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Saeed A, Park R, Pathak H, Al-Bzour AN, Dai J, Phadnis M, Al-Rajabi R, Kasi A, Baranda J, Sun W, Williamson S, Chiu YC, Osmanbeyoglu HU, Madan R, Abushukair H, Mulvaney K, Godwin AK, Saeed A. Clinical and biomarker results from a phase II trial of combined cabozantinib and durvalumab in patients with chemotherapy-refractory colorectal cancer (CRC): CAMILLA CRC cohort. Nat Commun 2024; 15:1533. [PMID: 38378868 PMCID: PMC10879200 DOI: 10.1038/s41467-024-45960-2] [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: 10/17/2023] [Accepted: 01/31/2024] [Indexed: 02/22/2024] Open
Abstract
CAMILLA is a basket trial (NCT03539822) evaluating cabozantinib plus the ICI durvalumab in chemorefractory gastrointestinal cancer. Herein, are the phase II colorectal cohort results. 29 patients were evaluable. 100% had confirmed pMMR/MSS tumors. Primary endpoint was met with ORR of 27.6% (95% CI 12.7-47.2%). Secondary endpoints of 4-month PFS rate was 44.83% (95% CI 26.5-64.3%); and median OS was 9.1 months (95% CI 5.8-20.2). Grade≥3 TRAE occurred in 39%. In post-hoc analysis of patients with RAS wild type tumors, ORR was 50% and median PFS and OS were 6.3 and 21.5 months respectively. Exploratory spatial transcriptomic profiling of pretreatment tumors showed upregulation of VEGF and MET signaling, increased extracellular matrix activity and preexisting anti-tumor immune responses coexisting with immune suppressive features like T cell migration barriers in responders versus non-responders. Cabozantinib plus durvalumab demonstrated anti-tumor activity, manageable toxicity, and have led to the activation of the phase III STELLAR-303 trial.
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Affiliation(s)
- Anwaar Saeed
- Department of Medicine, Division of Hematology & Oncology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA.
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
| | - Robin Park
- Division of Hematology and Medical Oncology, Moffitt Cancer Cente, Tampa, FL, USA
| | - Harsh Pathak
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Ayah Nedal Al-Bzour
- Department of Medicine, Division of Hematology & Oncology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Junqiang Dai
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Milind Phadnis
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Raed Al-Rajabi
- Department of Medicine, Division of Medical Oncology, University of Kansas Medical Center, Kansas City, Ks, USA
- University of Kansas Cancer Center, Kansas City, KS, USA
| | - Anup Kasi
- Department of Medicine, Division of Medical Oncology, University of Kansas Medical Center, Kansas City, Ks, USA
- University of Kansas Cancer Center, Kansas City, KS, USA
| | - Joaquina Baranda
- Department of Medicine, Division of Medical Oncology, University of Kansas Medical Center, Kansas City, Ks, USA
- University of Kansas Cancer Center, Kansas City, KS, USA
| | - Weijing Sun
- Department of Medicine, Division of Medical Oncology, University of Kansas Medical Center, Kansas City, Ks, USA
- University of Kansas Cancer Center, Kansas City, KS, USA
| | - Stephen Williamson
- Department of Medicine, Division of Medical Oncology, University of Kansas Medical Center, Kansas City, Ks, USA
- University of Kansas Cancer Center, Kansas City, KS, USA
| | | | | | - Rashna Madan
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Hassan Abushukair
- Department of Medicine, Division of Hematology & Oncology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Kelly Mulvaney
- University of Kansas Cancer Center, Kansas City, KS, USA
| | - Andrew K Godwin
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Cancer Center, Kansas City, KS, USA
- Kansas Institute for Precision Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Azhar Saeed
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA
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Ahram M, Abu Alragheb B, Abushukair H, Bawadi R, Al-Hussaini M. MicroRNAs Associated with Androgen Receptor and Metastasis in Triple-Negative Breast Cancer. Cancers (Basel) 2024; 16:665. [PMID: 38339416 PMCID: PMC10854913 DOI: 10.3390/cancers16030665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
It is crucial to identify novel molecular biomarkers and therapeutic targets for triple-negative breast cancer (TNBC). The androgen receptor (AR) is a regulator of TNBC, acting partially via microRNA molecules (miRNAs). In this study, we used PCR arrays to profile the expression of 84 miRNAs in 24 TNBC tissue samples, which were equally classified according to AR expression and/or metastasis. Several bioinformatics tools were then utilized to determine the potentially affected protein targets and signaling pathways. Seven miRNAs were found to be significantly more highly expressed in association with AR expression, including miR-328-3p and miR-489-3p. Increased expression of miR-205-3p was found to be significantly associated with metastasis. Certain miRNAs were specifically found to be differentially expressed in either metastatic or non-metastatic AR-positive tumors. A gene ontology (GO) analysis indicated biological roles in the regulation of transcription, cellular response to DNA damage, and the transforming growth factor-beta (TGF-beta) signaling pathway. The GO analysis also showed enrichment in kinase and transcription factor activities. The TGF-beta and a number of kinase-dependent pathways were also retrieved using the Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. This study offers an understanding of the role of AR in TNBC and further implicates miRNAs in mediating the effects of AR on TNBC.
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Affiliation(s)
- Mamoun Ahram
- Department of Physiology and Biochemistry, School of Medicine, The University of Jordan, Amman 11942, Jordan;
| | | | - Hassan Abushukair
- School of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Randa Bawadi
- Department of Physiology and Biochemistry, School of Medicine, The University of Jordan, Amman 11942, Jordan;
| | - Maysa Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman 11941, Jordan;
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Radford M, Abushukair H, Hentzen S, Cavalcante L, Saeed A. Targeted and Immunotherapy Approaches in HER2-Positive Gastric and Gastroesophageal Junction Adenocarcinoma: A New Era. J Immunother Precis Oncol 2023; 6:150-157. [PMID: 37637236 PMCID: PMC10448730 DOI: 10.36401/jipo-22-36] [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] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/28/2023] [Accepted: 05/05/2023] [Indexed: 08/29/2023]
Abstract
HER2-targeted therapy with the HER2 monoclonal antibody trastuzumab has achieved impressive outcomes in the first-line settings of patients with advanced gastric and gastroesophageal junction (GEJ) adenocarcinoma overexpressing HER2. However, considering that a substantial proportion of those patients eventually relapses, as well as the relatively limited performance of those agents in second-line settings, a deeper understanding of resistance mechanisms is needed for enhanced guidance for patients' therapeutic selection in the second-line setting and beyond. In this review, we highlight trastuzumab's (HER2-targeting agent) performance in patients with gastric or GEJ cancer, with insight into mechanisms of resistance. We also discuss the new integration of PD-1 inhibitor pembrolizumab into the trastuzumab for gastric cancer frontline regimen, the latest addition of trastuzumab deruxtecan to the treatment armamentarium, and the potential of pipeline HER2-targeting approaches and combinations in patients with gastric or GEJ adenocarcinoma.
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Affiliation(s)
- Maluki Radford
- Department of Medicine, Division of Medical Oncology, Kansas University Medical Center, Kansas City, KS, USA
| | - Hassan Abushukair
- Department of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Stijn Hentzen
- Department of Medicine, Division of Medical Oncology, Kansas University Medical Center, Kansas City, KS, USA
| | - Ludimila Cavalcante
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Anwaar Saeed
- Department of Medicine, Division of Hematology and Oncology, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
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Abushukair H, Ababneh O, Al-Bzour A, Sahin IH, Saeed A. Next generation immuno-oncology biomarkers in gastrointestinal cancer: what does the future hold? Expert Rev Mol Diagn 2023; 23:863-873. [PMID: 37642360 DOI: 10.1080/14737159.2023.2252739] [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: 06/24/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Gastrointestinal (GI) cancers pose a significant health burden worldwide, necessitating advancements in diagnostic and treatment approaches. One promising avenue is the utilization of next-generation biomarkers, which hold the potential to revolutionize GI cancer management. AREAS COVERED This review explores the latest breakthroughs and expert opinions surrounding the application of next-generation immunotherapy biomarkers. It encompasses various aspects of the currently utilized biomarkers of immunotherapy in the context of GI cancers focusing on microsatellite stable cancers. It explores the promising research on the next generation of biomarkers addressing the challenges associated with integrating them into clinical practice and the need for standardized protocols and regulatory guidelines. EXPERT OPINION Immune profiling, multiplex immunohistochemistry, analysis of immune cell subsets, and novel genomic and epigenomic markers integrated with machine-learning approaches offer new avenues for identifying robust biomarkers. Liquid biopsy-based approaches, such as circulating tumor DNA (ctDNA) and exosome-based analyses, hold promise for real-time monitoring and early detection of treatment response.
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Affiliation(s)
- Hassan Abushukair
- Department of Medicine, Division of Hematology & Oncology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Obada Ababneh
- Department of Medicine, Division of Hematology & Oncology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Ayah Al-Bzour
- Department of Medicine, Division of Hematology & Oncology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Ibrahim Halil Sahin
- Department of Medicine, Division of Hematology & Oncology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Anwaar Saeed
- Department of Medicine, Division of Hematology & Oncology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
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Abu Alragheb BO, Abushukair H, Al-Husseini M, Bawadi R, Ahram M. Abstract 3772: The association of androgen receptor with microRNA expression in triple-negative breast cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-3772] [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: 04/07/2023]
Abstract
Abstract
Introduction: Triple-negative breast cancer (TNBC) is an aggressive type that lacks targeted therapies posing a challenge in its management. This necessitates identifying novel targets that may play a role in the regulation and progression of TNBC. There is renewed interest in targeting the androgen receptor (AR) since it is expressed in TNBC and plays an important role in its biology. Studies have shown that AR can influence the behavior of TNBC via affecting the of expression microRNA molecules (miRNAs), which can modulate the expression of cancer-regulatory proteins. We aimed to profile the expression of miRNAs in human TNBC tissue samples in relation to the expression of AR and investigate their prognostic value.
Methods: The expression of 84 miRNAs in 24 TNBC tissue samples (12 AR-positive and 12 AR-negative) was examined using PCR array technology. Several bioinformatics tools were then utilized on the differentially expressed miRNAs (DE-miRNA) to determine the potentially affected protein targets and signaling pathways. Potential target genes (DEGs) for each miRNA were identified by miRWalk2.0. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were conducted for the target genes using the DAVID 6.8 bioinformatics tool. String and Cytoscape were used for establishing a PPI network and identifying the hub genes. Jamovi2.2 was used for the statistical analysis.
Results: A total of 7 DE-miRNAs were found to be significantly expressed in the tissue samples relative to AR expression. Good and poor survival outcomes, respectively, were found to be linked to miR-328-3p and miR-489-3p. Interestingly, these two miRNAs were found to be up-regulated in AR-positive tumors. The association of miR-328-3p with AR corroborates our previous findings that this miRNA is up-regulated upon AR activation in TNBC cells. Two other miRNAs, miR-17-5p and iR-193b-3p, were found to be significantly associated with high T3 and low N2 status, respectively. Gene Ontology (GO) analysis for the 7 DE-miRNAs indicated a role in the regulation of the cell cycle in various cellular components (CC) such as the “nucleus”, “centrosome”, and “transcription factor complex”. GO analysis also showed enrichment in kinase and transcription factor activities. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses retrieved numerous relevant signaling pathways such as that of the TGF-beta, MAPK, Th17 cell differentiation, and endocrine resistance.
Conclusion: This study offers an understanding of the molecular etiology of TNBC and further implicates miRNAs in mediating the effect of AR on TNBC. We also provide an integrative analysis of the AR-miRNA-TNBC gene network that can help in identifying potential therapeutic targets. Keywords: Breast Cancer, TNBC, Bioinformatics, miRNA, Androgen Receptor
Citation Format: Bayan O. Abu Alragheb, Hassan Abushukair, Maysa Al-Husseini, Randa Bawadi, Mamoun Ahram. The association of androgen receptor with microRNA expression in triple-negative breast cancer. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3772.
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Affiliation(s)
| | - Hassan Abushukair
- 2School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Maysa Al-Husseini
- 3Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Randa Bawadi
- 4Department of Physiology and Biochemistry, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mamoun Ahram
- 4Department of Physiology and Biochemistry, School of Medicine, The University of Jordan, Amman, Jordan
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Hamouri S, Alrabadi N, Syaj S, Abushukair H, Ababneh O, Al-Kraimeen L, Al-Sous M, Hecker E. Atrial resection for T4 non-small cell lung cancer with left atrium involvement: a systematic review and meta-analysis of survival. Surg Today 2023; 53:279-292. [PMID: 35000034 DOI: 10.1007/s00595-021-02446-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/25/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Extended resection for non-small cell lung cancer (NSCLC) with T4 left atrium involvement is controversial. We performed a systematic review and meta-analysis to evaluate the short- and long-term outcomes of this treatment strategy. METHODS We searched the PubMed database for studies on atrial resection in NSCLC patients. The primary investigated outcome was the effectiveness of the surgery represented by survival data and the secondary outcomes were postoperative morbidity, mortality, and recurrence. RESULTS Our search identified 18 eligible studies including a total of 483 patients. Eleven studies reported median overall survival and 17 studies reported overall survival rates. The estimated pooled 1, 3, 5-year overall survival rates were 69.1% (95% CI 61.7-76.0%), 21.5% (95% CI 12.3-32.3%), and 19.9% (95% CI 13.9-26.6%), respectively. The median overall survival was 24 months (95% CI 17.7-27 months). Most studies reported significant associations between better survival and N0/1 status, complete resection status, and neoadjuvant therapy. CONCLUSION Extended lung resection, including the left atrium, for NSCLC is feasible with acceptable morbidity and mortality when complete resection is achieved. Lymph node N0/1 status coupled with the use of neoadjuvant therapies is associated with better outcomes.
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Affiliation(s)
- Shadi Hamouri
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Nasr Alrabadi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sebawe Syaj
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Hassan Abushukair
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Obada Ababneh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Leen Al-Kraimeen
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Majd Al-Sous
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Erich Hecker
- Thoracic Surgery Department, Thoracic Center Ruhrgebiet in Herne, Herne, Germany
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Rous FA, Li P, Carskadon S, Singh SRK, Chacko R, Abushukair H, Gadgeel S, Palanisamy N. Brief Report: Prognostic relevance of 3q amplification in squamous cell carcinoma of the lung. JTO Clin Res Rep 2023; 4:100486. [PMID: 37025118 PMCID: PMC10070899 DOI: 10.1016/j.jtocrr.2023.100486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/09/2023] [Accepted: 02/19/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction Amplification of 3q is the most common genetic alteration identified in squamous cell carcinoma of the lung (LUSC), with the most frequent amplified region being 3q26 to 3q28. Methods In this analysis, we aim to describe the prognostic relevance of 3q amplification by focusing on a minimal common region (MCR) of amplification constituted of 25 genes. We analyzed 511 cases of LUSC from The Cancer Genome Atlas and included 476 in the final analysis. Results We identified a 25-gene MCR that was amplified in 221 (44.3%) cases and was associated with better disease-specific survival (not reported [NR] versus 9.25 y, 95% confidence interval [CI]: 5.24-NR, log-rank p = 0.011) and a progression-free interval of 8 years (95% CI: 5.1-NR) versus 4.9 years (95% CI: 3.5-NR, log-rank p = 0.020). Multivariable analysis revealed that MCR amplification was associated with improved disease-specific survival and progression-free interval. Conclusions Amplification of the 25-gene MCR within 3q was present in 44% of this cohort, consisting mainly of Caucasian patients with early stage LUSC. This analysis strongly indicates the prognostic relevance of the 25-gene MCR within 3q. We are further evaluating its prognostic and predictive relevance in a racially diverse patient population with advanced LUSC.
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Atri-Schuller A, Abushukair H, Cavalcante L, Hentzen S, Saeed A, Saeed A. Tumor Molecular and Microenvironment Characteristics in EBV-Associated Malignancies as Potential Therapeutic Targets: Focus on Gastric Cancer. Curr Issues Mol Biol 2022; 44:5756-5767. [PMID: 36421674 PMCID: PMC9689242 DOI: 10.3390/cimb44110390] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 09/30/2023] Open
Abstract
Although most people are infected with Epstein-Barr Virus (EBV) during their lifetime, only a minority of them develop an EBV-associated malignancy. EBV acts in both direct and indirect ways to transform infected cells into tumor cells. There are multiple ways in which the EBV, host, and tumor environment interact to promote malignant transformation. This paper focuses on some of the mechanisms that EBV uses to transform the tumor microenvironment (TME) of EBV-associated gastric cancer (EBVaGC) for its benefit, including overexpression of Indoleamine 2,3-Dioxygenase 1 (IDO1), synergism between H. pylori and EBV co-infection, and M1 to M2 switch. In this review, we expand on different modalities and combinatorial approaches to therapeutically target this mechanism.
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Affiliation(s)
- Aviva Atri-Schuller
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Hassan Abushukair
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Ludimila Cavalcante
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - Stijn Hentzen
- Department of Internal Medicine, Kansas University Medical Center, Kansas City, KS 66160, USA
| | - Azhar Saeed
- Department of Pathology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Anwaar Saeed
- Department of Medicine, Division of Medical Oncology, University of Kansas Cancer Center, 2330 Shawnee Mission Pkwy, Kansas City, KS 66205, USA
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Algargaz W, Mohamad I, Eid S, Khanfar A, Abushukair H. Stapler Pharyngeal Repair Versus Conventional Suturing After Laryngectomy in Jordanian Laryngeal Cancer Patients. Med Arch 2022; 76:363-367. [PMID: 36545454 PMCID: PMC9760230 DOI: 10.5455/medarh.2022.76.363-367] [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: 09/14/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background The use of staplers in surgical repair of the pharynx after laryngectomy has gained traction in recent years, with differing results. Objective In this study, we compare the use of stapler suturing (SS) after laryngectomy in comparison with the manual suturing (MS) technique in laryngeal cancer patients regarding pharyngocutaneous fistula (PCF) formation, operative time, blood loss, margin status, and length of hospital stay. Methods We conducted a retrospective cohort study of laryngeal cancer patients undergoing pharyngeal repair after total laryngectomy by either a stapler or manual suturing. Demographic data, stage of disease, postoperative complications, duration of hospital stay, and operative time were collected. Results A total of 59 laryngeal cancer patients were included, of which 22 underwent SS and 37 had MS. Our cohort was predominantly males (98%), and similar mean ages were observed across both suturing groups (60.5 vs 59.9, P = 0.83). Negative margins were more frequent with SS (100% vs 86.5%, P = 0.13) yet this difference was not statistically significant, whereas preoperative tracheostomy procedure was present more in MS patients (43.2% vs 0, P = 0.003). Lymph node involvement was higher in the manual suturing cohort, yet this difference was statistically insignificant (41.2% vs 25%, P = 0.49). The muscle flap procedure was significantly higher in the MS cohort (70.3% vs 20%, P = 0.001). In both groups, comparable PCF rates were noted (13.3% vs 10.8%) and there was no association between salvage laryngectomy and PCF occurrence in the entire cohort. For surgery details, there was no statistical difference between both groups in blood loss, hospitalization length, or oral feeding start. Only surgical time was significantly lower in the stapler cohort (277 vs 372.6 minutes, P = 0.000). Conclusion Both suturing techniques did not show any statistically significant difference in PCF rates. However, was markedly reduced with stapler use in comparison to manual suturing. Further randomized studies with larger sample size are needed to validate the role of stapler suturing for pharyngeal repair.
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Affiliation(s)
- Wisam Algargaz
- Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan,Department of Head and Neck Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Suhaib Eid
- Department of Head and Neck Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Asim Khanfar
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Hassan Abushukair
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Abushukair H, Ababneh O, Zaitoun S, Saeed A. Primary and secondary immune checkpoint inhibitors resistance in colorectal cancer: Key mechanisms and ways to overcome resistance. Cancer Treat Res Commun 2022; 33:100643. [PMID: 36175334 DOI: 10.1016/j.ctarc.2022.100643] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/22/2022] [Indexed: 02/09/2023]
Abstract
Immune checkpoint inhibitors (ICIs) have significantly advanced colorectal cancer treatment in recent years. Antibodies that target the proteins programmed cell death-1 (PD-1), programmed cell death-1 ligand 1 (PD-L1), and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) are among the ICIs that are currently being used in clinical practice. However, in colorectal cancer, ICI's effectiveness is limited to a fraction of patients with microsatellite instability-high (MSI-H), which only accounts for about 5% of advanced cases. The tumor microenvironment and intrinsic changes in tumor cells are just a couple of the many mechanisms that play a role in ICI primary or secondary resistance. In order to advance precision medicine and broaden the population benefiting from ICI, this paper highlights the main underlying mechanisms of ICIs resistance and suggested techniques to overcome it.
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Affiliation(s)
- Hassan Abushukair
- Faculty of Medicine, Jordan University of Science and Technology, 22110, Irbid, Jordan
| | - Obada Ababneh
- Faculty of Medicine, Jordan University of Science and Technology, 22110, Irbid, Jordan
| | - Sara Zaitoun
- Faculty of Medicine, Yarmouk University, 21163, Irbid, Jordan
| | - Anwaar Saeed
- Department of Medicine, Division of Medical Oncology, University of Kansas Cancer Center, 66205, Kansas City, KS, United States of America.
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Abushukair H, Syaj S, Ababneh O, Qarqash A, Schinke C, Thanendrarajan S, Zangari M, van Rhee F, Al Hadidi S. First- versus second-generation Bruton tyrosine kinase inhibitors in Waldenström's Macroglobulinemia: A systematic review and meta-analysis. Am J Hematol 2022; 97:942-950. [PMID: 35358350 DOI: 10.1002/ajh.26552] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 01/17/2023]
Abstract
Bruton tyrosine kinase inhibitors (BTKi) are important treatment options in Waldenström's macroglobulinemia (WM). Whether second-generation BTKi are associated with improved outcomes and/or better safety profile remains unclear. We did a systematic review and meta-analysis of clinical trials that reported data on the outcomes of patients with WM who received either first- or second-generation BTKi in the period between January 2010 and August 2021. Studies with twenty or fewer patients were excluded. The primary outcomes were efficacy measured by response and survival data. Eleven studies met the eligibility criteria and were included in the final analysis (n = 730 patients). A total of 298 patients received 1st-generation BTKi and 432 received a 2nd-generation BTKi. Pooled overall response rate (ORR) and major response rate (MRR) for both generations were similar (94.2% and 78.5% in 1st vs. 88.9% and 75.1% in 2nd, respectively). MRR for both generations was higher in MYD88 Mut/CXCR4 WT patients compared to MYD88 Mut/CXCR4 Mut patients (odds ratio [OR]: 3.9, 95% CI: 2.2 to 5.5). Pooled 18-mo progression-free survival (PFS) was similar for both generations (88.5% vs. 87.3%). Grade 3/4 atrial fibrillation was higher in 1st-generation BTKi (3.1% vs. 0.4%); however, grade-3/-4 infections and neutropenia were more frequent in 2nd-generarion BTKi (20.9% vs. 13.2%, 17.7% vs. 12%, respectively). The efficacy of 1st- and 2nd-generation BTKis is comparable. The 1st-generation BTKi were associated with a higher risk of atrial fibrillation, whereas infections and neutropenia occurred more frequently in 2nd-generation BTKi.
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Affiliation(s)
- Hassan Abushukair
- Faculty of Medicine Jordan University of Science and Technology Irbid Jordan
| | - Sebawe Syaj
- Faculty of Medicine Jordan University of Science and Technology Irbid Jordan
| | - Obada Ababneh
- Faculty of Medicine Jordan University of Science and Technology Irbid Jordan
| | - Aref Qarqash
- Faculty of Medicine Jordan University of Science and Technology Irbid Jordan
| | - Carolina Schinke
- Myeloma Center Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | - Sharmilan Thanendrarajan
- Myeloma Center Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | - Maurizio Zangari
- Myeloma Center Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | - Frits van Rhee
- Myeloma Center Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | - Samer Al Hadidi
- Myeloma Center Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences Little Rock Arkansas USA
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Ababneh O, Abushukair H, Qarqash A, Syaj S, Al Hadidi S. The Use of Bruton Tyrosine Kinase Inhibitors in Waldenström’s Macroglobulinemia. Clin Hematol Int 2022; 4:21-29. [PMID: 35950210 PMCID: PMC9358782 DOI: 10.1007/s44228-022-00007-5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/15/2022] [Indexed: 01/04/2023] Open
Abstract
The use of Bruton Tyrosine Kinase (BTK) inhibitors in Waldenström’s Macroglobulinemia (WM) is evolving. Ibrutinib, a first-generation BTK inhibitor, is currently approved for use in frontline and relapsed/refractory disease. Second-generation BTK inhibitors are being used and studied to improve clinical outcomes and/or safety profile. Zanubrutinib, one such second-generation inhibitor, was recently approved in treatment-naive and refractory/relapsed patients. Here, we review the use of BTK inhibitors in WM in front-line and refractory or relapsed settings. We also highlight common adverse events, the emergence of BTK inhibitors resistance, and future directions of their use.
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Affiliation(s)
- Obada Ababneh
- Faculty of Medicine, Jordan University of Science and Technology, P.O. 22110, Irbid, Jordan
| | - Hassan Abushukair
- Faculty of Medicine, Jordan University of Science and Technology, P.O. 22110, Irbid, Jordan
| | - Aref Qarqash
- Faculty of Medicine, Jordan University of Science and Technology, P.O. 22110, Irbid, Jordan
| | - Sebawe Syaj
- Faculty of Medicine, Jordan University of Science and Technology, P.O. 22110, Irbid, Jordan
| | - Samer Al Hadidi
- Myeloma Center, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR USA
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13
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Abushukair H, Abushukair A, Saeed A. Nivolumab in Esophageal Squamous-Cell Carcinoma. N Engl J Med 2022; 386:1959. [PMID: 35584167 DOI: 10.1056/nejmc2202880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | - Anwaar Saeed
- University of Kansas Cancer Center, Kansas City, KS
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Serhan A, Kiwan A, Abushukair H, Yassin A. Deep brain stimulation use in treating multiple sclerosis tremor: A practical approach for meta-analyses. Mult Scler Relat Disord 2022; 58:103491. [PMID: 35042091 DOI: 10.1016/j.msard.2022.103491] [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] [Received: 12/28/2021] [Accepted: 01/01/2022] [Indexed: 11/27/2022]
Abstract
Deep brain stimulation (DBS) has been introduced as a treatment option for multiple sclerosis (MS) related tremor. Recent emerging studies have investigated its efficacy and safety, yet no study has systematically assessed the evidence on this topic. Zali and colleagues have conducted the first systematic review and meta-analysis on the use of DBS in MS tremor patients. In this letter, we highlight some points in their meta-analysis regarding high heterogeneity levels that reflect some methodological concerns related to pooling studies with considerable variability. We also suggest some approaches to address this problem.
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Affiliation(s)
- Abdullah Serhan
- Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid 22110, Jordan
| | - Ahmad Kiwan
- Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid 22110, Jordan
| | - Hassan Abushukair
- Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid 22110, Jordan
| | - Ahmed Yassin
- Department of Neurosciences, Jordan University of Science and Technology, PO Box 3030, Irbid 22110, Jordan.
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Alshdaifat E, Sindiani A, Khasawneh W, Abu-Azzam O, Qarqash A, Abushukair H, Obeidat N. The impact of COVID-19 pandemic on training and mental health of residents: a cross-sectional study. BMC Med Educ 2021; 21:208. [PMID: 33849518 PMCID: PMC8041616 DOI: 10.1186/s12909-021-02655-2] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/06/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND Residency programs have been impacted by the Coronavirus disease 2019 (COVID-19) pandemic. In this study we aim to investigate and evaluate the impact of the pandemic on residents as well as residency training programs. METHODS This was a cross-sectional study including a survey of 43 questions prepared on Google forms and electronically distributed among a convenience sample of residents training at a tertiary center in North Jordan during the COVID-19 pandemic. Data were collected in the period between October 30th and November 8th of 2020. The survey included questions that addressed the impact of the pandemic on residents' health as well as training programs. The study participants included residents in training at KAUH in 2020 and were stratified according to the type of residency program (surgical residents (SRs) and non-surgical residents (NSRs)). Statistical methods included descriptive analysis, Chi-square or Fisher's exact test, Mann Whitney U test, and Cramer's V and r statistics as measures of effect sizes. RESULTS Of all 430 residents, 255 (59%) responded to the survey. A total of 17 (7%) of residents reported being infected with COVID-19 and a significant difference was reported between SRs and NSRs (10% vs 4%, V = .124 "small effect" (95% CI; .017-.229), p = 0.048). Approximately, 106 (42%) reported a decrease in the number of staff working at the clinic and 164 (64%) reported limited access to personal protective equipment during the pandemic. On a 4-point Likert scale for the feeling of anxiety, the median was 2 (2-3 IQR) in the NSRs group, vs 2 (1-2 IQR) in the SRs groups, with the NSRs being more likely to feel anxious (r = 0.13 "small effect" (95% CI; 0.007-0.249), p = .044). Similarly, the proportion of residents who reported feeling anxious about an inadequacy of protective equipment in the work area was significantly greater in the NSRs group (90.3% vs 75.2%; V = .201 "small effect" (95% CI; .078-.313), p = .001), as well as the proportion of residents who reported feeling increased stress and anxiety between colleagues being also significantly higher in the NSRs group (88.1% vs 76%; V = .158 "small effect" (95% CI; .032-.279), p = .012). CONCLUSION The burden of the ongoing pandemic on the mental health status of residents is very alarming and so providing residents with psychological counseling and support is needed. Also, critical implications on the flow of residency training programs have been noticed. This necessitates adapting and adopting smart educational techniques to compensate for such limitations.
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Affiliation(s)
- Eman Alshdaifat
- Department of Obstetrics and Gynecology, Faculty of medicine, Yarmouk University, P.O.Box: (566), Irbid, 21163 Jordan
| | - Amer Sindiani
- Department of Obstetrics and Gynecology, Faculty of medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Wasim Khasawneh
- Department of Pediatrics and Neonatology Faculty of medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar Abu-Azzam
- Department of Obstetrics and Gynecology, Faculty of medicine, Mutah University, Al-karak, Jordan
| | - Aref Qarqash
- Faculty of medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Hassan Abushukair
- Faculty of medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nail Obeidat
- Department of Obstetrics and Gynecology, Faculty of medicine, Jordan University of Science and Technology, Irbid, Jordan
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