1
|
Biswas D, Nag S, Khan AU, Ahamed F, Karim MR, Hasan MR, Haque AK. Hypoalbuminaemia as a Marker of Severity of Patients of Community Acquired Pneumonia. Mymensingh Med J 2023; 32:968-974. [PMID: 37777888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Community-acquired pneumonia (CAP) is a common presentation with an acute infection of the pulmonary parenchyma occurring in the community level. Despite the availability of potent antibiotics, it remains as a serious illness with significant morbidity and mortality in both developed and developing countries. This study was undertaken to determine the relation between serum Albumin and severity of CAP. This was a cross sectional descriptive study which was carried out in the Department of Medicine of Mymensingh Medical College Hospital (MMCH), Bangladesh from July 2019 to December 2019. The sample size was 67. Purposive sampling technique was employed. Patients of community acquired pneumonia (CAP), aged ≥14 years of both sex with recently developed radiological pulmonary shadowing with compatible clinical symptoms and signs were included. Patients who were chronically immunosuppressed, with chronic starvation, advanced liver disease or chronic kidney disease with or without receiving haemodialysis were excluded. Data analysis was done by SPSS software for Windows (version 23.0). The mean age 65.7±15.3 years, majority 13(19.4%) patients had chronic lung disease, 12(17.9%) had diabetes mellitus, 9(13.4%) had heart failure, 6(9.0%) had cerebrovascular disease, 6(9.0%) had neoplastic disease and 5(7.5%) had chronic renal failure. Majority 22(32.8%) patients had CURB-65 score 3, out of which 12(54.5%) had albumin level <20g/l, 9(40.9%) had albumin level 20.0-24.9g/l and 1(4.5%) had albumin level 25-29g/l. 17(25.4%) had score 4-5 out of which 10(58.8%) had albumin level <20g/l and 7(41.2%) had albumin level 20.0-24.9g/l, 15(22.4%) had score 2 and 13(19.4%) had score 0-1. Negative significant correction (r=-0.782; p=0.001) was found between CURB-65 score and albumin level. Significant number of patients with severe CAP show low serum albumin level at admission which is statistically significant when compared with CURB-65 score. Thus hypoalbuminaemia may be a good marker of severity of patients with CAP.
Collapse
Affiliation(s)
- D Biswas
- Dr Debashish Biswas, Indoor Medical Officer, Department of Medicine, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh
| | | | | | | | | | | | | |
Collapse
|
2
|
Nag S, Dikshit R, Desai S, Mane A, Mhatre S, Neve R, Gurav M, Bhosale N, Perumal P, Kembhavi Y, Jethwa D, Badwe R, Gupta S. Risk factors for the development of triple-negative breast cancer versus non-triple-negative breast cancer: a case-control study. Sci Rep 2023; 13:13551. [PMID: 37599285 PMCID: PMC10440340 DOI: 10.1038/s41598-023-40443-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/10/2023] [Indexed: 08/22/2023] Open
Abstract
The risk factors for breast cancer have been defined in several studies but there is deficient data for specific subtypes. We report here the pathological characteristics of a breast cancer cohort and risk factors for patients with triple-negative disease. In this case-control study, a prospective breast cancer cohort was evaluated for demographic, reproductive, obesity-related and other risk factors using a validated questionnaire. Tumors were characterized for routine pathological characteristics and immunohistochemical markers of basal-like breast cancer. Patients with triple-negative breast cancer (TNBC) constituted cases and those with non-TNBC were controls. Odds ratios (OR) were calculated for each risk factor and independent associations were tested in an unconditional logistic regression analysis. Between 2011 and 2014, 1146 patients were recruited, of whom 912 [TNBC 266 (29.1%), non-TNBC 646 (70.9%)] with sufficient pathology material were analysed. Reproductive factors of parity, breastfeeding, age-at-menarche, age at first full-term pregnancy and oral contraceptive use were not significantly associated with TNBC. Higher body mass index (BMI > 24.9 vs ≤ 24.9, OR 0.89, 95%CI 0.63-1.24, p = 0.49) was not significantly associated while lesser waist circumference (> 80 cm vs ≤ 80 cm, OR 0.64, 95%CI 0.45-0.9, p = 0.012) and lower waist-to-hip ratio were significantly associated (> 0.85 vs ≤ 0.85, OR 0.72, 95%CI 0.51-1.0, p = 0.056), with TNBC. History of tobacco use was not significantly associated while lower socio-economic status was borderline associated with TNBC (socio-economic category > 5 versus ≤ 5, OR 0.73, 95%CI 0.50-1.06, p = 0.106). No factor was significant after adjustment for covariates. Central obesity seems to be preferentially associated with non-TNBC, and lower socio-economic status with TNBC in India, while most other conventional risk factors of breast cancer show no significant association with TNBC versus non-TNBC.
Collapse
Affiliation(s)
- Shona Nag
- Medical Oncology, Jehangir Clinical Development Center, Pune, India
| | - Rajesh Dikshit
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sangeeta Desai
- Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anupama Mane
- Surgical Oncology, Jehangir Clinical Development Center, Pune, India
| | - Sharayu Mhatre
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Rakesh Neve
- Surgical Oncology, Jehangir Clinical Development Center, Pune, India
| | - Mamta Gurav
- Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Prema Perumal
- Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Yogesh Kembhavi
- Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Dinesh Jethwa
- Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Rajendra Badwe
- Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sudeep Gupta
- Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
- Tata Memorial Hospital/Centre, Room 1109, Homi Bhabha Block, Parel, Mumbai, 400012, India.
| |
Collapse
|
3
|
Ghose A, Agarwal A, Sirohi B, Nag S, Chuang L, Mitra S. Translating the COVID-19 experience in widening the HPV vaccination campaign for cervical cancer in India. Gynecol Oncol Rep 2023; 48:101247. [PMID: 37492441 PMCID: PMC10363615 DOI: 10.1016/j.gore.2023.101247] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 07/27/2023] Open
Abstract
India has proven by the success of COVID vaccination that it has a huge production and distribution capacity, availability of professionally trained medical staff, world renowned digital infrastructure to enrol people, conduct camps and maintain records, and a positive mindset among the people towards vaccination. There is an unmet need to enforce that cervical cancer is a "preventable tragedy," and vaccination is an invaluable way ahead. With this article, we hope to attract attention to translating India's successful COVID-19 vaccination campaign experience to developing the HPV vaccination campaign.
Collapse
Affiliation(s)
- Aruni Ghose
- United Kingdom Global Cancer Network, Manchester, UK
- Department of Medical Oncology, Barts Cancer Centre, St. Bartholomew's Hospital, Barts, Health NHS Trust, London, UK
- Department of Medical Oncology, Medway NHS Foundation Trust, Kent, UK
- Department of Medical Oncology, Mount Vernon Cancer Centre, East and North, Hertfordshire NHS Trust, London, UK
| | | | - Bhawna Sirohi
- United Kingdom Global Cancer Network, Manchester, UK
- Department of Medical Oncology, BALCO Medical Centre, Vedanta Medical Research, Foundation, Chhattisgarh, India
| | - Shona Nag
- Department of Oncology, Sahyadri Group of Hospitals, Maharashtra, India
| | - Linus Chuang
- Division of Gynaecologic Oncology, Nuvance Health, Danbury, CT, USA
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Swarupa Mitra
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| |
Collapse
|
4
|
Nag S, Aggarwal S, Rauthan A, Warrier N. Maintenance therapy for newly diagnosed epithelial ovarian cancer- a review. J Ovarian Res 2022; 15:88. [PMID: 35902911 PMCID: PMC9331490 DOI: 10.1186/s13048-022-01020-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/30/2022] [Indexed: 02/11/2023] Open
Abstract
Epithelial ovarian cancer (EOC) is the most lethal gynaecological cancer among women worldwide, with the 5-year survival rate ranging between 30 and 40%. Due to the asymptomatic nature of the condition, it is more likely to be diagnosed at an advanced stage, requiring an aggressive therapeutic approach. Cytoreductive surgery (CRS) along with systemic chemotherapy with paclitaxel and carboplatin has been the mainstay of the treatment in the frontline management of EOC. In recent years, neo-adjuvant chemotherapy, followed by interval CRS has become an important strategy for the management of advanced EOC. Due to the high rate of recurrence, the oncology community has begun to shift its focus to molecular-targeted agents and maintenance therapy in the frontline settings. The rationale for maintenance therapy is to delay the progression or relapse of the disease, as long as possible after first-line treatment, irrespective of the amount of residual disease. Tumours with homologous recombination deficiency (HRD) including BReast CAncer gene (BRCA) mutations are found to be sensitive to polyadenosine diphosphate-ribose polymerase (PARP) inhibitors and understanding of HRD status has become important in the frontline setting. PARP inhibitors are reported to provide a significant improvement in progression-free survival and have an acceptable safety profile. PARP inhibitors have also been found to act regardless of BRCA status. Recently, PARP inhibitors as maintenance therapy in the frontline settings showed encouraging results in EOC; however, the results from further trials and survival data from ongoing trials are awaited for understanding the role of this pathway in treatment of EOC. This review discusses an overview of maintenance strategies in newly diagnosed EOC along with considerations for maintenance therapy in EOC with a focus on PARP inhibitors.
Collapse
Affiliation(s)
- Shona Nag
- Sahyadri Speciality Hospitals, Pune, Maharashtra, India
| | | | | | | |
Collapse
|
5
|
Nag S, Varghese R, Soman N, Karsiya J, Bafna N. Fam-trastuzumab deruxtecan-nxki (Enhertu ®): A narrative drug review. Cancer Res Stat Treat 2022. [DOI: 10.4103/crst.crst_302_22] [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: 02/17/2023] Open
|
6
|
Nag S. Duration of trastuzumab use in patients with early breast cancer. Natl Med J India 2021; 34:285-286. [PMID: 35593237 DOI: 10.25259/nmji_338_21] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Shona Nag
- Department of Oncology, Sahyadri Hospitals, Pune, Maharashtra, India
| |
Collapse
|
7
|
Jiang Z, Hu X, Zhang Q, Sun T, Yin Y, Li H, Yan M, Tong Z, Oppermann CP, Liu Y, Costa R, Li M, Chen X, Cheng Y, Ouyang Q, Liao N, Wang X, Wu X, Feng J, Hegg R, Setty GK, Agarwal A, Bajpai J, Cheng J, Girotto G, Goswami C, Hu W, Huang J, Portugal MAC, Yang J, Zheng R, Franke FA, Liu Q, Liu Y, Lu Y, Souza C, Yu S, Kilara N, Panchal H, Singh A, Nag S, Liu J, Rapoport B, Tabane NKR, Wang H, Wang N, Han R, Zhang W. Abstract PS13-25: Management of abemaciclib associated diarrhea in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative advanced breast cancer: Analysis of the MONARCH plus study. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps13-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
In the phase III MONARCH plus study (NCT02763566) the cyclin-dependent kinase (CDK) 4&6 inhibitor abemaciclib in combination with non-steroidal aromatase inhibitors (NSAI) or with fulvestrant compared with placebo demonstrated its efficacy and acceptable safety profile at interim analysis in postmenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+/HER2-) locoregionally recurrent or metastatic breast cancer. One of the most common treatment-emergent adverse event (TEAE) was diarrhea, typically low grade and of early onset. We will further characterize abemaciclib-associated diarrhea and describe its management in MONARCH plus trial.
Methods:
MONARCH plus study included two cohorts of patients. Cohort A enrolled patients with initial treatment of endocrine therapy, received abemaciclib or placebo plus NSAI (anastrozole or letrozole); Cohort B enrolled patients who progressed on prior endocrine therapy, receiving abemaciclib or placebo plus fulvestrant. The relative dose intensity was defined as the percentage of actual dose received relative to the planned dose. The severity of diarrhea was reported by investigators and graded according to Common Terminology Criteria for Adverse Events Version 4.0 (CTCAE v4.0). Further analysis on diarrhea included time to onset, duration, supportive medication and dose modifications. Progression-free survival (PFS) was defined as time from randomization to death or progression (RECIST v1.1), and a stratified Cox proportional hazard model was used to estimate the hazard ratio (HR) between study intervention arm and placebo arm.
Results:
The median relative dose intensity of abemaciclib in abemaciclib plus NSAI arm and abemaciclib plus fulvestrant arm were 96.77% and 96.30% respectively. In abemaciclib plus NSAI arm and abemaciclib plus fulvestrant arm, the median time to onset of first reported diarrhea was 7 and 6 days and majority of diarrhea events occurred early (66.3% and 71.2% of patients reported diarrhea in Cycle 1 respectively). Diarrhea was typically of low grade (3.9% and 1.9% of patients reported Grade 3 in abemaciclib plus NSAI arm and abemaciclib plus fulvestrant arm, no Grade 4 diarrhea was reported in either arm). Median duration of grade ≥ 3 diarrhea was 2.5 and 3.5 days. Diarrhea was managed by dose adjustments and/or supportive medication (Table 1). Dose reductions were present in 2.0% and 2.9% of patients, and anti-diarrhea therapy was received in 30.2% and 32.7% of patients with abemaciclib plus NSAI and abemaciclib plus fulvestrant arm, respectively. As data cutoff, most diarrhea events were reported as resolved, and the incidence dropped below 10% (Grade 2) and 1% (Grade 3) by Cycle 2 in both arms and kept low incidence over time. Compared to the placebo arm, patients treated with abemaciclib combination who reported diarrhea within the first 7 days (abemaciclib + NSAI, HR [95% CI]: 0.289 [0.166, 0.502]; abemaciclib + fulvestrant, HR [95% CI]: 0.371 [0.213, 0.647]) had significant improvement in PFS.
Conclusion:
Majority of diarrhea events were of low grade in severity and well managed by anti-diarrheal medications, dose omissions or/and dose reductions in MONARCH plus patients.
Table 1. Summary of dose adjustments and supportive medications in patients experiencing diarrheaCohort ACohort BAbemaciclib + NSAIAbemaciclib + FulvestrantN = 205N = 104Diarrhea (any grade), n (%)164 (80.0)82 (78.8)1105 (51.2)52 (50.0)251 (24.9)28 (26.9)38 (3.9)2 (1.9)Outcome, number of events, n796333Recovered/resolved, n (%)757 (95.1)318 (95.5)Not recovered/resolved, n (%)17 (2.1)7 (2.1)Treatment change, n (%)Dose reduction4 (2.0)3 (2.9)Dose omission3 (1.5)3 (2.9)Treatment discontinuation00Anti-diarrhea therapies, n (%)62 (30.2)34 (32.7)loperamide48 (23.4)21 (20.2)berberine6 (2.9)6 (5.8)
Citation Format: Zefei Jiang, Xichun Hu, Qingyuan Zhang, Tao Sun, Yongmei Yin, Huiping Li, Min Yan, Zhongsheng Tong, Christina Pimentel Oppermann, Yunpeng Liu, Romulo Costa, Man Li, Xi Chen, Ying Cheng, Quchang Ouyang, Ning Liao, Xiaojia Wang, Xinhong Wu, Jifeng Feng, Roberto Hegg, Govindbabu Kanaka Setty, Amit Agarwal, Jyoti Bajpai, Jing Cheng, Gustavo Girotto, Chanchal Goswami, Wenjing Hu, Jian Huang, MA Coccia Portugal, Jin Yang, Rongsheng Zheng, Fabio Andre Franke, Qiang Liu, Yunjiang Liu, Yongkui Lu, Cristiano Souza, Shiying Yu, Nalini Kilara, Harsha Panchal, Ashish Singh, Shona Nag, Jian Liu, Bernardo Rapoport, Neonyana Keorapetse Rebecca Tabane, Hongxia Wang, Ning Wang, Rubing Han, Wanli Zhang. Management of abemaciclib associated diarrhea in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative advanced breast cancer: Analysis of the MONARCH plus study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS13-25.
Collapse
Affiliation(s)
- Zefei Jiang
- 1The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Xichun Hu
- 2Shanghai Tumor Hospital, Shanghai, China
| | - Qingyuan Zhang
- 3Harbin Medical University Cancer Hospital, Harbin, China
| | - Tao Sun
- 4Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang, China
| | - Yongmei Yin
- 5The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Huiping Li
- 6Beijing Cancer Hospital, Beijing, China
| | - Min Yan
- 7Henan Cancer Hospital, Zhengzhou, China
| | - Zhongsheng Tong
- 8Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | | | - Yunpeng Liu
- 10The First Hospital of China Medical University, Shenyang, China
| | - Romulo Costa
- 11Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | - Man Li
- 12Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xi Chen
- 13NO.900 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Nanjing, China
| | - Ying Cheng
- 14Jilin Cancer Hospital, Changchun, China
| | | | - Ning Liao
- 16Guangdong Province People's Hospital, Guangzhou, China
| | | | | | - Jifeng Feng
- 19Jiangsu Province Cancer Hospital, Nanjing, China
| | - Roberto Hegg
- 20Clin. Pesq.e Centro Estudos Oncologia Ginecológica e Mamária, São Paulo, Brazil
| | | | - Amit Agarwal
- 22Dr B. L. Kapur Super Speciality Hospital, New Delhi, India
| | | | | | - Gustavo Girotto
- 25Hospital de Base da Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil
| | | | - Wenjing Hu
- 27Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, China
| | - Jian Huang
- 28Second Affiliate Hospital of Zhejiang Medical University, Hangzhou, China
| | | | - Jin Yang
- 30The First Affiliated Hospital of Xi’an Jiaotong University, Xi‘an, China
| | - Rongsheng Zheng
- 31Afflilated Hospital of Bengbu Medical College, Bengbu, China
| | | | - Qiang Liu
- 33Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yunjiang Liu
- 34The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yongkui Lu
- 35The Affiliated Cancer Hospital of Guangxi Medical University, Nanning, China
| | | | | | - Nalini Kilara
- 38M.S. Ramaiah Clinical Research Centre, Banglore, India
| | - Harsha Panchal
- 39The Gujarat Cancer & Research Institute, Civil Hospital Campus, Ahmedabad, India
| | - Ashish Singh
- 40Christian Medical College and Hospital, Ludhiana, India
| | | | - Jian Liu
- 42Fujian Provincial Cancer Hospital, Fuzhou, China
| | - Bernardo Rapoport
- 43The Medical Oncology Centre of Rosebank, Johannesburg, South Africa
| | | | - Hongxia Wang
- 45Shanghai First People's Hospital, Shanghai, China
| | - Ning Wang
- 46Eli Lilly and Company, Shanghai, China
| | - Rubing Han
- 46Eli Lilly and Company, Shanghai, China
| | | |
Collapse
|
8
|
Dawood S, Chiu JWY, Huang CS, Nag S, Sookprasert A, Yap YS, Md Yusof M. Palbociclib and beyond for the treatment of HR + HER2- metastatic breast cancer: an Asian-Pacific perspective and practical management guide on the use of CDK4/6 inhibitors. Curr Med Res Opin 2020; 36:1363-1373. [PMID: 32544344 DOI: 10.1080/03007995.2020.1783646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Breast cancer is the most frequent cancer amongst women worldwide including in Asia where the incidence rate is rapidly increasing. Even with treatment, around 30% of patients with early breast cancer progress to metastatic disease, with hormone receptor positive (HR+) and human epidermal growth factor receptor 2 negative (HER2-) breast cancer the most common phenotype. First-line endocrine therapy targeting the estrogen receptor signaling pathway provides a median progression-free survival or time to progression of 6-15 months in HR + HER2- metastatic breast cancer. Recently, cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors, combined with endocrine therapy, have achieved more than two years median progression-free survival in HR + HER2- metastatic breast cancer. However, the characteristics of the Asian breast cancer population differ from those of Western populations and need to be considered when selecting a suitable treatment. Breast cancer is diagnosed at a younger age in Asian populations and late stage at presentation is generally more common in low-/middle-income countries than high-income countries. Consequently, the proportion of premenopausal women with metastatic breast cancer is higher in Asian compared with Western populations. While CDK4/6 inhibitors have been approved in the USA (FDA) since 2015, experience with them in Asia is more limited. We review the experience with the CDK4/6 inhibitor palbociclib in Asian patients with HR + HER2- metastatic breast cancer and provide guidance on the use of palbociclib in these patients.
Collapse
Affiliation(s)
| | - Joanne Wing-Yan Chiu
- Phase 1 Clinical Trials Center and the Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Chiun-Sheng Huang
- Breast Care Center, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Shona Nag
- Jehangir Hospital, JCDC Pune, Pune, India
| | - Aumkhae Sookprasert
- Srinagarind hospital; Department of Medicine, Khon-Kaen University, Khon Kaen, Thailand
| | | | | |
Collapse
|
9
|
Vaid AK, Gupta S, Doval DC, Agarwal S, Nag S, Patil P, Goswami C, Ostwal V, Bhagat S, Patil S, Barkate H. Expert Consensus on Effective Management of Chemotherapy-Induced Nausea and Vomiting: An Indian Perspective. Front Oncol 2020; 10:400. [PMID: 32292721 PMCID: PMC7120415 DOI: 10.3389/fonc.2020.00400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/05/2020] [Indexed: 11/25/2022] Open
Abstract
Chemotherapy-induced nausea and vomiting (CINV) is one of the most common and feared side effects in cancer patients undergoing chemotherapy. Scientific evidence proves its detrimental impact on a patient's quality of life (QoL), treatment compliance, and overall healthcare cost. Despite the CINV-management landscape witnessing a radical shift with the introduction of novel, receptor-targeting antiemetic agents, this side effect remains a chink in the armor of a treating oncologist. Though global guidelines acknowledge patient-specific risk factors and chemotherapeutic agent emetogenic potential in CINV control, a “one-fit-for-all” approach cannot be followed across all geographies. Hence, in a pioneering attempt, India-based oncologists conveyed easily implementable, region-specific, consensus-based statements on CINV prevention and management. These statements resulted from integrating the analysis of scientific evidence and guidelines on CINV by the experts, with their clinical experience. The statements will strengthen decision-making abilities of Indian oncologists/clinicians and help in achieving consistency in CINV prevention and management in the country. Furthermore, this document shall lay the foundation for developing robust Indian guidelines for CINV prevention and control.
Collapse
Affiliation(s)
- Ashok K Vaid
- Medical Oncology and Hematology, Medanta - The Medicity, Gurugram, India
| | | | - Dinesh C Doval
- Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Shyam Agarwal
- Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - Shona Nag
- Medical Oncology, Sahyadri Hospital, Pune, India
| | - Poonam Patil
- Medical Oncologist, Manipal Hospital, Bangalore, India
| | - Chanchal Goswami
- Oncology Services, MEDICA Super Speciality Hospital, Kolkata, India
| | - Vikas Ostwal
- Medical Oncology, TATA Memorial Hospital, Mumbai, India
| | - Sagar Bhagat
- Medical Services, HO IF, Glenmark Pharmaceuticals Ltd., Mumbai, India
| | - Saiprasad Patil
- Medical Services, IF, Glenmark Pharmaceuticals Ltd., Mumbai, India
| | - Hanmant Barkate
- Medical Services, IF & MEA, Glenmark Pharmaceuticals Ltd., Mumbai, India
| |
Collapse
|
10
|
Badwe R, Anderson B, Feldman N, Gupta S, Nag S, Pramesh CS. Abstract P6-13-04: Prospective comparison of cost, travel burden, and time to obtain multidisciplinary tumor board treatment plan through in-person visits vs. an AI enabled health technology. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p6-13-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Navya is a validated online cancer informatics solution that combines artificial intelligence (AI) based analysis of the guidelines and evidence, and rapid review (2 mins/case) by organ specific tumor board experts at Academic Medical Centers to deliver multidisciplinary expert treatment plan to patients within 24 hours. Initially developed for bresat cancer patients in India without ready access to expertise, over 28,000 patients across 68 countries with all cancers have since reached out to Navya. Prior research (SABCS 2014-2018 and ASCO 2017) showed, 1) 97% concordance of Navya predictions with an academic medical center in India and in the US 2) 97% of patients experienced significant anxiety relief due to the rapid, 24 hours turnaround time at the time of making a critical decision. 3) 79% of patients received treatment concordant with Navya recommendations on the ground. Unlike synchronized 1 patient: 1 doctor virtual consults in telemedicine where multidisciplinary collaborations are difficult, Navya uses AI to summarize medical cases and predict treatment plans that can be rapidly modified/vetted by multidisciplinary experts in 1-2 minutes asynchronously and collaboratively on a mobile app. This scales access to expertise for patients around the world beyond the limited availability of experts' time for telemedicine and in-person consults.
Methods: Three patient centered outcomes (travel distance, cost and time to receive expert treatment plan) were studied. All consecutive breast cancer patients who reached out to Navya between 1/1/17-1/31/19 but ultimately opted for in-person visit to an academic medical center were contacted by prospective phone follow up. This was compared to a balanced random sample of patients who only used Navya to obtain treatment plans.
Results: 195 in-person patients were reached for a prospective phone follow-ups and 132 of them had completed their visit at the academic medical center. 335 Navya patients were analyzed in the control group. The groups did not differ significantly in demographics or disease characteristics. In-person patients and Navya patients differed significantly with respect to 1) median travel distance (838 miles, IQR (237 -1105 miles) vs. 0 miles (p < 0.05)) 2) travel related costs of $1597 [95% CI +/- $240] vs $105 online processing fee 3) total time to receipt of treatment plan (7.23 days, IQR (0.45 - 22.35 days) vs. 0.51 days IQR (0.19-1.057) (p < 0.05)).
Conclusions: Cancer informatics solutions like Navya leverage AI to summarize the case, and predict guidelines and evidence based options. Combined by design with expert vetting from academic medical centers, such solutions can generate multidisciplinary treatment plans tailored to an individual patient. This scales ready access to expertise around the world. For patients with limited access to academic medical centers, such solutions eliminate travel burden, and significantly reduce cost and wait time to obtain a treatment plan. For experts who have no time to engage in telephone, video or written remote consults, vetting recommendations from the AI system with concise case summaries only takes 1-2 minutes per case. This model has shown significant ability to create access to specialty expertise, reduce the movement of patients to obtain treatment opinions, save costs and tremendously reduce waiting time for expertise in breast cancer, globally.
Citation Format: Rajendra Badwe, Benjamin Anderson, Nancy Feldman, Sudeep Gupta, Shona Nag, CS Pramesh. Prospective comparison of cost, travel burden, and time to obtain multidisciplinary tumor board treatment plan through in-person visits vs. an AI enabled health technology [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-13-04.
Collapse
Affiliation(s)
- Rajendra Badwe
- 1Department of Surgical Oncology, Breast Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - Benjamin Anderson
- 2Department of Surgical Oncology, Breast Global Health Initiative, Fred Hutchinson Cancer Center, Seattle, WA
| | - Nancy Feldman
- 3Department of Medical Oncology, UCLA-Olive View Medical Center, Los Angeles, CA
| | - Sudeep Gupta
- 4Department of Medical Oncology, Breast Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - Shona Nag
- 5National Cancer Grid, Mumbai, India
| | | |
Collapse
|
11
|
Gupta S, Nag S, Aggarwal S, Rauthan A, Warrier N. Maintenance therapy for recurrent epithelial ovarian cancer: current therapies and future perspectives - a review. J Ovarian Res 2019; 12:103. [PMID: 31685032 PMCID: PMC6827246 DOI: 10.1186/s13048-019-0579-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [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: 05/02/2019] [Accepted: 10/10/2019] [Indexed: 12/20/2022] Open
Abstract
Epithelial ovarian cancer (EOC) is usually diagnosed late at an advanced stage. Though EOC initially responds to treatment, the recurrence rate is pretty high. The efficacy of different targeted therapies reduces with each recurrence. Hence there is need of effective maintenance therapy in recurrent EOC. Recently, polyADP-ribose polymerase (PARP) inhibitors (PARPi) have been approved both for initial treatment of EOC and as its maintenance treatment. PARPi have also been found to act regardless of BRCA status or homologous recombination (HR) deficiency. Several trials testing PARPi early in maintenance therapy are in progress and their results will shed light on the optimal timing of maintenance therapy that gives the most benefit with least toxicity. Right patient selection for maintenance treatment is also a challenge. Hence, though PARPi are emerging as a promising maintenance treatment in recurrent EOC with prolongation of progression free survival (PFS), results from further trials and overall survival (OS) data from current trials are awaited to fulfill the gaps in understanding the role of this pathway in treatment of EOC. This review discusses the current therapies for EOC, challenges in the treatment of recurrent EOC, recent developments and trials in recurrent EOC maintenance with special focus on PARPi and future perspectives.
Collapse
Affiliation(s)
- Sudeep Gupta
- Advanced Centre for Treatment, Research & Education in Cancer, Tata Memorial Centre, Room 305, 3rd Floor, Paymaster Shodhika, Navi Mumbai, Mumbai, 410210, India.
| | | | | | | | | |
Collapse
|
12
|
Radhakrishnan V, Banavali S, Gupta S, Kumar A, Deshmukh C, Nag S, Beniwal S, Gopichand M, Naik R, Lakshmaiah K, Mandavia D, Ramchandra M, Prabhash K. Excellent CBR and prolonged PFS in non-squamous NSCLC with oral CA-170, an inhibitor of VISTA and PD-L1. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
13
|
Nag S, Krasikova R, Airaksinen AJ, Arakawa R, Petukhovd M, Gulyas B. Synthesis and biological evaluation of [ 18F]fluorovinpocetine, a potential PET radioligand for TSPO imaging. Bioorg Med Chem Lett 2019; 29:2270-2274. [PMID: 31257082 DOI: 10.1016/j.bmcl.2019.06.037] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 01/31/2023]
Abstract
Despite of various PET radioligands targeting the translocator protein TSPO 18-KDa are used for the investigations of neuroinflammatory conditions associated with neurological disorders, development of new TSPO radiotracers is still an active area of the researches with a major focus on the 18F-labelled radiotracers. Here, we report the radiochemical synthesis of [18F]vinpocetine, fluorinated analogue of previously reported TSPO radioligand, [11C]vinpocetine. Radiolabeling was achieved by [18F]fluoroethylation of apovincaminic acid with [18F]fluoroethyl bromide. [18F]vinpocetine was obtained in quantities >2.7 GBq in RCY of 13% (non-decay corrected), and molar activity >60 GBq/µmol within 95 min synthesis time. Preliminary PET studies in a cynomolgus monkey and metabolite studies by HPLC demonstrated similar results by [18F]vinpocetine as for [11C]vinpocetine, including high blood-brain barrier permeability, regional uptake pattern and fast washout from the NHP brain. These results demonstrate that [18F]fluorovinpocetine warrants further evaluation as an easier accessible alternative to [11C]vinpocetine.
Collapse
Affiliation(s)
- S Nag
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden.
| | - R Krasikova
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; N.P. Bechtereva Institute of Human Brain Russian Academy of Sciences, St.-Petersburg, Russia
| | - A J Airaksinen
- Department of Chemistry - Radiochemistry, University of Helsinki, Finland
| | - R Arakawa
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden
| | - M Petukhovd
- Petersburg Nuclear Physics Institute named after B.P. Konstantinov, NRC "Kurchatov Institute", Gatchina, Russia; Peter the Great St.-Petersburg Polytechnic University, St.-Petersburg, Russia
| | - B Gulyas
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| |
Collapse
|
14
|
Verma A, Nag S, Hasan Q, Priya Selvakumar V. Mainstreaming genetic counseling for BRCA testing into oncology clinics – Indian perspective. Indian J Cancer 2019; 56:S38-S47. [DOI: 10.4103/ijc.ijc_458_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
15
|
Nag S, Sinukumar S, Hegde S. Germline Testing for Predisposition to Breast/Ovarian Cancer Should Only be Offered to Selected Patients with Epithelial Ovarian Cancer. Indian J Gynecol Oncolog 2017. [DOI: 10.1007/s40944-017-0150-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
16
|
Bandyopadhyay A, Roy S, Boler AK, Bose K, Nag S. Cytological identification of Schaumann bodies within granulomas clinches the diagnosis of sarcoidosis. Cytopathology 2017; 29:213-214. [PMID: 29119658 DOI: 10.1111/cyt.12487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2017] [Indexed: 11/26/2022]
Affiliation(s)
- A Bandyopadhyay
- Department of Pathology, Burdwan Medical College, The West Bengal University of Health Sciences, Burdwan, West Bengal, India
| | - S Roy
- Department of Pathology, Burdwan Medical College, The West Bengal University of Health Sciences, Burdwan, West Bengal, India
| | - A K Boler
- Department of Pathology, Burdwan Medical College, The West Bengal University of Health Sciences, Burdwan, West Bengal, India
| | - K Bose
- Department of Pathology, Burdwan Medical College, The West Bengal University of Health Sciences, Burdwan, West Bengal, India
| | - S Nag
- Department of Radiology, Burdwan Scan Centre, Burdwan, West Bengal, India
| |
Collapse
|
17
|
Pai T, Gupta S, Gurav M, Nag S, Shet T, Patil A, Desai S. Evidence for the association of Epstein-Barr Virus in breast cancer in Indian patients using in-situ hybridization technique. Breast J 2017; 24:16-22. [PMID: 28557251 DOI: 10.1111/tbj.12828] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/18/2016] [Accepted: 08/22/2016] [Indexed: 11/30/2022]
Abstract
Epstein-Barr Virus (EBV) is etiologically linked to Burkitt lymphoma (BL), nasopharyngeal carcinoma, post-transplant lymphomas, Hodgkin disease, and possibly other tumors. However, the association of oncogenic EBV with breast carcinoma (BC) is still controversial and a matter of debate. We aimed to study the presence of EBV genome in BC cases in Indian patients and its association with the clinicopathological features. The formalin fixed paraffin embedded tissues from 83 women with primary invasive BC were studied for the presence of EBV by in-situ hybridization (ISH) technique for Epstein-Barr Virus Encoded RNA (EBER) with appropriate controls. Correlation of EBER-ISH positivity with clinicopathological features was performed using Fisher exact test and P<.05 was considered as significant. Eighty-three BC cases were comprised of 47 (56.5%) triple negative breast cancers (TNBC), 17 (20.5%) hormone positive and 19 (22.9%) HER2 positive cases. Of 83 cases, 25 cases (30.1%) were positive for EBER-ISH test. The positivity was restricted to the tumor cells and not seen in the surrounding breast lobules. EBER-ISH positivity was statistically associated with larger tumor size (52.6% in >5 cm tumors vs 19.3% in ≤5 cm; P=.014) and with TNBCs (21/47 [44.7%] in TNBCs vs 4/36 [11.1%] in non-TNBCs; P=.001). A possible causal association of EBV in BC cases in Indian patients is suggested by high frequency of EBER-ISH positivity noted in our study. This might have therapeutic significance because of the possible role of EBV specific cytotoxic T cells in targeting EBV associated tumor cells and can be considered as a potential targeted therapy. To the best of our knowledge, this is the first study from India to address this issue using EBER-ISH technique.
Collapse
Affiliation(s)
- Trupti Pai
- Division of Molecular Pathology, Tata Memorial Hospital, Mumbai, India.,Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Hospital - Advanced Centre for Therapy and Research in Cancer (ACTREC), Mumbai, India
| | - Mamta Gurav
- Division of Molecular Pathology, Tata Memorial Hospital, Mumbai, India.,Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | | | - Tanuja Shet
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Sangeeta Desai
- Division of Molecular Pathology, Tata Memorial Hospital, Mumbai, India.,Department of Pathology, Tata Memorial Hospital, Mumbai, India
| |
Collapse
|
18
|
Nag S, Tan M, Weinstein M. Parental Use of Sun Protection for Their Children – Does Skin Colour Matter? Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e64b] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: Excessive sun exposure during childhood years is a known risk factor for skin cancer. Fifty percent of lifetime UV exposure is acquired by age 19, highlighting the potential for prevention strategies in childhood. Existing guidelines from established pediatric, dermatology and cancer prevention societies are general and not specific to any skin phototype.
OBJECTIVES: Our primary objective was to compare the frequency of adequate sun protection used by parents of children with different skin phototypes. Our secondary objective was to explore parental attitudes and beliefs on sun safety for their children.
DESIGN/METHODS: Parents of children between the ages of 6 months to 6 years were systematically recruited. Parents received self-administered questionnaires containing 40-items that examine the amount of sun protection parents used on their children, as well as their attitudes and beliefs about sun safety. Parents were also requested to self-assess their child’s Fitzpatrick Phototype (FP), and based on this response, they were divided into two groups: “lighter-skinned” (FP I-III) and “darker-skinned” (FP IV-VI). Guidelines from the Canadian Dermatology Association (CDA) on sun safety were used to quantify adequate sun protection.
RESULTS: A total of 183 parents completed the questionnaires, and 150 eligible parents (the first 25 of each FP) were included in the study. Overall, only 17% of parents used adequate sun protection for their children. Parents of lighter-skinned children were significantly more likely to use adequate sun protection (OR=17.0). As their child got older, parents were also significantly less likely to use adequate sun protection for them (OR=0.64). A significantly larger portion of parents of lighter-skin children believe that sun exposure was harmful (OR=14.2) and perceived more value in sun protection (OR=14.2), whereas parents of darker-skin children were significantly more likely to believe that darker skin tones provided more sun protection (OR=4.1).
CONCLUSION: Our study suggests that parental sun protection efforts were overall low, but especially in parents of darker-skinned children. The identified underlying attitudes and beliefs can aid in the design and delivery of sun protection interventions in the future, to ensure sun safety for all children, especially in a multiracial population.
Collapse
|
19
|
Narayanan S, Nag S. Likelihood of use and perception towards biosimilars in rheumatoid arthritis: a global survey of rheumatologists. Clin Exp Rheumatol 2016; 34:S9-S11. [PMID: 26146845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/03/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Siva Narayanan
- Evidence Generation, Value and Access Center of Excellence, Ipsos Healthcare, Washington, DC, USA.
| | - S Nag
- Evidence Generation, Value and Access Center of Excellence, Ipsos Healthcare, Washington, DC, USA
| |
Collapse
|
20
|
Clay PG, Nag S, Graham CM, Narayanan S. Meta-Analysis of Studies Comparing Single and Multi-Tablet Fixed Dose Combination HIV Treatment Regimens. Medicine (Baltimore) 2015; 94:e1677. [PMID: 26496277 PMCID: PMC4620781 DOI: 10.1097/md.0000000000001677] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/21/2015] [Accepted: 09/02/2015] [Indexed: 01/08/2023] Open
Abstract
Availability of a single source review of once-daily fixed-dose single tablet regimen (STR) and multiple tablet fixed-dose regimen (MTR) would optimally inform healthcare providers and policy makers involved in the management of population with human immunodeficiency virus (HIV).We conducted a meta-analysis of published literature to compare patient adherence, clinical, and cost outcomes of STR to MTR.Published literature in English between 2005 and 2014 was searched using Embase, PubMed (Medline in-process), and ClinicalTrials.Gov databases. Two-level screening was undertaken by 2 independent researchers to finalize articles for evidence synthesis. Adherence, efficacy, safety, tolerability, healthcare resource use (HRU), and costs were assessed comparing STR to MTR. A random-effects meta-analysis was performed and heterogeneity examined using meta-regression.Thirty-five articles were identified for qualitative evidence synthesis, of which 9 had quantifiable data for meta-analysis (4 randomized controlled trials and 5 observational studies). Patients on STR were significantly more adherent when compared to patients on MTR of any frequency (odds ratio [OR]: 2.37 [95% CI: 1.68, 3.35], P < 0.001; 4 studies), twice-daily MTR (OR: 2.53 [95% CI: 1.13, 5.66], P = 0.02; 2 studies), and once-daily MTR (OR: 1.81 [95% CI: 1.15, 2.84], P = 0.01; 2 studies). The relative risk (RR) for viral load suppression at 48 weeks was higher (RR: 1.09 [95% CI: 1.04, 1.15], P = .0003; 3 studies) while RR of grade 3 to 4 laboratory abnormalities was lower among patients on STR (RR: 0.68 [95% CI: 0.49, 0.94], P = 0.02; 2 studies). Changes in CD4 count at 48 weeks, any severe adverse events (SAEs), grade 3 to 4 AEs, mortality, and tolerability were found comparable between STR and MTR. Several studies reported significant reduction in HRU and costs among STR group versus MTR.Study depicted comparable tolerability, safety (All-SAE and Grade 3-4 AE), and mortality and fewer Grade 3 to 4 lab abnormalities and better viral load suppression and adherence among patients on FDC-containing STR versus MTR; literature depicted favorable HRU and costs for STRs.These findings may help decision makers especially in resource-poor settings to plan for optimal HIV disease management when the choice of both STRs and MTRs are available.
Collapse
Affiliation(s)
- P G Clay
- From the University of North Texas System College of Pharmacy, Fort Worth, TX, USA (PGC) and Ipsos Healthcare, Global Evidence, Value and Access Center of Excellence, Washington, DC, USA (SN, CMG, SN)
| | | | | | | |
Collapse
|
21
|
Basak P, Pattanayak R, Nag S, Bhattacharyya M. pH-induced conformational isomerization of leghemoglobin from Arachis hypogea. Biochemistry Moscow 2014; 79:1255-61. [DOI: 10.1134/s0006297914110133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
22
|
Jahan M, Johnström P, Nag S, Takano A, Korsgren O, Johansson L, Halldin C, Eriksson O. Synthesis and biological evaluation of [¹¹C]AZ12504948; a novel tracer for imaging of glucokinase in pancreas and liver. Nucl Med Biol 2014; 42:387-94. [PMID: 25633247 DOI: 10.1016/j.nucmedbio.2014.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 10/07/2014] [Revised: 11/20/2014] [Accepted: 12/01/2014] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Glucokinase (GK) is potentially a target for imaging of islets of Langerhans. Here we report the radiosynthesis and preclinical evaluation of the GK activator, [(11)C]AZ12504948, for in vivo imaging of GK. METHODS [(11)C]AZ12504948 was synthesized by O-methylation of the precursor, AZ125555620, using carbon-11 methyl iodide ([(11)C]CH₃I). Preclinical evaluation was performed by autoradiography (ARG) of human tissues and PET/CT studies in pig and non-human primate. RESULT [(11)C]AZ12504948 was produced in reproducible good radiochemical yield in 28-30 min. Radiochemical purity of the formulated product was >98% for up to 2 h with specific radioactivities 855 ± 209 GBq/μmol (n=8). The preclinical evaluation showed some specificity for GK in liver, but not in pancreas. CONCLUSION [(11)C]AZ12504948 images GK in liver, but the low specificity impedes the visualization of GK in pancreas. Improved target specificity is required for further progress using PET probes based on this class of GK activators.
Collapse
Affiliation(s)
- M Jahan
- Karolinska Institutet, Department of Clinical Neuroscience, Center for Psychiatric Research and Education, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
| | - P Johnström
- Karolinska Institutet, Department of Clinical Neuroscience, Center for Psychiatric Research and Education, Karolinska University Hospital, SE-171 76 Stockholm, Sweden; AstraZeneca Translational Science Centre at Karolinska Institutet, SE-171 76, Stockholm, Sweden
| | - S Nag
- Karolinska Institutet, Department of Clinical Neuroscience, Center for Psychiatric Research and Education, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - A Takano
- Karolinska Institutet, Department of Clinical Neuroscience, Center for Psychiatric Research and Education, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - O Korsgren
- Department of Immunology, Genetics and Pathology, Division of Immunology, Uppsala University, SE 751 87 Uppsala, Sweden
| | | | - C Halldin
- Karolinska Institutet, Department of Clinical Neuroscience, Center for Psychiatric Research and Education, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - O Eriksson
- Preclinical PET Platform, Department of Medicinal Chemistry, Uppsala University, SE 751 87 Uppsala, Sweden
| |
Collapse
|
23
|
|
24
|
Babu KG, Prabhash K, Vaid AK, Sirohi B, Diwakar RB, Rao R, Kar M, Malhotra H, Nag S, Goswami C, Raina V, Mohan R. Nimotuzumab plus chemotherapy versus chemotherapy alone in advanced non-small-cell lung cancer: a multicenter, randomized, open-label Phase II study. Onco Targets Ther 2014; 7:1051-60. [PMID: 24966687 PMCID: PMC4063861 DOI: 10.2147/ott.s63168] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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] [Indexed: 12/31/2022] Open
Abstract
Background The purpose of this study was to evaluate the safety and efficacy of nimotuzumab in combination with chemotherapy (docetaxel and carboplatin) versus chemotherapy alone in patients with stage IIIB/IV non-small-cell lung cancer. Methods This multicenter, open-label, Phase II study randomized 110 patients to receive nimotuzumab plus chemotherapy (nimotuzumab group) or chemotherapy alone (control group), and comprised concomitant, maintenance, and follow-up phases. Nimotuzumab 200 mg was administered once weekly for 13 weeks during the first two phases with four cycles of chemotherapy and docetaxel 75 mg/m2 and carboplatin (area under the curve 5 mg/mL*min) every 3 weeks for a maximum of four cycles during the concomitant phase. The primary endpoint was objective response rate (sum of complete response and partial response). Secondary endpoints, ie, overall survival and progression-free survival, were estimated using the Kaplan–Meier method. Efficacy was evaluated on the intent-to-treat and efficacy-evaluable sets. Safety was assessed from adverse event and serious adverse event data. Results The objective response rate was significantly higher in the nimotuzumab group than in the control group in the intent-to-treat population (54% versus 34.5%; P=0.04). A complete response and partial response were achieved in 3.6% and 50% of patients, respectively, in the nimotuzumab group, and in 4% and 30.9% of patients, respectively, in the control group. No significant differences in median progression-free survival and overall survival were observed. Safety profiles were comparable between the two groups. Conclusion Nimotuzumab plus chemotherapy significantly improved the objective response rate as compared with chemotherapy alone. The combination was safe and well tolerated in patients with stage IIIB/IV non-small-cell lung cancer.
Collapse
Affiliation(s)
- K Govind Babu
- Kidwai Memorial Institute of Oncology, Bangalore, India
| | | | | | | | | | | | | | | | | | | | - Vinod Raina
- Institute Rotary Cancer Hospital, New Delhi, India
| | - Ravi Mohan
- King George Hospital, Visakhapatnam, India, India
| |
Collapse
|
25
|
Nag S, Mokha SS. Activation of a Gq-coupled membrane estrogen receptor rapidly attenuates α2-adrenoceptor-induced antinociception via an ERK I/II-dependent, non-genomic mechanism in the female rat. Neuroscience 2014; 267:122-34. [PMID: 24613724 DOI: 10.1016/j.neuroscience.2014.02.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 12/16/2013] [Revised: 02/24/2014] [Accepted: 02/24/2014] [Indexed: 01/04/2023]
Abstract
Though sex differences in pain and analgesia are known, underlying mechanisms remain elusive. This study addresses the selective contribution of membrane estrogen receptors (mERs) and mER-initiated non-genomic signaling mechanisms in our previously reported estrogen-induced attenuation of α2-adrenoceptor-mediated antinociception. By selectively targeting spinal mERs in ovariectomized female rats using β-estradiol 6-(O-carboxy-methyl)oxime bovine serum albumin (E2BSA) (membrane impermeant estradiol analog), and ERα selective agonist 4,4',4″-(4-propyl-[1H]-pyrazole-1,3,5-triyl)trisphenol (PPT), ERβ selective agonist 2,3-bis(4-hydroxyphenyl)-propionitrile (DPN), G-protein-coupled estrogen receptor 30 (GPR30) agonist G1 and Gq-coupled mER (Gq-mER) agonist STX, we provide strong evidence that Gq-mER activation may solely contribute to suppressing clonidine (an α2-adrenoceptor agonist)-induced antinociception, using the nociceptive tail-flick test. Increased tail-flick latencies (TFLs) by intrathecal (i.t.) clonidine were not significantly altered by i.t. PPT, DPN, or G1. In contrast, E2BSA or STX rapidly and dose-dependently attenuated clonidine-induced increase in TFL. ICI 182,780, the ER antagonist, blocked this effect. Consistent with findings with the lack of effect of ERα and ERβ agonists that modulate receptor-regulated transcription, inhibition of de novo protein synthesis using anisomycin also failed to alter the effect of E2BSA or STX, arguing against a contribution of genomic mechanisms. Immunoblotting of spinal tissue revealed that mER activation increased levels of phosphorylated extracellular signal-regulated kinase (ERK) but not of protein kinase A (PKA) or C (PKC). In vivo inhibition of ERK with U0126 blocked the effect of STX and restored clonidine antinociception. Although estrogen-induced delayed genomic mechanisms may still exist, data presented here indicate that Gq-mER may solely mediate estradiol-induced attenuation of clonidine antinociception via a rapid, reversible, and ERK-dependent, non-genomic mechanism, suggesting that Gq-mER blockade might provide improved analgesia in females.
Collapse
Affiliation(s)
- S Nag
- Department of Neuroscience and Pharmacology, Meharry Medical College, Nashville, TN 37208, United States.
| | - S S Mokha
- Department of Neuroscience and Pharmacology, Meharry Medical College, Nashville, TN 37208, United States
| |
Collapse
|
26
|
Nag S, Zhang X, Srivenugopal K, Wang MH, Wang W, Zhang R. Targeting MDM2-p53 Interaction for Cancer Therapy: Are We There Yet? Curr Med Chem 2014; 21:553-74. [DOI: 10.2174/09298673113206660325] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 10/02/2013] [Accepted: 10/22/2013] [Indexed: 11/22/2022]
|
27
|
Nag S, Lehmann L, Kettschau G, Toth M, Heinrich T, Thiele A, Varrone A, Halldin C. Development of a novel fluorine-18 labeled deuterated fluororasagiline ([18F]fluororasagiline-D2) radioligand for PET studies of monoamino oxidase B (MAO-B). Bioorg Med Chem 2013; 21:6634-41. [DOI: 10.1016/j.bmc.2013.08.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/03/2013] [Accepted: 08/07/2013] [Indexed: 11/16/2022]
|
28
|
Small KM, Nag S, Mokha SS. Activation of membrane estrogen receptors attenuates opioid receptor-like1 receptor-mediated antinociception via an ERK-dependent non-genomic mechanism. Neuroscience 2013; 255:177-90. [PMID: 24452062 DOI: 10.1016/j.neuroscience.2013.10.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 08/31/2013] [Revised: 10/11/2013] [Accepted: 10/16/2013] [Indexed: 10/26/2022]
Abstract
To our knowledge, the present data are the first to demonstrate that activation of membrane estrogen receptors (mERs) abolishes opioid receptor-like 1 (ORL1) receptor-mediated analgesia via extracellular signal-regulated kinase (ERK)-dependent non-genomic mechanisms. Estrogen was shown previously to both attenuate ORL1-mediated antinociception and down-regulate the ORL1 gene expression. The present study investigated whether non-genomic mechanisms contribute to estrogen-induced attenuation of ORL1-mediated antinociception by the mERs GPR30, Gq-coupled mER, ERα, and ERβ. E2BSA [β-estradiol-6-(O-carboxymethyl)oxime: bovine serum albumin] (0.5mM), a membrane impermeant analog of estradiol, injected intrathecally immediately prior to orphanin FQ (OFQ;10 nmol), the endogenous ligand for the ORL1 receptor, abolished OFQ's antinociceptive effect in both male and ovariectomized (OVX) female rats, assessed using the heat-induced tail-flick assay. This effect was not altered by protein synthesis inhibitor, anisomycin (125 μg), given intrathecally 15 min prior to E2BSA and OFQ. Intrathecal application of selective receptor agonists permitted the relative contributions of various estrogen receptors in mediating this blockade of the antinociceptive response of OFQ. Activation of GPR30, Gq-mER, ERα, but not ERβ abolished ORL1-mediated antinociception in males and OVX females. E2BSA produced a parallel and significant increase in the phosphorylation of ERK 2 only in OVX females, and pre-treatment with MEK/ERK 1/2 inhibitor, U0126 (10 μg), blocked the mER-mediated abolition of ORL1-mediated antinociception in OVX females. Taken together, the data are consistent with the interpretations that mER activation attenuates ORL1-mediated antinociception through a non-genomic, ERK 2-dependent mechanism in females.
Collapse
Affiliation(s)
- K M Small
- Department of Neuroscience and Pharmacology, Meharry Medical College, Nashville, TN 37208, USA
| | - S Nag
- Department of Neuroscience and Pharmacology, Meharry Medical College, Nashville, TN 37208, USA
| | - S S Mokha
- Department of Neuroscience and Pharmacology, Meharry Medical College, Nashville, TN 37208, USA.
| |
Collapse
|
29
|
Ranade AA, Bapsy PP, Nag S, Raghunadharao D, Raina V, Advani SH, Patil S, Maru A, Gangadharan VP, Goswami C, Sekhon JS, Sambasivaiah K, Parikh P, Bakshi A, Mohapatra R. A multicenter phase II randomized study of Cremophor-free polymeric nanoparticle formulation of paclitaxel in women with locally advanced and/or metastatic breast cancer after failure of anthracycline. Asia Pac J Clin Oncol 2013; 9:176-81. [PMID: 23176568 DOI: 10.1111/ajco.12035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2012] [Indexed: 12/01/2022]
Abstract
AIMS Paclitaxel is extensively used in the treatment of advanced carcinomas of the breast, ovary and non-small cell lung cancer. In clinical use it is formulated in the non-ionic surfactant polyethoxylated castor oil (Cremophor) and dehydrated alcohol to enhance drug solubility. Cremophor adds to toxic effects of paclitaxel by producing or contributing to the well-described hypersensitivity reactions that commonly occur during its infusion, affecting a large number of patients. This randomized trial was conducted to evaluate efficacy and safety of novel nanoparticle-based paclitaxel in the treatment of patients with advanced breast cancer. METHOD Patients were randomized to receive either nanoparticle paclitaxel (NP) 300 mg/m(2) , (NP300) or NP220 mg/m(2) or Cremophor paclitaxel 175 mg/m(2) (CP 175). NP was administered as a 1-h infusion without premedication and CP as a 3-h infusion with premedication every 3 weeks. RESULTS In total, 194 patients who had been administered at least one dose were included for safety analysis and 170 patients who completed at least two cycles of therapy were analyzed for efficacy. NP showed an overall response rate (complete response + partial response) of 40% in the NP220 and NP300 arms as compared to 31% in the CP arm. The incidence of neutropenia (all grades) was lowest in the NP220 arm (39.4%) compared to the NP300 (55%) and CP arm (50%). CONCLUSION NP is well tolerated and can be safely administered without any premedication in comparison to conventional paclitaxel, which requires the use of premedication before administration. NP demonstrates promising efficacy with a favorable safety profile.
Collapse
|
30
|
Qin JJ, Nag S, Voruganti S, Wang W, Zhang R. Natural product MDM2 inhibitors: anticancer activity and mechanisms of action. Curr Med Chem 2013; 19:5705-25. [PMID: 22830335 DOI: 10.2174/092986712803988910] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 06/04/2012] [Accepted: 06/04/2012] [Indexed: 12/12/2022]
Abstract
The mdm2 oncogene has recently been suggested to be a valuable target for cancer therapy and prevention. Overexpression of mdm2 is often seen in various human cancers and correlates with high-grade, late-stage, and more treatment-resistant tumors. The MDM2-p53 auto-regulatory loop has been extensively investigated and is an attractive cancer target, which indeed has been the main focus of anti-MDM2 drug discovery. Much effort has been expended in the development of small molecule MDM2 antagonists targeting the MDM2-p53 interaction, and a few of these have advanced into clinical trials. However, MDM2 exerts its oncogenic activity through both p53-dependent and -independent mechanisms. Recently, there is an increasing interest in identifying natural MDM2 inhibitors; some of them have been shown to decrease MDM2 expression and activity in vitro and in vivo. These identified natural MDM2 inhibitors include a plethora of diverse chemical frameworks, ranging from flavonoids, steroids, and sesquiterpenes to alkaloids. In addition to a brief review of synthetic MDM2 inhibitors, this review focuses on natural product MDM2 inhibitors, summarizing their biological activities in vitro and in vivo and the underlying molecular mechanisms of action, targeting MDM2 itself, regulators of MDM2, and/or the MDM2-p53 interaction. These MDM2 inhibitors can be used alone or in combination with conventional treatments, improving the prospects for cancer therapy and prevention. Their complex and unique molecular architectures may provide a stimulus for developing synthetic analogs in the future.
Collapse
Affiliation(s)
- J-J Qin
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, 1300 S. Coulter Street, Amarillo, TX 79106, USA
| | | | | | | | | |
Collapse
|
31
|
Abstract
The mTOR pathway is becoming increasingly important in several cancers including breast cancer. This review will focus on the role of its inhibition in the management of advanced breast cancer.
Collapse
Affiliation(s)
- Shona Nag
- Department of Medical Oncology, Jehangir Hospital and Medical Centre, Pune, Maharashtra, India
| |
Collapse
|
32
|
Nag S, Lehmann L, Kettschau G, Heinrich T, Thiele A, Varrone A, Gulyas B, Halldin C. Synthesis and evaluation of [18F]fluororasagiline, a novel positron emission tomography (PET) radioligand for monoamine oxidase B (MAO-B). Bioorg Med Chem 2012; 20:3065-71. [DOI: 10.1016/j.bmc.2012.02.056] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 02/23/2012] [Accepted: 02/25/2012] [Indexed: 11/24/2022]
|
33
|
Nagarajan M, Jones G, Frobe A, Ghosh-Laskar S, Kotzen J, Pokharel B, Shami A, Thephamongkhol K, Xiao Z, Nag S. 35 RESOURCE SPARING SHORT COURSE RADIATION VS. LONG COURSE RADIATION TO PALLIATE OESOPHAGEAL CANCER AFTER BRACHYTHERAPY: A REPORT OF IAEA RANDOMIZED TRIAL E33027. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70022-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
34
|
Parikh PM, Gupta S, Parikh B, Smruti BK, Issrani J, Topiwala S, Goswami C, Bhattacharya GS, Sen T, Sekhon JS, Malhotra H, Nag S, Chacko RT, Govind KB, Raja T, Vaid AK, Doval DC, Gupta S, Das PK. Management of primary and metastatic triple negative breast cancer: perceptions of oncologists from India. Indian J Cancer 2011; 48:158-64. [PMID: 21768659 DOI: 10.4103/0019-509x.82874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND In order to document the understanding of current evidence for the management of triple negative breast cancer and application of this knowledge in daily practice, we conducted an interactive survey of practicing Indian oncologists. MATERIALS AND METHODS A core group of academic oncologists devised two hypothetical triple negative cases (metastatic and early breast cancer, respectively) and multiple choice options under different clinical circumstances. The respondents were practicing oncologists in different Indian cities who participated in either an online survey or a meeting. The participants electronically chose their preferred option based on their everyday practice. RESULTS A total of 152 oncologists participated. Just over half (53.8%) preferred taxane based chemotherapy as first-line chemotherapy in the metastatic setting. In the adjuvant setting, a taxane regimen was chosen by 61%. Over half of respondents (52.6%) underestimated the baseline survival of a patient with node positive triple-negative tumor and 18.9% overestimated this survival compared to the estimate of the Adjuvant! program. DISCUSSION This data offers insight into the perceptions and practice of a diverse cross-section of practicing oncologists in India with respect to their therapeutic choices in metastatic and adjuvant settings in triple negative breast cancer.
Collapse
Affiliation(s)
- P M Parikh
- Indian Co-operative Oncology Network, Mumbai, India.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Parikh PM, Vaid A, Advani SH, Digumarti R, Madhavan J, Nag S, Bapna A, Sekhon JS, Patil S, Ismail PM, Wang Y, Varadhachary A, Zhu J, Malik R. Randomized, Double-Blind, Placebo-Controlled Phase II Study of Single-Agent Oral Talactoferrin in Patients With Locally Advanced or Metastatic Non–Small-Cell Lung Cancer That Progressed After Chemotherapy. J Clin Oncol 2011; 29:4129-36. [DOI: 10.1200/jco.2010.34.4127] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose To investigate the activity and safety of oral talactoferrin (TLF) in patients with stages IIIB to IV non–small-cell lung cancer (NSCLC) for whom one or two prior lines of systemic anticancer therapy had failed. Patients and Methods Patients (n = 100) were randomly assigned to receive either oral TLF (1.5 g in 15 mL phosphate-based buffer) or placebo (15 mL phosphate-based buffer) twice per day in addition to supportive care. Oral TLF or placebo was administered for a maximum of three 14-week cycles with dosing for 12 consecutive weeks followed by 2 weeks off. The primary objective was overall survival (OS) in the intent-to-treat (ITT) patient population. Secondary objectives included progression-free survival (PFS), disease control rate (DCR), and safety. Results TLF was associated with improvement in OS in the ITT patient population, meeting the protocol-specified level of significance of a one-tailed P = .05. Compared with the placebo group, median OS increased by 65% in the TLF group (3.7 to 6.1 months; hazard ratio, 0.68; 90% CI, 0.47 to 0.98; P = .04 with one-tailed log-rank test). Supportive trends were also observed for PFS and DCR. TLF was well tolerated and, generally, there were fewer adverse events (AEs) and grade ≥ 3 AEs reported in the TLF arm. AEs were consistent with those expected in late-stage NSCLC. Conclusion TLF demonstrated an apparent improvement in OS in patients with stages IIIB to IV NSCLC for whom one or two prior lines of systemic anticancer therapy had failed and was well tolerated. These results should be confirmed in a global phase III trial.
Collapse
Affiliation(s)
- Purvish M. Parikh
- Purvish M. Parikh, Tata Memorial Hospital; Suresh H. Advani, Jaslok Hospital and Research Centre, Mumbai; Ashok Vaid, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi; Raghunadharao Digumarti, Nizam's Institute of Medical Sciences, Hyderabad; Jayaprakash Madhavan, Regional Cancer Center, Medical College Campus, Trivandrum; Shona Nag, Jehangir Hospital, Pune; Ajay Bapna, Bhagavan Mahavir Cancer Hospital and Research Center, Jaipur; Jagdev S. Sekhon, Dayanand Medical College and Hospital,
| | - Ashok Vaid
- Purvish M. Parikh, Tata Memorial Hospital; Suresh H. Advani, Jaslok Hospital and Research Centre, Mumbai; Ashok Vaid, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi; Raghunadharao Digumarti, Nizam's Institute of Medical Sciences, Hyderabad; Jayaprakash Madhavan, Regional Cancer Center, Medical College Campus, Trivandrum; Shona Nag, Jehangir Hospital, Pune; Ajay Bapna, Bhagavan Mahavir Cancer Hospital and Research Center, Jaipur; Jagdev S. Sekhon, Dayanand Medical College and Hospital,
| | - Suresh H. Advani
- Purvish M. Parikh, Tata Memorial Hospital; Suresh H. Advani, Jaslok Hospital and Research Centre, Mumbai; Ashok Vaid, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi; Raghunadharao Digumarti, Nizam's Institute of Medical Sciences, Hyderabad; Jayaprakash Madhavan, Regional Cancer Center, Medical College Campus, Trivandrum; Shona Nag, Jehangir Hospital, Pune; Ajay Bapna, Bhagavan Mahavir Cancer Hospital and Research Center, Jaipur; Jagdev S. Sekhon, Dayanand Medical College and Hospital,
| | - Raghunadharao Digumarti
- Purvish M. Parikh, Tata Memorial Hospital; Suresh H. Advani, Jaslok Hospital and Research Centre, Mumbai; Ashok Vaid, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi; Raghunadharao Digumarti, Nizam's Institute of Medical Sciences, Hyderabad; Jayaprakash Madhavan, Regional Cancer Center, Medical College Campus, Trivandrum; Shona Nag, Jehangir Hospital, Pune; Ajay Bapna, Bhagavan Mahavir Cancer Hospital and Research Center, Jaipur; Jagdev S. Sekhon, Dayanand Medical College and Hospital,
| | - Jayaprakash Madhavan
- Purvish M. Parikh, Tata Memorial Hospital; Suresh H. Advani, Jaslok Hospital and Research Centre, Mumbai; Ashok Vaid, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi; Raghunadharao Digumarti, Nizam's Institute of Medical Sciences, Hyderabad; Jayaprakash Madhavan, Regional Cancer Center, Medical College Campus, Trivandrum; Shona Nag, Jehangir Hospital, Pune; Ajay Bapna, Bhagavan Mahavir Cancer Hospital and Research Center, Jaipur; Jagdev S. Sekhon, Dayanand Medical College and Hospital,
| | - Shona Nag
- Purvish M. Parikh, Tata Memorial Hospital; Suresh H. Advani, Jaslok Hospital and Research Centre, Mumbai; Ashok Vaid, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi; Raghunadharao Digumarti, Nizam's Institute of Medical Sciences, Hyderabad; Jayaprakash Madhavan, Regional Cancer Center, Medical College Campus, Trivandrum; Shona Nag, Jehangir Hospital, Pune; Ajay Bapna, Bhagavan Mahavir Cancer Hospital and Research Center, Jaipur; Jagdev S. Sekhon, Dayanand Medical College and Hospital,
| | - Ajay Bapna
- Purvish M. Parikh, Tata Memorial Hospital; Suresh H. Advani, Jaslok Hospital and Research Centre, Mumbai; Ashok Vaid, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi; Raghunadharao Digumarti, Nizam's Institute of Medical Sciences, Hyderabad; Jayaprakash Madhavan, Regional Cancer Center, Medical College Campus, Trivandrum; Shona Nag, Jehangir Hospital, Pune; Ajay Bapna, Bhagavan Mahavir Cancer Hospital and Research Center, Jaipur; Jagdev S. Sekhon, Dayanand Medical College and Hospital,
| | - Jagdev S. Sekhon
- Purvish M. Parikh, Tata Memorial Hospital; Suresh H. Advani, Jaslok Hospital and Research Centre, Mumbai; Ashok Vaid, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi; Raghunadharao Digumarti, Nizam's Institute of Medical Sciences, Hyderabad; Jayaprakash Madhavan, Regional Cancer Center, Medical College Campus, Trivandrum; Shona Nag, Jehangir Hospital, Pune; Ajay Bapna, Bhagavan Mahavir Cancer Hospital and Research Center, Jaipur; Jagdev S. Sekhon, Dayanand Medical College and Hospital,
| | - Shekhar Patil
- Purvish M. Parikh, Tata Memorial Hospital; Suresh H. Advani, Jaslok Hospital and Research Centre, Mumbai; Ashok Vaid, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi; Raghunadharao Digumarti, Nizam's Institute of Medical Sciences, Hyderabad; Jayaprakash Madhavan, Regional Cancer Center, Medical College Campus, Trivandrum; Shona Nag, Jehangir Hospital, Pune; Ajay Bapna, Bhagavan Mahavir Cancer Hospital and Research Center, Jaipur; Jagdev S. Sekhon, Dayanand Medical College and Hospital,
| | - Preeti M. Ismail
- Purvish M. Parikh, Tata Memorial Hospital; Suresh H. Advani, Jaslok Hospital and Research Centre, Mumbai; Ashok Vaid, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi; Raghunadharao Digumarti, Nizam's Institute of Medical Sciences, Hyderabad; Jayaprakash Madhavan, Regional Cancer Center, Medical College Campus, Trivandrum; Shona Nag, Jehangir Hospital, Pune; Ajay Bapna, Bhagavan Mahavir Cancer Hospital and Research Center, Jaipur; Jagdev S. Sekhon, Dayanand Medical College and Hospital,
| | - Yenyun Wang
- Purvish M. Parikh, Tata Memorial Hospital; Suresh H. Advani, Jaslok Hospital and Research Centre, Mumbai; Ashok Vaid, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi; Raghunadharao Digumarti, Nizam's Institute of Medical Sciences, Hyderabad; Jayaprakash Madhavan, Regional Cancer Center, Medical College Campus, Trivandrum; Shona Nag, Jehangir Hospital, Pune; Ajay Bapna, Bhagavan Mahavir Cancer Hospital and Research Center, Jaipur; Jagdev S. Sekhon, Dayanand Medical College and Hospital,
| | - Atul Varadhachary
- Purvish M. Parikh, Tata Memorial Hospital; Suresh H. Advani, Jaslok Hospital and Research Centre, Mumbai; Ashok Vaid, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi; Raghunadharao Digumarti, Nizam's Institute of Medical Sciences, Hyderabad; Jayaprakash Madhavan, Regional Cancer Center, Medical College Campus, Trivandrum; Shona Nag, Jehangir Hospital, Pune; Ajay Bapna, Bhagavan Mahavir Cancer Hospital and Research Center, Jaipur; Jagdev S. Sekhon, Dayanand Medical College and Hospital,
| | - Junming Zhu
- Purvish M. Parikh, Tata Memorial Hospital; Suresh H. Advani, Jaslok Hospital and Research Centre, Mumbai; Ashok Vaid, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi; Raghunadharao Digumarti, Nizam's Institute of Medical Sciences, Hyderabad; Jayaprakash Madhavan, Regional Cancer Center, Medical College Campus, Trivandrum; Shona Nag, Jehangir Hospital, Pune; Ajay Bapna, Bhagavan Mahavir Cancer Hospital and Research Center, Jaipur; Jagdev S. Sekhon, Dayanand Medical College and Hospital,
| | - Rajesh Malik
- Purvish M. Parikh, Tata Memorial Hospital; Suresh H. Advani, Jaslok Hospital and Research Centre, Mumbai; Ashok Vaid, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi; Raghunadharao Digumarti, Nizam's Institute of Medical Sciences, Hyderabad; Jayaprakash Madhavan, Regional Cancer Center, Medical College Campus, Trivandrum; Shona Nag, Jehangir Hospital, Pune; Ajay Bapna, Bhagavan Mahavir Cancer Hospital and Research Center, Jaipur; Jagdev S. Sekhon, Dayanand Medical College and Hospital,
| |
Collapse
|
36
|
Nag S, Devaraj A, Srinivasan R, Williams REA, Gupta N, Viswanathan GB, Tiley JS, Banerjee S, Srinivasan SG, Fraser HL, Banerjee R. Novel mixed-mode phase transition involving a composition-dependent displacive component. Phys Rev Lett 2011; 106:245701. [PMID: 21770581 DOI: 10.1103/physrevlett.106.245701] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 05/03/2011] [Indexed: 05/31/2023]
Abstract
Solid-solid displacive, structural phase transformations typically undergo a discrete structural change from a parent to a product phase. Coupling electron microscopy, three-dimensional atom probe, and first-principles computations, we present the first direct evidence of a novel mechanism for a coupled diffusional-displacive transformation in titanium-molybdenum alloys wherein the displacive component in the product phase changes continuously with changing composition. These results have implications for other transformations and cannot be explained by conventional theories.
Collapse
Affiliation(s)
- S Nag
- Department of Materials Science and Engineering, University of North Texas, Denton, Texas 76203, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
|
38
|
Abstract
Historically, the blood-brain barrier (BBB) was considered to be at the level of cerebral endothelium. Currently, the interaction of endothelium with other components of the vessel wall and with neurones and glial cells is considered to constitute a functional unit, termed the neurovascular unit that maintains cerebral homeostasis in steady states and brain injury. The emphasis of this review is on cerebral endothelium, the best-studied component of the neurovascular unit, and its permeability mechanisms in health and acute brain injury. Major advances have been made in unravelling the molecular structure of caveolae and tight junctions, both of which are components of the structural barrier to the entry of plasma proteins into brain. Time course studies suggest that caveolar changes precede junctional changes in acute brain injury. Additional factors modulating BBB permeability in acute brain injury are matrix metalloproteinases-2 and 9 and angiogenic factors, the most notable being vascular endothelial growth factor-A and angiopoietins (Ang) 1 and 2. Vascular endothelial growth factor-A and Ang2 have emerged as potent inducers of BBB breakdown while Ang1 is a potent anti-leakage factor. These factors have the potential to modulate permeability in acute brain injury and this is an area of ongoing research. Overall, a combination of haemodynamic, structural and molecular alterations affecting brain endothelium results in BBB breakdown in acute brain injury.
Collapse
Affiliation(s)
- S Nag
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.
| | | | | |
Collapse
|
39
|
Dawson R, Li Y, Gunes M, Heller D, Nag S, Collins R, Wronski C, Bennett M, Li Y. Optical Properties of Hydrogenated Amorphous Silicon, Silicon-Germanium and Silicon-Carbon Thin Films. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-258-595] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACTThe optical properties of solar cell grade hydrogenated amorphous silicon (a-Si:H), silicon germanium (a-SiGe:H) and silicon carbon (a-SiC:H) alloy thin films have been investigated over a wide photon energy range (0.8–4.8 eV) using a combination of subgap photoconductivity, reflection and transmission, and spectroscopie ellipsometry techniques in order to obtain accurate optical functions for solar cell modelling. Studies on films with thicknesses ranging from a few hundred Å to a few microns show that the optical spectra obtained by the different techniques agree closely over the energy ranges of overlap and display no thickness dependence from the Urbach tail energies and above. Thus, the results appear to be free of measurement and sample related artifacts. Three different methods provide a common value for the optical gap within ±0.02 eV and the result for a-Si:H is ∼0.1 eV below the mobility gap.
Collapse
|
40
|
Abstract
This review article provides the current recommendations and evidence for the correct management of anemia in cancer patients. The various options available include transfusions, iron and erythropoiesis stimulation. The indications, pros and cons of each option are discussed.
Collapse
Affiliation(s)
- K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | | | | | | |
Collapse
|
41
|
Bhattacharyya P, Bardhan S, Nag S, Mukherjee S, Verma A. Transthoracic decompression of emphysematous bulla: a novel experience. Indian J Chest Dis Allied Sci 2011; 53:51-53. [PMID: 21446225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Emphysematous bullae are closed air containing spaces in lung parenchyma that may severely compromise lung function in patients of chronic obstructive pulmonary disease (COPD). We describe a simple and minimally invasive procedure to decompress a large emphysematous bullae in a patient with advanced COPD and high surgical risk. Transthoracic decompression of the bulla was accomplished under short-acting anaesthesia and muscle relaxation resulting in significant symptomatic, radiological and functional improvement.
Collapse
Affiliation(s)
- P Bhattacharyya
- Institute of Pulmocare and Research, Calcutta Medical College, Kolkata, India.
| | | | | | | | | |
Collapse
|
42
|
Nag S, Lehmann L, Kettschau G, Heinrich T, Brumby T, Thiele A, Varrone A, Gulyas B, Halldin C. Synthesis of three F-18 labeled analogues of l-deprenyl for PET studies of monoamine oxidase B. Neuroimage 2010. [DOI: 10.1016/j.neuroimage.2010.04.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
43
|
Jones SC, Smith D, Nag S, Bilous MT, Winship S, Wood A, Bilous RW. Prevalence and nature of anaemia in a prospective, population-based sample of people with diabetes: Teesside anaemia in diabetes (TAD) study. Diabet Med 2010; 27:655-9. [PMID: 20546283 DOI: 10.1111/j.1464-5491.2010.02987.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [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] [Indexed: 11/29/2022]
Abstract
AIMS Anaemia occurs in 25% of people attending hospital diabetes clinics, but this may not be representative of all people with diabetes. We aimed to determine the prevalence of anaemia in a prospective population-based sample stratified by estimated glomerular filtration rate (eGFR) using the 4-point Modification of Diet in Renal Disease (MDRD) formula. METHODS All 7331 patients on our district register were stratified by eGFR. Seven hundred and thirty were approached by letter on two occasions. Two hundred and thirty-four (32%) returned questionnaires and blood samples. Responders (R), non-responders (NR) and the whole cohort (C) were similar: mean +/- sd age R 61.7 +/- 12.7 years; NR 61.3 +/- 15.1 years; C 61.8 +/- 14.2 years; diabetes duration R 8.8 +/- 8.6 years; NR 8.2 +/- 7.9 years; C 7.5 +/- 7.8 years, Type 1 diabetes R 10.1%, NR 10.8%, C 9.4%. Anaemia was defined using World Health Organization criteria: haemoglobin < 13 g/dl for men, < 12 g/dl for women. RESULTS Previously undiagnosed anaemia was present in 15% of the whole group, 36% with eGFR < 60 ml/min per 1.73 m(2) and 9% of those with eGFR > 60 ml/min per 1.73 m(2). Anaemia was as a result of erythropoietin deficiency in 34%, abnormal haematinics in 40% and was unexplained in 26% of patients. Five per cent of the patients had anaemia below the treatment threshold of 11 g/dl. CONCLUSIONS The prevalence of unrecognized anaemia in population-based cohorts is lower than that in hospital-based studies. Current clinical surveillance in the UK is failing to detect anaemia in stage 3-5 chronic kidney disease (eGFR < 60 ml/min per 1.73 m(2)) and current guidelines will not detect 9% of diabetic patients with anaemia and an eGFR > 60 ml/min per 1.73 m(2).
Collapse
Affiliation(s)
- S C Jones
- William Kelly Diabetes Centre, James Cook University Hospital, Middlesbrough, UK.
| | | | | | | | | | | | | |
Collapse
|
44
|
Maiya V, Sathiyanarayanan K, Gupta K, Bhangle J, Joseph J, Babu N, Nag S, Koppiker C. SIMULTANEOUS SYNCHRONOUS BILATERAL BREAST CARCINOMAS: RADIOTHERAPY TECHNIQUE AND TOXICITY PROFILE. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72959-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
45
|
Nag S, Sanyal S, Biswas NM. Bromocriptine induced hypoprolactinemia and accessory reproductive glands response to testosterone in castrated male rats. Andrologia 2009; 15 Spec No:560-4. [PMID: 6666862 DOI: 10.1111/j.1439-0272.1983.tb00212.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Testosterone stimulates the Accessory Reproductive Glands (ARG) and may increase the serum titres of prolactin in castrated male rats. Bromocriptine antagonizes the testosterone-induced alteration of ARG responses; the testosterone antagonistic action of bromocriptine depends on the degree of serum prolactin depletion.
Collapse
|
46
|
Abstract
AIMS Increased endothelial caveolae leading to transcytosis of plasma proteins is associated with blood-brain barrier (BBB) breakdown and cerebral oedema in brain injury. Increased expression of caveolin-1alpha (Cav-1), an integral caveolar membrane protein, was reported in endothelium of arterioles and veins with BBB breakdown to fibronectin post injury. In this study the phosphorylation state of Cav-1 and its association with BBB breakdown was determined in the rat cortical cold injury model over a period of days 0.5-6 post lesion. METHODS Expression of phosphorylated Cav-1 was determined by immunoblotting and dual labelling immunofluorescence for phosphorylated caveolin-1 and fibronectin, a marker of BBB breakdown. A phospho-specific monoclonal antibody that selectively recognizes only tyrosine 14-phosphorylated Cav-1 (PY14Cav-1) was used. RESULTS Immunoblots showed constitutive expression of PY14Cav-1 in cortex of control rats and a significant increase in PY14Cav-1 expression at the lesion site up to day 4 post lesion. PY14Cav-1 immunostaining was observed in the endothelium of lesion vessels at days 0.5-4 post lesion, in neutrophils at days 0.5 and 2 and in macrophages at day 6 post lesion. Dual labelling showed that 100% of vessels with BBB breakdown to fibronectin showed endothelial PY14Cav-1 on day 0.5, the percentage decreasing to 62% on day 4. On day 6, none of the vessels showed endothelial phosphorylated Cav-1. CONCLUSIONS The presence of phosphorylated Cav-1 in endothelium of vessels showing BBB breakdown suggests that phosphorylated Cav-1 signalling may be one of the factors associated with early BBB breakdown and brain oedema in brain injury.
Collapse
Affiliation(s)
- S Nag
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, and
| | - J L Manias
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, and
| | - D J Stewart
- Ottawa Health Research Institute, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
47
|
Neff RL, Sharif S, Al Saif O, Nag S, Grecula J, Walker M. The impact of initial surgery at a cancer hospital on the outcome of retroperitoneal sarcomas. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.10597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
48
|
Ranade AA, Bapsy PP, Nag S, Raghunadharao D, Raina V, Advani SH, Mishra SK, Tyagi S, Burman AC, Parikh PM. A novel, cremophor-free, polymeric nanoparticle paclitaxel (do/ndr/02) multicenter study in advanced/ metastatic breast cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.1115] [Citation(s) in RCA: 4] [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: 11/20/2022] Open
|
49
|
Gomez HL, Doval DC, Chavez MA, Ang PCS, Aziz Z, Nag S, Ng C, Franco SX, Chow LWC, Arbushites MC, Casey MA, Berger MS, Stein SH, Sledge GW. Efficacy and safety of lapatinib as first-line therapy for ErbB2-amplified locally advanced or metastatic breast cancer. J Clin Oncol 2008; 26:2999-3005. [PMID: 18458039 DOI: 10.1200/jco.2007.14.0590] [Citation(s) in RCA: 248] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE This study (EGF20009) assessed the efficacy and tolerability of two lapatinib administration schedules as first-line monotherapy in women with ErbB2-amplified locally advanced or metastatic breast cancer. PATIENTS AND METHODS Patients with ErbB2-amplified, locally advanced or metastatic breast cancer previously untreated in the metastatic setting were randomly assigned to one of two lapatinib dose cohorts and received either 1,500 mg once daily or 500 mg twice daily. Clinical response was assessed at weeks 8 and 12 and every 12 weeks thereafter. RESULTS A total of 138 patients were treated with lapatinib for a median of 17.6 weeks. The overall response rate (complete response [CR] plus partial response [PR]) was 24% in the intent-to-treat population, and 31% of patients derived clinical benefit (CR, PR, or stable disease for >or= 24 weeks). The median time to response was 7.9 weeks, and the progression-free survival rates at 4 and 6 months were 63% and 43%, respectively. The most common lapatinib-related adverse events (AEs) were diarrhea, rash, pruritus, and nausea, and these events were primarily grade 1 or 2. There were no significant differences in clinical activity or the AE profile between the dosing schedules. CONCLUSION Lapatinib demonstrated clinical activity and was well tolerated as first-line therapy in ErbB2-amplified locally advanced or metastatic breast cancer. This study supports further evaluation of lapatinib in first-line and early-stage ErbB2-overexpressing breast cancer.
Collapse
Affiliation(s)
- Henry L Gomez
- Instituto Nacional de Enfermedades Neoplásicas, Hospital Alberto Sabogal, Lima, Peru.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Julka PK, Chacko RT, Nag S, Parshad R, Nair A, Oh DS, Hu Z, Koppiker CB, Nair S, Dawar R, Dhindsa N, Miller ID, Ma D, Lin B, Awasthy B, Perou CM. A phase II study of sequential neoadjuvant gemcitabine plus doxorubicin followed by gemcitabine plus cisplatin in patients with operable breast cancer: prediction of response using molecular profiling. Br J Cancer 2008; 98:1327-35. [PMID: 18382427 PMCID: PMC2361717 DOI: 10.1038/sj.bjc.6604322] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 02/25/2008] [Accepted: 02/26/2008] [Indexed: 02/07/2023] Open
Abstract
This study examined the pathological complete response (pCR) rate and safety of sequential gemcitabine-based combinations in breast cancer. We also examined gene expression profiles from tumour biopsies to identify biomarkers predictive of response. Indian women with large or locally advanced breast cancer received 4 cycles of gemcitabine 1200 mg m(-2) plus doxorubicin 60 mg m(-2) (Gem+Dox), then 4 cycles of gemcitabine 1000 mg m(-2) plus cisplatin 70 mg m(-2) (Gem+Cis), and surgery. Three alternate dosing sequences were used during cycle 1 to examine dynamic changes in molecular profiles. Of 65 women treated, 13 (24.5% of 53 patients with surgery) had a pCR and 22 (33.8%) had a complete clinical response. Patients administered Gem d1, 8 and Dox d2 in cycle 1 (20 of 65) reported more toxicities, with G3/4 neutropenic infection/febrile neutropenia (7 of 20) as the most common cycle-1 event. Four drug-related deaths occurred. In 46 of 65 patients, 10-fold cross validated supervised analyses identified gene expression patterns that predicted with >or=73% accuracy (1) clinical complete response after eight cycles, (2) overall clinical complete response, and (3) pCR. This regimen shows strong activity. Patients receiving Gem d1, 8 and Dox d2 experienced unacceptable toxicity, whereas patients on other sequences had manageable safety profiles. Gene expression patterns may predict benefit from gemcitabine-containing neoadjuvant therapy.
Collapse
Affiliation(s)
- P K Julka
- Department of Radiotherapy and Oncology, AIIMS, New Delhi 110029, India
| | - R T Chacko
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - S Nag
- Department of Medical Oncology, HCJMRI, Pune, Maharashtra 411001, India
| | - R Parshad
- Department of Radiotherapy and Oncology, AIIMS, New Delhi 110029, India
| | - A Nair
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - D S Oh
- Departments of Genetics and Pathology and Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Z Hu
- Departments of Genetics and Pathology and Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - C B Koppiker
- Department of Medical Oncology, HCJMRI, Pune, Maharashtra 411001, India
| | - S Nair
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - R Dawar
- Department of Radiotherapy and Oncology, AIIMS, New Delhi 110029, India
| | - N Dhindsa
- Eli Lilly and Company (India) Pvt. Ltd., Gurgaon, Haryana 122001, India
| | - I D Miller
- Department of Pathology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZD, UK
| | - D Ma
- Eli Lilly and Company, Indianapolis, IN 46285, USA
| | - B Lin
- Eli Lilly and Company, Indianapolis, IN 46285, USA
| | - B Awasthy
- Health Care Global Enterprises, Curie Centre of Oncology, St John's Hospital Campus, Koramangala, Bangalore 560034, India
| | - C M Perou
- Departments of Genetics and Pathology and Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| |
Collapse
|