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Kulkarni AA, Hennessy C, Wilson G, Ramesh V, Hwang C, Awosika J, Bakouny Z, Khan H, Vilar-Compte D, McKay R, Jani C, Weissmann L, Griffiths E, Batist G, Bouganim N, Mavromatis B, Bashir B, Nguyen RH, Riess JW, Puc M, Kasi A, Berg S, Castillo DR, Hayes-Lattin B, Hosmer W, Flora D, Mishra S, French B, Warner JL, Lopes G, Peters S, Florez N. Brief Report: Impact of Anti-Cancer Treatments on Outcomes of COVID-19 in Patients With Thoracic Cancers: A CCC19 Registry Analysis. Clin Lung Cancer 2024:S1525-7304(24)00044-5. [PMID: 38744613 DOI: 10.1016/j.cllc.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 03/25/2024] [Accepted: 04/04/2024] [Indexed: 05/16/2024]
Affiliation(s)
| | | | | | | | | | | | | | - Hina Khan
- Legorreta Cancer Center at Brown University, Providence, RI
| | | | | | | | | | | | - Gerald Batist
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, Canada
| | - Nathaniel Bouganim
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, Canada
| | | | - Babar Bashir
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Ryan H Nguyen
- University of Illinois Hospital & Health Sciences System, Chicago, IL
| | - Jonathan W Riess
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | | | - Anup Kasi
- University of Kansas, Kansas City, KS
| | | | | | | | - Wylie Hosmer
- Hartford HealthCare Cancer Institute, Southington, CT
| | | | - Sanjay Mishra
- Legorreta Cancer Center at Brown University, Providence, RI
| | | | | | | | - Solange Peters
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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2
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Dorff T, Zengin Z, Henderson N, Ali A, Nguyen C, Hwang C, Barata PC, Bilen M, Graham L, Mo G, Kilari D, Tripathi A, Labriola M, Rothstein S, Garje R, Koshkin V, Patel V, Schweizer M, Armstrong A, McKay R, Alva A. Clinical implications of AR alterations in advanced prostate cancer: A multi-institutional collaboration. Res Sq 2023:rs.3.rs-3201150. [PMID: 37609284 PMCID: PMC10441451 DOI: 10.21203/rs.3.rs-3201150/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Background AR gene alterations can develop in response to pressure of testosterone suppression and androgen receptor targeting agents (ARTA). Despite this, the relevance of these gene alterations in the context of ARTA treatment and clinical outcomes remains unclear. Methods Patients with castration-resistant prostate cancer (CRPC) who had undergone genomic testing and received ARTA treatment were identified in the Prostate Cancer Precision Medicine Multi-Institutional Collaborative Effort (PROMISE) database. Patients were stratified according to the timing of genomic testing relative to the first ARTA treatment (pre-/post-ARTA). Clinical outcomes such as time to progression, PSA response, and overall survival were compared based on alteration types. Results In total, 540 CRPC patients who received ARTA and had tissue-based (n=321) and/or blood-based (n=244) genomic sequencing were identified. Median age was 62 years (range 39-90) at the time of the diagnosis. Majority were White (72.2%) and had metastatic disease (92.6%) at the time of the first ARTA treatment. Pre-ARTA genomic testing was available in 24.8% of the patients, and AR mutations and amplifications were observed in 8.2% and 13.1% of the patients, respectively. Further, time to progression was longer in patients with AR amplifications (25.7 months) compared to those without an AR alteration (9.6 months; p=0.03). In the post-ARTA group (n=406), AR mutations and AR amplifications were observed in 18.5% and 35.7% of the patients, respectively. The most common mutation in post-ARTA group was L702H (9.9%). Conclusion To our knowledge, this is the largest real-world clinicogenomics database-driven study exploring the development of ARalterations and their association with ARTA treatment outcomes. Our study showed that AR amplifications are associated with longer time to progression on first ARTA treatment. Further prospective studies are needed to optimize therapeutic strategies for patients with AR alterations.
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Affiliation(s)
| | | | | | | | | | | | - Pedro C Barata
- Division of Medical Oncology, Department of Medicine, University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center
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3
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Recio-Boiles A, Deshmukh SK, Chipollini J, Batai K, Wu S, Xiu J, Farrell A, Radovich M, Heath E, McKay R, Nabhan C. Abstract 1895: Molecular characterization of prostate cancer between Hispanic American and Non-Hispanic Whites: Implications for cancer ethnic health disparities. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-1895] [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: 04/07/2023]
Abstract
Abstract
Background: Although there is increased awareness leading to early detection and prevention, Hispanic American (HA) men with prostate cancer (PC) continue to have greater mortality rates compared to their Non-Hispanic White (NHW) counterparts. Moreover, HA men with PC are more likely to have more advanced disease compared to NHW men. Here, we characterized the molecular and immune differences in HA and NHW tumors and their association with PC ethnic disparity.
Methods: 88 PC samples (HA=34, NHW=54) obtained from treatment-naive metastatic hormone-sensitive PC (mHSPC) were analyzed by next-generation sequencing (592, NextSeq; WES, NovaSeq), Whole Transcriptome Sequencing (WTS; NovaSeq) (Caris Life Sciences, Phoenix, AZ). AR signature and NEPC score were calculated based on the expression level of previously defined genes (Hieronymus et al. 2006, Beltran et al. 2016). Medical record was reviewed in a deidentified fashion for clinal features. Statistical significance was determined using chi-square and Mann-Whitney U (p<0.05).
Results: HA patients with PC had higher level of PSA (111.5 vs 52.6 ng/ml, p=0.12) and stage (T4: 41% vs 14% p=0.01, M1c: 41% vs 16% p=0.04) but no significant difference in frequency of Gleason score > 4 (79% vs 73%, p=0.61) or stage N1 (69% vs 61%, p=0.85) compared to NHW. HA PC had a significantly higher frequency of TMPRSS2-fusion (46.4% vs 20.0%, p=0.04) compared to NHW PC. By Gene Set Enrichment Analysis, HA PC had enrichment of KRAS signaling (NES: 1.44, FDR=0.02), Hedgehog signaling (NES: 1.45, FDR=0.04), NOTCH signaling (NES: 1.41, FDR=0.07), Hypoxia (NES: 1.38, FDR=0.10) and IL2-STAT5 signaling (NES: 1.35, FDR=0.10) pathways compared to NHW tumors. There was no difference in median Androgen Receptor signature (p=0.78) or Neuroendocrine Prostate Cancer (NEPC) score (p=0.79). Also, no significant difference in AR positivity by IHC (100% vs 95.7%) between HA and NHW PC tumors (p=0.51). HA PC had significantly higher expression of stem cell markers ALDH1A1 (2.1-fold), ALDH1A2 (3-fold), and PROM1 (1.6-fold) and immunoinhibitory genes PDCD1LG2 (1.68-fold) and FOXP3 (1.45-fold) compared to NHW tumors (all p<0.05). Additionally, HA tumors had increased infiltration of M1 Macrophages (0.72% vs 0%) and NK cells (4.84% vs 3.55%, all p<0.05), and increased T-cell inflamed score (44.0 vs -49.0, p=0.14) compared to NHW.
Conclusion: Our data suggest that HA mHSPC is associated with higher levels of PSA, stage, TMPRSS2-fusions, stemness marker expression, immunoinhibitory gene expression, and increased M1 Macrophage and NK cell infiltration. Together, these findings suggest a crucial role of differential molecular and tumor immune microenvironment in PC ethnic disparity. A better understanding of these differences with additional research may help in designing the approaches for reducing the ethnic disparities gaps in PC patients.
Citation Format: Alejandro Recio-Boiles, Sachin Kumar Deshmukh, Juan Chipollini, Ken Batai, Sharon Wu, Joanne Xiu, Alex Farrell, Milan Radovich, Elisabeth Heath, Rana McKay, Chadi Nabhan. Molecular characterization of prostate cancer between Hispanic American and Non-Hispanic Whites: Implications for cancer ethnic health disparities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1895.
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Affiliation(s)
| | | | | | - Ken Batai
- 3Roswell Park Comprehensive Cancer Cen, Buffalo, NY
| | | | | | | | | | - Elisabeth Heath
- 4Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Rana McKay
- 5Moores Cancer Center, University of California, San Diego, CA
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4
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Alaiwi SA, Nassar A, Zarif T, Macaron W, Denu R, Freeman D, Abdel-Wahab N, El-Am E, Al-Hader A, Malvar C, McKay R, Padera R, Neilan TG, Choueiri T, Naqash AR. CLINICAL OUTCOMES AND TOXICITY PROFILE OF PATIENTS WITH PRIMARY CARDIAC TUMORS TREATED WITH IMMUNE CHECKPOINT INHIBITORS <ICI>. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02780-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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5
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Alaiwi SA, Nassar A, Zarif T, Macaron W, Denu R, Freeman D, Abdel-Wahab N, El-Am E, Al-Hader A, Malvar C, McKay R, Padera R, Neilan TG, Choueiri T, Naqash AR. CLINICAL OUTCOMES AND TOXICITY PROFILE OF PATIENTS WITH PRIMARY CARDIAC TUMORS TREATED WITH IMMUNE CHECKPOINT INHIBITORS <ICI>. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02795-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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6
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Agarwal N, McGregor B, Maughan B, Dorff T, Kelly W, Fang B, McKay R, Singh P, Pagliaro L, Dreicer R, Srinivas S, Loriot Y, Vaishampayan U, Goel S, Curran D, Panneerselvam A, Liu LF, Choueiri T, Pal S. LBA24 Cabozantinib (C) in combination with atezolizumab (A) in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC): Results of expanded cohort 6 of the COSMIC-021 study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2100] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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7
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Khanna P, Soh HJ, Chen CH, Saxena R, Amin S, Naughton M, Joslin PN, Moore A, Bakouny Z, O'Callaghan C, Catalano P, Signoretti S, McKay R, Choueiri TK, Bhasin M, Walther T, Bhatt RS. ACE2 abrogates tumor resistance to VEGFR inhibitors suggesting angiotensin-(1-7) as a therapy for clear cell renal cell carcinoma. Sci Transl Med 2021; 13:13/577/eabc0170. [PMID: 33472951 DOI: 10.1126/scitranslmed.abc0170] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/24/2020] [Indexed: 12/24/2022]
Abstract
Angiotensin converting enzyme 2 (ACE2) is an enzyme that belongs to the renin-angiotensin system (RAS) and antagonizes the classical angiotensin (Ang) II/angiotensin II receptor type 1 (AT1) receptor pathway. Here, we report that higher ACE2 expression correlates with better overall survival in patients with clear cell renal cell carcinoma (ccRCC). Moreover, ACE2 has inhibitory effects on tumor proliferation in ccRCC in vitro and in preclinical animal models of ccRCC. We further show that Ang-(1-7), a heptapeptide generated by ACE2, is the likely mediator of this effect. Vascular endothelial growth factor receptor-tyrosine kinase inhibitor (VEGFR-TKI) treatment of ccRCC xenografts decreased ACE2 expression, and combination treatment with VEGFR-TKI and Ang-(1-7) generated additive suppression of tumor growth and improved survival outcomes. Last, the addition of Ang-(1-7) to programmed death-ligand 1 (PD-L1) pathway inhibitor and VEGFR-TKI showed further growth suppression in an immunocompetent RCC model. Together, these results suggest that targeting the ACE2/Ang-(1-7) axis is a promising therapeutic strategy against ccRCC.
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Affiliation(s)
- Prateek Khanna
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.,Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA 02138, USA
| | - Hong Jie Soh
- Department of Pharmacology and Therapeutics, School of Medicine and School of Pharmacy, University College Cork, Cork T12 K8AF, Ireland
| | - Chun-Hau Chen
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Ruchi Saxena
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Seema Amin
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Maura Naughton
- Department of Pharmacology and Therapeutics, School of Medicine and School of Pharmacy, University College Cork, Cork T12 K8AF, Ireland
| | - Patrick Neset Joslin
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Andrew Moore
- Department of Pharmacology and Therapeutics, School of Medicine and School of Pharmacy, University College Cork, Cork T12 K8AF, Ireland
| | - Ziad Bakouny
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Carol O'Callaghan
- Department of Pharmacology and Therapeutics, School of Medicine and School of Pharmacy, University College Cork, Cork T12 K8AF, Ireland
| | - Paul Catalano
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.,Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Rana McKay
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Manoj Bhasin
- Division of Interdisciplinary Medicine and Biotechnology and Genomics, Proteomics, Bioinformatics and Systems Biology Center, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Thomas Walther
- Department of Pharmacology and Therapeutics, School of Medicine and School of Pharmacy, University College Cork, Cork T12 K8AF, Ireland. .,Institute of Medical Biochemistry and Molecular Biology, University Medicine Greifswald, Greifswald 17489, Germany
| | - Rupal S Bhatt
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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8
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Klebaner D, Travis Courtney P, Garraway IP, Einck J, Kumar A, Elena Martinez M, McKay R, Murphy JD, Parada H, Sandhu A, Stewart T, Yamoah K, Rose BS. Association of Health-Care System with Prostate Cancer-Specific Mortality in African American and Non-Hispanic White Men. J Natl Cancer Inst 2021; 113:1343-1351. [PMID: 33892497 DOI: 10.1093/jnci/djab062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/19/2021] [Accepted: 03/30/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Disparities in prostate cancer-specific mortality (PCSM) between African American and non-Hispanic White (White) patients have been attributed to biological and systemic factors. We evaluated drivers of these disparities in the Surveillance, Epidemiology and End Results (SEER) national registry and an equal-access system, the Veterans Health Administration (VHA). METHODS We identified African American and White patients diagnosed with prostate cancer between 2004-2015 in SEER (N = 311,691) and the VHA (N = 90,749). We analyzed the association between race and metastatic disease at presentation using multivariable logistic regression adjusting for sociodemographic factors, and PCSM using sequential competing-risks regression adjusting for disease and sociodemographic factors. RESULTS The median follow-up was 5.3 years in SEER and 4.7 years in the VHA. African American men were more likely than White men to present with metastatic disease in SEER (adjusted odds ratio = 1.23, 95% confidence interval [CI] = 1.17-1.30), but not in the VHA (adjusted odds ratio = 1.07, 95% CI = 0.98-1.17). African American versus White race was associated with an increased risk of PCSM in SEER (subdistribution hazard ratio [SHR] = 1.32, 95% CI = 1.10-1.60), but not in the VHA (SHR = 1.00, 95% CI: 0.93-1.08). Adjusting for disease extent, PSA, and Gleason score eliminated the association between race and PCSM in SEER (aSHR 1.04, 95% CI 0.93-1.16). CONCLUSIONS Racial disparities in PCSM were present in a nationally representative registry, but not in an equal-access healthcare system, due to differences in advanced disease at presentation. Strategies to increase healthcare access may bridge the racial disparity in outcomes. Longer follow-up is needed to fully assess mortality outcomes.Disparities between African American and non-Hispanic White (White) patients in cancer-specific mortality have been described across numerous cancer types and healthcare systems[1-5]. The survival gap between African American and White patients with prostate cancer has been well-characterized, with two-fold higher prostate cancer-specific mortality (PCSM) rates among African American patients depending on the setting[1, 6-10]. This disparity has been attributed to differences in prostate cancer biology in African American men, in addition to systemic factors in mediating this disparity, such as differential access to healthcare, Prostate-Specific Antigen (PSA) screening, and distrust in the healthcare system[1, 11-16].The Veterans Health Administration (VHA) is a relatively equal-access healthcare system that treats a large, ethnically diverse population of veterans. The Surveillance, Epidemiology and End Results (SEER) program is a national cancer registry program that collects data from the general United States (US) population. The goals of the present investigation were to 1) Compare PCSM between African American and White men within SEER and the VHA and 2) Identify modifiable system-level contributors to these disparities. We hypothesized that PCSM would be comparable among African American and White men in an equal-access setting, the VHA, but not in a national registry, SEER, and that this disparity in SEER would be in part driven by more advanced disease at presentation.
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Affiliation(s)
- Daniella Klebaner
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - P Travis Courtney
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California.,Veterans Health Administration San Diego Health Care System, La Jolla, California, USA
| | - Isla P Garraway
- Department of Urology, University of California Los Angeles School of Medicine, Los Angeles, California
| | - John Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - Abhishek Kumar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - Maria Elena Martinez
- Department of Population Sciences, University of California San Diego Moores Cancer Center, La Jolla, California.,Wertheim School of Public Health, University of California San Diego, La Jolla, California
| | - Rana McKay
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, California
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California.,Veterans Health Administration San Diego Health Care System, La Jolla, California, USA
| | - Humberto Parada
- Department of Epidemiology and Biostatistics, San Diego State University Graduate School of Public Health,San Diego, California
| | - Ajay Sandhu
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - Tyler Stewart
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, California
| | - Kosj Yamoah
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa Bay, Florida
| | - Brent S Rose
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California.,Veterans Health Administration San Diego Health Care System, La Jolla, California, USA
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9
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McKay R. Redefining the Clinical States of Prostate Cancer in the Modern Era. Oncology (Williston Park) 2021; 35:169. [PMID: 33877748 DOI: 10.46883/onc.2021.3504.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Schaeffer E, Srinivas S, Antonarakis ES, Armstrong AJ, Bekelman JE, Cheng H, D’Amico AV, Davis BJ, Desai N, Dorff T, Eastham JA, Farrington TA, Gao X, Horwitz EM, Ippolito JE, Kuettel MR, Lang JM, McKay R, McKenney J, Netto G, Penson DF, Pow-Sang JM, Reiter R, Richey S, Roach, III M, Rosenfeld S, Shabsigh A, Spratt DE, Teply BA, Tward J, Shead DA, Freedman-Cass DA. NCCN Guidelines Insights: Prostate Cancer, Version 1.2021. J Natl Compr Canc Netw 2021; 19:134-143. [DOI: 10.6004/jnccn.2021.0008] [Citation(s) in RCA: 126] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Prostate Cancer address staging and risk assessment after a prostate cancer diagnosis and include management options for localized, regional, and metastatic disease. Recommendations for disease monitoring and treatment of recurrent disease are also included. The NCCN Prostate Cancer Panel meets annually to reevaluate and update their recommendations based on new clinical data and input from within NCCN Member Institutions and from external entities. This article summarizes the panel’s discussions for the 2021 update of the guidelines with regard to systemic therapy for metastatic castration-resistant prostate cancer.
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Affiliation(s)
- Edward Schaeffer
- 1Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | - Heather Cheng
- 6Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Anthony Victor D’Amico
- 7Dana-Farber/Brigham and Women’s Cancer Center
- Massachusetts General Hospital Cancer Center
| | | | - Neil Desai
- 9UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | - Xin Gao
- 7Dana-Farber/Brigham and Women’s Cancer Center
- Massachusetts General Hospital Cancer Center
| | | | - Joseph E. Ippolito
- 14Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | - Jesse McKenney
- 18Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Sylvia Richey
- 23St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center
| | | | - Stan Rosenfeld
- 25University of California San Francisco Patient Services Committee Chair
| | - Ahmad Shabsigh
- 26The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Jonathan Tward
- 29Huntsman Cancer Institute at the University of Utah; and
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11
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Mateo J, McKay R, Abida W, Aggarwal R, Alumkal J, Alva A, Feng F, Gao X, Graff J, Hussain M, Karzai F, Montgomery B, Oh W, Patel V, Rathkopf D, Rettig M, Schultz N, Smith M, Solit D, Sternberg C, Van Allen E, VanderWeele D, Vinson J, Soule HR, Chinnaiyan A, Small E, Simons JW, Dahut W, Miyahira AK, Beltran H. Accelerating precision medicine in metastatic prostate cancer. ACTA ACUST UNITED AC 2020; 1:1041-1053. [PMID: 34258585 DOI: 10.1038/s43018-020-00141-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Despite advances in prostate cancer screening and treatment, available therapy options, particularly in later stages of the disease, remain limited and the treatment-resistant setting represents a serious unmet medical need. Moreover, disease heterogeneity and disparities in patient access to medical advances result in significant variability in outcomes across patients. Disease classification based on genomic sequencing is a promising approach to identify patients whose tumors exhibit actionable targets and make more informed treatment decisions. Here we discuss how we can accelerate precision oncology to inform broader genomically-driven clinical decisions for men with advanced prostate cancer, drug development and ultimately contribute to new treatment paradigms.
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Affiliation(s)
- Joaquin Mateo
- Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona Spain
| | - Rana McKay
- University of California at San Diego, San Diego, CA, USA
| | - Wassim Abida
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rahul Aggarwal
- University of California at San Francisco, San Francisco CA, USA
| | | | - Ajjai Alva
- University of Michigan, Ann Arbor, MI, USA
| | - Felix Feng
- University of California at San Francisco, San Francisco CA, USA
| | - Xin Gao
- Massachusetts General Hospital, Boston, MA, USA
| | - Julie Graff
- Oregon Health & Science University, VA Portland Health Care System, Portland, OR, USA
| | - Maha Hussain
- Lurie Comprehensive Cancer Center at Northwestern University, Chicago, IL USA
| | | | | | | | | | - Dana Rathkopf
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew Rettig
- University of California at Los Angeles, VA Greater Los Angeles, Los Angeles, CA, USA
| | | | | | - David Solit
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - David VanderWeele
- Lurie Comprehensive Cancer Center at Northwestern University, Chicago, IL USA
| | - Jake Vinson
- Prostate Cancer Clinical Trials Consortium, New York, NY, USA
| | | | | | - Eric Small
- University of California at San Francisco, San Francisco CA, USA
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12
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Abstract
Cancer vaccines, cytokines, and checkpoint inhibitors are immunotherapeutic agents that act within the cancer immunity cycle. Prostate cancer has provided unique opportunities for, and challenges to, immunotherapy drug development, including low tumor mutational burdens, limited expression of PD-L1, and minimal T-cell intratumoral infiltrates. Nevertheless, efforts are ongoing to help prime prostate tumors by turning a "cold" prostate cancer "hot" and thus rendering them more susceptible to immunotherapy. Combination treatments, use of molecular biomarkers, and use of new immunotherapeutic agents provide opportunities to enhance the immune response to prostate tumors.
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Affiliation(s)
- Devin Patel
- Department of Urology, University of California San Diego, 9400 Campus Point Drive, MC7987, La Jolla, CA 92093, USA
| | - Rana McKay
- Division of Hematology-Oncology, Department of Internal Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - J Kellogg Parsons
- Department of Urology, University of California San Diego, 9400 Campus Point Drive, MC7987, La Jolla, CA 92093, USA.
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Sarkar RR, Patel SH, Parsons JK, Deka R, Kumar A, Einck JP, Mundt AJ, Kader AK, Kane CJ, Riviere P, McKay R, Murphy JD, Rose BS. Testosterone therapy does not increase the risks of prostate cancer recurrence or death after definitive treatment for localized disease. Prostate Cancer Prostatic Dis 2020; 23:689-695. [PMID: 32513967 DOI: 10.1038/s41391-020-0241-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/02/2020] [Accepted: 05/27/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The safety of testosterone therapy (TT) after definitive treatment for localized prostate cancer remains undefined. We analyzed the risks of biochemical recurrence and mortality in men receiving TT after treatment for localized prostate cancer. METHODS Cohort analysis using the national US Veterans Affairs Informatics and Computing Infrastructure. We identified 69,984 patients with localized prostate cancer diagnosed from 2001 to 2015 treated with surgery or radiation. We coded receipt of TT after treatment as a time-dependent covariate; used the National Death Index to identify cause of death; and defined biochemical recurrence as PSA > 0.2 ng/mL after surgery and nadir + 2 ng/mL after radiation. We analyzed recurrence and mortality using cumulative incidence curves, Fine-Gray competing risk regression, and Cox regression. RESULTS This cohort included 28,651 surgery patients and 41,333 radiation patients, of whom 469 (1.64%) and 543 (1.31%), respectively, received TT with a median follow-up of 6.95 years. Comparing testosterone users to nonusers, there were no between-group differences in biochemical recurrence, prostate cancer-specific mortality, or overall mortality after surgery [hazard ratios (HR): 1.07; HR: 0.72 (p = 0.43); and HR: 1.11 (p = 0.43), respectively] or radiation [HR: 1.07; HR: 1.02 (p = 0.95); and HR: 1.02 (p = 0.86), respectively]. Limitations included lack of detailed data on TT duration and serum testosterone concentrations. CONCLUSIONS In this multi-ethnic national cohort, TT did not increase the risks of biochemical recurrence or prostate cancer-specific or overall mortality after surgery or radiation. These data suggest that TT is safe in appropriate men after definitive treatment of localized prostate cancer.
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Affiliation(s)
- Reith R Sarkar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA.,Veteran Affairs Healthcare, San Diego, CA, USA
| | - Sunil H Patel
- Veteran Affairs Healthcare, San Diego, CA, USA.,Department of Urology, University of California San Diego, La Jolla, CA, 92093, USA
| | - J Kellogg Parsons
- Department of Urology, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Rishi Deka
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Abhishek Kumar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA.,Veteran Affairs Healthcare, San Diego, CA, USA
| | - John P Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Arno J Mundt
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - A Karim Kader
- Department of Urology, University of California San Diego, La Jolla, CA, 92093, USA
| | - Christopher J Kane
- Department of Urology, University of California San Diego, La Jolla, CA, 92093, USA
| | - Paul Riviere
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA.,Veteran Affairs Healthcare, San Diego, CA, USA
| | - Rana McKay
- Division of Hematology-Oncology, Department of Internal Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA.,Veteran Affairs Healthcare, San Diego, CA, USA
| | - Brent S Rose
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA.,Veteran Affairs Healthcare, San Diego, CA, USA.,Department of Urology, University of California San Diego, La Jolla, CA, 92093, USA
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14
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Rencsok E, Bazzi L, McKay R, Huang F, Friedant A, Vinson J, Zarif J, Simmons S, Villanti P, Kantoff P, Heath E, George D, Mucci L. Abstract B022: Diversity of enrollment in prostate cancer clinical trials: Current status and future directions. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-b022] [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] Open
Abstract
Abstract
Background: Prostate cancer incidence and mortality rates differ substantially by race and ethnicity globally and within the United States. Despite these disparities, many cancer clinical trials have a lack of representation of U.S. minority groups, and race is often overlooked when reporting trial results. The purpose of this study is to assess diversity of participants in prostate cancer clinical trials.
Methods: Available trials were identified through a systematic review of clinical trials using the U.S. National Library of Medicine's Clinical Trials Database and PubMed. Completed global phase III and phase IV clinical trials evaluating treatment, primary prevention, or screening of prostate cancer with published results were included in the analysis. Trials were analyzed for availability of race and ethnicity data and categories represented. Temporal and geographic trends were analyzed.
Results: Of the 61 treatment-based clinical trials analyzed, 39 (63.9%) reported race data. Twenty-one race categories were represented across the trials, with the largest categories being White (83.2% of participants), Black or African American (7.5%), other/not reported (4.4%), and Asian (2.7%). All other race categories represented less than 2% of participants each. Six trials (9.8%) additionally reported ethnicity data: 81.1% of participants with data were not Hispanic or Latino, 7.6% of participants were Hispanic or Latino, and 11.3% of participants did not indicate their ethnicity. Of four prevention-based trials, all had data available on race, but only one additionally reported ethnicity. The majority of participants in prevention trials were White (84.6%), with similar representation across race and ethnicity categories compared to the treatment clinical trials. Only one of the five screening trials had available race data, again showing majority White participants (85.0%). Categories unique to prevention and screening trials include Hispanic (non-African American), Hispanic (African American), non-Hispanic White, and non-Hispanic Black. The Swedish branch of the European Randomized Study for Screening for Prostate Cancer (ERSPC) reported country of origin rather than race data: 15% of participants were non-European. Additionally, diversity of participants has not changed over time, and representation of countries in trials is unequal.
Conclusions: More than one-third of prostate cancer clinical trials do not report race/ethnicity data. Moreover, there is significant variability in the race categories reported in trials, with 26 categories represented across the analyzed trials. Of the trials reporting race data, over 80% of participants were White. Current initiatives, such as the International Registry of Men with Advanced Prostate Cancer (IRONMAN), are aiming to recruit representative populations to decrease racial and ethnic disparities and ensure that men at risk for or diagnosed with prostate cancer are better represented in research and receive the best possible care.
Citation Format: Emily Rencsok, Latifa Bazzi, Rana McKay, Franklin Huang, Adam Friedant, Jake Vinson, Jelani Zarif, Stacey Simmons, Paul Villanti, Philip Kantoff, Elisabeth Heath, Daniel George, Lorelei Mucci. Diversity of enrollment in prostate cancer clinical trials: Current status and future directions [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B022.
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Affiliation(s)
| | - Latifa Bazzi
- 2University of Michigan School of Public Health, Ann Arbor, MI,
| | - Rana McKay
- 3University of California San Diego Moores Cancer Center, La Jolla, CA,
| | | | - Adam Friedant
- 5Prostate Cancer Clinical Trials Consortium, New York, NY,
| | - Jake Vinson
- 5Prostate Cancer Clinical Trials Consortium, New York, NY,
| | - Jelani Zarif
- 6Johns Hopkins University School of Medicine, Baltimore, MD,
| | | | - Paul Villanti
- 8Movember Foundation, East Melbourne, VIC, Australia,
| | | | - Elisabeth Heath
- 10Wayne State University Karmanos Cancer Institute, Detroit, MI,
| | | | - Lorelei Mucci
- 12Harvard T.H. Chan School of Public Health, Boston, MA
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Narayan V, Harrison M, Cheng H, Kenfield S, Aggarwal R, Kwon D, McKay R, Hauger R, Hart N, Conzen S, Borno H, Jim H, Dicker A, Dorff T, Moslehi J, Mucci L, Parsons JK, Saad F, Soule H, Morgans A, Ryan CJ. Improving research for prostate cancer survivorship: A statement from the Survivorship Research in Prostate Cancer (SuRECaP) working group. Urol Oncol 2020; 38:83-93. [DOI: 10.1016/j.urolonc.2019.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/16/2019] [Accepted: 10/08/2019] [Indexed: 12/26/2022]
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16
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Vitzthum LK, Straka C, Sarkar RR, McKay R, Randall JM, Sandhu A, Murphy JD, Rose BS. Combined Androgen Blockade in Localized Prostate Cancer Treated With Definitive Radiation Therapy. J Natl Compr Canc Netw 2019; 17:1497-1504. [PMID: 31805534 DOI: 10.6004/jnccn.2019.7335] [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] [Received: 04/12/2019] [Accepted: 06/19/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The addition of androgen deprivation therapy to radiation therapy (RT) improves survival in patients with intermediate- and high-risk prostate cancer (PCa), but it is not known whether combined androgen blockade (CAB) with a gonadotropin-releasing hormone agonist (GnRH-A) and a nonsteroidal antiandrogen improves survival over GnRH-A monotherapy. METHODS This study evaluated patients with intermediate- and high-risk PCa diagnosed in 2001 through 2015 who underwent RT with either GnRH-A alone or CAB using the Veterans Affairs Informatics and Computing Infrastructure. Associations between CAB and prostate cancer-specific mortality (PCSM) and overall survival (OS) were determined using multivariable regression with Fine-Gray and multivariable Cox proportional hazards models, respectively. For a positive control, the effect of long-term versus short-term GnRH-A therapy was tested. RESULTS The cohort included 8,423 men (GnRH-A, 4,529; CAB, 3,894) with a median follow-up of 5.9 years. There were 1,861 deaths, including 349 resulting from PCa. The unadjusted cumulative incidences of PCSM at 10 years were 5.9% and 6.9% for those receiving GnRH-A and CAB, respectively (P=.16). Compared with GnRH-A alone, CAB was not associated with a significant difference in covariate-adjusted PCSM (subdistribution hazard ratio [SHR], 1.05; 95% CI, 0.85-1.30) or OS (hazard ratio, 1.02; 95% CI, 0.93-1.12). For high-risk patients, long-term versus short-term GnRH-A therapy was associated with improved PCSM (SHR, 0.74; 95% CI, 0.57-0.95) and OS (SHR, 0.82; 95% CI, 0.73-0.93). CONCLUSIONS In men receiving definitive RT for intermediate- or high-risk PCa, CAB was not associated with improved PCSM or OS compared with GnRH alone.
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Affiliation(s)
| | - Chris Straka
- aDepartment of Radiation Medicine and Applied Sciences
| | | | - Rana McKay
- bDivision of Hematology-Oncology, Department of Internal Medicine, and
| | - J Michael Randall
- bDivision of Hematology-Oncology, Department of Internal Medicine, and
| | - Ajay Sandhu
- aDepartment of Radiation Medicine and Applied Sciences.,cClinical and Translational Research Institute, University of California San Diego, San Diego, California
| | - James D Murphy
- aDepartment of Radiation Medicine and Applied Sciences.,cClinical and Translational Research Institute, University of California San Diego, San Diego, California
| | - Brent S Rose
- aDepartment of Radiation Medicine and Applied Sciences.,cClinical and Translational Research Institute, University of California San Diego, San Diego, California
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McKay R, Smart S, Cocks N. Investigating Tongue Strength and Endurance in Children Aged 6 to 11 Years. Dysphagia 2019; 35:762-772. [PMID: 31792616 DOI: 10.1007/s00455-019-10081-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/21/2019] [Accepted: 11/16/2019] [Indexed: 10/25/2022]
Abstract
Objective measures of tongue strength and endurance are used to assess lingual weakness and fatigue, and may have significant clinical value for dysphagia management. Recent studies investigating age and gender effects on tongue strength in children are limited by small sample sizes. The current study investigated age and gender effects on tongue strength with a larger sample size, and collected preliminary normative data for a paediatric population. This study also investigated the reliability of tongue endurance measures in children using a modified method, which has not previously been investigated. Using a cross-sectional design, this study examined tongue strength and endurance in 119 children aged 6 to 11 years, with no history of speech sound disorders, oro-motor deficits, dysphagia or cognitive impairment. Measures were collected using the Iowa Oral Performance Instrument. Children participated in two sessions, 45 min and 10 min in duration. Tongue strength was found to significantly increase with age (p < 0.001), while no gender effects were found. Modified tongue endurance measures involved using only one measure of maximal tongue strength to set parameters for tongue endurance scores. Despite this modification, data did not reach acceptable test-retest reliability, ICC = 0.68, p < 0.001; however, reliability improved from previous studies. These findings provide normative data for tongue strength, as a basis to compare individuals, and highlights the need for more reliable protocols for measuring tongue endurance. Normative data was collected from city-dwelling Australian children.
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Affiliation(s)
- R McKay
- Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - S Smart
- Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - N Cocks
- Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
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18
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Deka R, Simpson DR, Bryant AK, Nalawade V, McKay R, Murphy JD, Rose BS. Association of Androgen Deprivation Therapy With Dementia in Men With Prostate Cancer Who Receive Definitive Radiation Therapy. JAMA Oncol 2019; 4:1616-1617. [PMID: 30325986 DOI: 10.1001/jamaoncol.2018.4423] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Rishi Deka
- Veterans Affairs San Diego Health Care System, La Jolla, California.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla.,University of California San Diego Center for Precision Radiation Medicine, La Jolla
| | - Daniel R Simpson
- Veterans Affairs San Diego Health Care System, La Jolla, California.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla.,University of California San Diego Center for Precision Radiation Medicine, La Jolla
| | - Alex K Bryant
- Veterans Affairs San Diego Health Care System, La Jolla, California.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
| | - Vinit Nalawade
- Veterans Affairs San Diego Health Care System, La Jolla, California.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla.,University of California San Diego Center for Precision Radiation Medicine, La Jolla
| | - Rana McKay
- Veterans Affairs San Diego Health Care System, La Jolla, California.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
| | - J D Murphy
- Veterans Affairs San Diego Health Care System, La Jolla, California.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla.,University of California San Diego Center for Precision Radiation Medicine, La Jolla
| | - Brent S Rose
- Veterans Affairs San Diego Health Care System, La Jolla, California.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla.,University of California San Diego Center for Precision Radiation Medicine, La Jolla
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McKay R, Mills H, Werner L, Choudhury A, Choueiri T, Jacobus S, Pace A, Polacek L, Pomerantz M, Prisby J, Sweeney C, Walsh M, Taplin ME. Evaluating a Video-Based, Personalized Webpage in Genitourinary Oncology Clinical Trials: A Phase 2 Randomized Trial. J Med Internet Res 2019; 21:e12044. [PMID: 31045501 PMCID: PMC6538310 DOI: 10.2196/12044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/27/2018] [Revised: 12/08/2018] [Accepted: 12/31/2018] [Indexed: 01/22/2023] Open
Abstract
Background The pace of drug discovery and approvals has led to expanding treatments for cancer patients. Although extensive research exists regarding barriers to enrollment in oncology clinical trials, there are limited studies evaluating processes to optimize patient education, oral anticancer therapy administration, and adherence for patients enrolled in clinical trials. In this study, we assess the feasibility of a video-based, personalized webpage for patients enrolled in genitourinary oncology clinical trials involving 1 or more oral anticancer therapy. Objective The primary objective of this trial was to assess the differences in the number of patient-initiated violations in the intervention arm compared with a control arm over 4 treatment cycles. Secondary objectives included patient satisfaction, frequently asked questions by patients on the intervention arm, patient-initiated calls to study team members, and patient-reported stress levels. Methods Eligible patients enrolling on a therapeutic clinical trial for a genitourinary malignancy were randomized 2:1 to the intervention arm or control arm. Patients randomized to the intervention arm received access to a video-based, personalized webpage, which included videos of patients’ own clinic encounters with their providers, instructional videos on medication administration and side effects, and electronic versions of educational documents. Results A total of 99 patients were enrolled (89 were evaluable; 66 completed 4 cycles). In total, 71% (40/56) of patients in the intervention arm had 1 or more patient-initiated violation compared with 70% (23/33) in the control arm. There was no difference in the total number of violations across 4 cycles between the 2 arms (estimate=−0.0939, 95% CI−0.6295 to 0.4418, P value=.73). Median baseline satisfaction scores for the intervention and control arms were 72 and 73, respectively, indicating high levels of patient satisfaction in both arms. Median baseline patient-reported stress levels were 10 and 13 for the intervention and control arms, respectively, indicating low stress levels in both arms at baseline. Conclusions This study is among the first to evaluate a video-based, personalized webpage that provides patients with educational videos and video recordings of clinical trial appointments. Despite not meeting the primary endpoint of reduced patient-initiated violations, this study demonstrates the feasibility of a video-based, personalized webpage in clinical trials. Future research assessing this tool might be better suited for realms outside of clinical trials and might consider the use of an endpoint that assesses patient-reported outcomes directly. A major limitation of this study was the lack of prior data for estimating the null hypothesis in this population.
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Affiliation(s)
- Rana McKay
- University of California San Diego, La Jolla, CA, United States
| | - Hannah Mills
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Lillian Werner
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Atish Choudhury
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Toni Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Susanna Jacobus
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Amanda Pace
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Laura Polacek
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Mark Pomerantz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Judith Prisby
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Christopher Sweeney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Meghara Walsh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Mary-Ellen Taplin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
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20
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Deka R, Simpson DR, Panizzon MS, Hauger RL, Riviere P, Nalawade V, McKay R, Murphy JD, Rose BS. Stroke and thromboembolic events in men with prostate cancer treated with definitive radiation therapy with or without androgen deprivation therapy. Prostate Cancer Prostatic Dis 2019; 22:600-608. [PMID: 30988408 DOI: 10.1038/s41391-019-0150-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/26/2019] [Accepted: 03/24/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is conflicting evidence regarding the association between androgen deprivation therapy (ADT) for prostate cancer (PC) and the risk of developing stroke and thromboembolic events. Our study evaluated the association between ADT use and development of stroke, transient ischemic attack (TIA), deep vein thrombosis (DVT), and pulmonary embolism (PE) in a homogenous group of men with PC treated with definitive radiation therapy (RT) after controlling for multiple sources of confounding. METHODS Observational cohort study of patients diagnosed with PC at the US Department of Veterans Affairs between 1 January 2001 and October 31, 2015 and treated with definitive RT. Exposure was initiation of ADT within 1 year of PC diagnosis. Primary outcomes were development of stroke, TIA, DVT, or PE. RESULTS 44,246 men with median follow-up of 6.8 years. The overall cumulative incidences of stroke, TIA, DVT, and PE at 10 years were 6.0, 3.0, 3.4, and 1.9%, respectively. In the multivariable competing risks model, there was a significant association between ADT and stroke (subdistribution hazard ratio (SHR) = 1.19, 95% CI = 1.09-1.30, p < 0.01), TIA (SHR = 1.24, 95% CI = 1.08-1.41, p < 0.01), and DVT (SHR = 1.18, 95% CI = 1.04-1.34, p < 0.01). ADT was only associated with PE in men receiving ADT for > 1 year (SHR = 1.34, 95% CI = 1.06-1.69, p-value = 0.03). CONCLUSION We observed an increase in the risk of stroke, TIA, and DVT in men receiving ADT and an increased risk of PE in men receiving long-term ADT. These results highlight concerns regarding long-term risks of ADT on stroke and thromboembolic events in the treatment of PC.
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Affiliation(s)
- Rishi Deka
- VA San Diego Health Care System, La Jolla, CA, USA. .,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, CA, USA.
| | - Daniel R Simpson
- VA San Diego Health Care System, La Jolla, CA, USA.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Matthew S Panizzon
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA, USA.,Center for Behavior Genetics of Aging, University of California San Diego, La Jolla, CA, USA
| | - Richard L Hauger
- VA San Diego Health Care System, La Jolla, CA, USA.,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA, USA.,Center for Behavior Genetics of Aging, University of California San Diego, La Jolla, CA, USA
| | - Paul Riviere
- VA San Diego Health Care System, La Jolla, CA, USA.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Vinit Nalawade
- VA San Diego Health Care System, La Jolla, CA, USA.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Rana McKay
- VA San Diego Health Care System, La Jolla, CA, USA.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - James D Murphy
- VA San Diego Health Care System, La Jolla, CA, USA.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Brent S Rose
- VA San Diego Health Care System, La Jolla, CA, USA.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, CA, USA
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21
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Yim K, Bindayi A, McKay R, Mehrazin R, Raheem OA, Field C, Bloch A, Wake R, Ryan S, Patterson A, Derweesh IH. Rising Serum Uric Acid Level Is Negatively Associated with Survival in Renal Cell Carcinoma. Cancers (Basel) 2019; 11:cancers11040536. [PMID: 30991671 PMCID: PMC6520981 DOI: 10.3390/cancers11040536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 02/28/2019] [Revised: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 12/31/2022] Open
Abstract
Aim and Background: To investigate the association of serum uric acid (SUA) levels along with statin use in Renal Cell Carcinoma (RCC), as statins may be associated with improved outcomes in RCC and SUA elevation is associated with increased risk of chronic kidney disease (CKD). Methods: Retrospective study of patients undergoing surgery for RCC with preoperative/postoperative SUA levels between 8/2005–8/2018. Analysis was carried out between patients with increased postoperative SUA vs. patients with decreased/stable postoperative SUA. Kaplan-Meier analysis (KMA) calculated overall survival (OS) and recurrence free survival (RFS). Multivariable analysis (MVA) was performed to identify factors associated with increased SUA levels and all-cause mortality. The prognostic significance of variables for OS and RFS was analyzed by cox regression analysis. Results: Decreased/stable SUA levels were noted in 675 (74.6%) and increased SUA levels were noted in 230 (25.4%). A higher proportion of patients with decreased/stable SUA levels took statins (27.9% vs. 18.3%, p = 0.0039). KMA demonstrated improved 5- and 10-year OS (89% vs. 47% and 65% vs. 9%, p < 0.001) and RFS (94% vs. 45% and 93% vs. 34%, p < 0.001), favoring patients with decreased/stable SUA levels. MVA revealed that statin use (Odds ratio (OR) 0.106, p < 0.001), dyslipidemia (OR 2.661, p = 0.004), stage III and IV disease compared to stage I (OR 1.887, p = 0.015 and 10.779, p < 0.001, respectively), and postoperative de novo CKD stage III (OR 5.952, p < 0.001) were predictors for increased postoperative SUA levels. MVA for all-cause mortality showed that increasing BMI (OR 1.085, p = 0.002), increasing ASA score (OR 1.578, p = 0.014), increased SUA levels (OR 4.698, p < 0.001), stage IV disease compared to stage I (OR 7.702, p < 0.001), radical nephrectomy (RN) compared to partial nephrectomy (PN) (OR 1.620, p = 0.019), and de novo CKD stage III (OR 7.068, p < 0.001) were significant factors. Cox proportional hazard analysis for OS revealed that increasing age (HR 1.017, p = 0.004), increasing BMI (Hazard Ratio (HR) 1.099, p < 0.001), increasing SUA (HR 4.708, p < 0.001), stage III and IV compared to stage I (HR 1.537, p = 0.013 and 3.299, p < 0.001), RN vs. PN (HR 1.497, p = 0.029), and de novo CKD stage III (HR 1.684, p < 0.001) were significant factors. Cox proportional hazard analysis for RFS demonstrated that increasing ASA score (HR 1.239, p < 0.001, increasing SUA (HR 9.782, p < 0.001), and stage II, III, and IV disease compared to stage I (HR 2.497, p < 0.001 and 3.195, p < 0.001 and 6.911, p < 0.001) were significant factors. Conclusions: Increasing SUA was associated with poorer outcomes. Decreased SUA levels were associated with statin intake and lower stage disease as well as lack of progression to CKD and anemia. Further investigation is requisite.
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Affiliation(s)
- Kendrick Yim
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Ahmet Bindayi
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Rana McKay
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Reza Mehrazin
- Department of Urology, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA.
| | - Omer A Raheem
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Charles Field
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Aaron Bloch
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Robert Wake
- Department of Urology, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA.
| | - Stephen Ryan
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
| | - Anthony Patterson
- Department of Urology, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA.
| | - Ithaar H Derweesh
- Department of Urology, University of California at San Diego, La Jolla, CA, 92093, USA.
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Deka R, Rose BS, Bryant AK, Sarkar RR, Nalawade V, McKay R, Murphy JD, Simpson DR. Androgen deprivation therapy and depression in men with prostate cancer treated with definitive radiation therapy. Cancer 2019; 125:1070-1080. [DOI: 10.1002/cncr.31982] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/06/2018] [Accepted: 07/09/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Rishi Deka
- VA San Diego Health Care System La JollaCalifornia
- Department of Radiation Medicine and Applied Sciences University of California San Diego School of Medicine La JollaCalifornia
| | - Brent S. Rose
- VA San Diego Health Care System La JollaCalifornia
- Department of Radiation Medicine and Applied Sciences University of California San Diego School of Medicine La JollaCalifornia
| | - Alex K. Bryant
- VA San Diego Health Care System La JollaCalifornia
- Department of Radiation Medicine and Applied Sciences University of California San Diego School of Medicine La JollaCalifornia
| | - Reith R. Sarkar
- VA San Diego Health Care System La JollaCalifornia
- Department of Radiation Medicine and Applied Sciences University of California San Diego School of Medicine La JollaCalifornia
| | - Vinit Nalawade
- VA San Diego Health Care System La JollaCalifornia
- Department of Radiation Medicine and Applied Sciences University of California San Diego School of Medicine La JollaCalifornia
| | - Rana McKay
- VA San Diego Health Care System La JollaCalifornia
- Department of Radiation Medicine and Applied Sciences University of California San Diego School of Medicine La JollaCalifornia
| | - James D. Murphy
- VA San Diego Health Care System La JollaCalifornia
- Department of Radiation Medicine and Applied Sciences University of California San Diego School of Medicine La JollaCalifornia
| | - Daniel R. Simpson
- VA San Diego Health Care System La JollaCalifornia
- Department of Radiation Medicine and Applied Sciences University of California San Diego School of Medicine La JollaCalifornia
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Graham J, Wells J, McKay R, Vaishampayan U, Hansen A, Donskov F, Bjarnason G, Beuselinck B, De Velasco G, Duh M, Huynh L, Chang R, Zanotti G, Ramaswamy K, Choueiri T, Heng D. Clinical outcomes of patients with metastatic renal cell carcinoma (mRCC) treated with vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKI) and mammalian target of rapamycin inhibitors (mTORI) after immuno-oncology (IO) checkpoint inhibitors. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy283.098] [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: 11/14/2022] Open
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McDonald ML, Lane BR, Jimenez J, Lee HJ, Yim K, Bindayi A, Hamilton ZA, Field CA, Bloch AS, Dey S, Noyes S, McKay R, Millard F, Rini BI, Campbell SC, Derweesh IH. Renal Functional Outcome of Partial Nephrectomy for Complex R.E.N.A.L. Score Tumors With or Without Neoadjuvant Sunitinib: A Multicenter Analysis. Clin Genitourin Cancer 2018; 16:e289-e295. [DOI: 10.1016/j.clgc.2017.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/08/2017] [Accepted: 09/17/2017] [Indexed: 01/07/2023]
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Else T, Lerario AM, Everett J, Haymon L, Wham D, Mullane M, Wilson TL, Rainville I, Rana H, Worth AJ, Snyder NW, Blair IA, McKay R, Kilbridge K, Hammer G, Barletta J, Vaidya A. Adrenocortical carcinoma and succinate dehydrogenase gene mutations: an observational case series. Eur J Endocrinol 2017; 177:439-444. [PMID: 28819017 DOI: 10.1530/eje-17-0358] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/17/2017] [Accepted: 08/17/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Germline loss-of-function mutations in succinate dehydrogenase (SDHx) genes results in rare tumor syndromes that include pheochromocytoma, paraganglioma, and others. Here we report a case series of patients with adrenocortical carcinoma (ACC) that harbor SDHx mutations. PATIENTS AND RESULTS We report four unrelated patients with ACC and SDHx mutations. All cases presented with Cushing syndrome and large adrenal masses that were confirmed to be ACC on pathology. All four ACC specimens were found to have truncating mutations in either SDHC or SDHA, while cases 1, 2 and 3 also had the mutations confirmed in the germline: Case 1: SDHC c.397C > T, pR133X; Case 2: SDHC c.43C > T, p.R15X; Case 3: SDHA c.91C > T, p.R31X; Case 4: SDHA c.1258C > T, p.Q420X. Notably, Case 1 had a father and daughter who both harbored the same SDHC germline mutation, and the father had a paraganglioma and renal cell carcinoma. A combination of next generation sequencing, and/or immunohistochemistry, and/or mass spectroscopy was used to determine whether there was loss of heterozygosity and/or loss of SDH protein expression or function within the ACC. Potential evidence of loss of heterozygosity was observed only in Case 2. CONCLUSIONS We observed truncating mutations in SDHA or SDHC in the ACC and/or germline of four unrelated patients. Given how statistically improbable the concurrence of ACC and pathogenic germline SDHx mutations is expected to be, these observations raise the question whether ACC may be a rare manifestation of SDHx mutation syndromes. Further studies are needed to investigate the possible role of SDH deficiency in ACC pathogenesis.
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Affiliation(s)
- Tobias Else
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Antonio Marcondes Lerario
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica Everett
- Division of Molecular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Lori Haymon
- Aurora HealthCare Cancer Care, Genomic Medicine Program, Milwaukee, Wisconsin, USA
| | - Deborah Wham
- Aurora HealthCare Cancer Care, Genomic Medicine Program, Milwaukee, Wisconsin, USA
| | - Michael Mullane
- Aurora HealthCare Cancer Care, Genomic Medicine Program, Milwaukee, Wisconsin, USA
| | - Tremika LeShan Wilson
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Irene Rainville
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Huma Rana
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew J Worth
- Department of Systems Pharmacology and Translational Therapeutics, Penn SRP and Center for Excellence in Environmental Toxicology, Philadelphia, Pennsylvania, USA
| | - Nathaniel W Snyder
- Department of Systems Pharmacology and Translational Therapeutics, Penn SRP and Center for Excellence in Environmental Toxicology, Philadelphia, Pennsylvania, USA
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Ian A Blair
- Department of Systems Pharmacology and Translational Therapeutics, Penn SRP and Center for Excellence in Environmental Toxicology, Philadelphia, Pennsylvania, USA
| | - Rana McKay
- Moores Cancer Center, University of California, San Diego, California, USA
| | - Kerry Kilbridge
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Gary Hammer
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Justine Barletta
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Anand Vaidya
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Endocrinology, Diabetes, and Hypertension, Center for Adrenal Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Harshman LC, Werner L, Tripathi A, Wang X, Maughan BL, Antonarakis ES, Nakabayashi M, McKay R, Pomerantz M, Mucci LA, Taplin ME, Sweeney CJ, Lee GSM, Kantoff PW. The impact of statin use on the efficacy of abiraterone acetate in patients with castration-resistant prostate cancer. Prostate 2017; 77:1303-1311. [PMID: 28762529 PMCID: PMC5811259 DOI: 10.1002/pros.23390] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/22/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND Statins compete with DHEAS for influx through the SLCO2B1 transporter, which may prolong time to progression (TTP) on androgen deprivation therapy. Abiraterone acetate (AA) may also undergo SLCO-mediated transport. Based on preclinical findings showing antagonism, we hypothesized that statins may compete with AA for influx via SLCO2B1 and could negatively impact drug efficacy. METHODS We queried two institutional clinical databases (Dana-Farber Cancer Institute [DFCI], Johns Hopkins University [JHU]) for CRPC patients treated with AA. Treatment duration was a surrogate for TTP. Associations between statin use and AA duration were estimated using the Kaplan-Meier method. Multivariable Cox regression modeling adjusted for known prognostic factors. RESULTS Of the 224 DFCI and 270 JHU patients included, the majority (96%) had metastatic disease. Nearly half (41% and 45%) were statin users. In the DFCI cohort, there was a trend toward longer AA duration in statin users: 14.2 versus 9.2 months (HR 0.79, 95%CI: 0.57-1.09, P = 0.14). There was no association between statin use and AA duration in the JHU cohort: 8.3 versus 8.0 months (HR 0.89, 95%CI: 0.69-1.16, P = 0.38) in the statin users versus non-users, except for a trend in patients that had not previously received docetaxel or enzalutamide (HR 0.79; 95%CI: 0.57-1.10). CONCLUSIONS Contrary to our initial hypothesis, there was a trend toward longer (rather than shorter) AA duration in statin users in the entire DFCI cohort and in the enzalutamide- and docetaxel-naïve JHU patients. Together, these results do not support the hypothesis that statins interfere with AA efficacy.
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Affiliation(s)
- Lauren C. Harshman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Lillian Werner
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Abhishek Tripathi
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Xiaodong Wang
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Benjamin L. Maughan
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emmanuel S. Antonarakis
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mari Nakabayashi
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Rana McKay
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Mark Pomerantz
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Lorelei A. Mucci
- Department of Epidemiology, Harvard School of Public Health, Boston MA
| | - Mary-Ellen Taplin
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Christopher J. Sweeney
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Gwo-Shu Mary Lee
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Philip W. Kantoff
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
- Memorial Sloan Kettering Cancer Center, New York
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Meric-Bernstam F, Tannir N, Harding J, Voss M, Mier J, DeMichele A, Munster P, Patel M, Iliopoulos O, Owonikoko T, Whiting S, Orford K, Bennett M, Carvajal R, McKay R, Fan A, Telli M, Infante J. Phase 1 study of CB-839, a small molecule inhibitor of glutaminase, in combination with everolimus in patients (pts) with clear cell and papillary renal cell cancer (RCC). Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32626-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Meric-Bernstam F, Tannir NM, Mier JW, DeMichele A, Telli ML, Fan AC, Munster PN, Carvajal RD, Orford KW, Bennett MK, Iliopoulos O, Owonikoko TK, Patel MR, McKay R, Infante JR, Voss MH, Harding JJ. Phase 1 study of CB-839, a small molecule inhibitor of glutaminase (GLS), alone and in combination with everolimus (E) in patients (pts) with renal cell cancer (RCC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.4568] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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)
- Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics (Phase 1 Program), Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nizar M. Tannir
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James Walter Mier
- Department of Medicine, Dana-Farber/Harvard Cancer Center, Beth Israel Deaconess Medical Center, Boston, MA
| | - Angela DeMichele
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | | | | | | | - Manish R. Patel
- Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL
| | - Rana McKay
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | | | | | - James J. Harding
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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DeMichele A, Harding JJ, Telli ML, Munster PN, McKay R, Iliopoulos O, Orford KW, Bennett MK, Mier JW, Owonikoko TK, Patel MR, Carvajal RD, Meric-Bernstam F, Infante JR. Phase 1 study of CB-839, a small molecule inhibitor of glutaminase (GLS) in combination with paclitaxel (Pac) in patients (pts) with triple negative breast cancer (TNBC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.1011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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)
- Angela DeMichele
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA
| | - James J. Harding
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | | | | | - Rana McKay
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | | | | | | | - James Walter Mier
- Department of Medicine, Dana-Farber/Harvard Cancer Center, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Manish R. Patel
- Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL
| | | | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics (Phase 1 Program), Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Abstract
BACKGROUND That delusional and delusion-prone individuals 'jump to conclusions' is one of the most robust and important findings in the literature on delusions. However, although the notion of 'jumping to conclusions' (JTC) implies gathering insufficient evidence and reaching premature decisions, previous studies have not investigated whether the evidence gathering of delusion-prone individuals is, in fact, suboptimal. The standard JTC effect is a relative effect but using relative comparisons to substantiate absolute claims is problematic. In this study we investigated whether delusion-prone participants jump to conclusions in both a relative and an absolute sense. METHOD Healthy participants (n = 112) completed an incentivized probabilistic reasoning task in which correct decisions were rewarded and additional information could be requested for a small price. This combination of rewards and costs generated optimal decision points. Participants also completed measures of delusion proneness, intelligence and risk aversion. RESULTS Replicating the standard relative finding, we found that delusion proneness significantly predicted task decisions, such that the more delusion prone the participants were, the earlier they decided. This finding was robust when accounting for the effects of risk aversion and intelligence. Importantly, high-delusion-prone participants also decided in advance of an objective rational optimum, gathering fewer data than would have maximized their expected payoff. Surprisingly, we found that even low-delusion-prone participants jumped to conclusions in this absolute sense. CONCLUSIONS Our findings support and clarify the claim that delusion formation is associated with a tendency to 'jump to conclusions'. In short, most people jump to conclusions, but more delusion-prone individuals 'jump further'.
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Affiliation(s)
- L van der Leer
- ARC Centre of Excellence in Cognition and its Disorders,Department of Psychology,Royal Holloway,University of London,Egham,Surrey,UK
| | - B Hartig
- Department of Economics,Royal Holloway,University of London,Egham,Surrey,UK
| | - M Goldmanis
- Department of Economics,Royal Holloway,University of London,Egham,Surrey,UK
| | - R McKay
- ARC Centre of Excellence in Cognition and its Disorders,Department of Psychology,Royal Holloway,University of London,Egham,Surrey,UK
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Subramaniam K, Fallon K, Ruut T, Lane D, McKay R, Shadbolt B, Ang S, Cook M, Platten J, Pavli P, Taupin D. Infliximab reverses inflammatory muscle wasting (sarcopenia) in Crohn's disease. Aliment Pharmacol Ther 2015; 41:419-28. [PMID: 25580985 DOI: 10.1111/apt.13058] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [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] [Received: 09/07/2014] [Revised: 09/21/2014] [Accepted: 11/30/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Muscle wasting or sarcopenia arising from chronic inflammation is found in 60% of patients with Crohn's disease. Transcriptional protein NF-κB reduces muscle formation through MyoD transcription and increases muscle breakdown by proteolysis. AIM As TNF is a potent activator of NF-κB, and anti-TNF agent infliximab (IFX) prevents NF-κB activation, to determine whether or not Crohn's patients treated with IFX gain muscle volume and strength. METHODS We performed a prospective, repeated-measures cohort study in adult Crohn's disease patients with an acute disease flare. Patients were instructed not to vary diet or activity. Concomitant medications were kept stable. At week 1 (pre-treatment), week 16 (post-IFX induction) and week 25 (post-first IFX maintenance dose), we assessed (i) MRI volume of quadriceps femoris at anatomical mid-thigh; (ii) maximal concentric quadriceps contractions strength at three specific speeds of contraction; (iii) physical activity by validated instrument (IPAQ); (iv) Three-day food record of intake and composition (food-weighing method); (v) Serum levels of IL6. RESULTS Nineteen patients (58% female; mean age 33.2 ± 10.7 years) were recruited. IFX increased muscle volume in both legs from baseline (right, 1505 cm(3) ) to week 25 (right, 1569 cm(3) ; P = 0.010). IFX also increased muscle strength in both legs from baseline (right 30°/s, 184.8 Nm) to week 25 (right 30°/s, 213.6 Nm; P = 0.002). Muscle volume gain correlated with male gender (P = 0.003). Significant gains in muscle volume and strength were unrelated to prednisolone use. Serum IL6 levels decreased by week 25 (P = 0.037). CONCLUSION The anti-TNF agent infliximab reverses inflammatory sarcopenia in patients with Crohn's disease.
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Affiliation(s)
- K Subramaniam
- Gastroenterology and Hepatology Unit, Canberra Hospital, Garran, ACT, Australia
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Gralow JR, Biermann JS, Farooki A, Fornier MN, Gagel RF, Kumar R, Litsas G, McKay R, Podoloff DA, Srinivas S, Van Poznak CH. NCCN Task Force Report: Bone Health in Cancer Care. J Natl Compr Canc Netw 2013; 11 Suppl 3:S1-50; quiz S51. [DOI: 10.6004/jnccn.2013.0215] [Citation(s) in RCA: 177] [Impact Index Per Article: 16.1] [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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Peisah C, Chan DKY, McKay R, Kurrle SE, Reutens SG. Practical guidelines for the acute emergency sedation of the severely agitated older patient. Intern Med J 2011; 41:651-7. [DOI: 10.1111/j.1445-5994.2011.02560.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Pellegrino R, Brusasco V, Viegi G, Crapo RO, Burgos F, Casaburi R, Coates A, van der Grinten CPM, Gustafsson P, Hankinson J, Jensen R, Johnson DC, Macintyre N, McKay R, Miller MR, Navajas D, Pedersen OF, Wanger J. Definition of COPD: based on evidence or opinion? Eur Respir J 2008; 31:681-2. [PMID: 18310402 DOI: 10.1183/09031936.00154307] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Shim JH, Kim SE, Woo DH, Kim SK, Oh CH, McKay R, Kim JH. Directed differentiation of human embryonic stem cells towards a pancreatic cell fate. Diabetologia 2007; 50:1228-38. [PMID: 17457565 DOI: 10.1007/s00125-007-0634-z] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 01/15/2007] [Indexed: 12/13/2022]
Abstract
AIMS/HYPOTHESIS The relative lack of successful pancreatic differentiation of human embryonic stem cells (hESCs) may suggest that directed differentiation of hESCs into definitive endoderm and subsequent commitment towards a pancreatic fate are not readily achieved. The aim of this study was to investigate whether sequential exposure of hESCs to epigenetic signals that mimic in vivo pancreatic development can efficiently generate pancreatic endodermal cells, and whether these cells can be further matured and reverse hyperglycaemia upon transplantation. MATERIALS AND METHODS The hESCs were sequentially treated with serum, activin and retinoic acid (RA) during embryoid body formation. The patterns of gene expression and protein production associated with embryonic germ layers and pancreatic endoderm were analysed by RT-PCR and immunostaining. The developmental competence and function of hESC-derived PDX1-positive cells were evaluated after in vivo transplantation. RESULTS Sequential treatment with serum, activin and RA highly upregulated the expression of the genes encoding forkhead box protein A2 (FOXA2), SRY-box containing gene 17 (SOX17), pancreatic and duodenal homeobox 1 (PDX1) and homeobox HB9 (HLXB9). The population of pancreatic endodermal cells that produced PDX1 was significantly increased at the expense of ectodermal differentiation, and a subset of the PDX1-positive cells also produced FOXA2, caudal-type homeobox transcription factor 2 (CDX2), and nestin (NES). After transplantation, the PDX1-positive cells further differentiated into mature cell types producing insulin and glucagon, resulting in amelioration of hyperglycaemia and weight loss in streptozotocin-treated diabetic mice. CONCLUSIONS/INTERPRETATION Our strategy allows the progressive differentiation of hESCs into pancreatic endoderm capable of generating mature pancreatic cell types that function in vivo. These findings may establish the basis of further investigations for the purification of transplantable islet progenitors derived from hESCs.
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Affiliation(s)
- J H Shim
- Division of Biotechnology, College of Life Sciences and Biotechnology, Korea University, West Building/Room 304, Science Campus, 1 Anam-dong 5-ga, Sungbuk-goo, Seoul 136-713, Republic of Korea
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MacIntyre N, Crapo R, Viegi G, Johnson D, Van Der Grinten C, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, Gustafsson P, Hankinson J, Jensen R, McKay R, Miller M, Navajas D, Pedersen O, Pellegrino R, Wanger J. Standardisation de la détermination de la diffusion du monoxyde de carbone par la méthode en apnée. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)91119-5] [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: 11/29/2022]
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Miller M, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, Van Der Grinten C, Gustafsson P, Jensen R, Johnson D, MacIntyre N, McKay R, Navajas D, Pedersen O, Pellegrino R, Viegi G, Wanger J. Considérations générales sur les explorations fonctionnelles respiratoires. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)91116-x] [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: 12/01/2022]
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Miller M, Hankinson J, Brusasco V, Burgo F, Casaburi R, Coates A, Crapo R, Enright P, Van Der Grinten C, Gustafsson P, Jensen R, Johnson D, MacIntyre N, McKay R, Navajas D, Pedersen O, Pellegrino R, Viegi G, Wanger J. Standardisation de la spirométrie. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)91117-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lehr E, Hermary S, McKay R, Webb D, Lakey J, Coe J, Korbutt G, Ross D. P161. J Surg Res 2007. [DOI: 10.1016/j.jss.2006.12.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CPM, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J. Standardisation of spirometry. Eur Respir J 2006; 26:319-38. [PMID: 16055882 DOI: 10.1183/09031936.05.00034805] [Citation(s) in RCA: 10738] [Impact Index Per Article: 596.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- M R Miller
- University Hospital Birmingham NHS Trust, Birmingham, UK
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41
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Macintyre N, Crapo RO, Viegi G, Johnson DC, van der Grinten CPM, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, Gustafsson P, Hankinson J, Jensen R, McKay R, Miller MR, Navajas D, Pedersen OF, Pellegrino R, Wanger J. Standardisation of the single-breath determination of carbon monoxide uptake in the lung. Eur Respir J 2006; 26:720-35. [PMID: 16204605 DOI: 10.1183/09031936.05.00034905] [Citation(s) in RCA: 1561] [Impact Index Per Article: 86.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- N Macintyre
- Duke University Medical Center, Durham, NC, USA
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Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, Coates A, van der Grinten CPM, Gustafsson P, Hankinson J, Jensen R, Johnson DC, MacIntyre N, McKay R, Miller MR, Navajas D, Pedersen OF, Wanger J. Interpretative strategies for lung function tests. Eur Respir J 2006; 26:948-68. [PMID: 16264058 DOI: 10.1183/09031936.05.00035205] [Citation(s) in RCA: 3617] [Impact Index Per Article: 200.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- R Pellegrino
- Internal Medicine, University of Genoa, V.le Benedetto XV, 6, Genova I-16132, Italy
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Wanger J, Clausen JL, Coates A, Pedersen OF, Brusasco V, Burgos F, Casaburi R, Crapo R, Enright P, van der Grinten CPM, Gustafsson P, Hankinson J, Jensen R, Johnson D, Macintyre N, McKay R, Miller MR, Navajas D, Pellegrino R, Viegi G. Standardisation of the measurement of lung volumes. Eur Respir J 2005; 26:511-22. [PMID: 16135736 DOI: 10.1183/09031936.05.00035005] [Citation(s) in RCA: 1806] [Impact Index Per Article: 95.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- J Wanger
- Internal Medicine, University of Genoa, V.le Benedetto XV, 6, I-16132 Genova, Italy
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Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, van der Grinten CPM, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J. General considerations for lung function testing. Eur Respir J 2005; 26:153-61. [PMID: 15994402 DOI: 10.1183/09031936.05.00034505] [Citation(s) in RCA: 1267] [Impact Index Per Article: 66.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M R Miller
- University Hospital Birmingham NHS Trust, UK
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Engel YM, Levine RD, Thoman JW, Steinfeld JI, McKay R. Information theoretic analysis of quantal fluctuations in fluorescence lifetimes. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/j100330a032] [Citation(s) in RCA: 6] [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: 11/28/2022]
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Ahmed F, Robida A, McKay R. Imai technique for management of the coronary arteries arising from a solitary sinus in discordant ventriculo-arterial connections. Cardiol Young 2001; 11:578-9. [PMID: 11727920 DOI: 10.1017/s1047951101000889] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- F Ahmed
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
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Rhodes G, Yoshikawa S, Clark A, Lee K, McKay R, Akamatsu S. Attractiveness of facial averageness and symmetry in non-western cultures: in search of biologically based standards of beauty. Perception 2001; 30:611-25. [PMID: 11430245 DOI: 10.1068/p3123] [Citation(s) in RCA: 171] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Averageness and symmetry are attractive in Western faces and are good candidates for biologically based standards of beauty. A hallmark of such standards is that they are shared across cultures. We examined whether facial averageness and symmetry are attractive in non-Western cultures. Increasing the averageness of individual faces, by warping those faces towards an averaged composite of the same race and sex, increased the attractiveness of both Chinese (experiment 1) and Japanese (experiment 2) faces, for Chinese and Japanese participants, respectively. Decreasing averageness by moving the faces away from an average shape decreased attractiveness. We also manipulated the symmetry of Japanese faces by blending each original face with its mirror image to create perfectly symmetric versions. Japanese raters preferred the perfectly symmetric versions to the original faces (experiment 2). These findings show that preferences for facial averageness and symmetry are not restricted to Western cultures, consistent with the view that they are biologically based. Interestingly, it made little difference whether averageness was manipulated by using own-race or other-race averaged composites and there was no preference for own-race averaged composites over other-race or mixed-race composites (experiment 1). We discuss the implications of these results for understanding what makes average faces attractive. We also discuss some limitations of our studies, and consider other lines of converging evidence that may help determine whether preferences for average and symmetric faces are biologically based.
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Affiliation(s)
- G Rhodes
- Department of Psychology, University of Western Australia, Nedlands, Perth, WA 6907, Australia.
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McCarty CA, Wright S, McKay R, Taylor KI, Keeffe JE. Changes in management of diabetic retinopathy by Australian ophthalmologists as a result of the NHMRC clinical guidelines. Clin Exp Ophthalmol 2001; 29:230-4. [PMID: 11545421 DOI: 10.1046/j.1442-9071.2001.00428.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To document changes in management of diabetic retinopathy by Australian ophthalmologists after release of the National Health and Medical Research Council (NHMRC) clinical guidelines. METHODS Self-administered questionnaires were mailed to Australian ophthalmologists prior to release of the NHMRC guidelines for the management of diabetic retinopathy, and at one and 2.5 years after release of the guidelines. The questionnaires elicited information about current management practices in relation to diabetic retinopathy RESULTS The response rate for the baseline and two follow-up surveys was 82%, 81%, and 80%, respectively. More than 85% of the ophthalmologists responded that the guidelines were useful in improving management, were easy to understand, and were already part of their routine clinical practice. A relatively small percentage (12%) felt that the guidelines made recommendations that were not practical or feasible. Contrary to the NHMRC guidelines, at the second follow-up survey, only 50% of the ophthalmologists said that they would almost never perform fluorescein angiography in eyes with mild non-proliferative diabetic retinopathy. The change from baseline to the second follow-up in the percentage of ophthalmologists who would perform cataract surgery after treating clinically significant macular oedema (as advised by the NHMRC guidelines) was statistically significant (baseline = 83.7%, 95% confidence limit = 80.4, 87.0; second follow up = 90.4, 95% confidence limit = 87.3, 93.5). CONCLUSIONS Distribution of the printed NHMRC Clinical Practice Guidelines: Management of Diabetic Retinopathy and full colour Retinopathy Chart resulted in a significant change in the recommended order of treatment of clinically significant macular oedema. However no significant change in the use of fluorescein angiography was documented.
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Affiliation(s)
- C A McCarty
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Australia
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Wright SE, McKay R, Taylor KI, Keeffe JE, McCarty CA. Changes in attitudes and practices of optometrists in their management of diabetic retinopathy after the release of NHMRC guidelines. National Health and Medical Research Council. Clin Exp Ophthalmol 2001; 29:121-4. [PMID: 11446449 DOI: 10.1046/j.1442-9071.2001.00390.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to document attitudes and practices of Australian optometrists in their management of diabetic retinopathy prior to the release of the National Health and Medical Research Council (NHMRC) Clinical Practice Guidelines for the Management of Diabetic Retinopathy and at two time points following their release. A self-administered questionnaire was mailed to a stratified random sample of 500 Australian optometrists at the three time points. The same sample was used for the first two surveys and a new random sample was drawn for the second follow-up survey. The response to the three questionnaires was 86%, 80% and 84%, respectively. More than 90% of optometrists reported receiving a copy of the guidelines and 82% reported receiving the supplementary Retinopathy Chart. Fifty-seven per cent reported having read the guidelines at least once in entirety and 65% reported that they refer to the Retinopathy Chart at least monthly in their clinical practice. There was a significant decrease in the number of optometrists who reported that patient unwillingness to be dilated and their fear of precipitating angle closure glaucoma were moderate or major barriers to performing dilated ophthalmoscopy. Concomitantly, the percentage of optometrists who reported that they often or always perform dilated ophthalmoscopy on new patients with diabetes increased significantly from 74.5% (95% confidence limit = 70.2, 78.8) to 81.5% (95% confidence limit = 77.5, 85.5). There have been some significant changes in the self-reported management practices of optometrists in relation to diabetic retinopathy since the release of the NHMRC guidelines and Retinopathy Chart.
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Affiliation(s)
- S E Wright
- Centre for Eye Research Australia, University of Melbourne, Victoria.
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50
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Lumelsky N, Blondel O, Laeng P, Velasco I, Ravin R, McKay R. Differentiation of embryonic stem cells to insulin-secreting structures similar to pancreatic islets. Science 2001; 292:1389-94. [PMID: 11326082 DOI: 10.1126/science.1058866] [Citation(s) in RCA: 961] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although the source of embryonic stem (ES) cells presents ethical concerns, their use may lead to many clinical benefits if differentiated cell types can be derived from them and used to assemble functional organs. In pancreas, insulin is produced and secreted by specialized structures, islets of Langerhans. Diabetes, which affects 16 million people in the United States, results from abnormal function of pancreatic islets. We have generated cells expressing insulin and other pancreatic endocrine hormones from mouse ES cells. The cells self-assemble to form three-dimensional clusters similar in topology to normal pancreatic islets where pancreatic cell types are in close association with neurons. Glucose triggers insulin release from these cell clusters by mechanisms similar to those employed in vivo. When injected into diabetic mice, the insulin-producing cells undergo rapid vascularization and maintain a clustered, islet-like organization.
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Affiliation(s)
- N Lumelsky
- Laboratory of Molecular Biology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-4092, USA
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