1
|
Loughan AR, Willis KD, Braun SE, Rodin G, Lanoye A, Davies AE, Svikis D, Mazzeo S, Malkin M, Thacker L. Managing cancer and living meaningfully (CALM) in adults with malignant glioma: a proof-of-concept phase IIa trial. J Neurooncol 2022; 157:447-456. [PMID: 35437687 PMCID: PMC9909556 DOI: 10.1007/s11060-022-03988-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Managing Cancer and Living Meaningfully (CALM) is an evidence-based, brief, semi-structured psychotherapy designed to help patients with advanced cancer cope with the practical and profound challenges of their illness. However, no study to date has investigated its feasibility, acceptability, and preliminary effectiveness in adults with malignant glioma, despite the well-documented incidence of psychological distress in this vulnerable and underserved population. METHODS Fourteen patients with glioma and elevated symptoms of depression and/or death anxiety enrolled in the trial: 83% glioblastoma, 75% female, Mage = 56 years (SD = 15.1; range = 27-81). Feasibility was assessed based on established metrics. Acceptability was measured by post-session surveys and post-intervention interviews. Preliminary intervention effects were explored using paired t-tests, comparing psychological distress at baseline and post-intervention. RESULTS Of the 14 enrolled patients, 12 were evaluable. Nine completed the study (75% retention rate). Three patients withdrew due to substantial disease progression which affected their ability to participate. Participants reported high perceived benefit, and all recommended the program to others. Baseline to post-intervention assessments indicated reductions in death anxiety, generalized anxiety, and depression, and increases in spirituality. Quality of life and fear of cancer recurrence remained stable throughout the study period. CONCLUSIONS CALM appears feasible for use with adults with malignant glioma. Enrollment and retention rates were high and comparable to psychotherapy trials for patients with advanced cancer. High perceived benefit and reductions in symptoms of death anxiety, generalized anxiety, and depression were reported by participants. These findings are extremely encouraging and support further study of CALM in neuro-oncology. TRIAL REGISTRATION NUMBER NCT04646213 registered on 11/27/2020.
Collapse
Affiliation(s)
- Ashlee R Loughan
- Department of Neurology, School of Medicine, Virginia Commonwealth University, 1201 East Marshall St, Richmond, VA, 23298-0037, USA.
- Massey Cancer Center, Richmond, VA, USA.
- Division of Neuro-Oncology, Department of Neurology, Virginia Commonwealth University, School of Medicine, VCU Massey Cancer Center, 1201 East Marshall St, Richmond, VA, 23298-0037, USA.
| | - Kelcie D Willis
- Massey Cancer Center, Richmond, VA, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Sarah Ellen Braun
- Department of Neurology, School of Medicine, Virginia Commonwealth University, 1201 East Marshall St, Richmond, VA, 23298-0037, USA
- Massey Cancer Center, Richmond, VA, USA
| | - Gary Rodin
- Princess Margaret Cancer Center, Toronto, Canada
| | - Autumn Lanoye
- Massey Cancer Center, Richmond, VA, USA
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Alexandria E Davies
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Dace Svikis
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Suzanne Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Mark Malkin
- Department of Neurology, School of Medicine, Virginia Commonwealth University, 1201 East Marshall St, Richmond, VA, 23298-0037, USA
- Massey Cancer Center, Richmond, VA, USA
| | - Leroy Thacker
- Massey Cancer Center, Richmond, VA, USA
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| |
Collapse
|
2
|
Loughan A, Willis K, Lanoye A, Braun S, Rodin G, Davies A, Svikis D, Mazzeo S, Thacker L, Malkin M. QOLP-07. EXPLORING CALM IN PATIENTS WITH HIGH-GRADE GLIOMA. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.728] [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: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Patients with high-grade glioma report substantial psychological distress, yet are frequently excluded from psycho-oncology research. Managing Cancer and Living Meaningfully (CALM) is an expressive-supportive psychotherapy designed to address the inevitable challenges that patients with advanced cancer face. CALM was shown in a large randomized controlled trial to reduce depression and death-related distress, but brain cancer was an exclusion criterion.
METHODS
In this ongoing ORBIT Model Phase Ib Refine trial, 10 adults with high-grade glioma and heightened distress (PHQ/DADDS) participated in CALM. Feasibility and acceptability were assessed based on established metrics, satisfaction was explored by surveys and exit-interviews, and preliminary efficacy of reducing distress was analyzed by pre to post-CALM paired t-tests; effect sizes estimated using Cohen’s d.
RESULTS
Of 11 patients referred and screened, 10 enrolled in the study (91% enrollment rate; 70% GBM; 70% female; M age =55yrs). Reasons for withdrawal was disinterest in intervention topics (n=2). Eight patients completed baseline assessments and at least one CALM session. To date, seven have completed treatment. Retention is 63%, with one participant still in active treatment. No adverse events were determined to be study-related. Perceived benefit was high (4.8/5), and all participants reported they would recommend program to others. Pre- to post-CALM analyses show medium-to-large effects on reducing depression (d=1.2), anxiety (d=.74), and death-related distress (d=.54). Small effects were seen for quality-of-life improvement (d=.26). Fear of cancer recurrence worsened (d=.75).
CONCLUSIONS
Preliminary data suggests that CALM is both feasible and acceptable in adult patients with high-grade glioma. Enrollment and retention rates were adequate. Patients reported high benefit and recommendation to others. Depression, generalized anxiety, and death-related distress all improved with medium-to-large effects, suggesting CALM may be a promising intervention for high-grade glioma patients as they navigate the challenges of brain cancer. Adjunctive treatment may be necessary to address fear of cancer recurrence.
Collapse
Affiliation(s)
| | | | | | | | - Gary Rodin
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | | | | | | | | | | |
Collapse
|
3
|
Malkin M, Safonov K. Entropy charts and bifurcations for Lorenz maps with infinite derivatives. Chaos 2021; 31:043107. [PMID: 34251229 DOI: 10.1063/5.0040164] [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] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/17/2021] [Indexed: 06/13/2023]
Abstract
This paper deals with one-dimensional factor maps for the geometric model of Lorenz-type attractors in the form of two-parameter family of Lorenz maps on the interval I=[-1,1] given by Tc,ν(x)=(-1+c⋅|x|ν)⋅sign(x). This is the normal form for splitting the homoclinic loop with additional degeneracy in flows with symmetry that have a saddle equilibrium with a one-dimensional unstable manifold. Due to L. P. Shilnikov' results, such a bifurcation (under certain conditions) corresponds to the birth of the Lorenz attractor. We indicate those regions in the parameter plane where the topological entropy depends monotonically on the parameter c, as well as those for which the monotonicity does not take place. Also, we indicate the corresponding bifurcations for the Lorenz attractors.
Collapse
Affiliation(s)
- M Malkin
- Mathematical Center "Mathematics of Future Technologies," Lobachevsky State University, 23 Prospekt Gagarina, 603022 Nizhny Novgorod, Russia
| | - K Safonov
- Mathematical Center "Mathematics of Future Technologies," Lobachevsky State University, 23 Prospekt Gagarina, 603022 Nizhny Novgorod, Russia
| |
Collapse
|
4
|
Dragan M, Carli M, Malkin M, Yazbeck V. Abstract 807: Predictive biomarkers for Bevacizumab activity in recurrent glioblastoma: A single institution study. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-807] [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
Glioblastoma Multiforme (GBM) is an aggressive type of astrocytoma and the most common malignant brain tumor in adults. Bevacizumab is a recombinant monoclonal antibody that targets VEGF-A. VEGF is regulated by the hypoxia-inducible-factor (HIF-1α) pathway, with the tumor suppressor gene TP53 as one of the key regulating factors. Our study examines the relevance of various genetic mutations of the HIF-1α pathway and their predictive significance in patients diagnosed with recurrent GBM and treated with bevacizumab. A total of 41 patients diagnosed with recurrent GBM and treated with Bevacizumab at Virginia Commonwealth University from January 1990 through November 2018 were included in our study. Our study cohort consists of 56.1% males and 43.9% females, with an average age of 59.9 (SD 12.1), and 68.3% were Caucasian. The majority (90%) of the cohort were classified as de novo cases of GBM. The overall survival (OS) was 172.5 days (95% CI: 122.0, 218.5), with a minimum of 11 days and maximum of 904 days measured from the date of the first bevacizumab treatment to the date of death. The majority of patients (70.7%) responded to treatment, with 61% exhibiting a partial response and 9.8% exhibiting a complete response. The median first response to treatment (FRT) was 34 days (95% CI: 21, 40), with a minimum of 2 days and maximum of 76. All patients died during the follow-up period. Survival analyses for OS, along with FRT, were both performed with Kaplan-Meier curves generated individually. We have examined the clinical characteristics of our study cohort and are currently examining the genetic characteristics of the tumors in our cohort. At the time of the conference we will have updated genomic and radiographic data in addition to the current detailed clinical data.
Citation Format: Marcin Dragan, Matthew Carli, Mark Malkin, Victor Yazbeck. Predictive biomarkers for Bevacizumab activity in recurrent glioblastoma: A single institution study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 807.
Collapse
Affiliation(s)
| | | | - Mark Malkin
- Virginia Commonwealth University, Richmond, VA
| | | |
Collapse
|
5
|
Shafer D, Tombes MB, Shrader E, Ryan A, Bandyopadhyay D, Dent P, Malkin M. Phase I trial of dimethyl fumarate, temozolomide, and radiation therapy in glioblastoma. Neurooncol Adv 2020; 2:vdz052. [PMID: 32642720 PMCID: PMC7212848 DOI: 10.1093/noajnl/vdz052] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Dimethyl fumarate (DMF), an oral agent approved for the treatment of relapsing–remitting multiple sclerosis (RRMS), has promising preclinical activity against glioblastoma (GBM). This phase I study sought to determine the recommended phase 2 dose (RP2D) of DMF and evaluate its safety and toxicity when combined with standard concurrent radiotherapy (RT) and temozolomide (TMZ) followed by maintenance TMZ in patients with newly diagnosed GBM. Methods Using a standard 3 + 3 dose-escalation design with 3 dose levels, patients received daily DMF with 60 Gy RT and concurrent TMZ 75 mg/m2 daily, followed by maintenance DMF (continuously) and TMZ 150–200 mg/m2 on days 1–5 of each 28-day cycle for up to 6 cycles. The maximum tolerated dose (MTD) was determined by evaluation of dose-limiting toxicity (DLT) during the first 6 weeks of therapy. Results Twelve patients were treated at the 3 dose levels, and no DLTs were observed. There were no unexpected toxicities. The most common grade 3/4 treatment related adverse events (AEs) were lymphopenia (58%), decreased CD4 count (17%), and thrombocytopenia (17%). Four patients completed all planned treatment; seven patients had progression on treatment. One patient chose to withdraw from the study during maintenance. The median progression-free survival (PFS) for all patients was 8.7 months with no difference in PFS between those with stable disease or a partial response; median overall survival was 13.8 months. Conclusions DMF may be safely combined with RT and TMZ in patients with newly diagnosed GBM. The RP2D for DMF is 240 mg three times daily.
Collapse
Affiliation(s)
| | - Mary Beth Tombes
- Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Ellen Shrader
- Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Alison Ryan
- Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | | | - Paul Dent
- Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Mark Malkin
- Department of Neurology, Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| |
Collapse
|
6
|
Alnahhas I, Jawish M, Alsawas M, Zukas A, Prokop L, Murad MH, Malkin M. Autologous Stem-Cell Transplantation for Primary Central Nervous System Lymphoma: Systematic Review and Meta-analysis. Clin Lymphoma Myeloma Leuk 2018; 19:e129-e141. [PMID: 30584023 DOI: 10.1016/j.clml.2018.11.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/11/2018] [Accepted: 11/17/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is an aggressive form of non-Hodgkin lymphoma. Methotrexate is first-line chemotherapy. Autologous stem-cell transplantation (ASCT) is increasingly used as an alternative consolidative treatment to whole-brain radiotherapy. METHODS A systematic search of several databases was conducted up through January 10, 2018. Two investigators independently assessed study eligibility and extracted the data. Studies that reported survival outcomes after ASCT were included. RESULTS We screened 1517 references and included 43 studies. ASCT was used as consolidative treatment or as salvage treatment/at relapse. Thiotepa, busulfan, and cyclophosphamide and carmustine/thiotepa were commonly used conditioning regimens. In the consolidation setting, 94% of patients experienced or maintained complete or partial response after ASCT. The rates of overall survival (OS) and progression-free survival (PFS) were 94%, 86%, 82%, and 70% and 79%, 70%, 64%, and 54% after 1, 2, 3, and 5 years, respectively. The overall risk of relapse at 5 years was 24%. In the salvage/relapse settings, 85% of patients experienced or maintained complete response or partial response after ASCT. The rates of OS and PFS were 75%, 63%, 56%, and 54% and 85%, 62%, 59%, and 54% after 1, 2, 3, and 5 years, respectively. The risk of relapse at 5 years was 29%. Subgroup analysis showed that the use of carmustine and thiotepa as a conditioning regimen carried the lowest risk of transplant-related mortality. The thiotepa, busulfan, and cyclophosphamide regimen, on the other hand, showed numerically superior OS and PFS rates. CONCLUSION This review provides estimates for response and survival to aid in decision making when considering ASCT for patients with PCNSL.
Collapse
Affiliation(s)
- Iyad Alnahhas
- Division of Neuro-oncology, The Ohio State University, Columbus, OH.
| | | | - Mouaz Alsawas
- Evidence-Based Practice Center, Mayo Clinic, Rochester, MN
| | - Alicia Zukas
- Division of Neuro-oncology, Virginia Commonwealth University, Richmond, VA
| | - Larry Prokop
- Evidence-Based Practice Center, Mayo Clinic, Rochester, MN
| | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, MN
| | - Mark Malkin
- Division of Neuro-oncology, Virginia Commonwealth University, Richmond, VA
| |
Collapse
|
7
|
Alnahhas I, Jawish M, Alsawas M, Murad H, Zukas A, Malkin M. EPID-05. AUTOLOGOUS STEM CELL TRANSPLANT FOR PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA IN IMMUNOCOMPETENT PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
8
|
Loughan A, Shafer D, Lanoye A, Braun S, Dent P, Malkin M. NCOG-18. PHASE I TRIAL OF DIMETHYL FUMARATE, TEMOZOLOMIDE AND RADIATION THERAPY IN NEWLY DIAGNOSED GLIOBLASTOMA MULTIFORME: A PRELIMINARY NEUROCOGNITIVE PERSPECTIVE. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
9
|
Abbassi M, Riley R, Malkin M, Tang Y, Rajendran B, Yazbeck V. Treatment of Primary Central Nervous System Posttransplant Lymphoproliferative Disorder in an Adult Kidney Transplant Recipient: A Case Report. EXP CLIN TRANSPLANT 2017; 17:111-114. [PMID: 28447926 DOI: 10.6002/ect.2016.0171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Posttransplant lymphoproliferative disorder is a serious complication of solid-organ transplant. Extranodal involvement is common; however, isolated involvement of the central nervous system is extremely rare and represents a particularly difficult therapeutic challenge with no current consensus on optimal treatment. Here, we describe a 70-year-old woman who developed Epstein-Barr virus-related primary central nervous system lymphoma 19 months after kidney transplant. Immunosuppression was reduced, and the patient was started on high-dose methotrexate, which was complicated by acute kidney injury and discontinued. She then received a rituximab and temozolomide chemotherapeutic regimen and achieved complete clinical response. Seventeen months after diagnosis, she is alive and has not developed any other posttransplant lymphoproliferative disorder. We review the current literature and discuss treatment options for patients with primary central nervous system posttransplant lymphoproliferative disorder following kidney transplant.
Collapse
Affiliation(s)
- Mashya Abbassi
- From the School of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | | | | | | | | |
Collapse
|
10
|
Loughan A, Lanoye A, Malkin M. AGR-2Brain Tumor and Multiple Sclerosis: Differential Diagnosis and Neuropsychological Report. Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw041.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
11
|
Affiliation(s)
- Laurence Booth
- Departments of Biochemistry and Molecular Biology, Virginia Commonwealth University School of Medicine, and the Massey Cancer Center, Richmond, VA 23298, USA
| | - Mark Malkin
- Department of Neurology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Paul Dent
- Departments of Biochemistry and Molecular Biology, Virginia Commonwealth University School of Medicine, and the Massey Cancer Center, Richmond, VA 23298, USA
| |
Collapse
|
12
|
|
13
|
Cook MK, Malkin M, Karafin MS. The use of plasma exchange in Hashimoto's encephalopathy: A case report and review of the literature. J Clin Apher 2014; 30:188-92. [DOI: 10.1002/jca.21353] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 07/28/2014] [Accepted: 07/30/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Melissa K. Cook
- Department of Neurology; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Mark Malkin
- Department of Neurology; Virginia Commonwealth University; Richmond Virginia
| | - Matthew S. Karafin
- Medical Sciences Institute, BloodCenter of Wisconsin; Milwaukee Wisconsin
- Department of Pathology; Medical College of Wisconsin; Milwaukee Wisconsin
| |
Collapse
|
14
|
Roberts JL, Booth L, Conley A, Cruickshanks N, Malkin M, Kukreja RC, Grant S, Poklepovic A, Dent P. PDE5 inhibitors enhance the lethality of standard of care chemotherapy in pediatric CNS tumor cells. Cancer Biol Ther 2014; 15:758-67. [PMID: 24651037 DOI: 10.4161/cbt.28553] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We determined whether clinically relevant phosphodiesterase 5 (PDE5) inhibitors interacted with clinically relevant chemotherapies to kill medulloblastoma cells. In medulloblastoma cells PDE5 inhibitors interacted in a greater than additive fashion with vincristine/etoposide/cisplatin to cause cell death. Knockdown of PDE5 expression recapitulated the combination effects of PDE5 inhibitor drugs with chemotherapy drugs. Expression of dominant negative caspase 9 did not significantly inhibit chemotherapy lethality but did significantly reduce enhanced killing in combination with the PDE5 inhibitor sildenafil. Overexpression of BCL-XL and c-FLIP-s suppressed individual and combination drug toxicities. Knockdown of CD95 or FADD suppressed drug combination toxicity. Treatment with PDE5 inhibitors and chemotherapy drugs promoted autophagy which was maximal at ~12 h post-treatment, and in a cell type-dependent manner knockdown of Beclin1 or ATG5 either suppressed or enhanced drug combination lethality. PDE5 inhibitors enhanced the induction of chemotherapy-induced DNA damage in a nitric oxide synthase-dependent fashion. In conclusion, our data demonstrate that the combination of PDE5 inhibitors with standard of care chemotherapy agents for medulloblastoma represents a possible novel modality for future treatment of this disease.
Collapse
Affiliation(s)
- Jane L Roberts
- Department of Biochemistry; Virginia Commonwealth University; Richmond, VA USA
| | - Laurence Booth
- Department of Biochemistry; Virginia Commonwealth University; Richmond, VA USA
| | - Adam Conley
- Department of Neurosurgery; Virginia Commonwealth University; Richmond, VA USA
| | | | - Mark Malkin
- Department of Neurology; Virginia Commonwealth University; Richmond, VA USA
| | - Rakesh C Kukreja
- Department of Cardiology; Virginia Commonwealth University; Richmond, VA USA
| | - Steven Grant
- Department of Medicine; Virginia Commonwealth University; Richmond, VA USA
| | - Andrew Poklepovic
- Department of Medicine; Virginia Commonwealth University; Richmond, VA USA
| | - Paul Dent
- Department of Biochemistry; Virginia Commonwealth University; Richmond, VA USA
| |
Collapse
|
15
|
Stupp R, Wong ET, Kanner AA, Steinberg D, Engelhard H, Heidecke V, Kirson ED, Taillibert S, Liebermann F, Dbalý V, Ram Z, Villano JL, Rainov N, Weinberg U, Schiff D, Kunschner L, Raizer J, Honnorat J, Sloan A, Malkin M, Landolfi JC, Payer F, Mehdorn M, Weil RJ, Pannullo SC, Westphal M, Smrcka M, Chin L, Kostron H, Hofer S, Bruce J, Cosgrove R, Paleologous N, Palti Y, Gutin PH. NovoTTF-100A versus physician's choice chemotherapy in recurrent glioblastoma: a randomised phase III trial of a novel treatment modality. Eur J Cancer 2012; 48:2192-202. [PMID: 22608262 DOI: 10.1016/j.ejca.2012.04.011] [Citation(s) in RCA: 517] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 04/22/2012] [Accepted: 04/23/2012] [Indexed: 02/08/2023]
Abstract
PURPOSE NovoTTF-100A is a portable device delivering low-intensity, intermediate frequency electric fields via non-invasive, transducer arrays. Tumour Treatment Fields (TTF), a completely new therapeutic modality in cancer treatment, physically interfere with cell division. METHODS Phase III trial of chemotherapy-free treatment of NovoTTF (20-24h/day) versus active chemotherapy in the treatment of patients with recurrent glioblastoma. Primary end-point was improvement of overall survival. RESULTS Patients (median age 54 years (range 23-80), Karnofsky performance status 80% (range 50-100) were randomised to TTF alone (n=120) or active chemotherapy control (n=117). Number of prior treatments was two (range 1-6). Median survival was 6.6 versus 6.0 months (hazard ratio 0.86 [95% CI 0.66-1.12]; p=0.27), 1-year survival rate was 20% and 20%, progression-free survival rate at 6 months was 21.4% and 15.1% (p=0.13), respectively in TTF and active control patients. Responses were more common in the TTF arm (14% versus 9.6%, p=0.19). The TTF-related adverse events were mild (14%) to moderate (2%) skin rash beneath the transducer arrays. Severe adverse events occurred in 6% and 16% (p=0.022) of patients treated with TTF and chemotherapy, respectively. Quality of life analyses favoured TTF therapy in most domains. CONCLUSIONS This is the first controlled trial evaluating an entirely novel cancer treatment modality delivering electric fields rather than chemotherapy. No improvement in overall survival was demonstrated, however efficacy and activity with this chemotherapy-free treatment device appears comparable to chemotherapy regimens that are commonly used for recurrent glioblastoma. Toxicity and quality of life clearly favoured TTF.
Collapse
Affiliation(s)
- Roger Stupp
- Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Snyder LA, Honea N, Coons SW, Eschbacher J, Smith KA, Spetzler RF, Sanai N, Groves MD, DeGroot J, Tremont I, Forman A, Kang S, Pei BL, Julie W, Schultz D, Yuan Y, Guha N, Hwu WJ, Papadopoulos N, Camphausen K, Yung WA, Ryken T, Johnston SK, Graham C, Grimm S, Colman H, Raizer J, Chamberlain MC, Mrugala MM, Adair JE, Beard BC, Silbergeld DL, Rockhill JK, Kiem HP, Lee EQ, Batchelor TT, Lassman AB, Schiff DS, Kaley TJ, Wong ET, Mikkelsen T, Purow BW, Drappatz J, Norden AD, Beroukhim R, Weiss S, Alexander BM, Sceppa C, Gerard M, Hallisey SD, Bochacki CA, Smith KH, Muzikansky AM, Wen PY, Peereboom DM, Mikkelson T, Sloan AE, Rich JN, Supko JG, Ye X, Brewer C, Lamborn K, Prados M, Grossman SA, Zhu JJ, Recht LD, Colman H, Kesari S, Kim LJ, Balch AH, Pope CC, Brulotte M, Beelen AP, Chamberlain MC, Wong ET, Ram Z, Gutin PH, Stupp R, Marsh J, McDonald K, Wheeler H, Teo C, Martin L, Palmer L, Rodriguez M, Buckland M, Koh ES, Back M, Robinson B, Joseph D, Nowak AK, Saito R, Sonoda Y, Yamashita Y, Kanamori M, Kumabe T, Tominaga T, Rodon J, Tawbi HA, Thomas AL, Amakye DD, Granvil C, Shou Y, Dey J, Buonamici S, Dienstmann R, Mita AC, Dummer R, Hutterer M, Martha N, Sabine E, Thaddaus G, Florian S, Christine M, Stefan O, Richard G, Martin M, Johanna B, Jochen T, Ullrich H, Wolfgang W, Peter V, Gunther S, Field KM, Cher L, Wheeler H, Hovey E, Nowak AK, Simes J, Sawkins K, France T, Brown C, Nicholas MK, Chmura S, Paleologos N, Krouwer H, Malkin M, Junck L, Vick NA, Lukas RV, Jaeckle KA, Anderson SK, Kosel M, Sarkaria J, Brown P, Flynn PJ, Buckner JC, Galanis E, Batchelor T, Grossman S, Brem S, Lesser G, Voloschin A, Nabors LB, Mikkelsen T, Desideri S, Supko J, Peereboom D, Westphal M, Pietsch T, Bach F, Heese O, Vredenburgh JJ, Desjardins A, Reardon DA, Peters KB, Kirkpatrick JP, Herndon JE, Coan AD, Bailey L, Janney D, Lu C, Friedman HS, Desjardins A, Reardon DA, Peters KB, Herndon JE, Gururangan S, Norfleet J, Friedman HS, Vredenburgh JJ, Lassman AB, Kaley TJ, DeAngelis LM, Hormigo A, Mellinghoff IK, Otap DD, Seger J, Doyle LA, Ludwig E, Lacouture ME, Panageas KS, Rezazadeh A, LaRocca RV, Vitaz TW, Villanueva WG, Hodes J, Haysley L, Pertschuk D, Cloughesy TF, Chang SM, Aghi MK, Vogelbaum MA, Liau LM, Shafa B, Jolly DJ, Ibanez CE, Perez OD, Robbins JM, Gruber HE, Maher EA, Stewart C, Hatanpaa K, Raisanen J, Mashimo T, Yang XL, Muralidhara C, Madden C, Ramachandran A, Mickey B, Bachoo R. ONGOING CLINICAL TRIALS. Neuro Oncol 2011; 13:iii85-iii91. [PMCID: PMC3199166 DOI: 10.1093/neuonc/nor154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023] Open
|
17
|
Prithviraj GK, Sommers SR, Jump RL, Halmos B, Chambless LB, Parker SL, Hassam-Malani L, McGirt MJ, Thompson RC, Chambless LB, Parker SL, Hassam-Malani L, McGirt MJ, Thompson RC, Hunter K, Chamberlain MC, Le EM, Lee ELT, Chamberlain MC, Sadighi ZS, Pearlman ML, Slopis JM, Vats TS, Khatua S, DeVito NC, Yu M, Chen R, Pan E, Cloughesy T, Raizer J, Drappatz J, Gerena-Lewis M, Rogerio J, Yacoub S, Desjardin A, Groves MD, DeGroot J, Loghin M, Conrad CA, Hess K, Ni J, Ictech S, Hunter K, Yung WA, Porter AB, Dueck AC, Karlin NJ, Chamberlain MC, Olson J, Silber J, Reiner AS, Panageas KS, Iwamoto FM, Cloughesy TF, Aldape KD, Rivera AL, Eichler AF, Louis DN, Paleologos NA, Fisher BJ, Ashby LS, Cairncross JG, Roldan GB, Wen PY, Ligon KL, Shiff D, Robins HI, Rocque BG, Chamberlain MC, Mason WP, Weaver SA, Green RM, Kamar FG, Abrey LE, DeAngelis LM, Jhanwar SC, Rosenblum MK, Lassman AB, Cachia D, Alderson L, Moser R, Smith T, Yunus S, Saito K, Mukasa A, Narita Y, Tabei Y, Shinoura N, Shibui S, Saito N, Flechl B, Ackerl M, Sax C, Dieckmann K, Crevenna R, Widhalm G, Preusser M, Marosi C, Marosi C, Ay C, Preusser M, Dunkler D, Widhalm G, Pabinger I, Dieckmann K, Zielinski C, Belongia M, Jogal S, Schlingensiepen KH, Bogdahn U, Stockhammer G, Mahapatra AK, Venkataramana NK, Oliushine V, Parfenov V, Poverennova I, Hau P, Jachimczak P, Heinrichs H, Mammoser AG, Shonka NA, de Groot JF, Shibahara I, Sonoda Y, Kumabe T, Saito R, Kanamori M, Yamashita Y, Watanabe M, Ishioka C, Tominaga T, Silvani A, Gaviani P, Lamperti E, Botturi A, DiMeco F, Broggi G, Fariselli L, Solero CL, Salmaggi A, Green RM, Woyshner EA, Cloughesy TF, Shu F, Oh YS, Iganej S, Singh G, Vemuri SL, Theeler BJ, Ellezam B, Gilbert MR, Aoki T, Kobayashi H, Takano S, Nishikawa R, Shinoura N, Nagane M, Narita Y, Muragaki Y, Sugiyama K, Kuratsu J, Matsutani M, Sadighi ZS, Khatua S, Langford LA, Puduvalli VK, Shen D, Chen ZP, Zhang JP, Chen ZP, Bedekar D, Rand S, Connelly J, Malkin M, Paulson E, Mueller W, Schmainda K, Gallego O, Benavides M, Segura PP, Balana C, Gil M, Berrocal A, Reynes G, Garcia JL, Murata P, Bague S, Quintana MJ, Vasishta VG, Nagane M, Kobayashi K, Tanaka M, Tsuchiya K, Shiokawa Y, Bavle AA, Ayyanar K, Puduvalli VK, Prado MP, Hess KR, Hunter K, Ictech S, Groves MD, Gilbert MR, Liu V, Conrad CA, de Groot J, Loghin ME, Colman H, Levin VA, Alfred Yung WK, Hackney JR, Palmer CA, Markert JM, Cure J, Riley KO, Fathallah-Shaykh H, Nabors LB, Saria MG, Corle C, Hu J, Rudnick J, Phuphanich S, Mrugala MM, Lee LK, Fu BD, Bota DA, Kim RY, Brown T, Feely H, Hu A, Drappatz J, Wen PY, Lee JW, Carter B, Kesari S, Fu BD, Kong XT, Bota DA, Fu BD, Bota DA, Sparagana S, Belousova E, Jozwiak S, Korf B, Frost M, Kuperman R, Kohrman M, Witt O, Wu J, Flamini R, Jansen A, Curtalolo P, Thiele E, Whittemore V, De Vries P, Ford J, Shah G, Cauwel H, Edrich P, Sahmoud T, Franz D, Khasraw M, Brown C, Ashley DM, Rosenthal MA, Jiang X, Mou YG, Chen ZP, Oh M, kim E, Chang J, Juratli TA, Kirsch M, Schackert G, Krex D, Gilbert MR, Wang M, Aldape KD, Stupp R, Hegi M, Jaeckle KA, Armstrong TS, Wefel JS, Won M, Blumenthal DT, Mahajan A, Schultz CJ, Erridge SC, Brown PD, Chakravarti A, Curran WJ, Mehta MP, Hofland KF, Hansen S, Sorensen M, Schultz H, Muhic A, Engelholm S, Ask A, Kristiansen C, Thomsen C, Poulsen HS, Lassen UN, Zalatimo O, Weston C, Zoccoli C, Glantz M, Rahmanuddin S, Shiroishi MS, Cen SY, Jones J, Chen T, Pagnini P, Go J, Lerner A, Gomez J, Law M, Ram Z, Wong ET, Gutin PH, Bobola MS, Alnoor M, Silbergeld DL, Rostomily RC, Chamberlain MC, Silber JR, Martha N, Jacqueline S, Thaddaus G, Daniel P, Hans M, Armin M, Eugen T, Gunther S, Hutterer M, Tseng HM, Zoccoli CM, Glantz M, Zalatimo O, Patel A, Rizzo K, Sheehan JM, Sumrall AL, Vredenburgh JJ, Desjardins A, Reardon DA, Friiedman HS, Peters KB, Taylor LP, Stewart M, Blondin NA, Baehring JM, Foote T, Laack N, Call J, Hamilton MG, Walling S, Eliasziw M, Easaw J, Shirsat NV, Kundar R, Gokhale A, Goel A, Moiyadi AA, Wang J, Mutlu E, Oyan A, Yan T, Tsinkalovsky O, Jacobsen HK, Talasila KM, Sleire L, Pettersen K, Miletic H, Andersen S, Mitra S, Weissman I, Li X, Kalland KH, Enger PO, Sepulveda J, Belda C, Balana C, Segura PP, Reynes G, Gil M, Gallego O, Berrocal A, Blumenthal DT, Sitt R, Phishniak L, Bokstein F, Philippe M, Carole C, Andre MDP, Marylin B, Olivier C, L'Houcine O, Dominique FB, Philippe M, Isabelle NM, Olivier C, Frederic F, Stephane F, Henry D, Marylin B, L'Houcine O, Dominique FB, Errico MA, Kunschner LJ, Errico MA, Kunschner LJ, Soffietti R, Trevisan E, Ruda R, Bertero L, Bosa C, Fabrini MG, Lolli I, Jalali R, Julka PK, Anand AK, Bhavsar D, Singhal N, Naik R, John S, Mathew BS, Thaipisuttikul I, Graber J, DeAngelis LM, Shirinian M, Fontebasso AM, Jacob K, Gerges N, Montpetit A, Nantel A, Albrecht S, Jabado N, Mammoser AG, Shah K, Conrad CA, Di K, Linskey M, Bota DA, Thon N, Eigenbrod S, Kreth S, Lutz J, Tonn JC, Kretzschmar H, Peraud A, Kreth FW, Muggeri AD, Alderuccio JP, Diez BD, Jiang P, Chao Y, Gallagher M, Kim R, Pastorino S, Fogal V, Kesari S, Rudnick JD, Bresee C, Rogatko A, Sakowsky S, Franco M, Hu J, Lim S, Lopez A, Yu L, Ryback K, Tsang V, Lill M, Steinberg A, Sheth R, Grimm S, Helenowski I, Rademaker A, Raizer J, Nunes FP, Merker V, Jennings D, Caruso P, Muzikansky A, Stemmer-Rachamimov A, Plotkin S, Spalding AC, Vitaz TW, Sun DA, Parsons S, Welch MR, Omuro A, DeAngelis LM, Omuro A, Beal K, Correa D, Chan T, DeAngelis L, Gavrilovic I, Nolan C, Hormigo A, Lassman AB, Kaley T, Mellinghoff I, Grommes C, Panageas K, Reiner A, Barradas R, Abrey L, Gutin P, Lee SY, Slagle-Webb B, Glantz MJ, Sheehan JM, Connor JR, Schlimper CA, Schlag H, Stoffels G, Weber F, Krueger DA, Care MM, Holland K, Agricola K, Tudor C, Byars A, Sahmoud T, Franz DN, Raizer J, Rice L, Rademaker A, Chandler J, Levy R, Muro K, Grimm S, Nayak L, Iwamoto FM, Rudnick JD, Norden AD, Omuro A, Kaley TJ, Thomas AA, Fadul CE, Meyer LP, Lallana EC, Colman H, Gilbert M, Alfred Yung WK, Aldape K, De Groot J, Conrad C, Levin V, Groves M, Loghin M, Chris P, Puduvalli V, Nagpal S, Feroze A, Recht L, Rangarajan HG, Kieran MW, Scott RM, Lew SM, Firat SY, Segura AD, Jogal SA, Kumthekar PU, Grimm SA, Avram M, Patel J, Kaklamani V, McCarthy K, Cianfrocca M, Gradishar W, Mulcahy M, Von Roenn J, Helenowski I, Rademaker A, Raizer J, Galanis E, Anderson SK, Lafky JM, Kaufmann TJ, Uhm JH, Giannini C, Kumar SK, Northfelt DW, Flynn PJ, Jaeckle KA, Buckner JC, Omar AI, Panageas KS, Iwamoto FM, Cloughesy TF, Aldape KD, Rivera AL, Eichler AF, Louis DN, Paleologos NA, Fisher BJ, Ashby LS, Cairncross JG, Roldan GB, Wen PY, Ligon KL, Schiff D, Robins HI, Rocque BG, Chamberlain MC, Mason WP, Weaver SA, Green RM, Kamar FG, Abrey LE, DeAngelis LM, Jhanwar SC, Rosenblum MK, Lassman AB, Delios A, Jakubowski A, DeAngelis L, Grommes C, Lassman AB, Theeler BJ, Melguizo-Gavilanes I, Shonka NA, Qiao W, Wang X, Mahajan A, Puduvalli V, Hashemi-Sadraei N, Bawa H, Rahmathulla G, Patel M, Elson P, Stevens G, Peereboom D, Vogelbaum M, Weil R, Barnett G, Ahluwalia MS, Alvord EC, Rockne RC, Rockhill JK, Mrugala MM, Rostomily R, Lai A, Cloughesy T, Wardlaw J, Spence AM, Swanson KR, Zadeh G, Alahmadi H, Wilson J, Gentili F, Lassman AB, Wang M, Gilbert MR, Aldape KD, Beumer JJ, Wright J, Takebe N, Puduvalli VK, Hormigo A, Gaur R, Werner-Wasik M, Mehta MP, Gupta AJ, Campos-Gines A, Le K, Arango C, Richards M, Landeros M, Juan H, Chang JH, Kim JS, Cho JH, Seo CO, Baldock AL, Rockne R, Canoll P, Born D, Yagle K, Swanson KR, Alexandru D, Bota D, Linskey ME, Nabeel S, Raval SN, Raizer J, Grimm S, Rice L, Rosenow J, Levy R, Bredel M, Chandler J, New PZ, Plotkin SR, Supko JG, Curry WT, Chi AS, Gerstner ER, Stemmer-Rachamimov A, Batchelor TT, Ahluwalia MS, Hashemi N, Rahmathulla G, Patel M, Chao ST, Peereboom D, Weil RJ, Suh JH, Vogelbaum MA, Stevens GH, Barnett GH, Corwin D, Holdsworth C, Stewart R, Rockne R, Swanson K, Graber JJ, Kaley T, Rockne RC, Anderson AR, Swanson KR, Jeyapalan S, Goldman M, Boxerman J, Donahue J, Elinzano H, Evans D, O'Connor B, Puthawala MY, Oyelese A, Cielo D, Blitstein M, Dargush M, Santaniello A, Constantinou M, DiPetrillo T, Safran H, Plotkin SR, Halpin C, Merker V, Barker FG, Maher EA, Ganji S, DeBerardinis R, Hatanpaa K, Rakheja D, Yang XL, Mashimo T, Raisanen J, Madden C, Mickey B, Malloy C, Bachoo R, Choi C, Ranjan T, Yono N, Zalatimo O, Zoccoli C, Glantz M, Han SJ, Sun M, Berger MS, Aghi M, Gupta N, Parsa AT. MEDICAL AND NEURO-ONCOLOGY. Neuro Oncol 2011. [DOI: 10.1093/neuonc/nor152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
18
|
Nicholas MK, Lucas RV, Arzbaecher J, Paleologos N, Krouwer H, Malkin M, Omar A, Vick NA. Bevacizumab in combination with temozolomide in the adjuvant treatment of newly diagnosed glioblastoma multiforme: Preliminary results of a phase II study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2016 Background: Glioblastoma multiforme (GBM) is the most common and aggressive primary brain tumor. Current standard treatment consists of fractionated radiotherapy (RT) with daily oral temozolomide (TMZ) chemotherapy followed by 6 months of adjuvant TMZ chemotherapy. Median survival is 14.3 months. Because GBM is characterized by vascular proliferation and produces high levels of vascular endothelial growth factor (VEGF), attempts to better control the disease with targeted anti-angiogenesis therapies are underway. Here, we report preliminary safety and tolerability data of bevacizumab (BV) when added to monthly TMZ chemotherapy. Methods: Subjects received standard regional RT to a dose of 60 Gy in 30 fractions with dailyconcurrent TMZ (75 mg/m2) within 3–5 weeks of diagnosis. Four weeks after RT/TMZ, subjects received 5 consecutive daily TMZ doses (150–200 mg/m2) administered every 28 days. BV (10mg/kg) was given every 14 days. Treatment continued until either disease progression or unacceptable toxicity occurred. Results: 42 of 48 planned subjects were enrolled as of 12/30/08. Twenty-three remained on study. Of these, 4 were receiving RT/TMZ, 18 were receiving TMZ/BV and 1 was delayed post-RT/TMZ due to local wound infection. Nineteen were off-study. Eleven of those off-study never received BV due to: study withdrawal (n = 2), toxicity during RT/TMZ (n = 3) and post-RT/TMZ progression (n = 6). Seven subjects progressed while receiving TMZ/BV. Twenty-six of the 42 enrolled received at least one 28-day cycle of TMZ/BV (range 1 - 16 cycles). Duration of treatment, inclusive of RT/TMZ, ranged from 27 to 523 days. Best radiographic responses of evaluable subjects, using MacDonald criteria were: 5 complete, 9 partial, 13 stable and 7 progressive disease. Of those taken off study, 13 were due to disease progression. Of those removed from study due to toxicity, none were unexpected and only 1 (a GI bleed) occurred during the TMZ/BV phase. A statistical analysis of response and survival is pending. Conclusions: The co-administration of TMZ/BV following RT/TMZ for newly diagnosed GBM is safe and well-tolerated. [Table: see text]
Collapse
Affiliation(s)
- M. K. Nicholas
- University of Chicago, Chicago, IL; NorthShore University Health System, Evanston, IL; Regional Cancer Center, Waukesha Memorial Hospital, Waukesha, WI; Medical College of Wisconsin, Milwaukee, WI
| | - R. V. Lucas
- University of Chicago, Chicago, IL; NorthShore University Health System, Evanston, IL; Regional Cancer Center, Waukesha Memorial Hospital, Waukesha, WI; Medical College of Wisconsin, Milwaukee, WI
| | - J. Arzbaecher
- University of Chicago, Chicago, IL; NorthShore University Health System, Evanston, IL; Regional Cancer Center, Waukesha Memorial Hospital, Waukesha, WI; Medical College of Wisconsin, Milwaukee, WI
| | - N. Paleologos
- University of Chicago, Chicago, IL; NorthShore University Health System, Evanston, IL; Regional Cancer Center, Waukesha Memorial Hospital, Waukesha, WI; Medical College of Wisconsin, Milwaukee, WI
| | - H. Krouwer
- University of Chicago, Chicago, IL; NorthShore University Health System, Evanston, IL; Regional Cancer Center, Waukesha Memorial Hospital, Waukesha, WI; Medical College of Wisconsin, Milwaukee, WI
| | - M. Malkin
- University of Chicago, Chicago, IL; NorthShore University Health System, Evanston, IL; Regional Cancer Center, Waukesha Memorial Hospital, Waukesha, WI; Medical College of Wisconsin, Milwaukee, WI
| | - A. Omar
- University of Chicago, Chicago, IL; NorthShore University Health System, Evanston, IL; Regional Cancer Center, Waukesha Memorial Hospital, Waukesha, WI; Medical College of Wisconsin, Milwaukee, WI
| | - N. A. Vick
- University of Chicago, Chicago, IL; NorthShore University Health System, Evanston, IL; Regional Cancer Center, Waukesha Memorial Hospital, Waukesha, WI; Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
19
|
Perry JR, Rogers L, Laperriere N, Julian J, Geerts W, Agnelli G, Malkin M, Sawaya R, Baker R, Levine M. PRODIGE: A phase III randomized placebo-controlled trial of thromboprophylaxis using dalteparin low molecular weight heparin (LMWH) in patients with newly diagnosed malignant glioma. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.2011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2011 Background: Venous thromboembolism (VTE) occurs in 20–30% of patients with malignant glioma per year of survival. We have conducted an RCT testing the efficacy and safety of long-term dalteparin for the prevention of VTE in newly diagnosed malignant glioma. Methods: Adults with newly diagnosed malignant glioma were randomized to receive dalteparin 5,000 anti-Xa units or placebo, both subcutaneously daily for 6 months starting within the first month after surgery. Patients were allowed to continue study medication for up to 12 months. Because of the poor prognosis of malignant glioma it was determined apriori that the primary outcome was 6-month VTE-free survival. In order to detect a 60% VTE hazard reduction with LMWH with 80% power, 512 patients were required. Results: Recruitment began October 2002 and was closed in May 2006 because of expiration of study medication and no further re-supply. Of the 563 patients screened at 15 centers, 174 were excluded. Of the 389 eligible patients approached for consent, 186 were randomized: 99 to LMWH, 87 to placebo. Twenty-one patients developed objectively confirmed VTE during the first 6 months: 9 on LMWH and 12 on placebo (11% and 17% respectively; HR=0.7, 95% CI: 0.37–1.5, p=0.3). Over the 12 months there were 5 (5.1%) major bleeds with LMWH and 1 (1.2%) with placebo (HR=4.0, 95%CI: 0.5–34, p=0.2). All major bleeds were intracranial. Twelve-month mortality was 48% for LMWH and 45% for placebo (HR=1.2, 95%CI: 0.7–1.9, p=0.5). Conclusions: Although there was a trend in favor of the LMWH reducing VTE this was not statistically significant, likely as a result of low power. There was also a trend for increased intracranial bleeding with LMWH. Our study confirms the high incidence of thromboembolism in these patients; however, the role of long-term anticoagulant thromboprophylaxis remains unclear. Supported in part by a grant in aid from Pfizer Inc. and the Ontario Cancer Research Network. The PRODIGE steering committee thanks Terri Finch for superb administrative support. Pfizer
Collapse
Affiliation(s)
- J. R. Perry
- Sunnybrook Health Sciences Center, Toronto, ON, Canada; Henry Ford, Detroit, MI, Canada; Princess Margaret Hospital, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada; University of Perugia, Perugia, Italy; Medical College of Wisconsin, Milwaukee, WI; MD Anderson Cancer Center, Houston, TX; Royal Perth Hospital, Perth, Australia
| | - L. Rogers
- Sunnybrook Health Sciences Center, Toronto, ON, Canada; Henry Ford, Detroit, MI, Canada; Princess Margaret Hospital, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada; University of Perugia, Perugia, Italy; Medical College of Wisconsin, Milwaukee, WI; MD Anderson Cancer Center, Houston, TX; Royal Perth Hospital, Perth, Australia
| | - N. Laperriere
- Sunnybrook Health Sciences Center, Toronto, ON, Canada; Henry Ford, Detroit, MI, Canada; Princess Margaret Hospital, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada; University of Perugia, Perugia, Italy; Medical College of Wisconsin, Milwaukee, WI; MD Anderson Cancer Center, Houston, TX; Royal Perth Hospital, Perth, Australia
| | - J. Julian
- Sunnybrook Health Sciences Center, Toronto, ON, Canada; Henry Ford, Detroit, MI, Canada; Princess Margaret Hospital, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada; University of Perugia, Perugia, Italy; Medical College of Wisconsin, Milwaukee, WI; MD Anderson Cancer Center, Houston, TX; Royal Perth Hospital, Perth, Australia
| | - W. Geerts
- Sunnybrook Health Sciences Center, Toronto, ON, Canada; Henry Ford, Detroit, MI, Canada; Princess Margaret Hospital, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada; University of Perugia, Perugia, Italy; Medical College of Wisconsin, Milwaukee, WI; MD Anderson Cancer Center, Houston, TX; Royal Perth Hospital, Perth, Australia
| | - G. Agnelli
- Sunnybrook Health Sciences Center, Toronto, ON, Canada; Henry Ford, Detroit, MI, Canada; Princess Margaret Hospital, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada; University of Perugia, Perugia, Italy; Medical College of Wisconsin, Milwaukee, WI; MD Anderson Cancer Center, Houston, TX; Royal Perth Hospital, Perth, Australia
| | - M. Malkin
- Sunnybrook Health Sciences Center, Toronto, ON, Canada; Henry Ford, Detroit, MI, Canada; Princess Margaret Hospital, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada; University of Perugia, Perugia, Italy; Medical College of Wisconsin, Milwaukee, WI; MD Anderson Cancer Center, Houston, TX; Royal Perth Hospital, Perth, Australia
| | - R. Sawaya
- Sunnybrook Health Sciences Center, Toronto, ON, Canada; Henry Ford, Detroit, MI, Canada; Princess Margaret Hospital, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada; University of Perugia, Perugia, Italy; Medical College of Wisconsin, Milwaukee, WI; MD Anderson Cancer Center, Houston, TX; Royal Perth Hospital, Perth, Australia
| | - R. Baker
- Sunnybrook Health Sciences Center, Toronto, ON, Canada; Henry Ford, Detroit, MI, Canada; Princess Margaret Hospital, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada; University of Perugia, Perugia, Italy; Medical College of Wisconsin, Milwaukee, WI; MD Anderson Cancer Center, Houston, TX; Royal Perth Hospital, Perth, Australia
| | - M. Levine
- Sunnybrook Health Sciences Center, Toronto, ON, Canada; Henry Ford, Detroit, MI, Canada; Princess Margaret Hospital, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada; University of Perugia, Perugia, Italy; Medical College of Wisconsin, Milwaukee, WI; MD Anderson Cancer Center, Houston, TX; Royal Perth Hospital, Perth, Australia
| |
Collapse
|
20
|
Abstract
The risk of most primary brain cancers including gliomas and acoustic neuromas is unrelated to the use of mobile telephones in several studies. The long-term effects of mobile phones remain to be determined. An increased risk caused by short-term mobile phone use was reported for neuroepithelial tumors, a rare histologic subgroup of brain cancers that are characterized by neuronal features. We analyzed time trends in the age-adjusted incidence rate of adult neuronal cancers in the Surveillance, Epidemiology and End Results program from 1973 to 2002. The rates did not change during this period, despite the exponential increase in mobile phone subscriptions starting in 1984. These results indicate that mobile phone use is unrelated to the risk of neuronal cancers.
Collapse
Affiliation(s)
- Joshua E Muscat
- Penn State College of Medicine, 500 University Blvd., MC H 069 Hershey, PA 17033, USA.
| | | | | |
Collapse
|
21
|
Lieberman FS, Cloughesy T, Fine H, Kuhn J, Lamborn K, Malkin M, Robbins HI, Yung WA, Wen P, Prados M. NABTC phase I/II trial of ZD-1839 for recurrent malignant gliomas and unresectable meningiomas. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.1510] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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)
- F. S. Lieberman
- University of Pittsburgh, Pittsburgh, PA; University of California, Los Angeles, CA; National Cancer Institute, Bethesda, MD; University of Texas, San Antonio, TX; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Wisconsin, Madison, WI; MD Anderson Cancer Center, Houston, TX; Dana Farber Cancer Institute, Boston, MA
| | - T. Cloughesy
- University of Pittsburgh, Pittsburgh, PA; University of California, Los Angeles, CA; National Cancer Institute, Bethesda, MD; University of Texas, San Antonio, TX; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Wisconsin, Madison, WI; MD Anderson Cancer Center, Houston, TX; Dana Farber Cancer Institute, Boston, MA
| | - H. Fine
- University of Pittsburgh, Pittsburgh, PA; University of California, Los Angeles, CA; National Cancer Institute, Bethesda, MD; University of Texas, San Antonio, TX; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Wisconsin, Madison, WI; MD Anderson Cancer Center, Houston, TX; Dana Farber Cancer Institute, Boston, MA
| | - J. Kuhn
- University of Pittsburgh, Pittsburgh, PA; University of California, Los Angeles, CA; National Cancer Institute, Bethesda, MD; University of Texas, San Antonio, TX; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Wisconsin, Madison, WI; MD Anderson Cancer Center, Houston, TX; Dana Farber Cancer Institute, Boston, MA
| | - K. Lamborn
- University of Pittsburgh, Pittsburgh, PA; University of California, Los Angeles, CA; National Cancer Institute, Bethesda, MD; University of Texas, San Antonio, TX; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Wisconsin, Madison, WI; MD Anderson Cancer Center, Houston, TX; Dana Farber Cancer Institute, Boston, MA
| | - M. Malkin
- University of Pittsburgh, Pittsburgh, PA; University of California, Los Angeles, CA; National Cancer Institute, Bethesda, MD; University of Texas, San Antonio, TX; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Wisconsin, Madison, WI; MD Anderson Cancer Center, Houston, TX; Dana Farber Cancer Institute, Boston, MA
| | - H. I. Robbins
- University of Pittsburgh, Pittsburgh, PA; University of California, Los Angeles, CA; National Cancer Institute, Bethesda, MD; University of Texas, San Antonio, TX; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Wisconsin, Madison, WI; MD Anderson Cancer Center, Houston, TX; Dana Farber Cancer Institute, Boston, MA
| | - W. A. Yung
- University of Pittsburgh, Pittsburgh, PA; University of California, Los Angeles, CA; National Cancer Institute, Bethesda, MD; University of Texas, San Antonio, TX; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Wisconsin, Madison, WI; MD Anderson Cancer Center, Houston, TX; Dana Farber Cancer Institute, Boston, MA
| | - P. Wen
- University of Pittsburgh, Pittsburgh, PA; University of California, Los Angeles, CA; National Cancer Institute, Bethesda, MD; University of Texas, San Antonio, TX; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Wisconsin, Madison, WI; MD Anderson Cancer Center, Houston, TX; Dana Farber Cancer Institute, Boston, MA
| | - M. Prados
- University of Pittsburgh, Pittsburgh, PA; University of California, Los Angeles, CA; National Cancer Institute, Bethesda, MD; University of Texas, San Antonio, TX; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Wisconsin, Madison, WI; MD Anderson Cancer Center, Houston, TX; Dana Farber Cancer Institute, Boston, MA
| |
Collapse
|
22
|
|
23
|
Safdar A, Brown AE, Kraus DH, Malkin M. Paradoxical reaction syndrome complicating aural infection due to Mycobacterium tuberculosis during therapy. Clin Infect Dis 2000; 30:625-7. [PMID: 10722470 DOI: 10.1086/313731] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- A Safdar
- Infectious Diseases Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
| | | | | | | |
Collapse
|
24
|
|
25
|
Schupak K, Malkin M, Anderson L, Arbit E, Lindsley K, Leibel S. The relationship between the technical accuracy of stereotactic interstitial implantation for high grade gliomas and the pattern of tumor recurrence. Int J Radiat Oncol Biol Phys 1995; 32:1167-76. [PMID: 7607939 DOI: 10.1016/0360-3016(94)00652-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [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: 01/26/2023]
Abstract
PURPOSE To correlate the pattern of failure and subsequent survival with the technical accuracy of stereotactic brain tumor implantation. METHODS AND MATERIALS The patterns of failure of 47 consecutive patients with primary or recurrent gliomas after stereotactic implantation delivering 60 Gy via removable high activity 125I sources were reviewed. When the tumor was covered at all levels by the chosen isodose distribution, the implant was considered to be "ideal." If the coverage was not complete, a numerical description of the volume of tumor outside the isodose was assigned. Criteria for "adequate" and "inadequate" implants were defined. Standard radiographic criteria, with pathologic confirmation in 26 cases, were used to categorize the patterns of failure into the following components: central, peripheral, distant (within the brain parenchyma), leptomeningeal, and spinal. A peripheral failure was scored as being in the "direction of error" when the prescribed isodose did not cover the tumor volume and the subsequent tumor progression was in this region. Survival was calculated from the date of implantation. RESULTS Of 47 cases examined, 72% had an element of central and/or peripheral failure and 23% had a component of distant or meningeal failure. Among the patients with "adequate" or "inadequate" ("nonideal") implants who had a component of peripheral failure, only 19% were in the "direction of error." All patients with technically "inadequate" implants progressed in both the central and peripheral region. Among the groups who had "ideal," "adequate," and "inadequate" implants; 37%, 70%, and 75%, respectively, underwent reoperation [p = not significant (NS)]. Patients who underwent reoperation had a longer median survival than those who did not; 521 days vs. 298 days, respectively (p = 0.035). For patients with "nonideal" implants, a median survival of 470 days was found for patients undergoing reoperation vs. 184 days for those who did not (p = 0.016). CONCLUSIONS (a) Patients with "inadequate" implants failed in both the central and peripheral region in all cases. This pattern, while less common in those with "ideal" or "adequate" implants, occurred in the majority of cases. (b) The technical excellence of the implant had no impact on survival. (c) Patients with "nonideal" implants were more likely to have reoperation than those with "ideal" implants, and this intervention was associated with a significant survival advantage.
Collapse
Affiliation(s)
- K Schupak
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
| | | | | | | | | | | |
Collapse
|
26
|
Kleinberg L, Malkin M, Wallner K. Performance status of long term disease free survivors of intracranial gliomas. Int J Radiat Oncol Biol Phys 1992. [DOI: 10.1016/0360-3016(92)90429-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
27
|
Abstract
Thirty-nine patients with histologically proved primary neoplasms, focal neurologic deficits, and positive CSF cytology were evaluated by enhanced cranial CT and MR, or complete myelography and MR of the spine. Intracranial abnormalities were noted on CT in 56% of cases and included abnormal enhancement of subarachnoid space and ventricular walls, ventricular dilatation, obliteration of cortical sulci, and enhancing nodules within the subarachnoid cisterns and lumen of the lateral ventricles. Although the degree of ventricular enlargement and intraventricular tumor deposits were equally well seen on CT and MR, involvement of ventricular walls, tentorium, subarachnoid cisterns, or subarachnoid space interpreted as abnormal enhancement on CT was not readily appreciated on routine T1- and T2-weighted spin-echo sequences. Forty-four percent of CT and 65% of MR studies were interpreted as normal. There was high correlation of myelographic findings with clinical diagnosis, and no false-negative myelograms. Nodular filling defects within the subarachnoid space, thickening and crowding of roots of the cauda equina, irregularity of individual roots, and scalloping of the subarachnoid membranes were demonstrated. MR was rather insensitive in detecting these changes, revealing a definite abnormality of the subarachnoid space in 27% of patients with positive myelograms. False-negative interpretation of MR of the spine was made in 44% of cases.
Collapse
Affiliation(s)
- G Krol
- Department of Medical Imaging and Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021
| | | | | | | |
Collapse
|
28
|
Graham DR, Golding LA, Smith TA, Malkin M, Wolf MD. Sportsmedicine forum. PHYSICIAN SPORTSMED 1987; 15:51-3. [PMID: 27463573 DOI: 10.1080/00913847.1987.11709301] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
29
|
|
30
|
Malkin M, Zaifrani S. [Dacryocystorhinostomy with temporary intubation of the lacrimal drainage system]. Harefuah 1983; 104:271-2. [PMID: 6618325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
31
|
Abstract
Fracture of the anterior nasal spine is so rare that clinicians do not specifically look for it if other fractures of the middle third of the face have been ruled out. However, as suggested by this case, the possibility of fracture of the nasal spine should not be overlooked.
Collapse
|
32
|
Arends J, Kohl EJ, Cary JC, Fixx JF, Malkin M, Lichtblau PO, Albohm M, Stephenson OK. Letters. PHYSICIAN SPORTSMED 1979; 7:9-15. [PMID: 27432561 DOI: 10.1080/00913847.1979.11710807] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | | | - J F Fixx
- d 37 Crescent Road Riverside, Connecticut 06878
| | | | | | - M Albohm
- g Indiana University Bloomington , Indiana
| | | |
Collapse
|
33
|
Malkin M, Liebowitz L. A non-traditional approach in the treatment of pre-operative apprehension. Anesth Prog 1977; 24:75-8. [PMID: 274090 PMCID: PMC2516760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
34
|
Gitelman JM, Malkin M, Travin MS. Hemangioma of the lip: combined treatment. N Y State Dent J 1976; 42:420-2. [PMID: 1066580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
35
|
Malkin M, Berg R. Stafne defect of the anterior mandible. N Y State Dent J 1974; 40:17-9. [PMID: 4519494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
36
|
Malkin M, Lipmann F. A stimulation by cyclic 3',5'-adenosine monophosphate of amino acid activation and polymerization in reticulocyte hemolysates. Proc Natl Acad Sci U S A 1969; 64:973-80. [PMID: 4313337 PMCID: PMC223331 DOI: 10.1073/pnas.64.3.973] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
With reticulocyte supernatant, cyclic 3',5'-adenosine monophosphate at concentrations of 10(-3) to 10(-2)M causes stimulation of aminoacyl-tRNA synthetases for some, e.g., valine and leucine, but not all, amino acids; it is highest at nonsaturating concentrations of ATP. Similar concentrations of cyclic 3',5'-adenosine monophosphate are found to stimulate phenylalanine polymerization from phenylalanyl transfer ribonucleic acid on polyuridylic acid-charged reticulocyte ribosomes. The degree of stimulation is highest at low GTP concentrations. It is abolished by addition of phosphoenolpyruvate + pyruvate kinase, which stimulate similarly or more effectively at low GTP levels. Under the conditions of these experiments, cyclic 3',5'-adenosine monophosphate did not appreciably inhibit GTP hydrolysis.
Collapse
|
37
|
Abstract
The steroid antibiotic fusidic acid inhibits reticulocyte protein synthesis. This inhibition appears to be due to interference with the activity of the T(2) supernatant fraction, and strengthens the proposition that T(2) is functionally analogous to the G-factor of bacterial protein synthesis, which is also specifically inhibited by this antibiotic.
Collapse
|
38
|
Malkin M, Hirsch AC. Sjögren's syndrome: a radiographic study. J Oral Surg 1968; 26:334-7. [PMID: 5238927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
39
|
|
40
|
Douglas BL, Kresberg H, Sherman P, Malkin M, Jung E. Duocaine-A New Local Anesthetic Agent - A Clinical Research Report. J Am Dent Soc Anesthesiol 1958; 5:5-8. [PMID: 19598762 PMCID: PMC2067298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|