1
|
Routy B, Lenehan JG, Miller WH, Jamal R, Messaoudene M, Daisley BA, Hes C, Al KF, Martinez-Gili L, Punčochář M, Ernst S, Logan D, Belanger K, Esfahani K, Richard C, Ninkov M, Piccinno G, Armanini F, Pinto F, Krishnamoorthy M, Figueredo R, Thebault P, Takis P, Magrill J, Ramsay L, Derosa L, Marchesi JR, Parvathy SN, Elkrief A, Watson IR, Lapointe R, Segata N, Haeryfar SMM, Mullish BH, Silverman MS, Burton JP, Maleki Vareki S. Author Correction: Fecal microbiota transplantation plus anti-PD-1 immunotherapy in advanced melanoma: a phase I trial. Nat Med 2024; 30:604. [PMID: 37923839 DOI: 10.1038/s41591-023-02650-8] [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: 11/06/2023]
Affiliation(s)
- Bertrand Routy
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal (CRCHUM), Montreal, Quebec, Canada
- Hematology-Oncology Division, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - John G Lenehan
- Department of Oncology, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Wilson H Miller
- Lady Davis Institute of the Jewish General Hospital, Segal Cancer Centre, Montreal, Quebec, Canada
- Departments of Oncology and Medicine, McGill University, Montreal, Quebec, Canada
| | - Rahima Jamal
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal (CRCHUM), Montreal, Quebec, Canada
- Hematology-Oncology Division, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Meriem Messaoudene
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Brendan A Daisley
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
- Canadian Centre for Human Microbiome and Probiotics Research, London, Ontario, Canada
| | - Cecilia Hes
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal (CRCHUM), Montreal, Quebec, Canada
- Peter Brojde Lung Cancer Center, Jewish General Hospital, Montreal, Quebec, Canada
| | - Kait F Al
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
- Canadian Centre for Human Microbiome and Probiotics Research, London, Ontario, Canada
| | - Laura Martinez-Gili
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, St Mary's Hospital Campus, Imperial College London, London, UK
- Section of Bioinformatics, Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Michal Punčochář
- Department of Computational, Cellular and Integrative Biology, University of Trento, Trento, Italy
| | - Scott Ernst
- Department of Oncology, Western University, London, Ontario, Canada
| | - Diane Logan
- Department of Oncology, Western University, London, Ontario, Canada
| | - Karl Belanger
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal (CRCHUM), Montreal, Quebec, Canada
- Hematology-Oncology Division, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Khashayar Esfahani
- Lady Davis Institute of the Jewish General Hospital, Segal Cancer Centre, Montreal, Quebec, Canada
- Departments of Oncology and Medicine, McGill University, Montreal, Quebec, Canada
| | - Corentin Richard
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Marina Ninkov
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
| | - Gianmarco Piccinno
- Department of Computational, Cellular and Integrative Biology, University of Trento, Trento, Italy
| | - Federica Armanini
- Department of Computational, Cellular and Integrative Biology, University of Trento, Trento, Italy
| | - Federica Pinto
- Department of Computational, Cellular and Integrative Biology, University of Trento, Trento, Italy
| | - Mithunah Krishnamoorthy
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Rene Figueredo
- Department of Oncology, Western University, London, Ontario, Canada
| | - Pamela Thebault
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Panteleimon Takis
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, National Phenome Centre, Imperial College London, London, UK
- Section of Bioanalytical Chemistry, Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Jamie Magrill
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montréal, Quebec, Canada
| | - LeeAnn Ramsay
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montréal, Quebec, Canada
| | - Lisa Derosa
- Gustave Roussy Cancer Campus, Villejuif, France
- Cancer Medicine Department, Gustave Roussy, Villejuif, France
- Institut National de la Santé Et et de la Recherche Médicale (INSERM) U1015, ClinicObiome, Equipe Labellisée-28 Ligue Nationale contre le Cancer, Villejuif, France
- Université Paris-Saclay, Ile-de-France, France
| | - Julian R Marchesi
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, St Mary's Hospital Campus, Imperial College London, London, UK
| | - Seema Nair Parvathy
- Department of Medicine, Division of Infectious Diseases, Western University, London, Ontario, Canada
- Division of Infectious Diseases, St Joseph's Health Care, London, Ontario, Canada
| | - Arielle Elkrief
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Ian R Watson
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montréal, Quebec, Canada
- Department of Biochemistry, McGill University, Montréal, Quebec, Canada
| | - Rejean Lapointe
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal (CRCHUM), Montreal, Quebec, Canada
- Département de Médecine, Faculté de Médecine, Université de Montréal, Montréal, Quebec, Canada
| | - Nicola Segata
- Department of Computational, Cellular and Integrative Biology, University of Trento, Trento, Italy
| | - S M Mansour Haeryfar
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
- Department of Medicine, Division of Clinical Immunology and Allergy, Western University, London, Ontario, Canada
- Department of Surgery, Division of General Surgery, Western University, London, Ontario, Canada
| | - Benjamin H Mullish
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, St Mary's Hospital Campus, Imperial College London, London, UK
- Departments of Gastroenterology and Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Michael S Silverman
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
- Department of Medicine, Division of Infectious Diseases, Western University, London, Ontario, Canada
- Division of Infectious Diseases, St Joseph's Health Care, London, Ontario, Canada
| | - Jeremy P Burton
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
- Canadian Centre for Human Microbiome and Probiotics Research, London, Ontario, Canada
| | - Saman Maleki Vareki
- Department of Oncology, Western University, London, Ontario, Canada.
- Lawson Health Research Institute, London, Ontario, Canada.
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada.
- Department of Medical Biophysics, Western University, London, Ontario, Canada.
- Ontario Institute of Cancer Research, Toronto, Ontario, Canada.
| |
Collapse
|
2
|
Routy B, Lenehan JG, Miller WH, Jamal R, Messaoudene M, Daisley BA, Hes C, Al KF, Martinez-Gili L, Punčochář M, Ernst S, Logan D, Belanger K, Esfahani K, Richard C, Ninkov M, Piccinno G, Armanini F, Pinto F, Krishnamoorthy M, Figueredo R, Thebault P, Takis P, Magrill J, Ramsay L, Derosa L, Marchesi JR, Parvathy SN, Elkrief A, Watson IR, Lapointe R, Segata N, Haeryfar SMM, Mullish BH, Silverman MS, Burton JP, Maleki Vareki S. Fecal microbiota transplantation plus anti-PD-1 immunotherapy in advanced melanoma: a phase I trial. Nat Med 2023; 29:2121-2132. [PMID: 37414899 DOI: 10.1038/s41591-023-02453-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [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: 02/09/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023]
Abstract
Fecal microbiota transplantation (FMT) represents a potential strategy to overcome resistance to immune checkpoint inhibitors in patients with refractory melanoma; however, the role of FMT in first-line treatment settings has not been evaluated. We conducted a multicenter phase I trial combining healthy donor FMT with the PD-1 inhibitors nivolumab or pembrolizumab in 20 previously untreated patients with advanced melanoma. The primary end point was safety. No grade 3 adverse events were reported from FMT alone. Five patients (25%) experienced grade 3 immune-related adverse events from combination therapy. Key secondary end points were objective response rate, changes in gut microbiome composition and systemic immune and metabolomics analyses. The objective response rate was 65% (13 of 20), including four (20%) complete responses. Longitudinal microbiome profiling revealed that all patients engrafted strains from their respective donors; however, the acquired similarity between donor and patient microbiomes only increased over time in responders. Responders experienced an enrichment of immunogenic and a loss of deleterious bacteria following FMT. Avatar mouse models confirmed the role of healthy donor feces in increasing anti-PD-1 efficacy. Our results show that FMT from healthy donors is safe in the first-line setting and warrants further investigation in combination with immune checkpoint inhibitors. ClinicalTrials.gov identifier NCT03772899 .
Collapse
Affiliation(s)
- Bertrand Routy
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal (CRCHUM), Montreal, Quebec, Canada
- Hematology-Oncology Division, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - John G Lenehan
- Department of Oncology, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Wilson H Miller
- Lady Davis Institute of the Jewish General Hospital, Segal Cancer Centre, Montreal, Quebec, Canada
- Departments of Oncology and Medicine, McGill University, Montreal, Quebec, Canada
| | - Rahima Jamal
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal (CRCHUM), Montreal, Quebec, Canada
- Hematology-Oncology Division, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Meriem Messaoudene
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Brendan A Daisley
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
- Canadian Centre for Human Microbiome and Probiotics Research, London, Ontario, Canada
| | - Cecilia Hes
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal (CRCHUM), Montreal, Quebec, Canada
- Peter Brojde Lung Cancer Center, Jewish General Hospital, Montreal, Quebec, Canada
| | - Kait F Al
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
- Canadian Centre for Human Microbiome and Probiotics Research, London, Ontario, Canada
| | - Laura Martinez-Gili
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, St Mary's Hospital Campus, Imperial College London, London, UK
- Section of Bioinformatics, Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Michal Punčochář
- Department of Computational, Cellular and Integrative Biology, University of Trento, Trento, Italy
| | - Scott Ernst
- Department of Oncology, Western University, London, Ontario, Canada
| | - Diane Logan
- Department of Oncology, Western University, London, Ontario, Canada
| | - Karl Belanger
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal (CRCHUM), Montreal, Quebec, Canada
- Hematology-Oncology Division, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Khashayar Esfahani
- Lady Davis Institute of the Jewish General Hospital, Segal Cancer Centre, Montreal, Quebec, Canada
- Departments of Oncology and Medicine, McGill University, Montreal, Quebec, Canada
| | - Corentin Richard
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Marina Ninkov
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
| | - Gianmarco Piccinno
- Department of Computational, Cellular and Integrative Biology, University of Trento, Trento, Italy
| | - Federica Armanini
- Department of Computational, Cellular and Integrative Biology, University of Trento, Trento, Italy
| | - Federica Pinto
- Department of Computational, Cellular and Integrative Biology, University of Trento, Trento, Italy
| | - Mithunah Krishnamoorthy
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Rene Figueredo
- Department of Oncology, Western University, London, Ontario, Canada
| | - Pamela Thebault
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Panteleimon Takis
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, National Phenome Centre, Imperial College London, London, UK
- Section of Bioanalytical Chemistry, Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Jamie Magrill
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montréal, Quebec, Canada
| | - LeeAnn Ramsay
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montréal, Quebec, Canada
| | - Lisa Derosa
- Gustave Roussy Cancer Campus, Villejuif, France
- Cancer Medicine Department, Gustave Roussy, Villejuif, France
- Institut National de la Santé Et et de la Recherche Médicale (INSERM) U1015, ClinicObiome, Equipe Labellisée-28 Ligue Nationale contre le Cancer, Villejuif, France
- Université Paris-Saclay, Ile-de-France, France
| | - Julian R Marchesi
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, St Mary's Hospital Campus, Imperial College London, London, UK
| | - Seema Nair Parvathy
- Department of Medicine, Division of Infectious Diseases, Western University, London, Ontario, Canada
- Division of Infectious Diseases, St Joseph's Health Care, London, Ontario, Canada
| | - Arielle Elkrief
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Ian R Watson
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montréal, Quebec, Canada
- Department of Biochemistry, McGill University, Montréal, Quebec, Canada
| | - Rejean Lapointe
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal (CRCHUM), Montreal, Quebec, Canada
- Département de Médecine, Faculté de Médecine, Université de Montréal, Montréal, Quebec, Canada
| | - Nicola Segata
- Department of Computational, Cellular and Integrative Biology, University of Trento, Trento, Italy
| | - S M Mansour Haeryfar
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
- Department of Medicine, Division of Clinical Immunology and Allergy, Western University, London, Ontario, Canada
- Department of Surgery, Division of General Surgery, Western University, London, Ontario, Canada
| | - Benjamin H Mullish
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, St Mary's Hospital Campus, Imperial College London, London, UK
- Departments of Gastroenterology and Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Michael S Silverman
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
- Department of Medicine, Division of Infectious Diseases, Western University, London, Ontario, Canada
- Division of Infectious Diseases, St Joseph's Health Care, London, Ontario, Canada
| | - Jeremy P Burton
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
- Canadian Centre for Human Microbiome and Probiotics Research, London, Ontario, Canada
| | - Saman Maleki Vareki
- Department of Oncology, Western University, London, Ontario, Canada.
- Lawson Health Research Institute, London, Ontario, Canada.
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada.
- Department of Medical Biophysics, Western University, London, Ontario, Canada.
- Ontario Institute of Cancer Research, Toronto, Ontario, Canada.
| |
Collapse
|
3
|
Kuruvilla S, Vincent M, Sachdeva R, Pencz A, Dang M, Younus J, McArthur E, Breadner D, Raphael J, Blanchette P, Sanatani M, Logan D, Nayak R, Fortin D, Inculet R, Qiabi M, Malthaner R. EP02.01-013 Real World Treatment Patterns, Prevalence and Outcomes in Patients with KRAS Mutated Non Small Cell Lung Cancer in Southwestern Ontario. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
4
|
Miller WH, Routy B, Jamal R, Ernst DS, Logan D, Esfahani K, Belanger K, Elkrief A, Lapointe R, Thebault P, Ponce M, Parvathy SN, Messaoudene M, Silverman M, Maleki S, Lenehan JG. Fecal microbiota transplantation followed by anti–PD-1 treatment in patients with advanced melanoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9533 Background: The gut microbiome has been shown to be a biomarker of response in patients (pts) with melanoma. Strategies to modify the microbiome are currently being investigated. We report the effects of Fecal Microbiota Transplantation (FMT) on safety and anti-PD-1 response in pts with melanoma from a phase I trial (NCT03772899). Methods: 20 pts with advanced melanoma with RECIST-evaluable disease, without prior anti-PD-1 treatment for advanced disease, were recruited from 3 Canadian academic centers. Pts with ECOG > 2, autoimmune diseases, immunosuppression or unstable brain metastases were excluded. Pts received 80-100 g of healthy donor stool via oral capsules and were treated with anti-PD-1 one week later. The primary objective was safety of combining FMT with anti-PD-1 therapy. Objective response rate (ORR) by RECIST 1.1 and correlative studies were secondary objectives. Flow cytometry and multiplex ELISA were performed on pts blood samples. Avatar mice were transplanted with stool samples obtained from participants on the trial before and after FMT. Mice were subsequently implanted with B-16 or MCA-205 tumors and received anti-PD-1 antibodies. Results: Median age was 75.5 years, 12 (60%) were male, 18 (90%) had stage 4 disease, and 5 (25%) pts harbored a BRAF mutation. Median follow-up was 11.2 months. FMT-related adverse events included grade 2 diarrhea (2 pts) and hypophosphatemia (1 pt), and 13 pts (65%) experienced grade 1 gastrointestinal toxicities. Grade 3 immune-related adverse events (irAE) were one each of myocarditis, nephritis, and fatigue. Anti-PD-1 therapy was discontinued for toxicity in 2 (10%) pts. No unexpected irAE or death on treatment occurred. ORR was 65% (13/20), of which 3 were CR. Clinical benefit rate (includes SD lasting > 6 months) was 75% (15/20). Median PFS was not reached, and one pt died from their disease. Translational analyses demonstrated upregulation of IL-17 post-FMT in responders, which correlated with upregulation of the frequency of Th17 cells in peripheral blood. In parallel, murine experiments showed that feces from pts pre-FMT did not sensitize tumors to anti-PD-1. In both tumor models, only feces obtained post-FMT from responders restored anti-PD-1 efficacy in mice, providing strong support that FMT contributed to the anti-tumor response observed in pts. Conclusions: FMT followed by anti-PD-1 treatment in melanoma pts undergoing therapy is safe and may lead to improved anti-tumor responses that can be reproduced in tumor mouse models. The gut microbiome plays an important role in responses to anti-PD-1 in patients with advanced melanoma, paving the way for future microbiome-based interventions. Clinical trial information: NCT03772899.
Collapse
Affiliation(s)
- Wilson H. Miller
- Segal Cancer Centre at the Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Bertrand Routy
- Centre De Recherche Du Centre Hospitalier De L'université De Montréal (CRCHUM), Montréal, QC, Canada
| | - Rahima Jamal
- Hôpital Notre-Dame, CHUM, University of Montréal, CHUM Research Center (CRCHUM), Montreal, QC, Canada
| | - D. Scott Ernst
- Division of Medical Oncology, Department of Oncology, Western University, London, ON, Canada
| | - Diane Logan
- London Regional Cancer Program, London, ON, Canada
| | | | - Karl Belanger
- Centre hospitalier de l’Université de Montréal (CHUM), Centre de recherche du CHUM (CRCHUM), Université de Montréal, Montreal, QC, Canada
| | - Arielle Elkrief
- Centre hospitalier de l’Université de Montréal (CHUM), Centre de recherche du CHUM (CRCHUM), Université de Montréal, Montreal, QC, Canada
| | - Rejean Lapointe
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Department of medicine of the Faculty of medicine, Université de Montréal, Montreal, QC, Canada
| | - Pamela Thebault
- Centre de recherche du CHUM, Institut du Cancer de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Mayra Ponce
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Seema Nair Parvathy
- Division of infectious diseases, Department of Medicine, St-Joseph's Health Care, Western University, London, ON, Canada
| | - Meriem Messaoudene
- Centre De Recherche Du Centre Hospitalier De L'université De Montréal (CRCHUM), Montréal, QC, Canada
| | - Micheal Silverman
- Division of infectious diseases, Department of Medicine, St-Joseph's Health Care, Western University, London, ON, Canada
| | - Saman Maleki
- Lawson Health Research Institute, Western University, London, ON, Canada
| | | |
Collapse
|
5
|
Tong J, Mitchell B, Roth K, Logan D, Ernst S. Real-World Experience of Vismodegib in Advanced Basal Cell Carcinoma at a Canadian Cancer Center. J Cutan Med Surg 2021; 26:143-148. [PMID: 34663118 DOI: 10.1177/12034754211051234] [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: 11/17/2022]
Abstract
BACKGROUND Vismodegib is a novel Hedgehog pathway inhibitor that has revolutionized the treatment of patients with advanced basal cell carcinoma (BCC) who are poor candidates for surgery or radiation. Few studies have explored the use of vismodegib to facilitate further surgery or radiotherapy, and the optimal treatment duration to balance outcomes with adverse effects. OBJECTIVES To characterize the disease response, progression, and recurrence outcomes of BCC patients, and to report the impact of subsequent therapies. METHODS We performed a retrospective study of 46 adult patients with advanced basal cell carcinoma (aBCC), including both locally advanced (laBCC) and metastatic (mBCC) disease, treated with vismodegib at a single center from 2012 to 2019. RESULTS Thirty-six had laBCC, and 10 had mBCC. Treatment was given over a mean of 21.9 months. Twenty-three (50%) had a complete response (CR), and 19 (41.3%) achieved partial response (PR). Median time to maximal response was 5.3 months. Eleven (23.9%) had resected disease at median 17.2 months, and 11 patients (23.9%) received radiotherapy. Thirty-two (69.6%) experienced progressive disease after achievement of CR or PR. Among 17 CR patients, who stopped treatment, 14 (82.3%) experienced subsequent relapse; 6 (85%) attained a repeat response. Twenty (43.5%) discontinued treatment at least once due to adverse effects. CONCLUSIONS With a response rate of 91%, London Regional Cancer Center's (LRCP)'s experience with vismodegib supports its effectiveness in treatment of aBCC. Moreover, a significant number of patients treated with vismodegib became amenable to surgery or radiotherapy. Toxicity remained an important factor that limited treatment duration.
Collapse
Affiliation(s)
- Justin Tong
- 70384 Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Brandon Mitchell
- 70384 Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Kathryn Roth
- 70384 Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,London Regional Cancer Program, London Health Sciences Centre, ON, Canada
| | - Diane Logan
- 70384 Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,London Regional Cancer Program, London Health Sciences Centre, ON, Canada
| | - Scott Ernst
- 70384 Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,London Regional Cancer Program, London Health Sciences Centre, ON, Canada
| |
Collapse
|
6
|
Logan D, Luu T, Lakhani B, Howard B, Wilim M, Rivas M, Snipelisky D. Corticosteroids as Adjunct Therapy for Refractory Vasoplegia Following Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
7
|
Breadner D, Vincent MD, Correa R, Black M, Warner A, Qu M, Logan D, Sanatani M, Younus J, Yaremko B, Rodrigues G, Blanchette P, Laba J, Yu E, Goodale D, Lowes L, Bhat V, Gratton A, Sinfield J, Archer S, Morris C, Green E, Jones G, Allan A, Palma D, Raphael J. Abstract 770: Exploitation of treatment induced tumor lysis to enhance sensitivity of ctDNA analysis: a first-in-human pilot study. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Blood based liquid biopsies examining circulating tumour DNA (ctDNA) have increasing applications in non-small cell lung cancer (NSCLC). Limitations in sensitivity, especially in patients with limited disease burden, remains a barrier to ctDNA replacing tissue-based testing. There is a paucity of data regarding the optimal time to measure ctDNA, specifically the dynamics of ctDNA levels in the hours to days following a new and effective treatment. We hypothesize that chemotherapy or radiation will yield an increased abundance of ctDNA in plasma by inducing tumor lysis, allowing for the detection of genetic alterations that were occult in baseline testing.
Methods: Two prospective cohorts of twenty patients (pts) with stage III/IV NSCLC were enrolled. Cohort 1 (C1) contained patients starting the first cycle of platinum doublet chemoradiation (C1a, n=10) or the first cycle of platinum doublet cytotoxic chemotherapy ± immunotherapy without concurrent radiation (C1b, n=10). Cohort 2 (C2) contained patients receiving palliative radiation. Consenting patients provided baseline samples, the first ≤ 14 days prior to starting treatment and one immediately prior to treatment. In C1, subsequent samples were collected (A) 2-3, (B) 4-6, (C) 18-72 and (D) 42-96 hours post initiation of chemotherapy. Pts in C2 had samples collected immediately prior to radiotherapy fractions 2, 3, and 4. Samples were analyzed for ctDNA using the 36-gene amplicon-based NGS Inivata InVisionFirst®-Lung assay.
Results: Complete results were available for the first 28 of 40 enrolled pts, C1a - 8 pts, C1b - 8 pts, C2 - 12 pts. Detectable ctDNA was present at baseline in 21 pts (75%), 4 additional pts (14.3%) had detectable ctDNA in post treatment samples (C1a - 2pts, C1b - 1pt, C2 - 1pt). Three of the patients with detectable ctDNA at baseline (10.7%) had new genetic alterations detected in post treatment samples. A total of 7/28 pts (25%) had new genetic alterations detected in the post treatment samples. Mutant molecule numbers increased with treatment in 19 of 25 (76%) pts with detectable ctDNA, C1 - 11 of 15 pts (73.3%) and C2 - 8 of 10 pts (80%). ctDNA levels peaked a median of 2.2 hours (interquartile range (IQR): 1.5 - 2.9 hours) after the initiation of chemotherapy and a median of 1 day (IQR: 1-2 days) after radiation was commenced. The percentage increase in ctDNA levels was a median of 39.3% (IQR: -20.5 to +112.8%) in C1, with median increases of 22.0% and 39.3% in C1a and C1b, respectively. C2 had a median increase of 81.9% (IQR: 0 to +161.5%).
Conclusion: ctDNA levels increase in the hours to days after starting a new treatment. ctDNA testing in the acute post treatment phase can yield results that were not evident in pretreatment testing. Application of this principle could improve ctDNA utility as an alternate to tissue-based testing and/or improve sensitivity for the detection of treatment-resistant clones.
Citation Format: Daniel Breadner, Mark David Vincent, Rohann Correa, Morgan Black, Andrew Warner, Melody Qu, Diane Logan, Michael Sanatani, Jawaid Younus, Brian Yaremko, George Rodrigues, Phillip Blanchette, Joanna Laba, Edward Yu, David Goodale, Lori Lowes, Vasudeva Bhat, Albert Gratton, James Sinfield, Susan Archer, Clive Morris, Emma Green, Greg Jones, Alison Allan, David Palma, Jacques Raphael. Exploitation of treatment induced tumor lysis to enhance sensitivity of ctDNA analysis: a first-in-human pilot study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 770.
Collapse
Affiliation(s)
| | | | - Rohann Correa
- 1London Regional Cancer Program, London, Ontario, Canada
| | - Morgan Black
- 1London Regional Cancer Program, London, Ontario, Canada
| | - Andrew Warner
- 1London Regional Cancer Program, London, Ontario, Canada
| | - Melody Qu
- 1London Regional Cancer Program, London, Ontario, Canada
| | - Diane Logan
- 1London Regional Cancer Program, London, Ontario, Canada
| | | | - Jawaid Younus
- 1London Regional Cancer Program, London, Ontario, Canada
| | - Brian Yaremko
- 1London Regional Cancer Program, London, Ontario, Canada
| | | | | | - Joanna Laba
- 1London Regional Cancer Program, London, Ontario, Canada
| | - Edward Yu
- 1London Regional Cancer Program, London, Ontario, Canada
| | - David Goodale
- 1London Regional Cancer Program, London, Ontario, Canada
| | - Lori Lowes
- 1London Regional Cancer Program, London, Ontario, Canada
| | - Vasudeva Bhat
- 1London Regional Cancer Program, London, Ontario, Canada
| | - Albert Gratton
- 1London Regional Cancer Program, London, Ontario, Canada
| | - James Sinfield
- 1London Regional Cancer Program, London, Ontario, Canada
| | - Susan Archer
- 1London Regional Cancer Program, London, Ontario, Canada
| | | | - Emma Green
- 2Inivata Inc., Cambridge, United Kingdom
| | | | - Alison Allan
- 4Schulich School of Medicine, London, Ontario, Canada
| | - David Palma
- 1London Regional Cancer Program, London, Ontario, Canada
| | | |
Collapse
|
8
|
Borrie AE, Rose FA, Choi YH, Perera FE, Read N, Sexton T, Lock M, Vandenberg TA, Hahn K, Younus J, Logan D, Potvin K, Yaremko B, Yu E, Lenehan J, Welch S, Teft WA, Kim RB. Genetic and clinical predictors of arthralgia during letrozole or anastrozole therapy in breast cancer patients. Breast Cancer Res Treat 2020; 183:365-372. [PMID: 32632513 DOI: 10.1007/s10549-020-05777-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 06/25/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Female patients with breast cancer frequently develop arthralgia when treated with aromatase inhibitors (AI). Although the mechanism of AI-induced arthralgia is unknown, potential biomarkers have been identified. The purpose of this study was to investigate the clinical and genetic predictors of AI-induced arthralgia in a prospective cohort of patients with estrogen receptor-positive breast cancer. METHODS One hundred and ninety-six patients were enrolled at initiation of AI therapy with either letrozole or anastrozole. Patients completed two validated self-report questionnaires assessing pain, stiffness, and physical function at baseline, and repeated the questionnaires at two and at six months after the initiation of treatment with an AI. Germline DNA of all patients was genotyped for seven single-nucleotide polymorphisms (SNPs) previously identified by genetic screens and genome-wide association studies as associated with AI-induced arthralgia. RESULTS More than 50% of the study group experienced arthralgia symptoms. Genetic analysis revealed that four SNPs, in CYP19A1 (rs4775936) and ESR1 (rs9322336, rs2234693, rs9340799), were associated with the development of arthralgia (adjusted P = 0.016, 0.018, 0.017, 0.047). High body mass index (BMI) was also associated with the development of arthralgia symptoms (adjusted P = 0.001). Patients prescribed letrozole were significantly more likely to develop arthralgia than patients on anastrozole (P = 0.018), and also more likely to discontinue AI therapy due to arthralgia. The CYP19A1 (rs4775936) SNP was significantly associated with discontinuation of therapy due to intolerable arthralgia. CONCLUSIONS Our results suggested that BMI and AI drug (letrozole versus anastrozole) were clinical predictors of arthralgia, while genetic variants rs4775936, rs9322336, rs2234693, and rs9340799 were genetic predictors of AI-induced arthralgia. Significantly, rs4775936 was also a predictor of discontinuation of therapy.
Collapse
Affiliation(s)
- Adrienne E Borrie
- Department of Medicine, Division of Clinical Pharmacology, Western University, London, ON, Canada
- Department of Physiology and Pharmacology, LHSC-University Hospital, Western University, Room B9-116, 339 Windermere Road, London, ON, N6A 5A5, Canada
| | - Finnley A Rose
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Yun-Hee Choi
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | | | - Nancy Read
- Department of Oncology, Western University, London, ON, Canada
| | - Tracy Sexton
- Department of Oncology, Western University, London, ON, Canada
| | - Michael Lock
- Department of Oncology, Western University, London, ON, Canada
| | | | - Karin Hahn
- Department of Oncology, Western University, London, ON, Canada
| | - Jawaid Younus
- Department of Oncology, Western University, London, ON, Canada
| | - Diane Logan
- Department of Oncology, Western University, London, ON, Canada
| | - Kylea Potvin
- Department of Oncology, Western University, London, ON, Canada
| | - Brian Yaremko
- Department of Oncology, Western University, London, ON, Canada
| | - Edward Yu
- Department of Oncology, Western University, London, ON, Canada
| | - John Lenehan
- Department of Oncology, Western University, London, ON, Canada
| | - Stephen Welch
- Department of Oncology, Western University, London, ON, Canada
| | - Wendy A Teft
- Department of Medicine, Division of Clinical Pharmacology, Western University, London, ON, Canada
- Department of Physiology and Pharmacology, LHSC-University Hospital, Western University, Room B9-116, 339 Windermere Road, London, ON, N6A 5A5, Canada
| | - Richard B Kim
- Department of Medicine, Division of Clinical Pharmacology, Western University, London, ON, Canada.
- Department of Physiology and Pharmacology, LHSC-University Hospital, Western University, Room B9-116, 339 Windermere Road, London, ON, N6A 5A5, Canada.
| |
Collapse
|
9
|
Breadner DA, Vincent MD, Correa RJM, Black M, Warner A, Qu M, Logan D, Sanatani MS, Younus J, Yaremko BP, Rodrigues G, Blanchette PS, Laba J, Bhat V, Morris CD, Green E, Jones G, Allan AL, Palma DA, Raphael J. Exploitation of treatment induced tumor lysis to enhance sensitivity of ctDNA analysis: A first-in-human pilot study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.3530] [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
3530 Background: Blood based liquid biopsies examining circulating tumour DNA (ctDNA) have increasing applications in non-small cell lung cancer (NSCLC). Limitations in sensitivity remains a barrier to ctDNA replacing tissue-based testing. There is a paucity of data regarding the dynamics of ctDNA levels in the hours to days following a new treatment. We hypothesize that chemotherapy or radiation will yield an increased abundance of ctDNA in plasma by inducing tumor lysis, allowing for the detection of genetic alterations that were occult in baseline testing. Methods: Two prospective cohorts of 20 patients (pts) with stage III/IV NSCLC were enrolled. Cohort 1 (C1) contained pts starting the first cycle of platinum doublet chemoradiation (C1a, n=10) or the first cycle of platinum doublet cytotoxic chemotherapy ± immunotherapy without radiation (RT) (C1b, n=10). Cohort 2 (C2) contained pts receiving palliative RT alone. Two baseline samples were collected, the first ≤ 14 days prior to starting treatment and one immediately prior to treatment. In C1, subsequent samples were collected 3, 6, 24 and 48 hours post initiation of chemotherapy. Pts in C2 had samples collected immediately prior to RT fractions 2, 3, and 4. Samples were analyzed for ctDNA using the 36-gene amplicon-based NGS Inivata InVisionFirst-Lung assay. Results: Complete results were available for the first 35 of 40 enrolled pts, C1a – 10 pts, C1b – 9 pts, C2 – 16 pts. Detectable ctDNA was present at baseline in 27 pts (77%), 4 additional pts (11%) had detectable ctDNA in post treatment samples. Four of the patients with detectable ctDNA at baseline (15%) had new genetic alterations detected in post treatment samples. A total of 8/35 pts (23%) had new genetic alterations detected in the post treatment samples. Mutant molecule numbers increased with treatment in 23 of 31 (74%) pts with detectable ctDNA, C1 - 13 of 19 pts (68%) and C2 - 10 of 16 pts (63%). ctDNA levels peaked a median of 2.2 hours (IQR: 1.5 – 2.9 hours) after the initiation of chemotherapy and a median of 1 day (IQR: 1-2 days) after radiation was commenced. The percentage increase in ctDNA levels was a median of 29% (IQR: -18 to +112%) in C1. C2 had a median increase of 16% (IQR: 0 to +131%). Conclusions: ctDNA levels increase in the hours to days after starting treatment. ctDNA testing in the acute post treatment phase can yield results that were not evident in pretreatment testing. Application of this principle could improve ctDNA utility as an alternate to tissue-based testing and improve sensitivity for the detection of treatment-resistant clones.
Collapse
Affiliation(s)
| | | | | | - Morgan Black
- Department of Oncology, Division of Medical Oncology, Schulich School of Medicine & Dentistry, Western University and London Regional Cancer Program, London, ON, Canada
| | | | - Melody Qu
- London Regional Cancer Program, London, ON, Canada
| | - Diane Logan
- London Regional Cancer Program, London, ON, Canada
| | | | | | - Brian P Yaremko
- London Regional Cancer Program, University of Western Ontario, London, ON, Canada
| | - George Rodrigues
- Department of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - Phillip S. Blanchette
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Joanna Laba
- London Regional Cancer Program, London, ON, Canada
| | | | | | | | | | - Alison L Allan
- London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada
| | | | - Jacques Raphael
- London Regional Cancer Program, Western University, London, ON, Canada
| |
Collapse
|
10
|
Logan D, McEvoy CT, McKenna G, Kee F, Linden G, Woodside JV. Association between oral health status and future dietary intake and diet quality in older men: The PRIME study. J Dent 2019; 92:103265. [PMID: 31862215 DOI: 10.1016/j.jdent.2019.103265] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/11/2019] [Accepted: 12/15/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES This study investigated whether oral health status, defined as number of natural teeth and subsequent prosthodontic rehabilitation, was associated with future dietary intake and diet quality in older adults in The Prospective Epidemiological Study of Myocardial Infarction (PRIME). METHODS PRIME was originally established to explore cardiovascular risk factors in 50-59 year old men in Northern Ireland (1991-1994). A rescreening phase assessed oral health (2001-2004), while diet was assessed in 2015. Diet quality was characterised by the Dietary Diversity Score and Mediterranean Diet Score. In the current analysis, associations between oral health status, dietary intake and quality were assessed using regression models in 1096 participants. RESULTS Amongst study participants, the overall mean number of teeth was 18.5, 51.5 % had ≥21 natural teeth and 49.6 % wore dentures. Oral health status was categorised into five groups: 21-28 teeth with (n = 111) and without (n = 453) dentures, 1-20 teeth with (n = 354) and without (n = 99) dentures and edentate with dentures (n = 79). After full adjustment, men with ≥21 teeth and dentures had a higher future intake of fruit, vegetables, and nuts, and diet quality scores, compared to those with <21 teeth with dentures. Edentate men with dentures were less likely to achieve the future fruit dietary recommendation. CONCLUSIONS Having ≥21 natural remaining teeth positively affected the future intake of fruit, vegetables, and nuts, as well as diet quality. Dentures may be beneficial in men with ≥21 natural remaining teeth, as they were associated with an increased future intake of fruit, vegetables, and nuts and better diet quality. CLINICAL SIGNIFICANCE Oral health status is associated with dietary intake, after an average time period of 13 years, with those with a larger number of natural teeth having a better diet quality. Further research is required to investigate this relationship in larger, diverse populations with more detailed dietary assessment.
Collapse
Affiliation(s)
- D Logan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BA, United Kingdom
| | - C T McEvoy
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BA, United Kingdom
| | - G McKenna
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BA, United Kingdom
| | - F Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BA, United Kingdom
| | - G Linden
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BA, United Kingdom
| | - J V Woodside
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BA, United Kingdom
| |
Collapse
|
11
|
Hood S, Roy M, Keramidas M, Logan D, Godbout N, Mendrek A, Taylor V. Evaluating mindful attention awareness as a predictor of sleep quality in healthy young adults. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
12
|
Koppel S, Charlton JL, Hua P, Liu PY, Pham H, Stephan K, Logan D, St. Louis RM. ARE OLDER DRIVERS’ DRIVING PATTERNS DURING AN ON-ROAD DRIVING TASK REPRESENTATIVE OF THEIR REAL-WORLD DRIVING? Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Koppel
- Monash University Accident Research Centre, Melbourne, Victoria, Australia
| | - J L Charlton
- Monash University Accident Research Centre, Melbourne, Victoria, Australia
| | - P Hua
- BPsych(Hons), Monash University Accident Research Centre, Melbourne, Victoria, Australia
| | - P Y Liu
- Monash University Accident Research Centre, Melbourne, Victoria, Australia
| | - H Pham
- Monash University Accident Research Centre, Melbourne, Victoria, Australia
| | - K Stephan
- Monash University Accident Research Centre, Melbourne, Victoria, Australia
| | - D Logan
- Monash University Accident Research Centre, Melbourne, Victoria, Australia
| | - R M St. Louis
- Monash University Accident Research Centre, Melbourne, Victoria, Australia
| |
Collapse
|
13
|
Borrie AE, Rose RV, Choi YH, Perera FE, Read N, Sexton T, Lock M, Vandenberg TA, Hahn K, Dinniwell R, Younus J, Logan D, Potvin K, Yaremko B, Yu E, Lenehan J, Welch S, Tyndale RF, Teft WA, Kim RB. Letrozole concentration is associated with CYP2A6 variation but not with arthralgia in patients with breast cancer. Breast Cancer Res Treat 2018; 172:371-379. [PMID: 30094551 DOI: 10.1007/s10549-018-4910-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 07/28/2018] [Accepted: 08/02/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE The aromatase inhibitor (AI) letrozole is a first-line drug in the adjuvant treatment of breast cancer in postmenopausal women. Adherence to AI therapy, including letrozole, remains problematic due to the development of debilitating AI-induced arthralgia. Letrozole is metabolized in the liver by CYP2A6. It remains unknown if plasma letrozole levels or CYP2A6 genetic variation is associated with the development of arthralgia. METHODS We enrolled 126 female breast cancer patients initiated on letrozole therapy and prospectively collected blood samples at baseline and two follow-up time points to determine letrozole plasma concentrations and CYP2A6 genotype. At each visit, participants completed two validated questionnaires to assess the severity of arthralgia symptoms. RESULTS More than half (55%) of patients experienced a significant increase in their arthralgia symptoms after initiation of treatment. The clinical variables of body mass index (P = 0.0003) and age (P = 0.0430) were negatively and positively associated with plasma letrozole concentrations, respectively. CYP2A6 genotype was significantly associated with letrozole levels (P < 0.0001), and increased plasma letrozole levels were observed in patients with CYP2A6 reduced-function genotypes. Plasma levels of letrozole and CYP2A6 genotype were not significantly associated with a change in pain score from baseline. CONCLUSIONS CYP2A6 genotype was a significant predictor of letrozole plasma levels, but was not associated with the development of arthralgia.
Collapse
Affiliation(s)
- Adrienne E Borrie
- Division of Clinical Pharmacology, Department of Medicine, Western University, London, ON, Canada.,Department of Physiology and Pharmacology, Western University, London, ON, Canada
| | - Rhiannon V Rose
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Yun-Hee Choi
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | | | - Nancy Read
- Department of Oncology, Western University, London, ON, Canada
| | - Tracy Sexton
- Department of Oncology, Western University, London, ON, Canada
| | - Michael Lock
- Department of Oncology, Western University, London, ON, Canada
| | | | - Karin Hahn
- Department of Oncology, Western University, London, ON, Canada
| | | | - Jawaid Younus
- Department of Oncology, Western University, London, ON, Canada
| | - Diane Logan
- Department of Oncology, Western University, London, ON, Canada
| | - Kylea Potvin
- Department of Oncology, Western University, London, ON, Canada
| | - Brian Yaremko
- Department of Oncology, Western University, London, ON, Canada
| | - Edward Yu
- Department of Oncology, Western University, London, ON, Canada
| | - John Lenehan
- Department of Oncology, Western University, London, ON, Canada
| | - Stephen Welch
- Department of Oncology, Western University, London, ON, Canada
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, and Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Wendy A Teft
- Division of Clinical Pharmacology, Department of Medicine, Western University, London, ON, Canada.,Department of Physiology and Pharmacology, Western University, London, ON, Canada
| | - Richard B Kim
- Division of Clinical Pharmacology, Department of Medicine, Western University, London, ON, Canada. .,Department of Physiology and Pharmacology, Western University, London, ON, Canada. .,LHSC - University Hospital, Western University, Room B9-116, 339 Windermere Road, London, ON, N6A 5A5, Canada.
| |
Collapse
|
14
|
Baetz TD, Song X, Ernst DS, McWhirter E, Petrella TM, Savage KJ, Smylie M, Wong R, Lee CW, Look Hong N, Logan D, Raza MS, Abbas T, Nomikos D, Leung R, Chen BE, Dancey J. A randomized phase III study of duration of anti-PD-1 therapy in metastatic melanoma (STOP-GAP): Canadian Clinical Trials Group study (CCTG) ME.13. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps9600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Tara D. Baetz
- Division of Medical Oncology, Queen’s University, Kingston, ON, Canada
| | - Xinni Song
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Elaine McWhirter
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Teresa M. Petrella
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kerry J. Savage
- British Columbia Cancer Agency, Center for Lymphoid Cancer, Vancouver, BC, Canada
| | | | - Ralph Wong
- CancerCare Manitoba, Winnipeg, MB, Canada
| | | | | | - Diane Logan
- London Regional Cancer Program, London, ON, Canada
| | | | - Tahir Abbas
- Saskatoon Cancer Centre, Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon, SK, Canada
| | - Dora Nomikos
- NCIC Clinical Trials Group, Kingston, ON, Canada
| | - Roger Leung
- Canadian Cancer Trials Group, Kingston, ON, Canada
| | | | | |
Collapse
|
15
|
Nelson S, Logan D. The role of adverse childhood experiences (ACEs) in school-related impairment in youth with chronic pain. The Journal of Pain 2018. [DOI: 10.1016/j.jpain.2017.12.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
16
|
Koppel S, Charlton JL, Hua P, Liu PY, Pham H, Stephan K, Logan D, St Louis RM, Gao G, Griffiths D, Williams G, Witharanage T, Di Stefano M, Darzins P, Odell M, Porter MM, Mazer B, Gelinas I, Vrkljan B, Marshall S. Are older drivers' driving patterns during an on-road driving task representative of their real-world driving patterns? Traffic Inj Prev 2018; 19:S173-S175. [PMID: 30841798 DOI: 10.1080/15389588.2018.1532219] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The current study investigated whether older drivers' driving patterns during a customized on-road driving task were representative of their real-world driving patterns. METHODS Two hundred and eight participants (male: 68.80%; mean age = 81.52 years, SD = 3.37 years, range = 76.00-96.00 years) completed a customized on-road driving task that commenced from their home and was conducted in their own vehicle. Participants' real-world driving patterns for the preceding 4-month period were also collected via an in-car recording device (ICRD) that was installed in each participant's vehicle. RESULTS During the 4-month period prior to completing the on-road driving task, participants' median real-world driving trip distance was 2.66 km (interquartile range [IQR] = 1.14-5.79 km) and their median on-road driving task trip distance was 4.41 km (IQR = 2.83-6.35 km). Most participants' on-road driving task trip distances were classified as representative of their real-world driving trip distances (95.2%, n = 198). CONCLUSIONS These findings suggest that most older drivers were able to devise a driving route that was representative of their real-world driving trip distance. Future research will examine whether additional aspects of the on-road driving task (e.g., average speed, proportion of trips in different speed zones) are representative of participants' real-world driving patterns.
Collapse
Affiliation(s)
- S Koppel
- a Monash University Accident Research Centre , Victoria , Australia
| | - J L Charlton
- a Monash University Accident Research Centre , Victoria , Australia
| | - P Hua
- a Monash University Accident Research Centre , Victoria , Australia
| | - P Y Liu
- a Monash University Accident Research Centre , Victoria , Australia
| | - H Pham
- a Monash University Accident Research Centre , Victoria , Australia
| | - K Stephan
- a Monash University Accident Research Centre , Victoria , Australia
| | - D Logan
- a Monash University Accident Research Centre , Victoria , Australia
| | - R M St Louis
- a Monash University Accident Research Centre , Victoria , Australia
| | - G Gao
- a Monash University Accident Research Centre , Victoria , Australia
| | - D Griffiths
- a Monash University Accident Research Centre , Victoria , Australia
| | - G Williams
- a Monash University Accident Research Centre , Victoria , Australia
| | - T Witharanage
- a Monash University Accident Research Centre , Victoria , Australia
| | | | - P Darzins
- c Eastern Health , Victoria, Australia
| | - M Odell
- d Victorian Institute of Forensic Medicine , Victoria, Australia
| | - M M Porter
- e Faculty of Kinesiology and Recreation Management, and Centre on Aging , University of Manitoba , Canada
| | - B Mazer
- f McGill University , Winnipeg, Canada
| | - I Gelinas
- f McGill University , Winnipeg, Canada
| | - B Vrkljan
- g McMaster University , Hamilton, Canada
| | - S Marshall
- h Ottawa Hospital Research Institute , Ottawa, Canada
| |
Collapse
|
17
|
Clementi E, Chin S, Logan D. Supercomputers for Quantum Chemistry, Statistical Mechanics and Fluid Dynamics of Biological Systems. Isr J Chem 2013. [DOI: 10.1002/ijch.198600022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
18
|
Williams S, Logan D, Sieberg C, Simons L. Parent/child catastrophizing matches and mismatches: the effect on pain, symptoms, and disability. The Journal of Pain 2012. [DOI: 10.1016/j.jpain.2012.01.426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
19
|
Ursby T, Logan D, Neutze R, Schneider G, Thunnissen M. MAX IV MX: macromolecular crystallography at the new MAX IV 3 GeV storage ring. Acta Crystallogr A 2011. [DOI: 10.1107/s0108767311079426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
20
|
Cappelli M, Surh L, Walker M, Korneluk Y, Humphreys L, Verma S, Hunter A, Allanson J, Logan D. Psychological and social predictors of decisions about genetic testing for breast cancer in high-risk women. PSYCHOL HEALTH MED 2010. [DOI: 10.1080/13548500123484] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
21
|
Elder DHJ, Logan D, Currie P. 144 Bradycardia support in the district general hospital—development of a new protocol for managing bradycardia by the non-cardiologist. Heart 2010. [DOI: 10.1136/hrt.2010.196113.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
22
|
DiPetrillo T, Heron D, Fernando H, Landreneau R, Logan D, Briggs K, Fitzgerald T, Thomas C, Putnam J, Meyers B. Sublobar Resection and Iodine-125 Brachytherapy for Stage I NSCLC: Initial Quality Assurance Review of ACOSOG Z-4032. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
23
|
Chawla N, Neighbors C, Logan D, Lewis MA, Fossos N. Perceived approval of friends and parents as mediators of the relationship between self-determination and drinking. J Stud Alcohol Drugs 2009; 70:92-100. [PMID: 19118397 PMCID: PMC2629627 DOI: 10.15288/jsad.2009.70.92] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 06/17/2008] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Within the context of self-determination theory, individuals vary in the extent to which they are oriented toward autonomy and control. Previous research on the relationship between motivational orientations and drinking behavior among college students has suggested that students who are more autonomously oriented consume less alcohol whereas those who are more control oriented consume more alcohol. This research evaluated the extent to which these relationships are mediated by the perceived approval of friends and parents, both of which are important sources of potential influence on the behavior of college students. METHOD First-year students (N = 818, 58% female) who reported one or more heavy drinking episodes in the previous month completed online assessments of their drinking behavior, autonomous and controlled orientations, and perceptions of the approval of drinking (injunctive norms) by important others (friends and parents). RESULTS The results suggested that controlled orientation was associated with greater alcohol use and that this association was mediated by perceptions of friends being more approving of problematic drinking. In contrast, autonomous orientation was associated with less alcohol use and this association was mediated by perceptions of friends being less supportive of problematic drinking. No support was found for perceptions of parents' approval as a mediator of the associations between either orientation and drinking. CONCLUSIONS The findings highlight the importance of perceptions of friends' approval or disapproval of problematic drinking in understanding the relationship between self-determination and heavy drinking among college students.
Collapse
Affiliation(s)
- Neharika Chawla
- Department of Psychology, University of Washington, Box 351525, Seattle, Washington 98195-1525
| | - Clayton Neighbors
- Department of Psychology, University of Washington, Box 351525, Seattle, Washington 98195-1525
| | | | - Melissa A. Lewis
- Department of Psychology, University of Washington, Box 351525, Seattle, Washington 98195-1525
| | - Nicole Fossos
- Department of Psychology, University of Washington, Box 351525, Seattle, Washington 98195-1525
| |
Collapse
|
24
|
Dong W, Tang X, Yu Y, Griffith J, Nilsen R, Choi D, Baldwin J, Hilton L, Kelps K, Mcguire J, Morgan R, Smith M, Case M, Arnold J, Schüttler HB, Wang Q, Liu J, Reeves J, Logan D. Systems biology of the neurospora biological clock. IET Syst Biol 2007; 1:257-65. [PMID: 17907673 DOI: 10.1049/iet-syb:20060080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A major challenge of systems biology is explaining complex traits, such as the biological clock, in terms of the kinetics of macromolecules. The clock poses at least four challenges for systems biology: (i) identifying the genetic network to explain the clock mechanism quantitatively; (ii) specifying the clock's functional connection to a thousand or more genes and their products in the genome; (iii) explaining the clock's response to light and other environmental cues; and (iv) explaining how the clock's genetic network evolves. Here, the authors illustrate an approach to these problems by fitting an ensemble of genetic networks to microarray data derived from oligonucleotide arrays with approximately all 11 000 Neurospora crassa genes represented. A promising genetic network for the clock mechanism is identified.
Collapse
Affiliation(s)
- W Dong
- Genetics Department, University of Georgia, Athens, GA 30602, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Chu Q, Vincent M, Logan D, Mackay JA, Evans WK. Taxanes as first-line therapy for advanced non-small cell lung cancer: a systematic review and practice guideline. Lung Cancer 2005; 50:355-74. [PMID: 16139391 DOI: 10.1016/j.lungcan.2005.06.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Revised: 06/29/2005] [Accepted: 06/30/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED This evidence-based practice guideline on the use of paclitaxel (Taxol) or docetaxel (Taxotere) as first-line treatment for patients with advanced non-small cell lung cancer who are candidates for palliative first-line chemotherapy is based on a systematic search and review of literature published in full or in abstract form between 1985 and April 2005. Forty-five randomized trials, including 11 abstracts, were reviewed and clinicians in the province of Ontario, Canada, provided feedback on a draft version of the guideline. Two phase III trials detected a statistically significant survival advantage for a taxane (paclitaxel or docetaxel) with best supportive care versus best supportive care alone. Among the nine fully published phase III trials comparing platinum-based chemotherapies, taxane-platinum combinations achieved higher response rates compared with older chemotherapy combinations, although significantly longer survival was observed only for docetaxel-cisplatin compared with vindesine-cisplatin. Response rates and survival were generally not significantly different for taxane-platinum combinations compared with other current chemotherapy combinations, although the toxicity profile of the regimens varied. However, in one large trial, improved tumor response and modest survival and quality of life benefits were associated with docetaxel-cisplatin compared with vinorelbine-cisplatin. No statistically significant survival differences were detected in the three fully published phase III trials comparing a taxane-gemcitabine combination with a taxane-platinum regimen. RECOMMENDATIONS (i) paclitaxel or docetaxel combined with cisplatin is recommended as one of a number of chemotherapy options for the first-line treatment of advanced non-small cell lung cancer in patients with a good performance status; (ii) carboplatin may be combined with a taxane if a patient is unable or unwilling to take cisplatin; (iii) a taxane-gemcitabine combination may be considered for patients with a contraindication to cisplatin and carboplatin; (iv) no firm recommendation can be made on the optimal dose and schedule of taxane-based chemotherapy; however, commonly used regimens include cisplatin 75 mg/m2 combined with either docetaxel 75 mg/m2 or paclitaxel 135 mg/m2 (24-h infusion) and carboplatin AUC 6 combined with paclitaxel 225 mg/m2 (3-h infusion); (v) a single-agent taxane may be used if combination chemotherapy is considered inappropriate.
Collapse
Affiliation(s)
- Quincy Chu
- Department of Medical Oncology, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alt., Canada
| | | | | | | | | |
Collapse
|
26
|
Hansson S, Singh R, Gudkov A, Liljas A, Logan D. Fusidic acid resistance and sensitivity in ribosomal elongation factor G. Acta Crystallogr A 2005. [DOI: 10.1107/s010876730509032x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
27
|
Lundell A, Aspberg A, Logan D. Structural studies of the CLD from aggrecan. Acta Crystallogr A 2005. [DOI: 10.1107/s0108767305097515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
28
|
Laurie SA, Logan D, Markman BR, Mackay JA, Evans WK. Practice guideline for the role of combination chemotherapy in the initial management of limited-stage small-cell lung cancer. Lung Cancer 2004; 43:223-40. [PMID: 14739044 DOI: 10.1016/j.lungcan.2003.09.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED An evidence-based practice guideline was developed to identify the optimal combination chemotherapy regimen, schedule of administration, and duration of therapy for the first-line treatment of adults with limited-stage small-cell lung cancer. The guideline is based on a systematic search and review of literature published between 1985 and December 2002. Three reviewers selected studies for inclusion in the guideline according to pre-defined criteria. Fifty randomized controlled trials, five in abstract form, were included in the review, and feedback on a draft version of the guideline was obtained from medical oncologists in the province of Ontario, Canada. The most commonly used regimens in clinical trials are cyclophosphamide-doxorubicin(Adriamycin)-vincristine, and etoposide-cisplatin. No combination chemotherapeutic regimen has been conclusively shown to be superior to either of these regimens. Most studies comparing chemoradiation regimens used sequential rather than concurrent thoracic radiotherapy. When treating for cure with chemoradiation, there is evidence from one randomized controlled trial to support the use of etoposide-cisplatin over an anthracycline-containing regimen. There is conflicting evidence concerning a survival advantage for a regimen that alternates cyclophosphamide-doxorubicin-vincristine with etoposide-cisplatin compared with either regimen alone. If bolus etoposide-cisplatin is the treatment of choice, evidence from one randomized trial suggests that the optimal sequence of administration is cisplatin followed by etoposide. The use of maintenance chemotherapy is not indicated. There is insufficient evidence to support the routine use of dose-intensive regimens outside a clinical trial, to determine the optimal duration of chemotherapy, or to support the routine substitution of carboplatin for cisplatin in combination chemotherapy regimens in this patient population. RECOMMENDATIONS Etoposide-cisplatin is the preferred chemotherapy regimen for patients with limited-stage small-cell lung cancer when concurrent thoracic radiotherapy is used. It is reasonable to offer the alternation of etoposide-cisplatin with cyclophosphamide-doxorubicin-vincristine, provided the administration of radiotherapy concurrent with an anthracycline is avoided.
Collapse
|
29
|
Affiliation(s)
- E Fry
- Laboratory of Molecular Biophysics, University of Oxford, UK
| | | | | |
Collapse
|
30
|
Logan D, Larsson KM, Sjoeberg BM, Nordlund P. Structural basis for allosteric substrate specificity regulation in anaerobic ribonucleotide reductases. Acta Crystallogr A 2002. [DOI: 10.1107/s0108767302092735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
31
|
Liljas A, Hansson S, Kristensen O, Laurberg M, Logan D, Sanyal S, Selmer M, Su XD. Is tRNA mimicry mandatory for translation factors? Acta Crystallogr A 2002. [DOI: 10.1107/s0108767302096101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
32
|
Cappelli M, Surh L, Humphreys L, Verma S, Logan D, Hunter A, Allanson J. Measuring women's preferences for breast cancer treatments and BRCA1/BRCA2 testing. Qual Life Res 2002; 10:595-607. [PMID: 11822793 DOI: 10.1023/a:1013123915272] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In establishing decision models in the treatment and prevention of breast cancer, it is important to evaluate patients' preferences for such interventions. The objectives of the present study were: (i) to characterize women's preferences for breast cancer treatments and BRCA1/BRCA2 testing, using the rating scale and standard gamble techniques; and (ii) to identify factors associated with these quality of life indices. Data were collected from women with breast cancer (n = 60), high-risk relatives of women with breast cancer (n = 58), and women in the general population (n = 51). Regardless of group membership, participants favoured treatment and prevention options that involved minimal physical invasiveness. Women with breast cancer rated lumpectomy and radiation treatment more highly than high-risk relatives and women in the general population. Preferences did not differ according to participants' intentions to undergo BRCA testing. Age was the only demographic variable associated with health state preferences. These findings hold implications for the application of patient preferences to clinical decision making.
Collapse
Affiliation(s)
- M Cappelli
- Children's Hospital of Eastern Ontario, Ottawa, Canada.
| | | | | | | | | | | | | |
Collapse
|
33
|
Cappelli M, Surh L, Walker M, Korneluk Y, Humphreys L, Verma S, Hunter A, Allanson J, Logan D. Psychological and social predictors of decisions about genetic testing for breast cancer in high-risk women. ACTA ACUST UNITED AC 2001. [DOI: 10.1080/1354850012005436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
34
|
Graham ID, Evans WK, Logan D, O'Connor A, Palda V, McAuley L, Brouwers M, Harrison MB. Canadian oncologists and clinical practice guidelines: a national survey of attitudes and reported use. Provincial Lung Disease Site Group of Cancer Care Ontario. Oncology 2000; 59:283-90. [PMID: 11096339 DOI: 10.1159/000012184] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine (1) Canadian oncologists' attitudes toward practice guidelines, (2) oncologists' self-reported use of practice guidelines and, (3) physicians' characteristics and attitudes associated with self-reported use of practice guidelines. PARTICIPANTS AND METHODS A cross-sectional, self-administered postal survey was administered to Canadian oncologists. Main outcome measures were level of agreement with 8 descriptive statements about guidelines, score on the attitudinal scale of the guideline of Tunis et al., and physicians' stated use of guideline. chi(2) and logistic regression procedures were used to explore the relationship between physician characteristics and use of guidelines. RESULTS Over 80% of respondents agreed that they were good educational tools, convenient sources of advice, intended to improve quality of care; over 40% agreed that they were unbiased syntheses of expert opinion. Conversely, 42, 26, 20 and 16% felt they were intended to cut costs, were oversimplified cookbook medicine, were too rigid to apply to individual patients, and a challenge to physicians' authority, respectively. Forty-one percent reported using practice guidelines routinely or most of the time. Use was associated with positive attitudes about guidelines, receiving medical school training abroad and being a radiation oncologist. CONCLUSION Canadian oncologists were quite positive about practice guidelines and reported using them frequently. Our results suggest that use of guidelines by oncologists may be related to attitudes about guidelines in general, specialty within oncology and country of medical school training.
Collapse
Affiliation(s)
- I D Graham
- Clinical Epidemiology Unit, Ottawa Hospital, University of Ottawa, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
OBJECTIVE To investigate the prevalence and characteristics of aggressive behavior in adolescent inpatients and outpatients with major depressive disorder (MDD). Differences between males and females in prevalence and type of aggression, and level of parent-child agreement in report of aggression, were analyzed. METHOD Participants were 74 adolescents with MDD, aged 13 to 17 years. The Structured Clinical Interview for DSM-IV Axis I Disorders was used to identify MDD. Adolescents' aggressive behavior was assessed using an adapted version of the Brown-Goodwin Assessment for Lifetime History of Aggression; the Measure of Aggression, Violence, and Rage in Children; and the Buss-Durkee Hostility Inventory-Adapted Version. RESULTS Results indicate high levels of aggressive behavior in adolescents with MDD. Amount and type of aggression did not differ by gender. Results indicate poor correspondence between parent and adolescent reports of aggression, which was most marked for females. CONCLUSIONS Aggressive behaviors are highly prevalent in depressed youths, with similar types and levels evident in males and females. Parents tend to under-report and may not be cognizant of aggressive behavior that occurs outside the home, particularly for females.
Collapse
Affiliation(s)
- M Knox
- Medical College of Ohio, Toledo 43614, USA.
| | | | | | | | | |
Collapse
|
36
|
Gold-Steinberg S, Logan D. Integrating play therapy in the treatment of children with obsessive-compulsive disorder. Am J Orthopsychiatry 1999; 69:495-503. [PMID: 10553460 DOI: 10.1037/h0080397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
While behavioral and psychopharmacological approaches are the most effective interventions for treating obsessive-compulsive disorder (OCD), psychodynamically oriented play therapy can enhance the treatment of children with this disorder. Play therapy techniques are useful in addressing treatment resistance, feelings of shame around OCD symptoms, negative self-concept, and issues of psychosocial adjustment. A case study illustrates this integrated approach to treatment.
Collapse
Affiliation(s)
- S Gold-Steinberg
- University Center for the Child and the Family, University of Michigan, Ann Arbor, USA
| | | |
Collapse
|
37
|
Cappelli M, Surh L, Humphreys L, Verma S, Logan D, Hunter A, Allanson J. Psychological and social determinants of women's decisions to undergo genetic counseling and testing for breast cancer. Clin Genet 1999; 55:419-30. [PMID: 10450858 DOI: 10.1034/j.1399-0004.1999.550605.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study examined the demand for breast cancer genetic testing and counseling among Canadian women diagnosed with breast cancer under the age of 50, together with some of the factors predicting both their intentions to be tested and the degree to which they act on their intentions. Participants were 110 women under the age of 50 and comprised of two groups: 1) women diagnosed with breast cancer (BC, n = 60): and 2) an index group of unaffected women from the general population (GP, n = 50). All participants completed a survey that addressed family history of breast and other cancers, demographic variables, knowledge and attitudes about breast cancer, and genetic testing. Members of the BC group were offered genetic counseling and testing for BRCA1 and BRCA2 free of charge. Overall, 60% of participants indicated they would like the test, and 40% either did not want it or were uncertain. Seventy-two percent of women in the BC group wanted to be tested. Of these, only 49% had actually contacted the genetic counselor about testing at follow-up 3-15 months later. Intention to be tested was associated with presence of breast cancer, greater perceived benefits of testing, fewer perceived 'costs' of testing, and higher levels of concern about the risk of relatives developing breast cancer. Actual arranging to meet with the genetic counselor among women in the BC group was associated with fewer perceived costs of having the test. Results suggest a moderate level of interest in gene testing, though intention to be tested may not translate into actual uptake. Women who do choose to have the test may believe the potential 'costs' of using this new genetic technology to be relatively few. This has implications for genetic counselors in terms of providing balanced and complete information to women considering genetic testing for breast cancer susceptibility.
Collapse
Affiliation(s)
- M Cappelli
- Children's Hospital of Eastern Ontario, Ottawa, Canada.
| | | | | | | | | | | | | |
Collapse
|
38
|
Mazauric MH, Keith G, Logan D, Kreutzer R, Giegé R, Kern D. Glycyl-tRNA synthetase from Thermus thermophilus--wide structural divergence with other prokaryotic glycyl-tRNA synthetases and functional inter-relation with prokaryotic and eukaryotic glycylation systems. Eur J Biochem 1998; 251:744-57. [PMID: 9490048 DOI: 10.1046/j.1432-1327.1998.2510744.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The tRNA glycylation system is amongst the most complex aminoacylation systems since neither the oligomeric structure of the enzymes nor the discriminator base in tRNAs are conserved in the phylae. To understand better this structural diversity and its functional consequences, the prokaryotic glycylation system from Thermus thermophilus, an extreme thermophile, was investigated and its structural and functional inter-relations with those of other origins analyzed. Alignments of the protein sequence of the dimeric thermophilic glycyl-tRNA synthetase (Gly-tRNA synthetase) derived from its gene with sequences of other dimeric Gly-tRNA synthetases revealed an atypical character of motif 1 in all these class 2 synthetases. Interestingly, the sequence of the prokaryotic thermophilic enzyme resembles eukaryotic and archaebacterial Gly-tRNA synthetases, which are all dimeric, and diverges drastically from the tetrameric enzymes from other prokaryotes. Cross aminoacylations with tRNAs and synthetases of different origins provided information about functional interrelations between the glycylation systems. Efficient glycylations involving partners from T. thermophilus and Escherichia coli showed conservation of the recognition process in prokaryotes despite strong structural variations of the synthetases. However, Gly-tRNA synthetase from T. thermophilus acylates eukaryotic tRNA(Gly) while the charging ability of the E. coli enzyme is restricted to prokaryotic tRNA(Gly). A similar behaviour is found in eukaryotic systems where the restricted species specificity for tRNA glycylation of mammalian Gly-tRNA synthetase contrasts with the relaxed specificity of the yeast enzyme. The consensus sequence of the tRNAs charged by the various Gly-tRNA synthetases reveals conservation of only G1-C72 in the acceptor arm, C35 and C36 in the anticodon, and the (G10-Y25)-G45 triplet involved in tRNA folding. Conservation of these nucleotides indicates their key role in glycylation and suggests that they were part of the ancestral glycine identity set. These features are discussed in the context of the phylogenic connections between prokaryotes, eukaryotes, and archaebacteria, and of the particular place of T. thermophilus in this phylogeny.
Collapse
MESH Headings
- Amino Acid Sequence
- Animals
- Base Sequence
- Cloning, Molecular
- Consensus Sequence
- DNA Primers
- Genetic Variation
- Glycine-tRNA Ligase/biosynthesis
- Glycine-tRNA Ligase/chemistry
- Glycine-tRNA Ligase/genetics
- Humans
- Mammals
- Molecular Sequence Data
- Mutagenesis, Site-Directed
- Polymerase Chain Reaction
- Prokaryotic Cells
- RNA, Transfer, Gly/biosynthesis
- RNA, Transfer, Gly/chemistry
- RNA, Transfer, Gly/genetics
- Recombinant Proteins/biosynthesis
- Recombinant Proteins/chemistry
- Sequence Alignment
- Sequence Homology, Amino Acid
- Sequence Homology, Nucleic Acid
- Thermus thermophilus/enzymology
- Thermus thermophilus/genetics
Collapse
Affiliation(s)
- M H Mazauric
- UPR 9002 du CNRS, Institut de Biologie Moléculaire et Cellulaire, Strasbourg, France
| | | | | | | | | | | |
Collapse
|
39
|
Kudlacz E, Shatzer S, Logan D, Olsen K, Knippenberg R, Hsieh L, Esteve H, Maynard G. A role for histamine and substance P in immediate allergic responses in guinea pig airways: characterization of MDL 108,207DA, a dual H1/NK-1 receptor antagonist. Int Arch Allergy Immunol 1998; 115:169-78. [PMID: 9482707 DOI: 10.1159/000023898] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Histamine is a critical mediator of immediate hypersensitivity reactions. Sensory neuropeptides, such as substance P (SP), may also contribute to acute inflammatory responses. A compound which antagonizes both H1 and NK-1 receptors, such as MDL 108,207DA, may present a significant therapeutic advantage over pure antihistamines. METHODS The binding affinity of MDL 108,207DA for H1 and NK-1 receptors was evaluated and its potency of antagonism evaluated in vitro. The in vivo antagonism of SP- or histamine-induced microvascular leakage in guinea pig airways was examined. A role for these mediators in antigen-induced microvascular leakage in ovalbumin-sensitized guinea pig airways was examined using MDL 108,207DA as well as the NK-1-selective antagonist FK888 and the H1-selective antagonist pyrilamine alone or in combination. RESULTS The affinity of MDL 108,207DA for H1 and NK-1 receptors is similar to that of receptor-selective antagonists. The compound inhibits both receptors in vitro and in vivo with comparable potencies for each. The efficacy of FK888 in combination with pyrilamine and MDL 108,207DA on antigen-induced microvascular leakage in sensitized guinea pig airways supports a role for both SP and histamine in early allergic responses. CONCLUSION The contribution of both SP and histamine to immediate hypersensitivity reactions supports the utility of NK-1 and H1 receptor antagonist therapy. MDL 108,207DA incorporates both activities into the same compound and, as a result, may be useful in the treatment of allergic diseases.
Collapse
Affiliation(s)
- E Kudlacz
- Hoechst Marion Roussel, Cincinnati, Ohio 45215, USA
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Cappelli M, Surh L, Verma S, Ryan W, Logan D, Korneluk Y, Feeny D, Hunter A, Allanson J. Canadian women's attitudes towards breast cancer gene testing. Am J Hum Genet 1997; 61:A187. [PMID: 11644962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
|
41
|
Evans WK, Newman T, Graham I, Rusthoven JJ, Logan D, Shepherd FA, Chamberlain D. Lung cancer practice guidelines: lessons learned and issues addressed by the Ontario Lung Cancer Disease Site Group. J Clin Oncol 1997; 15:3049-59. [PMID: 9294467 DOI: 10.1200/jco.1997.15.9.3049] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The primary objective was to identify the lessons learned and issues addressed by the Disease Site Group (DSG) developing guidelines on lung cancer for practitioners in the province of Ontario. METHODS The minutes of the Ontario Lung Cancer Disease Site Group (LCDSG) and the meeting notes of a medical sociologist who attended all LCDSG meetings were reviewed to identify the disease-specific and generic issues addressed by the LCDSG during guideline development. RESULTS AND CONCLUSION The Ontario LCDSG has completed three practice guidelines and has five evidence-based recommendations (EBRs) in production. Topics for guideline development were selected on the basis of known practice variability (eg, advanced-stage non-small-cell lung cancer [NSCLC]); the size of the patient population that could potentially be affected by the guideline; results of phase II trials of new and potentially expensive agents (vinorelbine, paclitaxel, and docetaxel); and randomized controlled clinical trials that support new practice standards (combined modality therapy for unresectable stage III NSCLC). The wording of each EBR reflects the strength and quality of the evidence in support of the treatment option, the primary outcome(s), and the individual physician and discipline values concerning treatment outcomes in the absence of known patient values.
Collapse
Affiliation(s)
- W K Evans
- Ontario Cancer Treatment and Research Foundation, Ottawa Regional Cancer Centre, Canada.
| | | | | | | | | | | | | |
Collapse
|
42
|
Evans WK, Earle CC, Stewart DJ, Dahrouge S, Tomiak E, Goss G, Logan D, Goel R, Gertler SZ, Dulude H. Phase II study of a one hour paclitaxel infusion in combination with carboplatin for advanced non-small cell lung cancer. Lung Cancer 1997; 18:83-94. [PMID: 9268950 DOI: 10.1016/s0169-5002(97)00046-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To determine the activity, toxicity, and optimal dose of paclitaxel when given by one hour infusion combined with carboplatin in advanced non-small cell lung cancer (NSCLC). PATIENTS AND METHODS Thirty-seven previously untreated patients with stage IIIB or IV NSCLC were enrolled. Paclitaxel was administered by one hour infusion at a dose of 175 mg/m2 for the first cycle, and was escalated up to 255 mg/m2 over successive cycles if tolerated. In the absence of toxicity, the carboplatin dose was kept constant at an area under the concentration-time curve (AUC) of 6. Cycles were repeated at 3-week intervals until progression or intolerable toxicity occurred. RESULTS Thirty-six patients were evaluable for toxicity and survival, and thirty-five for responses. The partial response rate was 10 of 35 (29%) and there were no complete responses. The median duration of response was 4.8 months (range 0.5-11.7 months). The median survival duration was 6.5 months, and 1 year survival was 31%. The mean paclitaxel dose was 188 mg/m2. Treatment was generally well tolerated. Four patients (11%) had febrile neutropenia. Five patients (14%) had grade 3 neuropathy, and 4 (11%) had grade 3 nausea and vomiting. Minor toxicities included alopecia, myalgias, arthralgias and stomatitis. CONCLUSIONS Paclitaxel and carboplatin is a well-tolerated regimen that can safely be given by a one hour paclitaxel infusion. The modest response rate observed in this study may be due to either the low dose-intensity of paclitaxel or the short infusion duration. Further trials to optimize the relative doses of paclitaxel and carboplatin are needed.
Collapse
Affiliation(s)
- W K Evans
- Ottawa Regional Cancer Centre, University of Ottawa, Ontario Cancer Treatment and Research Foundation, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Eklund H, Eriksson M, Uhlin U, Nordlund P, Logan D. Ribonucleotide reductase--structural studies of a radical enzyme. Biol Chem 1997; 378:821-5. [PMID: 9377477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Ribonucleotide reductase contains a stable organic free radical essential for its activity located on a tyrosine residue in the small subunit of the enzyme called R2. The substrate binding site is, however, found in the catalytic subunit called R1. A long-range protein-mediated radical transfer pathway appears to be responsible for the delivery of the radical from the tyrosine in R2 to the substrate on R1. The active site is located deep inside the protein in a very stable beta/alpha-barrel structure and a hydrogen bonded system leads from the surface to Cys439 at the active site which is in excellent position to remove a hydrogen from the 3' of the ribose of a bound substrate nucleotide.
Collapse
Affiliation(s)
- H Eklund
- Department of Molecular Biology, Swedish University of Agricultural Sciences, Uppsala Biomedical Center, Sweden
| | | | | | | | | |
Collapse
|
44
|
Stewart D, Gertler S, Shamji F, Sachs H, Yau J, Goel R, Tomiak E, Logan D, Evans W. 182 High dose doxorubicin, cisplatin and tamoxifen vs mesothelioma. Lung Cancer 1997. [DOI: 10.1016/s0169-5002(97)89461-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
45
|
Stewart DJ, Tomiak EM, Goss G, Gertler SZ, Logan D, Huan S, Yau J, Dulude H, Evans WK. Paclitaxel plus hydroxyurea as second line therapy for non-small cell lung cancer. Lung Cancer 1996; 15:115-23. [PMID: 8865129 DOI: 10.1016/0169-5002(96)00576-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We tested paclitaxel (Taxol) and low dose hydroxyurea as second line therapy in 30 patients with non-small cell lung cancer since both drugs are active against non-small cell lung cancer in other settings, and since hydroxyurea may reverse chemotherapy resistance by disrupting double minute chromosomes. Hydroxyurea 500 mg was given orally each Monday, Wednesday, Friday starting 1 week before paclitaxel, and continuing until removal from study. Paclitaxel 135 mg/m2 was given i.v. over > or = 1 h every 3 weeks with dexamethasone, diphenhydramine, and ranitidine. Patients could have paclitaxel doses escalated to 175 mg/m2 in course 2 and to 200 mg/m2 in course 3, where tolerated. Sixteen males and 14 females were treated. All patients had previously received a single cisplatin-based chemotherapy regimen and 23 had previously received radiotherapy. Twelve patients had adenocarcinomas, six had squamous cell carcinomas, and 12 had large cell carcinomas. Eight patients had Stage IIIb cancers and 22 had Stage IV. Paclitaxel doses were 135 mg/m2 in 56 courses, 175 mg/m2 in 24, and 200 mg/m2 in 15. Treatment was well tolerated. Median granulocyte nadirs were 2.5 (x 10(9)/l) for paclitaxel 135 mg/m2, 1.8 for 175 mg/m2, and 1.3 for 200 mg/m2. No patient developed febrile neutropenia, and none required a dose reduction. Two patients had reversible anaphylaxis. Other toxicities were quite tolerable. They included fatigue, myalgias, dizziness, paresthesias, diarrhea, alopecia, mucositis, flushing, headache, swollen red hands, and anxiety. One patient had a partial remission and 15 had stable disease (including six with minor responses). Median survival was 20 (95% CI, 12-34) weeks, with 19% of patients remaining alive at 1 year from initiation of treatment. This is a well-tolerated regimen with modest activity as second line chemotherapy for patients with non-small cell lung cancer previously treated with cisplatin regimens. Higher doses would be feasible and other strategies are now being explored.
Collapse
Affiliation(s)
- D J Stewart
- Ontario Cancer Treatment and Research Foundation, University of Ottawa Faculty of Medicine, Ontario, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Lochrin C, Goss G, Cross P, Stewart D, Tomiak E, Agboola O, Aref I, Reid K, Girard A, Logan D, Crepeau A, Dahrouge S, Evans W. 1100 Concurrent daily chemotherapy with hyperfractionated thoracic irradiation in stage IIIA & B NSCLC. Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)96346-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
47
|
Lea S, Abu-Ghazaleh R, Blakemore W, Curry S, Fry E, Jackson T, King A, Logan D, Newman J, Stuart D. Structural comparison of two strains of foot-and-mouth disease virus subtype O1 and a laboratory antigenic variant, G67. Structure 1995; 3:571-80. [PMID: 8590018 DOI: 10.1016/s0969-2126(01)00191-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Foot-and-mouth disease viruses (FMDVs) are members of the picornavirus family and cause an economically important disease of cloven-hoofed animals. To understand the structural basis of antigenic variation in FMDV, we have determined the structures of two viruses closely related to strain O1BFS whose structure is known. RESULTS The two new structure are, like O1BFS, both serotype O viruses. The first, O1 Kaüfbeuren (O1K), is a field isolate dating from an outbreak of FMD in Europe in the 1960s. The second, called G67, is a quadruple mutant of O1K, generated in the laboratory, that bears point mutations conferring resistance to neutralizing by monoclonal antibodies, specific for each of the four major antigenic sites defined previously. The availability of the three related virus structures permits a detailed analysis of the way amino acid substitutions influence antigenicity. Structural changes are seen to be limited, in general, to the substituted side chain. For example, the GH loop of VP1, a highly antigenic and mobile protuberance which becomes ordered only under reducing conditions, was essentially indistinguishable in the three viruses despite the accumulation of up to four changes within its 15-residue sequence. At one of the other antigenic sites, however, changes between the two field strains did perturb both side-chain and main-chain structures in the vicinity. CONCLUSIONS The conservation of conformation of the GH loop of VP1 adds to the evidence implicating an integrin as the cellular receptor for FMDV, since this loop contains a conserved RGD (Arg-Gly-Asp) sequence structurally similar to the same tripeptide in some other integrin-binding proteins. Structural changes required for the virus to escape neutralization by monoclonal antibodies are generally small. The more extensive type of structural change exhibited by the field isolates probably reflects differing selective pressures operating in vivo and in vitro.
Collapse
Affiliation(s)
- S Lea
- Oxford Centre for Molecular Sciences, New Chemistry Laboratory, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Horbelt D, Delmore J, Meisel R, Cho S, Roberts D, Logan D. Mixed germ cell malignancy of the ovary concurrent with pregnancy. Obstet Gynecol 1994; 84:662-4. [PMID: 9205440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND A rare malignant germ cell tumor of the ovary during pregnancy was detected by screening of maternal serum alpha-fetoprotein (MSAFP). Treatment of this uncommon tumor during pregnancy incorporated combination chemotherapy including etoposide. CASE An 18-year-old primiparous woman undergoing antenatal genetic screening was found to have an extremely elevated MSAFP of 477.8 IU/mL, or 12.46 multiples of the median. Oophorectomy and staging laparotomy at 20.5 weeks' gestation resulted in the diagnosis of mixed germ cell tumor of the ovary, with both endodermal sinus tumor and grade 3 immature teratoma. The patient received three courses of cis-platinum, etoposide, and bleomycin. Maternal serum AFP titers had returned to normal pregnancy levels by the start of the second course. A healthy female infant was delivered at 39 weeks' gestation following induction of labor for pregnancy-induced hypertension. CONCLUSION Elevated MSAFP levels may be a presenting sign of malignant ovarian germ cell neoplasms. This report describes both surgical and chemotherapeutic treatment of a germ cell malignancy during pregnancy, with delivery at term. To date, major fetal toxicity from chemotherapy has not been identified.
Collapse
Affiliation(s)
- D Horbelt
- Department of Obstetrics and Gynecology, Pediatrics, and Family Medicine, University of Kansas School of Medicine-Wichita, USA
| | | | | | | | | | | |
Collapse
|
49
|
Stewart DJ, Evans WK, Logan D. Addition of pentoxifylline plus nifedipine to chemotherapy in patients with cisplatin-resistant cancers of the lung and other sites. Am J Clin Oncol 1994; 17:313-6. [PMID: 8048393 DOI: 10.1097/00000421-199408000-00006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Eight evaluable patients with cisplatin-resistant non-small cell lung cancer (6 patients), small cell lung cancer (1 patient), or both breast and ovarian cancer (1 patient) were entered on a study to determine whether the addition of nifedipine plus pentoxifylline to cisplatin-based chemotherapy would result in increased chemotherapy efficacy. No patient responded to treatment. Myelosuppression may have been augmented by the nifedipine and pentoxifylline (median granulocyte nadir, 0.3 x 10(9)/L). Two patients developed febrile neutropenia. Nifedipine and pentoxifylline had to be stopped in two evaluable patients due to hypotension, and three additional inevaluable patients withdrew from the study due to nifedipine-pentoxifylline toxicity before receiving their chemotherapy. There was no indication that other types of chemotherapy toxicity were increased by the addition of nifedipine and pentoxifylline. A major problem with the strategy followed in this protocol was that patients whose tumors had failed to respond to cisplatin-based regimens were often too ill to tolerate additional cisplatin, particularly when accompanied by nifedipine-associated hypotension.
Collapse
Affiliation(s)
- D J Stewart
- Ontario Cancer Treatment and Research Foundation, Ottawa Regional Cancer Centre, Canada
| | | | | |
Collapse
|
50
|
Rowlands D, Logan D, Abu-Ghazaleh R, Blakemore W, Curry S, Jackson T, King A, Lea S, Lewis R, Newman J. The structure of an immunodominant loop on foot and mouth disease virus, serotype O1, determined under reducing conditions. Arch Virol Suppl 1994; 9:51-8. [PMID: 8032279 DOI: 10.1007/978-3-7091-9326-6_6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Residues 136-159 of VPI of foot and mouth disease virus (FMDV) comprise the G-H loop of the protein and form a prominent feature on the surface of virus particles. This sequence contains an immunodominant neutralizing epitope, which can be mimicked with synthetic peptides, and includes an Arg, Gly, Asp motif which has been implicated in the binding of the virus to cellular receptors. Crystallographic analysis of native virus particles failed to resolve the structure of this region due to its disordered state. However, reduction of a disulphide bond between cysteine residues 134 of VP1 and 130 of VP2 caused the G-H loop to collapse onto the surface of the virus particle and allowed its conformation to be determined.
Collapse
Affiliation(s)
- D Rowlands
- Laboratory of Molecular Biophysics, University of Oxford
| | | | | | | | | | | | | | | | | | | |
Collapse
|