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Gaur AH, Capparelli EV, Calabrese K, Baltrusaitis K, Marzinke MA, McCoig C, Van Solingen-Ristea RM, Mathiba SR, Adeyeye A, Moye JH, Heckman B, Lowenthal ED, Ward S, Milligan R, Samson P, Best BM, Harrington CM, Ford SL, Huang J, Crauwels H, Vandermeulen K, Agwu AL, Smith-Anderson C, Camacho-Gonzalez A, Ounchanum P, Kneebone JL, Townley E, Bolton Moore C. Safety and pharmacokinetics of oral and long-acting injectable cabotegravir or long-acting injectable rilpivirine in virologically suppressed adolescents with HIV (IMPAACT 2017/MOCHA): a phase 1/2, multicentre, open-label, non-comparative, dose-finding study. Lancet HIV 2024; 11:e211-e221. [PMID: 38538160 DOI: 10.1016/s2352-3018(23)00300-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/06/2023] [Accepted: 11/13/2023] [Indexed: 04/07/2024]
Abstract
BACKGROUND Combined intramuscular long-acting cabotegravir and long-acting rilpivirine constitute the first long-acting combination antiretroviral therapy (ART) regimen approved for adults with HIV. The goal of the IMPAACT 2017 study (MOCHA [More Options for Children and Adolescents]) was to assess the safety and pharmacokinetics of these drugs in adolescents. METHODS In this phase 1/2, multicentre, open-label, non-comparative, dose-finding study, virologically suppressed adolescents (aged 12-17 years; weight ≥35 kg; BMI ≤31·5 kg/m2) with HIV-1 on daily oral ART were enrolled at 15 centres in four countries (Botswana, South Africa, Thailand, and the USA). After 4-6 weeks of oral cabotegravir (cohort 1C) or rilpivirine (cohort 1R), participants received intramuscular long-acting cabotegravir or long-acting rilpivirine every 4 weeks or 8 weeks per the adult dosing regimens, while continuing pre-study ART. The primary outcomes were assessments of safety measures, including all adverse events, until week 4 for oral cabotegravir and until week 16 for long-acting cabotegravir and long-acting rilpivirine, and pharmacokinetic measures, including the area under the plasma concentration versus time curve during the dosing interval (AUC0-tau) and drug concentrations, at week 2 for oral dosing of cabotegravir and at week 16 for intramuscular dosing of cabotegravir and rilpivirine. Enrolment into cohort 1C or cohort 1R was based on the participant's pre-study ART, meaning that masking was not done. For pharmacokinetic analyses, blood samples were drawn at weeks 2-4 after oral dosing and weeks 4-16 after intramuscular dosing. Safety outcome measures were summarised using frequencies, percentages, and exact 95% CIs; pharmacokinetic parameters were summarised using descriptive statistics. This trial is registered at ClinicalTrials.gov, NCT03497676, and is closed to enrolment. FINDINGS Between March 19, 2019, and Nov 25, 2021, 55 participants were enrolled: 30 in cohort 1C and 25 in cohort 1R. At week 16, 28 (97%, 95% CI 82-100) of the 29 dose-evaluable participants in cohort 1C and 21 (91%; 72-99) of the 23 dose-evaluable participants in cohort 1R had reported at least one adverse event, with the most common being injection-site pain (nine [31%] in cohort 1C; nine [39%] in cohort 1R; none were severe). One (4%, 95% CI 0-22) participant in cohort 1R had an adverse event of grade 3 or higher, leading to treatment discontinuation, which was defined as acute rilpivirine-related allergic reaction (self-limiting generalised urticaria) after the first oral dose. No deaths or life-threatening events occurred. In cohort 1C, the week 2 median cabotegravir AUC0-tau was 148·5 (range 37·2-433·1) μg·h/mL. The week 16 median concentrations for the every-4-weeks and every-8-weeks dosing was 3·11 μg/mL (range 1·22-6·19) and 1·15 μg/mL (<0·025-5·29) for cabotegravir and 52·9 ng/mL (31·9-148·0) and 39·1 ng/mL (27·2-81·3) for rilpivirine, respectively. These concentrations were similar to those in adults. INTERPRETATION Study data support using long-acting cabotegravir or long-acting rilpivirine, given every 4 weeks or 8 weeks, per the adult dosing regimens, in virologically suppressed adolescents aged 12 years and older and weighing at least 35 kg. FUNDING The National Institutes of Health and ViiV Healthcare.
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Affiliation(s)
- Aditya H Gaur
- St Jude Children's Research Hospital, Memphis, TN, USA.
| | | | | | - Kristin Baltrusaitis
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mark A Marzinke
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Adeola Adeyeye
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - John H Moye
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, MD, USA
| | | | - Elizabeth D Lowenthal
- University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shawn Ward
- Frontier Science Foundation, Boston, MA, USA
| | | | | | | | | | | | | | | | | | - Allison L Agwu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | - Ellen Townley
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Carolyn Bolton Moore
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; University of Alabama, Birmingham, AL, USA
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Semenkovich NP, Samson P, Badiyan SN, Vlacich GR, Stowe HB, Pellini B, Robinson CG, Chaudhuri AA. Circulating Tumor DNA for Early Risk Stratification of Oligometastatic Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:S29-S30. [PMID: 37784469 DOI: 10.1016/j.ijrobp.2023.06.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Some patients with oligometastatic disease experience prolonged progression-free survival when treated with local consolidative radiotherapy (RT). Precisely identifying these patients remains challenging, however. We hypothesized that pre-RT liquid biopsy circulating tumor DNA (ctDNA) analysis could risk-stratify oligometastatic non-small-cell lung cancer (NSCLC) patients and enable earlier personalized selection for consolidative RT. MATERIALS/METHODS A real-world multi-institutional cohort of 1,487 patients who were diagnosed with oligometastatic NSCLC was analyzed. Each patient underwent liquid biopsy ctDNA analysis using the Tempus xF assay (v2) at least once, for a total of 1,880 ctDNA assays. 20% of the cohort (n = 309) underwent RT after liquid biopsy was obtained and oligometastatic NSCLC was diagnosed by the treating physician. Each patient in the sub-cohort of 309 patients had oligometastatic disease, defined as metastatic disease present in 1-5 organ systems. Outcomes for overall survival (OS) and progression-free survival (PFS) were defined with respect to the initiation time of RT to minimize the risk of guarantee-time bias. ctDNA results were analyzed for variants using VarDict and characterized as pathogenic or likely pathogenic following ACMG/AMP guidelines for variant classification, as determined by SnpEff. Variants considered benign, likely benign, or having conflicting evidence were excluded from consideration. RESULTS Overall survival was significantly worse in oligometastatic NSCLC patients with detectable ctDNA pre-RT, as compared to those without detectable ctDNA pre-RT, with a median OS of 16.8 months versus 25 months (p = 0.030, HR = 1.65, CI = 1.05-2.61). Similar findings were also observed for PFS, which was worse in patents with detectable ctDNA pre-RT, with a median PFS of 5.4 months versus 8.8 months (p = 0.004, HR = 1.57, CI = 1.15-2.13). ctDNA variant allele frequency (VAF) levels demonstrated significant risk correlations, with the maximum pre-RT ctDNA VAF associated with increased risk of both disease progression (p = 0.0084) and death (p = 0.0073). These findings were corroborated by multivariate Cox proportional hazards modeling for PFS (p = 0.02, PFS HR = 4.69, CI = 1.42-13.30) and OS (p = 0.004, HR = 5.66, CI = 1.64-16.85). Notably, multivariate Cox modeling did not show significant impacts of other clinical parameters, including gender, age at diagnosis, smoking status, and squamous histology. Additionally, the ctDNA mutational burden (the number of detectable pathogenic or likely pathogenic variants) was significantly associated with risk for both PFS (p = 0.003, HR = 1.16, CI = 1.06-1.26) and OS (p = 0.003, HR = 1.15, CI = 1.04-1.25) in a multivariate Cox regression model. CONCLUSION These data suggest that liquid biopsy ctDNA detection represents a powerful pre-RT biomarker to risk-stratify oligometastatic NSCLC patients and potentially enable personalized decision-making for local consolidative RT.
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Affiliation(s)
- N P Semenkovich
- Department of Medicine, Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, MO
| | - P Samson
- Washington University in St. Louis, St. Louis, MO
| | - S N Badiyan
- Washington University School of Medicine, Department of Radiation Oncology, St. Louis, MO
| | - G R Vlacich
- Washington University School of Medicine, Department of Radiation Oncology, St. Louis, MO
| | - H B Stowe
- Washington University School of Medicine, Department of Radiation Oncology, St. Louis, MO
| | | | - C G Robinson
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - A A Chaudhuri
- Washington University School of Medicine, Department of Radiation Oncology, St. Louis, MO
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Kang KH, Price AT, Reynoso FJ, Laugeman E, Morris ED, Samson P, Huang J, Badiyan SN, Kim H, Brenneman RJ, Abraham CD, Knutson N, Henke LE. A Pilot Study of Simulation-Free Hippocampal-Avoidance Whole Brain Radiotherapy Using Diagnostic MR-Based and Online Adaptive Planning. Int J Radiat Oncol Biol Phys 2023; 117:e113. [PMID: 37784653 DOI: 10.1016/j.ijrobp.2023.06.894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We aimed to demonstrate the clinical feasibility and safety of a simulation-free hippocampal avoidance whole brain radiotherapy (HA-WBRT) workflow in a Phase I clinical trial (NCT05096286). Feasibility was defined as successful completion of the simulation-free HA-WBRT workflow through treatment delivery in at last 70% of treated patients. MATERIALS/METHODS Ten candidates for HA-WBRT were enrolled for treatment on a ring gantry CT-guided Linac with online adaptive capabilities. Structures were contoured on the diagnostic brain MRI, which was then registered to a separate head computed tomography (CT) of similar head shape, obtained from an atlas-based database. A HA-WBRT "pre-plan" was generated using the atlas-based CT (AB-CT) and the NRG-CC001 constraints. At first fraction, the AB-CT was used as the primary dataset and deformed to the patient's cone-beam CT (CBCT) for dose calculation. The brain, ventricles, and brainstem contours were matched through rigid translation and rotation to the corresponding anatomy on the CBCT to aid in alignment, given the differences in rotational head positioning from diagnostic MRI to CBCT setup. Lastly, the lens, optic nerves, and brain contours were manually edited based on CBCT visualization. Plans were then optimized, and the adaptive plan was chosen for treatment if the plan met all objectives. Workflow tasks were timed. In addition, conventional plans using patients' sim CTs were created for each patient for the purpose of prospective dosimetric comparison. The dosimetric parameters were compared for each patient between the delivered sim-free plan and the conventional sim CT plan using the sign test via statistical software, with p<.05 indicating significance. RESULTS Median time from approved sim order to first fraction was 4 days (range: 2-7); median time in room (door-to-door) was 49 minutes (range: 35-70). All patients successfully completed all ten fractions and 90% of the simulation-free radiation plans met all NRG-CC001 constraints. For one patient, the sim-free plan at fraction one failed the planning target volume (PTV) coverage objective (coverage of 89%); this was deemed acceptable for delivery by the treating radiation oncologist. An offline replan was then performed to meet NRG-CC001 constraints and used for the subsequent nine fractions. There was no clinically meaningful difference in dosimetric constraints between the sim-free plan (calculated on AB-CT) and conventional CT sim plan. Statistically, the sim-free plans provided improved PTV coverage to higher doses compared to the conventional plans (Table). At a median follow-up of 43 days (range: 9 -280), the intracranial progression-free survival rate was 90%. CONCLUSION Simulation-free HA-WBRT is feasible, results in plans that are dosimetrically comparable to conventional CT sim workflows and succeeds in decreasing time to initiation of HA-WBRT by at least 50%. Further studies with a larger cohort are warranted to optimize the workflow.
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Affiliation(s)
- K H Kang
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - A T Price
- University Hospitals, Department of Radiation Oncology, Case Western Reserve University, Cleveland, OH
| | - F J Reynoso
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - E Laugeman
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - E D Morris
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - P Samson
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - J Huang
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - S N Badiyan
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - H Kim
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - R J Brenneman
- Banner MD Anderson Cancer Center at Banner North Colorado Medical Center, Greeley, CO
| | - C D Abraham
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - N Knutson
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - L E Henke
- University Hospitals, Department of Radiation Oncology, Case Western Reserve University, Cleveland, OH
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Dong Z, Hao Y, Laugeman E, Hugo GD, Samson P, Chen Y, Zhao T. Performance of Adaptive Deep Learning Models for Dose Predictions on High-Quality Cone-Beam Computed Tomography Images. Int J Radiat Oncol Biol Phys 2023; 117:e661. [PMID: 37785959 DOI: 10.1016/j.ijrobp.2023.06.2097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Online plan generation remains a patient-specific and time-consuming process that can place a significant burden on clinics strained with staffing shortages. As previous research show that dose-volume histogram (DVH) prediction plays a crucial role in automatic treatment planning, the objective of this study is to assess the capability of adaptive deep learning models in predicting dose information in volumetric modulation radiotherapy plans using the high-quality CBCT images and contour information of organs-at-risk (OARs). MATERIALS/METHODS The relationship between dose-volume histograms (DVHs) in radiotherapy plans and the geometric information of organs-at-risk (OAR) and planning target volume (PTV) has been well established. To evaluate the performance of the current state-of-the-art convolutional neural network (CNN) models including VIT3D and Unet3D, and intuitive machine learning methods (i.e., SVM and MLP), we implemented those models for dose prediction and conducted a comprehensive analysis with treatment plans created from images acquired from patients who consented to participate an IRB-approved imaging study designed to evaluate the imaging performance of the system. In total, 20 plans created by certified medical dosimetrists were employed in this study, with 15 used for training the machine-learning models and the remaining 5 used for performance testing. Two evaluation metrics were used: 1) root mean square error (RMSE) of the predicted dose and true dose and 2) time spent on dose prediction. RESULTS The results of the analysis showed that the ViT-3D (Transformer) model had the lowest RMSE of 3.682 ±0.010, followed by the Unet-3D (CNN) model with an RMSE of. 3.973 ±0.021 The MLP model had an RMSE of 8.007 ±0.019 while the SVM model had the highest RMSE of 9.156 ±0.032. For a fair comparison, we use 4-fold cross validation (each has 15 training plans and 5 testing plans), and report the mean value with standard deviation. All models are optimized with Adam optimizer of a learning rate 0.01, and the training process is stopped after 100 epochs. These findings indicate that the ViT-3D (Transformer) model performed the best in terms of predicting the dose information in volumetric modulation radiotherapy plans based on the CBCT images and contour information of OARs. For tested plan which contains 81 CT images (512 × 512 resolution), the inference time to predict dose information with a general CPU machine (6-Core Intel Core i7) is about 1.5 minutes. With GPU resources, such as NVIDIA A100, the inference process can be finished within seconds. CONCLUSION The study demonstrated that current state-of-the-art machine-learning models can achieve promising accuracy in dose prediction using high-quality CBCT images. A well-trained machine-learning model could offer clinicians a quick and reliable prediction of the true dose to patients in the case of significant anatomical changes or provide patient-specific optimization objectives if replanning is warranted.
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Affiliation(s)
- Z Dong
- Washington University in St. Louis, St. Louis, MO
| | - Y Hao
- Washington University in St. Louis, St. Louis, MO
| | - E Laugeman
- Washington University in St. Louis, St. Louis, MO
| | - G D Hugo
- Washington University in St. Louis, Saint Louis, MO
| | - P Samson
- Washington University in St. Louis, St. Louis, MO
| | - Y Chen
- Washington University in St. Louis, St. Louis, MO
| | - T Zhao
- Washington University in St. Louis, St. Louis, MO
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Sigmund E, Laugeman E, Schiff JP, Schmidt M, Badiyan S, Robinson CG, Samson P. Temporospatial Feathering of Hot Spots for Computed Tomography-Guided Stereotactic Adaptive Radiotherapy (CT-STAR) for the Ultra-Central Thorax. Int J Radiat Oncol Biol Phys 2023; 117:e718-e719. [PMID: 37786096 DOI: 10.1016/j.ijrobp.2023.06.2224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) SBRT to the ultra-central thorax is limited by potential toxicity. It has been demonstrated that exposing proximal bronchial tree or pulmonary arteries to high dose per fraction (fx) treatment may induce bronchopulmonary hemorrhage, amongst other serious complications. Online adaptive radiotherapy is a technique that adjusts a treatment plan to the anatomy-of-the-day and benefits have been demonstrated in ultra-central thoracic disease. In addition, feathering is a treatment planning technique that generates several plans to avoid consistent organ-at-risk (OAR) doses throughout treatment. With daily adaptation, it may be possible to adjust the position of a hot spot (>120% prescription (Rx)) within the tumor each fx (temporospatial feathering) while respecting hard OAR constraints. We investigated the feasibility and plan quality of using CBCT-guided stereotactic adaptive radiotherapy (CT-STAR) for ultra-central lung tumors with hotspot temporospatial feathering. MATERIALS/METHODS Seven patients with ultra-central thoracic disease (6 patients with parenchymal tumors in contact with the trachea, proximal bronchial tree, great vessels, esophagus, or heart; 1 patient with a subcarinal lymph node) receiving standard of care radiotherapy were enrolled on an imaging study. An in-silico planning study first generated an SBRT plan (in silico Rx: 55 Gy in 5fx) that used a GTV_OPT (GTV minus OAR plus a safety margin) to optimize the location of the plan hotspot. Five spherical boost structures were manually created inside of the GTV_OPT structure. The same planning template was used except the boost structures were iteratively used in plan optimization instead of the GTV_OPT structure, to simulate the five CT-STAR fx hotspot temporospatially feathering. The five-plan composite was compared to the initial plan. RESULTS All plans generated met strict OAR constraints. Table 1 shows the mean difference in PTV, GTV, and OARs percent coverage by various isodose levels. Feathering the hotspot had negligible impact on target coverage by 50 Gy and 55 Gy isodose lines as well as OAR doses compared to the base SBRT plan. The feathered plan sum resulted in 14.7% increase in V66 Gy of the GTV. One patient saw a decrease in V66 Gy coverage to all target structures, though V50 Gy and V55 Gy were not affected. CONCLUSION We demonstrated the feasibility and utility of temporospatially adapting the hotspot for central lung SBRT, which safely increases the amount of tumor receiving more than 120% Rx.
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Affiliation(s)
- E Sigmund
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - E Laugeman
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - J P Schiff
- Washington University in St. Louis, St. Louis, MO
| | - M Schmidt
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - S Badiyan
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - C G Robinson
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - P Samson
- Washington University in St. Louis, St. Louis, MO
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Hogan JS, Kalaghchi B, Agabalogun T, Hilliard J, Kavanaugh J, Schmidt M, Atkinson AR, Ochoa LL, Contreras J, Samson P, Yang JC, Bergom C, Zoberi I, Thomas MA. Effect of Dose to the Heart and Cardiac Substructures on Cardiac Toxicity after Breast Cancer Radiation. Int J Radiat Oncol Biol Phys 2023; 117:e180. [PMID: 37784801 DOI: 10.1016/j.ijrobp.2023.06.1031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Pre-existing cardiovascular disease, chemotherapy, and higher mean heart dose are known risk factors for cardiac toxicity after breast radiation therapy. However, the relationship between cardiac substructure radiation exposure and toxicity is not well understood. We hypothesized that mean heart dose is a surrogate for global cardiac radiation exposure but that more specific dosimetric thresholds for the heart and its substructures could be identified, which could be used to guide radiation planning for breast cancer patients in the future. MATERIALS/METHODS In this cohort study, all breast cancer patients who received curative intent breast or chest wall radiotherapy at a single high-volume institution in 2014 and 2017 were included (n = 841). Baseline characteristics included hormone therapy, chemotherapy, menopausal status, diabetes, dyslipidemia, pre-existing cardiac toxicity, and age at diagnosis. Outcomes included any cardiac toxicity, arrhythmia, cardiomyopathy, ischemia, valvular, pericardial disease, and death. The heart and substructures, including left ventricle, right ventricle, left atrium, right atrium, aortic valve, pulmonic valve, mitral valve, tricuspid valve, and left anterior descending artery, were delineated on the simulation CT for each patient. Dosimetric variables, including mean dose, max dose, and V1, 2, 3, 4, 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, and 70 Gy for the heart and substructures (in cc) were extracted. For each dosimetric variable, multivariable logistic regression was performed using baseline covariates in addition to the single dosimetric variable. Patients with missing data values were excluded. Results were combined and False Discovery Rate p-value correction was performed. RESULTS Multiple cardiac substructure dosimetric variables were associated with increased risk of mortality on multivariable analysis (p < 0.05). For left atrium and right atrium, V2, 3, 4, and 5 Gy were all significant. For right ventricle, mean dose, V1, 2, 3, 4, 5, 10, 15, 20, 25, 30, and 35 Gy were significant. For mitral valve, mean dose, max dose, V3, 4, and 5 Gy were significant. For tricuspid valve, mean dose was significant. For aortic valve, max dose, mean dose, V4, and V5 Gy were significant. For the whole heart, V1, 2, 3, 4, 5, 10, 15, 20, 25, 30, and 35 Gy were significant. CONCLUSION We have identified multiple dosimetric variables for the heart and its substructures which were associated with increased risk of mortality after breast cancer radiation. In fact, for certain structures, there were multiple exposure thresholds which showed increased risk of toxicity, highlighting the complex relationship between substructure dose and outcomes. Further study into these relationships will identify the most critical cardiac substructure constraints that could be used in radiation treatment planning.
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Affiliation(s)
- J S Hogan
- Washington University in St. Louis, St. Louis, MO
| | - B Kalaghchi
- Washington University in St. Louis, St. Louis, MO
| | - T Agabalogun
- Washington University in St. Louis, St. Louis, MO
| | - J Hilliard
- Washington University in St. Louis, St. Louis, MO
| | - J Kavanaugh
- Washington University in St. Louis, St. Louis, MO
| | - M Schmidt
- Washington University in St. Louis, St. Louis, MO
| | - A R Atkinson
- Washington University in St. Louis, St. Louis, MO
| | - L L Ochoa
- Washington University in St. Louis, St. Louis, MO
| | - J Contreras
- Washington University in St. Louis, St. Louis, MO
| | - P Samson
- Washington University in St. Louis, St. Louis, MO
| | - J C Yang
- Washington University in St. Louis, St. Louis, MO
| | - C Bergom
- Washington University in St. Louis, St. Louis, MO
| | - I Zoberi
- Washington University in St. Louis, St. Louis, MO
| | - M A Thomas
- Washington University in St. Louis, St. Louis, MO
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Zhao T, Hilliard J, Lindsey A, Hao Y, Laugeman E, Samson P. Accuracy of Electron Density and Planning Dosimetry in a Novel High-Quality CBCT Imaging System. Int J Radiat Oncol Biol Phys 2023; 117:e749. [PMID: 37786168 DOI: 10.1016/j.ijrobp.2023.06.2292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) A high-quality Cone-Beam Computed Tomography (CBCT) imaging system has been FDA approved for imaging guidance and dose calculation in radiotherapy. This study aims to evaluate the accuracy of the relative electron density in CBCT images acquired in this CBCT imaging system in a phantom study and its dosimetric impact on treatment planning in a patient study. MATERIALS/METHODS Astoichiometric CT calibration was performed with a CIRS phantom (SunNuclear, Model 062M) to generate the HU-electron density curve for two tube voltages, 125kVp and 140 kVp, respectively. The phantom has a longitudinal length of 26.5 cm and is equipped with interchangeable inserts of various compositions, supplied by the vendor. Measurements were taken with solid water plates added to both ends of the phantom to allow adequate scattering and repeated for various clinical protocols with different combinations of tube voltages and exposures. The accuracy of the relative electron density of the CBCT imaging system was verified by comparing the calculated electron density from the Hounsfield Units (HU) measurements obtained from a Gammex phantom to the relative electron densities provided in vendor's specifications. To benchmark the relative electron density of the CBCT imaging system against a standard helical CT simulator, ten clinical plans that were created on CT simulation images were copied and recalculated on the CBCT images acquired immediately after the CT simulation, the latter of which was a standard procedure in current radiotherapy care for all patients who had given their consent to participate in the IRB-approved imaging study. The dose grids used in these calculations were 2.5mm x 2.5mm x 3mm. The Gamma passing rate was calculated using a standard 3mm/3% criterion with a 10% threshold. RESULTS Ourresults showed the difference between the averaged CBCT calibration curves acquired at tube voltages of 125 kVP and 140 kVp was less than 2%. The mean discrepancy of the relative electron densities from vendor's specification was 0.0045 with a range between -0.02 and 0.04. Relative electron densities in all inserts were within 2% from the vendor's specifications except the cortical bone insert. Gamma passing rate was between 96.02% and 98.49% with mean value of 97.4% and a standard deviation of 0.95%. We consider this reflects the fact that the CT simulation and CBCT imaging were performed in separated rooms, which resulted in slight anatomical deformation that could negatively impact the Gamma passing rate. CONCLUSION The CBCT imaging system provides sufficient accuracy of electron density for dose calculation, and the dose distribution calculated on the CBCT images is clinically equivalent to those calculated on helical CT images. The enhanced imaging quality of CBCT could further extend the role of imaging guidance to planning for adaptive radiotherapy, potentially reducing the need for re-simulation and interruptions in the radiotherapy course.
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Affiliation(s)
- T Zhao
- Washington University in St. Louis, St. Louis, MO
| | - J Hilliard
- Washington University in St. Louis, St. Louis, MO
| | - A Lindsey
- Washington University in St. Louis, St. Louis, MO
| | - Y Hao
- Washington University in St. Louis, St. Louis, MO
| | - E Laugeman
- Washington University in St. Louis, St. Louis, MO
| | - P Samson
- Washington University in St. Louis, St. Louis, MO
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Robinson CG, Contreras C, Moore KMS, Rentschler S, Schwarz JK, Bergom C, Knutson N, Prusator MT, Goddu SM, Hugo GD, Cuculich P, Samson P. Radiotherapy Dose as a Predictor of Outcomes Following Cardiac Radioablation for High-risk Refractory VT. Int J Radiat Oncol Biol Phys 2023; 117:e204. [PMID: 37784859 DOI: 10.1016/j.ijrobp.2023.06.1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Cardiac radioablation (CRA) is an emerging treatment for high-risk refractory ventricular tachycardia (VT). Despite a fixed prescription dose to the planning target volume (PTV) there is still considerable heterogeneity in the radiotherapy dose distribution due to planning technique, proximity to organs at risk, and radiation oncologist preference. The hypothesis is that plans with an inherently "hotter" internal dose to the PTV may lead to improved VT outcomes. MATERIALS/METHODS Single-center, IRB-approved retrospective case series of patients with refractory VT who had failed at least one prior CA (or were unfit for CA) treated with CRA. All patients were treated with a single fraction of 25 Gy prescribed to the PTV. Maximum dose to PTV was collected from each plan and stratified as high vs low above and below the median. Maximum dose was defined as the highest dose delivered to the "hottest" 0.035 cc of the PTV to avoid known variability in reporting of dose to single voxels within the treatment planning system. Rates of survival (OS), freedom from shock and/or storm (FFSS), and freedom from death, shock, and/or storm (FFDSS) were collected, and stratified by maximum dose to the PTV. Formal statistical comparisons were not performed due to limited patient numbers. RESULTS From 2015-2020, 22 patients were treated with CRA (18 with prior CA, 4 unfit for CA) for high-risk refractory VT. Median age was 64.5 years (range, 49-84), and 90.9% were male. 50% had ICM, with a median NYHA class of 3 (range, 1-4) and median EF of 25% (range, 15-58%). Median follow-up was 31.3 months. 2-year OS was 54.5%, FFSS was 42.4%, and FFDSS was 27.3%. Median maximum dose to the PTV was 42.2 Gy (range, 29.2-45.8 Gy). PTV maximum dose (high vs low) discriminated 2-year OS (63.6% vs 45.5%), FFSS (50% vs 30%) and FFDSS (36.4% vs 18.2%). For all endpoints, Kaplan-Meier curves overlapped for the first 6 months, and then diverged. CONCLUSION In patients with high-risk refractory VT treated with CRA, survival and VT outcomes were similar between both groups out to 6 months, with improved OS and VT control noted after that with higher maximum doses. With a prescription dose of 25 Gy to the PTV, adjusting planning parameters to maintain maximum doses > 42 Gy may improve durable outcomes and requires validation in a larger cohort.
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Affiliation(s)
- C G Robinson
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - C Contreras
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - K M S Moore
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - S Rentschler
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - J K Schwarz
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - C Bergom
- Washington University in St. Louis, St. Louis, MO
| | - N Knutson
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - M T Prusator
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - S M Goddu
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - G D Hugo
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - P Cuculich
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - P Samson
- Washington University in St. Louis, St. Louis, MO
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Zhao T, Beckert R, Hilliard J, Laugeman E, Hao Y, Hunerkoch K, Miller K, Brunt L, Hong D, Schiff JP, Samson P. An In Silico study of a One-Day One-Machine Workflow for Definitive Radiotherapy Cases on a Novel Simulation and Treatment Platform. Int J Radiat Oncol Biol Phys 2023; 117:e749. [PMID: 37786169 DOI: 10.1016/j.ijrobp.2023.06.2291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The workflow in Radiotherapy (RT) has largely unchanged for the past three decades, despite increasing evidence suggesting that delayed access to RT, including the wait time between consultation, simulation, and treatment appointments, can negatively impact clinical outcomes. In this pilot study, we present preliminary results of an in silico study that demonstrate the feasibility of a novel RT platform, which integrates simulation into the treatment process and enables patients to receive immediate RT after their initial RT consultation. MATERIALS/METHODS A prospective clinical study has been approved to assess the capabilities of a novel RT platform with a high quality CBCT system for imaging guidance as well as planning. This new platform enables a novel clinical workflow that allows clinicians to review contours and plans created on diagnostic CT images prior to the initial RT consultation and allow them to approve new plans adapted on the actual simulation dataset acquired on the first treatment fraction. Four patients receiving standard of care RT (three abdomen and one thorax) consented for this study and underwent additional experimental CBCT simulation on the new platform in addition to their standard CT simulation. The CBCT simulation was taken in two setups: with a specific mold on a flat couch and without a mold on a curved couch. To demonstrate the equivalence of the new workflow to the current standard of care, the plan created on the most recent diagnostic CT images was compared to the plans adapted on the experimental simulation images and the standard CT simulation images, using a knowledge-based model. Contours were propagated from approved datasets to the new datasets through deformable image registration. RESULTS All experimental simulations were completed between 14 and 21 minutes with the assistance of two therapists. The contouring, editing, and replanning process took less than one hour in all cases, in line with our experience and peer-reviewed literature. Despite notable anatomical changes observed, the dose-volume histograms (DVH) were consistent, as shown in Table 1. CONCLUSION The novel workflow presented herein was feasible and demonstrates that the integration of simulation with image-guided RT on one single platform may unlock the potential of accelerating the RT workflow and reducing the wait time for treatment from weeks to hours.
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Affiliation(s)
- T Zhao
- Washington University in St. Louis, St. Louis, MO
| | - R Beckert
- Washington University in St. Louis, St. Louis, MO
| | - J Hilliard
- Washington University in St. Louis, St. Louis, MO
| | - E Laugeman
- Washington University in St. Louis, St. Louis, MO
| | - Y Hao
- Washington University in St. Louis, St. Louis, MO
| | - K Hunerkoch
- Washington University in St. Louis, St. Louis, MO
| | - K Miller
- Washington University in St. Louis, St. Louis, MO
| | - L Brunt
- Washington University in St. Louis, St. Louis, MO
| | - D Hong
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - J P Schiff
- Washington University in St. Louis, St. Louis, MO
| | - P Samson
- Washington University in St. Louis, St. Louis, MO
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Liu W, Schiff JP, Beckert R, Kiser K, Kim T, Henke LE, Price AT, Kim H, Badiyan SN, Robinson CG, Samson P, Laugeman E. The Impact of Intra-Fraction Bowel Motion on Luminal Gastrointestinal Organ at Risk Dosimetry When Using Stereotactic Adaptive Radiotherapy for Abdominal Malignancies. Int J Radiat Oncol Biol Phys 2023; 117:e690. [PMID: 37786028 DOI: 10.1016/j.ijrobp.2023.06.2162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Daily online adaptive radiotherapy (ART) provides inter-fraction motion management of the luminal gastrointestinal (GI) structures when delivering abdominal SBRT. One potential drawback of ART is the time-consuming process, and intra-fraction GI changes from completion of the ART process to the end of treatment delivery have not been thoroughly evaluated. We explored intra-fraction bowel motion for patients receiving abdominal stereotactic adaptive radiotherapy (sART) MATERIALS/METHODS: Six patients with abdominal malignancies treated with CT-guided sART on a prospective feasibility trial had additional CBCT's acquired post-treatment (pTx-CBCT). All patients were prescribed to 50 Gy/5 fractions (fx), and the constraint for all GI OARs was V33≤0.5 cc. Time from initial CBCT (I-CBCT) used for adaptive planning to pTx-CBCT was collected. The luminal GI OAR (stomach (S), duodenum (D), small bowel (SB), and large bowel (LB)) were retrospectively contoured on pTx-CBCT. The OAR doses were compared between the I-CBCT and pTx-CBCT. The adaptive plan (PA) and initial plan (PI) doses were overlayed on the pTx-CBCT contours. The PA pTx-CBCT OAR doses were then compared to the PI pTx-CBCT OAR doses. A Boolean OAR structure of all GI OARs was evaluated to remove potential differences in structure definitions between providers. The T-test was used to compare differences in instances of D0.5cc ≥ 33 and 50 Gy. Patient charts were reviewed for grades (G) ≥ 3 toxicity. RESULTS Thirty fractions (fx) of sART were delivered and pTx-CBCT were acquired in 26 fx. Mean time from I-CBCT to pTx-CBCT acquisition was 66 min (38-98 min). On average at 0.5 cc the PA overdosed the S by 1.74 Gy based on pTx-CBCT anatomy compared to 2.35 Gy by the PI, the D by 0.47 Gy (PA) vs .84 Gy (PI), the SB by 1.14 Gy (PA) vs 1.43 Gy (PI), and the LB by 0.13 Gy (PA) vs 0.60 Gy (PI). The dose to the Boolean OAR structure was on average 2.51 Gy/fx higher than expected when overlaying the PA on the pTx-CBCT compared to 3.38 Gy/fx higher when overlaying the PI on the pTx-CBCT. There was no significant difference in the instance of the PA exceeding D0.5 cc ≥33 Gy vs the PI (p = 0.083), but the PA significantly reduced the instances of D0.5cc≥50 Gy (p = 0.001) compared to the PI. No patient experienced G≥3 toxicity at a median follow-up of 8 months (3-12). CONCLUSION These data demonstrate sART led to a significant decrease in dose to GI OARs, particularly for prescription dose or greater, even after accounting for intra-fractional bowel motion. While both the PI and the PA violated the V33 luminal GI OAR constraint in approximately ½ of pTx-CBCTs, the fraction of OARs receiving at least 50 Gy was significantly higher when overlaying the PI compared to the PA. While no G3 toxicities were reported in this small cohort, further studies are needed to characterize if the increased dose to GI OARs over the expected dose is clinically significant.
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Affiliation(s)
- W Liu
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - J P Schiff
- Tulane University School of Medicine, New Orleans, LA
| | - R Beckert
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - K Kiser
- MD Anderson Cancer Center, Houston, TX
| | - T Kim
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - L E Henke
- University Hospitals, Department of Radiation Oncology, Case Western Reserve University, Cleveland, OH
| | - A T Price
- University Hospitals, Department of Radiation Oncology, Case Western Reserve University, Cleveland, OH
| | - H Kim
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - S N Badiyan
- Washington University School of Medicine, Department of Radiation Oncology, St. Louis, MO
| | - C G Robinson
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - P Samson
- Washington University in St. Louis, St. Louis, MO
| | - E Laugeman
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
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Kalaghchi B, Hogan J, Agabalogun T, Atkinson A, Ochoa L, Samson P, Bergom C, Yang J, Zoberi I, Thomas M. Cardiac Events in Breast Cancer Patients Treated with Modern Radiotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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12
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Kim T, Kiser K, Laugeman E, Price A, Gach H, Knutson N, Hugo G, Samson P, Robinson C, Hatscher C, Henke L. Surface Imaging-Guided Adaptive Radiotherapy (ART): Imaging Protocol and Verification for Inter- and Intra-Fractional Motion Managements. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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13
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Hogan J, Kalaghchi B, Agabalogun T, Atkinson A, Ochoa L, Samson P, Bergom C, Yang J, Zoberi I, Thomas M. Cardiotoxicity in Patients with Ductal Carcinoma In Situ (DCIS) in the Contemporary Radiotherapy Era. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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14
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Nikanjam M, Tran L, Chadwick EG, Bwakura-Dangarembizi M, Bolton Moore C, Samson P, Spector SA, Chakhtoura N, Jean-Philippe P, Frenkel L, Zimmer B, Benns A, Libous J, Capparelli EV. Impact of CYP2B6 genotype, tuberculosis therapy, and formulation on efavirenz pharmacokinetics in infants and children under 40 months of age. AIDS 2022; 36:525-532. [PMID: 34873089 PMCID: PMC8881387 DOI: 10.1097/qad.0000000000003141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Dosing efavirenz (EFV) in children less than 3 years of age is challenging due to large variability in drug levels. This study evaluated differences in pharmacokinetics with tuberculosis (TB) therapy, formulation, age, and CYP2B6 genotype. DESIGN Pharmacokinetic data from three IMPAACT/PACTG studies (P382, P1021, and P1070) for children initiating therapy less than 40 months of age were evaluated. METHODS Pharmacokinetic data were combined in a population pharmacokinetic model. Exposure from the 2-week pharmacokinetic visit was compared with changes in viral RNA between the Week 0 and Week 4 visits. RESULTS The model included 103 participants (19 on TB therapy). CYP2B6 516 genotype information was available for 82 participants (TT: 15, GT: 28, GG: 39). Median age at the first pharmacokinetic visit was 17.0 months (range: 2.0-39.0 months). Liquid formulation led to a 42% decrease in bioavailability compared with opened capsules. TB therapy (isoniazid and rifampin) led to a 29% decreased clearance, however Monte Carlo simulations demonstrated the majority of participants on TB therapy receiving standard EFV dosing to be in the target area under the curve range. Clearance was 5.3-fold higher for GG than TT genotype and 3.3-fold higher for GT than TT genotype. Age did not have a significant effect on clearance in the final model. Initial viral RNA decay was lower for patients in the lowest quartile of exposures (area under the curves) than for higher quartiles (P = 0.013). CONCLUSION EFV dosing should account for CYP2B6 516 genotype and formulation, but does not require adjustment for concurrent TB therapy.
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Affiliation(s)
- Mina Nikanjam
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, California
| | - Lana Tran
- Division of Pharmacotherapy and Experimental Therapeutics, School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | - Ellen G Chadwick
- Department of Pediatrics, Northwestern University's Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mutsa Bwakura-Dangarembizi
- Department of Paediatrics and Child Health, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Carolyn Bolton Moore
- Centre for Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Pearl Samson
- Statistical and Data Management Center (SDMC) Harvard T.H. Chan School of Public Health, Center for Biostatistics in AIDS Research/Frontier Science Foundation, Boston, Massachusetts
| | - Stephen A Spector
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, California
| | - Nahida Chakhtoura
- Maternal and Pediatric Infectious Disease Branch (MPIDB), Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health
| | - Patrick Jean-Philippe
- Division of AIDS, National Institutes of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Lisa Frenkel
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Bonnie Zimmer
- Frontier Science and Technology Research Foundation, Amherst, New York
| | - Alex Benns
- Frontier Science and Technology Research Foundation, Amherst, New York
| | - Jennifer Libous
- IMPAACT Operations Center, FHI360, Durham, North Carolina, USA
| | - Edmund V Capparelli
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, California
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15
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Bekker A, Capparelli EV, Violari A, Cotton MF, Cababasay M, Wang J, Mathiba R, Wiesner L, Wiznia A, Samson P, Browning R, Moye J, Nakwa FL, Decloedt E, Rabie H, Mirochnick M, Cressey TR. Abacavir dosing in neonates from birth to 3 months of life: a population pharmacokinetic modelling and simulation study. Lancet HIV 2022; 9:e24-e31. [PMID: 34883066 PMCID: PMC8760861 DOI: 10.1016/s2352-3018(21)00266-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND No evidence-based optimal dosing guidance is available for abacavir liquid formulation use from birth. We used abacavir pharmacokinetic data from neonates and infants to determine an exact abacavir dosing strategy (mg/kg) for infants aged 0-3 months and to propose dosing by WHO weight band for neonates. METHODS Abacavir pharmacokinetic and safety data were pooled from three completed studies (1997-2020): PACTG 321 (USA), the Tygerberg Cohort (South Africa), and IMPAACT P1106 (South Africa). PACTG 321 and the Tygerberg Cohort were performed in neonates exposed to HIV receiving a single dose of abacavir. IMPAACT P1106 included predominantly low birthweight (<2500 g) infants on antiretroviral therapy enrolled when they were younger than 3 months. We developed a population pharmacokinetic model and performed simulations to achieve abacavir exposures (area under the curve for 0-12 h) within the target range of 3·2-25·2 μg·h/mL, previously reported in older children. FINDINGS 45 infants contributed 308 abacavir concentrations; 21 neonates were younger than 15 days. At first pharmacokinetic assessment, median postnatal age for PACTG 321 was 1 day and median bodyweight was 3·1 kg; for the Tygerberg Cohort it was 10 days and 3·3 kg; and for IMPAACT P1106 it was 73 days and 3·8 kg. Our model predicted a slow abacavir clearance of 2·51 mL/min per kg at birth, which doubled by 4 weeks of age. Therapeutic targets were achieved with exact abacavir doses of 2·0 mg/kg twice daily from 0 weeks to 4 weeks and 4·0 mg/kg twice daily from 4 weeks to 12 weeks. A fixed weight-band dosing strategy of 8 mg (for 2-3 kg), 10 mg (3-4 kg), and 12 mg (4-5 kg) abacavir twice daily achieved target exposures throughout the first 4 weeks of life without the need for dose adjustment due to age or bodyweight changes. No adverse events of grade 3 or higher were related to abacavir. INTERPRETATION Integration of these dosing strategies into national and international guidelines for the abacavir liquid formulation will expand antiretroviral options from birth and simplify the clinical management of neonates with HIV. FUNDING National Institute of Allergy and Infectious Diseases, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Mental Health, and the Collaborative Initiative for Paediatric HIV Education and Research Programme.
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Affiliation(s)
- Adrie Bekker
- Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
| | | | - Avy Violari
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark F Cotton
- Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Mae Cababasay
- Center for Biostatistics in AIDS Research, Harvard T H Chan School of Public Heath, Boston, MA, USA
| | - Jiajia Wang
- Center for Biostatistics in AIDS Research, Harvard T H Chan School of Public Heath, Boston, MA, USA
| | - Ruth Mathiba
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | | | | | - Renee Browning
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jack Moye
- Division of Extramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Firdose L Nakwa
- Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Eric Decloedt
- Division of Clinical Pharmacology, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | - Helena Rabie
- Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | | | - Tim R Cressey
- AMS/PHPT Research Collaboration, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; MIVEGEC, University of Montpellier, CNRS, IRD, Montpellier, France; Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
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16
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Kang K, Brenneman R, Waters M, Cordova J, Kennedy W, Brown S, Caruthers D, LaBrash J, Huang Y, Chaudhuri A, Vlacich G, Badiyan S, Samson P, Robinson C, Abraham C, Spraker M. The Influence of Neighborhood Socioeconomic Status and Follow-up on Survival in Early-Stage Non-Small Cell Lung Cancer Treated With Stereotactic Ablative Radiotherapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.996] [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: 11/27/2022]
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17
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Robinson C, Hugo G, Moore K, Samson P, Contreras C, Cooper D, Cuculich P. Enabling Best Practices for Cardiac Radioablation Through a Remote Education and Peer Review Program. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.698] [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: 11/27/2022]
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18
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Agabalogun T, Heiden B, Spraker M, Badiyan S, Vlacich G, Morgensztern D, Waqar S, Kozower B, Meyers B, Robinson C, Puri V, Samson P. Post-Operative Radiation Therapy for Non-Small Cell Lung Cancer Patients With Higher Positive to Examined Lymph Node Ratio is Associated With Improved Overall Survival. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1216] [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: 11/25/2022]
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19
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Price A, Canfield C, Hugo G, Kavanaugh J, Henke L, Laugeman E, Samson P, Kueny C, Cudney E. Techno-Economic Feasibility Analysis of a Fully-Mobile Radiation Oncology System Using Monte Carlo Simulation. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Mahmood M, Kennedy W, Stowe H, Thomas M, Zoberi J, Samson P, Ochoa L, Price A, Garcia-Ramirez J, Green O, Zoberi I. Single-Institution Phase 1/2 Prospective Trial Evaluating Three-Fraction Partial Breast Irradiation: Safety and Patient-Reported Outcomes of TRI-APBI. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.721] [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: 11/15/2022]
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21
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Krogstad P, Samson P, Acosta EP, Moye J, Townley E, Bradford S, Brown E, Denson K, Graham B, Hovind L, Sise T, Teppler H, Mathiba SR, Fairlie L, Winckler JL, Slade G, Meyers T. Pharmacokinetics and Safety of a Raltegravir-Containing Regimen in Children Aged 4 Weeks to 2 Years Living With Human Immunodeficiency Virus and Receiving Rifampin for Tuberculosis. J Pediatric Infect Dis Soc 2021; 10:201-204. [PMID: 32448902 PMCID: PMC7996637 DOI: 10.1093/jpids/piaa039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/09/2020] [Indexed: 11/14/2022]
Abstract
Pharmacological interactions limit treatment options for children living with human immunodeficiency virus (HIV) and tuberculosis (TB). We found that 12 mg/kg twice daily raltegravir chewable tablets (administered after crushing) safely achieved pharmacokinetic targets in children living with HIV aged 4 weeks to <2 years receiving concurrent rifampin to treat TB. CLINICAL TRIALS REGISTRATION NCT01751568.
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Affiliation(s)
- Paul Krogstad
- Departments of Pediatrics and Molecular and Medical Pharmacology, David Geffen School of Medicine at Los Angeles, Los Angeles, California, USA
| | - Pearl Samson
- Statistical and Data Management Center, Frontier Science Foundation/Harvard T.H. Chan School of Public Health Boston, Massachusetts, USA
| | - Edward P Acosta
- Department of Pharmacology and Toxicology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jack Moye
- Maternal and Pediatric Infectious Disease Branch, Division of Extramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Ellen Townley
- Columbus Technologies and Services, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | | | | | - Kayla Denson
- Frontier Science Foundation, Inc, Amherst, New York, USA
| | - Bobbie Graham
- Frontier Science Foundation, Inc, Amherst, New York, USA
| | - Laura Hovind
- Frontier Science Foundation, Inc, Amherst, New York, USA
| | - Thucuma Sise
- Columbus Technologies and Services, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Hedy Teppler
- Global Clinical Development - Infectious Diseases, Merck & Co, Inc, Kenilworth, New Jersey, USA
| | - Sisinyana Ruth Mathiba
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Lee Fairlie
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jana L Winckler
- Desmond Tutu TB Centre, Department of Paediatrics, Stellenbosch University, Cape Town South Africa
| | - Gretchen Slade
- Department of Paediatrics and Child Health, Family Clinical Research Unit, Stellenbosch University, Cape Town, South Africa
| | - Tammy Meyers
- Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Pellini B, Hasan S, Samson P, Earland N, Ward J, Waqar S, Baggstrom M, Robinson C, Govindan R, Devarakonda S, Morgensztern D. P49.03 Chemoradiation with Cisplatin-Etoposide versus Carboplatin-Etoposide in Limited-Stage Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.897] [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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Antao N, Samson P, Pellini B, Waqar S, Devarakonda S, Ward J, Govindan R, Morgensztern D. P09.26 Cause of Death in Patients with Squamous Cell Lung Cancer (SCC) Treated with Surgery. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.454] [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: 11/16/2022]
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Rosebush JC, Best BM, Chadwick EG, Butler K, Moye J, Smith E, Bradford S, Reding CA, Mathiba SR, Hanley S, Aziz M, Homans J, Acosta EP, Murtaugh W, Vourvahis M, Mcfadyen L, Hayward K, Mirochnick M, Samson P. Pharmacokinetics and safety of maraviroc in neonates. AIDS 2021; 35:419-427. [PMID: 33252481 PMCID: PMC7856036 DOI: 10.1097/qad.0000000000002762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate safety and pharmacokinetics of maraviroc administered with standard antiretroviral prophylaxis to HIV-1 exposed infants and to determine the appropriate dose of maraviroc during the first 6 weeks of life. DESIGN A phase I, multicentre, open-label study enrolling two sequential cohorts. METHODS IMPAACT 2007 participants enrolled by day 3 of life and were stratified by exposure to maternal efavirenz. Cohort 1 participants received two single 8 mg/kg maraviroc doses 1 week apart with pharmacokinetic sampling after each dose. Cohort 2 participants received 8 mg/kg maraviroc twice daily through 6 weeks of life with pharmacokinetic sampling at weeks 1 and 4. Maraviroc exposure target was Cavg at least 75 ng/ml. Laboratory and clinical evaluations assessed safety. RESULTS Fifteen Cohort 1 and 32 Cohort 2 HIV-exposed neonates were enrolled (median gestational age 39 weeks, 51% male). All 13 evaluable Cohort 1 infants met the pharmacokinetic target. Median exposure for the 25 evaluable Cohort 2 infants met the pharmacokinetic target but variability was high, with 17-33% of infants below target at Weeks 1 and 4. Pharmacokinetic target achievement was similar between efavirenz exposure strata. No Grade 3+ toxicities, early study or treatment discontinuations due to maraviroc occurred. CONCLUSION Median maraviroc exposure met the Cavg target in neonates receiving 8 mg/kg twice daily, although exposures were variable. Maternal efavirenz use did not impact maraviroc exposure and no discontinuations were due to maraviroc toxicity/intolerance. No infants acquired HIV-1 infection during follow-up. Maraviroc 8 mg/kg twice daily appears well tolerated during the first 6 weeks of life.
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Affiliation(s)
| | - Brookie M Best
- University of California San Diego, La Jolla, California
| | - Ellen G Chadwick
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Kevin Butler
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - John Moye
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
| | - Elizabeth Smith
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Rockville, Maryland
| | | | - Christina A Reding
- Frontier Science & Technology Research Foundation, Inc., Amherst, New York, USA
| | | | - Sherika Hanley
- Centre for the AIDS Programme in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Mariam Aziz
- Rush University Medical Center, Chicago, Illinois
| | - James Homans
- University of Southern California, Los Angeles, California
| | - Edward P Acosta
- Deparment of Pharmacology and Toxicology, University of Alabama at Birmingham, Birmingham, Alabama
| | - William Murtaugh
- IMPAACT Laboratory Center, Children's Hospital of Los Angeles, Los Angeles, California
| | - Manoli Vourvahis
- Clinical Pharmacology, Pfizer Global Research and Development, New York, New York, USA
| | - Lynn Mcfadyen
- Pharmacometrics, Pfizer Global Research and Development, Sandwich, UK
| | - Katy Hayward
- ViiV HealthCare, Research Triangle Park, North Carolina
| | | | - Pearl Samson
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Frontier Science & Technology Research Foundation, Inc., Amherst, New York, USA
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Goddu S, Mazur T, Prusator M, Samson P, Knutson N, Zhao T, Hugo G, Mutic S, Cuculich P, Robinson C. Novel Monte-Carlo Based IMPT Technique Utilizing Multi-Leaf Collimators on a Gantry Mounted Synchrocyclotron for Cardiac Radioablation of Ventricular Tachycardia Substrate. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2340] [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: 10/23/2022]
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Prusator M, Cammin J, Samson P, Robinson C, Cuculich P, Knutson N, Moore K, Goddu S, Hugo G. Evaluation of Target Motion Surrogate Suitability for Cardiac Radioablation of Ventricular Tachycardia. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.943] [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: 11/26/2022]
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27
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Samson P, Perez M, Carpenter L, Roach M, Bradley J, Kozower B, Meyers B, Puri V, Robinson C. Comparing Prospective Quality of Life Assessments Among Clinical Stage I Non-Small Cell Lung Cancer Patients Receiving Surgery versus Stereotactic Body Radiation Therapy at One Year. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Samson P, Roach M, Bradley J, Carpenter L, Kozower B, Meyers B, Puri V, Robinson C. Increased Rates of Serious Adverse Events among Stage I Non-small Cell Lung Cancer Surgical Patients who were Predicted to Receive Stereotactic Body Radiation Therapy by Treatment Allocation Modeling. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1185] [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: 11/26/2022]
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Higa N, Pelz A, Birch D, Beck IA, Sils T, Samson P, Bwakura-Dangarembizi M, Bolton-Moore C, Capparelli E, Chadwick E, Frenkel LM. Association of Virologic Failure and Nonnucleoside Reverse Transcriptase Inhibitor Resistance Found in Antiretroviral-Naive Children Infected With Human Immunodeficiency Virus and Given Efavirenz-Based Treatment. J Pediatric Infect Dis Soc 2020; 9:261-264. [PMID: 31194860 PMCID: PMC7192398 DOI: 10.1093/jpids/piz038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/15/2019] [Indexed: 11/12/2022]
Abstract
Among 66 antiretroviral-naive children aged <3 years with human immunodeficiency virus (HIV) or coinfected with HIV and tuberculosis and initiating efavirenz-based antiretroviral therapy (ART), non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance was detected before ART in 5 (7.6%). Virologic failure occurred in 2 of these children; they were last tested at 16 and 24 weeks of ART. Pre-ART NNRTI resistance was not associated with virologic failure.
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Affiliation(s)
- Nikki Higa
- Seattle Children’s Research Institute, Washington
| | - Amy Pelz
- Seattle Children’s Research Institute, Washington
| | - Donald Birch
- Seattle Children’s Research Institute, Washington
| | | | - Tatiana Sils
- Seattle Children’s Research Institute, Washington
| | - Pearl Samson
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Carolyn Bolton-Moore
- Centre for Infectious Disease Research in Zambia, Lusaka
- University of Alabama at Birmingham, Alabama
| | | | - Ellen Chadwick
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lisa M Frenkel
- Seattle Children’s Research Institute, Washington
- University of Washington, Seattle
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Meyers T, Samson P, Acosta EP, Moye J, Townley E, Bradford S, Marillo L, Denson K, Hovind L, Sise T, Teppler H, Mathiba SR, Masenya M, Hesseling A, Cotton MF, Krogstad P. Pharmacokinetics and safety of a raltegravir-containing regimen in HIV-infected children aged 2-12 years on rifampicin for tuberculosis. AIDS 2019; 33:2197-2203. [PMID: 31689263 PMCID: PMC7232968 DOI: 10.1097/qad.0000000000002369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Drug-drug interactions limit current antiretroviral treatment options for HIV-infected children with tuberculosis (TB). Rifampicin (RIF) induces UDP-glucuronosyltransferase activity, accelerating the clearance of raltegravir (RAL). We sought to establish an optimal and well tolerated dose of RAL when administered with RIF to HIV and TB co-infected children. DESIGN P1101 is a phase I/II open-label dose-finding study of RAL with RIF for children 2 to less than 12 years of age beginning treatment for HIV and active TB. SETTING Four sites in South Africa. METHODS Chewable RAL was given at 12 mg/kg per dose twice daily (twice the usual pediatric dose) with two nucleoside reverse transcriptase inhibitors. Intensive RAL pharmacokinetic sampling was conducted 5 to 8 days after antiretroviral therapy was initiated; a fourth antiretroviral agent was then added. RESULTS Children were recruited into two age-defined groups: cohort 1 (2 to <6 years old) and cohort 2 (6 to <12 years old). Pharmacological targets [geometric mean (GM) AUC12 h of 14-45 μmol/l h and GM C12 h ≥75 nmol/l) were reached in both cohort 1 (28.8 μmol/l h and 229 nmol/l) and cohort 2 (38.8 μmol/l h and 228 nmol/l). The RAL-based ART was well tolerated by most participants: one participant discontinued treatment because of grade 4 hepatitis that was possibly treatment-related. At week 8, 22 of 24 participants (92%) had HIV RNA concentrations below 400 copies/ml; 19 of 24 (79%) were below 50 copies/ml. CONCLUSION Giving 12 mg/kg twice daily of the chewable RAL formulation achieved pharmacokinetic targets safely in HIV-infected children receiving RIF for TB.
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Affiliation(s)
- Tammy Meyers
- aDepartment of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa bHarvard T.H. Chan School of Public Health/Frontier Science Foundation, Boston, Massachusetts cUniversity of Alabama at Birmingham, Birmingham, Alabama dEunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda eColumbiaUSA Technologies at the National Institute of Allergy and Infectious Diseases, Rockville, Maryland fFHI 360, Durham, North Carolina gFrontier Science & Technology Research Foundation, Inc, Amherst, New York hNational Institute of Allergy and Infectious Diseases, Rockville, Maryland iMerck & Co, Inc, Palo Alto, California, USA jPerinatal HIV Research Unit, University of the Witwatersrand kWits Reproductive Health and HIV Institute, Johannesburg lDesmond Tutu TB Centre, Western Cape mDepartment of Paediatrics and Child Health, FAM-CRU, Stellenbosch University, Cape Town, South Africa nDavid Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
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Sita T, Hassanzadeh C, Savoor R, Samson P, Bradley J, Gentile M, Roach M, Mohindra N, Waqar S, Robinson C, Kruser T. OA03.03 Multi-Institutional Study of Pneumonitis After Treatment with Durvalumab and Chemoradiotherapy for Non-Small Cell Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.09.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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32
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Goddu S, Hilliard J, Knutson N, Samson P, Mutic S, Hugo G, Reynoso F, Cuculich P, Bradley J, Robinson C. Optimized Volumetric Modulated Arc Technique for Noninvasive Cardiac Ablation to Treat Ventricular Tachycardia. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.795] [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]
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33
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Henke L, Cai B, Rudra S, Fischer-Valuck B, Samson P, Srivastava A, Gabani P, Roach M, Laugeman E, Luo J, Wan L, Hugo G, Kim H. Novel kV CBCT Imager on Ring Gantry Radiotherapy Unit Permits High Inter-rater Contour Uniformity. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.820] [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]
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34
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Bhat N, Samson P, Robinson C, Park H, Roach M, Badiyan S, Puri V, Bradley J, Vlacich G. Palliative Treatment Utilization and Outcomes in Elderly Patients with Locally Advanced Esophageal Carcinoma: A Review of the National Cancer Database. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2078] [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: 11/16/2022]
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35
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Samson P, Robinson C, Kennedy W, Gabani P, Roach M, Bradley J, Kozower B, Puri V, Meyers B. Treatment Allocation Modeling and Risk-Stratified Outcomes for Clinical Stage I Non-small Cell Lung Cancer Patients Receiving Surgery versus Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.01.023] [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: 11/30/2022]
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36
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Juloori A, Zajichek A, Kattan M, Mullen D, Samson P, Woody N, Roach M, Bradley J, Videtic G, Robinson C, Stephans K. An Externally Validated Nomogram for Predicting Distant Metastasis after Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer: Implications for Adjuvant Systemic Therapy. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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Samson P, Roach M, Bradley J, Carpenter L, Kozower B, Meyers B, Puri V, Robinson C. Comprehensive Baseline Clinical Assessments in Stage I Non-Small Cell Lung Cancer Patients May Facilitate Treatment Allocation Between Stereotactic Body Radiation Therapy and Surgery. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.170] [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: 10/28/2022]
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38
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Juloori A, Zajichek A, Kattan M, Mullen D, Samson P, Woody N, Roach M, Bradley J, Videtic G, Robinson C, Stephans K. MA01.03 An Externally Validated Nomogram for Predicting Distant Metastasis After SBRT for Early Stage Non-Small Cell Lung Cancer. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Samson P, Robinson C, Lockhart A, Roach M, Parikh P, Puri V, Vlacich G, Bradley J. Concurrent Chemoradiation is Associated With Improved Overall Survival Over Radiation Alone in the Treatment of Non-operative Clinical T1N0M0 Esophageal Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1045] [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: 10/18/2022]
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40
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Samson P, Kozower B, Roach M, DeWees T, Carpenter L, Gal K, Bradley J, Meyers B, Puri V, Robinson C, Crabtree T. Development of a Prospective Clinical Database for Stage I Non–small Cell Lung Cancer Patients to Identify High-Risk Individuals Appropriate for Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1782] [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: 10/18/2022]
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41
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Samson P, Keogan K, Robinson C, Bradley J, Roach M, Crabtree T, Kozower B, Puri V, Meyers B. Treatment Allocation Modeling for Clinical Stage I Non–small Cell Lung Cancer Patients to Facilitate the Shared Decision Making Process for Stereotactic Body Radiation Therapy Versus Surgical Resection. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1781] [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: 12/01/2022]
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42
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Gay AM, Samson P, Legré R. Fractures articulaires complètes de l’extrémité distale du radius chez le sujet jeune actif. Hand Surgery and Rehabilitation 2016; 35S:S51-S54. [DOI: 10.1016/j.hansur.2016.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 04/23/2016] [Accepted: 09/15/2016] [Indexed: 11/16/2022]
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43
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Robinson C, Samson P, Bradley J, Roach M, DeWees T, Waqar S, Baggstrom M, Govindan R, Higgins K, Simone C, Grover S, Puri V, Morgensztern D. Patterns of Care and Survival for Early Versus Delayed Radiation Therapy (RT) in Limited-Stage Small Cell Lung Cancer (LS-SCLC): A Review of the National Cancer Data Base. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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44
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Huang J, Samson P, Perkins S, DeWees T, Robinson C. Hypofractionated Versus Standard Radiation Therapy in Combination With Concurrent Chemotherapy for Elderly Glioblastoma Patients: A Review of the National Cancer Data Base. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nachman S, Ahmed A, Amanullah F, Becerra MC, Botgros R, Brigden G, Browning R, Gardiner E, Hafner R, Hesseling A, How C, Jean-Philippe P, Lessem E, Makhene M, Mbelle N, Marais B, McIlleron H, McNeeley DF, Mendel C, Murray S, Navarro E, Anyalechi EG, Porcalla AR, Powell C, Powell M, Rigaud M, Rouzier V, Samson P, Schaaf HS, Shah S, Starke J, Swaminathan S, Wobudeya E, Worrell C. Towards early inclusion of children in tuberculosis drugs trials: a consensus statement. Lancet Infect Dis 2015; 15:711-20. [PMID: 25957923 PMCID: PMC4471052 DOI: 10.1016/s1473-3099(15)00007-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Children younger than 18 years account for a substantial proportion of patients with tuberculosis worldwide. Available treatments for paediatric drug-susceptible and drug-resistant tuberculosis, albeit generally effective, are hampered by high pill burden, long duration of treatment, coexistent toxic effects, and an overall scarcity of suitable child-friendly formulations. Several new drugs and regimens with promising activity against both drug-susceptible and drug-resistant strains have entered clinical development and are either in various phases of clinical investigation or have received marketing authorisation for adults; however, none have data on their use in children. This consensus statement, generated from an international panel of opinion leaders on childhood tuberculosis and incorporating reviews of published literature from January, 2004, to May, 2014, addressed four key questions: what drugs or regimens should be prioritised for clinical trials in children? Which populations of children are high priorities for study? When can phase 1 or 2 studies be initiated in children? What are the relevant elements of clinical trial design? The consensus panel found that children can be included in studies at the early phases of drug development and should be an integral part of the clinical development plan, rather than studied after regulatory approval in adults is obtained.
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Affiliation(s)
| | - Amina Ahmed
- Levine Children's Hospital at Carolinas Medical Center, Charlotte, NC, USA
| | | | | | | | - Grania Brigden
- Médecins Sans Frontières, Access Campaign, Geneva, Switzerland
| | - Renee Browning
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Division of AIDS, Bethesda, MD, USA
| | | | - Richard Hafner
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Division of AIDS, Bethesda, MD, USA
| | - Anneke Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Cleotilde How
- Department of Pharmacology and Toxicology, University of the Philippines, Manila, Philippines
| | - Patrick Jean-Philippe
- Henry M Jackson Foundation-Division of AIDS, Contractor to National Institutes of Health, National Institute of Allergy and Infectious Diseases, Department of Health and Human Services, Bethesda, MD, USA
| | | | - Mamodikoe Makhene
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Division of AIDS, Bethesda, MD, USA
| | - Nontombi Mbelle
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Ben Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity and the Sydney Emerging Infectious Diseases and Biosecurity Institute and The Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa
| | | | | | | | - Eileen Navarro
- Division of Anti-Infective Products; Office of Antimicrobial Products, Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - E Gloria Anyalechi
- US Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, International Research and Programs Branch, Atlanta, GA, USA
| | - Ariel R Porcalla
- Division of Anti-Infective Products; Office of Antimicrobial Products, Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Clydette Powell
- US Agency for International Development, Washington, DC, USA
| | | | - Mona Rigaud
- New York University School of Medicine, NY, USA
| | | | - Pearl Samson
- Statistical and Data Analysis Center, Center for Biostatistics in AIDS Research and Frontier Science, Harvard School of Public Health, Boston, MA, USA
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Seema Shah
- Department of Bioethics, NIH Clinical Center, Bethesda, MD, USA
| | - Jeff Starke
- Baylor College of Medicine, Houston, TX, USA
| | | | - Eric Wobudeya
- Makerere University Johns Hopkins Research Collaboration, and Mulago National Referral Hospital, Kampala, Uganda
| | - Carol Worrell
- Eunice Kennedy Schriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD, USA
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46
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Kiser JJ, Rutstein RM, Samson P, Graham B, Aldrovandi G, Mofenson LM, Smith E, Schnittman S, Fenton T, Brundage RC, Fletcher CV. Atazanavir and atazanavir/ritonavir pharmacokinetics in HIV-infected infants, children, and adolescents. AIDS 2011; 25:1489-96. [PMID: 21610486 PMCID: PMC3177533 DOI: 10.1097/qad.0b013e328348fc41] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the pharmacokinetics of atazanavir (ATV) and ritonavir-boosted ATV (ATV/r) in children aged 91 days to 21 years. DESIGN A phase I/II, open-label, multicenter study of once-daily ATV and ATV/r as part of combination antiretroviral treatment in HIV-infected treatment-experienced and treatment-naive children. SETTING Sites in the United States and South Africa. PARTICIPANTS One hundred and ninety-five children enrolled; 172 had evaluable ATV pharmacokinetics on day 7. INTERVENTION Children were entered in age, dose, and formulation (powder or capsule) cohorts. Intensive pharmacokinetic sampling occurred 7 days after starting ATV. ATV doses were increased or decreased if the 24-h area under the concentration time curves (AUC0-24hr) were less than 30 or more than 90 μg × h/ml, respectively. MAIN OUTCOMES Cohorts satisfied protocol-defined pharmacokinetic criteria if the median ATV AUC0-24hr was 60 μg × h/ml or less, and AUC0-24hr and ATV concentrations 24-h postdose (C24) were more than 30 μg × h/ml and at least 60 ng/ml, respectively, in at least 80% of the children, with no individual AUC0-24hr less than 15 μg × h/ml. RESULTS Unboosted ATV capsules satisfied pharmacokinetic criteria at a dose of 520 mg/m for those aged more than 2 to 13 years or less and 620 mg/m for those aged more than 13 to 21 years or less. ATV/r capsules satisfied criteria at a dose of 205 mg/m for those aged more than 2 to 21 years or less. ATV/r powder satisfied criteria at a dose of 310 mg/m for those aged more than 2 to 13 years or less, but pharmacokinetics in those aged 2 years or less were highly variable. CONCLUSION Body surface area-determined doses of ATV capsules and of ATV/r powder and capsules provide ATV exposures in children of more than 2 years that approximate concentrations in adults receiving ATV/r.
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Affiliation(s)
| | | | | | - Bobbie Graham
- Frontier Science Technology Research Foundation, Amherst, NY
| | | | - Lynne M. Mofenson
- Pediatric, Adolescent and Maternal AIDS Branch, NICHD, NIH, Bethesda, MD
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Manalil NS, Junior Téo V, Braithwaite K, Brumbley S, Samson P, Helena Nevalainen K. Comparative analysis of the Metarhizium anisopliae secretome in response to exposure to the greyback cane grub and grub cuticles. Fungal Biol 2010; 114:637-45. [DOI: 10.1016/j.funbio.2010.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 03/24/2010] [Accepted: 05/14/2010] [Indexed: 11/16/2022]
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McIntyre JO, Samson P, Brenner SC, Dalton L, Dalton L, Fleischer S. EPR Studies of the Motional Characteristics of the Phospholipid in Functional Reconstituted Sarcoplasmic Reticulum Membrane Vesicles. Biophys J 2010; 37:53-6. [PMID: 19431497 DOI: 10.1016/s0006-3495(82)84595-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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White G, Samson P, Rowland‐Jones R, Thomas A. The implementation of a quality management system in the not‐for‐profit sector. The TQM Journal 2009. [DOI: 10.1108/17542730910953040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Samson P. [Congenital hand anomalies]. Chir Main 2008; 27 Suppl 1:S1. [PMID: 19007727 DOI: 10.1016/j.main.2008.10.004] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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