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Dalla Costa G, Nos C, Zabalza A, Buron M, Magyari M, Sellebjerg F, Guerrero AI, Roselli L, La Porta ML, Martinis M, Bailon R, Kontaxis S, Laporta E, Garcia E, Pokorny FB, Schuller BW, Folarin A, Stewart C, Leocani L, Vairavan S, Cummins N, Dobson R, Hotopf M, Narayan V, Montalban X, Sorensen PS, Comi G. A wearable device perspective on the standard definitions of disability progression in multiple sclerosis. Mult Scler 2024; 30:103-112. [PMID: 38084497 DOI: 10.1177/13524585231214362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a leading cause of disability among young adults, but standard clinical scales may not accurately detect subtle changes in disability occurring between visits. This study aims to explore whether wearable device data provides more granular and objective measures of disability progression in MS. METHODS Remote Assessment of Disease and Relapse in Central Nervous System Disorders (RADAR-CNS) is a longitudinal multicenter observational study in which 400 MS patients have been recruited since June 2018 and prospectively followed up for 24 months. Monitoring of patients included standard clinical visits with assessment of disability through use of the Expanded Disability Status Scale (EDSS), 6-minute walking test (6MWT) and timed 25-foot walk (T25FW), as well as remote monitoring through the use of a Fitbit. RESULTS Among the 306 patients who completed the study (mean age, 45.6 years; females 67%), confirmed disability progression defined by the EDSS was observed in 74 patients, who had approximately 1392 fewer daily steps than patients without disability progression. However, the decrease in the number of steps experienced over time by patients with EDSS progression and stable patients was not significantly different. Similar results were obtained with disability progression defined by the 6MWT and the T25FW. CONCLUSION The use of continuous activity monitoring holds great promise as a sensitive and ecologically valid measure of disability progression in MS.
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Affiliation(s)
| | - Carlos Nos
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mathias Buron
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Melinda Magyari
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Finn Sellebjerg
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ana Isabel Guerrero
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | - Raquel Bailon
- Biomedical Signal Interpretation & Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, Zaragoza, Spain
- Centro de Investigacion Biomedica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Spyridon Kontaxis
- Biomedical Signal Interpretation & Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, Zaragoza, Spain
- Centro de Investigacion Biomedica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Estela Laporta
- Biomedical Signal Interpretation & Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, Zaragoza, Spain
- Centro de Investigacion Biomedica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Esther Garcia
- Centro de Investigacion Biomedica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
- Department of Microelectronics and Electronic Systems, Autonomous University of Barcelona, Barcelona, Spain
| | - Florian B Pokorny
- Chair of Embedded Intelligence for Healthcare and Wellbeing, University of Augsburg, Augsburg, Germany
- Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Björn W Schuller
- Chair of Embedded Intelligence for Healthcare and Wellbeing, University of Augsburg, Augsburg, Germany
- Group on Language, Audio & Music, Imperial College London, London, UK
| | - Amos Folarin
- Department of Biostatistics & Health informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Callum Stewart
- Department of Biostatistics & Health informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Institute of Health Informatics, University College London, London, UK
| | | | - Srinivasan Vairavan
- Janssen Research and Development LLC, Janssen Global Services, LLC, Titusville, NJ, USA
| | - Nicholas Cummins
- Department of Biostatistics & Health informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Richard Dobson
- Department of Biostatistics & Health informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Vaibhav Narayan
- Janssen Research and Development LLC, Janssen Global Services, LLC, Titusville, NJ, USA
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Per Soelberg Sorensen
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Giancarlo Comi
- Vita-Salute San Raffaele University, Milan, Italy/Multiple Sclerosis Center, Casa di Cura Igea, Milan, Italy
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Kontaxis S, Laporta E, Garcia E, Martinis M, Leocani L, Roselli L, Buron MD, Guerrero AI, Zabala A, Cummins N, Vairavan S, Hotopf M, Dobson RJB, Narayan VA, La Porta ML, Costa GD, Magyari M, Sørensen PS, Nos C, Bailon R, Comi G. Automatic Assessment of the 2-Minute Walk Distance for Remote Monitoring of People with Multiple Sclerosis. Sensors (Basel) 2023; 23:6017. [PMID: 37447866 DOI: 10.3390/s23136017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/29/2023] [Accepted: 06/10/2023] [Indexed: 07/15/2023]
Abstract
The aim of this study was to investigate the feasibility of automatically assessing the 2-Minute Walk Distance (2MWD) for monitoring people with multiple sclerosis (pwMS). For 154 pwMS, MS-related clinical outcomes as well as the 2MWDs as evaluated by clinicians and derived from accelerometer data were collected from a total of 323 periodic clinical visits. Accelerometer data from a wearable device during 100 home-based 2MWD assessments were also acquired. The error in estimating the 2MWD was validated for walk tests performed at hospital, and then the correlation (r) between clinical outcomes and home-based 2MWD assessments was evaluated. Robust performance in estimating the 2MWD from the wearable device was obtained, yielding an error of less than 10% in about two-thirds of clinical visits. Correlation analysis showed that there is a strong association between the actual and the estimated 2MWD obtained either at hospital (r = 0.71) or at home (r = 0.58). Furthermore, the estimated 2MWD exhibits moderate-to-strong correlation with various MS-related clinical outcomes, including disability and fatigue severity scores. Automatic assessment of the 2MWD in pwMS is feasible with the usage of a consumer-friendly wearable device in clinical and non-clinical settings. Wearable devices can also enhance the assessment of MS-related clinical outcomes.
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Affiliation(s)
- Spyridon Kontaxis
- Laboratory of Biomedical Signal Interpretation and Computational Simulation (BSICoS), University of Zaragoza, 50018 Zaragoza, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28006 Barcelona, Spain
| | - Estela Laporta
- Laboratory of Biomedical Signal Interpretation and Computational Simulation (BSICoS), University of Zaragoza, 50018 Zaragoza, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28006 Barcelona, Spain
| | - Esther Garcia
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28006 Barcelona, Spain
- Department of Microelectronics and Electronic Systems, Autonomous University of Barcelona, 08193 Bellaterra, Spain
| | - Matteo Martinis
- Department of Medicine and Surgery, University Vita-Salute and Hospital San Raffaele, 20132 Milan, Italy
| | - Letizia Leocani
- Department of Medicine and Surgery, University Vita-Salute and Hospital San Raffaele, 20132 Milan, Italy
| | - Lucia Roselli
- Department of Medicine and Surgery, University Vita-Salute and Hospital San Raffaele, 20132 Milan, Italy
| | - Mathias Due Buron
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Ana Isabel Guerrero
- Multiple Sclerosis Center of Catalonia (CEMCAT), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Ana Zabala
- Multiple Sclerosis Center of Catalonia (CEMCAT), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Nicholas Cummins
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | | | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Richard J B Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | | | - Maria Libera La Porta
- Department of Medicine and Surgery, University Vita-Salute and Hospital San Raffaele, 20132 Milan, Italy
| | - Gloria Dalla Costa
- Department of Medicine and Surgery, University Vita-Salute and Hospital San Raffaele, 20132 Milan, Italy
| | - Melinda Magyari
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Per Soelberg Sørensen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Carlos Nos
- Multiple Sclerosis Center of Catalonia (CEMCAT), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Raquel Bailon
- Laboratory of Biomedical Signal Interpretation and Computational Simulation (BSICoS), University of Zaragoza, 50018 Zaragoza, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28006 Barcelona, Spain
| | - Giancarlo Comi
- Department of Medicine and Surgery, University Vita-Salute and Hospital San Raffaele, 20132 Milan, Italy
- Casa di Cura del Policlinico, 20144 Milan, Italy
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Esposito C, Rachiglio AM, La Porta ML, Sacco A, Roma C, Iannaccone A, Tatangelo F, Forgione L, Pasquale R, Barbaro A, Botti G, Ciardiello F, Normanno N. The S492R EGFR ectodomain mutation is never detected in KRAS wild-type colorectal carcinoma before exposure to EGFR monoclonal antibodies. Cancer Biol Ther 2013; 14:1143-6. [PMID: 24025416 DOI: 10.4161/cbt.26340] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The activity of the epidermal growth factor receptor (EGFR) antibodies cetuximab and panitumumab in metastatic colorectal carcinoma (mCRC) is significantly limited by molecular mechanisms leading to intrinsic or acquired resistance. The S492R mutation of the EGFR, which is caused by either the 1476C>A or the 1474A>C substitution, interferes with binding to cetuximab but not to panitumumab, and has been detected in mCRC with acquired resistance to cetuximab. Since mechanisms of acquired and intrinsic resistance to EGFR monoclonal antibodies in CRC significantly overlap, we evaluated the frequency of the S492R mutation in a series of KRAS-exon 2 wild-type CRC patients. Genomic DNA was extracted from formalin fixed paraffin embedded (FFPE) tissues that were obtained from 505 systemic therapy-naïve CRC patients. A PCR/sequencing method for the detection of the S492R mutation was developed, by using as positive control a plasmid in which the 1474A>C mutation was generated by site directed mutagenesis. The lowest level of detection of this assay was approximately 10% mutant DNA in a background of wild-type DNA. PCR sequencing analysis revealed no S492R mutations in any of the analyzed 505 CRC specimens. Our findings suggest that the S492R mutation is not involved in primary resistance to cetuximab in CRC. Therefore, patients with mCRC should not be routinely screened for this mutation prior therapy with cetuximab.
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Affiliation(s)
- Claudia Esposito
- Laboratory of Pharmacogenomics; Centro di Ricerche Oncologiche di Mercogliano (CROM); Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS; Mercogliano (AV), Italy
| | - Anna Maria Rachiglio
- Laboratory of Pharmacogenomics; Centro di Ricerche Oncologiche di Mercogliano (CROM); Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS; Mercogliano (AV), Italy
| | - Maria Libera La Porta
- Laboratory of Pharmacogenomics; Centro di Ricerche Oncologiche di Mercogliano (CROM); Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS; Mercogliano (AV), Italy
| | - Alessandra Sacco
- Laboratory of Pharmacogenomics; Centro di Ricerche Oncologiche di Mercogliano (CROM); Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS; Mercogliano (AV), Italy
| | - Cristin Roma
- Laboratory of Pharmacogenomics; Centro di Ricerche Oncologiche di Mercogliano (CROM); Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS; Mercogliano (AV), Italy
| | - Alessia Iannaccone
- Laboratory of Pharmacogenomics; Centro di Ricerche Oncologiche di Mercogliano (CROM); Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS; Mercogliano (AV), Italy
| | - Fabiana Tatangelo
- Surgical Pathology Unit; Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS; Naples, Italy
| | - Laura Forgione
- Laboratory of Pharmacogenomics; Centro di Ricerche Oncologiche di Mercogliano (CROM); Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS; Mercogliano (AV), Italy
| | - Raffaella Pasquale
- Laboratory of Pharmacogenomics; Centro di Ricerche Oncologiche di Mercogliano (CROM); Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS; Mercogliano (AV), Italy
| | - Americo Barbaro
- Laboratory of Pharmacogenomics; Centro di Ricerche Oncologiche di Mercogliano (CROM); Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS; Mercogliano (AV), Italy
| | - Gerardo Botti
- Surgical Pathology Unit; Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS; Naples, Italy
| | - Fortunato Ciardiello
- Dipartimento Medico-Chirurgico di Internistica Clinica e Sperimentale "F. Magrassi e A. Lanzara"; Seconda Università degli Studi di Napoli; Napoli, Italy
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit; Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS; Naples, Italy
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Normanno N, Rachiglio AM, Roma C, Fenizia F, Esposito C, Pasquale R, La Porta ML, Iannaccone A, Micheli F, Santangelo M, Bergantino F, Costantini S, De Luca A. Molecular diagnostics and personalized medicine in oncology: challenges and opportunities. J Cell Biochem 2013; 114:514-24. [PMID: 22991232 DOI: 10.1002/jcb.24401] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 09/07/2012] [Indexed: 02/01/2023]
Abstract
Increasing evidence demonstrates that target-based agents are active only in molecularly selected populations of patients. Therefore, the identification of predictive biomarkers has become mandatory to improve the clinical development of these novel drugs. Mutations of the epidermal growth factor receptor (EGFR) or rearrangements of the ALK gene in non-small-cell lung cancer, and BRAF mutations in melanoma are clear examples of driver mutations and predictive biomarkers of response to treatment with specific inhibitors. Predictive biomarkers might also identify subgroups of patients that are not likely to respond to specific drugs, as shown for KRAS mutations and anti-EGFR monoclonal antibodies in colorectal carcinoma. The discovery of novel driver molecular alterations and the availability of drugs capable to selectively block such oncogenic mechanisms are leading to a rapid increase in the number of putative biomarkers that need to be assessed in each single patient. In this respect, two different approaches are being developed to introduce a comprehensive molecular characterization in clinical practice: high throughput genotyping platforms, which allow the detection of recognized genetic aberrations in clinical samples, and next generation sequencing that can provide information on all the different types of cancer-causing alterations. The introduction of these techniques in clinical practice will increase the possibility to identify molecular targets in each individual patient, and will also allow to follow the molecular evolution of the disease during the treatment. By using these approaches, the development of personalized medicine for patients with cancer will finally become possible.
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Affiliation(s)
- Nicola Normanno
- Cell Biology and Biotherapy Unit, INT-Fondazione Pascale, Naples, Italy.
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Daniele G, Gallo M, Piccirillo MC, Giordano P, D'Alessio A, Del Giudice A, La Porta ML, Perrone F, Normanno N, De Luca A. Pharmacokinetic evaluation of capecitabine in breast cancer. Expert Opin Drug Metab Toxicol 2013; 9:225-35. [PMID: 23301520 DOI: 10.1517/17425255.2013.759939] [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] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Capecitabine , an oral prodrug of 5-fluorouracil (5-FU), is adsorbed in its intact form through the intestine and metabolized to 5-FU in tumour cells. In metastatic breast cancer (MBC), capecitabine is an effective and well-tolerated therapeutic option both in monotherapy and in combination with chemotherapeutic or molecular-targeted agents. AREAS COVERED We summarized data on pharmacokinetics and pharmacodynamics of capecitabine. We also produced a general review of the most relevant clinical studies of capecitabine in MBC. A literature search was performed using PubMed database including selected articles published in English language up to October 2012. EXPERT OPINION The unique pharmacodynamic/pharmacokinetic features represent the bases of the reduced toxicity and the activity of capecitabine in several tumours. Although during the past 10 years there has been an increasing use of this drug in MBC both as single agent and in combination, encouraging results of well tolerated and active combinations with novel agents will lead to a more extensive and protracted use of capecitabine. In view of this, some aspects should be further clarified such as the optimal starting dose and the introduction of alternative schedules of treatment.
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