Small Round Cell Tumor. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Paradela S, Fonseca E, Pita-Fernández S, Kantrow SM, Diwan AH, Herzog C, Prieto VG. Prognostic factors for melanoma in children and adolescents: a clinicopathologic, single-center study of 137 Patients. Cancer 2010; 116:4334-44. [PMID: 20549825 DOI: 10.1002/cncr.25222] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Cutaneous melanoma in childhood is rare; therefore, its prognostic factors and biologic behavior and the effectiveness of adjuvant diagnostic techniques in this group remain mostly unknown. METHODS The authors conducted a retrospective, observational study on the prognostic significance of clinical and pathologic findings from 137 cutaneous and mucosal melanomas in patients aged <18 years that were reviewed by the pathology department of a large cancer center during the period from 1992 to 2006. RESULTS Univariate analysis indicated that there was a significantly greater risk of metastases for patients who had previous nonmelanocytic malignancies, nodular histologic type, fusiform or spitzoid cytology, high Breslow thickness, vertical growth phase, high dermal mitotic activity, ulceration, and vascular invasion. Adjacent nevus and radial growth phase were associated with a better prognosis. Twelve patients (10.3%) died during follow-up. Decreased overall survival was related significantly to age >10 years, previous nonmelanocytic malignancy, high Breslow thickness, high Clark level, and the presence of metastases at diagnosis. All patients who died were aged ≥ 11 years, and 8 of those patients had metastases at diagnosis. In multivariate analysis, higher Breslow thickness predicted an increased risk of metastases, whereas age >10 years and the presence of metastases at diagnosis were associated with decreased survival. CONCLUSIONS Similar to adults, the detection of metastases at diagnosis in children with melanoma was 1 of the main factors that influenced overall survival. Melanomas that were detected in children aged <11 years appeared to have a less aggressive behavior than those detected in adults.
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Affiliation(s)
- Sabela Paradela
- Department of Dermatology, Juan Canalejo Hospital, La Coruna, Spain
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Alba A, Morales J, Fierro A, Zehnder C, Cao C, Orozco R, Herzog C, Calabrán L, Contreras L, Buckel E. Evaluation of late immunologic parameters among renal transplant recipients induced with Campath-1H. Transplant Proc 2010; 42:253-6. [PMID: 20172322 DOI: 10.1016/j.transproceed.2009.12.046] [Citation(s) in RCA: 3] [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: 12/20/2022]
Abstract
Organ transplantation success depends principally on avoiding rejection, a purpose almost accomplished with immunosuppressant therapy. Nevertheless, drug side effects have promoted the search for other mechanisms to restrain alloresponses. T-regulatory cells (Treg) might exert that function. Campath 1H (C1H) induces Treg proliferation in the period subsequent to T-cell depletion following C1H administration. In the present study, the status of Treg and de novo HLA antibody production was determined posttransplantation when T-cell repopulation had been completed. In 14 patients, the following parameters were analyzed: renal function, rejection, Treg, panel-reactive antibody (PRA), and HLA antibodies. Patient and graft survivals were 100%. At the moment of Treg determination (20 months following transplant) the mean tacrolimus level was 8.4 ng/mL. One patient experienced an antibody-mediated rejection at 15 months after transplantation while having 3.2% Treg, with excellent treatment responses. Mean leukocyte and lymphocyte counts were 5752 and 1183 cells/mm(3); the mean peripheral blood percentage of Treg of 7.1% +/- 5.9% was not different from that observed in subjects without induction (mean 5.5% +/- 2.5%). Three patients (21%) showed Treg greater than 8.0%. In seven patients, we compared Treg at 4 and 20 months posttransplant, observing a decline from a mean of 19.9% to 5.9% (P = .05). In seven recipients, posttransplant PRA was determined; five of them became "de novo" sensitized, three with a mean class I PRA of 16% and two with a mean class II PRA of 37%. In conclusion, patient and graft survivals were excellent, mean Treg percentage was not elevated with results lower than in the early posttransplant period. Rejection incidence was negligible. Late "de novo" sensitization occurred in 70% showing that B cell-mediated alloresponses were only partially controlled among recipients induced with C1H even when associated with sustained anticalcineurin treatment.
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Affiliation(s)
- A Alba
- Centro de Trasplante, Clínica Las Condes, Santiago, Chile
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Uribe M, Alba A, Hunter B, Valverde C, Godoy J, Ferrario M, Buckel E, Cavallieri S, Rebolledo R, Herzog C, Calabrán L, Flores L, Soto P. Chilean experience in liver transplantation for acute liver failure in children. Transplant Proc 2010; 42:293-5. [PMID: 20172334 DOI: 10.1016/j.transproceed.2009.12.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Acute liver failure (ALF) in children is a life-threatening condition, associated with high mortality, and in almost one third of the cases, with no other therapeutic option than orthotopic liver transplant (OLT). The aim of this study was to present our experience with OLT for ALF in pediatric patients in Chile. Patients fulfilling the criteria for ALF who were transplanted in our centers were prospectively included in an excel Microsoft database. We analyzed demographics, etiology, surgical techniques, complications, and long-term results. PATIENTS AND METHODS Between 1994 and 2009, we transplanted 52 pediatric patients with ALF. The most frequent known etiology was acute hepatitis A in 9 cases (18%), but in 26 cases (50%) it was impossible to determine the etiology. Thirty- one patients were males (63%). The overall mean age was 7.5 years and the mean weight, 28.1 kg. Thirty-five (67%) received a cadaveric graft. Among them in 18 cases (34%) the liver had to be reduced but 17 (33%) received whole livers. There were 17 (33%) recipients of living-related livers. Twenty-two patients needed reoperation, including 13 due to surgical complications (59%) and 9 (41%) as planned interventions. Ten patients were retransplanted. RESULTS Actuarial survival of patients at 1 year was 80% and at 5 and 10 years, 72%. Graft survival at 1 year was 79%, at 5 years 69%, and at 10 years 50%. CONCLUSION We have reported a series of pediatric liver transplant patients due to ALF whose results were comparable to other reported series. Living donor transplantation for ALF should be considered and offers a low morbidity rate without mortality.
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Affiliation(s)
- M Uribe
- Centro de Trasplante Clinica Las Condes and the Hospital Luis Calvo, Santiago, Chile.
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Echtermeyer F, Betrand J, Meinecke I, Neugebauer K, Herzog C, Lee YJ, Song YW, Dreier R, Pap T. Syndecan-4 regulates cartilage degradation in osteoarthritis. Ann Rheum Dis 2010. [DOI: 10.1136/ard.2010.129593u] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Silva E, Alba A, Castro A, Carrascal M, Buckel E, Aguiló J, Herzog C, Calabrán L, Morales J, Fierro J. Evaluation of HLA Matchmaker Compatibility as Predictor of Graft Survival and Presence of Anti-HLA Antibodies. Transplant Proc 2010; 42:266-9. [DOI: 10.1016/j.transproceed.2009.12.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Trippett TM, Herzog C, Whitlock JA, Wolff J, Kuttesch J, Bagatell R, Hunger SP, Boklan J, Smith AA, Arceci RJ, Katzenstein HM, Harbison C, Zhou X, Lu H, Langer C, Weber M, Gore L. Phase I and pharmacokinetic study of cetuximab and irinotecan in children with refractory solid tumors: a study of the pediatric oncology experimental therapeutic investigators' consortium. J Clin Oncol 2009; 27:5102-8. [PMID: 19770383 PMCID: PMC5321093 DOI: 10.1200/jco.2008.20.8975] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Accepted: 05/04/2009] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To determine the dose of cetuximab that can be safely combined with irinotecan for treatment of pediatric and adolescent patients with refractory solid tumors. PATIENTS AND METHODS This open-label, phase I study enrolled patients ages 1 to 18 years with advanced refractory solid tumors, including tumors of the CNS. Patient cohorts by age group (children, ages 1 to 12 years; adolescents, ages 13 to 18 years) received escalating weekly doses of cetuximab (75, 150, 250 mg/m(2)) in a 3 + 3 design, plus irinotecan (16 or 20 mg/m(2)/d) for 5 days for 2 consecutive weeks every 21 days. The primary end points were establishing the maximum-tolerated dose (MTD), recommended phase II dose (RPIID), and pharmacokinetics of the combination. Preliminary safety and efficacy data were also collected. RESULTS Twenty-seven children and 19 adolescents received a median of 7.1 and 6.0 weeks of cetuximab therapy, respectively. Cetuximab 250 mg/m(2) weekly plus irinotecan 16 mg/m(2)/d (pediatric) or 20 mg/m(2)/d (adolescent) have been established as the MTD/RPIID. Dose-limiting toxicities included diarrhea and neutropenia. Mild to moderate (grade 1 to 2) acneiform rash occurred in a majority of patients; no grade 3 to 4 rashes were observed. Cetuximab demonstrated dose-dependent clearance in both children and adolescents, similar to that in adults. There were two confirmed partial responses, both in patients with CNS tumors. Stable disease was achieved in 18 patients overall, including 10 patients with CNS tumors (38.5%). CONCLUSION The cetuximab/irinotecan combination can be given safely to children and adolescents with cancer. Promising activity, particularly in CNS tumors, warrants phase II evaluation of this regimen.
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Affiliation(s)
- Tanya M Trippett
- Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Morales J, Bono MR, Fierro A, Iñiguez R, Zehnder C, Rosemblatt M, Calabran L, Herzog C, Benavente D, Aguiló J, Pefaur J, Alba A, Ferrario M, Simon W, Contreras L, Buckel E. Alemtuzumab induction in kidney transplantation: clinical results and impact on T-regulatory cells. Transplant Proc 2009; 40:3223-8. [PMID: 19010240 DOI: 10.1016/j.transproceed.2008.03.066] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Alemtuzumab (ALT), a humanized monoclonal anti-CD52 antibody, was introduced in solid organ transplantation as an induction agent. ALT associated with anticalcineurins has provided a low incidence of acute rejection episodes (ARE) and potential tolerogenic properties. We analyzed the clinical outcomes and effects on peripheral Treg of renal transplant recipients treated with ALT. Six-month data on kidney alone or kidney combined with pancreas or liver patients treated with ALT and tacrolimus (TAC) in standard doses were compared with those on renal transplant recipients of similar demography who were not treated with ALT. We evaluated patient and graft survivals, ARE incidence, hematological parameters, renal function, adverse events, and CD4+CD25+FoxP3+ T cells in peripheral blood. Demographics of recipients, donors, and transplants were similar in both groups. Mean HLA mismatch was slightly greater among ALT-treated patients (3.5 vs 2.5). No combined transplantation was performed in the ALT-untreated group. Patient and graft survivals were 100% without rejection or serious infections in both groups. ALT-treated recipients showed anemia and leukopenia in 3 patients as well as severe lymphopenia in 5 recipients, who partially recovered on day 90. Final mean plasma creatinine was 1.4 mg/dL, while calculated creatinine clearance was approximately 65 mL/min in both groups. Mean Treg cell percentage was higher among ALT-treated recipients than the comparative group or healthy controls (P < .05). In conclusion, renal transplantation results obtained using ALT with rigorous immunosuppressive therapy were excellent; serious adverse events and acute rejection were absent. The effect of the increased proportion of Treg cells must be evaluated with longer observation.
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Affiliation(s)
- J Morales
- Centro de Trasplante, Clínica Las Condes, Laboratoric de Inmunologia, Facutad de Ciencìas, Universidad Andrés Bello and Fundación Ciencìa para la Vida, Santiago, Santiago, Chile.
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Zangos S, Müller C, Mayer F, Naguib NN, Nour-Eldin NEA, Hansmann ML, Herzog C, Hammerstingl RM, Thalhammer A, Mack M, Vogl TJ, Eichler K. [Retrospective 5-year analysis of MR-guided biopsies in a low-field MR system]. ROFO-FORTSCHR RONTG 2009; 181:658-63. [PMID: 19517340 DOI: 10.1055/s-0028-1109349] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the safety and clinical value of MR-guided biopsies in an open 0.2 T low-field system. MATERIALS AND METHODS A total of 322 patients with suspicious lesions of different body regions were biopsied in a low-field MRI system (0.2 T, Concerto, Siemens). The procedures were guided using T 1-weighted Flash sequences (TR/TE = 100/9; 70 degrees). The lesions were repeatedly biopsied using the coaxial technique with a 15-gauge (diameter 2 mm) puncture needle. Complications and biopsy findings were analyzed retrospectively. RESULTS In all cases the biopsy procedures were successfully performed with MR guidance. In 298 patients diagnosis was able to be confirmed on the basis of the probes. The clinical follow-up showed that in 24 patients the lesions were missed by MR-guided biopsy. From this a sensitivity of 86%, a specificity of 87% and an accuracy of 93% were calculated. In two patients major complications were observed (morbidity rate 0.6 %). CONCLUSION MR-guided biopsy can be performed safely and precisely in a low-field MR system and are a supplement to US or CT-guided biopsies.
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Affiliation(s)
- S Zangos
- Institut für Diagnostische und Interventionelle Radiologie, J.-W.-Goethe-Universität Frankfurt.
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Vidal C, Herzog C, Haeberle A, Bombarde C, Miquel M, Carimalo J, Launay J, Mouillet-Richard S, Lasmézas C, Dormont D, Kellermann O, Bailly Y. Early dysfunction of central 5-HT system in a murine model of bovine spongiform encephalopathy. Neuroscience 2009; 160:731-43. [DOI: 10.1016/j.neuroscience.2009.02.072] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 02/18/2009] [Accepted: 02/19/2009] [Indexed: 12/16/2022]
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38
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Hughes DP, Crutchley M, Douglas WI, Munsell MF, Vaporciyan AA, Herzog C, Tsai FW, Huh W. Incidence, detection, and management of cardiac metastasis in pediatric sarcoma patients. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.10060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10060 Background: Sarcoma metastasizing to the heart is a difficult and complicated clinical problem, yet local control is feasible and effective for select patients with cardiac metastasis. Diligence is required to detect these lesions while still amenable to treatment, and echocardiogram remains the best tool for detecting cardiac disease. Methods: We reviewed all echocardiograms (1330) performed on 307 pediatric sarcoma patients treated at UT M. D. Anderson Cancer Center between 1997 and 2008. Measures of cardiac function and pathology (including size of ventricles and atria, function of ventricles and valves, presence of metastasis, and presence of pericardial effusion) were assigned numerical values. Fisher's exact test and the Wilcoxon rank-sum test compared clinical characteristics of patients with and without cardiac metastases. Results: The prevalence of cardiac metastases was 1.6% (5/307) with 95% confidence interval 0.5% to 3.8%. The presence of cardiac metastasis positively correlated with pericardial effusion (p = 0.001) and tricuspid valve insufficiency (p = 0.014). The probability of a patient with pericardial effusion having a cardiac metastasis was 28.6% (95% CI: 3.7%-71%). Of the 5 patients with documented sarcoma metastasis to the heart, 3 had widespread refractory disease, were given no cardiac-specific therapy, and rapidly died from disease. One patient who had widespread disease controlled with chemotherapy and radiation had open resection of 2 cardiac metastases which resulted in site-specific disease control for 6 months before succumbing to progressive extra-cardiac disease. Another patient had isolated cardiac metastasis, treated with open resection of 2 metastases followed by adjuvant chemotherapy, and has been without recurrent cardiac metastases for 5 years and 9 months. Conclusions: Durable local control for sarcoma metastasizing to the heart is possible and effective for select patients. Pericardial effusion merits evaluation for potential associated cardiac metastasis. Echocardiogram monitoring of sarcoma patients remains important, and should include screening for possible cardiac metastasis. No significant financial relationships to disclose.
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Affiliation(s)
- D. P. Hughes
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - M. Crutchley
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - W. I. Douglas
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - M. F. Munsell
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - A. A. Vaporciyan
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - C. Herzog
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - F. W. Tsai
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - W. Huh
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
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Anderson P, Kopp L, Anderson N, Cornelius K, Herzog C, Hughes D, Huh W. Novel bone cancer drugs: investigational agents and control paradigms for primary bone sarcomas (Ewing's sarcoma and osteosarcoma). Expert Opin Investig Drugs 2008; 17:1703-15. [DOI: 10.1517/13543784.17.11.1703] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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40
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Bakker ABH, Python C, Kissling CJ, Pandya P, Marissen WE, Brink MF, Lagerwerf F, Worst S, van Corven E, Kostense S, Hartmann K, Weverling GJ, Uytdehaag F, Herzog C, Briggs DJ, Rupprecht CE, Grimaldi R, Goudsmit J. First administration to humans of a monoclonal antibody cocktail against rabies virus: safety, tolerability, and neutralizing activity. Vaccine 2008; 26:5922-7. [PMID: 18804136 DOI: 10.1016/j.vaccine.2008.08.050] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 07/22/2008] [Accepted: 08/31/2008] [Indexed: 11/25/2022]
Abstract
Immediate passive immune prophylaxis as part of rabies post-exposure prophylaxis (PEP) often cannot be provided due to limited availability of human or equine rabies immunoglobulin (HRIG and ERIG, respectively). We report first clinical data from two phase I studies evaluating a monoclonal antibody cocktail CL184 against rabies. The studies included healthy adult subjects in the USA and India and involved two parts. First, subjects received a single intramuscular dose of CL184 or placebo in a double blind, randomized, dose-escalation trial. Second, open-label CL184 (20IU/kg) was co-administered with rabies vaccine. Safety was the primary objective and rabies virus neutralizing activity (RVNA) was investigated as efficacy parameter. Pain at the CL184 injection site was reported by less than 40% of subjects; no fever or local induration, redness or swelling was observed. RVNA was detectable from day 1 to day 21 after a single dose of CL184 20 or 40IU/kg. All subjects had adequate (>0.5IU/mL) RVNA levels from day 14 onwards when combined with rabies vaccine. CL184 appears promising as an alternative to RIG in PEP.
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Abstract
In recent years MR imaging has played an increasingly important role in the diagnosis and treatment of prostate cancer. MR imaging of the prostate allows a clear delineation of the anatomic structures and prostate tumors when performing interventions such as biopsies, brachytherapy or thermal therapy of the prostate gland. MRI robotic assistance will improve the accuracy of the interventions. Due to the advantages of MR imaging MR-guided prostate interventions will play an increasing role in future.
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Affiliation(s)
- S Zangos
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany.
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42
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Burkhard T, Herzog C, Linzbach S, Spyridopoulos I, Hübner F, Vogl T. Cardiac 31P-MRS compared to echocardiographic findings in patients with hypertensive heart disease without overt systolic dysfunction – preliminary results. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073953] [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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43
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Burkhard T, Herzog C, Linzbach S, Spyridopoulos I, Vogl T. Impaired diastolic function in hypertension: cardiac MRI flow measurement compared to echocardiography. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073596] [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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44
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Hayes-Jordan A, Anderson P, Curley S, Herzog C, Lally KP, Green HL, Hunt K, Mansfield P. Continuous hyperthermic peritoneal perfusion for desmoplastic small round cell tumor. J Pediatr Surg 2007; 42:E29-32. [PMID: 17706484 DOI: 10.1016/j.jpedsurg.2007.05.047] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [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: 10/23/2022]
Abstract
Desmoplastic small round cell tumor (DSRCT) is a rare disease of children, adolescents, and young adults that begins and spreads on the peritoneal surfaces. Desmoplastic small round cell tumor usually presents with diffuse abdominal metastatic disease similar in gross appearance to carcinomatosis. To date, very aggressive treatment programs have yielded dismal outcomes. Here we present 2 cases of DSRCT that were treated with aggressive surgical excision followed by intraoperative continuous hyperthermic peritoneal perfusion using cisplatin. These are the first pediatric case reports of DSRCT being treated with continuous hyperthermic peritoneal perfusion, a procedure usually used in treatment of adult carcinomatosis.
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Affiliation(s)
- Andrea Hayes-Jordan
- Department of Surgical Oncology at the University of Texas MD Anderson Cancer Center and MDACC-Children's Cancer Hospital, USA.
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45
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Morales J, Fierro A, Benavente D, Zehnder C, Ferrario M, Contreras L, Herzog C, Buckel E. Conversion from a calcineurin inhibitor-based immunosuppressive regimen to everolimus in renal transplant recipients: effect on renal function and proteinuria. Transplant Proc 2007; 40:587-9. [PMID: 17445551 DOI: 10.1016/j.transproceed.2007.12.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
New immunosuppressive agents are being actively researched to avoid complications of chronic allograft nephropathy (CAN), calcineurin inhibitor (CNI) nephrotoxicity, and posttransplantation cancer. The family of mTOR inhibitors offers a unique immunosuppressive opportunity to avoid CNI toxicity and reduce the incidence of malignancy. Nevertheless, increasing data have demonstrated that sirolimus (SRL), the first mTOR introduced in the treatment of solid organ transplant recipients, induces proteinuria, an adverse event that could produce deterioration of long-term renal function. In this short-term study of patients followed for 1 to 16 months, we examined changes in renal function and proteinuria among renal transplant recipients converted from a CNI-based regimen to an everolimus (EVL)-based one, a recently introduced mTOR inhibitor. Our data showed that renal function can be optimized after conversion to EVL by up to 42% in recipients showing CAN grade 1 or 2, or CNI nephrotoxicity. Importantly, patients who improved their creatinine clearance did not show increased proteinuria measured in a voided specimen as the ratio of urinary protein and creatinine concentration (P/C). These results, if confirmed with long-term follow-up and a larger number of patients, would allow us to consider EVL as a promising agent for maintenance immunosuppressive regimens in kidney transplantation.
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Affiliation(s)
- J Morales
- Unidad de Trasplante, Clinica Las Condes, Santiago, Chile.
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46
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Morales J, Fierro A, Benavente D, Zehnder C, Ferrario M, Contreras L, Herzog C, Buckel E. Conversion from a calcineurin inhibitor-based immunosuppressive regimen to everolimus in renal transplant recipients: effect on renal function and proteinuria. Transplant Proc 2007; 39:591-3. [PMID: 17445551 DOI: 10.1016/j.transproceed.2006.12.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
New immunosuppressive agents are being actively researched to avoid complications of chronic allograft nephropathy (CAN), calcineurin inhibitor (CNI) nephrotoxicity, and posttransplantation cancer. The family of mTOR inhibitors offers a unique immunosuppressive opportunity to avoid CNI toxicity and reduce the incidence of malignancy. Nevertheless, increasing data have demonstrated that sirolimus (SRL), the first mTOR introduced in the treatment of solid organ transplant recipients, induces proteinuria, an adverse event that could produce deterioration of long-term renal function. In this short-term study of patients followed for 1 to 16 months, we examined changes in renal function and proteinuria among renal transplant recipients converted from a CNI-based regimen to an everolimus (EVL)-based one, a recently introduced mTOR inhibitor. Our data showed that renal function can be optimized after conversion to EVL by up to 42% in recipients showing CAN grade 1 or 2, or CNI nephrotoxicity. Importantly, patients who improved their creatinine clearance did not show increased proteinuria measured in a voided specimen as the ratio of urinary protein and creatinine concentration (P/C). These results, if confirmed with long-term follow-up and a larger number of patients, would allow us to consider EVL as a promising agent for maintenance immunosuppressive regimens in kidney transplantation.
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Affiliation(s)
- J Morales
- Unidad de Trasplante, Clinica Las Condes, Santiago, Chile.
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47
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Loutan L, Bovier P, Herzog C. Immunogenicity and safety of a virosomal hepatitis A vaccine in HIV-positive patients. Vaccine 2007; 25:6310-2. [PMID: 17640777 DOI: 10.1016/j.vaccine.2007.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 06/11/2007] [Accepted: 06/11/2007] [Indexed: 01/13/2023]
Abstract
This short report presents results of an open uncontrolled single centre study which evaluated immunogenicity and safety of a virosome-formulated hepatitis A vaccine (Epaxal) in 14 HIV-positive adult patients and 64 healthy adults receiving a primary immunisation and a booster dose 12 months later. Seroconversion rates (> or =20 mIU/mL), geometric mean concentration (GMC) of anti-HAV antibodies, local and systemic adverse events (AEs) were assessed at baseline and at Months 1, 6, 12, and 13. The seroconversion rate was 63.6% at Month 1 and 91.7% at Month 13 in HIV-positive patients versus 93.8 and 100% in healthy adults. The booster dose increased GMCs from 25.5 to 659.2 mIU/mL in HIV-positive patients versus 104 and 2986 mIU/mL in healthy adults. Epaxal was well tolerated by the HIV-positive patients and was at least as immunogenic as reported for aluminium-adsorbed vaccines. In conclusion, Epaxal can be considered an immunogenic and safe hepatitis A vaccine in HIV-positive patients.
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Affiliation(s)
- L Loutan
- Travel and Migration Medicine Unit, Geneva University Hospitals, rue Micheli-du-Crest 24, 1211 Geneva 14, Switzerland
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48
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Gore L, Kuttesch J, Hunger SP, Herzog C, Narendaren A, Boklan J, Foreman NK, Ivy SP, Boucher N, Trippett TM. A phase Ib study of oxaliplatin in combination with fluorouracil (5FU) and leucovorin (LV) in pediatric patients (pts) with advanced solid tumors. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.9548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9548 Background: Platinums have significant activity in a wide variety of pediatric tumors, and oxaliplatin exhibits synergy with 5FU and LV in adults with colorectal cancer in FOLFOX regimens. The primary objectives of this study are to determine the maximum tolerated dose (MTD) of the modified FOLFOX6 regimen in pediatric tumors. Secondary objectives include safety, PK pharmacokinetic (PK) and PET scan efficacy analyses. Methods: Pts age <21 years with advanced cancers and adequate organ function are eligible. Patients are stratified by tumor type (CNS or non-CNS) to better delineate the potential neurotoxicity in patients with altered neurologic function. Pts received oxaliplatin starting at 85 mg/m2 and LV 400 mg/m2 over 2 hours on day 1 followed by a 5FU bolus of 400 mg/m2 then 2,400 mg/m2 continuous infusion over 46 hours, every 2 weeks (3 courses = 1 cycle), with integrated PK sampling in a limited dose escalation design. Standard 3+3 dose escalation, definitions of dose limiting toxicity (DLT), and dose modification for toxicity are implemented. The MTD is expanded to 15 patients to confirm and further characterize tolerability and toxicity. Results: To date, 15 very heavily pre-treated patients (7 M, 8 F) have received 25 cycles (range 1–4, median 2) of treatment at 2 dose levels. One of 8 pts at dose level 2 (oxaliplatin 100 mg/m2) developed DLT (delay in repeat treatment > 14 days due to grade 3 platelets). Treatment has been well tolerated. The most frequently reported related grade 3–4 adverse events (AEs) are reversible leukocytes (29%), neutropenia (43%), platelets (35%) and lymphopenia (21%). 31 of 90 courses (34%) have been delayed for neutropenia and thrombocytopenia. Anti-tumor activity to date includes a confirmed partial response lasting 15 weeks in a patient with osteosarcoma, and prolonged stable disease in 5 other pts with brain tumors (2), hepatoblastoma (2) and sarcoma (1). Conclusions: The modified FOLFOX6 regimen has significant but reversible myelosuppression in heavily pre-treated pediatric patients, but is tolerable and has promising activity in several tumor types. Cohort expansion continues at 100 mg/m2 of oxaliplatin. PET scan and pharmacokinetic analyses will be presented. No significant financial relationships to disclose.
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Affiliation(s)
- L. Gore
- UCHSC At Fitzsimons, Aurora, CO; Vanderbilt University Medical Center, Nashville, TN; University of Florida Shands Cancer Center, Gainesville, FL; University of Texas, MD Anderson Cancer Center, Houston, TX; University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Phoenix Children's Hospital, Phoenix, AZ; National Cancer Institute, Rockville, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J. Kuttesch
- UCHSC At Fitzsimons, Aurora, CO; Vanderbilt University Medical Center, Nashville, TN; University of Florida Shands Cancer Center, Gainesville, FL; University of Texas, MD Anderson Cancer Center, Houston, TX; University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Phoenix Children's Hospital, Phoenix, AZ; National Cancer Institute, Rockville, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S. P. Hunger
- UCHSC At Fitzsimons, Aurora, CO; Vanderbilt University Medical Center, Nashville, TN; University of Florida Shands Cancer Center, Gainesville, FL; University of Texas, MD Anderson Cancer Center, Houston, TX; University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Phoenix Children's Hospital, Phoenix, AZ; National Cancer Institute, Rockville, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - C. Herzog
- UCHSC At Fitzsimons, Aurora, CO; Vanderbilt University Medical Center, Nashville, TN; University of Florida Shands Cancer Center, Gainesville, FL; University of Texas, MD Anderson Cancer Center, Houston, TX; University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Phoenix Children's Hospital, Phoenix, AZ; National Cancer Institute, Rockville, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - A. Narendaren
- UCHSC At Fitzsimons, Aurora, CO; Vanderbilt University Medical Center, Nashville, TN; University of Florida Shands Cancer Center, Gainesville, FL; University of Texas, MD Anderson Cancer Center, Houston, TX; University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Phoenix Children's Hospital, Phoenix, AZ; National Cancer Institute, Rockville, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J. Boklan
- UCHSC At Fitzsimons, Aurora, CO; Vanderbilt University Medical Center, Nashville, TN; University of Florida Shands Cancer Center, Gainesville, FL; University of Texas, MD Anderson Cancer Center, Houston, TX; University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Phoenix Children's Hospital, Phoenix, AZ; National Cancer Institute, Rockville, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - N. K. Foreman
- UCHSC At Fitzsimons, Aurora, CO; Vanderbilt University Medical Center, Nashville, TN; University of Florida Shands Cancer Center, Gainesville, FL; University of Texas, MD Anderson Cancer Center, Houston, TX; University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Phoenix Children's Hospital, Phoenix, AZ; National Cancer Institute, Rockville, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S. P. Ivy
- UCHSC At Fitzsimons, Aurora, CO; Vanderbilt University Medical Center, Nashville, TN; University of Florida Shands Cancer Center, Gainesville, FL; University of Texas, MD Anderson Cancer Center, Houston, TX; University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Phoenix Children's Hospital, Phoenix, AZ; National Cancer Institute, Rockville, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - N. Boucher
- UCHSC At Fitzsimons, Aurora, CO; Vanderbilt University Medical Center, Nashville, TN; University of Florida Shands Cancer Center, Gainesville, FL; University of Texas, MD Anderson Cancer Center, Houston, TX; University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Phoenix Children's Hospital, Phoenix, AZ; National Cancer Institute, Rockville, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - T. M. Trippett
- UCHSC At Fitzsimons, Aurora, CO; Vanderbilt University Medical Center, Nashville, TN; University of Florida Shands Cancer Center, Gainesville, FL; University of Texas, MD Anderson Cancer Center, Houston, TX; University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Phoenix Children's Hospital, Phoenix, AZ; National Cancer Institute, Rockville, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
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Trippett TM, Kuttesch J, Herzog C, Boklan J, Bagatell R, Hunger S, Arceci R, Lu H, Langer C, Gore L. A phase I study of cetuximab and irinotecan in pediatric patients (pts) with refractory solid tumors. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.9547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9547 Background: Irinotecan has shown antitumor activity in a number of pediatric tumors. In adults with colorectal cancer, combining irinotecan with cetuximab enhances clinical activity as compared to treatment with irinotecan alone. We implemented this first-in- pediatrics phase I study to determine the maximum tolerated dose (MTD) and recommended Phase II dose (RP2D) of cetuximab and irinotecan in pediatric patients. Methods: 35 heavily pre-treated pts with refractory solid tumors were enrolled: brainstem glioma/astrocytoma (16), hepatoblastoma (4), neuroblastoma (2), other (13). Weekly cetuximab was escalated in 3 sequential dose levels: 75, 150 or 250mg/m2; Irinotecan was given at 16 or 20 mg/m2/day over 1 hour [daily × 5] for two weeks, every 21 days. Correlative EGFR expression (immunohistochemistry and FISH) and/or mutations, pharmacokinetics (PK) of and immune response to cetuximab were performed. Results: Pts were treated in two age cohorts (ages 1–12 yrs = Group A, and 13–18 yrs = Group B). PK analyses show linearity, with similar t1/2, clearance, and volume of distribution between groups. Irinotecan-related DLT in 2/6 pts in Group A/dose 2 necessitated dose de-escalation. Three pts experienced Grade 3 hypersensitivity infusion reaction and were discontinued. A pt with an EGFR-negative high-grade glioma (dose level 1) achieved a >70% reduction in tumor size and remains on study for 16+ months (24 cycles). A pt with ependymoma experienced a partial response (PR) and continues on cycle 12+. 9 pts received ≥4 cycles of therapy. 16 pts had a best response of stable disease or PR (mean 17 wks, range 5–66+ wks) for a clinical benefit rate of 45%. Conclusions: The combination of cetuximab and irinotecan is well-tolerated over multiple repeat cycles without cumulative toxicity in children with refractory CNS and non-CNS solid tumors. Promising preliminary anti-cancer activity was observed in a variety of pediatric solid tumors. Detailed biologic correlative and PK data will be presented. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- T. M. Trippett
- Memorial Sloan-Kettering Cancer Center, New York, NY; Vanderbilt Children's Hospital, Nashville, TN; MD Anderson Cancer Center, Houston, TX; Phoenix Children's Hospital, Phoenix, AZ; University of Arizona Health Sciences Center, Tucson, AZ; University of Florida, Gainesville, FL; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Bristol-Myers Squibb, Wallingford, CT; University of Colorado Health Sciences Center, Denver, CO
| | - J. Kuttesch
- Memorial Sloan-Kettering Cancer Center, New York, NY; Vanderbilt Children's Hospital, Nashville, TN; MD Anderson Cancer Center, Houston, TX; Phoenix Children's Hospital, Phoenix, AZ; University of Arizona Health Sciences Center, Tucson, AZ; University of Florida, Gainesville, FL; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Bristol-Myers Squibb, Wallingford, CT; University of Colorado Health Sciences Center, Denver, CO
| | - C. Herzog
- Memorial Sloan-Kettering Cancer Center, New York, NY; Vanderbilt Children's Hospital, Nashville, TN; MD Anderson Cancer Center, Houston, TX; Phoenix Children's Hospital, Phoenix, AZ; University of Arizona Health Sciences Center, Tucson, AZ; University of Florida, Gainesville, FL; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Bristol-Myers Squibb, Wallingford, CT; University of Colorado Health Sciences Center, Denver, CO
| | - J. Boklan
- Memorial Sloan-Kettering Cancer Center, New York, NY; Vanderbilt Children's Hospital, Nashville, TN; MD Anderson Cancer Center, Houston, TX; Phoenix Children's Hospital, Phoenix, AZ; University of Arizona Health Sciences Center, Tucson, AZ; University of Florida, Gainesville, FL; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Bristol-Myers Squibb, Wallingford, CT; University of Colorado Health Sciences Center, Denver, CO
| | - R. Bagatell
- Memorial Sloan-Kettering Cancer Center, New York, NY; Vanderbilt Children's Hospital, Nashville, TN; MD Anderson Cancer Center, Houston, TX; Phoenix Children's Hospital, Phoenix, AZ; University of Arizona Health Sciences Center, Tucson, AZ; University of Florida, Gainesville, FL; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Bristol-Myers Squibb, Wallingford, CT; University of Colorado Health Sciences Center, Denver, CO
| | - S. Hunger
- Memorial Sloan-Kettering Cancer Center, New York, NY; Vanderbilt Children's Hospital, Nashville, TN; MD Anderson Cancer Center, Houston, TX; Phoenix Children's Hospital, Phoenix, AZ; University of Arizona Health Sciences Center, Tucson, AZ; University of Florida, Gainesville, FL; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Bristol-Myers Squibb, Wallingford, CT; University of Colorado Health Sciences Center, Denver, CO
| | - R. Arceci
- Memorial Sloan-Kettering Cancer Center, New York, NY; Vanderbilt Children's Hospital, Nashville, TN; MD Anderson Cancer Center, Houston, TX; Phoenix Children's Hospital, Phoenix, AZ; University of Arizona Health Sciences Center, Tucson, AZ; University of Florida, Gainesville, FL; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Bristol-Myers Squibb, Wallingford, CT; University of Colorado Health Sciences Center, Denver, CO
| | - H. Lu
- Memorial Sloan-Kettering Cancer Center, New York, NY; Vanderbilt Children's Hospital, Nashville, TN; MD Anderson Cancer Center, Houston, TX; Phoenix Children's Hospital, Phoenix, AZ; University of Arizona Health Sciences Center, Tucson, AZ; University of Florida, Gainesville, FL; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Bristol-Myers Squibb, Wallingford, CT; University of Colorado Health Sciences Center, Denver, CO
| | - C. Langer
- Memorial Sloan-Kettering Cancer Center, New York, NY; Vanderbilt Children's Hospital, Nashville, TN; MD Anderson Cancer Center, Houston, TX; Phoenix Children's Hospital, Phoenix, AZ; University of Arizona Health Sciences Center, Tucson, AZ; University of Florida, Gainesville, FL; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Bristol-Myers Squibb, Wallingford, CT; University of Colorado Health Sciences Center, Denver, CO
| | - L. Gore
- Memorial Sloan-Kettering Cancer Center, New York, NY; Vanderbilt Children's Hospital, Nashville, TN; MD Anderson Cancer Center, Houston, TX; Phoenix Children's Hospital, Phoenix, AZ; University of Arizona Health Sciences Center, Tucson, AZ; University of Florida, Gainesville, FL; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Bristol-Myers Squibb, Wallingford, CT; University of Colorado Health Sciences Center, Denver, CO
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Abstract
Meprins are zinc-dependent metalloproteinases that are highly expressed in the brush-border membranes of both the kidney and the intestines. Meprins are capable of proteolytically degrading extracellular matrix proteins, proteolytically processing bioactive proteins, and play a role in inflammatory processes. In this study, the function of meprin A in the acute kidney injury (AKI) model of cisplatin nephrotoxicity was examined. Normal linear localization of meprin A in the brush border membranes of proximal tubules was altered in AKI. The meprin A alpha-subunit was detected in the urine of both control and cisplatin-treated mice. A cleaved product of the meprin A beta-subunit, undetected in the urine of control mice, was found to be significantly increased in the urine during the progression of cisplatin nephrotoxicity. The excretion of this beta-fragment was found to be before the rise in serum creatinine and blood urea nitrogen (BUN) suggesting usefulness as a biomarker for AKI. Pretreatment of mice with a meprin A inhibitor afforded protection from cisplatin nephrotoxicity as reflected by significant decreases in serum creatinine, BUN, and the excretion of kidney injury molecule-1. These decreases in serum and urine biomarkers were accompanied by significant decreases in histologic markers such as leukocyte infiltration and apoptosis. Meprin A appears to be an important therapeutic target and urinary excretion appears to be a potential biomarker of AKI.
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Affiliation(s)
- C Herzog
- Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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