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Salter AI, Das M. Novel immunotherapy combinations in neoadjuvant non-small cell lung cancer (NSCLC): a better chance at cure? Transl Lung Cancer Res 2024; 13:673-677. [PMID: 38601451 PMCID: PMC11002516 DOI: 10.21037/tlcr-23-735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/20/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Alexander I. Salter
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Millie Das
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA, USA
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Banks LC, Kapphahn K, Das M, Patel MI. Randomized Trial of a Volunteer-Led Symptom Assessment Intervention on Documentation, Patient-Reported Outcomes, and Health Care Use Among Veterans With Lung Cancer. JCO Oncol Pract 2024; 20:419-428. [PMID: 38207246 DOI: 10.1200/op.23.00557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/03/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE Identification and documentation of Veterans' symptoms are crucial for optimal lung cancer care delivery. The objective of this study was to determine whether a volunteer-led proactive telephone symptom assessment intervention could improve comprehensive symptom documentation. METHODS Veterans with lung cancer were randomly assigned to usual care (control group) or usual care with proactive symptom assessment in which a peer volunteer made weekly phone calls to assess patient symptoms under nurse practitioner supervision. The primary outcome was oncologist documentation of symptoms in the electronic health record at all clinical visits within 6 months after enrollment. Secondary outcomes included patient satisfaction with decision, patient activation, health-related quality of life (HRQOL), and symptom burden, measured at baseline, and 3, 6, and 9 months after enrollment, and acute care use within 9 months after enrollment. RESULTS Among 60 Veterans randomly assigned, median (range) age was 70.2 (50-86) years; 57 (95.0%) were male. More intervention participants had oncologist documentation of symptoms than control group participants (24 [77.4%] v seven [24.1%], respectively; odds ratio, 16.46 [95% CI, 4.58 to 59.16]). Intervention group participants had greater improvements over time in HRQOL (expected mean difference, 25.3 [95% CI, 15.00 to 35.70]) and patient activation (expected mean difference, 13.6 [95% CI, 3.79 to 23.39]), lower symptom burden (expected mean difference, -6.39 [95% CI, -15.21 to -2.46]), lower rates of emergency room visits (incidence rate ratio, 0.48 [95% CI, 0.30 to 0.75]), and hospitalizations (incidence rate ratio, 0.47 [95% CI, 0.28 to 0.77]) than control group participants. CONCLUSION This symptom assessment intervention is an effective strategy for Veterans with lung cancer.
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Affiliation(s)
| | - Kris Kapphahn
- Quantitative Sciences Unit, Stanford School of Medicine, Stanford, CA
| | - Millie Das
- Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA
- Division of Oncology, Stanford School of Medicine, Stanford, CA
| | - Manali I Patel
- Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA
- Division of Oncology, Stanford School of Medicine, Stanford, CA
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Hui C, Brown E, Wong S, Das M, Wakelee H, Neal J, Ramchandran K, Myall NJ, Pham D, Xing L, Yang Y, Kovalchuk N, Yuan Y, Lu Y, Xiang M, Chin A, Diehn M, Loo BW, Vitzthum LK. Personalized Accelerated ChEmoRadiation (PACER) for Lung Cancer: Protocol for a Bayesian Optimal Phase I/II Trial. Clin Lung Cancer 2024; 25:186-189. [PMID: 38040540 DOI: 10.1016/j.cllc.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/07/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Prior attempts to escalate radiation dose for non-small cell lung cancer (NSCLC) have not improved survival. Given the high risk for cardiopulmonary toxicity with treatment and heterogenous presentation of locally advanced NSCLC, it is unlikely that a single dose regimen is optimal for all patients. This phase I/II trial aims to evaluate a novel treatment approach where the level of accelerated hypofractionation is determined by the predicted toxicity from dose to organs at risk (OARs). METHODS Patients ≥ 18 years old with lung cancer planned for fractionated radiotherapy to the lung with concurrent chemotherapy will be eligible. Radiation therapy (RT) will be delivered to a total dose of 60 to 66 Gy in 30, 25, or 20 fractions depending on the ability to meet constraints to key organs at risk including the lungs, heart, and esophagus. The primary endpoint is high grade pulmonary, esophageal, or cardiac toxicity. A Bayesian optimized design is used to determine stopping boundaries and evaluate the primary endpoint. CONCLUSION PACER will evaluate the safety and feasibility of personalized accelerated chemoradiotherapy for lung cancer.
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Affiliation(s)
- Caressa Hui
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Eleanor Brown
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Samantha Wong
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Millie Das
- Department of Medical Oncology, Stanford University, Stanford, CA
| | - Heather Wakelee
- Department of Medical Oncology, Stanford University, Stanford, CA
| | - Joel Neal
- Department of Medical Oncology, Stanford University, Stanford, CA
| | | | | | - Daniel Pham
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Lei Xing
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Yong Yang
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | | | - Ying Yuan
- Department of Biostatistics, Stanford University, Stanford, CA
| | - Ying Lu
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Stanford, CA
| | - Michael Xiang
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | - Alex Chin
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Lucas K Vitzthum
- Department of Radiation Oncology, Stanford University, Stanford, CA.
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Chaudhury R, Chakraborty A, Rahaman F, Sarkar T, Dey S, Das M. Mycorrhization in trees: ecology, physiology, emerging technologies and beyond. Plant Biol (Stuttg) 2024; 26:145-156. [PMID: 38194349 DOI: 10.1111/plb.13613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/30/2023] [Indexed: 01/10/2024]
Abstract
Mycorrhization has been an integral part of plants since colonization by the early land plants. Over decades, substantial research has highlighted its potential role in improving nutritional efficiency and growth, development and survival of crop plants. However, the focus of this review is trees. Evidence have been provided to explain ecological and physiological significance of mycorrhization in trees. Advances in recent technologies (e.g., metagenomics, artificial intelligence, machine learning, agricultural drones) may open new windows to apply this knowledge in promoting tree growth in forest ecosystems. Dual mycorrhization relationships in trees and even triple relationships among trees, mycorrhizal fungi and bacteria offer an interesting physiological system to understand how plants interact with other organisms for better survival. Besides, studies indicate additional roles of mycorrhization in learning, memorizing and communication between host trees through a common mycorrhizal network (CMN). Recent observations in trees suggest that mycorrhization may even promote tolerance to multiple abiotic (e.g., drought, salt, heavy metal stress) and biotic (e.g. fungi) stresses. Due to the extent of physiological reliance, local adaptation of trees is heavily impacted by the mycorrhizal community. This knowledge opens the possibility of a non-GMO avenue to promote tree growth and development. Indeed, mycorrhization could impact growth of trees in nurserys and subsequent survival of the inoculated trees in field conditions. Future studies might integrate hyperspectral imaging and drone technologies to identify tree communities that are deficient in nitrogen and spray mycorrhizal spore formulations on them.
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Affiliation(s)
- R Chaudhury
- Department of Life Sciences, Presidency University, Kolkata, India
| | - A Chakraborty
- Department of Life Sciences, Presidency University, Kolkata, India
| | - F Rahaman
- Department of Life Sciences, Presidency University, Kolkata, India
| | - T Sarkar
- Department of Life Sciences, Presidency University, Kolkata, India
| | - S Dey
- Department of Life Sciences, Presidency University, Kolkata, India
| | - M Das
- Department of Life Sciences, Presidency University, Kolkata, India
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Hui C, Marquez C, Lau B, Das M, Myall NJ, Roy M, Wakelee HA, Neal JW, Kovalchuk N, Chin A, Diehn M, Loo BW, Xiang M, Vitzthum LK. Patient Selection and Outcomes for Hypofractionated Accelerated Radiation and Concurrent Chemotherapy for Non-Small-Cell Lung Cancer. Clin Lung Cancer 2024; 25:e92-e100.e4. [PMID: 38065707 DOI: 10.1016/j.cllc.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 03/01/2024]
Abstract
PURPOSE/OBJECTIVES Adoption of hypofractionated accelerated radiation therapy (HART) with concurrent chemotherapy has been limited by toxicity concerns. We aimed to describe outcomes of patients treated with HART and concurrent chemotherapy and to evaluate dosimetry to organs at risk to guide patient selection. MATERIALS/METHODS We evaluated a retrospective cohort of NSCLC patients treated with concurrent chemotherapy with HART (>2.2 Gy per fraction) or standard fractionated radiation therapy (SFRT; 2-2.2 Gy fractions). Dosimetric parameters to key organs at risk were compared, and toxicity, patterns of recurrence and survival were calculated for the cohorts. RESULTS Fifty-three patients treated with HART were compared with 100 patients treated with SFRT. Median dose per fraction for the HART cohort was 2.75 Gy (range 2.4-3 Gy). HART patients had significantly lower doses to the lung, heart, and esophagus due to patient selection. The HART group and had rates of grade 2+ pneumonitis (9.4 vs. 19%, P = .16) and grade 2+ esophagitis (20.8 vs. 45%, P < .01) that compared favorably to SFRT. Cumulative incidence of in-field recurrence trended lower in the HART cohort (7.6% vs. 23.1%, P = .058). Among the HART group, 88.7% (47/53) met the newly proposed lung constraints based on the degree of hypofractionation CONCLUSION: In select patients with favorable dosimetry to organs at risk, definitive HART with concurrent chemotherapy achieved excellent local control with low toxicity. These results are being used to inform a prospective study on the safety and efficacy of HART with concurrent chemotherapy for select NSCLC patients.
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Affiliation(s)
- Caressa Hui
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Cesar Marquez
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Brianna Lau
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Millie Das
- Department of Medical Oncology, Stanford University, Stanford, CA
| | | | - Mohana Roy
- Department of Medical Oncology, Stanford University, Stanford, CA
| | | | - Joel W Neal
- Department of Medical Oncology, Stanford University, Stanford, CA
| | | | - Alex Chin
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Michael Xiang
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | - Lucas K Vitzthum
- Department of Radiation Oncology, Stanford University, Stanford, CA.
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Liu S, Chai T, Garcia-Marques F, Yin Q, Hsu EC, Shen M, Shaw Toland AM, Bermudez A, Hartono AB, Massey CF, Lee CS, Zheng L, Baron M, Denning CJ, Aslan M, Nguyen HM, Nolley R, Zoubeidi A, Das M, Kunder CA, Howitt BE, Soh HT, Weissman IL, Liss MA, Chin AI, Brooks JD, Corey E, Pitteri SJ, Huang J, Stoyanova T. UCHL1 is a potential molecular indicator and therapeutic target for neuroendocrine carcinomas. Cell Rep Med 2024; 5:101381. [PMID: 38244540 PMCID: PMC10897521 DOI: 10.1016/j.xcrm.2023.101381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/18/2023] [Accepted: 12/19/2023] [Indexed: 01/22/2024]
Abstract
Neuroendocrine carcinomas, such as neuroendocrine prostate cancer and small-cell lung cancer, commonly have a poor prognosis and limited therapeutic options. We report that ubiquitin carboxy-terminal hydrolase L1 (UCHL1), a deubiquitinating enzyme, is elevated in tissues and plasma from patients with neuroendocrine carcinomas. Loss of UCHL1 decreases tumor growth and inhibits metastasis of these malignancies. UCHL1 maintains neuroendocrine differentiation and promotes cancer progression by regulating nucleoporin, POM121, and p53. UCHL1 binds, deubiquitinates, and stabilizes POM121 to regulate POM121-associated nuclear transport of E2F1 and c-MYC. Treatment with the UCHL1 inhibitor LDN-57444 slows tumor growth and metastasis across neuroendocrine carcinomas. The combination of UCHL1 inhibitors with cisplatin, the standard of care used for neuroendocrine carcinomas, significantly delays tumor growth in pre-clinical settings. Our study reveals mechanisms of UCHL1 function in regulating the progression of neuroendocrine carcinomas and identifies UCHL1 as a therapeutic target and potential molecular indicator for diagnosing and monitoring treatment responses in these malignancies.
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Affiliation(s)
- Shiqin Liu
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA; Department of Radiology, Stanford University, Palo Alto, CA, USA
| | - Timothy Chai
- Stanford Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA
| | | | - Qingqing Yin
- Department of Radiology, Stanford University, Palo Alto, CA, USA
| | - En-Chi Hsu
- Department of Radiology, Stanford University, Palo Alto, CA, USA
| | - Michelle Shen
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA; Department of Radiology, Stanford University, Palo Alto, CA, USA
| | | | - Abel Bermudez
- Department of Radiology, Stanford University, Palo Alto, CA, USA
| | - Alifiani B Hartono
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Christopher F Massey
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Chung S Lee
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Liwei Zheng
- Department of Radiology, Stanford University, Palo Alto, CA, USA
| | - Maya Baron
- Department of Pediatrics, Stanford University, Stanford, CA, USA; Department of Genetics, Stanford University, Stanford, CA, USA
| | - Caden J Denning
- Department of Radiology, Stanford University, Palo Alto, CA, USA
| | - Merve Aslan
- Department of Radiology, Stanford University, Palo Alto, CA, USA
| | - Holly M Nguyen
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Rosalie Nolley
- Department of Urology, Stanford University, Stanford, CA, USA
| | - Amina Zoubeidi
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H 3Z6, Canada
| | - Millie Das
- Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA
| | | | - Brooke E Howitt
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - H Tom Soh
- Department of Radiology, Stanford University, Palo Alto, CA, USA; Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Irving L Weissman
- Stanford Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA; Department of Pathology, Stanford University, Stanford, CA, USA; Ludwig Center for Cancer Stem Cell Research and Medicine, Stanford University, Stanford, CA, USA
| | - Michael A Liss
- Department of Urology, UT Health San Antonio, San Antonio, TX, USA
| | - Arnold I Chin
- Department of Urology, University of California, Los Angeles, Los Angeles, CA, USA
| | - James D Brooks
- Department of Urology, Stanford University, Stanford, CA, USA
| | - Eva Corey
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Sharon J Pitteri
- Department of Radiology, Stanford University, Palo Alto, CA, USA
| | - Jiaoti Huang
- Department of Pathology, Duke University, Durham, NC, USA
| | - Tanya Stoyanova
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA; Department of Radiology, Stanford University, Palo Alto, CA, USA; Department of Urology, University of California, Los Angeles, Los Angeles, CA, USA.
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Shukla T, Nirban VS, Chandragiri A, Das M. Health equity and gendered border blindness: an exploration of healthcare services at the international border in Rajasthan. Public Health 2024; 227:148-153. [PMID: 38232562 DOI: 10.1016/j.puhe.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVES Citizens' access to health care and the delivery of the healthcare services is significantly affected by the spatiality of the regions and the connectedness of the elements of the healthcare system. This network of healthcare system, region and delivery of services faces myriad challenges in the borderland geography, which is characterised by accentuated military presence, poor physical infrastructure, disinterest of habitation near the border, lack of adequate, necessary and allied services such as schools and industry, social seclusion, migration etc. All these factors amalgamate to create an effect of gender-blind phenomenon as well as border-blind phenomenon. This is particularly acute for women and children. STUDY DESIGN A phenomenology research design has been used for the study. It encapsulates qualitative aspects of the views of those who experience marginalisation inclusive of gender-blind experiences. Marginalised women and frontline healthcare workers at the borderland were considered for the inquiry in this study. The study is a composite description of the phenomenon. METHODS The border districts of Rajasthan from the Radcliffe line of Rajasthan have been identified for the purpose of the study. Using narrative ethnography along with interviews, an examination was executed from health professionals and marginalised women to comprehend health care access and equity from the service provider's perspective as well as the beneficiary's perspective. RESULTS The study provides a range of attributions based on which it could be established that health inequities exist in bordering rural areas. CONCLUSIONS The study realises the geopolitical influence of the Radcliffe line, where borderlands are commonly vital to the continuum struggle between the centre and state. Yet, there remains a gap towards implementing various schemes and services due to varied reasons for access from main to far-off border areas, making the situation vulnerable from a resource deficiency point of view. The Health Equity Framework cannot meet Social Determinants of Health in borderland areas of Rajasthan.
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Affiliation(s)
- T Shukla
- Humanities and Social Sciences, BITS Pilani, Rajasthan, India.
| | - V S Nirban
- Humanities and Social Sciences, BITS Pilani, Rajasthan, India.
| | - A Chandragiri
- Humanities and Social Sciences, BITS Pilani, Rajasthan, India.
| | - M Das
- Humanities and Social Sciences, BITS Pilani, Rajasthan, India.
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Khurshid H, Ismaila N, Bian J, Dabney R, Das M, Ellis P, Feldman J, Hann C, Kulkarni S, Laskin J, Manochakian R, Mishra DR, Preeshagul I, Reddy P, Saxena A, Weinberg F, Kalemkerian GP. Systemic Therapy for Small-Cell Lung Cancer: ASCO-Ontario Health (Cancer Care Ontario) Guideline. J Clin Oncol 2023; 41:5448-5472. [PMID: 37820295 DOI: 10.1200/jco.23.01435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE To provide evidence-based recommendations to practicing clinicians on the management of patients with small-cell lung cancer. METHODS An Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary, community oncology, research methodology, and advocacy experts were convened to conduct a literature search, which included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2022. Outcomes of interest included response rates, overall survival, disease-free survival or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 95 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Evidence-based recommendations were developed to address systemic therapy options, timing of therapy, treatment in patients who are older or with poor performance status, role of biomarkers, and use of myeloid-supporting agents in patients with small-cell lung cancer.Additional information is available at www.asco.org/thoracic-cancer-guidelines.
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Affiliation(s)
| | - Nofisat Ismaila
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | | | | | | | - Peter Ellis
- Juravinski Cancer Center, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Jill Feldman
- EGFR Resisters Patient Advocacy Group, Deerfield, IL
| | | | - Swati Kulkarni
- Western University, Windsor Regional Cancer Program, Windsor, Ontario, Canada
| | - Janessa Laskin
- University of British Columbia, Vancouver, British Columbia, Canada
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Lopez C, Murillo A, Das M, Patel MI. Understanding Barriers and Facilitators to High-Quality Cancer Care Among Veterans With Lung Cancer: A Qualitative Study. JCO Oncol Pract 2023; 19:1153-1159. [PMID: 37774255 DOI: 10.1200/op.23.00228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 10/01/2023] Open
Abstract
PURPOSE Veteran populations have higher lung cancer incidence and worse overall survival compared with non-Veteran populations. Although recent clinical advancements have reduced lung cancer death rates, these advances are not routinely received among Veteran populations because of multilevel factors, including Veterans' complex comorbidities, limited health literacy, and other economic and social disadvantages. This study aimed to assess Veterans' perspectives regarding their lung cancer care with a specific focus on identifying modifiable barriers to evidence-based care delivery. METHODS We conducted 1:1 semistructured interviews with 24 Veterans diagnosed with lung cancer at the Veterans Affairs Palo Alto Health Care System. All interviews were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis. RESULTS Four themes emerged. These included (1) social and economic disadvantages can prevent routine delivery of evidence-based cancer care; (2) fragmented care contributes to worsening patient mental and emotional well-being; (3) lack of health system interventions to address limited health literacy inhibits patient engagement in shared decision making regarding diagnosis, genomic and molecular testing, targeted and other treatments, and end-of-life care; and (4) deep appreciation for care and VA trustworthiness facilitates adherence to cancer care recommendations. CONCLUSION This study revealed critical gaps in lung cancer care delivery and the role of institution-engendered trust in overcoming barriers in the VA system. Targeted solutions should address the identified barriers to routine, evidence-based lung cancer care delivery among Veterans.
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Affiliation(s)
| | | | - Millie Das
- VA Palo Alto Health Care System, Palo Alto, CA
| | - Manali I Patel
- Stanford University School of Medicine, Stanford, CA
- VA Palo Alto Health Care System, Palo Alto, CA
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Gensheimer MF, Gee H, Shirato H, Taguchi H, Snyder JM, Chin AL, Vitzthum LK, Maxim PG, Wakelee HA, Neal J, Das M, Chang DT, Kidd E, Hancock SL, Shultz DB, Horst KC, Le QT, Wong S, Brown E, Nguyen N, Liang R, Loo BW, Diehn M. Individualized Stereotactic Ablative Radiotherapy for Lung Tumors: The iSABR Phase 2 Nonrandomized Controlled Trial. JAMA Oncol 2023; 9:1525-1534. [PMID: 37707820 PMCID: PMC10502697 DOI: 10.1001/jamaoncol.2023.3495] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/11/2023] [Indexed: 09/15/2023]
Abstract
Importance Stereotactic ablative radiotherapy (SABR) is used for treating lung tumors but can cause toxic effects, including life-threatening damage to central structures. Retrospective data suggested that small tumors up to 10 cm3 in volume can be well controlled with a biologically effective dose less than 100 Gy. Objective To assess whether individualizing lung SABR dose and fractionation by tumor size, location, and histological characteristics may be associated with local tumor control. Design, Setting, and Participants This nonrandomized controlled trial (the iSABR trial, so named for individualized SABR) was a phase 2 multicenter trial enrolling participants from November 15, 2011, to December 5, 2018, at academic medical centers in the US and Japan. Data were analyzed from December 9, 2020, to May 10, 2023. Patients were enrolled in 3 groups according to cancer type: initial diagnosis of non-small cell lung cancer (NSCLC) with an American Joint Committee on Cancer 7th edition T1-3N0M0 tumor (group 1), a T1-3N0M0 new primary NSCLC with a history of prior NSCLC or multiple NSCLCs (group 2), or lung metastases from NSCLC or another solid tumor (group 3). Intervention Up to 4 tumors were treated with once-daily SABR. The dose ranged from 25 Gy in 1 fraction for peripheral tumors with a volume of 0 to 10 cm3 to 60 Gy in 8 fractions for central tumors with a volume greater than 30 cm3. Main outcome Per-group freedom from local recurrence (same-lobe recurrence) at 1 year, with censoring at time of distant recurrence, death, or loss to follow-up. Results In total, 217 unique patients (median [IQR] age, 72 [64-80] years; 129 [59%] male; 150 [69%] current or former smokers) were enrolled (some multiple times). There were 240 treatment courses: 79 in group 1, 82 in group 2, and 79 in group 3. A total of 285 tumors (211 [74%] peripheral and 74 [26%] central) were treated. The most common dose was 25 Gy in 1 fraction (158 tumors). The median (range) follow-up period was 33 (2-109) months, and the median overall survival was 59 (95% CI, 49-82) months. Freedom from local recurrence at 1 year was 97% (90% CI, 91%-99%) for group 1, 94% (90% CI, 87%-97%) for group 2, and 96% (90% CI, 89%-98%) for group 3. Freedom from local recurrence at 5 years ranged from 83% to 93% in the 3 groups. The proportion of patients with grade 3 to 5 toxic effects was low, at 5% (including a single patient [1%] with grade 5 toxic effects). Conclusions and Relevance The results of this nonrandomized controlled trial suggest that individualized SABR (iSABR) used to treat lung tumors may allow minimization of treatment dose and is associated with excellent local control. Individualized dosing should be considered for use in future trials. Trial Registration ClinicalTrials.gov Identifier: NCT01463423.
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Affiliation(s)
- Michael F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Harriet Gee
- Sydney West Radiation Oncology Network, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Hiroki Shirato
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Taguchi
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - John M Snyder
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Alexander L Chin
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Lucas K Vitzthum
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Peter G Maxim
- Department of Radiation Oncology, University of California Irvine, Irvine, California
| | - Heather A Wakelee
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Joel Neal
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Millie Das
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Elizabeth Kidd
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Steven L Hancock
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - David B Shultz
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen C Horst
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Samantha Wong
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Eleanor Brown
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Ngan Nguyen
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Rachel Liang
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
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11
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Qu F, Brough SC, Michno W, Madubata CJ, Hartmann GG, Puno A, Drainas AP, Bhattacharya D, Tomasich E, Lee MC, Yang D, Kim J, Peiris-Pagès M, Simpson KL, Dive C, Preusser M, Toland A, Kong C, Das M, Winslow MM, Pasca AM, Sage J. Crosstalk between small-cell lung cancer cells and astrocytes mimics brain development to promote brain metastasis. Nat Cell Biol 2023; 25:1506-1519. [PMID: 37783795 DOI: 10.1038/s41556-023-01241-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/25/2023] [Indexed: 10/04/2023]
Abstract
Brain metastases represent an important clinical problem for patients with small-cell lung cancer (SCLC). However, the mechanisms underlying SCLC growth in the brain remain poorly understood. Here, using intracranial injections in mice and assembloids between SCLC aggregates and human cortical organoids in culture, we found that SCLC cells recruit reactive astrocytes to the tumour microenvironment. This crosstalk between SCLC cells and astrocytes drives the induction of gene expression programmes that are similar to those found during early brain development in neurons and astrocytes. Mechanistically, the brain development factor Reelin, secreted by SCLC cells, recruits astrocytes to brain metastases. These astrocytes in turn promote SCLC growth by secreting neuronal pro-survival factors such as SERPINE1. Thus, SCLC brain metastases grow by co-opting mechanisms involved in reciprocal neuron-astrocyte interactions during brain development. Targeting such developmental programmes activated in this cancer ecosystem may help prevent and treat brain metastases.
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Affiliation(s)
- Fangfei Qu
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Siqi C Brough
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Wojciech Michno
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Chioma J Madubata
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Griffin G Hartmann
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Alyssa Puno
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Alexandros P Drainas
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Debadrita Bhattacharya
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Erwin Tomasich
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Myung Chang Lee
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Dian Yang
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Jun Kim
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Maria Peiris-Pagès
- Cancer Research UK Cancer Biomarker Centre, Manchester, UK
- Cancer Research UK Manchester Institute, Manchester, UK
| | - Kathryn L Simpson
- Cancer Research UK Cancer Biomarker Centre, Manchester, UK
- Cancer Research UK Manchester Institute, Manchester, UK
| | - Caroline Dive
- Cancer Research UK Cancer Biomarker Centre, Manchester, UK
- Cancer Research UK Manchester Institute, Manchester, UK
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Angus Toland
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Christina Kong
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Millie Das
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Monte M Winslow
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Anca M Pasca
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Julien Sage
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA.
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12
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Hui C, Wakelee HA, Neal JW, Ramchandran KJ, Das M, Nagpal S, Roy M, Huang J, Pollom E, Myall N. CNS Control after First-Line Osimertinib in Patients with Metastatic EGFR-Mutant NSCLC. Int J Radiat Oncol Biol Phys 2023; 117:e110. [PMID: 37784648 DOI: 10.1016/j.ijrobp.2023.06.888] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Although osimertinib (osi) has excellent intracranial activity in EGFR-mutant metastatic non-small cell lung cancer (NSCLC), there is no consensus regarding whether to continue osi for central nervous system (CNS) control with second-line chemotherapy (chemo) at the time of systemic progression. We aimed to compare CNS outcomes after first-line osi in patients receiving second-line chemo with or without continuation of osi. MATERIALS/METHODS We retrospectively reviewed patients with EGFR-mutant NSCLC with brain metastases (BrM) at the time of initiating first-line osi who experienced progression and started second-line chemo. Cumulative incidence of local and distant CNS progression, and extracranial (EC) progression was calculated from time of second-line chemo initiation with death as a competing risk. Overall survival (OS) was analyzed using Kaplan-Meier. RESULTS We included 52 patients with a median follow up of 9.6 months (range 0.4-36.4). Median OS and CNS progression-free survival (PFS) from the time of starting second-line chemo was 12.5 months (95% CI 8.1-16.9), and 5.3 months (95% CI 3.35-7.26), respectively. The 1-year cumulative incidence of local, distant CNS progression, any CNS progression, and EC progression was 14.4% (95% CI 4.5-24.2), 42.8% (95% CI 22.8-56.8), 42.8% (95% CI 22.8-56.8) and 66.8% (95% CI 53.5-80.2), respectively. After progression on first-line osi, 25 (48.1%) and 27 patients (51.9%) continued and discontinued osi, respectively. Patients who continued osi had significantly higher BrM burden than those who did not, with 17 (68%), 3 (12%), and 5 (20%) versus 26 (96%), 0, and 1 (3.7%) patient having <10 or >11 parenchymal brain lesions, or leptomeningeal disease (LMD) at the time of second line therapy, respectively (p<0.01). In those who continued osi vs those who did not, median OS (10.8 vs 12.5 months; p = 0.37), median intracranial PFS (5.3 vs 4.8 months; p = 0.99), 1-year cumulative incidence of local (8.4% versus 20 % p = 0.26), and 1-year distant CNS progression (24.8% vs 60%; p = 0.08) was not significantly different. CNS complications such as symptomatic, hospitalizations, and steroid initiation for CNS disease, and progression of LMD were not significantly different between the two groups. Eventually, 10 patients underwent salvage RT post first-line osi and median time to salvage RT was 7.8 months (range 2-9.4). Of patients who underwent salvage RT, 2 patients (20%) had continued osi with second-line chemo. Twelve patients (44.4%) who did not continue osi eventually re-started osi for progressive disease. CONCLUSION Patients who continued osi had significantly higher BrM tumor burden. Despite these patients being at higher risk for CNS progression, time to CNS progression and incidence of CNS complications were not significantly different in the two cohorts. Patients who discontinued osi were more likely to undergo salvage RT. Continuation of osi may allow patients to defer salvage RT.
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Affiliation(s)
- C Hui
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - H A Wakelee
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - J W Neal
- Stanford University School of Medicine, Stanford, CA
| | | | - M Das
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - S Nagpal
- Department of Neurology, Stanford Cancer Institute, Stanford, CA
| | - M Roy
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - J Huang
- Department of Medicine, Stanford University, Stanford, CA
| | - E Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - N Myall
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
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13
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Patel SR, Das M. Small Cell Lung Cancer: Emerging Targets and Strategies for Precision Therapy. Cancers (Basel) 2023; 15:4016. [PMID: 37627044 PMCID: PMC10452729 DOI: 10.3390/cancers15164016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023] Open
Abstract
Small cell lung cancer is an aggressive subtype of lung cancer with limited treatment options. Precision medicine has revolutionized cancer treatment for many tumor types but progress in SCLC has been slower due to the lack of targetable biomarkers. This review article provides an overview of emerging strategies for precision therapy in SCLC. Targeted therapies include targeted kinase inhibitors, monoclonal antibodies, angiogenesis inhibitors, antibody-drug conjugates, PARP inhibitors, and epigenetic modulators. Angiogenesis inhibitors and DNA-damaging agents, such as PARP and ATR inhibitors, have been explored in SCLC with limited success to date although trials are ongoing. The potential of targeting DLL3, a NOTCH ligand, through antibody-drug conjugates, bispecific T-cell engagers, and CAR T-cell therapy, has opened up new therapeutic options moving forward. Additionally, new research in epigenetic therapeutics in reversing transcriptional repression, modulating anti-tumor immunity, and utilizing antibody-drug conjugates to target cell surface-specific targets in SCLC are also being investigated. While progress in precision therapy for SCLC has been challenging, recent advancements provide optimism for improved treatment outcomes. However, several challenges remain and will need to be addressed, including drug resistance and tumor heterogeneity. Further research and biomarker-selected clinical trials are necessary to develop effective precision therapies for SCLC patients.
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Affiliation(s)
- Shruti R. Patel
- Department of Medicine, Division of Medical Oncology, Stanford Cancer Institute, Stanford University, Palo Alto, CA 94305, USA;
| | - Millie Das
- Department of Medicine, Division of Medical Oncology, Stanford Cancer Institute, Stanford University, Palo Alto, CA 94305, USA;
- Department of Medicine, Oncology Section, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
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14
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Iyer A, Ndlovu Z, Sharma J, Mansoor H, Bharati M, Kolan S, Morales M, Das M, Issakidis P, Ferlazzo G, Hirani N, Joshi A, Tipre P, Sutar N, England K. Operationalising targeted next-generation sequencing for routine diagnosis of drug-resistant TB. Public Health Action 2023; 13:43-49. [PMID: 37359066 PMCID: PMC10290261 DOI: 10.5588/pha.22.0041] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/24/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Phenotypic drug susceptibility testing (pDST) for Mycobacterium tuberculosis can take up to 8 weeks, while conventional molecular tests identify a limited set of resistance mutations. Targeted next-generation sequencing (tNGS) offers rapid results for predicting comprehensive drug resistance, and this study sought to explore its operational feasibility within a public health laboratory in Mumbai, India. METHODS Pulmonary samples from consenting patients testing Xpert MTB-positive were tested for drug resistance by conventional methods and using tNGS. Laboratory operational and logistical implementation experiences from study team members are shared below. RESULTS Of the total number of patients tested, 70% (113/161) had no history of previous TB or treatment; however, 88.2% (n = 142) had rifampicin-resistant/multidrug-resistant TB (RR/MDR-TB). There was a high concordance between resistance predictions of tNGS and pDST for most drugs, with tNGS more accurately identifying resistance overall. tNGS was integrated and adapted into the laboratory workflow; however, batching samples caused significantly longer result turnaround time, fastest at 24 days. Manual DNA extraction caused inefficiencies; thus protocol optimisations were performed. Technical expertise was required for analysis of uncharacterised mutations and interpretation of report templates. tNGS cost per sample was US$230, while for pDST this was US$119. CONCLUSIONS Implementation of tNGS is feasible in reference laboratories. It can rapidly identify drug resistance and should be considered as a potential alternative to pDST.
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Affiliation(s)
- A Iyer
- Médecins Sans Frontières (MSF), Mumbai, India
| | - Z Ndlovu
- MSF, Southern African Medical Unit, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J Sharma
- Médecins Sans Frontières (MSF), Mumbai, India
| | - H Mansoor
- Médecins Sans Frontières (MSF), Mumbai, India
| | - M Bharati
- Médecins Sans Frontières (MSF), Mumbai, India
| | - S Kolan
- Médecins Sans Frontières (MSF), Mumbai, India
| | - M Morales
- Médecins Sans Frontières (MSF), Mumbai, India
| | - M Das
- Médecins Sans Frontières (MSF), Mumbai, India
| | - P Issakidis
- MSF, Southern African Medical Unit, Cape Town, South Africa
| | - G Ferlazzo
- MSF, Southern African Medical Unit, Cape Town, South Africa
| | - N Hirani
- Department of Mycobacteriology, Sir JJ Group of Hospitals, Mumbai, India
| | - A Joshi
- Department of Mycobacteriology, Sir JJ Group of Hospitals, Mumbai, India
| | - P Tipre
- National Tuberculosis Elimination Programme, Mumbai, India
| | - N Sutar
- National Tuberculosis Elimination Programme, Mumbai, India
| | - K England
- Independent Consultant, Honolulu, HI, USA
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15
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Das M. Are We Getting Closer to the Promise of Cure? New Progress and Future Directions in the Treatment of Early-Stage Non-Small-Cell Lung Cancer. JCO Oncol Pract 2023:OP2300170. [PMID: 37116106 DOI: 10.1200/op.23.00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Affiliation(s)
- Millie Das
- Stanford University, Department of Medicine, Division of Oncology, Stanford, CA
- VA Palo Alto Health Care System, Department of Medicine, Palo Alto, CA
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16
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Das M, Ogale S, Jovanoski N, Johnson A, Nguyen C, Bhagwakar J, Lee JS. Cost-effectiveness of adjuvant atezolizumab for patients with stage II-IIIA PD-L1+ non-small-cell lung cancer. Immunotherapy 2023; 15:573-581. [PMID: 37021770 DOI: 10.2217/imt-2022-0311] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Aim: Atezolizumab improved disease-free survival (DFS) versus best supportive care (BSC) as adjuvant treatment following resection and platinum-based chemotherapy for stage II-IIIA PD-L1+ NSCLC in IMpower010. Materials & methods: This cost-effectiveness study evaluated atezolizumab versus BSC (US commercial payer perspective) using a Markov model with DFS, locoregional recurrence, first- and second-line metastatic recurrence and death health states, and a lifetime time horizon with 3% annual discounting. Results: Atezolizumab provided 1.045 additional quality-adjusted life-years (QALY) at an incremental cost of $48,956, yielding an incremental cost-effectiveness ratio of $46,859/QALY. Scenario analysis showed similar findings in a Medicare population ($48,512/QALY). Conclusion: At a willingness-to-pay threshold of $150,000/QALY and an incremental cost-effectiveness ratio of $46,859/QALY, atezolizumab is cost-effective versus BSC for adjuvant NSCLC treatment.
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Affiliation(s)
- Millie Das
- Stanford Cancer Institute, Stanford University, VA Palo Alto Health Care System, Palo Alto, CA 94305, USA
| | - Sarika Ogale
- Genentech Inc, South San Francisco, CA 94080, USA
| | | | - Ann Johnson
- Genentech Inc, South San Francisco, CA 94080, USA
| | | | | | - Janet S Lee
- Genentech Inc, South San Francisco, CA 94080, USA
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17
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Wu J, Su C, La J, Corrigan J, Das M, Do N, Brophy M, Ahmed S, Han S, Fillmore N, Kelley M. PP01.05 Impact of PD-L1 Status on Survival on Immunotherapy Monotherapy in Real-World Patients with Poor Performance Status: A US Nationwide Veterans Affairs Study. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.031] [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: 01/30/2023]
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18
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Gensheimer MF, Gupta D, Patel MI, Fardeen T, Hildebrand R, Teuteberg W, Seevaratnam B, Asuncion MK, Alves N, Rogers B, Hansen J, DeNofrio J, Shah NH, Parikh D, Neal J, Fan AC, Moore K, Ruiz S, Li C, Khaki AR, Pagtama J, Chien J, Brown T, Tisch AH, Das M, Srinivas S, Roy M, Wakelee H, Myall NJ, Huang J, Shah S, Lee H, Ramchandran K. Use of Machine Learning and Lay Care Coaches to Increase Advance Care Planning Conversations for Patients With Metastatic Cancer. JCO Oncol Pract 2023; 19:e176-e184. [PMID: 36395436 DOI: 10.1200/op.22.00128] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Patients with metastatic cancer benefit from advance care planning (ACP) conversations. We aimed to improve ACP using a computer model to select high-risk patients, with shorter predicted survival, for conversations with providers and lay care coaches. Outcomes included ACP documentation frequency and end-of-life quality measures. METHODS In this study of a quality improvement initiative, providers in four medical oncology clinics received Serious Illness Care Program training. Two clinics (thoracic/genitourinary) participated in an intervention, and two (cutaneous/sarcoma) served as controls. ACP conversations were documented in a centralized form in the electronic medical record. In the intervention, providers and care coaches received weekly e-mails highlighting upcoming clinic patients with < 2 year computer-predicted survival and no prior prognosis documentation. Care coaches contacted these patients for an ACP conversation (excluding prognosis). Providers were asked to discuss and document prognosis. RESULTS In the four clinics, 4,968 clinic visits by 1,251 patients met inclusion criteria (metastatic cancer with no prognosis previously documented). In their first visit, 28% of patients were high-risk (< 2 year predicted survival). Preintervention, 3% of both intervention and control clinic patients had ACP documentation during a visit. By intervention end (February 2021), 35% of intervention clinic patients had ACP documentation compared with 3% of control clinic patients. Providers' prognosis documentation rate also increased in intervention clinics after the intervention (2%-27% in intervention clinics, P < .0001; 0%-1% in control clinics). End-of-life care intensity was similar in intervention versus control clinics, but patients with ≥ 1 provider ACP edit met fewer high-intensity care measures (P = .04). CONCLUSION Combining a computer prognosis model with care coaches increased ACP documentation.
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Affiliation(s)
| | - Divya Gupta
- Stanford University School of Medicine, Stanford CA
| | - Manali I Patel
- Stanford University School of Medicine, Stanford CA.,VA Palo Alto Health Care System, Palo Alto, CA
| | | | | | | | | | | | - Nina Alves
- Stanford University School of Medicine, Stanford CA
| | - Brian Rogers
- Stanford University School of Medicine, Stanford CA
| | | | - Jan DeNofrio
- Stanford University School of Medicine, Stanford CA
| | - Nigam H Shah
- Stanford University School of Medicine, Stanford CA
| | - Divya Parikh
- Stanford University School of Medicine, Stanford CA
| | - Joel Neal
- Stanford University School of Medicine, Stanford CA
| | - Alice C Fan
- Stanford University School of Medicine, Stanford CA
| | - Kaidi Moore
- Stanford University School of Medicine, Stanford CA
| | - Shann Ruiz
- Stanford University School of Medicine, Stanford CA
| | - Connie Li
- Stanford University School of Medicine, Stanford CA
| | | | - Judy Pagtama
- Stanford University School of Medicine, Stanford CA
| | - Joanne Chien
- Stanford University School of Medicine, Stanford CA
| | | | | | - Millie Das
- Stanford University School of Medicine, Stanford CA
| | | | - Mohana Roy
- Stanford University School of Medicine, Stanford CA
| | | | | | - Jane Huang
- Stanford University School of Medicine, Stanford CA
| | - Sumit Shah
- Stanford University School of Medicine, Stanford CA
| | - Howard Lee
- Stanford University School of Medicine, Stanford CA
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19
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Mansoor H, Hirani N, Chavan V, Das M, Sharma J, Bharati M, Oswal V, Iyer A, Morales M, Joshi A, Ferlazzo G, Isaakidis P, Ndlovu Z, England K. Clinical utility of target-based next-generation sequencing for drug-resistant TB. Int J Tuberc Lung Dis 2023; 27:41-48. [PMID: 36853141 PMCID: PMC9879084 DOI: 10.5588/ijtld.22.0138] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND: In high TB burden countries, access to drug susceptibility testing is a major bottleneck. Targeted next-generation sequencing (tNGS) is a promising technology for rapid resistance detection. This study assessed the role of tNGS for the diagnosis of drug-resistant TB (DR-TB).METHODS: A total of 161 samples from bacteriologically confirmed TB cases were subjected to tNGS using the Deeplex® Myc-TB kit and sequenced using the MiSeq platform. These samples were also processed for conventional phenotypic DST (pDST) using 13 drugs on Mycobacteria Growth Indicator Tube and line-probe assays (MTBDRplus and MTBDRsl).RESULTS: There were 146 DR-TB and 15 drug-susceptible TB (DS-TB) samples. About 70% of patients with DR-TB had no previous TB treatment history. Overall, 88.2% had rifampicin-resistant/multidrug-resistant TB (RR/MDR-TB), 58.5% pre-extensively drug-resistant TB (pre-XDR-TB) and 9.2% had XDR-TB as defined by the WHO (2020). Around 8% (n = 13) of samples were non-culturable; however, identified 8 were resistant to first and second-line drugs using tNGS. Resistance frequency was similar across methods, with discordance in drugs less reliable using pDST or with limited mutational representation within databases. Sensitivities were aligned with literature reports for most drugs. We observed 10% heteroresistance, while 75% of strains were of Lineages 2 and 3.CONCLUSIONS: Programme data supported tNGS in the diagnosis of DR-TB for early treatment using individualised regimens.
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Affiliation(s)
| | - N. Hirani
- Grant Medical College, Sir Jamshedjee Jeejebhoy Group of Hospitals, Mumbai, India
| | - V. Chavan
- Médecins Sans Frontières, Mumbai, India
| | - M. Das
- Médecins Sans Frontières, Mumbai, India
| | - J. Sharma
- Médecins Sans Frontières, Mumbai, India
| | | | - V. Oswal
- National TB Elimination Programme, Mumbai, India
| | - A. Iyer
- Médecins Sans Frontières, Mumbai, India
| | | | - A. Joshi
- Grant Medical College, Sir Jamshedjee Jeejebhoy Group of Hospitals, Mumbai, India
| | - G. Ferlazzo
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - P. Isaakidis
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
,Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Z. Ndlovu
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
,Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - K. England
- Independent Consultant, Infectious Disease Microbiologist, Honolulu, Hawaii, USA
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20
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Nief CA, No HJ, Louie CY, Vitzthum L, Das M. Regression of Malignant Pleural Mesothelioma in Absence of Chemotherapy or Surgery: A Case Series. Clin Lung Cancer 2023; 24:76-81. [PMID: 36323592 DOI: 10.1016/j.cllc.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/07/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Corrine A Nief
- Stanford Medical School, Stanford University, Stanford, CA.
| | | | - Christine Y Louie
- Department of Pathology, VA Palo Alto Health Care System, Palo Alto, CA
| | - Lucas Vitzthum
- Department of Radiation Oncology, Stanford University, Stanford, CA; Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA
| | - Millie Das
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; Stanford Cancer Institute, Stanford, CA; Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA
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Raja N, No H, Von Eyben R, Das M, Roy M, Myall N, Chin A, Diehn M, Loo B, Chang D, Pollom E, Vitzthum L. Characterizing Metastatic Non-Small Cell Lung Cancer Presenting to an Academic Medical Center in an Era of Changing Treatment Paradigms. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1582] [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: 10/31/2022]
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22
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Hui C, Qu V, Wang JY, von Eyben R, Chang YC, Chiang PL, Liang CH, Lu JT, Li G, Hayden-Gephart M, Wakelee H, Neal J, Ramchandran K, Das M, Nagpal S, Soltys S, Myall N, Pollom E. Local control of brain metastases with osimertinib alone in patients with EGFR-mutant non-small cell lung cancer. J Neurooncol 2022; 160:233-240. [PMID: 36227422 DOI: 10.1007/s11060-022-04145-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/21/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Although osimertinib has excellent intracranial activity in metastatic non-small cell lung cancer (NSCLC) with exon 19 deletion or L858R EGFR alterations, measures of local control of brain metastases are less well-reported. We describe lesion-level outcomes of brain metastases treated with osimertinib alone. METHODS We retrospectively reviewed patients with EGFR-mutant NSCLC with untreated brain metastasis measuring ≥ 5 mm at the time of initiating osimertinib. Cumulative incidence of local recurrence in brain (LRiB) was calculated with death as a competing risk, and univariable and multivariable analyses were conducted to identify factors associated with LRiB. RESULTS We included 284 brain metastases from 37 patients. Median follow-up was 20.1 months. On initial MRI after starting osimertinib, patient-level response was complete response (CR) in 11 (15%), partial response (PR) in 33 (45%), stable disease (SD) in 18 (25%) and progressive disease (PD) in 11 (15%). The 1-year cumulative incidence of LRiB was 14% (95% CI 9.9-17.9) and was significantly different in patients with a CR (0%), PR (4%), and SD (11%; p = 0.02). Uncontrolled primary tumor (adjusted hazard ratio [aHR] 3.78, 95% CI 1.87-7.66; p < 0.001), increasing number of prior systemic therapies (aHR 2.12, 95% CI 1.49-3.04; p < 0.001), and higher ECOG score (aHR 7.8, 95% CI 1.99-31.81; p = 0.003) were associated with LRiB. CONCLUSIONS Although 1-year cumulative incidence of LRiB is < 4% with a CR or PR, 1-year cumulative incidence of LRiB is over 10% for patients with less than a PR to osimertinib on initial MRI. These patients should be followed closely for need for additional treatment such as stereotactic radiosurgery.
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Affiliation(s)
- Caressa Hui
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, USA
| | - Vera Qu
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, USA
| | - Jen-Yeu Wang
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, USA
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, USA
| | | | | | | | | | - Gordon Li
- Department of Neurosurgery, Stanford University, Palo Alto, CA, USA
| | | | - Heather Wakelee
- Department of Medical Oncology, Stanford University, Palo Alto, CA, USA
| | - Joel Neal
- Department of Medical Oncology, Stanford University, Palo Alto, CA, USA
| | | | - Millie Das
- Department of Medical Oncology, Stanford University, Palo Alto, CA, USA
| | - Seema Nagpal
- Department of Neurology, Stanford University, Palo Alto, CA, USA
| | - Scott Soltys
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, USA
| | - Nathaniel Myall
- Department of Medical Oncology, Stanford University, Palo Alto, CA, USA. .,Department of Medical Oncology, Stanford University, 300 Pasteur Dr Rm JC007, Stanford, CA, 94305, USA.
| | - Erqi Pollom
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, USA. .,Department of Radiation Oncology, Stanford University, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA.
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23
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Lopez C, Murillo A, Das M, Patel MI. Understanding the barriers and experiences of veterans with lung cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
160 Background: Veteran populations have higher lung cancer incidence and lower overall survival rates than non-veterans. Despite clinical advancements in lung cancer which reduce lung cancer death rates and access to care, many Veterans face barriers in receipt of such guideline-based care due to many factors including complex comorbidities, low health literacy, and significant economic and social disadvantages. In fact, the underrepresentation of Veterans in clinical trials confer even more difficulty to ensure cancer treatment and prognosis thoughtfully considers their unique challenges and needs. Few studies have evaluated Veterans’ perspectives regarding unmet needs and potential solutions to address equitable care delivery among these populations. The objective of this study was to evaluate Veterans’ perspectives regarding their lung cancer care to identify modifiable barriers that could be addressed to improve care. Methods: We conducted semi-structured interviews with fourteen Veterans diagnosed with lung cancer at the VA Palo Alto Health Care System. All interviews were recorded, transcribed and analyzed interviews using the constant comparative method of qualitative analysis. Results: All participants noted the main barrier to lung cancer care was transportation with inadequate financial coverage for gas and extensive commutes that contributed to significant anxiety and stress regarding their cancer care. Participants noted challenges in navigating the health system and suggested better understanding of the structure and function of cancer care team members to overcome these barriers. Participants noted difficulty comprehending and interpreting their cancer prognosis and were unaware of advance directives. All participants were unaware of precision medicine, namely molecular tumor testing or genomic cancer sequencing and its implications on their treatments. Conclusions: This study revealed critical gaps in lung cancer among Veterans in one VA facility. Targeted solutions should be considered to address barriers identified which include transportation access, proactive distress management, and knowledge regarding lung cancer care delivery.
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Affiliation(s)
| | - Ariana Murillo
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Millie Das
- VA Palo Alto Health Care System, Mountain View, CA
| | - Manali I. Patel
- Division of Oncology, Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA
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24
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Banks L, Wujcik D, Stricker C, Das M, Shanbhag L, Lin S, Patel M. EP04.02-003 Improving Supportive Care for Patients with Thoracic Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.443] [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: 10/14/2022]
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25
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Das M, Ogale S, Johnson A, Nguyen C, Bhagwakar J, Jovanoski N, Lee J. EP04.01-017 Cost-Effectiveness of Atezolizumab for Adjuvant Treatment of Patients with Stage II-IIIA PD-L1+ Non-small Cell Lung Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Das M, Naik KC, Biswal N, Panda RN. Structure and Decay Properties of Th Isotopes Using E-RMFT Formalism. Atom Indo 2022. [DOI: 10.17146/aij.2022.1156] [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: 11/09/2022] Open
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27
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Ali B, Arnquist I, Baxter D, Behnke E, Bressler M, Broerman B, Chen C, Clark K, Collar J, Cooper P, Cripe C, Crisler M, Dahl C, Das M, Durnford D, Fallows S, Farine J, Filgas R, García-Viltres A, Giroux G, Harris O, Hillier T, Hoppe E, Jackson C, Jin M, Krauss C, Kumar V, Laurin M, Lawson I, Leblanc A, Leng H, Levine I, Licciardi C, Linden S, Mitra P, Monette V, Moore C, Neilson R, Noble A, Nozard H, Pal S, Piro MC, Plante A, Priya S, Rethmeier C, Robinson A, Savoie J, Sonnenschein A, Starinski N, Štekl I, Tiwari D, Vázquez-Jáuregui E, Wichoski U, Zacek V, Zhang J. Results on photon-mediated dark-matter–nucleus interactions from the PICO-60
C3F8
bubble chamber. Int J Clin Exp Med 2022. [DOI: 10.1103/physrevd.106.042004] [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: 11/07/2022]
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28
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Waliany S, Wakelee H, Ramchandran K, Das M, Huang J, Myall N, Li C, Pagtama J, Tisch AH, Neal JW. Characterization of ERBB2 (HER2) Alterations in Metastatic Non-small Cell Lung Cancer and Comparison of Outcomes of Different Trastuzumab-based Regimens. Clin Lung Cancer 2022; 23:498-509. [PMID: 35753988 DOI: 10.1016/j.cllc.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION About 3%-5% of mNSCLC have ERBB2 (HER2) alterations, but currently, there are no FDA-approved targeted therapies for this indication. We compared treatment response between trastuzumab-based and non-targeted regimens in ERBB2-mutant mNSCLC. METHODS This retrospective, single-institution study included patients with mNSCLC with ERBB2 alterations identified by next-generation sequencing. Best overall response was determined using Response Evaluation Criteria in Solid Tumors 1.1. RESULTS We identified 3 groups of patients: ERBB2-mutant/EGFR-wildtype mNSCLC (n = 33), ERBB2-amplified/EGFR-wildtype mNSCLC without concurrent ERBB2 mutations (n = 6), and ERBB2-altered/EGFR-mutant mNSCLC (n = 8). Observed mutations included A775_G776insYVMA (n = 23), Gly778_Pro780dup (n = 4), Ser310Phe (n = 3), and others (n = 5). Among the 33 with ERBB2-mutant/EGFR-wildtype mNSCLC, those with and without A775_G776insYVMA had significantly different median overall survival (OS) of 17.7 and 52.9 months, respectively (Cox regression multivariable HR: 5.03, 95% CI: 1.37-18.51, P = .02). In those with mNSCLC with A775_G776insYVMA, trastuzumab-based therapies were associated with greater OS (20.3 vs. 9.8 months; multivariable HR: 0.19, 95% CI: 0.04-0.87, P = .032). Objective response and disease control rates (median tumor size change) in the 33 patients with ERBB2-mutant/EGFR-wildtype mNSCLC were 40.0% and 80.0% (-35.8%), respectively, for patients treated with trastuzumab deruxtecan; 0% and 30.0% (-5.2%) for trastuzumab emtansine; and 7.1% and 50.0% (-13.0%) for trastuzumab/chemotherapy combinations. CONCLUSION In ERBB2-mutant/EGFR-wildtype mNSCLC, while most trastuzumab-based regimens had modest activity in this real-world analysis, trastuzumab deruxtecan had highest response rates and best tumor size reduction. Receipt of any trastuzumab-based regimen was associated with greater OS with A775_G776insYVMA. There remains an unmet need for approved targeted therapies for ERBB2-mutant/EGFR-wildtype NSCLC.
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Affiliation(s)
- Sarah Waliany
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Heather Wakelee
- Department of Medicine, Stanford University School of Medicine, Stanford, CA; Division of Oncology, Stanford University School of Medicine, Stanford, CA; Stanford Cancer Institute, Stanford, CA
| | - Kavitha Ramchandran
- Department of Medicine, Stanford University School of Medicine, Stanford, CA; Division of Oncology, Stanford University School of Medicine, Stanford, CA; Stanford Cancer Institute, Stanford, CA
| | - Millie Das
- Department of Medicine, Stanford University School of Medicine, Stanford, CA; Division of Oncology, Stanford University School of Medicine, Stanford, CA; Stanford Cancer Institute, Stanford, CA; Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA
| | - Jane Huang
- Department of Medicine, Stanford University School of Medicine, Stanford, CA; Division of Oncology, Stanford University School of Medicine, Stanford, CA; Stanford Cancer Institute, Stanford, CA
| | - Nathaniel Myall
- Department of Medicine, Stanford University School of Medicine, Stanford, CA; Division of Oncology, Stanford University School of Medicine, Stanford, CA; Stanford Cancer Institute, Stanford, CA
| | - Connie Li
- Stanford Cancer Institute, Stanford, CA
| | | | | | - Joel W Neal
- Department of Medicine, Stanford University School of Medicine, Stanford, CA; Division of Oncology, Stanford University School of Medicine, Stanford, CA; Stanford Cancer Institute, Stanford, CA.
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Banks LC, Kapphahn K, Das M, Wujcik D, Stricker CT, Shanbhag L, Lin S, Zhu G, Patel MI. Improving supportive care for patients with thoracic cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1520 Background: Improving lung cancer care among Veterans is a priority within the Veterans Affairs due to higher rates of lung cancer incidence, morbidity, and mortality among Veterans compared to non-veterans. Unaddressed symptom burden is common due to many factors including complex comorbidities, psychosocial challenges, smoking history and limited social support networks. Additionally, complications from social determinants of health can obstruct successful discussions of symptom-burden between Veterans and their clinical care teams which can limit compliance with recommended symptom management strategies. To overcome these barriers, we conducted a randomized controlled trial to test the effectiveness of a lay volunteer-led proactive symptom assessment and symptom intervention. The objective was to determine if the intervention improved clinician documentation from baseline to 6-months post-enrollment compared to usual care. Secondary outcomes included change in patient activation, health-related quality of life (HrQOL), and symptom-burden. Methods: Patients were randomized into the lay volunteer proactive symptom assessment intervention plus usual cancer care (intervention group) or usual cancer care alone (control group). We conducted electronic health record review to assess primary cancer-clinician symptom documentation of Veterans’ symptoms identified as moderate-to-severe at baseline and 6-months using the Edmonton Symptom Assessment Scale. Patient surveys with validated assessments were used to assess patient activation, HrQOL and symptom burden at baseline (time of enrollment) and 6-months post-enrollment. We used regression models to evaluate differences in our primary and secondary outcomes. Results: 60 Veterans were consented and randomized into the study (29 control; 31 intervention). There were no differences in demographic or clinical factors across groups. The median age was 70 years (range 56-85), 95% were male, 70% identified their race as White, 53% were married and 48% had a 2-year or 4-year college degree. The majority had at least 3 comorbidities (54%), diagnosed with stage 3 or 4 (62%) and received systemic treatment with chemotherapy and/or radiation (77%). At 6-months post-enrollment as compared to baseline, the intervention group had greater improvements in symptom documentation (56% from 12.5% vs. 29% from 43%, p = 0.01), greater improvements in patient activation (p<0.001), HrQOL (<0.001), and lower symptom burden (p<0.001) than the control group. Conclusions: Integration of proactive symptom assessment by lay volunteers has a significant and meaningful effect on symptom documentation, patient activation, quality of life, and reducing symptom burden among Veterans with lung cancer. Clinical trial information: NCT03216109.
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Affiliation(s)
| | - Kris Kapphahn
- Stanford University School of Medicine, Stanford, CA
| | - Millie Das
- VA Palo Alto Health Care System, Mountain View, CA
| | | | | | | | | | - Ge Zhu
- VA Palo Alto, Palo Alto, CA
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30
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Bates A, Naseer MZ, Taylor M, Denham N, Yue A, Das M, Morris GM, Ullah W. UK multi-centre retrospective study of the learning curve and relative performance of the rhythmia high density mapping system for atrial ablation. Europace 2022. [DOI: 10.1093/europace/euac053.071] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): University Hospital Southampton
Background
Rhythmia HDx® is a novel ultra-high density electroanatomical mapping system using an innovative 64 electrode basket catheter. A learning curve is a recognised phenomenon for any new technology and was examined in this study.
Purpose
Comparison of performance, long-term success, and complications using Rhythmia for atrial ablation in the UK.
Methods
Retrospective data collection from three centres across the UK from the introduction of Rhythmia. Patients were matched with controls who had undergone ablation using the well-established Carto3 mapping system. Assessed were: fluoroscopy, radiofrequency ablation and procedure times; acute and long term success, and complications.
Results
253 study patients with 253 controls were included. Significant correlations existed between procedural efficiency metrics and centre experience for de novo atrial fibrillation (AF) ablation (procedure time, Spearman’s ρ = -0.624; ablation time, ρ = -0.795), and de novo atrial flutter (AFlut) ablation (ablation time, ρ = -0.566; fluoroscopy time, ρ = -0.520). No such correlations existed for redo AF, redo AFlut, de novo atrial tachycardia (AT), or redo AT cases. For de novo AF and AFlut, procedural efficiency metrics were significantly improved after 10 procedures in each centre, (procedure time [AF only, p = 0.001], ablation time [AF, p < 0.0005; AFlut p < 0.0005] and fluoroscopy time [AFlut only, p = 0.0022]), and became comparable to controls (Figures 1 and 2). Acute success and long-term success did not see significant improvement with experience but were comparable to the control group. There was no relationship between experience and complications, which were comparable to Carto3 (3.6% in both groups).
Conclusion
A short learning curve exists with the use of Rhythmia HDx for standardised procedures (de novo AF / AFlut). Procedural performance improves and becomes comparable to Carto3 following 10 cases at each centre. Clinical outcomes at 6 and 12 months, and complications are not affected by this learning curve and remain comparable with controls.
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Affiliation(s)
- A Bates
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - MZ Naseer
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - M Taylor
- Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom of Great Britain & Northern Ireland
| | - N Denham
- Manchester Royal Infirmary, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - A Yue
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - M Das
- Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom of Great Britain & Northern Ireland
| | - GM Morris
- Manchester Royal Infirmary, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - W Ullah
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
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31
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No HJ, Raja N, Von Eyben R, Das M, Roy M, Myall N, Neal J, Wakelee H, Chin A, Diehn M, Loo BW, Chang DT, Pollom EL, Vitzthum LK. Characterization of Metastatic Non-Small Cell Lung Cancer and Oligometastatic Incidence in an Era of Changing Treatment Paradigms. Int J Radiat Oncol Biol Phys 2022; 114:603-610. [DOI: 10.1016/j.ijrobp.2022.04.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 11/29/2022]
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32
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Patel MI, Banks L, Das M. Improving supportive care for patients with Thoracic Malignancies – A randomized controlled trial. Contemp Clin Trials Commun 2022; 28:100929. [PMID: 35669484 PMCID: PMC9163421 DOI: 10.1016/j.conctc.2022.100929] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/16/2022] [Accepted: 05/24/2022] [Indexed: 11/26/2022] Open
Abstract
Veterans have higher lung cancer incidence and mortality rates than civilians. Frequently, Veterans with lung cancer suffer from undertreated symptoms due to complex comorbidities, limited social support, and reluctance in discussing symptoms with their oncologists. Evidence supports proactive symptom screening among civilians with cancer; however, no studies to date have evaluated whether Veteran volunteer-led proactive symptom screening is feasible and effective among Veterans with lung cancer. The “Improving Supportive Care for Patients with Thoracic Malignancies” study was co-developed by a pre-established Veteran and Family Advisory Board. Veterans with lung cancer are randomized in a 1:1 allocation to either a 9-month intervention combined with usual oncology care (intervention group) or usual oncology care alone (control group). A Veteran volunteer is assigned to all Veterans in the intervention group and conducts weekly symptom assessments using validated symptom surveys and reviews all symptom scores with an oncology nurse practitioner. The primary outcome is to evaluate whether the intervention improves documentation of symptoms at 6 months post-enrollment among Veterans in the intervention group as compared with the control group. Secondary outcomes include changes in patient-reported outcomes (i.e., symptom burden, patient activation, patient satisfaction with decision, health-related quality of life) and differences in acute care use (i.e., emergency department visits, hospitalizations) from baseline (time of enrollment in the study) to 3-, 6-, and 9-months post enrollment. This study addresses a significant concern expressed by Veterans and their caregivers. Findings can advance our understanding of how to improve symptom-burden among Veterans with lung cancer. ClinicalTrials.gov Registration #NCT03216109.
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Affiliation(s)
- Manali I. Patel
- Division of Oncology, Stanford University School of Medicine, Stanford, CA, United States
- Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
- Corresponding author. Division of Oncology, Stanford University, 1701 Page Mill Drive, Palo Alto, CA, 94306, United States.
| | - Lakedia Banks
- Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Millie Das
- Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
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Waliany S, Zhu H, Wakelee H, Padda SK, Das M, Ramchandran K, Myall NJ, Chen T, Witteles RM, Neal JW. Pharmacovigilance Analysis of Cardiac Toxicities Associated With Targeted Therapies for Metastatic NSCLC. J Thorac Oncol 2021; 16:2029-2039. [PMID: 34418561 DOI: 10.1016/j.jtho.2021.07.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/24/2021] [Accepted: 07/21/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Targeted therapies have transformed treatment of driver-mutated metastatic NSCLC. We compared cardiovascular adverse events between and within targeted therapy classes. METHODS We used WHO pharmacovigilance database VigiBase to compare odds of heart failure, conduction disease, QT prolongation, supraventricular tachycardia (SVT), and ventricular arrhythmias between inhibitors of EGFR (erlotinib, gefitinib, afatinib, osimertinib), BRAF (dabrafenib), MEK (trametinib), and ALK and ROS1 (alectinib, brigatinib, ceritinib, crizotinib, lorlatinib). RESULTS Of 98,765 adverse reactions reported with NSCLC targeted therapies, 1783 (1.8%) were arrhythmias and 1146 (1.2%) were heart failure. ALK and ROS1 inhibitors were associated with increased odds of conduction disease (reporting OR [ROR] = 12.95, 99% confidence interval [CI]: 10.14-16.55) and QT prolongation (ROR = 5.16, 99% CI: 3.92-6.81) relative to BRAF and EGFR inhibitors. Among ALK and ROS1 inhibitors, crizotinib had highest odds of conduction disease (ROR = 1.75, 99% CI: 1.30-2.36) and QT prolongation (ROR = 1.91, 99% CI: 1.22-3.00). Dabrafenib (ROR = 2.24, 99% CI: 1.86-2.70) and trametinib (ROR = 2.44, 99% CI: 2.03-2.92) had higher odds of heart failure than other targeted therapies. Osimertinib was strongly associated with QT prolongation (ROR = 6.13, 99% CI: 4.43-8.48), heart failure (ROR = 3.64, 99% CI: 2.94-4.50), and SVT (ROR = 1.90, 99% CI: 1.26-2.86) relative to other targeted therapies. CONCLUSIONS ALK and ROS1 inhibitors are associated with higher odds of conduction disease and QT prolongation than other targeted therapies. Osimertinib is strongly associated with QT prolongation, SVT, and heart failure relative to other EGFR inhibitors and targeted therapies. Monitoring for heart failure and arrhythmias should be considered with NSCLC targeted therapies, especially osimertinib.
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Affiliation(s)
- Sarah Waliany
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Han Zhu
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Heather Wakelee
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford, California
| | - Sukhmani K Padda
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford, California
| | - Millie Das
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford, California; Department of Medicine, VA Palo Alto Health Care System, Palo Alto, California
| | - Kavitha Ramchandran
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford, California
| | - Nathaniel J Myall
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford, California
| | - Thomas Chen
- Division of Oncology, Stanford Cancer Center South Bay, San Jose, California
| | - Ronald M Witteles
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Joel W Neal
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Oncology, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford, California.
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White MN, Piper-Vallillo AJ, Gardner RM, Cunanan K, Neal JW, Das M, Padda SK, Ramchandran K, Chen TT, Sequist LV, Piotrowska Z, Wakelee HA. Chemotherapy Plus Immunotherapy Versus Chemotherapy Plus Bevacizumab Versus Chemotherapy Alone in EGFR-Mutant NSCLC After Progression on Osimertinib. Clin Lung Cancer 2021; 23:e210-e221. [PMID: 34887193 DOI: 10.1016/j.cllc.2021.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Patients with EGFR-mutant lung cancer who have had disease progression on osimertinib commonly receive platinum doublet chemotherapy, but whether adding immunotherapy or bevacizumab provides additional benefit is unknown. MATERIALS AND METHODS This was a retrospective analysis at 2 university-affiliated institutions. Patients with EGFR-mutant lung cancer who had progression on osimertinib and received next-line therapy with platinum doublet chemotherapy (chemo), platinum doublet chemotherapy plus immunotherapy (chemo-IO), or platinum doublet chemotherapy plus bevacizumab (chemo-bev), were identified; patients who continued osimertinib with these regimens were included. Efficacy outcomes including duration on treatment (DOT) and overall survival (OS) from the start of chemotherapy were assessed. Associations of treatment regimen with outcomes were evaluated using adjusted Cox regression models, using pairwise comparisons between groups. RESULTS 104 patients were included: 57 received chemo, 12 received chemo-IO, and 35 received chemo-bev. In adjusted models, patients who received chemo-IO had worse OS than did those who received chemo (hazard ratio (HR) 2.66, 95% CI 1.25-5.65; P= .011) or those who received chemo-bev (HR 2.37, 95% CI 1.09-5.65; P= .030). A statistically significant difference in OS could not be detected in patients who received chemo-bev versus those who received chemo (HR 1.50, 95% CI 0.84-2.69; P= .17). CONCLUSION In this retrospective study, giving immunotherapy with platinum doublet chemotherapy after progression on osimertinib was associated with a worse OS compared with platinum doublet chemotherapy alone. Platinum doublet chemotherapy without immunotherapy (with consideration of continuation of osimertinib, in selected cases) is a reasonable choice in this setting, while we await results of clinical trials examining optimal next-line chemotherapy-based regimens in EGFR-mutant lung cancer.
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Affiliation(s)
- Maya N White
- Department of Medicine, Division of Oncology, Stanford University, Stanford CA
| | - Andrew J Piper-Vallillo
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA
| | - Rebecca M Gardner
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA
| | - Kristen Cunanan
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA
| | - Joel W Neal
- Department of Medicine, Division of Oncology, Stanford University, Stanford CA
| | - Millie Das
- Department of Medicine, Division of Oncology, Stanford University, Stanford CA; Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA
| | - Sukhmani K Padda
- Department of Medicine, Division of Oncology, Stanford University, Stanford CA
| | - Kavitha Ramchandran
- Department of Medicine, Division of Oncology, Stanford University, Stanford CA
| | | | - Lecia V Sequist
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA
| | - Zofia Piotrowska
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA
| | - Heather A Wakelee
- Department of Medicine, Division of Oncology, Stanford University, Stanford CA.
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Gensheimer M, Gee H, Von Eyben R, Shirato H, Taguchi H, Wong S, Brown E, Nguyen N, Liang R, Maxim P, Wakelee H, Neal J, Das M, Loo B, Diehn M. A Phase II Trial of Individualized Stereotactic Ablative Radiotherapy for Lung Tumors (iSABR). Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.212] [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: 10/20/2022]
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Devine M, Merriott D, Say C, Yoo C, Yi E, Lau B, Ko R, Shaheen S, Neal J, Wakelee H, Das M, Loo B, Diehn M, Chin A, Vitzthum L. Patterns of Care in Patients With Isolated Nodal Recurrence After Definitive Stereotactic Ablative Radiotherapy for Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1235] [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: 11/29/2022]
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Das M, Padda SK, Weiss J, Owonikoko TK. Advances in Treatment of Recurrent Small Cell Lung Cancer (SCLC): Insights for Optimizing Patient Outcomes from an Expert Roundtable Discussion. Adv Ther 2021; 38:5431-5451. [PMID: 34564806 PMCID: PMC8475485 DOI: 10.1007/s12325-021-01909-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/25/2021] [Indexed: 10/31/2022]
Abstract
Second-line treatment options for patients with relapsed, extensive-stage small cell lung cancer (ES-SCLC) are limited, and even with currently available treatments, prognosis remains poor. Until recently, topotecan (a topoisomerase I inhibitor) was the only drug approved by the United States (US) Food and Drug Administration (FDA) for the management of ES-SCLC following progression after first-line treatment with etoposide plus a platinum derivative (EP; carboplatin preferred). With the most recent approval of EP plus a programmed death ligand 1 (PD-L1) inhibitor, there are now more therapeutic options for managing ES-SCLC. A number of novel agents have emerging data for activity in relapsed ES-SCLC, and single-agent lurbinectedin (an alkylating drug and selective inhibitor of oncogenic transcription and DNA repair machinery in tumor cells) has conditional FDA approval for use in this patient population. Trilaciclib, a short-acting cyclin-dependent kinase 4/6 (CDK 4/6) inhibitor, has also been recently approved as a supportive intervention for use prior to an EP or a topotecan-containing regimen to diminish the incidence of chemotherapy-induced myelosuppression. The current review is based on a recent expert roundtable discussion and summarizes current therapeutic agents and emerging data on newer agents and biomarkers. It also provides evidence-based clinical considerations and a treatment decision tool for oncologists treating patients with relapsed ES-SCLC. This paper discusses the importance of various factors to consider when selecting a second-line treatment option, including prior first-line treatment, available second-line treatment options, tumor platinum sensitivity, and patient characteristics (such as performance status, comorbidities, and patient-expressed and perceived values).
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Marar M, Bryant A, Nalawade V, Das M, Jr BL, Diehn M, Chin A, Murphy J, Vitzthum L. Impact of Facility Treatment Volume on Stereotactic Ablative Radiotherapy (SABR) Outcomes in Early-Stage Non-Small Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1262] [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: 11/29/2022]
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Hellyer JA, White MN, Gardner RM, Cunanan K, Padda SK, Das M, Ramchandran K, Neal JW, Wakelee HA. Impact of Tumor Suppressor Gene Co-Mutations on Differential Response to EGFR TKI Therapy in EGFR L858R and Exon 19 Deletion Lung Cancer. Clin Lung Cancer 2021; 23:264-272. [PMID: 34838441 DOI: 10.1016/j.cllc.2021.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND In most studies, patients with EGFR L858R mutant non-small cell lung cancer (NSCLC) have a shorter duration of response to EGFR tyrosine kinase inhibitor (TKI) therapy than do patients with EGFR exon 19 deletion NSCLC. The role that co-mutations play in this observation is unknown. METHODS We performed a single-institution retrospective analysis of patients with EGFR-mutant NSCLC (exon 19 deletion or L858R mutation) who received frontline EGFR TKI for metastatic disease between 2014 and 2019, and who had STAMP next-generation sequencing (NGS), a 130-gene platform. Time to treatment failure (TTF) and overall survival were calculated using Cox models adjusted for age, race, and brain metastases. Co-mutations in key tumor suppressor genes (TP53, RB1, KEAP1, CDKN2A, or CTNNB1) were identified and their effects on outcomes were evaluated. Analyses were stratified according to receipt of osimertinib versus nonosimertinib as frontline EGFR TKI. RESULTS Of 137 patients, 72 (57%) had EGFR exon 19 deletions and 65 (43%) had EGFR L858R mutations. Median TTF and OS on frontline TKI was shorter for the L858R cohort versus the exon 19 deletion cohort in univariate analysis. In adjusted models, this difference persisted for TTF but was no longer significant for OS. The difference in TTF in L858R mutant tumors was driven by the presence of co-mutations in key tumor suppressor genes. CONCLUSION Patients with metastatic NSCLC with mutations in EGFR L858R had shorter TTF on frontline TKI compared to patients with EGFR exon 19 deletions. Co-mutations in tumor suppressor genes may play an important role in the differential response to TKI therapy.
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Affiliation(s)
- Jessica A Hellyer
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
| | - Maya N White
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
| | - Rebecca M Gardner
- Quantitative Sciences Unit, Stanford School of Medicine, Stanford, CA
| | - Kristen Cunanan
- Quantitative Sciences Unit, Stanford School of Medicine, Stanford, CA
| | - Sukhmani K Padda
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
| | - Millie Das
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA; Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA
| | - Kavitha Ramchandran
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
| | - Joel W Neal
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
| | - Heather A Wakelee
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA.
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Gleeson D, Cliff S, Das M. Eruptive keratoacanthomas associated with dupilumab therapy. Br J Dermatol 2021; 186:376-377. [PMID: 34608625 DOI: 10.1111/bjd.20781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022]
Abstract
We would like to present the case of eruptive keratoacanthomas associated with dupilumab therapy, which occurred in an 85-year-old woman receiving biologic therapy for the treatment of atopic dermatitis. With the increasing prevalence of Dupilumab usage, this is an important potential complication of which clinicians should be aware.
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Affiliation(s)
- D Gleeson
- East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - S Cliff
- East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - M Das
- East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
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Mahanta G, Das M, Nayak MK, Shaw S. Irreversibility Analysis of 3D Magnetohydrodynamic Casson Nanofluid Flow Past Through Two Bi-Directional Stretching Surfaces with Nonlinear Radiation. j nanofluids 2021. [DOI: 10.1166/jon.2021.1793] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Application of the nanoparticles with different non-Newtonian base fluid has huge application in the industries where the heat generation or energy transform takes place and many such applications are designing the advanced energy system at high temperature, aerodynamics, energy extraction
etc. In the present study, we have analyzed irreversibility for a 3-dimensional MHD, incompressible, electrically conducting Casson nanofluid flow through the two horizontal stretching surfaces. To make it more practical and broad, the flow field has been incorporated with porosity, suction/injection,
non-linear radiation with fall velocity with convective heating conditions at the boundaries and entropy generation which is an important physical phenomenon in thermodynamics. Influence of imperative parameters of the flow field and physical parameters have discussed with the entropy generation.
In a limiting case, a comparison made. It is observed that the suction phenomena boost up the local Nusselt and Sherwood number at the surface while restricted the skin friction. The non-Newtonian rheology (as Casson number) restricted the skin friction and the same phenomena observed for
the local heat and mass transfer. The entropy boosts up with the enhancement of the magnetic parameter, temperature ratio and Brinkman number. Further nanoparticle concentration improve the thermal conductivity leads an improvement in the efficiency of the heat transfer takes place. With the
augment in thermal radiation, magnetic parameter and Brinkman number, the entropy generation of the systems gets accelerated.
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Affiliation(s)
- G. Mahanta
- Department of Mathematics C. V. Raman Global University, Bhubaneswar 752054, India
| | - M. Das
- Department Mathematics, KIIT Deemed to be University, Bhubaneswar 751024, India
| | - M. K. Nayak
- Department of Mathematics C. V. Raman Global University, Bhubaneswar 752054, India
| | - S. Shaw
- Department of Mathematics and Statistical Sciences, Botswana International University of Science and Technology, Private Bag 16, Palapye, Botswana
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Das M, Das AC, Panda S, Greco Lucchina A, Mohanty R, Manfredi B, Rovati M, Giacomello MS, Colletti L, Mortellaro C, Satpathy A, Del Fabbro M. Clinical efficacy of grape seed extract as an adjuvant to scaling and root planing in treatment of periodontal pockets. J BIOL REG HOMEOS AG 2021; 35:89-96. [PMID: 34281305 DOI: 10.23812/21-2supp1-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Grape seed extract (GSE), a naturally producing polyphenolic compound, is found to be a potent hostmodulatory agent and considered for management of periodontal disease. Its anti-bacterial, antioxidant, and anti-inflammatory property may aid in achieving periodontal health. To assess the clinical efficacy of GSE in adjunct to scaling and root planing (SRP) in healing of periodontal pockets. The present study was a longitudinal, parallel design, randomized clinical trial. Seventy-two patients (mean age 39.2±8.6 years) with periodontal pockets were randomly divided into two groups; Test group received intra-pocket delivery of GSE with SRP and Control group received SRP alone. The clinical parameters like Plaque Index (PI), Gingival Index (GI), Probing Depth (PD) and Relative Attachment Level (RAL) were recorded at baseline and 3 months. 64 patients completed the study. Test group at the end of 3 months had statistically significant reduced PD (p=0.002) and RAL (p=0.01). No significant difference was observed for PI and GI at the end of 3 months. Intra-pocket application of GSE with SRP could be beneficial in management of periodontal pockets.
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Affiliation(s)
- M Das
- Department of Periodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan University, K8, Kalinga Nagar, Bhubaneswar, Odisha, India
| | - A C Das
- Department of Periodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan University, K8, Kalinga Nagar, Bhubaneswar, Odisha, India
| | - S Panda
- Department of Periodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan University, K8, Kalinga Nagar, Bhubaneswar, Odisha, India.,Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - A Greco Lucchina
- Saint Camillus International University of Health and Medical Science, Rome, Italy
| | - R Mohanty
- Department of Periodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan University, K8, Kalinga Nagar, Bhubaneswar, Odisha, India
| | - B Manfredi
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - M Rovati
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - M S Giacomello
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - L Colletti
- Department of Periodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan University, K8, Kalinga Nagar, Bhubaneswar, Odisha, India
| | - C Mortellaro
- Saint Camillus International University of Health and Medical Science, Rome, Italy
| | - A Satpathy
- Department of Periodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan University, K8, Kalinga Nagar, Bhubaneswar, Odisha, India
| | - M Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy.,Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Shah RP, Selby HM, Mukherjee P, Verma S, Xie P, Xu Q, Das M, Malik S, Gevaert O, Napel S. Machine Learning Radiomics Model for Early Identification of Small-Cell Lung Cancer on Computed Tomography Scans. JCO Clin Cancer Inform 2021; 5:746-757. [PMID: 34264747 PMCID: PMC8812622 DOI: 10.1200/cci.21.00021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/26/2021] [Accepted: 06/08/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Small-cell lung cancer (SCLC) is the deadliest form of lung cancer, partly because of its short doubling time. Delays in imaging identification and diagnosis of nodules create a risk for stage migration. The purpose of our study was to determine if a machine learning radiomics model can detect SCLC on computed tomography (CT) among all nodules at least 1 cm in size. MATERIALS AND METHODS Computed tomography scans from a single institution were selected and resampled to 1 × 1 × 1 mm. Studies were divided into SCLC and other scans comprising benign, adenocarcinoma, and squamous cell carcinoma that were segregated into group A (noncontrast scans) and group B (contrast-enhanced scans). Four machine learning classification models, support vector classifier, random forest (RF), XGBoost, and logistic regression, were used to generate radiomic models using 59 quantitative first-order and texture Imaging Biomarker Standardization Initiative compliant PyRadiomics features, which were found to be robust between two segmenters with minimum Redundancy Maximum Relevance feature selection within each leave-one-out-cross-validation to avoid overfitting. The performance was evaluated using a receiver operating characteristic curve. A final model was created using the RF classifier and aggregate minimum Redundancy Maximum Relevance to determine feature importance. RESULTS A total of 103 studies were included in the analysis. The area under the receiver operating characteristic curve for RF, support vector classifier, XGBoost, and logistic regression was 0.81, 0.77, 0.84, and 0.84 in group A, and 0.88, 0.87, 0.85, and 0.81 in group B, respectively. Nine radiomic features in group A and 14 radiomic features in group B were predictive of SCLC. Six radiomic features overlapped between groups A and B. CONCLUSION A machine learning radiomics model may help differentiate SCLC from other lung lesions.
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Affiliation(s)
- Rajesh P. Shah
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
- Department of Radiology, Stanford University, Stanford, CA
| | - Heather M. Selby
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
- Department of Medicine, Center for Biomedical Informatics Research (BMIR), Stanford University, Stanford, CA
| | - Pritam Mukherjee
- Department of Medicine, Center for Biomedical Informatics Research (BMIR), Stanford University, Stanford, CA
| | - Shefali Verma
- Palo Alto Veterans Institute for Research, Palo Alto, CA
| | - Peiyi Xie
- Department of Medicine, Center for Biomedical Informatics Research (BMIR), Stanford University, Stanford, CA
- Present address: Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qinmei Xu
- Department of Medicine, Center for Biomedical Informatics Research (BMIR), Stanford University, Stanford, CA
- Present address: Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
| | - Millie Das
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
- Department of Medicine—Oncology, Stanford University, Stanford, CA
| | - Sachin Malik
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
- Department of Radiology, Stanford University, Stanford, CA
| | - Olivier Gevaert
- Department of Medicine, Center for Biomedical Informatics Research (BMIR), Stanford University, Stanford, CA
| | - Sandy Napel
- Department of Radiology, Stanford University, Stanford, CA
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Das M, Mamnoon F, Mansoor H, Meneguim AC, Singh P, Shah I, Ravi S, Kalon S, Hossain FN, Ferlazzo G, Isaakidis P, Furin J, Acharya S, Thakur HP. New TB drugs for the treatment of children and adolescents with rifampicin-resistant TB in Mumbai, India. Int J Tuberc Lung Dis 2021; 24:1265-1271. [PMID: 33317670 DOI: 10.5588/ijtld.20.0165] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Médecins Sans Frontières (MSF) clinic in Mumbai, India.OBJECTIVE: To determine the final treatment outcomes, culture conversion and adverse events (AEs) during treatment among children and adolescents (0-19 years) with rifampicin-resistant tuberculosis (RR-TB) who received ambulatory injectable-free treatment, including bedaquiline (BDQ) and/or delamanid (DLM) during September 2014-January 2020.DESIGN: This was a retrospective cohort study based on review of routinely collected programme data.RESULTS: Twenty-four patients were included; the median age was 15.5 years (min-max 3-19) and 15 (63%) were females. None were HIV-coinfected. All had fluoroquinolone resistance. Twelve received treatment, including BDQ and DLM, 11 received DLM and one BDQ. The median exposure to BDQ (n = 13) and DLM (n = 23) was 82 (IQR 80-93) and 82 (IQR 77-96) weeks, respectively. Seventeen (94%) patients with positive culture at baseline (n = 18) had negative culture during treatment; median time for culture-conversion was 7 weeks (IQR 5-11). Twenty-three (96%) had successful treatment outcomes: cured (n = 16) or completed treatment (n = 7); one died. Eleven (46%) had 17 episodes of AEs. Two of 12 serious AEs were associated with new drugs (QTcF >500 ms).CONCLUSION: Based on one of the largest global cohorts of children and adolescents to receive new TB drugs, this study has shown that injectable-free regimens containing BDQ and/or DLM on ambulatory basis were effective and well-tolerated among children and adolescents and should be made routinely accessible to these vulnerable groups.
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Affiliation(s)
- M Das
- Médecins Sans Frontières, Mumbai, Tata Institute of Social Sciences, Mumbai
| | | | | | | | - P Singh
- Médecins Sans Frontières, Mumbai
| | - I Shah
- Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - S Ravi
- Médecins Sans Frontières, Mumbai
| | - S Kalon
- Médecins Sans Frontières, Mumbai
| | | | - G Ferlazzo
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - P Isaakidis
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - S Acharya
- Mumbai Districts AIDS Control Society, Mumbai
| | - H P Thakur
- Tata Institute of Social Sciences, Mumbai, National Institute of Health and Family Welfare, New Delhi, India
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Binkley MS, Jeon YJ, Nesselbush M, Moding EJ, Nabet B, Almanza D, Yoo C, Kurtz DM, Owen SG, Backhus LM, Berry MF, Shrager JB, Ramchandran KJ, Padda SK, Das M, Neal JW, Wakelee HA, Alizadeh AA, Loo BW, Diehn M. Abstract PO-059: Investigating gene expression profiles associated with clinical radiation resistance in KEAP1/NFE2L2 wildtype lung cancer. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.radsci21-po-059] [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
Background: We previously reported that approximately half of local recurrences (LR) after radiotherapy for localized NSCLC harbor mutations in KEAP1 or NFE2L2. Here we sought to explore factors associated with LR after radiotherapy in KEAP1/NFE2L2 wildtype NSCLC. Methods: We identified consecutive patients with stage IA1-IIIC NSCLC treated at our institution with chemoradiotherapy (CRT) or stereotactic ablative radiotherapy (SABR) from 2009-2018 and who had genotyping performed on tumor tissue with full coverage of common recurrent lung cancer driver genes including TP53, KRAS, KEAP1, and NFE2L2. We defined LR as tumor regrowth within the prescription dose radiotherapy volume. Our primary objective was to identify factors associated with LR in KEAP1/NFE2L2WT tumors. We performed RNA-seq on a subset of cases with available tissue using the SMARTer Stranded total RNA-seq Kit v2 (Takara Bio USA, Inc.). Statistical analysis was performed using R (version 3.6) with differential gene expression performed using ‘DESeq2’. All P-values were two-sided and considered significant at P<0.05 with adjustment for multiple hypothesis testing when appropriate. Results: We identified 139 consecutive patients with localized NSCLC who received tumor genotyping and were treated with CRT for stage IIB-IIIC NSCLC (n=58) or SABR for stage I-IIB NSCLC (n=81). 26 (18.7%) of these patients harbored KEAP1/NFE2L2WT tumors. Clinical factors such as tumor volume (P=0.18), histology (P=0.87), and radiation dose (P=0.3) were not associated with LR in this subset. Similarly, somatic mutation analysis did not reveal association of any recurrent driver mutations with LR in these KEAP1/NFE2L2WT tumors, including in TP53 (n=19; P=0.73) or KRAS (n=9; P=0.98). Tissue was available for RNA-seq analysis of 38 KEAP1/NFE2L2WT tumors, of which the majority were adenocarcinomas (n=25, 65.8%) and approximately half each received CRT (n=20, 52.6%) and SABR (n=18, 47.4%). Gene set enrichment analysis revealed a trend for association of LR with expression of hypoxia genes (P=0.07, Q=0.28). Similarly, a previously reported 10-gene radiation sensitivity index (RSI) was not associated with LR (P=0.34). Individual gene analysis identified KRT14 as being significantly less expressed in cases with LR (adjusted P=2.2e-9). In a validation cohort of 24 stage I-IIA KEAP1/NFE2L2WT patients from the TCGA who were treated with radiotherapy, those who died had lower expression of KRT14 than those who did not (P=0.0003). Conclusions: In summary, we identify low expression of KRT14, a squamous cell carcinoma differentiation gene, as a potential biomarker for increased risk of LR after definitive radiotherapy of KEAP1/NFE2L2WT NSCLC. Validation in larger cohorts and biological characterization will be required to determine if this biomarker could be useful for guiding precision radiotherapy approaches.
Citation Format: Michael S. Binkley, Young-Jun Jeon, Monica Nesselbush, Everett J. Moding, Barzin Nabet, Diego Almanza, Christopher Yoo, David M. Kurtz, Susie Grant Owen, Leah M. Backhus, Mark F. Berry, Joseph B. Shrager, Kavitha J. Ramchandran, Sukhmani K. Padda, Millie Das, Joel W. Neal, Heather A. Wakelee, Ash A. Alizadeh, Billy W. Loo, Maximilian Diehn. Investigating gene expression profiles associated with clinical radiation resistance in KEAP1/NFE2L2 wildtype lung cancer [abstract]. In: Proceedings of the AACR Virtual Special Conference on Radiation Science and Medicine; 2021 Mar 2-3. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(8_Suppl):Abstract nr PO-059.
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Affiliation(s)
| | | | | | | | - Barzin Nabet
- 3Department of Oncology Biomarker Development, Genentech, South San Francisco, CA
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Moding EJ, Liu Y, Hui AB, He J, Qiao Y, Xu T, Yao L, Gandhi S, Liao Z, Das M, Ramchandran KJ, Padda SK, Neal JW, Wakelee HA, Loo BW, Lin SH, Alizadeh AA, Diehn M. Abstract PO-069: Circulating tumor DNA kinetics to identify genomic predictors of rapid response to chemoradiation in non-small cell lung cancer. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.radsci21-po-069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
Introduction: Despite evidence that a subset of patients with locoregionally advanced non-small cell lung cancer (NSCLC) can be cured with radiation doses less than 60 Gy, there are currently no validated approaches to identify patients that could benefit from radiation dose de-escalation. Normal tissue changes including inflammation and fibrosis can be difficult to distinguish from residual disease on standard imaging during and following chemoradiation therapy (CRT), making assessment of treatment response and identification of favorable responders challenging. We hypothesized that circulating tumor DNA (ctDNA) kinetics during CRT could be used as a surrogate of response to identify genomic predictors of rapid response to treatment. Methods: We applied cancer personalized profiling by deep sequencing (CAPP-Seq) ctDNA analysis to 61 patients treated with CRT for Stage II-III NSCLC. We quantified ctDNA concentrations pre-CRT and a median of 21 days into CRT (mid-CRT) to determine the log-fold change in ctDNA concentration and identify “rapid responders.” The association between ctDNA log-fold change as a continuous variable with progression-free survival (PFS) was analyzed using univariable and multivariable regression, including gender, age, and stage as co-variables. The prevalence of driver gene single nucleotide variants in rapid responders versus slow responders was compared for each gene using Fisher’s exact tests with P-values adjusted using the Benjamini-Hochberg procedure. Results: Mid-CRT ctDNA log-fold change was significantly associated with progression-free survival as a continuous variable on both univariable (P=0.02) and multivariable analysis (P=0.03). Among patients whose ctDNA log-fold change was more negative than -2.15, 10/11 (91%) did not recur within the radiation field. We defined ctDNA rapid responders as the 10 patients with the largest decrease in ctDNA concentration mid-CRT without local progression. Compared with slow responders, ctDNA rapid responders had a trend towards more TP53 mutations (P=0.12), but no driver mutations were significantly enriched in rapid responders. Notably, mutations in common driver genes KEAP1, NFE2L2, KRAS, and EGFR were observed in 36% of slow responders and 0% of rapid responders (P=0.03). Conclusions: Our results suggest that ctDNA kinetics during CRT can identify patients responding favorably to treatment. Additional molecular characterization of ctDNA rapid responders may enable identification of patients who could benefit from treatment de-escalation.
Citation Format: Everett J. Moding, Yufei Liu, Angela B. Hui, Jianzhong He, Yawei Qiao, Ting Xu, Luyang Yao, Saumil Gandhi, Zhongxing Liao, Millie Das, Kavitha J. Ramchandran, Sukhmani K. Padda, Joel W. Neal, Heather A. Wakelee, Billy W. Loo, Steven H. Lin, Ash A. Alizadeh, Maximilian Diehn. Circulating tumor DNA kinetics to identify genomic predictors of rapid response to chemoradiation in non-small cell lung cancer [abstract]. In: Proceedings of the AACR Virtual Special Conference on Radiation Science and Medicine; 2021 Mar 2-3. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(8_Suppl):Abstract nr PO-069.
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Affiliation(s)
| | - Yufei Liu
- 2MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Ting Xu
- 2MD Anderson Cancer Center, Houston, TX
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White M, Neal J, Gardner R, Cunanan K, Das M, Padda S, Ramchandran K, Chen T, Wakelee H. 141P Chemotherapy with or without immunotherapy or bevacizumab for EGFR-mutated lung cancer after progression on osimertinib. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01983-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gogoi P, Das M, Begum P, Maji TK. Nature of sorption of trivalent arsenic on novel iron oxyhydroxide stabilized starch/OMMT composite: A mechanistic approach. J Water Health 2021; 19:336-350. [PMID: 33901028 DOI: 10.2166/wh.2021.267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Materials which are chemically, energetically and operationally acceptable for arsenic water treatment are highly required. In this study a hybrid material (SICC) of aminated starch, oxyhydroxide of iron and OMMT clay has been demonstrated for arsenic treatment. This new material was highly efficient in arsenic water treatment which could reduce arsenic concentration far below detection limits. All binding interactions during material preparation and arsenic sorption were exclusively characterized with FT-IR, XRD and other spectroscopic tools. A molecular modeling on the basis of density functional theory was carried out to verify the above findings. Influence of material dose, treatment time, initial ion concentration, varying temperatures, etc., on extent of sorption was studied in detail. The thermodynamic parameters viz. ΔG (>-11 kJ/mol), ΔH (42.48 kJ/mol), ΔS (177.6 JK-1 mol-1) and E a (59.16 kJ/mol) determined the feasibility of the process, its endothermic behavior and most importantly the chemical nature of the sorption accompanied by ion-exchange to some extent. The sorption followed a monolayer chemisorption pattern as determined by the Langmuir model (R2 = 0.973, R L = 0.081) with a qmax = 2.04 at 303 K. The binding of As(III) on the material was governed by a pseudo second order kinetic model.
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Affiliation(s)
- P Gogoi
- Department of Chemistry, Sipajhar College, Darrang, Assam 784145, India
| | - M Das
- Department of Chemical Sciences, Tezpur University, Assam 784028, India E-mail:
| | - P Begum
- Department of Chemistry, Gargaon College, Sivasagar, Assam 785686, India
| | - T K Maji
- Department of Chemical Sciences, Tezpur University, Assam 784028, India E-mail:
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Nesvet JC, Antilla KA, Pancirer DS, Lozano AX, Preiss JS, Ma W, Fu A, Park SM, Gambhir SS, Fan AC, Neal JW, Padda SK, Das M, Li T, Wakelee HA, Wang SX. Giant Magnetoresistive Nanosensor Analysis of Circulating Tumor DNA Epidermal Growth Factor Receptor Mutations for Diagnosis and Therapy Response Monitoring. Clin Chem 2021; 67:534-542. [PMID: 33393992 DOI: 10.1093/clinchem/hvaa307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/28/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Liquid biopsy circulating tumor DNA (ctDNA) mutational analysis holds great promises for precision medicine targeted therapy and more effective cancer management. However, its wide adoption is hampered by high cost and long turnaround time of sequencing assays, or by inadequate analytical sensitivity of existing portable nucleic acid tests to mutant allelic fraction in ctDNA. METHODS We developed a ctDNA Epidermal Growth Factor Receptor (EGFR) mutational assay using giant magnetoresistive (GMR) nanosensors. This assay was validated in 36 plasma samples of non-small cell lung cancer patients with known EGFR mutations. We assessed therapy response through follow-up blood draws, determined concordance between the GMR assay and radiographic response, and ascertained progression-free survival of patients. RESULTS The GMR assay achieved analytical sensitivities of 0.01% mutant allelic fraction. In clinical samples, the assay had 87.5% sensitivity (95% CI = 64.0-97.8%) for Exon19 deletion and 90% sensitivity (95% CI = 69.9-98.2%) for L858R mutation with 100% specificity; our assay detected T790M resistance with 96.3% specificity (95% CI = 81.7-99.8%) with 100% sensitivity. After 2 weeks of therapy, 10 patients showed disappearance of ctDNA by GMR (predicted responders), whereas 3 patients did not (predicted nonresponders). These predictions were 100% concordant with radiographic response. Kaplan-Meier analysis showed responders had significantly (P < 0.0001) longer PFS compared to nonresponders (N/A vs. 12 weeks, respectively). CONCLUSIONS The GMR assay has high diagnostic sensitivity and specificity and is well suited for detecting EGFR mutations at diagnosis and noninvasively monitoring treatment response at the point-of-care.
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Affiliation(s)
- Jared C Nesvet
- Department of Chemistry, Stanford University, Stanford, CA, USA
| | - Katie A Antilla
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
| | - Danielle S Pancirer
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Alexander X Lozano
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jordan S Preiss
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Weijie Ma
- Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis School of Medicine, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | | | - Seung-Min Park
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.,Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Sanjiv S Gambhir
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.,Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA.,Canary Center at Stanford for Cancer Early Detection, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Alice C Fan
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Joel W Neal
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA.,Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Sukhmani K Padda
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA.,Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Millie Das
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA.,Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.,VA Palo Alto Healthcare System, Department of Medicine, Palo Alto, CA, USA
| | - Tianhong Li
- Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis School of Medicine, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Heather A Wakelee
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA.,Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Shan X Wang
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA.,Canary Center at Stanford for Cancer Early Detection, Stanford University School of Medicine, Palo Alto, CA, USA.,Department of Electrical Engineering, Stanford University, Stanford, CA, USA
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Elsey H, Fieroze F, Shawon RA, Nasreen S, Hicks JP, Das M, Huque R, Hirano I, Wallace HJ, Saidur M. Understanding demand for, and feasibility of, centre-based child-care for poor urban households: a mixed methods study in Dhaka, Bangladesh. BMC Public Health 2020; 20:1899. [PMID: 33302914 PMCID: PMC7727228 DOI: 10.1186/s12889-020-09891-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/15/2020] [Indexed: 01/31/2023] Open
Abstract
Background Centre-based child-care has potential to provide multiple health and development benefits to children, families and societies. With rapid urbanisation, increasing numbers of low-income women work with reduced support from extended family, leaving a child-care vacuum in many low- and middle-income countries. We aimed to understand perceptions of, and demand for, centre-based child-care in Dhaka, Bangladesh among poor, urban households, and test the feasibility of delivering sustainable centre-based child-care. Methods We used sequential mixed methods including a household survey (n = 222) and qualitative interviews with care-givers (n = 16), community leaders (n = 5) and policy-makers (n = 5). We co-produced and piloted a centre-based child-care model over ten-months, documenting implementation. A co-design focus group with mothers, parents’ meetings, and qualitative interviews with child-care centre users (n = 5), non-users (n = 3), ex-users (n = 3) and staff (2) were used to refine the model and identify implementation issues. Results We found 24% (95% CI: 16,37%) of care-givers reported turning-down paid work due to lack of child-care and 84% (95% CI:74, 91%) reported wishing to use centre-based child-care and were willing to pay up to 283 Takka (~$3.30) per month. Adjusted odds of reported need for child-care among slum households were 3.8 times those of non-slum households (95% CI: 1.4, 10). Implementation highlighted that poor households needed free child-care with food provided, presenting feasibility challenges. Meta-inference across quantitative and qualitative findings identified the impact of the urban environment on child-care through long working hours, low social capital and fears for child safety. These influences interacted with religious and social norms resulting in caution in using centre-based child-care despite evident need. Conclusion Sustainable provision of centre-based care that focuses on early childhood development requires subsidy and careful design sensitive to the working lives of poor families, particularly women and must respond to the dynamics of the urban environment and community values. We recommend increased research and policy focus on the evaluation and scale-up of quality centre-based child-care, emphasising early-childhood development, to support low-income working families in urban areas.
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Affiliation(s)
- H Elsey
- Department of Health Sciences, University of York, Seebohm Rowntree Building, York, YO10 5DD, UK.
| | - F Fieroze
- ARK Foundation, Suite no C3, C4. House no. 6, Road no 109, Gulshan 2, Dhaka, 1212, Bangladesh
| | - R A Shawon
- Department of Public Health Sciences, Centre for Injury Prevention and Research Bangladesh (CIPRB), House # B-162, Road # 23, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - S Nasreen
- ARK Foundation, Suite no C3, C4. House no. 6, Road no 109, Gulshan 2, Dhaka, 1212, Bangladesh
| | - J P Hicks
- Nuffield Centre for International Health and Development, University of Leeds, Room 10.31, Level 10, Worsley Building, Leeds, LS2 9NL, UK
| | - M Das
- Nuffield Centre for International Health and Development, University of Leeds, Room 1029, Level 10, Worsley Building, Leeds, LS2 9NL, UK
| | - R Huque
- ARK Foundation, Suite no C3, C4. House no. 6, Road no 109, Gulshan 2, Dhaka, 1212, Bangladesh
| | - I Hirano
- Nuffield Centre for International Health and Development, University of Leeds, Worsley Building, Leeds, LS2 9NL, UK.,Present address: Japanese International Cooperation Agency, 5-25 Nibancho, Chiyoda City, Tokyo, 102-0084, Japan
| | - H J Wallace
- School of Medicine, University of Notre Dame Australia, 19 Mouat St, Fremantle, Western Australia, 6959, Australia
| | - M Saidur
- Department of Public Health Sciences, Centre for Injury Prevention and Research Bangladesh (CIPRB), House # B-162, Road # 23, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
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