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Goulart H, Sastow D, Moshier E, Martin L, Mascarenhas J, Tremblay D. Systematic review and meta-analysis evaluating clinical outcomes in adult acute myeloid leukemia patients with central nervous system involvement. Leuk Res 2024; 137:107452. [PMID: 38335816 DOI: 10.1016/j.leukres.2024.107452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/07/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
Patients with acute myeloid leukemia (AML) may experience extramedullary involvement when disease is present outside of the blood and bone marrow. In particular, the presence of central nervous system (CNS) involvement has traditionally been thought of as a poor prognostic factor. In the presently available literature, there is a paucity of conclusive data surrounding CNS AML given its rarity and lack of unified screening practices. Thus, we performed a systematic review and meta-analysis in order to more definitively characterize survival outcomes in this patient population. In this meta-analysis, we evaluated survival outcomes and response rates from clinical studies on patients with AML stratified by the presence of CNS involvement. Twelve studies were included in the meta-analysis with a resulting hazard ratio (HR) for overall survival (OS) of 1.34 with a 95 % CI of 1.14 to 1.58. These findings suggest that CNS involvement in adult patients with AML is associated with an increased hazard of mortality compared to those patients without CNS involvement. As such, CNS involvement should be viewed as negative prognostic marker, and attention should be made to ensure prompt identification and treatment of patients who experience this complication.
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Affiliation(s)
- Hannah Goulart
- Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dahniel Sastow
- Division of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Erin Moshier
- Department of Population Health Science and Policy, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Lily Martin
- Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - John Mascarenhas
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Douglas Tremblay
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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Bloom JR, Rodriguez-Russo C, Hsieh K, Dickstein DR, Sheu RD, Jain M, Moshier E, Liu J, Gupta V, Kirke DN, Roof S, Misiukiewicz K, Posner M, Bakst R, Sindhu KK, Sharma S. Head and Neck Cancer Patient Population, Management, and Oncologic Outcomes from the COVID-19 Pandemic. Curr Oncol 2024; 31:436-446. [PMID: 38248114 PMCID: PMC10814981 DOI: 10.3390/curroncol31010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
The COVID-19 pandemic precipitated drastic changes in cancer care. Its impact on the U.S. head and neck cancer population has yet to be fully understood. This study aims to understand the impact of pandemic-related changes on the head and neck cancer population. An observational study of head and neck cancer patients at a single institution during the spring of 2020 and 2019 was performed. Clinical characteristics and survival outcomes were analyzed. In 2020, 54 head and neck cancer patients were evaluated in the department of radiation oncology vs. 74 patients seen in 2019; 42% of the patients were female in 2019 versus 24% in 2020 (p = 0.036). The median follow-up time was 19.4 and 31 months for 2020 and 2019, respectively. After adjusting for stage, the relapse-free survival probability at 6 and 12 months was 79% and 69% in 2020 vs. 96% and 89% in 2019, respectively (p = 0.036). There was no significant difference in the overall survival, with 94% and 89% in 2020 and 2019, respectively (p = 0.61). Twenty-one percent of patients received induction chemotherapy in 2020 versus 5% in 2019 (p = 0.011); significantly more treatment incompletions occurred in 2020, 9% vs. 0% in 2019 (p = 0.012). Moreover, the stage-adjusted RFS differed between cohorts, suggesting head and neck cancer patients seen during the initial wave of COVID-19 may experience worse oncologic outcomes.
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Affiliation(s)
- Julie R. Bloom
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Carlos Rodriguez-Russo
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Kristin Hsieh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Daniel R. Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Ren-Dih Sheu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Mayuri Jain
- Department of Population Health Science and Policy, Tisch Cancer Institute Biostatistics Shared Resource Facility, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Erin Moshier
- Department of Population Health Science and Policy, Tisch Cancer Institute Biostatistics Shared Resource Facility, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jerry Liu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Diana N. Kirke
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Scott Roof
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Krzysztof Misiukiewicz
- Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Marshall Posner
- Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY 10029, USA
| | - Richard Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Kunal K. Sindhu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Sonam Sharma
- Department of Radiation Oncology, Summit Health, Berkeley Heights, NJ 07922, USA
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Shah UA, Moshier E, Derkach A, Huang Y, Mailankody S, Tan CR, Maclachlan K, Hultcrantz M, Korde N, Hassoun H, Thibaud S, Sanchez L, Rodriguez C, Richard S, Richter J, Rossi A, Cho HJ, Lesokhin A, Chari A, Usmani SZ, Jagannath S, Parekh S, Gallagher EJ. Prevalence and impact of diabetes on survival of patients with multiple myeloma in different racial groups. Blood Adv 2024; 8:236-247. [PMID: 37772981 PMCID: PMC10918423 DOI: 10.1182/bloodadvances.2023010815] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/24/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 09/30/2023] Open
Abstract
ABSTRACT Multiple myeloma (MM) is twice as common in Black individuals compared with in White individuals, and diabetes mellitus (DM) disproportionately affects Black patients. Although numerous studies have shown a correlation between DM and MM, this has not been studied in the context of race and in vivo mechanisms. We conducted a retrospective clinical study of 5383 patients with MM of which 15% had DM (White, 12% and Black, 25%). Multivariable Cox models showed reduced overall survival (OS) for patients with DM (hazard ratio, 1.27; 95% confidence interval, 1.11-1.47; P < .001). This appeared to be driven by a marked difference in OS between White patients with and without DM but not in Black patients. In contrast, obesity was associated with better OS in Black patients but not in White patients. To complement this analysis, we assessed MM growth in a genetically engineered immunocompromised nonobese diabetic (Rag1-/-/muscle creatinine kinase promoter expression of a human IGF1R [M] with a lysine [K] to arginine [R] point mutation) mouse model to evaluate the mechanisms linking DM and MM. MM.1S xenografts grew in more Rag1-/-/MKR mice and grew more rapidly in the Rag1-/-/MKR mice compared with in controls. Western blot analysis found that MM1.S xenografts from Rag1-/-/MKR mice had higher phosphorylated S6 ribosomal protein (Ser235/236) levels, indicating greater activation of the mammalian target of rapamycin pathway. Our study is, to our knowledge, the first to evaluate racial differences in DM prevalence and survival in MM, as well as the effect of DM on tumor growth in mouse models. Our results suggest that DM may contribute to the higher incidence of MM in Black patients; and to improve survival in MM, DM management cannot be ignored.
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Affiliation(s)
- Urvi A. Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Erin Moshier
- Department of Population Health Science and Policy, Mount Sinai Health System, New York, NY
| | - Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yuanhui Huang
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Carlyn R. Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Kylee Maclachlan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Santiago Thibaud
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Larysa Sanchez
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Cesar Rodriguez
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shambavi Richard
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joshua Richter
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Adriana Rossi
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hearn Jay Cho
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexander Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ajai Chari
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Saad Z. Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sundar Jagannath
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Samir Parekh
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emily J. Gallagher
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY
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Sylla P, Sands D, Ricardo A, Bonaccorso A, Polydorides A, Berho M, Marks J, Maykel J, Alavi K, Zaghiyan K, Whiteford M, Mclemore E, Chadi S, Shawki SF, Steele S, Pigazzi A, Albert M, DeBeche-Adams T, Moshier E, Wexner SD. Multicenter phase II trial of transanal total mesorectal excision for rectal cancer: preliminary results. Surg Endosc 2023; 37:9483-9508. [PMID: 37700015 PMCID: PMC10709232 DOI: 10.1007/s00464-023-10266-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/27/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Transanal TME (taTME) combines abdominal and transanal dissection to facilitate sphincter preservation in patients with low rectal tumors. Few phase II/III trials report long-term oncologic and functional results. We report early results from a North American prospective multicenter phase II trial of taTME (NCT03144765). METHODS 100 patients with stage I-III rectal adenocarcinoma located ≤ 10 cm from the anal verge (AV) were enrolled across 11 centers. Primary and secondary endpoints were TME quality, pathologic outcomes, 30-day and 90-day outcomes, and stoma closure rate. Univariable regression analysis was performed to assess risk factors for incomplete TME and anastomotic complications. RESULTS Between September 2017 and April 2022, 70 males and 30 females with median age of 58 (IQR 49-62) years and BMI 27.8 (IQR 23.9-31.8) kg/m2 underwent 2-team taTME for tumors located a median 5.8 (IQR 4.5-7.0) cm from the AV. Neoadjuvant radiotherapy was completed in 69%. Intersphincteric resection was performed in 36% and all patients were diverted. Intraoperative complications occurred in 8% including 3 organ injuries, 2 abdominal and 1 transanal conversion. The 30-day and 90-day morbidity rates were 49% (Clavien-Dindo (CD) ≥ 3 in 28.6%) and 56% (CD ≥ 3 in 30.4% including 1 mortality), respectively. Anastomotic complications were reported in 18% including 10% diagnosed within 30 days. Higher anastomotic risk was noted among males (p = 0.05). At a median follow-up of 5 (IQR 3.1-7.4) months, 98% of stomas were closed. TME grade was complete or near complete in 90%, with positive margins in 2 cases (3%). Risk factors for incomplete TME were ASA ≥ 3 (p = 0.01), increased time between NRT and surgery (p = 0.03), and higher operative blood loss (p = 0.003). CONCLUSION When performed at expert centers, 2-team taTME in patients with low rectal tumors is safe with low conversion rates and high stoma closure rate. Mid-term results will further evaluate oncologic and functional outcomes.
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Affiliation(s)
- Patricia Sylla
- Division of Colon and Rectal Surgery, Mount Sinai Hospital, New York, NY, USA.
- Division of Colon and Rectal Surgery, Mount Sinai Hospital, New York, NY, USA.
| | - Dana Sands
- Department of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Alison Ricardo
- Division of Colon and Rectal Surgery, Mount Sinai Hospital, New York, NY, USA
| | | | | | - Mariana Berho
- Executive Administration Florida, Cleveland Clinic Florida, Weston, FL, USA
| | - John Marks
- Department of Colorectal Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Justin Maykel
- Division of Colon and Rectal Surgery, UMass Memorial Medical Center, Worcester, MA, USA
| | - Karim Alavi
- Division of Colon and Rectal Surgery, UMass Memorial Medical Center, Worcester, MA, USA
| | - Karen Zaghiyan
- Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mark Whiteford
- Gastrointestinal and Minimally Invasive Surgical Division, The Oregon Clinic, Providence Cancer Center, Portland, OR, USA
| | - Elisabeth Mclemore
- Division of Colorectal Surgery, Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Sami Chadi
- Division of Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre and University Health Network, Toronto, ON, Canada
| | - Sherief F Shawki
- Department of Colorectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Scott Steele
- Department of Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Alessio Pigazzi
- Division of Colorectal Surgery, Department of Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - Matthew Albert
- Department of Colon and Rectal Surgery, Advent Health Orlando, Orlando, FL, USA
| | | | - Erin Moshier
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Steven D Wexner
- Department of Colorectal Surgery, Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
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5
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Li K, Chadha M, Paluch K, Moshier E, Rosenstein BS. The Effect of Age on Health-Related Quality of Life in Patients Treated for Early Stage, Estrogen Receptor Positive Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e190-e191. [PMID: 37784826 DOI: 10.1016/j.ijrobp.2023.06.1054] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Prospective studies on Health-related quality of life (HRQoL) evaluating the effect of age on outcomes in breast cancer (BC) is not well studied. This study aims to examine the physical and mental health perceptions in BC patients enrolled in an international, multi-center REQUITE study. MATERIALS/METHODS This study includes 2,057 patients with ER+ early-stage BC treated with breast conservation surgery, radiation (RT), and endocrine therapy (ET) across Europe and North America between April 2014 and March 2017. The prospectively collected HRQoL dataset includes EORTC30 and Multidimensional Fatigue Inventory (MFI-20) at baseline, post-RT, 1, 2, and 3 years of follow up. Patients were stratified by age: 851 aged <70 (younger) and 201 aged ≥ 70 (older). The median age (range) for the younger and older cohort is 57 years (30-69 years) and 75 years (70-86 years), respectively. Analysis includes descriptive statistics and univariable logistic regression. RESULTS Older patients had a greater burden of comorbid conditions including increased BMI (27.3 vs 26.5; P = 0.006), history of diabetes (10.9% vs 6.6%; P = 0.0336), heart disease (15.4% vs 6.1%; P<0.0001), rheumatoid arthritis (6.5% vs 3.2%; P = 0.0280), hypertension (54.2% vs 25.0%; P<0.0001), and polypharmacy (37.8% vs 16.7%; P<0.0001) compared to younger patients. Higher utilization of aromatase inhibitor (67.7% vs 42.4%; P<0.0001) in older patients, and tamoxifen (63.7% vs 36.5%; P<0.0001) in younger patients. The T-stage distribution in younger and older patients is T1 = 82.4% vs 68.7%, T2 = 9.8% vs 26.4%, T3 = 0.1% vs 1%, respectively. The 3-year relapse-free survival was similar in both groups (P = 0.183). Significant worsening in fatigue (P<0.0001, P<0.0001), pain (P = 0.0274, P<0.0001), cognitive functioning (P = 0.0291, P<0.0001), and global health status (P = 0.0064, P<0.0001) was observed during follow up from baseline in both groups (older patients, younger patients). Compared to older patients where significant deterioration persisted, younger patients showed improvement in most HRQoL measures over the duration of follow up years. Older patients had poorer global health status (OR = 1.19 vs 0.8, P = 0.0214) than younger patients from baseline at 2 years. On the MFI-20 measure, both age groups showed worsening fatigue from baseline at post-RT, but eventual recovery noted in the 1-to-3-year follow up period. CONCLUSION Older patients, present with greater comorbidities, polypharmacy, and later stages in BC, reported worsening fatigue, pain, cognitive functioning, and global health status during 3 years follow up. One limitation of this study is that patients were predominately White, potentially limiting the generalizability of these observations. Further studies supplementing biomarkers and prognostic signatures with functional measures such as HRQoL may provide a useful tool to guide risk-tailored treatment in older patients with breast cancer.
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Affiliation(s)
- K Li
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - M Chadha
- Icahn School of Medicine at Mount Sinai, Department of Radiation Oncology, New York, NY
| | - K Paluch
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science & Policy, New York, NY
| | - E Moshier
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science & Policy, New York, NY
| | - B S Rosenstein
- Icahn School of Medicine at Mount Sinai, Department of Radiation Oncology, New York, NY
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Hotca AE, Jacobi A, Bloom JR, Hsieh K, Cherry DR, Sheu R, Runnels J, Moshier E, Fu W, Sahni G, Goodman KA. The Role of Coronary Artery Calcium Score to Assess Risk of Cardiovascular Disease in Irradiated Esophageal Cancer Patients. Int J Radiat Oncol Biol Phys 2023; 117:e302. [PMID: 37785103 DOI: 10.1016/j.ijrobp.2023.06.2319] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Coronary artery calcium (CAC) score is an important predictive imaging marker of cardiovascular disease (CVD). While studies have found positive association between CAC score and cardiac toxicity in irradiated lung and breast cancer patients, there are no studies assessing CAC scores in esophageal cancer (EC). While a cardiac-gated CT is required for standard Agatston CAC score, visual assessment of CAC via ordinal scoring on non-gated CT has shown good concordance with Agatston score. In this study, we sought to examine whether visual assessment of CAC, measured on standard of care, non-contrast chest CT, predicts the development of adverse cardiovascular events (ACVE) in irradiated EC patients. MATERIALS/METHODS This is a single institution retrospective study of EC patients treated with RT from 2010-2021. We included patients with available PET/CT at diagnosis or chest CT simulation scan without contrast, and excluded those with history of percutaneous coronary intervention, coronary bypass surgery, or prior thoracic RT. Pre-treatment characteristics, clinical factors, and grade ≥ 3 (G3+) adverse cardiovascular events (ACVE) (CTCAEv5.0) were evaluated. Visual assessment of CAC was performed using ordinal method (CAC scored from 0 to 12), by a thoracic radiologist. Fine and Gray regression was used to compute hazard ratios for time to first ACVE. Univariate analyses using Cox proportional hazards were used for overall survival (OS). ACVEs were recorded from start of oncologic treatment and OS calculated after completion of RT. RESULTS A total of 118 patients were analyzed with a median follow-up of 16 months. Median age was 67 years, 65% male, 43% white, 59% with EC of distal esophagus, and 59% had squamous cell carcinoma. Median mean heart dose was 21.93 Gy (range 0.15-36.94). 24% developed G3+ ACVEs: atrial fibrillation 9%, stroke 6%, heart failure 4%, pulmonary embolism 4%, pericardial effusion 3%, myocardial infarction 2%, heart block 2%, and cardiac death 1%. On univariate analyses, CAC >1 vs. CAC ≤ 1 trended towards increased risk of ACVE (HR = 1.95, 95% CI = 0.89-4.26; p = 0.094), however it is not predictive of OS (HR = 1.31, 95% CI = 0.75-2.30; p = 0.343). Proportion of patients with ACVEs was greater in CAC>1 group (Table). When compared to patients with CAC ≤ 1, those with CAC >1 were older (median age 62 vs 72 years, p = 0.0015), less likely to be never smokers (38% vs 30%, p = 0.0437), and more likely to have hypertension (43% vs 64%, p = 0.0197), and hyperlipidemia (30% vs 47%, p = 0.0557). CONCLUSION This is the first study to investigate the relationship between CAC score and ACVEs in EC. While the study was underpowered (likely due to low rates of recorded ACVEs), to detect a significant association between CAC score and ACVEs, there was a trend towards increased risk of ACVEs in patients with a CAC score >1 by visual ordinal scoring. Further prospective evaluation with a larger cohort is warranted.
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Affiliation(s)
- A E Hotca
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - A Jacobi
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J R Bloom
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - K Hsieh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - D R Cherry
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - R Sheu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J Runnels
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - E Moshier
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science & Policy, New York, NY
| | - W Fu
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science & Policy, New York, NY
| | - G Sahni
- Cardiology Division, Icahn School of Medicine at Mount Sinai, New York, NY
| | - K A Goodman
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
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7
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Arend I, Moshier E, Azuri Y, Heymann A, Mamistavlov M, Soleimani L, Sano M, Beeri MS, Ravona-Springer R. Neuroticism is associated with increase in depression symptoms over time in older adults with type 2 diabetes. Int J Geriatr Psychiatry 2023; 38:e6011. [PMID: 37803500 DOI: 10.1002/gps.6011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/25/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES The likelihood of depression symptoms in those with type 2 diabetes (T2D) is high. Psychological risk factors enhancing comorbidity of depression symptoms in T2D are yet to be determined. The present study examines the cross-sectional and longitudinal relationship between personality traits and distinct depression dimensions in older adults with T2D. METHODS Participants were older adults (age ≥65yeas) with T2D from the Israel Diabetes and Cognitive Decline (IDCD) study (N = 356), with complete data on depression [Geriatric Depression Scale (GDS) - 15 item version] and its dimensions- namely, dysphoric mood, apathy, hopelessness, memory complains and anxiety, and on personality [Big Five Inventory (BFI)]. Logistic and mixed linear regression models examined cross-sectional and longitudinal associations while adjusting for socio-demographics, cognition, cardiovascular and diabetes-related factors. RESULTS Cross-sectionally, high neuroticism was associated with high scores in total GDS and in all depression-dimensions, except memory complaints. Higher extroversion was associated with lower total GDS and with lower scores on all depression dimensions, except anxiety. High levels of neuroticism were associated with increase in total number of depression symptoms over time. CONCLUSIONS In older adults with T2D, neuroticism and extroversion are associated with most depression dimensions suggesting that these traits relate to a global depression symptomatology rather than to any specific dimension or phenomenology. High neuroticism was associated with increase in depression symptoms over time, highlighting its role in the development of depression symptoms in older adults with T2D.
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Affiliation(s)
- Isabel Arend
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Erin Moshier
- Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yossi Azuri
- Department of Family Medicine, The Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - Anthony Heymann
- Department of Family Medicine, The Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - Mery Mamistavlov
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Laili Soleimani
- Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mary Sano
- Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michal Schnaider Beeri
- Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Psychiatry, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ramit Ravona-Springer
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel
- Department of Psychiatry, Sheba Medical Center, Tel-Hashomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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8
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Sylla P, Berho M, Sands D, Ricardo A, Bonaccorso A, Moshier E, Hain E, Letchinger R, Marks J, Whiteford M, Mclemore E, Maykel J, Alavi K, Zaghiyan K, Chadi S, Shawki SF, Steele S, Pigazzi A, Albert M, DeBeche-Adams T, Polydorides A, Wexner S. Discordance in Total Mesorectal Excision Specimen Grading in a Prospective Phase 2 Multicenter Rectal Cancer Trial: Are We Overestimating the Quality of Our Resections? Ann Surg 2023; 278:452-463. [PMID: 37450694 DOI: 10.1097/sla.0000000000005948] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To report the results of a rigorous quality control (QC) process in the grading of total mesorectal excision (TME) specimens during a multicenter prospective phase 2 trial of transanal TME. BACKGROUND Grading of TME specimens is based on the macroscopic assessment of the mesorectum and standardized through synoptic pathology reporting. TME grade is a strong predictor of outcomes with incomplete (IC) TME associated with increased rates of local recurrence relative to complete or near complete (NC) TME. Although TME grade serves as an endpoint in most rectal cancer trials, in protocols incorporating centralized review of TME specimens for quality assurance, discordance in grading and the management thereof has not been previously described. METHODS A phase 2 prospective transanal TME trial was conducted from 2017 to 2022 across 11 North American centers with TME quality as the primary study endpoint. QC measures included (1) training of site pathologists in TME protocols, (2) blinded grading of de-identified TME specimen photographs by central pathologists, and (3) reconciliation of major discordance before trial reporting. Cohen Kappa statistic was used to assess agreement in grading. RESULTS Overall agreement in grading of 100 TME specimens between site and central reviewer was rated as fair, (κ = 0.35; 95% CI: 0.10-0.61; P < 0.0001). Concordance was noted in 54%, with minor and major discordance in 32% and 14% of cases, respectively. Upon reconciliation, 13/14 (93%) major discordances were resolved. Pre versus postreconciliation rates of complete or NC and IC TME are 77%/16% and 7% versus 69%/21% and 10%. Reconciliation resulted in a major upgrade (IC-NC; N = 1) or major downgrade (NC/C-IC, N = 4) in 5 cases overall (5%). CONCLUSIONS A 14% rate of major discordance was observed in TME grading between the site and central reviewers. The resolution resulted in a major change in final TME grade in 5% of cases, which suggests that reported rates or TME completeness are likely overestimated in trials. QC through a central review of TME photographs and reconciliation of major discordances is strongly recommended.
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Affiliation(s)
- Patricia Sylla
- Division of Colon and Rectal Surgery, Mount Sinai Hospital, New York, NY
| | - Mariana Berho
- Executive Administration Florida, Cleveland Clinic Florida, Weston, FL
| | - Dana Sands
- Department of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, FL
| | - Alison Ricardo
- Division of Colon and Rectal Surgery, Mount Sinai Hospital, New York, NY
| | | | - Erin Moshier
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Elisabeth Hain
- Department of Colon and Rectal Surgery, Mount Sinai Hospital, New York, NY
| | - Riva Letchinger
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - John Marks
- Department of Colorectal Surgery, Lankenau Medical Center, Wynnewood, PA
| | - Mark Whiteford
- Gastrointestinal and Minimally Invasive Surgical Division, the Oregon Clinic Providence Cancer Center, Portland, OR
| | - Elisabeth Mclemore
- Department of Surgery, Division of Colorectal Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Justin Maykel
- Division of Colon and Rectal Surgery, UMass Memorial Medical Center, Worcester, MA
| | - Karim Alavi
- Division of Colon and Rectal Surgery, UMass Memorial Medical Center, Worcester, MA
| | - Karen Zaghiyan
- Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sami Chadi
- Department of Surgery, Division of Surgical Oncology, Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada
| | | | - Scott Steele
- Department of Surgery, Cleveland Clinic, Cleveland, OH
| | - Alessio Pigazzi
- Department of Surgery, Division of Colorectal Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Matthew Albert
- Department of Colon and Rectal Surgery, Advent Health Orlando, Orlando, FL
| | | | | | - Steven Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL
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9
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Goldstone SE, Terlizzi JP, Levine RA, Moshier E, Pereira Vera B. A Prospective, Dual-Center Trial of Circumferential Radiofrequency Ablation of Anal High-Grade Squamous Intraepithelial Lesions Demonstrate Improved Long-term Efficacy Over Historical Controls of Targeted Ablation. Dis Colon Rectum 2023; 66:764-773. [PMID: 35522783 DOI: 10.1097/dcr.0000000000002365] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Targeted ablation of anal canal high-grade dysplasia results in high recurrence over time. Circumferential radiofrequency ablation might decrease recurrence. OBJECTIVE This study aimed to determine the safety and efficacy of circumferential radiofrequency ablation for anal high-grade dysplasia. DESIGN This was a dual-center, prospective trial of circumferential radiofrequency ablation with a 1-year follow-up with longer follow-up data abstracted from medical records of study patients returning after trial for surveillance. Ten participants from the identically conducted pilot circumferential radiofrequency ablation trial were included to improve sample size for longer-term analysis. SETTINGS This study included 3 surgeons at 2 sites. PATIENTS The study included 51 patients undergoing circumferential radiofrequency ablation for anal canal high-grade dysplasia. INTERVENTION Circumferential radiofrequency ablation of anal canal high-grade dysplasia and targeted radiofrequency ablation of recurrence. MAIN OUTCOME MEASURES The primary outcome measures were circumferential radiofrequency ablation efficacy and associated morbidity. RESULTS Fifty-one participants underwent circumferential radiofrequency ablation but 48 participants returned for 1 or more postprocedure high-resolution anoscopy and were evaluable. The mean age of participants was 43 years, most were male (94%), 33% were living with HIV, and 58% had 3 or more high-grade dysplasias treated. Sixty percent had no recurrence, whereas 19% had 1 recurrence, 15% had 2 recurrences, and 6% had 3 recurrences. Most recurrences (66%) developed within the first 6 months. Kaplan-Meier probability of recurrence combining both series was 19% at 3 months, 30% at 6 months, and approximately 40% after 6 months out to 30 months. Most common morbidities were pain (85.4%) lasting for a median of 21 (range, 4-91) days and bleeding (91%) lasting for a median of 21 (range, 5-87) days. Of those with pain and bleeding, 65% and 85%, respectively, described it as mild. No patients developed fistulas, stricture, or incontinence. No serious adverse events related to circumferential radiofrequency ablation occurred. Having a previous recurrence was the only significant predictor of a subsequent recurrence (HR, 28.53) for recurrence at 9 months or before. LIMITATIONS Enrollment ended prematurely, 10 participants from the pilot study were combined to increase the sample size, and longer-term follow-up was collected retrospectively were the limitations of this study. CONCLUSIONS Circumferential radiofrequency ablation has improved efficacy over targeted ablation but with increased pain and bleeding. See Video Abstract at http://links.lww.com/DCR/B973 . ESTUDIO PROSPECTIVO BICNTRICO SOBRE LA ABLACIN POR RADIOFRECUENCIA CIRCUNFERENCIAL DE LESIONES ANALES INTRAEPITELIALES ESCAMOSAS DE ALTO GRADO DEMOSTRANDO MAYOR EFICACIA A LARGO PLAZO CON RELACIN A CONTROLES HISTRICOS DE ABLACIN DIRIGIDA ANTECEDENTES:La ablación dirigida de la displasia de alto grado en el canal anal proporciona como resultados una alta recidiva a largo plazo. La ablación por radiofrecuencia circunferencial podría disminuir la reincidencia.OBJETIVO:Determinar la seguridad y eficacia de la ablación por radiofrecuencia circunferencial para la displasia anal de alto grado.DISEÑO:Estudio prospectivo bicéntrico de ablación por radiofrecuencia circunferencial con un seguimiento de 1 año, en base al monitoreo prolongado de datos, obtenidos de los registros medicos, de todos los pacientes incluidos en el estudio y que fueron controlados clinicamente. Diez participantes del estudio piloto de ablación por radiofrecuencia circunferencial realizada de manera idéntica, se combinaron para mejorar el análisis del tamaño de la muestra a largo plazo.PACIENTES:Se incluyeron 51 pacientes sometidos a la ablación por radiofrecuencia circunferencial de una lesion displásica de alto grado en el canal anal.AJUSTES:Tres cirujanos en 2 centros.INTERVENCIÓN:Ablación por radiofrecuencia circunferencial de la displasia de alto grado en el canal anal y ablación por radiofrecuencia dirigida de la recidiva.PRINCIPALES MEDIDAS DE RESULTADOS:Las medidas primarias fueron la eficacia de la ablación por radiofrecuencia circunferencial y la morbilidad asociada.RESULTADOS:Cincuenta y un participantes se sometieron a la ablación por radiofrecuencia circunferencial, de los cuales, 48 regresaron para ser evaluados con ≥1 anuscopias de alta resolución, después del procedimiento. La edad media de los participantes fue de 43 años, en su mayoría hombres (94%), el 33% eran portadores de VIH y el 58% tenía ≥3 lesiones displásicas de alto grado tratadas. El sesenta por ciento no tuvo recidiva, mientras que el 19%, 15% y 6% tuvieron 1, 2 o 3 recidivas. La mayoría de las recaídas (66%) se desarrollaron dentro de los primeros 6 meses. La probabilidad de recurrencia de Kaplan-Meier combinando ambas series fue del 19 % a los 3 meses, del 30 % a los 6 meses y aproximadamente del 40 % entre los 6 y 30 meses. Los indicadores de morbilidad más frecuentes fueron, el dolor (85,4%) con una mediana de duración de 21 días (rango, 4-91) y sangrado (91%) con una mediana de duración de 21días (rango, 5-87). Aquellos pacientes con dolor (65%) y sangrado (85%) respectivamente, los describieron como leves. Ningún paciente desarrolló fístula, estenosis o incontinencia. No se produjeron eventos adversos graves relacionados con la ablación por radiofrecuencia circunferencial. Tener una recurrencia previa fue el único factor predictivo importante de una recidiva ulterior (RH 28,53) en casos de recaída a los 9 meses o antes.LIMITACIONES:Como el registro finalizó prematuramente, se agregaron 10 participantes del estudio piloto para aumentar el tamaño de la muestra. El seguimiento a largo plazo fué recopilado retrospectivamente.CONCLUSIONES:La ablación por radiofrecuencia circunferencial ha mejorado la eficacia sobre la ablación dirigida pero con dolor y sangrado mas importantes. Consulte Video Resumen en http://links.lww.com/DCR/B973 . ( Traducción-Dr. Xavier Delgadillo ).
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Affiliation(s)
- Stephen E Goldstone
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joseph P Terlizzi
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rebecca A Levine
- Department of Surgery, Montefiore Medical Center, The Bronx, New York
| | - Erin Moshier
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Barbara Pereira Vera
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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10
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Mouhieddine TH, Van Oekelen O, Melnekoff DT, Li J, Ghodke-Puranik Y, Lancman G, Thibaud S, Pan D, Rajeeve S, Agte S, Aleman A, Sanchez L, Richard S, Rossi A, Richter J, Cho HJ, Rodriguez C, Lagana A, Moshier E, Chari A, Jagannath S, Parekh S. Sequencing T-cell redirection therapies leads to deep and durable responses in patients with relapsed/refractory myeloma. Blood Adv 2023; 7:1056-1064. [PMID: 36018226 PMCID: PMC10033902 DOI: 10.1182/bloodadvances.2022007923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/25/2022] [Accepted: 08/08/2022] [Indexed: 11/20/2022] Open
Abstract
T-cell redirection therapy using chimeric antigen receptor (CAR) T cells and bispecific antibodies (BiAbs) has shown promising efficacy in heavily pretreated patients with relapsed/refractory multiple myeloma (RRMM), leading to the approval of 2 CAR T-cell products and numerous BiAb trials. Data on the outcomes after relapse following BiAbs are urgently required to develop strategies for sequencing salvage therapies. We identified 58 patients progressing after a BiAb trial at Mount Sinai Hospital. Progression-free survival (PFS) to the first salvage (PFS1), second salvage therapy (PFS2), and overall survival (OS) were estimated using the Kaplan-Meier method. The median age of the patients was 67 years, and 78% had high-risk cytogenetics. They had a median of 6 prior therapy lines, 89% were triple-class refractory, and 44% were penta-drug refractory. After the BiAb trial, patients were followed for a median of 30.5 months and received a median of 2 additional salvage therapies (range, 1-9). The most common first salvage was T-cell redirection in 19 patients (10 BiAb and 9 CAR T cells). Ten patients underwent T-cell redirection as a second salvage treatment. T-cell redirection therapy as first or second salvage was feasible and associated with a median PFS1 of 28.9 months, PFS2 of 30.9 months, and an OS of 62% at 2 years. The sequential use of different T-cell redirection therapies is possible and may lead to deep and durable responses following the relapse after BiAb therapy in RRMM.
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Affiliation(s)
- Tarek H. Mouhieddine
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Oliver Van Oekelen
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David T. Melnekoff
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeanne Li
- Department of Population Health Science and Policy, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yogita Ghodke-Puranik
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Guido Lancman
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Santiago Thibaud
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Darren Pan
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sridevi Rajeeve
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sarita Agte
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Adolfo Aleman
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Larysa Sanchez
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shambavi Richard
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Adriana Rossi
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joshua Richter
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hearn Jay Cho
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Cesar Rodriguez
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alessandro Lagana
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Erin Moshier
- Department of Population Health Science and Policy, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ajai Chari
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sundar Jagannath
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Samir Parekh
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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11
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Lancman G, Moshier E, Cho HJ, Parekh S, Richard S, Richter J, Rodriguez C, Rossi A, Sanchez L, Jagannath S, Chari A. Trial designs and endpoints for immune therapies in multiple myeloma. Am J Hematol 2023; 98 Suppl 2:S35-S45. [PMID: 36200130 DOI: 10.1002/ajh.26753] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/18/2022] [Accepted: 09/29/2022] [Indexed: 11/08/2022]
Abstract
Immune therapies, including CAR-T cells, bispecific antibodies, and antibody-drug conjugates, are revolutionizing the treatment of multiple myeloma. In this review, we discuss clinical trial design considerations relevant to immune therapies. We first examine issues pertinent to specific populations, including elderly, patients with renal impairment, high-risk/extramedullary disease, and prior immune therapies. We then highlight trial designs to optimize the selection of dose and schedule, explore rational combination therapies based on preclinical data, and evaluate the nuances of commonly used endpoints. By exploiting their pharmacokinetic/pharmacodynamic profiles and utilizing novel translational insights, we can optimize the use of immune therapies in multiple myeloma.
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Affiliation(s)
- Guido Lancman
- Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Erin Moshier
- Department of Population Health Science and Policy, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Hearn Jay Cho
- Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Samir Parekh
- Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Shambavi Richard
- Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Joshua Richter
- Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Cesar Rodriguez
- Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Adriana Rossi
- Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Larysa Sanchez
- Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Sundar Jagannath
- Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Ajai Chari
- Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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12
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Pan D, Mouhieddine TH, Upadhyay R, Casasanta N, Lee A, Zubizarreta N, Moshier E, Richter J. Outcomes with panobinostat in heavily pretreated multiple myeloma patients. Semin Oncol 2023:S0093-7754(23)00039-8. [PMID: 37005144 DOI: 10.1053/j.seminoncol.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023]
Abstract
Panobinostat is an oral pan histone-deacetylase inhibitor used in the treatment of relapsed and refractory multiple myeloma. Previously published studies of panobinostat demonstrated synergy with bortezomib but included few patients exposed to newer agent combinations (ie, panobinostat plus daratumumab or carfilzomib). Here, we report outcomes of panobinostat-based combinations at an academic medical center among patients whose disease had been heavily pretreated with modern agents. We retrospectively analyzed 105 patients with myeloma treated with panobinostat at The Mount Sinai Hospital in New York City between October 2012 and October 2021. These patients had a median age of 65 (range 37-87) and had received a median of 6 prior lines of therapy while in 53% the disease was classified as triple class refractory and in 54% the disease had high-risk cytogenetics. Panobinostat was most commonly utilized at 20 mg (64.8%) as part of a triplet (61.0%) or quadruplet (30.5%). Aside from steroids, panobinostat was most commonly administered in combination with lenalidomide, pomalidomide, carfilzomib, and daratumumab in descending order of frequency. Among the 101 response-evaluable patients, the overall response rate was 24.8%, clinical benefit rate (≥minimal response) was 36.6%, and median progression-free survival was 3.4 months. Median overall survival was 19.1 months. The most common toxicities ≥grade 3 were hematologic, primarily neutropenia (34.3%), thrombocytopenia (27.6%), and anemia (19.1%). Panobinostat-based combinations produced modest response rates in patients with heavily pretreated multiple myeloma, over half of whom had triple-class refractory disease. Panobinostat warrants continued investigation as a tolerable oral option for recapturing responses in patients whose disease has progressed after receipt of standard-of-care therapies.
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13
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Rabinowitz Y, Ravona-Springer R, Heymann A, Moshier E, Berman Y, Schwartz J, Sano M, Aisenberg D, Schnaider-Beeri M. Physical Activity Is Associated with Slower Cognitive Decline in Older Adults with Type 2 Diabetes. J Prev Alzheimers Dis 2023; 10:497-502. [PMID: 37357290 DOI: 10.14283/jpad.2023.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Abstract
BACKGROUND Physical activity is associated with slower cognitive decline in old age. Type 2 diabetes (T2d) is a risk factor for dementia and cognitive decline. Physical activity protects against several T2d complications. Yet, little is known about the contribution of physical activity to cognitive health among the elderly with T2d. OBJECTIVES To examine the association between physical activity and cognitive decline in older adults with T2d. DESIGN This is a prospective longitudinal study using data from the Israel Diabetes and Cognitive Decline (IDCD) study. SETTING ICDC study (N=1,213), is a population-based cohort of adults over the age of 65, diagnosed with type 2 diabetes, who were cognitively normal at baseline and followed up every 18 months. PARTICIPANTS Participants with at least one follow-up assessment who were in the same physical activity group consistently and had complete demographic data. MEASUREMENTS Physical activity was measured using Minnesota Leisure Time Activity Questionnaire, cognitive functioning was measured using a broad neuropsychological assessment measuring Executive Functioning, Attention/Working Memory, Semantic Categorization and Episodic Memory. RESULTS Participants were classified into physical activity groups based on self-reported physical activity at baseline and all follow ups: "active" - participation in recreational physical activity (n=286); "non-active"- the only physical activity was walking from place to place (n=93) and "sedentary" (n=19). Linear mixed effects models were applied to adjust for key demographic and cardiovascular risk factors. Participants were 72.4 (SD 4.6) years old, had 13.3 (SD 3.6) years of education, and 163 (41%) were female. In the fully adjusted model, compared to the non-active group the active group had significantly slower rate of decline in Global Cognition (p=0.005), Executive Functioning (p=.014), and Attention/Working Memory (p=.01). There were no significant group differences for Semantic Categorization (p=.17) and Episodic Memory (p=.88). CONCLUSIONS Among initially cognitively normal and independent older adults with T2d, a physically active lifestyle was associated with a slower rate of cognitive decline. Future research should examine whether promoting physical activity may prevent or delay onset of dementia in this high-risk population.
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Affiliation(s)
- Y Rabinowitz
- Yaacov Rabinowitz, Israel, Akiva 22, Ra'anana, Israel, 972-54-5421240, , ORCID ID: https://orcid.org/0000-0003-2642-7304
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14
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Mouhieddine TH, Moshier E, Thibaud S, Puliafito B, Rattu M, Jakubowski R, Sanchez L, Rossi A, Rodriguez C, Richard S, Cho HJ, Parekh S, Chari A, Steinberg A, Richter J. Bridging advanced myeloma patients to subsequent treatments and clinical trials with classical chemotherapy and stem cell support. Bone Marrow Transplant 2023; 58:80-86. [PMID: 36261708 DOI: 10.1038/s41409-022-01848-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/02/2022] [Accepted: 10/06/2022] [Indexed: 01/12/2023]
Abstract
Rapidly progressing relapsed/refractory multiple myeloma (RRMM) patients with compromised marrow have limited treatment options. Thus, non-myeloablative chemotherapy with a stem cell boost (SCB) may provide disease control and hematopoietic improvement as bridge to subsequent therapies. We identified 96 patients who received a SCB between January 2011 and December 2019 at the Mount Sinai Hospital. Patients had a median age of 64 years, received a median of 7 prior lines of therapy and 68 and 42% were triple-class and penta-drug refractory, respectively. Chemotherapy included melphalan (MEL) (n = 16), melphalan + carmustine (BCNU/MEL) (n = 52) or a variant of DCEP (dexamethasone, cyclophosphamide, etoposide, cisplatin) (n = 28). Median time to neutrophil recovery was 10 days and was significantly lower with DCEP (8 days) compared to MEL and BCNU/MEL (10-11 days) (p = 0.0047). Time to progression, progression-free survival and overall survival were 3.19, 2.7 and 8.38 months, respectively. The BCNU/MEL group had the highest response rate of 85% (p = 0.05), clinical benefit rate of 94% (p = 0.0014), progression-free survival of 3.3 months (p = 0.4) and overall survival of 8.7 months (p = 0.5). Sixty-six patients (69%) were bridged to new lines of therapy, including clinical trials. Non-myeloablative chemotherapy with SCB provides rapid disease control and marrow recovery with potential to receive further therapy.
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Affiliation(s)
- Tarek H Mouhieddine
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Erin Moshier
- Department of Population Health Science and Policy, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Santiago Thibaud
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Benjamin Puliafito
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Mohammad Rattu
- Department of Pharmacy, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Rita Jakubowski
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Larysa Sanchez
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Adriana Rossi
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Cesar Rodriguez
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Shambavi Richard
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Hearn Jay Cho
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Samir Parekh
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ajai Chari
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Amir Steinberg
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Joshua Richter
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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15
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Caro J, Madero-Marroquin R, Zubizarreta N, Moshier E, Tremblay D, Coltoff A, Lancman G, Fuller R, Rana M, Mascarenhas J, Jacobs SE. Impact of Fluoroquinolone Prophylaxis on Neutropenic Fever, Infections, and Antimicrobial Resistance in Newly Diagnosed AML Patients. Clin Lymphoma Myeloma Leuk 2022; 22:903-911. [PMID: 36109322 DOI: 10.1016/j.clml.2022.08.001] [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] [Received: 06/07/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Fluoroquinolone prophylaxis is recommended during induction chemotherapy for patients with acute myeloid leukemia (AML) to reduce risk of neutropenic fever and systemic bacterial infections. We evaluated the effectiveness of primary fluoroquinolone prophylaxis in an area with high fluoroquinolone resistance. MATERIALS AND METHODS We performed a retrospective chart review of newly diagnosed adult AML patients who received frontline therapy at Mount Sinai Hospital in New York, NY, between 2012 and 2019. Primary outcome was development of neutropenic fever. Secondary outcomes were development of systemic bacterial infections and infections with multidrug-resistant organisms and Clostridioides difficile. Infectious outcomes were collected through 6 months after therapy initiation. We estimated the effect of fluoroquinolone prophylaxis with a time-dependent Cox proportional hazards model. RESULTS Of 121 included patients, 87 received antibiotic prophylaxis and 34 did not. There was no difference in baseline characteristics, although the prophylaxis group had longer neutropenia duration (median 30 vs. 23 days, P = .013). The prophylaxis group had a reduced risk of neutropenic fever (hazard ratio 0.59, P = .039). The prophylaxis group had fewer gram-positive (P = .043) and gram-negative (P = .049) bloodstream infections and fewer clinically documented infections during frontline therapy (P = .005) and follow-up (P = .026). There was no difference in incidence of C. difficile or infection with fluoroquinolone-resistant or multidrug-resistant organisms. There was no mortality difference between groups. CONCLUSION In an area with high fluoroquinolone resistance, primary fluoroquinolone prophylaxis in newly diagnosed AML patients reduced the risk of neutropenic fever and systemic bacterial infections without increased antimicrobial resistance. Prospective, randomized studies are needed to confirm these observations.
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Affiliation(s)
- Jessica Caro
- Monter Cancer Center, Northwell Health, Lake Success, NY.
| | - Rafael Madero-Marroquin
- Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and Mount Sinai West, New York, NY
| | - Nicole Zubizarreta
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Erin Moshier
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Douglas Tremblay
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alex Coltoff
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Guido Lancman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Risa Fuller
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Meenakshi Rana
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - John Mascarenhas
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Samantha E Jacobs
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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16
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Ravona‐Springer R, Heymann A, Moshier E, Yore I, Shamir T, Soleimani L, Beeri MS. Midlife engagement in cognitive activities and cognitive function in middle aged individuals at high risk for AD. Alzheimers Dement 2022. [DOI: 10.1002/alz.067046] [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: 12/24/2022]
Affiliation(s)
- Ramit Ravona‐Springer
- Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
- Memory clinic, Sheba Medical Center Ramat‐Gan Israel
- The Joseph Sagol Neuroscience Center, Sheba Medical Center Ramat Gan Israel
| | - Anthony Heymann
- Maccabi Health Services Jerusalem Israel
- Tel Aviv University Tel Aviv Israel
| | - Erin Moshier
- The Icahn School of Medicine at Mount Sinai New York NY USA
| | - Iska Yore
- The Joseph Sagol Neuroscience Center Ramat Gan Israel
| | - Tamar Shamir
- The Joseph Sagol Neuroscience Center Ramat Gan Israel
| | | | - Michal Schnaider Beeri
- The Joseph Sagol Neuroscience Center, Sheba Medical Center Ramat Gan Israel
- Icahn School of Medicine at Mount Sinai New York NY USA
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17
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Zaveri S, Nevid D, Ru M, Moshier E, Pisapati K, Reyes SA, Port E, Romanoff A. ASO Visual Abstract: Racial Disparities in Time to Treatment Persist in the Setting of a Comprehensive Breast Center. Ann Surg Oncol 2022; 29:6705. [PMID: 35902501 DOI: 10.1245/s10434-022-12114-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shruti Zaveri
- Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniella Nevid
- Dubin Breast Center, Tisch Cancer Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meng Ru
- Department of Population Health Science and Policy, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin Moshier
- Department of Population Health Science and Policy, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kereeti Pisapati
- Dubin Breast Center, Tisch Cancer Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sylvia A Reyes
- Dubin Breast Center, Tisch Cancer Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elisa Port
- Dubin Breast Center, Tisch Cancer Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anya Romanoff
- Department of Global Health and Health System Design, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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18
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Nehlsen AD, Sindhu KK, Wolken T, Khan F, Kyriakakos CK, Ward SC, Moshier E, Taouli B, Buckstein M. Characterization and Prediction of Signal Intensity Changes in Normal Liver Parenchyma on Gadoxetic Acid-enhanced MRI Scans after Liver-directed Radiation Therapy. Radiol Imaging Cancer 2022; 4:e210100. [PMID: 35904411 PMCID: PMC9358658 DOI: 10.1148/rycan.210100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 05/17/2022] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
Purpose To better characterize and understand the significance of focal liver reaction (FLR) development in a large cohort of patients who underwent gadoxetic acid-enhanced MRI after being treated with radiation therapy (RT) for hepatobiliary tumors. Materials and Methods This retrospective study evaluated 100 patients (median age, 65 years [first and third quartiles, 60-69 years]; 80 men) who underwent RT for hepatocellular carcinoma, bile duct tumors, or liver metastases at Mount Sinai Hospital between March 1, 2018, and February 29, 2020. CT simulation scans were fused to MRI scans obtained 1-6 months and 6-12 months after RT, using the hepatobiliary phase of the MRI. To define FLR volume, two radiation oncologists independently delineated the borders of the hypointensity observed on MRI scans in the liver region where RT was delivered. Biologically effective dose (BED) thresholds for the formation of FLRs were calculated, along with albumin-bilirubin (ALBI) scores and grades, and overall survival. Results Most patients developed FLRs, which decreased in volume over time. Median BED threshold values for FLR development were 63.6 Gy at 1-6 months and 88.7 Gy at 6-12 months. While higher baseline ALBI scores were associated with a lower rate of FLRs, there was a significant association between FLR volume and increase in ALBI score at 1-6 months (P = .048). Twelve- and 24-month survival estimates for the cohort were 81% and 48%, respectively. Histopathologic analysis of seven explanted liver specimens demonstrated findings consistent with radiation-induced liver disease. Conclusion FLRs were a clear measure of liver damage after RT and were associated with the development of liver dysfunction and focal radiation-induced liver disease. Keywords: MRI, Radiation Therapy Supplemental material is available for this article. © RSNA, 2022.
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19
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Rosen DC, Winoker JS, Mullen G, Moshier E, Sim A, Pathak P, Wagaskar V, Sfakianos JP, Reddy A, Palese M, Badani KK, Wiklund P, Tewari A, Mehrazin R. Robotic Vs. Ultrasound TAP Block Vs. Local Anesthetic in Urology: Results of UROTAP Randomized Trial. BJU Int 2022; 130:815-822. [PMID: 35727844 DOI: 10.1111/bju.15833] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To prospectively compare robotically administered transperitoneal transversus abdominis plane to ultrasound-guided TAP (UTAP) to local anesthesia (LA) for pain control and narcotic use in robotic prostatectomy (RP) and robotic partial nephrectomy (RPN) patients. SUBJECTS/PATIENTS AND METHODS Patients undergoing RP or RPN were randomized in a single blind 2:2:1 fashion to RTAP:UTAP:LA, with the study powered to evaluate superiority of UTAP to LA and non-inferiority of RTAP to UTAP. We compared time to deliver the block, operating room time, postoperative pain scores using the visual analog scale (VAS), and intraoperative and postoperative analgesia consumption. RESULTS 143 patients were randomized and received a treatment. There was no significant difference in patient baseline characteristics. UTAP did not demonstrate superiority to LA in terms of pain control. RTAP and LA were faster than UTAP (time to perform block 2.5 vs. 2.5 vs. 6.25 min, p<.001). There was no difference in postoperative narcotic, acetaminophen, ketorolac, or ondansetron requirements among all three groups (p>0.05). The study was terminated early due to the unexpected efficacy of LA. CONCLUSION UTAP and RTAP do not provide superior pain control to LA. LA's efficiency, effectiveness, and ease of administration make it a first line therapy for postoperative analgesia.
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Affiliation(s)
- Daniel C Rosen
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jared S Winoker
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Greg Mullen
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin Moshier
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alan Sim
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Prachee Pathak
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vinayak Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Avinash Reddy
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashutosh Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Zaveri S, Nevid D, Ru M, Moshier E, Pisapati K, Reyes SA, Port E, Romanoff A. Racial Disparities in Time to Treatment Persist in the Setting of a Comprehensive Breast Center. Ann Surg Oncol 2022; 29:6692-6703. [PMID: 35697955 DOI: 10.1245/s10434-022-11971-w] [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] [Received: 06/23/2021] [Accepted: 05/16/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Racial disparities in breast cancer care have been linked to treatment delays. We explored whether receiving care at a comprehensive breast center could mitigate disparities in time to treatment. METHODS Retrospective chart review identified breast cancer patients who underwent surgery from 2012 to 2018 at a comprehensive breast center. Time-to-treatment intervals were compared among self-identified racial and ethnic groups by negative binomial regression models. RESULTS Overall, 2094 women met the inclusion criteria: 1242 (59%) White, 262 (13%) Black, 302 (14%) Hispanic, 105 (5%) Asian, and 183 (9%) other race or ethnicity. Black and Hispanic patients more often had Medicaid insurance, higher American Society of Anesthesiologists (ASA) scores, advanced-stage breast cancer, mastectomy, and additional imaging after breast center presentation (p < 0.05). After controlling for other variables, racial or ethnic minority groups had consistently longer intervals to treatment, with Black women experiencing the greatest disparity (incidence rate ratio 1.42). Time from initial comprehensive breast center visit to treatment was also significantly shorter in White patients versus non-White patients (p < 0.0001). Black race, Medicaid insurance/being uninsured, older age, earlier stage, higher ASA score, undergoing mastectomy, having reconstruction, and requiring additional pretreatment work-up were associated with a longer time from initial visit at the comprehensive breast center to treatment on multivariable analysis (p < 0.05). CONCLUSION Racial or ethnic minority groups have significant delays in treatment even when receiving care at a comprehensive breast center. Influential factors include insurance delays and necessity of additional pretreatment work-up. Specific policies are needed to address system barriers in treatment access.
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Affiliation(s)
- Shruti Zaveri
- Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniella Nevid
- Dubin Breast Center, Tisch Cancer Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meng Ru
- Department of Population Health Science and Policy, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin Moshier
- Department of Population Health Science and Policy, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kereeti Pisapati
- Dubin Breast Center, Tisch Cancer Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sylvia A Reyes
- Dubin Breast Center, Tisch Cancer Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elisa Port
- Dubin Breast Center, Tisch Cancer Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anya Romanoff
- Department of Global Health and Health System Design, The Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,The New York Academy of Medicine, 1216 Fifth Avenue, Room 556C, New York, NY, 10029, USA.
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21
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Patel R, Hovstadius M, Kier MW, Moshier E, Zimmerman BS, Cascetta KP, Jaffer S, Sparano JA, Tiersten A. Correlation of Ki67 working group prognostic risk categories with oncotype DX recurrence score (RS) in early breast cancer (EBC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
553 Background: The 21-gene RS (Oncotype DX) provides prognostic information for distant recurrence risk and is predictive of adjuvant chemotherapy benefit in hormone receptor (HR)-positive, HER-2 negative EBC. Ki67 protein expression is a proliferation marker that is determined by immunohistochemistry (IHC). The International Ki67 Working Group (IKWG) has provided guidelines for clinical use of Ki67 for prognostic classification (PMID: 33369635). The objectives of this study were to determine the correlation between IHC-measured Ki67 with the 21-gene RS, and evaluate their association with other anatomic and biologic tumor features. Methods: We performed a retrospective chart review of women with HR-positive, HER-2 negative EBC with 0-3 positive lymph nodes who had both Ki67 (via IHC using MIB-1 antibody on surgical specimen at our institutional pathology CLIA laboratory) and 21-gene RS between 2013 to 2021. Patients were categorized into Ki67 low (≤ 5%), intermediate (6-29%), and high (≥30%) based on IKWG recommendations. Overall and risk stratified agreement between Ki67 and RS were assessed using the proportion of agreement and Kappa statistic. Linear regression was used to test for associations between tumor features of ER%, PR%, and tumor size and log transformed Ki67 and RS. A t-test was used to compare average log transformed Ki67 and RS by tumor differentiation and nodal status. Results: We identified 461 patients with HR-positive BC of whom 26.7% were ≤ 50 years at diagnosis, 30% pre-menopausal and 10% node-positive. Overall, 29% (n = 137) of patients had low Ki67, 49% (n = 227) intermediate, and 21% (n = 97) high Ki67. 18% (n = 85) had RS 0-10, 67% (n = 311) had RS 11-25 and 14% (n = 65) had RS ≥ 26. There was no significant agreement (kappa < 0) between Ki67 and RS (Kappa = -0.0035, p = 0.5406) in the overall population and fair agreement (kappa 0.21-0.40) between high Ki67 and RS (Kappa = 0.2510, p < 0.0001). Higher ER% was significantly associated with lower RS (p < 0.0001) and lower Ki67 (p = 0.0042). High tumor grade was associated with higher RS and higher Ki67 (p < 0.0001). Higher PR% was associated with lower RS (p > 0.0001) but not lower Ki67. Positive nodal status and larger tumor size were associated with higher Ki67 (p = 0.0081, p < 0.0001) but not RS. Among the 49% of patients with intermediate Ki67 of 6-29%, the distribution of low, intermediate, and high RS was 24%, 65%, and 11%, respectively. Conclusions: In this group of patients selected to have a 21-gene RS, there was no correlation between Ki67 and RS in the overall population, and fair agreement between high Ki67 and high RS. Among the approximately one-half with an intermediate Ki67 of 6-29%, 89% would be spared chemotherapy based on a low-intermediate RS. In patients with high Ki67, 68% might be spared chemotherapy based on the RS. In the low Ki67 group, 6% had a high RS. Ki67 has limited utility in identifying patients with high or low RS.
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Affiliation(s)
- Rima Patel
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Erin Moshier
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | | | - Amy Tiersten
- Icahn School of Medicine at Mount Sinai, New York, NY
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22
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Tremblay D, Srisuwananukorn A, Ronner L, Podoltsev N, Gotlib J, Heaney ML, Kuykendall A, O’Connell CL, Shammo JM, Fleischman A, Mesa R, Yacoub A, Hoffman R, Moshier E, Zubizarreta N, Mascarenhas J. European LeukemiaNet Response Predicts Disease Progression but Not Thrombosis in Polycythemia Vera. Hemasphere 2022; 6:e721. [PMID: 35747843 PMCID: PMC9208865 DOI: 10.1097/hs9.0000000000000721] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/14/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Douglas Tremblay
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Lukas Ronner
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Nikolai Podoltsev
- Hematology Section, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jason Gotlib
- Stanford University Medical Center, Palo Alto, CA, USA
| | - Mark L. Heaney
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, USA
| | - Andrew Kuykendall
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Casey L. O’Connell
- Jane Anne Nohl Division of Hematology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jamile M. Shammo
- Division of Hematology/Oncology, Rush University Medical Center, Chicago, IL, USA
| | | | - Ruben Mesa
- UT Health San Antonio Cancer Center, San Antonio, TX, USA
| | | | - Ronald Hoffman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Erin Moshier
- Department of Population Health Science and Policy, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Nicole Zubizarreta
- Department of Population Health Science and Policy, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - John Mascarenhas
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
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23
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Karzai S, Port E, Siderides C, Valente C, Ahn S, Moshier E, Ru M, Pisapati K, Couri R, Margolies L, Schmidt H, Cate S. ASO Visual Abstract: Impact of Screening Mammography on Treatment in Young Women Diagnosed with Breast Cancer. Ann Surg Oncol 2022. [PMID: 35476300 DOI: 10.1245/s10434-022-11636-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shkala Karzai
- Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Elisa Port
- Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Cleo Siderides
- Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Christopher Valente
- Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Soojin Ahn
- Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Erin Moshier
- Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Meng Ru
- Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Kereeti Pisapati
- Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Ronald Couri
- Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Laurie Margolies
- Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Hank Schmidt
- Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Sarah Cate
- Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA.
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Takahashi M, Hwang M, Misiukiewicz K, Gupta V, Miles BA, Bakst R, Genden E, Selkridge I, Botzler J, Virani V, Moshier E, Bonomi MR, Posner MR. Quality of Life Analysis of HPV-Positive Oropharyngeal Cancer Patients in a Randomized Trial of Reduced-Dose Versus Standard Chemoradiotherapy: 5-Year Follow-Up. Front Oncol 2022; 12:859992. [PMID: 35463348 PMCID: PMC9024140 DOI: 10.3389/fonc.2022.859992] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Human papillomavirus-positive oropharyngeal carcinoma (HPVOPC) portends a more favorable prognosis compared to environmentally related oropharynx cancer (EROPC). Patients with HPVOPC may be overtreated and endure unnecessary long-term toxicities. Methods Patients with untreated locally advanced HPVOPC received induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (TPF) and were randomized to standard chemoradiotherapy (sdCRT) (70 Gy) or reduced-dose chemoradiotherapy (rdCRT) (56 Gy) with weekly carboplatin. Patients were followed for changes in five validated quality of life (QoL) surveys: MD Anderson Dysphagia Inventory and Symptom Inventory for head and neck cancer (MDADI, MDASI-HN), Xerostomia Questionnaire (XQ), and European Organization for Research and Treatment of Cancer Questionnaire (EORTC) with head and neck module (EORTC HN). The secondary endpoints of this study were 5-year progression-free survival (PFS) and overall survival (OS). Results Twenty patients were enrolled and randomized to rdCRT (n = 12) or sdCRT (n = 8). Median follow-up was 88 months. At 5 years, difference in QoL changes all favored the rdCRT arm and two QoL scales reached statistical significance (EORTC global health score: 11.49 vs. -23.94, P = 0.014; EORTC symptom scale: -7.76 vs. 15.19, P = 0.015). The 5-year PFS and OS were 87.5% and 83.3% for sdCRT and rdCRT, respectively. Conclusions Therefore, rdCRT after TPF in HPVOPC is feasible in accordance with the earlier results of the Quarterback Trial and long-term follow-up. These limited results are more favorable in specific QoL domains compared to those of sdCRT and demonstrate equivalent long-term survival. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT01706939, The Quarterback Trial [NCT 01706939].
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Affiliation(s)
- Mai Takahashi
- The Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, United States
| | - Michael Hwang
- The Departments of Hematology/Oncology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Krysztof Misiukiewicz
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,The Departments of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Vishal Gupta
- Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Brett A Miles
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Richard Bakst
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Eric Genden
- Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Isaiah Selkridge
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - John Botzler
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Vruti Virani
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Erin Moshier
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Biostatistics in the Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Marcelo R Bonomi
- The Departments of Hematology/Oncology, The Ohio State University, Columbus, OH, United States
| | - Marshall R Posner
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,The Departments of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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25
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Martins Maia C, Siderides C, Jaffer S, Weltz C, Cate S, Ahn S, Boolbol S, Ru M, Moshier E, Port E, Schmidt H. ASO Visual Abstract: Mastectomy or Margin Reexcision? A Nomogram for Close/Positive Margins after Lumpectomy for DCIS. Ann Surg Oncol 2022. [PMID: 35381937 DOI: 10.1245/s10434-022-11359-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Catarina Martins Maia
- Breast Surgical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, USA. .,Jacobi Medical Center / Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Cleo Siderides
- Breast Surgical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, USA
| | - Shabnam Jaffer
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christina Weltz
- Breast Surgical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, USA
| | - Sarah Cate
- Breast Surgical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, USA
| | - Soojin Ahn
- Department of Surgery, NYU Long Island School of Medicine, Mineola, New York, NY, USA
| | - Susan Boolbol
- Department of Breast Surgery, Nuvance Health, Poughkeepsie, New York, NY, USA
| | - Meng Ru
- Institute for Health Care Delivery Science, Tisch Cancer Institute Biostatistics Shared Resource Facility, New York, NY, USA
| | - Erin Moshier
- Institute for Health Care Delivery Science, Tisch Cancer Institute Biostatistics Shared Resource Facility, New York, NY, USA
| | - Elisa Port
- Breast Surgical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, USA
| | - Hank Schmidt
- Breast Surgical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY, USA
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26
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Karzai S, Port E, Siderides C, Valente C, Ahn S, Moshier E, Ru M, Pisapati K, Couri R, Margolies L, Schmidt H, Cate S. Impact of Screening Mammography on Treatment in Young Women Diagnosed with Breast Cancer. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11581-6. [PMID: 35364765 DOI: 10.1245/s10434-022-11581-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/21/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is little data exploring the impact of screening mammography on subsequent treatment in the 40-49-year age group with breast cancer. We sought to assess the association between frequency of mammography in young women and extent of surgery and chemotherapy required. METHODS An IRB-approved retrospective review was performed of patients diagnosed with breast cancer between ages 40 and 49 years from 1 January 2010 to 19 November 2018 within a single health system. Patients were grouped based on last screening 1-24 months prior to diagnosis (1-24 group), > 25 months prior to diagnosis (> 25 group), never screened, and > 25+ never screened (combination group). Multivariate logistic regression models were used to assess for associations between screening intervals and tumor and nodal stage, chemotherapy use, and extent of surgery. RESULTS Of 869 patients included for analysis, 20% were never screened, 60% screened 1-24 months, and 19% screened > 25 months prior to diagnosis. Compared with the 1-24 months group, the never-screened group, > 25 months group, and combined group were more likely to receive chemotherapy. The never-screened and combined groups were more likely to undergo mastectomy and/or axillary lymph node dissection. Of patients undergoing upfront surgery, the > 25 months and combined groups were more likely to receive adjuvant chemotherapy, while the never-screened and combined groups were more likely to have nodal disease. CONCLUSION Our findings support the initiation of screening mammography at age 40 years to reduce the risk of aggressive treatments for newly diagnosed breast cancers in this group.
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Affiliation(s)
- Shkala Karzai
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elisa Port
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cleo Siderides
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher Valente
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Soojin Ahn
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin Moshier
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meng Ru
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kereeti Pisapati
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ronald Couri
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laurie Margolies
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hank Schmidt
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah Cate
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Berger NF, Zimmerman BS, Seidman D, Cascetta KP, Moshier E, Nezolosky M, Trlica K, Ryncarz A, Keeton C, Tiersten A. Impact of the COVID-19 Pandemic on Cancer Care and Quality of Life for Patients With Breast and Gynecologic Malignancies: A Single-Center Survey-Based Study. J Patient Exp 2022; 9:23743735221077543. [PMID: 35187223 PMCID: PMC8850998 DOI: 10.1177/23743735221077543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This study evaluated the mental health and cancer treatment-related impact of the first wave of the COVID-19 pandemic on patients with breast and gynecologic cancers. An 18-question survey was administered in June 2020 at a New York City-based cancer center to assess the quality of life (QOL) and overall health (OH) during both the pandemic time period from March 1, 2020, through June 30, 2020, and the pre-pandemic period (prior to March 1, 2020). Survey questions were answered on a 5-point Likert scale and a 7-point EORTC QLQ-C30 QOL scale. Differences in mean QOL and OH scores were evaluated using a paired t-test. QOL and OH were significantly worsened by the pandemic, with significant increases in anxiety, depression, and mood swings.
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Affiliation(s)
- Natalie F. Berger
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Natalie F. Berger, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029, USA.
| | - Brittney S. Zimmerman
- Hematology/Oncology Department, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Danielle Seidman
- Hematology/Oncology Department, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Krystal P. Cascetta
- Hematology/Oncology Department, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Erin Moshier
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michelle Nezolosky
- Hematology/Oncology Department, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kara Trlica
- Hematology/Oncology Department, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alisa Ryncarz
- Hematology/Oncology Department, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Caitlin Keeton
- Hematology/Oncology Department, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy Tiersten
- Hematology/Oncology Department, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Mouhieddine TH, Hieulle J, Moshier E, Richard S, Richter J, Cho HJ, Parekh S, Barlogie B, Chari A, Jagannath S, Madduri D. Treatment Bridging With a 28-Day Metronomic Therapy (Metro-28) for Relapsed Refractory Multiple Myeloma. Clin Lymphoma Myeloma Leuk 2022; 22:129-132. [PMID: 34670732 DOI: 10.1016/j.clml.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/07/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Tarek H Mouhieddine
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Julia Hieulle
- Department of Hematology, CHU, Univ. Lille, Lille, France
| | - Erin Moshier
- Department of Population Health Science and Policy, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shambavi Richard
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joshua Richter
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hearn Jay Cho
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Samir Parekh
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Bart Barlogie
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ajai Chari
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sundar Jagannath
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Deepu Madduri
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
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29
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Martins Maia C, Siderides C, Jaffer S, Weltz C, Cate S, Ahn S, Boolbol S, Ru M, Moshier E, Port E, Schmidt H. Mastectomy or Margin Re-excision? A Nomogram for Close/Positive Margins After Lumpectomy for DCIS. Ann Surg Oncol 2022; 29:3740-3748. [DOI: 10.1245/s10434-021-11293-3] [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] [Received: 07/23/2021] [Accepted: 12/15/2021] [Indexed: 11/18/2022]
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Alberty‐Oller JJ, Reyes S, Moshier E, Ru M, Weltz S, Santos A, Pisapati K, Port E, Jaffer S. Does previous history of cancer or atypia predict histologic upgrade for pure intraductal papillomas diagnosed via core biopsy? A study of 490 cases at a single institution. Cancer Rep (Hoboken) 2021; 5:e1481. [PMID: 34729946 PMCID: PMC8955065 DOI: 10.1002/cnr2.1481] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/17/2021] [Accepted: 06/04/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Management of pure intraductal papillomas (IDP) without atypia diagnosed on core needle biopsy (CNB) remains controversial given highly variable rates of upgrade in the literature. AIM We sought to identify clinical and histologic factors that predict upgrade to atypia or malignancy in a large population. METHODS AND RESULTS A retrospective review was performed of all cases of pure IDP diagnosed on CNB and then surgically excised at a single institution from 2008 to 2018. Clinical, radiologic, and pathologic factors were compared in the no upgrade, upgrade to atypia, or upgrade to cancer groups. Univariate analysis was performed comparing no upgrade and upgrade to cancer or atypia. Four hundred and thirty nine patients were identified with a total of 490 IDP and a median age of 50 years (range 16-85). Of these patients, 54 (12.3%) were upgraded to atypia after surgical excision and five (1.1%) were upgraded to cancer. The presence of multiple papillomas in a single patient was a significant predictor of upgrade to cancer or atypia (p < .01), as well as age over ≥55 years (p < .01) and a prior history of cancer (p < .01). No other clinical, radiologic and histologic factors were found to be significant predictors of upgrade. 40/439 (9.1%) patients in the total cohort had prior history of cancer, and of these, 2/40 (5%) were found to have a new cancer after excision. CONCLUSIONS In patients with pure IDP on CNB, the upgrade rate to malignancy was 1.1%, while 12.3% were upgraded to atypia. The clinical significance of identifying atypia in a papilloma is unknown, especially in a patient with a prior history of atypia or cancer. However, the majority of patients who were upgraded to either atypia or cancer had no prior history of high-risk or malignant breast disease and are therefore considered true clinical upgrades. As such excision for IDP should be considered.
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Affiliation(s)
- J. Jaime Alberty‐Oller
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Sylvia Reyes
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Erin Moshier
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Meng Ru
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Sarah Weltz
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Antonio Santos
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Kereeti Pisapati
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Elisa Port
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Shabnam Jaffer
- Mount Sinai HospitalDubin Breast Center of the Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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Smith A, Kerns S, Rowley J, Moshier E, Green S, Rosenstein B. Quantifying Risk of Ipsilateral Arm Lymphedema Causing Functional Impairment in Breast Cancer Patients: Results From a Prospective, Multi-Centre International Study of Treatment Toxicity. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.776] [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: 11/30/2022]
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Nehlsen A, Moshier E, Taouli B, Kyriakakos C, Buckstein M. Characterization and Predication of Signal Changes in Normal Liver Parenchyma on Gadoxetic Acid Enhanced Magnetic Resonance Imaging After Liver Directed Radiation Therapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Naymagon L, Tremblay D, Zubizarreta N, Moshier E, Mascarenhas J, Schiano T. Safety, Efficacy, and Long-Term Outcomes of Anticoagulation in Cirrhotic Portal Vein Thrombosis. Dig Dis Sci 2021; 66:3619-3629. [PMID: 33151401 DOI: 10.1007/s10620-020-06695-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/23/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND The role of anticoagulation (AC) in the management of cirrhotic patients with portal vein thrombosis (PVT) remains unclear. AIMS We conducted a retrospective study of cirrhotic patients diagnosed with PVT from 1/1/2000 through 2/1/2019, comparing those who received AC to those who did not. METHODS Outcomes included rate of complete radiographic resolution (CRR) of PVT, recanalization of occlusive PVT (RCO), PVT extension, major bleeding, and overall survival (OS). The log-rank test was used to compare Kaplan-Meier distributions of time-to-event outcomes. Multivariable Cox-proportional-hazards modeling was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals. RESULTS A total of 214 patients were followed for a median 27 months (IQR 12-48). Eighty-six patients (39%) received AC. AC was associated with significantly greater CRR (48% vs. 27%, p = 0.0007), (multivariable HR for CRR with AC; 2.49 (1.54-4.04, p = 0.0002)). AC was also associated with significantly greater RCO (69% vs. 28%, p = 0.0013), (multivariable HR for RCO with AC; 4.86 (1.91-12.37, p = 0.0009)). Rates of major bleeding were similar with and without AC (20% vs. 17%, p = 0.5207), multivariable HR for major bleeding with AC; 1.29 (0.68-2.46, p = 0.4423)). OS rates in the AC and no-AC groups were 83% and 70%, respectively (p = 0.1362), (HR for death with AC; 0.69 (0.38-1.28, p = 0.2441)). Among 75 patients who had CRR, 10 (13%) experienced recurrent PVT during follow-up (none were receiving AC at the time of recurrence). CONCLUSIONS AC appears safe and effective for the treatment of cirrhotic PVT; however, prospective studies to confirm these findings and evaluate additional outcomes are needed.
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Affiliation(s)
- Leonard Naymagon
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1079, New York, NY, 10029, USA.
| | - Douglas Tremblay
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1079, New York, NY, 10029, USA
| | - Nicole Zubizarreta
- Department of Population Health Science and Policy, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin Moshier
- Department of Population Health Science and Policy, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John Mascarenhas
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1079, New York, NY, 10029, USA
| | - Thomas Schiano
- Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Nehlsen AD, Sindhu KK, Moshier E, Richter J, Richard S, Chari A, Sanchez L, Parekh S, Cho HJ, Jagannath S, Dharmarajan K. The Safety and Efficacy of Radiation Therapy with Concurrent Dexamethasone, Cyclophosphamide, Etoposide, and Cisplatin-Based Systemic Therapy for Multiple Myeloma. Clin Lymphoma Myeloma Leuk 2021; 22:192-197. [PMID: 34736880 DOI: 10.1016/j.clml.2021.09.015] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/07/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The concurrent delivery of radiation therapy (RT) with salvage chemotherapies in the management of relapsed and refractory multiple myeloma (MM) is an area of ongoing investigation. This study examined the safety and efficacy of palliative RT given in the setting of concurrent dexamethasone, cyclophosphamide, etoposide, and cisplatin (DCEP). PATIENTS AND METHODS Fifty-five patients with MM received RT to 64 different sites within three weeks of receiving DCEP from 2010 to 2020. A median dose of 20 Gray (range 8-32.5 Gy) was delivered in a median of 5 fractions (range 1-15). Patients received a median of 1 cycle (range 1-5) of DCEP. Rates of hematologic and RT toxicity were recorded along with pain, radiographic, and laboratory responses to treatment. RESULTS RT was completed in 98% of patients. 21% of patients experienced RTOG grade 3+ hematologic toxicity before RT, which increased to 35% one-month post-RT (P = .13) before decreasing to 12% at 3 to 6 months (P = .02). The most common toxicity experienced was thrombocytopenia. Grade 1 to 2 non-hematologic RT-related toxicity was reported in 15% of patients while on treatment and fell to 6% one-month after completing RT. Pain resolved in 94% of patients with symptomatic lesions at baseline. Stable disease or better was observed in 34/39 (87%) of the targeted lesions on surveillance imaging. CONCLUSION RT administered concurrently with DCEP was well-tolerated by most of the patients in this series, with low rates of hematologic and RT-related toxicity. RT was also very effective, with the vast majority of patients demonstrating resolution of their pain and a significant response on follow-up imaging.
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Affiliation(s)
- Anthony D Nehlsen
- Icahn School of Medicine at Mount Sinai, Radiation Oncology, NY, NY, USA.
| | - Kunal K Sindhu
- Icahn School of Medicine at Mount Sinai, Radiation Oncology, NY, NY, USA
| | - Erin Moshier
- Icahn School of Medicine at Mount Sinai, Biostatistics, NY, NY, USA
| | - Joshua Richter
- Icahn School of Medicine at Mount Sinai, Hematology and Oncology, NY, NY, USA
| | - Shambavi Richard
- Icahn School of Medicine at Mount Sinai, Hematology and Oncology, NY, NY, USA
| | - Ajai Chari
- Icahn School of Medicine at Mount Sinai, Hematology and Oncology, NY, NY, USA
| | - Larysa Sanchez
- Icahn School of Medicine at Mount Sinai, Hematology and Oncology, NY, NY, USA
| | - Samir Parekh
- Icahn School of Medicine at Mount Sinai, Hematology and Oncology, NY, NY, USA
| | - Hearn Jay Cho
- Icahn School of Medicine at Mount Sinai, Hematology and Oncology, NY, NY, USA
| | - Sundar Jagannath
- Icahn School of Medicine at Mount Sinai, Hematology and Oncology, NY, NY, USA
| | - Kavita Dharmarajan
- Icahn School of Medicine at Mount Sinai, Radiation Oncology, NY, NY, USA
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Berger NF, Zimmerman BS, Tharakan S, Suchman K, Cascetta KP, Blanter J, Moshier E, Ru M, Jaffer S, Tiersten A. Secondary Invasive Breast Events among Patients with Hormone-Positive Breast Cancer and High-Risk Oncotype DX Recurrence Scores 26-30 and ≥31. Oncology 2021; 99:699-702. [PMID: 34425579 DOI: 10.1159/000517843] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/09/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Oncotype DX Recurrence Score (ODx RS) is the most widely adopted genomic assay used to guide treatment for patients with early-stage, hormone-positive (HR+) breast cancer (BC), with higher scores predicting greater risk of recurrence and benefit from chemotherapy. Patients with ODx RS >25 typically recieve adjuvant chemotherapy; however, data regarding efficacy of chemotherapy for reducing recurrence in this population have been mixed. OBJECTIVES This study aimed to evaluate outcomes of patients with early-stage HR+ BC with high-risk ODx RS (26-30 and ≥31) in order to assess treatment patterns and outcomes. We hypothesized that the benefit of chemotherapy in these groups may be minimal and that select patients may forgo chemotherapy in favor of more aggressive endocrine therapy and ovarian suppression. METHODS We performed a retrospective analysis of 515 patients with early-stage, HR+ BC with high-risk ODx RS 26-30 and ≥31 treated between 2006 and 2018. Patients were stratified by RS: low-risk (≤10), intermediate-risk (11-25), and high-risk (≥26). The Kaplan-Meier method was used to estimate the time to secondary invasive breast events (SIBE) or distributions overall and among different RS groups with the log rank test used to compare distributions between groups. RESULTS Rates of chemotherapy administration were 7% among the low-risk group, 18% among the intermediate-risk group, and 83% among high-risk patients with 41 SIBE (8%) reported. When stratified by ODx RS, 5-year rates of SIBE were 4%, 6%, and 16% for low-risk, intermediate-risk, and high-risk RS, respectively. Among the 27 lymph node (LN)-negative patients with ODx RS 26-30, 74% received chemotherapy. The 5-year rate of SIBE was 25% among patients who received chemotherapy and 33% among those who did not (p = 0.5489). Among the 23 LN-negative patients with ODx RS ≥31, 91% of patients received chemotherapy. The 5-year rate of SIBE was 0% both with and without chemotherapy. CONCLUSIONS There was no statistically significant difference in SIBE for patients with high-risk ODx RS based on chemotherapy treatment. More aggressive endocrine therapy with ovarian suppression has become an alternative to chemotherapy among patients with intermediate-risk ODx RS (16-25). This approach may be useful among patients with high-risk ODx RS, with additional studies needed in this patient population.
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Affiliation(s)
- Natalie F Berger
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brittney S Zimmerman
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Serena Tharakan
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kelly Suchman
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Krystal P Cascetta
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Julia Blanter
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Erin Moshier
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Meng Ru
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shabnam Jaffer
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy Tiersten
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Lotan R, Ganmore I, Livny A, Itzhaki N, Waserman M, Shelly S, Zacharia M, Moshier E, Uribarri J, Beisswenger P, Cai W, Troen AM, Beeri MS. Effect of Advanced Glycation End Products on Cognition in Older Adults with Type 2 Diabetes: Results from a Pilot Clinical Trial. J Alzheimers Dis 2021; 82:1785-1795. [PMID: 34250935 DOI: 10.3233/jad-210131] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 01/12/2023]
Abstract
BACKGROUND Dietary advanced glycation end-products (AGEs) are linked to cognitive decline. However, clinical trials have not tested the effect of AGEs on cognition in older adults. OBJECTIVE The aim of the current pilot trial was to examine the feasibility of an intervention to reduce dietary AGEs on cognition and on cerebral blood flow (CBF). METHODS The design is a pilot randomized controlled trial of dietary AGEs reduction in older adults with type 2 diabetes. Seventy-five participants were randomized to two arms. The control arm received standard of care (SOC) guidelines for good glycemic control; the intervention arm, in addition to SOC guidelines, were instructed to reduce their dietary AGEs intake. Global cognition and CBF were assessed at baseline and after 6 months of intervention. RESULTS At baseline, we found a reverse association between AGEs and cognitive functioning, possibly reflecting the long-term toxicity of AGEs on the brain. There was a significant improvement in global cognition at 6 months in both the intervention and SOC groups which was more prominent in participants with mild cognitive impairment. We also found that at baseline, higher AGEs were associated with increased CBF in the left inferior parietal cortex; however, 6 months of the AGEs lowering intervention did not affect CBF levels, despite lowering AGEs exposure in blood. CONCLUSION The current pilot trial focused on the feasibility and methodology of intervening through diet to reduce AGEs in older adults with type 2 diabetes. Our results suggest that participants with mild cognitive impairment may benefit from an intensive dietary intervention.
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Affiliation(s)
- Roni Lotan
- The Nutrition and Brain Health Laboratory, The Institute of Biochemistry, Food and Nutrition Science, The Robert H. Smith Faculty of Agriculture Food and the Environment, The Hebrew University of Jerusalem, Rehovot, Israel.,The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ithamar Ganmore
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel.,Memory Clinic, Sheba Medical Center, Tel Hashomer, Israel.,Neurology department, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abigail Livny
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Israel
| | - Nofar Itzhaki
- Division of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Israel
| | - Mark Waserman
- Division of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Israel
| | - Shahar Shelly
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel.,Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Moran Zacharia
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Erin Moshier
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jaime Uribarri
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Weijing Cai
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aron M Troen
- The Nutrition and Brain Health Laboratory, The Institute of Biochemistry, Food and Nutrition Science, The Robert H. Smith Faculty of Agriculture Food and the Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Michal Schnaider Beeri
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Israel.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Naymagon L, Tremblay D, Zubizarreta N, Moshier E, Schiano T, Mascarenhas J. Portal vein thrombosis patients harboring JAK2V617F have poor long-term outcomes despite anticoagulation. J Thromb Thrombolysis 2021; 50:652-660. [PMID: 32034618 DOI: 10.1007/s11239-020-02052-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Non-cirrhotic portal vein thrombosis (ncPVT) most often occurs in the setting of intraabdominal proinflammatory processes. Less often, ncPVT may result from primary hematologic thrombophilia (most commonly JAK2V617F). Although these etiologic categories are pathophysiologically distinct, they are treated similarly using anticoagulation. We conducted a retrospective assessment of outcomes among ncPVT patients harboring JAK2V617F, and compared them to outcomes among patients with other etiologies for ncPVT, to determine whether anticoagulation alone is adequate therapy for JAK2V617F associated PVT. Outcomes were complete radiographic resolution (CRR) of PVT, recanalization (RC) of occlusive PVT, and development of significant portal hypertension (SPH). Three-hundred-thirty ncPVT patients seen between 1/2000 and 1/2019, including 37 harboring JAK2V617F (JAK2), 203 with other evident etiology (OE) for PVT, and 90 with no evident etiology (NE) for PVT followed for a median 29 months (53, 21, and 32 months respectively). Outcomes among the JAK2 cohort were dismal relative to the other groups. CRR rates were 8%, 31%, and 55% for the JAK2, NE, and OE cohorts respectively (multivariable HR JAK2:OE = 0.15 (0.05, 0.49), p = 0.0016). RC rates were 16%, 33%, and 49% for the JAK2, NE, and OE cohorts respectively (multivariable HR for RC JAK2:OE = 0.24 (0.09, 0.63), p = 0.0036). SPH rates were 49%, 32%, and 17% for the JAK2, NE, and OE cohorts respectively (multivariable HR for SPH JAK2:OE = 1.23 (0.62, 2.42), p = 0.5492). Given the strikingly poor outcomes among patients harboring JAK2V617F, anticoagulation alone does not appear to be adequate therapy for this cohort. Further investigation into thrombolysis and/or thrombectomy as an adjunct to anticoagulation is merited in this high-risk group.
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Affiliation(s)
- Leonard Naymagon
- Tisch Cancer Institute, Icahn School of Medicine At Mount Sinai, One Gustave L. Levy Place, Box 1079, New York, NY, 10029, USA.
| | - Douglas Tremblay
- Tisch Cancer Institute, Icahn School of Medicine At Mount Sinai, One Gustave L. Levy Place, Box 1079, New York, NY, 10029, USA
| | - Nicole Zubizarreta
- Department of Population Health Science and Policy/Tisch Cancer Institute, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Erin Moshier
- Department of Population Health Science and Policy/Tisch Cancer Institute, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Thomas Schiano
- Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - John Mascarenhas
- Tisch Cancer Institute, Icahn School of Medicine At Mount Sinai, One Gustave L. Levy Place, Box 1079, New York, NY, 10029, USA
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Shapiro CL, Zubizarreta N, Moshier E, Brockway JP, Mandeli J, Markham MJ, Kozlik MM, Crist S, Jacobsen PB. Quality Care in Survivorship: Lessons Learned From the ASCO Quality Oncology Practice Initiative. JCO Oncol Pract 2021; 17:e1170-e1180. [PMID: 34283637 DOI: 10.1200/op.21.00290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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
PURPOSE The ASCO Quality Oncology Practice Initiative (QOPI) project was established to evaluate the influence of guideline recommendations on routine clinical practice. METHODS QOPI provided summary data from 839 unique practices in which data were collected every six months from the Fall of 2015 to the Spring of 2019. From these data, six items were chosen based on their relationship to domains of survivorship. A zero-inflated negative binomial regression model was used to test for trends in QOPI measures adherence rates over time. The models were adjusted for the time period, region, practice-ownership, multispecialty site, fellowship program, and hospital type. RESULTS Smoking cessation counseling recommended and smoking cessation counseling administered or referred both increased over time, 50%-61% (adjusted incidence rate ratios (IRR), 1.028; 95% CI, 1.016 to 1.040; P < .001) and 34%-49% (adjusted IRR, 1.052; 95% CI, 1.035 to 1.070; P < .001), respectively. Infertility risks discussed before chemotherapy increased from 36% to 53% (adjusted IRR, 1.056; 95% CI, 1.035 to 1.078; P < .001) and fertility options discussed or referred to specialists increased from 23% to 38% (adjusted IRR, 1.074; 95% CI, 1.046 to 1.102; P < .001). Twenty-nine percent documented a positron emission tomography, computed tomography, or bone scan within the first 12 months for women diagnosed with early breast cancer treated for curative intent (adjusted IRR, 1.000; 95% CI, 0.977 to 1.024; P = .971). Tumor marker surveillance within 12 months increased from 78% to 87% (adjusted IRR, 1.018; 95% CI, 1.002 to 1.033; P = .023). CONCLUSION As scientific evidence to guide cancer survivorship care grows, the role of guideline recommendations permeating clinical practice using quality metrics will become increasingly important.
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Affiliation(s)
| | - Nicole Zubizarreta
- The Tisch Cancer Institute, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Erin Moshier
- The Tisch Cancer Institute, Icahn School of Medicine at Mt Sinai, New York, NY
| | | | - John Mandeli
- The Tisch Cancer Institute, Icahn School of Medicine at Mt Sinai, New York, NY
| | | | | | | | - Paul B Jacobsen
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD
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Tremblay D, Ronner L, Podoltsev N, Gotlib J, Heaney M, Kuykendall A, O'Connell C, Shammo JM, Fleischman A, Mesa R, Yacoub A, Hoffman R, Moshier E, Zubizarreta N, Mascarenhas J. Ruxolitinib discontinuation in polycythemia vera: Patient characteristics, outcomes, and salvage strategies from a large multi-institutional database. Leuk Res 2021; 109:106629. [PMID: 34082375 DOI: 10.1016/j.leukres.2021.106629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 01/28/2023]
Abstract
Ruxolitinib is approved for the treatment of patients with polycythemia vera (PV) who are intolerant or resistant to hydroxyurea. While ruxolitinib discontinuation in myelofibrosis is associated with dismal outcomes, the analogous experience in PV has not been reported. Using a large, multi-institutional database of PV patients, we identified 93 patients with PV who were treated with ruxolitinib, of whom 22 discontinued therapy. Adverse events were the primary reason for discontinuation. After a median follow-up of 18.2 months following ruxolitinib discontinuation, no patients experienced a thrombotic event. One patient died 20.8 months after discontinuation. As compared with the 71 patients who were still receiving treatment with ruxolitinib at last follow up, patients who discontinued ruxolitinib were older at time of treatment initiation (67.5 versus 64.8 years, p = 0.0058), but had similar patient and disease characteristics. After discontinuation, only 4 patients (18 %) received subsequent cytoreductive therapy, including hydroxyurea in one patient and pegylated interferon α-2a in three patients. In stark contrast to the experience in myelofibrosis, discontinuation of ruxolitinib in PV was associated with generally favorable outcomes. However, there is a lack of available salvage therapies, highlighting the need for further therapeutic development in PV.
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Affiliation(s)
- Douglas Tremblay
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, United States
| | - Lukas Ronner
- Department of Medicine, Hospital of the University of Pennsylvania, United States
| | - Nikolai Podoltsev
- Department of Internal Medicine (Hematology), Yale University School of Medicine, New Haven, CT, United States
| | - Jason Gotlib
- Stanford University School of Medicine / Stanford Cancer Institute, Stanford, CA, United States
| | - Mark Heaney
- Columbia University Medical Center, New York, NY, United States
| | - Andrew Kuykendall
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Casey O'Connell
- Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Jamile M Shammo
- Department of Internal Medicine, Division of Hematology/Oncology, Rush University Medical Center, Chicago, IL, United States
| | - Angela Fleischman
- Irvine Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, United States
| | - Ruben Mesa
- Department of Hematology and Oncology, Mays MD Anderson Cancer Center at UT Health San Antonio, San Antonio, TX, United States
| | | | - Ronald Hoffman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, United States
| | - Erin Moshier
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai Tisch Cancer Institute, New York, NY, United States
| | - Nicole Zubizarreta
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai Tisch Cancer Institute, New York, NY, United States
| | - John Mascarenhas
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, United States.
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Hovstadius SM, Zimmerman BS, Berwick S, Blanter J, Berger NF, Moshier E, Berkalieva A, Jaffer S, Cascetta KP, Tiersten A. Trends in use of ovarian suppression (OS) for premenopausal patients with early-stage hormone positive breast cancer and Intermediate Risk (IR) Oncotype Recurrence Scores (RS) from 2006-2020: A retrospective database analysis. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e12522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12522 Background: Oncotype RS is a 21-gene assay used to predict the risk of recurrence and benefit from chemotherapy in early-stage, hormone positive (HR+), node-negative breast cancer (BC). The TAILORx trial showed that many patients with RS<25 can avoid chemotherapy and the small absolute benefit may be due to chemotherapy-induced menopause in premenopausal patients. The SOFT-TEXT trials found that premenopausal women have higher rates of freedom from recurrence and 8-year survival when receiving OS with endocrine therapy (ET). These studies suggest that premenopausal women with IR RS (16-25) benefit from aggressive ET with OS but trends in OS use have not been adequately studied. We predict that OS use has increased in premenopausal patients over time. Methods: We identified 87 premenopausal patients with early-stage, HR+ BC with IR Oncotype RS (16-25) who were treated with ET between 2006-2020 at our large NYC academic cancer center. The Cochran-Armitage test was used for trends in the proportions of patients receiving OS and chemotherapy over time. The log-rank test was used to compare distributions of recurrence rates between RS groups. Results: Median age was 46 years and median RS was 19. Overall, 23 (26%) patients received chemotherapy and 30 (34%) received OS (via leuprolide, goserelin or surgical oophorectomy) with ET. 55 (63%) received tamoxifen alone, 10 (11%) tamoxifen + OS, and 20 (23%) aromatase inhibitor (AI) + OS. Between 2006-2010, 2 (17%) patients received OS and 2 (17%) received chemotherapy compared to 9 (24%) and 12 (32%) between 2011-2015, and 19 (51%) and 9 (24%) between 2016-2020, respectively (Table). There was a significant increasing proportion of patients receiving OS; p=0.0064, but no significant trend in chemotherapy receipt; p=0.8910. There were 8 (9%) patients that recurred, with a borderline significant difference in secondary invasive breast event rates in patients receiving tamoxifen alone (8, 15%) compared to those on tamoxifen + OS or AI + OS (0, 0%), (p=0.0520). There were no significant differences in recurrence rates based on chemotherapy receipt (p=0.1868) or RS group 16-20 vs 21-25 (p= 0.1836). Conclusions: There has been a significant increase in the use of OS with ET in premenopausal women with IR RS in our study population. This study shows how the results of the SOFT-TEXT trial have been adapted into current practice. Future studies are needed to evaluate real-world recurrence rates with the use of increased OS and whether chemotherapy rates have decreased over time.[Table: see text]
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Affiliation(s)
| | | | - Shana Berwick
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Julia Blanter
- Division of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Erin Moshier
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | - Amy Tiersten
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
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Takahashi M, Hwang M, Misiukiewicz K, Bakst RL, Miles BA, Gupta V, Bonomi MR, Sharma S, Botzler J, Genden EM, Moshier E, Selkridge I, Posner MR. Quality of life analysis of HPV-positive oropharyngeal cancer patients in a randomized trial of reduced-dose (rdCRT) versus standard (sdCRT) chemoradiotherapy: Five-year follow-up. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6062] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6062 Background: Human papillomavirus-positive oropharyngeal cancer (HPV OPC) portends a more favorable prognosis compared to HPV-negative cases. To prevent overtreatment, long-term morbidity and deterioration in functionality and quality of life (QoL), multiple studies have focused on de-intensification techniques for HPV OPC treatment. To this end, we prospectively assessed differences in patient reported QoL in locally advanced HPV OPC patients receiving rdCRTversus sdCRT)in a randomized trial using a sequential therapy plan. Methods: Patients were enrolled between December 2012 and February 2016; received 3 cycles of induction docetaxel, cisplatin, and 5-FU; and were randomized to sdCRT (70 Gy) or rdCRT (56 Gy) with weekly carboplatin. Patients were followed for Progression Free Survival (PFS), Overall Survival (OS), and changes in QoL as assessed by the MD Anderson Dysphagia Inventory (MDADI), MD Anderson Symptom Inventory (MDASI Head and Neck), Xerostomia Questionnaire (XQ), and the European Organization for Research and Treatment of Cancer Questionnaire (EORTC QLQ-C30) with the head and neck module (EORTC HN). A mixed model ANOVA was used to estimate changes from baseline QoL to that at each follow-up timepoint and to compare the difference in QoL changes between the treatment arms. Results: We randomized 20 HPV+ locally advanced (LA) patients (median age: 56.5 yrs) to rdCRT (12 subjects) or sdCRT (8 subjects). 70% had high risk features. At a median follow-up of 81.5 mos, PFS and OS were 87.5% and 83.3% for sdCRT and rdCRT, respectively with a median OS of 76 mos in both arms. One patient in the sdCRT arm developed an HPV negative retromolar trigone squamous cell cancer in the radiation field 7 yrs after therapy. Baseline QoL was identical in the 15 patients who completed the QoL modules. Patients receiving rdCRT hadsignificantly lower declines in QoL scores at 3-6 month follow-up. At 5 yrs, differences in QoL changes all favored the rdCRT arm (Table) and two QoL scales reached statistical significance (P<0.05). Conclusions: In HPV OPC patients, rdCRT resulted in comparable long-term survival and greater improvement in specific domains of QoL when compared to sdCRT. Our results support the need for a larger, long-term Phase 3 study in LA HPVOPC to assess these two treatments with respect to survival, QoL, and safety. Clinical trial information: NCT02945631. [Table: see text]
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Affiliation(s)
- Mai Takahashi
- Harvard University T H Chan School of Public Health, Boston, MA
| | | | | | - Richard Lorne Bakst
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY
| | - Brett A. Miles
- Department of Otolaryngology, Mount Sinai Medical Center, New York, NY
| | | | | | | | | | | | - Erin Moshier
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Marshall R. Posner
- Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
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Posner MR, Misiukiewicz K, Miles BA, Sharma S, Gupta V, Genden EM, Botzler J, Selkridge I, Moshier E, Virani V, Bakst RL. Survival (OS) and progression-free survival (PFS) results after induction chemotherapy (IC) followed by de-escalated chemoradiotherapy (RDCRT) for locally advanced (LA) HPV positive oropharynx cancer (HPVOPC. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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
6058 Background: HPVOPC has a significantly better prognosis and survival than HPV negative cancer resulting in overtreatment with significant acute and late toxicities and mortality. Radiation therapy is the single greatest determinant of toxicity. Studies to support reduction of radiation dose are a high priority. IC improves local regional control, reduces distant metastases, and may support radiotherapy de-escalation. Patients with T4, ECE, and N2c disease have poorer local regional control (LRC) and a higher rate of distant metastases (DM) and may be suitable for this option. Methods: Data was combined for the experimental arm of a previously reported Phase 3 trial (12 subjects, NCT01706939) and a continuation Phase 2 trial (20 subjects, NCT02945631). After informed consent subjects who were PCR+ HPVOPC, smoked < 20 py, and were LA or functionally unresectable were treated with Taxotere, cisplatin and reduced 5-fluorouracil (mTPF) for 3 cycles and then assessed for response. Responders were treated with 5600 cGy and weekly carboplatin, and then followed for LRC, DM, PFS, OAS and toxicity. Data was analyzed as of 2/1/21. 85% LRC at 3 years was considered non inferior to standard of care chemoradiotherapy. An acceptable end point was predetermined to be 80% PFS and 85% LRC at 3 years in this LA population. Results: 32 subjects were entered and included in the analysis, all responded to IC and had RDCRT. 2 patients with non-HPV16 subtypes were initially entered, treated with IC, responded, and then were taken off study and excluded from the analysis due to non-HPV 16 subtype. They were treated with 7000 cGy and are alive and well. Poor risk factors (ECE, T4, N2c, Non-HPV16 subtype) were present in 72% of 32 subjects; 22 (69%) never smoked. At data cutoff with a median follow up of 50m (21-95m), 28/32 (87.5%) have LRC, 1/32 DM (3.1%), OS is 28/32 (87.5%) and PFS is 27/32 (84.4%). All 5 patients who recurred did so in the first 12m (median 8m); all had 1 or more poor risk factors and 1 is alive with disease 42m post recurrence. 2 year LRC, PFS and OS are 87.4% [95% CI: 69.8%, 95.1%], 84.4% [95% CI: 66.5%, 93.2%] and 90.6% [95% CI: 73.7%, 96.9%] respectively. There was no therapy-related mortality, generally rapid recovery from CRT and minimal long term consequences (to be reported). Conclusions: Induction with mTPF followed by RDCRT resulted in excellent LRC, PFS and OS in patients with LA HPV OPC and significant risk factors. These results compare favorably to standard of care and other dose de-escalation trials in high and low risk categories. This treatment paradigm is highly effective in a LA, high risk HPVOPC patients and is a reasonable treatment option to be compared to other de-escalation treatment plans in Phase 3 trials for this higher risk population. Clinical trial information: NCT02945631, NCT01706939.
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Affiliation(s)
- Marshall R. Posner
- Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Brett A. Miles
- Department of Otolaryngology, Mount Sinai Medical Center, New York, NY
| | | | | | | | | | | | - Erin Moshier
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Richard Lorne Bakst
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY
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Zimmerman BS, Berwick S, Kessler AJ, Seidman D, Hovstadius SM, Moshier E, Blanter J, Berkalieva A, Jaffer S, Berger NF, Cascetta KP, Tiersten A. Application of RSClin to guide treatment recommendations for premenopausal patients with early-stage hormone-positive breast cancer and intermediate risk oncotype recurrence scores. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e12511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12511 Background: The RSClin model, which incorporates the Oncotype Recurrence Score (RS) and clinicopathologic features, was recently developed to further tailor prognosis and prediction of chemotherapy benefit for patients with early-stage hormone positive (HR+) breast cancer (BC) (Sparano et al, 2020). The RSClin calculator is available online to assist treatment planning for situations where chemotherapy benefit is uncertain. Covariates include Oncotype RS, tumor grade, tumor size and patient age. The risk calculator generates a 10-year distant recurrence risk and absolute chemotherapy benefit. This tool may be especially helpful to determine treatment management for premenopausal patients with early-stage HR+ BC with intermediate risk (IR) Oncotype RS (16-25). We retrospectively applied RSClin to this patient population to determine if it would have changed treatment recommendations. Methods: We identified premenopausal women with node-negative early-stage BC with IR RS (16-25) within our large Oncotype database. Using the RSClin model, we selected >5% absolute chemotherapy benefit as a reasonable cutoff to recommend chemotherapy. We compared the treatment recommendation based on RSClin with the treatment previously recommended by breast oncologists at our large academic medical center in New York City. Results: There were 86 patients who met criteria with a median age of 46 years. Of these, 26 patients (30%) were recommended chemotherapy plus endocrine therapy (ET) and 60 (70%) were recommended ET alone. After applying the RSClin model (data available for 83/86 patients), 19 (23%) would have resulted in a change in treatment recommendation and 64 (77%) would have remained unchanged. Overall, 8 (10%) would have withheld chemotherapy when it was previously offered and 11 (13%) would have recommended chemotherapy when it was previously excluded. There were 8 (9%) secondary invasive breast events in this population, with 2 (2%) being ipsilateral, 3 (3%) being contralateral and 3 (3%) metastatic at a median follow up of 46.9 months. Conclusions: The RSClin model would have changed management of premenopausal patients with IR RS in 23% of patients. This model, although not yet prospectively validated, may help individualize therapy for patients with less definitive treatment plans. Using RSClin, we can aim to minimize recurrence rates and avoid unnecessary chemotherapy in selected patients. This model is easy to apply and will have important clinical utility moving forward.
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Affiliation(s)
| | - Shana Berwick
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | - Erin Moshier
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Julia Blanter
- Division of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | | | - Amy Tiersten
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
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Berwick S, Zimmerman BS, Hovstadius SM, Blanter J, Moshier E, Berkalieva A, Berger NS, Jaffer S, Cascetta KP, Tiersten A. Tolerance of aromatase inhibitors in post-menopausal patients with early-stage hormone receptor positive (HR+) breast cancer: A real-world retrospective analysis in a large oncotype database. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e12532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12532 Background: Aromatase inhibitors (AIs) compose the backbone of adjuvant endocrine therapy for early-stage HR+ breast cancer. Prior studies have demonstrated equivalence in efficacy between aromatase inhibitors in current clinical use. Thus choice of aromatase inhibitors is initially influenced by provider patterns and tailored based on adverse side effects. This study retrospectively evaluates the prevalence of intolerance to AIs warranting a change in therapy. Methods: We identified 181 post-menopausal patients with early-stage, HR+ breast cancer within a database of women who underwent oncotype testing at a large, urban medical center, with 167 (92%) receiving an AI. Patients were excluded if they had received chemotherapy. The Kaplan-Meier method was used to estimate median duration of endocrine therapy (ET). The Fisher’s exact test was used to compare proportions of patients requiring a switch in adjuvant AI and the Wilcoxon rank-sum test was used to compare age distributions. Results: Of the patients identified, 153 (90%) had stage IA disease with a median oncotype RS of 19. 167 (92%) patients received an AI as adjuvant therapy. Median duration of endocrine therapy (ET) was 83.5 months, with over 90% of patients on ET more than 5 years. Among the 152 patients with available data on ET interruptions, 52 (34%) patients had a change or interruption in their ET of these 40 (77%) were attributed to a medication side effect. The AI prescribed most frequently as initial therapy was anastrozole 138/165 (84%). 33 (24%) of patients who received anastrozole required a drug switch within the class, (no sig difference based on initial adjuvant therapy; p=0.4281). 12 (7%) patients required a switch from an AI to tamoxifen at some point during therapy. Changes in AI adjuvant therapy were most commonly attributed to joint pains 24 (46%), followed by hot flashes 2 (4%) and weight gain, 2 (4%). There was no statistically significant difference in median age between patients who interrupted ET due to medication side effect or other reason; p=0.2906. Conclusions: This study enforces previous findings that a significant proportion of women require a change in their adjuvant ET, most commonly due to adverse medication effects such as joint pain. The majority of the women in this database were initiated on anastrozole as initial adjuvant ET of whom 24% required a drug switch.[Table: see text]
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Affiliation(s)
- Shana Berwick
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Julia Blanter
- Division of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Erin Moshier
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | | | - Amy Tiersten
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
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Marqueen KE, Moshier E, Buckstein M, Ang C. Neoadjuvant therapy for gastrointestinal stromal tumors: A propensity score-weighted analysis. Int J Cancer 2021; 149:177-185. [PMID: 33634858 DOI: 10.1002/ijc.33536] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 12/22/2022]
Abstract
Retrospective and single-arm prospective studies have reported clinical benefit with neoadjuvant imatinib for GISTs. In the absence of randomized Phase III data, the impact of neoadjuvant systemic therapy (NAT) on survival compared to upfront resection (UR) remains unknown. We identified N = 16 308 patients within the National Cancer Database (2004-2016) who underwent resection of localized GIST of the stomach, esophagus, small bowel and colorectum, with or without ≥3 months of NAT. Inverse probability of treatment weighting adjusted for covariable imbalance among treatment groups. We estimated the effect of NAT on overall survival with a weighted time-dependent Cox proportional hazards model, and on 90-day postoperative mortality and R0 resection with weighted logistic regressions. Eight hundred sixty-five (5.3%) patients received NAT compared to 15 443 (94.7%) who underwent UR. Median NAT duration was 6.3 months. 53.7% of NAT patients were male vs 48.6% of UR patients, 67.3% vs 65.1% had primary gastric GIST and 72.8% vs 49.7% were at high risk. NAT patients had larger tumors and higher mitotic index. >3 months of NAT was associated with a significant survival benefit (weighted HR 0.85 [0.80-0.91]). 90-day postoperative mortality rate was 4/865 (0.5%) among NAT patients vs 346/15443 (2.2%). NAT was associated with lower odds of 90-day postoperative mortality. R0 resection rate was not significantly different between groups. In conclusion, despite higher risk features among NAT patients, this analysis suggests that NAT for localized GIST is associated with a modest survival benefit and lower risk of 90-day postoperative mortality, with no difference in likelihood of achieving an R0 resection.
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Affiliation(s)
- Kathryn E Marqueen
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Erin Moshier
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Buckstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Celina Ang
- Department of Medicine, Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Zimmerman BS, Seidman D, Cascetta KP, Ru M, Moshier E, Tiersten A. Prognostic Factors and Survival Outcomes among Patients with Breast Cancer and Brain Metastases at Diagnosis: A National Cancer Database Analysis. Oncology 2021; 99:280-291. [PMID: 33652435 DOI: 10.1159/000512212] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/08/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to assess for clinicopathologic and socioeconomic features that predict improved survival for patients with advanced breast cancer with synchronous brain metastases at diagnosis. METHODS We utilized the National Cancer Database (NCDB) to identify all patients with brain metastases present at diagnosis, with adequate information on receptor status (ER, PR, Her2), clinical T stage of cT1-4, clinical M1, with 3,943 patients available for analysis. The association between brain metastases patterns and patient/disease variables was examined by robust Poisson regression model. Cox proportional hazards model was used to quantify the associations between overall survival (OS) and these variables. RESULTS In univariable analysis, OS was significantly associated with the number of sites of metastases (p < 0.0001). Patients with 2 or more additional extracranial sites of metastases had significantly worse OS (median 8.8 months, 95% confidence interval [CI] 7.8, 9.9) than patients with brain metastases only (median OS 10.6 months, 95% CI 9.4, 12.9) or brain metastases plus one other extracranial site of metastases (median OS 13.1 months, 95% CI 11.8, 14.4). Risk factors which predicted poor prognosis included triple-negative disease, high comorbidity score, poorly differentiated tumors, invasive lobular histology, multi-organ involvement of metastases, and government or lack of insurance. Factors which improve survival include younger age and Hispanic race. DISCUSSION/CONCLUSION Using a large NCDB, we identified various factors associated with prognosis for patients with brain metastases at the time of breast cancer diagnosis. Insurance status and related socioeconomic challenges provide potential areas for improvement in care for these patients. This information may help stratify patients into prognostic categories at the time of diagnosis to improve treatment plans.
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Affiliation(s)
- Brittney S Zimmerman
- Hematology/Oncology Department, Icahn School of Medicine at Mount Sinai, New York, New York, USA,
| | - Danielle Seidman
- Hematology/Oncology Department, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Krystal P Cascetta
- Hematology/Oncology Department, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Meng Ru
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Erin Moshier
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy Tiersten
- Hematology/Oncology Department, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Zimmerman BS, Cascetta K, Berger N, Tharakan S, Suchman K, Blanter J, Moshier E, Ru M, Jaffer S, Tiersten A. Abstract PS6-27: Secondary invasive breast events (SIBE) among patients with oncotype DX recurrence scores (RS) 26-30 and >31: Results from a large oncotype database. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps6-27] [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: Oncotype RS is a 21-gene assay used to predict the likelihood of distant recurrence and benefit of chemotherapy in patients with lymph node negative (LN-), hormone positive (HR+) breast cancer (BC). The Oncotype RS is used to identify patients who may be spared chemotherapy in the adjuvant setting without adverse impact on survival or secondary invasive breast events (SIBE). Results of the TAILORx trial (Sparano et al, 2018) provided evidence that chemotherapy can likely be spared for most patients with oncotype RS<25, with chemotherapy benefit potentially related to chemotherapy-induced menopause. More aggressive endocrine therapy with concurrent ovarian suppression in pre-menopausal women may mitigate the need for chemotherapy among patients with higher RS. We developed a large oncotype database to determine rates of SIBE (ipsilateral recurrence, contralateral breast cancer or metastatic recurrence) among patients with higher genomic risk (Oncotype RS 26-30 and > 31) to determine the benefit of chemotherapy among these groups. Methods:We identified 887 patients with early-stage, HR+ BC treated between 2006-2018. Among these patients, 515 had treatment and follow-up data available for SIBE analysis. Median follow-up for SIBE was 62 months with 41 SIBE (8%) including both LN+ and LN- patients. When stratified by RS using conservative cutoffs (Sparano et al, 2018): low risk (<10), intermediate risk (11-25), and high risk (>26), 5 year rates of SIBE were 4%, 6% and 16% respectively. The Kaplan Meier method was used to estimate the time to SIBE distributions overall and among different RS groups with the log rank test used to compare distributions between groups. Results: Among 887 patients, 616 (69%) were post-menopausal. A total of 654 (74%) patients had surgical management, of which 226 underwent mastectomy (35%) and 428 underwent lumpectomy (65%). Among the 630 patients who received adjuvant therapy, 14 (2%) received chemotherapy alone, 143 (23%) received a combination of chemotherapy/endocrine therapy and 473 (75%) received endocrine therapy alone. Twenty-four patients (3%) refused one or more recommended therapies. Three hundred fourteen patients (50%) also received radiation therapy. Rates of chemotherapy administration were 8% among low RS, 16% among intermediate RS and 82% among high RS patients (73% for RS 26-30 and 90% for RS >31). One-hundred eighty six of 887 patients were missing chemotherapy administration data as they were likely treated at another center. Patients with treatment data available and adequate follow up were included in the SIBE analysis (n=515). Among the 27 LN- patients with RS 26-30, twenty (74%) received chemotherapy and the remaining seven (26%) did not. The five year rate of SIBE was 25% among patients who received chemotherapy and 33% among those who did not receive chemotherapy; p=0.5489. Among the 23 LN negative patients with RS >31, twenty-one (91%) patients received chemotherapy and the remaining two (9%) did not. The five year rate of SIBE was 0% in both patients who received chemotherapy and in patients who did not receive chemotherapy; p-value not estimable in this subgroup due to no SIBE in either group. Conclusion: In this large oncotype database, there was no statistically significant difference in SIBE for patients with higher genomic risk (RS 26-30 and >31) whether or not they received chemotherapy. This data was limited by small numbers of patients in these sub-groups. More aggressive endocrine therapy with ovarian suppression has become an alternative option to spare chemotherapy in intermediate risk patients (RS 11-25). This approach may be useful among patients with even higher risk oncotype scores. Prospective randomized studies may be useful to determine utility of chemotherapy among patients with RS >26.
Citation Format: Brittney S Zimmerman, Krystal Cascetta, Natalie Berger, Serena Tharakan, Kelly Suchman, Julia Blanter, Erin Moshier, Meng Ru, Shabnam Jaffer, Amy Tiersten. Secondary invasive breast events (SIBE) among patients with oncotype DX recurrence scores (RS) 26-30 and >31: Results from a large oncotype database [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-27.
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Affiliation(s)
| | | | | | | | - Kelly Suchman
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Julia Blanter
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Erin Moshier
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Meng Ru
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Amy Tiersten
- Icahn School of Medicine at Mount Sinai, New York, NY
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Zimmerman BS, Seidman D, Berger N, Cascetta KP, Nezolosky M, Trlica K, Ryncarz A, Keeton C, Moshier E, Tiersten A. Abstract SS2-02: Patient perception of breast and gynecologic cancer care during the SARS-CoV-2 (COVID-19) pandemic in NYC: A single center survey-based study. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ss2-02] [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: The 2019 novel coronavirus has become a world-wide pandemic which has disproportionately affected patients undergoing treatment for cancer. Within the field of medical oncology, dramatic changes in practice patterns occurred rapidly to accommodate transition of resources, while maintaining safety of oncology patients. At our large cancer treatment center in NYC, there have been significant changes in the delivery of surgical and medical treatments, with a shift towards neo-adjuvant therapy, oral chemotherapy administration, extended ovarian suppression, as well as closure or delay of many clinical trials. This study aims to determine the impact of the COVID-19 pandemic on the perceived oncology related care of patients with breast/gynecologic cancers as measured by survey results, as well as the impact on quality of life (QOL) and overall health (OH). Methods: A 34-question survey was administered to all patients receiving care at our outpatient center between March 1, 2020 and June 30, 2020. Of the 622 patients who received the survey via RedCap online or physical copy in clinic, 211 (34%) completed the survey. Survey questions were answered on a 5-point Likert scale and 7-point EORTC QLQ-C30 QOL scale. There is no existing COVID specific questionnaire, therefore we designed several original questions. Difference in mean QOL scores prior to the pandemic and at the end of the response period were evaluated using a paired t-test. Results: Of the 184 patients who responded to the question about their diagnostic history, 54 (30%) of patients had a history of DCIS (ductal carcinoma in situ)/ADH (atypical ductal hyperplasia)/LCIS (lobular carcinoma in situ), 94 (51%) had a history of invasive breast cancer, 6 (3%) had a gynecologic malignancy and 30 (16%) responded “other.” Due to the COVID pandemic, 121 patients (58%) reported that they had a medical oncology visit cancelled, delayed or changed from in-person to video telehealth. Of the 156 respondents that had endocrine therapy or chemotherapy scheduled, 26 (17%) reported a cancellation or delay of their medical treatment. As a result of the pandemic, 186 (91%), 110 (57%) and 119 (60%) of patients reported new or increased levels of anxiety, depression and mood swings, respectively. A minority of patients (n=39, 19%) felt that the COVID pandemic negatively impacted their cancer care, and a majority (n=151, 73%) felt that the changes in delivering cancer care during the pandemic were in their best interest (somewhat/strongly agree). Overall, QOL was reported with a mean (SD) of 5.5 (1.3) out of 7 (1=very poor, 7-excellent) prior to the pandemic, and 5.1 (1.4) out of 7 by the end of the pandemic period (March 1 through June 30, 2020); p<0.0001. Fifty-three (26%) of patients reported having excellent (7) QOL prior to pandemic which decreased to 32 (16%) after the pandemic period; p<0.0001. Overall health was reported with a mean (SD) of 5.3 (1.3) out of 7 prior to the pandemic, and 5.1 (1.3) out of 7 by the end of the response period; p=0.0368. Conclusions: The COVID-19 pandemic required major changes in the care of patients with breast and gynecologic cancer in order to balance continued oncologic care with safety of COVID exposure. In our study population, 17% of patients at our center reported a delay or cancellation in their medical treatment and 58% reported a change to their medical oncology visits. Despite this, only 19% of all patients felt that the changes in care delivery as a result of the COVID-19 pandemic negatively impacted their cancer care, and the large majority (73%) felt that the changes were made in their best interest. The QOL for our patients was significantly affected by the pandemic, with increases in anxiety, depression and mood swings, and a numeric decrease in QOL and OH.
Citation Format: Brittney S Zimmerman, Danielle Seidman, Natalie Berger, Krystal P Cascetta, Michelle Nezolosky, Kara Trlica, Alisa Ryncarz, Caitlin Keeton, Erin Moshier, Amy Tiersten. Patient perception of breast and gynecologic cancer care during the SARS-CoV-2 (COVID-19) pandemic in NYC: A single center survey-based study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SS2-02.
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Affiliation(s)
| | | | | | | | | | - Kara Trlica
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alisa Ryncarz
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Erin Moshier
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amy Tiersten
- Icahn School of Medicine at Mount Sinai, New York, NY
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Zimmerman BS, Seidman D, Berger N, Cascetta KP, Nezolosky M, Trlica K, Ryncarz A, Keeton C, Moshier E, Tiersten A. Abstract SS2-08: Patient perception of telehealth services for breast and gynecologic cancer care during the SARS-CoV-2 (COVID-19) pandemic in NYC: A single center survey-based study. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ss2-08] [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: Prior to the COVID-19 pandemic, telehealth was rarely utilized in providing oncologic care. At our large NYC based outpatient clinic, telehealth services were quickly adapted for utilization for visits that could be completed outside of the clinic, in order to limit patient exposure to the novel coronavirus. This survey-based study aimed to assess patient perceptions of the utility of telehealth in their oncologic care during a time of national crisis. Methods: A 34-question survey was administered to all patients receiving care at our outpatient center between March 1, 2020 and June 30, 2020 including those who had visits delayed or cancelled during this time period. Of the 622 patients who received the survey via RedCap online or physical copy in clinic, 211 (34%) completed the survey. For evaluation of the Telehealth provided during the pandemic, we have adapted the validated SUTAQ (Service User Technology Acceptability Questionnaire) which assesses patient acceptability of telehealth via measures of accessibility, comfort, usability, privacy and security, confidentiality, satisfaction, convenience and health benefits with in-home telemonitoring. Results: All patients who completed the survey had a history of DCIS/ADH/LCIS, invasive breast cancer or gynecologic malignancy. Of the total survey respondents, 72 (35%) participated in a telehealth visit during the four month evaluation period. For all survey questions, “agreement” was considered if the patient selected mildly, moderately or strongly agreed on the SUTAQ scale. Of patients who participated in telehealth visits, 66 (92%) felt that the telehealth saved them time, 52 (72%) felt it increased their access to care and 56 (81%) felt it helped improve their health. Only 8 (12%) of patients felt that telehealth made them feel uncomfortable and 4 (6%) worried about confidentiality related to telehealth usage. Overall, 65 (92%) of patients were satisfied with the telehealth services they received and 64 (89%) would recommend these services to people with similar health conditions. Twenty-five (35%) felt that telehealth can be a replacement for their normal health care and 67 (93%) reported it could be a good addition to their care. Fifty-four (76%) would be interested in participating in telehealth visits in the future. Conclusions: Overall, patients expressed satisfaction with the use of telehealth services for oncologic care during the COVID pandemic. Although most patients do not feel that this is a suitable replacement for their in person care, they expressed that it was certainly a good addition to their care. A large majority of patients expressed interest in continuing to participate in telehealth visits in the future. Telehealth services should be carefully adapted as a long term addition to the in person clinical care of patients with cancer. These services should be utilized to optimize patient satisfaction, save time and increase access to care, especially among high risk patients.
Citation Format: Brittney S Zimmerman, Danielle Seidman, Natalie Berger, Krystal P Cascetta, Michelle Nezolosky, Kara Trlica, Alisa Ryncarz, Caitlin Keeton, Erin Moshier, Amy Tiersten. Patient perception of telehealth services for breast and gynecologic cancer care during the SARS-CoV-2 (COVID-19) pandemic in NYC: A single center survey-based study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SS2-08.
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Affiliation(s)
| | | | | | | | | | - Kara Trlica
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alisa Ryncarz
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Erin Moshier
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amy Tiersten
- Icahn School of Medicine at Mount Sinai, New York, NY
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Naymagon L, Tremblay D, Zubizarreta N, Moshier E, Naymagon S, Mascarenhas J, Schiano T. The Natural History, Treatments, and Outcomes of Portal Vein Thrombosis in Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2021; 27:215-223. [PMID: 32185400 PMCID: PMC8427727 DOI: 10.1093/ibd/izaa053] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Portal vein thrombosis (PVT) is a poorly described complication of inflammatory bowel disease (IBD). We sought to better characterize presentations, compare treatments, and assess outcomes in IBD-related PVT. METHODS We conducted a retrospective investigation of IBD-related PVT at our institution. Multivariable Cox proportional hazards modeling was used to estimate adjusted hazard ratios across treatments. RESULTS Sixty-three patients with IBD-related PVT (26 with Crohn disease, 37 with ulcerative colitis) were followed for a median 21 months (interquartile ratio [IQR] = 9-52). Major risk factors included intra-abdominal surgery (60%), IBD flare (33%), and intra-abdominal infection (13%). Primary hematologic thrombophilias were rare and did not impact management. Presentations were generally nonspecific, and diagnosis was incidental. Ninety-two percent of patients (58/63) received anticoagulation (AC), including 23 who received direct oral anticoagulants (DOACs), 22 who received warfarin, and 13 who received enoxaparin. All anticoagulated patients started AC within 3 days of diagnosis. Complete radiographic resolution (CRR) of PVT occurred in 71% of patients. We found that DOACs were associated with higher CRR rates (22/23; 96%) relative to warfarin (12/22; 55%): the hazard ratio of DOACs to warfarin was 4.04 (1.83-8.93; P = 0.0006)). Patients receiving DOACs required shorter courses of AC (median 3.9 months; IQR = 2.7-6.1) than those receiving warfarin (median 8.5 months; IQR = 3.9-NA; P = 0.0190). Incidence of gut ischemia (n = 3), symptomatic portal hypertension (n = 3), major bleeding (n = 4), and death (n = 2) were rare, and no patients receiving DOACs experienced these adverse outcomes. CONCLUSIONS We show that early and aggressive use of AC can lead to excellent outcomes in IBD-associated PVT and that DOACs are associated with particularly favorable outcomes in this setting.
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Affiliation(s)
- Leonard Naymagon
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Douglas Tremblay
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nicole Zubizarreta
- Department of Population Health Science and Policy/Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Erin Moshier
- Department of Population Health Science and Policy/Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Steven Naymagon
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John Mascarenhas
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas Schiano
- Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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