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Akhtar D, Donaldson MA, Akhtar NH, Owen D, Gan S. A258 ROSAI-DORFMAN0-DESTOMBES DISEASE: A RARE CAUSE OF OBSTRUCTIVE JAUNDICE. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859387 DOI: 10.1093/jcag/gwab049.257] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Rosai-Dorfman-Destombes Disease (RDD) is rare histiocytic disorder that is most frequently seen in children and young adults. Gastrointestinal involvement is reported in <1% of cases and typically involves the small bowel and colon. Pancreatic and hepatic involvement has been previously reported but is extremely rare. Aims To describe a case of obstructive jaundice in the setting of a very rare histiocytic disorder known as RDD. Methods Case Report Results A 59-year old previously healthy male of Asian descent presented with obstructive jaundice. Initial imaging demonstrated intra and extrahepatic biliary duct dilation with concurrent diffuse enlargement of the pancreas compatible with autoimmune pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) was performed with stenting and biopsy. ERCP demonstrated a distal common bile duct stricture with biopsies suggestive of low grade reactive changes and inflammation. Subsequent endoscopic ultrasound (EUS) guided biopsy of the pancreas showed active and chronic inflammation, necrosis, and atrophic pancreatic tissue, with no definitive evidence of autoimmune pancreatitis (Figure 1). Ca-19-9 and IgG4 were normal. He was treated with a course of prednisone and responded well, with repeat CT imaging showing almost complete resolution of the previously demonstrated pancreatic changes. A diagnosis of autoimmune pancreatitis was made. He re-presented 6-months later, however, with fatigue and repeat imaging now displayed lymphadenopathy in the neck, chest, and abdomen, and a bulky pancreatic head with associated hepatomegaly. Lymph node excisional biopsy confirmed the diagnosis of RDD with the presence of scattered histiocytic cells showing emperipolesis with a low number of IgG4 positive cells (Figure 1). The patient was promptly initiated on prednisone and rituximab and has since then had excellent clinical response. Conclusions RDD is a rare non-Langerhans cell histiocytosis of unknown etiology that has a prevalence of 1:200 000. RDD clinically presents with painless bilateral cervical lymphadenopathy and can manifest with both nodal and extra nodal involvement. The most common sites of extra nodal disease are the skin and central nervous system, but rarely, can also present with pancreatic involvement. The use of fine needle guided biopsy in diagnosing RDD with extra nodal disease can be limited by low yield, sclerotic tissue, or non-diagnostic findings. For this reason, RDD with pancreatic involvement can masquerade as autoimmune pancreatitis, pancreatic malignancy and IgG4-related disease.This case report raises awareness about RDD with pancreatic and biliary involvement, a rare entity, that can present with obstructive jaundice. ![]()
Figure 1: Histological sections of lymph node(left) with hystiocytic cells showing emperipolesis(arrow) and pancreas(right) showing active and chronic inflamation, necrosis and atrophy Funding Agencies None
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Affiliation(s)
- D Akhtar
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - M A Donaldson
- The University of British Columbia Department of Medicine, Vancouver, BC, Canada
| | - N H Akhtar
- School of Medicine, University College Dublin, Dublin, Ireland
| | - D Owen
- The University of British Columbia Department of Medicine, Vancouver, BC, Canada
| | - S Gan
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
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Akhtar NH, Akhtar D, Tam L, Nimmo M, Donnellan F. A59 A RARE PRESENTATION OF COLLAGENOUS GASTRODUODENITIS WITH 10 YEAR FOLLOW UP. J Can Assoc Gastroenterol 2022. [DOI: 10.1093/jcag/gwab049.058] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Collagenous gastritis(CG) is a rare form of gastritis defined histologically by the presence of >10um of subepithelial surface collagen deposition. CG can further be categorized in childhood onset CG and adult onset CG. The prevalence of childhood CG is 2.1/100,000 in children aged younger than 18. Adult onset CG remains a rare entity. Here, we describe a rare presentation of collagenous gastroduodenitis in an adult patient and the interval progression over a 10 year period.
Aims
To increase awareness of a rare condition with limited data on available treatment modalities and clinical outcomes in adults.
Methods
Case Report
Results
A 35 year old female with no past medical history presented with worsening fatigue and increased shortness of breath with no overt gastrointestinal bleeding symptoms. There was no previous history of radiation exposure or family history of autoimmune disease. Laboratory investigations revealed iron deficiency anemia with a hemoglobin of 69 and a ferritin of 11. TTG serology and anti-parietal antibody was also negative. Esophagogastroduodenoscopy biopsies confirmed the diagnosis of collagenous gastritis localized to the gastric body with the presence of acute and chronic inflammatory changes. The patient was started on proton pump inhibitor therapy. In the interval period, the patient denies any new onset of gastrointestinal symptoms other than occasional heartburn. She remains iron deficient and requires regular iron infusions. Follow up endoscopy 10 years later now demonstrates diffuse mucosal abnormalities with a nodular contour involving the entire stomach and extending into the duodenal bulb. Biopsies showed features compatible with collagenous gastroduodenitis with active inflammation and pyloric metaplasia(Figure 1). There was atrophy of the stomach mucosa with no parietal cells identified and no endocrine hyperplasia. Immunostaining for Helicobacter pylori was negative. Flexible sigmoidoscopy was also performed revealing endoscopically normal colonic mucosa to the descending colon.
Conclusions
CG is a rare disease entity with unclear pathogenesis. Multiple case reports describe some association with autoimmune disease such as celiac disease. To date, no standard treatment has been identified for the management of CG. CG presents endoscopically with nodular changes, mucosal atrophy and collagen deposition. Over time, adult onset CG can progress to involve the entire stomach. Clinically, adult onset CG usually presents with a diarrhea predominant phenotype with associated collagenous colitis. Treatment modalities that have been trialed include PPI, corticosteroids, sucralfate, azathioprine,5-aminosalicylates, iron supplementation and hypoallergenic diets. Here we describe a rare presentation of collagenous gastroduodenitis and subsequent 10 year follow up in order to better understand this disease entity.
Funding Agencies
None
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Affiliation(s)
- N H Akhtar
- School of Medicine, University College Dublin, Dublin, Ireland
| | - D Akhtar
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - L Tam
- Internal Medicine, University of Saskatchewan, Regina, SK, Canada
| | - M Nimmo
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - F Donnellan
- Vancouver General Hospital, Vancouver, BC, Canada
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Buttar J, Akhtar NH, Akhtar D, Barker C, Bressler B, Atkinson K. A179 AUTOLOGOUS BONE MARROW TRANSPLANT FOR REFRACTORY CROHN’S DISEASE: A CASE SERIES. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859245 DOI: 10.1093/jcag/gwab049.178] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Crohn’s disease (CD), a form of inflammatory bowel disease (IBD) is a chronic, immune mediated condition characterized by gastrointestinal inflammation. Approximately 25% of CD patients have pharmacologically refractory disease, in which stem cell therapy has been shown to play a role.
Aims
A case series was performed to analyze the efficacy of autologous bone marrow transplantation (ABMT) for refractory CD in British Columbia(B.C).
Methods
A chart review was conducted on patients who had undergone ABMT for treatment refractory CD between 2001 to 2021 in B.C. Demographic, clinical, laboratory and endoscopic data was collected.
Results
Case details are summarized in Table 1. 3 patients(2 female and one male) were included. All patients failed conventional therapies prior to ABMT. 2 patients underwent surgical intervention (colectomy with ileostomy) prior to ABMT. Average time from diagnosis to ABMT was 8.83 + 6.6 years. All 3 patients received standard myeloablative therapy. There were no intestinal complications post ABMT. 6 months post-ABMT transplant, all 3 patients showed significant improvement, with CDAI scores <150. Endoscopic assessment post-ABMT revealed endoscopic remission in 2 of the 3 patients. 2 of the 3 patients were in clinical remission at 12 months follow up. 1 patient relapsed and required further immunosuppressive therapy. This patient was trialed on thalidomide at 15 months post-ABMT and ultimately passed away 18 months post-ABMT from an unrelated cause. 10 years post-transplant, the remaining 2 patients remain in clinical and endoscopic remission with CDAI scores <150.
Conclusions
Despite medical and surgical therapeutic advances, a subset of CD patients develop refractive disease associated with significant morbidity and mortality. In this population, there is increasing evidence in support of stem cell therapy as a treatment modality, with acute mortality less than 5% for patients with malignancy driven primarily by infectious complications and treatment-related toxicity. Clinical trials are currently underway to evaluate ABMT in CD. This case series presents the only Canadian data to date on the use of ABMT for refractory CDs and their subsequent follow up.
Funding Agencies
None
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Affiliation(s)
- J Buttar
- The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - N H Akhtar
- School of Medicine, University College Dublin, Dublin, Ireland
| | - D Akhtar
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - C Barker
- BC Children’s Hospital, Vancouver, BC, Canada
| | - B Bressler
- Pacific Gastroenterology Associates, Vancouver, BC, Canada
| | - K Atkinson
- Royal Columbian Hospital, New Westminster, BC, Canada
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Akhtar D, Donaldson MA, Akhtar NH, Yang H, Donnellan F. A136 A RARE CAUSE OF AUTOIMMUNE ATROPHIC PANGASTRITIS COMPLICATED WITH GASTRIC OUTLET OBSTRUCTION. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859241 DOI: 10.1093/jcag/gwab049.135] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Chronic gastritis comes in two well recognized forms: environmental, which is most commonly antral or multifocal in distribution and is typically caused by Helicobacter Pylori (HP) infection, and autoimmune gastritis(AIG), which affects the corpus and fundus. Presented here is a case of autoimmune atrophic pangastritis(AIAP). Aims To increase awareness of a rare condition with limited data on available treatment modalities. Methods Case Report Results A 68-year old female with autoimmune hypothyroidism, presented with weight loss and elevated anti-TTG serology. Index esophagogastroduodenoscopy (EGD) biopsies demonstrated chronic non-specific gastritis limited to the antrum. Strict gluten free diet adherence was initiated. Testing for HLA revealed HLADq2 and HLADq8 negativity but HLADq2.5 positivity. Subsequent EGD showed a markedly atrophic appearing gastric body. The corresponding biopsies demonstrated persistent moderately chronic active gastritis with severe atrophy now involving the body, fundus and antrum. The biopsies were negative for HP. Notably, there was a lack of ECL-cell hyperplasia and the number of antral G cells appeared decreased. Anti-parietal cell antibody serology was positive with a titre of 1:80. Despite combination therapy with budesonide and mesalamine and treatment for HP given persistent symptoms, the patient’s course was further complicated by gastric-outlet obstruction (GOO). Urgent EGD biopsies showed pyloric stenosis requiring dilation. Endoscopic Ultrasound (EUS) guided biopsies were negative for malignancy. The patient was started on corticosteroids and azathioprine(AZA). Most recently, an EGD on AZA, continued to demonstrate severe chronic active pangastritis now with intestinal metaplasia involving the body. Corticosteroid therapy was reinitiated with a plan to start mycophenolate mofetil (MMF). Conclusions AIAP is a rarely described entity, not well documented in the literature. An eight patient case series reported a distinctive form of atrophic gastritis that was independent of HP infection with the absence of neuroendocrine hyperplasia that involved the body and antrum. Thyroid disease, specifically Hashimoto thyroiditis is present in about 40% of patients with AIG. Additionally, AIG progression to atrophic gastritis with intestinal metaplasia confers an increased risk for gastric adenocarcinoma in more than 10% of patients. Limited literature exists regarding the management of AIAP. Pediatric data suggests the use of prednisone and/or azathioprine for AIAP. Furthermore, a recent case report of AIAP demonstrated clinical and endoscopic remission with MMF. Currently, no guidelines exist for the treatment, screening and monitoring of patients with AIAP. This case report presents a rare case of AIAP refractory to AZA complicated with GOO and adds to the little literature that exists. Funding Agencies None
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Affiliation(s)
- D Akhtar
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - M A Donaldson
- The University of British Columbia Department of Medicine, Vancouver, BC, Canada
| | - N H Akhtar
- School of Medicine, University College Dublin, Dublin, Ireland
| | - H Yang
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - F Donnellan
- Vancouver General Hospital, Vancouver, BC, Canada
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Diamond E, Molina AM, Carbonaro M, Akhtar NH, Giannakakou P, Tagawa ST, Nanus DM. Cytotoxic chemotherapy in the treatment of advanced renal cell carcinoma in the era of targeted therapy. Crit Rev Oncol Hematol 2015; 96:518-26. [PMID: 26321263 DOI: 10.1016/j.critrevonc.2015.08.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 01/28/2014] [Revised: 05/26/2015] [Accepted: 08/05/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Renal cell carcinoma (RCC) is a heterogeneous disease with regards to histology, progression, and response to treatment. Cytotoxic chemotherapy has been extensively studied in metastatic RCC (mRCC). Responses in most studies are modest and the mechanisms of resistance remain poorly understood. Targeted therapies have significantly improved outcomes in mRCC; however, most patients eventually relapse and die of their disease. Early clinical data suggest that combinations of chemotherapy and targeted agents are clinically active and are well tolerated. METHODS We reviewed the available literature for published clinical trials incorporating traditional chemotherapeutic agents in the treatment of mRCC. These papers were identified through a Medline search and were included if they employed at least one chemotherapeutic agent in the treatment of mRCC. The literature was also reviewed for information regarding mechanisms of chemotherapy resistance. RESULTS The data regarding the use of cytotoxic chemotherapy in mRCC consist of small, non-randomized phase I and II studies. The major response proportions with single agent chemotherapies are low but combination regimens either with other cytotoxic agents, cytokines, or targeted agents have demonstrated moderate activity. Disparate trial designs and lack of head to head clinical trials make it difficult to compare the efficacy of chemotherapy with that of immunotherapy or targeted agents. Chemotherapy is particularly useful in patients with collecting duct histology and predominantly sarcomatoid differentiation. Chemotherapy resistance may be mediated by overexpression of p-glycoprotein efflux pumps and the dysregulation of the microtubule-hypoxia inducible factor signaling axis. CONCLUSIONS The role of cytotoxic chemotherapy in the treatment for clear cell RCC remains poorly defined. Cytotoxic chemotherapy is considered a standard of care in patients with mRCC with predominantly sarcomatoid differentiation and collecting duct RCC variants (Motzer et al., 2014). Early trials combining chemotherapy with targeted therapies are generally well tolerated and show clinical activity. A better understanding of the biology of aggressive subsets of RCC and mechanisms of resistance will help elucidate the role of cytotoxic agents in the current treatment paradigm of RCC.
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Affiliation(s)
- E Diamond
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - A M Molina
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - M Carbonaro
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - N H Akhtar
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - P Giannakakou
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - S T Tagawa
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - D M Nanus
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
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6
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Akhtar NH, Nanus DM, Vallabhajosula S, Osborne J, Beltran H, Tyrell L, Nadeau K, Saran A, Mileo G, Goldsmith SJ, Bander NH, Tagawa ST. Radiolabeled anti–prostate-specific membrane antigen (PSMA) monoclonal antibody J591 for metastatic castration-resistant prostate cancer (CRPC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15186] [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: 11/20/2022] Open
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7
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Tagawa ST, Saran A, Akhtar NH, Goel S, Mileo G, Kung S, Beltran H, Milowsky MI, Mazumdar M, Wright JJ, Nanus DM. Final phase II results of NCI 6981: A phase I/II study of sorafenib (S) plus gemcitabine (GEM) and capecitabine (CAP) for advanced renal cell carcinoma (RCC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15165] [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: 11/20/2022] Open
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8
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Nanus DM, Tagawa ST, Dutcher JP, Akhtar NH, Saran A, Mazumdar M, Milowsky MI, Gudas LJ. NCI 6896: A phase I trial of suberoylanilide hydroxamic acid (SAHA) and 13-cis retinoic acid in the treatment of patients with advanced renal cell carcinoma (RCC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
349 Background: Retinoid resistance in RCC inversely correlates with levels of intracellular retinol and retinyl esters suggesting that increasing intracellular levels of all-trans retinoic acid (RA) or enabling RA to become a more potent initiator of transcription will improve RA mediated anti-tumor effects. The combination of all-trans RA and a histone deacetylase (HDAC) inhibitor inhibited renal cancer cell proliferation and tumor growth in a xenograft model more than either drug alone. We performed a phase I clinical trial to evaluate the safety and preliminary efficacy of combining the oral HDAC inhibitor SAHA (vorinostat) plus oral 13-cis RA (isotretinoin) in patients with advanced RCC. Secondary endpoints include analysis of peripheral blood samples to study the effects on retinoid metabolites and retinoid related genes. Methods: Patients (pts) with metastatic RCC (any histology) who have failed at least two lines of prior therapy were eligible. Vorinostat (300 mg bid x 3 consecutive days per week + isotretinoin co-administered at 0.25 mg/kg, 0.375 mg/kg, or 0.5 mg/kg PO bid x 3 days per week in cohorts using standard 3+3 dose escalation. Dose limiting toxicity (DLT) was defined as any grade > 3 toxicity during the first cycle. Results: 14 pts have enrolled on the trial of which 12 are evaluable for toxicity (6 cohort 1; 3 cohort 2; 3 cohort 3) and 11 for tumor response. Common grade 1-2 toxicities included fatigue and GI effects (nausea, diarrhea, anorexia). One pt on dose-level 1 experienced a DLT (grade 3 depression). One patient experienced a partial response and 10 patients had stable disease lasting a median of 4 months (range 2–10 mos). Three patients progressed with brain metastases in the setting of stable systemic disease for at least 6 months. Pharmacokinetic and correlative studies examining expression of retinoid related genes are ongoing. Conclusions: The recommended phase II dose is vorinostat (300 mg bid) + isoretinoin (0.5 mg/kg PO bid) 3 days per week. The combination of vorinostat and isotretinoin was well tolerated, and there was evidence of antitumor activity in this heavily pretreated population of patients with refractory metastatic RCC. [Table: see text]
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Affiliation(s)
- D. M. Nanus
- Weill Cornell Medical College, New York, NY; Montefiore Medical Center North Division, New York, NY; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S. T. Tagawa
- Weill Cornell Medical College, New York, NY; Montefiore Medical Center North Division, New York, NY; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J. P. Dutcher
- Weill Cornell Medical College, New York, NY; Montefiore Medical Center North Division, New York, NY; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - N. H. Akhtar
- Weill Cornell Medical College, New York, NY; Montefiore Medical Center North Division, New York, NY; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - A. Saran
- Weill Cornell Medical College, New York, NY; Montefiore Medical Center North Division, New York, NY; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - M. Mazumdar
- Weill Cornell Medical College, New York, NY; Montefiore Medical Center North Division, New York, NY; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - M. I. Milowsky
- Weill Cornell Medical College, New York, NY; Montefiore Medical Center North Division, New York, NY; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - L. J. Gudas
- Weill Cornell Medical College, New York, NY; Montefiore Medical Center North Division, New York, NY; Memorial Sloan-Kettering Cancer Center, New York, NY
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Akhtar NH, Nanus DM, Osborne J, Vallabhajosula S, Beltran H, Tyrell L, Nadeau K, Goldsmith SJ, Bander NH, Tagawa ST. Antiprostate-specific membrane antigen (PSMA)-based radioimmunotherapy: A combined analysis of radiolabeled-J591 studies. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.136] [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
136 Background: J591 is a monoclonal antibody which selectively binds the external domain of PSMA with high affinity. Two phase I trials of radiolabeled-J591 have been published; two additional studies have been completed. 90Y is a beta-emitting particle optimal for tumor lesions 28-42 mm in size; 177Lu is best suited for lesions 1-3 mm in diameter [O'Donoghue J Nuc Med 1995]. Methods: With WCMC IRB approval, long-term follow-up of 4 clinical trials and the ongoing studies was analyzed. Prospectively collected data were supplemented with retrospective additions when necessary. Median survival (OS) was calculated by Kaplan- Meier methodology. Results: Between 10/00 and 7/10, 132 pts with metastatic CRPC received radiolabeled J591 (103 received 177Lu-J591, 29 90Y-J591) with a median follow-up of 68.5 months (mo). Median age 70.3 yrs; all progressed after multiple lines of hormonal therapy, 41.7% received prior chemo, 48.5% received post-J591 chemo. Median Halabi nomogram score for the group was 146 (range 97- 196). OS for the entire group was 16.7 mo [95% CI 13.8, 19.7]. 26 (19.7%) experienced > 30% PSA decline, with OS of 22.4 mo (vs 13.6 mo for those with any PSA increase, p=0.08; p=0.006 at phase II doses). Pts receiving 177Lu-J591 had more 30% PSA declines than 90Y-J591 (21.3% vs 6.9%, p=0.06). 37.9% had measurable disease; those who received 90Y-J591 were more likely to have measurable response than 177Lu-J591 [p=0.04]. All objective tumor responses also had significant PSA declines. Of 15 pts with baseline and follow-up CTC counts (CellSearch methodology), 12 (80%) became or remained favorable at follow-up; 3 became or remained unfavorable. Conclusions: Radiolabled J591 is tolerable and efficacious. As predicted based upon their physical properties, 177Lu-J591 appears more effective for lower volume disease, with objective responses in larger volume disease only with 90Y-J591. Current trials utilizing 177Lu-J591 focus on predictive biomarkers, dose fractionation to improve tolerance and efficacy, combination with chemotherapy, and “salvage radioimmunotherapy” to delay the onset of metastases in men with progressive biochemical (micrometastatic) disease best suitable for 177Lu-J591. [Table: see text]
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Affiliation(s)
| | | | - J. Osborne
- Weill Cornell Medical College, New York, NY
| | | | - H. Beltran
- Weill Cornell Medical College, New York, NY
| | - L. Tyrell
- Weill Cornell Medical College, New York, NY
| | - K. Nadeau
- Weill Cornell Medical College, New York, NY
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