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Feng Z, He X, Zhang X, Wu Y, Xing B, Knowles A, Shan Q, Miller S, Hojnacki T, Ma J, Katona BW, Gade TPF, Siegel DL, Schrader J, Metz DC, June CH, Hua X. Author Correction: Potent suppression of neuroendocrine tumors and gastrointestinal cancers by CDH17CAR T cells without toxicity to normal tissues. Nat Cancer 2024; 5:691. [PMID: 38605236 DOI: 10.1038/s43018-024-00766-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Affiliation(s)
- Zijie Feng
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Xin He
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Xuyao Zhang
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Yuan Wu
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Bowen Xing
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Alison Knowles
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Qiaonan Shan
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Samuel Miller
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Taylor Hojnacki
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jian Ma
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Bryson W Katona
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Terence P F Gade
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Don L Siegel
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jörg Schrader
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - David C Metz
- Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Carl H June
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Xianxin Hua
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Metz DC. Regarding the American Gastroenterological Association Clinical Practice Update on Exocrine Pancreatic Insufficiency. Gastroenterology 2024; 166:713. [PMID: 37944647 DOI: 10.1053/j.gastro.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Affiliation(s)
- David C Metz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Soulen MC, Teitelbaum UR, Mick R, Eads J, Mondschein JI, Dagli M, van Houten D, Damjanov N, Schneider C, Cengel K, Metz DC. Integrated Capecitabine-Temozolomide with Radioembolization for Liver-Dominant G2 NETs: Long-Term Outcomes of a Single-Institution Retrospective Study. Cardiovasc Intervent Radiol 2024; 47:60-68. [PMID: 38057498 DOI: 10.1007/s00270-023-03614-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE Capecitabine-Temozolomide (CapTem) is an oral chemotherapy regimen for NETs. Both drugs are radiosensitizers. Integrating CapTem and Y90 transarterial radioembolization (TARE) in patients with grade 2 neuroendocrine tumor (NET) liver metastases achieved an encouraging objective response rate (ORR) and progression-free survival (PFS) in a feasibility study. This study expands that report to a larger cohort with longer follow-up. METHODS Therapy consisted of monthly cycles of capecitabine 600 mg/m2 twice daily for 14 days and temozolomide 150-200 mg/m2 on day 10-14. Simulation angiography was performed during the initial cycle. The dominant lobe was treated with 90Y-resin microspheres using BSA dosimetry on day 7 of the second cycle of CapTem. Patients with bilobar disease had the other lobe treated on day 7 of the third or fourth cycle. CapTem was continued until progression or intolerance. Clinical and laboratory assessment was done monthly and imaging every 3 months. RESULTS 35/37 patients completed the prescribed regimen. Primary sites of disease were pancreas (16), lung (10), gut (7) and unknown (4). Mean duration of CapTem was 12 months (range, 4-32 months). ORR in the liver was 72% with a disease control rate of 100%. Median PFS was 36 months (95% CI, 25-45 months). Median overall survival was 41 months (95% CI, 24-87 months) from initiation of CapTemY90 therapy and 130 months (95% CI, 56-172 months) from initial diagnosis. CONCLUSION Chemoradiation with CapTem and TARE provided durable control of G2 NET liver metastases for substantially longer than expectations for embolotherapy or chemotherapy alone.
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Affiliation(s)
- Michael C Soulen
- Neuroendocrine Tumor Program, Division of Interventional Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
- Neuroendocrine Tumor Program, Department of Radiology, Abramson Cancer Center, University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Ursina R Teitelbaum
- Neuroendocrine Tumor Program, Division of Medical Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Rosemarie Mick
- Department of Biostatistics, Epidemiology and Informatics, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer Eads
- Neuroendocrine Tumor Program, Division of Medical Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey I Mondschein
- Neuroendocrine Tumor Program, Division of Interventional Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Mandeep Dagli
- Neuroendocrine Tumor Program, Division of Interventional Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Diana van Houten
- Neuroendocrine Tumor Program, Division of Interventional Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Nevena Damjanov
- Neuroendocrine Tumor Program, Division of Medical Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Charles Schneider
- Neuroendocrine Tumor Program, Division of Medical Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Keith Cengel
- Neuroendocrine Tumor Program, Division of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - David C Metz
- Neuroendocrine Tumor Program, Division of Gastroenterology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
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Metz DC. Editorial: deja vu all over again-let the P-CAB wars begin. Aliment Pharmacol Ther 2023; 57:912-913. [PMID: 36952269 DOI: 10.1111/apt.17412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Affiliation(s)
- David C Metz
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Walker MP, Shenoy V, Metz DC, Stanley CA, Fraker D, Chandrasekhara V, Amaro A. Case presentation of 8-year follow up of recurrent malignant duodenal Insulinoma and lymph node metastases and literature review of malignant Insulinoma management. BMC Endocr Disord 2022; 22:310. [PMID: 36494838 PMCID: PMC9733155 DOI: 10.1186/s12902-022-01219-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 11/04/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Insulinoma is an uncommon insulin-secreting neuroendocrine tumor that presents with severe recurrent hypoglycemia. Although cases of extrapancreatic insulinomas have been reported, the majority of insulinomas occur in the pancreas. The number of reported cases of ectopic insulinomas with follow-up assessments is limited and they do not report disease recurrence. The current report presents the first documented case of recurrent extrapancreatic insulinoma with 8 years of follow-up, provides relevant literature review, and proposes surveillance and treatment strategies. CASE PRESENTATION We describe an insulinoma localized in the duodenal wall of a 36-year-old female who presented in 2013 with weight gain and Whipple's triad and was successfully managed with duodenotomy and enucleation. She presented again in 2017 with recurrent Whipple's triad and was found to have metastatic disease localized exclusively to peripancreatic lymph nodes. Primary pancreatic insulinoma was not evident and her hypoglycemia resolved following lymph node dissection. Eight years after initial presentation continuous glucose monitoring (CGM) showed a trend for euglycemia, and PET-CT Gallium 68 DOTATATE scan evaluation indicated absence of recurrent disease. CONCLUSION Insulinomas are rare clinical entities and extrapancreatic insulinomas are particularly uncommon. Follow-up evaluation and treatment strategies for ectopic insulinoma recurrence presents a significant clinical challenge as the condition has hitherto remained undescribed in the literature. Available evidence in the literature indicates that lymph node metastases of intrapancreatic insulinomas likely do not change prognosis. Given the absence of long-term data informing the management and monitoring of patients with extrapancreatic insulinoma, we suggest patient education for hypoglycemic symptoms, monitoring for hypoglycemia with CGM, annual imaging, and a discussion with patients regarding treatment with octreotide or alternative somatostatin receptor analog therapies.
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Affiliation(s)
- Michelle P Walker
- Department of Endocrinology, University of Pennsylvania, 3400 Civic Center Boulevard, West Pavilion, 4th Floor, Philadelphia, PA, 19104, USA.
| | - Vikram Shenoy
- Department of Endocrinology, Christiana Care, 4735 Ogletown Stanton Road, Suite MAP2, Newark, DE, 19713, USA
| | - David C Metz
- Department of Gastroenterology, University of Pennsylvania, 3400 Civic Center Boulevard, South Pavilion, 4th Floor, Philadelphia, PA, 19104, USA
| | - Charles A Stanley
- Department of Endocrinology and Metabolism, Children's Hospital of Philadelphia, 3516 Civic Center Boulevard #802, Philadelphia, PA, 19104, USA
| | - Douglas Fraker
- Department of Endocrine and Oncologic Surgery, University of Pennsylvania, 3400 Civic Center Boulevard, West Pavilion, 3rd Floor, Philadelphia, PA, 19104, USA
| | - Vinay Chandrasekhara
- Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street. SW, Rochester, MN, 55905, USA
| | - Anastassia Amaro
- Department of Endocrinology, University of Pennsylvania, 3400 Civic Center Boulevard, West Pavilion, 4th Floor, Philadelphia, PA, 19104, USA
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Dellon ES, Gonsalves N, Abonia JP, Alexander JA, Arva NC, Atkins D, Attwood SE, Auth MKH, Bailey DD, Biederman L, Blanchard C, Bonis PA, Bose P, Bredenoord AJ, Chang JW, Chehade M, Collins MH, Di Lorenzo C, Dias JA, Dohil R, Dupont C, Falk GW, Ferreira CT, Fox AT, Genta RM, Greuter T, Gupta SK, Hirano I, Hiremath GS, Horsley-Silva JL, Ishihara S, Ishimura N, Jensen ET, Gutiérrez-Junquera C, Katzka DA, Khoury P, Kinoshita Y, Kliewer KL, Koletzko S, Leung J, Liacouras CA, Lucendo AJ, Martin LJ, McGowan EC, Menard-Katcher C, Metz DC, Miller TL, Moawad FJ, Muir AB, Mukkada VA, Murch S, Nhu QM, Nomura I, Nurko S, Ohtsuka Y, Oliva S, Orel R, Papadopoulou A, Patel DA, Pesek RD, Peterson KA, Philpott H, Putnam PE, Richter JE, Rosen R, Ruffner MA, Safroneeva E, Schreiner P, Schoepfer A, Schroeder SR, Shah N, Souza RF, Spechler SJ, Spergel JM, Straumann A, Talley NJ, Thapar N, Vandenplas Y, Venkatesh RD, Vieira MC, von Arnim U, Walker MM, Wechsler JB, Wershil BK, Wright BL, Yamada Y, Yang GY, Zevit N, Rothenberg ME, Furuta GT, Aceves SS. International Consensus Recommendations for Eosinophilic Gastrointestinal Disease Nomenclature. Clin Gastroenterol Hepatol 2022; 20:2474-2484.e3. [PMID: 35181570 PMCID: PMC9378753 DOI: 10.1016/j.cgh.2022.02.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/28/2022] [Accepted: 02/07/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Substantial heterogeneity in terminology used for eosinophilic gastrointestinal diseases (EGIDs), particularly the catchall term "eosinophilic gastroenteritis," limits clinical and research advances. We aimed to achieve an international consensus for standardized EGID nomenclature. METHODS This consensus process utilized Delphi methodology. An initial naming framework was proposed and refined in iterative fashion, then assessed in a first round of Delphi voting. Results were discussed in 2 consensus meetings, and the framework was updated and reassessed in a second Delphi vote, with a 70% threshold set for agreement. RESULTS Of 91 experts participating, 85 (93%) completed the first and 82 (90%) completed the second Delphi surveys. Consensus was reached on all but 2 statements. "EGID" was the preferred umbrella term for disorders of gastrointestinal (GI) tract eosinophilic inflammation in the absence of secondary causes (100% agreement). Involved GI tract segments will be named specifically and use an "Eo" abbreviation convention: eosinophilic gastritis (now abbreviated EoG), eosinophilic enteritis (EoN), and eosinophilic colitis (EoC). The term "eosinophilic gastroenteritis" is no longer preferred as the overall name (96% agreement). When >2 GI tract areas are involved, the name should reflect all of the involved areas. CONCLUSIONS This international process resulted in consensus for updated EGID nomenclature for both clinical and research use. EGID will be the umbrella term, rather than "eosinophilic gastroenteritis," and specific naming conventions by location of GI tract involvement are recommended. As more data are developed, this framework can be updated to reflect best practices and the underlying science.
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Affiliation(s)
- Evan S Dellon
- Center for Esophageal Diseases and Swallowing and Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Nirmala Gonsalves
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - J Pablo Abonia
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Nicoleta C Arva
- Department of Pathology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dan Atkins
- Section of Pediatric Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Stephen E Attwood
- Department of Health Services Research, Durham University, Durham, United Kingdom
| | - Marcus K H Auth
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Alder Hey Children's NHS Foundation Trust and University of Liverpool, Liverpool, United Kingdom
| | - Dominique D Bailey
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York; Division of Digestive and Liver Disease, Department of Medicine, Columbia University Irving Medical Center, New York, New York; Columbia Center for Human Development, Columbia University Irving Medical Center, New York, New York
| | - Luc Biederman
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Carine Blanchard
- Department of Gastro-Intestinal Health, Immunology group, Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Peter A Bonis
- Division of Gastroenterology, Tufts University School of Medicine, Boston, Massachusetts
| | - Paroma Bose
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Riley Hospital for Children and Community Health Network, Indiana University School of Medicine, Indianapolis, Indianapolis
| | - Albert J Bredenoord
- Department of Gastroenterology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Joy W Chang
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MichiganI
| | - Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Margaret H Collins
- Division of Pathology and Laboratory Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Ranjan Dohil
- Division on Pediatric Gastroenterology, Rady's Children's Hospital, University of California, San Diego, San Diego, California
| | - Christophe Dupont
- Ramsay Group, Marcel Sembat Clinic, Paris Descartes University, Paris, France
| | - Gary W Falk
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania Philadelphia, Pennsylvania
| | - Cristina T Ferreira
- Hospital Santo Antônio, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Adam T Fox
- Paediatric Allergy, Guy's & St. Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
| | - Robert M Genta
- Division of Gastroenterology, Department of Pathology and Medicine, Baylor College of Medicine, Houston, Texas; Inform Diagnostics, Irving, Texas
| | - Thomas Greuter
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland; Division of Gastroenterology and Hepatology, University Hospital Lausanne, Lausanne, Switzerland
| | - Sandeep K Gupta
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Riley Hospital for Children and Community Health Network, Indiana University School of Medicine, Indianapolis, Indianapolis
| | - Ikuo Hirano
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Girish S Hiremath
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Shimane, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Shimane, Japan
| | - Elizabeth T Jensen
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Carolina Gutiérrez-Junquera
- Pediatric Gastroenterology Unit, University Hospital Puerta de Hierro Majadahonda, Autonomous University of Madrid, Majadahonda, Spain
| | - David A Katzka
- Division of Gastroenterology, Mayo Clinic Rochester, Minnesota
| | - Paneez Khoury
- Human Eosinophil Section, National Institute of Allergy and Infectious Diseases/National Institutes of Health, Bethesda, Maryland
| | | | - Kara L Kliewer
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sibylle Koletzko
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany; Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland
| | - John Leung
- Division of Gastroenterology, Tufts University School of Medicine, Boston, Massachusetts
| | - Chris A Liacouras
- Center for Pediatric Eosinophilic Disorders, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Instituto de Investigación Sanitaria Princesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Tomelloso, Spain
| | - Lisa J Martin
- Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Emily C McGowan
- Division of Allergy and Immunology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Calies Menard-Katcher
- Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado; Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, Colorado
| | - David C Metz
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania Philadelphia, Pennsylvania
| | | | - Fouad J Moawad
- Division of Gastroenterology and Hepatology, Scripps Clinic, La Jolla, California
| | - Amanda B Muir
- Center for Pediatric Eosinophilic Disorders, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vincent A Mukkada
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Simon Murch
- Warwick University Medical School, Coventry, United Kingdom
| | - Quan M Nhu
- Division of Gastroenterology and Hepatology, Scripps Clinic, La Jolla, California; Department of Molecular Medicine, Scripps Research Institute, San Diego, California; Division of Allergy and Immunology, University of California, San Diego, La Jolla, California
| | - Ichiro Nomura
- Division of Eosinophilic Gastrointestinal Disorders, Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, Massachusetts
| | - Yoshikazu Ohtsuka
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Salvatore Oliva
- Pediatric Digestive Endoscopy, Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, University Hospital, University of Rome, Rome, Italy
| | - Rok Orel
- University Children's Hospital Ljubljana, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Alexandra Papadopoulou
- Division of Gastroenterology and Hepatology, Children's Hospital Agia Sofia, First Department of Pediatrics, University of Athens, Athens, Greece
| | - Dhyanesh A Patel
- Center for Esophageal Disorders, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert D Pesek
- Division of Allergy and Immunology, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Hamish Philpott
- Department of Gastroenterology, Lyell McEwin Hospital, University of Adelaide, Adelaide, Australia
| | - Philip E Putnam
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Joel E Richter
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Rachel Rosen
- Aerodigestive Center, Boston Children's Hospital, Boston, Massachusetts
| | - Melanie A Ruffner
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ekaterina Safroneeva
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Philipp Schreiner
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Alain Schoepfer
- Division of Gastroenterology and Hepatology, University Hospital Lausanne, Lausanne, Switzerland
| | - Shauna R Schroeder
- Division of Gastroenterology, Hepatology, and Nutrition, Phoenix Children's Hospital, Phoenix, Arizona
| | - Neil Shah
- Portland Hospital, London, United Kingdom; Reckitt Healthcare, Slough, United Kingdom
| | - Rhonda F Souza
- Division of Gastroenterology and Center for Esophageal Diseases, Baylor Scott & White Center for Esophageal Research, Baylor University Medical Center, Baylor Scott & White Research Institute, Dallas, Texas
| | - Stuart J Spechler
- Division of Gastroenterology and Center for Esophageal Diseases, Baylor Scott & White Center for Esophageal Research, Baylor University Medical Center, Baylor Scott & White Research Institute, Dallas, Texas
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alex Straumann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Nicholas J Talley
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia; National Health and Medical Research Council Centre of Research Excellence on Digestive Health, Newcastle, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Nikhil Thapar
- Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, School of Medicine, University of Queensland, Brisbane, Australia; Woolworths Centre for Child Nutrition Research, Queensland University of Technology, Brisbane, Australia
| | - Yvan Vandenplas
- KidZ Health Castle, Vrije Universiteit Brussel, Brussels, Belgium
| | - Rajitha D Venkatesh
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
| | - Mario C Vieira
- Center for Pediatric Gastroenterology, Hospital Pequeno Príncipe, Curitiba, Brazil
| | - Ulrike von Arnim
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Magdeburg, Germany
| | - Marjorie M Walker
- Department of Pathology, College of Health, Medicine and Wellbeing, Faculty of Health and Medicine, University of Newcastle Callaghan, Australia
| | - Joshua B Wechsler
- Division of Gastroenterology, Hepatology, and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Barry K Wershil
- Division of Gastroenterology, Hepatology, and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Benjamin L Wright
- Division of Allergy, Asthma, and Clinical Immunology, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona; Section of Allergy and Immunology, Division of Pulmonology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Yoshiyuki Yamada
- Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan
| | - Guang-Yu Yang
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Noam Zevit
- Institute of Gastroenterology, Hepatology, and Nutrition, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel-Aviv University, Petah-Tikva, Israel
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Glenn T Furuta
- Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado; Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, Colorado
| | - Seema S Aceves
- Division of Allergy, Immunology, and Rheumatology, Departments of Pediatrics and Medicine, Rady Children's Hospital, University of California San Diego, San Diego, California
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Perkons NR, Metz DC, Siegelman ES, Yang Z, Collingwood R, Fortuna D, Pryma DA, Abt P, Hoteit MA. Where LI-RADS Falls Short: Two Cases of Image-diagnosed HCC, Found to Be NET on Explant. Transplantation 2022; 106:e350-e351. [PMID: 35731153 DOI: 10.1097/tp.0000000000004115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Nicholas R Perkons
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David C Metz
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Evan S Siegelman
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Zhaohai Yang
- Department of Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robin Collingwood
- Department of Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Danielle Fortuna
- Department of Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Daniel A Pryma
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Peter Abt
- Division of Transplant Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Maarouf A Hoteit
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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8
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Feng Z, He X, Zhang X, Wu Y, Xing B, Knowles A, Shan Q, Miller S, Hojnacki T, Ma J, Katona BW, Gade TPF, Siegel DL, Schrader J, Metz DC, June CH, Hua X. Potent suppression of neuroendocrine tumors and gastrointestinal cancers by CDH17CAR T cells without toxicity to normal tissues. Nat Cancer 2022; 3:581-594. [PMID: 35314826 DOI: 10.1038/s43018-022-00344-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 02/09/2022] [Indexed: 12/15/2022]
Abstract
Gastrointestinal cancers (GICs) and neuroendocrine tumors (NETs) are often refractory to therapy after metastasis. Adoptive cell therapy using chimeric antigen receptor (CAR) T cells, though remarkably efficacious for treating leukemia, is yet to be developed for solid tumors such as GICs and NETs. Here we isolated a llama-derived nanobody, VHH1, and found that it bound cell surface adhesion protein CDH17 upregulated in GICs and NETs. VHH1-CAR T cells (CDH17CARTs) killed both human and mouse tumor cells in a CDH17-dependent manner. CDH17CARTs eradicated CDH17-expressing NETs and gastric, pancreatic and colorectal cancers in either tumor xenograft or autochthonous mouse models. Notably, CDH17CARTs do not attack normal intestinal epithelial cells, which also express CDH17, to cause toxicity, likely because CDH17 is localized only at the tight junction between normal intestinal epithelial cells. Thus, CDH17 represents a class of previously unappreciated tumor-associated antigens that is 'masked' in healthy tissues from attack by CAR T cells for developing safer cancer immunotherapy.
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Affiliation(s)
- Zijie Feng
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Xin He
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Xuyao Zhang
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Yuan Wu
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Bowen Xing
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Alison Knowles
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Qiaonan Shan
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Samuel Miller
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Taylor Hojnacki
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jian Ma
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Bryson W Katona
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Terence P F Gade
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Don L Siegel
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jörg Schrader
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - David C Metz
- Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Carl H June
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Xianxin Hua
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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9
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Rico K, Duan S, Pandey RL, Chen Y, Chakrabarti JT, Starr J, Zavros Y, Else T, Katona BW, Metz DC, Merchant JL. Genome analysis identifies differences in the transcriptional targets of duodenal versus pancreatic neuroendocrine tumours. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000765. [PMID: 34750164 PMCID: PMC8576490 DOI: 10.1136/bmjgast-2021-000765] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/06/2021] [Indexed: 12/12/2022] Open
Abstract
Objective Gastroenteropancreatic neuroendocrine tumours (GEP-NETs) encompass a diverse group of neoplasms that vary in their secretory products and in their location within the gastrointestinal tract. Their prevalence in the USA is increasing among all adult age groups. Aim To identify the possible derivation of GEP-NETs using genome-wide analyses to distinguish small intestinal neuroendocrine tumours, specifically duodenal gastrinomas (DGASTs), from pancreatic neuroendocrine tumours. Design Whole exome sequencing and RNA-sequencing were performed on surgically resected GEP-NETs (discovery cohort). RNA transcript profiles available in the Gene Expression Omnibus were analysed using R integrated software (validation cohort). Digital spatial profiling (DSP) was used to analyse paraffin-embedded GEP-NETs. Human duodenal organoids were treated with 5 or 10 ng/mL of tumor necrosis factor alpha (TNFα) prior to qPCR and western blot analysis of neuroendocrine cell specification genes. Results Both the discovery and validation cohorts of small intestinal neuroendocrine tumours induced expression of mesenchymal and calcium signalling pathways coincident with a decrease in intestine-specific genes. In particular, calcium-related, smooth muscle and cytoskeletal genes increased in DGASTs, but did not correlate with MEN1 mutation status. Interleukin 17 (IL-17) and tumor necrosis factor alpha (TNFα) signalling pathways were elevated in the DGAST RNA-sequencing. However, DSP analysis confirmed a paucity of immune cells in DGASTs compared with the adjacent tumour-associated Brunner’s glands. Immunofluorescent analysis showed production of these proinflammatory cytokines and phosphorylated signal transducer and activator of transcription 3 (pSTAT3) by the tumours and stroma. Human duodenal organoids treated with TNFα induced neuroendocrine tumour genes, SYP, CHGA and NKX6.3. Conclusions Stromal–epithelial interactions induce proinflammatory cytokines that promote Brunner’s gland reprogramming.
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Affiliation(s)
- Karen Rico
- Department of Medicine, University of Arizona Medical Center - University Campus, Tucson, Arizona, USA
| | - Suzann Duan
- Department of Medicine, University of Arizona Medical Center - University Campus, Tucson, Arizona, USA
| | - Ritu L Pandey
- Department of Cellular and Molecular Medicine, University of Arizona Medical Center - University Campus, Tucson, Arizona, USA
| | - Yuliang Chen
- Department of Cellular and Molecular Medicine, University of Arizona Medical Center - University Campus, Tucson, Arizona, USA
| | - Jayati T Chakrabarti
- Department of Cellular and Molecular Medicine, University of Arizona Medical Center - University Campus, Tucson, Arizona, USA
| | - Julie Starr
- Department of Internal Medicine, Division of Gastroenterology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Yana Zavros
- Department of Cellular and Molecular Medicine, University of Arizona Medical Center - University Campus, Tucson, Arizona, USA
| | - Tobias Else
- Department of Internal Medicine-Endocrinology, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Bryson W Katona
- Department of Internal Medicine, Division of Gastroenterology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - David C Metz
- Department of Internal Medicine, Division of Gastroenterology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Juanita L Merchant
- Department of Medicine, University of Arizona Medical Center - University Campus, Tucson, Arizona, USA
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10
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Palchaudhuri S, Attalla S, Mehta SJ, Parsikia A, White RT, Ahmad NA, Ginsberg GG, Weiss MS, Demopoulos C, Keogh J, Metz DC, Kochman ML, Siddique SM. A Multimodal Interdisciplinary QI Intervention Is Associated with Reduction in After Hours Inpatient Endoscopy Cases. ACTA ACUST UNITED AC 2021; 23:226-233. [PMID: 34458878 DOI: 10.1016/j.tige.2021.05.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background and Aims Increasing demand for inpatient endoscopic services results in performing more non-emergent endoscopic cases after-hours, which poses risks to patient safety and negatively impacts patient and provider satisfaction. This study sought to quantify the existing state using quality improvement (QI) methodology, design targeted interventions, and determine their effectiveness. Methods We conducted an existing state evaluation through a process map, time-series study, and caseload analysis from 7/2017-12/2018. Using end-of-workday (EOW) as a proxy for patient/provider dissatisfaction and risk for patient safety events, we performed a prospective evaluation of a staged interdisciplinary multimodal intervention aimed to decrease the proportion of days with EOW after 7PM, decrease the proportion of cases begun after 5PM, and decrease EOW variability. The post-intervention period was 6/2019-2/2020. Results Based on existing state analyses, we implemented a series of targeted interventions: (1) provider workflow tips, (2) expedited transport for select patients, (3) pathway to reschedule appropriate cases to outpatient endoscopy, and (4) increased staffing for high caseload days through resource pooling. The proportion of days with EOW after 7PM decreased from 42.4% to 29.3% (caseload-adjusted odds ratio of 0.39, p< 0.001). Despite increased caseload, cases begun after 5PM decreased from 17.5% to 14.2% (OR 0.75, p = 0.009). EOW SD decreased from 2:20 hours to 1:36 hours. Conclusions The multimodal intervention reduced days with EOW after 7PM and the proportion of cases begun after 5PM, despite increased caseload. This study shows how applying research methods to implement QI interventions successfully decreases late inpatient endoscopic cases.
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Affiliation(s)
- Sonali Palchaudhuri
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA
| | - Sara Attalla
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA
| | - Shivan J Mehta
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA
| | - Afshin Parsikia
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA
| | - Richard T White
- Perioperative Services, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA
| | - Nuzhat A Ahmad
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA
| | - Gregory G Ginsberg
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA
| | - Mark S Weiss
- Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Colleen Demopoulos
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA
| | - John Keogh
- Perioperative Services, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA.,Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - David C Metz
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA
| | - Michael L Kochman
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA
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11
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Hanna A, Kim-Kiselak C, Tang R, Metz DC, Yang Z, DeMatteo R, Fraker DL, Roses RE. ASO Visual Abstract: Gastric Neuroendocrine Tumors: Reappraisal of Type in Predicting Outcome. Ann Surg Oncol 2021. [PMID: 34263372 DOI: 10.1245/s10434-021-10349-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Andrew Hanna
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
| | | | - Rebecca Tang
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - David C Metz
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Zhaohai Yang
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ronald DeMatteo
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas L Fraker
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert E Roses
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
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12
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Hanna A, Kim-Kiselak C, Tang R, Metz DC, Yang Z, DeMatteo R, Fraker DL, Roses RE. Gastric Neuroendocrine Tumors: Reappraisal of Type in Predicting Outcome. Ann Surg Oncol 2021; 28:8838-8846. [PMID: 34120268 DOI: 10.1245/s10434-021-10293-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/25/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Type I gastric neuroendocrine tumors (GNETs) are typically managed either expectantly or endoscopically. In contrast, locoregional surgery has been recommended for patients with type III GNETs because of the risk of metastasis. This study aimed to identify predictors of outcome independent of type in a contemporary cohort of GNET patients. METHODS A single-institution retrospective cohort study of 121 patients with a pathologic diagnosis of primary GNET between January 2009 and June 2019 was performed. GNETs were designated as type 1 (n = 74) if atrophic gastritis was present, or as type III (n = 47) in the absence of atrophic gastritis. Demographic, clinical, and histopathologic factors were examined using Kaplan-Meier and multivariable Cox regression to assess the impact of various factors on recurrence and overall survival. RESULTS Median follow-up for the entire cohort was 62.7 months. While there was no difference in OS in patients with different GNET types (p = 0.10), higher tumor grade (p = 0.02) and presence of nodal or distant metastases (p = 0.02) predicted worse survival on multivariable analysis. Among type III GNET patients, those with small (< 0.5 cm), grade 1 lesions ("low-risk") were less likely to develop metastases (0% versus 33%, p < 0.01) and more likely to survive (100% versus 67%, p < 0.01) at 5 years. CONCLUSIONS Size and tumor grade predict recurrence and survival in patients with GNETs irrespective of type. Small, low-grade type III GNETs are associated with minimal risk of progression and may be managed accordingly.
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Affiliation(s)
- Andrew Hanna
- Department of General Surgery, University of Pennsylvania, Philadelphia, PA, USA.
| | | | - Rebecca Tang
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - David C Metz
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Zhaohai Yang
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ronald DeMatteo
- Department of General Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas L Fraker
- Department of General Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert E Roses
- Department of General Surgery, University of Pennsylvania, Philadelphia, PA, USA
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13
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Abdel-Aziz Y, Metz DC, Howden CW. Review article: potassium-competitive acid blockers for the treatment of acid-related disorders. Aliment Pharmacol Ther 2021; 53:794-809. [PMID: 33592125 DOI: 10.1111/apt.16295] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/31/2020] [Accepted: 01/29/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Potassium-competitive acid blockers (P-CABs) are a novel group of acid-suppressing medicines for the management of acid-related disorders. AIMS To review published clinical pharmacology studies and clinical trials of P-CABs. METHODS We conducted a comprehensive literature search including Medline (PubMed), EMBASE, Web of Science and the Cochrane Library from inception until November 2020, for studies of the clinical pharmacology of P-CABs and relevant clinical trials of those that are currently licensed or in development. RESULTS Most publications concerned vonoprazan, which forms the bulk of this review. It is currently licensed in some Asian and South American countries and is being developed for North America. In clinically relevant doses, P-CABs have produced more rapid and profound suppression of intragastric acidity than proton pump inhibitors (PPIs). Vonoprazan was non-inferior to lansoprazole in healing erosive oesophagitis (2 randomised controlled trials [RCTs] in 1137 subjects) and superior in maintaining remission (1 RCT; 607 subjects). In 2 RCTs (1120 total subjects), both vonoprazan and tegoprazan were non-inferior to lansoprazole for healing peptic ulcers. Three RCTs and numerous non-randomised studies have compared vonoprazan-based and PPI-based regimens for Helicobacter pylori infection; vonoprazan-based triple or dual regimens have been highly effective. CONCLUSIONS P-CABs have some potential advantages over PPIs. To date, most research has been conducted in Asia; results of clinical trials that are underway in the United States and Europe are anticipated in 2021.
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Affiliation(s)
- Yousef Abdel-Aziz
- Division of Gastroenterology, University of Tennessee College of Medicine, Memphis, TN, USA
| | - David C Metz
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Colin W Howden
- Division of Gastroenterology, University of Tennessee College of Medicine, Memphis, TN, USA
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14
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Scott AT, Tessmann JB, Braun T, Brown B, Breheny PJ, Darbro BW, Bellizzi AM, Dillon JS, O'Dorisio TM, Alderson A, Bennett B, Bernat JA, Metz DC, Howe JR. Presacral neuroendocrine tumors associated with the Currarino syndrome. Am J Med Genet A 2021; 185:1582-1588. [PMID: 33650152 DOI: 10.1002/ajmg.a.62145] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 12/14/2022]
Abstract
Currarino syndrome (CS) is an autosomal dominant syndrome caused by mutations in MNX1 and characterized by anorectal abnormalities, partial sacral agenesis, and presacral masses. The presacral masses are typically benign; however, malignant degeneration can occur, and presacral neuroendocrine tumors (NETs) have been reported in six cases. We report three individuals from two families affected by CS in which multiple individuals developed presacral NETs. The first family, 491, had six members with features of CS, including two siblings who presented with presacral, Grade 2 NETs, one of which had metastasized to bone and lymph nodes. A germline c.874C>T (p.Arg292Trp) mutation was found in a highly conserved region of MNX1 in three affected members who underwent sequencing. A second somatic variant/deletion in MNX1 was not detected in either patient's tumor. In the second family, 342, the proband presented with an incidentally discovered presacral NET. The proband's father had previously undergone resection of a presacral NET, and so genetic testing was performed, which did not reveal an MNX1 mutation or copy number variants. The lack of a second, somatic mutation in the tumors from family 491 argues against MNX1 acting as a tumor suppressor, and the absence of a germline MNX1 mutation in family 342 suggests that other genetic and anatomic factors contribute to the development of presacral NETs. These cases highlight the variable presentation of CS, and the potential for malignancy in these patients.
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Affiliation(s)
- Aaron T Scott
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Jonathon B Tessmann
- Center for Bioinformatics and Computational Biology, University of Iowa College of Engineering, Iowa City, Iowa, USA
| | - Terry Braun
- Center for Bioinformatics and Computational Biology, University of Iowa College of Engineering, Iowa City, Iowa, USA
| | - Bartley Brown
- Center for Bioinformatics and Computational Biology, University of Iowa College of Engineering, Iowa City, Iowa, USA
| | - Patrick J Breheny
- Department of Biostatistics, College of Public Health, Boston, Massachusetts, USA
| | - Benjamin W Darbro
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Andrew M Bellizzi
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Joseph S Dillon
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Thomas M O'Dorisio
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Alice Alderson
- Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Bonita Bennett
- Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - John A Bernat
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - David C Metz
- Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - James R Howe
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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15
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Kipnis ST, Hung M, Kumar S, Heckert JM, Lee H, Bennett B, Soulen MC, Pryma DA, Mankoff DA, Metz DC, Eads JR, Katona BW. Laboratory, Clinical, and Survival Outcomes Associated With Peptide Receptor Radionuclide Therapy in Patients With Gastroenteropancreatic Neuroendocrine Tumors. JAMA Netw Open 2021; 4:e212274. [PMID: 33755166 PMCID: PMC7988364 DOI: 10.1001/jamanetworkopen.2021.2274] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Peptide receptor radionuclide therapy (PRRT) is approved in the US for treatment of gastroenteropancreatic neuroendocrine tumors (NETs), but data on PRRT outcomes within US populations remain scarce. OBJECTIVE To analyze the first 2 years of PRRT implementation at a US-based NET referral center. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted using medical records of patients with metastatic NET receiving PRRT from 2018 through 2020 in a NET program at a tertiary referral center. Included patients were those at the center with metastatic NETs who received at least 1 dose of PRRT over the study period. Laboratory toxic effects were assessed using Common Terminology Criteria for Adverse Events version 5.0. Tumor response was determined using Response Evaluation Criteria in Solid Tumors 1.1. Survival analysis was conducted to identify factors associated with progression-free survival (PFS) and overall survival. Data were analyzed from August 2018 through August 2020. EXPOSURES Receiving 4 cycles of lutetium-177-dotatate infusion, separated by 8-week intervals targeted to 7.4 GBq (200 mCi) per dose. MAIN OUTCOMES AND MEASURES Data were compared from before and after PRRT to determine hematologic, liver, and kidney toxic effects and to assess tumor progression and patient survival. RESULTS Among 78 patients receiving at least 1 dose of PRRT, median (interquartile range) age at PRRT initiation was 59.8 (53.5-69.2) years and 39 (50.0%) were men. The most common primary NET sites included small bowel, occurring in 34 patients (43.6%), and pancreas, occurring in 22 patients (28.2%). World Health Organization grade 1 or 2 tumors occurred in 62 patients (79.5%). Among all patients, 56 patients underwent pretreatment with tumor resection (71.8%), 49 patients received nonsomatostatin analogue systemic therapy (62.8%), and 49 patients received liver-directed therapy (62.8%). At least 1 grade 2 or greater toxic effect was found in 47 patients (60.3%). Median PFS was 21.6 months for the study group, was not reached by 22 months for patients with small bowel primary tumors, and was 13.3 months for patients with pancreatic primary tumors. Having a small bowel primary tumor was associated with a lower rate of progression compared with having a pancreatic primary tumor (hazard ratio, 0.19; 95% CI, 0.07-0.55; P = .01). Median overall survival was not reached. CONCLUSIONS AND RELEVANCE This cohort study of patients with metastatic NETs found that PRRT was associated with laboratory-measured toxic effects during treatment for most patients and an overall median PFS of 21.6 months. Patients with small bowel NETs had longer PFS after PRRT compared with patients with pancreatic NETs.
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Affiliation(s)
- Sarit T. Kipnis
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Matthew Hung
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Shria Kumar
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jason M. Heckert
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Hwan Lee
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Bonita Bennett
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Michael C. Soulen
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Daniel A. Pryma
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - David A. Mankoff
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - David C. Metz
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jennifer R. Eads
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Bryson W. Katona
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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16
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Kumar S, Metz DC, Kaplan DE, Goldberg DS. Low Rates of Retesting for Eradication of Helicobacter pylori Infection After Treatment in the Veterans Health Administration. Clin Gastroenterol Hepatol 2021; 19:305-313.e1. [PMID: 32272245 PMCID: PMC7541590 DOI: 10.1016/j.cgh.2020.03.059] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Expert consensus mandates retesting for eradication of Helicobacter pylori infection after treatment, but it is not clear how many patients are actually retested. We evaluated factors associated with retesting for H pylori in a large, nationwide cohort. METHODS We performed a retrospective cohort study of patients with H pylori infection (detected by urea breath test, stool antigen, or pathology) who were prescribed an eradication regimen from January 1, 1994 through December 31, 2018 within the Veterans Health Administration (VHA). We collected data on demographic features, smoking history, socioeconomic status, facility poverty level and academic status, and provider specialties and professions. The primary outcome was retesting for eradication. Statistical analyses included mixed-effects logistic regression. RESULTS Of 27,185 patients prescribed an H pylori eradication regimen, 6486 patients (23.9%) were retested. Among 7623 patients for whom we could identify the provider who ordered the test, 2663 patients (34.9%) received the order from a gastroenterological provider. Female sex (odds ratio, 1.22; 95% CI, 1.08-1.38; P = .002) and history of smoking (odds ratio, 1.24; 95% CI, 1.15-1.33; P < .001) were patient factors associated with retesting. There was an interaction between method of initial diagnosis of H pylori infection and provider who ordered the initial test (P < .001). There was significant variation in rates of retesting among VHA facilities (P < .001). CONCLUSIONS In an analysis of data from a VHA cohort of patients with H pylori infection, we found low rates of retesting after eradication treatment. There is significant variation in rates of retesting among VHA facilities. H pylori testing is ordered by nongastroenterology specialists two-thirds of the time. Confirming eradication of H pylori is mandatory and widespread quality assurance protocols are needed.
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Affiliation(s)
- Shria Kumar
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - David C. Metz
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania
| | - David E. Kaplan
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania,Division of Gastroenterology, Veterans Health Administration
| | - David S. Goldberg
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine
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17
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Metz DC, Liu E, Joish VN, Huynh L, Totev TI, Duh MS, Seth K, Giacalone S, Lapuerta P, Morse MA. Survival and Clinical Outcomes with Telotristat Ethyl in Patients with Carcinoid Syndrome. Cancer Manag Res 2020; 12:9713-9719. [PMID: 33116830 PMCID: PMC7548219 DOI: 10.2147/cmar.s276519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose The TELEACE study showed reductions in tumor size in patients with neuroendocrine tumors, receiving telotristat ethyl in US clinical practice. Here, we report progression-free survival, time to tumor progression, changes in carcinoid syndrome symptoms, and indictors of overall health. Patients and Methods This was a retrospective, single arm, pre-post medical chart review of patients with locally advanced or metastatic neuroendocrine tumors and documented carcinoid syndrome receiving telotristat ethyl for at least 6 months. Patients with poorly differentiated tumors, mixed tumor types or conflicting clinical trial enrollment were excluded. Descriptive statistics, Kaplan–Meier and chi-square tests were used to evaluate PFS, tumor progression, changes in symptoms, body weight and ECOG performance status before and after telotristat ethyl initiation. Subgroup analyses were conducted in patients with the same pre- and post-telotristat ethyl background treatment. Results Anonymized data for 200 patients were provided by 114 physicians; patients received telotristat ethyl for a median of 9 months. Median time to tumor progression was 39.8 months (IQR, 18.7–39.8); most had no tumor progression at 6 (92%) and 12 months (87%). Median progression-free survival was 23.7 months (17.8–39.8); most had progression-free survival at 6 (90%) and 12 months (80%). Results were consistent in the subgroup of 65 patients with the same pre/post background treatment. Nearly all patients had improved carcinoid syndrome symptoms, stable or improved weight and ECOG performance status. Conclusion Patients showed improvements in clinical outcomes and indicators of overall health following treatment with telotristat ethyl in this exploratory pilot study, consistent with previously observed reductions in tumor size.
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Affiliation(s)
- David C Metz
- Neuroendocrine Tumor Program at Penn Medicine, Philadelphia, PA 19104, USA
| | - Eric Liu
- The Neuroendocrine Institute at Rocky Mountain Cancer Centers, Denver, CO 80218, USA
| | - Vijay N Joish
- Lexicon Pharmaceuticals, Inc, The Woodlands, TX 77831, USA
| | | | | | | | - Kiernan Seth
- Lexicon Pharmaceuticals, Inc, The Woodlands, TX 77831, USA
| | | | - Pablo Lapuerta
- Lexicon Pharmaceuticals, Inc, The Woodlands, TX 77831, USA
| | - Michael A Morse
- Duke Cancer Institute, School of Medicine, Duke University, Durham, NC 27710, USA
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18
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Serper M, Nunes F, Ahmad N, Roberts D, Metz DC, Mehta SJ. Positive Early Patient and Clinician Experience with Telemedicine in an Academic Gastroenterology Practice During the COVID-19 Pandemic. Gastroenterology 2020; 159:1589-1591.e4. [PMID: 32565015 PMCID: PMC7301815 DOI: 10.1053/j.gastro.2020.06.034] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Marina Serper
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania,Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
| | - Frederick Nunes
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Nuzhat Ahmad
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Divya Roberts
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - David C. Metz
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Shivan J. Mehta
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania,Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania,Correspondence Address correspondence to: Shivan J. Mehta, MD, MBA, MSHP, 14-174 PCAM South Tower, 3400 Civic Center Blvd, Philadelphia, Pennsylvania 19104. fax: 215-573-8778
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19
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Eads JR, Reidy-Lagunes D, Soares HP, Chan JA, Anthony LB, Halfdanarson TR, Naraev BG, Wolin EM, Halperin DM, Li D, Pommier RF, Zacks JS, Morse MA, Metz DC. Differential Diagnosis of Diarrhea in Patients With Neuroendocrine Tumors. Pancreas 2020; 49:1123-1130. [PMID: 32991344 DOI: 10.1097/mpa.0000000000001658] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patients with neuroendocrine tumors (NETs) and carcinoid syndrome experience diarrhea that can have a debilitating effect on quality of life. Diarrhea also may develop in response to other hormonal syndromes associated with NETs, surgical complications, medical comorbidities, medications, or food sensitivities. Limited guidance on the practical approach to the differential diagnosis of diarrhea in these patients can lead to delays in appropriate treatment. This clinical review and commentary underscore the complexity in identifying the etiology of diarrhea in patients with NETs. Based on our collective experience and expertise, we offer a practical algorithm to guide medical oncologists and other care providers to expedite effective management of diarrhea and related symptoms in patients with NETs.
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Affiliation(s)
- Jennifer R Eads
- From the Department of Medicine, Division of Hematology and Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Diane Reidy-Lagunes
- Department of Medicine, Division of Solid Tumor, Gastrointestinal Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heloisa P Soares
- Division of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Jennifer A Chan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Lowell B Anthony
- Division of Medical Oncology, University of Kentucky Medical Center, Markey Cancer Center, Lexington, KY
| | | | - Boris G Naraev
- Division of Cancer Medicine, Banner MD Anderson Cancer Center, The University of Texas MD Anderson Cancer Center, Gilbert, AZ
| | - Edward M Wolin
- Department of Medicine, Division of Hematology/Oncology, Icahn School of Medicine, Center for Carcinoid and Neuroendocrine Tumors, Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY
| | - Daniel M Halperin
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daneng Li
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | - Rodney F Pommier
- Division of Surgical Oncology, Oregon Health & Science University, Portland, OR
| | - Jerome S Zacks
- Department of Medicine (Cardiology), The Mount Sinai School of Medicine, The Carcinoid Heart Center, New York, NY
| | - Michael A Morse
- Department of Medical Oncology, Duke University Medical Center, Durham, NC
| | - David C Metz
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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20
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Morse MA, Liu E, Joish VN, Huynh L, Cheng M, Duh MS, Seth K, Lapuerta P, Metz DC. Antiproliferative Effects of Telotristat Ethyl in Patients with Neuroendocrine Tumors: The TELEACE Real-World Chart Review Study. Cancer Manag Res 2020; 12:6607-6614. [PMID: 32801896 PMCID: PMC7402667 DOI: 10.2147/cmar.s261257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/13/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose Neuroendocrine tumors (NETs) associated with carcinoid syndrome (CS) overproduce serotonin, mediated by tryptophan hydroxylase-1 (TPH1). The TPH inhibitor telotristat ethyl (TE) reduces peripheral serotonin and relieves CS symptoms. We conducted a real-world clinical practice study to explore the effects of TE on tumor growth in patients with NETs and CS. Patients and Methods Single-arm, pre/post chart review study of patients with advanced NETs who received TE for ≥6 months and had ≥2 radiological scans within 12 months before and ≥1 scan after TE initiation. Linear regression and longitudinal analyses assessed changes in tumor size controlling for background NET treatment. Results Two hundred patients were enrolled, most (61%) had well-differentiated gastrointestinal NETs (61%) and received TE for an average of 12 months (SD, 7.3). Mean reduction in tumor size after TE initiation was 0.59 cm (p=0.006). Longitudinal analysis showed an 8.5% reduction in tumor size (p=0.045) from pre- to post-TE periods. Documented NET treatment prior to initiating TE and time between scans were not significant predictors of changes in tumor size. Results were consistent in a subgroup of patients with the same documented NET treatment before and after initiating TE. Conclusion TE may have antitumor effects consistent with serotonin overproduction in tumor growth.
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Affiliation(s)
- Michael A Morse
- Duke Cancer Institute, School of Medicine, Duke University, Durham, NC, USA
| | - Eric Liu
- The Neuroendocrine Institute at Rocky Mountain Cancer Centers, Denver, CO, USA
| | - Vijay N Joish
- Lexicon Pharmaceuticals, Inc., The Woodlands, TX, USA
| | | | | | | | - Kiernan Seth
- Lexicon Pharmaceuticals, Inc., The Woodlands, TX, USA
| | | | - David C Metz
- Neuroendocrine Tumor Program at Penn Medicine, Philadelphia, PA, USA
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21
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Halfdanarson TR, Strosberg JR, Tang L, Bellizzi AM, Bergsland EK, O'Dorisio TM, Halperin DM, Fishbein L, Eads J, Hope TA, Singh S, Salem R, Metz DC, Naraev BG, Reidy-Lagunes DL, Howe JR, Pommier RF, Menda Y, Chan JA. The North American Neuroendocrine Tumor Society Consensus Guidelines for Surveillance and Medical Management of Pancreatic Neuroendocrine Tumors. Pancreas 2020; 49:863-881. [PMID: 32675783 DOI: 10.1097/mpa.0000000000001597] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This article is the result of the North American Neuroendocrine Tumor Society consensus conference on the medical management of pancreatic neuroendocrine tumors from July 19 to 20, 2018. The guidelines panel consisted of medical oncologists, pathologists, gastroenterologists, endocrinologists, and radiologists. The panel reviewed a series of questions regarding the medical management of patients with pancreatic neuroendocrine tumors as well as questions regarding surveillance after resection. The available literature was reviewed for each of the question and panel members voted on controversial topics, and the recommendations were included in a document circulated to all panel members for a final approval.
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Affiliation(s)
| | | | - Laura Tang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew M Bellizzi
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Emily K Bergsland
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Thomas M O'Dorisio
- Department of Medicine, Division of Endocrinology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Daniel M Halperin
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lauren Fishbein
- Department of Medicine, Division of Endocrinology, Metabolism and Diabetes, Division of Biomedical Informatics and Personalized Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Jennifer Eads
- Division of Hematology and Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Simron Singh
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago IL
| | - David C Metz
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | | | - James R Howe
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Rodney F Pommier
- Department of Surgery, Oregon Health and Science University, Portland, OR
| | - Yusuf Menda
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Jennifer A Chan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
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22
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Hope TA, Bodei L, Chan JA, El-Haddad G, Fidelman N, Kunz PL, Mailman J, Menda Y, Metz DC, Mittra ES, Pryma DA, Reidy-Lagunes DL, Singh S, Strosberg JR. NANETS/SNMMI Consensus Statement on Patient Selection and Appropriate Use of 177Lu-DOTATATE Peptide Receptor Radionuclide Therapy. J Nucl Med 2020; 61:222-227. [PMID: 32015164 DOI: 10.2967/jnumed.119.240911] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/12/2019] [Indexed: 12/27/2022] Open
Affiliation(s)
- Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California .,Department of Radiology, San Francisco VA Medical Center, San Francisco, California
| | - Lisa Bodei
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jennifer A Chan
- Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Nicholas Fidelman
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Pamela L Kunz
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | | | - Yusuf Menda
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - David C Metz
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erik S Mittra
- Department of Diagnostic Radiology, Division of Nuclear Medicine & Molecular Imaging, Oregon Health & Science University, Portland, Oregon
| | - Daniel A Pryma
- Division of Nuclear Medicine & Clinical Molecular Imaging, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Simron Singh
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario; and
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23
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Singh S, Bergsland EK, Card CM, Hope TA, Kunz PL, Laidley DT, Lawrence B, Leyden S, Metz DC, Michael M, Modahl LE, Myrehaug S, Padda SK, Pommier RF, Ramirez RA, Soulen M, Strosberg J, Sung A, Thawer A, Wei B, Xu B, Segelov E. Commonwealth Neuroendocrine Tumour Research Collaboration and the North American Neuroendocrine Tumor Society Guidelines for the Diagnosis and Management of Patients With Lung Neuroendocrine Tumors: An International Collaborative Endorsement and Update of the 2015 European Neuroendocrine Tumor Society Expert Consensus Guidelines. J Thorac Oncol 2020; 15:1577-1598. [PMID: 32663527 DOI: 10.1016/j.jtho.2020.06.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 06/14/2020] [Accepted: 06/29/2020] [Indexed: 12/12/2022]
Abstract
Lung neuroendocrine tumors (LNETs) are uncommon cancers, and there is a paucity of randomized evidence to guide practice. As a result, current guidelines from different neuroendocrine tumor societies vary considerably. There is a need to update and harmonize global consensus guidelines. This article reports the best practice guidelines produced by a collaboration between the Commonwealth Neuroendocrine Tumour Research Collaboration and the North American Neuroendocrine Tumor Society. We performed a formal endorsement and updating process of the 2015 European Neuroendocrine Tumor Society expert consensus article on LNET. A systematic review from January 2013 to October 2017 was conducted to procure the most recent evidence. The stepwise endorsement process involved experts from all major subspecialties, patients, and advocates. Guided by discussion of the most recent evidence, each statement from the European Neuroendocrine Tumor Society was either endorsed, modified, or removed. New consensus statements were added if appropriate. The search yielded 1109 new publications, of which 230 met the inclusion criteria. A total of 12 statements were endorsed, 22 statements were modified or updated, one was removed, and two were added. Critical answered questions for each topic in LNET were identified. Through the consensus process, guidelines for the management of patients with local and metastatic neuroendocrine tumors have been updated to include both recent evidence and practice changes relating to technological and definitional advances. The guidelines provide clear, evidence-based statements aimed at harmonizing the global approach to patients with LNETs, on the basis of the principles of person-centered and LNET-specific care. The importance of LNET-directed research and person-centered care throughout the diagnosis, treatment, and follow-up journey is emphasized along with directions for future collaborative research.
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Affiliation(s)
- Simron Singh
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| | - Emily K Bergsland
- Department of Medicine, Division of Hematology/Oncology, University of California, San Francisco, San Francisco, California
| | | | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, Division of Hematology/Oncology, University of California, San Francisco, San Francisco, California
| | - Pamela L Kunz
- Department of Medicine, Yale University, New Haven, Connecticut
| | - David T Laidley
- Department of Medical Imaging, Division of Nuclear Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Ben Lawrence
- Discipline of Oncology, University of Auckland, Auckland, New Zealand
| | - Simone Leyden
- Unicorn Foundation, Blairgowrie, Victoria, Australia
| | - David C Metz
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Michael
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Lucy E Modahl
- Auckland Radiology Group, Auckland City Hospital, Auckland, New Zealand
| | - Sten Myrehaug
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sukhmani K Padda
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | | | - Robert A Ramirez
- Department of Medical Oncology, Ochsner Medical Center, New Orleans, Louisiana
| | - Michael Soulen
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Arthur Sung
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University, Stanford, California
| | - Alia Thawer
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Benjamin Wei
- Department of Surgery, Birmingham Medical Center, University of Alabama, Birmingham, Alabama
| | - Bin Xu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eva Segelov
- Department of Oncology, Monash Health, Monash University, Melbourne, Victoria, Australia
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Kumar S, Metz DC, Chandrasekhara V, Kaplan DE, Goldberg DS. The impact of endoscopic submucosal dissection for gastric adenocarcinomas in the United States. Tech Innov Gastrointest Endosc 2020; 22:93-98. [PMID: 35360344 PMCID: PMC8967066 DOI: 10.1016/j.tige.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND AIMS Recent studies show promise for endoscopic submucosal dissection (ESD) in the US, but do not identify the potential impact of ESD among newly diagnosed gastric cancers. We utilize the Veterans Health Administration to identify cancers suitable for ESD, to define the role of ESD in the US. METHODS Retrospective cohort study using the Veterans Affairs Central Cancer Registry to identify patients with gastric cancer who underwent surgical resection from 1995-2018. TNM stage was used to categorize those who would meet absolute vs expanded indications for ESD. Primary outcome was lymph node status. Secondary analysis was performed with death as outcome. RESULTS Of 12,584 primary gastric cancers, 4,735 (37.6%) were non-metastatic gastric adenocarcinomas. Median age at diagnosis was 70.3 years, 4,676 (98.8%) male. 2,306 (48.7%) underwent surgical resection, of which 636 (27.6%) were T1 lesions or cancer in situ. Of these, 44 (6.9%) met absolute indications for resection, 99 (15.6%) met established expanded criteria, and 98 (15.4%) may meet expanded criteria. Half of all tumors in each group were proximal in location.Rate of lymph node positivity was: 4.5%; 95% CI:0.5-15.5% in absolute group; 8.1%; 95% CI:3.6-15.3% in expanded group; 13.3%; 95% CI:7.3-21.6 in those potentially meeting expanded criteria. Lymph nodes positivity was associated with death (HR 1.49; 95% CI:1.36-1.62, p<0.001). CONCLUSIONS Less than 10% of T1 or in situ cancers meet absolute criteria for ESD. Those that meet expanded criteria had higher risk for lymph node metastases, particularly proximal tumors. Future studies should evaluate the safety of ESD in proximal gastric tumors.
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Affiliation(s)
- Shria Kumar
- Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania
| | - David C. Metz
- Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania
| | | | - David E. Kaplan
- Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania
- Division of Gastroenterology, Veterans Health Administration
| | - David S. Goldberg
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania
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25
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Beveridge CA, Falk GW, Ahuja NK, Yang YX, Metz DC, Lynch KL. Low Yield of Cross-Sectional Imaging in Patients With Esophagogastric Junction Outflow Obstruction. Clin Gastroenterol Hepatol 2020; 18:1643-1644. [PMID: 31362120 DOI: 10.1016/j.cgh.2019.07.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/10/2019] [Accepted: 07/23/2019] [Indexed: 02/07/2023]
Abstract
Esophagogastric junction outflow obstruction (EGJOO) is an abnormal finding on high-resolution manometry (HRM) characterized by an elevated median integrated relaxation pressure with some intact peristalsis.1 EGJOO is associated with heterogeneous symptoms, disease course, and response to treatment.1-4 It can be idiopathic or secondary with causes including malignancy, infiltrative disease, or structural etiology.1,3 Therefore, Chicago Classification of Esophageal Motility Disorders version 3.0 (CC v3.0) states a finding of EGJOO should prompt further investigation with cross-sectional imaging (CSI): endoscopic ultrasound (EUS) or computed tomography (CT) scan. However, there are limited data on the added yield of CSI to conventional modalities, namely esophagogastroduodenoscopy (EGD) and barium esophagram (BE). In previous studies, yield was small or unspecified.2,5-8 The aim of this study was to examine the yield of CSI for diagnosing secondary causes of EGJOO.
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Affiliation(s)
- Claire A Beveridge
- Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Gary W Falk
- Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Nitin K Ahuja
- Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Yu-Xiao Yang
- Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - David C Metz
- Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kristle L Lynch
- Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Abstract
Background & Aims Infection with Helicobacter pylori (HP) affects 50% of the world. Previous studies have suggested an association between HP and pancreatic adenocarcinoma (PC). These association studies have been limited in their ability to identify the incidence and risk factors of PC among HP infected individuals and the impact of HP eradication on PC. Methods Retrospective cohort study within the Veterans Administration of 103,595 patients (median age 62.3; 92.0% male) with HP diagnosis based on pathology, stool antigen, urea breath test, or serum antibody between 1/1/1994-12/31/2018. Primary outcome was future PC diagnosis. A time to event with competing risk analysis was performed, evaluating patient demographics and history, method of HP diagnosis, and whether the patient received HP treatment. Secondary analysis of those treated evaluated whether confirmed eradication was associated with PC. Results The cumulative incidence of PC at 5 and 10 years was 0.37% and 0.54%, respectively. Patients who developed PC were older, male, reside in areas with higher poverty. Preceding diabetes and chronic pancreatitis were strongly associated with PC. Factors not associated with PC included receiving an eradication regimen, diagnosis of an active infection (versus prior exposure alone), and eradication of HP. Conclusions PC after HP is rare. Chronic pancreatitis is the main risk factor for PC. Active HP infection, treatment of HP infection, or eradication of HP are not associated with future PC. This study calls into question the association between PC and HP.
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Affiliation(s)
- Shria Kumar
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania
| | - David C Metz
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania
| | - David E Kaplan
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania.,Division of Gastroenterology, Veterans Health Administration
| | - David S Goldberg
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine
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Kumar S, Metz DC, Kaplan DE, Goldberg DS. Seroprevalence of Helicobacter pylori Infection in a National Cohort of Veterans With Noncardia Gastric Adenocarcinoma. Clin Gastroenterol Hepatol 2020; 18:1235-1237.e1. [PMID: 31336199 PMCID: PMC6980451 DOI: 10.1016/j.cgh.2019.07.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/11/2019] [Indexed: 02/07/2023]
Abstract
Conventional teaching is that Helicobacter pylori infection is required for the development of non-cardia gastric adenocarcinoma (NCGC) through a sequence of atrophic gastritis, intestinal metaplasia, dysplasia, and finally, cancer.1-3 However, studies have not demonstrated a 100% rate of H pylori infection in gastric malignancy, hypothesized to be due to false negatives, gastric atrophy leading to apparent loss of infection, and inclusion of cardia, nonintestinal cancers.1-3.
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Affiliation(s)
- Shria Kumar
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - David C Metz
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David E Kaplan
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Gastroenterology, Veterans Health Administration, Philadelphia, Pennsylvania
| | - David S Goldberg
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Kumar S, Metz DC, Ginsberg GG, Kaplan DE, Goldberg DS. Oesophageal and proximal gastric adenocarcinomas are rare after detection of Helicobacter pylori infection. Aliment Pharmacol Ther 2020; 51:781-788. [PMID: 32133681 PMCID: PMC8063492 DOI: 10.1111/apt.15677] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 01/31/2020] [Accepted: 02/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Helicobacter pylori infection is the most important risk factor for non-proximal gastric adenocarcinoma, yet some posit it is protective against oesophageal adenocarcinoma and proximal gastric cancers. AIMS To evaluate the incidence of and risk factors for future oesophageal and proximal gastric cancers, utilizing the largest North American cohort of patients with previously identified H pylori. Also to identify whether treatment and eradication of H pylori alter future oesophageal and proximal gastric cancer risk. METHODS Retrospective cohort study within the Veterans Administration of 36 803 patients (median age 60.4 years; 91.8% male) with confirmed H pylori between 01 January 1994 and 31 December 2018. Primary outcome was diagnosis of future oesophageal and proximal gastric cancers. A time to event with competing risk analysis was performed, evaluating patient factors and whether the patient received H pylori treatment. Secondary analysis of those treated evaluated whether confirmed eradication was associated with cancer. RESULTS The cumulative incidence of oesophageal and proximal gastric cancers 5, 10 and 15 years after H pylori detection was 0.145%, 0.26% and 0.34%. Risk of future oesophageal or proximal gastric cancer was similar amongst whites (reference), African Americans (SHR 0.87, 95%CI 0.57-1.43) and American Indians (SHR 1.31, 95%CI 0.18-9.60) but substantially reduced in those of Asian (no cases amongst 213 H pylori positive) or native Hawaiian origin (no cases amongst 295 H pylori positive) (P < .001). Increasing age (SHR 1.17 per 5 years, 95% CI: 1.09-1.25, P < 0.001) and smoking (SHR 2.06, 95% CI: 1.33-3.18, P = 0.001) were associated with oesophageal and proximal gastric cancers. Neither treatment of H pylori nor eradication status were associated with cancer (P > 0.20). CONCLUSIONS In the largest study of US patients with H pylori, we demonstrate that rates of oesophageal and proximal gastric cancers after treatment of H pylori are low. Older age, and smoking are associated with future cancer, whilst Asian or Native Hawaiian race are protective. H pylori treatment and eradication are not associated with future cancer.
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Affiliation(s)
- Shria Kumar
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David C. Metz
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory G. Ginsberg
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David E. Kaplan
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA,Division of Gastroenterology, Veterans Health Administration, Philadelphia, PA, USA
| | - David S. Goldberg
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Hope TA, Abbott A, Colucci K, Bushnell DL, Gardner L, Graham WS, Lindsay S, Metz DC, Pryma DA, Stabin MG, Strosberg JR. NANETS/SNMMI Procedure Standard for Somatostatin Receptor-Based Peptide Receptor Radionuclide Therapy with 177Lu-DOTATATE. J Nucl Med 2020; 60:937-943. [PMID: 31263080 DOI: 10.2967/jnumed.118.230607] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
With the recent approval of 177Lu-DOTATATE for use in gastroenteropancreatic neuroendocrine tumors, access to peptide receptor radionuclide therapy is increasing. Representatives from the North American Neuroendocrine Tumor Society and the Society of Nuclear Medicine and Molecular Imaging collaborated to develop a practical consensus guideline for the administration of 177Lu-DOTATATE. In this paper, we discuss patient screening, maintenance somatostatin analog therapy requirements, treatment location and room preparation, drug administration, and patient release as well as strategies for radiation safety, toxicity monitoring, management of potential complications, and follow-up. Controversies regarding the role of radiation dosimetry are discussed as well. This document is designed to provide practical guidance on how to safely treat patients with this therapy.
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Affiliation(s)
- Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California .,Department of Radiology, San Francisco VA Medical Center, San Francisco, California
| | | | - Karen Colucci
- Lehigh Valley Health Network, Allentown, Pennsylvania
| | - David L Bushnell
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa.,Iowa City VA Medical Center, Iowa City, Iowa
| | - Linda Gardner
- Department of Nuclear Medicine, University of California, Los Angeles, Los Angeles, California
| | - William S Graham
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Sheila Lindsay
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - David C Metz
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel A Pryma
- Division of Nuclear Medicine & Clinical Molecular Imaging, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Heckert JM, Kipnis ST, Kumar S, Botterbusch S, Alderson A, Bennett B, Creamer C, Eads JR, Soulen MC, Pryma DA, Mankoff DA, Metz DC, Katona BW. Abnormal Pretreatment Liver Function Tests Are Associated with Discontinuation of Peptide Receptor Radionuclide Therapy in a U.S.-Based Neuroendocrine Tumor Cohort. Oncologist 2020; 25:572-578. [PMID: 32141667 DOI: 10.1634/theoncologist.2019-0743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/05/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Peptide receptor radionuclide therapy (PRRT) is effective for treating midgut neuroendocrine tumors (NETs); however, incorporation of PRRT into routine practice in the U.S. is not well studied. Herein we analyze the first year of PRRT implementation to determine tolerance of PRRT and factors that increase risk of PRRT discontinuation. MATERIALS AND METHODS Medical records were reviewed and data were abstracted on all patients with NETs scheduled for PRRT during the first year of PRRT implementation at a U.S. NET referral center (August 2018 through July 2019). Logistic regression was used to identify factors associated with PRRT discontinuation. RESULTS Fifty-five patients (56% male) were scheduled for PRRT over the study period. The most common primary NET location was small bowel (47%), followed by pancreas (26%), and 84% of the NETs were World Health Organization grade 1 or 2. The cohort was heavily pretreated with somatostatin analog (SSA) therapy (98%), non-SSA systemic therapy (64%), primary tumor resection (73%), and liver-directed therapy (55%). At the time of analysis, 52 patients completed at least one PRRT treatment. Toxicities including bone marrow suppression and liver function test (LFT) abnormalities were comparable to prior publications. Eleven patients (21%) prematurely discontinued PRRT because of toxicity or an adverse event. Pretreatment LFT abnormality was associated with increased risk of PRRT cancellation (odds ratio: 12; 95% confidence interval: 2.59-55.54; p < .001). CONCLUSION PRRT can be administered to a diverse NET population at a U.S. NET referral center. Baseline liver function test abnormality increases the likelihood of PRRT discontinuation. IMPLICATIONS FOR PRACTICE Peptide receptor radionuclide therapy (PRRT) can be successfully implemented at a U.S. neuroendocrine tumor (NET) referral center in a NET population that is diverse in tumor location, grade, and prior treatment history. Toxicity and adverse effects of PRRT are comparable to prior reports; however, 21% of individuals prematurely discontinued PRRT. Patients with baseline liver function test abnormalities were more likely to discontinue PRRT than patients with normal liver function tests, which should be taken into consideration when selecting treatment options for NETs.
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Affiliation(s)
- Jason M Heckert
- Division of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarit T Kipnis
- Division of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shria Kumar
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Samuel Botterbusch
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alice Alderson
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bonita Bennett
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Caroline Creamer
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer R Eads
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael C Soulen
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel A Pryma
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David A Mankoff
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David C Metz
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bryson W Katona
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Strosberg J, Kunz PL, Hendifar A, Yao J, Bushnell D, Kulke MH, Baum RP, Caplin M, Ruszniewski P, Delpassand E, Hobday T, Verslype C, Benson A, Srirajaskanthan R, Pavel M, Mora J, Berlin J, Grande E, Reed N, Seregni E, Paganelli G, Severi S, Morse M, Metz DC, Ansquer C, Courbon F, Al-Nahhas A, Baudin E, Giammarile F, Taïeb D, Mittra E, Wolin E, O'Dorisio TM, Lebtahi R, Deroose CM, Grana CM, Bodei L, Öberg K, Polack BD, He B, Mariani MF, Gericke G, Santoro P, Erion JL, Ravasi L, Krenning E. Impact of liver tumour burden, alkaline phosphatase elevation, and target lesion size on treatment outcomes with 177Lu-Dotatate: an analysis of the NETTER-1 study. Eur J Nucl Med Mol Imaging 2020; 47:2372-2382. [PMID: 32123969 PMCID: PMC7396396 DOI: 10.1007/s00259-020-04709-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To assess the impact of baseline liver tumour burden, alkaline phosphatase (ALP) elevation, and target lesion size on treatment outcomes with 177Lu-Dotatate. METHODS In the phase 3 NETTER-1 trial, patients with advanced, progressive midgut neuroendocrine tumours (NET) were randomised to 177Lu-Dotatate (every 8 weeks, four cycles) plus octreotide long-acting release (LAR) or to octreotide LAR 60 mg. Primary endpoint was progression-free survival (PFS). Analyses of PFS by baseline factors, including liver tumour burden, ALP elevation, and target lesion size, were performed using Kaplan-Meier estimates; hazard ratios (HRs) with corresponding 95% CIs were estimated using Cox regression. RESULTS Significantly prolonged median PFS occurred with 177Lu-Dotatate versus octreotide LAR 60 mg in patients with low (< 25%), moderate (25-50%), and high (> 50%) liver tumour burden (HR 0.187, 0.216, 0.145), and normal or elevated ALP (HR 0.153, 0.177), and in the presence or absence of a large target lesion (diameter > 30 mm; HR, 0.213, 0.063). Within the 177Lu-Dotatate arm, no significant difference in PFS was observed amongst patients with low/moderate/high liver tumour burden (P = 0.7225) or with normal/elevated baseline ALP (P = 0.3532), but absence of a large target lesion was associated with improved PFS (P = 0.0222). Grade 3 and 4 liver function abnormalities were rare and did not appear to be associated with high baseline liver tumour burden. CONCLUSIONS 177Lu-Dotatate demonstrated significant prolongation in PFS versus high-dose octreotide LAR in patients with advanced, progressive midgut NET, regardless of baseline liver tumour burden, elevated ALP, or the presence of a large target lesion. Clinicaltrials.gov : NCT01578239, EudraCT: 2011-005049-11.
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Affiliation(s)
- Jonathan Strosberg
- Gastrointestinal Department/Neuroendocrine Tumor Division, Moffitt Cancer Center, Tampa, FL, USA.
| | - Pamela L Kunz
- Department of Medicine - Med/Oncology, Stanford University Medical Center, Stanford, CA, USA
| | - Andrew Hendifar
- Department of Internal Medicine/Hematology/Oncology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - James Yao
- Department of Gastrointestinal Medicinal Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Bushnell
- Department of Radiology, The University of Iowa, Iowa City, IA, USA
| | - Matthew H Kulke
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Richard P Baum
- Department of Nuclear Medicine, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Martyn Caplin
- Department of Gastroenterology and Tumour Neuroendocrinology, Royal Free Hospital, London, UK
| | | | - Ebrahim Delpassand
- Department of Clinical Nuclear Medicine, Excel Diagnostics Imaging Clinic, Houston, TX, USA
| | - Timothy Hobday
- Department of Oncology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Chris Verslype
- Department of Hepatology, University Hospitals and KU Leuven, Leuven, Belgium
| | - Al Benson
- Hematology Oncology Division, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Rajaventhan Srirajaskanthan
- Department of Gastroenterology and General Internal Medicine, King's College Hospital - NHS Foundation Trust, London, UK
| | - Marianne Pavel
- Division of Hepatology and Gastroenterology, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Jaume Mora
- Department of Nuclear Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Jordan Berlin
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Enrique Grande
- Department of Medical Oncology, MD Anderson Cancer Center, Madrid, Spain
| | - Nicholas Reed
- Department of Medical Oncology, Beatson Oncology Centre, Glasgow, UK
| | - Ettore Seregni
- Department of Nuclear Medicine Therapy and Endocrinology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Paganelli
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Stefano Severi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Michael Morse
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - David C Metz
- GI Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Catherine Ansquer
- Nuclear Medicine Department, Hôtel Dieu, University Hospital, Nantes, France
| | - Frédéric Courbon
- Medical Imaging, Oncology University Institut Claudius Regaud, Toulouse, France
| | - Adil Al-Nahhas
- Division of Imaging and Interventional Radiology, Imperial College London, London, UK
| | - Eric Baudin
- Department of Endocrine Oncology and Nuclear Medicine, Institut Gustave Roussy, Villejuif, France
| | - Francesco Giammarile
- Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - David Taïeb
- Department of Nuclear Medicine, Hôpital de la Timone, Marseille, France
| | - Erik Mittra
- Department of Nuclear Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Edward Wolin
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thomas M O'Dorisio
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
| | - Rachida Lebtahi
- Department of Nuclear Medicine, Royal Free Hospital, London, UK
| | - Christophe M Deroose
- Nuclear Medicine Department, University Hospitals and KU Leuven, Leuven, Belgium
| | - Chiara M Grana
- Division of Nuclear Medicine, Istituto Europeo di Oncologia, Milan, Italy
| | - Lisa Bodei
- Department of Nuclear Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kjell Öberg
- Department of Endocrine Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Berna Degirmenci Polack
- Department of Medical Information, Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Beilei He
- Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Maurizio F Mariani
- Research and Development, Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Germo Gericke
- Research and Development, Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Paola Santoro
- Department of Clinical Development, Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Jack L Erion
- Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Laura Ravasi
- Research and Development, Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Eric Krenning
- Department of Nuclear Medicine, Cyclotron Rotterdam BV, Erasmus University Medical Center, Rotterdam, Netherlands
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Kumar S, Metz DC, Ellenberg S, Kaplan DE, Goldberg DS. Risk Factors and Incidence of Gastric Cancer After Detection of Helicobacter pylori Infection: A Large Cohort Study. Gastroenterology 2020; 158:527-536.e7. [PMID: 31654635 PMCID: PMC7010558 DOI: 10.1053/j.gastro.2019.10.019] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [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: 07/31/2019] [Revised: 09/13/2019] [Accepted: 10/16/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Nearly all studies of gastric adenocarcinoma in the United States have relied on national cancer databases, which do not include data on Helicobacter pylori infection, the most well-known risk factor for gastric cancer. We collected data from a large cohort of patients in the United States to calculate the incidence of and risk factors for nonproximal gastric adenocarcinomas after detection of H pylori. Secondary aims included identifying how treatment and eradication affect cancer risk. METHODS We performed a retrospective cohort study, collecting data from the Veterans Health Administration on 371,813 patients (median age 62 years; 92.3% male) who received a diagnosis of H pylori infection from January 1, 1994, through December 31, 2018. The primary outcome was a diagnosis of distal gastric adenocarcinoma 30 days or more after detection of H pylori infection. We performed a time to event with competing risk analysis (with death before cancer as a competing risk). RESULTS The cumulative incidence of cancer at 5, 10, and 20 years after detection of H pylori infection was 0.37%, 0.5%, and 0.65%, respectively. Factors associated with cancer included older age at time of detection of H pylori infection (subhazard ratio [SHR], 1.13; 95% confidence interval [CI], 1.11-1.15; P < .001), black/African American race (SHR, 2.00; 95% CI, 1.80-2.22), Asian race (SHR, 2.52; 95% CI, 1.64-3.89) (P < .001 for race), Hispanic or Latino ethnicity (SHR, 1.59; 95% CI, 1.34-1.87; P < .001), and history of smoking (SHR, 1.38; 95% CI, 1.25-1.52; P < .001). Women had decreased risk of gastric adenocarcinoma compared with men (SHR, 0.52; 95% CI, 0.40-0.68; P < .001); patients whose H pylori infection was detected based on serum antibody positivity also had a reduced risk of cancer (SHR 0.74; 95% CI, 0.54-1.04; P = .04). Patients who received treatment for their H pylori infection still had an increased risk of gastric cancer (SHR, 1.16; 95% CI, 0.74-1.83; P = .51) but confirmed H pylori eradication after treatment reduced risk of gastric cancer (SHR, 0.24; 95% CI, 0.15-0.41; P < .001). CONCLUSIONS In a study of 371,813 veterans with a diagnosis of H pylori infection, we found significantly higher risks of gastric cancer in racial and ethnic minorities and smokers. Treatment of H pylori infection decreased risk only if eradication was successful. Studies are needed on the effects of screening high-risk persons and to identify quality measures for diagnosis, resistance patterns, and treatment efficacy.
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Affiliation(s)
- Shria Kumar
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | - David C. Metz
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania
| | - Susan Ellenberg
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania
| | - David E. Kaplan
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania,Division of Gastroenterology, Veterans Health Administration
| | - David S. Goldberg
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania,Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine
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Morse M, Liu E, Joish VN, Huynh L, Cheng M, Totev T, Duh MS, Lapuerta P, Metz DC. Exploring telotristat ethyl’s antiproliferative effects in patients with carcinoid syndrome (TELEACE): A real-world observational study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
618 Background: Serotonin may have proliferative effects on neuroendocrine tumors (NETs). Inhibition of tryptophan hydroxylase (TPH), with resulting reduction of serotonin, may impact tumor size and growth (TG) in patients with NETs. We investigated the effects of TPH inhibitor telotristat ethyl (TE) on TG among patients receiving TE in clinical practice. Methods: A chart review study of 200 patients who had initiated TE was conducted. All patients had ≥2 radiological scans in the past 12 months prior to TE initiation and ≥1 scan post-TE initiation. Data were collected via a secure online portal. Descriptive statistics summarized physician and patient characteristics, and documented background NET treatment (i.e., somatostatin analog [SSA] and/or non-SSA). Longitudinal analyses of TG were assessed using a generalized linear regression model after controlling for documented background NET treatment and time since first scan. Results: Most physicians (71/114) were community-based oncologists. On average, patients were 61 ± 10 years old when initiating TE, 57% male, and 74% white; 61% had well-differentiated tumor with 61% of gastrointestinal origin. Patients received TE for an average of 12.0 ± 7.3 months and 82% (n = 163) were still receiving TE treatment at the time of data collection. The mean time from first scan to TE initiation was 5.6 ± 4.7 months and from TE initiation to last scan was 7.2 ± 6.3 months. Significant mean reductions in tumor size, after TE initiation, of 0.6 cm (p = 0.006) and TG of 8.5% (p = 0.045) were observed. Documented background NET treatment prior to initiating TE and time since first scan were not significant predictors of TG reduction. Results were consistent in a subset (n = 65) of patients who had no change in documented background NET treatment before and after initiating TE (mean reductions in tumor size 0.6 cm, p = 0.044 and TG 8.1%, p = 0.203). Conclusions: Treatment with TE may impact TG in patients with NETs. Prospective clinical studies are warranted to further examine the antiproliferative effects of TE.
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Affiliation(s)
| | - Eric Liu
- The Neuroendocrine Institute at Rocky Mountain Cancer Centers, Denver, CO
| | | | | | - Mu Cheng
- Analysis Group, Inc., Boston, MA
| | | | | | | | - David C. Metz
- University of Pennsylvania School of Medicine, Philadelphia, PA
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Kumar S, Sangitha R, Nachamkin I, Metz DC. Resistance patterns of refractory H. pylori infection in a referral center in the Delaware Valley. ACTA ACUST UNITED AC 2019; 2:6-12. [PMID: 32377173 DOI: 10.1002/ygh2.382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction H. pylori (HP) resistance is increasing in the US. Guidelines suggest treatment based on local resistance patterns, yet are poorly studied. We describe resistance patterns of the Delaware Valley. Methods A retrospective study of patients referred to the Hospital of the University of Pennsylvania, between 2009-2019 who underwent endoscopy for culture. Chart review identified demographics, history, endoscopic and culture results, treatment, and follow up. Results Of 109 patients referred for refractory HP, 90 had identified HP. Median age was 53.2 years and the majority was female (74%), with median 2 previous antibiotic courses for HP. Gastric erythema was the most common endoscopic abnormality. 65 (72.2%) were culture positive, and 45 (69.2%) were resistant to levofloxacin, 27 (41.5%) to metronidazole, and 39 (43.3%) to clarithromycin.Being resistant to any one of the 3 antibiotics was associated with resistance to either of the other two. There was an association with number of previous antibiotics with resistance (OR 1.74, p<0.05).We prescribed therapy to 77 patients based on susceptibility profiles, and 34 (37.8%) were cured, 14 (15.6%) underwent endoscopic surveillance, 3 (3.3%) were followed by infectious disease, and 39 (43.3%) were lost to follow up. Conclusions Antibiotic resistance is associated with refractory HP, and continues to rise. Culturing is associated with cure, and its use in clinical practice regarding efficacy, cost-effectiveness, and ability to minimize antibiotic resistance should be further studied. Overall follow-up is limited by loss to follow up, emphasizing the need for appropriate treatment.
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Affiliation(s)
- Shria Kumar
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania
| | - Ravindra Sangitha
- Division of Medicine, Perelman School of Medicine at the University of Pennsylvania
| | - Irving Nachamkin
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania
| | - David C Metz
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania
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Folkert IW, Sinnamon AJ, Concors SJ, Bennett BJ, Fraker DL, Mahmoud NN, Metz DC, Stashek KM, Roses RE. Grade is a Dominant Risk Factor for Metastasis in Patients with Rectal Neuroendocrine Tumors. Ann Surg Oncol 2019; 27:855-863. [DOI: 10.1245/s10434-019-07848-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Indexed: 02/06/2023]
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Leyden S, Kolarova T, Bouvier C, Caplin M, Conroy S, Davies P, Dureja S, Falconi M, Ferolla P, Fisher G, Goldstein G, Hicks RJ, Lawrence B, Majima Y, Metz DC, O'Toole D, Ruszniewski P, Wiedenmann B, Hollander R. Unmet needs in the international neuroendocrine tumor (NET) community: Assessment of major gaps from the perspective of patients, patient advocates and NET health care professionals. Int J Cancer 2019; 146:1316-1323. [PMID: 31509608 PMCID: PMC7004101 DOI: 10.1002/ijc.32678] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/08/2019] [Accepted: 08/20/2019] [Indexed: 12/19/2022]
Abstract
Due to the increasing incidence and prevalence of neuroendocrine tumors (NETs), there is a need to assess any gaps in awareness and care. A survey was undertaken in 2017 to identify perceived unmet needs from the perspectives of patients/families, patient advocates and health care professionals (HCPs). The survey consisted of 33–37 questions (depending on type of respondent) across four areas: information, care, treatments and research. In total, 443 participants from 26 countries responded: 338 patients/families, 35 advocates and 70 HCPs. Perceived unmet needs regarding provision of information at diagnosis differed between groups. While 59% of HCPs believed they provided sufficient information, informational needs were mostly/fully met for only 30% of patients and 18% of advocates. Additionally, 91% of patients and 97% of advocates felt that patients had to search for information themselves. Availability of Gallium‐68‐Dotatate PET/CT scan was limited for the majority of patients (patients: 73%; advocates: 85%; HCP: 86%), as was access to treatments, particularly peptide receptor radionuclide therapy (patients: 42%; advocates: 95%; HCPs: 77%). All groups felt that standards of care, including psychological needs and diagnosis of mental health, were not fully met. Although about two‐thirds of patients were managed by a multidisciplinary team, 14% of patients reportedly did not have enough contact. All groups supported more patient involvement in research; patients and advocates prioritized improvement in diagnosis and HCPs focused on clinical trials. This survey revealed significant unmet needs but differing perceptions regarding these among the groups. There is a need for investigation and collaboration to improve standards of care for NET patients. What's new? Even though the incidence of neuroendocrine tumors (NETs) has been rising worldwide, the current management of patients varies considerably, potentially leaving many with suboptimal care. An international survey was carried out in 2017 to investigate unmet needs in the NET patient community. The survey revealed that patients perceive numerous unmet needs in key areas including provision of information, diagnostics and treatment access, care standards, and research involvement. While healthcare professionals were aware of these gaps, they generally underestimated their magnitude. Patients and healthcare professionals need to work together to improve the lives and prospects of the increasing numbers of patients.
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Affiliation(s)
| | | | | | - Martyn Caplin
- Neuroendocrine Tumour Unit, Royal Free Hospital, London, United Kingdom
| | | | | | - Sugandha Dureja
- Department of Nuclear Medicine & Molecular Imaging, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Massimo Falconi
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Centre, San Raffaele Scientific Institute - "Vita e Salute" University, Milan, Italy
| | - Piero Ferolla
- Department of Internal Medicine and Endocrine Sciences, University of Perugia, Perugia, Italy
| | - George Fisher
- Stanford University School of Medicine, Stanford, CA
| | | | - Rodney J Hicks
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Ben Lawrence
- Discipline of Oncology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - David C Metz
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dermot O'Toole
- National Centre for Neuroendocrine Tumours, St. Vincent's University and Department of Clinical Medicine, St. James Hospital and Trinity College, Dublin, Ireland
| | | | - Bertram Wiedenmann
- Department of Hepatology, Gastroenterology and Endocrinology, Charité Medical School, Berlin, Germany
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Singh S, Moody L, Chan DL, Metz DC, Strosberg J, Asmis T, Bailey DL, Bergsland E, Brendtro K, Carroll R, Cleary S, Kim M, Kong G, Law C, Lawrence B, McEwan A, McGregor C, Michael M, Pasieka J, Pavlakis N, Pommier R, Soulen M, Wyld D, Segelov E. Follow-up Recommendations for Completely Resected Gastroenteropancreatic Neuroendocrine Tumors. JAMA Oncol 2019; 4:1597-1604. [PMID: 30054622 DOI: 10.1001/jamaoncol.2018.2428] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
There is no consensus on optimal follow-up for completely resected gastroenteropancreatic neuroendocrine tumors. Published guidelines for follow-up are complex and emphasize closer surveillance in the first 3 years after resection. Neuroendocrine tumors have a different pattern and timescale of recurrence, and thus require more practical and tailored follow-up. The Commonwealth Neuroendocrine Tumour Collaboration convened an international multidisciplinary expert panel, in collaboration with the North American Neuroendocrine Tumor Society, to create patient-centered follow-up recommendations for completely resected gastroenteropancreatic neuroendocrine tumors. This panel used the RAND/UCLA (University of California, Los Angeles) Appropriateness Method to generate recommendations. A large international survey was conducted outlining current the surveillance practice of neuroendocrine tumor practitioners and shortcomings of the current guidelines. A systematic review of available data to date was supplemented by recurrence data from 2 large patient series. The resultant guidelines suggest follow-up for at least 10 years for fully resected small-bowel and pancreatic neuroendocrine tumors and also identify clinical situations in which no follow-up is required. These recommendations stratify follow-up strategies based on evidence-based prognostic factors that allow for a more individualized patient-centered approach to this complex and heterogeneous malignant neoplasm.
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Affiliation(s)
- Simron Singh
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lesley Moody
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David L Chan
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David C Metz
- Perelman School of Medicine, Department of Gastroenterology, University of Pennsylvania, Philadelphia
| | - Jonathan Strosberg
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Centre, Tampa, Florida
| | - Timothy Asmis
- Department of Internal Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dale L Bailey
- Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Emily Bergsland
- Department of Medical Oncology, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco
| | - Kari Brendtro
- North American Neuroendocrine Tumor Society, Albany, New York
| | - Richard Carroll
- Department of Endocrinology, Wellington Regional Hospital, Wellington, New Zealand
| | - Sean Cleary
- Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Michelle Kim
- Department of Gastroenterology, Mount Sinai Hospital, New York, New York
| | - Grace Kong
- Department of Nuclear Medicine, Peter MacCullum Cancer Centre, Melbourne, Australia
| | - Calvin Law
- Department of Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ben Lawrence
- Department of Medical Oncology, Auckland Hospital, Auckland, New Zealand
| | - Alexander McEwan
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Caitlin McGregor
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michael Michael
- Department of Medical Oncology, Peter MacCullum Cancer Centre, Melbourne, Australia
| | - Janice Pasieka
- Department of Surgery, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
| | - Rodney Pommier
- Department of Surgery, Oregon Health & Science University, Portland
| | - Michael Soulen
- Perelman School of Medicine, Department of Medical Imaging, University of Pennsylvania, Philadelphia
| | - David Wyld
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Eva Segelov
- Department of Medical Oncology, Monash University, Clayton, Australia
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Leyden S, Kolarova T, Bouvier C, Caplin ME, Conroy S, Davies P, Dureja S, Falconi M, Ferolla P, Fisher GA, Goldstein G, Hicks RJ, Lawrence BJ, Majima Y, Metz DC, O'Toole D, Ruszniewski PB, Wiedenmann B, Hollander R. Access to diagnostics and treatment of neuroendocrine tumors (NETs): The difference between patient perception and reality. J Glob Oncol 2019. [DOI: 10.1200/jgo.2019.5.suppl.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6 Background: The aim of this global patient survey was to better understand the needs and expectations of patients with NETs regarding access to diagnostic tools and treatment. Methods: In 2017, an online, questionnaire survey of NET patients/family members, patient advocates and healthcare professionals (HCPs) was conducted. Results: In total, 443 participants from 26 countries responded: 338 patients/families; 35 advocates; 70 HCPs. Following NET diagnosis, many patients use patient association (69%) and HCP (48%) websites to fulfill their informational needs. Patients overestimated the availability of key diagnostic tools and treatments compared to HCPs: Gallium-68-Dotatate PET/CT scan was believed available by 28% of patients vs. 14% of HCPs; fluorodeoxyglucose PET by 77% of patients vs. 64% of HCPs; peptide receptor radionuclide therapy by 58% of patients vs. 23% of HCPs; genetic test/precision medicine by 75% of patients vs. 71% of HCPs; and transplantation by 86% of patients vs. 55% of HCPs. Reasons reported by patients and advocates for unavailability of treatment were: not provided by healthcare system (28% & 67%, respectively); non-referral (19% & 33%, respectively), unable to afford treatment (18% & 57%, respectively); treatment not covered by insurance (17% & 24%, respectively); distance to treatment centre (15% & 48%, respectively). Almost a third (30%) of patients had to travel more than 300 km/186 miles for treatment or consultation with a NET specialist, while 34% of patients did not have access to an MDT and those that did may be in contact with them less than once per year (14%). In contrast, advocates and HCPs believe there is wider availability of MDTs (94% and 70%, respectively). Conclusions: Patients are increasingly well-educated about NETs and often travel considerable distances to obtain specialist treatment. However, there remains considerable disparity in what patients feel is available to them in terms of the latest tools and treatments, compared to what is there in reality. This significant difference in perception needs to be managed delicately by both advocates and healthcare professionals.
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Affiliation(s)
| | | | | | - Martyn E. Caplin
- Neuroendocrine Tumour Centre, St. Vincent's University and Department of Clinical Medicine, St. James Hospital and Trinity College, Dublin, Ireland
| | | | | | - Sugandha Dureja
- Department of Nuclear Medicine & Molecular Imaging, Fortis Memorial Research Institute, Gurgaon, India
| | - Massimo Falconi
- Università Vita Salute - Ospedale San Raffaele, Milan, Italy
| | - Piero Ferolla
- Department of Medical Oncology, Perugia Hospital, Multidisciplinary Group for Diagnosis and Treatment of Neuroendocrine Tumors, Umbria Regional Cancer Network, Perugia, Italy
| | | | | | | | - Benjamin James Lawrence
- Discipline of Oncology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - David C. Metz
- University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Dermot O'Toole
- National Centre for Neuroendocrine Tumours, St. Vincent's University and Department of Clinical Medicine, St. James Hospital and Trinity College, Dublin, Ireland
| | | | | | - Ron Hollander
- Neuroendocrine Tumor Research Foundation, Boston, MA
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Affiliation(s)
- Jeri W Nieves
- Mailman School of Public Health and Institute of Human Nutrition, Columbia University, New York, New York
| | | | - David C Metz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karen E Hansen
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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Leyden S, Kolarova T, Bouvier C, Caplin ME, Conroy S, Davies P, Dureja S, Falconi M, Ferolla P, Fisher GA, Goldstein G, Hicks RJ, Lawrence BJ, Majima Y, Metz DC, O'Toole D, Ruszniewski PB, Wiedenmann B, Hollander R. Access to diagnostics and treatment of neuroendocrine tumors (NETs): The difference between patient perception and reality. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e13524] [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
e13524 Background: The aim of this global patient survey was to better understand the needs and expectations of patients with NETs regarding access to diagnostic tools and treatment. Methods: In 2017, an online, questionnaire survey of NET patients/family members, patient advocates and healthcare professionals (HCPs) was conducted. Results: In total, 443 participants from 26 countries responded: 338 patients/families; 35 advocates; 70 HCPs. Following NET diagnosis, many patients use patient association (69%) and HCP (48%) websites to fulfill their informational needs. Patients overestimated the availability of key diagnostic tools and treatments compared to HCPs: Gallium-68-Dotatate PET/CT scan was believed available by 28% of patients vs. 14% of HCPs; fluorodeoxyglucose PET by 77% of patients vs. 64% of HCPs; peptide receptor radionuclide therapy by 58% of patients vs. 23% of HCPs; genetic test/precision medicine by 75% of patients vs. 71% of HCPs; and transplantation by 86% of patients vs. 55% of HCPs. Reasons reported by patients and advocates for unavailability of treatment were: not provided by healthcare system (28% & 67%, respectively); non-referral (19% & 33%, respectively), unable to afford treatment (18% & 57%, respectively); treatment not covered by insurance (17% & 24%, respectively); distance to treatment centre (15% & 48%, respectively). Almost a third (30%) of patients had to travel more than 300 km/186 miles for treatment or consultation with a NET specialist, while 34% of patients did not have access to an MDT and those that did may be in contact with them less than once per year (14%). In contrast, advocates and HCPs believe there is wider availability of MDTs (94% and 70%, respectively). Conclusions: Patients are increasingly well-educated about NETs and often travel considerable distances to obtain specialist treatment. However, there remains considerable disparity in what patients feel is available to them in terms of the latest tools and treatments, compared to what is there in reality. This significant difference in perception needs to be managed delicately by both advocates and healthcare professionals.
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Affiliation(s)
| | | | | | - Martyn E. Caplin
- Neuroendocrine Tumour Centre, St. Vincent's University and Department of Clinical Medicine, St. James Hospital and Trinity College, Dublin, Ireland
| | | | | | - Sugandha Dureja
- Department of Nuclear Medicine & Molecular Imaging, Fortis Memorial Research Institute, Gurgaon, India
| | - Massimo Falconi
- Università Vita Salute - Ospedale San Raffaele, Milan, Italy
| | - Piero Ferolla
- Dept. Internal Medicine and Endocrine Sciences, University of Perugia and Multidisciplinary Group for Diagnosis and Treatment of Neuroendocrine Tumors, Umbria Region Cancer Network, Perugia, Italy
| | | | | | | | - Benjamin James Lawrence
- Discipline of Oncology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - David C. Metz
- University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Dermot O'Toole
- National Centre for Neuroendocrine Tumours, St. Vincent's University and Department of Clinical Medicine, St. James Hospital and Trinity College, Dublin, Ireland
| | | | | | - Ron Hollander
- Neuroendocrine Tumor Research Foundation, Boston, MA
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Abstract
PURPOSE OF REVIEW The diagnosis of gastric neuroendocrine tumors (NETs) is being made with increased frequency likely as a result of more upper endoscopies being done for unrelated reasons. It is therefore vital that gastroenterologists become familiar with the basic work-up and management of patients found to have these tumors. This review describes the classification, pathophysiology, clinical characteristics, and treatment options of the different gastric NETs. RECENT FINDINGS In addition to the three traditional subtypes of gastric NETs, additional cases associated with achlorhydria and appropriate hypergastrinemia may exist. The management of gastric NETs between 1 and 2 cm in size remains controversial and needs to be individualized. Gastric NETs are uncommon but are now diagnosed more frequently. This review highlights the role of hypergastrinemia in their development and the controversies around their management.
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Affiliation(s)
- Craig R Gluckman
- Division of Gastroenterology and Hepatology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - David C Metz
- Division of Gastroenterology and Hepatology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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Newberry C, Saha A, Siddique SM, Metz DC, Domenico C, Choi K, Gitelman E, Mehta S. A Novel Clinical Decision Support System for Gastrointestinal Bleeding Risk Stratification in the Critically Ill. Jt Comm J Qual Patient Saf 2019; 45:440-445. [PMID: 30833110 DOI: 10.1016/j.jcjq.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Acid suppression therapy can reduce the development of stress and medication-related mucosal disease when prescribed appropriately. Suboptimal inpatient prescribing of acid suppression therapy therefore may lead to increased development of gastrointestinal hemorrhage in high-risk populations. The aim of this quality improvement study was to improve appropriate acid suppression therapy in patients admitted to ICUs in an academic medical center. INTERVENTION DEVELOPMENT, IMPLEMENTATION, AND ADAPTATION An adaptable, multifaceted implementation strategy guided by unit-based root cause analysis was initially developed in a single ICU with a high-risk population. Identifiable targets of intervention, including provider awareness, unstructured rounding protocols, and electronic communication tools, were augmented by the development of an automated alert system. This electronic dashboard risk-stratified patients based on information derived from the electronic medical record (EMR). The dashboard then offered clinical decision support. Use of the dashboard and percentage of appropriate acid suppression therapy prescriptions were tracked over time. RESULTS Appropriate acid suppression therapy prescribing was improved from 72.9% to 86.0% (p < 0.001). CONCLUSION Automated technology including an EMR-supported electronic dashboard was the foundation of successful intervention. Considering the deleterious effects of both under- and overprescribing of acid suppression therapy, particularly in high-risk patient populations, this type of technology may lead to enhanced patient outcomes.
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Hansen KE, Nieves JW, Nudurupati S, Metz DC, Perez MC. Dexlansoprazole and Esomeprazole Do Not Affect Bone Homeostasis in Healthy Postmenopausal Women. Gastroenterology 2019; 156:926-934.e6. [PMID: 30445008 DOI: 10.1053/j.gastro.2018.11.023] [Citation(s) in RCA: 25] [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: 08/23/2018] [Revised: 11/06/2018] [Accepted: 11/08/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Epidemiological studies have associated proton pump inhibitor (PPI) therapy with osteoporotic fractures, but it is not clear if PPIs directly cause osteoporosis. We evaluated the effect of dexlansoprazole and esomeprazole on bone turnover, bone mineral density (BMD), true fractional calcium absorption (TFCA), serum and urine levels of minerals, and levels of parathyroid hormone (PTH) in healthy postmenopausal women. METHODS We performed a prospective, multicenter, double-blind study of 115 healthy, postmenopausal women (45 to 75 years of age) from November 4, 2010, through August 7, 2014. Women were randomly assigned to groups given dexlansoprazole (60 mg), esomeprazole (40 mg), or placebo daily for 26 weeks. We measured plasma levels of procollagen type 1 N-terminal propeptide (P1NP) and C-terminal telopeptide of type 1 collagen (CTX) at 0 (baseline), 13, and 26 weeks. Primary outcomes were percent change in P1NP and CTX between weeks 0 and 26. We also measured changes in serum and urine levels of mineral, BMD, PTH (all subjects), and TFCA (n = 30). RESULTS Between baseline and week 26, there were no significant within-group differences in markers of bone turnover; there was a nonsignificant increase in CTX levels in the dexlansoprazole group (0.12 ng/mL). The esomeprazole and dexlansoprazole groups had significantly increased levels of P1NP (18.2% and 19.2%, respectively) and CTX (22.0% and 27.4%, respectively) at week 26 compared with the placebo group, although these values remained within normal ranges. There were no statistically significant differences between groups in serum or urine levels of minerals, BMD, or PTH at week 26. PPI therapy did not reduce TFCA. CONCLUSIONS In a prospective study of postmenopausal women, we found significant increases in markers of bone turnover in women given PPI therapy compared with women given placebo, but levels remained within the normal reference range. We found no significant differences among groups in changes in BMD, PTH, serum or urine levels of minerals, or TFCA. Our findings indicate that 26 weeks of treatment with a PPI has no clinically meaningful effects on bone homeostasis. Clinicaltrials.gov no: NCT01216293.
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Affiliation(s)
- Karen E Hansen
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
| | - Jeri W Nieves
- Mailman School of Public Health, Columbia University, New York, New York
| | - Sai Nudurupati
- Takeda Development Center Americas, Inc., Deerfield, Illinois
| | - David C Metz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Mahmud N, Stashek K, Katona BW, Tondon R, Shroff SG, Roses R, Furth EE, Metz DC. The incidence of neoplasia in patients with autoimmune metaplastic atrophic gastritis: a renewed call for surveillance. Ann Gastroenterol 2018; 32:67-72. [PMID: 30598594 PMCID: PMC6302190 DOI: 10.20524/aog.2018.0325] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/11/2018] [Indexed: 12/14/2022] Open
Abstract
Background Autoimmune metaplastic atrophic gastritis (AMAG) is an immune-mediated process that may lead to pernicious anemia (PA) and an increased risk of gastric cancer. Although some literature supports 3- or 5-year endoscopic surveillance for gastric cancer in patients with PA, no formal guidance exists for the general AMAG population. We sought to identify the prevalence and incidence rates of dysplasia or adenocarcinoma in patients with AMAG in order to clarify endoscopic best practices. Methods A retrospective study of 150 patients diagnosed with AMAG on endoscopic gastric biopsy between 1/2010 and 11/2015 was performed at a tertiary medical center. Clinical and pathologic data were obtained in order to calculate the prevalence and the incidence rate of dysplasia or adenocarcinoma. Results The cohort was predominantly female (82%) and white (61%), with median age 64 years. PA was present in 47% of patients. On index endoscopy, the prevalence of adenocarcinoma was 5.3%. A total of 59 patients with AMAG, but without neoplasia on initial biopsy, underwent subsequent endoscopic surveillance. Two patients, both of whom had confirmed PA, developed adenocarcinoma. The incidence rate of adenocarcinoma among this group was 14.2 cases per 1000 person-years, which far exceeds that of the general population (0.073 per 1000 person-years) based on Surveillance, Epidemiology, and End Results data. Conclusions AMAG is associated with a high prevalence and incidence of gastric cancer, and endoscopic surveillance should be considered. Prospective cohort studies and cost effectiveness analyses are needed to better estimate cancer risk and recommended endoscopic surveillance intervals in these patients.
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Affiliation(s)
- Nadim Mahmud
- Division of Gastroenterology (Nadim Mahmud, Bryson W. Katona, David C. Metz)
| | - Kristen Stashek
- Pathology (Kristen Stashek, Rashmi Tondon, Stuti G. Shroff, Emma E. Furth)
| | - Bryson W Katona
- Division of Gastroenterology (Nadim Mahmud, Bryson W. Katona, David C. Metz)
| | - Rashmi Tondon
- Pathology (Kristen Stashek, Rashmi Tondon, Stuti G. Shroff, Emma E. Furth)
| | - Stuti G Shroff
- Pathology (Kristen Stashek, Rashmi Tondon, Stuti G. Shroff, Emma E. Furth)
| | - Robert Roses
- Surgery (Robert Roses), University of Pennsylvania, Philadelphia, PA, United States
| | - Emma E Furth
- Pathology (Kristen Stashek, Rashmi Tondon, Stuti G. Shroff, Emma E. Furth)
| | - David C Metz
- Division of Gastroenterology (Nadim Mahmud, Bryson W. Katona, David C. Metz)
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Dellon ES, Liacouras CA, Molina-Infante J, Furuta GT, Spergel JM, Zevit N, Spechler SJ, Attwood SE, Straumann A, Aceves SS, Alexander JA, Atkins D, Arva NC, Blanchard C, Bonis PA, Book WM, Capocelli KE, Chehade M, Cheng E, Collins MH, Davis CM, Dias JA, Di Lorenzo C, Dohil R, Dupont C, Falk GW, Ferreira CT, Fox A, Gonsalves NP, Gupta SK, Katzka DA, Kinoshita Y, Menard-Katcher C, Kodroff E, Metz DC, Miehlke S, Muir AB, Mukkada VA, Murch S, Nurko S, Ohtsuka Y, Orel R, Papadopoulou A, Peterson KA, Philpott H, Putnam PE, Richter JE, Rosen R, Rothenberg ME, Schoepfer A, Scott MM, Shah N, Sheikh J, Souza RF, Strobel MJ, Talley NJ, Vaezi MF, Vandenplas Y, Vieira MC, Walker MM, Wechsler JB, Wershil BK, Wen T, Yang GY, Hirano I, Bredenoord AJ. Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterology 2018; 155:1022-1033.e10. [PMID: 30009819 PMCID: PMC6174113 DOI: 10.1053/j.gastro.2018.07.009] [Citation(s) in RCA: 642] [Impact Index Per Article: 107.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/21/2018] [Accepted: 07/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Over the last decade, clinical experiences and research studies raised concerns regarding use of proton pump inhibitors (PPIs) as part of the diagnostic strategy for eosinophilic esophagitis (EoE). We aimed to clarify the use of PPIs in the evaluation and treatment of children and adults with suspected EoE to develop updated international consensus criteria for EoE diagnosis. METHODS A consensus conference was convened to address the issue of PPI use for esophageal eosinophilia using a process consistent with standards described in the Appraisal of Guidelines for Research and Evaluation II. Pediatric and adult physicians and researchers from gastroenterology, allergy, and pathology subspecialties representing 14 countries used online communications, teleconferences, and a face-to-face meeting to review the literature and clinical experiences. RESULTS Substantial evidence documented that PPIs reduce esophageal eosinophilia in children, adolescents, and adults, with several mechanisms potentially explaining the treatment effect. Based on these findings, an updated diagnostic algorithm for EoE was developed, with removal of the PPI trial requirement. CONCLUSIONS EoE should be diagnosed when there are symptoms of esophageal dysfunction and at least 15 eosinophils per high-power field (or approximately 60 eosinophils per mm2) on esophageal biopsy and after a comprehensive assessment of non-EoE disorders that could cause or potentially contribute to esophageal eosinophilia. The evidence suggests that PPIs are better classified as a treatment for esophageal eosinophilia that may be due to EoE than as a diagnostic criterion, and we have developed updated consensus criteria for EoE that reflect this change.
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Affiliation(s)
- Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Chris A Liacouras
- Center for Pediatric Eosinophilic Diseases, Division of Gastroenterology and Hepatology & Nutrition, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Javier Molina-Infante
- Department of Gastroenterology, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain and Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Glenn T Furuta
- Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado and Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, Colorado
| | - Jonathan M Spergel
- Center for Pediatric Eosinophilic Diseases, Division of Allergy-Immunology, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
| | - Noam Zevit
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Stuart J Spechler
- Center for Esophageal Diseases, Baylor University Medical Center and Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, Texas
| | - Stephen E Attwood
- Department of Health Services Research, Durham University, Durham, UK
| | | | - Seema S Aceves
- Division of Allergy, Immunology, Departments of Pediatrics and Medicine, University of California-San Diego and Rady Children's Hospital, San Diego, La Jolla, California
| | | | - Dan Atkins
- Allergy & Immunology Section, Children's Hospital Colorado and Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, Colorado
| | - Nicoleta C Arva
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Carine Blanchard
- Institute of Nutritional Science, Nestlé Research Center, Vevey, Switzerland
| | - Peter A Bonis
- Division of Gastroenterology, Tufts University School of Medicine, Boston, Massachusetts
| | - Wendy M Book
- American Partnership for Eosinophilic Disorders, Atlanta, Georgia
| | - Kelley E Capocelli
- Department of Pediatric Pathology, Children's Hospital Colorado, Aurora, Colorado
| | - Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Edaire Cheng
- Departments of Pediatrics and Internal Medicine, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Margaret H Collins
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Carla M Davis
- Allergy and Immunology Section of the Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Jorge A Dias
- Pediatric Gastroenterology, Centro Hospitalar S. João, Porto, Portugal
| | - Carlo Di Lorenzo
- Division of Gastroenterology and Hepatology & Nutrition, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Ranjan Dohil
- Division of Gastroenterology and Hepatology, University of California-San Diego, Rady Children's Hospital, San Diego, California
| | | | - Gary W Falk
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Cristina T Ferreira
- Federal University of Health Sciences of Porto Alegre, Hospital Santo Antônio, Porto Alegre, RS, Brazil
| | - Adam Fox
- Department of Paediatric Allergy, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Nirmala P Gonsalves
- Division of Gastroenterology and Hepatology, Northwestern University-Feinberg School of Medicine, Chicago, Illinois
| | - Sandeep K Gupta
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Illinois, University of Illinois, Peoria, Illinois
| | - David A Katzka
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota
| | - Yoshikazu Kinoshita
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
| | - Calies Menard-Katcher
- Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado and Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, Colorado
| | - Ellyn Kodroff
- Campaign Urging Research for Eosinophilic Diseases, Lincolnshire, Illinois
| | - David C Metz
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Stephan Miehlke
- Centre for Digestive Diseases, Internal Medicine Center, Eppendorf, Hamburg, Germany
| | - Amanda B Muir
- Center for Pediatric Eosinophilic Diseases, Division of Gastroenterology and Hepatology & Nutrition, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Vincent A Mukkada
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Simon Murch
- Department of Paediatrics, University Hospital Coventry & Warwickshire, Coventry, UK
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, Massachusetts
| | - Yoshikazu Ohtsuka
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Rok Orel
- University of Ljubljana, Faculty of Medicine, University Children's Hospital, Ljubljana, Slovenia
| | - Alexandra Papadopoulou
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Children's Hospital Agia Sofia, Athens, Greece
| | | | - Hamish Philpott
- Northern Adelaide Local Health Network, Department of Gastroenterology, University of Adelaide, South Australia
| | - Philip E Putnam
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joel E Richter
- University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Rachel Rosen
- Aerodigestive Center, Boston Children's Hospital, Boston, Massachusetts
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Alain Schoepfer
- Division of Gastroenterology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | | | - Neil Shah
- Department of Paediatric Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Javed Sheikh
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Rhonda F Souza
- Center for Esophageal Diseases, Baylor University Medical Center and Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, Texas
| | - Mary J Strobel
- American Partnership for Eosinophilic Disorders, Atlanta, Georgia
| | | | - Michael F Vaezi
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Mario C Vieira
- Department of Pediatrics, Pontifical University of Paraná and Center for Pediatric Gastroenterology, Hospital Pequeno Príncipe, Curitiba, Brazil
| | - Marjorie M Walker
- Anatomical Pathology University of Newcastle Faculty of Health and Medicine School of Medicine and Public Health Callaghan, New South Wales, Australia
| | - Joshua B Wechsler
- Eosinophilic Gastrointestinal Diseases Program, Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Barry K Wershil
- Eosinophilic Gastrointestinal Diseases Program, Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ting Wen
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Guang-Yu Yang
- Department of Pathology, Northwestern University-Feinberg School of Medicine, Chicago, Illinois
| | - Ikuo Hirano
- Division of Gastroenterology and Hepatology, Northwestern University-Feinberg School of Medicine, Chicago, Illinois
| | - Albert J Bredenoord
- Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
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Alvarez MJ, Subramaniam PS, Tang LH, Grunn A, Aburi M, Rieckhof G, Komissarova EV, Hagan EA, Bodei L, Clemons PA, Dela Cruz FS, Dhall D, Diolaiti D, Fraker DA, Ghavami A, Kaemmerer D, Karan C, Kidd M, Kim KM, Kim HC, Kunju LP, Langel Ü, Li Z, Lee J, Li H, LiVolsi V, Pfragner R, Rainey AR, Realubit RB, Remotti H, Regberg J, Roses R, Rustgi A, Sepulveda AR, Serra S, Shi C, Yuan X, Barberis M, Bergamaschi R, Chinnaiyan AM, Detre T, Ezzat S, Frilling A, Hommann M, Jaeger D, Kim MK, Knudsen BS, Kung AL, Leahy E, Metz DC, Milsom JW, Park YS, Reidy-Lagunes D, Schreiber S, Washington K, Wiedenmann B, Modlin I, Califano A. A precision oncology approach to the pharmacological targeting of mechanistic dependencies in neuroendocrine tumors. Nat Genet 2018; 50:979-989. [PMID: 29915428 PMCID: PMC6421579 DOI: 10.1038/s41588-018-0138-4] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 04/06/2018] [Indexed: 12/30/2022]
Abstract
We introduce and validate a new precision oncology framework for the systematic prioritization of drugs targeting mechanistic tumor dependencies in individual patients. Compounds are prioritized on the basis of their ability to invert the concerted activity of master regulator proteins that mechanistically regulate tumor cell state, as assessed from systematic drug perturbation assays. We validated the approach on a cohort of 212 gastroenteropancreatic neuroendocrine tumors (GEP-NETs), a rare malignancy originating in the pancreas and gastrointestinal tract. The analysis identified several master regulator proteins, including key regulators of neuroendocrine lineage progenitor state and immunoevasion, whose role as critical tumor dependencies was experimentally confirmed. Transcriptome analysis of GEP-NET-derived cells, perturbed with a library of 107 compounds, identified the HDAC class I inhibitor entinostat as a potent inhibitor of master regulator activity for 42% of metastatic GEP-NET patients, abrogating tumor growth in vivo. This approach may thus complement current efforts in precision oncology.
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Affiliation(s)
- Mariano J Alvarez
- Department of Systems Biology, Columbia University, New York, NY, USA
- DarwinHealth Inc, New York, NY, USA
| | | | - Laura H Tang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Adina Grunn
- Department of Systems Biology, Columbia University, New York, NY, USA
| | - Mahalaxmi Aburi
- Department of Systems Biology, Columbia University, New York, NY, USA
| | - Gabrielle Rieckhof
- Institute for Systems Genetics, New York University Langone Medical Center, New York, NY, USA
| | | | | | - Lisa Bodei
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Division of Pathology, European Institute of Oncology, Milan, Italy
| | | | - Filemon S Dela Cruz
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Deepti Dhall
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Diolaiti
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Douglas A Fraker
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Daniel Kaemmerer
- Department of General and Visceral Surgery, Zentralklinik, Bad Berka, Germany
| | - Charles Karan
- Sulzberger Columbia Genome Center, Columbia University, New York, NY, USA
| | - Mark Kidd
- Wren Laboratories, Branford, CT, USA
| | - Kyoung M Kim
- Division of Hematology Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee C Kim
- Division of Hematology Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Lakshmi P Kunju
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
- Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ülo Langel
- Department of Neurochemistry, the Arrhenius Laboratories for Nat. Sci., Stockholm University, Stockholm, Sweden
- Laboratory of Molecular Biotechnology, Institute of Technology, University of Tartu, Tartu, Estonia
| | - Zhong Li
- Falconwood Foundation, New York, NY, USA
| | - Jeeyun Lee
- Division of Hematology Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hai Li
- Sulzberger Columbia Genome Center, Columbia University, New York, NY, USA
| | - Virginia LiVolsi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Roswitha Pfragner
- Institute of Pathophysiology and Immunology, Medical University of Graz, Graz, Austria
| | - Allison R Rainey
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronald B Realubit
- Sulzberger Columbia Genome Center, Columbia University, New York, NY, USA
| | - Helen Remotti
- Department of Pathology, Columbia University, New York, NY, USA
| | - Jakob Regberg
- Department of Neurochemistry, the Arrhenius Laboratories for Nat. Sci., Stockholm University, Stockholm, Sweden
| | - Robert Roses
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anil Rustgi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Stefano Serra
- Department of Pathology, University Health Network, University of Toronto, Toronto, Canada
| | - Chanjuan Shi
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Xiaopu Yuan
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Massimo Barberis
- Division of Pathology, European Institute of Oncology, Milan, Italy
| | - Roberto Bergamaschi
- Division of Colon and Rectal Surgery, State University of New York, Stony Brook, NY, USA
| | - Arul M Chinnaiyan
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
- Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI, USA
- Howard Hughes Medical Institute, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Tony Detre
- Falconwood Foundation, New York, NY, USA
| | - Shereen Ezzat
- Department of Pathology, University Health Network, University of Toronto, Toronto, Canada
| | | | - Merten Hommann
- Department of General and Visceral Surgery, Zentralklinik, Bad Berka, Germany
| | - Dirk Jaeger
- Medical Oncology, National Center for Tumor Diseases Heidelberg, University Medical Center Heidelberg, Heidelberg, Germany
| | | | | | - Andrew L Kung
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - David C Metz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey W Milsom
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Young S Park
- Division of Hematology Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Stuart Schreiber
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, USA
| | - Kay Washington
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bertram Wiedenmann
- Department of Internal Medicine, Division of Gastroenterology, Charite, Universitätsmedizin Berlin, Berlin, Germany
| | - Irvin Modlin
- Emeritus Professor Gastrointestinal Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA.
| | - Andrea Califano
- Department of Systems Biology, Columbia University, New York, NY, USA.
- Department of Biomedical Informatics, Columbia University, New York, NY, USA.
- Department of Biochemistry and Molecular Biophysics, Columbia University, New York, NY, USA.
- J.P. Sulzberger Columbia Genome Center, Columbia University, New York, NY, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA.
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47
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Whitson MJ, Lynch KL, Yang YX, Metz DC, Falk GW. Lack of proton pump inhibitor trial prior to commencing therapy for eosinophilic esophagitis is common in the community. Dis Esophagus 2018; 31:4774511. [PMID: 29293904 DOI: 10.1093/dote/dox143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Indexed: 12/11/2022]
Abstract
Eosinophilic esophagitis is characterized by eosinophil inflammation restricted to the esophagus and the resulting symptoms of esophageal dysfunction. Critical to the diagnosis of eosinophilic esophagitis is a trial of proton pump inhibitor therapy to exclude alternative causes of esophageal eosinophilia such as proton pump inhibitor-responsive esophageal eosinophilia. While consensus guidelines recommend a proton pump inhibitor trial prior to diagnosis, little is known about its implementation in clinical practice. The primary aim of this study is to assess the frequency of proton pump inhibitor trial prior to the diagnosis of eosinophilic esophagitis in community practice. The secondary aim is to assess the frequency of other treatments for eosinophilic esophagitis, including topical steroids and/or dietary therapy, in patients who did not undergo a proton pump inhibitor trial prior to diagnosis or who had an alternative diagnosis to eosinophilic esophagitis upon completed workup. We conducted a single-center, case series of patients referred to the Hospital of the University of Pennsylvania for eosinophilic esophagitis management between 2010 and 2015. This case series consisted of 125 patients who were referred from community practitioners with a presumptive diagnosis of eosinophilic esophagitis. Upon review, 90 out of 125 (72%) patients had not had a proton pump inhibitor trial or esophageal pH testing prior to the diagnosis of eosinophilic esophagitis being made. Of these patients, 77.8% (70/90) had already received either topical steroid or dietary therapy for presumed eosinophilic esophagitis. Of the 125 patients initially diagnosed with eosinophilic esophagitis, 32 (25.6%) were found to have an alternative diagnosis, and 79.2% of this subset of patients (25/32) had previously received topical steroid or dietary therapy. This study demonstrates that a substantial number of patients with presumed eosinophilic esophagitis have not had a proton pump inhibitor trial prior to diagnosis in community practice. This led to the misclassification of patients and potentially to the use of less optimal medical therapies in a substantial number of these patients.
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Affiliation(s)
- M J Whitson
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - K L Lynch
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Y-X Yang
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - D C Metz
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - G W Falk
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Harris C, Kim MK, Baeg KJ, Lee MR, Starr J, Brais LK, Ward S, Stashek K, Chan JA, Labow DM, Sarpel U, Schwartz ME, Sung MW, Wisnivesky JP, Warner RRP, Metz DC, Kulke MH. Predictors of recurrence in patients with surgically resected pancreatic neuroendocrine tumors. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
408 Background: Current surveillance guidelines regarding follow up of patients with resected pancreatic neuroendocrine tumors (PNETs) are based on limited data, and there have been few studies evaluating recurrence risk in such patients. We assessed disease-free survival (DFS) in a large, multi-institutional cohort of patients with resected PNETs. Methods: Patients with surgically resected, non-metastatic PNETs between 1990-2017 were identified using institutional databases at three institutions: Mount Sinai Hospital, Dana-Farber Cancer Institute, and University of Pennsylvania. Recurrence date was defined as the imaging date documenting first recurrence (n = 56); if an imaging date was not available, then July 1 of that year was used in calculations (n = 9). Kaplan-Meier analysis was used to estimate DFS; multivariate Cox regression analysis was used to assess DFS adjusted for patient and disease-related characteristics, including tumor stage and grade. Results: We identified a total of 418 patients with surgically resected, non-metastatic PNETs between 1990-2017. Of these patients, 299 patients had complete stage and tumor grade information and were used for subsequent analysis. Patients were 48.6% male with a median age of 57.5 years at time of surgery. The distribution of AJCC stage and grade was as follows: 170 (56.9%) patients were stage I, 129 (43.1%) were stage II; 167 (55.9%) had grade 1, 121 (40.5%) had grade 2, and 11 (3.7%) had grade 3 tumors. Median follow-up was 2.6 years (interquartile range = 4.2); during this time, 65 (21.7%) patients developed disease recurrence. After adjusting for potential confounders, patients with more advanced stage and higher tumor grade were significantly more likely to develop disease recurrence (Hazard Ratio (HR): 6.9, 95% CI: 2.5-19.1 for stage II; HR 4.0 (1.7-9.5) for grade 2; HR 2.6 (0.4-17.8) for grade 3). Both higher stage and tumor grade were associated with decreased DFS (p < 0.0001 for both). Conclusions: In surgically resected PNETs, with a median follow-up time of 2.6 years, both higher stage and higher grade are associated with decreased DFS. Further follow up of this cohort is planned.
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Affiliation(s)
| | | | | | - Mi Ri Lee
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Julie Starr
- University of Pennsylvania, Philadelphia, PA
| | | | - Stephen Ward
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | - Umut Sarpel
- Mount Sinai School of Medicine, New York, NY
| | | | - Max W. Sung
- Mount Sinai Tisch Cancer Institute, New York, NY
| | | | | | - David C. Metz
- University of Pennsylvania School of Medicine, Philadelphia, PA
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49
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Chan DL, Moody L, Segelov E, Metz DC, Strosberg JR, Pavlakis N, Singh S. Follow-Up for Resected Gastroenteropancreatic Neuroendocrine Tumours: A Practice Survey of the Commonwealth Neuroendocrine Tumour Collaboration (CommNETS) and the North American Neuroendocrine Tumor Society (NANETS). Neuroendocrinology 2018. [PMID: 29539613 DOI: 10.1159/000488394] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Indexed: 12/14/2022]
Abstract
OBJECTIVES There is no consensus regarding optimal follow-up in resected gastroenteropancreatic neuroendocrine tumours (NETs). We aimed to perform a practice survey to ascertain follow-up patterns by health care practitioners and highlight areas of variation that may benefit from further quantitative research. METHODS A Web-based survey targeted at NET health care providers in Australia, New Zealand, Canada, and the USA was developed by a steering committee of medical oncologists and a research methodologist. Thirty-seven questions elicited information regarding adherence to guidelines, the influence of risk factors on follow-up, and the frequency and choice of modality in follow-up. RESULTS There were 163 respondents: 59 from Australia, 25 from New Zealand, 46 from Canada, and 33 from the USA (50% medical oncology, 23% surgery, 13% nuclear medicine, and 15% other). Thirty-eight percent of the respondents were "very familiar" with the NCCN NET guidelines, 33% with the ENETS guidelines, and 17% with the ESMO guidelines; however, only 15, 27, and 10%, respectively, found them "very useful"; 63% reported not using guidelines at their institution. The commonest investigations used were CT scans (66%) and chromogranin A (86%). The US respondents were more likely to follow patients up past 5 years, and the Australian respondents utilized more functional and less cross-sectional imaging. When poor prognostic factors were introduced, the respondents recommended more visits and tests. CONCLUSIONS This large international survey highlights variation in current follow-up practices not well addressed by the current guidelines. More quantitative research is required to inform the development of evidence-based guidelines tailored to the pattern of recurrence in NETs.
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Affiliation(s)
- David L Chan
- Department of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Lesley Moody
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Eva Segelov
- Department of Oncology, Monash Health and Monash University, Melbourne, Victoria, Australia
| | - David C Metz
- Division of Gastroenterology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jonathan R Strosberg
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Nick Pavlakis
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Simron Singh
- Department of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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50
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Dougherty MK, Santoiemma PP, Weber AT, Metz DC, Yang YX. Low yield for non-targeted biopsies of the stomach and esophagus during elective esophagogastroduodenoscopy. Endosc Int Open 2017; 5:E1268-E1277. [PMID: 29218319 PMCID: PMC5718909 DOI: 10.1055/s-0043-119791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 07/31/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Biopsies of non-specific mucosal findings are often performed during esophagogastroduodenoscopy (EGD). We sought to determine the prevalence and clinical utility of non-targeted biopsies of the stomach and esophagus. PATIENTS AND METHODS We conducted a retrospective review of 949 outpatient EGDs performed at a US tertiary referral center. Non-targeted biopsies of the stomach were defined as either "normal" or "mild" to "moderate" "erythema" or "inflammation" without other endoscopic features. Non-targeted biopsies of the esophagus and gastroesophageal junction (GEJ) were defined as endoscopically "normal" mucosa. The primary outcome was the proportion of non-targeted biopsies resulting in "definite management change." Secondary outcomes included histopathologic diagnoses of Helicobacter pylori, intestinal metaplasia and esophageal eosinophilia. RESULTS Of 949 EGDs, 332 (35.0 %, 95 % CI 31.9 - 38.1 %) had a non-targeted biopsy taken at any site. Erythema in the gastric body and antrum was biopsied at a rate of 83 - 86 %, while biopsies of "normal"-appearing mucosa occurred at rates from 3 % (GEJ) to 15 % (body and antrum). The percentage of non-targeted biopsies that led to definite management change ranged from 5 % in the GEJ and esophagus to 9 % in the antrum, but did not significantly differ by mucosal appearance. Multivariable regression analyses suggested associations of language and age > 50 with management change from non-targeted gastric biopsy. CONCLUSIONS Non-targeted biopsies of the stomach and esophagus led to definite management change in a small proportion of patients. Further studies are needed to identify patient and/or endoscopic characteristics and techniques to improve the yield of this practice.
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Affiliation(s)
- Michael K. Dougherty
- Division of Gastroenterology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Phillip P. Santoiemma
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Andrew T. Weber
- Department of Medicine, University of California Los Angeles, Los Angeles, California, United States
| | - David C. Metz
- Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Yu-Xiao Yang
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States,Corresponding author Yu-Xiao Yang, MD, MSCE, FACP Division of GastroenterologyDepartment of MedicinePerelman School of Medicine at the University of Pennsylvania423 Guardian Drive733 Blockley HallPhiladelphia, PA 19104
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