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Khoshkhoo S, Wang Y, Chahine Y, Erson-Omay EZ, Robert SM, Kiziltug E, Damisah EC, Nelson-Williams C, Zhu G, Kong W, Huang AY, Stronge E, Phillips HW, Chhouk BH, Bizzotto S, Chen MH, Adikari TN, Ye Z, Witkowski T, Lai D, Lee N, Lokan J, Scheffer IE, Berkovic SF, Haider S, Hildebrand MS, Yang E, Gunel M, Lifton RP, Richardson RM, Blümcke I, Alexandrescu S, Huttner A, Heinzen EL, Zhu J, Poduri A, DeLanerolle N, Spencer DD, Lee EA, Walsh CA, Kahle KT. Contribution of Somatic Ras/Raf/Mitogen-Activated Protein Kinase Variants in the Hippocampus in Drug-Resistant Mesial Temporal Lobe Epilepsy. JAMA Neurol 2023; 80:578-587. [PMID: 37126322 PMCID: PMC10152377 DOI: 10.1001/jamaneurol.2023.0473] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/31/2022] [Indexed: 05/02/2023]
Abstract
Importance Mesial temporal lobe epilepsy (MTLE) is the most common focal epilepsy subtype and is often refractory to antiseizure medications. While most patients with MTLE do not have pathogenic germline genetic variants, the contribution of postzygotic (ie, somatic) variants in the brain is unknown. Objective To test the association between pathogenic somatic variants in the hippocampus and MTLE. Design, Setting, and Participants This case-control genetic association study analyzed the DNA derived from hippocampal tissue of neurosurgically treated patients with MTLE and age-matched and sex-matched neurotypical controls. Participants treated at level 4 epilepsy centers were enrolled from 1988 through 2019, and clinical data were collected retrospectively. Whole-exome and gene-panel sequencing (each genomic region sequenced more than 500 times on average) were used to identify candidate pathogenic somatic variants. A subset of novel variants was functionally evaluated using cellular and molecular assays. Patients with nonlesional and lesional (mesial temporal sclerosis, focal cortical dysplasia, and low-grade epilepsy-associated tumors) drug-resistant MTLE who underwent anterior medial temporal lobectomy were eligible. All patients with available frozen tissue and appropriate consents were included. Control brain tissue was obtained from neurotypical donors at brain banks. Data were analyzed from June 2020 to August 2022. Exposures Drug-resistant MTLE. Main Outcomes and Measures Presence and abundance of pathogenic somatic variants in the hippocampus vs the unaffected temporal neocortex. Results Of 105 included patients with MTLE, 53 (50.5%) were female, and the median (IQR) age was 32 (26-44) years; of 30 neurotypical controls, 11 (36.7%) were female, and the median (IQR) age was 37 (18-53) years. Eleven pathogenic somatic variants enriched in the hippocampus relative to the unaffected temporal neocortex (median [IQR] variant allele frequency, 1.92 [1.5-2.7] vs 0.3 [0-0.9]; P = .01) were detected in patients with MTLE but not in controls. Ten of these variants were in PTPN11, SOS1, KRAS, BRAF, and NF1, all predicted to constitutively activate Ras/Raf/mitogen-activated protein kinase (MAPK) signaling. Immunohistochemical studies of variant-positive hippocampal tissue demonstrated increased Erk1/2 phosphorylation, indicative of Ras/Raf/MAPK activation, predominantly in glial cells. Molecular assays showed abnormal liquid-liquid phase separation for the PTPN11 variants as a possible dominant gain-of-function mechanism. Conclusions and Relevance Hippocampal somatic variants, particularly those activating Ras/Raf/MAPK signaling, may contribute to the pathogenesis of sporadic, drug-resistant MTLE. These findings may provide a novel genetic mechanism and highlight new therapeutic targets for this common indication for epilepsy surgery.
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Affiliation(s)
- Sattar Khoshkhoo
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Yilan Wang
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts
- Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, Massachusetts
| | - Yasmine Chahine
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts
| | - E. Zeynep Erson-Omay
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Stephanie M. Robert
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Emre Kiziltug
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Eyiyemisi C. Damisah
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | | | - Guangya Zhu
- Interdisciplinary Research Center on Biology and Chemistry, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, Shanghai, China
| | - Wenna Kong
- Interdisciplinary Research Center on Biology and Chemistry, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, Shanghai, China
| | - August Yue Huang
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Edward Stronge
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - H. Westley Phillips
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles
| | - Brian H. Chhouk
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts
| | - Sara Bizzotto
- Sorbonne University, Paris Brain Institute (ICM), National Institute of Health and Medical Research (INSERM), National Center for Scientific Research (CNRS), Paris, France
| | - Ming Hui Chen
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts
| | - Thiuni N. Adikari
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Australia
| | - Zimeng Ye
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Australia
| | - Tom Witkowski
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Australia
| | - Dulcie Lai
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
| | - Nadine Lee
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts
| | - Julie Lokan
- Department of Anatomical Pathology, Austin Health, Heidelberg, Australia
| | - Ingrid E. Scheffer
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
- Department of Pediatrics, University of Melbourne, Royal Children’s Hospital, Parkville, Australia
- Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Heidelberg, Australia
| | - Samuel F. Berkovic
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Australia
- Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Heidelberg, Australia
| | - Shozeb Haider
- Department of Pharmaceutical and Biological Chemistry, University College London School of Pharmacy, London, United Kingdom
| | - Michael S. Hildebrand
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
| | - Edward Yang
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Murat Gunel
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Richard P. Lifton
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut
- Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, New York
| | | | - Ingmar Blümcke
- Department of Neuropathology, University Hospitals Erlangen, Erlangen, Germany
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio
| | - Sanda Alexandrescu
- Department of Pathology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anita Huttner
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Erin L. Heinzen
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
- Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill
| | - Jidong Zhu
- Interdisciplinary Research Center on Biology and Chemistry, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, Shanghai, China
| | - Annapurna Poduri
- Epilepsy Genetics Program, Division of Epilepsy and Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nihal DeLanerolle
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Dennis D. Spencer
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Eunjung Alice Lee
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Christopher A. Walsh
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Department of Neurology and Pediatrics, Harvard Medical School, Boston, Massachusetts
- Allen Discovery Center for Human Brain Evolution, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- Howard Hughes Medical Institute, Boston, Massachusetts
| | - Kristopher T. Kahle
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, New York
- Department of Neurosurgery, Boston Children’s Hospital, Boston, Massachusetts
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2
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Galea LA, Hildebrand MS, Witkowski T, Joy C, McEvoy CR, Hanegbi U, Aga A. ALK-rearranged renal cell carcinoma with TPM3::ALK gene fusion and review of the literature. Virchows Arch 2023; 482:625-633. [PMID: 36370168 DOI: 10.1007/s00428-022-03451-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/11/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
ALK-rearranged renal cell carcinoma (ALK-RCC) is a very rare novel molecularly defined entity in the recently published fifth edition of the World Health Organization classification of tumours. We describe a case of ALK-RCC in a 76-year-old female. The tumour was composed of discohesive rhabdoid cells and pleomorphic, multinucleated cells (equivalent to ISUP/WHO grade 4). The tumour showed expression with PAX8, Keratin 7 and alpha methylacyl CoA racemase. ALK (D5F3 clone) was strongly and diffusely positive. ALK-FISH showed significant split signals of ALK, confirming the diagnosis. RNA sequencing showed TPM3::ALK rearrangement. Including the current case, there are 14 reported ALK-RCC cases with the same TPM3 fusion partner gene. Review of these published cases highlights their morphological heterogeneity and stresses the importance of running ALK immunohistochemistry on difficult cases to classify renal tumours. This is important while identification of ALK-RCC has clinical significance due to the availability of targeted therapy with ALK inhibitors.
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Affiliation(s)
- Laurence A Galea
- Department of Anatomical Pathology, Melbourne Pathology, Sonic Healthcare, Private Bag 5, Collingwood, VIC, 3066, Australia.
| | - Michael S Hildebrand
- Epilepsy Research Centre, Department of Medicine, University of Melbourne, Austin Health, Melbourne, VIC, Australia
- Neuroscience Group, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Tom Witkowski
- Epilepsy Research Centre, Department of Medicine, University of Melbourne, Austin Health, Melbourne, VIC, Australia
| | - Christopher Joy
- Department of Cytogenetics, Sullivan Nicolaides Pathology, Sonic Healthcare, Brisbane, QLD, Australia
| | - Christopher R McEvoy
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Uri Hanegbi
- Australian Urology Associates, Malvern, Melbourne, VIC, Australia
- Cabrini Hospital, Melbourne, VIC, Australia
| | - Ahmad Aga
- Department of Anatomical Pathology, Cabrini Pathology, Sonic Healthcare, Melbourne, VIC, Australia
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3
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Ye Z, Lin S, Zhao X, Bennett MF, Brown NJ, Wallis M, Gao X, Sun L, Wu J, Vedururu R, Witkowski T, Gardiner F, Stutterd C, Duan J, Mullen SA, McGillivray G, Bodek S, Valente G, Reagan M, Yao Y, Li L, Chen L, Boys A, Adikari TN, Cao D, Hu Z, Beshay V, Zhang VW, Berkovic SF, Scheffer IE, Liao J, Hildebrand MS. Mosaicism in tuberous sclerosis complex: Lowering the threshold for clinical reporting. Hum Mutat 2022; 43:1956-1969. [PMID: 36030538 DOI: 10.1002/humu.24454] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/20/2022] [Accepted: 08/21/2022] [Indexed: 01/25/2023]
Abstract
Tuberous sclerosis complex (TSC) is a multi-system genetic disorder. Most patients have germline mutations in TSC1 or TSC2 but, 10%-15% patients do not have TSC1/TSC2 mutations detected on routine clinical genetic testing. We investigated the contribution of low-level mosaic TSC1/TSC2 mutations in unsolved sporadic patients and families with TSC. Thirty-one sporadic TSC patients negative on routine testing and eight families with suspected parental mosaicism were sequenced using deep panel sequencing followed by droplet digital polymerase chain reaction. Pathogenic variants were found in 22/31 (71%) unsolved sporadic patients, 16 were mosaic (median variant allele fraction [VAF] 6.8% in blood) and 6 had missed germline mutations. Parental mosaicism was detected in 5/8 families (median VAF 1% in blood). Clinical testing laboratories typically only report pathogenic variants with allele fractions above 10%. Our findings highlight the critical need to change laboratory practice by implementing higher sensitivity assays to improve diagnostic yield, inform patient management and guide reproductive counseling.
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Affiliation(s)
- Zimeng Ye
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Sufang Lin
- Department of Neurology, Epilepsy Centre, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Xia Zhao
- Department of Neurology, Epilepsy Centre, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Mark F Bennett
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Heidelberg, Victoria, Australia.,Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
| | - Natasha J Brown
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Royal Children's Hospital, The University of Melbourne, Parkville, Victoria, Australia.,Victorian Clinical Genetics Services, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Mathew Wallis
- Austin Health, Heidelberg, Victoria, Australia.,Tasmania Clinical Genetics Service, Royal Hobart Hospital, Tasmania, Australia.,School of Medicine, University of Tasmania, Tasmania, Australia.,Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Xinyi Gao
- AmCare Genomics Laboratory, Guangzhou, Guangdong Province, China
| | - Li Sun
- AmCare Genomics Laboratory, Guangzhou, Guangdong Province, China
| | - Jiarui Wu
- AmCare Genomics Laboratory, Guangzhou, Guangdong Province, China
| | - Ravikiran Vedururu
- Molecular Diagnostic Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Tom Witkowski
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Fiona Gardiner
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Chloe Stutterd
- Victorian Clinical Genetics Services, Royal Children's Hospital, Parkville, Victoria, Australia.,Austin Health, Heidelberg, Victoria, Australia
| | - Jing Duan
- Department of Neurology, Epilepsy Centre, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Saul A Mullen
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Heidelberg, Victoria, Australia.,Austin Health, Heidelberg, Victoria, Australia
| | - George McGillivray
- Victorian Clinical Genetics Services, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Simon Bodek
- Austin Health, Heidelberg, Victoria, Australia
| | | | - Matthew Reagan
- Department of Medicine, Peninsula Health, Monash University, Frankston, Victoria, Australia
| | - Yi Yao
- Department of Neurology, Epilepsy Centre, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Lin Li
- Department of Neurology, Epilepsy Centre, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Li Chen
- Department of Neurology, Epilepsy Centre, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Amber Boys
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Thiuni N Adikari
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Heidelberg, Victoria, Australia.,School of Medicine, University of Tasmania, Tasmania, Australia
| | - Dezhi Cao
- Department of Neurology, Epilepsy Centre, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Zhanqi Hu
- Department of Neurology, Epilepsy Centre, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Victoria Beshay
- Molecular Diagnostic Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Victor W Zhang
- AmCare Genomics Laboratory, Guangzhou, Guangdong Province, China
| | - Samuel F Berkovic
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Heidelberg, Victoria, Australia.,Austin Health, Heidelberg, Victoria, Australia
| | - Ingrid E Scheffer
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Heidelberg, Victoria, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Royal Children's Hospital, The University of Melbourne, Parkville, Victoria, Australia.,Austin Health, Heidelberg, Victoria, Australia.,The Florey Institute, Parkville, Victoria, Australia
| | - Jianxiang Liao
- Department of Neurology, Epilepsy Centre, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Michael S Hildebrand
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Heidelberg, Victoria, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Austin Health, Heidelberg, Victoria, Australia
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4
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Manos K, Khor R, Chong G, Palmer J, MacManus M, Keane C, Scott AM, Shortt J, Ritchie D, Churilov L, Johnston L, Witkowski T, Barraclough A, Lee ST, Lin W, Koldej R, Hawkes E. Abstract CT208: Phase I Dose Escalation Study of Radiotherapy and Durvalumab (MEDI4736) in Relapsed or Refractory Diffuse Large B-cell Lymphoma (DLBCL): The RaDD Study. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-ct208] [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: Most DLBCL & FL responds well to first line treatment, yet relapsed disease outcomes are poor. Immune checkpoint inhibition (ICI) with PD/PD1 inhibitors (PD1i) yield high response rates in some lymphomas; though single agent PD1i yields a disappointing ORR of 10% in heavily pre-treated DLBCL, some responses are durable. RT stimulates anti-tumour immunity through several mechanisms and may enhance response to ICI. Concurrent ICI & RT is synergistic in preclinical studies & solid tumours, improving local & distant (abscopal) response. RT to multiple disease sites may broaden the spectrum of tumour antigen release and overcome clonal variation between disease sites to further augment the immune response. A dose-response relationship between RT and antigen release has yet to be established. This phase I dose escalation study aims to determine the safety profile of RT in combination with durvalumab, an anti-PD-L1 monoclonal antibody, in relapsed/refractory DLBCL and FL.
Study Design and Methods: RaDD (NCT03610061) is a phase I dose escalation study to determine the safety profile of escalating dose and number of sites of RT in combination with durvalumab in relapsed/refractory (RR) DLBCL & FL. Eligible patients (pts) have received ≥ 1 prior line of therapy and are ineligible for or relapsed after autologous stem cell transplant (auto-SCT). Pts with active autoimmune disease, CNS involvement, prior allogeneic-SCT or chronic steroid use are excluded. RT dose and site escalation proceeds according to a 3+3 design with 6 dose levels (cohorts 1-6). Treatment comprises external beam RT to target site(s) daily for 5 days (Cohorts 1-5); Cohort 6 receives a further 5 daily fractions (max 30Gy). Durvalumab 1500mg IV commences day 2 of RT and continues 4-weekly until disease progression. Pts can continue until a second radiological progression if clinical benefit is ongoing. The dose limiting toxicity period is 28 days from start of RT.
The primary endpoint is the toxicity, drug pharmacokinetics, maximum tolerated dose (MTD) and recommended phase two dose (RP2D) of simultaneous RT and durvalumab. Secondary endpoints include response rates, progression-free survival and overall survival.
Correlative studies will examine the tumour-immune system interaction; an exploratory PET substudy with novel tracers for durvalumab (89Zr-Durvalumab) & CD8+ T cells (89Zr -Df-IAB22M2C) will also be performed.
Projected enrolment for determination of the MTD and RP2D is 6-30 pts pending toxicity. Recruitment will continue to 36 pts for secondary endpoint analysis. 22 pts are enrolled to date in the main study, with 2 patients enrolled in the PET-substudy.
Acknowledgements: Victorian Cancer Agency (grant funding - TRP16006), Astra Zeneca (durvalumab and funding), Celgene (funding), Imaginab (89Zr -Df-IAB22M2C).
Citation Format: Kate Manos, Richard Khor, Geoffrey Chong, Jodie Palmer, Michael MacManus, Colm Keane, Andrew M. Scott, Jake Shortt, David Ritchie, Leonid Churilov, Laura Johnston, Tom Witkowski, Allison Barraclough, Sze Ting Lee, Wendi Lin, Rachel Koldej, Eliza Hawkes. Phase I Dose Escalation Study of Radiotherapy and Durvalumab (MEDI4736) in Relapsed or Refractory Diffuse Large B-cell Lymphoma (DLBCL): The RaDD Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT208.
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Affiliation(s)
| | | | - Geoffrey Chong
- 2Olivia Newton-John Cancer Research Institute at Austin Health, Heidelberg, Australia
| | - Jodie Palmer
- 3Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
| | | | - Colm Keane
- 5Princess Alexandra Hospital, Woolloongabba, Australia
| | - Andrew M. Scott
- 2Olivia Newton-John Cancer Research Institute at Austin Health, Heidelberg, Australia
| | | | - David Ritchie
- 7Australian Cancer Research Foundation at Royal Melbourne Hospital, Melbourne, Australia
| | | | | | - Tom Witkowski
- 3Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
| | | | - Sze Ting Lee
- 2Olivia Newton-John Cancer Research Institute at Austin Health, Heidelberg, Australia
| | - Wendi Lin
- 1Austin Health, Heidelberg, Australia
| | - Rachel Koldej
- 7Australian Cancer Research Foundation at Royal Melbourne Hospital, Melbourne, Australia
| | - Eliza Hawkes
- 2Olivia Newton-John Cancer Research Institute at Austin Health, Heidelberg, Australia
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5
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Goh SK, Cox DRA, Wong BKL, Musafer A, Witkowski T, Do H, Muralidharan V, Dobrovic A. A Synthetic DNA Construct to Evaluate the Recovery Efficiency of Cell-Free DNA Extraction and Bisulfite Modification. Clin Chem 2021; 67:1201-1209. [PMID: 34151944 DOI: 10.1093/clinchem/hvab095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/20/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Despite improvements in the genetic and epigenetic analysis of cell-free DNA (cfDNA), there has been limited focus on assessing the preanalytical variables of recovery efficiency following cfDNA extraction and bisulfite modification. Quantification of recovery efficiency after these steps can facilitate quality assurance and improve reliability when comparing serial samples. METHODS We developed an exogenous DNA Construct to Evaluate the Recovery Efficiency of cfDNA extraction and BISulfite modification (CEREBIS) after cfDNA extraction and/or subsequent bisulfite modification from plasma. The strategic placement of cytosine bases in the 180 bp CEREBIS enabled PCR amplification of the construct by a single primer set both after plasma DNA extraction and following subsequent bisulfite modification. RESULTS Plasma samples derived from 8 organ transplant donors and 6 serial plasma samples derived from a liver transplant recipient were spiked with a known number of copies of CEREBIS. Recovery of CEREBIS after cfDNA extraction and bisulfite modification was quantified with high analytical accuracy by droplet digital PCR. The use of CEREBIS and quantification of its recovery was useful in identifying problematic extractions. Furthermore, its use was shown to be invaluable towards improving the reliability of the analysis of serial samples. CONCLUSIONS CEREBIS can be used as a spike-in control to address the preanalytical variable of recovery efficiency both after cfDNA extraction from plasma and following bisulfite modification. Our approach can be readily implemented and its application may have significant benefits, especially in settings where longitudinal quantification of cfDNA for disease monitoring is necessary.
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Affiliation(s)
- Su Kah Goh
- Department of Surgery-Austin Precinct, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, Austin Hospital, HPB & Transplant Unit, Melbourne, Victoria, Australia.,Department of Surgery-Austin Precinct, Translational Genomics and Epigenomics Laboratory, The University of Melbourne, Melbourne, Victoria, Australia
| | - Daniel R A Cox
- Department of Surgery-Austin Precinct, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, Austin Hospital, HPB & Transplant Unit, Melbourne, Victoria, Australia.,Department of Surgery-Austin Precinct, Translational Genomics and Epigenomics Laboratory, The University of Melbourne, Melbourne, Victoria, Australia
| | - Boris Ka Leong Wong
- Department of Surgery-Austin Precinct, Translational Genomics and Epigenomics Laboratory, The University of Melbourne, Melbourne, Victoria, Australia.,School of Cancer Medicine, La Trobe University, Bundoora, Victoria, Australia.,Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
| | - Ashan Musafer
- Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
| | - Tom Witkowski
- Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
| | - Hongdo Do
- School of Cancer Medicine, La Trobe University, Bundoora, Victoria, Australia.,The University of Melbourne, Parkville Precinct, Victoria, Australia.,Pathology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Vijayaragavan Muralidharan
- Department of Surgery-Austin Precinct, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, Austin Hospital, HPB & Transplant Unit, Melbourne, Victoria, Australia
| | - Alexander Dobrovic
- Department of Surgery-Austin Precinct, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Surgery-Austin Precinct, Translational Genomics and Epigenomics Laboratory, The University of Melbourne, Melbourne, Victoria, Australia.,School of Cancer Medicine, La Trobe University, Bundoora, Victoria, Australia.,Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
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6
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Parakh S, Musafer A, Paessler S, Witkowski T, Suen CSNLW, Tutuka CSA, Carlino MS, Menzies AM, Scolyer RA, Cebon J, Dobrovic A, Long GV, Klein O, Behren A. PDCD1 Polymorphisms May Predict Response to Anti-PD-1 Blockade in Patients With Metastatic Melanoma. Front Immunol 2021; 12:672521. [PMID: 34177913 PMCID: PMC8220213 DOI: 10.3389/fimmu.2021.672521] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 02/25/2021] [Accepted: 05/21/2021] [Indexed: 01/06/2023] Open
Abstract
A significant number of patients (pts) with metastatic melanoma do not respond to anti-programmed cell death 1 (PD1) therapies. Identifying predictive biomarkers therefore remains an urgent need. We retrospectively analyzed plasma DNA of pts with advanced melanoma treated with PD-1 antibodies, nivolumab or pembrolizumab, for five PD-1 genotype single nucleotide polymorphisms (SNPs): PD1.1 (rs36084323, G>A), PD1.3 (rs11568821, G>A), PD1.5 (rs2227981, C>T) PD1.6 (rs10204225, G>A) and PD1.9 (rs2227982, C>T). Clinico-pathological and treatment parameters were collected, and presence of SNPs correlated with response, progression free survival (PFS) and overall survival (OS). 115 patients were identified with a median follow up of 18.7 months (range 0.26 – 52.0 months). All were Caucasian; 27% BRAF V600 mutation positive. At PD-1 antibody commencement, 36% were treatment-naïve and 52% had prior ipilimumab. The overall response rate was 43%, 19% achieving a complete response. Overall median PFS was 11.0 months (95% CI 5.4 - 17.3) and median OS was 31.1 months (95% CI 23.2 - NA). Patients with the G/G genotype had more complete responses than with A/G genotype (16.5% vs. 2.6% respectively) and the G allele of PD1.3 rs11568821 was significantly associated with a longer median PFS than the AG allele, 14.1 vs. 7.0 months compared to the A allele (p=0.04; 95% CI 0.14 – 0.94). No significant association between the remaining SNPs and responses, PFS or OS were observed. Despite limitations in sample size, this is the first study to demonstrate an association of a germline PD-1 polymorphism and PFS in response to anti-PD-1 therapy in pts with metastatic melanoma. Extrinsic factors like host germline polymorphisms should be considered with tumor intrinsic factors as predictive biomarkers for immune checkpoint regulators.
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Affiliation(s)
- Sagun Parakh
- Medical Oncology Unit, Austin Health, Melbourne, VIC, Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia.,La Trobe University School of Cancer Medicine, Melbourne, VIC, Australia
| | - Ashan Musafer
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia.,La Trobe University School of Cancer Medicine, Melbourne, VIC, Australia
| | - Sabrina Paessler
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia
| | - Tom Witkowski
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia.,La Trobe University School of Cancer Medicine, Melbourne, VIC, Australia
| | - Connie S N Li Wai Suen
- Department of Mathematics and Statistics, La Trobe University, Melbourne, VIC, Australia
| | | | - Matteo S Carlino
- Department of Medical Oncology, Westmead and Blacktown Hospitals, Sydney, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia.,Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jonathan Cebon
- Medical Oncology Unit, Austin Health, Melbourne, VIC, Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia.,La Trobe University School of Cancer Medicine, Melbourne, VIC, Australia
| | - Alexander Dobrovic
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia.,La Trobe University School of Cancer Medicine, Melbourne, VIC, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia.,Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia.,Department of Clinical Medicine, Macquarie University, Sydney, NSW, Australia
| | - Oliver Klein
- Medical Oncology Unit, Austin Health, Melbourne, VIC, Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia
| | - Andreas Behren
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia.,La Trobe University School of Cancer Medicine, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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7
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Da Gama Duarte J, Woods K, Quigley LT, Deceneux C, Tutuka C, Witkowski T, Ostrouska S, Hudson C, Tsao SCH, Pasam A, Dobrovic A, Blackburn JM, Cebon J, Behren A. Ropporin-1 and 1B Are Widely Expressed in Human Melanoma and Evoke Strong Humoral Immune Responses. Cancers (Basel) 2021; 13:1805. [PMID: 33918976 PMCID: PMC8069442 DOI: 10.3390/cancers13081805] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/17/2022] Open
Abstract
Antibodies that block immune regulatory checkpoints (programmed cell death 1, PD-1 and cytotoxic T-lymphocyte-associated antigen 4, CTLA-4) to mobilise immunity have shown unprecedented clinical efficacy against cancer, demonstrating the importance of antigen-specific tumour recognition. Despite this, many patients still fail to benefit from these treatments and additional approaches are being sought. These include mechanisms that boost antigen-specific immunity either by vaccination or adoptive transfer of effector cells. Other than neoantigens, epigenetically regulated and shared antigens such as NY-ESO-1 are attractive targets; however, tissue expression is often heterogeneous and weak. Therefore, peptide-specific therapies combining multiple antigens rationally selected to give additive anti-cancer benefits are necessary to achieve optimal outcomes. Here, we show that Ropporin-1 (ROPN1) and 1B (ROPN1B), cancer restricted antigens, are highly expressed and immunogenic, inducing humoral immunity in patients with advanced metastatic melanoma. By multispectral immunohistochemistry, 88.5% of melanoma patients tested (n = 54/61) showed ROPN1B expression in at least 1 of 2/3 tumour cores in tissue microarrays. Antibody responses against ROPN1A and ROPN1B were detected in 71.2% of melanoma patients tested (n = 74/104), with increased reactivity seen with more advanced disease stages. Thus, ROPN1A and ROPN1B may indeed be viable targets for cancer immunotherapy, alone or in combination with other cancer antigens, and could be combined with additional therapies such as immune checkpoint blockade.
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Affiliation(s)
- Jessica Da Gama Duarte
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC 3084, Australia; (J.D.G.D.); (K.W.); (L.T.Q.); (C.D.); (C.T.); (T.W.); (S.O.); (C.H.); (S.C.-H.T.); (A.P.); (A.D.); (J.C.)
- School of Cancer Medicine, La Trobe University, Bundoora, VIC 3086, Australia
| | - Katherine Woods
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC 3084, Australia; (J.D.G.D.); (K.W.); (L.T.Q.); (C.D.); (C.T.); (T.W.); (S.O.); (C.H.); (S.C.-H.T.); (A.P.); (A.D.); (J.C.)
- School of Cancer Medicine, La Trobe University, Bundoora, VIC 3086, Australia
| | - Luke T. Quigley
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC 3084, Australia; (J.D.G.D.); (K.W.); (L.T.Q.); (C.D.); (C.T.); (T.W.); (S.O.); (C.H.); (S.C.-H.T.); (A.P.); (A.D.); (J.C.)
- School of Cancer Medicine, La Trobe University, Bundoora, VIC 3086, Australia
| | - Cyril Deceneux
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC 3084, Australia; (J.D.G.D.); (K.W.); (L.T.Q.); (C.D.); (C.T.); (T.W.); (S.O.); (C.H.); (S.C.-H.T.); (A.P.); (A.D.); (J.C.)
- School of Cancer Medicine, La Trobe University, Bundoora, VIC 3086, Australia
| | - Candani Tutuka
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC 3084, Australia; (J.D.G.D.); (K.W.); (L.T.Q.); (C.D.); (C.T.); (T.W.); (S.O.); (C.H.); (S.C.-H.T.); (A.P.); (A.D.); (J.C.)
- School of Cancer Medicine, La Trobe University, Bundoora, VIC 3086, Australia
| | - Tom Witkowski
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC 3084, Australia; (J.D.G.D.); (K.W.); (L.T.Q.); (C.D.); (C.T.); (T.W.); (S.O.); (C.H.); (S.C.-H.T.); (A.P.); (A.D.); (J.C.)
- School of Cancer Medicine, La Trobe University, Bundoora, VIC 3086, Australia
| | - Simone Ostrouska
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC 3084, Australia; (J.D.G.D.); (K.W.); (L.T.Q.); (C.D.); (C.T.); (T.W.); (S.O.); (C.H.); (S.C.-H.T.); (A.P.); (A.D.); (J.C.)
- School of Cancer Medicine, La Trobe University, Bundoora, VIC 3086, Australia
| | - Chris Hudson
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC 3084, Australia; (J.D.G.D.); (K.W.); (L.T.Q.); (C.D.); (C.T.); (T.W.); (S.O.); (C.H.); (S.C.-H.T.); (A.P.); (A.D.); (J.C.)
- School of Cancer Medicine, La Trobe University, Bundoora, VIC 3086, Australia
| | - Simon Chang-Hao Tsao
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC 3084, Australia; (J.D.G.D.); (K.W.); (L.T.Q.); (C.D.); (C.T.); (T.W.); (S.O.); (C.H.); (S.C.-H.T.); (A.P.); (A.D.); (J.C.)
- School of Cancer Medicine, La Trobe University, Bundoora, VIC 3086, Australia
| | - Anupama Pasam
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC 3084, Australia; (J.D.G.D.); (K.W.); (L.T.Q.); (C.D.); (C.T.); (T.W.); (S.O.); (C.H.); (S.C.-H.T.); (A.P.); (A.D.); (J.C.)
- School of Cancer Medicine, La Trobe University, Bundoora, VIC 3086, Australia
| | - Alexander Dobrovic
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC 3084, Australia; (J.D.G.D.); (K.W.); (L.T.Q.); (C.D.); (C.T.); (T.W.); (S.O.); (C.H.); (S.C.-H.T.); (A.P.); (A.D.); (J.C.)
- School of Cancer Medicine, La Trobe University, Bundoora, VIC 3086, Australia
- Department of Clinical Pathology, Melbourne Medical School, University of Melbourne, Parkville, VIC 3010, Australia
| | - Jonathan M. Blackburn
- Department of Integrative Biomedical Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa;
- Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Jonathan Cebon
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC 3084, Australia; (J.D.G.D.); (K.W.); (L.T.Q.); (C.D.); (C.T.); (T.W.); (S.O.); (C.H.); (S.C.-H.T.); (A.P.); (A.D.); (J.C.)
- School of Cancer Medicine, La Trobe University, Bundoora, VIC 3086, Australia
- Medical Oncology Unit, Austin Health, Heidelberg, VIC 3084, Australia
| | - Andreas Behren
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC 3084, Australia; (J.D.G.D.); (K.W.); (L.T.Q.); (C.D.); (C.T.); (T.W.); (S.O.); (C.H.); (S.C.-H.T.); (A.P.); (A.D.); (J.C.)
- School of Cancer Medicine, La Trobe University, Bundoora, VIC 3086, Australia
- Department of Medicine—Austin, Melbourne Medical School, University of Melbourne, Parkville, VIC 3010, Australia
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8
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Hawkes EA, Manos K, Chong G, Palmer J, MacManus MP, Keane C, Scott AM, Shortt J, Ritchie D, Churilov L, Johnston L, Witkowski T, Barraclough AA, Lee ST, Lin W, Koldej R, Khor R. Phase I study of radiotherapy (RT) & durvalumab in relapsed/refractory diffuse large B-cell lymphoma (DLBCL) & follicular lymphoma (FL): The RADD study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.tps8075] [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: 11/20/2022] Open
Abstract
TPS8075 Background: Most DLBCL & FL responds well to first line treatment, yet relapsed disease outcomes are poor. PD1/PDL1 inhibitors yield high response rates in some lymphomas, but single agent therapy in heavily pre-treated pts are disappointing. RT stimulates anti-tumor immunity through several mechanisms and may enhance response to immune checkpoint inhibition (ICI). Concurrent ICI & RT is synergistic in preclinical studies & solid tumors, improving local & distant (abscopal) response. RT to multiple disease sites may broaden the spectrum of tumor antigen release and overcome clonal variation between disease sites to further augment the immune response. Methods: RaDD (NCT03610061) is a phase I, 3+3 dose escalation study to determine the safety profile of escalating dose & number of sites of RT in combination with Durvalumab (anti-PD-L1 antibody) in RR DLBCL & FL. Eligible pts (i.e. ≥1 prior therapy, ineligible for auto-SCT, no contraindication to PDL1i) receive 5 fractions of external beam RT to target site(s). 5 RT dose & site levels are included (dose range 2.5Gy-20Gy to 1-3 sites). Durvalumab 1500mg IV commences day 2 of RT and continues 4-weekly until confirmed disease progression. The DLT period is 28 days from start of RT. Primary endpoint is the recommended phase two dose (RP2D) of RT in combination with durvalumab. Secondary endpoints include response rates, PFS & OS. Correlative studies will examine the tumour-immune system interaction; an exploratory PET substudy with novel tracers for durvalumab (89Zr-Durvalumab) & CD8+ T cells (89Zr -Df-IAB22M2C) will also be performed. Projected enrollment for determination of maximum tolerated dose (MTD) & RP2D is 6-30 pts pending toxicity. Recruitment will continue to 36 pts for secondary endpoint analysis. 9 pts are enrolled across cohorts 1-3 to date. Clinical trial information: NCT03610061 .
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Affiliation(s)
- Eliza Anne Hawkes
- Austin Health and Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
| | | | - Geoffrey Chong
- Austin Health and Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
| | - Jodie Palmer
- Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
| | | | - Colm Keane
- Princess Alexandra Hospital, Woolloongabba, Australia
| | - Andrew Mark Scott
- Austin Health and Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
| | - Jake Shortt
- Monash University and Monash Health, Melbourne, Australia
| | - David Ritchie
- Peter MacCallum Cancer Centre & Royal Melbourne Hospital, Melbourne, Australia
| | | | | | - Tom Witkowski
- Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
| | | | - Sze Ting Lee
- Austin Health and Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
| | - Wendi Lin
- Austin Health, Heidelberg, Australia
| | - Rachel Koldej
- Australian Cancer Research Foundation at Royal Melbourne Hospital, Melbourne, Australia
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9
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Witkowski T, Konat-Baska K, Dupla D, Maciejczyk A, Matkowski R, Jankowska EA, Kosmala W. P1355 Short-term cardiac side-effects from radiotherapy in women with breast cancer. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Breast cancer radiotherapy provides an apparent benefit for long-term survival and local recurrence rate. However, there is still much concern about the early and late radiation-induced cardiac toxicity. Therefore, various radiotherapy techniques have been developed to reduce the cardiopulmonary radiation doses in patients with left-sided breast cancer, who are at particular risk of developing post-radiation cardiac injury.
Aim
We sought to investigate the early effect of radiotherapy on left (LV) and right ventricular (RV) function in females subjected to this treatment.
Methods
Fifty left-sided breast cancer patients , who underwent adjuvant radiotherapy between May 2017 and May 2018 were included in the study. Forty-nine enrollees were initially treated with breast conserving surgery, and 1 - with mastectomy and axillary lymph node resection. Adjuvant radiotherapy was carefully planned to minimize the radiation side effects and 37 patient received radiotherapy with deep inspiration breath hold technique and 13 patients with free breathing technique. In most cases (n = 33), 3D conformal tangential field radiation therapy was applied, 13 patients received radiotherapy with dynamic-Rapid-Arc technique with additional 3D fields, and 4 patients underwent radiotherapy only with Rapid-Arc technique. Before surgery and 3 months after radiotherapy, echocardiography with measurement of conventional cardiac function parameters, as well as LV and RV longitudinal deformation analysis by speckle tracking technique was performed, and venous blood for biomarkers - galectin-3 reflecting myocardial fibrosis and NT-proBNP was sampled.
Results At a mean follow-up of 97 ± 19 days , there were no significant changes in any of the studied cardiac systolic or diastolic function parameters (Table). There were no relationships between the change in LV longitudinal strain at follow-up and type of radiotherapy, as well as type of radiotherapy gating (both R = 0.02, p = 0.90). Similarly, no analogous associations were demonstrated for RV longitudinal strain (R = 0.02, p = 0.88, and R = 0.04, p = 0.77, respectively). No significant changes were found post radiotherapy in serum galectin-3 (7.2 ± 2.6 ng/ml vs. 6.8 ± 2.5 ng/ml; p = 0.58) and NT-proBNP (83 ± 68 pg/ml vs. 84 ± 54 pg/ml; p = 0.90).
Conclusions
Breast cancer radiotherapy with the use of contemporary planning techniques shows an excellent early cardiac safety.
Abstract P1355 Figure.
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Affiliation(s)
| | | | - D Dupla
- Wroclaw Medical University, Wroclaw, Poland
| | | | | | | | - W Kosmala
- Wroclaw Medical University, Wroclaw, Poland
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10
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Colebatch AJ, Ferguson P, Newell F, Kazakoff SH, Witkowski T, Dobrovic A, Johansson PA, Saw RPM, Stretch JR, McArthur GA, Long GV, Thompson JF, Pearson JV, Mann GJ, Hayward NK, Waddell N, Scolyer RA, Wilmott JS. Molecular Genomic Profiling of Melanocytic Nevi. J Invest Dermatol 2019; 139:1762-1768. [PMID: 30772300 DOI: 10.1016/j.jid.2018.12.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 01/15/2023]
Abstract
The benign melanocytic nevus is the most common tumor in humans and rarely transforms into cutaneous melanoma. Elucidation of the nevus genome is required to better understand the molecular steps of progression to melanoma. We performed whole genome sequencing on a series of 14 benign melanocytic nevi consisting of both congenital and acquired types. All nevi had driver mutations in the MAPK signaling pathway, either BRAF V600E or NRAS Q61R/L. No additional definite driver mutations were identified. Somatic mutations in nevi with higher mutation loads showed a predominance of mutational signatures 7a and 7b, consistent with UVR exposure, whereas nevi with lower mutation loads (including all three congenital nevi) had a predominance of the ubiquitous signatures 1 and 5. Two nevi had mutations in promoter regions predicted to bind E26 transformation-specific family transcription factors, as well as subclonal mutations in the TERT promoter. This paper presents whole genome data from melanocytic nevi. We confirm that UVR is involved in the etiology of a subset of nevi. This study also establishes that TERT promoter mutations are present in morphologically benign skin nevi in subclonal populations, which has implications regarding the interpretation of this emerging biomarker in sensitive assays.
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Affiliation(s)
- Andrew J Colebatch
- Melanoma Institute Australia, The University of Sydney, New South Wales, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
| | - Peter Ferguson
- Melanoma Institute Australia, The University of Sydney, New South Wales, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Felicity Newell
- Queensland Institute of Medical Research, Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Stephen H Kazakoff
- Queensland Institute of Medical Research, Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Tom Witkowski
- Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
| | - Alexander Dobrovic
- Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia; School of Cancer Medicine and Molecular Cancer Prevention Program, La Trobe University, Bundoora, Victoria, Australia; Department of Clinical Pathology, University of Melbourne, Parkville, Victoria, Australia
| | - Peter A Johansson
- Queensland Institute of Medical Research, Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Melanoma and Surgical Oncology, Discipline of Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jonathan R Stretch
- Melanoma Institute Australia, The University of Sydney, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Grant A McArthur
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Melanoma and Surgical Oncology, Discipline of Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - John V Pearson
- Queensland Institute of Medical Research, Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
| | - Nicholas K Hayward
- Queensland Institute of Medical Research, Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Nicola Waddell
- Queensland Institute of Medical Research, Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, New South Wales, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - James S Wilmott
- Melanoma Institute Australia, The University of Sydney, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Colebatch AJ, Witkowski T, Waring PM, McArthur GA, Wong SQ, Dobrovic A. Optimizing Amplification of the GC-Rich TERT Promoter Region Using 7-Deaza-dGTP for Droplet Digital PCR Quantification of TERT Promoter Mutations. Clin Chem 2018; 64:745-747. [PMID: 29382647 DOI: 10.1373/clinchem.2017.284257] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Andrew J Colebatch
- Research Division, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre Victoria, Australia .,Department of Pathology, University of Melbourne, Victoria, Australia
| | - Tom Witkowski
- Translational Genomics and Epigenomics Laboratory, Olivia Newton-John Cancer Research Institute, Victoria, Australia
| | - Paul M Waring
- Department of Pathology, University of Melbourne, Victoria, Australia
| | - Grant A McArthur
- Research Division, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre Victoria, Australia
| | - Stephen Q Wong
- Research Division, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre Victoria, Australia.,Department of Pathology, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre Victoria, Australia
| | - Alexander Dobrovic
- Department of Pathology, University of Melbourne, Victoria, Australia.,Translational Genomics and Epigenomics Laboratory, Olivia Newton-John Cancer Research Institute, Victoria, Australia.,School of Cancer Medicine, La Trobe University, Victoria, Australia
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12
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Colebatch A, Witkowski T, Waring P, McArthur G, Wong S, Dobrovic A. Sensitive detection of TERT promoter mutations reveals early acquisition and heterogeneity in cutaneous melanoma. Pathology 2017. [DOI: 10.1016/j.pathol.2016.12.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Goh SK, Musafer A, Witkowski T, Muralidharan V, Christophi C, Do H, Dobrovic A. Comparison of 3 Methodologies for Genotyping of Small Deletion and Insertion Polymorphisms. Clin Chem 2016; 62:1012-9. [DOI: 10.1373/clinchem.2016.256388] [Citation(s) in RCA: 6] [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] [Received: 02/19/2016] [Accepted: 04/25/2016] [Indexed: 12/16/2022]
Abstract
Abstract
BACKGROUND
The quantification of genomic chimerism is increasingly recognized for its clinical significance after transplantation. Before the measurement of chimerism, accurate genotyping of genetic polymorphisms for informative alleles that can distinguish donor DNA from recipient DNA is essential. The ease of allelic discrimination of small deletion and insertion polymorphisms (DIPs) makes DIPs attractive markers to track chimerism. Current methodologies for the genotyping of DIPs are largely based on “open-tube” approaches. “Closed-tube” approaches involving no or minimal post-PCR handling are preferred. We compared 3 distinct methodologies to determine an optimal platform for DIP genotyping.
METHODS
Genomic DNA from 19 normal individuals was genotyped for 6 small biallelic DIPs using high-resolution melting analysis (HRMA), probe-free droplet digital PCR (ddPCR), and microfluidic electrophoresis of PCR products. For HRMA, 3 different platforms were compared.
RESULTS
Our newly developed probe-free ddPCR approach allowed the genotype of each DIP to be determined by fluorescence intensity based on amplicon size. Microfluidic electrophoresis also allowed genotypes to be determined by amplicon size. HRMA assays allowed the genotype of each DIP to be determined by melting profile. Genotyping results were concordant between the 3 methodologies. HRMA was the most readily performed methodology and was robust across 3 separate HRMA-capable platforms.
CONCLUSIONS
We demonstrated the effectiveness of probe-free ddPCR to accurately genotype small biallelic DIPs. Nevertheless, HRMA proved to be the optimal approach for genotyping small DIPs because closed-tube approaches are preferred owing to rapid and less laborious workflows and least risk of PCR contamination.
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Affiliation(s)
- Su Kah Goh
- Translational Genomics and Epigenomics Laboratory, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - Ashan Musafer
- Translational Genomics and Epigenomics Laboratory, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
| | - Tom Witkowski
- Translational Genomics and Epigenomics Laboratory, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
| | | | - Christopher Christophi
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - Hongdo Do
- Translational Genomics and Epigenomics Laboratory, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
- School of Cancer Medicine, La Trobe University, Victoria, Australia
- Department of Pathology, University of Melbourne, Victoria, Australia
| | - Alexander Dobrovic
- Translational Genomics and Epigenomics Laboratory, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
- School of Cancer Medicine, La Trobe University, Victoria, Australia
- Department of Pathology, University of Melbourne, Victoria, Australia
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Van De Heyning CM, Magne J, Mahjoub H, Pibarot P, O'connor K, Pirlet C, Pierard L, Lancellotti P, Mohty D, Pibarot P, Deltreuil M, Tanguy B, Cassat C, Dumesnil J, Virot P, Zilberszac R, Gabriel H, Maurer G, Rosenhek R, Mizariene V, Zaliaduonyte-Peksiene D, Janenaite J, Marcinkeviciene J, Vaisvila T, Jankauskiene E, Ereminiene E, Vaskelyte J, Jurkevicius R, Ewe S, Haeck M, Witkowski T, Auger D, Leong D, Abate E, Ajmone N, Bax J, Delgado V. Oral Abstract Session: Predicting outcome in valvular heart disease * Thursday 8 December 2011, 08:30-10:00 * Location: Kaposvar. European Journal of Echocardiography 2011. [DOI: 10.1093/ejechocard/jer200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Witkowski T, Thomas J, Delgado V, Ng A, Auger A, Leong D, Bax J, Marsan N, Florescu M, Magda L, Mihalcea D, Enescu O, Suran B, Mincu R, Cinteza M, Vinereanu D, Khalifa EA, Mornos C, Ionac A, Cozma D, Petrescu L, Mornos A, Pescariu S, Dragulescu S, Laser K, Hauffe P, Koerperich H, Peters B, Kececioglu D, Dumitrascu A, Dumitrascu C, Sarov R, Mantu I, Tanaseanu C, Oliva Sandoval M, Gonzalez Carrillo J, Romero Puche A, Cerdan Sanchez M, Garcia Navarro M, Saura Espin D, Lacunza Ruiz J, Gimeno Blanes J, De La Morena Valenzuela G, Valdes Chavarri M, Flessas N, Velitsista S, Tsorlalis Y, Berry C, Tzemos N, Staron A, Gasior Z, Tabor Z, Sengupta P, Mornos C, Cozma D, Ionac A, Pescariu S, Petrescu L, Mornos A, Dragulescu S. Moderated Poster Sessions 2: From deformation imaging to clinical decision * Thursday 8 December 2011, 14:00-18:00 * Location: Moderated Poster Area. European Journal of Echocardiography 2011. [DOI: 10.1093/ejechocard/jer207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Pinna GD, Maestri R, Mortara A, Johnson P, Andrews D, Ponikowski P, Witkowski T, La Rovere MT, Sleight P. Long-term time-course of nocturnal breathing disorders in heart failure patients. Eur Respir J 2009; 35:361-7. [DOI: 10.1183/09031936.00066709] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Witkowski T, Pitel A, Beaunieux H, Viader F, Desgranges B, Eustache F. Sergueï Sergueïevitch Korsakoff (1854-1900) : le savant, le penseur, le psychiatre, l’humaniste. Rev Neurol (Paris) 2008; 164:F291-8. [DOI: 10.1016/s0035-3787(08)75136-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Viscusi ER, Goldstein S, Witkowski T, Andonakakis A, Jan R, Gabriel K, Du W, Techner L, Wallin B. Alvimopan, a peripherally acting mu-opioid receptor antagonist, compared with placebo in postoperative ileus after major abdominal surgery. Surg Endosc 2005; 20:64-70. [PMID: 16333556 DOI: 10.1007/s00464-005-0104-y] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Accepted: 07/29/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Alvimopan is a peripherally acting mu-opioid receptor (PAM-OR) antagonist for accelerating gastrointestinal recovery after surgery. METHODS Patients undergoing open laparotomy (bowel resection, n = 418; hysterectomy, n = 197) were randomized to receive alvimopan 6 or 12 mg or placebo orally > or = 2 h before surgery and then b.i.d. until hospital discharge (up to 7 days). The primary efficacy endpoint was time to gastrointestinal (GI) recovery (measured by toleration of solid food and passage of flatus/stool; GI-3). Secondary endpoints included time to GI-2 recovery (toleration of solid food and passage of stool) and hospital discharge order written (DCO). RESULTS Alvimopan did not significantly accelerate GI-3 compared with placebo [6 mg: hazard ratio (HR) = 1.20, p = 0.080; 12 mg: HR = 1.24, p = 0.038). However, after adjustment for significant covariates (sex/surgical duration), benefits were significant for both doses (6 mg: HR = 1.24, p = 0.037; 12 mg: HR = 1.26, p = 0.028). Alvimopan also significantly accelerated time to GI-2 (6 mg: HR = 1.37, p = 0.008; 12 mg: HR = 1.33, p = 0.018) and DCO (6 mg: HR = 1.31, p = 0.008; 12 mg: HR = 1.28, p = 0.015). Adverse events were similar between groups. CONCLUSIONS Alvimopan (6 or 12 mg) accelerates GI recovery and is well tolerated in patients undergoing open laparotomy.
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Affiliation(s)
- E R Viscusi
- Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107-5092, USA.
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Miguel R, Witkowski T, Nagashima H, Fragen R, Bartkowski R, Foldes FF, Shanks C. Evaluation of neuromuscular and cardiovascular effects of two doses of rapacuronium (ORG 9487) versus mivacurium and succinylcholine. Anesthesiology 1999; 91:1648-54. [PMID: 10598606 DOI: 10.1097/00000542-199912000-00016] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND This study compares the neuromuscular blocking and cardiovascular effects of rapacuronium (ORG 9487), a new aminosteroid nondepolarizing muscle relaxant, to recommended intubating doses of succinylcholine and mivacurium. METHODS Adult patients were randomized in an open-label fashion to receive 1-5 microg/kg fentanyl before 1.5 mg/kg propofol induction followed by 1.5 or 2.5 mg/kg rapacuronium, 1.0 mg/kg succinylcholine, or 0.25 mg/kg mivacurium (i.e., 0.15 mg/kg followed by 0.1 mg/kg 30 s later). RESULTS Patient neuromuscular blockade status was monitored by measuring the train-of-four response to a supramaximal stimulus at the ulnar nerve every 12 s. Percentage of the first twitch of the train-of-four (T1) at 60 s was similar in patients receiving 1.5 mg/kg rapacuronium, 2.5 mg/kg rapacuronium, and succinylcholine and was significantly less than in patients in the mivacurium group (26, 16, and 18%, respectively, vs. 48%; P < 0.01). Times to 80% T1 depression were also similar among patients in the 1.5 mg/kg rapacuronium, 2.5 mg/kg rapacuronium, and succinylcholine groups and significantly longer in the mivacurium group (62, 54, and 54 s, respectively, vs. 112 s; P < 0.01). Clinical duration was longer in all groups compared with the succinylcholine group; however, clinical duration in the 1.5 mg/kg rapacuronium group was shorter compared with the mivacurium group (15 vs. 21 min, respectively; P < 0.01). Heart rate changes were mild in the 1.5 mg/kg rapacuronium, succinylcholine, and mivacurium groups. The patients in the 2.5 mg/kg rapacuronium group had significantly higher heart rates compared with patients in the mivacurium group. No differences were found in blood pressure changes among patients in the four groups. CONCLUSIONS Rapacuronium, 1.5 and 2.5 mg/kg, produced neuromuscular blockade as rapidly as succinylcholine and significantly faster than mivacurium. Although succinylcholine continued to show the shortest duration, 1.5 mg/kg rapacuronium used a rapid onset and a relatively short duration and may be considered an alternative to succinylcholine.
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Affiliation(s)
- R Miguel
- Department of Anesthesiology, H. Lee Moffitt Cancer Center, University of South Florida, Tampa 33612, USA.
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Abstract
We report two laboratory experiments which compare two competing explanations of performance deficits following failure: one based on Seligman's learned helplessness theory (LHT), and the other, on self-esteem protection theory (SEPT). In both studies, participants (Study 1: N = 40 pupils from secondary schools in Walbrzych, Poland; Study 2: N = 45 students from the University of Bielefeld, Germany) were confronted with either success or failure in a first phase of the experiment. Then, in the second phase of the experiment the participants had to work on a set of mathematical problems (Study 1) or a set of tasks taken from Raven's Progressive Matrices (Study 2) either privately or in public. In both studies failure in the first phase causes performance deficits in the second phase only if the participants had to solve the test tasks in public. These results were interpreted in line with SEPT and as incompatible with LHT.
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Affiliation(s)
- T Witkowski
- Department of Psychology, Universität Hildesheim, Germany
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Kovac AL, Azad SS, Steer P, Witkowski T, Batenhorst R, McNeal S. Remifentanil versus alfentanil in a balanced anesthetic technique for total abdominal hysterectomy. J Clin Anesth 1997; 9:532-41. [PMID: 9347428 DOI: 10.1016/s0952-8180(97)00140-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVES To compare the intraoperative effects and recovery characteristics of remifentanil hydrochloride and alfentanil when administered as part of balanced anesthesia, and to assess the effects of an additional remifentanil infusion administered as analgesic pretreatment before removal of the uterus. DESIGN Multicenter, double-blind, randomized, parallel-group study. SETTING Two university hospitals. PATIENTS 35 ASA physical status I, II, and III women scheduled for elective total abdominal hysterectomy with general endotracheal anesthesia. INTERVENTIONS Patients were premedicated with midazolam 0.05 mg/kg intravenously (i.v.). Anesthesia was induced with thiopental 2 mg/kg, vecuronium 0.15 mg/kg, and a single dose of opioid over 60 seconds (Pump 1): remifentanil 2 micrograms/kg (Remi/Placebo and Remi/Remi groups) or alfentanil 50 micrograms/kg (Alf/Placebo group). Anesthesia was maintained with a nitrous oxide/oxygen mixture (66:34 ratio) and a continuous opioid infusion: remifentanil 0.25 microgram/kg/min (Remi/Placebo and Remi/Remi) or alfentanil 0.5 microgram/kg/min (Alf/Placebo). At skin incision, a second blinded drug infusion was also initiated (Pump 2): remifentanil 0.25 microgram/kg/min (Remi/Remi) or saline placebo (Remi/Placebo and Alf/Placebo). Intraoperative responses were controlled with single doses of opioid and/or rate titrations via Pump 1. Pump 2 was terminated on removal of the uterus. Pump 1 was terminated at skin closure. MEASUREMENTS AND MAIN RESULTS The mean (+/- SD) opioid infusion rates administered for the duration of Pump 2 to suppress responses to removal of the uterus were 0.49 +/- 0.27 microgram/kg/min, 1.99 +/- 1.34 micrograms/kg/min, and 0.49 +/- 0.07 microgram/kg/min for the Remi/Placebo, Alf/Placebo, and Remi/Remi groups, respectively. At these rates, similar proportions of patients in the Remi/Placebo (67%) and the Alf/Placebo (60%) groups had responses. Fewer patients had responses in the Remi/Remi group (8%) compared with the Remi/Placebo and Alf/Placebo groups (p < 0.05). The mean total opioid doses used during maintenance were 84.6 micrograms/kg (Remi/Placebo), 393 micrograms/kg (Alf/Placebo), and 68.7 micrograms/kg (Remi/Remi). Awakening times were significantly shorter (p < 0.05) in the remifentanil population compared with the alfentanil population, but discharge times were similar. More patients received naloxone to reverse opioid effects in the alfentanil population (60%) than in the remifentanil population (20%) (p < 0.05). CONCLUSIONS A mean remifentanil infusion of 0.49 microgram/kg/min is as effective as a mean alfentanil infusion of 1.99 micrograms/kg/min in suppressing intraoperative responses. Doubling of the remifentanil infusion to 0.5 microgram/kg/min before the major stress event improves suppression of responses and lowers intraoperative use of remifentanil without prolonging recovery times. Remifentanil allows faster awakening times than alfentanil, but preemptive administration of postoperative analgesics is recommended to facilitate discharge.
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Affiliation(s)
- A L Kovac
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City 66160-7415, USA
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Ali HH, Lien CA, Witkowski T, Brull SJ, Stout RG, Bartkowski R, Silverman DG, Patel S, Ascher JA, Goudsouzian NG. Efficacy and safety of divided dose administration of mivacurium for a 90-second tracheal intubation. J Clin Anesth 1996; 8:276-81. [PMID: 8695129 DOI: 10.1016/0952-8180(96)85617-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY OBJECTIVE To compare the safety and effectiveness of 0.25 mg divided doses of mivacurium chloride to succinylcholine for a 90-second tracheal intubation. DESIGN Randomized, double-blind, multicenter study in two groups. SETTING Operating rooms at four university medical centers. PATIENTS 200 healthy ASA status I and II adult patients scheduled for elective surgery with general anesthesia and endotracheal intubation. INTERVENTIONS Patients were premedicated with 1 to 2 mg midazolam and 2 micrograms/kg fentanyl. Anesthesia was induced with 2 mg/kg propofol. Group A received 0.25 mg/kg mivacurium given as a divided dose (0.15 mg/kg followed in 30 seconds with 0.1 mg/kg). Group B (control) received 1.5 mg/kg succinylcholine (SCh) preceded two minutes earlier by 50 micrograms/kg d-tubocurarine (dtc). MEASUREMENTS AND MAIN RESULTS Tracheal intubation grading, train-of-four response of the adductor pollicis, heart rate (HR), and mean arterial blood pressure (MAP) were measured and evaluated. Chi-square analysis was performed for comparison between Group A and Group B with respect to the frequency distribution of intubation using the scores excellent, good, and poor and not possible (combined). Group B had a significantly higher excellent score of intubation than Group A, 84% versus 56% (p < 0.0001). No significant difference was found between the two groups when the scores excellent and good were combined (Fisher's Exact test, p = 0.28). The changes in MAP and HR were similar for the two groups. CONCLUSIONS When Sch is not desirable, mivacurium 0.25 mg/kg given as a divided dose provides good to excellent intubation conditions 90 seconds after the initial dose without significant changes in MAP or HR. It can be an appropriate alternative for short surgical procedures. It must be emphasized that this conclusion does not apply to rapid-sequence induction-intubation.
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Affiliation(s)
- H H Ali
- Department of Anaesthesia, Harvard Medical School, Massachusetts General Hospital, Boston 02114, USA
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Mesropian J, Witkowski T. Why is one quote higher than another? Wis Dent Assoc J 1987; 63:698-9. [PMID: 3482495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Mesropian J, Witkowski T. Answers to common misconceptions about claims made insurance. Wis Dent Assoc J 1987; 63:643. [PMID: 3482490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Kholoussy AM, Yang Y, Bonacquisti K, Witkowski T, Takenaka K, Matsumoto T. The competence and bacteriologic effect of the telescoped intestinal valve after small bowel resection. Am Surg 1986; 52:555-9. [PMID: 3767143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In 20 dogs the distal one-third of the small intestine and the proximal 10 cm of the ascending colon were resected. Bowel continuity was established by the telescoping technique to create an intestinal valve in ten dogs (group A) and by conventional end-to-end anastomosis in ten dogs (group B). Diarrhea and weight loss were similar in both groups. The ileal bacterial growth was significantly higher than the jejunum in group A (P less than 0.001) but not in group B. The jejunal bacterial growth in group B was significantly higher than that in group A (P less than 0.01). Intestinal transit times were 212 +/- 16.0, 219 +/- 152.4, and 163 +/- 85.8 minutes for normal dogs, groups A and B respectively. The competence of the normal ileocecal valve, the telescoped valve, and conventional anastomosis were 56 +/- 1.7, 49.9 +/- 17.4 and 13.2 +/- 7.8 cm of barium, respectively. Artificial intestinal valve formed by the telescoping technique is safe, simple, and effective in reducing bacterial overgrowth in the jejunum and appears to prolong intestinal transit time.
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Witkowski T. Cost-effective methodology for work order records. J Clin Eng 1982; 7:165-71. [PMID: 10257555 DOI: 10.1097/00004669-198204000-00017] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Confusion and inefficiency in the medical electronics laboratory can be reduced with the implementation of a good recordkeeping system. One such orderly process includes a work order form, a device record card, and a status indication form. With consistent use, this system has met with success. It is anticipated that, with further development, the system can grow into a solid data base.
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