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Simmons VN, Sutton SK, Meltzer LR, Martinez U, Palmer AM, Meade CD, Jacobsen PB, McCaffrey JC, Haura EB, Brandon TH. Preventing smoking relapse in patients with cancer: A randomized controlled trial. Cancer 2020; 126:5165-5172. [PMID: 32902856 DOI: 10.1002/cncr.33162] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Abstaining from smoking after a cancer diagnosis is critical to mitigating the risk of multiple adverse health outcomes. Although many patients with cancer attempt to quit smoking, the majority relapse. The current randomized controlled trial evaluated the efficacy of adapting an evidence-based smoking relapse prevention (SRP) intervention for patients with cancer. METHODS The trial enrolled 412 patients newly diagnosed with cancer who had recently quit smoking. Participants were randomized to usual care (UC) or SRP. Participants in the UC group received the institution's standard of care for treating tobacco use. Participants in the SRP group in addition received a targeted educational DVD plus a validated self-help intervention for preventing smoking relapse. The primary outcome was smoking abstinence at 2 months, 6 months, and 12 months. RESULTS Abstinence rates for participants in the SRP and UC groups were 75% versus 71% at 2 months and 69% versus 64% at 6 months (Ps > .20). At 12 months, abstinence rates among survivors were 68% for those in the SRP group and 63% for those in the UC group (P = .38). Post hoc analyses revealed that across 2 months and 6 months, patients who were married/partnered were more likely to be abstinent after SRP than UC (P = .03). CONCLUSIONS A smoking relapse prevention intervention did not reduce relapse rates overall, but did appear to have benefited those participants who had the social support of a partner. Future work is needed to extend this effect to the larger population of patients.
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Affiliation(s)
- Vani N Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida, Tampa, Florida.,Department of Psychology, University of South Florida, Tampa, Florida.,Department of Thoracic Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Steven K Sutton
- Department of Oncologic Sciences, University of South Florida, Tampa, Florida.,Department of Psychology, University of South Florida, Tampa, Florida.,Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Lauren R Meltzer
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Ursula Martinez
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida, Tampa, Florida
| | - Amanda M Palmer
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida.,Department of Psychology, University of South Florida, Tampa, Florida
| | - Cathy D Meade
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida, Tampa, Florida.,Department of Nursing, University of South Florida, Tampa, Florida
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, Maryland
| | - Judith C McCaffrey
- Department of Otolaryngology, University of South Florida, Tampa, Florida.,Department of Otolaryngology-Head and Neck Surgery, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Eric B Haura
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Thomas H Brandon
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida, Tampa, Florida.,Department of Psychology, University of South Florida, Tampa, Florida.,Department of Thoracic Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
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Meltzer LR, Meade CD, Diaz DB, Carrington MS, Brandon TH, Jacobsen PB, McCaffrey JC, Haura EB, Simmons VN. Development of a Targeted Smoking Relapse-Prevention Intervention for Cancer Patients. J Cancer Educ 2018; 33:440-447. [PMID: 27476432 PMCID: PMC5288399 DOI: 10.1007/s13187-016-1089-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We describe the series of iterative steps used to develop a smoking relapse-prevention intervention customized to the needs of cancer patients. Informed by relevant literature and a series of preliminary studies, an educational tool (DVD) was developed to target the unique smoking relapse risk factors among cancer patients. Learner verification interviews were conducted with 10 cancer patients who recently quit smoking to elicit feedback and inform the development of the DVD. The DVD was then refined using iterative processes and feedback from the learner verification interviews. Major changes focused on visual appeal, and the inclusion of additional testimonials and graphics to increase comprehension of key points and further emphasize the message that the patient is in control of their ability to maintain their smoking abstinence. Together, these steps resulted in the creation of a DVD titled Surviving Smokefree®, which represents the first smoking relapse-prevention intervention for cancer patients. If found effective, the Surviving Smokefree® DVD is an easily disseminable and low-cost portable intervention which can assist cancer patients in maintaining smoking abstinence.
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Affiliation(s)
- Lauren R Meltzer
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 4115 E Fowler Ave, Tampa, FL, 33617, USA
| | - Cathy D Meade
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 4115 E Fowler Ave, Tampa, FL, 33617, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Nursing, University of South Florida, Tampa, FL, USA
| | - Diana B Diaz
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 4115 E Fowler Ave, Tampa, FL, 33617, USA
| | - Monica S Carrington
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 4115 E Fowler Ave, Tampa, FL, 33617, USA
| | - Thomas H Brandon
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 4115 E Fowler Ave, Tampa, FL, 33617, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Paul B Jacobsen
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 4115 E Fowler Ave, Tampa, FL, 33617, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Nursing, University of South Florida, Tampa, FL, USA
| | - Judith C McCaffrey
- Department of Otolaryngology, University of South Florida, Tampa, FL, USA
- Department of Otolaryngology - Head and Neck Surgery, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Eric B Haura
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Vani N Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 4115 E Fowler Ave, Tampa, FL, 33617, USA.
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.
- Department of Nursing, University of South Florida, Tampa, FL, USA.
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
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3
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Díaz DB, Brandon TH, Sutton SK, Meltzer LR, Hoehn HJ, Meade CD, Jacobsen PB, McCaffrey JC, Haura EB, Lin HY, Simmons VN. Smoking relapse-prevention intervention for cancer patients: Study design and baseline data from the surviving SmokeFree randomized controlled trial. Contemp Clin Trials 2016; 50:84-9. [PMID: 27468664 DOI: 10.1016/j.cct.2016.07.015] [Citation(s) in RCA: 8] [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: 04/27/2016] [Revised: 07/15/2016] [Accepted: 07/17/2016] [Indexed: 11/29/2022]
Abstract
Continued smoking after a cancer diagnosis contributes to several negative health outcomes. Although many cancer patients attempt to quit smoking, high smoking relapse rates have been observed. This highlights the need for a targeted, evidence-based smoking-relapse prevention intervention. The design, method, and baseline characteristics of a randomized controlled trial assessing the efficacy of a self-help smoking-relapse prevention intervention are presented. Cancer patients who had recently quit smoking were randomized to one of two conditions. The Usual Care (UC) group received the institution's standard of care. The smoking relapse-prevention intervention (SRP) group received standard of care, plus 8 relapse-prevention booklets mailed over a 3month period, and a targeted educational DVD developed specifically for cancer patients. Four hundred and fourteen participants were enrolled and completed a baseline survey. Primary outcomes will be self-reported smoking status at 6 and 12-months after baseline. Biochemical verification of smoking status was completed for a subsample. If found to be efficacious, this low-cost intervention could be easily disseminated with significant potential for reducing the risk of negative cancer outcomes associated with continued smoking.
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Affiliation(s)
- Diana B Díaz
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States.
| | - Thomas H Brandon
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States.
| | - Steven K Sutton
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States.
| | - Lauren R Meltzer
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States.
| | - Hannah J Hoehn
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States.
| | - Cathy D Meade
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States.
| | - Paul B Jacobsen
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States.
| | - Judith C McCaffrey
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States
| | - Eric B Haura
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States.
| | - Hui-Yi Lin
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States.
| | - Vani N Simmons
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States.
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Haddad RI, Lydiatt WM, Ball DW, Busaidy NL, Byrd D, Callender G, Dickson P, Duh QY, Ehya H, Haymart M, Hoh C, Hunt JP, Iagaru A, Kandeel F, Kopp P, Lamonica DM, McCaffrey JC, Moley JF, Parks L, Raeburn CD, Ridge JA, Ringel MD, Scheri RP, Shah JP, Smallridge RC, Sturgeon C, Wang TN, Wirth LJ, Hoffmann KG, Hughes M. Anaplastic Thyroid Carcinoma, Version 2.2015. J Natl Compr Canc Netw 2016; 13:1140-50. [PMID: 26358798 DOI: 10.6004/jnccn.2015.0139] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Thyroid Carcinoma focuses on anaplastic carcinoma because substantial changes were made to the systemic therapy recommendations for the 2015 update. Dosages and frequency of administration are now provided, docetaxel/doxorubicin regimens were added, and single-agent cisplatin was deleted because it is not recommended for patients with advanced or metastatic anaplastic thyroid cancer.
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Valderrabano P, Leon ME, Centeno BA, Otto KJ, Khazai L, McCaffrey JC, Russell JS, McIver B. Institutional prevalence of malignancy of indeterminate thyroid cytology is necessary but insufficient to accurately interpret molecular marker tests. Eur J Endocrinol 2016; 174:621-9. [PMID: 26903551 DOI: 10.1530/eje-15-1163] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/17/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Several molecular marker tests are available to refine the diagnosis of thyroid nodules. Knowing the true prevalence of malignancy (PoM) within each cytological category is considered necessary to select the most appropriate test and to interpret results accurately. We describe our institutional PoM among cytological categories and report our experience with molecular markers. DESIGN Single-center retrospective study. METHODS We calculated the institutional PoM for each category of the Bethesda system (Bethesda) on all thyroid nodules with cytological evaluation from October 2008 to May 2014. We estimated the predictive values for Afirma, miRInform, and ThyroSeq v2, based on published sensitivity and specificity. Finally, we assessed our own experience with miRInform. RESULTS The PoMs for Bethesda III and IV categories were 21 and 28%, respectively. ThyroSeq v2 achieves the highest theoretical negative and positive predictive values (NPV and PPV) in Bethesda III (98 and 75%) and Bethesda IV categories (96 and 83%). At our institution, miRInform detected a mutation in 16% of 109 indeterminate nodules tested, all in Bethesda IV specimens. Histology was available in 56 (51%) nodules. The observed sensitivity and specificity in Bethesda IV specimens were 63 and 86%, yielding an NPV and a PPV of 75 and 77%, respectively. CONCLUSIONS For our current Bethesda III and IV PoM, the actual performance of miRInform was worse than expected. Theoretically ThyroSeq v2 should have the best performance, but it could be affected in the same way as miRInform, given the similarities between the tests. Assessing the institutional performance of each test is necessary along with PoM individualization.
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Affiliation(s)
| | - Marino E Leon
- Department of Anatomic PathologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Barbara A Centeno
- Department of Anatomic PathologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Kristen J Otto
- Department of Head and Neck, and Endocrine OncologyTampa, Florida, USA
| | - Laila Khazai
- Department of Anatomic PathologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | | | - Jeffery S Russell
- Department of Head and Neck, and Endocrine OncologyTampa, Florida, USA
| | - Bryan McIver
- Department of Head and Neck, and Endocrine OncologyTampa, Florida, USA
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6
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Frakes JM, Strom TJ, Naghavi AO, Trotti A, Rao NG, McCaffrey JC, Otto KJ, Padhya T, Caudell JJ. Outcomes of mucosal melanoma of the head and neck. J Med Imaging Radiat Oncol 2015; 60:268-73. [PMID: 26597431 DOI: 10.1111/1754-9485.12404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 09/17/2015] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Mucosal melanoma of the head and neck is a rare disease with limited data available on outcomes; therefore, we reviewed our institutional experience. METHODS An institutional database was queried and 38 patients with head and neck mucosal melanoma were identified. Charts were abstracted and local control (LC), progression-free survival (PFS) and overall survival (OS) were calculated. RESULTS Most patients had T4 disease (86%), although nodes were positive in 11%. En bloc or endoscopic resection was performed on 93%. Adjuvant or definitive radiotherapy to a median dose of 60 Gy was utilized in 90%. Chemotherapy was given in 21%, and 16% received interferon. Three-year LC, PFS and OS were 90%, 48% and 59%, respectively. Median OS was 4.6 years. Site of first failure was distant in 52% of cases. CONCLUSION With aggressive therapy median OS was 4.6 years in this cohort. Distant recurrence remains the primary mode of failure. It may be reasonable to include mucosal melanoma patients in trials of systemic agents along with high-risk cutaneous melanomas.
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Affiliation(s)
- Jessica M Frakes
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Tobin J Strom
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Arash O Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Andy Trotti
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Nikhil G Rao
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Judith C McCaffrey
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Kristen J Otto
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Tapan Padhya
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Jimmy J Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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7
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Frakes JM, Naghavi AO, Demetriou SK, Strom TJ, Russell JS, Kish JA, McCaffrey JC, Otto KJ, Padhya TA, Harrison LB, Trotti AM, Caudell JJ. Determining optimal follow-up in the management of human papillomavirus-positive oropharyngeal cancer. Cancer 2015; 122:634-41. [DOI: 10.1002/cncr.29782] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/10/2015] [Accepted: 10/14/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Jessica M. Frakes
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Arash O. Naghavi
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Stephanie K. Demetriou
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Tobin J. Strom
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Jeffery S. Russell
- Department of Head and Neck and Endocrine Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Julie A. Kish
- Department of Senior Adult Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Judith C. McCaffrey
- Department of Head and Neck and Endocrine Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Kristen J. Otto
- Department of Head and Neck and Endocrine Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Tapan A. Padhya
- Department of Head and Neck and Endocrine Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Louis B. Harrison
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Andy M. Trotti
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Jimmy J. Caudell
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
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Jackson RS, Myhill JA, Padhya TA, McCaffrey JC, McCaffrey TV, Mhaskar RS. The Effects of Preoperative Embolization on Carotid Body Paraganglioma Surgery. Otolaryngol Head Neck Surg 2015; 153:943-50. [DOI: 10.1177/0194599815605323] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 08/20/2015] [Indexed: 12/12/2022]
Abstract
Objective There is no definitive consensus on the impact of preoperative embolization on carotid body paraganglioma management. The purpose of this study was to assess the effects of preoperative embolization on carotid body paraganglioma excision. Data Sources A systematic search was conducted without limits, and it included studies published on or before July 2013 from PubMed, CINAHL, Web of Knowledge, and the Cochrane Library. Relevant synonyms for the search terms “paraganglioma,”“carotid body tumor,” and “embolization” were applied. Review Methods Studies evaluating patients undergoing surgical intervention with embolization for carotid body tumors were included. Two reviewers independently assessed the titles and abstracts for inclusion and extracted the data. The guidelines set forth by the Cochrane Collaboration were followed in the process of data extraction. Data were pooled with a fixed effects model, and standardized mean difference (SMD) and 95% confidence intervals (95% CIs) are reported. Results A total of 22 studies (15 nonrandomized studies with a comparator, 7 single-arm studies) were included, enrolling 578 patients with 607 tumors. Patients undergoing preoperative embolization had significantly less estimated blood loss compared with those of surgical excision only (12 studies; 295 tumors; SMD: –0.52; 95% CI: –0.77, –0.28). Patients undergoing preoperative embolization had less operative time compared with that of surgical excision only (6 studies; 174 tumors; SMD: –0.46; 95% CI: –0.77, –0.14). Conclusion Surgical excision with preoperative embolization appears to decrease estimated blood loss and operative time when compared with that without preoperative embolization for carotid body paragangliomas.
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Affiliation(s)
- Ryan S. Jackson
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jeffrey A. Myhill
- Department of Otolaryngology, NEA Baptist Clinic, Jonesboro, Arkansas, USA
| | - Tapan A. Padhya
- Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa, Florida, USA
- Department of Head and Neck Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Judith C. McCaffrey
- Department of Head and Neck Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Thomas V. McCaffrey
- Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa, Florida, USA
- Department of Head and Neck Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Rahul S. Mhaskar
- Division of Evidence-Based Medicine, Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
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Cabanillas ME, Schlumberger M, Jarzab B, Martins RG, Pacini F, Robinson B, McCaffrey JC, Shah MH, Bodenner DL, Topliss D, Andresen C, O'Brien JP, Ren M, Funahashi Y, Allison R, Elisei R, Newbold K, Licitra LF, Sherman SI, Ball DW. A phase 2 trial of lenvatinib (E7080) in advanced, progressive, radioiodine-refractory, differentiated thyroid cancer: A clinical outcomes and biomarker assessment. Cancer 2015; 121:2749-56. [PMID: 25913680 PMCID: PMC4803478 DOI: 10.1002/cncr.29395] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 03/03/2015] [Accepted: 03/05/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Lenvatinib is an oral, multitargeted tyrosine kinase inhibitor of the vascular endothelial growth factor receptors 1 through 3 (VEGFR1-VEGFR3), fibroblast growth factor receptors 1 through 4 (FGFR1-FGFR4), platelet-derived growth factor receptor α (PDGFRα), ret proto-oncogene (RET), and v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog (KIT) signaling networks implicated in tumor angiogenesis. Positive phase 1 results in solid tumors prompted a phase 2 trial in patients with advanced, radioiodine-refractory, differentiated thyroid cancer (RR-DTC). METHODS Fifty-eight patients with RR-DTC who had disease progression during the previous 12 months received lenvatinib 24 mg once daily in 28-day cycles until disease progression, unmanageable toxicity, withdrawal, or death. Previous VEGFR-targeted therapy was permitted. The primary endpoint was the objective response rate (ORR) based on independent imaging review. Secondary endpoints included progression-free survival (PFS) and safety. Serum levels of 51 circulating cytokines and angiogenic factors also were assessed. RESULTS After ≥14 months of follow-up, patients had an ORR of 50% (95% confidence interval [CI], 37%-63%) with only partial responses reported. The median time to response was 3.6 months, the median response duration was 12.7 months, and the median PFS was 12.6 months (95% CI, 9.9-16.1 months). The ORR for patients who had received previous VEGF therapy (n = 17) was 59% (95% CI, 33%-82%). Lower baseline levels of angiopoietin-2 were suggestive of tumor response and longer PFS. Grade 3 and 4 treatment-emergent adverse events, regardless of their relation to treatment, occurred in 72% of patients and most frequently included weight loss (12%), hypertension (10%), proteinuria (10%), and diarrhea (10%). CONCLUSIONS In patients with and without prior exposure to VEGF therapy, the encouraging response rates, median time to response, and PFS for lenvatinib have prompted further investigation in a phase 3 trial. Cancer 2015;121:2749-2756. © 2015 American Cancer Society.
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Affiliation(s)
- Maria E. Cabanillas
- Department of Endocrine Neoplasia and Hormonal DisordersDivision of Internal MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine OncologyGustave Roussy Institute and Université Paris‐SudVillejuifFrance
| | - Barbara Jarzab
- Department of Nuclear Medicine and Endocrine OncologyMaria Sklodowska‐Curie Memorial Cancer Center and Institute of OncologyGliwice Branch, Gliwice PolandWybrzeze Armii Krajowej 15, 44‐101 GliwicePoland
| | - Renato G. Martins
- Department of Thoracic/Head and Neck Oncology, School of MedicineUniversity of WashingtonSeattleWashington
| | - Furio Pacini
- Section of EndocrinologyUniversity of SienaSienaItaly
| | - Bruce Robinson
- Faculty of Medicine, Cancer Genetics UnitKolling Institute, Royal North Shore Hospital, University of SydneyNew South WalesAustralia
| | | | - Manisha H. Shah
- Ohio State University Comprehensive Cancer CenterColumbusOhio
| | - Donald L. Bodenner
- Department of GeriatricsUniversity of Arkansas for Medical sciencesLittle RockArkansas
| | - Duncan Topliss
- Department of Endocrinology and DiabetesThe Alfred HospitalMelbourneVictoriaAustralia
| | | | | | - Min Ren
- Eisai IncWoodcliff LakeNew Jersey
| | | | - Roger Allison
- Cancer Care ServicesThe Royal Brisbane and Women's HospitalHerstonQueenslandAustralia
| | | | - Kate Newbold
- Department of OncologyRoyal Marsden HospitalLondonUnited Kingdom
| | - Lisa F. Licitra
- Foundation for Cancer Research and TreatmentNational Tumor InstituteMilanItaly
| | - Steven I. Sherman
- Department of Endocrine Neoplasia and Hormonal DisordersDivision of Internal MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Douglas W. Ball
- The Johns Hopkins University School of MedicineBaltimoreMaryland
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10
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Shindo ML, Caruana SM, Kandil E, McCaffrey JC, Orloff LA, Porterfield JR, Shaha A, Shin J, Terris D, Randolph G. Management of invasive well-differentiated thyroid cancer: an American Head and Neck Society consensus statement. AHNS consensus statement. Head Neck 2014; 36:1379-90. [PMID: 24470171 DOI: 10.1002/hed.23619] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 01/24/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Invasive differentiated thyroid cancer (DTC) is relatively frequent, yet there is a paucity of specific guidelines devoted to its management. The Endocrine Committee of the American Head and Neck Society (AHNS) convened a panel to provide clinical consensus statements based on review of the literature, synthesized with the expert opinion of the group. METHODS An expert panel, selected from membership of the AHNS, constructed the manuscript and recommendations for management of DTC with invasion of recurrent laryngeal nerve, trachea, esophagus, larynx, and major vessels based on current best evidence. A Modified Delphi survey was then constructed by another expert panelist utilizing 9 anchor points, 1 = strongly disagree to 9 = strongly agree. Results of the survey were utilized to determine which statements achieved consensus, near-consensus, or non-consensus. RESULTS After endorsement by the AHNS Endocrine Committee and Quality of Care Committee, it received final approval from the AHNS Council.
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Affiliation(s)
- Maisie L Shindo
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
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11
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Tanvetyanon T, Rao NG, Padhya T, McCaffrey JC, Caudell JJ, Kish JA, De Conti RC, Trotti A, Eikman EA. Impact of tumor metabolic response by PET/CT on the survival after salvage re-irradiation of head and neck cancers. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.6047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Nikhil G Rao
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Tapan Padhya
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | | | - Julie Ann Kish
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | - Andy Trotti
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Edward A Eikman
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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12
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Condamine T, Kumar V, Ramachandran IR, Youn JI, Celis E, Finnberg N, El-Deiry WS, Winograd R, Vonderheide RH, English NR, Knight SC, Yagita H, McCaffrey JC, Antonia S, Hockstein N, Witt R, Masters G, Bauer T, Gabrilovich DI. ER stress regulates myeloid-derived suppressor cell fate through TRAIL-R-mediated apoptosis. J Clin Invest 2014; 124:2626-39. [PMID: 24789911 DOI: 10.1172/jci74056] [Citation(s) in RCA: 266] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Myeloid-derived suppressor cells (MDSCs) dampen the immune response thorough inhibition of T cell activation and proliferation and often are expanded in pathological conditions. Here, we studied the fate of MDSCs in cancer. Unexpectedly, MDSCs had lower viability and a shorter half-life in tumor-bearing mice compared with neutrophils and monocytes. The reduction of MDSC viability was due to increased apoptosis, which was mediated by increased expression of TNF-related apoptosis-induced ligand receptors (TRAIL-Rs) in these cells. Targeting TRAIL-Rs in naive mice did not affect myeloid cell populations, but it dramatically reduced the presence of MDSCs and improved immune responses in tumor-bearing mice. Treatment of myeloid cells with proinflammatory cytokines did not affect TRAIL-R expression; however, induction of ER stress in myeloid cells recapitulated changes in TRAIL-R expression observed in tumor-bearing hosts. The ER stress response was detected in MDSCs isolated from cancer patients and tumor-bearing mice, but not in control neutrophils or monocytes, and blockade of ER stress abrogated tumor-associated changes in TRAIL-Rs. Together, these data indicate that MDSC pathophysiology is linked to ER stress, which shortens the lifespan of these cells in the periphery and promotes expansion in BM. Furthermore, TRAIL-Rs can be considered as potential targets for selectively inhibiting MDSCs.
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13
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Leon M, McCaffrey JC, Padhya TA, Savell JG, McCaffrey TV. Androgen Receptors Expression in Mammary Analogue Secretory Carcinoma of Salivary Gland. Am J Clin Pathol 2013. [DOI: 10.1093/ajcp/140.suppl1.095] [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: 11/12/2022] Open
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14
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May JT, Rao N, Sabater RD, Boutrid H, Caudell JJ, Merchant F, Han G, Padhya TA, McCaffrey JC, Tanvetyanon T, Deconti R, Kish J, McCaffrey TV, Trotti A. Intensity-modulated radiation therapy as primary treatment for oropharyngeal squamous cell carcinoma. Head Neck 2013; 35:1796-800. [PMID: 23468387 DOI: 10.1002/hed.23245] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2012] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Over the past decade, intensity-modulated radiation therapy (IMRT) has gained widespread use in the treatment of head and neck cancer. METHODS All patients with squamous cell carcinoma of the oropharynx treated with primary IMRT with or without chemotherapy over a 5-year period were reviewed. Outcomes and morbidity were analyzed and compared with previously published data. RESULTS In all, 170 patients were included in the analysis. The 3-year local control, locoregional control, disease-free survival, and overall survival rates were 92%, 91%, 80%, and 87%, respectively. Feeding tubes were present in 55% of patients during treatment, but remained in only 1% 2 years following treatment. CONCLUSIONS This study confirms that IMRT yields excellent treatment outcomes for oropharyngeal carcinoma. Although acute toxicity remains a problem, late toxicity rates are low and long-term feeding tube dependence is rare compared with conventional radiation therapy.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents/therapeutic use
- Carboplatin/therapeutic use
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Cetuximab
- Chemotherapy, Adjuvant
- Cisplatin/therapeutic use
- Disease-Free Survival
- Enteral Nutrition
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Oropharyngeal Neoplasms/drug therapy
- Oropharyngeal Neoplasms/mortality
- Oropharyngeal Neoplasms/pathology
- Oropharyngeal Neoplasms/radiotherapy
- Radiotherapy Planning, Computer-Assisted
- Radiotherapy, Intensity-Modulated/adverse effects
- Retrospective Studies
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Affiliation(s)
- James T May
- Head and Neck Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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15
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Youn JI, Kumar V, Collazo M, Nefedova Y, Condamine T, Cheng P, Villagra A, Antonia S, McCaffrey JC, Fishman M, Sarnaik A, Horna P, Sotomayor E, Gabrilovich DI. Epigenetic silencing of retinoblastoma gene regulates pathologic differentiation of myeloid cells in cancer. Nat Immunol 2013; 14:211-20. [PMID: 23354483 PMCID: PMC3578019 DOI: 10.1038/ni.2526] [Citation(s) in RCA: 267] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 12/17/2012] [Indexed: 01/04/2023]
Abstract
Two major populations of myeloid-derived suppressor cells (MDSC), monocytic MDSC (M-MDSC) and polymorphonuclear MDSC (PMN-MDSC) regulate immune responses in cancer and other pathologic conditions. Under physiologic conditions, Ly6ChiLy6G− inflammatory monocytes, which are the normal counterpart of M-MDSC, differentiate into macrophages and dendritic cells (DCs). PMN-MDSC is the predominant group of MDSC that accumulates in cancer. Here we show that a large proportion of M-MDSC in tumor-bearing mice acquired phenotypic, morphological and functional features of PMN-MDSC. Acquisition of this phenotype, but not the functional attributes of PMN-MDSC, was mediated by transcriptional silencing of the retinoblastoma (Rb) gene through epigenetic modifications mediated by histone deacetylase 2 (HDAC-2). These data demonstrate novel mechanism regulation of myeloid cells in cancer.
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Affiliation(s)
- Je-In Youn
- Departments of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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16
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Simmons VN, Litvin EB, Jacobsen PB, Patel RD, McCaffrey JC, Oliver JA, Sutton SK, Brandon TH. Predictors of smoking relapse in patients with thoracic cancer or head and neck cancer. Cancer 2012; 119:1420-7. [PMID: 23280005 DOI: 10.1002/cncr.27880] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 08/21/2012] [Accepted: 10/04/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cancer patients who continue smoking are at increased risk for adverse outcomes including reduced treatment efficacy and poorer survival rates. Many patients spontaneously quit smoking after diagnosis; however, relapse is understudied. The goal of this study was to evaluate smoking-related, affective, cognitive, and physical variables as predictors of smoking after surgical treatment among patients with lung cancer and head and neck cancer. METHODS A longitudinal study was conducted with 154 patients (57% male) who recently quit smoking. Predictor variables were measured at baseline (ie, time of surgery); smoking behavior was assessed at 2, 4, 6, and 12 months after surgery. Analyses of 7-day point prevalence were performed using a Generalized Estimating Equations approach. RESULTS Relapse rates varied significantly depending on presurgery smoking status. At 12 months after surgery, 60% of patients who smoked during the week prior to surgery had resumed smoking versus only 13% who were abstinent prior to surgery. Smoking rates among both groups were relatively stable across the 4 follow-ups. For patients smoking before surgery (N = 101), predictors of smoking relapse included lower quitting self-efficacy, higher depression proneness, and greater fears about cancer recurrence. For patients abstinent before surgery (N = 53), higher perceived difficulty quitting and lower cancer-related risk perceptions predicted smoking relapse. CONCLUSIONS Efforts to encourage early cessation at diagnosis, and increased smoking relapse-prevention efforts in the acute period following surgery, may promote long-term abstinence. Several modifiable variables are identified to target in future smoking relapse-prevention interventions for cancer patients.
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Affiliation(s)
- Vani Nath Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL 33647, USA.
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17
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Hoyne DS, McCaffrey JC. Pathology quiz case 2. Multifocal amyloidosis of the supraglottic and glottic larynx. ACTA ACUST UNITED AC 2012; 138:689, 690-1. [PMID: 22801900 DOI: 10.1001/archoto.2012.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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18
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Schlumberger M, Jarzab B, Cabanillas ME, Robinson B, Pacini F, Ball DW, McCaffrey JC, Newbold K, Allison R, Martins R, Licitra LF, Shah MH, Bodenner D, Elisei R, Burmeister LA, Funahashi Y, Sellecchia R, Andresen C, O'Brien JP, Sherman SI. A phase II trial of the multitargeted kinase inhibitor lenvatinib (E7080) in advanced medullary thyroid cancer (MTC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.5591] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [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
5591 Background: Lenvatinib is an oral tyrosine kinase inhibitor targeting VEGFR1-3, FGFR1-4, RET, KIT and PDGFRβ. In phase I studies of lenvatinib partial responses (PR) were observed in thyroid as well as melanoma, endometrial, and renal cancers. Methods: Patients (pts) with unresectable MTC and disease progression demonstrated by RECIST during the prior 12 months were enrolled. Pts may have received prior VEGFR targeted therapy. Pts were treated with a starting dose of lenvatinib 24 mg once daily in 28 day cycles until disease progression or development of unmanageable toxicities. Primary end point was Response Rate (RR) by RECIST. Tumor genetic analysis and circulating cytokine and angiogenic factors (CAF) analysis were performed. Results: 59 pts were enrolled (med age: 52; Male: 63%;) and are evaluable for response. 54% of pts required dose reduction for management of toxicity, and 22% were withdrawn from therapy due to toxicity. The most common treatment-related adverse events were proteinuria 58% (Gr3: 2%), diarrhea 56% (Gr3: 5%), hypertension 48% (Gr3: 7%), fatigue 44% (Gr3: 5%), decreased appetite 41% (Gr3: 5%), nausea 34% (Gr3: 0), and weight decreased 32% (Gr3: 3%). No Gr4 events were reported for these event categories. Confirmed PRs were observed in 21pts (RR: 36%, 95% CI: 24-49) based on independent imaging review (IIR) and 29 pts (RR: 49%, 95% CI: 36-62) based on investigator assessment. For pts who received prior VEGFR-directed treatment (n=26) RR=35% (IIR); with no prior VEGFR-directed treatment (n=33) RR=36 % (IIR). Median PFS by IRR is 9.0 mo (95% CI: 7.0-) (based on minimum 8 mo. f/u, 46% events observed). There was no clear difference in treatment response between RET-mutant (RET-mu) and RET-wild type (RET-wt) patients. Low baseline levels of ANG2, sTie-2, HGF and IL-8 were associated with greater tumor shrinkage and prolonged PFS whereas high baseline levels of VEGF and sVEGFR3 were associated with greater tumor shrinkage. Conclusions: Lenvatinib administered orally at a dose of 24 mg once daily to patients with MTC is associated with manageable toxicity and a RR of 36%, identifying lenvatinib as a promising new potential therapeutic agent for treating patients affected with this disease.
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Affiliation(s)
| | - Barbara Jarzab
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | | | | | - Furio Pacini
- Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | | | | | - Roger Allison
- The Royal Brisbane and Women's Hospital, Herston, Australia
| | - Renato Martins
- University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | - Lisa F. Licitra
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Manisha H. Shah
- The Ohio State University Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, OH
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19
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Carballido EM, Burton JN, Pelayo MR, McCaffrey JC, Padhya T, McCaffrey TV, Trotti A, Rao NG, Reich R, Tanvetyanon T, De Conti RC, Kish JA. Should age affect our treatment decisions for head and neck cancer? J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.5564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5564 Background: Current opinion suggests elderly patients (pts) with head and neck cancer, those 65 or older, do not tolerate surgery, chemotherapy, or radiation as well as their younger counterparts. If this holds true, elderly pts may not be offered standard treatments to prevent assumed complications. Methods: A retrospective cohort study at our comprehensive cancer center was conducted of newly diagnosed pts with head and neck squamous cell carcinoma to explore differences in treatment-related complications between older and younger groups. We included data from the first 199 eligible pts (99 younger than 65 year old and 100 older than 65) evaluated between April 2009 and June 2010. Results: 79% of pts receiving treatment were male with a mean age of 54.9 and 71.6 years for the younger and older groups respectively. The older group had significantly more comorbidities (p < 0.001). The majority of older pts presented with oral cavity tumors (46%) while the oropharynx was the predominant site in the younger group (45%). 55% of younger and 49% of older pts presented with stage 4 disease across all sites. A total of 51 pts were p16 positive with no statistical differences between the groups. Surgery was the initial treatment for 57% of older pts (p < 0.008) while 46% of younger pts received concurrent chemotherapy and radiation as the primary treatment (p < 0.008). There was no statistically significant difference in surgical or radiation complications between the groups. Although most pts receiving chemotherapy experienced complications, older pts had slightly more (93% vs. 78%; p<0.031). The mean survival was 24.8 months with no statistical difference between groups. Significantly more pts in the older group, at last follow-up, were disease free (p < 0.012). Conclusions: The treatment of elderly pts with head and neck squamous cell carcinoma in our experience was congruent with that of younger pts. Elderly pts did not suffer more complications with surgery or radiation, however chemotherapy produced somewhat more complications in the elderly pts. Elderly pts did display less evidence of disease on follow-up. Age is always a consideration when treating individuals, but should not preclude the curative standard.
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Affiliation(s)
| | | | | | | | - Tapan Padhya
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | - Andy Trotti
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Nikhil G Rao
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Richard Reich
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | | | - Julie Ann Kish
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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20
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Tuttle RM, Ball DW, Byrd D, Dilawari RA, Doherty GM, Duh QY, Ehya H, Farrar WB, Haddad RI, Kandeel F, Kloos RT, Kopp P, Lamonica DM, Loree TR, Lydiatt WM, McCaffrey JC, Olson JA, Parks L, Ridge JA, Shah JP, Sherman SI, Sturgeon C, Waguespack SG, Wang TN, Wirth LJ. Thyroid carcinoma. J Natl Compr Canc Netw 2011; 8:1228-74. [PMID: 21081783 DOI: 10.6004/jnccn.2010.0093] [Citation(s) in RCA: 165] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Corzo CA, Condamine T, Lu L, Cotter MJ, Youn JI, Cheng P, Cho HI, Celis E, Quiceno DG, Padhya T, McCaffrey TV, McCaffrey JC, Gabrilovich DI. HIF-1α regulates function and differentiation of myeloid-derived suppressor cells in the tumor microenvironment. ACTA ACUST UNITED AC 2010; 207:2439-53. [PMID: 20876310 PMCID: PMC2964584 DOI: 10.1084/jem.20100587] [Citation(s) in RCA: 871] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Myeloid-derived suppressor cells (MDSCs) are a major component of the immune-suppressive network described in cancer and many other pathological conditions. We demonstrate that although MDSCs from peripheral lymphoid organs and the tumor site share similar phenotype and morphology, these cells display profound functional differences. MDSC from peripheral lymphoid organs suppressed antigen-specific CD8(+) T cells but failed to inhibit nonspecific T cell function. In sharp contrast, tumor MDSC suppressed both antigen-specific and nonspecific T cell activity. The tumor microenvironment caused rapid and dramatic up-regulation of arginase I and inducible nitric oxide synthase in MDSC, which was accompanied by down-regulation of nicotinamide adenine dinucleotide phosphate-oxidase and reactive oxygen species in these cells. In contrast to MDSC from the spleen, MDSC from the tumor site rapidly differentiated into macrophages. Exposure of spleen MDSC to hypoxia resulted in the conversion of these cells to nonspecific suppressors and their preferential differentiation to macrophages. Hypoxia-inducible factor (HIF) 1α was found to be primarily responsible for the observed effects of the tumor microenvironment on MDSC differentiation and function. Thus, hypoxia via HIF-1α dramatically alters the function of MDSC in the tumor microenvironment and redirects their differentiation toward tumor-associated macrophages, hence providing a mechanistic link between different myeloid suppressive cells in the tumor microenvironment.
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Affiliation(s)
- Cesar A Corzo
- H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL 33612, USA
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22
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Herber DL, Cao W, Nefedova Y, Novitskiy SV, Nagaraj S, Tyurin VA, Corzo A, Cho HI, Celis E, Lennox B, Knight SC, Padhya T, McCaffrey TV, McCaffrey JC, Antonia S, Fishman M, Ferris RL, Kagan VE, Gabrilovich DI. Lipid accumulation and dendritic cell dysfunction in cancer. Nat Med 2010; 16:880-6. [PMID: 20622859 PMCID: PMC2917488 DOI: 10.1038/nm.2172] [Citation(s) in RCA: 482] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 05/27/2010] [Indexed: 02/07/2023]
Abstract
Professional antigen presenting cells, dendritic cells (DC) are responsible for initiation and maintenance of immune responses. Here, we report that a substantial proportion of DCs in tumor-bearing mice and cancer patients have increased levels of triglycerides. Lipid accumulation in DCs was caused by increased uptake of extracellular lipids due to up-regulation of scavenger receptor A. DCs with high lipid content were not able to effectively stimulate allogeneic T cells or present tumor-associated antigens. DCs with high and normal lipid levels did not differ in expression of MHC and co-stimulatory molecules. However, lipid-laden DCs had reduced capacity to process antigens. Pharmacological normalization of lipid levels in DCs with an inhibitor of acetyl-CoA carboxylase restored the functional activity of DCs and substantially enhanced the effects of a cancer vaccine. These findings support the regulation of immune responses in cancer by manipulation of lipid levels in DCs.
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Affiliation(s)
- Donna L Herber
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
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23
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Simmons VN, Litvin EB, Patel RD, Jacobsen PB, McCaffrey JC, Bepler G, Quinn GP, Brandon TH. Patient-provider communication and perspectives on smoking cessation and relapse in the oncology setting. Patient Educ Couns 2009; 77:398-403. [PMID: 19846270 PMCID: PMC2787754 DOI: 10.1016/j.pec.2009.09.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 08/26/2009] [Accepted: 09/04/2009] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To fill a gap in research by examining cancer patient-provider communication regarding tobacco use and patients' perspectives regarding their experiences with smoking cessation and relapse. METHODS In-depth interviews were conducted with 20 lung and head and neck cancer patients and 11 health care providers. RESULTS Qualitative analyses revealed that cancer patients express high levels of motivation to quit smoking; however, patients do not ask providers for assistance with quitting and maintaining abstinence and relapsed patients are reluctant to disclose smoking behavior due to stigma and guilt. Health care providers vary in the advice and type of assistance they supply, and their awareness and sensitivity to relapsed patients' feelings. Whereas providers emphasized long-term risks of continued smoking in their interactions with patients and recommendations for intervention content, patients expressed a preference for a balance between risks and benefits. CONCLUSION Findings underscore the need for increased awareness, emphasis, and communication about the immediate risks of continued smoking and the benefits of continued abstinence specifically for cancer patients. PRACTICE IMPLICATIONS Our findings demonstrate the potential to affect cancer outcomes by improved training in conducting smoking cessation and relapse-prevention interventions. Additional training could be given to health care providers to increase adherence to clinical practice guidelines (5 A's), to learn ways to enhance patients' motivation to maintain abstinence, and to deliver smoking messages in a non-threatening manner.
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Affiliation(s)
- Vani Nath Simmons
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, Tampa, USA.
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24
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Corzo CA, Cotter MJ, Cheng P, Cheng F, Kusmartsev S, Sotomayor E, Padhya T, McCaffrey TV, McCaffrey JC, Gabrilovich DI. Mechanism regulating reactive oxygen species in tumor-induced myeloid-derived suppressor cells. J Immunol 2009; 182:5693-701. [PMID: 19380816 DOI: 10.4049/jimmunol.0900092] [Citation(s) in RCA: 564] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Myeloid-derived suppressor cells (MDSC) are a major component of the immune suppressive network described in cancer and many other pathological conditions. Recent studies have demonstrated that one of the major mechanisms of MDSC-induced immune suppression is mediated by reactive oxygen species (ROS). However, the mechanism of this phenomenon remained unknown. In this study, we observed a substantial up-regulation of ROS by MDSC in all of seven different tumor models and in patients with head and neck cancer. The increased ROS production by MDSC is mediated by up-regulated activity of NADPH oxidase (NOX2). MDSC from tumor-bearing mice had significantly higher expression of NOX2 subunits, primarily p47(phox) and gp91(phox), compared with immature myeloid cells from tumor-free mice. Expression of NOX2 subunits in MDSC was controlled by the STAT3 transcription factor. In the absence of NOX2 activity, MDSC lost the ability to suppress T cell responses and quickly differentiated into mature macrophages and dendritic cells. These findings expand our fundamental understanding of the biology of MDSC and may also open new opportunities for therapeutic regulation of these cells in cancer.
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Affiliation(s)
- Cesar A Corzo
- H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, 33612, USA
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25
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Abstract
We describe the histopathologic findings of perineural invasion in orbital mucormycosis in a man with diabetes in ketoacidosis. Linear enhancement on MRI beginning at the orbital apex was correlated with fungal tracking of the trigeminal and lacrimal nerves. Mucormycosis can spread considerable distances from its primary focus of infection along peripheral nerves, a phenomenon that can be identified clinically with contrast-enhanced MRI.
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Affiliation(s)
- Curtis E Margo
- Department of Ophthalmology, James A. Haley Veterans Hospital, Tampa, Florida, USA.
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26
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Chang SJ, Sims J, Murtagh FR, McCaffrey JC, Messina JL. Proliferating trichilemmal cysts of the scalp on CT. AJNR Am J Neuroradiol 2006; 27:712-4. [PMID: 16552022 PMCID: PMC7976987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Proliferating trichilemmal cysts, also known as pilar tumors, are slow-growing lobulated masses most commonly found on the scalp of elderly women. We present the case of a 69-year-old woman with a 25-year history of multiple enlarging scalp masses. The patient was evaluated for surgical consultation after the dominant mass presented with malignant degeneration. A CT of the head revealed multiple large, subcutaneous, cystic masses with calcifications.
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Affiliation(s)
- S J Chang
- Department of Radiology, University of South Florida College of Medicine, Tampa, Fla, USA
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27
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Abstract
BACKGROUND Although rare, invasion of the upper aerodigestive tract by well-differentiated thyroid carcinoma can be a source of significant morbidity as well as mortality for the patient. Effective management of patients with invasive thyroid carcinoma requires an understanding of the patterns of invasion and methods of treatment, including surgical resection and adjuvant therapy. METHODS The author reports on experience with invasive well-differentiated thyroid carcinoma, discussing diagnosis (based on physical examination, imaging studies, and endoscopy) as well as treatment options (based on degree of aerodigestive tract invasion). RESULTS Direct intraluminal invasion of thyroid carcinoma requires definitive resection of aerodigestive tract lumen to remove all gross disease. However, when the lumen is not involved, "shaving" tumor from airway or esophagus is an acceptable treatment with a similar locoregional control rate and minimal morbidity when compared to definitive aerodigestive tract resection. CONCLUSIONS Successful treatment of invasive thyroid carcinoma should improve survival and reduce not only the morbidity of the disease, but also the morbidity of the surgical procedure.
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Affiliation(s)
- J C McCaffrey
- Head and Neck Program, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa 33612, USA.
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Slocum GG, Black LA, McCaffrey JC, Robertson AH. Report of Committee to Confer with American Public Health Association and with International Association of Milk and Food Sanitarians on Methods for Examination of Dairy Products. J AOAC Int 1958. [DOI: 10.1093/jaoac/41.1.72b] [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: 11/14/2022]
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