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Seo S, Keam B, Shin SH, Chae YS, Kim TM, Park LC, Hong SB, Ahn MJ, Kim SB. A phase Ia/Ib study of novel anti-ErbB3 monoclonal antibody, barecetamab (ISU104) in refractory solid cancers and monotherapy or in combination with cetuximab in recurrent or metastatic head and neck cancer. Int J Cancer 2023; 153:1501-1511. [PMID: 37357950 DOI: 10.1002/ijc.34622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/22/2023] [Accepted: 04/05/2023] [Indexed: 06/27/2023]
Abstract
We evaluated the safety, tolerability, pharmacokinetics and antitumor activity of barecetamab monotherapy and combination cetuximab therapy in patients with advanced solid cancers, especially head and neck cancer (HNC). Part 1 was a 3 + 3 dose-escalation study in which 15 patients received barecetamab at 1, 3, 5, 10 and 20 mg/kg intravenously (IV) on days 1 and 28 and weekly in patients with advanced solid cancer. Part 2 was a dose-expansion study including two patient groups with advanced HNC, including six patients receiving barecetamab at 20 mg/kg IV every 3 weeks and 12 patients receiving barecetamab and cetuximab (400 mg/m2 on day 1 followed by 250 mg/m2 every week). No dose-limiting toxicities (DLTs) were observed. Maximum serum target engagement was reached with trough levels of doses ≥3 mg/kg IV weekly. Common adverse drug reactions were diarrhea, stomatitis, dermatitis acneiform and decreased appetite. One durable complete response of more than 17 months was observed, and the overall response and disease control rates were 36.4% (4/11) and 81.1% (9/11), respectively, in the combination therapy group. In conclusion, DLT was not observed in barecetamab at 1 to 20 mg/kg. The recommended phase II dose was determined to be 20 mg/kg triweekly. Barecetamab and in cetuximab combination was well tolerated and demonstrated meaningful antitumor effects.
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Affiliation(s)
- Seyoung Seo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seong Hoon Shin
- Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Yee Soo Chae
- Department of Oncology/Hematology, Kyungpook National University Medical Center Biobank, Daegu, Republic of Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Lee Chun Park
- Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Seung-Beom Hong
- Research Center, ISU ABXIS Co., Ltd., Seongnam, Republic of Korea
| | - Myung-Ju Ahn
- Department of Hematology/Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Lee J, Park S, Jung HA, Lee SH, Seo S, Kim SB, Kim JW, Lee KW, Kang EJ, Kim JW, Choi YJ, Shim BY, An HJ, Park LC, Shin SH, Kim JJ, Oh SY, Kim MK, Ahn MJ. A phase 2 multicenter study of docetaxel-PM and trastuzumab-pkrb combination therapy in recurrent or metastatic salivary gland carcinomas. Cancer 2023; 129:2966-2974. [PMID: 37246414 DOI: 10.1002/cncr.34892] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/24/2023] [Accepted: 04/18/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Salivary duct carcinoma (SDC) is uncommon but is the most aggressive subtype of salivary gland carcinomas. The high positivity rate for human epidermal growth factor receptor 2 (HER2) led to an investigation of the efficacy of HER2-targeted agents. Docetaxel-PM (polymeric micelle) is a low-molecular-weight, nontoxic, biodegradable, and docetaxel-loaded micellar formulation. Trastuzumab-pkrb is a biosimilar to trastuzumab. METHODS This was a multicenter, single-arm, open-label phase 2 study. Patients with HER2-positive (immunohistochemistry [IHC] score of ≥2+ and/or HER2/chromosome enumeration probe 17 [CEP17] ratio of ≥2.0) advanced SDCs were enrolled. Patients received docetaxel-PM (75 mg/m2 ) and trastuzumab-pkrb (8 mg/kg in the first cycle and 6 mg/kg in subsequent cycles) every 3 weeks. Primary end point was objective response rate (ORR). RESULTS A total of 43 patients were enrolled. The best objective responses were partial response in 30 (69.8%) patients and stable disease in 10 (23.3%) patients, leading to an ORR of 69.8% (95% confidence interval [CI], 53.9-82.8) and a disease control rate of 93.0% (80.9-98.5). Median progression-free survival, duration of response, and overall survival were 7.9 (6.3-9.5), 6.7 (5.1-8.4), and 23.3 (19.9-26.7) months, respectively. Patients with HER2 IHC score of 3+ or HER2/CEP17 ratio ≥2.0 demonstrated better efficacies compared to those with HER2 IHC score of 2+. Thirty-eight (88.4%) patients experienced treatment-related adverse events (TRAE). Because of TRAE, nine (20.9%), 14 (32.6%), and 19 (44.2%) patients required temporary discontinuation, permanent discontinuation, or dose reduction, respectively. CONCLUSIONS The combination of docetaxel-PM and trastuzumab-pkrb demonstrated promising antitumor activity with a manageable toxicity profile in HER2-positive advanced SDC. PLAIN LANGUAGE SUMMARY Salivary duct carcinoma (SDC) is uncommon but is the most aggressive subtype of salivary gland carcinomas. SDC shares morphological and histological similarities with invasive ductal carcinoma of breast, which led to an investigation of hormonal receptor and human epidermal growth factor receptor 2 (HER2)/neu expression status in SDC. In this study, patients with HER2-positive SDC were enrolled and treated with combination of docetaxel-polymeric micelle and trastuzumab-pkrb. Promising antitumor activities were shown with objective response rate of 69.8%, disease control rate of 93.0%, median progression-free survival of 7.9 months, median duration of response of 6.7 months, and median overall survival of 23.3 months.
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Affiliation(s)
- Jiyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sehhoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Ae Jung
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se-Hoon Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seyoung Seo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eun Joo Kang
- Division of Medical Oncology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Ju Won Kim
- Division of Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yoon Ji Choi
- Division of Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Byoung-Yong Shim
- Department of Medical Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ho-Jung An
- Department of Medical Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Lee Chun Park
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Seong Hoon Shin
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Jae-Joon Kim
- Medical Oncology and Hematology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Korea
| | - So Yeon Oh
- Medical Oncology and Hematology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Korea
| | - Min Kyoung Kim
- Department of Oncology/Hematology, Yeungnam University Hospital, Daegu, Korea
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lee J, Park S, Jung HA, Lee SH, Seo S, Kim SB, Kim JW, Lee KW, Kang EJ, Kim JW, Choi YJ, Shim BY, An HJ, Park LC, Shin S, Kim JJ, Oh SY, Kim MK, Ahn MJ. Phase II study of trastuzumab-pkrb and docetaxel anhydrous combination therapy in recurrent or metastatic salivary ductal carcinomas (KCSG HN18-08/KM11). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6018] [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: 11/10/2022] Open
Abstract
6018 Background: Salivary gland cancers (SGCs) are relatively rare, accounting for 1-6% of all neoplasms of the head and neck, have diverse disease course with respect to origin and pathology. Salivary duct carcinoma (SDC) is the most aggressive tumor subtype of primary SGC, showing high rates of local recurrence and distant metastases. In regard to previous studies which reported a high prevalence of HER2 positivity in SDCs, we conducted a single-arm, phase II study to evaluate the antitumor activity and safety of Herzuma (a trastuzumab biosimilar which demonstrated an equivalent efficacy to reference trastuzumab) in combination with docetaxel anhydrous (Nanoxel) in patients with HER2-positive advanced SDCs. Methods: Eligible patients had histologically confirmed HER2-positive (defined as IHC≥2+ and/or FISH HER2/CEN17 ratio ≥2.0) recurrent/metastatic SDC, or subtypes of SGC that were pathologically similar to SDC (excluding ACCs). They received Herzuma (8mg/kg i.v. loading dose, followed by 6mg/kg i.v.) and Nanoxel (75mg/m2 i.v.) every 3 weeks. The primary endpoint was the investigator-assessed objective response rate (ORR) according to RECIST v1.1. Secondary endpoints were overall survival (OS), progression-free survival (PFS), and safety. The calculated sample size was 43 patients for H1 of ORR ≥40%. Safety was evaluated by CTCAE v4.0. Results: A total of 43 patients were enrolled. Patient characteristics included: median age 60 (range 35–81); 86% male; 84% ECOG1; 84% SDC, 9% adenocarcinoma, 2% high grade mucoepidermoid carcinoma, and 5% other subtypes. Confirmed ORR was seen in 67% (95% CI, 52–81). No patient had a complete response as their BOR, 29 (67%) had a partial response, 11 (26%) had stable disease, 1 (2%) had progressive disease, and 2 (5%) were unevaluable. The DCR was 93% (95% CI, 81–99). The median PFS and OS were 8.2 months (95% CI, 6.7–9.7) and 23.3 months (95% CI, 19.9–26.7), respectively. Thirty-eight (88%) patients experienced a treatment-related AE (TRAE), with 15 (35%) patients experiencing ≥grade 3 TRAE including: neutropenia (10), febrile neutropenia (4), anemia (1), sepsis (1), anaphylaxis (1), decreased LVEF (1). There were no treatment-related deaths. Conclusions: The study met the primary endpoint of ORR. Herzuma and Nanoxel combination therapy demonstrated a promising treatment outcome in patients with HER2-positive recurrent/metastatic SDC. Clinical trial information: NCT03614364.
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Affiliation(s)
- Jiyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sehhoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun Ae Jung
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Se-Hoon Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seyoung Seo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji-Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Keun Wook Lee
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eun Joo Kang
- Division of Medical Oncology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Ju Won Kim
- Korea University Anam Hospital, Seoul, South Korea
| | - Yoon Ji Choi
- Korea University College of Medicine, Seoul, South Korea
| | - Byoung Yong Shim
- St. Vincent's Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Ho Jung An
- Division of Medical Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Lee Chun Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
| | - SeongHoon Shin
- Department of Internal Medicine, Kosin University Gospel Hospital, Busan, South Korea
| | - Jae-Joon Kim
- Medical Oncology and Hematology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - So Yeon Oh
- Medical Oncology and Hematology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea
| | - Min Kyoung Kim
- Department of Internal Medicine, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, South Korea
| | - Myung-Ju Ahn
- Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, South Korea
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Chae YK, Kim WB, Davis AA, Park LC, Anker JF, Simon NI, Rhee K, Song J, Cho A, Chang S, Ko T, Oh M, Bhave M, Viveiros P. Mass spectrometry-based serum proteomic signature as a potential biomarker for survival in patients with non-small cell lung cancer receiving immunotherapy. Transl Lung Cancer Res 2020; 9:1015-1028. [PMID: 32953481 PMCID: PMC7481587 DOI: 10.21037/tlcr-20-148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background VeriStrat test is a serum assay which uses a mass spectrometry (MS)-based proteomic signature derived from machine learning. It is currently used as a prognostic marker for patients with non-small cell lung cancer (NSCLC) receiving chemotherapy. However, little is known about its role for NSCLC patients receiving immune checkpoint inhibitors (ICIs). Methods This is a retrospective study that includes 47 patients with advanced stage NSCLC without an activating EGFR mutation, who underwent the VeriStrat test from 2016 to 2018. Spectra from blood samples were evaluated to assign patients into the VeriStrat ‘Good’ (VS-G) or VeriStrat ‘Poor’ (VS-P) risk group. The clinical outcomes of 32 patients who received programmed cell death 1 (PD-1) inhibitors nivolumab or pembrolizumab were analyzed by VeriStrat status. Results The VS-G group demonstrated significantly higher progression-free survival (PFS) and overall survival (OS) compared to the VS-P group among overall NSCLC patients regardless of treatment (median PFS of 7.1 vs. 4.2 months, P=0.013, and median OS, not reached vs. 17.2 months, P=0.012). Among NSCLC patients treated with ICIs, VS-G classification was associated with significantly increased PFS in comparison to VS-P classification (median PFS of 6.2 vs. 3.0 months, P=0.012), while the differences in OS trended towards significance (median OS, not reached vs. 16.5 months P=0.076). Multivariate analysis showed that the VeriStrat status was significantly correlated with PFS and OS in NSCLC patients treated with ICIs (P=0.017, P=0.034, respectively). Conclusions MS-based serum proteomic signature has potential as a biomarker for survival outcome in NSCLC patients receiving immunotherapy.
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Affiliation(s)
- Young Kwang Chae
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Won Bin Kim
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrew A Davis
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lee Chun Park
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Hematology/Oncology, Internal Medicine, Kosin University, Busan, Republic of Korea
| | - Jonathan F Anker
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nicholas I Simon
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kyunghoon Rhee
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Junho Song
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anderson Cho
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sangmin Chang
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Taeyeong Ko
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael Oh
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Manali Bhave
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Pedro Viveiros
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Kim YS, Ji JH, Oh SY, Lee S, Huh SJ, Lee JH, Song K, Son CH, Roh MS, Lee GW, Lee J, Kim ST, Kim CK, Jang JS, Hwang IG, Ahn HK, Park LC, Oh SY, Kim S, Lee S, Lim D, Lee SI, Kang JH. A Randomized Controlled Trial of Epidermal Growth Factor Ointment for Treating Epidermal Growth Factor Receptor Inhibitor-Induced Skin Toxicities. Oncologist 2020; 25:e186-e193. [PMID: 31492766 PMCID: PMC6964120 DOI: 10.1634/theoncologist.2019-0221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/27/2019] [Accepted: 07/18/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The efficacy of epidermal growth factor (EGF) receptor (EGFR) inhibitors in patients with non-small cell lung cancer (NSCLC), pancreatic cancer (PC), or colorectal cancer (CRC) has been demonstrated. However, dermatological reactions to these inhibitors can cause significant physical and psychosocial discomfort. The objective of the present study was to evaluate the efficacy of EGF ointment for EGFR inhibitor-related skin adverse events (ERSEs). MATERIALS AND METHODS This placebo-controlled, double-blind, multicenter, pilot phase III trial enrolled patients with NSCLC, PC, or CRC treated with EGFR inhibitors. Patients with grade ≥2 ERSEs were included. Patients were randomized to three treatment arms: arm 1, placebo; arm 2, 1 ppm of EGF ointment; and arm 3, 20 ppm of EGF ointment. Patients applied ointment to their skin lesions twice daily. RESULTS Efficacy evaluation was available for 80 patients (9 for PC, 28 for NSCLC, and 43 for CRC). Responses were 44.4% in arm 1, 61.5% in arm 2, and 77.8% in arm 3. There was a linear correlation between EGF concentrations and responses (p = .012). Quality of life (QoL) was assessed for 74 patients. Maximum changes in composite scores by Skindex-16 after treatment were significantly different among arms (mean ± SD: -5.2 ± 8.6 for arm 1, -11.7 ± 14.2 for arm 2, and - 18.6 ± 17.7 for arm 3; p = .008). EGF arms showed significant improvement in emotions (p = .005) and functioning (p = .044) scores over the placebo arm. CONCLUSION EGF ointment is effective for managing ERSEs. It can also improve patients' QoL compared with placebo. Clinical trial identification number. NCT02284139 IMPLICATIONS FOR PRACTICE: Patients with non-small cell lung cancer, pancreatic cancer, or colorectal cancer who are treated with epidermal growth factor (EGF) receptor (EGFR) inhibitors may experience dermatologic reactions to their treatment. This study investigated the benefit of an EGF ointment in the treatment of these adverse events and observed the ointment to be effective in managing EGFR inhibitor-related skin adverse events.
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Affiliation(s)
- Young Saing Kim
- Department of Internal Medicine, Gachon University Gil Medical CenterIncheonRepublic of Korea
| | - Jun Ho Ji
- Division of Hematology‐Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of MedicineChangwonRepublic of Korea
| | - Sung Yong Oh
- Department of Internal Medicine, Dong‐A University HospitalBusanRepublic of Korea
| | - Suee Lee
- Department of Internal Medicine, Dong‐A University HospitalBusanRepublic of Korea
| | - Seok Jae Huh
- Department of Internal Medicine, Dong‐A University HospitalBusanRepublic of Korea
| | - Ji Hyun Lee
- Department of Internal Medicine, Dong‐A University HospitalBusanRepublic of Korea
| | - Ki‐Hoon Song
- Department of Dermatology, National Cancer CenterGoyangRepublic of Korea
| | - Choon Hee Son
- Department of Pulmonology, Dong‐A University HospitalBusanRepublic of Korea
| | - Mee Sook Roh
- Department of Pathology, Dong‐A University College of MedicineBusanRepublic of Korea
| | - Gyeong Won Lee
- Department of Internal Medicine, Gyeongsang National University HospitalJinjuRepublic of Korea
| | - Jeeyun Lee
- Department of Medicine, Samsung Medical CenterSeoulRepublic of Korea
| | - Seung Tae Kim
- Department of Medicine, Samsung Medical CenterSeoulRepublic of Korea
| | - Chan Kyu Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon HospitalBucheonRepublic of Korea
| | - Joung Soon Jang
- Department of Internal Medicine, Chung‐Ang University College of MedicineSeoulRepublic of Korea
| | - In Gyu Hwang
- Department of Internal Medicine, Chung‐Ang University College of MedicineSeoulRepublic of Korea
| | - Hee Kyung Ahn
- Department of Internal Medicine, Gachon University Gil Medical CenterIncheonRepublic of Korea
| | - Lee Chun Park
- Division of Hematology‐Oncology, Department of Medicine, Kosin University College of MedicineBusanRepublic of Korea
| | - So Yeon Oh
- Department of Internal Medicine, Pusan National University Yangsan HospitalYangsanRepublic of Korea
| | - Seong‐Geun Kim
- Department of Internal Medicine, Pusan National University Yangsan HospitalYangsanRepublic of Korea
| | - Sang‐Cheol Lee
- Department of Internal Medicine, Soonchunhyang University Hospital CheonanCheonanRepublic of Korea
| | - Do‐Hyoung Lim
- Department of Internal Medicine, Dankook University College of MedicineCheonanRepublic of Korea
| | - Soon Il Lee
- Department of Internal Medicine, Dankook University College of MedicineCheonanRepublic of Korea
| | - Jung Hun Kang
- Department of Internal Medicine, Gyeongsang National University HospitalJinjuRepublic of Korea
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Chae YK, Saleem N, Roh Y, Bilal H, Viveiros P, Sukhadia B, Lin X, Sheikh MM, Park LC. Exceptional response to chemotherapy followed by concurrent radiotherapy and immunotherapy in a male with primary retroperitoneal serous Adenocarcinoma: a case report and literature review. BMC Cancer 2019; 19:748. [PMID: 31362708 PMCID: PMC6668104 DOI: 10.1186/s12885-019-5934-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 07/12/2019] [Indexed: 11/16/2022] Open
Abstract
Background Primary retroperitoneal serous adenocarcinoma (PRSA) is an extremely uncommon malignancy exclusively reported in females. Due to the rarity of the disease, it is difficult to establish a standardized treatment. Case presentation We describe a unique case of PRSA in a 71-year-old male who presented with right-sided lower back pain and numbness. Magnetic resonance imaging identified a mass invading the adjacent psoas muscle and twelfth rib. Tissue biopsy confirmed poorly differentiated PRSA. Patient was initially treated with neoadjuvant carboplatin and paclitaxel chemotherapy regimen. This resulted in complete radiological resolution of the tumor. However, 12 weeks later, rapid recurrence was noted on follow-up CT scan. The patient was then treated with external radiotherapy with concurrent nivolumab, an anti-PD-1 antibody. The patient displayed a positive response to treatment with reduction in primary tumor and metastases and had a sustained disease control. Conclusion Treatment with radiotherapy in combination with anti-PD-1 antibody could be an effective modality of management for PRSA. Electronic supplementary material The online version of this article (10.1186/s12885-019-5934-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Young Kwang Chae
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL- 60611, USA.
| | - Naira Saleem
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL- 60611, USA
| | - Yoonhwan Roh
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL- 60611, USA
| | - Haris Bilal
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL- 60611, USA
| | - Pedro Viveiros
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL- 60611, USA
| | - Bhoomika Sukhadia
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL- 60611, USA
| | - Xiaoqi Lin
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Muhammad Mubbashir Sheikh
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL- 60611, USA
| | - Lee Chun Park
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL- 60611, USA
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Chae YK, Viveiros P, Lopes G, Sukhadia B, Sheikh MM, Saravia D, Florou V, Sokol ES, Frampton GM, Chalmers ZR, Ali SM, Ross JS, Chang S, Wang S, Chiec L, Rahbari A, Mohindra N, Villaflor V, Shin SH, Oh M, Anker J, Park LC, Wang V, Chuang J, Park W. Clinical and Immunological Implications of Frameshift Mutations in Lung Cancer. J Thorac Oncol 2019; 14:1807-1817. [PMID: 31238177 DOI: 10.1016/j.jtho.2019.06.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 02/06/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Presently, programmed death ligand 1 is the most commonly used biomarker to predict response to immune checkpoint inhibitors (ICIs) in NSCLC. Owing to its several limitations, there is continuous search for more precise and reliable markers. Frameshift mutations by insertion or deletion (fsindels) are suggested to induce more immunogenic tumor-specific neoantigens, conferring better response to ICIs. Positive correlation of fsindels with ICI response has been studied in melanoma and renal cell carcinoma. We investigated the implication of fsindels in the clinical outcomes and immune landscape of patients with NSCLC treated with ICIs. METHODS We utilized The Cancer Genome Atlas data set to analyze tumor mutational burden, neoantigen burden, and immune landscape in relation to fsindel status. In addition, utilizing the clinical data from 122 patients treated with ICIs, we evaluated the influence of fsindels on disease response rates and survival outcomes. RESULTS A positive correlation between fsindel burden and tumor mutational burden and activated CD4/CD8 T-cell infiltration was shown. Presence of fsindels was also associated with significant prolongation of progression-free survival in patients treated with ICIs (median 6.2 versus 2.7 months [p = 0.01]). In addition, significant differences in the overall response rates (26% versus 12% [p = 0.04]) and disease control rates (68% versus 48% [p = 0.02]) were observed in patients with fsindels. CONCLUSION Our findings suggest that fsindels may have a predictive role for ICI response in NSCLC.
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Affiliation(s)
- Young Kwang Chae
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Pedro Viveiros
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Gilberto Lopes
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Bhoomika Sukhadia
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Diana Saravia
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Vaia Florou
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | | | | | - Zachary R Chalmers
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois; Foundation Medicine, Cambridge, Massachusetts
| | - Siraj M Ali
- Foundation Medicine, Cambridge, Massachusetts
| | | | - Sangmin Chang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Si Wang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lauren Chiec
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ashkon Rahbari
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Nisha Mohindra
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Victoria Villaflor
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Sang Ha Shin
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael Oh
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jonathan Anker
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lee Chun Park
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Victor Wang
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
| | - Jeffrey Chuang
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
| | - Wungki Park
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida; Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
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8
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Park LC, Song YJ, Kim DJ, Kim MJ, Jo JC, Lee WS, Shin HJ, Oh SY, Do YR, Jeong JY, Lee HS. The effects of erythropoiesis-stimulating agents on the management of chemotherapy-induced anemia and tumor growth in diffuse large B-cell lymphoma patients. Int J Cancer 2019; 145:2459-2467. [PMID: 30973963 DOI: 10.1002/ijc.32328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/20/2019] [Accepted: 04/02/2019] [Indexed: 11/11/2022]
Abstract
Erythropoiesis-stimulating agents (ESAs), such as erythropoietin (EPO) and darbepoetin, may alleviate anemia in diffuse large B-cell lymphoma (DLBCL) patients. However, many cancer cells express EPO receptors (EPOR), through which exogenously administered ESAs potentially promote cancer cell growth. We conducted preclinical/phase II studies to investigate the safety and efficacy of ESAs for managing chemotherapy-related anemia in DLBCL patients. We examined EPOR expression in germinal center B-cell (GCB)- and activated B-cell (ABC)-DLBCL cell lines, and investigated the effects of ESAs on cell proliferation, and rituximab-mediated complement-dependent cytotoxicity (CDC). The clinical study enrolled 50 histologically confirmed DLBCL patients receiving rituximab/cyclophosphamide/doxorubicin/vincristine/prednisolone (R-CHOP) who had hemoglobin levels <10.0 g/dl after a maximum of three R-CHOP cycles and received ≥4 doses of fixed-dose darbepoetin (360 μg) once every 3 weeks. EPOR mRNA was detected in all GCB-DLBCL cell lines, but little/none was detected in ABC-DLBCL cell lines. GCB-DLBCL and ABC-DLBCL cell proliferation was unaffected by EPO or darbepoetin. Rituximab-mediated CDC of DLBCL cell lines with/without EPOR expression was not affected adversely by EPO. In the clinical study, baseline mean hemoglobin was 9.19 g/dl; the overall mean change in hemoglobin was 1.59 ± 1.3 g/dl (16 weeks). Forty-eight percent of enrolled patients achieved a hematopoietic response. Our study shows that ESAs do not affect the growth of DLBCL cells or rituximab-mediated CDC under the experimental conditions that we used, and the appropriate use of ESAs may be effective and safe for DLBCL patients with anemia after R-CHOP.
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Affiliation(s)
- Lee Chun Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Yeon-Joo Song
- Central Medical Research Institute, Kosin University Gospel Hospital, Busan, South Korea.,Cancer Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Da Jung Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Min-Jung Kim
- Cancer Research Institute, Kosin University College of Medicine, Busan, South Korea.,Department of Biochemistry, Kosin University College of Medicine, Busan, South Korea
| | - Jae-Cheol Jo
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Won Sik Lee
- Department of Internal Medicine, Busan Paik Hospital, Busan, South Korea
| | - Ho-Jin Shin
- Department of Internal Medicine, Busan National University Hospital, Busan, South Korea
| | - Sung Yong Oh
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea
| | - Young Rok Do
- Department of Hemato-Oncology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Jee-Yeong Jeong
- Cancer Research Institute, Kosin University College of Medicine, Busan, South Korea.,Department of Biochemistry, Kosin University College of Medicine, Busan, South Korea
| | - Ho Sup Lee
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
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9
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Chae YK, Viveiros P, Heleno CT, Bilal H, Sukhadia BA, Oh MS, Sheikh MM, Iams WT, Park LC. Use of Cabozantinib in a Patient With EGFR-Mutated Non-Small-Cell Lung Cancer Harboring Acquired CCDC6-RET Fusion. JCO Precis Oncol 2019; 3:1800295. [PMID: 32914006 PMCID: PMC7446309 DOI: 10.1200/po.18.00295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2019] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Wade T Iams
- Northwestern University, Chicago, IL.,Vanderbilt University, Nashville, TN
| | - Lee Chun Park
- Northwestern University, Chicago, IL.,Kosin University, Pusan, South Korea
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10
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Chae YK, Rhee K, Park LC, Cho A, Chang S, Ko T, Davis A, Bhave M, Cruz M, Iams W. Abstract 3693: Immunologic and clinical implications of polymerase δ ( POLD) and Polymerase ϵ ( POLE) gene mutations in non-small cell lung cancer (NSCLC). Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-3693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
POLD1 plays a role in proofreading the polymerase δ complex while POLE encodes the major catalytic and proofreading subunit of the polymerase ϵ complex. Mutations in POLD1 and POLE increase spontaneous somatic mutation rates which have been linked with favorable response to PD-1 inhibitor in NSCLC. However, little is known about its impact on the immune landscape and prognosis.
We analyzed genomic, transcriptomic and clinical data from The Cancer Genome Atlas (TCGA) database using cBioPortal of patients with lung adenocarcinoma (ADC, 522 samples) and squamous cell carcinoma (SQCC, 504 samples). We compared patient samples with at least one mutation (M group) in POLD/E family genes (POLD1, POLD2, POLD3, POLD4, POLE, POLE2, POLE3, POLE4) with patient samples without any mutations in above mentioned gene set (N group). The tumor immune landscape was analyzed from RNA-seq z-scores of 812 ‘immune metagene' signatures (Angelova, M. et al, 2015) which were used to predict immune infiltration of 31 distinct immune cells for each tumor sample.
POLD family gene mutation frequency was 0.5% (5/1026 samples) while POLE family gene mutation frequency was 2.0% (21/1026 samples). M group showed significantly higher tumor mutational burden (TMB) in both ADC (median mutation count M:475 N:149, t-test p=0.003) and SQCC (median mutation count M: 318 N:218, t-test p=0.01). In ADC, infiltration of activated CD8 T-cells (M:46% N:26%, chi square test p=0.11) and activated CD4 T-cells (M:46% N:29%, chi square test p=0.19) were not significant. In SQCC, M group showed significantly higher infiltration of activated CD8 T-cells (M:54% N:27%, chi square test p=0.03) while infiltration of activated CD4 T-cells (M:46% N:36%, chi square test p=0.44) was not significant. In terms of survival, in ADC, there was significantly worse survival in M group compared to N group (median M:21 N:50 months, log-rank test p<0.001), while in SQCC, there was no significant difference (median M:66 N:62 months, log-rank test p=0.70).
This is the first comprehensive report describing the immunologic and clinical implication of POLD/E family gene mutation status in NSCLC. In summary, POLD/E family gene mutation was linked with higher TMB in NSCLC. In adenocarcinoma, mutational status of POLD/E was associated with an unfavorable survival outcome suggesting potential prognostic implications.
Citation Format: Young Kwang Chae, Kyunghoon Rhee, Lee Chun Park, Anderson Cho, Sangmin Chang, Taeyeong Ko, Andrew Davis, Manali Bhave, Marcello Cruz, Wadw Iams. Immunologic and clinical implications of polymerase δ (POLD) and Polymerase ϵ (POLE) gene mutations in non-small cell lung cancer (NSCLC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3693.
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Affiliation(s)
- Young Kwang Chae
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kyunghoon Rhee
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lee Chun Park
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Anderson Cho
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sangmin Chang
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Taeyeong Ko
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew Davis
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Manali Bhave
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Marcello Cruz
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Wadw Iams
- Northwestern University Feinberg School of Medicine, Chicago, IL
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11
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Chae YK, Rhee K, Park LC, Cho A, Ko T, Chang S, Davis A, Bhave M, Cruz M, Iams W. Abstract 4608: Immunologic and clinical implications of harboring mutations in mismatch repair (MMR) genes in non-small cell lung cancer (NSCLC). Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-4608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
MMR system is one of many cellular DNA repair mechanisms, verifying and maintaining repeat count of microsatellites during cell division. Mutations in MMR genes lead to increased genomic instability and tumor mutational burden (TMB). MMR gene mutation is known to occur in many solid tumors, including colorectal and endometrial tumors. Pembrolizumab, a PD-1 inhibitor, has recently been approved for MMR-deficient tumors regardless of their histologic origin. A minor portion of NSCLC has been reported to have traits of MMR deficiency. However, little is known regarding its biologic and clinical implications in NSCLC. Here we examined the association between the mutational status in MMR genes and change in TMB, immune cell landscape, and clinical outcome in NSCLC. We analyzed genomic, transcriptomic, and clinical data from The Cancer Genome Atlas (TCGA) database using cBioPortal of patients with lung adenocarcinoma (ADC, 522 samples) and squamous cell carcinoma (SQCC, 504 samples). We compared the group with at least one mutation (M) in 17 MMR genes (MLH1, MLH3, MSH2, MSH3, MSH4, MSH5, MSH6, PMS1, PMS2, PCNA, EXO1, POLD1, RFC1, RFC2, RFC3, RFC4, RFC5) with the group without mutation (N). The tumor immune landscape was analyzed from RNA-seq z-scores of 812 "immune metagene" signatures (Angelova M et al., 2015) which were used to predict immune infiltration of 31 distinct immune cells for each tumor sample. Among 522 samples of ADC, 9.2% (48 samples) of MMR gene mutations were found while among 504 samples of SQCC, 9.1% (46 samples) were detected. In ADC, M group did not have significant difference in TMB compared to N group (median mutation count M:206.5 N:150.5, t-test p=0.14). There was no significant difference in activated CD4 T-cell (M:31% N:30%, chi square test p=0.81), CD8 T-cell infiltration (M:35% N:26%, chi square test p=0.16) and overall survival (median M:33 N:50 months, log-rank test p=0.27). In SQCC, M group demonstrated significantly higher TMB (median mutation count M:268 N:206.5, t-test p=0.0001) compared to N group. However, activated CD4 T-cell (M:22% N:37%, chi square test p=0.04) infiltration was significantly low. CD8 T-cell infiltration (M:26% N:28%, chi square test p=0.79) did not show any significant difference. In terms of survival, although not statistically significant, there was a trend towards worse survival in M group compared to N group (median M:35 N:65 months, log-rank test p=0.07). This is the first comprehensive report describing the immunologic and clinical implication of MMR gene mutation in NSCLC. Interestingly, similar to colorectal cancer, in SQCC there was a positive correlation between MMR gene mutation and higher TMB. However, there was no clear association with activated CD8 T-cell infiltration nor any association with favorable prognosis.
Citation Format: Young Kwang Chae, Kyunghoon Rhee, Lee Chun Park, Anderson Cho, Taeyeong Ko, Sangmin Chang, Andrew Davis, Manali Bhave, Marcello Cruz, Wadw Iams. Immunologic and clinical implications of harboring mutations in mismatch repair (MMR) genes in non-small cell lung cancer (NSCLC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4608.
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Affiliation(s)
- Young Kwang Chae
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kyunghoon Rhee
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lee Chun Park
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Anderson Cho
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Taeyeong Ko
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sangmin Chang
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew Davis
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Manali Bhave
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Marcello Cruz
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Wadw Iams
- Northwestern University Feinberg School of Medicine, Chicago, IL
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12
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Chae YK, Cho A, Rhee K, Davis A, Iams W, Bhave M, Cruz M, Park LC. Abstract 5547: Durable remission with nivolumab, anti-PD-1 monoclonal antibody, in a patient with advanced thymic carcinoma. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-5547] [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
Thymic carcinoma is a rare neoplasm with poor prognosis that forms on the outside surface of the thymus. Due to the rarity of the disease, there are no randomized clinical trials that guide therapy. Currently, there are clinical trials under way to assess the efficacy of anti-programmed death 1 (PD-1) monoclonal antibodies for the treatment of advanced thymic carcinomas. However, the role of PD-1 inhibitors in treating thymic carcinoma remains mostly unknown. Here we present a case of a patient with thymic carcinoma who showed durable remission when treated with nivolumab. 61-year-old male was diagnosed with thymic carcinoma during an episode of COPD exacerbation in April 2015. The patient was treated with neoadjuvant chemotherapy regimen consisting of four cycles of carboplatin and paclitaxel every three weeks from June to September 2015. The mass was resected in October 2015. Margins were found to be grossly positive. The patient was deemed a poor candidate for adjuvant chemotherapy, and in February 2016 the decision was made to begin 3 mg/kg nivolumab therapy considering the poor prognosis of disease and high risk of recurrence. Close to two years after initiating therapy, he currently has no measurable disease and tolerates the medication without side effects. This is the first report demonstrating durable remission of thymic carcinoma with nivolumab treatment. Our case suggests that prospective trials evaluating the use of nivolumab in patients with thymic carcinoma are warranted.
Citation Format: Young Kwang Chae, Anderson Cho, Kyunghoon Rhee, Andrew Davis, Wade Iams, Manali Bhave, Marcelo Cruz, Lee Chun Park. Durable remission with nivolumab, anti-PD-1 monoclonal antibody, in a patient with advanced thymic carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5547.
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13
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Lee HS, Kim DJ, Park LC, Lee JJ, Jung SH, Jo JC, Lee JH, Cho SH, Chae YK. Can bortezomib combined chemotherapy be helpful for even elderly unfit patients with newly diagnosed multiple myeloma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e20020] [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)
- Ho Sup Lee
- Kosin University College of Medicine, Kosin University Gospel Hospital, Busan, Korea, Republic of (South)
| | - Da Jung Kim
- Kosin University College of Medicine, Kosin University Gospel Hospital, Busan, Korea, Republic of (South)
| | - Lee Chun Park
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Je-Jung Lee
- Chonnam National University Hwasun Hospital, Hwasun, Korea, Republic of (South)
| | - Sung-Hoon Jung
- Chonnam National University Hwasun Hospital, Hwasun, Korea, Republic of (South)
| | | | - Ji Hyun Lee
- Dong-A University Hospital, Busan, Korea, Republic of (South)
| | - Su-Hee Cho
- Division of Hemato-Oncology, Department of Internal Medicine, Samsung Medical Center, Seoul, Korea, Republic of (South)
| | - Young Kwang Chae
- Northwestern Medicine Developmental Therapeutics Institute, Chicago, IL
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14
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Oh SY, Lee S, Kang JH, Kim ST, Kim CK, Jang JS, Hwang IG, Kim YS, Ahn HK, Park LC, Ji JH, Oh SY, Kim SG, Lee S, Lee SC, Lee J. Pilot trial of epidermal growth factor (EGF) ointment for the patients with epidermal growth factor receptor (EGFR) inhibitor related skin side effects. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.10054] [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)
- Sung Yong Oh
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea, Republic of (South)
| | - Suee Lee
- Department of Internal Medicine, Dong-A University Medical Center, Busan, Korea, Republic of (South)
| | - Jung Hun Kang
- Gyengsang National University Hospital, Jinju, Korea, Republic of (South)
| | - Seung Tae Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of (South)
| | - Chan Kyu Kim
- Soonchunhyang University Bucheon Hospital, Bucheon, Korea, Republic of (South)
| | - Joung Soon Jang
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - In Gyu Hwang
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Young Saing Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea, Republic of (South)
| | - Hee Kyung Ahn
- Department of Medical Oncology, Gachon University Gil Medical Center, Incheon, Korea, Republic of (South)
| | - Lee Chun Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea, Republic of (South)
| | - Jun Ho Ji
- Division of Hemato-Oncology, Department of Internal Medicine, Changwon Samsung Medical Center, Changwon, Korea, Republic of (South)
| | - So Yeon Oh
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea South
| | - Seong-Geun Kim
- Pusan National University Yangsan Hospital, Yangsan, Korea, Republic of (South)
| | - Soonil Lee
- Department of Internal Medicine, Dankook University Hospital, Cheonan, Korea, Republic of (South)
| | - Sang-Cheol Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Soonchunhyang University Hospital Seoul, Soonchunhyang University College of Medicine, Seoul, Korea, Republic of (South)
| | - Jeeyun Lee
- Samsung Medical Center, Seoul, Korea, Republic of (South)
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Lee HS, Kim DJ, Park LC, Jeong JY, Jo JC, Chae YK. The effects of erythropoiesis-stimulating agents on the management of chemotherapy-induced anemia and tumor growth in diffuse large B-cell lymphoma patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e19538] [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)
- Ho Sup Lee
- Kosin University Gospel Hospital, Busan, Korea South
| | - Da Jung Kim
- Kosin University College of Medicine, Kosin University Gospel Hospital, Busan, Korea, Republic of (South)
| | - Lee Chun Park
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jee-yeong Jeong
- 2Department of Biochemistry Cancer Research Institute, Kosin University College of Medicine, Busan, Korea, Republic of (South)
| | | | - Young Kwang Chae
- Northwestern Medicine Developmental Therapeutics Institute, Chicago, IL
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16
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Park LC, Rhee K, Kim WB, Cho A, Song J, Anker JF, Oh M, Bais P, Namburi S, Chuang J, Chae YK. Immunologic and clinical implications of CD73 expression in non-small cell lung cancer (NSCLC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.12050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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)
- Lee Chun Park
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kyunghoon Rhee
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Won Bin Kim
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Anderson Cho
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Junho Song
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Michael Oh
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Preeti Bais
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
| | | | | | - Young Kwang Chae
- Northwestern Medicine Developmental Therapeutics Institute, Chicago, IL
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Kim MJ, Kim YS, Oh SY, Lee S, Choi YJ, Seol YM, Park MJ, Kim KH, Park LC, Kang JH, Hwang IG, Lee SI, Lim ST, Kim HS, Lim HY, Rha SY, Kim HJ. Retrospective analysis of palliative chemotherapy for the patients with bladder adenocarcinoma: Korean Cancer Study Group Genitourinary and Gynecology Cancer Committee. Korean J Intern Med 2018; 33:383-390. [PMID: 27048257 PMCID: PMC5840579 DOI: 10.3904/kjim.2015.162] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 12/12/2015] [Accepted: 12/31/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND/AIMS Because of rarity, role of chemotherapy of bladder adenocarcinoma are still unidentified. Therefore, we performed a retrospective analysis of the clinical features and chemotherapy outcomes of bladder adenocarcinoma. METHODS Eligible patients for this retrospective analysis were initially diagnosed with bladder adenocarcinoma and presented with a clinically no other primary site of origin. The collected data included age, gender, performance status, stage, hemoglobin, albumin, initial date of diagnosis, treatment modality utilized, response to treatment, presence of relapse, last status of patient, and last date of follow-up. RESULTS We retrospectively reviewed 29 patients, who were treated with chemotherapy for bladder adenocarcinoma at 10 Korean medical institutions from 2004 to 2014. The median age of patients was 58 years (range, 17 to 78) and 51.7% of the patients were female. Urachal adenocarcinoma was identified in 15 patients. Of 27 symptomatic patients, 22 experienced gross hematuria. Twelve patients were treated with 5-f luorouracil based chemotherapy, five were gemcitabine based, three were taxane and others. Thirteen of them achieved complete response (10.3%) or partial response (34.5%). Median progression-free survival (PFS) and overall survival (OS) for all patients were 10.6 months (95% confidence interval [CI], 9.5 to 11.6) and 24.5 months (95% CI, 1.2 to 47.8), respectively. The cases of urachal adenocarcinoma exhibited worse tendency in PFS and OS (p = 0.024 and p = 0.046, respectively). CONCLUSIONS Even though bladder adenocarcinoma had been observed moderate effectiveness to chemotherapy, bladder adenocarcinoma is a highly aggressive form of bladder cancer. PFS and OS were short especially in urachal carcinoma.
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Affiliation(s)
- Moon Jin Kim
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Sung Yong Oh
- Dong-A University Hospital, Busan, Korea
- Correspondence to Sung Yong Oh, M.D. Department of Internal Medicine, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-gu, Busan 49201, Korea Tel: +82-51-240-2808 Fax: +82-51-246-5044 E-mail:
| | - Suee Lee
- Dong-A University Hospital, Busan, Korea
| | | | | | - Min Jae Park
- Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ki Hyang Kim
- Inje University Busan Paik Hospital, Busan, Korea
| | | | - Jung Hun Kang
- Gyeongsang National University Hospital, Jinju, Korea
| | - In-Gyu Hwang
- Chung-Ang University College of Medicine, Seoul, Korea
| | - Soon Il Lee
- Dankook University College of Medicine, Cheonan, Korea
| | | | - Hyo Song Kim
- Yonsei University College of Medicine, Seoul, Korea
| | - Ho Yeong Lim
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lee EM, Park LC, Lee HS, Shin SH, Kim YS. Retrospective analysis on the clinical efficacy of bevacizumab combined with FOLFOX4 in the first line treatment of metastatic colorectal cancer. KMJ 2017. [DOI: 10.7180/kmj.2017.32.2.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives The addition of bevacizumab to standard chemotherapy has been improved survival outcomes in patients with metastatic colorectal cancer. However, the combination of bevacizumab with oxaliplatin-based chemotherapy as first-line treatment showed limited survival benefit. The purpose of this study was to investigate the clinical efficacy and toxicity of the combination of bevacizumab to oxaliplatin and leucovorin (FOLFOX4) in the first-line treatment of patient with metastatic colorectal cancer. Methods Between December 2004 and September 2009, medical records of patients who were diagnosed with metastatic colorectal cancer and received the first line chemotherapy with bevacizumab and FOLFOX4, were retrospectively reviewed. Results A total of forty patients were analyzed. The median age of the patients was 55 years (range, 33-80), and 55% was male. The patients received a total of 206 cycles of therapy (median 4 cycles per patient; range 1 – 15 cycles). Of these 40 patients, none achieved complete response (CR) and 15 achieved a partial response (PR), for the overall response rate (ORR) 37.5% (95% CI, 22.5-52.5). Median progression free survival (PFS) was 6.9 months (95% CI, 3.4-10.5) and median overall survival (OS) was 22.6 months (95% CI, 17.3-27.8The most common grade 3 or 4 hematologic toxicity and non-hematologic toxicity were neutropenia (10.0%) and diarrhea (10.0%), respectively. Two patients experienced gastrointestinal perforation. Conclusions In this study, the combination bevacizumab with FOLFOX4 was associated with favorable OS, but did not showed favorable PFS and ORR.
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Go SI, Koo DH, Kim ST, Song HN, Kim RB, Jang JS, Oh SY, Lee KH, Lee SI, Kim SG, Park LC, Lee SC, Park BB, Ji JH, Yi SY, Lee YG, Yun J, Bruera E, Hwang IG, Kang JH. Antiemetic Corticosteroid Rotation from Dexamethasone to Methylprednisolone to Prevent Dexamethasone-Induced Hiccup in Cancer Patients Treated with Chemotherapy: A Randomized, Single-Blind, Crossover Phase III Trial. Oncologist 2017; 22:1354-1361. [PMID: 28687626 DOI: 10.1634/theoncologist.2017-0129] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/15/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To assess whether the rotation of dexamethasone to methylprednisolone decreases the intensity of dexamethasone-induced hiccup (DIH) in cancer patients treated with chemotherapy. MATERIALS AND METHODS Adult patients who experienced DIH within 3 days after the administration of dexamethasone as an antiemetic were screened. Eligible patients were randomly assigned to receive dexamethasone (n = 33) or methylprednisolone (n = 32) as an antiemetic (randomization phase). In the next cycle of chemotherapy, the dexamethasone group received methylprednisolone and vice versa in the methylprednisolone group (crossover phase). The primary endpoint was the difference in hiccup intensity as measured using the numeric rating scale (NRS) between two groups. RESULTS No female patients were enrolled, although the study did not exclude them. At the randomization phase, hiccup frequency was 28/33 (84.8%) in the dexamethasone group versus 20/32 (62.5%) in the methylprednisolone group (p = .04). Intensity of hiccup was significantly higher in the dexamethasone group than that in the methylprednisolone group (mean NRS, 3.5 vs. 1.4, p < .001). At the crossover phase, hiccup intensity was further decreased after the rotation of dexamethasone to methylprednisolone in the dexamethasone group (mean NRS, 3.5 to 0.9, p < .001), while it was increased by rotating methylprednisolone to dexamethasone in the methylprednisolone group (mean NRS, 1.4 to 3.3, p = .025). There were no differences in emesis intensity between the two groups at either the randomization or crossover phases. Clinicaltrials.gov identifier: NCT01974024. CONCLUSION Dexamethasone-induced hiccup is a male-predominant phenomenon that can be ameliorated by rotating dexamethasone to methylprednisolone without compromising the antiemetic efficacy. IMPLICATIONS FOR PRACTICE In this randomized, multicenter, phase III trial, hiccup intensity was significantly lower when the antiemetic corticosteroid was rotated from dexamethasone to methylprednisolone without a change in emesis intensity than that when dexamethasone was maintained. At the crossover phase, hiccup intensity was increased again if dexamethasone was readministered instead of methylprednisolone. The present study demonstrated that dexamethasone-induced hiccup can be improved by rotating from dexamethasone to methylprednisolone without compromising its antiemetic efficacy.
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Affiliation(s)
- Se-Il Go
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Republic of Korea
| | - Dong-Hoe Koo
- Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Tae Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Haa-Na Song
- Division of Hematology/Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Rock Bum Kim
- Department of Preventive Medicine and Environmental Health, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Joung-Soon Jang
- Division of Hematology/Oncology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sung Yong Oh
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Kyung Hee Lee
- Division of Oncology-Hematology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Soon Il Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Seong-Geun Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Lee Chun Park
- Division of Hematology-Oncology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan, Republic of Korea
| | - Sang-Cheol Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Soonchunhyang University Hospital Cheonan, Cheonan, Republic of Korea
| | - Byeong-Bae Park
- Division of Hematology/Oncology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jun Ho Ji
- Division of Hematology and Oncology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Seong Yoon Yi
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Yun-Gyoo Lee
- Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jina Yun
- Division of Hematology/Oncology, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - In Gyu Hwang
- Division of Hematology/Oncology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jung Hun Kang
- Division of Hematology/Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
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Park LC, Lee HS, Lee EM, Shin SH, Kim YS. Prognostic Significance of Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Diffuse Large B-Cell Lymphoma Patients Treated with R-CHOP. KMJ 2016. [DOI: 10.7180/kmj.2016.31.2.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives The both values of neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) were reported as indexes of systemic inflammation and readily available and inexpensive prognostic markers in patients with solid cancer. The objective of this study was to clarify whether the NLR and PLR were significant prognostic markers in Korean diffuse large B-cell lymphoma (DLBCL) patients treated with R-CHOP as a first line therapy. Methods : We retrospectively collected the clinical data of ninety nine DLBCL patients treated with R-CHOP from 2004 to 2012 and analyzed. NLR and PLR were calculated from complete blood count (CBC) and differential leukocyte count. Results : In univariate analysis, NLR was significantly associated with 5-year progression free survival(PFS) rate (P= 0.039), but not significantly associated with 5-year overal survival (OS) rate (P= 0.276). PLR was not significantly associated with 5-year PFS (P= 0.632) and OS rate (P= 0.855). In multivariate analysis, NLR was not a significant independent prognostic factor for 5-year PFS (P= 0.415) and OS rate (P= 0.991). Conclusion : The NLR can be considered a useful predictor of survival outcome. The PLR is not a valid predictor of survival outcome.
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Oh SY, Kim YS, Lee JH, Kim M, Choi YJ, Soel YM, Park MJ, Kim KH, Park LC, Kang JH, Hwang IG, Kim HS, Lim ST, Rha SY, Lee S. Retrospective analysis of chemotherapy for the patients with advanced bladder adenocarcinoma. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.7_suppl.399] [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
399 Background: By definition, primary adenocarcinoma of the bladder (PAB) is a malignant neoplasm derived from urothelium of the bladder showing histologically pure glandular differentiation. Because of its rarity, role of chemotherapy for metastatic adenocarcinoma of bladder is still questionable. Therefore, we performed a retrospective analysis of the clinical features and chemotherapy outcomes of metastatic PAB to evaluate the clinical findings at presentation, overall survival (OS) and progression-free survival (PFS) and prognostic factors. Methods: Eligible patients for this retrospective analysis were initially diagnosed with adenocarcinoma and presented with a clinically no other primary site of origin. The collected data included age, gender, performance status, stage, hemoglobin, albumin, initial date of diagnosis, treatment modality utilized, response to treatment, presence of relapse, last status of patient, and last date of follow-up. Results: We retrospectively reviewed 29 patients who treated with chemotherapy as metastatic PAB at 10 Korean medical institutions from 2004 to 2014.The median age of patients was 58 years (range, 17 to 78 years) and 51.7% of the patients were female. Fifteen patients were urachal adenocarcinoma. Of 27 symptomatic patients, 22 experienced gross hematuria. Ten patients had two or more metastatic sites of the lungs (51.7%), peritoneum (41.4%), and ovary (20.7%), as the most common sites. Twelve patients were treated with 5-FU based chemotherapy, 5 were gemcitabine based, 3 were taxane and adriamycin based, and others. 13 of them achieved CR (10.3%) or PR (34.5%). Median PFS and OS for all patients were 10.6 months (95% confidence interval [CI], 9.5 to 11.6 months) and 24.5 months (95% CI, 1.2 to 47.8 months), respectively. In the prognostic factor analysis, the cases of urachal adenocarcinoma had worse tendency in PFS and OS (p=0.024 and P=0.046, respectively). Conclusions: Metastatic Despite most of chemotherapy, PFS and OS were short especially in urachal carcinoma, however, there were some long-term survivors, therefore, additional research on the predictive markers of several clinical, pathological differences and their treatments will be needed.
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Affiliation(s)
- Sung Yong Oh
- Medical Research Center for Cancer Molecular Therapy, Dong-A University College of Medicine, Busan, South Korea
| | | | - Ji Hyun Lee
- Dong-A University Hospital, Busan, South Korea
| | - Moonjin Kim
- Department of Medicine, Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Yong Mi Soel
- Pusan National University Hospital, Pusan, South Korea
| | - Min Jae Park
- Busan University Yangsan Hospital, Yangsan, South Korea
| | - Ki Hyang Kim
- Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Lee Chun Park
- Division of Hemato-Oncology, Department of Internal Medicine, Samsung Medical Center, Seoul, South Korea
| | | | - In-Gyu Hwang
- Chung-Ang University College of Medicine, Seoul, South Korea
| | - Hyo Song Kim
- Department of Internal Medicine, Division of Medical Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Sun Young Rha
- Yonsei University College of Medicine, Seoul, South Korea
| | - Soonil Lee
- Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, South Korea
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Park LC, Jeong JY, Ji JH, Park S, Ahn JS, Im YH, Park YH. Intra-tumoral Metastatic Double Primary Carcinoma: Synchronous Metastatic Tumor in Lung from Breast and Thyroid Carcinoma. Cancer Res Treat 2014; 46:200-3. [PMID: 24851113 PMCID: PMC4022830 DOI: 10.4143/crt.2014.46.2.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 04/04/2013] [Indexed: 02/06/2023] Open
Abstract
Cases of phenotypic heterogeneity of cells within tumors have recently been reported. Here, we report on a patient with characteristic intra-tumor double primary metastases in the lung. This patient was a 40-year-old Korean woman who had been diagnosed with breast cancer (T1N0M0, estrogen receptor/progesterone receptor/HER2 +/+/+) and papillary thyroid cancer three years prior and underwent a complete surgical resection followed by appropriate adjuvant treatment with radiation, hormone, and radioactive iodine. She was recently admitted for newly developed pulmonary nodules. Metastasectomy through video-assisted thoracoscopic surgery revealed recurrent double primary cancer with two different components (metastatic ductal carcinomas from the breast and metastatic papillary carcinomas from the thyroid gland) in each pulmonary nodule in the right upper lobe and right middle lobe. To the best of our knowledge, this is the first report of simultaneous recurrent double metastasis in one organ from different primary origins.
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Affiliation(s)
- Lee Chun Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. ; Division of Hematology-Oncology, Department of Medicine, Kosin University College of Medicine, Busan, Korea
| | - Ji Yun Jeong
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Ho Ji
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Silvia Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Seok Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Hyuck Im
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Hee Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Yoh KA, Lee HS, Park LC, Lee EM, Shin SH, Park DJ, Ye BJ, Kim YS. The prognostic significance of elevated levels of serum ferritin before chemotherapy in patients with non-Hodgkin lymphoma. Clin Lymphoma Myeloma Leuk 2013; 14:43-9. [PMID: 24200518 DOI: 10.1016/j.clml.2013.09.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 09/12/2013] [Accepted: 09/24/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Elevated levels of serum ferritin have been documented to be an adverse prognostic factor in patients with hematologic malignancies undergoing hematopoietic stem cell transplantation. The purpose of this study was to estimate the correlation between elevated levels of serum ferritin and survival outcomes in patients with non-Hodgkin lymphoma (NHL). PATIENTS AND METHODS A total of 267 patients who were newly diagnosed with NHL and who received chemotherapy between September 1999 and April 2012 were retrospectively analyzed. RESULTS In multivariate analysis, other chemotherapy regimens excluding CHOP-like chemotherapy regimens (cyclophosphamide, adriamycin, vincristine, prednisolone) and RCHOP (rituximab plus CHOP), a high level of β2-microglobulin, a high-intermediate/high risk according to the international prognostic index (IPI), and elevated levels of serum ferritin were all significant independent prognostic factors for 5-year progression-free survival rates. RCHOP and other chemotherapy regimens, a high level of β2-microglobulin, a high-intermediate/high IPI risk, and high levels of serum ferritin were significant independent prognostic factors for 5-year overall survival rates. CONCLUSION Elevated levels of serum ferritin of 500 ng/mL or more as well as the use of chemotherapy regimens besides CHOP-like or RCHOP, a high-intermediate/high risk IPI, and a high level of beta2-microglobulin in NHL may be an important marker for predicting poor survival outcomes.
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Affiliation(s)
- Kyung Ah Yoh
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Ho Sup Lee
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea.
| | - Lee Chun Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Eun Mi Lee
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Seong Hoon Shin
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Dae Jin Park
- Department of Pharmacology, Kosin University College of Medicine, Busan, South Korea
| | - Byeong Jin Ye
- Department of Occupational and Environmental Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Yang Soo Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
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Lee HS, Park LC, Lee EM, Shin SH, Kim YS, Moon JH, Lee WS, Shin HJ, Kim MH, Ye BJ, Chung JS. Predictive factors for rapid neutrophil and platelet engraftment after allogenic peripheral blood stem cell transplantation in patients with acute leukemia. Ann Hematol 2013; 92:1685-93. [PMID: 23896629 DOI: 10.1007/s00277-013-1847-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 07/09/2013] [Indexed: 10/26/2022]
Abstract
The aim of this study was to investigate predictive factors for rapid engraftment after allogeneic peripheral blood stem cell transplantation (alloPBSCT) in patients with acute leukemia. Two hundred sixty-two patients receiving alloPBSCT were analyzed. Subset analyses of donor stem cells were conducted using a flow cytometric method. The correlation between rapid engraftment of neutrophils, platelets, and donor stem cells doses, as well as other recipient and donor clinical factors, was analyzed. In univariate analysis, factors correlated with neutrophil engraftment (≥0.5 × 10(9)/L) by day 12 were achievement of complete remission (CR) after induction chemotherapy (CR1) before hematopoietic cell transplantation (HCT) and high numbers of CD34+ cells, CD3+ T cells, and CD3+/CD4+ T cells. Factors correlated with platelet engraftment (≥20 × 10(9)/L) by day 12 were achievement of CR1 before HCT, donor and recipient sex mismatch, and high numbers of mononuclear cells, CD34+ cells, CD3+ T cells, CD3+/CD4+ T cells, CD3+/CD8+ T cells, and CD56+ NK cells. In multivariate analysis, independent predictive factors for rapid neutrophil and platelet engraftment were CR1 before HCT (p < 0.001 and p = 0.002, respectively), high number of donor CD34+ cells (p = 0.005 and p < 0.001, respectively), and high number of CD3+ T cells (p = 0.005 and p = 0.001, respectively). In conclusion, achieving CR1 before HCT, as well as larger quantities of donor CD34+ and CD3+ T cells, may predict rapid neutrophil and platelet engraftment after PBSCT.
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Affiliation(s)
- Ho Sup Lee
- Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
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Lee SJ, Park LC, Lee J, Kim S, Choi MK, Hong JY, Park S, Maeng CH, Chang W, Kim YS, Park SH, Park JO, Lim HY, Kang WK, Park YS. Unique perception of clinical trials by Korean cancer patients. BMC Cancer 2012; 12:594. [PMID: 23234342 PMCID: PMC3572433 DOI: 10.1186/1471-2407-12-594] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 11/26/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In the past few years, the number of clinical trials has increased rapidly in East Asia, especially for gastric and hepatobiliary cancer that are prevalent in Asian populations. However, the actual degree of understanding or perceptions of clinical trials by cancer patients in East Asian countries have seldom been studied. METHODS Between July 1st and November 30th of 2011, we conducted a prospective study to survey cancer patients regarding their awareness of, and willingness to participate in, a clinical trial. Patients with gastrointestinal/hepatobiliary cancer who visited the Hematology-Oncology outpatient clinic at Samsung Medical Center (SMC) were enrolled. A total of 21 questions were asked including four questions which used the Visual analogue scale (VAS) score. RESULTS In this survey study, 1,000 patients were asked to participate and 675 patients consented to participate (67.5%). The awareness of clinical trials was substantially higher in patients who had a higher level of education (p<0.001), were married (p=0.004), and had a higher economic status (p=0.001). However, the willingness to participate in a clinical trial was not affected by the level of education or economic status of patients. The most influential factors for patient willingness to participate were a physician recommendation (n=181, 26.8%), limited treatment options (n=178, 26.4%), and expectations of effectiveness of new anti-cancer drugs (n=142, 21.0%). Patients with previous experience in clinical trials had a greater willingness to participate in clinical trials compared to patients without previous experience (p<0.001). CONCLUSIONS This large patient cohort survey study showed that Korean cancer patients are more aware of clinical trials, but awareness did not translate into willingness to participate.
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Affiliation(s)
- Su Jin Lee
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong Gangnam-gu, Seoul, 135-710, Korea
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Park LC, Woo SY, Kim S, Jeon H, Ko YH, Kim SJ, Kim WS. Incidence, risk factors and clinical features of venous thromboembolism in newly diagnosed lymphoma patients: Results from a prospective cohort study with Asian population. Thromb Res 2012; 130:e6-12. [DOI: 10.1016/j.thromres.2012.03.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 03/05/2012] [Accepted: 03/26/2012] [Indexed: 12/21/2022]
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Park S, Moon SH, Park LC, Hwang DW, Ji JH, Maeng CH, Cho SH, Ahn HK, Lee JY, Kim SJ, Choi JY, Kim WS. The impact of baseline and interim PET/CT parameters on clinical outcome in patients with diffuse large B cell lymphoma. Am J Hematol 2012; 87:937-40. [PMID: 22730093 DOI: 10.1002/ajh.23267] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Taking a step forward from the IPI, attention is focused on the role of 18F-FDG PET/CT as a tool for guidance in risk stratification in patients with aggressive non-Hodgkin's lymphoma (NHL). Here, we analyzed the predictive value of various PET/CT parameters in patients with DLBCL. Particularly, we were interested in patients with an IPI score of 1, 2, or 3, whose prognosis are confusing. Between Jul 2008 and Feb 2010, a total of 100 patients (including 57 patients with an IPI score of 1-3) who were treated with R-CHOP for DLBCL, and had assessable PET/CT parameters were analyzed in this study. Absolute value of SUVmax, SUVsum(sum of SUVmax) and TLGsum(SUVmean x Volumemeta) from baseline and interim PET/CT, and ΔSUVsum, ΔSUVmax, and ΔTLGsum between baseline and interim PET/CT were selected as PET/CT parameters. The median number of R-CHOP cycles was 6, and interim PET/CT was performed after 2 or 3 cycles. None of the parameters which showed percentile change between initial and interim PET/CT were associated with prognosis. Instead, absolute value of SUVsum from baseline PET/CT, and SUVmax and SUVsum from interim PET/CT were significantly relevant to PFS in all patients, and in patients with an IPI score of 1–3.
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Affiliation(s)
- Silvia Park
- Division of Hematology-Oncology, Department of Medicine, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, Korea
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Cho SH, Park LC, Ji JH, Park S, Hwang DW, Lee JY, Choi YL, Han JH, Sun JM, Ahn JS, Park K, Ahn MJ. Efficacy of EGFR tyrosine kinase inhibitors for non-adenocarcinoma NSCLC patients with EGFR mutation. Cancer Chemother Pharmacol 2012; 70:315-20. [DOI: 10.1007/s00280-012-1876-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 03/27/2012] [Indexed: 11/28/2022]
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Park LC, Lee J, Kim HY, Choi MK, Hong JY, Park S, Maeng CH, Do I, Park SH, Park J, Kang W, Lim H, Park YS. Perceptions of clinical trials in gastrointestinal/hepatobiliary cancer patients: A comprehensive survey in a Korean tertiary hospital. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e13094] [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
e13094 Background: In the past few years, the volume of clinical trials has increased rapidly in East Asia, especially in Asian prevalent cancer types such as gastric cancer, hepatobiliary cancer. The actual degree of understanding or perceptions of clinical trials by cancer patients have been rarely studied in East Asian countries. Methods: Between July 1st 2011 and November 30th 2011, we conducted a prospective survey study regarding cancer patient’s awareness and willingness to participate a clinical trial. The questionnaire consisted of 21 questions based on an Index of Clinical Trial Understanding. Patients with gastrointestinal/hepatobiliary cancer who visited the Hemato-Oncology outpatient clinic at Samsung Medical Center and signed informed consent form were enrolled. The survey was conducted by a well-trained research nurse and statistical analysis was analyzed at the biostatistics core at SMC. Results: In this survey study, 1,000 patients were asked to participate and 675 patients consented to participate (67.5%). The awareness of clinical trial was substantially higher in patients with higher level of education (p<.001), married (p=.004), and higher economic status (p=.001). Nevertheless, willingness to participate the clinical trial was not significantly increased by higher level of education (p=.286), married (p=.685) and higher income (p=.310). The most common source for acquisition of clinical trial was attending physicians (52.0%) followed by mass media (36.6%), other patients (6.39%), internet (3.3%) and others (1.5%). The most influential factors for patient’s willingness to participate were physician’s opinion (n=181, 26.8%), limited treatment options (n=178, 26.4%), and expectations towards new anti-cancer drug (n=142, 21.0%). Patients were likely to refuse to participate a clinical trial due to unverified treatment modality (n=320, 47.4%) and negativity for clinical trials (n=193, 28.6%). Conclusions: We surveyed a large patient cohort to specifically inquire willingness and awareness of clinical trial in Asian-prevalent cancer types. Further correlative analyses with various variable will be presented at the meeting.
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Affiliation(s)
- Lee Chun Park
- Division of Hemato-Oncology, Department of Internal Medicine, Samsung Medical Center, Seoul, South Korea
| | - Jeeyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hee Young Kim
- ONCO CRC Team (Clinical Trial Center), Samsung Medical Center, Seoul, South Korea
| | - Moon Ki Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung Yong Hong
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Silvia Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chi Hoon Maeng
- Department of Hemato-Oncology, Samsung Medical Center, Seoul, South Korea
| | - Ingu Do
- Samsung Cancer Research Institute, Seoul, South Korea
| | - Se Hoon Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joonoh Park
- Divisions of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - WonKi Kang
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hoyeong Lim
- Divisions of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Suk Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Cho SH, Park S, Park LC, Ji JH, Lee JY, Hwang DW, Maeng CH, Ahn HK, Ahn MJ, Park K, Ahn JS, Sun JM. Metabolic response evaluated by 18F-FDG PET/CT as a potential tool in identifying subgroup of patients with advanced non-small cell lung cancer for immediate maintenance treatment after first-line chemotherapy. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e18148] [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
e18148 Background: Platinum-based doublet regimens have been a mainstay of first-line treatment with advanced non–small cell lung cancerand ans the present guidelines recommend four to six cycles and waiting until disease progression. However subsequent disease progression is often rapid so sequential and maintenance therapy was performed in many studies. But almost studies didn’t show the significant survival benefit. Thus, we supposed that FDG PET may be a useful to determine what subgroup have better prognosis Methods: We founded out fifty-two patients who diagnosed to underwent baseline and follow-up FDG PET after 4 cycles of first-line platinum based chemotherapy. We obstained patient's characteristics and response rate (RR), progression-free survival (PFS), and overall survival (OS) from the medical records. And we checked maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG) from FDG PET. Results: Univariate analysis showed that MTV (hazard ratio = 1.032, P = 0.007) and TLG (hazard ratio = 1.030, P = 0.001) were independent predictive factors associated with decreased PFS and gender (hazard ratio = 5.248, P = 0.026), smoking (hazard ratio = 7.798, P = 0.006), EGFR mutation (hazard ratio = 0.106, P = 0.030) and TLG (hazard ratio = 1.027, P = 0.046) were significant predictors of OS. Histopathology was a marginally significant prognostic factor (P = 0.058). Multivariate analysis showed that TLG (hazard ratio = 1.030, P = 0.001) were independent predictive factors associated with decreased PFS and smoking (hazard ratio = 10.588, P = 0.002) and TLG (hazard ratio = 1.043, P = 0.007) were significant predictors of OS. Conclusions: There is a correlation between TLG and PFS significantly. We suggest that follow-up FDG PET after 4 cycle chemotherpy can help to discriminate patients who have benefit through sequential and maintenance therapy. But it need specific value for clinical use, so more large-scale prospective study is warranted.
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Affiliation(s)
- Su-Hee Cho
- Division of Hemato-Oncology, Department of Internal Medicine, Samsung Medical Center, Seoul, South Korea
| | - Silvia Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Lee Chun Park
- Division of Hemato-Oncology, Department of Internal Medicine, Samsung Medical Center, Seoul, South Korea
| | - Jun Ho Ji
- Division of Hemato-Oncology, Department of Internal Medicine, Samsung Medical Center, Seoul, South Korea
| | - Ji Yean Lee
- Division of Hemato-Oncology, Department of Internal Medicine, Samsung Medical Center, Seoul, South Korea
| | | | - Chi Hoon Maeng
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hee Kyung Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Myung-ju Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Keunchil Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin Seok Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jong-Mu Sun
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Maeng CH, Park S, Jung HA, Ahn HK, Hwang DW, Park K, Ahn MJ, Ji JH, Park LC, Cho SH, Lee JY. Comparison of clinical outcomes between concurrent chemoradiotherapy followed by adjuvant chemotherapy and concurrent chemoradiotherapy alone for patients associated with locally advanced nasopharyngeal carcinoma: A retrospective analysis of single center experience. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e16003] [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
e16003 Background: Up to date, the mainstay of treatment is concurrent chemoradiotherapy (CCRT) with or without adjuvant chemotherapy for locally advanced nasopharyngeal carcinoma. However, the exact role of adjuvant chemotherapy has not been established yet. Methods: Medical record review and data collection were performed for 148 patients who were diagnosed of locally advanced nasopharyngeal carcinoma from October 1996 to September 2009. We analyzed clinical outcomes between the patients who received CCRT followed by adjuvant chemotherapy with cisplatin and 5-FU, and CCRT alone. Results: The estimated 5 year survival rates were 78.3% for the CCRT group and 69.1% for the CCRT followed by adjuvant chemotherapy, respectively (p=0.223). For patients of TNM stage IVA or IVB, the progression-free survival (PFS) and overall survival (OS) had no significant differences between the two groups (p=0.062 and 0.538, respectively). For the patients with stage I, II or III at diagnosis, the PFS and OS were not statistically significant either (p=0.112 and 0.266, respectively). Conclusions: For all stages of nasopharyngeal carcinoma, adjuvant chemotherapy after CCRT did not affect the survival or recurrent rate. A randomized prospective study with long-term follow-up is necessary.
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Affiliation(s)
- Chi Hoon Maeng
- Department of Hemato-Oncology, Samsung Medical Center, Seoul, South Korea
| | - Silvia Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun Ae Jung
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hee Kyung Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Keunchil Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Myung-Ju Ahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jun Ho Ji
- Division of Hemato-Oncology, Department of Internal Medicine, Samsung Medical Center, Seoul, South Korea
| | - Lee Chun Park
- Division of Hemato-Oncology, Department of Internal Medicine, Samsung Medical Center, Seoul, South Korea
| | - Su-Hee Cho
- Division of Hemato-Oncology, Department of Internal Medicine, Samsung Medical Center, Seoul, South Korea
| | - Ji Yean Lee
- Division of Hemato-Oncology, Department of Internal Medicine, Samsung Medical Center, Seoul, South Korea
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Park S, Ahn HK, Park LC, Hwang DW, Ji JH, Maeng CH, Cho SH, Lee JY, Park KT, Ahn JS, Park YH, Im YH. Implications of different CA 15-3 levels according to breast cancer subtype at initial diagnosis of recurrent or metastatic breast cancer. Oncology 2012; 82:180-7. [PMID: 22433564 DOI: 10.1159/000336081] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 12/21/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND CA 15-3 is derived from proteolytic shedding of the extracellular domain of mucin 1 (MUC1) glycoprotein. Luminal subtype breast cancer shows a higher expression in MUC1 genes, and a positive relationship between MUC1 expression and estrogen receptor (ER) expression has been reported. In this study, we attempted to determine the difference of CA 15-3 level according to the subtype of breast cancer. METHODS From January 2000 to December 2009, a total of 707 patients who were diagnosed with metastatic or recurrent breast cancer at Samsung Medical Center were included in this study. Among these, 536 patients with available clinical data including pretreatment CA 15-3 and immunohistochemistry for ER, progesterone receptor (PgR) and hormone receptor 2 (HER2) were analyzed in this study. Patients were classified into 3 groups according to their receptor status: ER-positive (ER+) and/or PgR+ irrespective of HER2 (HR+), ER-/PgR-/HER2+ (HER2-enriched) and ER-/PgR-/HER2- (triple negative, TN). RESULTS The supranormal values of CA 15-3 were frequently observed in HR+ breast cancer compared to other types (45.6% for HR+, 24.4% for HER2-enriched and 28.8% for TN; p < 0.001). The increase of marker levels differed significantly among the 3 groups (24 U/ml for HR+, 13 U/ml for HER2-enriched and 18 U/ml for TN; p < 0.001). CONCLUSIONS The increase of both marker levels and the frequency of supranormal values of CA 15-3 were more frequently observed in HR+ breast cancer, which is positively associated with MUC1 expression. These results could potentially serve as a basis for expanding the clinical implications of CA 15-3 in the field of clinical trials for novel targeted therapies in breast cancer.
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Affiliation(s)
- Silvia Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Park LC, Lee HS, Shin SH, Park SJ, Park MI, Oh SY, Kwon HC, Baek JH, Choi YJ, Kang MJ, Kim YS. Bevacizumab as a second- or later-line of treatment for metastatic colorectal cancer. World J Gastroenterol 2012; 18:1104-9. [PMID: 22416186 PMCID: PMC3296985 DOI: 10.3748/wjg.v18.i10.1104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 01/12/2012] [Accepted: 02/08/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the efficacy of bevacizumab in patients with metastatic colorectal cancer (MCRC) who have failed prior chemotherapy without bevacizumab.
METHODS: Between March 2002 and June 2010, 40 patients in South Korea with MCRC who were treated with bevacizumab plus chemotherapy as a second or later-line treatment were analyzed retrospectively for their overall response rate (ORR), overall survival (OS), and progression-free survival (PFS). The tumor responses were assessed using the Response Evaluation Criteria in Solid Tumors guidelines.
RESULTS: All of the patients had progressed under prior chemotherapy without bevacizumab. Three patients (7.5%) exhibited an ORR, twenty one patients (52.5%) exhibited stable disease (SD), and fifteen patients (37.5%) exhibited disease progression. The median duration of the OS and PFS were 14.0 mo and 6.13 mo respectively. The median OSs were 16.60, 14.07 and 13.00 mo for second-line, third-line and fourth- or later-line treatments, respectively. The median PFSs were 7.23, 7.30 and 3.87 mo for the second-line, third-line and fourth- or later-line treatments, respectively.
CONCLUSION: In patients with MCRC, bevacizumab combined chemotherapy may be beneficial during second- or later-line treatment.
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Lee HS, Park LC, Shin SH, Lee SU, Chang HK, Huh B, Jung GS, Kim MH, Kim YS. Successful Chemotherapy Following Autologous Stem Cell Transplantation in Multiple Myeloma and Multi-organ Dysfunction with Infiltration of Eosinophils: A Case Report. Cancer Res Treat 2011; 43:199-203. [PMID: 22022299 PMCID: PMC3192883 DOI: 10.4143/crt.2011.43.3.199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 09/27/2010] [Indexed: 12/04/2022] Open
Abstract
Eosinophils are derived from hematopoietic stem cells. Peripheral blood eosinophilia is defined as an absolute eosinophil count of ≥0.5×109/L. Eosinophilia is classified into primary or clonal eosinophilia, secondary eosinophilia, and idiopathic categories including idiopathic hypereosinophilic syndrome. Both hematopoietic and solid neoplasms may be associated with peripheral blood eosinophilia, but multiple myeloma is rarely associated with eosinophilia. We now report the case of a 31-year-old man with multiple myeloma associated with marked eosinophilia who developed multiple organ dysfunction with infiltration of eosinophils. He recovered after treatment with chemotherapy followed by autologous stem cell transplantation.
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Affiliation(s)
- Ho Sup Lee
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Park LC, Lee HS, Shin SH, Im H, Ye BJ, Song MK, Oh SY, Lee SM, Lee WS, Kim YS. Herpesviridae viral infections following rituximab combined chemotherapy in patients with diffuse large B-cell lymphoma. Acta Haematol 2011; 125:230-6. [PMID: 21325812 DOI: 10.1159/000323421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 09/15/2010] [Accepted: 12/07/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Herpesviridae viral infections (HVIs) are particularly common in patients with hematologic malignancies after undergoing hematopoietic stem cell transplantation or receiving chemotherapy. However, there have been few reports on the incidence and risk factors of HVIs in diffuse large B-cell lymphoma (DLBL) patients treated with rituximab combined chemotherapy. METHODS We analyzed 270 patients who were newly diagnosed with DLBL. All of the patients had received rituximab combined chemotherapy between June 2004 and April 2010. RESULTS Twenty-nine patients (10.7%) developed HVI a median of 5.57 months (range 0.37-30.03) after initial chemotherapy. The estimated cumulative incidence rates of HVIs were 8.3 and 12.8% at 1 and 3 years, respectively, in all patients. Independent risk factors for HVIs were a high international prognostic index risk [p = 0.017, hazard ratio (HR) 2.633, 95% confidence interval (CI) 1.185-5.850], neutropenic fever (p = 0.023, HR 2.476, 95% CI 1.134-5.406) and a high cumulative dose of steroids (p = 0.023, HR 2.921, 95% CI 1.162-7.346). CONCLUSION A high international prognostic index risk, neutropenic fever and a high cumulative dose of steroids appear to be risk factors for HVI in DLBL patients who are undergoing rituximab combined chemotherapy.
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Affiliation(s)
- Lee Chun Park
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
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Park LC, Albers DS, Xu H, Lindsay JG, Beal MF, Gibson GE. Mitochondrial impairment in the cerebellum of the patients with progressive supranuclear palsy. J Neurosci Res 2001; 66:1028-34. [PMID: 11746433 DOI: 10.1002/jnr.10062] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abnormalities in energy metabolism and oxidative stress accompany many neurodegenerative diseases, including progressive supranuclear palsy (PSP). Previously, we showed decreased activities of a mitochondrial enzyme complex, alpha-ketoglutarate dehydrogenase complex (KGDHC), and marked increases in tissue malondialdehyde levels in post-mortem superior frontal cortex from the patients with PSP. The current study demonstrates that KGDHC is also significantly diminished (-58%) in the cerebellum from patients with PSP (n = 14), compared to age-matched control brains (n = 13). In contrast to cortex, markers of oxidative stress, such as malondialdehyde, tyrosine nitration or general protein carbonyl modification, did not increase in cerebellum. Furthermore, the protein levels of the individual components of KGDHC did not decline. The activities of two other mitochondrial enzymes were measured to determine whether the changes in KGDHC were selective. The activity of aconitase, a mitochondrial enzyme with an iron/sulfur cluster, is also significantly diminished (-50%), whereas glutamate dehydrogenase activity is unchanged. The present results suggest that the interaction of metabolic impairment and oxidative stress is region-specific in PSP brain. In cerebellum, reductions in KGDHC occur in the absence of increases in common measures of oxidative stress, and may underlie the metabolic deficits and contribute to pathological and clinical manifestation related to the cerebellum in patients with PSP.
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Affiliation(s)
- L C Park
- Department of Neurology and Neuroscience, Weill Medical College of Cornell University, 785 Mamaroneck Avenue, White Plains, NY 10605, USA
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Abstract
Thiamine deficiency (TD) is a model of chronic impairment of oxidative metabolism that leads to neurodegeneration. TD induces oxidative stress and death in neurons, but does not kill astrocytes, microglia or brain endothelial cells. TD primary hippocampal neurons were either cultured alone, or co-cultured with primary astrocytes or microglia. After 7 days of TD, 50% of the neurons died, and the processes of many of the surviving neurons were severely truncated. When TD neurons were co-cultured with astrocytes or microglia, neurons did not die nor show decreased neurite outgrowth. Thus, neuronal-glial interactions are critical for maintaining neuronal homeostasis during chronic metabolic impairment.
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Affiliation(s)
- L C Park
- Department of Neurology and Neuroscience, Weill Medical College of Cornell University at Burke Medical Research Institute, 785 Mamaroneck Avenue, White Plains, NY 10605, USA
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Abstract
Oxidative stress occurs in brains of Alzheimer's disease (AD) patients. A major question in AD research is whether the oxidative stress is just secondary to neurodegeneration. To test whether oxidative stress is an inherent property of AD tissues, the ability of cultured fibroblasts bearing the AD Presenilin-1 246 Ala-->Glu mutation to handle reactive oxygen species (ROS) was compared to controls. Although ROS in cells from AD subjects were only slightly less than cells from controls under basal conditions (-10%) or after exposure to H(2)O(2) (-16%), treatment with antioxidants revealed clear differences. Pretreatment with DMSO, a hydroxyl radical scavenger, reduced basal and H(2)O(2)-induced ROS levels significantly more in cells from controls (-22%, -22%) than in those from AD subjects (-4%, +14%). On the other hand, pretreatment with Trolox diminished H(2)O(2)-induced ROS significantly more in cells from AD (-60%) than control subjects (-39%). In summary, cells from AD patients have greater Trolox sensitive ROS and less DMSO sensitive ROS than controls. The results demonstrate that fibroblasts bearing this PS-1 mutation have altered means of handling oxidative stress and appear useful for determining the mechanism underlying the altered redox metabolism.
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Affiliation(s)
- G E Gibson
- Department of Neurology and Neuroscience, Weill Medical College of Cornell University, at Burke Medical Research Institute, 785 Mamaroneck Avenue, White Plains, NY 10605, USA.
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Gibson GE, Haroutunian V, Zhang H, Park LC, Shi Q, Lesser M, Mohs RC, Sheu RK, Blass JP. Mitochondrial damage in Alzheimer's disease varies with apolipoprotein E genotype. Ann Neurol 2000; 48:297-303. [PMID: 10976635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Brain metabolism and the activity of the alpha-ketoglutarate dehydrogenase complex (KGDHC), a mitochondrial enzyme, are diminished in brains from patients with Alzheimer's disease (AD). In 109 subjects, the Clinical Dementia Rating (CDR) score was highly correlated with brain KGDHC activity. In AD patients who carried the epsilon 4 allele of the apolipoprotein E gene (ApoE4), the CDR score correlated better with KGDHC activity than with the densities of neuritic plaques or neuritic tangles. In contrast, in patients without ApoE4, the CDR score correlated significantly better with tangles and plaques than with KGDHC activity. The results suggest that mitochondrial/oxidative damage may be more important for the cognitive dysfunction in AD patients who carry ApoE4 than in those who do not.
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Affiliation(s)
- G E Gibson
- Department of Neurology and Neuroscience, Weill Medical College of Cornell University, White Plains, NY 10605, USA
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40
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Calingasan NY, Park LC, Gandy SE, Gibson GE. Disturbances of the blood-brain barrier without expression of amyloid precursor protein- containing neuritic clusters or neuronal loss during late stages of thiamine deficiency in guinea pigs. Dev Neurosci 2000; 20:454-61. [PMID: 9778584 DOI: 10.1159/000017343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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] [Indexed: 11/19/2022] Open
Abstract
Generalized oxidative deficits associated with experimental thiamine deficiency (TD) lead to selective neurodegeneration. In mouse brain, TD produces region-specific breach of the blood-brain barrier (BBB), neuronal loss and an accumulation of amyloid precursor protein (APP) in abnormal neurites. The APP-laden abnormal neurites within the damaged areas of mouse brain aggregate into neuritic clusters which strikingly resemble the neuritic component of Alzheimer amyloid plaques. However, amyloid beta-peptide (Abeta) immunoreactivity has not been demonstrated in these neuritic clusters, possibly because the Abeta region of APP in mice contains three amino acid substitutions as compared with the amino acid sequence of human Abeta. In contrast, the guinea pig nucleic acid sequence is more related to the human sequence and the Abeta region is identical in sequence to that of human APP. Thus, the current studies tested whether the presence of an authentic Abeta fragment of APP (i.e., identical to that of man) might make guinea pigs more vulnerable to the development of Abeta-containing neuritic clusters following TD. During late stages of TD, BBB abnormalities, manifested by immunoglobulin G (IgG) extravasation and increased NADPH diaphorase reactivity in microvessels, occurred in brain areas known to be damaged by TD in mice. However, despite the prolonged thiamine deprivation and the advanced neurological symptoms of guinea pigs, no significant neuronal loss or altered APP/Abeta immunostaining occurred in any brain region. Microglial activation, another early marker of damage in mice, was not evident in thiamine-deficient guinea pig brain. Ferritin immunoreactivity and iron deposition in oligodendrocytes within areas of BBB abnormalities were either slightly enhanced or unchanged as compared to controls. This is the first report of brain abnormalities in the guinea pig model of dietary and pyrithiamine-induced TD. The results demonstrate species differences in the response to TD-induced damage, and further support the role of BBB and nitric oxide in the initial events in TD pathology.
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Affiliation(s)
- N Y Calingasan
- Department of Neurology and Neuroscience, Cornell University Medical College at Burke Medical Research Institute, White Plains, N.Y., USA
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Gibson GE, Park LC, Zhang H, Sorbi S, Calingasan NY. Oxidative stress and a key metabolic enzyme in Alzheimer brains, cultured cells, and an animal model of chronic oxidative deficits. Ann N Y Acad Sci 2000; 893:79-94. [PMID: 10672231 DOI: 10.1111/j.1749-6632.1999.tb07819.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [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] [Indexed: 11/29/2022]
Abstract
Oxidative stress and diminished metabolism occur in several neurodegenerative disorders. Brains from Alzheimer's disease (AD) patients exhibit several indicators of oxidative stress and have reduced activities of the alpha-ketoglutarate dehydrogenase complex (KGDHC), a key mitochondrial enzyme. Whether these abnormalities are secondary to neurodegenerative processes or are inherent properties of the cells cannot be determined in autopsy brain. Studies in cultured fibroblasts suggest that AD-related differences in oxidative stress and KGDHC reflect inherent properties of AD cells. KGDHC is sensitive to oxidative stress whether the enzyme is studied in cells, in purified mitochondria, or as an isolated protein. Reductions of brain KGDHC in living rodents lead to oxidative stress and selective cell death. The results suggest that KGDHC participates in a deleterious cascade of events related to oxidative stress that are critical in selective neuronal loss in neurodegenerative diseases.
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Affiliation(s)
- G E Gibson
- Department of Neurology and Neuroscience, Weill Medical College of Cornell University at Burke Medical Research Institute, White Plains, New York 10605, USA.
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Abstract
Altered energy metabolism is characteristic of many neurodegenerative disorders. Reductions in the key mitochondrial enzyme complex, the alpha-ketoglutarate dehydrogenase complex (KGDHC), occur in a number of neurodegenerative disorders including Alzheimer's Disease (AD). The reductions in KGDHC activity may be responsible for the decreases in brain metabolism, which occur in these disorders. KGDHC can be inactivated by several mechanisms, including the actions of free radicals (Reactive Oxygen Species, ROS). Other studies have associated specific forms of one of the genes encoding KGDHC (namely the DLST gene) with AD, Parkinson's disease, as well as other neurodegenerative diseases. Reductions in KGDHC activity can be plausibly linked to several aspects of brain dysfunction and neuropathology in a number of neurodegenerative diseases. Further studies are needed to assess mechanisms underlying the sensitivity of KGDHC to oxidative stress and the relation of KGDHC deficiency to selective vulnerability in neurodegenerative diseases.
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Affiliation(s)
- G E Gibson
- Department of Neurology and Neuroscience, Weill Medical College of Cornell University, Burke Medical Research Institute, White Plains, NY 10605, USA.
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Albers DS, Augood SJ, Park LC, Browne SE, Martin DM, Adamson J, Hutton M, Standaert DG, Vonsattel JP, Gibson GE, Beal MF. Frontal lobe dysfunction in progressive supranuclear palsy: evidence for oxidative stress and mitochondrial impairment. J Neurochem 2000; 74:878-81. [PMID: 10646541 DOI: 10.1046/j.1471-4159.2000.740878.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.6] [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] [Indexed: 11/20/2022]
Abstract
Recent data from our laboratory have shown a regionally specific increase in lipid peroxidation in postmortem progressive supranuclear palsy (PSP) brain. To extend this finding, we measured activities of mitochondrial enzymes as well as tissue malondialdehyde (MDA) levels in postmortem superior frontal cortex (Brodmann's area 9; SFC) from 14 pathologically confirmed cases of PSP and 13 age-matched control brains. Significant decreases (-39%) in alpha-ketoglutarate dehydrogenase complex/glutamate dehydrogenase ratio and significant increases (+36%) in tissue MDA levels were observed in the SFC in PSP; no differences in complex I or complex IV activities were detected. Together, these results suggest that mitochondrial dysfunction and lipid peroxidation may underlie the frontal metabolic and functional deficits observed in PSP.
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Affiliation(s)
- D S Albers
- Department of Neurology and Neuroscience, Cornell University Medical College, New York, NY 10021, USA.
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Park LC, Calingasan NY, Sheu KF, Gibson GE. Quantitative alpha-ketoglutarate dehydrogenase activity staining in brain sections and in cultured cells. Anal Biochem 2000; 277:86-93. [PMID: 10610692 DOI: 10.1006/abio.1999.4359] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The activity of a key mitochondrial enzyme, the alpha-ketoglutarate dehydrogenase complex (KGDHC), declines in the brains of patients with neurodegenerative diseases such as Alzheimer's disease, as well as in thiamine-deficient (TD) animals. The decreased activity often occurs without a reduction in enzyme protein, which negates the use of immunocytochemistry to study cellular or regional changes in enzyme activity within the brain. To overcome this limitation, an activity staining method using nitroblue tetrazolium was developed. The histochemical activity staining was standardized in cultured cells. The assay was linear with time and was highly specific for KGDHC. The dark-blue reaction product (formazan) formed a pattern that was consistent with mitochondrial localization. Treatment of the cultured cells with both reversible and irreversible inhibitors decreased formazan production, whereas conventional enzyme assays on cell lysates only revealed loss of KGDHC activity with irreversible inhibitors. The activity staining was also linear with time and highly specific for KGDHC activity in mouse brain sections. Staining occurred throughout the brain, and discrete neuronal populations exhibited particularly intense staining. The pattern of staining differed markedly from the distribution of KGDHC protein by immunocytochemistry. Generalized decreases in the intensity of activity staining that occurred in the TD brains compared to controls were comparable with the loss of KGDHC activity by conventional enzyme assay. Thus, the present study introduces a new histochemical method to measure KGDHC activity at the cellular and regional level, which will be useful to determine changes of in situ enzyme activity.
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Affiliation(s)
- L C Park
- Department of Neurology, Weill Medical College of Cornell University at Burke Medical Research Institute, 785 Mamaroneck Avenue, White Plains, New York, 10605, USA
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Park LC, Calingasan NY, Uchida K, Zhang H, Gibson GE. Metabolic impairment elicits brain cell type-selective changes in oxidative stress and cell death in culture. J Neurochem 2000; 74:114-24. [PMID: 10617112 DOI: 10.1046/j.1471-4159.2000.0740114.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [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] [Indexed: 01/19/2023]
Abstract
Abnormalities in oxidative metabolism and inflammation accompany many neurodegenerative diseases. Thiamine deficiency (TD) is an animal model in which chronic oxidative stress and inflammation lead to selective neuronal death, whereas other cell types show an inflammatory response. Therefore, the current studies determined the response of different brain cell types to TD and/or inflammation in vitro and tested whether their responses reflect inherent properties of the cells. The cells that have been implicated in TD-induced neurotoxicity, including neurons, microglia, astrocytes, and brain endothelial cells, as well as neuroblastoma and BV-2 microglial cell lines, were cultured in either thiamine-depleted media or in normal culture media with amprolium, a thiamine transport inhibitor. The activity levels of a key mitochondrial enzyme, alpha-ketoglutarate dehydrogenase complex (KGDHC), were uniquely distributed among different cell types: The highest activity was in the endothelial cells, and the lowest was in primary microglia and neurons. The unique distribution of the activity did not account for the selective response to TD. TD slightly inhibited general cellular dehydrogenases in all cell types, whereas it significantly reduced the activity of KGDHC exclusively in primary neurons and neuroblastoma cells. Among the cell types tested, only in neurons did TD induce apoptosis and cause the accumulation of 4-hydroxy-2-nonenal, a lipid peroxidation product. On the other hand, chronic lipopolysaccharide-induced inflammation significantly inhibited cellular dehydrogenase and KGDHC activities in microglia and astrocytes but not in neurons or endothelial cells. The results demonstrate that the selective cell changes during TD in vivo reflect inherent properties of the different brain cell types.
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Affiliation(s)
- L C Park
- Department of Neurology and Neuroscience, Weill Medical College of Cornell University at Burke Medical Research Institute, White Plains, New York 10605, USA
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Abstract
Many halogenated foreign compounds are detoxified by conversion to the corresponding cysteine S-conjugate, which is N-acetylated and excreted. However, several halogenated cysteine S-conjugates [e.g. S-(1,1,2,2-tetrafluoroethy)-L-cysteine (TFEC)] are converted to mitochondrial toxicants by cysteine S-conjugate beta-lyases. In the present work, we showed that TFEC appreciably inactivated highly purified alpha-ketoglutarate dehydrogenase complex (KGDHC) in the presence of a cysteine S-conjugate beta-lyase. Incubation of PC12 cells (which contain endogenous cysteine S-conjugate beta-lyase activity) with TFEC led to a concentration- and time-dependent loss of endogenous KGDHC activity. A 24-hr exposure to 1 mM TFEC decreased KGDHC activity in the cells by 90%. Although treatment with TFEC did not inhibit intrinsic pyruvate dehydrogenase complex (PDHC) activity, it inhibited dichloroacetate/Mg2+-mediated activation/dephosphorylation of PDHC in the PC12 cells by 90%. To determine the selectivity of enzymes targeted by TFEC, several cytosolic and mitochondrial enzymes involved in energy metabolism [malate dehydrogenase, glyceraldehyde 3-phosphate dehydrogenase, glutamate dehydrogenase, lactate dehydrogenase, cytosolic and mitochondrial aspartate aminotransferases (AspAT)] were also assayed in the PC12 cells exposed to 1 mM TFEC for 24 hr. Of these enzymes, only mitochondrial AspAT, a key enzyme of the malate-aspartate shuttle, was inhibited. The present results demonstrate a selective vulnerability of mitochondrial enzymes to toxic cysteine S-conjugates. The data indicate that TFEC may be a useful cellular/mitochondrial toxicant for elucidating the consequences of the diminished mitochondrial function that accompanies numerous neurodegenerative diseases.
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Affiliation(s)
- L C Park
- Department of Neurology and Neuroscience, Weill Medical College of Cornell University, New York, NY, USA
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Calingasan NY, Chun WJ, Park LC, Uchida K, Gibson GE. Oxidative stress is associated with region-specific neuronal death during thiamine deficiency. J Neuropathol Exp Neurol 1999; 58:946-58. [PMID: 10499437 DOI: 10.1097/00005072-199909000-00005] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.3] [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] [Indexed: 11/26/2022] Open
Abstract
Thiamine deficiency (TD) is a model of chronic impairment of oxidative metabolism and selective neuronal loss. TD leads to region-specific neuronal death and elevation of inducible nitric oxide synthase (iNOS) in macrophages/microglia in mouse brain. Identification of the initial site of neuronal death in the submedial thalamic nucleus allowed us to test the role of iNOS and oxidative stress in TD-induced neuronal death. The pattern of neuronal loss, which begins after 9 days of TD, overlapped with induction of the oxidative stress marker heme oxygenase-1 (HO-1) in microglia. Neuronal death and microglial HO-1 induction spread to engulf the whole thalamus after 11 days of TD. As in past studies, reactive iron and ferritin accumulated in microglia beginning on day 10. The lipid peroxidation product, 4-hydroxynonenal (HNE) accumulated in the remaining thalamic neurons only after 11 days of TD. These responses were not likely mediated by iNOS because HO-1 induction and HNE accumulation were comparable in iNOS knockout mice and wild-type controls. These results show that region and cell specific oxidative stress is associated with selective neurodegeneration during TD. Thus, TD is a useful model to help elucidate neuron-microglial interaction in neurodegenerative diseases associated with oxidative stress.
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Affiliation(s)
- N Y Calingasan
- Weill Medical College of Cornell University at Burke Medical Research Institute, White Plains, New York 10605, USA
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Park LC, Zhang H, Sheu KF, Calingasan NY, Kristal BS, Lindsay JG, Gibson GE. Metabolic impairment induces oxidative stress, compromises inflammatory responses, and inactivates a key mitochondrial enzyme in microglia. J Neurochem 1999; 72:1948-58. [PMID: 10217272 DOI: 10.1046/j.1471-4159.1999.0721948.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.5] [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] [Indexed: 11/20/2022]
Abstract
Microglial activation, oxidative stress, and dysfunctions in mitochondria, including the reduction of cytochrome oxidase activity, have been implicated in neurodegeneration. The current experiments tested the effects of reducing cytochrome oxidase activity on the ability of microglia to respond to inflammatory insults. Inhibition of cytochrome oxidase by azide reduced oxygen consumption and increased reactive oxygen species (ROS) production but did not affect cell viability. Azide also attenuated microglial activation, as measured by nitric oxide (NO.) production in response to lipopolysaccharide (LPS). It is surprising that the inhibition of cytochrome oxidase also diminished the activity of the alpha-ketoglutarate dehydrogenase complex (KGDHC), a Krebs cycle enzyme. This reduction was exaggerated when the azide-treated microglia were also treated with LPS. The combination of the azide-stimulated ROS and LPS-induced NO. would likely cause peroxynitrite formation in microglia. Thus, the possibility that KGDHC was inactivated by peroxynitrite was tested. Peroxynitrite inhibited the activity of isolated KGDHC, nitrated tyrosine residues of all three KGDHC subunits, and reduced immunoreactivity to antibodies against two KGDHC components. Thus, our data suggest that inhibition of the mitochondrial respiratory chain diminishes aerobic energy metabolism, interferes with microglial inflammatory responses, and compromises mitochondrial function, including KGDHC activity, which is vulnerable to NO. and peroxynitrite that result from microglial activation. Thus, activation of metabolically compromised microglia can further diminish their oxidative capacity, creating a deleterious spiral that may contribute to neurodegeneration.
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Affiliation(s)
- L C Park
- Department of Neurology and Neuroscience, Cornell University Medical College at Burke Medical Research Institute, White Plains, New York 10605, USA
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Conti B, Park LC, Calingasan NY, Kim Y, Kim H, Bae Y, Gibson GE, Joh TH. Cultures of astrocytes and microglia express interleukin 18. Brain Res Mol Brain Res 1999; 67:46-52. [PMID: 10101231 DOI: 10.1016/s0169-328x(99)00034-0] [Citation(s) in RCA: 139] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Interleukin 18 (IL-18 or interferon-gamma inducing factor) is a recently discovered pro-inflammatory cytokine and powerful stimulator of the cell-mediated immune response. IL-18 is produced by several sources including monocytes/macrophages, keratinocytes and the zona reticularis and zona fasciculata of the adrenal cortex. IL-18 occurs in brain but its cellular source in the CNS has never been investigated. The presence of IL-18 and its response to stimulation in the brain was tested with primary cultures of microglia, astrocytes and hippocampal neurons. IL-18 mRNA was present in astrocytes and microglia, but not in neurons. The endotoxin lipopolysaccharide (LPS) did not affect IL-18 in astrocytes, but LPS robustly increased IL-18 mRNA in microglia. IL-18 protein was constitutively expressed in astrocytes and induced in microglia by LPS. The levels of interleukin-1beta converting enzyme (ICE), an activating enzyme, and caspase 3 (CPP32), an inactivating enzyme, were assessed to investigate the presence of the appropriate processing enzymes in the cultured cells. ICE was present at constitutive levels in microglia and astrocytes suggesting that these cell types may produce and secrete matured IL-18. Active forms of CPP32 were not detectable in either cell type indicating the absence of a degradative pathway of IL-18. The present results demonstrate that microglia and astrocytes are sources of brain IL-18 and add a new member to the family of cytokines produced in the brain.
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Affiliation(s)
- B Conti
- Laboratory of Molecular Neurobiology, Cornell University Medical College at The Burke Medical Research Institute, 785 Mamaroneck Ave., White Plains, NY 10605, USA
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Cho S, Volpe BT, Bae Y, Hwang O, Choi HJ, Gal J, Park LC, Chu CK, Du J, Joh TH. Blockade of tetrahydrobiopterin synthesis protects neurons after transient forebrain ischemia in rat: a novel role for the cofactor. J Neurosci 1999; 19:878-89. [PMID: 9920651 PMCID: PMC6782138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/1998] [Revised: 11/05/1998] [Accepted: 11/06/1998] [Indexed: 02/10/2023] Open
Abstract
The generation of nitric oxide (NO) aggravates neuronal injury. (6R)-5,6,7,8-Tetrahydro-L-biopterin (BH4) is an essential cofactor in the synthesis of NO by nitric oxide synthase (NOS). We attempted to attenuate neuron degeneration by blocking the synthesis of the cofactor BH4 using N-acetyl-3-O-methyldopamine (NAMDA). In vitro data demonstrate that NAMDA inhibited GTP cyclohydrolase I, the rate-limiting enzyme for BH4 biosynthesis, and reduced nitrite accumulation, an oxidative metabolite of NO, without directly inhibiting NOS activity. Animals exposed to transient forebrain ischemia and treated with NAMDA demonstrated marked reductions in ischemia-induced BH4 levels, NADPH-diaphorase activity, and caspase-3 gene expression in the CA1 hippocampus. Moreover, delayed neuronal injury in the CA1 hippocampal region was significantly attenuated by NAMDA. For the first time, these data demonstrate that a cofactor, BH4, plays a significant role in the generation of ischemic neuronal death, and that blockade of BH4 biosynthesis may provide novel strategies for neuroprotection.
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Affiliation(s)
- S Cho
- Department of Neurology and Neuroscience, Cornell University Medical College at W. M. Burke Medical Research Institute, White Plains, New York 10605, USA
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