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Furlanis GM, Favaro J, Bresolin N, Grioni D, Baro V, D’Amico A, Sartori S, Denaro L, Landi A. Role of Vagus Nerve Stimulation in Refractory and Super Refractory Status Epilepticus: A Pediatric Case Series. Brain Sci 2023; 13:1589. [PMID: 38002548 PMCID: PMC10669853 DOI: 10.3390/brainsci13111589] [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: 10/03/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Status epilepticus is a life-threatening condition that is defined as refractory (RSE) when the seizure activity continues despite treatment with benzodiazepine and a second appropriate treatment. Super refractory status epilepticus (SRSE) is an RSE that persists or recurs for ≥24 h. Few papers have reported the outcomes of pediatric patients affected by RSE and SRSE and treated with neuromodulation therapies. Vagus nerve stimulation (VNS) is an approved treatment for drug-resistant epilepsy. We present our findings of pediatric patients treated with VNS for RSE/SRSE. METHODS We present a case series of seven consecutive pediatric patients treated with VNS for SRSE since 2012 by a single surgeon in Monza and Padua. A rapid titration was started soon after implantation. We considered electroclinical data before and after VNS implantation and at the last follow-up. RESULTS We achieved the resolution of SRSE in five out of seven patients in a mean time of two weeks. At the last follow-up, these patients had a significant reduction of seizure burden without any relapse of SE. DISCUSSION AND CONCLUSIONS Based on our limited findings, we discuss the potential role of VNS therapy in similar but distinct clinical contexts. For patients with drug-resistant epilepsy and RSE/SRSE, prompt VNS consideration is suggested, offering rapid responses and potentially reducing pharmacological load. Meanwhile, in NORSE/FIRES, we suggest early neuromodulation during the acute phase if standard treatments prove ineffective or not tolerated. This approach may leverage VNS's potential anti-inflammatory effects and neuromodulation, enhancing patient-specific treatments. Expanding case studies and prolonged follow-ups are recommended to strengthen these clinical insights.
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Affiliation(s)
- Giulia Melinda Furlanis
- Pediatric and Functional Neurosurgery, Department of Neuroscience, Padua University Hospital, via Giustiniani 5, 35127 Padova, Italy; (G.M.F.); (A.L.)
| | - Jacopo Favaro
- Neurology and Neurophysiology Unit, Department of Women’s and Children’s Health, Padua University Hospital, 35128 Padova, Italy; (J.F.)
| | - Nicola Bresolin
- Pediatric and Functional Neurosurgery, Department of Neuroscience, Padua University Hospital, via Giustiniani 5, 35127 Padova, Italy; (G.M.F.); (A.L.)
| | | | - Valentina Baro
- Pediatric and Functional Neurosurgery, Department of Neuroscience, Padua University Hospital, via Giustiniani 5, 35127 Padova, Italy; (G.M.F.); (A.L.)
| | - Alberto D’Amico
- Pediatric and Functional Neurosurgery, Department of Neuroscience, Padua University Hospital, via Giustiniani 5, 35127 Padova, Italy; (G.M.F.); (A.L.)
| | - Stefano Sartori
- Neurology and Neurophysiology Unit, Department of Women’s and Children’s Health, Padua University Hospital, 35128 Padova, Italy; (J.F.)
| | - Luca Denaro
- Pediatric and Functional Neurosurgery, Department of Neuroscience, Padua University Hospital, via Giustiniani 5, 35127 Padova, Italy; (G.M.F.); (A.L.)
| | - Andrea Landi
- Pediatric and Functional Neurosurgery, Department of Neuroscience, Padua University Hospital, via Giustiniani 5, 35127 Padova, Italy; (G.M.F.); (A.L.)
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Furlanis GM, Fascetti Leon F, Bresolin N, Favaro J, Baro V, D'Amico A, Denaro L, Sartori S, Landi A. Aesthetic transaxillary subpectoral placement of vagus nerve stimulator in children and young adults: A technical note. Epilepsy Behav 2023; 147:109419. [PMID: 37677901 DOI: 10.1016/j.yebeh.2023.109419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Vagus nerve stimulation (VNS) is a neuromodulation therapy for drug-resistant epilepsy (DRE), refractory status epilepticus, and treatment-resistant depression. The lead is tunneled into the subcutaneous space and connected to the generator, which is usually implanted in a subcutaneous pocket below the clavicle. Surgical complications in the chest region include skin breakdown or infection. An alternative approach is to perform a subclavear subpectoral implantation. In our surgical series, we report a new aesthetic implantation method for VNS generators in children and young patients: the transaxillary subpectoral placement. MATERIALS AND METHODS From May 2021 to May 2023, 10 vagus nerve stimulation generators were placed subpectorally with a transaxillary approach by the authors. We considered operative time, surgical complications such as blood loss, infections, device migration, pain, and adverse events at follow-up. RESULTS In this surgical series, we reviewed all cases of subpectoral implantation of VNS generators in children and young adults at our institution in the last 2 years. All patients were treated with subpectoral Sentiva 1000 (Livanova PLC) insertion with axillary access by a neurosurgeon and a pediatric surgeon. The operative time was slightly longer compared to the traditional subcutaneous implant. All generators reported impedances within the optimal range. Blood loss was not significant and no other perioperative complications were reported. Patients and families were highly satisfied with the outcomes in terms of comfort and aesthetic results after surgery and at the last follow-up. No cases of infection occurred, and no malfunctions or displacements of the generator were registered at clinical follow-up. CONCLUSION The transaxillary subpectoral placement of theVNS generator is an aesthetic and anatomic approach, which provides several benefits to children and young adults.
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Affiliation(s)
- Giulia Melinda Furlanis
- Pediatric and Functional Neurosurgery Unit, Department of Neuroscience, Padua University Hospital, Italy.
| | - Francesco Fascetti Leon
- Pediatric Surgery Unit, Department of Women's and Children's Health, Padua University Hospital, Italy
| | - Nicola Bresolin
- Pediatric and Functional Neurosurgery Unit, Department of Neuroscience, Padua University Hospital, Italy
| | - Jacopo Favaro
- Pediatric Neurology and Neurophysiology, Department of Women's and Children's Health, Padua University Hospital, Italy
| | - Valentina Baro
- Pediatric and Functional Neurosurgery Unit, Department of Neuroscience, Padua University Hospital, Italy
| | - Alberto D'Amico
- Pediatric and Functional Neurosurgery Unit, Department of Neuroscience, Padua University Hospital, Italy
| | - Luca Denaro
- Pediatric and Functional Neurosurgery Unit, Department of Neuroscience, Padua University Hospital, Italy
| | - Stefano Sartori
- Pediatric Neurology and Neurophysiology, Department of Women's and Children's Health, Padua University Hospital, Italy
| | - Andrea Landi
- Pediatric and Functional Neurosurgery Unit, Department of Neuroscience, Padua University Hospital, Italy
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Favaro J, Colombo MA, Mikulan E, Sartori S, Nosadini M, Pelizza MF, Rosanova M, Sarasso S, Massimini M, Toldo I. The maturation of aperiodic EEG activity across development reveals a progressive differentiation of wakefulness from sleep. Neuroimage 2023:120264. [PMID: 37399931 DOI: 10.1016/j.neuroimage.2023.120264] [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: 03/07/2023] [Revised: 06/04/2023] [Accepted: 07/01/2023] [Indexed: 07/05/2023] Open
Abstract
During development, the brain undergoes radical structural and functional changes following a posterior-to-anterior gradient, associated with profound changes of cortical electrical activity during both wakefulness and sleep. However, a systematic assessment of the developmental effects on aperiodic EEG activity maturation across vigilance states is lacking, particularly regarding its topographical aspects. Here, in a population of 160 healthy infants, children and teenagers (from 2 to 17 years, 10 subjects for each year), we investigated the development of aperiodic EEG activity in wakefulness and sleep. Specifically, we parameterized the shape of the aperiodic background of the EEG Power Spectral Density (PSD) by means of the spectral exponent and offset; the exponent reflects the rate of exponential decay of power over increasing frequencies and the offset reflects an estimate of the y-intercept of the PSD. We found that sleep and development caused the EEG-PSD to rotate over opposite directions: during wakefulness the PSD showed a flatter decay and reduced offset over development, while during sleep it showed a steeper decay and a higher offset as sleep becomes deeper. During deep sleep (N2, N3) only the spectral offset decreased over age, indexing a broad-band voltage reduction. As a result, the difference between values in deep sleep and those in both light sleep (N1) and wakefulness increased with age, suggesting a progressive differentiation of wakefulness from sleep EEG activity, most prominent over the frontal regions, the latest to complete maturation. Notably, the broad-band spectral exponent values during deep sleep stages were entirely separated from wakefulness values, consistently across developmental ages and in line with previous findings in adults. Concerning topographical development, the location showing the steepest PSD decay and largest offset shifted from posterior to anterior regions with age. This shift, particularly evident during deep sleep, paralleled the migration of sleep slow wave activity and was consistent with neuroanatomical and cognitive development. Overall, aperiodic EEG activity distinguishes wakefulness from sleep regardless of age; while, during development, it reveals a postero-anterior topographical maturation and a progressive differentiation of wakefulness from sleep. Our study could help to interpret changes due to pathological conditions and may elucidate the neurophysiological processes underlying the development of wakefulness and sleep.
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Affiliation(s)
- Jacopo Favaro
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children Health, University of Padua, 35128, Padua, Italy.
| | - Michele A Colombo
- Department of Clinical and Biomedical Sciences "L. Sacco", University of Milan, 20157, Milan, Italy.
| | - Ezequiel Mikulan
- Department of Clinical and Biomedical Sciences "L. Sacco", University of Milan, 20157, Milan, Italy
| | - Stefano Sartori
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children Health, University of Padua, 35128, Padua, Italy; Neuroimmunology Group, Pediatric Research Institute "Città della Speranza", 35127, Padua, Italy; Department of Neuroscience, University of Padua, 35121, Padua, Italy
| | - Margherita Nosadini
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children Health, University of Padua, 35128, Padua, Italy; Neuroimmunology Group, Pediatric Research Institute "Città della Speranza", 35127, Padua, Italy
| | - Maria Federica Pelizza
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children Health, University of Padua, 35128, Padua, Italy
| | - Mario Rosanova
- Department of Clinical and Biomedical Sciences "L. Sacco", University of Milan, 20157, Milan, Italy
| | - Simone Sarasso
- Department of Clinical and Biomedical Sciences "L. Sacco", University of Milan, 20157, Milan, Italy
| | - Marcello Massimini
- Department of Clinical and Biomedical Sciences "L. Sacco", University of Milan, 20157, Milan, Italy; IRCCS, Fondazione Don Carlo Gnocchi Onlus, 20148, Milan, Italy.
| | - Irene Toldo
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children Health, University of Padua, 35128, Padua, Italy
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Mikulan E, Russo S, Zauli FM, d'Orio P, Parmigiani S, Favaro J, Knight W, Squarza S, Perri P, Cardinale F, Avanzini P, Pigorini A. A comparative study between state-of-the-art MRI deidentification and AnonyMI, a new method combining re-identification risk reduction and geometrical preservation. Hum Brain Mapp 2021; 42:5523-5534. [PMID: 34520074 PMCID: PMC8559469 DOI: 10.1002/hbm.25639] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 01/03/2023] Open
Abstract
Deidentifying MRIs constitutes an imperative challenge, as it aims at precluding the possibility of re-identification of a research subject or patient, but at the same time it should preserve as much geometrical information as possible, in order to maximize data reusability and to facilitate interoperability. Although several deidentification methods exist, no comprehensive and comparative evaluation of deidentification performance has been carried out across them. Moreover, the possible ways these methods can compromise subsequent analysis has not been exhaustively tested. To tackle these issues, we developed AnonyMI, a novel MRI deidentification method, implemented as a user-friendly 3D Slicer plugin-in, which aims at providing a balance between identity protection and geometrical preservation. To test these features, we performed two series of analyses on which we compared AnonyMI to other two state-of-the-art methods, to evaluate, at the same time, how efficient they are at deidentifying MRIs and how much they affect subsequent analyses, with particular emphasis on source localization procedures. Our results show that all three methods significantly reduce the re-identification risk but AnonyMI provides the best geometrical conservation. Notably, it also offers several technical advantages such as a user-friendly interface, multiple input-output capabilities, the possibility of being tailored to specific needs, batch processing and efficient visualization for quality assurance.
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Affiliation(s)
- Ezequiel Mikulan
- Dipartimento di Scienze Biomediche e Cliniche "L.Sacco", Università degli Studi di Milano, Milano, Italy
| | - Simone Russo
- Dipartimento di Scienze Biomediche e Cliniche "L.Sacco", Università degli Studi di Milano, Milano, Italy
| | - Flavia Maria Zauli
- Dipartimento di Scienze Biomediche e Cliniche "L.Sacco", Università degli Studi di Milano, Milano, Italy
| | - Piergiorgio d'Orio
- "Claudio Munari" Epilepsy and Parkinson Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Sara Parmigiani
- Dipartimento di Scienze Biomediche e Cliniche "L.Sacco", Università degli Studi di Milano, Milano, Italy
| | - Jacopo Favaro
- Department of Women's and Children's Health, Pediatric Neurology and Neurophysiology Unit, University of Padua, Padua, Italy
| | - William Knight
- Centre for Computing and Social Responsibility, De Montfort University, Leicester, UK
| | - Silvia Squarza
- Department of Neuroradiology, "Claudio Munari" Epilepsy and Parkinson Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Pierluigi Perri
- Dipartimento di Scienze Giuridiche Cesare Beccaria, Università degli Studi di Milano, Milano, Italy
| | - Francesco Cardinale
- "Claudio Munari" Epilepsy and Parkinson Surgery Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Pietro Avanzini
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma, Italy
| | - Andrea Pigorini
- Dipartimento di Scienze Biomediche e Cliniche "L.Sacco", Università degli Studi di Milano, Milano, Italy
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Mikulan E, Russo S, Zauli FM, d'Orio P, Parmigiani S, Favaro J, Knight W, Squarza S, Perri P, Cardinale F, Avanzini P, Pigorini A. Cover Image. Hum Brain Mapp 2021. [DOI: 10.1002/hbm.25080] [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: 11/08/2022] Open
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Cainelli E, Di Giacomo DL, Mantegazza G, Vedovelli L, Favaro J, Boniver C. Prognostic role of Mini-Mental State Pediatric Examination (MMSPE) on neuropsychological functioning. Neurol Sci 2020; 41:619-623. [PMID: 31729580 DOI: 10.1007/s10072-019-04141-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/05/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the ability of the Mini-Mental State Pediatric Examinations (MMSPE) in the individuation of neuropsychological impairments. METHOD MMSPE was administered to 60 children attending a primary or lower secondary school suffering from neurological diseases, admitted to our neuropsychology services. All children performed both a MMSPE examination and a neuropsychological evaluation. Results of neuropsychological evaluation and MMSPE were dichotomized. Positive predictive value (PPV), negative predictive value (NPV), and accuracy were also calculated. RESULTS The diagnostic performance of MMSPE showed a good overall accuracy (0.83, CI 95% 0.64-0.91), NPV (0.81, CI 95% 0.73-1.00), PPV (0.87, CI 95% 0.68-0.94), specificity (0.91, CI 95% 0.81-1.00), sensitivity (0.74, CI 95% 0.57-0.90), and odds ratio of 28.5 (CI 95% 6.6-123), p < 0.001. CONCLUSIONS MMSPE has a good prognostic ability in predicting neuropsychological problems in the context of different neurological pediatric diseases. We suggest that this instrument could greatly improve pediatric clinical practice in identifying high-risk children.
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Affiliation(s)
- Elisa Cainelli
- Department of Developmental Psychology and Socialization, University of Padova, Via Venezia 8, 35133, Padua, Italy. .,Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy.
| | - Deborah Lidia Di Giacomo
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | | | - Luca Vedovelli
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Jacopo Favaro
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - Clementina Boniver
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
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Casiglia E, Casiglia E, Tikhonoff V, Albertini F, Lapenta AM, Gasparotti F, Finatti F, Rossi AM, Zanette G, Giacomello M, Giordano N, Favaro J, Facco E. The Mysterious Hypnotic Analgesia: Experimental Evidences. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/psych.2018.98112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Casiglia E, Albertini F, Tikhonoff V, Gasparotti F, Favaro J, Finatti F, Rempelou P, Lapenta AM, Spinella P. Experimental Approach to the Transmission of Information in Hypnosis. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/psych.2018.91001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Casiglia E, Tikhonoff V, Albertini F, Montagnana M, Danese E, Mazza A, Favaro J, Finatti F, Benati M, Maso LD, Gasparotti F, Spinella P, Palatini P. Effects of Caffeine and Coffee on Incident Heart Failure in General Population. Role of the CYP1A2 -163C>A Polymorphism. ACTA ACUST UNITED AC 2017. [DOI: 10.31871/wjrr.5.1.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Blackwell KL, Hamilton EP, Marcom PK, Peppercorn J, Spector N, Kimmick G, Hopkins J, Favaro J, Rocha G, Parks M, Love C, Scotland P, Dave SS. Abstract S4-03: Exome sequencing reveals clinically actionable mutations in the pathogenesis and metastasis of triple negative breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-s4-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Triple negative breast cancer (TNBC) represents a particularly aggressive and difficult to treat form of breast cancer. No specific genetic alterations have been described as characteristic of the disease, with the exception of association with BRCA1/2, EGFR, and KRAS mutations. In this study, we sought to define clinically actionable mutations in untreated metastatic tumors as well as compare the mutational status of metastatic samples with germ-line and primary tumors using whole exome sequencing.
We prospectively enrolled 38 patients with newly diagnosed metastatic TNBC and collected matched specimens of germ-line DNA, primary tumor and metastatic tumor. Median DFI from time of initial primary diagnosis to recurrence was 18 months (IQR = 1-24 months) and 9 patients presented with de novo metastatic disease. 34/38 patients went on to receive first-line treatment with nab-paclitaxel, carboplatin, and bevacizumab and ORR/PFS/OS are available.
Sites of TNBC metastatic tissue (n = 31) included: liver (10), chest wall (13), non-regional lymph nodes (4), and lung (4). 7 patients had inadequate metastatic tumor for sequencing. We performed whole-exome sequencing for all samples using the Agilent solution-based system of exon capture, which uses RNA baits to target all protein coding genes (CCDS database), as well as ∼700 human miRNAs from miRBase (v13). In all, we generated over 10 GB of sequencing data using high throughput sequencing on the Illumina platform.
We observed striking genetic heterogeneity among the metastatic and primary tumors. There was no single driver mutation that was common to the metastatic tumors indicating the diverse genetic pathways that contribute to metastasis. Early analysis suggests that mutations in APC and MTOR occur more frequently in metastatic tumors than in primary tumors. Nonsense mutations of ER were detected in both primary and metastatic tumors but not in germ-line DNA. EGFR and HER2 mutations were not found in any of the primary or metastatic TNBC samples.
This data provides the most comprehensive genetic portrait of metastatic and primary TNBC to date, and represents a significant first step in identifying the genetic causes of the disease, drivers of recurrence, and potential therapeutic targets. Full results, including the primary versus metastatic tumor mutational analysis will be presented.
This study was funded by a Susan G. Komen Grant SAC 100001.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr S4-03.
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Affiliation(s)
- KL Blackwell
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - EP Hamilton
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - PK Marcom
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - J Peppercorn
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - N Spector
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - G Kimmick
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - J Hopkins
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - J Favaro
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - G Rocha
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - M Parks
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - C Love
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - P Scotland
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
| | - SS Dave
- Duke Cancer Institute, Durham, NC; Forsyth Oncology, Winston-Salem, NC; Novant Oncology Research, Charlotte, NC
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