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Shadman M, Sharman JP, Levy MY, Porter R, Zafar SF, Burke JM, Chaudhry A, Freeman BB, Misleh JG, Yimer HA, Cultrera JL, Guthrie TH, Kingsley E, Rao SS, Chen DY, Cohen A, Feng S, Huang J, Flinn I. Preliminary results of the phase 2 study of zanubrutinib in patients with previously treated B-cell malignancies intolerant to ibrutinib and/or acalabrutinib. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e19506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19506 Background: Many patients (pts) with B-cell malignancies require continuous treatment with Bruton tyrosine kinase inhibitors (BTKi). Adverse events (AEs) are a common reason for ibrutinib (ibr) or acalabrutinib (acala) discontinuation. Early data from BGB-3111-215 showed zanubrutinib (zanu) was well tolerated in pts with B-cell malignancies intolerant to ibr or acala. We report preliminary results with a median follow-up of 4.2 mo. Methods: Pts meeting protocol criteria for intolerance to ibr, acala or both (without documented progressive disease) were given zanu monotherapy (160 mg twice daily or 320 mg once daily). Recurrence of AEs that led to intolerance of prior BTKi and additional safety measures were assessed based on the Common Terminology Criteria for AEs v5.0. Investigators determined responses using disease status at study entry as baseline. Results: As of November 1, 2020 (cutoff), 44 pts (n=34 chronic lymphocytic leukemia/small lymphocytic lymphoma, n=6 Waldenström macroglobulinemia, n=2 mantle cell lymphoma, n=2 marginal zone lymphoma) were enrolled, received ≥1 dose of zanu, and analyzed for safety. Median age was 70.5 y (range, 49-91); median duration of treatment was 4.2 mo (range, 0.1-12.6). Median number of prior regimens was 2 (range, 1-12). Regarding prior BTKi, 39 pts received ibr only, 4 received ibr and acala, and 1 received acala only. The median number of ibr- or acala-intolerant AEs per pt was 2 (range, 1-5). 83% of ibr and 78% of acala intolerant events did not reccur on zanu; Table. At data cutoff, 43 pts remained on treatment; 1 withdrew consent due to zanu-unrelated grade 3 syncope. Overall, 34 pts (77.3%) reported any AE; most commonly reported AEs were myalgia (n=9; 20.5%), contusion (n=8; 18.2%), dizziness (n=7; 15.9%), fatigue (n=7; 15.9%), and cough (n=5; 11.4%). Grade ≥3 AEs were reported in 6 pts (13.6%), serious AEs in 1 pt (2.3%, febrile neutropenia and salmonella infection), AEs requiring dose interruptions in 6 pts (13.6%), and AEs leading to dose reduction in 2 pts (4.5%). No AEs led to zanu discontinuation. No deaths were reported. All efficacy evaluable pts (26/26 [100%]) maintained (10 [38.5%]) or achieved deepening (16 [61.5%]) of their response. Conclusions: Zanu provides an additional treatment option after intolerance to other BTKi, demonstrating tolerability and sustained or improved efficacy. Updated results will be presented. Recurrence and Severity Change of AEs Leading to Ibr or Acala Intolerance. Clinical trial information: NCT04116437. [Table: see text]
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Affiliation(s)
- Mazyar Shadman
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | | | - Moshe Y. Levy
- Texas Oncology-Baylor Charles A. Sammons Cancer Center, Dallas, TX
| | | | | | | | | | | | | | | | | | | | - Ed Kingsley
- Comprehensive Cancer Centers of Nevada, Las Vegas, NV
| | | | | | | | | | | | - Ian Flinn
- Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN
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Sher AF, Bruce JY, Gabrail NY, Anderson IC, Patrikidou A, Sanborn RE, Cho JY, Lee AS, Lee JS, Nott LM, Oh DY, Oh SC, Oh SY, Wang Y, Wang Z, Guthrie TH. Open-label, phase II study of ladiratuzumab vedotin (LV) for castration-resistant prostate cancer (SGNLVA-005, trial-in-progress). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.tps185] [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
TPS185 Background: LIV-1 is a transmembrane protein expressed in a variety of cancer types. SGN-LIV1A, or ladiratuzumab vedotin (LV), is a novel investigational humanized IgG1 antibody-drug conjugate (ADC) directed against LIV-1. LV mediates delivery of monomethyl auristatin E (MMAE), which drives antitumor activity through cytotoxic cell killing and induces immunogenic cell death. In a phase 1 study, LV was tolerable and active in heavily pretreated patients with metastatic breast cancer (Modi 2017). This study is currently evaluating the safety and efficacy of LV in different advanced solid tumors with various LIV-1 expression, including metastatic castration-resistant prostate cancer (mCRPC), advanced gastric and gastroesophageal junction (GEJ) adenocarcinoma, esophageal squamous cell carcinoma, small cell lung cancer (SCLC), non-small cell lung cancer (squamous and nonsquamous), head and neck squamous cell carcinoma, and melanoma. Methods: SGNLVA-005 (NCT04032704) is an open-label, phase 2 study evaluating LV monotherapy in patients with previously treated, locally advanced unresectable or metastatic advanced solid tumors, including mCRPC. Patients with mCRPC will receive LV administered as a 30 minute intravenous infusion (IV) at 1.25 mg/kg every 1 week. Up to 30 patients with mCRPC will be enrolled. Patients in the mCRPC cohort must have metastatic castration-resistant disease, have received no more than 1 prior line of androgen receptor-targeted therapy, have ≥28 days between androgen receptor-targeted therapy and start of study treatment, an Eastern Cooperative Oncology Group (ECOG) score of 0 or 1, and adequate organ function. In addition, mCRPC patients with measurable and non-measurable disease are eligible if the protocol-defined criteria are met. mCRPC patients must not have BRCA gene mutations, prior cytotoxic chemotherapy in the metastatic mCRPC setting, prior radioisotope therapy, or radiotherapy to ≥30% of bone marrow. Patients are not preselected based on tumor LIV-1 expression. Their tumor samples will be analyzed for correlation between LIV-1 expression and response. Safety and efficacy will be monitored throughout the study. Study objectives include objective tumor response rate per RECIST 1.1 and prostate-specific antigen (PSA) response rate per Prostate Cancer Clinical Trials Working Group 3 (both primary); safety and tolerability, disease control rate, duration of response, progression-free and overall survival, and pharmacokinetics and immunogenicity (all secondary); and pharmacodynamics. Study accrual is ongoing in the USA, Italy, South Korea, Taiwan, Australia, and the UK. Clinical trial information: NCT04032704.
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Affiliation(s)
| | | | | | | | | | - Rachel E. Sanborn
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR
| | - Jae Yong Cho
- Gangnam Severance Hospital, Yonsei University, Seoul, South Korea
| | | | - Jong-Seok Lee
- Seoul National University Bundang Hospital, Seongnam-Si, South Korea
| | | | - Do-Youn Oh
- Seoul National University Hospital, Seoul, South Korea
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Sher AF, Bruce JY, Oh SY, Anderson IC, Oh DY, Nott LM, Lee JS, Lin CC, Mehra R, Shim BY, Su WC, Guthrie TH, Gabrail NY, Sanborn RE, Lee AS, Cortinovis DL, Swiecicki P, Wang Y, Wang Z, Cho JY. Open-label, phase II study of ladiratuzumab vedotin (LV) for advanced gastric and gastroesophageal junction adenocarcinoma (SGNLVA-005, Trial-in-Progress). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.tps256] [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
TPS256 Background: LIV-1 is a transmembrane protein expressed in a variety of cancer types. SGN-LIV1A, or ladiratuzumab vedotin (LV), is a novel investigational humanized IgG1 antibody-drug conjugate (ADC) directed against LIV-1. LV mediates delivery of monomethyl auristatin E (MMAE), which drives antitumor activity through cytotoxic cell killing and induces immunogenic cell death. In a phase 1 study, LV was tolerable and active in heavily pretreated patients with metastatic breast cancer at a recommended dose of 2.5 mg/kg every 21 days (Modi 2017). More frequent, fractionated dosing has improved the activity and/or safety of other ADCs. Thus, this study is currently evaluating the safety and efficacy of weekly LV dosing (Days 1, 8, and 15 of every 3-week cycle) in different advanced solid tumors with various LIV-1 expression, including advanced gastric and gastroesophageal junction (GEJ) adenocarcinoma, esophageal squamous cell carcinoma, small cell lung cancer (SCLC), non-small cell lung cancer (squamous and nonsquamous), head and neck squamous cell carcinoma, castration resistant prostate cancer, and melanoma. Methods: SGNLVA-005 (NCT04032704) is an open-label, phase 2 study evaluating LV monotherapy in patients with 8 different advanced solid tumors in two parts (administered as a 30 minute intravenous infusion [IV]: Part A LV 2.5 mg/kg IV every 3 weeks [up to n = 72 total]; Part B LV 1.0 or 1.25 mg/kg every 1 week [up to n = 252 total]). The study is enrolling previously treated patients with unresectable locally advanced or metastatic disease. Patients must have measurable disease per RECIST v1.1, an Eastern Cooperative Oncology Group (ECOG) score of 0 or 1, and adequate organ function. Cohort specific inclusion criteria require that patients in the gastric and GEJ adenocarcinoma and esophageal squamous cell carcinoma cohorts must have received and progressed during or after no more than 1 prior line of platinum based cytotoxic chemotherapy. Patients in the gastric and GEJ adenocarcinoma cohort may have received prior anti-programmed cell death (ligand) 1 (anti-PD[L]1) therapy (unless contraindicated), and patients with known human epidermal growth factor receptor 2 (HER2) overexpression must have received prior HER2-targeted therapy. Patients are not preselected based on tumor LIV-1 expression. Tumor samples will be analyzed for correlation between LIV-1 expression and tumor response. Safety and efficacy will be monitored throughout the study. Study objectives include objective response rate (primary); safety and tolerability, disease control rate, duration of response, progression-free and overall survival, and pharmacokinetics and immunogenicity (all secondary); and pharmacodynamics. Study accrual is ongoing in the USA, Italy, South Korea, Taiwan, Australia, and the UK. Clinical trial information: NCT04032704.
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Affiliation(s)
| | | | | | | | - Do-Youn Oh
- Seoul National University Hospital, Seoul, South Korea
| | | | - Jong-Seok Lee
- Seoul National University Bundang Hospital, Seongnam-Si, South Korea
| | - Chia-Chi Lin
- National Taiwan University Hospital, Taipei, Taiwan
| | | | - Byoung Yong Shim
- St. Vincent's Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Wu-Chou Su
- National Cheng Kung University Hospital, Tainan, Taiwan
| | | | | | - Rachel E. Sanborn
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR
| | | | | | - Paul Swiecicki
- University of Michigan Medical School, Department of Internal Medicine, Division of Hematology/Oncology, Ann Arbor, MI
| | | | | | - Jae Yong Cho
- Gangnam Severance Hospital, Yonsei University, Seoul, South Korea
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Diaz Duque AE, Perekhrestenko T, Musteata V, Zodelava M, Guthrie TH, Strack T, Burnett C, Wilson S, Waltzman RJ, Baetz TD, Persky DO. A phase II study of MT-3724, a novel CD20-targeting engineered toxin body, to evaluate safety, pharmacodynamics, and efficacy in subjects with relapsed or refractory diffuse large B-cell lymphoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.tps8074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS8074 Background: Engineered toxin bodies (ETBs) are comprised of a proprietarily engineered form of Shiga-like Toxin A subunit (SLT-A) genetically fused to antibody-like binding domains. ETBs work through novel mechanisms of action and are capable of forcing internalization, self-routing through intracellular compartments to the cytosol, and inducing potent cell-kill via the enzymatic and permanent inactivation of ribosomes. MT-3724 represents a novel ETB modality comprised of an anti-CD20 single-chain variable fragment genetically fused to SLT-A. It is capable of efficient internalization once bound to CD20 and can induce potent direct cell-kill via enzymatic ribosome inactivation. MT-3724 is currently being studied in three ongoing Phase 2 studies for relapsed or refractory diffuse large B-cell lymphoma (r/rDLBCL). Methods: The primary objective of this single-arm, Phase 2 study (NCT02361346) is to determine the efficacy of MT-3724 monotherapy in r/rDLBCL based on overall response rate (ORR), defined as the proportion of subjects with a complete/partial response according to the Lugano criteria, as assessed by independent, central review. Key secondary objectives include safety, progression-free survival, investigator‐assessed ORR, duration of response, overall survival, and pharmacodynamics. Adverse events will be assessed and documented according to Common Terminology Criteria for Adverse Events version 5.0. Key eligibility criteria include adult subjects with histologically confirmed, r/rDLBCL, with ≥2 prior standard of care systemic NHL treatment regimens, and ≥1 measurable lesion. As rituximab and other CD20-targeting antibodies compete with MT-3724 for the same CD20 domain, minimum washout periods from these agents must be observed. Subjects remain eligible post stem cell transplant or chimeric antigen receptor T-cell therapy. Subjects will receive 50 µg/kg MT-3724 IV over 1 hour on Days 1, 3, 5, 8, 10 and 12 of a 21-day treatment cycle. The anticipated sample size is N = 100. Interim analyses will be performed to confirm minimum efficacy thresholds based on the encouraging data observed in the completed phase 1 portion of the study [Hamlin et al. Blood 2019;134(Suppl 1):4098]. Multiple global sites are enrolling subjects. Clinical trial information: NCT02361346 .
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Affiliation(s)
| | - Tetiana Perekhrestenko
- Medical Center Named by Academician Yuriy Spizhenko (ARENSIA Exploratory Medicine Unit), Kyiv, Ukraine
| | - Vasile Musteata
- Institute of Oncology, ARENSIA Exploratory Medicine Unit, Chisinau, Moldova, The Republic of
| | | | | | | | | | | | | | - Tara D. Baetz
- Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, ON, Canada
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Ataga KI, Kutlar A, Kanter J, Liles D, Cancado R, Friedrisch J, Guthrie TH, Knight-Madden J, Alvarez OA, Gordeuk VR, Gualandro S, Colella MP, Smith WR, Rollins SA, Stocker JW, Rother RP. Crizanlizumab for the Prevention of Pain Crises in Sickle Cell Disease. N Engl J Med 2017; 376:429-439. [PMID: 27959701 PMCID: PMC5481200 DOI: 10.1056/nejmoa1611770] [Citation(s) in RCA: 508] [Impact Index Per Article: 72.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The up-regulation of P-selectin in endothelial cells and platelets contributes to the cell-cell interactions that are involved in the pathogenesis of vaso-occlusion and sickle cell-related pain crises. The safety and efficacy of crizanlizumab, an antibody against the adhesion molecule P-selectin, were evaluated in patients with sickle cell disease. METHODS In this double-blind, randomized, placebo-controlled, phase 2 trial, we assigned patients to receive low-dose crizanlizumab (2.5 mg per kilogram of body weight), high-dose crizanlizumab (5.0 mg per kilogram), or placebo, administered intravenously 14 times over a period of 52 weeks. Patients who were receiving concomitant hydroxyurea as well as those not receiving hydroxyurea were included in the study. The primary end point was the annual rate of sickle cell-related pain crises with high-dose crizanlizumab versus placebo. The annual rate of days hospitalized, the times to first and second crises, annual rates of uncomplicated crises (defined as crises other than the acute chest syndrome, hepatic sequestration, splenic sequestration, or priapism) and the acute chest syndrome, and patient-reported outcomes were also assessed. RESULTS A total of 198 patients underwent randomization at 60 sites. The median rate of crises per year was 1.63 with high-dose crizanlizumab versus 2.98 with placebo (indicating a 45.3% lower rate with high-dose crizanlizumab, P=0.01). The median time to the first crisis was significantly longer with high-dose crizanlizumab than with placebo (4.07 vs. 1.38 months, P=0.001), as was the median time to the second crisis (10.32 vs. 5.09 months, P=0.02). The median rate of uncomplicated crises per year was 1.08 with high-dose crizanlizumab, as compared with 2.91 with placebo (indicating a 62.9% lower rate with high-dose crizanlizumab, P=0.02). Adverse events that occurred in 10% or more of the patients in either active-treatment group and at a frequency that was at least twice as high as that in the placebo group were arthralgia, diarrhea, pruritus, vomiting, and chest pain. CONCLUSIONS In patients with sickle cell disease, crizanlizumab therapy resulted in a significantly lower rate of sickle cell-related pain crises than placebo and was associated with a low incidence of adverse events. (Funded by Selexys Pharmaceuticals and others; SUSTAIN ClinicalTrials.gov number, NCT01895361 .).
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Affiliation(s)
- Kenneth I Ataga
- From the Division of Hematology-Oncology, University of North Carolina, Chapel Hill (K.I.A.), and the Division of Hematology-Oncology, East Carolina University, Greenville (D.L.) - both in North Carolina; the Sickle Cell Center, Medical College of Georgia, Augusta University, Augusta (A.K.); the Division of Pediatrics, Medical University of South Carolina, Charleston (J.K.); the Department of Hematology-Oncology, Santa Casa Medical School of São Paulo (R.C.), and the Division of Hematology, University of São Paulo (S.G.), São Paulo, the Hematology and Bone Marrow Transplantation Service, Hospital de Clínicas de Porto Alegre, Porto Alegre (J.F.), and the Hematology and Hemotherapy Center, University of Campinas, Campinas (M.P.C.) - all in Brazil; the Baptist Cancer Institute, Baptist Medical Center, Jacksonville, FL (T.H.G.); the Sickle Cell Unit, University of the West Indies, Mona, Jamaica (J.K.-M.); the Division of Pediatric Hematology-Oncology, University of Miami, Miami (O.A.A.); the Department of Medicine, University of Illinois at Chicago, Chicago (V.R.G.); the Division of General Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (W.R.S.); and Selexys Pharmaceuticals, Oklahoma City (S.A.R., J.W.S., R.P.R.)
| | - Abdullah Kutlar
- From the Division of Hematology-Oncology, University of North Carolina, Chapel Hill (K.I.A.), and the Division of Hematology-Oncology, East Carolina University, Greenville (D.L.) - both in North Carolina; the Sickle Cell Center, Medical College of Georgia, Augusta University, Augusta (A.K.); the Division of Pediatrics, Medical University of South Carolina, Charleston (J.K.); the Department of Hematology-Oncology, Santa Casa Medical School of São Paulo (R.C.), and the Division of Hematology, University of São Paulo (S.G.), São Paulo, the Hematology and Bone Marrow Transplantation Service, Hospital de Clínicas de Porto Alegre, Porto Alegre (J.F.), and the Hematology and Hemotherapy Center, University of Campinas, Campinas (M.P.C.) - all in Brazil; the Baptist Cancer Institute, Baptist Medical Center, Jacksonville, FL (T.H.G.); the Sickle Cell Unit, University of the West Indies, Mona, Jamaica (J.K.-M.); the Division of Pediatric Hematology-Oncology, University of Miami, Miami (O.A.A.); the Department of Medicine, University of Illinois at Chicago, Chicago (V.R.G.); the Division of General Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (W.R.S.); and Selexys Pharmaceuticals, Oklahoma City (S.A.R., J.W.S., R.P.R.)
| | - Julie Kanter
- From the Division of Hematology-Oncology, University of North Carolina, Chapel Hill (K.I.A.), and the Division of Hematology-Oncology, East Carolina University, Greenville (D.L.) - both in North Carolina; the Sickle Cell Center, Medical College of Georgia, Augusta University, Augusta (A.K.); the Division of Pediatrics, Medical University of South Carolina, Charleston (J.K.); the Department of Hematology-Oncology, Santa Casa Medical School of São Paulo (R.C.), and the Division of Hematology, University of São Paulo (S.G.), São Paulo, the Hematology and Bone Marrow Transplantation Service, Hospital de Clínicas de Porto Alegre, Porto Alegre (J.F.), and the Hematology and Hemotherapy Center, University of Campinas, Campinas (M.P.C.) - all in Brazil; the Baptist Cancer Institute, Baptist Medical Center, Jacksonville, FL (T.H.G.); the Sickle Cell Unit, University of the West Indies, Mona, Jamaica (J.K.-M.); the Division of Pediatric Hematology-Oncology, University of Miami, Miami (O.A.A.); the Department of Medicine, University of Illinois at Chicago, Chicago (V.R.G.); the Division of General Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (W.R.S.); and Selexys Pharmaceuticals, Oklahoma City (S.A.R., J.W.S., R.P.R.)
| | - Darla Liles
- From the Division of Hematology-Oncology, University of North Carolina, Chapel Hill (K.I.A.), and the Division of Hematology-Oncology, East Carolina University, Greenville (D.L.) - both in North Carolina; the Sickle Cell Center, Medical College of Georgia, Augusta University, Augusta (A.K.); the Division of Pediatrics, Medical University of South Carolina, Charleston (J.K.); the Department of Hematology-Oncology, Santa Casa Medical School of São Paulo (R.C.), and the Division of Hematology, University of São Paulo (S.G.), São Paulo, the Hematology and Bone Marrow Transplantation Service, Hospital de Clínicas de Porto Alegre, Porto Alegre (J.F.), and the Hematology and Hemotherapy Center, University of Campinas, Campinas (M.P.C.) - all in Brazil; the Baptist Cancer Institute, Baptist Medical Center, Jacksonville, FL (T.H.G.); the Sickle Cell Unit, University of the West Indies, Mona, Jamaica (J.K.-M.); the Division of Pediatric Hematology-Oncology, University of Miami, Miami (O.A.A.); the Department of Medicine, University of Illinois at Chicago, Chicago (V.R.G.); the Division of General Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (W.R.S.); and Selexys Pharmaceuticals, Oklahoma City (S.A.R., J.W.S., R.P.R.)
| | - Rodolfo Cancado
- From the Division of Hematology-Oncology, University of North Carolina, Chapel Hill (K.I.A.), and the Division of Hematology-Oncology, East Carolina University, Greenville (D.L.) - both in North Carolina; the Sickle Cell Center, Medical College of Georgia, Augusta University, Augusta (A.K.); the Division of Pediatrics, Medical University of South Carolina, Charleston (J.K.); the Department of Hematology-Oncology, Santa Casa Medical School of São Paulo (R.C.), and the Division of Hematology, University of São Paulo (S.G.), São Paulo, the Hematology and Bone Marrow Transplantation Service, Hospital de Clínicas de Porto Alegre, Porto Alegre (J.F.), and the Hematology and Hemotherapy Center, University of Campinas, Campinas (M.P.C.) - all in Brazil; the Baptist Cancer Institute, Baptist Medical Center, Jacksonville, FL (T.H.G.); the Sickle Cell Unit, University of the West Indies, Mona, Jamaica (J.K.-M.); the Division of Pediatric Hematology-Oncology, University of Miami, Miami (O.A.A.); the Department of Medicine, University of Illinois at Chicago, Chicago (V.R.G.); the Division of General Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (W.R.S.); and Selexys Pharmaceuticals, Oklahoma City (S.A.R., J.W.S., R.P.R.)
| | - João Friedrisch
- From the Division of Hematology-Oncology, University of North Carolina, Chapel Hill (K.I.A.), and the Division of Hematology-Oncology, East Carolina University, Greenville (D.L.) - both in North Carolina; the Sickle Cell Center, Medical College of Georgia, Augusta University, Augusta (A.K.); the Division of Pediatrics, Medical University of South Carolina, Charleston (J.K.); the Department of Hematology-Oncology, Santa Casa Medical School of São Paulo (R.C.), and the Division of Hematology, University of São Paulo (S.G.), São Paulo, the Hematology and Bone Marrow Transplantation Service, Hospital de Clínicas de Porto Alegre, Porto Alegre (J.F.), and the Hematology and Hemotherapy Center, University of Campinas, Campinas (M.P.C.) - all in Brazil; the Baptist Cancer Institute, Baptist Medical Center, Jacksonville, FL (T.H.G.); the Sickle Cell Unit, University of the West Indies, Mona, Jamaica (J.K.-M.); the Division of Pediatric Hematology-Oncology, University of Miami, Miami (O.A.A.); the Department of Medicine, University of Illinois at Chicago, Chicago (V.R.G.); the Division of General Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (W.R.S.); and Selexys Pharmaceuticals, Oklahoma City (S.A.R., J.W.S., R.P.R.)
| | - Troy H Guthrie
- From the Division of Hematology-Oncology, University of North Carolina, Chapel Hill (K.I.A.), and the Division of Hematology-Oncology, East Carolina University, Greenville (D.L.) - both in North Carolina; the Sickle Cell Center, Medical College of Georgia, Augusta University, Augusta (A.K.); the Division of Pediatrics, Medical University of South Carolina, Charleston (J.K.); the Department of Hematology-Oncology, Santa Casa Medical School of São Paulo (R.C.), and the Division of Hematology, University of São Paulo (S.G.), São Paulo, the Hematology and Bone Marrow Transplantation Service, Hospital de Clínicas de Porto Alegre, Porto Alegre (J.F.), and the Hematology and Hemotherapy Center, University of Campinas, Campinas (M.P.C.) - all in Brazil; the Baptist Cancer Institute, Baptist Medical Center, Jacksonville, FL (T.H.G.); the Sickle Cell Unit, University of the West Indies, Mona, Jamaica (J.K.-M.); the Division of Pediatric Hematology-Oncology, University of Miami, Miami (O.A.A.); the Department of Medicine, University of Illinois at Chicago, Chicago (V.R.G.); the Division of General Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (W.R.S.); and Selexys Pharmaceuticals, Oklahoma City (S.A.R., J.W.S., R.P.R.)
| | - Jennifer Knight-Madden
- From the Division of Hematology-Oncology, University of North Carolina, Chapel Hill (K.I.A.), and the Division of Hematology-Oncology, East Carolina University, Greenville (D.L.) - both in North Carolina; the Sickle Cell Center, Medical College of Georgia, Augusta University, Augusta (A.K.); the Division of Pediatrics, Medical University of South Carolina, Charleston (J.K.); the Department of Hematology-Oncology, Santa Casa Medical School of São Paulo (R.C.), and the Division of Hematology, University of São Paulo (S.G.), São Paulo, the Hematology and Bone Marrow Transplantation Service, Hospital de Clínicas de Porto Alegre, Porto Alegre (J.F.), and the Hematology and Hemotherapy Center, University of Campinas, Campinas (M.P.C.) - all in Brazil; the Baptist Cancer Institute, Baptist Medical Center, Jacksonville, FL (T.H.G.); the Sickle Cell Unit, University of the West Indies, Mona, Jamaica (J.K.-M.); the Division of Pediatric Hematology-Oncology, University of Miami, Miami (O.A.A.); the Department of Medicine, University of Illinois at Chicago, Chicago (V.R.G.); the Division of General Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (W.R.S.); and Selexys Pharmaceuticals, Oklahoma City (S.A.R., J.W.S., R.P.R.)
| | - Ofelia A Alvarez
- From the Division of Hematology-Oncology, University of North Carolina, Chapel Hill (K.I.A.), and the Division of Hematology-Oncology, East Carolina University, Greenville (D.L.) - both in North Carolina; the Sickle Cell Center, Medical College of Georgia, Augusta University, Augusta (A.K.); the Division of Pediatrics, Medical University of South Carolina, Charleston (J.K.); the Department of Hematology-Oncology, Santa Casa Medical School of São Paulo (R.C.), and the Division of Hematology, University of São Paulo (S.G.), São Paulo, the Hematology and Bone Marrow Transplantation Service, Hospital de Clínicas de Porto Alegre, Porto Alegre (J.F.), and the Hematology and Hemotherapy Center, University of Campinas, Campinas (M.P.C.) - all in Brazil; the Baptist Cancer Institute, Baptist Medical Center, Jacksonville, FL (T.H.G.); the Sickle Cell Unit, University of the West Indies, Mona, Jamaica (J.K.-M.); the Division of Pediatric Hematology-Oncology, University of Miami, Miami (O.A.A.); the Department of Medicine, University of Illinois at Chicago, Chicago (V.R.G.); the Division of General Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (W.R.S.); and Selexys Pharmaceuticals, Oklahoma City (S.A.R., J.W.S., R.P.R.)
| | - Victor R Gordeuk
- From the Division of Hematology-Oncology, University of North Carolina, Chapel Hill (K.I.A.), and the Division of Hematology-Oncology, East Carolina University, Greenville (D.L.) - both in North Carolina; the Sickle Cell Center, Medical College of Georgia, Augusta University, Augusta (A.K.); the Division of Pediatrics, Medical University of South Carolina, Charleston (J.K.); the Department of Hematology-Oncology, Santa Casa Medical School of São Paulo (R.C.), and the Division of Hematology, University of São Paulo (S.G.), São Paulo, the Hematology and Bone Marrow Transplantation Service, Hospital de Clínicas de Porto Alegre, Porto Alegre (J.F.), and the Hematology and Hemotherapy Center, University of Campinas, Campinas (M.P.C.) - all in Brazil; the Baptist Cancer Institute, Baptist Medical Center, Jacksonville, FL (T.H.G.); the Sickle Cell Unit, University of the West Indies, Mona, Jamaica (J.K.-M.); the Division of Pediatric Hematology-Oncology, University of Miami, Miami (O.A.A.); the Department of Medicine, University of Illinois at Chicago, Chicago (V.R.G.); the Division of General Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (W.R.S.); and Selexys Pharmaceuticals, Oklahoma City (S.A.R., J.W.S., R.P.R.)
| | - Sandra Gualandro
- From the Division of Hematology-Oncology, University of North Carolina, Chapel Hill (K.I.A.), and the Division of Hematology-Oncology, East Carolina University, Greenville (D.L.) - both in North Carolina; the Sickle Cell Center, Medical College of Georgia, Augusta University, Augusta (A.K.); the Division of Pediatrics, Medical University of South Carolina, Charleston (J.K.); the Department of Hematology-Oncology, Santa Casa Medical School of São Paulo (R.C.), and the Division of Hematology, University of São Paulo (S.G.), São Paulo, the Hematology and Bone Marrow Transplantation Service, Hospital de Clínicas de Porto Alegre, Porto Alegre (J.F.), and the Hematology and Hemotherapy Center, University of Campinas, Campinas (M.P.C.) - all in Brazil; the Baptist Cancer Institute, Baptist Medical Center, Jacksonville, FL (T.H.G.); the Sickle Cell Unit, University of the West Indies, Mona, Jamaica (J.K.-M.); the Division of Pediatric Hematology-Oncology, University of Miami, Miami (O.A.A.); the Department of Medicine, University of Illinois at Chicago, Chicago (V.R.G.); the Division of General Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (W.R.S.); and Selexys Pharmaceuticals, Oklahoma City (S.A.R., J.W.S., R.P.R.)
| | - Marina P Colella
- From the Division of Hematology-Oncology, University of North Carolina, Chapel Hill (K.I.A.), and the Division of Hematology-Oncology, East Carolina University, Greenville (D.L.) - both in North Carolina; the Sickle Cell Center, Medical College of Georgia, Augusta University, Augusta (A.K.); the Division of Pediatrics, Medical University of South Carolina, Charleston (J.K.); the Department of Hematology-Oncology, Santa Casa Medical School of São Paulo (R.C.), and the Division of Hematology, University of São Paulo (S.G.), São Paulo, the Hematology and Bone Marrow Transplantation Service, Hospital de Clínicas de Porto Alegre, Porto Alegre (J.F.), and the Hematology and Hemotherapy Center, University of Campinas, Campinas (M.P.C.) - all in Brazil; the Baptist Cancer Institute, Baptist Medical Center, Jacksonville, FL (T.H.G.); the Sickle Cell Unit, University of the West Indies, Mona, Jamaica (J.K.-M.); the Division of Pediatric Hematology-Oncology, University of Miami, Miami (O.A.A.); the Department of Medicine, University of Illinois at Chicago, Chicago (V.R.G.); the Division of General Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (W.R.S.); and Selexys Pharmaceuticals, Oklahoma City (S.A.R., J.W.S., R.P.R.)
| | - Wally R Smith
- From the Division of Hematology-Oncology, University of North Carolina, Chapel Hill (K.I.A.), and the Division of Hematology-Oncology, East Carolina University, Greenville (D.L.) - both in North Carolina; the Sickle Cell Center, Medical College of Georgia, Augusta University, Augusta (A.K.); the Division of Pediatrics, Medical University of South Carolina, Charleston (J.K.); the Department of Hematology-Oncology, Santa Casa Medical School of São Paulo (R.C.), and the Division of Hematology, University of São Paulo (S.G.), São Paulo, the Hematology and Bone Marrow Transplantation Service, Hospital de Clínicas de Porto Alegre, Porto Alegre (J.F.), and the Hematology and Hemotherapy Center, University of Campinas, Campinas (M.P.C.) - all in Brazil; the Baptist Cancer Institute, Baptist Medical Center, Jacksonville, FL (T.H.G.); the Sickle Cell Unit, University of the West Indies, Mona, Jamaica (J.K.-M.); the Division of Pediatric Hematology-Oncology, University of Miami, Miami (O.A.A.); the Department of Medicine, University of Illinois at Chicago, Chicago (V.R.G.); the Division of General Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (W.R.S.); and Selexys Pharmaceuticals, Oklahoma City (S.A.R., J.W.S., R.P.R.)
| | - Scott A Rollins
- From the Division of Hematology-Oncology, University of North Carolina, Chapel Hill (K.I.A.), and the Division of Hematology-Oncology, East Carolina University, Greenville (D.L.) - both in North Carolina; the Sickle Cell Center, Medical College of Georgia, Augusta University, Augusta (A.K.); the Division of Pediatrics, Medical University of South Carolina, Charleston (J.K.); the Department of Hematology-Oncology, Santa Casa Medical School of São Paulo (R.C.), and the Division of Hematology, University of São Paulo (S.G.), São Paulo, the Hematology and Bone Marrow Transplantation Service, Hospital de Clínicas de Porto Alegre, Porto Alegre (J.F.), and the Hematology and Hemotherapy Center, University of Campinas, Campinas (M.P.C.) - all in Brazil; the Baptist Cancer Institute, Baptist Medical Center, Jacksonville, FL (T.H.G.); the Sickle Cell Unit, University of the West Indies, Mona, Jamaica (J.K.-M.); the Division of Pediatric Hematology-Oncology, University of Miami, Miami (O.A.A.); the Department of Medicine, University of Illinois at Chicago, Chicago (V.R.G.); the Division of General Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (W.R.S.); and Selexys Pharmaceuticals, Oklahoma City (S.A.R., J.W.S., R.P.R.)
| | - Jonathan W Stocker
- From the Division of Hematology-Oncology, University of North Carolina, Chapel Hill (K.I.A.), and the Division of Hematology-Oncology, East Carolina University, Greenville (D.L.) - both in North Carolina; the Sickle Cell Center, Medical College of Georgia, Augusta University, Augusta (A.K.); the Division of Pediatrics, Medical University of South Carolina, Charleston (J.K.); the Department of Hematology-Oncology, Santa Casa Medical School of São Paulo (R.C.), and the Division of Hematology, University of São Paulo (S.G.), São Paulo, the Hematology and Bone Marrow Transplantation Service, Hospital de Clínicas de Porto Alegre, Porto Alegre (J.F.), and the Hematology and Hemotherapy Center, University of Campinas, Campinas (M.P.C.) - all in Brazil; the Baptist Cancer Institute, Baptist Medical Center, Jacksonville, FL (T.H.G.); the Sickle Cell Unit, University of the West Indies, Mona, Jamaica (J.K.-M.); the Division of Pediatric Hematology-Oncology, University of Miami, Miami (O.A.A.); the Department of Medicine, University of Illinois at Chicago, Chicago (V.R.G.); the Division of General Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (W.R.S.); and Selexys Pharmaceuticals, Oklahoma City (S.A.R., J.W.S., R.P.R.)
| | - Russell P Rother
- From the Division of Hematology-Oncology, University of North Carolina, Chapel Hill (K.I.A.), and the Division of Hematology-Oncology, East Carolina University, Greenville (D.L.) - both in North Carolina; the Sickle Cell Center, Medical College of Georgia, Augusta University, Augusta (A.K.); the Division of Pediatrics, Medical University of South Carolina, Charleston (J.K.); the Department of Hematology-Oncology, Santa Casa Medical School of São Paulo (R.C.), and the Division of Hematology, University of São Paulo (S.G.), São Paulo, the Hematology and Bone Marrow Transplantation Service, Hospital de Clínicas de Porto Alegre, Porto Alegre (J.F.), and the Hematology and Hemotherapy Center, University of Campinas, Campinas (M.P.C.) - all in Brazil; the Baptist Cancer Institute, Baptist Medical Center, Jacksonville, FL (T.H.G.); the Sickle Cell Unit, University of the West Indies, Mona, Jamaica (J.K.-M.); the Division of Pediatric Hematology-Oncology, University of Miami, Miami (O.A.A.); the Department of Medicine, University of Illinois at Chicago, Chicago (V.R.G.); the Division of General Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (W.R.S.); and Selexys Pharmaceuticals, Oklahoma City (S.A.R., J.W.S., R.P.R.)
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6
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Amin A, Lawson DH, Salama AK, Koon HB, Guthrie TH, Thomas SS, O'Day S, Shaheen MF, Zhang B, Francis S, Hodi FS. A single-arm, open-label, phase II study to evaluate the safety of vemurafenib (VEM) followed by ipilimumab (IPI) in BRAF V600-mutated metastatic melanoma (MM). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Asim Amin
- Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC
| | | | | | - Henry B. Koon
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
| | | | | | - Steven O'Day
- Los Angeles Skin Cancer Institute at Beverly Hills Cancer Center, Beverly Hills, CA
| | | | - Bin Zhang
- Bristol-Myers Squibb, Wallingford, NJ
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7
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Yardley DA, Melisko ME, Forero A, Daniel BR, Montero AJ, Guthrie TH, Canfield VA, Oakman CA, Chew HK, Ferrario C, Volas-Redd GH, Young RR, Henry NL, Aneiro L, He Y, Turner CD, Davis TA, Vahdat LT. METRIC: A randomized international study of the antibody-drug conjugate glembatumumab vedotin (GV or CDX-011) in patients (pts) with metastatic gpNMB-overexpressing triple-negative breast cancer (TNBC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.tps1110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Denise A. Yardley
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN
| | - Michelle E. Melisko
- UC San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | | | | | | | | | | | | | | | | | - Gena H. Volas-Redd
- Georgia Cancer Specialists affiliated with Northside Hospital Cancer Institute, Atlanta, GA
| | | | - Norah Lynn Henry
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | | | - Yi He
- Celldex Therapeutics, Inc., Hampton, NJ
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8
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Yardley DA, Richards PD, Reeves JA, Dees EC, Osborne CRC, Soliman HH, Paul D, Ademuyiwa FO, Guthrie TH, Bromund JL, Xu Y, Ibrahim AB. Final results of a phase 2 study of ramucirumab (RAM) plus eribulin (E) versus E in advanced metastatic breast cancer (MBC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.1035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Denise A. Yardley
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN
| | - Paul D. Richards
- Oncology and Hematology Associates of Southwest Virginia, Salem, VA
| | | | | | | | | | | | | | | | | | - Yihuan Xu
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly & Co, Bridgewater, NJ
| | - Ayman B. Ibrahim
- ImClone Systems Corporation, a wholly owned subsidiary of Eli Lilly and Company, Bridgewater, NJ
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9
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Hodi FS, Amin A, Saenger YM, Pennock GK, Guthrie TH, Salama AK, Flaherty LE, Koon HB, Lawson DH, Shaheen MF, Balogh A, Konto C, O'Day S. CA184-240: A single-arm, open-label phase II study of vemurafenib followed by ipilimumab in patients with BRAF V600-mutated advanced melanoma (AM). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.tps9103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS9103 Background: Ipilimumab (Ipi), a fully human monoclonal antibody that binds to cytotoxic T-lymphocyte antigen-4 expressed on T cells, and vemurafenib (Vem), a small molecule inhibitor of BRAF V600-mutated kinase, are both approved treatments for AM. Ipi has shown improved overall survival (OS) in two randomized phase III trials of patients with previously treated (3 mg/kg monotherapy) and previously untreated (10 mg/kg plus dacarbazine) AM. Vem has shown improved OS in a randomized phase III trial of patients that harbor the BRAF V600E mutation. The most common drug-related adverse events (AEs) with Ipi monotherapy were immune-related GI tract and skin toxicities, which were generally manageable using treatment guidelines. The most common AEs with Vem were arthralgia, rash, and fatigue. Vem can induce rapid and substantial responses, and resistance mechanisms are a focus of current investigation. This study will evaluate the safety of Vem lead-in followed by Ipi (prior to resistance) in patients with BRAF V600-mutated AM. Methods: An estimated 45 patients will be enrolled. Eligible patients include those ≥18 years old with previously untreated AM, a BRAF V600 mutation, and an ECOG PS of 0 or 1. Major exclusion criteria are primary ocular melanoma, active brain metastases, and autoimmune disease. Patients will initially receive Vem for 6 weeks (960 mg twice daily). After a washout period of 3-10 days (per protocol), patients will be initiated on Ipi at 10 mg/kg (every 3 wk for 4 doses, then once every 12 wk beginning at week 24, until disease progression or unacceptable toxicity). Vem will be restarted at the time of disease progression on Ipi (no minimum time to restart) or unacceptable toxicity on Ipi (restart minimum of 1 mo after the last dose of Ipi). Vem will be restarted at the last dose level tolerated at the end of the lead-in phase. Patients will be followed every 12 weeks for toxicity and/or disease progression, and subsequently will be followed every 12 weeks for survival. The objectives of this study are to estimate the incidence of grade 3-4 drug-related AEs. Exploratory objectives include the evaluation of efficacy (OS). Clinical trial information: NCT01673854.
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Affiliation(s)
| | - Asim Amin
- Levine Cancer Institute, Charlotte, NC
| | | | | | | | | | | | | | | | | | | | | | - Steven O'Day
- The Beverly Hills Cancer Center, Beverly Hills, CA
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10
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Pullarkat VA, Gernsheimer TB, Wasser JS, Newland A, Guthrie TH, de Wolf JTM, Stewart R, Berger D. Quantifying the reduction in immunoglobulin use over time in patients with chronic immune thrombocytopenic purpura receiving romiplostim (AMG 531). Am J Hematol 2009; 84:538-40. [PMID: 19569197 DOI: 10.1002/ajh.21463] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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11
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Garg P, Rana F, Gupta R, Buzaianu EM, Guthrie TH. Predictors of toxicity and toxicity profile of adjuvant chemotherapy in elderly breast cancer patients. Breast J 2009; 15:404-8. [PMID: 19508671 DOI: 10.1111/j.1524-4741.2009.00745.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Women older than 70 years have been underrepresented in breast cancer adjuvant chemotherapy trials due to concerns about toxicity, safety and tolerance of chemotherapy. The aim of our study was to assess the tolerance of chemotherapy in older women with breast cancer and determine patterns of toxicity including the impact of age, chemotherapy regimen, functional status and comorbid conditions on this toxicity. We retrospectively reviewed the charts of early stage (stages 1 and 2) breast cancer patients older than 70 years from 1998 to 2004. A total of 62 patients, with mean age of 74.3 years, were identified. Chemotherapy was completed in 89% patients. Overall 79% completed chemotherapy without any significant side-effects, dose reductions, or breaks during chemotherapy. Using logistic regression model increasing age was not associated with early termination of chemotherapy (p = 0.19, OR: 0.868, 95% CI: 0.7-1.076). However, increasing age, lower functional status, and higher comorbidity index scores were associated with reduction in dose and breaks in chemotherapy. None of the patients who received pegfilgrastim prophylactically developed high-grade neutropenia. Our study suggests that adjuvant chemotherapy is safe in elderly patients. Older patients with good functional status and low comorbidity index scores tolerate chemotherapy as well as the younger patients. Prophylactic use of pegfilgrastim may reduce occurrence of severe neutropenia and related toxicity such as febrile neutropenia in the elderly patient.
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Affiliation(s)
- Praveen Garg
- Department of Medicine, Division of Hematology-Oncology, University of Florida, Jacksonville, Florida 32207, USA.
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12
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Pham DC, Guthrie TH, Villas BH, Salazar E. Refractory idiopathic pure red cell aplasia complicated by immune thrombocytopenia successfully treated with subcutaneous alemtuzumab. Am J Hematol 2008; 83:603. [PMID: 18273896 DOI: 10.1002/ajh.21155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
MESH Headings
- Alemtuzumab
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/administration & dosage
- Antibodies, Neoplasm/immunology
- Antibodies, Neoplasm/therapeutic use
- Hemoglobins/metabolism
- Humans
- Immunotherapy
- Injections, Subcutaneous
- Male
- Red-Cell Aplasia, Pure/blood
- Red-Cell Aplasia, Pure/complications
- Red-Cell Aplasia, Pure/drug therapy
- Red-Cell Aplasia, Pure/immunology
- Thrombocytopenia/blood
- Thrombocytopenia/complications
- Thrombocytopenia/drug therapy
- Thrombocytopenia/immunology
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13
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Kuter DJ, Bussel JB, Lyons RM, Pullarkat V, Gernsheimer TB, Senecal FM, Aledort LM, George JN, Kessler CM, Sanz MA, Liebman HA, Slovick FT, de Wolf JTM, Bourgeois E, Guthrie TH, Newland A, Wasser JS, Hamburg SI, Grande C, Lefrère F, Lichtin AE, Tarantino MD, Terebelo HR, Viallard JF, Cuevas FJ, Go RS, Henry DH, Redner RL, Rice L, Schipperus MR, Guo DM, Nichol JL. Efficacy of romiplostim in patients with chronic immune thrombocytopenic purpura: a double-blind randomised controlled trial. Lancet 2008; 371:395-403. [PMID: 18242413 DOI: 10.1016/s0140-6736(08)60203-2] [Citation(s) in RCA: 597] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Chronic immune thrombocytopenic purpura (ITP) is characterised by accelerated platelet destruction and decreased platelet production. Short-term administration of the thrombopoiesis-stimulating protein, romiplostim, has been shown to increase platelet counts in most patients with chronic ITP. We assessed the long-term administration of romiplostim in splenectomised and non-splenectomised patients with ITP. METHODS In two parallel trials, 63 splenectomised and 62 non-splenectomised patients with ITP and a mean of three platelet counts 30x10(9)/L or less were randomly assigned 2:1 to subcutaneous injections of romiplostim (n=42 in splenectomised study and n=41 in non-splenectomised study) or placebo (n=21 in both studies) every week for 24 weeks. Doses of study drug were adjusted to maintain platelet counts of 50x10(9)/L to 200x10(9)/L. The primary objectives were to assess the efficacy of romiplostim as measured by a durable platelet response (platelet count > or =50x10(9)/L during 6 or more of the last 8 weeks of treatment) and treatment safety. Analysis was per protocol. These studies are registered with ClinicalTrials.gov, numbers NCT00102323 and NCT00102336. FINDINGS A durable platelet response was achieved by 16 of 42 splenectomised patients given romplostim versus none of 21 given placebo (difference in proportion of patients responding 38% [95% CI 23.4-52.8], p=0.0013), and by 25 of 41 non-splenectomised patients given romplostim versus one of 21 given placebo (56% [38.7-73.7], p<0.0001). The overall platelet response rate (either durable or transient platelet response) was noted in 88% (36/41) of non-splenectomised and 79% (33/42) of splenectomised patients given romiplostim compared with 14% (three of 21) of non-splenectomised and no splenectomised patients given placebo (p<0.0001). Patients given romiplostim achieved platelet counts of 50x10(9)/L or more on a mean of 13.8 (SE 0.9) weeks (mean 12.3 [1.2] weeks in splenectomised group vs 15.2 [1.2] weeks in non-splenectomised group) compared with 0.8 (0.4) weeks for those given placebo (0.2 [0.1] weeks vs 1.3 [0.8] weeks). 87% (20/23) of patients given romiplostim (12/12 splenectomised and eight of 11 non-splenectomised patients) reduced or discontinued concurrent therapy compared with 38% (six of 16) of those given placebo (one of six splenectomised and five of ten non-splenectomised patients). Adverse events were much the same in patients given romiplostim and placebo. No antibodies against romiplostim or thrombopoietin were detected. INTERPRETATION Romiplostim was well tolerated, and increased and maintained platelet counts in splenectomised and non-splenectomised patients with ITP. Many patients were able to reduce or discontinue other ITP medications. Stimulation of platelet production by romiplostim may provide a new therapeutic option for patients with ITP.
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Affiliation(s)
- David J Kuter
- Massachusetts General Hospital, Boston, MA 02114, USA.
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14
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Redfern CH, Guthrie TH, Bessudo A, Densmore JJ, Holman PR, Janakiraman N, Leonard JP, Levy RL, Just RG, Smith MR, Rosenfelt FP, Wiernik PH, Carter WD, Gold DP, Melink TJ, Gutheil JC, Bender JF. Phase II trial of idiotype vaccination in previously treated patients with indolent non-Hodgkin's lymphoma resulting in durable clinical responses. J Clin Oncol 2006; 24:3107-12. [PMID: 16754937 DOI: 10.1200/jco.2005.04.4289] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate idiotype (Id) vaccination as a single agent in previously treated patients with indolent non-Hodgkin's lymphoma. PATIENTS AND METHODS Patients underwent biopsy for determination of their lymphoma-specific Id sequence. Recombinant Id protein was manufactured and covalently linked with keyhole limpet hemocyanin (KLH) to generate Id/KLH. Patients received Id/KLH 1 mg on day 1 subcutaneously, with granulocyte-macrophage colony-stimulating factor 250 mug on days 1 to 4, monthly for 6 months. Booster injections were administered until progression. Both clinical and immune responses were evaluated. RESULTS Thirty-two previously treated patients received at least one injection of Id/KLH, and 31 were assessed for efficacy. Responses were observed in four patients (one complete response and three partial responses). Median time to onset of response was 5.9 months (range, 2.3 to 14.1 months). Median duration of response has not been reached but should be at least 19.4 months (range, 10.4 to 27.2+ months). Median time to progression is 13.5 months. The most common adverse events were mild to moderate injection site reactions. Six (67%) of nine patients tested demonstrated a cellular immune response, and four (20%) of 20 patients demonstrated an antibody response against their Id. CONCLUSION This trial demonstrates that Id/KLH alone can induce tumor regression and durable objective responses. Further study of Id/KLH is recommended in other settings where efficacy may be further enhanced as in first-line therapy or after cytoreductive therapy.
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Abstract
Intramedullary spinal cord metastases (ISCMs) are very rare, but can cause devastating complications from underlying breast cancer. We report the case of a woman with known metastatic breast cancer and progressive neurologic deterioration caused by an ISCM. The epidemiology, pathogenesis, clinical presentation, diagnostic considerations, and therapeutic options are discussed.
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Affiliation(s)
- Augusto E Villegas
- Department of Medicine, Hematology Oncology Division, University of Florida Health Science Center, 653-1 West 8th St., Jacksonville, FL 32209-6511, USA.
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16
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George JN, Raskob GE, Vesely SK, Moore D, Lyons RM, Cobos E, Towell BL, Klug P, Guthrie TH. Initial management of immune thrombocytopenic purpura in adults: a randomized controlled trial comparing intermittent anti-D with routine care. Am J Hematol 2003; 74:161-9. [PMID: 14587042 DOI: 10.1002/ajh.10424] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [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: 01/01/2023]
Abstract
We conducted a randomized clinical trial in adults with a new diagnosis of ITP and a platelet count <30000/muL to test the hypothesis that initial intermittent treatment with anti-D may avoid or defer the need for splenectomy when compared to current routine care (glucocorticoid treatment, followed by splenectomy). Splenectomy was to be performed in the anti-D group if patients failed to respond to three consecutive anti-D treatments given within 10 days. The incidences of splenectomy were 14 of 37 (38%) in the routine care group and 14 of 33 (42%) in the anti-D group (absolute risk reduction = 4.6% in favor of the routine care group, 95% CI, -18.4 to 27.6%). However, splenectomy was performed prematurely, not according to the protocol, in 11 of 14 patients in the anti-D group. The median time to splenectomy was 36 days (range, 9-78) in the routine care group and 112 days (range, 19-558) in the anti-D group (P = 0.045 at 100 days after randomization, P = 0.840 at 1 year after randomization, using log-rank analysis). Patients in the anti-D group were treated with prednisone for fewer days (70 days) compared to the routine care group (112 days, P = 0.01). No major bleeding events occurred. In this study, initial treatment of patients with intermittent anti-D initially deferred splenectomy. Whether our aggressive regimen of anti-D could have prevented splenectomy if it had been adhered to in all patients remains uncertain. However, compliance with this anti-D regimen was not feasible for many patients and/or their physicians.
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Affiliation(s)
- James N George
- Department of Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73190, USA.
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17
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Abstract
BACKGROUND Although there have been few case series of primary pelvic non-Hodgkin's lymphoma (NHL) reported over the past two decades, no patient with acquired immunodeficiency syndrome (AIDS)-related primary pelvic NHL has been reported. CASE We report a human immunodeficiency virus (HIV)-infected patient with primary cervical NHL. After surgical biopsy, she received standard NHL combination chemotherapy plus standard HIV highly active antiretroviral therapy (HAART), and remains disease free 38 months since therapy. We also report two other cases of primary pelvic NHL. CONCLUSIONS Primary pelvic NHL is rare, with clinical presentation similar to other common gynecologic malignancies. It is treated with combination chemotherapy and pelvic radiotherapy, and generally has good prognosis. Adding HAART to other standard therapies for patients with AIDS-related pelvic lymphoma may improve the prognosis of this category of patients.
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Affiliation(s)
- Dat C Pham
- Division of Hematology Oncology, University of Florida HSC Jacksonville, Jacksonville, FL 32209, USA.
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18
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Swenson CE, Bolcsak LE, Batist G, Guthrie TH, Tkaczuk KH, Boxenbaum H, Welles L, Chow SC, Bhamra R, Chaikin P. Pharmacokinetics of doxorubicin administered i.v. as Myocet (TLC D-99; liposome-encapsulated doxorubicin citrate) compared with conventional doxorubicin when given in combination with cyclophosphamide in patients with metastatic breast cancer. Anticancer Drugs 2003; 14:239-46. [PMID: 12634619 DOI: 10.1097/00001813-200303000-00008] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Myocet (TLC D-99) is a liposomal formulation of the anti-neoplastic drug doxorubicin with an improved therapeutic index compared with conventional doxorubicin. The objective of this study was to assess the plasma disposition of doxorubicin when administered i.v. as TLC D-99 and to compare this to conventional drug. Metabolite (doxorubicinol) plasma levels were also quantitated in both treatment groups. Plasma was collected during the first course of treatment from 10 patients receiving TLC D-99 60 mg/m and 10 receiving conventional doxorubicin 60 mg/m2, each with cyclophosphamide 600 mg/m2. Samples were assayed for total doxorubicin (all doxorubicin regardless of whether it is encapsulated or not), encapsulated doxorubicin (TLC D-99 group only) and doxorubicinol using high-performance liquid chromatography. Plasma concentrations of total doxorubicin were higher in patients receiving TLC D-99 than in patients receiving conventional doxorubicin. The clearance of total doxorubicin after administration of TLC D-99 was lower (approximately 9-fold) and the volume of distribution at steady state was less (25-fold) than that of doxorubicin after conventional drug. Doxorubicinol was detected in the plasma of all patients in both treatment groups. The mean AUC(0-infinity) of doxorubicinol for patients receiving TLC D-99 (1.5+/-0.4 M x h) was not statistically different than that in patients receiving conventional doxorubicin (1.8+/-0.4 M x h), although the appearance of the peak doxorubicinol concentration occurred later and was lower in patients receiving TLC D-99. There was a correlation between the plasma AUC(0-infinity) of total doxorubicin and the degree of myelosuppression in patients receiving conventional doxorubicin, but this correlation was not found in patients receiving TLC D-99.
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19
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Abstract
Cases involving breast cancer are the second most common cause of malpractice litigation. The leading allegation is failure to diagnose, followed by improper treatment. The most common physicians involved are those giving direct care to women: obstetricians/gynecologists, family medicine physicians, and internists. This review addresses frequent areas of litigation, offering practice guidelines for avoidance of malpractice claims. In addition, two new areas of breast cancer management will be reviewed-breast cancer prevention and breast cancer genetic testing-as potential new areas of malpractice litigation.
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Affiliation(s)
- Troy H. Guthrie
- Division of Hematology/Oncology, University of Florida Health Science Center, Jacksonville, Florida
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20
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Abstract
The objective of this study was to assess the effect of protein A immunoabsorption in terms of response rate and toxicities in patients with classical thrombotic thrombocytopenic purpura (TTP) refractory to therapeutic plasma exchange. The study included nine females and one male with a diagnosis of classical TTP treated at multiple university hospital centers with protein A immunoabsorption (PAI) after having failed plasma exchange. The 10 patients had an age range 17-62 years. Prior to PAI, the patients had failed to respond to a mean of 15 (range 6-39) therapeutic plasma exchanges. Three patients had previous episodes of TTP. Evaluation for response to PAI included serial measurements of serum creatinine, lactate dehydrogenase (LDH), hemoglobin, hematocrit, and platelet count before, during, and up to 18 months post-PAI treatment. Seven of 10 study patients had resolution of their TTP. Six of the patients required six or fewer therapeutic PAIs and one required 12 treatments. All responding patients had evidence of improvement by the third PAI treatment. Three patients demonstrated no response to PAI, with two patients expiring from complications of TTP and one patient demonstrating a complete response to a subsequent therapy. No significant toxicity was noted with the use of PAI in this setting. Protein A immunoabsorption in patients with classical TTP refractory to plasma exchange can produce durable complete remissions and warrants comparative studies.
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Affiliation(s)
- T G Gaddis
- Department of Medicine, University of Florida Health Science Center/Jacksonville 32209, USA
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21
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22
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23
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Chang BK, Guthrie TH, Hayakawa K, Gangarosa LP. A pilot study of iontophoretic cisplatin chemotherapy of basal and squamous cell carcinomas of the skin. Arch Dermatol 1993; 129:425-427. [PMID: 8466212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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24
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Snyder HW, Mittelman A, Oral A, Messerschmidt GL, Henry DH, Korec S, Bertram JH, Guthrie TH, Ciavarella D, Wuest D. Treatment of cancer chemotherapy-associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome by protein A immunoadsorption of plasma. Cancer 1993; 71:1882-92. [PMID: 8448753 DOI: 10.1002/1097-0142(19930301)71:5<1882::aid-cncr2820710527>3.0.co;2-e] [Citation(s) in RCA: 90] [Impact Index Per Article: 2.9] [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: 01/30/2023]
Abstract
BACKGROUND Chemotherapy-associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (C-TTP/HUS) is a condition involving thrombocytopenia, microangiopathic hemolytic anemia, and progressive renal dysfunction that develops in 2-10% of patients with a history of malignant neoplasms treated with certain chemotherapeutic agents. Pathogenesis of the disease may depend on the following: (1) generation of endothelial lesions in the kidney microvasculature, resulting from drug toxic effects and/or generation of small soluble circulating immune complexes (CIC), and (2) generation of autoantibodies and/or CIC that trigger aggregation and deposition of platelets around the lesions. METHODS Extracorporeal immunoadsorption treatment of plasma (PROSORBA columns, IMRE Corporation, Seattle, WA) to remove immunoglobulin G and CIC was evaluated in 55 patients for the potential to induce significant clinical benefits (increase in platelet count, decrease in hemolysis, stabilization of renal function) and longer survival. RESULTS Response to therapy was achieved in 25 of 55 patients examined. Response was associated with an estimated 1-year survival rate of 61%, as compared with an estimated survival rate of only 22% in those who did not respond (P = 0.0001). Patients whose malignant neoplasms were in complete or partial remission at the time of development of C-TTP/HUS had a significantly higher estimated 1-year survival rate (74%) as compared with a historic control group of patients receiving other treatments (22%, P = 0.0161). Clinical responses were correlated with normalization of serum levels of CIC and complement components C3c and C4. There were no side effects associated with 75% of treatments. Immunoadsorption therapy was associated with generally mild to moderate manageable side effects, such as fever, chills, nausea/vomiting, respiratory symptoms, pain, hypertension, and hypotension, which were reported in 25% of procedures. CONCLUSIONS This multicenter study establishes protein A immunoadsorption as an effective and safe treatment for cancer chemotherapy-associated TTP/HUS, an otherwise fatal disease.
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Affiliation(s)
- H W Snyder
- IMRE Corporation, Seattle, Washington 98109-4517
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25
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Guthrie TH, Gaddis TG. Geriatric oncology. J Fla Med Assoc 1993; 80:112-116. [PMID: 8455009] [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: 05/22/2023]
Abstract
The rapid increase in persons aged 65 and older will account for 20% of the total United States population by the year 2030. The incidence of malignancy likewise increases with advancing age. These factors are likely to result in an epidemic of geriatric cancer cases. Physicians should become knowledgeable on current issues in geriatric oncology which include: how to appropriately select geriatric patients with malignancies for surgical, medical or radiotherapeutic intervention; age as a bias for treatment selection; toxicities from cancer therapy in the elderly and how they can be modified; cancer screening and prevention measures in the elderly, and the special issues of informed consent and pain control in the geriatric cancer patient.
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Affiliation(s)
- T H Guthrie
- Division of Hematology/Medical Oncology, University of Florida Health Science Center, Jacksonville
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26
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Snyder HW, Cochran SK, Balint JP, Bertram JH, Mittelman A, Guthrie TH, Jones FR. Experience with protein A-immunoadsorption in treatment-resistant adult immune thrombocytopenic purpura. Blood 1992; 79:2237-45. [PMID: 1571540] [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: 12/27/2022] Open
Abstract
Extracorporeal immunoadsorption of plasma to remove IgG and circulating immune complexes (CIC) was evaluated as a therapy for adults with treatment-resistant immune thrombocytopenic purpura (ITP). Seventy-two patients with initial platelet counts less than 50,000/microL who had failed at least two other therapies were studied. They received an average of six treatments of 0.25 to 2.0 L plasma per procedure over a 2- to 3-week period using columns of staphylococcal protein A-silica (PROSORBA immunoadsorption treatment columns; IMRE Corp, Seattle, WA). The treatments caused an acute increase in the platelet count to greater than 100,000/microL in 18 patients and to 50,000 to 100,000/microL in 15 patients. The median time to response was 2 weeks. Responses were transient (less than 1 month duration) in seven of those patients (10%), but no additional relapses were reported over a follow-up period of up to 26 months (mean of 8 months). Clinical responses were associated with significant decreases in specific serum platelet autoantibodies (including anti-glycoprotein IIb/IIIa), platelet-associated Ig, and CIC. Thirty percent of treatments were associated with transient mild to moderate side effects usually presenting as a hypersensitivity-type reaction. Continued administration of failed therapies for ITP, which always included low-dose corticosteroids (less than or equal to 30 mg/d), had no demonstrable influence on the effectiveness of immunoadsorption treatment but did depress the incidence and severity of side effects. The degree of effectiveness of protein A immunoadsorption therapy in patients with treatment-resistant ITP is promising and further controlled studies in this patient population are warranted.
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Affiliation(s)
- H W Snyder
- North Idaho Cancer Center, Coeur d'Alene
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27
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Guthrie TH, Porubsky ES, Luxenberg MN, Shah KJ, Wurtz KL, Watson PR. Cisplatin-based chemotherapy in advanced basal and squamous cell carcinomas of the skin: results in 28 patients including 13 patients receiving multimodality therapy. J Clin Oncol 1990; 8:342-6. [PMID: 2405109 DOI: 10.1200/jco.1990.8.2.342] [Citation(s) in RCA: 111] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
This study reports the results of cisplatin (CDDP)-based chemotherapy (CT) as sole therapy and as neoadjuvant (NA) therapy in 28 consecutive patients (pts) with advanced basal cell (BC) and squamous cell (SC) cancers of the skin. CT in 24 pts consisted of CDDP 75 mgm/m2 and doxorubicin (Dox) 50 mg/m2 intravenously (IV) every 3 weeks with Dox being omitted in four pts due to severe preexisting cardiac disease. Thirteen of the 28 pts received CT in the NA setting, five before surgery and eight before radiation therapy (RT). Response rates to CT were complete remission (CR) in eight of 28 (28%) pts, partial remission (PR) in 11 of 28 (40%) for an overall response rate of 68%. Thirteen pts received a second treatment modality with five of 13 pts having a CR to CT alone before the second modality and seven converting to CR postsecond modality for a total CR rate of 12 of 13 (92%) in the multimodality group. Duration of responses in the CT-only group ranged from 4 to 82 months; however, only two patients remain in remission in this group. Of the twelve CRs from the multimodality therapy group, 11 of 12 (91%) pts remain in CR with duration of response ranging from 3 to 81 months. Toxicities were manageable, with no toxic deaths and only five pts stopped CT secondary to side effects. This study suggests the combination of CDDP and Dox is highly effective in BC and SC cancers of the skin and by itself can produce long unmaintained remissions, but when combined with a second modality of therapy, it is capable of producing not only long unmaintained CRs but probable cures in the majority of pts.
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Affiliation(s)
- T H Guthrie
- Department of Hematology/Medical Oncology, Medical College of Georgia, Augusta 30912
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28
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Abstract
Cisplatin-associated hemolytic-uremic syndrome (HUS), an under-reported form of HUS induced by chemotherapy, typically pursues a fulminant and lethal course. We report the cases of two patients with squamous cell carcinoma of the head and neck who developed massive hemolysis, profound thrombocytopenia, and dialysis-dependent renal failure after therapy with cisplatin. Plasma exchange was ineffective in both patients, but plasma perfusion with a staphylococcal protein A column produced a dramatic and permanent response in the second patient. These cases show the importance of considering HUS as a cause of renal failure in such patients who receive cisplatin-based chemotherapy, and support the role of staphylococcal protein A plasma perfusion as treatment for this condition.
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Affiliation(s)
- P R Watson
- Medical College of Georgia, Augusta 30912
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29
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Abstract
Carcinoma of unknown histogenesis or primary site is an increasingly recognized syndrome regarded by most physicians as having a grim prognosis. Elaborate evaluations using low yield, and often misleading, radiologic studies focused on identifying primary sites in the lung, liver, pancreas, or gastrointestinal tract offer little benefit to the vast majority of patients. Increasing evidence has accumulated showing that subsets of patients within this broad syndrome exist in whom recognition and proper therapy may result in meaningful prolongation of life or potential cure. In this review, clinical clues and diagnostic aids for identification of nine treatable subsets of patients with the carcinoma of unknown origin (CUO) syndrome are emphasized. Current state-of-the-art treatment for each subset with subsequent end results are stated.
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Affiliation(s)
- T H Guthrie
- Department of Hematology/Medical Oncology, Medical College of Georgia, Augusta 30912-9300
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30
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Guthrie TH, Oral A. Immune thrombocytopenia purpura: a pilot study of staphylococcal protein A immunomodulation in refractory patients. Semin Hematol 1989; 26:3-9. [PMID: 2727721] [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: 01/02/2023]
Abstract
Idiopathic thrombocytopenia purpura (ITP) is a primary immune thrombocytopenia that is typically manifested in adults by acute bleeding, severe thrombocytopenia, and normal to increased megakaryocytes in the bone marrow. Labeling studies suggest that most patients with ITP have an IgG antibody directed against the platelet membrane resulting in sequestration in the spleen. Splenectomy and/or corticosteroids remain the mainstay of therapy, with permanent remissions induced in 75% of patients. Despite the use of cyclophosphamide, azathioprine, vincristine, high-dose gamma globulin, and other forms of therapy, less than 50% of refractory patients achieve long-term satisfactory platelet counts. In view of these facts, ten consecutive patients with immune thrombocytopenia, unrelated to human immunodeficiency virus (HIV), received plasma perfusion over a staphylococcal protein A column (PROSORBA column) to evaluate efficacy and toxicity. All patients had an initial platelet count less than 50,000 and had failed corticosteroids. Five patients had also failed splenectomy. Two patients were not splenectomized due to pediatric age, two due to severe coexisting medical conditions, and one due to refusal of operation. Multiple other forms of therapy had also failed in this cohort of patients. Patients received two to ten treatments with the protein A column. All patients are evaluable for response and toxicities. Of the ten patients, results were as follows: complete response in one (platelet count greater than 150,000); partial response in four (platelet count greater than 50,000 and less than 150,000); and no response in five. Duration of responses ranged from 1 to 6 or more months.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- T H Guthrie
- Section of Hematology, Medical Oncology, Medical College of Georgia, Augusta 30912
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31
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Abstract
Forty adults with idiopathic thrombocytopenic purpura (ITP), aged over 45 years, were seen from March 1954 to December 1983 at the Medical College of Georgia. All patients had bleeding manifestations at presentation. Twenty-one of 40 (52.5%) during the follow-up period had either life-threatening or fatal bleeding episodes. There were no significant differences for the presence of any presenting clinical or laboratory feature for patients who achieved a complete remission compared with those who did not. A complete response to therapy, younger age, higher presenting hemoglobin level, and absence of central nervous system bleeding favorably influenced overall survival. Therapy was ineffective in this age group, with only 12 patients (30%) achieving a permanent complete remission. Fourteen patients (35%) died either from bleeding or from direct complications of therapy. This analysis of ITP in the older adult suggests a disease refractory to therapy that is associated with major morbidity and mortality.
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32
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Morris LE, Guthrie TH. Busulfan-induced hepatitis. Am J Gastroenterol 1988; 83:682-3. [PMID: 3376924] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A 61-yr-old man with chronic myelocytic leukemia treated continuously for 8 yr with busulfan presented with fever, abdominal pain, and elevated liver enzymes in a cholestatic pattern. Evaluation of his liver and biliary tract with ultrasound and computerized tomography disclosed no structural abnormality. A percutaneous needle liver biopsy revealed cellular cholestasis with focal liver cell necrosis accompanied by a mild inflammatory infiltrate. Busulfan was discontinued, with subsequent normalization of liver enzymes and resolution of fever. These findings are interpreted as being compatible with busulfan-induced hepatitis.
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33
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Abstract
Idiopathic thrombocytopenic purpura (ITP) is a primary immune thrombocytopenia that is typically manifested in adults by acute bleeding, severe thrombocytopenia, and normal to increased megakaryocytes in the bone marrow. Labeling studies suggest that most patients with ITP have an IgG antibody directed against the platelet membrane resulting in sequestration in the spleen, and that sequestration in other organs such as the liver bodes a poor prognosis. Splenectomy and/or corticosteroids remain the mainstay of therapy, with permanent remissions induced in 75% of patients. We review alternative forms of therapy such as immunosuppressive agents, high-dose gamma-globulin, and others to enable the practicing physician to select the best treatment for patients refractory to standard therapy. Age appears to influence response to therapy and morbidity, with advancing age imparting a poorer prognosis.
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Affiliation(s)
- D P Brannan
- Department of Internal Medicine, Naval Hospital, Oakland, Calif
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34
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Guthrie TH, Watson P. Prostate cancer. Am Fam Physician 1987; 36:217-24. [PMID: 3314438] [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: 01/05/2023]
Abstract
Prostate cancer is the most frequent malignancy in elderly men. Common presentations include asymptomatic prostate nodules, unexplained bone pain or bladder outlet obstruction. Histologic grading clearly influences the prognosis. Either potency-saving subcapsular prostatectomy or radiation therapy is effective in treating localized disease. New prospects for hormonal therapy of metastatic prostate cancer include antiandrogens and gonadotropin-releasing analogs.
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35
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Abstract
Fifteen consecutive patients with refractory adult acute leukemia (RAAL) were treated with a combination of high-dose, continuous-infusion cyclophosphamide, cytarabine, vincristine, and prednisone (Hi-COAP). The initial nine patients received cyclophosphamide 350 mg/m2 as a 24-hour intravenous (IV) infusion over 5 days; cytarabine, 100 mg/m2 IV bolus every 12 hours for ten doses; vincristine, 2.0 mg IV bolus on day 1; and prednisone, 100 mg orally for 7 days. The last six patients had the cyclophosphamide infusion lengthened to 7 days, and the cytarabine increased to 14 doses. All patients were evaluable for toxicity and response. Seven patients (47%) obtained a complete remission and six patients (40%) a partial remission. Median duration of all remissions has been 7.0 months with a range of 1 to 32 months. Toxicity has been limited to primarily myelosuppression with no hemorrhagic cystitis, central nervous system (CNS), hepatic, or pulmonary toxicity noted. Gastrointestinal toxicity was mild, with no effect on nutritional status noted. Median duration of complete responders was 8.5 months. Thus, Hi-COAP demonstrates promising efficacy with minimal toxicity in RAAL and warrants further exploration in multiinstitutional trials.
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36
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Abstract
Eight patients, aged 62 to 85 years, with nine instances of histologically proven basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) involving the eyelids and periorbital tissues, were treated with systemic and/or local (iontophoresis) chemotherapy using cisplatin (Platinol) and doxorubicin (Adriamycin). All patients had either refused surgery, would have required extensive procedures, or had medical problems contraindicating surgery. Systemic chemotherapy induced a complete or partial remission in eight of nine lesions. No patient has required maintenance chemotherapy and no significant toxic side effects were encountered. The length of follow-up ranged from 2 to 50 months. Iontophoretic therapy with cisplatin was used to treat five small foci of new, recurrent or persistent tumor(s) in three of these patients and resulted in a partial response in all five lesions. Systemic or local chemotherapy offers an alternative to current standard forms of treatment for BCC and SCC in selected cases.
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37
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Turner WA, Gallup DG, Talledo OE, Otken LB, Guthrie TH. Neuroendocrine carcinoma of the uterine cervix complicated by pregnancy: case report and review of the literature. Obstet Gynecol 1986; 67:80S-83S. [PMID: 3003642 DOI: 10.1097/00006250-198603001-00023] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A case report of neuroendocrine carcinoma of the cervix complicating pregnancy is presented. This represents the fourth reported case. Clinical staging was FIGO IB, and treatment consisted of radical surgery and aggressive chemotherapy. Electron microscopy confirmed the diagnosis of neuroendocrine carcinoma. The pregnancy-associated cases and a review of neuroendocrine cervical carcinoma are discussed.
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38
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Abstract
Acute, profound cisplatin-induced deafness has rarely been reported. Ototoxic reactions to cisplatin in the past have been subclinical, with most hearing loss occurring in the high-frequency range. A patient was treated with ultra-high-dose cisplatin who suffered acute profound deafness. Methods are suggested for preventing similar complications in other patients given cisplatin in high-dose ranges.
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39
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Guthrie TH, McElveen LJ, Porubsky ES, Harmon JD. Cisplatin and doxorubicin. An effective chemotherapy combination in the treatment of advanced basal cell and squamous carcinoma of the skin. Cancer 1985; 55:1629-32. [PMID: 4038911 DOI: 10.1002/1097-0142(19850415)55:8<1629::aid-cncr2820550802>3.0.co;2-i] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Eleven patients with advanced basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) of the skin were treated with cis-diamminedichloroplatinum II (cisplatin) and doxorubicin. Seven patients had prior surgery and six of these seven had prior radiation therapy. All patients had an adequate trial of chemotherapy. One patient received a second course of chemotherapy after relapse. Responses were seen in 10 of 12 (87%) of chemotherapy courses, and 5 of 11 patients (46%) have an unmaintained complete remission lasting 2 to 31 months. Toxicity was acceptable and consisted primarily of gastrointestinal side effects. These results indicate the combination of cisplatin and doxorubicin has significant activity in both advanced BCC and SCC of the skin. In addition, a portion of patients treated with the combination achieve a long-term unmaintained disease-free state.
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40
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Luxenberg MN, Guthrie TH. Chemotherapy of eyelid and peritorbital tumors. Trans Am Ophthalmol Soc 1985; 83:162-80. [PMID: 3832525 PMCID: PMC1298695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Eight patients with nine histologically proven BCC or SCC involving the eyelids and periorbital tissues were treated with systemic and/or local (iontophoresis) chemotherapy using cisplatin and doxorubicin. All patients had either refused surgery, would have required extensive procedures, or had medical problems contraindicating surgery. Systemic chemotherapy induced a CR or PR in eight of nine lesions. No patient has required maintenance chemotherapy and no significant toxic side effects were encountered. The length of follow-up ranges from 2 to 50 months. Iontophoretic therapy with cisplatin was used to treat five small foci of new, recurrent or persistent tumor(s) in three of these patients, and resulted in a partial response in all five lesions. Systemic or local chemotherapy offers an alternative to current standard forms of treatment for BCC and SCC in selected cases.
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41
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Abstract
Hypertrophic pulmonary osteoarthropathy is an uncommon paraneoplastic syndrome occasionally associated with nasopharyngeal lymphoepitheliomas. We treated two patients with previously diagnosed lymphoepitheliomas in whom hypertrophic pulmonary osteoarthropathy preceded the recognition of pulmonary metastases. Both patients' disabling arthritic syndromes resolved with effective therapy directed at their neoplasms.
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42
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Hatfield HA, Guthrie TH. Breast cancer concepts. Am Fam Physician 1984; 30:195-200. [PMID: 6464959] [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: 01/20/2023]
Abstract
Surgery is the primary treatment for early breast cancer. Several studies have shown that routine postoperative radiation therapy does not increase patient survival. Chemotherapy is currently recommended as an adjuvant to mastectomy in patients with positive axillary nodes. Patients who have recurrent disease and tumors that are hormone-receptor-negative, or tumors that are unresponsive and hormone-receptor-positive, are receiving significant survival benefits from combination chemotherapy.
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Guthrie TH, Hatfield HA. Male germ cell tumors. Am Fam Physician 1983; 28:256-61. [PMID: 6685427] [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: 01/21/2023]
Abstract
New treatment approaches to male germ cell tumors have produced dramatic improvements in both survival and cure rates. The traditional use of surgery and radiation therapy for all male germ cell neoplasms has given way to individualized therapy based on histology, stage and the serum tumor markers. Cure rates of 95 percent for seminomas and 80 percent for nonseminomatous germ cell tumors are now achieved.
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Guthrie TH, Fortson WC, Spearman DR. Abnormal liver-spleen scan associated with hyperviscosity syndrome. Arch Intern Med 1983; 143:1824-5. [PMID: 6412643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A patient with hyperviscosity syndrome was noted to have an abnormal liver radionuclide scan. Ultrasound and normalization of the liver scan after plasmapheresis confirmed the non-neoplastic nature of the patchy labeling defects. This case suggests a new cause for labeling abnormalities on liver radionuclide scans in patients with a syndrome where liver biopsies would be unusually hazardous. Possible mechanisms for this scintigraphic pattern in the hyperviscosity syndrome are briefly discussed.
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Guthrie TH, Beckman JB. The direct hematopoietic toxicity of ethyl alcohol. J Med Assoc Ga 1983; 72:323-6, 328. [PMID: 6864119] [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: 01/22/2023]
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Abstract
Three cases of pure red cell aplasia (PRCA) associated with carcinoma, previously considered a rare paraneoplastic syndrome, are reported. Two cases responded to steroid therapy. In two the diagnosis of PRCA was obscured by the carcinoma until bone marrow examination revealed the true cause of the anemia. These three cases once again support routine bone marrow examination to determine the cause of anemia, regardless of other medical problems.
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Graves T, Correa SP, Taylor AT, Guthrie TH. Treatment of L-asparaginase allergic reaction. Drug Intell Clin Pharm 1983; 17:130. [PMID: 6572133 DOI: 10.1177/106002808301700211] [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: 01/20/2023]
Abstract
The treatment of an allergic reaction to L-asparaginase is discussed in the presentation of a case of a 26-year-old man with chronic myelogenous leukemia who was undergoing methotrexate-L-asparaginase rescue therapy. The possible mechanism of action of L-asparaginase is reviewed, and precautions for use of L-asparaginase in combination therapy with methotrexate are presented.
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Guthrie TH, Mahizhnan P. Brief communication: Legionnaire's disease successfully treated in acute myelocytic leukemia during severe neutropenia. Med Pediatr Oncol 1983; 11:180-1. [PMID: 6574308 DOI: 10.1002/mpo.2950110310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A patient with acute nonlymphocytic leukemia developed progressive lung infiltrates and unremitting fevers during a profound neutropenic state. Legionnaire's disease was diagnosed by simple immunologic studies and successfully treated with erythromycin. This index case alerts physicians toward a treatable infection which would not normally be susceptible to the empiric antibiotic regimens given neutropenic patients with fevers.
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Guthrie TH, Porubsky ES. Successful systemic chemotherapy of advanced squamous and basal cell carcinoma of the skin with cis-diamminedichloroplatinum III and doxorubicin. Laryngoscope 1982; 92:1298-9. [PMID: 6890609 DOI: 10.1288/00005537-198211000-00014] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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