Naxitamab (NAX) treatment for refractory/relapsed (R/R) high-risk neuroblastoma (HR-NB): Response data and efficacy in patient (pt) subgroups

e22019

Background: Almost half of pts with NB present with high-risk disease, most of whom experience persistence of disease or disease progression. Further, residual disease in the bone/bone marrow (BM) can drive relapse. NAX is a humanized GD2-binding monoclonal antibody indicated under accelerated approval in the US with GM-CSF for the treatment of R/R HR-NB in the bone/BM in pts ≥1 year of age with a partial response (PR), minor response (MR), or stable disease (SD) to prior therapy. Here we characterize the response data of NAX overall and efficacy in pt subgroups. Methods: Trial 201 is an ongoing registrational phase II trial evaluating NAX in pts with R/R HR-NB. Pts with progressive or residual soft tissue disease were excluded. NAX was administered over 30-60 min in the outpatient setting on Days 1/3/5 at 3 mg/kg/day with GM-CSF at 250 µg/m2/day on Days –4 to 0 and 500 µg/m2/day on Days 1 to 5; cycles were every 4 wks. Efficacy was evaluated by independent pathology and radiology review per revised International Neuroblastoma Response Criteria. Results: Results presented here are from an ad hoc interim analysis (Aug 5, 2020) of 48 pts (safety population) and 36 (efficacy population). Pts in the efficacy population received a median of 7 cycles (range 1–11). Overall response rate (ORR; complete response [CR] + PR) was 58% (44% CR; Table). Of the 9 responders who had PR initially, 4 improved to CR. Median number of cycles before onset of response (CR or PR) was 2 (range 2–8) and median time to onset of response (CR or PR) was 7.3 wks (95% CI 6–17). Median duration of response was 24.9 wks (95% CI 25–not estimable). The most common adverse events (CTCAE graded) were infusion-related reactions including hypotension and pain, which occurred in 98% and 96% of pts, respectively. Adverse events were managed with established guidelines. Conclusions: NAX provided a clinically meaningful response in pts with R/R HR-NB limited to bone/BM – frequent sites of residual disease. Response rates were generally consistent across subgroups. These efficacy results combined with a manageable safety profile and use in the outpatient setting demonstrate that NAX addresses a significant unmet medical need. Clinical trial information: NCT03363373. [Table: see text]

A phase II study of abemaciclib in patients (pts) with brain metastases (BM) secondary to HR+, HER2- metastatic breast cancer (MBC)

1017

Background: Abemaciclib is a selective CDK4 & 6 inhibitor approved to treat HR+, HER2- MBC pts on a continuous dosing schedule as monotherapy or in combination with endocrine therapy (ET). Clinical data demonstrate abemaciclib penetrates the blood brain barrier resulting in comparable concentrations in tissues and plasma. Methods: JPBO is a Simon 2-stage trial evaluating abemaciclib in 6 pt cohorts with BM secondary to HR+ MBC, non-small cell lung cancer, or melanoma. Here, we report on HR+, HER2- MBC pts. Eligible pts had ≥1 new or not previously irradiated measurable BM ≥10mm or a progressive previously irradiated BM. Pts receiving ET at the time of enrollment were permitted to continue the same ET provided that extracranial (EC) disease was stable ≥3 months and the CNS progression occurred on the ET. Abemaciclib was orally administered 200mg BID. Primary endpoint was objective intracranial response rate (OIRR; [CR+PR]) based on Neuro-Oncology BM response assessment criteria (RANO-BM). Secondary endpoints included intracranial clinical benefit rate, PFS, and safety. Results: 58 HR+, HER2- MBC pts were enrolled and 52 pts were evaluable. Pts had a median of 4 prior systemic therapies, 75% of pts had prior chemotherapies (0-6, median of 2), and 71% of pts had prior ET (0-4, median of 1), in the metastatic setting. 50% of pts had prior whole brain radiotherapy, 39% stereotactic radiosurgery, and 8% surgical resection of BM. Median time from radiation to study enrollment was 9.4 months. Out of the 52 evaluable patients, 3 pts had a confirmed intracranial response (6% OIRR), and 38% of pts showed a decrease in the sum of their intracranial target lesions. Intracranial clinical benefit rate (CR+PR+SD persisting for ≥ 6 months) was 25%. Median PFS was 4.4 months (95% CI, 2.6-5.5). Safety and tolerability were similar to previous reports for abemaciclib. Conclusions: Abemaciclib demonstrated intracranial clinical benefit in heavily pretreated HR+, HER2- MBC pts with BM in this study. Further evaluations are ongoing to identify ABC patients with BM who might benefit most from abemaciclib. Clinical trial information: NCT02308020.

PLC-beta1, activated via mGluRs, mediates activity-dependent differentiation in cerebral cortex

During development of the cerebral cortex, the invasion of thalamic axons and subsequent differentiation of cortical neurons are tightly coordinated. Here we provide evidence that glutamate neurotransmission triggers a critical signaling mechanism involving the activation of phospholipase C-beta1 (PLC-beta1) by metabotropic glutamate receptors (mGluRs). Homozygous null mutation of either PLC-beta1 or mGluR5 dramatically disrupts the cytoarchitectural differentiation of 'barrels' in the mouse somatosensory cortex, despite segregation in the pattern of thalamic innervation. Furthermore, group 1 mGluR-stimulated phosphoinositide hydrolysis is dramatically reduced in PLC-beta1-/- mice during barrel development. Our data indicate that PLC-beta1 activation via mGluR5 is critical for the coordinated development of the neocortex, and that presynaptic and postsynaptic components of cortical differentiation can be genetically dissociated.

Client satisfaction with service coordinators' provision of home based long-term care services

This descriptive study investigates the reliability and validity of the Service Coordinator Satisfaction Measure (SCSM) which was developed to measure client satisfaction with service coordination in a pilot home based long-term care (LTC) program. The SCSM measures the subdimensions of service delivery and service sufficiency, as well as overall satisfaction with service coordination. Reliability testing with a sample of 213 clients indicated that the SCSM had high internal consistency (Cronbach's alpha = .86) and validity testing with the SCSM and a criterion measure also yielded significant positive correlations (r = .57, p < .01). Results showed that clients ranged between being unsure and satisfied with their service coordinator. Analysis of the subdimensions in the SCSM indicated clients were more satisfied with service delivery than they were with service sufficiency, suggesting that clients were somewhat ambiguous about assuming a greater role in managing their own home based LTC needs.

Enhancing breastfeeding initiation in adolescent mothers through the Breastfeeding Educated and Supported Teen (BEST) Club

The purpose of this study was to determine if specific breastfeeding education, provided by a lactation consultant in group classes for pregnant adolescents, would increase breastfeeding initiation among students enrolled in a high school adolescent pregnancy program. Ninety-one pregnant adolescents participated in the study and were divided into two groups: those who did not receive specific breastfeeding education and those who did, through the Breastfeeding Educated and Supported Teen (BEST) Club. There were no significant differences in breastfeeding initiation with regard to age or ethnicity. Of the 48 adolescents who received no specific education, 7 (14.6%) initiated breastfeeding. Of the 43 adolescents in the education group, 28 (65.1%) initiated breastfeeding, which indicates a significant difference between groups with regard to infant feeding choice (P < .001). The results of this study indicate that targeted educational programs designed for the adolescent learner may be successful in improving breastfeeding initiation in this population.

The Client Encounter Form: conceptual development, reliability analysis, and clinical applications

This descriptive correlational study investigated the reliability of a new measure of client-nurse practitioner interaction, the Client Encounter Form (CEF), and used the CEF to describe the domains of client-nurse practitioner interaction that occurred during problem and preventative visits at a primary care clinic. The CEF is based on Cox's Interactional Model of Client Health Behavior. Data were collected from a convenience sample of 41 primary care clinic visits. Descriptive data on all clients and the patterns of use characterized by the CEF were collected using retrospective chart review (n = 60). Reliability testing showed the CEF has high interrater reliability; Cohen's Kappas for its dimensions ranged from 0.78-1.0. The CEF was also shown to be useable in a primary care clinic. Health information, affective support, goal setting, and technical procedures were consistently part of the nurse-client interactions in this sample, demonstrating they are part of the nurse practitioner model of care. Analysis revealed different patterns of interaction for preventative and problem-oriented visits. Preventative visits had higher levels of health promotion information, psychological affective support, and health promotion goal-setting behaviors. Problem visits included more information regarding the client's diagnosis, medications, and treatments, and more affective support related to the client's physical condition.

Using a nursing framework to measure client satisfaction at a nurse-managed clinic

There is considerable literature on nurse-managed clinics and client satisfaction with nurse practitioner care. However, the methodological weaknesses of satisfaction measures which are often used limits confidence in the study findings. Satisfaction measures typically lack reliability analysis and/or have limited validity testing. This descriptive, correlational study investigates the validity and reliability of a new measure, the Client Satisfaction Tool (CST) and determines the degree of satisfaction that clients at a newly established senior health clinic had with the primary care services they were receiving. The CST is based upon Cox's Interactional Model of Client Health Behavior and thus was explicitly developed to measure client satisfaction with a nurse practitioner model of care. A convenience sample of 38 clients completed the CST. Responses to the CST indicated that users of the senior health clinic were satisfied with the care they received. Reliability testing showed that the tool has high internal consistency (Chronbach's alpha was 0.956) and high stability (r = 0.974). Construct validity testing with measures of perceived health changes showed that the tool has both convergent (r = 0.599, P < 0.01) and divergent (r = 0.194, P > 0.10) validity. Thus, the CST is a methodologically sound measure of client satisfaction that can be used in future research that examines client satisfaction with nurse practitioner care.

Using a nursing framework to establish a nurse-managed Senior Health Clinic

This article describes the organizing framework and evaluation component of a newly initiated nurse-managed Senior Health Clinic that is being collaboratively run by a school of nursing and a senior service agency in Central Florida. Background is provided on choosing a partner agency; negotiations; developing a mission statement, goals, and operation plans; determining the target audience; and marketing strategies. The clinic targets residents who are 55 years old and older and who do not currently have a primary care provider. Cox's (1982) Interactional model for Client Health Behavior provides the framework for care delivery and all process and outcome evaluation activities. As such, the model provides an innovative nursing focus to the delivery of primary care services. Client characteristics are used to form the components of the client data collection tool, which was developed to provide baseline information on seniors who are using the clinic. Three elements of client professional interaction are included in the Health Care Form, which documents the nurse practitioner services that were provided: health information, affective support, and professional technical competencies. The Client Satisfaction Tool measures the client's satisfaction with each of the elements of client-professional interaction that are theorized to influence health outcomes. Information management is facilitated by a computer program that enables staff to enter the information directly into the computer. Data collection is ongoing and will quantify the type and extensiveness of services provided and the quality of care at the Senior Health Clinic.

The effect of bladder training on urinary incontinence in community-dwelling older women

OBJECTIVE

The effect of bladder training on urinary incontinence among a group of community-based older women was investigated.

DESIGN

Quasi-experimental.

SETTING AND SUBJECTS

Nineteen functionally independent, community-dwelling women, aged 64 to 88 years, with a history of urinary incontinence occurring at least once a week, participated in the study.

METHODS

Bladder training methods consisted of mandatory voiding schedules, self-monitored voiding records, and weekly telephone communication between subject and researcher.

MAIN OUTCOME MEASURES

The number of incontinent episodes over a 1-week period was used to determine the effectiveness of bladder training.

RESULTS

The mean frequency of incontinent episodes at baseline was compared to the frequency of incontinent episodes at both end of treatment and at 6-month follow-up.

CONCLUSIONS

Bladder training is effective in reducing episodes of urinary incontinence in community-dwelling older women.

Home-based management of urinary incontinence: a pilot study with both frail and independent elders

OBJECTIVE

The participation of older rural women and their caregivers in a pilot research study on behavioral management interventions for urinary incontinence is described.

DESIGN

A quasiexperimental design was used.

SETTING AND SUBJECTS

Women 55 years old and older and living in a rural county in North Florida who had episodes of urinary incontinence twice or more per week were included. Outreach was directed at two groups of elders with incontinence, those who were functioning independently and those who were frail and dependent on caregivers for assistance with activities of daily living.

METHODS

Behavioral management of continence comprised three techniques for the management of urinary incontinence: self-monitoring, scheduling regimens and pelvic muscle exercise with biofeedback.

MAIN OUTCOME MEASURES

The main outcome measures were episodes of urine loss and amount (In grams) of urine loss with time, determined with a weighed pad test.

RESULTS

Behavioral management of continence resulted in significant decrease in urinary incontinence; decreases in frequency and volume of urine loss were found among all study participants when data were analyzed.

CONCLUSIONS

Although behavioral management of continence was effective in reducing incontinence among independent, community-dwelling elderly women, there was a marked lack of response to this project by frail elders and their caregivers. The same barriers to implementing time-intensive behavioral management interventions among frail elders in long-term care facilities may operate in the home setting.

Measuring pain in neonates: evaluating an instrument and developing a common language

This paper describes the development and evaluation of the Pain Assessment Tool (PAT), a scoring system that was developed by a group of neonatal nurses to assess neonates' pain. To test the practical application of the tool and to compare the scoring system with nurses' subjective pain assessments, a pilot study was conducted with a sample of 20 neonates during the 24 hours following their surgery. The study found that PAT effectively quantified neonates' pain and that PAT scores reflected nurses' perceptions of the pain experienced by neonates. Based on the PAT scores, 15 babies experienced discomfort that required nursing comfort measures and eight babies needed both comfort measures and analgesia to relieve pain. Recommendations for future use of the Pain Assessment Tool are discussed.

A phase II study to evaluate recombinant platelet-derived growth factor-BB in the treatment of stage 3 and 4 pressure ulcers

OBJECTIVE

To determine the efficacy of the daily topical application of recombinant platelet-derived growth factor-BB (rPDGF-BB), a recognized vulnerary agent, in the treatment of deep pressure ulcers.

DESIGN

Prospective, randomized, double-blind trial.

SETTING

Patients were treated in a nursing home or a hospital setting before transfer to a nursing home.

PATIENTS

Eligibility criteria included a clean pressure ulcer that had been adequately debrided and the absence of severe cardiac, pulmonary, or renal conditions. The causes of the ulcers were not related to a venous or arterial vascular disorder. The patients were elderly (mean age, 68 to 74 years).

INTERVENTIONS

After randomization, patients were given daily topical aqueous rPDGF-BB (dosage, 100 or 300 micrograms/mL) or placebo and saline gauze dressings were applied daily in addition to frequent turning.

MAIN OUTCOME MEASURE

Serial volume measurements of the healing wounds were taken using alginate molds.

RESULTS

The ulcers of 41 patients were analyzed. At the end of 28 days, median ulcer volumes had decreased to 83%, 29%, and 40% of the initial size in the groups receiving placebo, rPDGF-BB, 100 micrograms/dL, and rPDGF-BB, 300 micrograms/mL, respectively. When adjusted for initial volume, ulcer volume after 28 days of treatment was smaller in the rPDGF-BB-treated groups compared with the placebo group (analysis of covariance, P = .056). Ulcers in the two rPDGF-BB-treated groups were significantly smaller in volume compared with those in the placebo group, using a linear contrast procedure.

CONCLUSIONS

Data from this small trial suggest that local application of rPDGF-BB may be of therapeutic benefit in accelerating the healing of chronic pressure ulcers.

The biophysical profile in labor

To determine whether the biophysical profile would be a valuable intrapartum addition to fetal heart rate monitoring in predicting umbilical arterial acid-base status at delivery, 95 patients at term had serial studies during labor and umbilical artery blood gas analysis. There was no significant association between biophysical profile score and cord blood pH, nor was there a difference in scores between the acidemic and nonacidemic groups. Of the five components of the initial biophysical profile, only a nonreactive nonstress test (NST) was associated with both pH 7.20 or less (P = .019) and metabolic acidemia (P = .016). None of the individual variables of the final examination correlated with a pH of 7.20 or less. However, a nonreactive NST was associated with metabolic acidemia (P = .03), as was the presence of breathing (P = .03). Of the ten infants with pH 7.20 or less, eight had an initial and five had a final biophysical profile score of 8 or higher. Of the five whose pH was less than 7.15, four had an initial and three a final score of 8 or more. Finally, of the five with metabolic acidemia, four had an initial and two a final score of 8 or higher. Half of the acidemic fetuses had final biophysical profile scores of 8 or higher, suggesting that this score in labor is not reliable to rule out acidemia at delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Social network characteristics and the duration of primary relationships after entry into long-term care

This research extends the study of social network analysis into the context of long-term care. Network density, reciprocity, and intensity were hypothesized to explain duration of the ties between frail elderly persons and their networks after they enter a residential care home (RCH), which is a type of long-term care facility. Using longitudinal data from interviews with 81 new, elderly RCH residents and 75 of their closest others, multiple regression analyses showed that the density of frail elderly people's networks has the strongest effect on tie duration. Secondary direct effects were also shown for reciprocity, mental status, being state-financed, White, and having returned home. The intensity of elderly people's ties does not explain tie duration.

Social networks and health: impact on returning home after entry into residential care homes

This research extends the study of social network analysis and labeling theories into the context of residential care homes (RCHs). Findings suggest that: (1) when members of intense social networks decide to move elderly persons into RCHs, placement is truly needed and (2) although the likelihood of returning home from RCHs is affected by sociocultural characteristics, the functional and cognitive status of the resident are of primary importance.

Quantitation of regional cardiac function by two-dimensional echocardiography. I. Patterns of contraction in the normal left ventricle

Regional differences in wall motion and wall thickening were quantitated in the normal left ventricle using two-dimensional echocardiography (2-D echo). Using a computer-aided system, the left ventricle was subdivided in a standardized manner into 40 segments of five 2-D echo short-axis cross sections from the mitral valve level to the low left ventricle or apex. Measurements of sectional and segmental cavity areas, muscle areas and endocardial as well as epicardial perimeters, allowed assessment of contractile function using such indexes as endocardial systolic fractional area change (FAC), wall thickening (WTh), and circumferential fiber shortening (shortening). In 50 normal anesthetized, closed-chest dogs (including 10 studies in the conscious state) and in 32 normal humans, left ventricular contractile function increased significantly from base to apex. Thus, in anesthetized dogs, sectional FAC, WTh and shortening increased from left ventricular base to apex as follows: 39.4 +/- 5.1% to 61.6 +/- 7.2%, 20.5 +/- 6.6% to 46.7 +/- 11.5% and 22.7 +/- 3.4% to 35.4 +/- 5.9%, respectively. Similar trends were noted in conscious dogs. In man, sectional FAC, WTh and shortening also increased from the mitral valve to the low left ventricular level: 38.8 +/- 3.3% to 60.7 +/- 4.5%, 23.9 +/- 5.6% to 28.9 +/- 7.6% and 21.4 +/- 5.0% to 30.6 +/- 5.6%, respectively. Detailed segmental analysis in individual cross sections also revealed regional differences in contraction. Generally, contraction was most vigorous in posterior regions of the left ventricle. The septal regions exhibited lowest contraction at the base, but also the greatest increase from base to apex, both in the canine and human. Lateral regions did not show significant changes along the length of the left ventricle. Diastolic wall thickness also varied. We conclude that contraction in the normal left ventricle cannot be assumed to be uniform or symmetrical. These normal regional differences in function should be taken into account when evaluating altered physiologic states and in studying effects of therapeutic interventions.