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Fakih M, Raghav KPS, Chang DZ, Larson T, Cohn AL, Huyck TK, Cosgrove D, Fiorillo JA, Tam R, D'Adamo D, Sharma N, Brennan BJ, Wang YA, Coppieters S, Zebger-Gong H, Weispfenning A, Seidel H, Ploeger BA, Mueller U, Oliveira CSVD, Paulson AS. Regorafenib plus nivolumab in patients with mismatch repair-proficient/microsatellite stable metastatic colorectal cancer: a single-arm, open-label, multicentre phase 2 study. EClinicalMedicine 2023; 58:101917. [PMID: 37090438 PMCID: PMC10119887 DOI: 10.1016/j.eclinm.2023.101917] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 04/25/2023] Open
Abstract
Background Anti-programmed cell death protein 1 antibodies plus multikinase inhibitors have shown encouraging activity in several tumour types, including colorectal cancer. This study assessed regorafenib plus nivolumab in patients with microsatellite stable/mismatch repair-proficient metastatic colorectal cancer. Methods This single-arm, open-label, multicentre phase 2 study enrolled adults from 13 sites in the USA with previously treated advanced microsatellite stable/mismatch repair-proficient metastatic colorectal cancer. Eligible patients had known extended RAS and BRAF status, progression or intolerance to no more than two (for extended RAS mutant) or three (for extended RAS wild type) lines of systemic chemotherapy and an Eastern Cooperative Oncology Group performance status of 0 or 1. Regorafenib 80 mg/day was administered orally for 3 weeks on/1 week off (increased to 120 mg/day if 80 mg/day was well tolerated) with intravenous nivolumab 480 mg every 4 weeks. Primary endpoint was objective response rate. Secondary endpoints included safety, overall survival, and progression-free survival. Exploratory endpoints included biomarkers associated with antitumour activity. Patients who received at least one dose of study intervention were included in the efficacy and safety analyses. Tumour assessments were carried out every 8 weeks for the first year, and every 12 weeks thereafter until progressive disease/end of the study, and objective response rate was analysed after all patients had met the criteria for primary completion of five post-baseline scans and either 10-months' follow-up or drop out. This trial is registered with ClinicalTrials.gov, number NCT04126733. Findings Between 14 October 2019 and 14 January 2020, 94 patients were enrolled, 70 received treatment. Five patients had a partial response, yielding an objective response rate of 7% (95% CI 2.4-15.9; p = 0.27). All responders had no liver metastases at baseline. Median overall survival (data immature) and progression-free survival were 11.9 months (95% CI 7.0-not evaluable) and 1.8 months (95% CI 1.8-2.4), respectively. Most patients (97%, 68/70) experienced a treatment-related adverse event; 51% were grade 1 or 2, 40% were grade 3, 3% were grade 4, and 3% were grade 5. The most common (≥20%) events were fatigue (26/70), palmar-plantar erythrodysesthesia syndrome (19/70), maculopapular rash (17/70), increased blood bilirubin (14/70), and decreased appetite (14/70). Higher baseline expression of tumour biomarkers of immune sensitivity correlated with antitumour activity. Interpretation Further studies are warranted to identify subgroups of patients with clinical characteristics or biomarkers that would benefit most from treatment with regorafenib plus nivolumab. Funding Bayer/Bristol Myers Squibb.
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Affiliation(s)
- Marwan Fakih
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
- Corresponding author. City of Hope Comprehensive Cancer Center, Duarte, CA, 91010, USA.
| | - Kanwal Pratap Singh Raghav
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Tim Larson
- Minnesota Oncology/The US Oncology Network, Minneapolis, MN, USA
| | | | | | - David Cosgrove
- Division of Medical Oncology, Vancouver Cancer Center, Compass Oncology, Vancouver, WA, USA
| | | | - Rachel Tam
- Bristol Myers Squibb, Lawrenceville, NJ, USA
| | | | | | | | - Ying A. Wang
- Bayer HealthCare Pharmaceuticals, Cambridge, MA, USA
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Dunkel IJ, Doz F, Foreman NK, Hargrave D, Lassaletta A, André N, Hansford JR, Hassall T, Eyrich M, Gururangan S, Bartels U, Gajjar A, Howell L, Warad D, Pacius M, Tam R, Wang Y, Zhu L, Cohen K. Nivolumab With or Without Ipilimumab in Pediatric Patients With High-Grade CNS Malignancies: Safety, Efficacy, Biomarker, and Pharmacokinetics: CheckMate 908. Neuro Oncol 2023:7048451. [PMID: 36808285 PMCID: PMC10398811 DOI: 10.1093/neuonc/noad031] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Therapeutic options are limited in pediatric CNS malignancies. CheckMate 908 (NCT03130959) is an open-label, sequential-arm, phase 1b/2 study investigating nivolumab (NIVO) and NIVO+ipilimumab (IPI) in pediatric patients with high-grade CNS malignancies. METHODS Patients (N=166) in 5 cohorts received NIVO 3 mg/kg every 2 weeks (Q2W) or NIVO 3 mg/kg+IPI 1 mg/kg every 3 weeks (4 doses) followed by NIVO 3 mg/kg Q2W. Primary endpoints included overall survival (OS; newly diagnosed diffuse intrinsic pontine glioma [DIPG]) and progression-free survival (PFS; other recurrent/progressive or relapsed/resistant CNS cohorts). Secondary endpoints included other efficacy metrics and safety. Exploratory endpoints included pharmacokinetics and biomarker analyses. RESULTS As of January 13, 2021, median OS (80% CI) was 11.7 (10.3-16.5) and 10.8 (9.1-15.8) months with NIVO and NIVO+IPI, respectively, in newly diagnosed DIPG. Median PFS (80% CI) with NIVO and NIVO+IPI was 1.7 (1.4-2.7) and 1.3 (1.2-1.5) months, respectively, in recurrent/progressive high-grade glioma; 1.4 (1.2-1.4) and 2.8 (1.5-4.5) months in relapsed/resistant medulloblastoma; and 1.4 (1.4-2.6) and 4.6 (1.4-5.4) months in relapsed/resistant ependymoma. In patients with other recurrent/progressive CNS tumors, median PFS (95% CI) was 1.2 (1.1-1.3) and 1.6 (1.3-3.5) months, respectively. Grade 3/4 treatment-related adverse-event rates were 14.1% (NIVO) and 27.2% (NIVO+IPI). NIVO and IPI first-dose trough concentrations were lower in youngest and lowest-weight patients. Baseline tumor programmed death ligand 1 expression was not associated with survival. CONCLUSIONS NIVO±IPI did not demonstrate clinical benefit relative to historical data. The overall safety profiles were manageable with no new safety signals.
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Affiliation(s)
- Ira J Dunkel
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - François Doz
- SIREDO Center, Institut Curie and University Paris Cité, Paris, France
| | | | | | | | - Nicolas André
- Hopital pour Enfants de la Timone, AP-HM and Centre de Recherche en Cancérologie de Marseille, Aix Marseille Université, Marseille, France
| | - Jordan R Hansford
- The Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Department of Pediatrics, Melbourne, VIC, Australia
| | - Tim Hassall
- Queensland Children's Hospital, South Brisbane, QLD, Australia
| | | | | | - Ute Bartels
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Amar Gajjar
- St. Jude's Children's Hospital, Memphis, TN, USA
| | - Lisa Howell
- Alder Hey Children's Hospital, Liverpool, UK
| | | | | | - Rachel Tam
- Bristol Myers Squibb, Princeton, NJ, USA
| | - Yu Wang
- Bristol Myers Squibb, Princeton, NJ, USA
| | - Li Zhu
- Bristol Myers Squibb, Princeton, NJ, USA
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Feeney K, Joubert WL, Bordoni RE, Babu S, Marimuthu S, Hipkin B, Huang L, Tam R, Acosta Rivera M. RELATIVITY-123: A phase 3, randomized, open-label study of nivolumab (NIVO) + relatlimab (RELA) fixed-dose combination (FDC) versus regorafenib or trifluridine + tipiracil (TAS-102) in later-line metastatic colorectal cancer (mCRC). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.tps278] [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: 01/25/2023] Open
Abstract
TPS278 Background: The standard of care (SoC) for first-line management of non-microsatellite instability-high/deficient mismatch repair (non-MSI-H/dMMR; also referred to as microsatellite-stable/proficient MMR) mCRC includes systemic chemotherapy and targeted agents that improve overall survival (OS). However, in patients (pts) with later-line disease, current SoC treatments (including regorafenib and TAS-102) are associated with poor responses (objective response rates [ORR] < 2%) that are not durable, limited OS (6.4-7.1 months) and substantial toxicity. Immunotherapies targeting programmed death (PD)-1 show promising efficacy in pts with MSI-H mCRC; however, single-agent immunotherapy does not provide benefit for pts with non-MSI-H/dMMR mCRC. Therefore, additional treatment options with an improved benefit-risk profile in pts with later-line non-MSI-H/dMMR mCRC are needed. Emerging data suggest that dual inhibition of LAG-3 and PD-1 has the potential to boost immune surveillance and elicit durable responses in non-MSI-H/dMMR mCRC. RELA is a human immunoglobulin G4 lymphocyte-activation gene 3 (LAG-3)-blocking antibody that enhances the antitumor immune response. Here we describe the RELATIVITY-123 study investigating NIVO + RELA FDC in later-line mCRC. Methods: RELATIVITY-123 (NCT05328908) is a phase 3, randomized (1:1), open-label study to assess NIVO + RELA FDC versus regorafenib or TAS-102 in adult pts with later lines of non-MSI-H/dMMR mCRC. Inclusion criteria include metastatic or recurrent unresectable CRC, recent progression following 1–4 prior lines of treatment (or documented intolerance of prior systemic chemotherapy regimens), ECOG performance status ≤ 1, and measurable disease per RECIST version (v) 1.1. Exclusion criteria include confirmed MSI-H/deficient mismatch repair, prior treatment with an immunotherapy, regorafenib, or TAS-102 and history of significant cardiovascular disease, interstitial lung disease/pneumonitis, or autoimmune disease. Dual primary endpoints are OS in all randomized pts and in randomized pts with PD-L1 CPS ≥ 1. Secondary endpoints include ORR, progression-free survival, and duration of response by blinded independent central review and investigator per RECIST v1.1, safety, and time until definitive deterioration-physical function and -quality of life in all randomized pts and in randomized pts with PD-L1 CPS ≥ 1. The study initiated in April 2022 and is enrolling globally. Clinical trial information: NCT05328908 .
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Affiliation(s)
- Kynan Feeney
- St. John of God Murdoch Hospital, Perth, Australia
| | | | | | - Sunil Babu
- Fort Wayne Medical Oncology and Hematology, Fort Wayne, IN
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Thakur MD, Franz CJ, Brennan L, Brouwer-Visser J, Tam R, Korski K, Koeppen H, Ziai J, Babitzki G, Ranchere-Vince D, Vasiljevic A, Dijoud F, Marec-Bérard P, Rochet I, Cannarile MA, Marabelle A. Immune contexture of paediatric cancers. Eur J Cancer 2022; 170:179-193. [PMID: 35660252 DOI: 10.1016/j.ejca.2022.03.012] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The clinical development of immune checkpoint-targeted immunotherapies has been disappointing so far in paediatric solid tumours. However, as opposed to adults, very little is known about the immune contexture of paediatric malignancies. METHODS We investigated by gene expression and immunohistochemistry (IHC) the immune microenvironment of five major paediatric cancers: Ewing sarcoma (ES), osteosarcoma (OS), rhabdomyosarcoma (RMS), medulloblastoma (MB) and neuroblastoma (NB; 20 cases each; n = 100 samples total), and correlated them with overall survival. RESULTS NB and RMS tumours had high immune cell gene expression values and high T-cell counts but were low for antigen processing cell (APC) genes. OS and ES tumours showed low levels of T-cells but the highest levels of APC genes. OS had the highest levels of macrophages (CSF1R, CD163 and CD68), whereas ES had the lowest. MB appeared as immune deserts. Tregs (FOXP3 staining) were higher in both RMS and OS. Most tumours scored negative for PD-L1 in tumour and immune cells, with only 11 of 100 samples positive for PD-L1 staining. PD-L1 and OX40 levels were generally low across all five indications. Interestingly, NB had comparable levels of CD8 by IHC and by gene expression to adult tumours. However, by gene expression, these tumours were low for T-cell cytotoxic molecules GZMB, GZMA and PRF1. Surprisingly, the lower the level of tumour infiltrative CD8 T-cells, the better the prognosis was in NB, RMS and ES. Gene expression analyses showed that MYCN-amplified NB have higher amounts of immune suppressive cells such as macrophages, myeloid-derived suppressor cells and Tregs, whereas the non-MYCN-amplified tumours were more infiltrated and had higher expression levels of Teff. CONCLUSIONS Our results describe the quality and quantity of immune cells across five major paediatric cancers and provide some key features differentiating these tumours from adult tumour types. These findings explain why anti-PD(L)1 might not have had single agent success in paediatric cancers. These results provides the rationale for the development of biologically stratified and personalised immunotherapy strategies in children with relapsing/refractory cancers.
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Affiliation(s)
| | - Carl J Franz
- Lake Tahoe Community College, South Lake Tahoe, CA, USA
| | - Laura Brennan
- Roche Pharma Research and Early Development, Early Biomarker Development Oncology, Roche Innovation Center New York, Little Falls, NJ, USA
| | - Jurriaan Brouwer-Visser
- Roche Pharma Research and Early Development, Early Biomarker Development Oncology, Roche Innovation Center New York, Little Falls, NJ, USA
| | | | - Konstanty Korski
- Roche Innovation Center Munich, Pharma Research and Early Development, Penzberg, Germany
| | | | | | | | | | - Alexandre Vasiljevic
- Team Fluid, INSERM U1028, CNRS UMR 5292, Lyon Neurosciences Recherche Center, Université Lyon 1, Lyon, France
| | - Frédérique Dijoud
- Centre de Pathologie Est, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
| | - Perrine Marec-Bérard
- Institut d'Hématologie et d'Oncologie Pédiatrique (iHOPe), Centre Léon Bérard, Lyon, France
| | - Isabelle Rochet
- Institut d'Hématologie et d'Oncologie Pédiatrique (iHOPe), Centre Léon Bérard, Lyon, France
| | - Michael A Cannarile
- Roche Innovation Center Munich, Pharma Research and Early Development, Penzberg, Germany
| | - Aurélien Marabelle
- Institut d'Hématologie et d'Oncologie Pédiatrique (iHOPe), Centre Léon Bérard, Lyon, France; Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France; Laboratoire de Recherche Translationelle en Immunothérapies, INSERM U1015, Gustave Roussy, Villejuif, France; Centre d'Investigation Clinique BIOTHERIS, INSERM CIC1428, Gustave Roussy, Villejuif, France; Faculté de Médecine, Université Paris Saclay, Le Kremlin-Bicetre, France.
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5
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Dunkel IJ, Cohen K, Foreman NK, Hargrave D, Lassaletta A, André N, Hansford JR, Hassall T, Eyrich M, Gururangan S, Bartels U, Gajjar A, Howell L, Warad D, Pacius M, Tam R, Wang Y, Zhu L, Doz F. IMMU-08. Nivolumab with or without ipilimumab in pediatric patients with high-grade CNS malignancies: efficacy, safety, biomarker, and pharmacokinetic results from Checkmate 908. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.301] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: Limited data exist regarding checkpoint inhibitor efficacy for pediatric CNS malignancies. METHODS: CheckMate 908 is an open-label, sequential-arm, phase 1b/2 study investigating nivolumab (NIVO) and NIVO + ipilimumab (IPI) in 5 cohorts of pediatric patients previously treated with standard-of-care (NCT03130959). Patients received NIVO-3mg/kg Q2W or NIVO-3mg/kg + IPI-1mg/kg Q3W (4 doses) followed by NIVO-3mg/kg Q2W. Primary endpoints included OS (newly diagnosed DIPG) and PFS (other CNS cohorts); secondary endpoints included other efficacy metrics/safety. Exploratory endpoints included pharmacokinetics/biomarker analyses. Comparisons between treatments/cohorts were not planned. RESULTS: At data cutoff (13-Jan-2021), 166 patients received NIVO (n=85) or NIVO+IPI (n=81) at median (m) ages of 10.0yrs (range, 1-21) and 11.0yrs (1-21), respectively. In newly diagnosed DIPG, mOS (80% CI) was 11.7mos (10.3-16.5) with NIVO (n=23) and 10.8mos (9.1-15.8) with NIVO+IPI (n=22). In recurrent/progressive HGG, mPFS (80% CI) was 1.7mos (1.4-2.7) with NIVO (n=16) and 1.3mos (1.2-1.5) with NIVO+IPI (n=15). In relapsed/resistant medulloblastoma, mPFS (80% CI) was 1.4mos (1.2-1.4) with NIVO (n=15) and 2.8mos (1.5-4.5) with NIVO+IPI (n=15). In relapsed/resistant ependymoma, mPFS (80% CI) was 1.4mos (1.4-2.6) with NIVO (n=12) and 4.6mos (1.4-5.4) with NIVO+IPI (n=10). In other recurrent/progressive CNS tumors, mPFS (95% CI) was 1.2mos (1.1-1.3) with NIVO (n=19) and 1.6mos (1.3-3.5) with NIVO+IPI (n=19). Median treatment duration was 2.1mos (range, 0-41.7+ [NIVO]/0-29.6+ [NIVO+IPI]). Grade 3/4 treatment-related AEs occurred in 14.1% (NIVO) and 27.2% (NIVO+IPI) of patients. NIVO and IPI first dose trough concentrations were lower in youngest and lowest-weight patients. Baseline tumor PD-L1 expression was not associated with survival. Tumor mutational burden was high in 1 patient (NIVO+IPI) with HGG (OS=11.0mos). CONCLUSIONS: NIVO±IPI demonstrated no clinical benefit in pediatric patients with high-grade CNS malignancies, consistent with available historical data. The safety profiles were manageable.
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Affiliation(s)
- Ira J Dunkel
- Memorial Sloan Kettering Cancer Center, New York , NY , USA
| | | | | | - Darren Hargrave
- Great Ormond Street Hospital for Children , London , United Kingdom
| | | | - Nicolas André
- Hopital pour Enfants de la Timone, AP-HM and Centre de Recherche en Cancérologie de Marseille, Aix Marseille Université , Marseille , France
| | - Jordan R Hansford
- The Royal Children's Hospital, Murdoch Children’s Research Institute, Department of Pediatrics, University of Melbourne , Melbourne, VIC , Australia
| | - Tim Hassall
- Queensland Children’s Hospital, South Brisbane , QLD , Australia
| | | | | | - Ute Bartels
- The Hospital For Sick Children , Toronto, ON , Canada
| | - Amar Gajjar
- St. Jude's Children's Research Hospital , Memphis, TN , USA
| | - Lisa Howell
- Alder Hey Children's Hospital , Liverpool , United Kingdom
| | | | | | - Rachel Tam
- Bristol Myers Squibb , Princeton, NJ , USA
| | - Yu Wang
- Bristol Myers Squibb , Princeton, NJ , USA
| | - Li Zhu
- Bristol Myers Squibb , Princeton, NJ , USA
| | - François Doz
- Institut Curie and University of Paris , Paris , France
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Johnson P, Chan JK, Vavasour IM, Abel S, Lee LE, Yong H, Laule C, Li DKB, Tam R, Traboulsee A, Carruthers RL, Kolind SH. Quantitative MRI findings indicate diffuse white matter damage in Susac Syndrome. Mult Scler J Exp Transl Clin 2022; 8:20552173221078834. [PMID: 35186315 PMCID: PMC8851927 DOI: 10.1177/20552173221078834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 01/21/2022] [Indexed: 11/15/2022] Open
Abstract
Background Susac Syndrome (SuS) is an autoimmune endotheliopathy impacting the brain, retina and cochlea that can clinically mimic multiple sclerosis (MS). Objective To evaluate non-lesional white matter demyelination changes in SuS compared to MS and healthy controls (HC) using quantitative MRI. Methods 3T MRI including myelin water imaging and diffusion basis spectrum imaging were acquired for 7 SuS, 10 MS and 10 HC participants. Non-lesional white matter was analyzed in the corpus callosum (CC) and normal appearing white matter (NAWM). Groups were compared using ANCOVA with Tukey correction. Results SuS CC myelin water fraction (mean 0.092) was lower than MS(0.11, p = 0.01) and HC(0.11, p = 0.04). Another myelin marker, radial diffusivity, was increased in SuS CC(0.27μm2/ms) compared to HC(0.21μm2/ms, p = 0.008) and MS(0.23μm2/ms, p = 0.05). Fractional anisotropy was lower in SuS CC(0.82) than HC(0.86, p = 0.04). Fiber fraction (reflecting axons) did not differ from HC or MS. In NAWM, radial diffusivity and apparent diffusion coefficient were significantly increased in SuS compared to HC(p < 0.001 for both measures) and MS(p = 0.003, p < 0.001 respectively). Conclusions Our results provided evidence of myelin damage in SuS, particularly in the CC, and more extensive microstructural injury in NAWM, supporting the hypothesis that there are widespread microstructural changes in SuS syndrome including diffuse demyelination.
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Affiliation(s)
| | - JK Chan
- Department of Medicine (Neurology), University of British Columbia, Canada
| | - IM Vavasour
- Department of Radiology, University of British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD)
| | | | | | - H Yong
- Department of Medicine (Neurology), University of British Columbia, Canada
| | - C Laule
- Department of Radiology, University of British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD)
- Department of Pathology and Laboratory Medicine, University of British Columbia, Canada
- Department of Physics and Astronomy, University of British Columbia, Canada
| | - DKB Li
- Department of Medicine (Neurology), University of British Columbia, Canada
- Department of Radiology, University of British Columbia, Canada
| | - R Tam
- Department of Radiology, University of British Columbia, Canada
- School of Biomedical Engineering, University of British Columbia, Canada
| | | | - RL Carruthers
- Department of Medicine (Neurology), University of British Columbia, Canada
| | - SH Kolind
- Department of Medicine (Neurology), University of British Columbia, Canada
- Department of Radiology, University of British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD)
- Department of Physics and Astronomy, University of British Columbia, Canada
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7
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Vavasour IM, Becquart P, Gill J, Zhao G, Yik JT, Traboulsee A, Carruthers RL, Kolind SH, Schabas AJ, Sayao AL, Devonshire V, Tam R, Moore GRW, Stukas S, Wellington CL, Quandt JA, Li DKB, Laule C. Diffusely abnormal white matter in clinically isolated syndrome is associated with parenchymal loss and elevated neurofilament levels. Mult Scler Relat Disord 2021; 57:103422. [PMID: 34871858 DOI: 10.1016/j.msard.2021.103422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/23/2021] [Accepted: 11/20/2021] [Indexed: 11/19/2022]
Abstract
We characterized the frequency of diffusely abnormal white matter (DAWM) across a broad spectrum of multiple sclerosis (MS) participants. 35% of clinically isolated syndrome (CIS), 57% of relapsing remitting and 64% of secondary progressive MS participants demonstrated DAWM. CIS with DAWM had decreased cortical thickness, higher lesion load and a higher concentration of serum neurofilament light chain compared to CIS without DAWM. DAWM may be useful in identifying CIS patients with greater injury to their brains. Larger and longitudinal studies are warranted.
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Affiliation(s)
- I M Vavasour
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.
| | - P Becquart
- Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Gill
- Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - G Zhao
- MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada
| | - J T Yik
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada; Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Traboulsee
- MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada; Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - R L Carruthers
- Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - S H Kolind
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada; MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada; Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - A J Schabas
- Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - A L Sayao
- Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - V Devonshire
- Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - R Tam
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada; MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada; School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - G R W Moore
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada; Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - S Stukas
- Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - C L Wellington
- Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - J A Quandt
- Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - D K B Li
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada; MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada; Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - C Laule
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada; Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
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Tang L, Ho K, Tam R, Hawkins N, Lim M, Andrade J. Machine learning for predicting AF ablation outcomes using daily heart rhythm data at baseline. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
While numerous studies have shown that catheter ablation is superior to antiarrhythmic drug (AAD) in treating atrial fibrillation (AF), the long term outcomes have been limited by arrhythmia recurrence. Reliable data and methods to predict ablation outcomes will thus be valuable for treatment planning.
Objective
To evaluate the utility of machine learning and various types of input variables, viz. patient characteristics at baseline, and daily heart rhythm data recorded prior to ablation for outcome prediction.
Methods
We acquired permission to analyze data collected from a randomized clinical trial that recorded daily biomeasures from >345 patients who were referred for first catheter ablation due to AF refractory to at least one AAD. After standardizing the dataset, each patient sample is characterized by a set of daily measures, viz. heart rate variability (HRV) and AF burden (AFB), which is the total minutes in AF per day. We next performed comparative analyses on 19 candidate model variants to evaluate each model's ability in identifying patients who were to experience at least one episode of AF recurrence during post-ablation period starting from day 91 up to day 365 post-ablation, per standard guidelines. We examined: i) use of a set of daily biomeasures jointly with baseline sex and age; and ii) observation lengths of the pre-ablation period. We also examined the use of baseline CHA2DS2-VASc scores, left-atrial volume (LAV), atrial diameter, medical history. We conducted multiple sets of 3-fold cross validation (CV) experiments, each fold independently trained a candidate model with 236 samples (two thirds of the dataset) and performed evaluation on the left-out samples. About 50% of cohort belongs to one class. Each fold scored a model and its input variables in terms of sensitivity (SEN), specificity (SPEC), area under receiver operating characteristic curve (AUC), etc. To circumvent risks of overfitting highly parameterized models to our training subset, we shortlisted 19 models that have few hyper-parameters, e.g. stepwise regression, random forest (RF), linear discriminant analysis (LDA).
Results
CV results demonstrated that LDA and RF gave comparable performances, with RF achieving highest AUC of 0.68±0.06 using 30 days of rhythm data prior to ablation (SEN of 65.9±7.82; SPEC of 66.3±0.57). When observation period extended to 90 days prior, AUC improved to 0.691±0.02. In contrast, use of LAV alone was not adequate to predict outcome (AUC∼0.5), and when combined with all aforementioned baseline variables, the best model achieved AUC of 0.58±0.05. Feature analyses from the trained models suggest that AFB had highest relevance in predicting outcome. Using only daily AFB, RF and LDA respectively achieved AUC of 0.608±0.04 and 0.652±0.04.
Conclusions
Our results suggest the value of pre-ablation rhythm data for improving outcome-prediction. Future work will validate these findings using large public datasets.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Huawei-Data Science Institute Research Program; Natural Sciences and Engineering Research Council of Canada (NSERC)
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Affiliation(s)
- L Tang
- University of British Columbia, Vancouver, Canada
| | - K Ho
- University of British Columbia, Vancouver, Canada
| | - R Tam
- University of British Columbia, Vancouver, Canada
| | - N Hawkins
- University of British Columbia, Vancouver, Canada
| | - M Lim
- University of British Columbia, Vancouver, Canada
| | - J Andrade
- University of British Columbia, Vancouver, Canada
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Innocenti F, Ou FS, Qu X, Zemla T, Niedzwiecki D, Tam R, Mahajan S, Goldberg RM, Bertagnolli MM, Blanke CD, Sanoff H, Atkins J, Polite B, Venook AP, Lenz HJ, Kabbarah O. Reply to S. Sorscher. J Clin Oncol 2019; 37:2291-2293. [DOI: 10.1200/jco.19.01366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Federico Innocenti
- Federico Innocenti, MD, PhD, University of North Carolina at Chapel Hill, Chapel Hill, NC; Fang-Shu Ou, PhD, Mayo Clinic Minnesota, Rochester, MN; Xueping Qu, PhD, Genentech, South San Francisco, CA; Tyler Zemla, MS, Mayo Clinic Minnesota, Rochester, MN; Donna Niedzwiecki, PhD, Duke University, Durham, NC; Rachel Tam, PhD and Shilpi Mahajan, PhD, Genentech, South San Francisco, CA; Richard M. Goldberg, MD, West Virginia University Cancer Institute, Morgantown, WV; Monica M. Bertagnolli, MD, Dana-Farber
| | - Fang-Shu Ou
- Federico Innocenti, MD, PhD, University of North Carolina at Chapel Hill, Chapel Hill, NC; Fang-Shu Ou, PhD, Mayo Clinic Minnesota, Rochester, MN; Xueping Qu, PhD, Genentech, South San Francisco, CA; Tyler Zemla, MS, Mayo Clinic Minnesota, Rochester, MN; Donna Niedzwiecki, PhD, Duke University, Durham, NC; Rachel Tam, PhD and Shilpi Mahajan, PhD, Genentech, South San Francisco, CA; Richard M. Goldberg, MD, West Virginia University Cancer Institute, Morgantown, WV; Monica M. Bertagnolli, MD, Dana-Farber
| | - Xueping Qu
- Federico Innocenti, MD, PhD, University of North Carolina at Chapel Hill, Chapel Hill, NC; Fang-Shu Ou, PhD, Mayo Clinic Minnesota, Rochester, MN; Xueping Qu, PhD, Genentech, South San Francisco, CA; Tyler Zemla, MS, Mayo Clinic Minnesota, Rochester, MN; Donna Niedzwiecki, PhD, Duke University, Durham, NC; Rachel Tam, PhD and Shilpi Mahajan, PhD, Genentech, South San Francisco, CA; Richard M. Goldberg, MD, West Virginia University Cancer Institute, Morgantown, WV; Monica M. Bertagnolli, MD, Dana-Farber
| | - Tyler Zemla
- Federico Innocenti, MD, PhD, University of North Carolina at Chapel Hill, Chapel Hill, NC; Fang-Shu Ou, PhD, Mayo Clinic Minnesota, Rochester, MN; Xueping Qu, PhD, Genentech, South San Francisco, CA; Tyler Zemla, MS, Mayo Clinic Minnesota, Rochester, MN; Donna Niedzwiecki, PhD, Duke University, Durham, NC; Rachel Tam, PhD and Shilpi Mahajan, PhD, Genentech, South San Francisco, CA; Richard M. Goldberg, MD, West Virginia University Cancer Institute, Morgantown, WV; Monica M. Bertagnolli, MD, Dana-Farber
| | - Donna Niedzwiecki
- Federico Innocenti, MD, PhD, University of North Carolina at Chapel Hill, Chapel Hill, NC; Fang-Shu Ou, PhD, Mayo Clinic Minnesota, Rochester, MN; Xueping Qu, PhD, Genentech, South San Francisco, CA; Tyler Zemla, MS, Mayo Clinic Minnesota, Rochester, MN; Donna Niedzwiecki, PhD, Duke University, Durham, NC; Rachel Tam, PhD and Shilpi Mahajan, PhD, Genentech, South San Francisco, CA; Richard M. Goldberg, MD, West Virginia University Cancer Institute, Morgantown, WV; Monica M. Bertagnolli, MD, Dana-Farber
| | - Rachel Tam
- Federico Innocenti, MD, PhD, University of North Carolina at Chapel Hill, Chapel Hill, NC; Fang-Shu Ou, PhD, Mayo Clinic Minnesota, Rochester, MN; Xueping Qu, PhD, Genentech, South San Francisco, CA; Tyler Zemla, MS, Mayo Clinic Minnesota, Rochester, MN; Donna Niedzwiecki, PhD, Duke University, Durham, NC; Rachel Tam, PhD and Shilpi Mahajan, PhD, Genentech, South San Francisco, CA; Richard M. Goldberg, MD, West Virginia University Cancer Institute, Morgantown, WV; Monica M. Bertagnolli, MD, Dana-Farber
| | - Shilpi Mahajan
- Federico Innocenti, MD, PhD, University of North Carolina at Chapel Hill, Chapel Hill, NC; Fang-Shu Ou, PhD, Mayo Clinic Minnesota, Rochester, MN; Xueping Qu, PhD, Genentech, South San Francisco, CA; Tyler Zemla, MS, Mayo Clinic Minnesota, Rochester, MN; Donna Niedzwiecki, PhD, Duke University, Durham, NC; Rachel Tam, PhD and Shilpi Mahajan, PhD, Genentech, South San Francisco, CA; Richard M. Goldberg, MD, West Virginia University Cancer Institute, Morgantown, WV; Monica M. Bertagnolli, MD, Dana-Farber
| | - Richard M. Goldberg
- Federico Innocenti, MD, PhD, University of North Carolina at Chapel Hill, Chapel Hill, NC; Fang-Shu Ou, PhD, Mayo Clinic Minnesota, Rochester, MN; Xueping Qu, PhD, Genentech, South San Francisco, CA; Tyler Zemla, MS, Mayo Clinic Minnesota, Rochester, MN; Donna Niedzwiecki, PhD, Duke University, Durham, NC; Rachel Tam, PhD and Shilpi Mahajan, PhD, Genentech, South San Francisco, CA; Richard M. Goldberg, MD, West Virginia University Cancer Institute, Morgantown, WV; Monica M. Bertagnolli, MD, Dana-Farber
| | - Monica M. Bertagnolli
- Federico Innocenti, MD, PhD, University of North Carolina at Chapel Hill, Chapel Hill, NC; Fang-Shu Ou, PhD, Mayo Clinic Minnesota, Rochester, MN; Xueping Qu, PhD, Genentech, South San Francisco, CA; Tyler Zemla, MS, Mayo Clinic Minnesota, Rochester, MN; Donna Niedzwiecki, PhD, Duke University, Durham, NC; Rachel Tam, PhD and Shilpi Mahajan, PhD, Genentech, South San Francisco, CA; Richard M. Goldberg, MD, West Virginia University Cancer Institute, Morgantown, WV; Monica M. Bertagnolli, MD, Dana-Farber
| | - Charles David Blanke
- Federico Innocenti, MD, PhD, University of North Carolina at Chapel Hill, Chapel Hill, NC; Fang-Shu Ou, PhD, Mayo Clinic Minnesota, Rochester, MN; Xueping Qu, PhD, Genentech, South San Francisco, CA; Tyler Zemla, MS, Mayo Clinic Minnesota, Rochester, MN; Donna Niedzwiecki, PhD, Duke University, Durham, NC; Rachel Tam, PhD and Shilpi Mahajan, PhD, Genentech, South San Francisco, CA; Richard M. Goldberg, MD, West Virginia University Cancer Institute, Morgantown, WV; Monica M. Bertagnolli, MD, Dana-Farber
| | - Hanna Sanoff
- Federico Innocenti, MD, PhD, University of North Carolina at Chapel Hill, Chapel Hill, NC; Fang-Shu Ou, PhD, Mayo Clinic Minnesota, Rochester, MN; Xueping Qu, PhD, Genentech, South San Francisco, CA; Tyler Zemla, MS, Mayo Clinic Minnesota, Rochester, MN; Donna Niedzwiecki, PhD, Duke University, Durham, NC; Rachel Tam, PhD and Shilpi Mahajan, PhD, Genentech, South San Francisco, CA; Richard M. Goldberg, MD, West Virginia University Cancer Institute, Morgantown, WV; Monica M. Bertagnolli, MD, Dana-Farber
| | - James Atkins
- Federico Innocenti, MD, PhD, University of North Carolina at Chapel Hill, Chapel Hill, NC; Fang-Shu Ou, PhD, Mayo Clinic Minnesota, Rochester, MN; Xueping Qu, PhD, Genentech, South San Francisco, CA; Tyler Zemla, MS, Mayo Clinic Minnesota, Rochester, MN; Donna Niedzwiecki, PhD, Duke University, Durham, NC; Rachel Tam, PhD and Shilpi Mahajan, PhD, Genentech, South San Francisco, CA; Richard M. Goldberg, MD, West Virginia University Cancer Institute, Morgantown, WV; Monica M. Bertagnolli, MD, Dana-Farber
| | - Blasé Polite
- Federico Innocenti, MD, PhD, University of North Carolina at Chapel Hill, Chapel Hill, NC; Fang-Shu Ou, PhD, Mayo Clinic Minnesota, Rochester, MN; Xueping Qu, PhD, Genentech, South San Francisco, CA; Tyler Zemla, MS, Mayo Clinic Minnesota, Rochester, MN; Donna Niedzwiecki, PhD, Duke University, Durham, NC; Rachel Tam, PhD and Shilpi Mahajan, PhD, Genentech, South San Francisco, CA; Richard M. Goldberg, MD, West Virginia University Cancer Institute, Morgantown, WV; Monica M. Bertagnolli, MD, Dana-Farber
| | - Alan P. Venook
- Federico Innocenti, MD, PhD, University of North Carolina at Chapel Hill, Chapel Hill, NC; Fang-Shu Ou, PhD, Mayo Clinic Minnesota, Rochester, MN; Xueping Qu, PhD, Genentech, South San Francisco, CA; Tyler Zemla, MS, Mayo Clinic Minnesota, Rochester, MN; Donna Niedzwiecki, PhD, Duke University, Durham, NC; Rachel Tam, PhD and Shilpi Mahajan, PhD, Genentech, South San Francisco, CA; Richard M. Goldberg, MD, West Virginia University Cancer Institute, Morgantown, WV; Monica M. Bertagnolli, MD, Dana-Farber
| | - Heinz-Josef Lenz
- Federico Innocenti, MD, PhD, University of North Carolina at Chapel Hill, Chapel Hill, NC; Fang-Shu Ou, PhD, Mayo Clinic Minnesota, Rochester, MN; Xueping Qu, PhD, Genentech, South San Francisco, CA; Tyler Zemla, MS, Mayo Clinic Minnesota, Rochester, MN; Donna Niedzwiecki, PhD, Duke University, Durham, NC; Rachel Tam, PhD and Shilpi Mahajan, PhD, Genentech, South San Francisco, CA; Richard M. Goldberg, MD, West Virginia University Cancer Institute, Morgantown, WV; Monica M. Bertagnolli, MD, Dana-Farber
| | - Omar Kabbarah
- Federico Innocenti, MD, PhD, University of North Carolina at Chapel Hill, Chapel Hill, NC; Fang-Shu Ou, PhD, Mayo Clinic Minnesota, Rochester, MN; Xueping Qu, PhD, Genentech, South San Francisco, CA; Tyler Zemla, MS, Mayo Clinic Minnesota, Rochester, MN; Donna Niedzwiecki, PhD, Duke University, Durham, NC; Rachel Tam, PhD and Shilpi Mahajan, PhD, Genentech, South San Francisco, CA; Richard M. Goldberg, MD, West Virginia University Cancer Institute, Morgantown, WV; Monica M. Bertagnolli, MD, Dana-Farber
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10
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Piskol R, Huw L, Sergin I, Kljin C, Modrusan Z, Kim D, Kljavin N, Tam R, Patel R, Burton J, Penuel E, Qu X, Koeppen H, Sumiyoshi T, de Sauvage F, Lackner MR, de Sousa e Melo F, Kabbarah O. A Clinically Applicable Gene-Expression Classifier Reveals Intrinsic and Extrinsic Contributions to Consensus Molecular Subtypes in Primary and Metastatic Colon Cancer. Clin Cancer Res 2019; 25:4431-4442. [DOI: 10.1158/1078-0432.ccr-18-3032] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/29/2019] [Accepted: 04/15/2019] [Indexed: 01/10/2023]
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Innocenti F, Ou FS, Qu X, Zemla TJ, Niedzwiecki D, Tam R, Mahajan S, Goldberg RM, Bertagnolli MM, Blanke CD, Sanoff H, Atkins J, Polite B, Venook AP, Lenz HJ, Kabbarah O. Mutational Analysis of Patients With Colorectal Cancer in CALGB/SWOG 80405 Identifies New Roles of Microsatellite Instability and Tumor Mutational Burden for Patient Outcome. J Clin Oncol 2019; 37:1217-1227. [PMID: 30865548 DOI: 10.1200/jco.18.01798] [Citation(s) in RCA: 201] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE CALGB/SWOG 80405 was a randomized phase III trial that found no statistically significant difference in overall survival (OS) in patients with first-line metastatic colorectal cancer treated with chemotherapy plus either bevacizumab or cetuximab. Primary tumor DNA from 843 patients has been used to discover genetic markers of OS. PATIENTS AND METHODS Gene mutations were determined by polymerase chain reaction. Microsatellite status was determined by genotyping of microsatellites. Tumor mutational burden (TMB) was determined by next-generation sequencing. Cox proportional hazard models were used, with adjusting factors. Interaction of molecular alterations with either the bevacizumab or the cetuximab arms was tested. RESULTS Patients with high TMB in their tumors had longer OS than did patients with low TMB (hazard ratio [HR], 0.73 [95% CI, 0.57 to 0.95]; P = .02). In patients with microsatellite instability-high (MSI-H) tumors, longer OS was observed in the bevacizumab arm than in the cetuximab arm (HR, 0.13 [95% CI, 0.06 to 0.30]; interaction P < .001 for interaction between microsatellite status and the two arms). Patients with BRAF mutant tumors had shorter OS than did patients with wild-type (WT) tumors (HR, 2.01 [95% CI, 1.49 to 2.71]; P < .001). Patients with extended RAS mutant tumors had shorter OS than did patients with WT tumors (HR, 1.52 [95% CI, 1.26 to 1.84]; P < .001). Patients with triple-negative tumors (WT for NRAS/KRAS/BRAF) had a median OS of 35.9 months (95% CI, 33.0 to 38.8 months) versus 22.2 months (95% CI, 19.6 to 24.4 months ) in patients with at least one mutated gene in their tumors (P < .001). CONCLUSION In patients with metastatic colorectal cancer treated in first line, low TMB, and BRAF and RAS mutations are negative prognostic factors. Patients with MSI-H tumors benefited more from bevacizumab than from cetuximab, and studies to confirm this effect of MSI-H are warranted.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Hanna Sanoff
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - James Atkins
- 8 Southeast Clinical Oncology Research Consortium, Winston-Salem, NC
| | - Blasé Polite
- 9 University of Chicago Comprehensive Cancer Center, Chicago, IL
| | - Alan P Venook
- 10 University of California San Francisco, San Francisco, CA
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12
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Kang H, Hii M, Le M, Tam R, Riddehough A, Traboulsee A, Kolind S, Freedman MS, Li DKB. Gadolinium Deposition in Deep Brain Structures: Relationship with Dose and Ionization of Linear Gadolinium-Based Contrast Agents. AJNR Am J Neuroradiol 2018; 39:1597-1603. [PMID: 30139752 DOI: 10.3174/ajnr.a5751] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 06/20/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Dose-dependent association between hyperintensity in deep brain structures on unenhanced T1WIs and gadolinium-based contrast agent administrations has been demonstrated with subsequent histopathological confirmation of gadolinium deposition. Our aim was to determine whether greater exposure to linear gadolinium-based contrast agent administration is associated with higher signal intensity in deep brain structures on unenhanced T1-weighted MR imaging. Secondary objective was to compare signal intensity differences between ionic and nonionic linear gadolinium-based contrast agents. MATERIALS AND METHODS Subjects with secondary-progressive MS originally enrolled in a multicenter clinical trial were studied retrospectively. Eighty subjects (high-exposure cohort) received 9 linear gadolinium-based contrast agent administrations (30 nonionic/50 ionic) between week -4 and year 1 and a tenth administration by year 2. One hundred fifteen subjects (low-exposure cohort) received 2 administrations (40 nonionic/75 ionic) between week -4 and year 1 and a third administration by year 2. Signal intensities were measured on unenhanced T1WIs by placing sample-points on the dentate nucleus, globus pallidus, caudate, thalamus, pons, and white matter, and they were normalized using the following ratios: dentate/pons, globus pallidus/white matter, caudate/white matter, and thalamus/white matter. RESULTS Between week -4 and year 1, subjects in the high-exposure cohort showed increased signal intensity ratios in all regions (P < .01), while the low-exposure cohort showed only an increase in the dentate nucleus (P = .003). Between years 1 and 2, when both cohorts received only 1 additional gadolinium-based contrast agent, no significant changes were observed. In the high-exposure cohort, significantly higher changes in signal intensity ratios were observed in subjects receiving linear nonionic than in those receiving linear ionic gadolinium-based contrast agents. CONCLUSIONS Hyperintensity in deep brain structures from gadolinium deposition is related to the number of doses and the type of linear gadolinium-based contrast agent (nonionic greater than ionic) administration.
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Affiliation(s)
- H Kang
- From the Department of Radiology (H.K., M.L., R.T., S.K., D.K.B.L.)
| | - M Hii
- University of British Columbia MS/MRI Research Group (M.H., R.T., A.R., A.T., S.K., D.K.B.L.)
| | - M Le
- From the Department of Radiology (H.K., M.L., R.T., S.K., D.K.B.L.)
| | - R Tam
- From the Department of Radiology (H.K., M.L., R.T., S.K., D.K.B.L.).,University of British Columbia MS/MRI Research Group (M.H., R.T., A.R., A.T., S.K., D.K.B.L.)
| | - A Riddehough
- University of British Columbia MS/MRI Research Group (M.H., R.T., A.R., A.T., S.K., D.K.B.L.)
| | - A Traboulsee
- University of British Columbia MS/MRI Research Group (M.H., R.T., A.R., A.T., S.K., D.K.B.L.).,Department of Medicine and Division of Neurology (A.T., S.K., D.K.B.L.)
| | - S Kolind
- From the Department of Radiology (H.K., M.L., R.T., S.K., D.K.B.L.).,University of British Columbia MS/MRI Research Group (M.H., R.T., A.R., A.T., S.K., D.K.B.L.).,Department of Medicine and Division of Neurology (A.T., S.K., D.K.B.L.).,Department of Physics and Astronomy (S.K.), University of British Columbia, Vancouver, British Columbia, Canada
| | - M S Freedman
- Department of Medicine and Division of Neurology (M.S.F.), University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Canada
| | - D K B Li
- From the Department of Radiology (H.K., M.L., R.T., S.K., D.K.B.L.).,University of British Columbia MS/MRI Research Group (M.H., R.T., A.R., A.T., S.K., D.K.B.L.).,Department of Medicine and Division of Neurology (A.T., S.K., D.K.B.L.)
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13
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Mackay A, Burford A, Molinari V, Jones D, Izquierdo E, Brouwer-Visser J, Giangaspero F, Haberler C, Pietsch T, Jacques T, Figarella-Branger D, Rodriguez D, Morgan P, Raman P, Waanders A, Resnick A, Massimino M, Garre ML, Smith H, Capper D, Pfister S, Wurdinger T, Tam R, Garcia J, Thakur MD, Vassal G, Grill J, Jaspan T, Varlet P, Jones C. HGG-24. MOLECULAR, PATHOLOGICAL, RADIOLOGICAL AND IMMUNE PROFILING OF NON-BRAINSTEM PAEDIATRIC HIGH GRADE GLIOMA FROM THE HERBY PHASE II RANDOMISED TRIAL. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tim Jaspan
- University of Nottingham, Nottingham, UK
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14
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Mackay A, Burford A, Molinari V, Jones DTW, Izquierdo E, Brouwer-Visser J, Giangaspero F, Haberler C, Pietsch T, Jacques TS, Figarella-Branger D, Rodriguez D, Morgan PS, Raman P, Waanders AJ, Resnick AC, Massimino M, Garrè ML, Smith H, Capper D, Pfister SM, Würdinger T, Tam R, Garcia J, Thakur MD, Vassal G, Grill J, Jaspan T, Varlet P, Jones C. Molecular, Pathological, Radiological, and Immune Profiling of Non-brainstem Pediatric High-Grade Glioma from the HERBY Phase II Randomized Trial. Cancer Cell 2018; 33:829-842.e5. [PMID: 29763623 PMCID: PMC5956280 DOI: 10.1016/j.ccell.2018.04.004] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/28/2018] [Accepted: 04/10/2018] [Indexed: 12/30/2022]
Abstract
The HERBY trial was a phase II open-label, randomized, multicenter trial evaluating bevacizumab (BEV) in addition to temozolomide/radiotherapy in patients with newly diagnosed non-brainstem high-grade glioma (HGG) between the ages of 3 and 18 years. We carried out comprehensive molecular analysis integrated with pathology, radiology, and immune profiling. In post-hoc subgroup analysis, hypermutator tumors (mismatch repair deficiency and somatic POLE/POLD1 mutations) and those biologically resembling pleomorphic xanthoastrocytoma ([PXA]-like, driven by BRAF_V600E or NF1 mutation) had significantly more CD8+ tumor-infiltrating lymphocytes, and longer survival with the addition of BEV. Histone H3 subgroups (hemispheric G34R/V and midline K27M) had a worse outcome and were immune cold. Future clinical trials will need to take into account the diversity represented by the term "HGG" in the pediatric population.
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Affiliation(s)
- Alan Mackay
- Division of Molecular Pathology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK
| | - Anna Burford
- Division of Molecular Pathology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK
| | - Valeria Molinari
- Division of Molecular Pathology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK
| | - David T W Jones
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany; Division of Paediatric Neuro-oncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elisa Izquierdo
- Division of Molecular Pathology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK
| | | | - Felice Giangaspero
- Department of Radiology, Oncology and Anatomic-Pathology Sciences, Sapienza University, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
| | - Christine Haberler
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Torsten Pietsch
- DGNN Brain Tumor Reference Center, Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Thomas S Jacques
- UCL Great Ormond Street Institute of Child Health, London, UK; Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | | | | | | | - Pichai Raman
- The Center for Data Driven Discovery in Biomedicine (D(3)b), Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Angela J Waanders
- The Center for Data Driven Discovery in Biomedicine (D(3)b), Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adam C Resnick
- The Center for Data Driven Discovery in Biomedicine (D(3)b), Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS, Istituto Nazionale Tumori, Milan, Italy
| | | | - Helen Smith
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - David Capper
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health, Institute of Neuropathology, Berlin, Germany; Department of Neuropathology, University Hospital Heidelberg and Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan M Pfister
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany; Division of Paediatric Neuro-oncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Würdinger
- Department of Neurosurgery, Brain Tumor Center Amsterdam, VU Medical Center, Amsterdam, the Netherlands
| | | | | | | | - Gilles Vassal
- Pediatric and Adolescent Oncology and Unite Mixte de Recherche 8203 du Centre National de la Recherche Scientifique, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Jacques Grill
- Pediatric and Adolescent Oncology and Unite Mixte de Recherche 8203 du Centre National de la Recherche Scientifique, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Tim Jaspan
- Nottingham University Hospitals, Nottingham, UK
| | - Pascale Varlet
- Sainte-Anne Hospital, Paris-Descartes University, Paris, France
| | - Chris Jones
- Division of Molecular Pathology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK.
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Wei R, Lunn SE, Tam R, Gust SL, Classen B, Kerr PM, Plane F. Vasoconstrictor stimulus determines the functional contribution of myoendothelial feedback to mesenteric arterial tone. J Physiol 2018; 596:1181-1197. [PMID: 29411383 DOI: 10.1113/jp274797] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/17/2018] [Indexed: 12/16/2022] Open
Abstract
KEY POINTS In isolated resistance arteries, endothelial modulation of vasoconstrictor responses to α1 -adrenoceptor agonists occurs via a process termed myoendothelial feedback: localized inositol trisphosphate (InsP3 )-dependent Ca2+ transients activate intermediate conductance Ca2+ -activated K+ (IKCa ) channels, hyperpolarizing the endothelial membrane potential to limit further reductions in vessel diameter. We demonstrate that IKCa channel-mediated myoendothelial feedback limits responses of isolated mesenteric arteries to noradrenaline and nerve stimulation, but not to the thromboxane A2 mimetic U46619 or to increases in intravascular pressure. In contrast, in the intact mesenteric bed, although responses to exogenous noradrenaline were limited by IKCa channel-mediated myoendothelial feedback, release of NO and activation of endothelial small conductance Ca2+ -activated K+ (SKCa ) channels in response to increases in shear stress appeared to be the primary mediators of endothelial modulation of vasoconstriction. We propose that (1) the functional contribution of myoendothelial feedback to arterial tone is determined by the nature of the vasoconstrictor stimulus, and (2) although IKCa channel-mediated myoendothelial feedback may contribute to local control of arterial diameter, in the intact vascular bed, increases in shear stress may be the major stimulus for engagement of the endothelium during vasoconstriction. ABSTRACT Constriction of isolated resistance arteries in response to α1 -adrenoceptor agonists is limited by reciprocal engagement of inhibitory endothelial mechanisms via myoendothelial feedback. In the current model of feedback, agonist stimulation of smooth muscle cells results in localized InsP3 -dependent Ca2+ transients that activate endothelial IKCa channels. The subsequent hyperpolarization of the endothelial membrane potential then feeds back to the smooth muscle to limit further reductions in vessel diameter. We hypothesized that the functional contribution of InsP3 -IKCa channel-mediated myoendothelial feedback to limiting arterial diameter may be influenced by the nature of the vasoconstrictor stimulus. To test this hypothesis, we investigated the functional role of myoendothelial feedback in modulating responses of rat mesenteric resistance arteries to the adrenoceptor agonist noradrenaline, the thromboxane A2 mimetic U46619, increases in intravascular pressure and stimulation of perivascular sympathetic nerves. In isolated arteries, responses to noradrenaline and stimulation of sympathetic nerves, but not to U46619 and increases in intravascular pressure, were modulated by IKCa channel-dependent myoendothelial feedback. In the intact mesenteric bed perfused under conditions of constant flow, responses to exogenous noradrenaline were modulated by myoendothelial feedback, but shear stress-induced release of NO and activation of endothelial SKCa channels appeared to be the primary mediators of endothelial modulation of vasoconstriction to agonists and nerve stimulation. Thus, we propose that myoendothelial feedback may contribute to local control of diameter within arterial segments, but at the level of the intact vascular bed, increases in shear stress may be the major stimulus for engagement of the endothelium during vasoconstriction.
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Affiliation(s)
- R Wei
- Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2H7, Canada
| | - S E Lunn
- Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2H7, Canada
| | - R Tam
- Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2H7, Canada
| | - S L Gust
- Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2H7, Canada
| | - B Classen
- Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2H7, Canada
| | - P M Kerr
- Department of Nursing Science, Faculty of Nursing, MacEwan University, Edmonton, Alberta, T5J 4S2, Canada
| | - F Plane
- Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2H7, Canada.,Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, T6G 2H7, Canada
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Yong M, Smith S, O’Dempsey S, Grant R, Wiemers P, Saxena P, Tam R, Iyer A, Yadav S. Current Outcomes of Valvular Surgery for Indigenous Australians With Rheumatic Heart Disease: A Single-centre Experience. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.829] [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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Traboulsee A, Li D, Tam R, Zhao G, Riddehough A, Fang J, Dangond F, Kappos L. Subcutaneous interferon β-1a three times weekly and the natural evolution of gadolinium-enhancing lesions into chronic black holes in relapsing and progressive multiple sclerosis: Analysis of PRISMS and SPECTRIMS trials. Mult Scler J Exp Transl Clin 2017; 3:2055217317745340. [PMID: 29276624 PMCID: PMC5734469 DOI: 10.1177/2055217317745340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 11/03/2017] [Indexed: 11/17/2022] Open
Abstract
Background Evolution of gadolinium-enhancing lesions into chronic black holes (CBH) may be reduced by interferon (IFN) therapy. Objective The objective of this paper is to assess the effect of IFN β-1a and placebo on CBH evolution and disability in patients with relapsing–remitting multiple sclerosis (RRMS), as well as CBH evolution in patients with secondary progressive multiple sclerosis (SPMS). Methods A post hoc, exploratory analysis of patients with RRMS and SPMS with monthly MRI scans (months –1 to 9) from two separate placebo-controlled clinical trials of IFN β-1a was conducted. Results In RRMS patients, the risk of ≥1 evolved CBH was lower for IFN β-1a versus placebo (odds ratio 0.42; p = 0.024); volume of newly evolved CBH was numerically reduced. A numerically higher proportion of patients with ≥1 evolving CBH vs no evolving CBH had confirmed three-month disability progression (four-year rate 55.8% vs 43.1%, respectively). Proportion of lesions evolving into CBH (patient level: 34.7% vs 12.6%, p < 0.0001; lesion level: 28.8% vs 11.0%, p < 0.0001) and evolved CBH volume (median 33.5 mm3 (Quartile 1, 0.0; Quartile 3, 173.4) vs 0.0 mm3 (0.0; 52.4); p = 0.0008) was higher for SPMS than RRMS patients treated with IFN β-1a. Conclusion In RRMS, IFN β-1a significantly decreased the proportion of new T1 Gd+ lesions evolving into CBH and the risk of developing a CBH. In patients with SPMS, more lesions develop to CBH, indicating reduced repair capacity, and the natural history of lesion development appears to be unaffected by IFN β-1a treatment.
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Affiliation(s)
- A Traboulsee
- Department of Medicine, Faculty of Medicine, University of British Columbia, Canada
| | - Dkb Li
- Department of Medicine, Faculty of Medicine, University of British Columbia, Canada
| | - R Tam
- University of British Columbia, Canada
| | - G Zhao
- Division of Neurology, University of British Columbia, Canada
| | - A Riddehough
- Division of Neurology, University of British Columbia, Canada
| | | | | | - L Kappos
- Departments of Medicine, Biomedicine, Clinical Research and Biomedical Engineering, University Hospital Basel, Switzerland
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Traboulsee A, Machan L, Girard M, Raymond J, Vosoughi R, Hardy B, Edmond F, Bone J, Gariepy J, Tam R, Klass D, Isserow S, Rauscher A, Sadovnick A, Li D, Illes J, Siskin G. Venoplasty of chronic cerebral spinal venous insufficiency to improve MS patient reported outcomes is not superior to sham treatment at week 2 or week 12. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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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Barha C, Dao E, Best J, Hsiung R, Tam R, Liu-Ambrose T. SEX-DEPENDENT EFFECT OF EXERCISE ON BRAIN HEALTH IN OLDER ADULTS WITH VCI. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C. Barha
- Physical Therapy, University of British Columbia, Burnaby, British Columbia, Canada
| | - E. Dao
- Physical Therapy, University of British Columbia, Burnaby, British Columbia, Canada
| | - J. Best
- Physical Therapy, University of British Columbia, Burnaby, British Columbia, Canada
| | - R.G. Hsiung
- Physical Therapy, University of British Columbia, Burnaby, British Columbia, Canada
| | - R. Tam
- Physical Therapy, University of British Columbia, Burnaby, British Columbia, Canada
| | - T. Liu-Ambrose
- Physical Therapy, University of British Columbia, Burnaby, British Columbia, Canada
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Huw LY, Piskol R, Melo FDSE, Kim D, Qu X, Koeppen H, Lackner M, Hampton G, Kabbarah O, Tam R. Abstract 2708: A custom gene expression panel for consensus molecular subtype classification of archival primary and metastatic colorectal cancers. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-2708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Stratification of Colorectal Cancer (CRC) into actionable molecular subtypes has tremendous clinical value. Recently, a consolidated classifier identified four molecularly distinct CRC subtypes (CMS1-4) that were associated with unique biology and clinical outcomes based on global transcriptional analysis of frozen tissues. Here, we developed and applied a novel CRC panel that is ideally suited for transcriptional classification of archival clinical samples. Findings from in silico analysis demonstrated that the 800 genes on our panel could accurately classify CRC samples from external public datasets into the correct CMS subtypes. We applied our panel in the analysis of a novel cohort of 312 formalin-fixed paraffin-embedded (FFPE) tissues from 205 patients, and were able to detect all 4 CMS subtypes in primary CRCs and in metastases. When we examined the CMS subtypes of primary tumors and matched metastases from 50 patients we found 70% of cases to be concordant, as were key biologies, such as WNT/MYC pathway activation in CMS2 and EMT features in tumors of the CMS4 subtypes. This was confirmed by in situ hybridization (ISH) using the markers ASCL2 for CMS2 and SPARC for CMS4, respectively. Discordance in the CMS subtypes between primary tumors and matched metastases were observed in 30% of cases and may reflect tumor heterogeneity. Our findings suggest that our CRC-focused panel many have clinical utility for CMS classification of FFPE samples, and point to potential risks of using CMS subtypes of primary tumors to inform clinical decision-making at the metastatic stage in a subset of patients.
Citation Format: Ling-Yuh Huw, Robert Piskol, Felipe de Sosa e Melo, Doris Kim, Xueping Qu, Hartmut Koeppen, Mark Lackner, Garret Hampton, Omar Kabbarah, Rachel Tam. A custom gene expression panel for consensus molecular subtype classification of archival primary and metastatic colorectal cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2708. doi:10.1158/1538-7445.AM2017-2708
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Affiliation(s)
| | | | | | - Doris Kim
- Genentech, Inc., South San Francisco, CA
| | - Xueping Qu
- Genentech, Inc., South San Francisco, CA
| | | | | | | | | | - Rachel Tam
- Genentech, Inc., South San Francisco, CA
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Dao E, Best J, Hsiung R, Sossi V, Jacova C, Tam R, Liu-Ambrose T. EFFECTS OF AMYLOID ON CHANGES IN COGNITIVE AND PHYSICAL FUNCTION IN VASCULAR COGNITIVE IMPAIRMENT. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E. Dao
- University of British Columbia, Vancouver, British Columbia, Canada,
| | - J. Best
- University of British Columbia, Vancouver, British Columbia, Canada,
| | - R.G. Hsiung
- University of British Columbia, Vancouver, British Columbia, Canada,
| | - V. Sossi
- University of British Columbia, Vancouver, British Columbia, Canada,
| | - C. Jacova
- Pacific University, Forest Grove, Oregon
| | - R. Tam
- University of British Columbia, Vancouver, British Columbia, Canada,
| | - T. Liu-Ambrose
- University of British Columbia, Vancouver, British Columbia, Canada,
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Mackay A, Burford A, Molinari V, Jones D, Rodriguez D, Morgan P, Pfister S, Wurdinger T, Tam R, das Thakur M, Garcia J, Vassal G, Grill J, Jaspan T, Varlet P, Jones C. HGG-03. INTEGRATED MOLECULAR AND PATHOLOGICAL CHARACTERISATION OF NON-BRAINSTEM PAEDIATRIC HIGH GRADE GLIOMA FROM THE HERBY PHASE II RANDOMISED TRIAL. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox083.092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Innocenti F, Ou FS, Zemla T, Niedzwiecki D, Qu X, Tam R, Mahajan S, Goldberg RM, Mayer RJ, Bertagnolli MM, Sanoff HK, Hochster HS, Blanke CD, Venook AP, Lenz HJ, Kabbarah O. Somatic DNA mutations, MSI status, mutational load (ML): Association with overall survival (OS) in patients (pts) with metastatic colorectal cancer (mCRC) of CALGB/SWOG 80405 (Alliance). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.3504] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3504 Background: CALGB 80405 was a randomized phase III trial that found no difference in OS in first-line mCRC pts treated with either bevacizumab (Bev) or cetuximab (Cet). Primary tumor DNA from 361 pts, including KRAS mutant (mut) pts, has been profiled for somatic gene mutations/ML/MSI to discover molecular markers of OS. Methods: Mutations in 11 genes were determined by PCR, MSI by microsatellite analysis, and ML by next-generation sequencing (FoundationOne). Cox proportional hazard models are used, stratified by prior XRT and +/- adjuvant chemotherapy; adjusted by age, race, gender, synchronous vs. metachronous, liver metastases, sidedness, all RAS. Results: BRAF: Mut pts had shorter OS than wild-type (wt) pts (HR 1.92, 95% CI 1.34,2.75; p<0.001); HR 1.65 (1.09,2.50) after adjusting for sidedness (p 0.022). In mut pts longer OS is observed in Bev arm vs. Cet arm (p 0.041); in wt pts no arm difference is observed (p 0.291, table). MSI: OS does not differ between MSI-H and MSI-S pts (HR 0.78 [0.40, 1.52], p 0.450). In MSI-H pts longer OS is observed in Bev arm vs. Cet arm (p 0.002); in MSI-S pts no difference is observed (p 0.305, table). ML: Hypermutated MSI-H pts are excluded. In a subset of 205 pts, pts with ML>5 (N=93) have longer OS than pts with ML≤5 (N=112) (HR 0.65 [0.42,1.00], p 0.048). In Bev arm higher ML confers longer OS than lower ML (HR 0.85 [0.80,0.96], p 0.004); in Cet arm no difference is observed (HR 0.99 [0.90,1.09], p 0.862). Conclusions: BRAF is a strong negative prognostic factor in mCRC, even when sidedness is taken into account. ML is a novel marker for further evaluation. The effect of Bev and Cet in either BRAF mut or MSI-H pts should be tested in larger datasets. Updated results from more screened samples will be presented. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | - Robert J. Mayer
- Dana-Farber Cancer Institute/Partners CancerCare, Boston, MA
| | | | - Hanna Kelly Sanoff
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | - Alan P. Venook
- University of California, San Francisco, San Francisco, CA
| | - Heinz-Josef Lenz
- Division of Medical Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
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Rosell R, Dafni U, Felip E, Curioni-Fontecedro A, Gautschi O, Peters S, Massutí B, Palmero R, Aix SP, Carcereny E, Früh M, Pless M, Popat S, Kotsakis A, Cuffe S, Bidoli P, Favaretto A, Froesch P, Reguart N, Puente J, Coate L, Barlesi F, Rauch D, Thomas M, Camps C, Gómez-Codina J, Majem M, Porta R, Shah R, Hanrahan E, Kammler R, Ruepp B, Rabaglio M, Kassapian M, Karachaliou N, Tam R, Shames DS, Molina-Vila MA, Stahel RA. Erlotinib and bevacizumab in patients with advanced non-small-cell lung cancer and activating EGFR mutations (BELIEF): an international, multicentre, single-arm, phase 2 trial. Lancet Respir Med 2017; 5:435-444. [PMID: 28408243 DOI: 10.1016/s2213-2600(17)30129-7] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/09/2017] [Accepted: 03/09/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND The tyrosine kinase inhibitor erlotinib improves the outcomes of patients with advanced non-small-cell lung carcinoma (NSCLC) harbouring epidermal growth factor receptor (EGFR) mutations. The coexistence of the T790M resistance mutation with another EGFR mutation in treatment-naive patients has been associated with a shorter progression-free survival to EGFR inhibition than in the absence of the T790M mutation. To test this hypothesis clinically, we developed a proof-of-concept study, in which patients with EGFR-mutant NSCLC were treated with the combination of erlotinib and bevacizumab, stratified by the presence of the pretreatment T790M mutation. METHODS BELIEF was an international, multicentre, single-arm, phase 2 trial done at 29 centres in eight European countries. Eligible patients were aged 18 years or older and had treatment-naive, pathologically confirmed stage IIIB or stage IV lung adenocarcinoma with a confirmed, activating EGFR mutation (exon 19 deletion or L858R mutation). Patients received oral erlotinib 150 mg per day and intravenous bevacizumab 15 mg/kg every 21 days and were tested centrally for the pretreatment T790M resistance mutation with a peptide nucleic acid probe-based real-time PCR. The primary endpoint was progression-free survival. The primary efficacy analysis was done in the intention-to-treat population and was stratified into two parallel substudies according to the centrally confirmed pretreatment T790M mutation status of enrolled patients (T790M positive or negative). The safety analysis was done in all patients that have received at least one dose of trial treatment. This trial was registered with ClinicalTrials.gov, number NCT01562028. FINDINGS Between June 11, 2012, and Oct 28, 2014, 109 patients were enrolled and included in the efficacy analysis. 37 patients were T790M mutation positive and 72 negative. The overall median progression-free survival was 13·2 months (95% CI 10·3-15·5), with a 12 month progression-free survival of 55% (95% CI 45-64). The primary endpoint was met only in substudy one (T790M-positive patients). In the T790M-positive group, median progression-free survival was 16·0 months (12·7 to not estimable), with a 12 month progression-free survival of 68% (50-81), whereas in the T790M-negative group, median progression-free survival was 10·5 months (9·4-14·2), with a 12 month progression-free survival of 48% (36-59). Of 106 patients included in the safety analysis, five had grade 4 adverse events (one acute coronary syndrome, one biliary tract infection, one other neoplasms, and two colonic perforations) and one died due to sepsis. INTERPRETATION The BELIEF trial provides further evidence of benefit for the combined use of erlotinib and bevacizumab in patients with NSCLC harbouring activating EGFR mutations. FUNDING European Thoracic Oncology Platform, Roche.
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Affiliation(s)
- Rafael Rosell
- Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Urania Dafni
- Frontier Science Foundation-Hellas & National and Kapodistrian University of Athens, Athens, Greece
| | - Enriqueta Felip
- Vall d'Hebron University Hospital, Institute of Oncology, Barcelona, Spain
| | - Alessandra Curioni-Fontecedro
- University Hospital Zurich, Clinic of Oncology, Zurich, Switzerland; Swiss Group of Clinical Cancer Research, Bern, Switzerland
| | - Oliver Gautschi
- Cantonal Hospital Lucerne, Medical Oncology, Lucerne, Switzerland; Swiss Group of Clinical Cancer Research, Bern, Switzerland
| | - Solange Peters
- Centre Hospitalier Universitaire Vaudois, Département d'Oncologie, Lausanne, Switzerland; Swiss Group of Clinical Cancer Research, Bern, Switzerland
| | - Bartomeu Massutí
- Hospital General Universitario Alicante, Oncología Médica, Alicante, Spain
| | - Ramon Palmero
- Catalan Institute of Oncology, Hospital Duran i Reynals, Bellvitge, Spain
| | | | - Enric Carcereny
- Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Martin Früh
- Cantonal Hospital St Gallen, Oncology and Hematology, St Gallen, Switzerland; Swiss Group of Clinical Cancer Research, Bern, Switzerland
| | - Miklos Pless
- Cantonal Hospital Winterthur, Medical Oncology, Winterthur, Switzerland; Swiss Group of Clinical Cancer Research, Bern, Switzerland
| | - Sanjay Popat
- Medical Oncology, Royal Marsden Hospital, London, UK
| | - Athanasios Kotsakis
- University General Hospital of Heraklion, Medical Oncology, Heraklion, Crete, Greece
| | - Sinead Cuffe
- Cancer Trials Ireland and St James's Hospital, Medical Oncology, Dublin, Ireland
| | - Paolo Bidoli
- Ospedale San Gerardo, Oncologia Medica, Monza, Italy
| | | | - Patrizia Froesch
- Instituto Oncologica Della Svizzera Italiana, Bellinzona, Switzerland; Swiss Group of Clinical Cancer Research, Bern, Switzerland
| | - Noemí Reguart
- Hospital Clínic, Medical Oncology & Genomics and Targeted Therapeutics in Solid Tumors, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Javier Puente
- Thoracic, Urologic & Melanoma Cancer Unit Medical Oncology Department Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Linda Coate
- University Hospital Limerick and Cancer Trials Ireland, Limerick, Ireland
| | - Fabrice Barlesi
- Aix Marseille University; Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Daniel Rauch
- Okologiezentrum Thun-Berner Oberland, Thun, Switzerland; Swiss Group of Clinical Cancer Research, Bern, Switzerland
| | - Michael Thomas
- Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
| | | | | | | | - Rut Porta
- Insitut Catalan d'Oncologia and University of Girona, Girona, Spain
| | | | - Emer Hanrahan
- Cancer Trials Ireland and St Vincent's University Hospital, Dublin, Ireland
| | - Roswitha Kammler
- European Thoracic Oncology Platform Coordinating Office, Bern, Switzerland
| | - Barbara Ruepp
- European Thoracic Oncology Platform Coordinating Office, Bern, Switzerland
| | - Manuela Rabaglio
- European Thoracic Oncology Platform Coordinating Office, Bern, Switzerland
| | | | - Niki Karachaliou
- Institute of Oncology Rosell, University Hospital Sagrat Cor, Barcelona, Spain
| | - Rachel Tam
- Oncology Biomarker Development, Genentech, South San Francisco, CA, USA
| | - David S Shames
- Oncology Biomarker Development, Genentech, South San Francisco, CA, USA
| | | | - Rolf A Stahel
- University Hospital Zurich, Clinic of Oncology, Zurich, Switzerland; Swiss Group of Clinical Cancer Research, Bern, Switzerland.
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Penuel E, Kapp AV, Do A, Tam R, Sumiyoshi T, Marathe C, Sa S, Peale F, Lackner M, Holden S, Seiwert T, Pirzkall A. Abstract 1553: Biomarker evaluation in a randomized phase 2 study of MEHD7945A (MEHD) versus cetuximab (Cet) in ≥2 line recurrent/metastatic (R/M) squamous cell carcinomas of the head and neck (SCCHN) [MEHGAN]. Tumour Biol 2015. [DOI: 10.1158/1538-7445.am2015-1553] [Citation(s) in RCA: 4] [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: 11/16/2022] Open
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MacMillan EL, Tam R, Zhao Y, Vavasour IM, Li DKB, Oger J, Freedman MS, Kolind SH, Traboulsee AL. Progressive multiple sclerosis exhibits decreasing glutamate and glutamine over two years. Mult Scler 2015; 22:112-6. [DOI: 10.1177/1352458515586086] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/11/2015] [Indexed: 11/17/2022]
Abstract
Background: Few biomarkers of progressive multiple sclerosis (MS) are sensitive to change within the two-year time frame of a clinical trial. Objective: To identify biomarkers of MS disease progression with magnetic resonance spectroscopy (MRS) in secondary progressive MS (SPMS). Methods: Forty-seven SPMS subjects were scanned at baseline and annually for two years. Concentrations of N-acetylaspartate, total creatine, total choline, myo-inositol, glutamate, glutamine, and the sum glutamate+glutamine were measured in a single white matter voxel. Results: Glutamate and glutamine were the only metabolites to show an effect with time: with annual declines of (95% confidence interval): glutamate −4.2% (−6.2% to −2.2%, p < 10−4), glutamine −7.3% (−11.8% to −2.9%, p = 0.003), and glutamate+glutamine −5.2% (−7.6% to −2.8%, p < 10−4). Metabolite rates of change were more apparent than changes in clinical scores or brain atrophy measures. Conclusions: The high rates of change of both glutamate and glutamine over two years suggest they are promising new biomarkers of MS disease progression.
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Affiliation(s)
- EL MacMillan
- Division of Neurology, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - R Tam
- Department of Radiology, Faculty of Medicine, The University of British Columbia, Vancouver, Canada/UBC MS/MRI Research Group, The University of British Columbia, Vancouver, Canada
| | - Y Zhao
- UBC MS/MRI Research Group, The University of British Columbia, Vancouver, Canada
| | - IM Vavasour
- Department of Radiology, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - DKB Li
- Department of Radiology, Faculty of Medicine, The University of British Columbia, Vancouver, Canada/UBC MS/MRI Research Group, The University of British Columbia, Vancouver, Canada
| | - J Oger
- Division of Neurology, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - MS Freedman
- Department of Neurology, Faculty of Medicine, The University of Ottawa, Canada
| | - SH Kolind
- Division of Neurology, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - AL Traboulsee
- Division of Neurology, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
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Russell E, Maguire G, Tran L, Reid C, Walsh W, Brown A, Baker R, Tam R, Bennetts J. Does annual site-specific caseload influence valve surgical outcome in Australia? Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.695] [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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Kapoun A, O'Reilly E, Cohn A, Bendell J, Smith L, Strickler J, Gluck W, Liu Y, Wallace B, Tam R, Cancilla B, Brunner A, Hill D, Zhou L, Dupont J, Zhang C, Wang M. 465 Biomarker analysis in Phase 1b study of anti-cancer stem cell antibody Tarextumab (TAR) in combination with nab-paclitaxel and gemcitabine (Nab-P+Gem) demonstrates pharmacodynamic (PD) modulation of the Notch pathway in patients (pts) with untreated metastatic pancreatic cancer (mPC). Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70591-x] [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: 11/17/2022]
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O'Brien CL, Wilson TR, Spoerke JM, Xiao Y, Savage H, Tam R, Schleifman E, Patel R, Huw L, Koeppen H, Fu L, Sumiyoshi T, O'Shaughnessy J, Lackner M. Abstract LB-179: Molecular biomarker profiling of archival primary breast cancers from a Phase 3 adjuvant study of capecitabine in early stage breast cancer patients. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-lb-179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Current clinical practice stratifies patients for treatment and enrollment in clinical breast cancer studies based on ER, PR and HER2 status. Emerging data suggest that these three biomarkers do not fully capture the heterogeneity that exists within breast cancer. In addition, understanding the genetic landscape of breast cancer is critical for defining clinically actionable patient subsets that may derive benefit from targeted therapies. PIK3CA and TP53 mutations have previously been reported to be the most common mutations within breast cancer; however the prognostic significance of these alterations, as well as their overlap/exclusivity with other important biomarkers is poorly understood.
USON 01062 (O’Shaughnessy J, et al. Proc SABCS, 2010, abstract S4-2) is a phase III study that evaluated the addition of capecitabine to standard adjuvant chemotherapy. The study did not meet its primary endpoint of 5-year disease-free survival (HR 0.84, p=0.125), but showed improvement in overall survival (HR 0.68, p=0.011). FFPE primary breast cancers were obtained from approximately 2000 of the 2610 patients (pts) enrolled, and here we report results from our comprehensive biomarker analyses on 817 of these pts. Samples were profiled using a multiplexed PCR-based platform to determine somatic mutations in 6 key oncogenes, as well as assayed for 800 breast cancer-related genes encompassing a variety of signaling pathways and published breast cancer signatures. IHC for the proliferation marker Ki67 and the tumor suppressor PTEN was also performed.
Intrinsic subtyping analysis determined that 296 pts’ cancers were basal, 69 were HER2-enriched, 327 were luminal A, 124 were luminal B and 1 was normal-like. Approximately 80% of the triple negative breast cancers (TNBCs) were of the basal subtype, and 80% of the ER+ cancers were of the luminal A and B subtypes. The most heterogeneous group was the HER2-enriched group that was comprised of 60% HER2+ and 30% TN cancers. PIK3CA mutations were found at a frequency of 44% in luminal A, 24% in luminal B, 33% in HER2-enriched and 3% in the basal subtypes. Within the TNBC subset, 42% were basal like 1/2, 21% were immunomodulatory, 15% were mesenchymal stem-like, 13% were mesenchymal-like and 9% were luminal AR.
In conclusion, luminal A breast cancers were the most common subtype treated with chemotherapy on this adjuvant trial that evaluated the effectiveness of the anti-proliferative agent, capecitabine. Intrinsic subtyping and molecular profiling of pts’ primary breast cancer reveals the substantial heterogeneity of early breast cancers, highlighting the challenges in identifying patients who may benefit from adjuvant capecitabine based on standard clinical-pathologic features. Analysis of intrinsic subtyping, Ki67 levels and genomic alterations of these early breast cancer pts will be presented.
Citation Format: Carol Lynn O'Brien, Tim R. Wilson, Jill M. Spoerke, Yuanyuan Xiao, Heidi Savage, Rachel Tam, Erica Schleifman, Rajesh Patel, Ling Huw, Hartmut Koeppen, Ling Fu, Teiko Sumiyoshi, Joyce O'Shaughnessy, Mark Lackner. Molecular biomarker profiling of archival primary breast cancers from a Phase 3 adjuvant study of capecitabine in early stage breast cancer patients. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr LB-179. doi:10.1158/1538-7445.AM2014-LB-179
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Affiliation(s)
| | | | | | | | | | - Rachel Tam
- 1Genentech, Inc., South San Francisco, CA
| | | | | | - Ling Huw
- 1Genentech, Inc., South San Francisco, CA
| | | | - Ling Fu
- 1Genentech, Inc., South San Francisco, CA
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Pesek JJ, Matyska MT, Williamser EJ, Tam R. Variable-temperature, solid-state NMR studies of bonded liquid crystal stationary phases for HPLC. Chromatographia 2014. [DOI: 10.1007/bf02688044] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [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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Zhang L, Chen L, Sah S, Latham GJ, Patel R, Song Q, Koeppen H, Tam R, Schleifman E, Mashhedi H, Chalasani S, Fu L, Sumiyoshi T, Raja R, Forrest W, Hampton GM, Lackner MR, Hegde P, Jia S. Profiling cancer gene mutations in clinical formalin-fixed, paraffin-embedded colorectal tumor specimens using targeted next-generation sequencing. Oncologist 2014; 19:336-43. [PMID: 24664487 DOI: 10.1634/theoncologist.2013-0180] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The success of precision oncology relies on accurate and sensitive molecular profiling. The Ion AmpliSeq Cancer Panel, a targeted enrichment method for next-generation sequencing (NGS) using the Ion Torrent platform, provides a fast, easy, and cost-effective sequencing workflow for detecting genomic "hotspot" regions that are frequently mutated in human cancer genes. Most recently, the U.K. has launched the AmpliSeq sequencing test in its National Health Service. This study aimed to evaluate the clinical application of the AmpliSeq methodology. METHODS We used 10 ng of genomic DNA from formalin-fixed, paraffin-embedded human colorectal cancer (CRC) tumor specimens to sequence 46 cancer genes using the AmpliSeq platform. In a validation study, we developed an orthogonal NGS-based resequencing approach (SimpliSeq) to assess the AmpliSeq variant calls. RESULTS Validated mutational analyses revealed that AmpliSeq was effective in profiling gene mutations, and that the method correctly pinpointed "true-positive" gene mutations with variant frequency >5% and demonstrated high-level molecular heterogeneity in CRC. However, AmpliSeq enrichment and NGS also produced several recurrent "false-positive" calls in clinically druggable oncogenes such as PIK3CA. CONCLUSION AmpliSeq provided highly sensitive and quantitative mutation detection for most of the genes on its cancer panel using limited DNA quantities from formalin-fixed, paraffin-embedded samples. For those genes with recurrent "false-positive" variant calls, caution should be used in data interpretation, and orthogonal verification of mutations is recommended for clinical decision making.
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Affiliation(s)
- Liangxuan Zhang
- Departments of Oncology Biomarker Development, Biostatistics, and Pathology, Genentech Inc., South San Francisco, California, USA; Technology Development, Asuragen Inc., Austin, Texas, USA
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Schleifman EB, Tam R, Patel R, Tsan A, Sumiyoshi T, Fu L, Desai R, Schoenbrunner N, Myers TW, Bauer K, Smith E, Raja R. Next generation MUT-MAP, a high-sensitivity high-throughput microfluidics chip-based mutation analysis panel. PLoS One 2014; 9:e90761. [PMID: 24658394 PMCID: PMC3962342 DOI: 10.1371/journal.pone.0090761] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 02/03/2014] [Indexed: 11/19/2022] Open
Abstract
Molecular profiling of tumor tissue to detect alterations, such as oncogenic mutations, plays a vital role in determining treatment options in oncology. Hence, there is an increasing need for a robust and high-throughput technology to detect oncogenic hotspot mutations. Although commercial assays are available to detect genetic alterations in single genes, only a limited amount of tissue is often available from patients, requiring multiplexing to allow for simultaneous detection of mutations in many genes using low DNA input. Even though next-generation sequencing (NGS) platforms provide powerful tools for this purpose, they face challenges such as high cost, large DNA input requirement, complex data analysis, and long turnaround times, limiting their use in clinical settings. We report the development of the next generation mutation multi-analyte panel (MUT-MAP), a high-throughput microfluidic, panel for detecting 120 somatic mutations across eleven genes of therapeutic interest (AKT1, BRAF, EGFR, FGFR3, FLT3, HRAS, KIT, KRAS, MET, NRAS, and PIK3CA) using allele-specific PCR (AS-PCR) and Taqman technology. This mutation panel requires as little as 2 ng of high quality DNA from fresh frozen or 100 ng of DNA from formalin-fixed paraffin-embedded (FFPE) tissues. Mutation calls, including an automated data analysis process, have been implemented to run 88 samples per day. Validation of this platform using plasmids showed robust signal and low cross-reactivity in all of the newly added assays and mutation calls in cell line samples were found to be consistent with the Catalogue of Somatic Mutations in Cancer (COSMIC) database allowing for direct comparison of our platform to Sanger sequencing. High correlation with NGS when compared to the SuraSeq500 panel run on the Ion Torrent platform in a FFPE dilution experiment showed assay sensitivity down to 0.45%. This multiplexed mutation panel is a valuable tool for high-throughput biomarker discovery in personalized medicine and cancer drug development.
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Affiliation(s)
- Erica B. Schleifman
- Oncology Biomarker Development, Genentech Inc., South San Francisco, California, United States of America
| | - Rachel Tam
- Oncology Biomarker Development, Genentech Inc., South San Francisco, California, United States of America
| | - Rajesh Patel
- Oncology Biomarker Development, Genentech Inc., South San Francisco, California, United States of America
| | - Alison Tsan
- Chemistry and Innovation Technology, Pleasanton, California, United States of America
| | - Teiko Sumiyoshi
- Oncology Biomarker Development, Genentech Inc., South San Francisco, California, United States of America
| | - Ling Fu
- Oncology Biomarker Development, Genentech Inc., South San Francisco, California, United States of America
| | - Rupal Desai
- Oncology Biomarker Development, Genentech Inc., South San Francisco, California, United States of America
| | - Nancy Schoenbrunner
- Chemistry and Innovation Technology, Pleasanton, California, United States of America
| | - Thomas W. Myers
- Program in Core Research, Roche Molecular Systems Inc., Pleasanton, California, United States of America
| | - Keith Bauer
- Program in Core Research, Roche Molecular Systems Inc., Pleasanton, California, United States of America
| | - Edward Smith
- Program in Core Research, Roche Molecular Systems Inc., Pleasanton, California, United States of America
| | - Rajiv Raja
- Oncology Biomarker Development, Genentech Inc., South San Francisco, California, United States of America
- * E-mail:
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Schleifman EB, Desai RM, Spoerke J, Victoria Wong C, Abbas I, O'Brien C, Hampton G, Wilson T, Koeppen H, Patel R, Sumiyoshi T, Fu L, Tam R, Raja R, Lackner M. Abstract 3462: High-throughput qRT-PCR expression profiling of estrogen receptor positive breast tumors. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-3462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The class I phosphatidylinositol 3’ kinases (PI3K) play a major role in proliferation and survival in a wide variety of human cancers, and activation of the PI3K pathway is thought to be an important driver in estrogen receptor positive (ER+) breast cancer. A key factor in successful development of drugs targeting this pathway will be development in appropriate molecular subsets. Important questions relevant to PI3K inhibitor development in ER+ breast cancers are whether these inhibitors will work equally well in luminal A compared to luminal B tumors, and whether gene expression signatures of pathway activation may have additional utility in patient stratification beyond PIK3CA mutation status alone.
The goal of this study was to develop a methodology for high throughput profiling of ER+ breast cancers, in order to enable molecular subtyping of patients enrolled in clinical studies. To accomplish this, we developed an analysis platform to measure the relative expression of 90 breast cancer and PI3K pathway specific genes in formalin-fixed paraffin-embedded (FFPE) tissue. The content for this panel consists of genes known to be important for epithelial-mesenchymal biology, proliferation rate, and transcriptional output of the PI3K pathway. The 96 assay panel (including 6 housekeeping genes) was developed on the Fluidigm Biomark microfluidics platform and was extensively validated using well-characterized breast cancer cell lines and FFPE breast cancer samples of known subtypes based on immunohistochemistry for HER2, ER, and PR. All assays showed high levels of inter-and intra-chip reproducibility and were sensitive on standard curves down to 3ng RNA input.
Using this method we were able to separate breast cancers into distinct molecular subtypes, as well as identify more proliferative luminal B type tumors. In addition, PIK3CA mutation status, a potential biomarker, was determined using a highly specific and sensitive qRT-PCR mutation assay, in order to allow comparison with the PI3K pathway activation signature. We extended these analyses to a small cohort of patient samples consisting of matched primary and metastatic tumor tissues, and report here the correlation of primary and matched metastatic ER+ breast cancer FFPE tumor samples at both the gene expression and mutational levels. We found that the majority of matched pairs were concordant for both mutation status and gene expression, though a subset did show differences. Future studies will examine the prognostic significance and clinical relevance of this gene signature.
Citation Format: Erica B. Schleifman, Rupal M. Desai, Jill Spoerke, Cheryl Victoria Wong, Ilma Abbas, Carol O'Brien, Garret Hampton, Timothy Wilson, Hartmut Koeppen, Rajesh Patel, Teiko Sumiyoshi, Ling Fu, Rachel Tam, Rajiv Raja, Mark Lackner. High-throughput qRT-PCR expression profiling of estrogen receptor positive breast tumors. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3462. doi:10.1158/1538-7445.AM2013-3462
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Ling Fu
- Genentech, South San Francisco, CA
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Kim D, Choi YJ, French D, Patel R, Fu L, Wong C, Abbas I, Tam R, Schleifman E, Sumiyoshi T, Faarborg A, Yauch B, Hampton G, Amler L, Raja R, Kabbarah O. Abstract 1203: Molecular stratification of bladder cancer reveals distinct subtypes associated with unique clinical behaviors. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-1203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Bladder cancer is a common malignancy, and in the US approximately 15,000 patients a year succumb to metastatic disease. The transition from the non-invasive to the lethal invasive variety is poorly understood, and this is reflected by the lack of efficacious treatment options for patients presenting with advanced disease. Notably, a significant fraction of superficial cancers can recur, requiring additional surgeries and conferring a higher risk for disease progression. Stratifying bladder cancers into molecular subtypes with defined clinical attributes could highlight non-invasive tumors with high risk of recurrence and reveal opportunities for therapeutic intervention in advanced disease. To this end, we molecularly characterized a collection of ∼200 clinically-annotated, formalin-fixed, paraffin-embedded tissues that represent non-invasive and invasive/advanced stage histopathologies. Tumors were assessed for mutation status at ∼100 mutation hotspots in key oncogenes as well as for the expression levels of ∼100 genes on a custom Fluidigm™ platform to interrogate key bladder cancer pathways, such as the FGFR3, PI3K and MAPK signaling axes. Integrative analysis of gene expression, mutation, and clinical data identified non-invasive subtypes that were FGFR3 mutation positive and exhibited a pathway up regulation gene expression signature. In contrast, invasive tumors were FGFR3 wild type and displayed less prominent pathway up regulation. As expected, invasive tumors had significantly worse disease-free survival (DFS) than their non-invasive counterparts (HR = 0.54; P = 0.03). On the molecular level, advanced tumors exhibited dysregulation of key pathways, including p53 and PI3K. Although similar histologically, and of common FGFR3 mutation status, tumors of the non-invasive type could be further classified into two distinct transcriptional subtypes associated with remarkably different DFS profiles (HR = 0.29; P = 0.004). Our molecular stratification of bladder cancer identified distinct subtypes associated with their respective clinical behaviors. In advanced disease, we defined molecular alterations that highlight opportunities for therapeutic intervention. We also identified a novel subtype of non-invasive malignancies associated with a surprisingly high risk of recurrence, highlighting the value of molecular stratification for identifying bladder cancer patients who might benefit from more aggressive treatment than the current standard of care.
Citation Format: Doris Kim, YJ Choi, Dorothy French, Rajesh Patel, Ling Fu, Cheryl Wong, Ilma Abbas, Rachel Tam, Erica Schleifman, Teiko Sumiyoshi, Anna Faarborg, Bob Yauch, Garret Hampton, Lukas Amler, Rajiv Raja, Omar Kabbarah. Molecular stratification of bladder cancer reveals distinct subtypes associated with unique clinical behaviors. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1203. doi:10.1158/1538-7445.AM2013-1203
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Affiliation(s)
- Doris Kim
- Genentech, Inc., South San Francisco, CA
| | - YJ Choi
- Genentech, Inc., South San Francisco, CA
| | | | | | - Ling Fu
- Genentech, Inc., South San Francisco, CA
| | | | - Ilma Abbas
- Genentech, Inc., South San Francisco, CA
| | - Rachel Tam
- Genentech, Inc., South San Francisco, CA
| | | | | | | | - Bob Yauch
- Genentech, Inc., South San Francisco, CA
| | | | | | - Rajiv Raja
- Genentech, Inc., South San Francisco, CA
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Patel R, Tsan A, Tam R, Desai R, Spoerke J, Schoenbrunner N, Myers TW, Bauer K, Smith E, Raja R. Mutation scanning using MUT-MAP, a high-throughput, microfluidic chip-based, multi-analyte panel. PLoS One 2012; 7:e51153. [PMID: 23284662 PMCID: PMC3524125 DOI: 10.1371/journal.pone.0051153] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 10/17/2012] [Indexed: 01/07/2023] Open
Abstract
Targeted anticancer therapies rely on the identification of patient subgroups most likely to respond to treatment. Predictive biomarkers play a key role in patient selection, while diagnostic and prognostic biomarkers expand our understanding of tumor biology, suggest treatment combinations, and facilitate discovery of novel drug targets. We have developed a high-throughput microfluidics method for mutation detection (MUT-MAP, mutation multi-analyte panel) based on TaqMan or allele-specific PCR (AS-PCR) assays. We analyzed a set of 71 mutations across six genes of therapeutic interest. The six-gene mutation panel was designed to detect the most common mutations in the EGFR, KRAS, PIK3CA, NRAS, BRAF, and AKT1 oncogenes. The DNA was preamplified using custom-designed primer sets before the TaqMan/AS-PCR assays were carried out using the Biomark microfluidics system (Fluidigm; South San Francisco, CA). A cross-reactivity analysis enabled the generation of a robust automated mutation-calling algorithm which was then validated in a series of 51 cell lines and 33 FFPE clinical samples. All detected mutations were confirmed by other means. Sample input titrations confirmed the assay sensitivity with as little as 2 ng gDNA, and demonstrated excellent inter- and intra-chip reproducibility. Parallel analysis of 92 clinical trial samples was carried out using 2-100 ng genomic DNA (gDNA), allowing the simultaneous detection of multiple mutations. DNA prepared from both fresh frozen and formalin-fixed, paraffin-embedded (FFPE) samples were used, and the analysis was routinely completed in 2-3 days: traditional assays require 0.5-1 µg high-quality DNA, and take significantly longer to analyze. This assay can detect a wide range of mutations in therapeutically relevant genes from very small amounts of sample DNA. As such, the mutation assay developed is a valuable tool for high-throughput biomarker discovery and validation in personalized medicine and cancer drug development.
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Affiliation(s)
- Rajesh Patel
- Oncology Biomarker Development, Genentech Inc., South San Francisco, California, United States of America.
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Cheng C, Tam R, Marney L, Miller L. Clinical Profile of the Systemic Inflammatory Response Syndrome After Cardiac Surgery at the Townsville Hospital, Australia. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.08.045] [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: 10/15/2022]
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Abstract
Brief periods of heat stress of even a few days can have a detrimental effect on yield production worldwide, causing devastating economic and societal impacts. Here we report on the identification of a new heat-response regulon in plants controlled by the multiprotein bridging factor 1c (MBF1c) protein of Arabidopsis thaliana. Members of the highly conserved MBF1 protein family function as non-DNA-binding transcriptional co-activators involved in regulating metabolic and development pathways in different organisms from yeast to humans. Nonetheless, our studies suggest that MBF1c from Arabidopsis functions as a transcriptional regulator which binds DNA and controls the expression of 36 different transcripts during heat stress, including the important transcriptional regulator DRE-binding protein 2A (DREB2A), two heat shock transcription factors (HSFs), and several zinc finger proteins. We further identify CTAGA as a putative response element for MBF1c, demonstrate that the DNA-binding domain of MBF1c has a dominant-negative effect on heat tolerance when constitutively expressed in plants, and show that constitutive expression of MBF1c in soybean enhances yield production in plants grown under controlled growth conditions without causing adverse effects on growth. Our findings could have a significant impact on improving heat tolerance and yield of different crops subjected to heat stress.
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Affiliation(s)
- Nobuhiro Suzuki
- Department of Biological Sciences, College of Arts and Sciences, University of North Texas, 1155 Union Circle #305220, Denton, TX 76203
| | - Hiroe Sejima
- Department of Biochemistry and Molecular Biology, University of Nevada, Mail Stop 200, Reno NV 89557, USA
| | - Rachel Tam
- Department of Biochemistry and Molecular Biology, University of Nevada, Mail Stop 200, Reno NV 89557, USA
| | - Karen Schlauch
- Department of Biochemistry and Molecular Biology, University of Nevada, Mail Stop 200, Reno NV 89557, USA
| | - Ron Mittler
- Department of Biological Sciences, College of Arts and Sciences, University of North Texas, 1155 Union Circle #305220, Denton, TX 76203
- Department of Plant Sciences, Hebrew University of Jerusalem, Jerusalem 91904, Israel
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Fiene A, McNeil K, Kermeen F, Chambers D, Stuart K, Fawcett J, Tam R, Hart G, Hopkins P. 35: The Australian Experience with Combined Heart-Lung-Liver Transplantation. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Miller G, Schlauch K, Tam R, Cortes D, Torres MA, Shulaev V, Dangl JL, Mittler R. The plant NADPH oxidase RBOHD mediates rapid systemic signaling in response to diverse stimuli. Sci Signal 2009; 2:ra45. [PMID: 19690331 DOI: 10.1126/scisignal.2000448] [Citation(s) in RCA: 595] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Cell-to-cell communication and long-distance signaling play a key role in the response of plants to pests, mechanical wounding, and extreme environmental conditions. Here, we report on a rapid systemic signal in Arabidopsis thaliana that traveled at a rate of 8.4 centimeters per minute and was dependent on the respiratory burst oxidase homolog D (RbohD) gene. Signal propagation was accompanied by the accumulation of reactive oxygen species (ROS) in the extracellular spaces between cells and was inhibited by the suppression of ROS accumulation at locations distant from the initiation site. The rapid systemic signal was triggered by wounding, heat, cold, high-intensity light, and salinity stresses. Our results reveal the profound role that ROS play in mediating rapid, long-distance, cell-to-cell propagating signals in plants.
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Affiliation(s)
- Gad Miller
- Department of Biochemistry and Molecular Biology, University of Nevada, Reno, 89557, USA
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Schyvens CG, Andrews MC, Tam R, Mori TA, Croft KD, McKenzie KU, Whitworth JA, Zhang Y. Antioxidant Vitamins and Adrenocorticotrophic Hormone-Induced Hypertension in Rats. Clin Exp Hypertens 2009; 29:465-78. [DOI: 10.1080/10641960701615774] [Citation(s) in RCA: 3] [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: 10/22/2022]
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Chen KP, Herman PR, Zhang J, Tam R. Fabrication of strong long-period gratings in hydrogen-free fibers with 157-nm F2-laser radiation. Opt Lett 2001; 26:771-773. [PMID: 18040445 DOI: 10.1364/ol.26.000771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Long-period gratings were fabricated in standard telecommunication fiber (Corning SMF-28) by use of what is believed to be record short-wavelength light from a 157-nm F(2) laser. Strong loss peaks were formed without the need for enhancement techniques such as hydrogen loading. The magnitude of the attenuation peak was sensitive to the single-pulse laser fluence, decreasing with increasing pulse fluence as a result of nonuniform 157-nm laser interaction with both the fiber cladding and core. The long-period fiber gratings have good wavelength stability (Dlambda~7 nm) under thermal annealing at 150 degrees C.
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Tam R. A modification to aid open tracheostomy. J R Coll Surg Edinb 2001; 46:189; author reply 190. [PMID: 11478025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Tam R. Percutaneous (Portex) tracheostomy: an audit of the Newcastle experience. Ann R Coll Surg Engl 2001; 83:144. [PMID: 11320927 PMCID: PMC2503342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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Gardner M, Tam R. Off pump cabg (OPCAB) in patients with ascending aortic pathology. Heart Lung Circ 2000. [DOI: 10.1046/j.1443-9506.2000.09569.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lau Q, Thomson B, Burstow D, Tesar P, Tam R. Is an annuloplasty ring necessary in mitral valve repair for isolated posterior leaflet prolapse? Heart Lung Circ 2000. [DOI: 10.1046/j.1443-9506.2000.0948x.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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46
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Lau Q, Burstow D, Tam R. Is an annuloplasty ring necessary in mitral valve repair for isolated posterior leaflet prolapse? Heart Lung Circ 2000. [DOI: 10.1046/j.1443-9506.2000.09144.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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47
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Tam R, Chan PK. Soft-tissue case 35. Presentation. Cecal diverticulitis. Can J Surg 2000; 43:338, 384. [PMID: 11045090 PMCID: PMC3695138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Affiliation(s)
- R Tam
- Hong Kong Adventist Hospital, Hong Kong
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48
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Colosimo M, Kevat D, Clarke L, Duhig E, Abraham R, Musgrave K, Matar K, Windsor M, Tam R, Wyld D, Horwood K, Zimmerman P, Fong K. Novel histological determinants of outcome in surgically resected non-small cell lung cancer (NSCLC). Lung Cancer 2000. [DOI: 10.1016/s0169-5002(00)80747-3] [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: 10/27/2022]
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49
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Tam R, Lee MP. Soft-tissue case 34. Rectus sheath hematoma. Can J Surg 2000; 43:254, 306. [PMID: 10948683 PMCID: PMC3695211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Affiliation(s)
- R Tam
- Canossa Hospital, Hong Kong
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50
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Schwabe JW, Rodriguez-Esteban C, De La Peña J, Tavares AT, Ng JK, Banayo EM, Foys B, Eshelman B, Magallon J, Tam R, Izpisúa-Belmonte JC. Outgrowth and patterning of the vertebrate limb. Cold Spring Harb Symp Quant Biol 1998; 62:431-5. [PMID: 9598378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J W Schwabe
- Salk Institute, Gene Expression Laboratory, La Jolla, California 92037-1099, USA
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