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Katz MHG, Petroni GR, Bauer T, Reilley MJ, Wolpin BM, Stucky CC, Bekaii-Saab TS, Elias R, Merchant N, Dias Costa A, Lenehan P, Cardot-Ruffino V, Rodig S, Pfaff K, Dougan SK, Nowak JA, Varadhachary GR, Slingluff CL, Rahma O. Multicenter randomized controlled trial of neoadjuvant chemoradiotherapy alone or in combination with pembrolizumab in patients with resectable or borderline resectable pancreatic adenocarcinoma. J Immunother Cancer 2023; 11:e007586. [PMID: 38040420 PMCID: PMC10693876 DOI: 10.1136/jitc-2023-007586] [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] [Accepted: 10/18/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is a challenging target for immunotherapy because it has an immunosuppressive tumor microenvironment. Neoadjuvant chemoradiotherapy can increase tumor-infiltrating lymphocyte (TIL) density, which may predict overall survival (OS). We hypothesized that adding programmed cell death protein 1 (PD-1) blockade to chemoradiotherapy would be well tolerated and increase TILs among patients with localized PDAC. METHODS Patients were randomized 2:1 to Arm A (receiving pembrolizumab plus chemoradiotherapy (capecitabine and external beam radiation)) or Arm B (receiving chemoradiotherapy alone) before anticipated pancreatectomy. Primary endpoints were (1) incidence and severity of adverse events during neoadjuvant therapy and (2) density of TILs in resected tumor specimens. TIL density was assessed using multiplexed immunofluorescence histologic examination. RESULTS Thirty-seven patients were randomized to Arms A (n=24) and B (n=13). Grade ≥3 adverse events related to neoadjuvant treatment were experienced by 9 (38%) and 4 (31%) patients in Arms A and B, respectively, with one patient experiencing dose-limiting toxicity in Arm A. Seventeen (71%) and 7 (54%) patients in Arms A and B, respectively, underwent pancreatectomy. Median CD8+ T-cell densities in Arms A and B were 67.4 (IQR: 39.2-141.8) and 37.9 (IQR: 22.9-173.4) cells/mm2, respectively. Arms showed no noticeable differences in density of CD8+Ki67+, CD4+, or CD4+FOXP3+ regulatory T cells; M1-like and M2-like macrophages; or granulocytes. Median OS durations were 27.8 (95% CI: 17.1 to NR) and 24.3 (95% CI: 12.6 to NR) months for Arms A and B, respectively. CONCLUSIONS Adding pembrolizumab to neoadjuvant chemoradiotherapy was safe. However, no convincing effect on CD8+ TILs was observed.
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Affiliation(s)
- Matthew H G Katz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gina R Petroni
- Division of Translational Research and Applied Statistics, Department of Public Health Sciences, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Todd Bauer
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Matthew J Reilley
- Division of Hematology and Oncology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Brian M Wolpin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Tanios S Bekaii-Saab
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Mayo Clin, Phoenix, Arizona, USA
| | - Rawad Elias
- Hartford HealthCare Cancer Institute, Plainville, Connecticut, USA
| | - Nipun Merchant
- Department of Surgery, University of Miami, Coral Gables, Florida, USA
| | - Andressa Dias Costa
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick Lenehan
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Immunology, Harvard Medical School, Boston, Massachusetts, USA
| | - Victoire Cardot-Ruffino
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Immunology, Harvard Medical School, Boston, Massachusetts, USA
| | - Scott Rodig
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Immunology, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen Pfaff
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stephanie K Dougan
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Immunology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan Andrew Nowak
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Immunology, Harvard Medical School, Boston, Massachusetts, USA
| | - Gauri R Varadhachary
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Craig L Slingluff
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Osama Rahma
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
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Qiang L, Hoffman MT, Ali LR, Castillo JI, Kageler L, Temesgen A, Lenehan P, Wang SJ, Bello E, Cardot-Ruffino V, Uribe GA, Yang A, Dougan M, Aguirre AJ, Raghavan S, Pelletier M, Cremasco V, Dougan SK. Transforming Growth Factor-β Blockade in Pancreatic Cancer Enhances Sensitivity to Combination Chemotherapy. Gastroenterology 2023; 165:874-890.e10. [PMID: 37263309 PMCID: PMC10526623 DOI: 10.1053/j.gastro.2023.05.038] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/30/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND & AIMS Transforming growth factor-b (TGFb) plays pleiotropic roles in pancreatic cancer, including promoting metastasis, attenuating CD8 T-cell activation, and enhancing myofibroblast differentiation and deposition of extracellular matrix. However, single-agent TGFb inhibition has shown limited efficacy against pancreatic cancer in mice or humans. METHODS We evaluated the TGFβ-blocking antibody NIS793 in combination with gemcitabine/nanoparticle (albumin-bound)-paclitaxel or FOLFIRINOX (folinic acid [FOL], 5-fluorouracil [F], irinotecan [IRI] and oxaliplatin [OX]) in orthotopic pancreatic cancer models. Single-cell RNA sequencing and immunofluorescence were used to evaluate changes in tumor cell state and the tumor microenvironment. RESULTS Blockade of TGFβ with chemotherapy reduced tumor burden in poorly immunogenic pancreatic cancer, without affecting the metastatic rate of cancer cells. Efficacy of combination therapy was not dependent on CD8 T cells, because response to TGFβ blockade was preserved in CD8-depleted or recombination activating gene 2 (RAG2-/-) mice. TGFβ blockade decreased total α-smooth muscle actin-positive fibroblasts but had minimal effect on fibroblast heterogeneity. Bulk RNA sequencing on tumor cells sorted ex vivo revealed that tumor cells treated with TGFβ blockade adopted a classical lineage consistent with enhanced chemosensitivity, and immunofluorescence for cleaved caspase 3 confirmed that TGFβ blockade increased chemotherapy-induced cell death in vivo. CONCLUSIONS TGFβ regulates pancreatic cancer cell plasticity between classical and basal cell states. TGFβ blockade in orthotropic models of pancreatic cancer enhances sensitivity to chemotherapy by promoting a classical malignant cell state. This study provides scientific rationale for evaluation of NIS793 with FOLFIRINOX or gemcitabine/nanoparticle (albumin-bound) paclitaxel chemotherapy backbone in the clinical setting and supports the concept of manipulating cancer cell plasticity to increase the efficacy of combination therapy regimens.
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Affiliation(s)
- Li Qiang
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Immunology, Harvard Medical School, Boston, Massachusetts
| | - Megan T Hoffman
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Immunology, Harvard Medical School, Boston, Massachusetts
| | - Lestat R Ali
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jaime I Castillo
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lauren Kageler
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Immunology, Harvard Medical School, Boston, Massachusetts
| | - Ayantu Temesgen
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Immunology, Harvard Medical School, Boston, Massachusetts
| | - Patrick Lenehan
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Immunology, Harvard Medical School, Boston, Massachusetts
| | - S Jennifer Wang
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Elisa Bello
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Victoire Cardot-Ruffino
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Immunology, Harvard Medical School, Boston, Massachusetts
| | - Giselle A Uribe
- Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Annan Yang
- Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Michael Dougan
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Andrew J Aguirre
- Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Srivatsan Raghavan
- Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Marc Pelletier
- Novartis Institute for Biomedical Research, Cambridge, Massachusetts
| | - Viviana Cremasco
- Novartis Institute for Biomedical Research, Cambridge, Massachusetts
| | - Stephanie K Dougan
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Immunology, Harvard Medical School, Boston, Massachusetts.
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Walsh MJ, Ali LR, Lenehan P, Kureshi CT, Kureshi R, Dougan M, Knipe DM, Dougan SK. Blockade of innate inflammatory cytokines TNF α, IL-1 β, or IL-6 overcomes virotherapy-induced cancer equilibrium to promote tumor regression. Immunother Adv 2023; 3:ltad011. [PMID: 37461742 PMCID: PMC10349916 DOI: 10.1093/immadv/ltad011] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/30/2023] [Indexed: 07/20/2023] Open
Abstract
Cancer therapeutics can lead to immune equilibrium in which the immune response controls tumor cell expansion without fully eliminating the cancer. The factors involved in this equilibrium remain incompletely understood, especially those that would antagonize the anti-tumor immune response and lead to tumor outgrowth. We previously demonstrated that continuous treatment with a non-replicating herpes simplex virus 1 expressing interleukin (IL)-12 induces a state of cancer immune equilibrium highly dependent on interferon-γ. We profiled the IL-12 virotherapy-induced immune equilibrium in murine melanoma, identifying blockade of innate inflammatory cytokines, tumor necrosis factor alpha (TNFα), IL-1β, or IL-6 as possible synergistic interventions. Antibody depletions of each of these cytokines enhanced survival in mice treated with IL-12 virotherapy and helped to overcome equilibrium in some tumors. Single-cell RNA-sequencing demonstrated that blockade of inflammatory cytokines resulted in downregulation of overlapping inflammatory pathways in macrophages, shifting immune equilibrium towards tumor clearance, and raising the possibility that TNFα blockade could synergize with existing cancer immunotherapies.
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Affiliation(s)
- Michael J Walsh
- Department of Microbiology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
- Harvard Program in Virology, Boston, MA, USA
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lestat R Ali
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Patrick Lenehan
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Immunology, Harvard Medical School, Boston, MA, USA
| | - Courtney T Kureshi
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Immunology, Harvard Medical School, Boston, MA, USA
| | - Rakeeb Kureshi
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Immunology, Harvard Medical School, Boston, MA, USA
| | - Michael Dougan
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - David M Knipe
- Department of Microbiology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Stephanie K Dougan
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Immunology, Harvard Medical School, Boston, MA, USA
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Walsh MJ, Stump CT, Kureshi R, Lenehan P, Ali LR, Dougan M, Knipe DM, Dougan SK. IFNγ is a central node of cancer immune equilibrium. Cell Rep 2023; 42:112219. [PMID: 36881506 PMCID: PMC10214249 DOI: 10.1016/j.celrep.2023.112219] [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: 09/22/2022] [Revised: 01/09/2023] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
Tumors in immune equilibrium are held in balance between outgrowth and destruction by the immune system. The equilibrium phase defines the duration of clinical remission and stable disease, and escape from equilibrium remains a major clinical problem. Using a non-replicating HSV-1 vector expressing interleukin-12 (d106S-IL12), we developed a mouse model of therapy-induced immune equilibrium, a phenomenon previously seen only in humans. This immune equilibrium was centrally reliant on interferon-γ (IFNγ). CD8+ T cell direct recognition of MHC class I, perforin/granzyme-mediated cytotoxicity, and extrinsic death receptor signaling such as Fas/FasL were all individually dispensable for equilibrium. IFNγ was critically important and played redundant roles in host and tumor cells such that IFNγ sensing in either compartment was sufficient for immune equilibrium. We propose that these redundant mechanisms of action are integrated by IFNγ to protect from oncogenic or chronic viral threats and establish IFNγ as a central node in therapy-induced immune equilibrium.
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Affiliation(s)
- Michael J Walsh
- Department of Microbiology, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA; Harvard Program in Virology, Boston, MA, USA; Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Courtney T Stump
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Immunology, Harvard Medical School, Boston, MA, USA
| | - Rakeeb Kureshi
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Department of Immunology, Harvard Medical School, Boston, MA, USA
| | - Patrick Lenehan
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Department of Immunology, Harvard Medical School, Boston, MA, USA
| | - Lestat R Ali
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Michael Dougan
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - David M Knipe
- Department of Microbiology, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA.
| | - Stephanie K Dougan
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Department of Immunology, Harvard Medical School, Boston, MA, USA.
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Qiang L, Ali L, Hoffman M, Silva JIC, Lenehan P, Bello E, Pelletier M, Cremasco V, Dougan S. Abstract C029: Chemotherapy backbone alters the mechanism of action of TGFb blockade in pancreatic cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.panca22-c029] [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: 11/17/2022]
Abstract
Abstract
TGFβ plays a critical role in promoting pancreatic tumor progression, attenuating CD8 T cell proliferation and cytokine production, enhancing the differentiation of myofibroblasts and the deposition of extracellular matrix. However, single agent TGFβ blockade has shown limited efficacy in mouse models of pancreatic cancer. Here we showed that in combination with chemotherapy, using either gemcitabine/n(ab)-paclitaxel or FOLFIRINOX, neutralization of TGFβ can reduce tumor burden in the poorly immunogenic 6694c2 orthotopic pancreatic cancer mouse model, without affecting the metastatic rate of cancer cells. As expected, anti-TGFβ with combination chemotherapy significantly increased the mean survival time of the orthotopic mouse models. Surprisingly, the efficacy of both combinational therapies is not dependent on CD8 T cells in either immunogenic or non-immunogenic models, as CD8 depleted or RAG2 knockout mice are responsive to the treatments to similar levels. Instead, comparing to chemotherapy single treatment, in the presence of TGFβ blocking antibody, tumor cells are more vulnerable to chemotherapy-induced cell death, both in vitro and in vivo. Recent studies from Raghavan et al. demonstrated that the plasticity of the classical and basal lineage of pancreatic cancer can be regulated by TGFβ ligand. Consistently, here we show that single-cell analysis and limited bulk RNAseq on tumor cells sorted ex vivo revealed 6694c2 tumor cells treated with TGFβ blockade maintain classical lineage, the state of pancreatic cancer with more sensitivity to chemotherapy and better prognosis. FOLFIRINOX treatments have largely modified tumor stromal landscape, with a unique CAF population presented expressing high levels of PTX3, which further verified by immunohistochemistry. This study provides the scientific rationale for the evaluation of TGFβ with both chemotherapy backbone in the clinical setting, as well as supports the concept of plasticity of pancreatic cancer cell state and plasticity of stromal cell landscape in tumors, providing foundations for future investigations on the mechanisms of TGFβ with different chemotherapy backbone in regulating the crosstalk among fibroblast subsets, immune cells and pancreatic cancer cells.
Citation Format: Li Qiang, Lestat Ali, Meggie Hoffman, Jaime Ivan Castillo Silva, Patrick Lenehan, Elisa Bello, Marc Pelletier, Viviana Cremasco, Stephanie Dougan. Chemotherapy backbone alters the mechanism of action of TGFb blockade in pancreatic cancer [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr C029.
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Affiliation(s)
- Li Qiang
- 1Dana-Farber Cancer Institute, Boston, MA
| | - Lestat Ali
- 1Dana-Farber Cancer Institute, Boston, MA
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Qiang L, Liu S, Ro G, Ali L, Lenehan P, Hambizer F, Dougan M, Dougan S. Abstract C082: Signaling pathways inducing tumoricidal phagocytosis in pancreatic cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.panca22-c082] [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: 11/17/2022]
Abstract
Abstract
Macrophages can be repolarized to promote tumor destruction, particularly by triggering tumoricidal phagocytosis of cancer cells. Despite the increasing interest in monoclonal antibody therapies targeting tumor antigens to drive cancer cell elimination via phagocidal macrophages, we still face tremendous challenges in developing adequate therapeutics due to lack of knowledge of the signaling pathways that induce phagocidal macrophages. Our previous work showed that cIAP1/2 antagonism and T cell derived cytokines promote anti-tumor immunity by reprogramming tumoricidal macrophages to phagocytose both live and dead tumor cells. Here we performed transcriptional analysis on both macrophages and tumor cells treated with cIAP1/2 antagonism or vehicle and identified candidate positive and negative regulators of phagocytosis. We are demonstrating how these receptors-ligand pairs on macrophages and tumor cells are induced and the mechanisms by which they effect tumor cell destruction. We also performed an in vitro CRISPR screen on tumor cells cocultured with macrophages, treated with cIAP1/2 antagonism or vehicle, recovered the DNA of phagocytosed tumor cells from within macrophages and compared to non-phagocytosed tumor cells to discover mediators of resistance or sensitivity to both baseline phagocytosis (efferocytosis) and cIAP1/2 antagonism induced phagocytosis.Our screen revealed a striking lack of dependence on MHC class I for tumors treated in vivo. Genes involved in phagocytosis resistance instead converged on regulation of the cytoskeleton and the tumor suppressor gene Stk11. This study will provide critical insights on tumoricidal macrophages, uncover the key pathways reprogramming these myeloid cells, and decipher the essential tumor-intrinsic pathways resulting in sensitivity and resistance to anti-tumor phagocytosis.
Citation Format: Li Qiang, Samantha Liu, Gabrielle Ro, Lestat Ali, Patrick Lenehan, Felix Hambizer, Michael Dougan, Stephanie Dougan. Signaling pathways inducing tumoricidal phagocytosis in pancreatic cancer [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr C082.
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Affiliation(s)
- Li Qiang
- 1Dana-Farber Cancer Institute, Boston, MA,
| | | | | | - Lestat Ali
- 1Dana-Farber Cancer Institute, Boston, MA,
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Walsh M, Ali L, Stump C, Lenehan P, Dougan M, Knipe D, Dougan S. IFNγ from IL-12 virotherapy stably controls tumors independent of T cell cytotoxicity and IFNγ sensing by tumor cells. The Journal of Immunology 2022. [DOI: 10.4049/jimmunol.208.supp.118.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Although some work has been done to understand the equilibrium phase of cancer immunoediting, it is still common for immunotherapies to generate stable disease or for patients to relapse after being seemingly tumor-free. We have repurposed the non-lytic herpes simplex virus (HSV)-1 d106S vaccine vector for local delivery of IL-12. Our replication-defective d106S virus releases a large burst of IL-12 locally within the tumor environment, synergizing with a type I IFN response induced by the virus. We have shown that d106S-IL12 induces regression and long-term stable immune equilibrium in murine B16 melanoma. Intriguingly, individual depletion of CD8+ T cells, CD4+ T cells, or NK cells does not affect stable tumor control. However, triple depletion of these cell types leads to tumor outgrowth suggesting these cells have redundant functions. Indeed, IFNγ, likely secreted by these lymphocytes, is essential for controlling tumors in response to d106S-IL12 treatment. The inability of tumors to respond to IFNγ and present antigen to CD8+ T cells through MHC-I often renders tumors resistant to checkpoint blockade and other immunotherapies reliant on direct T cell cytotoxicity. Surprisingly, B16 tumors defective in IFNγ-sensing or MHC-I presentation are still stably maintained in response to IL-12 virotherapy. This suggests that while IFNγ secretion by lymphocytes is necessary, IFNγ and the lymphocytes themselves are not required to act directly on cancer cells to stably control tumor growth. Single-cell RNA-sequencing of immune cells infiltrating the tumor indicates that IFNγ is primarily acting on myeloid cells. Thus, myeloid cells activated by IFNγ may be a method to control growth of checkpoint blockade-resistant tumors.
Supported by grants from NIH (P01-AI098681) and Melanoma Research Alliance
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Affiliation(s)
- Michael Walsh
- 1Harvard Medical School
- 2Department of Cancer Immunology and Virology, Dana Farber Cancer Institute
| | - Lestat Ali
- 2Department of Cancer Immunology and Virology, Dana Farber Cancer Institute
| | - Courtney Stump
- 2Department of Cancer Immunology and Virology, Dana Farber Cancer Institute
| | - Patrick Lenehan
- 2Department of Cancer Immunology and Virology, Dana Farber Cancer Institute
| | | | | | - Stephanie Dougan
- 2Department of Cancer Immunology and Virology, Dana Farber Cancer Institute
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Corchado-Garcia J, Zemmour D, Hughes T, Bandi H, Cristea-Platon T, Lenehan P, Pawlowski C, Bade S, O’Horo JC, Gores GJ, Williams AW, Badley AD, Halamka J, Virk A, Swift MD, Wagner T, Soundararajan V. Analysis of the Effectiveness of the Ad26.COV2.S Adenoviral Vector Vaccine for Preventing COVID-19. JAMA Netw Open 2021; 4:e2132540. [PMID: 34726743 PMCID: PMC8564583 DOI: 10.1001/jamanetworkopen.2021.32540] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Continuous assessment of the effectiveness and safety of the US Food and Drug Administration-authorized SARS-CoV-2 vaccines is critical to amplify transparency, build public trust, and ultimately improve overall health outcomes. OBJECTIVE To evaluate the effectiveness of the Johnson & Johnson Ad26.COV2.S vaccine for preventing SARS-CoV-2 infection. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness research study used large-scale longitudinal curation of electronic health records from the multistate Mayo Clinic Health System (Minnesota, Arizona, Florida, Wisconsin, and Iowa) to identify vaccinated and unvaccinated adults between February 27 and July 22, 2021. The unvaccinated cohort was matched on a propensity score derived from age, sex, zip code, race, ethnicity, and previous number of SARS-CoV-2 polymerase chain reaction tests. The final study cohort consisted of 8889 patients in the vaccinated group and 88 898 unvaccinated matched patients. EXPOSURE Single dose of the Ad26.COV2.S vaccine. MAIN OUTCOMES AND MEASURES The incidence rate ratio of SARS-CoV-2 infection in the vaccinated vs unvaccinated control cohorts, measured by SARS-CoV-2 polymerase chain reaction testing. RESULTS The study was composed of 8889 vaccinated patients (4491 men [50.5%]; mean [SD] age, 52.4 [16.9] years) and 88 898 unvaccinated patients (44 748 men [50.3%]; mean [SD] age, 51.7 [16.7] years). The incidence rate ratio of SARS-CoV-2 infection in the vaccinated vs unvaccinated control cohorts was 0.26 (95% CI, 0.20-0.34) (60 of 8889 vaccinated patients vs 2236 of 88 898 unvaccinated individuals), which corresponds to an effectiveness of 73.6% (95% CI, 65.9%-79.9%) and a 3.73-fold reduction in SARS-CoV-2 infections. CONCLUSIONS AND RELEVANCE This study's findings are consistent with the clinical trial-reported efficacy of Ad26.COV2.S and the first retrospective analysis, suggesting that the vaccine is effective at reducing SARS-CoV-2 infection, even with the spread of variants such as Alpha or Delta that were not present in the original studies, and reaffirm the urgent need to continue mass vaccination efforts globally.
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Affiliation(s)
| | | | | | | | | | | | | | - Sairam Bade
- nference Labs, Murgesh Pallya, Bengaluru, Karnataka, India
| | - John C. O’Horo
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gregory J. Gores
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Amy W. Williams
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Andrew D. Badley
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - John Halamka
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Abinash Virk
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Melanie D. Swift
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Venky Soundararajan
- nference, Cambridge, Massachusetts
- nference Labs, Murgesh Pallya, Bengaluru, Karnataka, India
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Pawlowski C, Rincón-Hekking J, Awasthi S, Pandey V, Lenehan P, Venkatakrishnan AJ, Bade S, O'Horo JC, Virk A, Swift MD, Williams AW, Gores GJ, Badley AD, Halamka J, Soundararajan V. Cerebral Venous Sinus Thrombosis is not Significantly Linked to COVID-19 Vaccines or Non-COVID Vaccines in a Large Multi-State Health System. J Stroke Cerebrovasc Dis 2021; 30:105923. [PMID: 34627592 PMCID: PMC8494567 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105923] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 05/10/2021] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To assess the association of COVID-19 vaccines and non-COVID-19 vaccines with cerebral venous sinus thrombosis (CVST). Materials and method We retrospectively analyzed a cohort of 771,805 vaccination events across 266,094 patients in the Mayo Clinic Health System between 01/01/2017 and 03/15/2021. The primary outcome was a positive diagnosis of CVST, identified either by the presence of a corresponding ICD code or by an NLP algorithm which detected positive diagnosis of CVST within free-text clinical notes. For each vaccine we calculated the relative risk by dividing the incidence of CVST in the 30 days following vaccination to that in the 30 days preceding vaccination. Results We identified vaccination events for all FDA-approved COVID-19 vaccines including Pfizer-BioNTech (n = 94,818 doses), Moderna (n = 36,350 doses) and Johnson & Johnson - J&J (n = 1,745 doses). We also identified vaccinations events for 10 common FDA-approved non-COVID-19 vaccines (n = 771,805 doses). There was no statistically significant difference in the incidence rate of CVST in 30-days before and after vaccination for any vaccine in this population. We further found the baseline CVST incidence in the study population between 2017 and 2021 to be 45 to 98 per million patient years. Conclusions This real-world evidence-based study finds that CVST is rare and is not significantly associated with COVID-19 vaccination in our patient cohort. Limitations include the rarity of CVST in our dataset, a relatively small number of J&J COVID-19 vaccination events, and the use of a population drawn from recipients of a SARS-CoV-2 PCR test in a single health system.
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Affiliation(s)
- Colin Pawlowski
- nference, inc., One Main Street, Suite 400, East Arcade, Cambridge, MA 02142, USA
| | - John Rincón-Hekking
- nference, inc., One Main Street, Suite 400, East Arcade, Cambridge, MA 02142, USA
| | - Samir Awasthi
- nference, inc., One Main Street, Suite 400, East Arcade, Cambridge, MA 02142, USA
| | - Viral Pandey
- nference, inc., One Main Street, Suite 400, East Arcade, Cambridge, MA 02142, USA
| | - Patrick Lenehan
- nference, inc., One Main Street, Suite 400, East Arcade, Cambridge, MA 02142, USA
| | - A J Venkatakrishnan
- nference, inc., One Main Street, Suite 400, East Arcade, Cambridge, MA 02142, USA
| | - Sairam Bade
- nference Labs, 2nd Floor, 22 3rd Cross Rd, Murgesh Pallya, Bengaluru, India
| | | | | | | | | | | | | | | | - Venky Soundararajan
- nference, inc., One Main Street, Suite 400, East Arcade, Cambridge, MA 02142, USA; nference Labs, 2nd Floor, 22 3rd Cross Rd, Murgesh Pallya, Bengaluru, India.
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10
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Razonable RR, Pawlowski C, O'Horo JC, Arndt LL, Arndt R, Bierle DM, Borgen MD, Hanson SN, Hedin MC, Lenehan P, Puranik A, Seville MT, Speicher LL, Tulledge-Scheitel SM, Venkatakrishnan AJ, Wilker CG, Badley AD, Ganesh R. Casirivimab-Imdevimab treatment is associated with reduced rates of hospitalization among high-risk patients with mild to moderate coronavirus disease-19. EClinicalMedicine 2021; 40:101102. [PMID: 34485873 PMCID: PMC8404031 DOI: 10.1016/j.eclinm.2021.101102] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Real-world clinical data to support the use of casirivimab-imdevimab for the treatment of outpatients with mild to moderate coronavirus disease-19 (COVID-19) is needed. This study aimed to assess the outcomes of casirivimab-imdevimab treatment of mild to moderate COVID-19. METHODS A retrospective cohort of 696 patients who received casirivimab-imdevimab between December 4, 2020 and April 9, 2021 was compared to a propensity-matched control of 696 untreated patients with mild to moderate COVID-19 at Mayo Clinic sites in Arizona, Florida, Minnesota, and Wisconsin. Primary outcome was rate of hospitalization at days 14, 21 and 28 after infusion. FINDINGS The median age of the antibody-treated cohort was 63 years (interquartile range, 52-71); 45·5% were ≥65 years old; 51.4% were female. High-risk characteristics were hypertension (52.4%), body mass index ≥35 (31.0%), diabetes mellitus (24.6%), chronic lung disease (22.1%), chronic renal disease (11.4%), congestive heart failure (6.6%), and compromised immune function (6.7%). Compared to the propensity-matched untreated control, patients who received casirivimab-imdevimab had significantly lower all-cause hospitalization rates at day 14 (1.3% vs 3.3%; Absolute Difference: 2.0%; 95% confidence interval (CI): 0.5-3.7%), day 21 (1.3% vs 4.2%; Absolute Difference: 2.9%; 95% CI: 1.2-4.7%), and day 28 (1.6% vs 4.8%; Absolute Difference: 3.2%; 95% CI: 1.4-5.1%). Rates of intensive care unit admission and mortality at days 14, 21 and 28 were similarly low for antibody-treated and untreated groups. INTERPRETATION Among high-risk patients with mild to moderate COVID-19, casirivimab-imdevimab treatment was associated with a significantly lower rate of hospitalization. FUNDING Mayo Clinic.
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Affiliation(s)
| | | | | | - Lori L. Arndt
- Mayo Clinic Health System, Eau Claire, WI, United States
| | - Richard Arndt
- Mayo Clinic Health System, Eau Claire, WI, United States
| | | | | | | | | | | | | | | | | | | | | | - Caroline G. Wilker
- Mayo Clinic Health System Franciscan Healthcare, La Crosse, WI, United States
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11
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Heckler M, Ali LR, Clancy-Thompson E, Qiang L, Ventre KS, Lenehan P, Roehle K, Luoma A, Boelaars K, Peters V, McCreary J, Boschert T, Wang ES, Suo S, Marangoni F, Mempel TR, Long HW, Wucherpfennig KW, Dougan M, Gray NS, Yuan GC, Goel S, Tolaney SM, Dougan SK. Inhibition of CDK4/6 Promotes CD8 T-cell Memory Formation. Cancer Discov 2021; 11:2564-2581. [PMID: 33941591 PMCID: PMC8487897 DOI: 10.1158/2159-8290.cd-20-1540] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [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: 10/23/2020] [Revised: 03/25/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022]
Abstract
CDK4/6 inhibitors are approved to treat breast cancer and are in trials for other malignancies. We examined CDK4/6 inhibition in mouse and human CD8+ T cells during early stages of activation. Mice receiving tumor-specific CD8+ T cells treated with CDK4/6 inhibitors displayed increased T-cell persistence and immunologic memory. CDK4/6 inhibition upregulated MXD4, a negative regulator of MYC, in both mouse and human CD8+ T cells. Silencing of Mxd4 or Myc in mouse CD8+ T cells demonstrated the importance of this axis for memory formation. We used single-cell transcriptional profiling and T-cell receptor clonotype tracking to evaluate recently activated human CD8+ T cells in patients with breast cancer before and during treatment with either palbociclib or abemaciclib. CDK4/6 inhibitor therapy in humans increases the frequency of CD8+ memory precursors and downregulates their expression of MYC target genes, suggesting that CDK4/6 inhibitors in patients with cancer may augment long-term protective immunity. SIGNIFICANCE: CDK4/6 inhibition skews newly activated CD8+ T cells toward a memory phenotype in mice and humans with breast cancer. CDK4/6 inhibitors may have broad utility outside breast cancer, particularly in the neoadjuvant setting to augment CD8+ T-cell priming to tumor antigens prior to dosing with checkpoint blockade.This article is highlighted in the In This Issue feature, p. 2355.
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Affiliation(s)
- Max Heckler
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Immunology, Harvard Medical School, Boston, Massachusetts
| | - Lestat R Ali
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Immunology, Harvard Medical School, Boston, Massachusetts
| | - Eleanor Clancy-Thompson
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Immunology, Harvard Medical School, Boston, Massachusetts
| | - Li Qiang
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Immunology, Harvard Medical School, Boston, Massachusetts
| | - Katherine S Ventre
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Patrick Lenehan
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Immunology, Harvard Medical School, Boston, Massachusetts
| | - Kevin Roehle
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Immunology, Harvard Medical School, Boston, Massachusetts
| | - Adrienne Luoma
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Immunology, Harvard Medical School, Boston, Massachusetts
| | - Kelly Boelaars
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Vera Peters
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Julia McCreary
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Program in Chemical Biology, Harvard Medical School, Boston, Massachusetts
| | - Tamara Boschert
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Eric S Wang
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Shengbao Suo
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Francesco Marangoni
- Department of Medicine, Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - Thorsten R Mempel
- Department of Medicine, Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - Henry W Long
- Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kai W Wucherpfennig
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Immunology, Harvard Medical School, Boston, Massachusetts
| | - Michael Dougan
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Nathanael S Gray
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Guo-Cheng Yuan
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Genetics and Genomic Sciences, The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shom Goel
- Peter MacCallum Cancer Centre, Melbourne, Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Sara M Tolaney
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Stephanie K Dougan
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts.
- Department of Immunology, Harvard Medical School, Boston, Massachusetts
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12
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McMurry R, Lenehan P, Awasthi S, Silvert E, Puranik A, Pawlowski C, Venkatakrishnan AJ, Anand P, Agarwal V, O'Horo JC, Gores GJ, Williams AW, Badley AD, Halamka J, Virk A, Swift MD, Carlson K, Doddahonnaiah D, Metzger A, Kayal N, Berner G, Ramudu E, Carpenter C, Wagner T, Rajasekharan A, Soundararajan V. Real-time analysis of a mass vaccination effort confirms the safety of FDA-authorized mRNA COVID-19 vaccines. Med (N Y) 2021; 2:965-978.e5. [PMID: 34230920 PMCID: PMC8248717 DOI: 10.1016/j.medj.2021.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/04/2021] [Accepted: 06/15/2021] [Indexed: 02/04/2023]
Abstract
Background As the coronavirus disease 2019 (COVID-19) vaccination campaign unfolds, it is important to continuously assess the real-world safety of Food and Drug Administration (FDA)-authorized vaccines. Curation of large-scale electronic health records (EHRs) enables near-real-time safety evaluations that were not previously possible. Methods In this retrospective study, we deployed deep neural networks over a large EHR system to automatically curate the adverse effects mentioned by physicians in over 1.2 million clinical notes between December 1, 2020 and April 20, 2021. We compared notes from 68,266 individuals who received at least one dose of BNT162b2 (n = 51,795) or mRNA-1273 (n = 16,471) to notes from 68,266 unvaccinated individuals who were matched by demographic, geographic, and clinical features. Findings Individuals vaccinated with BNT162b2 or mRNA-1273 had a higher rate of return to the clinic, but not the emergency department, after both doses compared to unvaccinated controls. The most frequently documented adverse effects within 7 days of each vaccine dose included myalgia, headache, and fatigue, but the rates of EHR documentation for each side effect were remarkably low compared to those derived from active solicitation during clinical trials. Severe events, including anaphylaxis, facial paralysis, and cerebral venous sinus thrombosis, were rare and occurred at similar frequencies in vaccinated and unvaccinated individuals. Conclusions This analysis of vaccine-related adverse effects from over 1.2 million EHR notes of more than 130,000 individuals reaffirms the safety and tolerability of the FDA-authorized mRNA COVID-19 vaccines in practice. Funding This study was funded by nference. This is a study of the mRNA COVID-19 vaccines developed by Pfizer/BioNTech and Moderna. Although these vaccines have been shown to be safe and tolerated in clinical trials, it is important to confirm their safety profiles in practice. The results from this study show that individuals receiving these vaccines are likely to experience muscle and joint soreness, but they are not more likely to seek out emergent clinical care or experience severe medical events than unvaccinated individuals. As one of the largest real-world safety studies of COVID-19 vaccines to date, these data reinforce that we should continue expanding efforts to deliver more vaccines with high confidence in their safety.
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Affiliation(s)
- Reid McMurry
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | - Patrick Lenehan
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | - Samir Awasthi
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | - Eli Silvert
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | - Arjun Puranik
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | - Colin Pawlowski
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | | | - Praveen Anand
- nference Labs, 2nd Floor, 22 3rd Cross Rd, Murgesh Pallya, Bengaluru, Karnataka 560017, India
| | - Vineet Agarwal
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | | | | | | | | | | | | | | | - Katie Carlson
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | | | - Anna Metzger
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | - Nikhil Kayal
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | - Gabi Berner
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | - Eshwan Ramudu
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | | | - Tyler Wagner
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
| | | | - Venky Soundararajan
- nference, One Main Street, East Arcade, Cambridge, MA 02142, USA
- nference Labs, 2nd Floor, 22 3rd Cross Rd, Murgesh Pallya, Bengaluru, Karnataka 560017, India
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13
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Ganesh R, Pawlowski C, O'Horo JC, Arndt LL, Arndt R, Bell SJ, Bierle DM, Borgen MD, Hanson SN, Heyliger A, Larsen JJ, Lenehan P, Orenstein R, Puranik A, Speicher LL, Tulledge-Scheitel SM, Venkatakrishnan AJ, Wilker CG, Badley AD, Razonable RR. Association of Intravenous Bamlanivimab Use with Reduced Hospitalization, Intensive Care Unit Admission, and Mortality in Patients with Mild to Moderate COVID-19. medRxiv 2021:2021.05.23.21257670. [PMID: 34075387 PMCID: PMC8168391 DOI: 10.1101/2021.05.23.21257670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Clinical data to support the use of bamlanivimab for the treatment of outpatients with mild to moderate coronavirus disease-19 (COVID-19) is needed. METHODS 2,335 patients who received single-dose bamlanivimab infusion between November 12, 2020 to February 17, 2021 were compared with a propensity-matched control of 2,335 untreated patients with mild to moderate COVID-19 at Mayo Clinic facilities across 4 states. The primary outcome was the rate of hospitalization at days 14, 21 and 28. RESULTS The median age of the population was 63; 47.3% of the bamlanivimab-treated cohort were ≥65 years; 49.3% were female. High-risk characteristics included hypertension (54.2%), body mass index ≥35 (32.4%), diabetes mellitus (26.5%), chronic lung disease (25.1%), malignancy (16.6%), and renal disease (14.5%). Patients who received bamlanivimab had lower all-cause hospitalization rates at days 14 (1.5% vs 3.5%; Odds Ratio [OR], 0.38), 21 (1.9% vs 3.9%; OR, 0.46), and 28 (2.5% vs 3.9%; OR, 0.61). Secondary exploratory outcomes included lower intensive care unit admission rates at days 14 (0.14% vs 1%; OR, 0.12), 21 (0.25% vs 1%; OR: 0.24) and 28 (0.56% vs 1.1%; OR: 0.52), and lower all-cause mortality at days 14 (0% vs 0.33%), 21 (0.05% vs 0.4%; OR,0.08) and 28 (0.11% vs 0.44%; OR, 0.01). Adverse events were uncommon with bamlanivimab, occurring in 19/2355, most commonly fever (n=6), nausea (n=5), and lightheadedness (n=3). CONCLUSIONS Among high-risk patients with mild to moderate COVID-19, treatment with bamlanivimab was associated with a statistically significant lower rate of hospitalization compared with usual care. FUNDING Mayo Clinic.
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14
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Roehle K, Qiang L, Ventre KS, Heid D, Ali LR, Lenehan P, Heckler M, Crowley SJ, Stump CT, Ro G, Godicelj A, Bhuiyan AM, Yang A, Quiles Del Rey M, Biary T, Luoma AM, Bruck PT, Tegethoff JF, Nopper SL, Li J, Byrne KT, Pelletier M, Wucherpfennig KW, Stanger BZ, Akin JJ, Mancias JD, Agudo J, Dougan M, Dougan SK. cIAP1/2 antagonism eliminates MHC class I-negative tumors through T cell-dependent reprogramming of mononuclear phagocytes. Sci Transl Med 2021; 13:eabf5058. [PMID: 34011631 PMCID: PMC8406785 DOI: 10.1126/scitranslmed.abf5058] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 10/30/2020] [Revised: 02/23/2021] [Accepted: 04/26/2021] [Indexed: 01/19/2023]
Abstract
Loss of major histocompatibility complex (MHC) class I and interferon-γ (IFN-γ) sensing are major causes of primary and acquired resistance to checkpoint blockade immunotherapy. Thus, additional treatment options are needed for tumors that lose expression of MHC class I. The cellular inhibitor of apoptosis proteins 1 and 2 (cIAP1/2) regulate classical and alternative nuclear factor κB (NF-κB) signaling. Induction of noncanonical NF-κB signaling with cIAP1/2 antagonists mimics costimulatory signaling, augmenting antitumor immunity. We show that induction of noncanonical NF-κB signaling induces T cell-dependent immune responses, even in β2-microglobulin (β2M)-deficient tumors, demonstrating that direct CD8 T cell recognition of tumor cell-expressed MHC class I is not required. Instead, T cell-produced lymphotoxin reprograms both mouse and human macrophages to be tumoricidal. In wild-type mice, but not mice incapable of antigen-specific T cell responses, cIAP1/2 antagonism reduces tumor burden by increasing phagocytosis of live tumor cells. Efficacy is augmented by combination with CD47 blockade. Thus, activation of noncanonical NF-κB stimulates a T cell-macrophage axis that curtails growth of tumors that are resistant to checkpoint blockade because of loss of MHC class I or IFN-γ sensing. These findings provide a potential mechanism for controlling checkpoint blockade refractory tumors.
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Affiliation(s)
- Kevin Roehle
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Immunology, Harvard Medical School, Boston, MA 02115, USA
| | - Li Qiang
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Immunology, Harvard Medical School, Boston, MA 02115, USA
| | - Katherine S Ventre
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Daniel Heid
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Immunology, Harvard Medical School, Boston, MA 02115, USA
| | - Lestat R Ali
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Immunology, Harvard Medical School, Boston, MA 02115, USA
| | - Patrick Lenehan
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Immunology, Harvard Medical School, Boston, MA 02115, USA
| | - Max Heckler
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Immunology, Harvard Medical School, Boston, MA 02115, USA
| | - Stephanie J Crowley
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Courtney T Stump
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Gabrielle Ro
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Anže Godicelj
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Immunology, Harvard Medical School, Boston, MA 02115, USA
| | - Aladdin M Bhuiyan
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Annan Yang
- Division of Radiation and Genome Stability, Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Maria Quiles Del Rey
- Division of Radiation and Genome Stability, Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Tamara Biary
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Adrienne M Luoma
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Immunology, Harvard Medical School, Boston, MA 02115, USA
| | - Patrick T Bruck
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Jana F Tegethoff
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Svenja L Nopper
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Jinyang Li
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Katelyn T Byrne
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Marc Pelletier
- Novartis Institute for Biomedical Research, Cambridge, MA 02139, USA
| | - Kai W Wucherpfennig
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Immunology, Harvard Medical School, Boston, MA 02115, USA
| | - Ben Z Stanger
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - James J Akin
- Novartis Institute for Biomedical Research, Cambridge, MA 02139, USA
| | - Joseph D Mancias
- Division of Radiation and Genome Stability, Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Judith Agudo
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Immunology, Harvard Medical School, Boston, MA 02115, USA
| | - Michael Dougan
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Stephanie K Dougan
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.
- Department of Immunology, Harvard Medical School, Boston, MA 02115, USA
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15
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Walsh M, Lenehan P, Ali L, Dougan M, Knipe D, Dougan SK. Virally delivered cytokine therapy drives immune equilibrium in melanoma. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.90.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Although a modified, replicating herpes simplex virus (HSV) encoding GM-CSF was FDA-approved for the treatment of melanoma (T-VEC), which was revolutionary for the field of oncolytic virotherapy, there are several areas for improvement. First, the live virus cannot be safely administered to immunocompromised patients. Second, GM-CSF induces immune-suppressive myeloid cells and is likely not the optimal insert. To this end, our lab has used a non-replicating HSV virus, termed d106S, to serve as a safe viral vector for the treatment of cancers. We have repurposed the non-lytic HSV-1 d106S vaccine vector for local delivery of IL-12. Our replication-defective d106S virus releases a large burst of IL-12 locally within the tumor environment, synergizing with a type I IFN response induced by the virus. We have shown that d106S-IL12 induces regression and long-term stable immune equilibrium in murine B16 melanoma. These results are promising, demonstrating that the d106S vector can deliver immunotherapeutic cargo and induce shrinkage of established tumors. Intriguingly, most mice do not fully clear their tumors but establish an equilibrium phase and withdrawal of therapy eventually leads to tumor outgrowth. We have profiled the immune response induced by d106S-IL12 at separate time points, identifying several points of possible intervention, including blockade of innate inflammatory cytokines IL-1β, TNFα and IL-6. Indeed, blockade of each of these inflammatory cytokines provides a boost to the response initiated by d106S-IL12, which we have further profiled with single-cell RNA-sequencing.
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Affiliation(s)
| | | | - Lestat Ali
- 1Harvard Med. Sch
- 2Dana Farber Cancer Institute
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Mattson J, Ramage T, Pham C, Beier L, Lenehan P, Fox J. 152 Ultrafest, a One-Day Bedside Ultrasound Symposium, Improves Medical Students’ Practical Knowledge and Skills in Cardiac Ultrasound. Ann Emerg Med 2014. [DOI: 10.1016/j.annemergmed.2014.07.178] [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: 10/24/2022]
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18
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Foley ME, Ryan H, Kearney E, Herlihy A, Craig H, Kelehan P, Mooney E, Lenehan P, Flannelly G. Apparent improvement in survival for carcinoma of the cervix following the introduction of chemoradiation--a Will Rogers phenomenon. Ir Med J 2013; 106:74-77. [PMID: 23951975] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The improved survival for bulky cervical cancers (> 4cm) reported with combination platinum based chemoradiation (1999) prompted a move away from surgery as these cases frequently received adjuvant radiotherapy and were exposed to the morbidity of multimodality treatment. The period pre-1999 (Group 1) was compared with post-1999 (Group 2) when chemoradiation was the preferred treatment for bulky operable cervical cancer. Significantly more cases were treated surgically among Group 1 compared with Group 2 (79% vs. 62%; P < 0.001). Switching from surgery to radiotherapy improved survival in both treatment categories (73% vs. 78% and 37% vs. 44%, respectively) but with no improvement in overall survival (70%/ov.s 70%). Survival (86%) was similar in both groups among surgically treated women with tumors < 4 cm, but significantly more in Group 2 with negative nodes received postoperative adjuvant chemoradiotherapy (Groups 1 vs. 2; 16% vs.37.5%: P < 0.001) and overall the surgically treated patients received more not less multimodality treatment (46.5% vs. 59%; P = 0.7).
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Affiliation(s)
- M E Foley
- Dept. of Obstetrics & Gynaecology, UCD,National Maternity Hospital, Holles St, Dublin 2.
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Chummun K, Fitzpatrick M, Lenehan P, Boylan P, Mooney E, Flannelly G. Diagnostic and therapeutic dilemma associated with atypical glandular cells on liquid-based cervical cytology. Cytopathology 2012; 23:378-82. [DOI: 10.1111/j.1365-2303.2012.00981.x] [Citation(s) in RCA: 6] [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: 11/30/2022]
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20
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Shireen R, Brennan D, Flannelly G, Fennelly D, Lenehan P, Foley M. Survival in women with ovarian cancer before and after the introduction of adjuvant paclitaxel; a 25-year, single institution review. Ir Med J 2012; 105:47-50. [PMID: 22455239] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Adjuvant chemotherapy regime for ovarian cancer patients remains to be a contentious issue. The aim of this study was to compare the overall and progression-free survival of women with ovarian cancer before and after introduction of paclitaxel in our unit in 1992. A sample of 112 women who received adjuvant therapy following surgery for ovarian cancer was collected, 68 (61%) received platinum+alkylating agent before 1992 and later 44 (39%) received platinum+paclitaxel. Five-year survival was same in both treatment groups when there was no macroscopic disease after surgery (78% versus 70%) and when residual disease was <2 cm (50% versus 40%). Survival was greater in women with residual disease >2 cm in the platinum+paclitaxel group (50% versus 24%), (p = 0.04). However, progression-free survival was similar in both groups irrespective of stage or residual volume of disease. Therefore consideration to selective use of paclitaxel could reduce patient morbidity and costs significantly.
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Affiliation(s)
- R Shireen
- Department of Obstetrics, National Maternity Hospital, Holles St., Dublin 2
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21
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Abstract
BACKGROUND Wheat allergy is 1 of the most common food allergies in children, yet few data are available regarding its natural history. OBJECTIVES To define the natural course of wheat allergy and identify factors that help predict outcome in a large referral population of children with wheat allergy. METHODS Patients were included in the study if they had a history of a symptomatic reaction to wheat and a positive wheat IgE test result. Clinical history, laboratory results, and final outcome were recorded for 103 patients who met the inclusion criteria. Resolution of wheat allergy was determined based on food challenge results. Kaplan-Meier survival curves were generated to depict resolution of wheat allergy. RESULTS Rates of resolution were 29% by 4 years, 56% by 8 years, and 65% by 12 years. Higher wheat IgE levels were associated with poorer outcomes. The peak wheat IgE level recorded was a useful predictor of persistent allergy (P < .001), although many children outgrew wheat allergy with even the highest levels of wheat IgE. CONCLUSION The median age of resolution of wheat allergy is approximately 6 1/2 years in this population. In a significant minority of patients, wheat allergy persists into adolescence.
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Affiliation(s)
- Corinne A Keet
- Affiliations: Department of Pediatrics, Division of Pediatric Allergy and Immunology, Johns Hopkins School of Medicine, Baltimore, Maryland 21227, USA
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22
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O'daly BJ, Sweeney KJ, Hill ADK, Lenehan P, Mcdermott EWM. Incisional Hernia Complicating Pregnancy In Ehlers-Danlos Syndrome. Scott Med J 2008. [DOI: 10.1258/rsmsmj.53.3.57j] [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: 11/18/2022]
Affiliation(s)
- BJ O'daly
- Surgical Professorial Unit, St. Vincent's University Hospital, Dublin 4, IRELAND and
| | - Karl J Sweeney
- Surgical Professorial Unit, St. Vincent's University Hospital, Dublin 4, IRELAND and
| | - ADK Hill
- Surgical Professorial Unit, St. Vincent's University Hospital, Dublin 4, IRELAND and
| | - P Lenehan
- Department of Obstetrics, National Maternity Hospital, Dublin 2, IRELAND
| | - EWM Mcdermott
- Surgical Professorial Unit, St. Vincent's University Hospital, Dublin 4, IRELAND and
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23
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Burke C, Foley M, Lenehan P, Kelehan P, Flannelly G. Early stage endometrial carcinoma--a study of management and outcome. Ir Med J 2007; 100:621-623. [PMID: 18277731] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The surgical management of early stage endometrial carcinoma is controversial. The benefits of pelvic lymphadenectomy and administration of radiotherapy in this group have been disputed. We aimed to document the experience of stage 1 endometrial carcinoma at the National Maternity Hospital during the 10 year period 1989-1998 and to evaluate and compare clinical outcomes between retrospectively-assigned low and high-risk tumour groups. Seventy seven women were diagnosed with Stage 1 endometrial carcinoma in this period. Thirty-nine women had low-risk and 38 had high-risk tumours. Women with high-risk tumours were older and had a higher rate of lymph-vascular space invasion by tumour on histological examination. Three women (3.9%) developed disease recurrence and died of their disease; one low-risk and two high-risk tumour patients. Survival without recurrence did not differ between the two risk groups. No consistent pattern existed in surgical staging between the two risk groups. A prospectively-assigned definition of risk would minimise variations in clinical practice by providing a basis for a more tailored approach to adjuvant treatments.
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Affiliation(s)
- C Burke
- National Maternity Hospital, Dublin.
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24
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Abed Z, O'Leary M, Hand K, Flannelly G, Lenehan P, Murphy J, Foley M. Cervical screening history in patients with early stage carcinoma of the cervix. Ir Med J 2006; 99:140-2. [PMID: 16892918] [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] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
This study aimed to examine whether a decade of heightened publicity on issues relating to cervical screening has changed the screening profile of women presenting with cervical cancer at the National Maternity Hospital. The screening history of 100 women diagnosed with early/surgically treated cervical cancer between 1998 and 2002 was compared with a similar study conducted in 1982 /1990. The percentage of women never screened was similar - 24 %( 2002) and 23% (1990). The interval between last recorded smear and diagnosis of disease was greater than 5 years in 45.6% and 41.7% respectively. Overall 60% of women in the recent period had either failed to avail of screening or were not screened within 5 years of diagnosis compared with 64% in 1990. Multiparous women comprised 90% of the study group and 50% of those inadequately screened were attending their general practitioner on a regular basis - therefore affording a potential for opportunistic screening The current method of screening has failed in this group and has not improved in 10 years despite of increased population awareness and greater opportunities for screening than ever before and would support an argument for a National Screening Program.
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Affiliation(s)
- Z Abed
- Dept of Obstetrics and Gynaecology, National Maternity Hospital, Dublin
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25
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Eder JP, Hidalgo M, Mendelson D, Ryan PD, Arun B, Lovalvo J, Eiseman I, Olson S, Lenehan P, Garland LL. A phase I clinical and pharmacokinetic (PK) study of oral CI-1033 + docetaxel (DOC) in the treatment of patients with advanced solid tumors. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. P. Eder
- Dana-Farber Cancer Inst, Boston, MA; Johns Hopkins Univ, Baltimore, MD; Arizona Cancer Ctr, Scottsdale, AZ; MGH Cancer Ctr, Boston, MA; M.D. Anderson Cancer Ctr, Houston, TX; Pfizer Inc., Ann Arbor, MI; Arizona Cancer Ctr, Tucson, AZ
| | - M. Hidalgo
- Dana-Farber Cancer Inst, Boston, MA; Johns Hopkins Univ, Baltimore, MD; Arizona Cancer Ctr, Scottsdale, AZ; MGH Cancer Ctr, Boston, MA; M.D. Anderson Cancer Ctr, Houston, TX; Pfizer Inc., Ann Arbor, MI; Arizona Cancer Ctr, Tucson, AZ
| | - D. Mendelson
- Dana-Farber Cancer Inst, Boston, MA; Johns Hopkins Univ, Baltimore, MD; Arizona Cancer Ctr, Scottsdale, AZ; MGH Cancer Ctr, Boston, MA; M.D. Anderson Cancer Ctr, Houston, TX; Pfizer Inc., Ann Arbor, MI; Arizona Cancer Ctr, Tucson, AZ
| | - P. D. Ryan
- Dana-Farber Cancer Inst, Boston, MA; Johns Hopkins Univ, Baltimore, MD; Arizona Cancer Ctr, Scottsdale, AZ; MGH Cancer Ctr, Boston, MA; M.D. Anderson Cancer Ctr, Houston, TX; Pfizer Inc., Ann Arbor, MI; Arizona Cancer Ctr, Tucson, AZ
| | - B. Arun
- Dana-Farber Cancer Inst, Boston, MA; Johns Hopkins Univ, Baltimore, MD; Arizona Cancer Ctr, Scottsdale, AZ; MGH Cancer Ctr, Boston, MA; M.D. Anderson Cancer Ctr, Houston, TX; Pfizer Inc., Ann Arbor, MI; Arizona Cancer Ctr, Tucson, AZ
| | - J. Lovalvo
- Dana-Farber Cancer Inst, Boston, MA; Johns Hopkins Univ, Baltimore, MD; Arizona Cancer Ctr, Scottsdale, AZ; MGH Cancer Ctr, Boston, MA; M.D. Anderson Cancer Ctr, Houston, TX; Pfizer Inc., Ann Arbor, MI; Arizona Cancer Ctr, Tucson, AZ
| | - I. Eiseman
- Dana-Farber Cancer Inst, Boston, MA; Johns Hopkins Univ, Baltimore, MD; Arizona Cancer Ctr, Scottsdale, AZ; MGH Cancer Ctr, Boston, MA; M.D. Anderson Cancer Ctr, Houston, TX; Pfizer Inc., Ann Arbor, MI; Arizona Cancer Ctr, Tucson, AZ
| | - S. Olson
- Dana-Farber Cancer Inst, Boston, MA; Johns Hopkins Univ, Baltimore, MD; Arizona Cancer Ctr, Scottsdale, AZ; MGH Cancer Ctr, Boston, MA; M.D. Anderson Cancer Ctr, Houston, TX; Pfizer Inc., Ann Arbor, MI; Arizona Cancer Ctr, Tucson, AZ
| | - P. Lenehan
- Dana-Farber Cancer Inst, Boston, MA; Johns Hopkins Univ, Baltimore, MD; Arizona Cancer Ctr, Scottsdale, AZ; MGH Cancer Ctr, Boston, MA; M.D. Anderson Cancer Ctr, Houston, TX; Pfizer Inc., Ann Arbor, MI; Arizona Cancer Ctr, Tucson, AZ
| | - L. L. Garland
- Dana-Farber Cancer Inst, Boston, MA; Johns Hopkins Univ, Baltimore, MD; Arizona Cancer Ctr, Scottsdale, AZ; MGH Cancer Ctr, Boston, MA; M.D. Anderson Cancer Ctr, Houston, TX; Pfizer Inc., Ann Arbor, MI; Arizona Cancer Ctr, Tucson, AZ
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26
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Simon G, Olson S, Langevin M, Eiseman I, Mahany J, Helmke W, Garrett C, Lush R, Lenehan P, Sullivan D. 281 Phase I study of intravenous (IV) CI-1033 in patients with advanced solid tumors. EJC Suppl 2004. [DOI: 10.1016/s1359-6349(04)80289-1] [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: 10/26/2022] Open
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27
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Campos SM, Seiden MV, Oza A, Plante M, Potkul R, Hamid O, Lenehan P, Kaldjian E, Jordan C, Hirte H. A phase 2, single agent study of CI-1033 administered at two doses in ovarian cancer patients who failed platinum therapy. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.5054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. M. Campos
- Dana-Farber, Boston, MA; Massachusetts General Hospital, Boston, MA; Princess Margaret, Toronto, ON, Canada; Pavilion L'Hotel-Dieu de Quebec, Quebec City, PQ, Canada; Loyola University Medical Center, Chicago, IL; Pfizer, Inc, Ann Arbor, MI; Hamilton Cancer Centre, Hamilton, ON, Canada
| | - M. V. Seiden
- Dana-Farber, Boston, MA; Massachusetts General Hospital, Boston, MA; Princess Margaret, Toronto, ON, Canada; Pavilion L'Hotel-Dieu de Quebec, Quebec City, PQ, Canada; Loyola University Medical Center, Chicago, IL; Pfizer, Inc, Ann Arbor, MI; Hamilton Cancer Centre, Hamilton, ON, Canada
| | - A. Oza
- Dana-Farber, Boston, MA; Massachusetts General Hospital, Boston, MA; Princess Margaret, Toronto, ON, Canada; Pavilion L'Hotel-Dieu de Quebec, Quebec City, PQ, Canada; Loyola University Medical Center, Chicago, IL; Pfizer, Inc, Ann Arbor, MI; Hamilton Cancer Centre, Hamilton, ON, Canada
| | - M. Plante
- Dana-Farber, Boston, MA; Massachusetts General Hospital, Boston, MA; Princess Margaret, Toronto, ON, Canada; Pavilion L'Hotel-Dieu de Quebec, Quebec City, PQ, Canada; Loyola University Medical Center, Chicago, IL; Pfizer, Inc, Ann Arbor, MI; Hamilton Cancer Centre, Hamilton, ON, Canada
| | - R. Potkul
- Dana-Farber, Boston, MA; Massachusetts General Hospital, Boston, MA; Princess Margaret, Toronto, ON, Canada; Pavilion L'Hotel-Dieu de Quebec, Quebec City, PQ, Canada; Loyola University Medical Center, Chicago, IL; Pfizer, Inc, Ann Arbor, MI; Hamilton Cancer Centre, Hamilton, ON, Canada
| | - O. Hamid
- Dana-Farber, Boston, MA; Massachusetts General Hospital, Boston, MA; Princess Margaret, Toronto, ON, Canada; Pavilion L'Hotel-Dieu de Quebec, Quebec City, PQ, Canada; Loyola University Medical Center, Chicago, IL; Pfizer, Inc, Ann Arbor, MI; Hamilton Cancer Centre, Hamilton, ON, Canada
| | - P. Lenehan
- Dana-Farber, Boston, MA; Massachusetts General Hospital, Boston, MA; Princess Margaret, Toronto, ON, Canada; Pavilion L'Hotel-Dieu de Quebec, Quebec City, PQ, Canada; Loyola University Medical Center, Chicago, IL; Pfizer, Inc, Ann Arbor, MI; Hamilton Cancer Centre, Hamilton, ON, Canada
| | - E. Kaldjian
- Dana-Farber, Boston, MA; Massachusetts General Hospital, Boston, MA; Princess Margaret, Toronto, ON, Canada; Pavilion L'Hotel-Dieu de Quebec, Quebec City, PQ, Canada; Loyola University Medical Center, Chicago, IL; Pfizer, Inc, Ann Arbor, MI; Hamilton Cancer Centre, Hamilton, ON, Canada
| | - C. Jordan
- Dana-Farber, Boston, MA; Massachusetts General Hospital, Boston, MA; Princess Margaret, Toronto, ON, Canada; Pavilion L'Hotel-Dieu de Quebec, Quebec City, PQ, Canada; Loyola University Medical Center, Chicago, IL; Pfizer, Inc, Ann Arbor, MI; Hamilton Cancer Centre, Hamilton, ON, Canada
| | - H. Hirte
- Dana-Farber, Boston, MA; Massachusetts General Hospital, Boston, MA; Princess Margaret, Toronto, ON, Canada; Pavilion L'Hotel-Dieu de Quebec, Quebec City, PQ, Canada; Loyola University Medical Center, Chicago, IL; Pfizer, Inc, Ann Arbor, MI; Hamilton Cancer Centre, Hamilton, ON, Canada
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28
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Walsh T, O'Brien D, Khawaja N, Ryan R, Lenehan P. Bowel evisceration. Ir Med J 2004; 97:20-1. [PMID: 15055918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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29
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Meyer M, Jeong E, Bolinger B, Chen L, Lenehan P, Slichenmyer W, Natale RB. Phase 1 drug interaction study of suramin and warfarin in patients with prostate cancer. Am J Clin Oncol 2001; 24:167-71. [PMID: 11319293 DOI: 10.1097/00000421-200104000-00014] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Potential interaction between suramin and warfarin was evaluated when coadministered to patients with cancer. Thirteen men with advanced hormone-refractory prostate cancer were initially stabilized with warfarin to a prothrombin time (PT) of 2 +/- 0.2 International Normalized Ratio (INR) during a lead-in period of 4 weeks. A baseline daily warfarin dose was established, and treatment with suramin plus hydrocortisone was then started. The effect of suramin on the anticoagulant activity of warfarin was assessed in each patient by comparing his baseline warfarin dose with average daily doses required to maintain the same INR level over each of the initial 6 weeks of a 12-week course of suramin treatment. The average daily dose of warfarin required to maintain PT at 2 +/- 0.2 INR decreased from a baseline value of 4.2 to between 3.4 and 4.0 during the 6 weeks of suramin plus warfarin treatment. Despite failing to demonstrate equivalence applying a 90% confidence interval approach, required reductions in warfarin dose were clinically minor and the combination was well tolerated. Based on these results, the eligibility criteria for a large ongoing randomized study were amended to allow entry of men receiving warfarin therapy. This interaction study, together with experience gained in a larger trial setting, has confirmed that warfarin and suramin can be safely coadministered, provided that coagulation status is appropriately monitored.
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Affiliation(s)
- M Meyer
- Pfizer Global Research and Development, Ann Arbor Laboratories, Michigan 48105, USA.
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Crown J, Chan K, O'Leary M, Ballot J, King T, Murphy J, Lenehan P, Drumm J, McCarthy D, Fennelly D. Feasibility of an accelerated multi-cycle high-dose chemotherapy regimen including high-dose thiotepa for patients (Pts) with poor risk ovarian cancer (OC). Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)81330-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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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31
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Geary M, Lenehan P, Kelehan P. Recurrent atypical polypoid adenomyoma in association with ovarian carcinoma-a cautionary tale. J OBSTET GYNAECOL 1997; 17:502. [PMID: 15511943 DOI: 10.1080/01443619750112655] [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: 10/27/2022]
Affiliation(s)
- M Geary
- National Maternity Hospital, Dublin, Ireland
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Ong S, Geary M, Lenehan P. Ataxia as a presentation of ovarian carcinoma. J OBSTET GYNAECOL 1997; 17:102. [PMID: 15511788 DOI: 10.1080/01443619750114329] [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: 10/14/2022]
Affiliation(s)
- S Ong
- St Vincent's Hospital, Dublin, Ireland
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Abstract
Dilatation and curettage (D + C) is the most common operation performed in Britain. The liberal use of D + C has been criticised. The objective of this study was to evaluate the use of outpatient endometrial pipelle biopsy and determine its safety in terms of detecting abnormalities. Complications and financial costs were also evaluated. Data were reviewed from an active gynaecological unit from February 1993 to January 1995. A total of 303 D + Cs and 104 endometrial pipelle biopsies were performed in this period. Nine malignancies were detected by D + C and 1 by pipelle biopsy. A total of 24 and 3 benign abnormalities were detected by each method respectively. There was a higher complication rate in the D + C group but the failure rate was higher in the endometrial pipelle biopsy group. The monetary savings over this period is estimated at 20,307 pounds. There were no missed malignancies to our knowledge over the 8 yr period since endometrial pipelle biopsy was introduced to the hospital.
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Affiliation(s)
- S Ong
- St. Vincent's Hospital, Elm Park, Dublin
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34
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Ong S, Geary M, Lenehan P. Ataxia as a presentation of ovarian carcinoma. J OBSTET GYNAECOL 1996. [DOI: 10.3109/01443619609030102] [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: 11/13/2022]
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35
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Geary M, Foley M, Lenehan P, Murphy J, Fennelly J. Recurrent ovarian carcinoma: diagnosis and second-line therapy. Ir Med J 1995; 88:68-70. [PMID: 7775151] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Approximately 10% of patients with ovarian cancer will develop a recurrence. Successful treatment of recurring disease has been documented, and recent developments in chemotherapy are encouraging. In our study, CA125 Tumour Marker was a useful marker to monitor the course of such disease, and detected recurring ovarian cancer at a sub-clinical level, leading to earlier diagnosis. This may have implications for outcome.
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Affiliation(s)
- M Geary
- National Maternity Hospital, Dublin, Ireland
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36
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Carson KD, Grimes SB, McGinley JM, Thornton MT, Mulhall J, Bourke AM, McCrory C, Marsh B, Hone R, Phelan D, White M, Fabry J, Hughes D, Carson K, Donnelly M, Shanahan E, Fitzpatrick GJ, Bourke M, Warde D, Buggy D, Hughes N, Taylor A, Dowd N, Markham T, Blunnie W, Nicholson G, O’Leary E, Cunningham AJ, Dwyer R, McMechan S, Cullen C, Dempsey G, Wright G, MacKenzie G, Anderson J, Adgey J, Walsh M, O’Callaghan P, Graham I, O’Hare JA, Geoghegan M, Iman N, Shah P, Chander R, Lavin F, Daly K, Johnston PW, Imam Z, Adgey AAJ, Rusk RA, Richardson SG, Hale A, Kinsella BM, FitzGerald GA, King G, Crean P, Gearty G, Cawley T, Docherty JR, Geraghty J, Osborne H, Upton J, D’Arcy G, Stinson J, Cooke T, Colgan MP, Hall M, Tyrrell J, Gaffney K, Grouden M, Moore DJ, Shanik G, Feely J, Delanty N, Reilly M, Lawson JA, Fitzgerald DJ, Reilly MP, McAdam BF, Bergin C, Walshe MJ, Herity NA, Allen JD, Silke B, Singh HP, O’Neill S, Hargrove M, Coleman E, Shorten E, Aherne T, Kelly BE, Hill DH, McIlrath E, Morrow BC, Lavery GG, Blackwood B, Fee JPH, Kevin L, Doran M, Tansey D, Boylan I, McShane AJ, O’Reilly G, Tuohy B, Grainger P, Larkin T, Mahady J, Malone J, Condon C, Donoghue T, O’Leary J, Lyons JF, Tay YK, Tham SN, Khoo Tan HS, Gibson G, O’Grady A, Leader M, Walshe J, Carmody M, Donohoe J, Murphy GM, O’Connor W, Barnes L, Watson R, Darby C, O’Moore R, Mulcahy F, O’Toole E, O’Briain DS, Young MM, Buckley D, Healy E, Rogers S, Ni Scannlain N, McKenna MJ, McBrinn Y, Murray B, Freaney R, Barrett E, Razza Q, Abuaisha F, Powell D, Murray TM, Powell AM, O’Mongain E, O’Neill J, Kernan RP, O’Connor P, Clarke D, Fearon U, Cunningham SK, McKenna TJ, Hayes F, Heffernan A, Sheahan K, Harper R, Johnston GD, Atkinson AB, Sheridan B, Bell PM, Heaney AP, Loughrey G, McCance DR, Hadden DR, Kennedy AL, McNamara P, O’Shaughnessy C, Loughrey HC, Reid I, Teahan S, Caldwell M, Walsh TN, McSweeney J, Hennessy TP, Caldwell MTP, Byrne PJ, Hennessy TPJ, El-Magbri AA, Stevens FM, O’Sullivan R, McCarthy CF, Laundon J, Heneghan MA, Kearns M, Goulding J, Egan EL, McMahon BP, Hegarty F, Malone JF, Merriman R, MacMathuna P, Crowe J, Lennon J, White P, Clarke E, Prabhakar MC, Ryan E, Graham D, Yeoh PL, Kelly P, McKeogh D, O’Keane C, Kitching A, Mulligan E, Gorey TF, Mahmud N, O’Connell M, Goggins M, Keeling PWN, Weir DG, Kelleher D, McDonald GSA, Maguire D, O’Sullivan G, Harvey B, Cherukuri A, McGrath JP, Timon C, Lawlor P, O’Shea J, Buckley M, English L, Walsh T, O’Morain C, Lavelle SM, Kanagaratnam B, Harding B, Murphy B, Kavanagh J, Kerr D, Lavelle E, O’Gorman T, Liston S, Fitzpatrick C, Fitzpatrick P, Turner M, Murphy AW, Cafferty D, Dowling J, Bury G, Kaf Al-Ghazal S, Zimmermann E, O’Donoghue J, McCann J, Sheehan C, Boissel L, Lynch M, Cryan B, Fanning S, O’Meara D, Fennell J, Byrne PM, Lyons D, Mulcahy R, Pooransingh A, Walsh JB, Coakley D, O’Neill D, Ryall N, Connolly P, Namushi R, Lawler M, Locasciulli A, Bacigalupo A, Humphries P, McCann SR, Pamphilon D, Reidy M, Madden M, Finch T, Borton M, Barnes CA, Lawlor SE, Gardiner N, Egan LJ, Orren A, Doherty J, Curran C, O’Hanlon D, Kent P, Kerin M, Maher D, Given HF, Lynch S, McManus R, O’Farrelly C, Madrigal L, Feighery C, O’Donoghue D, Whelan CA, Rea IM, Stewart M, Campbell P, Alexander HD, Crockard AD, Morris TCM, Maguire H, Davidson F, Kaminski GZ, Butler K, Hillary IB, Parfrey NA, Crowley B, McCreary C, Keane C, O’Reilly M, Goh J, Kennedy M, Fitzgerald M, Scott T, Murphy S, Hildebrand J, Holliman R, Smith C, Kengasu K, Riain UN, Cormican M, Flynn J, Glennon M, Smith T, Whyte D, Keane CT, Barry T, Noone D, Maher M, Dawson M, Gilmartin JJ, Gannon F, Eljamel MS, Allcut D, Pidgeon CN, Phillips J, Rawluk D, Young S, Toland J, Deveney AM, Waddington JL, O’Brien DP, Hickey A, Maguire E, Phillips JP, Al-Ansari N, Cunney R, Smyth E, Sharif S, Eljamel M, Pidgeon C, Maguire EA, Burke ET, Staunton H, O’Riordan JI, Hutchinson M, Norton M, McGeeney B, O’Connor M, Redmond JMT, Feely S, Boyle G, McAuliffe F, Foley M, Kelehan P, Murphy J, Greene RA, Higgins J, Darling M, Byrne P, Kondaveeti U, Gordon AC, Hennelly B, Woods T, Harrison RF, Geary M, Sutherst JR, Turner MJ, DeLancey JOL, Donnelly VS, O’Connell PR, O’Herlihy C, Barry-Kinsella C, Sharma SC, Drury L, Lewis S, Stratton J, Ni Scanaill S, Stuart B, Hickey K, Coulter-Smith S, Moloney A, Robson MS, Murphy M, Keane D, Stronge J, Boylan P, Gonsalves R, Blankson S, McGuinness E, Sheppard B, Bonnar J, MacDonagh-White CM, Kelleher CC, Newell J, White O, Young Y, Hallahan C, Carroll K, Tipton K, McDermott EW, Reynolds JV, Nolan N, McCann A, Rafferty R, Sweeney P, Carney D, O’Higgins NJ, Duffy MJ, Grimes H, Gallagher S, O’Hanlon DM, Strattan J, Lenehan P, Robson M, Cusack YA, O’Riordain D, Mercer PM, Smyth PPA, Gallagher HJ, Moule B, Cooke TG, McArdle CS, Burke C, Vance A, Saidtéar C, Early A, Eustace P, Maguire L, Cullinane ABP, Prosser ES, Coca-Prados M, Harvey BJ, Saidléar C, Orwa S, Fitzsimons RB, Bradley O, Hogan M, Zimmerman L, Wang J, Kuliszewski M, Liu J, Post M, Premkumar, Conran MJ, Nolan G, Duff D, Oslizlok P, Denham B, O’Connell PA, Birthistle K, Hitchcock R, Carrington D, Calvert S, Holmes K, Smith DF, Hetherton AM, Mott MG, Oakhill A, Foreman N, Foot A, Dixon J, Walsh S, Mortimer G, O’Sullivan C, Kilgallen CM, Sweeney EC, Brayden DJ, Kelly JG, McCormack PME, Hayes C, Johnson Z, Dack P, Hosseini J, O’Connell T, Hemeryck L, Condren L, McCormack P, McAdam B, Lawson J, Keimowitz R, O’Leary A, Pilkington R, Adebayo GI, Gaffney P, McGettigan P, McManus J, O’Shea B, Wen Y, Killalea S, Golden J, Swanwick G, Clare AW, Mulvany F, Byrne M, O’Callaghan E, Byrne H, Cannon N, Kinsella T, Cassidy B, Shepard N, Horgan R, Larkin C, Cotter D, Coffey VP, Sham PC, Murray LH, Lane A, Kinsella A, Murphy P, Colgan K, Sloan D, Gilligan P, McEnri J, Ennis JT, Stack J, Corcoran E, Walsh D, Thornton L, Temperley I, Lawlor E, Tobin A, Hillary I, Nelson HG, Martin M, Ryan FM, Christie MA, Murray D, Keane E, Holmes E, Hollyer J, Strangeways J, Foster P, Stanwell-Smith R, Griffin E, Conlon T, Hayes E, Clarke T, Fogarty J, Moloney AC, Killeen P, Farrell S, Clancy L, Hynes M, Conlon C, Foley-Nolan C, Shelley E, Collins C, McNamara E, Hayes B, Creamer E, LaFoy M, Costigan P, Al fnAnsari N, Cunney RJ, Smyth EG, Johnson H, McQuoid G, Gilmer B, Browne G, Keogh JAB, Jefferson A, Smith M, Hennessy S, Burke CM, Sreenan S, Power CK, Pathmakanthan S, Poulter LW, Chan A, Sheehan M, Maguire M, O’Connor CM, FitzGerald MX, Southey A, Costello CM, McQuaid K, Urbach V, Thomas S, Horwitz ER, Mulherin D, FitzGerald O, Bresnihan B, Kirk G, Veale DJ, Belch JJF, Mofidi A, Mofidi R, Quigley C, McLaren M, Veale D, D’Arrigo C, Couto JC, Woof J, Greer M, Cree I, Belch J, Hone S, Fenton J, Hamilton S, McShane D. National Scientific Medical Meeting 1994 Abstracts. Ir J Med Sci 1994. [DOI: 10.1007/bf02943102] [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: 10/21/2022]
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Walsh PN, Conliffe C, Abdulkadir AS, Kelehan P, Conroy R, Foley M, Lenehan P, Murphy JF, Stronge J, Cantwell B, Wright C, Millward M, Carpenter M, Lennard T, Wilson R, Home C, Corbett AR, O’Sullivan G, Collins JK, Doran M, McDermott EWM, Mercer P, Smyth P, O’Higgins NJ, Duffy MJ, Reilly D, McDermott E, Faul C, Fennelly JJ, O’Higgins N, Lowry S, Russell H, Atkinson R, Hickey I, O’Brien F, O’Mahony A, O’Donoghue M, Pomeroy M, Prosser ES, Barker F, Casey M, Carroll K, Davis M, Duffy G, O’Kennedy R, Smyth PPA, O’Carroll D, Hetherton AM, Coveney E, McAlister V, Murray MJ, Brayden DJ, O’Hora A, Street J, O’Leary J, Pollock AM, Crowley M, Healy I, Murphy J, Landers R, Burke L, O’Brien D, Annis P, Hogan J, Kealy W, Lewis FA, Doyle CT, Callaghan M, Whelan A, Feighery C, Bresnihan B, Kelleher D, Reams G, Murphy A, Hall N, Casey EB, Mulherin D, Doherty E, Yanni G, Wallace E, Jackson J, Bennett M, Tighe O, Mulcahy H, O’Donoghue D, Croke DT, Cahill RJ, Beattie S, Hamilton H, O’Morain C, Corridan B, Collins RA, O’Morain CA, Fitzgerald E, Gilvarry JM, Leader M, Fielding JF, Johnson BT, Lewis SA, Love AHG, Johnston BT, Collins JSA, McFarland RJ, Johnston PW, Collins BJ, Kilgallen CM, Murphy GM, Markey GM, McCormack JA, Curry RC, Morris TCM, Alexander HD, Edgar S, Treacy M, O’Connell MA, Weir DG, Sheehan J, O’Loughlin G, Traynor O, Walsh N, Xia HX, Daw MA, Keane CT, Dupont C, Gibson G, McGinnity E, Walshe J, Carmody M, Donohoe J, McGrath P, O’Moore R, Kieran E, Rogers S, McKenna KE, Walsh M, Bingham EA, Hughes AE, Nevin NC, Todd DJ, Stanford CF, Callender ME, Burrows D, Paige DG, Allen GE, O’Brien DP, Gough DB, Phelan C, Given HF, Kamal SZ, Kehoe S, Coldicott S, Luesley D, Ward K, MacDonnell HF, Mullins S, Gordon I, Norris LA, Devitt M, Bonnar J, Sharma SC, Sheppard BL, Fitzsimons R, Kingston S, Garvey M, Hoey HMCV, Glasgow JFT, Moore R, Robinson PH, Murphy E, Murphy JFA, Wood AE, Sweeney P, Neligan M, MacLeod D, Cunnane G, Kelly P, Corcoran P, Clancy L, Drury RM, Drury MI, Powell D, Firth RGR, Jones T, Ferris BF, O’Flynn W, O’Donnell J, Kingston SM, Cunningham F, Hinds GME, McCluskey DR, Howell F, O’Mahony M, Devlin J, O’Reilly O, Buttanshaw C, Jennings S, Keane ER, Foley-Nolan C, Ryan FM, Taylor M, Lyons RA, O’Kelly F, Mason J, Carroll D, Doherty K, Flynn M, O’Dwyer R, Gilmartin JJ, McCarthy CF, Armstrong C, Mannion D, Feely T, Fitzpatrick G, Cooney CM, Aleong JC, Rooney R, Lyons J, Phelan DM, Joshi GP, McCarroll SM, Blunnie WP, O’Brien TM, Moriarty DC, Brangan J, Kelly CP, Kenny P, Gallagher H, McGovern E, Luke D, Lowe D, Rice T, Phelan D, Lyons JB, Lyons FM, McCoy DM, McGinley J, Hurley J, McDonagh P, Crowley JJ, Donnelly SM, Tobin M, Fitzgerald O, Maurer BJ, Quigley PJ, King G, Duly EB, Trinick TR, Boyle D, Wisdom GB, Geoghegan F, Collins PB, Goss C, Younger K, Mathias P, Graham I, MacGowan SW, Sidhu P, McEneaney DJ, Cochrane DJ, Adgey AAJ, Anderson JM, Moriarty J, Fahy C, Lavender A, Lynch L, McGovern C, Nugent AM, Neely D, Young I, McDowell I, O’Kane M, Nicholls DP, McEneaney D, Nichols DP, Campbell NPS, Campbell GC, Halliday MI, O’Donnell AF, Lonergan M, Ahearne T, O’Neill J, Keaveny TV, Ramsbottom D, Boucher-Hayes D, Sheahan R, Garadaha MT, Kidney D, Freyne P, Gearty G, Crean P, Singh HP, Hargrove M, Subareddy K, Hurley JP, O’Rourke W, O’Connor C, FitzGerald MX, McDonnell TJ, Chan R, Stinson J, Hemeryck L, Feely J, Chopra MP, Sivner A, Sadiq SM, Abernathy E, Plant L, Bredin CP, Hickey P, Slevin G, McCrory K, Long M, Conlon P, Walker F, Fitzgerald P, O’Neill SJ, O’Connor CM, Quigley C, Donnelly S, Southey A, Healy E, Mulcahy F, Lyons DJ, Keating J, O’Mahony C, Roy D, Shattock AG, Hillary IB, Waiz A, Hossain R, Chakraborthy B, Clancy LP, O’Reilly L, Byrne C, Costello E, O’Shaughnessy E, Cryan B, Farrell J, Walshe JJ, Mellotte GJ, Ho CA, Morgan SH, Bending MR, Bonner J. Inaugural national scientific medical meeting. Ir J Med Sci 1993. [PMCID: PMC7101915 DOI: 10.1007/bf02942100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Foley M, Lenehan P, Murphy JF, Kelehan P. Distant metastases following surgical treatment of cervical carcinoma. Ir Med J 1990; 83:62-4. [PMID: 2391212] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Fifty patients with early carcinoma of the cervix were treated by radical hysterectomy and pelvic lymphadenectomy. Twelve patients (24%) had positive nodes and received adjuvant pelvic radiotherapy. The mean duration of follow-up was seven years and all patients had at least four years follow-up. Five patients died from recurrence; four from isolated distant metastases and one from a pelvic side wall recurrence. The disease-free interval for patients with distant metastases was six months to two years and the metastases were to lung and bone.
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Affiliation(s)
- M Foley
- Department of Gynaecology, National Maternity Hospital, Dublin
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Flannelly G, Turner MJ, Lenehan P, Kelehan P, Murphy JF. Is routine endometrial curettage of value at cervical cone biopsy? J OBSTET GYNAECOL 1990. [DOI: 10.3109/01443619009151186] [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: 11/13/2022]
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Lenehan P. Cervical cancer--changing perspectives. Ir J Med Sci 1988; 157:179-80. [PMID: 3182236 DOI: 10.1007/bf02949292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
We report a case of pregnancy with spontaneous vaginal delivery in a patient who had bilateral total hip arthroplasty. Guidelines for management of such patients are discussed, as this is a clinical situation which is likely to be seen more frequently. Orthopaedic consultation is important, if possible with the surgeon who performed the operations.
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Affiliation(s)
- J Monaghan
- National Maternity Hospital, Dublin, Ireland
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Lenehan P, Murphy J, Kelehan P, O'Dwyer P, Foley M, Boylan P. Cone biopsy of the cervix: 200 cases. Ir Med J 1986; 79:351-3. [PMID: 3804686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Bryson SC, Lenehan P, Lickrish GM. The treatment of grade 3 cervical intraepithelial neoplasia with cryotherapy: an 11-year experience. Am J Obstet Gynecol 1985; 151:201-6. [PMID: 3970086 DOI: 10.1016/0002-9378(85)90012-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The results of treatment of 453 patients with grade 3 cervical intraepithelial neoplasia by cryotherapy are presented. After excluding 31 patients who were lost to follow-up, the failure rate of primary treatment in the remaining 422 patients was 7.1% (30 patients). Outpatient re-treatment of those with persistent disease achieved an overall cure rate of 98%. Statistical analysis to determine prognostic significance with regard to persistent disease was carried out on the following variables: grade, size, and type of freeze. Type of freeze was the only variable to show statistical significance. Cryotherapy remains an effective outpatient modality for the treatment of grade 3 cervical neoplasia. A rigid protocol of patient selection and meticulous cryotherapy technique play a large role in obtaining the high cure rates reported in this study.
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Manning D, Hensey O, Lenehan P, O'Brien N. Unstable hip in the newborn. Ir Med J 1982; 75:463-4. [PMID: 7161026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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