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Thurman JT, Hawkins SC, Fifer D, Clark JR, Abo B. Wilderness Paramedic-A Practice Analysis. PREHOSP EMERG CARE 2023; 28:646-655. [PMID: 37943634 DOI: 10.1080/10903127.2023.2281372] [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: 04/24/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Abstract
Emergency medical services (EMS) has existed in its modern form for over 50 years. EMS has become a critical public safety net and access point to the larger health care system. Mature EMS systems are in place in most urban areas. However, EMS systems are not as developed in wilderness areas. A barrier to further development of these systems is the lack of an agreed-upon standard of minimum competence and validation of specialized practice. A practice analysis was completed to create such standards. The practice analysis was completed using a multi-step process. A group of subject matter experts constructed a survey of tasks and knowledge needed for wilderness EMS (WEMS) specialty practice. The tasks and knowledge were validated through an industry survey. A total of 947 surveys were submitted for analysis. Of these, 196 were at least 55% complete and used for analysis. North America was heavily represented as a primary practice location with 177 (90.3%) responses out of the 196 total. Of these 177 responses, 164 (92.7%) were from the United States and 12 (6.8%) were from Canada. One hundred seven of the 116 tasks identified by the subject matter expert group were passed by the survey group, and 164 of the 175 knowledge statements were passed by the survey group. An index of agreement (IOA) was calculated and found to be greater than 0.9 for each task and knowledge statement across all subgroups. A content coverage rating was also calculated and the results indicate survey participants felt the content was "adequate" to "well" covered. The survey results were used to construct a pilot examination. Beta testing of the pilot examination was performed. The beta test results were analyzed and a cut score was determined using the Angoff method with a Beuk compromise. The final product of this process is a defensible exam that will certify candidates' cognitive knowledge of the specialty of WEMS. Completion of this practice analysis solidifies WEMS as distinct subspecialty of out-of-hospital medicine. Additionally, it establishes a consensus definition of wilderness paramedicine and standards that may be used by WEMS systems and regulatory entities.
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Affiliation(s)
- Jeffrey T Thurman
- International Board of Specialty Certification, Red Rock, Texas
- Clinical Faculty (Gratis), Department of Emergency Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Seth C Hawkins
- Department of Emgergency Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - David Fifer
- Department of Paramedic Science, Eastern Kentucky University, Richmond, Kentucky
| | - John R Clark
- International Board of Specialty Certification, Red Rock, Texas
| | - Benjamin Abo
- International Board of Specialty Certification, Red Rock, Texas
- Department of Emergency Medicine, Florida State University College of Medicine, Tallahassee, Florida
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Chizk TM, Lee JA, Clark JR, Worthington ML. ShinyFruit: interactive fruit phenotyping software and its application in blackberry. Front Plant Sci 2023; 14:1182819. [PMID: 37868309 PMCID: PMC10585260 DOI: 10.3389/fpls.2023.1182819] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023]
Abstract
Introduction Horticultural plant breeding programs often demand large volumes of phenotypic data to capture visual variation in quality of harvested products. Increasing the throughput potential of phenomic pipelines enables breeders to consider data-hungry molecular breeding strategies such as genome-wide association studies and genomic selection. Methods We present an R-based web application called ShinyFruit for image-based phenotyping of size, shape, and color-related qualities in fruits and vegetables. Here, we have demonstrated one potential application for ShinyFruit by comparing its estimates of fruit length, width, and red drupelet reversion (RDR) with ImageJ and analogous manual phenotyping techniques in a population of blackberry cultivars and breeding selections from the University of Arkansas System Division of Agriculture Fruit Breeding Program. Results ShinyFruit results shared a strong positive correlation with manual measurements for blackberry length (r = 0.96) and ImageJ estimates of RDR (r = 0.96) and significant, albeit weaker, correlations with manual RDR estimation methods (r = 0.62 - 0.70). Neither phenotyping method detected genotypic differences in blackberry fruit width, suggesting that this trait is unlikely to be heritable in the population observed. Discussion It is likely that implementing a treatment to promote RDR expression in future studies might strengthen the documented correlation between phenotyping methods by maximizing genotypic variance. Even so, our analysis has suggested that ShinyFruit provides a viable, open-source solution to efficient phenotyping of size and color in blackberry fruit. The ability for users to adjust analysis settings should also extend its utility to a wide range of fruits and vegetables.
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Affiliation(s)
- T. Mason Chizk
- Department of Horticulture, University of Arkansas, Fayetteville, AR, United States
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Shi CR, Shaughnessy M, Sehgal K, Clark JR, Reynolds KL, Toyohara J, Chen ST. Successful rechallenge with pembrolizumab after case of progressive immunotherapy-related mucocutaneous eruption (PIRME), a Stevens-Johnson syndrome-like reaction. Int J Dermatol 2023; 62:1292-1294. [PMID: 36628976 DOI: 10.1111/ijd.16572] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Connie R Shi
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Kartik Sehgal
- Department of Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - John R Clark
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kerry L Reynolds
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Steven T Chen
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
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Chizk TM, Clark JR, Johns C, Nelson L, Ashrafi H, Aryal R, Worthington ML. Genome-wide association identifies key loci controlling blackberry postharvest quality. Front Plant Sci 2023; 14:1182790. [PMID: 37351206 PMCID: PMC10282842 DOI: 10.3389/fpls.2023.1182790] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/27/2023] [Indexed: 06/24/2023]
Abstract
Introduction Blackberry (Rubus subgenus Rubus) is a soft-fruited specialty crop that often suffers economic losses due to degradation in the shipping process. During transportation, fresh-market blackberries commonly leak, decay, deform, or become discolored through a disorder known as red drupelet reversion (RDR). Over the past 50 years, breeding programs have achieved better fruit firmness and postharvest quality through traditional selection methods, but the underlying genetic variation is poorly understood. Methods We conducted a genome-wide association of fruit firmness and RDR measured in 300 tetraploid fresh-market blackberry genotypes from 2019-2021 with 65,995 SNPs concentrated in genic regions of the R. argutus reference genome. Results Fruit firmness and RDR had entry-mean broad sense heritabilities of 68% and 34%, respectively. Three variants on homologs of polygalacturonase (PG), pectin methylesterase (PME), and glucan endo-1,3-β-glucosidase explained 27% of variance in fruit firmness and were located on chromosomes Ra06, Ra01, and Ra02, respectively. Another PG homolog variant on chromosome Ra02 explained 8% of variance in RDR, but it was in strong linkage disequilibrium with 212 other RDR-associated SNPs across a 23 Mb region. A large cluster of six PME and PME inhibitor homologs was located near the fruit firmness quantitative trait locus (QTL) identified on Ra01. RDR and fruit firmness shared a significant negative correlation (r = -0.28) and overlapping QTL regions on Ra02 in this study. Discussion Our work demonstrates the complex nature of postharvest quality traits in blackberry, which are likely controlled by many small-effect QTLs. This study is the first large-scale effort to map the genetic control of quantitative traits in blackberry and provides a strong framework for future GWAS. Phenotypic and genotypic datasets may be used to train genomic selection models that target the improvement of postharvest quality.
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Affiliation(s)
- T. Mason Chizk
- Department of Horticulture, University of Arkansas, Fayetteville, AR, United States
| | - John R. Clark
- Department of Horticulture, University of Arkansas, Fayetteville, AR, United States
| | - Carmen Johns
- Department of Horticulture, University of Arkansas, Fayetteville, AR, United States
| | - Lacy Nelson
- Department of Horticulture, University of Arkansas, Fayetteville, AR, United States
| | - Hamid Ashrafi
- Department of Horticultural Science, North Carolina State University, Raleigh, NC, United States
| | - Rishi Aryal
- Department of Horticultural Science, North Carolina State University, Raleigh, NC, United States
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Clark JR. Mastering the Patient Handoff. Air Med J 2023; 42:86-87. [PMID: 36958877 DOI: 10.1016/j.amj.2023.01.005] [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: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
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O’Boyle CJ, Siravegna G, Varmeh S, Queenan N, Michel A, Sing Pang KC, Stein J, Thierauf JC, Sadow PM, Faquin WC, Wang W, Deschler DG, Emerick KS, Varvares MA, Park JC, Clark JR, Chan AW, Busse PM, Corcoran RB, Wirth LJ, Lin DT, Iafrate AJ, Richmon JD, Faden DL. Cell-free human papillomavirus DNA kinetics after surgery for human papillomavirus-associated oropharyngeal cancer. Cancer 2022; 128:2193-2204. [PMID: 35139236 PMCID: PMC10032347 DOI: 10.1002/cncr.34109] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/14/2021] [Accepted: 12/24/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND New ultrasensitive methods for detecting residual disease after surgery are needed in human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV+OPSCC). METHODS To determine whether the clearance kinetics of circulating tumor human papillomavirus DNA (ctHPVDNA) is associated with postoperative disease status, a prospective observational study was conducted in 33 patients with HPV+OPSCC undergoing surgery. Blood was collected before surgery, postoperative days 1 (POD 1), 7, and 30 and with follow-up. A subcohort of 12 patients underwent frequent blood collections in the first 24 hours after surgery to define early clearance kinetics. Plasma was run on custom droplet digital polymerase chain reaction (ddPCR) assays for HPV genotypes 16, 18, 33, 35, and 45. RESULTS In patients without pathologic risk factors for recurrence who were observed after surgery, ctHPVDNA rapidly decreased to <1 copy/mL by POD 1 (n = 8/8). In patients with risk factors for macroscopic residual disease, ctHPVDNA was markedly elevated on POD 1 (>350 copies/mL) and remained elevated until adjuvant treatment (n = 3/3). Patients with intermediate POD 1 ctHPVDNA levels (1.2-58.4 copies/mL) all possessed pathologic risk factors for microscopic residual disease (n = 9/9). POD 1 ctHPVDNA levels were higher in patients with known adverse pathologic risk factors such as extranodal extension >1 mm (P = .0481) and with increasing lymph nodes involved (P = .0453) and were further associated with adjuvant treatment received (P = .0076). One of 33 patients had a recurrence that was detected by ctHPVDNA 2 months earlier than clinical detection. CONCLUSIONS POD 1 ctHPVDNA levels are associated with the risk of residual disease in patients with HPV+OPSCC undergoing curative intent surgery and thus could be used as a personalized biomarker for selecting adjuvant treatment in the future. LAY SUMMARY Human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV+OPSCC) is increasing at epidemic proportions and is commonly treated with surgery. This report describes results from a study examining the clearance kinetics of circulating tumor HPV DNA (circulating tumor human papillomavirus DNA [ctHPVDNA]) following surgical treatment of HPV+OPSCC. We found that ctHPVDNA levels 1 day after surgery are associated with the risk of residual disease in patients with HPV+OPSCC and thus could be used as a personalized biomarker for selecting adjuvant treatment in the future. These findings are the first to demonstrate the potential utility of ctHPVDNA in patients with HPV+OPSCC undergoing surgery.
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Affiliation(s)
- Connor J. O’Boyle
- Department of Otolaryngology–Head and Neck Surgery Massachusetts Eye and Ear, Boston, Massachusetts
| | - Giulia Siravegna
- Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Shohreh Varmeh
- Department of Otolaryngology–Head and Neck Surgery Massachusetts Eye and Ear, Boston, Massachusetts
| | - Natalia Queenan
- Department of Otolaryngology–Head and Neck Surgery Massachusetts Eye and Ear, Boston, Massachusetts
| | - Alexa Michel
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Kim Chang Sing Pang
- Department of Otolaryngology–Head and Neck Surgery Massachusetts Eye and Ear, Boston, Massachusetts
- Vrije Universiteit of Amsterdam, Amsterdam, the Netherlands
| | - Jarrod Stein
- Department of Otolaryngology–Head and Neck Surgery Massachusetts Eye and Ear, Boston, Massachusetts
| | - Julia C. Thierauf
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Peter M. Sadow
- Department of Otolaryngology–Head and Neck Surgery Massachusetts Eye and Ear, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - William C. Faquin
- Department of Otolaryngology–Head and Neck Surgery Massachusetts Eye and Ear, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Wei Wang
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Daniel G. Deschler
- Department of Otolaryngology–Head and Neck Surgery Massachusetts Eye and Ear, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Kevin S. Emerick
- Department of Otolaryngology–Head and Neck Surgery Massachusetts Eye and Ear, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Mark A. Varvares
- Department of Otolaryngology–Head and Neck Surgery Massachusetts Eye and Ear, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jong C. Park
- Harvard Medical School, Boston, Massachusetts
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - John R. Clark
- Harvard Medical School, Boston, Massachusetts
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Annie W. Chan
- Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Paul M. Busse
- Harvard Medical School, Boston, Massachusetts
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Ryan B. Corcoran
- Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Lori J. Wirth
- Harvard Medical School, Boston, Massachusetts
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Derrick T. Lin
- Department of Otolaryngology–Head and Neck Surgery Massachusetts Eye and Ear, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - A. John Iafrate
- Harvard Medical School, Boston, Massachusetts
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeremy D. Richmon
- Department of Otolaryngology–Head and Neck Surgery Massachusetts Eye and Ear, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Daniel L. Faden
- Department of Otolaryngology–Head and Neck Surgery Massachusetts Eye and Ear, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
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Varanasi A, Worthington M, Nelson L, Brown A, Chizk TM, Threlfall R, Howard L, Conner P, Figueroa-Balderas R, Massonnet M, Cantu D, Clark JR. Glutathione S-transferase: a candidate gene for berry color in muscadine grapes (Vitis rotundifolia). G3 (Bethesda) 2022; 12:6550507. [PMID: 35302606 PMCID: PMC9073687 DOI: 10.1093/g3journal/jkac060] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/09/2022] [Indexed: 01/27/2023]
Abstract
Muscadine grapes (Vitis rotundifolia Michx.) are a specialty crop cultivated in the southern United States. Muscadines (2n = 40) belong to the Muscadinia subgenus of Vitis, while other cultivated grape species belong to the subgenus Euvitis (2n = 38). The muscadine berry color locus was mapped to a 0.8 Mbp region syntenic with chromosome 4 of Vitis vinifera. In this study, we identified glutathione S-transferase4 as a likely candidate gene for anthocyanin transport within the berry color locus. PCR and Kompetitive allele-specific PCR genotyping identified a single intragenic SNP (C/T) marker corresponding to a proline to leucine mutation within the muscadine glutathione S-transferase4 (VrGST4) that differentiated black (CC and CT) from bronze (TT) muscadines in 126 breeding selections, 76 cultivars, and 359 progeny from 3 mapping populations. Anthocyanin profiling on a subset of the progeny indicated a dominant VrGST4 action. VrGST4 was expressed in skins of both black and bronze muscadines at similar levels. While nonsynonymous polymorphisms between black and bronze muscadines were discovered in VrGSTF12, another Type I GST-coding gene in the muscadine color locus, this gene was ruled out as a possible candidate for berry color because RNA sequencing indicated it is not expressed in berry skins at véraison from black or bronze genotypes. These results suggest that the bronze phenotype in muscadines is regulated by a mechanism distinct from the MybA gene cluster responsible for berry color variation in Vitis vinifera.
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Affiliation(s)
- Aruna Varanasi
- Department of Horticulture, University of Arkansas, Fayetteville, AR 72701, USA
| | | | - Lacy Nelson
- Department of Horticulture, University of Arkansas, Fayetteville, AR 72701, USA
| | - Autumn Brown
- Department of Horticulture, University of Arkansas, Fayetteville, AR 72701, USA
| | - Thomas Mason Chizk
- Department of Horticulture, University of Arkansas, Fayetteville, AR 72701, USA
| | - Renee Threlfall
- Department of Food Science, University of Arkansas, Fayetteville, AR 72701, USA
| | - Luke Howard
- Department of Food Science, University of Arkansas, Fayetteville, AR 72701, USA
| | - Patrick Conner
- Department of Horticulture, University of Georgia, Tifton, GA 31793, USA
| | - Rosa Figueroa-Balderas
- Department of Viticulture & Enology, University of California, Davis, Davis, CA 95616, USA
| | - Mélanie Massonnet
- Department of Viticulture & Enology, University of California, Davis, Davis, CA 95616, USA
| | - Dario Cantu
- Department of Viticulture & Enology, University of California, Davis, Davis, CA 95616, USA
| | - John R Clark
- Department of Horticulture, University of Arkansas, Fayetteville, AR 72701, USA
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Zafar A, Drobni ZD, Lei M, Gongora CA, Quinaglia T, Lou UY, Mosarla R, Murphy SP, Jones-O’Connor M, Mahmood A, Hartmann S, Gilman HK, Weekes CD, Nipp R, Clark JR, Clark JW, Blaszkowsky LS, Tavares E, Neilan TG. The efficacy and safety of cardio-protective therapy in patients with 5-FU (Fluorouracil)-associated coronary vasospasm. PLoS One 2022; 17:e0265767. [PMID: 35390017 PMCID: PMC8989300 DOI: 10.1371/journal.pone.0265767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 03/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Coronary vasospasm is a known side effect of 5-FU (fluorouracil) therapy. Beyond switching to non-5FU-based chemotherapy, there are no established treatments for 5-FU associated coronary vasospam. Our objective was to assess the safety and efficacy of re-challenge with 5-FU after pre-treatment with calcium channel blockers (CCBs) and long-acting nitrates among patients 5-FU associated coronary vasospasm. Methods We conducted a retrospective study of patients with 5-FU coronary vasospasm at a single academic center. By protocol, those referred to cardio-oncology received pre-treatment with either combination [nitrates and CCBs] or single-agent therapy [nitrates or CCBs]) prior to re-challenge with 5-FU. Our primary outcome was overall survival. Other important outcomes included progression-free survival and safety. Results Among 6,606 patients who received 5-FU from January 2001 to Dec 2020, 115 (1.74%) developed coronary vasospasm. Of these 115 patients, 81 patients continued 5-FU therapy, while 34 stopped. Of the 81 who continued, 78 were referred to cardio-oncology and prescribed CCBs and/or nitrates prior to subsequent 5-FU, while the remaining 3 continued 5-FU without cardiac pre-treatment. Of the 78, 56.4% (44/78) received both nitrates and CCBs, 19.2% (15/78) received CCBs alone, and 24.4% (19/78) received nitrates alone. When compared to patients who stopped 5-FU, those who continued 5-FU after pre-treatment (single or combination therapy) had a decreased risk of death (HR 0.42, P = 0.005 [95% CI 0.23–0.77]) and a trend towards decreased cancer progression (HR 0.60, P = 0.08 [95% CI 0.34–1.06]). No patient in the pre-treatment group had a myocardial infarct after re-challenge; however, chest pain (without myocardial infarction) recurred in 19.2% (15/78) among those who received cardiac pre-treatment vs. 66.7% (2/3) among those who did not (P = 0.048). There was no difference in efficacy or the recurrence of vasospasm among patients who received pre-treatment with a single agent (nitrates or CCBs) or combination therapy (14.7% (5/34) vs. 25.0% (11/44), P = 0.26). Conclusion Re-challenge after pre-treatment with CCBs and nitrates guided by a cardio-oncology service was safe and allowed continued 5-FU therapy.
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Affiliation(s)
- Amna Zafar
- Department of Radiology and Division of Cardiology, Cardiovascular Imaging Research Center (CIRC), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Cardiovascular Diseases and Hypertension, Department of Medicine, Robert Wood Johnson University Hospital, Rutgers Medical School, New Brunswick, New Jersey, United States of America
| | - Zsofia D. Drobni
- Department of Radiology and Division of Cardiology, Cardiovascular Imaging Research Center (CIRC), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Matthew Lei
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Carlos A. Gongora
- Department of Radiology and Division of Cardiology, Cardiovascular Imaging Research Center (CIRC), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Thiago Quinaglia
- Department of Radiology and Division of Cardiology, Cardiovascular Imaging Research Center (CIRC), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Uvette Y. Lou
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ramya Mosarla
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sean P. Murphy
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Maeve Jones-O’Connor
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ali Mahmood
- Division of Cardiology, Department of Medicine, Morristown Medical Center, Morristown, New Jersey, United States of America
| | - Sarah Hartmann
- Department of Radiology and Division of Cardiology, Cardiovascular Imaging Research Center (CIRC), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Hannah K. Gilman
- Department of Radiology and Division of Cardiology, Cardiovascular Imaging Research Center (CIRC), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Colin D. Weekes
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ryan Nipp
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - John R. Clark
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jeffrey W. Clark
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Lawrence S. Blaszkowsky
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Erica Tavares
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Tomas G. Neilan
- Department of Radiology and Division of Cardiology, Cardiovascular Imaging Research Center (CIRC), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Cardiology, Department of Medicine, Cardio-Oncology Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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Oh J, Carlson JCT, Landeros C, Lee H, Ferguson S, Faquin WC, Clark JR, Pittet MJ, Pai SI, Weissleder R. Abstract P056: Rapid serial immunoprofiling of the tumor immune microenvironment by fine needle sampling. Cancer Immunol Res 2022. [DOI: 10.1158/2326-6074.tumimm21-p056] [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
As the field of cancer immunotherapy brings forth novel and combinatorial agents, there is increasing effort to discover and integrate predictive and/or prognostic biomarkers into treatment algorithms in order to optimize cancer care. While tissue-based methods can elucidate tumor-immune cell compositions at a single time point, serial assessment of the tumor immune microenvironment (TME) can provide unique insight into how various therapies may modulate target tumor and/or immune cell populations over time. We propose that single-cell sampling via fine needle aspirates (FNA) can facilitate such analyses with a favorable risk-benefit profile. Thus, we developed and optimized a multiplexed bioorthogonal approach (FAST-FNA) which has been coupled with a deep learning algorithm that allows for comprehensive cellular analyses of FNA samples. We demonstrate that the FAST-FNA assay reproducibly captures the TME profile as compared to standard labor-intensive flow cytometry and immunohistochemical assays, and, furthermore, allows for time course analysis of the evolving TME in mouse and human cancers in vivo. The translational significance of the FNA-based technology is highlighted in the ability to rapidly assess PD-L1 expression within the TME and is further extended through the serial quantitation of both tumor and immune cell markers in cancer patients treated with immunotherapy. Collectively, these data indicate that FAST-FNA can serve as a robust and versatile clinical tool to monitor the evolving TME and has the potential to provide early insight into treatment response.
Citation Format: Juhyun Oh, Jonathan C. T. Carlson, Christian Landeros, Hakho Lee, Scott Ferguson, William C. Faquin, John R. Clark, Mikael J. Pittet, Sara I. Pai, Ralph Weissleder. Rapid serial immunoprofiling of the tumor immune microenvironment by fine needle sampling [abstract]. In: Abstracts: AACR Virtual Special Conference: Tumor Immunology and Immunotherapy; 2021 Oct 5-6. Philadelphia (PA): AACR; Cancer Immunol Res 2022;10(1 Suppl):Abstract nr P056.
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Affiliation(s)
- Juhyun Oh
- 1Massachusetts General Hospital, Boston, MA
| | | | | | - Hakho Lee
- 1Massachusetts General Hospital, Boston, MA
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Clark JR. Don't Let Them Take Your License. Air Med J 2022; 41:11-13. [PMID: 35248329 DOI: 10.1016/j.amj.2021.10.015] [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: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
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11
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Siravegna G, O'Boyle CJ, Varmeh S, Queenan N, Michel A, Stein J, Thierauf J, Sadow PM, Faquin WC, Perry SK, Bard AZ, Wang W, Deschler DG, Emerick KS, Varvares MA, Park JC, Clark JR, Chan AW, Andreu Arasa VC, Sakai O, Lennerz J, Corcoran RB, Wirth LJ, Lin DT, Iafrate AJ, Richmon JD, Faden DL. Cell free HPV DNA provides an accurate and rapid diagnosis of HPV-associated head and neck cancer. Clin Cancer Res 2021; 28:719-727. [PMID: 34857594 DOI: 10.1158/1078-0432.ccr-21-3151] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/15/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE HPV-associated Head and Neck Squamous Cell Carcinoma(HPV+HNSCC) is the most common HPV-associated malignancy in the United States and continues to increase in incidence. Current diagnostic approaches for HPV+HNSCC rely on tissue biopsy followed by histomorphologic assessment and detection of HPV indirectly by p16 immunohistochemistry. Such approaches are invasive and have variable sensitivity. EXPERIMENTAL DESIGN We conducted a prospective observational study in 140 subjects (70 cases and 70 controls) to test the hypothesis that a non-invasive diagnostic approach for HPV+HNSCC would have improved diagnostic accuracy, lower cost, and shorter Diagnostic Interval compared to standard approaches. Blood was collected, processed for circulating tumor HPV DNA(ctHPVDNA) and analyzed with custom ddPCR assays for HPV genotypes 16,18, 33, 35 and 45. Diagnostic performance, cost and Diagnostic Interval were calculated for standard clinical work up and compared to a non-invasive approach using ctHPVDNA combined with cross-sectional imaging and physical exam findings. RESULTS Sensitivity and specificity of ctHPVDNA for detecting HPV+HNSCC was 98.4% and 98.6%. Sensitivity and specificity of a composite non-invasive diagnostic using ctHPVDNA and imaging/physical exam were 95.1% and 98.6%. Diagnostic accuracy of this non-invasive approach was significantly higher than standard of care (Youden index 0.937 vs 0.707, p=0.0006). Costs of non-invasive diagnostic were 36-38% less than standard clinical work up and the median Diagnostic Interval was 26 days less. CONCLUSIONS A non-invasive diagnostic approach for HPV+HNSCC demonstrated improved accuracy, reduced cost and a shorter time to diagnosis compared to standard clinical workup and could be a viable alternative in the future.
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Affiliation(s)
| | - Connor J O'Boyle
- Otolaryngology-Head and Neck Suirgery, Massachusetts Eye and Ear
| | | | - Natalia Queenan
- Otolaryngology-Head and Neck Suirgery, Massachusetts Eye and Ear
| | | | - Jarrod Stein
- Otolaryngology-Head and Neck Suirgery, Massachusetts Eye and Ear, Massachusetts General Hospital, Harvard Medical School, Broad Institute
| | - Julia Thierauf
- Department of Otolaryngology, Head and Neck Surgery, 1985
| | | | | | - Simon K Perry
- Department of Pathology, Massachusetts General Hospital
| | - Adam Z Bard
- Department of Pathology, Massachusetts General Hospital
| | - Wei Wang
- 6. Departments of Medicine and Neurology, Brigham and Women's Hospital
| | - Daniel G Deschler
- Otology and Laryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School
| | - Kevin S Emerick
- Otolaryngology-Head and Neck Suirgery, Massachusetts Eye and Ear, Massachusetts General Hospital, Harvard Medical School, Broad Institute
| | - Mark A Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary,, Harvard Medical School
| | - Jong C Park
- Hematology and Oncology, Massachusetts General Hospital
| | - John R Clark
- Hematology and Oncology, Massachusetts General Hospital/Harvard Medical School
| | - Annie W Chan
- Radiation Oncology, Massachusetts General Hospital
| | | | - Osamu Sakai
- Department or Radiology, Boston Medical Center
| | | | | | - Lori J Wirth
- Department of Medicine, Massachusetts General Hospital
| | | | | | - Jeremy D Richmon
- Otolaryngology-Head and Neck Suirgery, Massachusetts Eye and Ear, Massachusetts General Hospital, Harvard Medical School, Broad Institute
| | - Daniel L Faden
- Otolaryngology-Head and Neck Suirgery, Massachusetts Eye and Ear, Massachusetts General Hospital, Harvard Medical School, Broad Institute
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12
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Oh J, Carlson JCT, Landeros C, Lee H, Ferguson S, Faquin WC, Clark JR, Pittet MJ, Pai SI, Weissleder R. Rapid Serial Immunoprofiling of the Tumor Immune Microenvironment by Fine Needle Sampling. Clin Cancer Res 2021; 27:4781-4793. [PMID: 34233961 PMCID: PMC8416923 DOI: 10.1158/1078-0432.ccr-21-1252] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 04/05/2021] [Revised: 05/19/2021] [Accepted: 06/30/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE There is increasing effort to discover and integrate predictive and/or prognostic biomarkers into treatment algorithms. While tissue-based methods can reveal tumor-immune cell compositions at a single time point, we propose that single-cell sampling via fine needle aspiration (FNA) can facilitate serial assessment of the tumor immune microenvironment (TME) with a favorable risk-benefit profile. EXPERIMENTAL DESIGN Primary antibodies directed against 20 murine and 25 human markers of interest were chemically modified via a custom linker-bio-orthogonal quencher (FAST) probe. A FAST-FNA cyclic imaging and analysis pipeline were developed to derive quantitative response scores. Single cells were harvested via FNA and characterized phenotypically and functionally both in preclinical and human samples using the newly developed FAST-FNA assay. RESULTS FAST-FNA samples analyzed manually versus the newly developed deep learning-assisted pipeline gave highly concordant results. Subsequently, an agreement analysis showed that FAST and flow cytometry of surgically resected tumors were positively correlated with an R2 = 0.97 in preclinical samples and an R2 = 0.86 in human samples with the detection of the relevant tumor and immune biomarkers of interest. Finally, the feasibility of applying this minimally invasive approach to analyze the TME during immunotherapy was assessed in patients with cancer revealing local antitumor immune programs. CONCLUSIONS The FAST-FNA is an innovative technology that combines bio-orthogonal chemistry coupled with a computational analysis pipeline for the comprehensive profiling of single cells obtained through FNA. This is the first demonstration that the complex and rapidly evolving TME during treatment can be accurately and serially measured by simple FNA.
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Affiliation(s)
- Juhyun Oh
- Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonathan C T Carlson
- Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Harvard Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Christian Landeros
- Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard-MIT Program in Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Hakho Lee
- Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Scott Ferguson
- Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - William C Faquin
- Division of Head and Neck Pathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John R Clark
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Harvard Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Mikael J Pittet
- Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
- Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
- Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Sara I Pai
- Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts.
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Harvard Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
- Division of Interventional Radiology, Department of Radiology Massachusetts General Hospital, Boston, Massachusetts
- Department of Systems Biology, Harvard Medical School, Boston, Massachusetts
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13
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Hanna GJ, O'Neill A, Cutler JM, Flynn M, Vijaykumar T, Clark JR, Wirth LJ, Lorch JH, Park JC, Mito J, Lohr JG, Kaufman J, Zon LI, Haddad RI. Abstract CT165: A phase II trial of all-trans retinoic acid (ATRA) in advanced adenoid cystic carcinoma. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-ct165] [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
Purpose: Recurrent or metastatic adenoid cystic carcinoma (R/M ACC) is a rare cancer often arising from the salivary glands of the head and neck. While effective therapies are lacking, preclinical models have suggested that retinoic acid agonists may inhibit ACC growth by blocking MYB binding at translocated gene enhancers. We conducted a phase II trial evaluating retinoic acid as a potential novel therapy for R/M ACC. Patients and methods: Patients with histologically confirmed R/M ACC of any primary site with measurable disease (RECIST v1.1), clinical or radiographic progression within 12 months prior to enrollment, and any number of prior lines of therapy were eligible. Cohort 1 (CH1) received ATRA 45 mg/m2 split oral daily dosing on days 1-14 of a 28-day cycle; cohort 2 (CH2) received the same dosing continuously; treatment continued until disease progression. The primary endpoint was best overall response: ≥5 patients in CH1 with disease in response (CR+PR) among N=25 (assuming ≥2 of N=14 accrued in first stage of a two-stage design had disease in response) provided 85% power to target a >10% response rate (one-sided 9% binomial test). Secondary endpoints: safety, progression-free survival (PFS), overall survival. Exploratory analyses: ATRA impact on MYB expression, define resistance mechanisms, and monitor circulating tumor DNA. All had targeted tumor sequencing prior to enrollment. Results: Between 8/2019 and 2/2020, N=14 enrolled in stage 1 CH1. Primary endpoint of response to continue accrual into stage 2 in CH1 was not met; by 5/2020, N=4 enrolled in CH2 when the trial closed to accrual (budget constraints). Among 18 patients, median age: 58, 61% (11/18) women; each patient had a median of 3 organs (range, 1-4) with metastatic disease. 39% had 2+ prior lines of therapy. Best overall response: CR+PR 0%; SD 61% (11/18); PD 28% (5/18); unevaluable 11% (2/18). Median duration of stability 3.5 months (range, 1-12.3+). One patient (CH1) remains on drug with SD >1 year. Half of those who received prior VEGFR therapy achieved SD (4/8). At a median follow-up of 7.9 months, median PFS was 3.2 months (95% CI, 1.8-3.9). N=1 required dose adjustment; N=1 came off drug for toxicity. There were no grade 3-4 adverse events (headache, dry skin were common); no deaths due to treatment. Median tumor mutational burden was 0 (range, 0-5). NOTCH1 was the most frequent alteration (4, 22%) with 2 evaluable NOTCH1-mutant patients exhibiting SD. Mutations in the PI3K pathway, TP53, and TERT promoter were common. Low MYB protein expression was associated with longer duration of stability (p<0.01). Conclusion: While the trial did not meet its prespecified overall response endpoint, SD was observed among R/M ACC patients with disease progression 12 months prior to enrollment. This combined with limited toxicity makes ATRA a treatment option for long-term growth stabilization alone, or worth exploring in combination with other agents for R/M ACC.
Citation Format: Glenn J. Hanna, Anne O'Neill, Jennifer M. Cutler, Michelle Flynn, Tushara Vijaykumar, John R. Clark, Lori J. Wirth, Jochen H. Lorch, Jong C. Park, Jeffrey Mito, Jens G. Lohr, Jeffrey Kaufman, Leonard I. Zon, Robert I. Haddad. A phase II trial of all-trans retinoic acid (ATRA) in advanced adenoid cystic carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT165.
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14
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Hanna GJ, ONeill A, Cutler JM, Flynn M, Vijaykumar T, Clark JR, Wirth LJ, Lorch JH, Park JC, Mito JK, Lohr JG, Kaufman J, Burr NS, Zon LI, Haddad RI. A phase II trial of all-trans retinoic acid (ATRA) in advanced adenoid cystic carcinoma. Oral Oncol 2021; 119:105366. [PMID: 34091189 DOI: 10.1016/j.oraloncology.2021.105366] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 04/19/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Effective therapies are lacking for recurrent, metastatic adenoid cystic carcinoma (R/M ACC) and preclinical models suggest retinoic acid agonists inhibit ACC growth. This phase II trial evaluated all-trans retinoic acid (ATRA) as a novel therapy for ACC. METHODS Patients with R/M ACC (any site) with clinical and/or radiographic progression ≤12 months prior to study entry were eligible. Cohort 1 (CH1) received ATRA 45 mg/m2 split oral daily dosing on days 1-14 of a 28-day cycle; Cohort 2 (CH2) received the same dosing continuously. Primary endpoint was best overall response rate (CR + PR) (RECIST v1.1). Secondary endpoints: safety and progression-free survival (PFS). Exploratory analyses: ATRA impact on MYB expression and genomic predictors of response. RESULTS Eighteen patients enrolled. There were no responses, but 61% (11/18) had stable disease (SD) and 28% (5/18) progression as best response; 11% (2/18) unevaluable. Median duration of stability: 3.7 months (95%CI, 1.9-3.9). One patient (CH1) remains on drug with SD approaching 1 year. Half of those who received prior VEGFR therapy achieved SD (4/8). At median follow up of 7.9 months, median PFS was 3.2 months (95%CI, 1.8-3.9). N = 1 required dose adjustment; N = 1 came off drug for toxicity. There were no grade 3-4 adverse events. NOTCH1 and PI3K pathway alterations were most frequent. Low MYB protein expression was associated with longer duration of stability on ATRA (P < 0.01). CONCLUSION(S) While the trial did not meet its prespecified response endpoint, ATRA alone or in combination may be a low toxicity treatment for disease growth stabilization in R/M ACC.
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Affiliation(s)
- Glenn J Hanna
- Department of Medical Oncology, Center for Head & Neck Oncology, Center for Salivary and Rare Head and Neck Cancers, Dana-Farber Cancer Institute, Boston, USA.
| | - Anne ONeill
- Department of Data Science, Dana-Farber Cancer Institute, Boston, USA
| | - Jennifer M Cutler
- Department of Medical Oncology, Center for Head & Neck Oncology, Center for Salivary and Rare Head and Neck Cancers, Dana-Farber Cancer Institute, Boston, USA
| | - Michelle Flynn
- Department of Medical Oncology, Center for Head & Neck Oncology, Center for Salivary and Rare Head and Neck Cancers, Dana-Farber Cancer Institute, Boston, USA
| | - Tushara Vijaykumar
- Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - John R Clark
- Center for Head and Neck Cancers, Massachusetts General Hospital, Boston, USA
| | - Lori J Wirth
- Center for Head and Neck Cancers, Massachusetts General Hospital, Boston, USA
| | - Jochen H Lorch
- Department of Medical Oncology, Center for Head & Neck Oncology, Center for Salivary and Rare Head and Neck Cancers, Dana-Farber Cancer Institute, Boston, USA
| | - Jong C Park
- Center for Head and Neck Cancers, Massachusetts General Hospital, Boston, USA
| | - Jeffrey K Mito
- Department of Pathology, Brigham & Women's Hospital, Boston, USA
| | - Jens G Lohr
- Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, USA
| | | | | | - Leonard I Zon
- Department of Stem Cell and Regenerative Biology, Boston Children's Hospital and Harvard Medical School, Boston, USA
| | - Robert I Haddad
- Department of Medical Oncology, Center for Head & Neck Oncology, Center for Salivary and Rare Head and Neck Cancers, Dana-Farber Cancer Institute, Boston, USA
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15
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Barry CP, MacDhabheid C, Tobin K, Stassen LF, Lennon P, Toner M, O'Regan E, Clark JR. 'Out of house' virtual surgical planning for mandible reconstruction after cancer resection: is it oncologically safe? Int J Oral Maxillofac Surg 2020; 50:999-1002. [PMID: 33317906 DOI: 10.1016/j.ijom.2020.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/14/2020] [Accepted: 11/06/2020] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to investigate whether the time delay between 'out of house' proprietary virtual surgical planning (OH-VSP) of the mandibular resection for oral cancer and the actual surgery results in compromised margins and oncological disadvantage for the patient. Outcomes of patients who had OH-VSP of their mandibular resection and reconstruction were compared with those of patients who had the same surgery using a conventional non-VSP approach. The groups were similar in patient demographics, tumour stage and size, nodal status, and reconstruction complexity. VSP resulted in a significant reduction in operating time (P<0.01). VSP did not affect bony (P=0.49) or soft tissue (P=0.22) margin status. In summary, VSP reduced the operating theatre time, and despite the time interval between bony resection planning and surgery, there was no compromise to the oncological safety of the operation.
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Affiliation(s)
- C P Barry
- Head and Neck Surgery Unit, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland; School of Dental Science, Trinity College, Dublin, Ireland.
| | - C MacDhabheid
- Head and Neck Surgery Unit, St James's Hospital, Dublin, Ireland
| | - K Tobin
- School of Medicine, Trinity College, Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Ireland
| | - L F Stassen
- Head and Neck Surgery Unit, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland
| | - P Lennon
- Head and Neck Surgery Unit, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland
| | - M Toner
- School of Dental Science, Trinity College, Dublin, Ireland; Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - E O'Regan
- School of Medicine, Trinity College, Dublin, Ireland; Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - J R Clark
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Central Clinical School, University of Sydney, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
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16
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Park JC, Durbeck J, Clark JR. Predictive value of peripheral lymphocyte counts for immune checkpoint inhibitor efficacy in advanced head and neck squamous cell carcinoma. Mol Clin Oncol 2020; 13:87. [PMID: 33194194 DOI: 10.3892/mco.2020.2157] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/09/2020] [Indexed: 12/30/2022] Open
Abstract
Anti-programmed death 1 (PD-1) immune checkpoint inhibitors (ICI) have revolutionized the treatment of advanced head and neck squamous cell carcinoma (HNSCC) but benefit only a small subset of patients. Several studies have previously assessed the predictive value of peripheral lymphocyte count for ICI therapy responses; however the optimal lymphocyte measure for the best predictive value in HNSCC is unknown. The present study examined the predictive values of multiple peripheral lymphocyte measures for anti-PD-1 ICI therapy in advanced HNSCC. Clinicopathologic data were retrospectively collected on patients with recurrent or metastatic HNSCC who had received anti-PD-1 therapy. The association between clinical outcomes and various peripheral lymphocyte count measures was analyzed, including absolute lymphocyte count (ALC) and neutrophil-to-lymphocyte ratios (NLR) at baseline, week 6, and change from baseline to week 6. The primary outcome of interest was progression-free survival (PFS). A total of 108 patients with HNSCC who had received anti-PD-1 therapy were identified. The median PFS was 4.1 months. Week 6 high ALC (≥0.77) and low NLR (<6.2) were associated with a longer PFS (5.6 vs. 3.1 months, P=0.002; and 8.7 vs. 2.9 months, P=0.001, respectively). Decreased NLR during treatment was also associated with an improved PFS (6.7 vs. 2.7 months; P=0.015). Baseline lymphocyte counts and absolute lymphocyte changes during treatment did not predict ICI outcome. The present single institution retrospective study suggested that ALC and NLR values at week 6, and on-treatment NLR dynamic change have predictive value for anti-PD-1 therapy response.
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Affiliation(s)
- Jong Chul Park
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA.,Harvard Medical School, Boston, MA 02115, USA
| | - Julia Durbeck
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, USA
| | - John R Clark
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA.,Harvard Medical School, Boston, MA 02115, USA
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17
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Petrides GA, Clark JR. Focused tumour dissection: an alternative conservative parotidectomy approach. Br J Oral Maxillofac Surg 2020; 59:244-246. [PMID: 33168365 DOI: 10.1016/j.bjoms.2020.08.076] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/12/2020] [Indexed: 11/25/2022]
Affiliation(s)
- G A Petrides
- The University of New South Wales, Sydney, Australia.
| | - J R Clark
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia; Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
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18
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Johal M, Leinkram D, Wallace C, Clark JR. The Sydney Modified Alberta Reconstruction Technique (SM-ART) for dental rehabilitation following mandibulectomy or maxillectomy. Int J Oral Maxillofac Surg 2020; 50:615-618. [PMID: 33069518 DOI: 10.1016/j.ijom.2020.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/11/2020] [Accepted: 09/17/2020] [Indexed: 11/30/2022]
Abstract
The Sydney Modification of the Alberta Mandibular Reconstruction technique (SM-ART) is a hybrid of the Rohner method and the Alberta Reconstructive Technique (ART). SM-ART differs from ART in three ways, notably the use of custom plates, intraoral placement of implants via three-dimensionally printed guides and a skin graft buried deep into the skin paddle of the fibula flap in the first stage of the reconstruction.
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Affiliation(s)
- M Johal
- St George & Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
| | - D Leinkram
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia
| | - C Wallace
- Central Clinical School, Faculty of Health and Medical Sciences, University of Sydney, Australia; Westmead Oral Restorative Sciences, Sydney, Australia
| | - J R Clark
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Central Clinical School, Faculty of Health and Medical Sciences, University of Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
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Clark JR, Pierce GW. Paramedic Board Certification: The International Board of Specialty Certification Turns 20. Air Med J 2020; 39:334-339. [PMID: 33012468 DOI: 10.1016/j.amj.2020.07.006] [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: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
The International Board of Specialty Certification (IBSC) has been offering specialty certification for 20 years. Originally formed as the Board for Critical Care Transport Paramedic Certification (BCCTPC), the first official examination at the Air Medical Transport Conference (AMTC) in October of 2000. Paramedic specialty certification flourished because of the vision and tireless commitment of a small group of paramedic champions. Some of that group from 20 years ago included David O. Bump, John R. Clark, Dr. John Cole, Dr. Robert Donovan, Chris Giller, Lisa Gilmore, Jonathan Gryniuk; Bob Hesse, TJ Kennedy, Brian Schaeffer, and Jackie Stocking. Without their tenacity, paramedic specialty certification would not be celebrating this milestone. The IBSC is a functional specialty board with a mission to support paramedicine specialties anywhere in the world. The Certified Flight Paramedic (FP-C®), Certified Critical Care Paramedic (CCP-C®) Certified Tactical Paramedic (TP-C®), Certified Tactical Responder (TR-C®) and Certified Community Paramedic (CP-C®) examinations are well established and have become a recognized standard for clinical competency by medical providers in the United States, Europe, South Africa and the Middle East. Founded in 2000, the IBSC is a not-for-profit professional certification organization responsible for the administration and development of specialty certification exams for critical care professionals. The mission of the IBSC is to improve quality of care in all aspects of specialty EMS care across a wide variety of settings by providing a portfolio of certification exams that are an objective, fair, and honest validation of specialty knowledge to paramedics and other allied health providers are called upon to perform critical care transport. Exams are developed that are responsive to the needs of the paramedic community. Currently, there are nearly 10,000 board certified providers in one of the five specialty designations.
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Affiliation(s)
- John R Clark
- International Board of Specialty Certification, Snellville, GA.
| | - Graham W Pierce
- International Board of Specialty Certification, Snellville, GA
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20
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Clark JR. Discrimination and the Bona Fide Occupational Qualification. Air Med J 2020; 39:324-326. [PMID: 33012464 DOI: 10.1016/j.amj.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
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22
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Park JC, Wirth LJ, Clark JR, Durbeck J, Ho WJ, Boudadi K, Kang H. Immune checkpoint inhibitor in nasopharyngeal carcinoma: Multi-institution experience. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6538 Background: The current standard treatment for unresectable recurrent/metastatic (R/M) nasopharyngeal carcinoma (NPC) is cytotoxic chemotherapy but prognosis remains poor. Recent phase I-II trials of anti-PD-1 therapy (aPD-1) have demonstrated promising activity in R/M NPC, but the published experience is primarily limited to Epstein-Barr virus (EBV) positive tumors in the Asian population. Here we report our three institutional real-world experience with aPD-1 in patients (pts) with R/M NPC. Methods: A retrospective analysis was conducted after IRB approval at the Massachusetts General, Johns Hopkins, and University California San Francisco Hospitals. Demographic and clinical data was collected on pts with R/M NPC who received aPD-1 at the participating institutions. Objective response rate (ORR) was the primary outcome of interest and progression free survival (PFS) and overall survival were secondary outcomes. Univariate and multivariate analyses were conducted to assess association between clinicopathologic factors and outcomes, using logistic regression models. Results: A total of 36 pts were identified: 20 pts were treated with pembrolizumab and 16 with nivolumab. Median age was 50 (15-74). Twenty-nine (81%) were male. Twenty pts (56%) were Asian. Twenty-nine pts (81%) had EBV positive disease. Nine (25%) had aPD-1 as first-line therapy (1L). Molecular profiling results were available in 16 pts: TP53 mutation was the most common alteration (25%) and was limited to EBV negative tumors. Median total mutational burden (TMB) was 3/Mb (1-28). Median PD-L1 expression was 10% (0-90). Median follow up was 13.9 months (mos). Objective response was evaluable in all 36 pts: 9 pts achieved objective response (ORR 25.0%, 95% CI 12.1-42.2) with 2 complete responses: EBV positive vs. negative (27.6% vs. 14.2%, P=0.472), Asian vs. non-Asian (25% vs. 25%, P=1.000), and 1L vs. >1L (33.3% vs. 22.2%, P=0.511). Thirteen pts had stable disease (disease control rate 61.1%). Responses were seen in both TMB high (28/Mb) and low (1/Mb) tumors and no association with PD-L1 expression was observed. One-year survival rate was 81.3%. EBV positive pts had a trend towards better survival (84.8 vs. 66.7, P=0.640). Median PFS was 5.5 mos and not different between EBV positive vs. negative pts (5.6 vs. 4.0 mos, P=0.919). Conclusions: Our multi-institutional real-world experience with checkpoint inhibitor therapy in R/M NPC confirms that a similar degree of activity is seen as reported in the phase I-II experience in diverse races, but efficacy seems more prominent in EBV positive disease.
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Affiliation(s)
- Jong Chul Park
- Massachusetts General Hospital Cancer Center, Boston, MA
| | - Lori J. Wirth
- Massachusetts General Hospital Cancer Center and Harvard University, Boston, MA
| | - John R Clark
- Massachusetts General Hospital Cancer Center, Boston, MA
| | | | - Won Jin Ho
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Karim Boudadi
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Hyunseok Kang
- University of California, San Francisco, San Francisco, CA
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Oh LJ, Phan K, Kim SW, Low TH, Gupta R, Clark JR. Elective neck dissection versus observation for early-stage oral squamous cell carcinoma: Systematic review and meta-analysis. Oral Oncol 2020; 105:104661. [PMID: 32244173 DOI: 10.1016/j.oraloncology.2020.104661] [Citation(s) in RCA: 29] [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] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Oral squamous cell carcinoma (OSCC) is the seventh most common cancer globally, and has been identified as a growing health concern. This study aims to evaluate the current literature comparing elective neck dissection to observation in the treatment of early-stage tongue SCC, focusing on nodal recurrence, overall survival, disease specific survival statistics from randomised controlled trials comparing the two interventions. METHODS Systematic review and meta-analysis was conducted according to PRISMA guidelines. The odds ratio (OR) was used as a summary statistic. RESULTS From 8 studies, there was a total of 372 cases of recurrence, 98 (15.1%) in END group and 274 (41.5%) in the Observation group. There was a significantly lower rate of recurrence in the END group compared to observation (OR 0.25, 95% CI 0.16-0.39, I2 = 54%, P < 0.00001). END was associated with higher overall survival rates when compared with observation (OR 1.95, 95% CI 1.40-2.73, I2 = 14%, P < 0.0001). END was also associated with higher disease-specific survival compared with observation (OR 1.88, 95% CI 1.21-2.93), I2 = 47%, P = 0.005), with no significant heterogeneity noted. CONCLUSIONS END was associated with significantly lower recurrence rates and higher overall and disease-specific survival compared to a conservative observation approach in early-stage oral SCC with clinically N0 neck.
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Affiliation(s)
- L J Oh
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Central Clinical School, University of Sydney, Sydney, Australia.
| | - K Phan
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - S W Kim
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - T H Low
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Central Clinical School, University of Sydney, Sydney, Australia
| | - R Gupta
- Central Clinical School, University of Sydney, Sydney, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - J R Clark
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Central Clinical School, University of Sydney, Sydney, Australia
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Zafar A, Mosarla R, Drobni Z, Alvi R, Lei M, Lou UY, Murphy S, Jones-O'Connor M, Raghu VK, Rokicki A, Banerji D, Weekes CD, Clark JR, Clark J, Blaszkowsky LS, Tavares E, Neilan TG. THE INCIDENCE, RISK FACTORS AND OUTCOMES WITH 5-FU (FLUOROURACIL)-ASSOCIATED CORONARY VASOSPASM. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30818-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Clark JR. Should I Stay or Should I Go? Air Med J 2020; 39:82-83. [PMID: 32197697 DOI: 10.1016/j.amj.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/25/2020] [Indexed: 06/10/2023]
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Koenigs MB, Lefranc-Torres A, Bonilla-Velez J, Patel KB, Hayes DN, Glomski K, Busse PM, Chan AW, Clark JR, Deschler DG, Emerick KS, Hammon RJ, Wirth LJ, Lin DT, Mroz EA, Faquin WC, Rocco JW. Association of Estrogen Receptor Alpha Expression With Survival in Oropharyngeal Cancer Following Chemoradiation Therapy. J Natl Cancer Inst 2019; 111:933-942. [PMID: 30715409 PMCID: PMC6748818 DOI: 10.1093/jnci/djy224] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 06/19/2018] [Revised: 09/23/2018] [Accepted: 11/29/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Oropharyngeal squamous carcinoma (OPSC) continues to increase in incidence secondary to human papillomavirus (HPV) infection. Despite the good overall prognosis for these patients, treatment with chemoradiation is associated with morbidity and treatment failure. Better predictors for disease outcome are needed to guide de-intensification regimens. We hypothesized that estrogen receptor α (ERα), a prognostic biomarker in oncology with therapeutic implications, might have similar utility in OPSC. METHODS To investigate associations among ERα and demographics, HPV status, and survival, we analyzed ERα mRNA expression of head and neck squamous carcinomas (HNSC) from The Cancer Genome Atlas (TCGA) and immunohistochemistry (IHC) of pretreatment biopsy specimens from an independent group of 215 OPSC patients subsequently treated with primary chemoradiation (OPSC-CR). Associations among variables were evaluated with Fisher exact tests and logistic regression; associations with survival were evaluated with log-rank tests and Cox proportional hazards regression. RESULTS Among 515 patients in TCGA, ERα mRNA expression was highest in HPV-positive OPSC. High ERα mRNA expression was associated with improved survival among those receiving chemoradiation (hazard ratio adjusted for HPV status = 0.44, 95% confidence interval = 0.21 to 0.92). In OPSC-CR, ERα was positive by IHC in 51.6% of tumors and was associated with improved overall, disease-specific, progression-free, and relapse-free survival (log-rank tests: P < .001, P < .001, P = .002, P = .003, respectively); statistically significant associations of ERα positivity with improved survival were maintained after adjusting for clinical risk factors including HPV status. CONCLUSION In two independent cohorts, ERα is a potential biomarker for improved survival that also may represent a therapeutic target in OPSC.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - James W Rocco
- Correspondence to: James W. Rocco, MD, PhD, Department of Otolaryngology – Head and Neck Surgery, The Ohio State University Comprehensive Cancer Center – James, 818 Biomedical Research Tower, 460 West 12th Avenue, Columbus, OH 43210 (e-mail: )
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Lewter J, Worthington ML, Clark JR, Varanasi AV, Nelson L, Owens CL, Conner P, Gunawan G. High-density linkage maps and loci for berry color and flower sex in muscadine grape (Vitis rotundifolia). Theor Appl Genet 2019; 132:1571-1585. [PMID: 30756127 DOI: 10.1007/s00122-019-03302-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/02/2019] [Indexed: 06/09/2023]
Abstract
Linkage maps of muscadine grape generated using genotyping-by-sequencing (GBS) provide insight into genome collinearity between Muscadinia and Euvitis subgenera and genetic control of flower sex and berry color. The muscadine grape, Vitis rotundifolia, is a specialty crop native to the southeastern USA. Muscadine vines can be male, female, or perfect-flowered, and berry color ranges from bronze to black. Genetic linkage maps were constructed using genotyping-by-sequencing in two F1 populations segregating for flower sex and berry color. The linkage maps consisted of 1244 and 2069 markers assigned to 20 linkage groups (LG) for the 'Black Beauty' × 'Nesbitt' and 'Supreme' × 'Nesbitt' populations, respectively. Data from both populations were used to generate a consensus map with 2346 markers across 20 LGs. A high degree of collinearity was observed between the genetic maps and the Vitis vinifera physical map. The higher chromosome number in muscadine (2n = 40) compared to V. vinifera (2n = 38) was accounted for by the behavior of V. vinifera chromosome 7 as two independently segregating LGs in muscadine. The muscadine sex locus mapped to an interval that aligned to 4.64-5.09 Mb on V. vinifera chromosome 2, a region which includes the previously described V. vinifera subsp. sylvestris sex locus. While the MYB transcription factor genes controlling fruit color in V. vinifera are located on chromosome 2, the muscadine berry color locus mapped to an interval aligning to 11.09-11.88 Mb on V. vinifera chromosome 4, suggesting that a mutation in a different gene in the anthocyanin biosynthesis pathway determines berry color in muscadine. These linkage maps lay the groundwork for marker-assisted breeding in muscadine and provide insight into the evolution of Vitis species.
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Affiliation(s)
- Jennifer Lewter
- Department of Horticulture, University of Arkansas, 316 Plant Sciences Bldg., Fayetteville, AR, 72701, USA
| | - Margaret L Worthington
- Department of Horticulture, University of Arkansas, 316 Plant Sciences Bldg., Fayetteville, AR, 72701, USA.
| | - John R Clark
- Department of Horticulture, University of Arkansas, 316 Plant Sciences Bldg., Fayetteville, AR, 72701, USA
| | - Aruna V Varanasi
- Department of Horticulture, University of Arkansas, 316 Plant Sciences Bldg., Fayetteville, AR, 72701, USA
| | - Lacy Nelson
- Department of Horticulture, University of Arkansas, 316 Plant Sciences Bldg., Fayetteville, AR, 72701, USA
| | - Christopher L Owens
- USDA-ARS Grape Genetics Research Unit, Cornell University, 630 W. North St., Geneva, NY, 14456, USA
- IFG, 8224 Espresso Dr. Suite 200, Bakersfield, CA, 93312, USA
| | - Patrick Conner
- Department of Horticulture, University of Georgia, 4604 Research Way, Tifton, GA, 31793, USA
| | - Gunawati Gunawan
- Department of Horticulture, University of Georgia, 4604 Research Way, Tifton, GA, 31793, USA
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Clark JR. The Fireman's Rule. Air Med J 2019; 38:10-11. [PMID: 30711075 DOI: 10.1016/j.amj.2018.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 11/20/2018] [Indexed: 06/09/2023]
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Stuhlmiller DFE, Clark JR, Caffrey S, Betterton M, Nollette C, Raynovich W. National Association of EMS Educator's Position Paper on the Critical Care Paramedic. PREHOSP EMERG CARE 2018; 23:593-595. [PMID: 30326749 DOI: 10.1080/10903127.2018.1536772] [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: 10/28/2022]
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Clark JR. Can You Keep a Secret? Air Med J 2018; 37:282-284. [PMID: 30322627 DOI: 10.1016/j.amj.2018.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 06/08/2023]
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Clark JR. A Duty to Warn. Air Med J 2018; 37:229-230. [PMID: 29935699 DOI: 10.1016/j.amj.2018.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/30/2018] [Indexed: 06/08/2023]
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Park JC, Wirth LJ, Flaherty K, Lawrence DP, Demehri S, Kraft S, Foreman R, Clark JR, Cohen JV, Kim Y, Boland GM, Frederick DT, Sullivan RJ. Immune checkpoint inhibition (ICI) in advanced cutaneous squamous cell carcinoma (cSCC): Clinical response and correlative biomarker analysis. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.9564] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jong Chul Park
- Massachusetts General Hospital Cancer Center, Boston, MA
| | - Lori J. Wirth
- Massachusetts General Hospital Cancer Center, Boston, MA
| | | | - Donald P. Lawrence
- Massachusetts General Hospital and Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | - John R Clark
- Massachusetts General Hospital Cancer Center, Boston, MA
| | | | - Yuhree Kim
- Massachusetts General Hospital, Boston, MA
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Clark JR. Will a Screwdriver Work? Air Med J 2018; 37:16-17. [PMID: 29332768 DOI: 10.1016/j.amj.2017.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/22/2017] [Indexed: 06/07/2023]
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Clark JR. Reporting Abuse. Air Med J 2017; 36:287-289. [PMID: 29132588 DOI: 10.1016/j.amj.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/11/2017] [Indexed: 06/07/2023]
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Johnson MA, Clark JR, Wagner WL, McDade LA. A molecular phylogeny of the Pacific clade of Cyrtandra (Gesneriaceae) reveals a Fijian origin, recent diversification, and the importance of founder events. Mol Phylogenet Evol 2017; 116:30-48. [DOI: 10.1016/j.ympev.2017.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 05/01/2017] [Accepted: 07/07/2017] [Indexed: 12/14/2022]
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Clark JR. Vehicular Manslaughter. Air Med J 2017; 36:229-230. [PMID: 28886780 DOI: 10.1016/j.amj.2017.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 07/25/2017] [Indexed: 06/07/2023]
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Clark JR. Conflict of Interest. Air Med J 2017; 36:160-161. [PMID: 28739232 DOI: 10.1016/j.amj.2017.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 05/17/2017] [Indexed: 06/07/2023]
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Clark JR. Good People Don't Smoke Marijuana. Air Med J 2017; 36:99-100. [PMID: 28499691 DOI: 10.1016/j.amj.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 02/17/2017] [Indexed: 06/07/2023]
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Clark JR. Winner, Winner, Chicken Dinner. Air Med J 2017; 36:52-53. [PMID: 28336011 DOI: 10.1016/j.amj.2017.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 01/26/2017] [Indexed: 06/06/2023]
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Clark JR. Two Girls Falsely Imprisoned After Mother Killed. Air Med J 2016; 35:197-199. [PMID: 27393751 DOI: 10.1016/j.amj.2016.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 04/25/2016] [Indexed: 06/06/2023]
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Clark JR. A Horse Is a Horse, of Course, of Course. Air Med J 2016; 35:63-64. [PMID: 27021668 DOI: 10.1016/j.amj.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/08/2015] [Indexed: 06/05/2023]
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Clark JR. The Erosion of Privacy. Air Med J 2015; 34:240-242. [PMID: 26354297 DOI: 10.1016/j.amj.2015.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 06/14/2015] [Indexed: 06/05/2023]
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Amit M, Yen TC, Liao CT, Chaturvedi P, Agarwal JP, Kowalski LP, Kohler HF, Ebrahimi A, Clark JR, Cernea CR, Brandao SJ, Kreppel M, Zöller J, Fliss MD, Bachar G, Shpitzer T, Bolzoni VA, Patel PR, Jonnalagadda S, Robbins KT, Iyer NG, Skanthakumar T, Shah JP, Patel SG, Gil Z. Prognostic Performance of Current Stage III Oral Cancer Patients After Curative Intent Resection: Evidence to Support a Revision of the American Joint Committee on Cancer Staging System. Ann Surg Oncol 2015; 22 Suppl 3:S985-91. [PMID: 26314876 DOI: 10.1245/s10434-015-4842-3] [Citation(s) in RCA: 3] [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] [Received: 08/05/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The American Joint Committee on Cancer (AJCC) stage III classification of oral cavity squamous cell carcinoma (OCSCC) represents a heterogeneous group of patients with early local disease with regional metastases (T1N1 and T2N1) and advanced local disease with or without regional metastasis (T3N0 and T3N1). OBJECTIVE The aim of this study was to evaluate prognostic heterogeneity in the stage III category. METHODS AND PATIENTS An international retrospective multicenter study of 1815 patients who were treated for OCSCC from 2003 to 2011. RESULTS Kaplan-Meier survival analysis and multivariate models of stage III patients revealed better overall survival (OS; HR 2.12, 95 % CI 1.03-4.15; p = 0.01) and disease-specific survival (DSS; HR 1.7, 95 % CI 1.16-4.12; p = 0.04) rates for patients with T1-2N1/T3N0 disease than for patients with T3N1 disease. The outcomes of patients with T3N1 and stage IVa disease were similar (p = 0.89 and p = 0.78 for OS and DSS, respectively). Modifying stage classification by transferring the T3N1 category to the stage VIa group resulted in a better prognostic performance [Harrell's concordance index, C index 0.76; Akaike's Information Criterion (AIC) 4131.6] compared with the AJCC 7th edition staging system (C index 0.65; AIC 4144.9) for OS. When DSS was assessed, the suggested staging system remained the best performing model (C index 0.71; AIC 1061.3) compared with the current AJCC 7th edition staging (C index 0.64; AIC 1066.2). CONCLUSIONS The prognosis of T3N1 and stage IVa disease are similar in OCSCC, suggesting that these categories could be combined in future revisions of the nodal staging system to enhance prognostic accuracy.
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Affiliation(s)
- M Amit
- The Laboratory for Applied Cancer Research, Clinical Research Institute at Rambam, Rappaport Institute for Research in Medical Science, Haifa, Israel.,Department of Otolaryngology, Head and Neck Surgery, Head and Neck Center, Rambam Medical Center, Rappaport School of Medicine, The Technion, Israel Institute of Technology, 66036, Haifa, Israel
| | - T C Yen
- Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - C T Liao
- Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | | | | | | | - A Ebrahimi
- Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, Australia.,Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia
| | - J R Clark
- Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, Australia
| | - C R Cernea
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - S J Brandao
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - M Kreppel
- Department of Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany
| | - J Zöller
- Department of Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany
| | - M D Fliss
- Department of Pathology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - G Bachar
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
| | - T Shpitzer
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
| | - V A Bolzoni
- Department of ENT, University of Brescia, Owensboro, Italy
| | - P R Patel
- University of Auckland, Auckland, New Zealand
| | - S Jonnalagadda
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - K T Robbins
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - N G Iyer
- Singhealth/Duke-NUS Head and Neck Centre, National Cancer Centre Singapore, Singapore, Singapore
| | - T Skanthakumar
- Singhealth/Duke-NUS Head and Neck Centre, National Cancer Centre Singapore, Singapore, Singapore
| | - J P Shah
- Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S G Patel
- Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Z Gil
- The Laboratory for Applied Cancer Research, Clinical Research Institute at Rambam, Rappaport Institute for Research in Medical Science, Haifa, Israel. .,Department of Otolaryngology, Head and Neck Surgery, Head and Neck Center, Rambam Medical Center, Rappaport School of Medicine, The Technion, Israel Institute of Technology, 66036, Haifa, Israel.
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