1
|
Casal Moura M, Deng Z, Brooks SR, Tew W, Fervenza FC, Kallenberg CGM, Langford CA, Merkel PA, Monach PA, Seo P, Spiera RF, St Clair EW, Stone JH, Prunotto M, Grayson PC, Specks U. Risk of relapse of ANCA-associated vasculitis among patients homozygous for the proteinase 3 gene Val119Ile polymorphism. RMD Open 2023; 9:e002935. [PMID: 36990659 PMCID: PMC10069578 DOI: 10.1136/rmdopen-2022-002935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/15/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND The frequency of proteinase 3 gene (PRTN3) polymorphisms in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is not fully characterised. We hypothesise that the presence of a PRTN3 gene polymorphism (single nucleotide polymorphism (SNP) rs351111) is relevant for clinical outcomes. METHODS DNA variant calling for SNP rs351111 (chr.19:844020, c.355G>A) in PRTN3 gene assessed the allelic frequency in patients with PR3-AAV included in the Rituximab in ANCA-Associated Vasculitis trial. This was followed by RNA-seq variant calling to characterise the mRNA expression. We compared clinical outcomes between patients homozygous for PRTN3-Ile119 or PRTN3-Val119. RESULTS Whole blood samples for DNA calling were available in 188 patients. 75 patients with PR3-AAV had the allelic variant: 62 heterozygous PRTN3-Val119Ile and 13 homozygous for PRTN3-Ile119. RNA-seq was available for 89 patients and mRNA corresponding to the allelic variant was found in 32 patients with PR3-AAV: 25 heterozygous PRTN3-Val119Ile and 7 homozygous for PRTN3-Ile119. The agreement between the DNA calling results and mRNA expression of the 86 patients analysed by both methods was 100%. We compared the clinical outcomes of 64 patients with PR3-AAV: 51 homozygous for PRTN3-Val119 and 13 homozygous for PRTN3-Ile119. The frequency of severe flares at 18 months in homozygous PRTN3-Ile119 was significantly higher when compared with homozygous PRTN3-Val119 (46.2% vs 19.6%, p=0.048). Multivariate analysis identified homozygous PR3-Ile119 as main predictor of severe relapse (HR 4.67, 95% CI 1.16 to 18.86, p=0.030). CONCLUSION In patients with PR3-AAV, homozygosity for PRTN3-Val119Ile polymorphism appears associated with higher frequency of severe relapse. Further studies are necessary to better understand the association of this observation with the risk of severe relapse.
Collapse
Affiliation(s)
- Marta Casal Moura
- Pulmonary and Critical Care Medicine, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, USA
- Biomedicina, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Zuoming Deng
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland, USA
| | - Stephen R Brooks
- Office of Science and Technology, Biodata Mining and Discovery Section, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland, USA
| | - Wei Tew
- ITGR Diagnostics Discovery, Genentech Inc, South San Francisco, California, USA
| | - Fernando C Fervenza
- Nephrology and Hypertension, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, USA
| | - Cees G M Kallenberg
- Rheumatology and Clinical Immunology, University of Groningen, Groningen, The Netherlands
| | - Carol A Langford
- Rheumatic and Immunologic Disease, Cleveland Clinic, Cleveland, Ohio, USA
| | - Peter A Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul A Monach
- Department of Medicine, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - Philip Seo
- Rheumatology, Johns Hopkins, Baltimore, Maryland, USA
| | - Robert F Spiera
- Department of Medicine, Hospital for Special Surgery, New York, New York, USA
| | | | - John H Stone
- Vasculitis and Glomerulonephritis Center, Rheumatology, Immunology and Allergy Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marco Prunotto
- School of Pharmaceutical Sciences, University of Geneva, Geneve, Switzerland
| | - Peter C Grayson
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland, USA
| | - Ulrich Specks
- Pulmonary and Critical Care Medicine, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, USA
| |
Collapse
|
2
|
Casal Moura M, Deng Z, Brooks S, Tew W, Hummel A, Fervenza F, Kallenberg C, Langford C, Merkel PA, Monach PA, Seo P, Spiera R, St. Clair W, Stone JH, Prunotto M, Grayson P, Specks U. POS0244 ASSOCIATION OF PROTEINASE 3 GENE (PRTN3) Val119Ile POLYMORPHISM (SNP rs351111) WITH RISK OF RELAPSE AMONG HOMOZYGOUS PATIENTS WITH PR3 ANCA-ASSOCIATED VASCULITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe frequency of the proteinase 3 gene (PRTN3) polymorphisms in patients with ANCA-associated vasculitis (AAV) is not well characterized. We hypothesize that PRTN3 gene polymorphisms induce allosteric changes in PR3 conformation which may alter its interaction with ligands and PR3-ANCA during inflammation with potential implications for disease presentation and clinical outcomes.ObjectivesTo analyze the association of PRTN3 Val119Ile polymorphism (SNP rs351111) with risk of relapse risk among homozygous patients with PR3 ANCA-associated vasculitis.MethodsDNA variant calling for SNP rs351111 (chr.19:844020, c.355G>A) in PRTN3 gene assessed the allelic frequency in patients with PR3-AAV included in the Rituximab versus Cyclophosphamide (RAVE) trial. This was followed by RNA-seq variant calling to characterize the mRNA expression. We compared clinical presentation and outcomes between patients homozygous for PR3-Ile119 or PR3-Val119.ResultsSerum samples for DNA calling were available in 188 of the 197 patients with AAV in the RAVE cohort. 75 PR3-AAV patients had the allelic variant: 13 patients were homozygous for PR3-Ile119 and 62 patients were heterozygous PR3-Val119Ile with an allele frequency threshold of 29.3 – 55.1% of reads (Figure 1A and 1B). RNA-seq was available for 89 patients and the mRNA corresponding to the allelic variant was found in 35 PR3-AAV patients: 13 patients were homozygous for PR3-Ile119 and 22 patients were heterozygous PR3-Val119Ile with an allele frequency threshold of 11.1 – 62.8% of reads (Figure 1A and 1C). The agreement between the DNA calling results and the mRNA expression of the 86 patients that overlapped was 100%. We found an additional homozygous patient for PR3-Val119 in which blood was not available for DNA calling. We compared the clinical presentation and outcomes of 74 patients with PR3-AAV: 13 homozygous for PR3-Ile119 and 51 homozygous for PR3-Val119 (Table 1). The frequency of severe flares at 18 months in homozygous PR3-Ile119 was ≥ 2x higher when compared with homozygous PR3-Val119 (46.2% vs. 19.6%, p=0.048). We found no differences in clinical presentation.Figure 1.RAVE trial population distribution according to the zygosity status for PRTN3 gene (PR3 and MPO-ANCA patients) and DNA or RNA variant calling (panel A). Allelic frequency for rs351111, chr.19:844020 (c.355G>A) in PRTN3 among patients with AAV (PR3 and MPO-ANCA) in the DNA (panel B) and RNA (panel C) variant calling.Table 1.Outcomes of patients with PR3-ANCA according with PRTN3 zygosity.PR3-ANCA (n=64)Homozygous PR3-Val119(n=51)HomozygousPR3-Ile119(n=13)p-value Remission, n (%)45 (88.2)13 (100)0.194 Complete remission, n (%)36 (70.6)10 (76.9)0.650 Any flare 18 months, n (%)30 (58.8)7 (53.8)0.746 Severe Relapse* 18 months, n (%)10 (19.6)6 (46.2)0.048* Relapse was considered “Severe” if Birmingham Vasculitis Activity Score for Wegener’s Granulomatosis (BVAS/WG) > 3 or one major item as per the RAVE trial definition.Abbreviations: ANCA - anti-neutrophil cytoplasmic antibody; Ile – isoleucine; n- number; PR3 - proteinase 3; Val - valine.ConclusionIn patients with PR3-AAV the presence of PRTN3 Val119Ile polymorphism was associated with higher frequency of severe relapse. Further studies are necessary to understand the association of this observation with the risk of severe relapse.References[1]Stone JH et al N Engl J Med 2010; 363:221-232Disclosure of InterestsNone declared
Collapse
|
3
|
|
4
|
Makker V, Boucicaut N, Cadoo K, Grisham R, Hyman D, O'Cearbhail R, Snyder Charen A, Tew W, Martin M, Aghajanian C. A phase 1 study of selinexor (S) in combination with paclitaxel (P) and carboplatin (C) in patients (pts) with advanced ovarian (OC) or endometrial cancers (EC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx372.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
5
|
Tseng J, Suidan R, Zivanovic O, Gardner G, Levine D, Sonoda Y, Abu-Rustum N, Tew W, Chi D, Long Roche K. Diverting ileostomy during primary cytoreductive surgery for ovarian cancer: Associated factors and postoperative outcomes. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
6
|
Cowan R, Eriksson A, Kim C, Zhou Q, Iasonos A, Tew W, Long Roche K, Sonoda Y, Chi D, Gardner G. Recurrent ovarian cancer: Can second clinical remission surpass the first? Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
7
|
Ducie J, Whitney M, Park K, Soslow R, Alektiar K, Tew W, Konner J, Aghajanian C, Leitao M, Sonoda Y, Abu-Rustum N. Sentinel lymph node mapping for early-stage cervical cancer: A single institution's experience. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
8
|
Kennedy WP, Maciuca R, Wolslegel K, Tew W, Abbas AR, Chaivorapol C, Morimoto A, McBride JM, Brunetta P, Richardson BC, Davis JC, Behrens TW, Townsend MJ. Association of the interferon signature metric with serological disease manifestations but not global activity scores in multiple cohorts of patients with SLE. Lupus Sci Med 2015; 2:e000080. [PMID: 25861459 PMCID: PMC4379884 DOI: 10.1136/lupus-2014-000080] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/03/2015] [Accepted: 03/11/2015] [Indexed: 01/01/2023]
Abstract
Objectives The interferon (IFN) signature (IS) in patients with systemic lupus erythematosus (SLE) includes over 100 genes induced by type I IFN pathway activation. We developed a method to quantify the IS using three genes—the IS metric (ISM)—and characterised the clinical characteristics of patients with SLE with different ISM status from multiple clinical trials. Methods Blood microarray expression data from a training cohort of patients with SLE confirmed the presence of the IS and identified surrogate genes. We assayed these genes in a quantitative PCR (qPCR) assay, yielding an ISM from the IS. The association of ISM status with clinical disease characteristics was assessed in patients with extrarenal lupus and lupus nephritis from four clinical trials. Results Three genes, HERC5, EPSTI and CMPK2, correlated well with the IS (p>0.96), and composed the ISM qPCR assay. Using the 95th centile for healthy control data, patients with SLE from different studies were classified into two ISM subsets—ISM-Low and ISM-High—that are longitudinally stable over 36 weeks. Significant associations were identified between ISM-High status and higher titres of anti-dsDNA antibodies, presence of anti extractable nuclear antigen autoantibodies, elevated serum B cell activating factor of the tumour necrosis factor family (BAFF) levels, and hypocomplementaemia. However, measures of overall clinical disease activity were similar for ISM-High and ISM-Low groups. Conclusions The ISM is an IS biomarker that divides patients with SLE into two subpopulations—ISM-High and ISM-Low—with differing serological manifestations. The ISM does not distinguish between high and low disease activity, but may have utility in identifying patients more likely to respond to treatment(s) targeting IFN-α. Clinicaltrials.gov registration number NCT00962832.
Collapse
Affiliation(s)
- William P Kennedy
- Departments of Early Clinical Development , Genentech , South San Francisco, California , USA
| | - Romeo Maciuca
- Department of Biostatistics, Genentech , South San Francisco , California , USA
| | - Kristen Wolslegel
- Department of ITGR Diagnostics Discovery , Genentech , South San Francisco, California , USA
| | - Wei Tew
- Department of ITGR Diagnostics Discovery , Genentech , South San Francisco, California , USA
| | - Alexander R Abbas
- Department of Bioinformatics and Computational Biology , Genentech , South San Francisco, California , USA
| | - Christina Chaivorapol
- Department of Bioinformatics and Computational Biology , Genentech , South San Francisco, California , USA
| | - Alyssa Morimoto
- Department of Bioanalytical Sciences , Genentech , South San Francisco, California , USA
| | - Jacqueline M McBride
- Department of Pharmacodynamic Biomarkers ITGR , Genentech , South San Francisco, California , USA
| | - Paul Brunetta
- Department of Late Stage Immunology Product Development , Genentech , South San Francisco, California , USA
| | - Bruce C Richardson
- Department of Medicine , University of Michigan and the Ann Arbor VA Hospital , Ann Arbor, Michigan , USA
| | - John C Davis
- Departments of Early Clinical Development , Genentech , South San Francisco, California , USA
| | - Timothy W Behrens
- Department of ITGR Human Genetics , Genentech , South San Francisco, California , USA
| | - Michael J Townsend
- Department of ITGR Diagnostics Discovery , Genentech , South San Francisco, California , USA
| |
Collapse
|
9
|
Korc-Grodzicki B, McEvoy L, Tew W. Building a geriatrics service in a cancer center: Lessons learned during its first 5years. J Geriatr Oncol 2014. [DOI: 10.1016/j.jgo.2014.09.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
10
|
Von Gruenigen V, Huang H, Tew W, Hurria A, Lankes H, DiSilvestro P, Mannel R, Beumer J, Heugel A, Herzog T. 3Geriatric assessment and tolerance to chemotherapy in elderly women with ovarian, primary peritoneal or fallopian tube cancer: A Gynecologic Oncology Group study. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.07.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
11
|
Barlin J, Dao F, Zgheib NB, Ferguson S, Sabbatini P, Hensley M, Konner J, Tew W, Aghajanian C, Chi D. Progression-free and overall survival of a modified outpatient regimen of primary intravenous/intraperitoneal paclitaxel and intraperitoneal cisplatin is comparable to results from GOG 172. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
12
|
|
13
|
Tanner E, Iasonos A, Kostolias A, Tew W, Zhou Q, Park K, Alektiar K, Barakat R, Abu-Rustum N. Outcomes of surgery for stage IB cervical cancer: Variations between squamous and adenocarcinoma histology. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
14
|
Hensley ML, Kravetz S, Sima C, Tew W, Pereira L, Sabbatini P, Whalen C, Aghajanian CA, Zarwan C, Berlin S. Eribulin mesylate (halichondrin B Analog E7389) in platinum-resistant epithelial ovarian cancer (PR-EOC): A CTEP-sponsored phase II study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5561] [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
5561 Background: Eribulin mesylate is a tubulin inhibitor whose mechanism of action differs from that of other anti-tubulin agents, suppressing microtubule growth without affecting depolymerization, and sequestering tubulin into non-functional aggregates. In NIH:OVCAR-3 human EOC xenograft models, eribulin increased survival and reduced size and number of metastases, with activity superior to paclitaxel. We sought to determine the frequency of objective response to treatment with eribulin in patients (pts) with PR-EOC. Methods: Pts with PR-EOC, fallopian tube or peritoneal cancer (progression-free interval from last platinum-based therapy < 6 months), measurable disease, < 2 prior cytotoxic regimens, ECOG performance status 0–1, and adequate organ function were eligible. Treatment: eribulin 1.4 mg/m2 over 15 minutes IV days 1 and 8, every 21 days. Response assessed by CT for RECIST every other cycle. Results: 36 pts (median age 61, range 38–80; median platinum-free interval 3 months, range 0.1–5.9; all having received platinum-taxane first-line treatment) enrolled. 35 are evaluable for response (1 pt off-study for unrelated myocardial infarction in cycle 1). Two pts achieved partial responses (PR-5.7%), with response durations of 84 days and 128 days. Time to PR was 2.8 months in both. >50% decrease in CA125 for more than two measurements was observed in 3/31 CA125-evaluable pts. 16/35 (46%) had stable disease as best response. Median progression-free survival was 2 months (range 1–7 months). Per patient, at least possibly-related grade 3–4 toxicities were: neutropenia 44%, leucopenia 31%, anemia 3%, lymphopenia 3%, febrile neutropenia 3%, muscle weakness 3%, hypophosphatemia 3%, hypokalemia 6%, infection 6%, thrombosis 6%. Conclusions: Eribulin has minimal activity in PR-EOC with objective response observed in only 5.7% of pts. Time to objective response was nearly 3 months. Median PFS was 2 months. Activity of eribulin in platinum-sensitive patients is being studied in a separate phase II cohort. [Table: see text]
Collapse
Affiliation(s)
- M. L. Hensley
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Lahey Clinic, Boston, MA
| | - S. Kravetz
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Lahey Clinic, Boston, MA
| | - C. Sima
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Lahey Clinic, Boston, MA
| | - W. Tew
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Lahey Clinic, Boston, MA
| | - L. Pereira
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Lahey Clinic, Boston, MA
| | - P. Sabbatini
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Lahey Clinic, Boston, MA
| | - C. Whalen
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Lahey Clinic, Boston, MA
| | - C. A. Aghajanian
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Lahey Clinic, Boston, MA
| | - C. Zarwan
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Lahey Clinic, Boston, MA
| | - S. Berlin
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Lahey Clinic, Boston, MA
| |
Collapse
|
15
|
Konner JA, Grabon D, Pezzulli S, Iasonos A, Sabbatini P, Hensley M, Bell-McGuinn K, Tew W, Spriggs D, Aghajanian C. A phase II study of intravenous (IV) and intraperitoneal (IP) paclitaxel, IP cisplatin, and IV bevacizumab as first-line chemotherapy for optimal stage II or III ovarian, primary peritoneal, and fallopian tube cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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
5539 Background: IP cisplatin (Cis) plus IV/IP paclitaxel (Tax) is a standard therapy for optimally debulked ovarian cancer. Bevacizumab (Bev) is a recombinant humanized IgG1 monoclonal antibody directed against vascular endothelial growth factor. Activity of Bev in recurrent ovarian cancer has been reported in phase II trials. In this study IP Cis and IV/IP Tax are combined with IV Bev as front-line therapy. Methods: Patients with optimal (<1 cm residual), FIGO stage II or III, epithelial ovarian, fallopian tube, or peritoneal cancer, acceptable organ function, and KPS ≥ 70% are eligible. Patients receive 6 cycles of chemotherapy plus Bev: Tax 135 mg/m2 IV over 3 hours on Day 1, Cis 75 mg/m2 IP on Day 2, Tax 60 mg/m2 IP on Day 8, Bev 15 mg/kg IV on Day 1 (starting cycle 2). Bev is continued every 3 weeks for 17 treatments after chemotherapy is complete. This study will enroll 41 patients. The primary endpoint is safety and tolerability, determined by whether at least 60% of patients complete the prescribed 6 cycles of cytotoxic chemotherapy without unacceptable toxicity. Results: Thirty-nine women [median age 56 (40–69)] have been treated on study: 26 (67%) completed 6 IV/IP cycles; 5 (13%) are receiving ongoing IV/IP treatment; 4 (10%) experienced IP port malfunction (3 finished 5 IV/IP cycles, 1 came off study for port revision); 3 (8%) switched from IP Cis to IV carboplatin due to grade 3 nephrotoxicity in cycle 1 (n = 2) or grade 3 hypertension in cycle 6 (n = 1); and 1 (2.5%) patient died following rectosigmoid anastomotic dehiscence during cycle 4. Grade 3/4 treatment-related toxicities include hypertension (10%), vasovagal events (10%), neutropenia (26%), nausea/vomiting (10%), and hypomagnesemia (8%). There were 3 occurrences of grade 3 abdominal pain (8%); and 3 adhesion-related grade 3 small bowel obstructions (8%), during cycles 3, 9, and 15, respectively. Conclusions: The addition of Bev to this IV/IP regimen appears to be feasible. Bev may increase the risk of small bowel obstruction/perforation in these patients. Enrollment continues and updated results will be presented. [Table: see text]
Collapse
Affiliation(s)
- J. A. Konner
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - D. Grabon
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S. Pezzulli
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - A. Iasonos
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - P. Sabbatini
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - M. Hensley
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - W. Tew
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - D. Spriggs
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - C. Aghajanian
- Memorial Sloan-Kettering Cancer Center, New York, NY
| |
Collapse
|
16
|
Hurria A, Mohile S, Lichtman S, Owusu C, Klepin H, Gross C, Hansen K, Klapper S, Togawa K, Tew W. Geriatric assessment of older adults with cancer: Baseline data from a 500 patient multicenter study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9546 Background: As the cancer population ages, a brief, comprehensive measure is needed to characterize the “functional age” of a patient, in order to optimize treatment decisions and evaluate outcomes based on factors other than chronological age. A geriatric assessment (GA) evaluates factors other than age that predict morbidity and mortality in older adults. The goals of this study are to describe the results of a GA performed in 500 older adults with cancer from 7 participating institutions and to evaluate the feasibility of completing this assessment in oncology practice. Methods: The GA is comprised of validated measures of functional status, comorbidity, cognition, psychological status, social functioning and support, and nutritional status (Hurria et al, Cancer 2005). The GA was completed prior to the start of a new chemotherapy regimen in patients age ≥ 65 with a solid tumor or lymphoma. Results: 500 patients (mean age 73; range 65–91) completed the GA. The most common tumor types were lung (29%), GI (29%) and breast/gyn (22%) cancer; 57% had stage IV disease. The GA revealed that 41% of patients needed assistance with instrumental activities of daily living despite a mean physician-reported KPS of 85 (range 50–100), 92% had ≥1 comorbid medical conditions (mean 2.5; range 0–9), 95% took ≥ 1 medications (mean 5; range 0–23), 16% had ≥ 1 falls in the past 6 months, 6% had gross cognitive impairment on the Blessed Orientation-Memory-Concentration Test, and 39% had > 5% weight loss in the past 6 months. The mean time to complete the GA was 27 minutes (range 10–80); 94% were satisfied with the GA length and 70% were able to complete the GA without assistance. Multivariate logistic regression identified the following sociodemiographic and disease variables predict the need for assistance with completion of the GA: age ≥ 80 (p=0.02), high school education or less (p<0.01), non-white race (p<0.01), and the presence of metastatic disease (p=0.01). Conclusions: This brief GA is largely self-administered, can be completed by the majority of older patients without assistance, and identifies important deficits and problems that may impact morbidity and mortality. Prospective data are being acquired to identify factors in the GA that predict chemotherapy toxicity in older adults with cancer. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- A. Hurria
- City of Hope, Duarte, CA; University of Rochester, Rochester, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Case Western University, Cleveland, OH; Wake Forest University, Winston-Salem, NC; Yale University, New Haven, CT
| | - S. Mohile
- City of Hope, Duarte, CA; University of Rochester, Rochester, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Case Western University, Cleveland, OH; Wake Forest University, Winston-Salem, NC; Yale University, New Haven, CT
| | - S. Lichtman
- City of Hope, Duarte, CA; University of Rochester, Rochester, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Case Western University, Cleveland, OH; Wake Forest University, Winston-Salem, NC; Yale University, New Haven, CT
| | - C. Owusu
- City of Hope, Duarte, CA; University of Rochester, Rochester, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Case Western University, Cleveland, OH; Wake Forest University, Winston-Salem, NC; Yale University, New Haven, CT
| | - H. Klepin
- City of Hope, Duarte, CA; University of Rochester, Rochester, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Case Western University, Cleveland, OH; Wake Forest University, Winston-Salem, NC; Yale University, New Haven, CT
| | - C. Gross
- City of Hope, Duarte, CA; University of Rochester, Rochester, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Case Western University, Cleveland, OH; Wake Forest University, Winston-Salem, NC; Yale University, New Haven, CT
| | - K. Hansen
- City of Hope, Duarte, CA; University of Rochester, Rochester, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Case Western University, Cleveland, OH; Wake Forest University, Winston-Salem, NC; Yale University, New Haven, CT
| | - S. Klapper
- City of Hope, Duarte, CA; University of Rochester, Rochester, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Case Western University, Cleveland, OH; Wake Forest University, Winston-Salem, NC; Yale University, New Haven, CT
| | - K. Togawa
- City of Hope, Duarte, CA; University of Rochester, Rochester, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Case Western University, Cleveland, OH; Wake Forest University, Winston-Salem, NC; Yale University, New Haven, CT
| | - W. Tew
- City of Hope, Duarte, CA; University of Rochester, Rochester, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Case Western University, Cleveland, OH; Wake Forest University, Winston-Salem, NC; Yale University, New Haven, CT
| |
Collapse
|
17
|
Juretzka M, Hensley ML, Tew W, Konner J, Aghajanian C, Leitao M, Iasonos A, Soslow R, Park K, Sabbatini P. A phase 2 trial of oral imatinib in patients with epithelial ovarian, fallopian tube, or peritoneal carcinoma in second or greater remission. EUR J GYNAECOL ONCOL 2008; 29:568-572. [PMID: 19115680] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE OF INVESTIGATION To determine the effect of imatinib on progression-free survival in patients with epithelial ovarian cancer in second or greater complete clinical remission (CCR). METHODS 35 patients were enrolled between 10/2002 and 1/2005. Eligible patients received imatinib at 400 mg daily orally. RESULTS One patient withdrew consent, and two patients received protocol therapy in first remission and were excluded. Five patients were removed for possibly related toxicity. No associations were seen between PDGF-R staining and PFS. CONCLUSIONS Treatment with imatinib for patients with ovarian cancer in second CCR or greater did not prolong the PFS beyond the historical estimate.
Collapse
Affiliation(s)
- M Juretzka
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Konner JA, Fallon K, Pezzuli S, Iasonos A, Sabbatini P, Hensley M, Chiang A, Tew W, Spriggs D, Aghajanian C. A phase II study of intravenous (IV) and intraperitoneal (IP) paclitaxel (Tax), IP cisplatin (Cis), and IV bevacizumab (Bev) as first-line chemotherapy for optimal stage II or III ovarian, primary peritoneal, and fallopian tube cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5523 Background: IP Cis plus IV/IP Tax is a standard therapy for optimally debulked ovarian cancer. Bev is a recombinant humanized IgG1 monoclonal antibody directed against vascular endothelial growth factor (VEGF). Activity of Bev against recurrent ovarian cancer has been reported in phase II trials. In this study IP Cis and IV/IP Tax are combined with IV Bev as front-line therapy to assess safety and tolerability. Methods: Patients with optimal (<1 cm residual), FIGO stage II or III, epithelial ovarian, fallopian tube, or peritoneal cancer, acceptable organ function, and KPS = 70% are eligible. Patients receive 6 cycles of chemotherapy plus Bev (starting cycle 2): Tax 135 mg/m2 IV over 3 hours on Day 1, Cis 75 mg/m2 IP on Day 2, Tax 60 mg/m2 IP on Day 8, Bev 15 mg/kg IV on Day 1. Extended treatment with Bev is continued every 3 weeks for 17 treatments after chemotherapy is complete. The study will enroll 41 patients. The primary endpoint is safety and tolerability, determined by the proportion of patients who complete the prescribed 6 cycles of cytotoxic chemotherapy without discontinuation and without dose-limiting non-hematologic and non-electrolyte toxicity. A stopping rule will be applied if excessive toxicity is encountered. Results: To date, 8 women have been treated on the study. Median age: 53 (48–59). All 31 planned doses of chemotherapy have been administered in full. One dose of IP Tax was delayed for 2 days due to abdominal pain. One patient had her first dose of Bev delayed for 1 cycle due to surgical wound infection. There have been no toxicities > grade 3. Grade 1/2 toxicities include: fatigue (87.5%); nausea (50%); and hypomagnesemia (37.5%). Grade 3 toxicities per patient: fatigue (12.5%); hyponatremia (25%); hypokalemia (25%); hypertension (12.5%); abdominal pain (12.5%); and neutropenia (12.5%). Of the 5 patients with pretreatment CA125 >35 Units/mL, 4 normalized their value after 1 cycle of chemotherapy and 1 patient normalized after 2 cycles. Conclusions: Preliminary experience suggests that the combination of IV Bev with IP Cis plus IV/IP Tax may be well tolerated. Enrollment continues and updated results will be presented. No significant financial relationships to disclose.
Collapse
|
19
|
Tam-McDevitt JT, Tew W, Klapper S, Hauser R, Lichtman S. Reporting of clinical trial data: Are we fully utilizing the current clinical trial data to help manage the older adult cancer population? J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.19546] [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
19546 Background: The number of older cancer patients will continue to increase as the population ages. Thus the demand for information on how to manage this population will continue to increase in importance. Clinical trials provide pertinent information to clinicians on treatment options, however, are the current available results matching the needs for the older cancer population? Methods: An evaluation was performed of published clinical trials to determine whether the data was analyzed, reported and discussed using age related criteria. Prospective studies involving 50 or more patients published from 01/2005–12/2006 in the Journal of Clinical Oncology (JCO), Cancer, and the Journal of the National Cancer Institute (JNCI) were reviewed. Results: There were 258 JCO, 58 Cancer, and 17 JNCI articles with the prespecified criteria. The median number of patients enrolled per trial is 212 (JCO), 77.5 (Cancer), and 954 (JNCI). The mean age of patients enrolled for all studies was 59.4 years (range 16 to 93 years). The number (%) of studies which stratified for age is 54 (20.9%) for JCO, 17 (29.3%) for Cancer, and 7 (41%) for JNCI. The number (%) of studies which included age in their analyses is 75 (29%) for JCO, 14 (24%) for Cancer, and 6 (35.3%) for JNCI. Age was mentioned in the discussion section in 40 (15.5%), 8 (13.8%), and 6 (35.3%), JCO, Cancer, and JNCI articles, respectively. Conclusions: The current clinical trials fail to provide ample data which clinicians need to best manage the older cancer population. Since there was a lack of age related analyses, valuable data may have gone unreported. ASCO and other organizations recognize the lack of data on the management of older cancer patients. The underrepresentation of this population in clinical trials certainly contributes to this lack of data. Data mining of these existing studies involving large numbers of patients may provide valuable age related information for clinicians. The continued development of trials involving the older cancer population will aid in increasing our knowledge. We would also like to put forth that journal reviewers and editors should require the incorporation and reporting of age related analyses in studies, especially those involving large number of patients. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- J. T. Tam-McDevitt
- Geriatric Oncology Consortium, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - W. Tew
- Geriatric Oncology Consortium, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S. Klapper
- Geriatric Oncology Consortium, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - R. Hauser
- Geriatric Oncology Consortium, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S. Lichtman
- Geriatric Oncology Consortium, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| |
Collapse
|
20
|
Hensley ML, Larkin J, Ishill N, Abu-Rustum N, Sabbatini P, Konner J, Tew W, Spriggs D, Aghajanian CA. Phase II study of adjuvant gemcitabine plus docetaxel (GD) for completely resected stage I-IV high grade uterine leiomyosarcoma (HGuLMS). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5591] [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
5591 Background: Patients (pts) with completely resected stage I-IV HGuLMS are at high risk for recurrence, with reported 2-year progression-free survival ranging from 19–30% (Dinh, Gyn Onc 2004; Major, Cancer 1993). No adjuvant treatment has been shown to improve survival, although prospective data are limited. GD achieves objective responses in metastatic uLMS. We sought to determine whether 4 cycles GD given after complete resection of stage I-IV HGuLMS would yield a 2-year PFS of at least 40%, in order to determine whether GD was worth pursuing as an adjuvant strategy in a randomized trial. Methods: Eligible pts with completely resected HGuLMS within 8 weeks of surgery, no prior GD, no evidence of disease on post-resection CT, KPS = 80, and adequate organ function were treated with G 900 mg/m2 over 90 minutes days 1 and 8 + D 75 mg/m2 d8, with GCSF or pegfilgrastim, every 3 weeks for 4 cycles. CT was performed at baseline, after cycle 4, and every 3 months. Progression defined as new evidence of disease on CT. Results: 25 pts (median age 49, range 37–73) enrolled; 23 evaluable (1-never treated, 1-ineligible). Grade 3 related toxicities were: neutropenia (2/23) 8.7%, febrile neutropenia (2/23) 8.7%, anemia (2/23) 8.7%, thrombocytopenia (1/23) 4.3%, diarrhea (1/23) 4.3%, hyperglycemia (2/23) 8.7%, pulmonary (2/23) 8.7%; there were no ≥ grade 4 toxicities. With median follow-up of 29 months (range 0.5 to 45 months) for all pts, PFS at 2 y and 3 y is 45%, and median OS is not yet reached. For the 18 pts with stage I or II uLMS 2-y and 3-y PFS is 58%, and median PFS is 38 months (95%C.I. 6 months to not yet reached). Sites of first recurrence were: lung only-3/23 (13%); pelvis only-5/23 (22%); both-5 (22%). Treatment of recurrence was at physician discretion and included resection, resection plus pelvic radiation, and/or chemotherapy. Conclusions: Pts treated with post-resection GD for stage I-IV HGuLMS had 2-y and 3-y PFS that appears superior to historical rates of PFS. Incorporation of GD into a randomized trial of adjuvant chemotherapy vs adjuvant pelvic radiation for resected stage I and II uLMS is planned. No significant financial relationships to disclose.
Collapse
Affiliation(s)
| | - J. Larkin
- Memor Sloan Kettering Cancer Ctr, New York, NY
| | - N. Ishill
- Memor Sloan Kettering Cancer Ctr, New York, NY
| | | | | | - J. Konner
- Memor Sloan Kettering Cancer Ctr, New York, NY
| | - W. Tew
- Memor Sloan Kettering Cancer Ctr, New York, NY
| | - D. Spriggs
- Memor Sloan Kettering Cancer Ctr, New York, NY
| | | |
Collapse
|
21
|
Hurria A, Lichtman S, Priyadarshi S, Gardes J, Zuckerman E, Hamlin P, Tew W, Kelly E, Abou-Alfa GK, Lachs M. Feasibility of a self-administered geriatric assessment tool for older patients with cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.18519] [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
18519 Background: As the population ages, there is an emerging need to develop a geriatric assessment (GA) tool for oncologists to characterize the ‘functional age‘ of older patients in order to tailor treatment, stratify outcomes by factors other than chronological age, and develop interventions to optimize cancer treatment. The GA tool must be easy to administer in order to minimize burden on clinic resources. The goal of this study was to determine the feasibility of administering a brief, comprehensive, self-administered GA tool to older patients before their meeting with the oncologist. Methods: The self-administered GA tool addresses the following domains: functional status, comorbidity, psychological state, nutritional status, and social support. The measures which comprise the tool are brief, reliable, validated, predictive of mortality and morbidity in older patients, and do not require a staff member to administer. Feasibility was assessed by the following parameters: 1) % able to complete the GA tool unassisted; 2) % requiring the assistance of staff members versus non-staff members; 3) overall patient satisfaction; 4) time to complete. Results: 168 (96%) of 175 patients completed the GA tool with a mean age of 76 (range 64–92) with AJCC stages [I (33%), II (17%), III (10%), IV (39%)] across a variety of tumor types. Of the study cohort, 67% were women, 57% were married, and 89% were retired. Median time to complete the GA tool was 13 minutes and mean time was 16 minutes (SD 11, range 3–60). Most completed the GA tool on their own (75%) or received assistance from a friend or family member (20%). Only 4% required assistance from a member of the healthcare team. Patient satisfaction with the GA tool was high: 88% satisfied with the length, 92% reported no difficult questions, and 97% reported no upsetting questions. Based on the assessment scores, the following interventions were offered: referral to a social worker (38%), nutritionist (43%), visiting nurse/home health aide (30%), internist (23%), rehabilitation (13%), ENT (13%), ophthalmology (7%), and psychiatry (5%). Conclusion: This brief, comprehensive, self-administered GA tool is feasible for use in the outpatient oncology setting. Prospective trials are needed to determine the effectiveness of the interventions offered. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- A. Hurria
- Memorial Sloan-Kettering Cancer Center, New York, NY; New York Downtown Hospital, New York, NY; Weill Medical College of Cornell University, New York, NY
| | - S. Lichtman
- Memorial Sloan-Kettering Cancer Center, New York, NY; New York Downtown Hospital, New York, NY; Weill Medical College of Cornell University, New York, NY
| | - S. Priyadarshi
- Memorial Sloan-Kettering Cancer Center, New York, NY; New York Downtown Hospital, New York, NY; Weill Medical College of Cornell University, New York, NY
| | - J. Gardes
- Memorial Sloan-Kettering Cancer Center, New York, NY; New York Downtown Hospital, New York, NY; Weill Medical College of Cornell University, New York, NY
| | - E. Zuckerman
- Memorial Sloan-Kettering Cancer Center, New York, NY; New York Downtown Hospital, New York, NY; Weill Medical College of Cornell University, New York, NY
| | - P. Hamlin
- Memorial Sloan-Kettering Cancer Center, New York, NY; New York Downtown Hospital, New York, NY; Weill Medical College of Cornell University, New York, NY
| | - W. Tew
- Memorial Sloan-Kettering Cancer Center, New York, NY; New York Downtown Hospital, New York, NY; Weill Medical College of Cornell University, New York, NY
| | - E. Kelly
- Memorial Sloan-Kettering Cancer Center, New York, NY; New York Downtown Hospital, New York, NY; Weill Medical College of Cornell University, New York, NY
| | - G. K. Abou-Alfa
- Memorial Sloan-Kettering Cancer Center, New York, NY; New York Downtown Hospital, New York, NY; Weill Medical College of Cornell University, New York, NY
| | - M. Lachs
- Memorial Sloan-Kettering Cancer Center, New York, NY; New York Downtown Hospital, New York, NY; Weill Medical College of Cornell University, New York, NY
| |
Collapse
|
22
|
Konner JA, Ahmed S, Gerst S, Vander Els N, Pezzuli S, Sabbatini P, Hensley M, Dupont J, Tew W, Aghajanian C. Phase I study of MORAb-003, a humanized anti-folate receptor-alpha monoclonal antibody, in platinum resistant ovarian cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.5027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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
5027 Background: Folate receptor alpha (FRA) is over-expressed in the majority of epithelial ovarian cancers (EOC) but largely absent from normal tissue. MORAb-003 (M3) is a humanized monoclonal antibody (MAb) to FRA. Binding of M3 to FRA can prevent phosphorylation of substrates specific for the Lyn kinase; suppress proliferation of cells over-expressing FRA; mediate FRA-positive tumor cell killing via antibody-dependent cellular and complement-dependent mechanisms; and suppress tumor growth in vivo of FRA-expressing tumors in rodent xenograft models. Toxicology studies in non-human primates found no evidence of toxicity with M3 at supra-pharmacological doses. This open-label, multiple-infusion, first-in-human, dose-escalation trial evaluates the safety, pharmacokinetics (PK), and antitumor activity of M3 in patients with platinum-resistant EOC. Methods: Sequential cohorts of patients receive four weekly infusions at escalating dose levels of M3, from 12.5 mg/m2 to 100 mg/m2. Human anti-human antibody (HAHA) and PK analyses are performed. Eligible patients have EOC that relapsed < 6 months after platinum-based therapy, acceptable organ function, Karnofsky Performance Status ≥ 70%, and measurable disease by GOG-RECIST criteria. Patients undergo pulmonary function testing (PFT) at baseline, and at end of study. Results: To date, 7 women have been treated with M3: 3 at the 12.5 mg/m2 dose, 3 at 25 mg/m2, and 1 at 37.5 mg/m2. Median age was 60. Neither dose limiting toxicity nor HAHA has been observed. Grade 1 rash occurred in 1 patient. Grade 1/2 fever following drug administration occurred in 2 patients. Grade 2 FEV1 decrease was observed in a patient with likely pulmonary lymphangitic metastasis. One subject at 25 mg/m2 had radiographically stable disease. At low doses, the PK analysis demonstrated the half-life to be shorter than anticipated based on animal studies, possibly due to tumor binding. Radiolableled imaging studies are underway to determine the distribution of M3. Conclusions: The FRA-specific MAb MORAb-003 appears to be well tolerated in patients with EOC. Enrollment continues and updated results will be presented. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- J. A. Konner
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S. Ahmed
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S. Gerst
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - N. Vander Els
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S. Pezzuli
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - P. Sabbatini
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - M. Hensley
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J. Dupont
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - W. Tew
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - C. Aghajanian
- Memorial Sloan-Kettering Cancer Center, New York, NY
| |
Collapse
|
23
|
DeLisi LE, Sakuma M, Tew W, Kushner M, Hoff AL, Grimson R. Schizophrenia as a chronic active brain process: a study of progressive brain structural change subsequent to the onset of schizophrenia. Psychiatry Res 1997; 74:129-40. [PMID: 9255858 DOI: 10.1016/s0925-4927(97)00012-7] [Citation(s) in RCA: 350] [Impact Index Per Article: 13.0] [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: 02/05/2023]
Abstract
Brain structural deviation is known to be present in chronic patients with schizophrenia when compared with normal age-matched individuals. While the assumption is that these differences are based on a neurodevelopmental disturbance, whether they are static or continue to change throughout the disease process remains unknown. The following report describes a prospective follow-up study of first episode cases of schizophrenic illness. Analyses of MRI evaluations on an approximate annual basis for a minimum of four years are presented on 50 patients and 20 controls. Computer-assisted image analysis measuring the volume of several brain regions, using the program ANALYZE (Mayo Clinic), was performed on all scans. Patients were compared with controls for the rate of change over time in size of structures. No differences were found for the volumes of the caudate nucleus, temporal lobes, or hippocampus; and no changes in the degree of cerebral laterality were detected. However, there was a significant difference in the rate of change in the overall volumes of left and right hemispheres (P < 0.0004 and 0.001, respectively), right cerebellum (P < 0.02) and area of the isthmus of the corpus callosum (P < 0.05). The left cerebral ventricle had significantly greater enlargement over time when measured on coronal slice sequences (P < 0.02), but was not detected by axial views. These findings suggest that a subtle active brain process may be continuing through the first few years of a schizophrenic illness causing greater than the normal adult cortical deterioration. Further studies using other methods of image analysis and over a longer period of time are needed to determine the course and nature of this biologic process.
Collapse
Affiliation(s)
- L E DeLisi
- Department of Psychiatry, HSC, SUNY Stony Brook 11794, USA.
| | | | | | | | | | | |
Collapse
|
24
|
Abstract
OBJECTIVE A cortical gray matter deficit has been found in cross-sectional studies of patients with chronic schizophrenia. The purpose of this study was to examine whether this deficit is present early in the course of illness. METHOD The authors measured cortical gray matter volume on magnetic resonance images acquired within 6 months of onset of illness from 22 patients with first-episode schizophrenia and 51 age-matched comparison subjects from the Stony Brook First Episode Study. RESULTS A significant cortical gray matter deficit and lateral ventricular enlargement were found in schizophrenic patients relative to the comparison group. CONCLUSIONS The presence of the cortical gray matter deficit close to onset of illness supports the role of preexisting structural brain deficits in the genesis of schizophrenia.
Collapse
Affiliation(s)
- K O Lim
- Psychiatry Service (116-A3), VA Palo Alto Health Care System, CA 94304, USA.
| | | | | | | | | | | |
Collapse
|
25
|
DeLisi LE, Tew W, Xie S, Hoff AL, Sakuma M, Kushner M, Lee G, Shedlack K, Smith AM, Grimson R. A prospective follow-up study of brain morphology and cognition in first-episode schizophrenic patients: preliminary findings. Biol Psychiatry 1995; 38:349-60. [PMID: 8547454 DOI: 10.1016/0006-3223(94)00376-e] [Citation(s) in RCA: 180] [Impact Index Per Article: 6.2] [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: 01/31/2023]
Abstract
Brain morphological abnormalities have been reported in several independent investigations of chronic schizophrenic patients. The present study is a prospective 4-year follow-up of first-episode schizophrenic patients to determine whether some of these abnormalities may be a consequence of regional brain structural change over time after the onset of a first psychotic episode. Whole hemisphere, temporal lobes, superior temporal gyrus, hippocampus, caudate, corpus callosum, and lateral ventricles were measured in a series of MRI scans taken over a 4-year period in 20 patients and five controls. Total volume reduction was noted in both hemispheres to a greater degree in patients than controls. When adjusted for total brain size, left ventricular enlargement occurred in patients, but not controls, over time. These preliminary data suggest that subtle cortical atrophy may be occurring over time after the onset of illness.
Collapse
Affiliation(s)
- L E DeLisi
- Department of Psychiatry, State University of New York at Stony Brook 11794, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
Transplantation of femoral vein grafts was performed on 33 mongrel dogs to assess graft patency and valvular function after storage in glutaraldehyde. The grafts were removed from the donor, flushed with room temperature heparinized lactated Ringer's solution, and then stored in a 0.2% glutaraldehyde solution for 16 hr. At the time of grafting, the veins were again flushed with lactated Ringer's and anastomosed orthotopically to the recipient. An arteriovenous fistula was also created. Postoperatively the animals received daily doses of aspirin (2 mg/kg) and dipyridamol (50 mg). The following groups were studied: Group I (n = 10) served as controls and received fresh autografts. Group II (n = 13) received autografts stored for 16 hr in 0.2% glutaraldehyde. Group III (n = 10) received allografts stored similarly in glutaraldehyde for 16 hr. The grafts were monitored for evidence of patency. All grafts were removed for histological evaluation when patency was no longer detected or at the end of 7 weeks. Of the fresh and glutaraldehyde-preserved autografts (Group 1), 100% were patent at 7 weeks, and generally retained valve function. Patency of allografts was only slightly inferior but valve function was disappointingly poor at 7 weeks.
Collapse
Affiliation(s)
- M Kaya
- University of Mississippi Medical Center, Jackson 39216-4505
| | | | | | | | | |
Collapse
|