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Choueiri TK, Labaki C, Bakouny Z, Hsu CY, Schmidt AL, de Lima Lopes G, Hwang C, Singh SR, Jani C, Weissmann LB, Griffiths EA, Halabi S, Wu U, Berg S, O'Connor TE, Wise-Draper TM, Panagiotou OA, Klein EJ, Joshi M, Yared F, Dutra MS, Gatson NTN, Blau S, Singh H, Nanchal R, McKay RR, Nonato TK, Quinn R, Rubinstein SM, Puc M, Mavromatis BH, Vikas P, Faller B, Zaren HA, Del Prete S, Russell K, Reuben DY, Accordino MK, Singh H, Friese CR, Mishra S, Rivera DR, Shyr Y, Farmakiotis D, Warner JL. Breakthrough SARS-CoV-2 infections among patients with cancer following two and three doses of COVID-19 mRNA vaccines: a retrospective observational study from the COVID-19 and Cancer Consortium. Lancet Reg Health Am 2023; 19:100445. [PMID: 36818595 PMCID: PMC9925160 DOI: 10.1016/j.lana.2023.100445] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 01/03/2023] [Accepted: 01/24/2023] [Indexed: 02/16/2023]
Abstract
Background Breakthrough SARS-CoV-2 infections following vaccination against COVID-19 are of international concern. Patients with cancer have been observed to have worse outcomes associated with COVID-19 during the pandemic. We sought to evaluate the clinical characteristics and outcomes of patients with cancer who developed breakthrough SARS-CoV-2 infections after 2 or 3 doses of mRNA vaccines. Methods We evaluated the clinical characteristics of patients with cancer who developed breakthrough infections using data from the multi-institutional COVID-19 and Cancer Consortium (CCC19; NCT04354701). Analysis was restricted to patients with laboratory-confirmed SARS-CoV-2 diagnosed in 2021 or 2022, to allow for a contemporary unvaccinated control population; potential differences were evaluated using a multivariable logistic regression model after inverse probability of treatment weighting to adjust for potential baseline confounding variables. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported. The primary endpoint was 30-day mortality, with key secondary endpoints of hospitalization and ICU and/or mechanical ventilation (ICU/MV). Findings The analysis included 2486 patients, of which 564 and 385 had received 2 or 3 doses of an mRNA vaccine prior to infection, respectively. Hematologic malignancies and recent receipt of systemic anti-neoplastic therapy were more frequent among vaccinated patients. Vaccination was associated with improved outcomes: in the primary analysis, 2 doses (aOR: 0.62, 95% CI: 0.44-0.88) and 3 doses (aOR: 0.20, 95% CI: 0.11-0.36) were associated with decreased 30-day mortality. There were similar findings for the key secondary endpoints of ICU/MV (aOR: 0.60, 95% CI: 0.45-0.82 and 0.37, 95% CI: 0.24-0.58) and hospitalization (aOR: 0.60, 95% CI: 0.48-0.75 and 0.35, 95% CI: 0.26-0.46) for 2 and 3 doses, respectively. Importantly, Black patients had higher rates of hospitalization (aOR: 1.47, 95% CI: 1.12-1.92), and Hispanic patients presented with higher rates of ICU/MV (aOR: 1.61, 95% CI: 1.06-2.44). Interpretation Vaccination against COVID-19, especially with additional doses, is a fundamental strategy in the prevention of adverse outcomes including death, among patients with cancer. Funding This study was partly supported by grants from the National Cancer Institute grant number P30 CA068485 to C-YH, YS, SM, JLW; T32-CA236621 and P30-CA046592 to C.R.F; CTSA 2UL1TR001425-05A1 to TMW-D; ACS/FHI Real-World Data Impact Award, P50 MD017341-01, R21 CA242044-01A1, Susan G. Komen Leadership Grant Hunt to MKA. REDCap is developed and supported by Vanderbilt Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS/NIH).
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Affiliation(s)
| | | | - Ziad Bakouny
- Dana-Farber Cancer Institute, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Chih-Yuan Hsu
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | | | | | - Clara Hwang
- Division of Hematology and Medical Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Sunny R.K. Singh
- Division of Hematology and Medical Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Chinmay Jani
- Department of Internal Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA
| | - Lisa B. Weissmann
- Department of Internal Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA
| | | | | | - Ulysses Wu
- Hartford HealthCare Cancer Institute, Hartford, CT, USA
| | - Stephanie Berg
- Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, USA
| | - Timothy E. O'Connor
- Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, USA
| | | | - Orestis A. Panagiotou
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | - Elizabeth J. Klein
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | | | - Fares Yared
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Sibel Blau
- Northwest Medical Specialties, PLLC, Puyallup, WA, USA
| | | | | | - Rana R. McKay
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Taylor K. Nonato
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Ryann Quinn
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | | | - Praveen Vikas
- Holden Comprehensive Cancer Center, Iowa City, IA, USA
| | - Bryan Faller
- Missouri Baptist Medical Center Cancer Center/Heartland NCORP, St Louis, MO, USA
| | | | | | - Karen Russell
- Tallahassee Memorial Healthcare, Tallahassee, FL, USA
| | | | - Melissa K. Accordino
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Harpreet Singh
- U.S. Food and Drug Administration, Silver Spring, MD, USA
| | | | - Sanjay Mishra
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | | | - Yu Shyr
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Dimitrios Farmakiotis
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | - Jeremy L. Warner
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
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Navani V, Wells JC, Boyne DJ, Cheung WY, Brenner DM, McGregor BA, Labaki C, Schmidt AL, McKay RR, Meza L, Pal SK, Donskov F, Beuselinck B, Otiato M, Ludwig L, Powles T, Szabados BE, Choueiri TK, Heng DYC. CABOSEQ: The Effectiveness of Cabozantinib in Patients With Treatment Refractory Advanced Renal Cell Carcinoma: Results From the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC). Clin Genitourin Cancer 2023; 21:106.e1-106.e8. [PMID: 35945133 DOI: 10.1016/j.clgc.2022.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND There are limited data evaluating the activity of cabozantinib (CABO) as second line (2L) therapy post standard of care ipilimumab-nivolumab (IPI-NIVO) or immuno-oncology(IO)/vascular endothelial growth factor inhibitor (VEGFi) combinations (IOVE). MATERIALS AND METHODS Using the IMDC database, we sought to identify the objective response rate, time to treatment failure (TTF) and overall survival (OS) of 2L CABO after IPI-NIVO, IOVE combinations, pazopanib or sunitinib (PAZ/SUN) or other first line (1L) therapies. Multivariable Cox regression, adjusted for underlying differences in IMDC groups, was used to compare differences in OS for 2L CABO based on preceding therapy. RESULTS Three hundred and forty-six patients received 2L CABO (78 post IPI NIVO, 46 post IOVE, 161 post PAZ/SUN, 61 post Other). Of the entire cohort, 12.6%, 62.6%, and 24.8% were IMDC favourable, intermediate, and poor risk, respectively. Patients that received 1L IPI-NIVO had a median OS of 21.4 (95% CI, 12.1 - NE [Not evaluable]) months compared to 15.7 (95% CI, 9.3 - NE) months in 1L IOVE and 20.7 (95% CI, 15.6 - 35.6) months in 1L PAZ/SUN, P = .28. Median TTF from the initiation of 2L CABO in the overall population was 7.6 (95% CI, 6.6 - 9.0) months. We were unable to detect a significant difference in 2L CABO OS based on type of 1L therapy received: 1L IPI-NIVO (reference group) vs. 1L IOVE HR 1.73 (95% CI, 0.83 - 3.62 P = .14), 1L PAZ/SUN 1.16 (95% CI, 0.67 - 2.00 P = .60), however given the retrospective observational nature of this work a lack of sufficient power may contribute to this. CONCLUSION In a large real world dataset, we identified clinically meaningful activity of 2L CABO after all evaluated contemporary 1L therapies, irrespective of whether the 1L regimen included a VEGFi. These are real world benchmarks with which to counsel our patients.
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Affiliation(s)
| | | | | | - Winson Y Cheung
- Tom Baker Cancer Centre, Calgary, Canada; University of Calgary, Calgary, Canada
| | | | | | | | | | - Rana R McKay
- University of California San Diego, Moores Cancer Center, La Jolla, United States
| | - Luis Meza
- City of Hope Comprehensive Cancer Center, Duarte, United States
| | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, United States
| | - Frede Donskov
- University Hospital of Southern Denmark, Esbjerg, Denmark
| | | | | | | | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
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Bakouny Z, Labaki C, Grover P, Awosika J, Gulati S, Hsu CY, Alimohamed SI, Bashir B, Berg S, Bilen MA, Bowles D, Castellano C, Desai A, Elkrief A, Eton OE, Fecher LA, Flora D, Galsky MD, Gatti-Mays ME, Gesenhues A, Glover MJ, Gopalakrishnan D, Gupta S, Halfdanarson TR, Hayes-Lattin B, Hendawi M, Hsu E, Hwang C, Jandarov R, Jani C, Johnson DB, Joshi M, Khan H, Khan SA, Knox N, Koshkin VS, Kulkarni AA, Kwon DH, Matar S, McKay RR, Mishra S, Moria FA, Nizam A, Nock NL, Nonato TK, Panasci J, Pomerantz L, Portuguese AJ, Provenzano D, Puc M, Rao YJ, Rhodes TD, Riely GJ, Ripp JJ, Rivera AV, Ruiz-Garcia E, Schmidt AL, Schoenfeld AJ, Schwartz GK, Shah SA, Shaya J, Subbiah S, Tachiki LM, Tucker MD, Valdez-Reyes M, Weissmann LB, Wotman MT, Wulff-Burchfield EM, Xie Z, Yang YJ, Thompson MA, Shah DP, Warner JL, Shyr Y, Choueiri TK, Wise-Draper TM, Gandhi R, Gartrell BA, Goel S, Halmos B, Makower DF, O' Sullivan D, Ohri N, Portes M, Shapiro LC, Shastri A, Sica RA, Verma AK, Butt O, Campian JL, Fiala MA, Henderson JP, Monahan RS, Stockerl-Goldstein KE, Zhou AY, Bitran JD, Hallmeyer S, Mundt D, Pandravada S, Papaioannou PV, Patel M, Streckfuss M, Tadesse E, Gatson NTN, Kundranda MN, Lammers PE, Loree JM, Yu IS, Bindal P, Lam B, Peters MLB, Piper-Vallillo AJ, Egan PC, Farmakiotis D, Arvanitis P, Klein EJ, Olszewski AJ, Vieira K, Angevine AH, Bar MH, Del Prete SA, Fiebach MZ, Gulati AP, Hatton E, Houston K, Rose SJ, Steve Lo KM, Stratton J, Weinstein PL, Garcia JA, Routy B, Hoyo-Ulloa I, Dawsey SJ, Lemmon CA, Pennell NA, Sharifi N, Painter CA, Granada C, Hoppenot C, Li A, Bitterman DS, Connors JM, Demetri GD, Florez (Duma) N, Freeman DA, Giordano A, Morgans AK, Nohria A, Saliby RM, Tolaney SM, Van Allen EM, Xu WV, Zon RL, Halabi S, Zhang T, Dzimitrowicz H, Leighton JC, Graber JJ, Grivas P, Hawley JE, Loggers ET, Lyman GH, Lynch RC, Nakasone ES, Schweizer MT, Vinayak S, Wagner MJ, Yeh A, Dansoa Y, Makary M, Manikowski JJ, Vadakara J, Yossef K, Beckerman J, Goyal S, Messing I, Rosenstein LJ, Steffes DR, Alsamarai S, Clement JM, Cosin JA, Daher A, Dailey ME, Elias R, Fein JA, Hosmer W, Jayaraj A, Mather J, Menendez AG, Nadkarni R, Serrano OK, Yu PP, Balanchivadze N, Gadgeel SM, Accordino MK, Bhutani D, Bodin BE, Hershman DL, Masson C, Alexander M, Mushtaq S, Reuben DY, Bernicker EH, Deeken JF, Jeffords KJ, Shafer D, Cárdenas AI, Cuervo Campos R, De-la-Rosa-Martinez D, Ramirez A, Vilar-Compte D, Gill DM, Lewis MA, Low CA, Jones MM, Mansoor AH, Mashru SH, Werner MA, Cohen AM, McWeeney S, Nemecek ER, Williamson SP, Peters S, Smith SJ, Lewis GC, Zaren HA, Akhtari M, Castillo DR, Cortez K, Lau E, Nagaraj G, Park K, Reeves ME, O'Connor TE, Altman J, Gurley M, Mulcahy MF, Wehbe FH, Durbin EB, Nelson HH, Ramesh V, Sachs Z, Wilson G, Bardia A, Boland G, Gainor JF, Peppercorn J, Reynolds KL, Rosovsky RP, Zubiri L, Bekaii-Saab TS, Joyner MJ, Riaz IB, Senefeld JW, Shah S, Ayre SK, Bonnen M, Mahadevan D, McKeown C, Mesa RA, Ramirez AG, Salazar M, Shah PK, Wang CP, Bouganim N, Papenburg J, Sabbah A, Tagalakis V, Vinh DC, Nanchal R, Singh H, Bahadur N, Bao T, Belenkaya R, Nambiar PH, O’Cearbhaill RE, Papadopoulos EB, Philip J, Robson M, Rosenberg JE, Wilkins CR, Tamimi R, Cerrone K, Dill J, Faller BA, Alomar ME, Chandrasekhar SA, Hume EC, Islam JY, Ajmera A, Brouha SS, Cabal A, Choi S, Hsiao A, Jiang JY, Kligerman S, Park J, Razavi P, Reid EG, Bhatt PS, Mariano MG, Thomson CC, Glace M(G, Knoble JL, Rink C, Zacks R, Blau SH, Brown C, Cantrell AS, Namburi S, Polimera HV, Rovito MA, Edwin N, Herz K, Kennecke HF, Monfared A, Sautter RR, Cronin T, Elshoury A, Fleissner B, Griffiths EA, Hernandez-Ilizaliturri F, Jain P, Kariapper A, Levine E, Moffitt M, O'Connor TL, Smith LJ, Wicher CP, Zsiros E, Jabbour SK, Misdary CF, Shah MR, Batist G, Cook E, Ferrario C, Lau S, Miller WH, Rudski L, Santos Dutra M, Wilchesky M, Mahmood SZ, McNair C, Mico V, Dixon B, Kloecker G, Logan BB, Mandapakala C, Cabebe EC, Jha A, Khaki AR, Nagpal S, Schapira L, Wu JTY, Whaley D, Lopes GDL, de Cardenas K, Russell K, Stith B, Taylor S, Klamerus JF, Revankar SG, Addison D, Chen JL, Haynam M, Jhawar SR, Karivedu V, Palmer JD, Pillainayagam C, Stover DG, Wall S, Williams NO, Abbasi SH, Annis S, Balmaceda NB, Greenland S, Kasi A, Rock CD, Luders M, Smits M, Weiss M, Chism DD, Owenby S, Ang C, Doroshow DB, Metzger M, Berenberg J, Uyehara C, Fazio A, Huber KE, Lashley LN, Sueyoshi MH, Patel KG, Riess J, Borno HT, Small EJ, Zhang S, Andermann TM, Jensen CE, Rubinstein SM, Wood WA, Ahmad SA, Brownfield L, Heilman H, Kharofa J, Latif T, Marcum M, Shaikh HG, Sohal DPS, Abidi M, Geiger CL, Markham MJ, Russ AD, Saker H, Acoba JD, Choi H, Rho YS, Feldman LE, Gantt G, Hoskins KF, Khan M, Liu LC, Nguyen RH, Pasquinelli MM, Schwartz C, Venepalli NK, Vikas P, Zakharia Y, Friese CR, Boldt A, Gonzalez CJ, Su C, Su CT, Yoon JJ, Bijjula R, Mavromatis BH, Seletyn ME, Wood BR, Zaman QU, Kaklamani V, Beeghly A, Brown AJ, Charles LJ, Cheng A, Crispens MA, Croessmann S, Davis EJ, Ding T, Duda SN, Enriquez KT, French B, Gillaspie EA, Hausrath DJ, Hennessy C, Lewis JT, Li X(L, Prescott LS, Reid SA, Saif S, Slosky DA, Solorzano CC, Sun T, Vega-Luna K, Wang LL, Aboulafia DM, Carducci TM, Goldsmith KJ, Van Loon S, Topaloglu U, Moore J, Rice RL, Cabalona WD, Cyr S, Barrow McCollough B, Peddi P, Rosen LR, Ravindranathan D, Hafez N, Herbst RS, LoRusso P, Lustberg MB, Masters T, Stratton C. Interplay of Immunosuppression and Immunotherapy Among Patients With Cancer and COVID-19. JAMA Oncol 2023; 9:128-134. [PMID: 36326731 PMCID: PMC9634600 DOI: 10.1001/jamaoncol.2022.5357] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/11/2022] [Indexed: 11/06/2022]
Abstract
Importance Cytokine storm due to COVID-19 can cause high morbidity and mortality and may be more common in patients with cancer treated with immunotherapy (IO) due to immune system activation. Objective To determine the association of baseline immunosuppression and/or IO-based therapies with COVID-19 severity and cytokine storm in patients with cancer. Design, Setting, and Participants This registry-based retrospective cohort study included 12 046 patients reported to the COVID-19 and Cancer Consortium (CCC19) registry from March 2020 to May 2022. The CCC19 registry is a centralized international multi-institutional registry of patients with COVID-19 with a current or past diagnosis of cancer. Records analyzed included patients with active or previous cancer who had a laboratory-confirmed infection with SARS-CoV-2 by polymerase chain reaction and/or serologic findings. Exposures Immunosuppression due to therapy; systemic anticancer therapy (IO or non-IO). Main Outcomes and Measures The primary outcome was a 5-level ordinal scale of COVID-19 severity: no complications; hospitalized without requiring oxygen; hospitalized and required oxygen; intensive care unit admission and/or mechanical ventilation; death. The secondary outcome was the occurrence of cytokine storm. Results The median age of the entire cohort was 65 years (interquartile range [IQR], 54-74) years and 6359 patients were female (52.8%) and 6598 (54.8%) were non-Hispanic White. A total of 599 (5.0%) patients received IO, whereas 4327 (35.9%) received non-IO systemic anticancer therapies, and 7120 (59.1%) did not receive any antineoplastic regimen within 3 months prior to COVID-19 diagnosis. Although no difference in COVID-19 severity and cytokine storm was found in the IO group compared with the untreated group in the total cohort (adjusted odds ratio [aOR], 0.80; 95% CI, 0.56-1.13, and aOR, 0.89; 95% CI, 0.41-1.93, respectively), patients with baseline immunosuppression treated with IO (vs untreated) had worse COVID-19 severity and cytokine storm (aOR, 3.33; 95% CI, 1.38-8.01, and aOR, 4.41; 95% CI, 1.71-11.38, respectively). Patients with immunosuppression receiving non-IO therapies (vs untreated) also had worse COVID-19 severity (aOR, 1.79; 95% CI, 1.36-2.35) and cytokine storm (aOR, 2.32; 95% CI, 1.42-3.79). Conclusions and Relevance This cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially IO, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm. Trial Registration ClinicalTrials.gov Identifier: NCT04354701.
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Affiliation(s)
- Ziad Bakouny
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chris Labaki
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Punita Grover
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Joy Awosika
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Shuchi Gulati
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Chih-Yuan Hsu
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Saif I Alimohamed
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Babar Bashir
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Mehmet A Bilen
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | | | | | - Aakash Desai
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Arielle Elkrief
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Omar E Eton
- Hartford Healthcare Cancer Institute, Hartford, Connecticut
| | | | | | | | | | | | | | | | | | | | | | - Mohamed Hendawi
- Aurora Cancer Center, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Emily Hsu
- Hartford Healthcare Cancer Institute, Hartford, Connecticut
| | - Clara Hwang
- Henry Ford Cancer Institute, Detroit, Michigan
| | - Roman Jandarov
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | | | | | - Monika Joshi
- Penn State Cancer Institute, Hershey, Pennsylvania
| | - Hina Khan
- Brown University and Lifespan Cancer Institute, Providence, Rhode Island
| | - Shaheer A Khan
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
| | - Natalie Knox
- Loyola University Medical Center, Maywood, Illinois
| | - Vadim S Koshkin
- UCSF, Helen Diller Comprehensive Cancer Center, San Francisco
| | | | - Daniel H Kwon
- UCSF, Helen Diller Comprehensive Cancer Center, San Francisco
| | - Sara Matar
- Hollings Cancer Center, MUSC, Charleston
| | - Rana R McKay
- Moores Cancer Center, UCSD, San Diego, California
| | - Sanjay Mishra
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Feras A Moria
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Nora L Nock
- Case Comprehensive Cancer Center, Department of Population and Quantitative Health Sciences, Cleveland, Ohio
| | | | - Justin Panasci
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | | | | | | | - Yuan J Rao
- George Washington University, Washington, DC
| | | | | | - Jacob J Ripp
- University of Kansas Medical Center, Kansas City
| | - Andrea V Rivera
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Andrew L Schmidt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Gary K Schwartz
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
| | | | - Justin Shaya
- Moores Cancer Center, UCSD, San Diego, California
| | - Suki Subbiah
- Stanley S. Scott Cancer Center, LSU, New Orleans, Louisiana
| | - Lisa M Tachiki
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | | | | | - Zhuoer Xie
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Michael A Thompson
- Aurora Cancer Center, Advocate Aurora Health, Milwaukee, Wisconsin.,Tempus Labs, Chicago, Illinois
| | - Dimpy P Shah
- Mays Cancer Center, UT Health, San Antonio, Texas
| | | | - Yu Shyr
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Trisha M Wise-Draper
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Omar Butt
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ang Li
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eric Lau
- for the COVID-19 and Cancer Consortium
| | | | - Kyu Park
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ting Bao
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ji Park
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Erin Cook
- for the COVID-19 and Cancer Consortium
| | | | - Susie Lau
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Anup Kasi
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Li C Liu
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | - Chris Su
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tan Ding
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | - Sara Saif
- for the COVID-19 and Cancer Consortium
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Groha S, Alaiwi SA, Xu W, Naranbhai V, Nassar AH, Bakouny Z, El Zarif T, Saliby RM, Wan G, Rajeh A, Adib E, Nuzzo PV, Schmidt AL, Labaki C, Ricciuti B, Alessi JV, Braun DA, Shukla SA, Keenan TE, Van Allen E, Awad MM, Manos M, Rahma O, Zubiri L, Villani AC, Fairfax B, Hammer C, Khan Z, Reynolds K, Semenov Y, Schrag D, Kehl KL, Freedman ML, Choueiri TK, Gusev A. Germline variants associated with toxicity to immune checkpoint blockade. Nat Med 2022; 28:2584-2591. [PMID: 36526723 PMCID: PMC10958775 DOI: 10.1038/s41591-022-02094-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 10/18/2022] [Indexed: 12/23/2022]
Abstract
Immune checkpoint inhibitors (ICIs) have yielded remarkable responses but often lead to immune-related adverse events (irAEs). Although germline causes for irAEs have been hypothesized, no individual variant associated with developing irAEs has been identified. We carried out a genome-wide association study of 1,751 patients on ICIs across 12 cancer types. We investigated two irAE phenotypes: (1) high-grade (3-5) and (2) all-grade events. We identified 3 genome-wide significant associations (P < 5 × 10-8) in the discovery cohort associated with all-grade irAEs: rs16906115 near IL7 (combined P = 3.6 × 10-11; hazard ratio (HR) = 2.1); rs75824728 near IL22RA1 (combined P = 3.5 × 10-8; HR = 1.8); and rs113861051 on 4p15 (combined P = 1.2 × 10-8, HR = 2.0); rs16906115 was replicated in 3 independent studies. The association near IL7 colocalized with the gain of a new cryptic exon for IL7, a critical regulator of lymphocyte homeostasis. Patients carrying the IL7 germline variant exhibited significantly increased lymphocyte stability after ICI initiation, which was itself predictive of downstream irAEs and improved survival.
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Affiliation(s)
- Stefan Groha
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of Harvard & MIT, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sarah Abou Alaiwi
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Wenxin Xu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Vivek Naranbhai
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Amin H Nassar
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ziad Bakouny
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Talal El Zarif
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Renee Maria Saliby
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Guihong Wan
- Harvard Medical School, Boston, MA, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Ahmad Rajeh
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Elio Adib
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Pier V Nuzzo
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Genoa, Italy
| | - Andrew L Schmidt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Chris Labaki
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Biagio Ricciuti
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Joao Victor Alessi
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Genoa, Italy
| | - David A Braun
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Center of Molecular and Cellular Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Sachet A Shukla
- Broad Institute of Harvard & MIT, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Translational Immunogenomics Lab, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tanya E Keenan
- Broad Institute of Harvard & MIT, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Eliezer Van Allen
- Broad Institute of Harvard & MIT, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mark M Awad
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Genoa, Italy
| | - Michael Manos
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Osama Rahma
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Alexandra-Chloe Villani
- Broad Institute of Harvard & MIT, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Center for Immunology and Inflammatory Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Zia Khan
- Genentech, South San Francisco, CA, USA
| | - Kerry Reynolds
- Harvard Medical School, Boston, MA, USA
- Division of Medical Oncology, Bartlett, Massachusetts General Hospital, Boston, MA, USA
| | - Yevgeniy Semenov
- Harvard Medical School, Boston, MA, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Deborah Schrag
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kenneth L Kehl
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Matthew L Freedman
- Broad Institute of Harvard & MIT, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Toni K Choueiri
- Harvard Medical School, Boston, MA, USA
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alexander Gusev
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Broad Institute of Harvard & MIT, Cambridge, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Division of Genetics, Brigham and Women's Hospital, Boston, MA, USA.
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5
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Loo Gan C, Huang J, Pan E, Xie W, Schmidt AL, Labaki C, Meza L, Bouchard G, Li H, Jackson-Spence F, Sánchez-Ruiz C, Powles T, Kumar SA, Weise N, Hall WA, Rose BS, Beuselinck B, Suarez C, Pal SK, Choueiri TK, Heng DY, McKay RR. Real-world Practice Patterns and Safety of Concurrent Radiotherapy and Cabozantinib in Metastatic Renal Cell Carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol Oncol 2022; 6:204-211. [PMID: 36328934 DOI: 10.1016/j.euo.2022.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/26/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is a paucity of data on the safety of cabozantinib use in combination with radiotherapy. OBJECTIVE To report the practice patterns, safety, and efficacy of cabozantinib with radiotherapy in metastatic renal cell carcinoma (mRCC). DESIGN, SETTING, AND PARTICIPANTS An international multicenter retrospective study was conducted. Patients with mRCC treated with cabozantinib at any line of therapy and who received radiotherapy between 30 d prior to the start date of cabozantinib and 30 d following discontinuation of cabozantinib, from 2014 to 2020, were included. Concurrent use was defined as the use of cabozantinib on radiotherapy treatment days during any course of radiotherapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcomes of interest were the rate of grade ≥3 adverse events (AEs) occurring within 90 d of receipt of radiotherapy. Secondary outcomes included hospitalization rate and patterns of cabozantinib and radiotherapy use. Baseline characteristics and AEs were presented descriptively. RESULTS AND LIMITATIONS A total of 127 consecutive patients were included. Most patients had clear cell histology (88%), had International Metastatic Renal Cell Carcinoma Database Consortium intermediate-risk disease (57%), and had received at least one prior line of therapy (93%). Of 127 patients, 67 (53%) received concurrent cabozantinib with radiotherapy, while the remaining held cabozantinib on radiotherapy days. Overall, grade 3-4 AEs occurred in 6.3% (n = 8/127) of patients. No grade 5 events were observed. In patients treated with conventional palliative radiotherapy (n = 88), the rate of grade 3-4 AEs in those who had concurrent versus those who had nonconcurrent cabozantinib was 6.3% (n = 3/48) versus 5.0% (n = 2/40). No patient was hospitalized due to radiotherapy-related toxicity. In patients treated with stereotactic ablative body radiotherapy (SABR; n = 50), the rate of grade 3-4 AEs in those who had concurrent versus those who had nonconcurrent cabozantinib was 3.6% (n = 1/28) versus 9.1% (n = 2/22). One patient in the nonconcurrent group was hospitalized due to muscle weakness suspected to be related to associated vasogenic edema 19 d after SABR for multiple brain metastases. CONCLUSIONS In this real-world study of patients with mRCC treated with cabozantinib, 53% of patients received radiotherapy concurrently, with few grade 3-4 AEs reported within 90 d of receiving radiotherapy. The use of radiotherapy and cabozantinib requires a risk-benefit assessment of patient and disease characteristics to optimize therapy regimens. PATIENT SUMMARY Our study reports the real-world experience of using radiotherapy in patients receiving cabozantinib for metastatic kidney cancer. Over half of the patients continued taking cabozantinib while receiving radiotherapy, and few patients developed serious side effects. The combined use of radiotherapy and cabozantinib requires a careful risk-benefit assessment to achieve optimal treatment outcomes.
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6
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Bakouny Z, Labaki C, Bhalla S, Schmidt AL, Steinharter JA, Cocco J, Tremblay DA, Awad MM, Kessler A, Haddad RI, Evans M, Busser F, Wotman M, Curran CR, Zimmerman BS, Bouchard G, Jun T, Nuzzo PV, Qin Q, Hirsch L, Feld J, Kelleher KM, Seidman D, Huang H, Anderson-Keightly HM, El Zarif T, Alaiwi SA, Champagne C, Rosenbloom TD, Stewart PS, Johnson BE, Trinh Q, Tolaney SM, Galsky MD, Choueiri TK, Doroshow DB. Oncology clinical trial disruption during the COVID-19 pandemic: a COVID-19 and cancer outcomes study. Ann Oncol 2022; 33:836-844. [PMID: 35715285 PMCID: PMC9197329 DOI: 10.1016/j.annonc.2022.04.071] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 03/14/2022] [Accepted: 04/18/2022] [Indexed: 12/01/2022] Open
Abstract
Background COVID-19 disproportionately impacted patients with cancer as a result of direct infection, and delays in diagnosis and therapy. Oncological clinical trials are resource-intensive endeavors that could be particularly susceptible to disruption by the pandemic, but few studies have evaluated the impact of the pandemic on clinical trial conduct. Patients and methods This prospective, multicenter study assesses the impact of the pandemic on therapeutic clinical trials at two large academic centers in the Northeastern United States between December 2019 and June 2021. The primary objective was to assess the enrollment on, accrual to, and activation of oncology therapeutic clinical trials during the pandemic using an institution-wide cohort of (i) new patient accruals to oncological trials, (ii) a manually curated cohort of patients with cancer, and (ii) a dataset of new trial activations. Results The institution-wide cohort included 4756 new patients enrolled to clinical trials from December 2019 to June 2021. A major decrease in the numbers of new patient accruals (−46%) was seen early in the pandemic, followed by a progressive recovery and return to higher-than-normal levels (+2.6%). A similar pattern (from −23.6% to +30.4%) was observed among 467 newly activated trials from June 2019 to June 2021. A more pronounced decline in new accruals was seen among academically sponsored trials (versus industry sponsored trials) (P < 0.05). In the manually curated cohort, which included 2361 patients with cancer, non-white patients tended to be more likely taken off trial in the early pandemic period (adjusted odds ratio: 2.60; 95% confidence interval 1.00-6.63), and substantial pandemic-related deviations were recorded. Conclusions Substantial disruptions in clinical trial activities were observed early during the pandemic, with a gradual recovery during ensuing time periods, both from an enrollment and an activation standpoint. The observed decline was more prominent among academically sponsored trials, and racial disparities were seen among people taken off trial.
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Affiliation(s)
- Z Bakouny
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - C Labaki
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - S Bhalla
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - A L Schmidt
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - J A Steinharter
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - J Cocco
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - D A Tremblay
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - M M Awad
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - A Kessler
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - R I Haddad
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - M Evans
- Department of Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, USA
| | - F Busser
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - M Wotman
- Department of Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, USA
| | - C R Curran
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - B S Zimmerman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - G Bouchard
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - T Jun
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - P V Nuzzo
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - Q Qin
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - L Hirsch
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - J Feld
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - K M Kelleher
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - D Seidman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - H Huang
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | | | - T El Zarif
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - S Abou Alaiwi
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - C Champagne
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - T D Rosenbloom
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - P S Stewart
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - B E Johnson
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - Q Trinh
- Division of Urological Surgery, Brigham and Women's Hospital, Boston, USA
| | - S M Tolaney
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - M D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - T K Choueiri
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA.
| | - D B Doroshow
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA.
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7
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Schmidt AL, Labaki C, Hsu CY, Bakouny Z, Balanchivadze N, Berg SA, Blau S, Daher A, El Zarif T, Friese CR, Griffiths EA, Hawley JE, Hayes-Lattin B, Karivedu V, Latif T, Mavromatis BH, McKay RR, Nagaraj G, Nguyen RH, Panagiotou OA, Portuguese AJ, Puc M, Santos Dutra M, Schroeder BA, Thakkar A, Wulff-Burchfield EM, Mishra S, Farmakiotis D, Shyr Y, Warner JL, Choueiri TK. COVID-19 vaccination and breakthrough infections in patients with cancer. Ann Oncol 2022; 33:340-346. [PMID: 34958894 PMCID: PMC8704021 DOI: 10.1016/j.annonc.2021.12.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Vaccination is an important preventive health measure to protect against symptomatic and severe COVID-19. Impaired immunity secondary to an underlying malignancy or recent receipt of antineoplastic systemic therapies can result in less robust antibody titers following vaccination and possible risk of breakthrough infection. As clinical trials evaluating COVID-19 vaccines largely excluded patients with a history of cancer and those on active immunosuppression (including chemotherapy), limited evidence is available to inform the clinical efficacy of COVID-19 vaccination across the spectrum of patients with cancer. PATIENTS AND METHODS We describe the clinical features of patients with cancer who developed symptomatic COVID-19 following vaccination and compare weighted outcomes with those of contemporary unvaccinated patients, after adjustment for confounders, using data from the multi-institutional COVID-19 and Cancer Consortium (CCC19). RESULTS Patients with cancer who develop COVID-19 following vaccination have substantial comorbidities and can present with severe and even lethal infection. Patients harboring hematologic malignancies are over-represented among vaccinated patients with cancer who develop symptomatic COVID-19. CONCLUSIONS Vaccination against COVID-19 remains an essential strategy in protecting vulnerable populations, including patients with cancer. Patients with cancer who develop breakthrough infection despite full vaccination, however, remain at risk of severe outcomes. A multilayered public health mitigation approach that includes vaccination of close contacts, boosters, social distancing, and mask-wearing should be continued for the foreseeable future.
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Affiliation(s)
- A L Schmidt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - C Labaki
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - C-Y Hsu
- Department of Biostatistics, Vanderbilt University, Nashville, USA
| | - Z Bakouny
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - N Balanchivadze
- Hematology and Oncology Fellowship Program, Henry Ford Cancer Institute, Detroit, USA
| | - S A Berg
- Department of Internal Medicine and Cancer Biology, Division of Hematology and Oncology, Cardinal Bernardin Cancer Centre, Loyola University Chicago, Maywood, USA
| | - S Blau
- Division of Oncology, Northwest Medical Specialties, Tacoma, USA; Division of Hematology, University of Washington, Seattle, USA
| | - A Daher
- Hartford HealthCare Medical Group, Hartford, USA
| | - T El Zarif
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - C R Friese
- University of Michigan School of Nursing, School of Public Health, and Rogel Cancer Centre, Ann Arbor, USA
| | - E A Griffiths
- Leukemia Section, Roswell Park Comprehensive Cancer Centre, Buffalo, USA
| | - J E Hawley
- Herbert Irving Comprehensive Cancer Centre, Columbia University Irving Medical Centre, New York, USA; University of Washington/Fred Hutchinson Cancer Research Center, Seattle, USA
| | - B Hayes-Lattin
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, USA
| | - V Karivedu
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Wexner Medical Centre, Columbus, USA
| | - T Latif
- Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, USA
| | - B H Mavromatis
- Department of Cancer, Oncology, Hematology, UPMC Western Maryland, Cumberland, USA
| | - R R McKay
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, USA
| | - G Nagaraj
- Division of Medical Oncology & Hematology, Department of Medicine, Loma Linda University Cancer Centre, Loma Linda, USA
| | - R H Nguyen
- Department of Medicine, Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, USA
| | - O A Panagiotou
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, USA
| | - A J Portuguese
- Division of Hematology, University of Washington, Seattle, USA
| | - M Puc
- Department of Surgery, Section of Thoracic Surgery, Virtua Health, Marlton, USA
| | - M Santos Dutra
- Segal Cancer Centre of the Jewish General Hospital, Montréal, Canada
| | | | - A Thakkar
- Division of Oncology, Montefiore Medical Centre, Bronx, USA
| | - E M Wulff-Burchfield
- Department of Medicine, Divisions of Medical Oncology and Palliative Medicine, The University of Kansas Health System, Westwood, USA
| | - S Mishra
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, USA
| | - D Farmakiotis
- Department of Medicine, Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, USA
| | - Yu Shyr
- Department of Biostatistics, Vanderbilt University, Nashville, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, USA
| | - J L Warner
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, USA; Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, USA; Department of Biomedical Informatics, Vanderbilt University, Nashville, USA.
| | - T K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA.
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8
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Elkrief A, Hennessy C, Kuderer NM, Rubinstein SM, Wulff-Burchfield E, Rosovsky RP, Vega-Luna K, Thompson MA, Panagiotou OA, Desai A, Rivera DR, Khaki AR, Tachiki L, Lynch RC, Stratton C, Elias R, Batist G, Kasi A, Shah DP, Bakouny Z, Cabal A, Clement J, Crowell J, Dixon B, Friese CR, Fry SL, Grover P, Gulati S, Gupta S, Hwang C, Khan H, Kim SJ, Klein EJ, Labaki C, McKay RR, Nizam A, Pennell NA, Puc M, Schmidt AL, Shahrokni A, Shaya JA, Su CT, Wall S, Williams N, Wise-Draper TM, Mishra S, Grivas P, French B, Warner JL, Wildes TM. Geriatric risk factors for serious COVID-19 outcomes among older adults with cancer: a cohort study from the COVID-19 and Cancer Consortium. Lancet Healthy Longev 2022; 3:e143-e152. [PMID: 35187516 PMCID: PMC8843069 DOI: 10.1016/s2666-7568(22)00009-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Older age is associated with poorer outcomes of SARS-CoV-2 infection, although the heterogeneity of ageing results in some older adults being at greater risk than others. The objective of this study was to quantify the association of a novel geriatric risk index, comprising age, modified Charlson comorbidity index, and Eastern Cooperative Oncology Group performance status, with COVID-19 severity and 30-day mortality among older adults with cancer. METHODS In this cohort study, we enrolled patients aged 60 years and older with a current or previous cancer diagnosis (excluding those with non-invasive cancers and premalignant or non-malignant conditions) and a current or previous laboratory-confirmed COVID-19 diagnosis who reported to the COVID-19 and Cancer Consortium (CCC19) multinational, multicentre, registry between March 17, 2020, and June 6, 2021. Patients were also excluded for unknown age, missing data resulting in unknown geriatric risk measure, inadequate data quality, or incomplete follow-up resulting in unknown COVID-19 severity. The exposure of interest was the CCC19 geriatric risk index. The primary outcome was COVID-19 severity and the secondary outcome was 30-day all-cause mortality; both were assessed in the full dataset. Adjusted odds ratios (ORs) and 95% CIs were estimated from ordinal and binary logistic regression models. FINDINGS 5671 patients with cancer and COVID-19 were included in the analysis. Median follow-up time was 56 days (IQR 22-120), and median age was 72 years (IQR 66-79). The CCC19 geriatric risk index identified 2365 (41·7%) patients as standard risk, 2217 (39·1%) patients as intermediate risk, and 1089 (19·2%) as high risk. 36 (0·6%) patients were excluded due to non-calculable geriatric risk index. Compared with standard-risk patients, high-risk patients had significantly higher COVID-19 severity (adjusted OR 7·24; 95% CI 6·20-8·45). 920 (16·2%) of 5671 patients died within 30 days of a COVID-19 diagnosis, including 161 (6·8%) of 2365 standard-risk patients, 409 (18·5%) of 2217 intermediate-risk patients, and 350 (32·1%) of 1089 high-risk patients. High-risk patients had higher adjusted odds of 30-day mortality (adjusted OR 10·7; 95% CI 8·54-13·5) than standard-risk patients. INTERPRETATION The CCC19 geriatric risk index was strongly associated with COVID-19 severity and 30-day mortality. Our CCC19 geriatric risk index, based on readily available clinical factors, might provide clinicians with an easy-to-use risk stratification method to identify older adults most at risk for severe COVID-19 as well as mortality. FUNDING US National Institutes of Health National Cancer Institute Cancer Center.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Orestis A Panagiotou
- Department of Health Services Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | | | | | | | - Lisa Tachiki
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Ryan C Lynch
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Catherine Stratton
- Yale Cancer Center at Yale University School of Medicine, New Haven, CT, USA
| | - Rawad Elias
- Hartford Healthcare Cancer Institute, Hartford, CT, USA
| | - Gerald Batist
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Anup Kasi
- The University of Kansas Medical Center, Kansas City, KS, USA
| | - Dimpy P Shah
- Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | | | - Angelo Cabal
- Moores Comprehensive Cancer Center at the University of California, San Diego (UCSD), San Diego, CA, USA
| | | | | | | | | | - Stacy L Fry
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Punita Grover
- University of Cincinnati Cancer Center, Cincinnati, OH, USA
| | - Shuchi Gulati
- University of Cincinnati Cancer Center, Cincinnati, OH, USA
| | - Shilpa Gupta
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Hina Khan
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Soo Jung Kim
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Elizabeth J Klein
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Rana R McKay
- Moores Comprehensive Cancer Center at the University of California, San Diego (UCSD), San Diego, CA, USA
| | - Amanda Nizam
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | | | | | | | | | - Justin A Shaya
- Moores Comprehensive Cancer Center at the University of California, San Diego (UCSD), San Diego, CA, USA
| | | | - Sarah Wall
- The Ohio State University, Columbus, OH, USA
| | | | | | - Sanjay Mishra
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Petros Grivas
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA
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9
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Fu J, Reid SA, French B, Hennessy C, Hwang C, Gatson NT, Duma N, Mishra S, Nguyen R, Hawley JE, Singh SRK, Chism DD, Venepalli NK, Warner JL, Choueiri TK, Schmidt AL, Fecher LA, Girard JE, Bilen MA, Ravindranathan D, Goyal S, Wise-Draper TM, Park C, Painter CA, McGlown SM, de Lima Lopes G, Serrano OK, Shah DP. Racial Disparities in COVID-19 Outcomes Among Black and White Patients With Cancer. JAMA Netw Open 2022; 5:e224304. [PMID: 35344045 PMCID: PMC8961318 DOI: 10.1001/jamanetworkopen.2022.4304] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Non-Hispanic Black individuals experience a higher burden of COVID-19 than the general population; hence, there is an urgent need to characterize the unique clinical course and outcomes of COVID-19 in Black patients with cancer. OBJECTIVE To investigate racial disparities in severity of COVID-19 presentation, clinical complications, and outcomes between Black patients and non-Hispanic White patients with cancer and COVID-19. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the COVID-19 and Cancer Consortium registry from March 17, 2020, to November 18, 2020, to examine the clinical characteristics and outcomes of COVID-19 in Black patients with cancer. Data analysis was performed from December 2020 to February 2021. EXPOSURES Black and White race recorded in patient's electronic health record. MAIN OUTCOMES AND MEASURES An a priori 5-level ordinal scale including hospitalization intensive care unit admission, mechanical ventilation, and all-cause death. RESULTS Among 3506 included patients (1768 women [50%]; median [IQR] age, 67 [58-77] years), 1068 (30%) were Black and 2438 (70%) were White. Black patients had higher rates of preexisting comorbidities compared with White patients, including obesity (480 Black patients [45%] vs 925 White patients [38%]), diabetes (411 Black patients [38%] vs 574 White patients [24%]), and kidney disease (248 Black patients [23%] vs 392 White patients [16%]). Despite the similar distribution of cancer type, cancer status, and anticancer therapy at the time of COVID-19 diagnosis, Black patients presented with worse illness and had significantly worse COVID-19 severity (unweighted odds ratio, 1.34 [95% CI, 1.15-1.58]; weighted odds ratio, 1.21 [95% CI, 1.11-1.33]). CONCLUSIONS AND RELEVANCE These findings suggest that Black patients with cancer experience worse COVID-19 outcomes compared with White patients. Understanding and addressing racial inequities within the causal framework of structural racism is essential to reduce the disproportionate burden of diseases, such as COVID-19 and cancer, in Black patients.
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Affiliation(s)
- Julie Fu
- Department of Internal Medicine, Hematology-Oncology, Tufts Medical Center Cancer Center, Stoneham, Massachusetts
| | - Sonya A. Reid
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville, Tennessee
- Vanderbilt-Ingram Cancer Center at Vanderbilt University Medical Center, Nashville, Tennessee
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Cassandra Hennessy
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Clara Hwang
- Department of Internal Medicine, Division of Hematology-Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - Na Tosha Gatson
- Geisinger Health System, Danville, Danville, Pennsylvania
- Department of Cancer Medicine, Division of Neuro-Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Narjust Duma
- Division of Medical Oncology, Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Sanjay Mishra
- Vanderbilt-Ingram Cancer Center at Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ryan Nguyen
- Department of Hematology and Oncology, University of Illinois, Chicago
| | - Jessica E. Hawley
- Herbert Irving Comprehensive Cancer Center at Columbia University, New York, New York
- Now with Division of Oncology, Fred Hutchinson Cancer Research Center, University of Washington, Seattle
| | - Sunny R. K. Singh
- Department of Internal Medicine, Division of Hematology-Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | | | - Neeta K. Venepalli
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill
| | - Jeremy L. Warner
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville, Tennessee
- Vanderbilt-Ingram Cancer Center at Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee
| | - Toni K. Choueiri
- Division of Medical Oncology, Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Andrew L. Schmidt
- Division of Medical Oncology, Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | - Mehmet A. Bilen
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Deepak Ravindranathan
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Sharad Goyal
- Department of Radiation Oncology, George Washington University, Washington, DC
| | - Trisha M. Wise-Draper
- Department of Internal Medicine, Division of Hematology-Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Cathleen Park
- Department of Hematology-Oncology, University of California, Davis
| | - Corrie A. Painter
- Count Me In, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | | | - Gilberto de Lima Lopes
- Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami, Florida
| | - Oscar K. Serrano
- Department of Surgery, Hartford HealthCare Cancer Institute, Hartford, Connecticut
| | - Dimpy P. Shah
- Population Health Sciences, Mays Cancer Center at University of Texas Health San Antonio MD Anderson, San Antonio
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10
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Satyanarayana G, Enriquez KT, Sun T, Klein EJ, Abidi M, Advani SM, Awosika J, Bakouny Z, Bashir B, Berg S, Bernardes M, Egan PC, Elkrief A, Feldman LE, Friese CR, Goel S, Gomez CG, Grant KL, Griffiths EA, Gulati S, Gupta S, Hwang C, Jain J, Jani C, Kaltsas A, Kasi A, Khan H, Knox N, Koshkin VS, Kwon DH, Labaki C, Lyman GH, McKay RR, McNair C, Nagaraj G, Nakasone ES, Nguyen R, Nonato TK, Olszewski AJ, Panagiotou OA, Puc M, Razavi P, Robilotti EV, Santos-Dutra M, Schmidt AL, Shah DP, Shah SA, Vieira K, Weissmann LB, Wise-Draper TM, Wu U, Wu JTY, Choueiri TK, Mishra S, Warner JL, French B, Farmakiotis D. Coinfections in Patients with Cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) Study. Open Forum Infect Dis 2022; 9:ofac037. [PMID: 35198648 PMCID: PMC8860152 DOI: 10.1093/ofid/ofac037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/24/2022] [Indexed: 12/15/2022] Open
Abstract
Background The frequency of coinfections and their association with outcomes have not been adequately studied among patients with cancer and coronavirus disease 2019 (COVID-19), a high-risk group for coinfection. Methods We included adult (≥18 years) patients with active or prior hematologic or invasive solid malignancies and laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection, using data from the COVID-19 and Cancer Consortium (CCC19, NCT04354701). We captured coinfections within ±2 weeks from diagnosis of COVID-19, identified factors cross-sectionally associated with risk of coinfection, and quantified the association of coinfections with 30-day mortality. Results Among 8765 patients (hospitalized or not; median age, 65 years; 47.4% male), 16.6% developed coinfections: 12.1% bacterial, 2.1% viral, 0.9% fungal. An additional 6.4% only had clinical diagnosis of a coinfection. The adjusted risk of any coinfection was positively associated with age >50 years, male sex, cardiovascular, pulmonary, and renal comorbidities, diabetes, hematologic malignancy, multiple malignancies, Eastern Cooperative Oncology Group Performance Status, progressing cancer, recent cytotoxic chemotherapy, and baseline corticosteroids; the adjusted risk of superinfection was positively associated with tocilizumab administration. Among hospitalized patients, high neutrophil count and C-reactive protein were positively associated with bacterial coinfection risk, and high or low neutrophil count with fungal coinfection risk. Adjusted mortality rates were significantly higher among patients with bacterial (odds ratio [OR], 1.61; 95% CI, 1.33–1.95) and fungal (OR, 2.20; 95% CI, 1.28–3.76) coinfections. Conclusions Viral and fungal coinfections are infrequent among patients with cancer and COVID-19, with the latter associated with very high mortality rates. Clinical and laboratory parameters can be used to guide early empiric antimicrobial therapy, which may improve clinical outcomes.
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Affiliation(s)
| | | | - Tianyi Sun
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth J Klein
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | - Maheen Abidi
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Shailesh M Advani
- Cancer Prevention and Control, Department of Oncology, Georgetown University School of Medicine, Georgetown University, Washington DC, USA
| | - Joy Awosika
- University of Cincinnati Cancer Center, Cincinnati, OH, USA
| | | | - Babar Bashir
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - Stephanie Berg
- Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, USA
| | - Marilia Bernardes
- Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Pamela C Egan
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | | | - Lawrence E Feldman
- University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
| | | | - Shipra Goel
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | | | - Keith L Grant
- Hartford HealthCare Cancer Institute, Hartford, CT, USA
| | | | - Shuchi Gulati
- University of Cincinnati Cancer Center, Cincinnati, OH, USA
| | | | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Jayanshu Jain
- The University of Kansas Cancer Center, Overland Park, KS, USA
| | | | - Anna Kaltsas
- Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Anup Kasi
- The University of Kansas Cancer Center, Overland Park, KS, USA
| | - Hina Khan
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | - Natalie Knox
- Stritch School of Medicine at Loyola University, Maywood, IL, USA
| | - Vadim S Koshkin
- Helen Diller Family Comprehensive Cancer Center at the University of California at San Francisco, San Francisco, CA, USA
| | - Daniel H Kwon
- Helen Diller Family Comprehensive Cancer Center at the University of California at San Francisco, San Francisco, CA, USA
| | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Washington Seattle, WA, USA
| | - Rana R McKay
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Christopher McNair
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Elisabeth S Nakasone
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Washington Seattle, WA, USA
| | - Ryan Nguyen
- University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
| | - Taylor K Nonato
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Adam J Olszewski
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | - Orestis A Panagiotou
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | | | - Pedram Razavi
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | | | | | | | - Dimpy P Shah
- Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Sumit A Shah
- Stanford Cancer Institute at Stanford University, Stanford, CA, USA
| | - Kendra Vieira
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | | | | | - Ulysses Wu
- Hartford HealthCare Cancer Institute, Hartford, CT, USA
| | - Julie Tsu-Yu Wu
- Stanford Cancer Institute at Stanford University, Stanford, CA, USA
| | | | - Sanjay Mishra
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Dimitrios Farmakiotis
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
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11
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Schmidt AL, Tucker MD, Bakouny Z, Labaki C, Hsu CY, Shyr Y, Armstrong AJ, Beer TM, Bijjula RR, Bilen MA, Connell CF, Dawsey SJ, Faller B, Gao X, Gartrell BA, Gill D, Gulati S, Halabi S, Hwang C, Joshi M, Khaki AR, Menon H, Morris MJ, Puc M, Russell KB, Shah NJ, Sharifi N, Shaya J, Schweizer MT, Steinharter J, Wulff-Burchfield EM, Xu W, Zhu J, Mishra S, Grivas P, Rini BI, Warner JL, Zhang T, Choueiri TK, Gupta S, McKay RR. Association Between Androgen Deprivation Therapy and Mortality Among Patients With Prostate Cancer and COVID-19. JAMA Netw Open 2021; 4:e2134330. [PMID: 34767021 PMCID: PMC8590166 DOI: 10.1001/jamanetworkopen.2021.34330] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 12/30/2022] Open
Abstract
IMPORTANCE Androgen deprivation therapy (ADT) has been theorized to decrease the severity of SARS-CoV-2 infection in patients with prostate cancer owing to a potential decrease in the tissue-based expression of the SARS-CoV-2 coreceptor transmembrane protease, serine 2 (TMPRSS2). OBJECTIVE To examine whether ADT is associated with a decreased rate of 30-day mortality from SARS-CoV-2 infection among patients with prostate cancer. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed patient data recorded in the COVID-19 and Cancer Consortium registry between March 17, 2020, and February 11, 2021. The consortium maintains a centralized multi-institution registry of patients with a current or past diagnosis of cancer who developed COVID-19. Data were collected and managed using REDCap software hosted at Vanderbilt University Medical Center in Nashville, Tennessee. Initially, 1228 patients aged 18 years or older with prostate cancer listed as their primary malignant neoplasm were included; 122 patients with a second malignant neoplasm, insufficient follow-up, or low-quality data were excluded. Propensity matching was performed using the nearest-neighbor method with a 1:3 ratio of treated units to control units, adjusted for age, body mass index, race and ethnicity, Eastern Cooperative Oncology Group performance status score, smoking status, comorbidities (cardiovascular, pulmonary, kidney disease, and diabetes), cancer status, baseline steroid use, COVID-19 treatment, and presence of metastatic disease. EXPOSURES Androgen deprivation therapy use was defined as prior bilateral orchiectomy or pharmacologic ADT administered within the prior 3 months of presentation with COVID-19. MAIN OUTCOMES AND MEASURES The primary outcome was the rate of all-cause 30-day mortality after COVID-19 diagnosis for patients receiving ADT compared with patients not receiving ADT after propensity matching. RESULTS After exclusions, 1106 patients with prostate cancer (before propensity score matching: median age, 73 years [IQR, 65-79 years]; 561 (51%) self-identified as non-Hispanic White) were included for analysis. Of these patients, 477 were included for propensity score matching (169 who received ADT and 308 who did not receive ADT). After propensity matching, there was no significant difference in the primary end point of the rate of all-cause 30-day mortality (OR, 0.77; 95% CI, 0.42-1.42). CONCLUSIONS AND RELEVANCE Findings from this cohort study suggest that ADT use was not associated with decreased mortality from SARS-CoV-2 infection. However, large ongoing clinical trials will provide further evidence on the role of ADT or other androgen-targeted therapies in reducing COVID-19 infection severity.
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Affiliation(s)
- Andrew L. Schmidt
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Ziad Bakouny
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chris Labaki
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chih-Yuan Hsu
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yu Shyr
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew J. Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, North Carolina
| | - Tomasz M. Beer
- Oregon Health and Science University Knight Cancer Institute, Portland
| | | | - Mehmet A. Bilen
- Winship Cancer Institute of Emory University, Atlanta, Georgia
| | | | | | | | - Xin Gao
- Massachusetts General Hospital, Boston
| | | | - David Gill
- Intermountain Healthcare, Salt Lake City, Utah
| | - Shuchi Gulati
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Susan Halabi
- Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, North Carolina
| | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, Michigan
| | - Monika Joshi
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Ali Raza Khaki
- University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle
- Stanford University, Stanford, California
| | - Harry Menon
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | | | | | | | - Neil J. Shah
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nima Sharifi
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Justin Shaya
- Moores Cancer Center, University of California, San Diego
| | - Michael T. Schweizer
- University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle
| | - John Steinharter
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Wenxin Xu
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jay Zhu
- Penn State Cancer Institute, Hershey, Pennsylvania
| | - Sanjay Mishra
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Petros Grivas
- University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle
| | - Brian I. Rini
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Tian Zhang
- Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, North Carolina
| | - Toni K. Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Shilpa Gupta
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Rana R. McKay
- Moores Cancer Center, University of California, San Diego
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12
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Li A, Kuderer NM, Hsu CY, Shyr Y, Warner JL, Shah DP, Kumar V, Shah S, Kulkarni AA, Fu J, Gulati S, Zon RL, Li M, Desai A, Egan PC, Bakouny Z, Kc D, Hwang C, Akpan IJ, McKay RR, Girard J, Schmidt AL, Halmos B, Thompson MA, Patel JM, Pennell NA, Peters S, Elshoury A, de Lima Lopes G, Stover DG, Grivas P, Rini BI, Painter CA, Mishra S, Connors JM, Lyman GH, Rosovsky RP. The CoVID-TE risk assessment model for venous thromboembolism in hospitalized patients with cancer and COVID-19. J Thromb Haemost 2021; 19:2522-2532. [PMID: 34260813 PMCID: PMC8420489 DOI: 10.1111/jth.15463] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/24/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hospitalized patients with COVID-19 have increased risks of venous (VTE) and arterial thromboembolism (ATE). Active cancer diagnosis and treatment are well-known risk factors; however, a risk assessment model (RAM) for VTE in patients with both cancer and COVID-19 is lacking. OBJECTIVES To assess the incidence of and risk factors for thrombosis in hospitalized patients with cancer and COVID-19. METHODS Among patients with cancer in the COVID-19 and Cancer Consortium registry (CCC19) cohort study, we assessed the incidence of VTE and ATE within 90 days of COVID-19-associated hospitalization. A multivariable logistic regression model specifically for VTE was built using a priori determined clinical risk factors. A simplified RAM was derived and internally validated using bootstrap. RESULTS From March 17, 2020 to November 30, 2020, 2804 hospitalized patients were analyzed. The incidence of VTE and ATE was 7.6% and 3.9%, respectively. The incidence of VTE, but not ATE, was higher in patients receiving recent anti-cancer therapy. A simplified RAM for VTE was derived and named CoVID-TE (Cancer subtype high to very-high risk by original Khorana score +1, VTE history +2, ICU admission +2, D-dimer elevation +1, recent systemic anti-cancer Therapy +1, and non-Hispanic Ethnicity +1). The RAM stratified patients into two cohorts (low-risk, 0-2 points, n = 1423 vs. high-risk, 3+ points, n = 1034) where VTE occurred in 4.1% low-risk and 11.3% high-risk patients (c statistic 0.67, 95% confidence interval 0.63-0.71). The RAM performed similarly well in subgroups of patients not on anticoagulant prior to admission and moderately ill patients not requiring direct ICU admission. CONCLUSIONS Hospitalized patients with cancer and COVID-19 have elevated thrombotic risks. The CoVID-TE RAM for VTE prediction may help real-time data-driven decisions in this vulnerable population.
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Affiliation(s)
- Ang Li
- Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
| | | | - Chih-Yuan Hsu
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, USA
| | - Yu Shyr
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, USA
| | - Jeremy L Warner
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, USA
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, Tennessee, USA
| | - Dimpy P Shah
- Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, Texas, USA
| | - Vaibhav Kumar
- Section of Hematology-Oncology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Surbhi Shah
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Amit A Kulkarni
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Julie Fu
- Hematology Oncology, Tufts Medical Center Cancer Center, Boston & Stoneham, Massachusetts, USA
| | - Shuchi Gulati
- Division of Hematology/Oncology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Rebecca L Zon
- Division of Hematology, Brigham and Women's Hospital Boston, Boston, Massachusetts, USA
| | - Monica Li
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Aakash Desai
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Pamela C Egan
- Brown University and Lifespan Cancer Institute, Providence, Rhode Island, USA
| | - Ziad Bakouny
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Devendra Kc
- Hartford HealthCare Cancer Institute, Hartford, Connecticutt, USA
| | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Imo J Akpan
- Herbert Irving Comprehensive Cancer Center at Columbia University, New York, New York, USA
| | - Rana R McKay
- Moores Cancer Center at the University of California, San Diego, California, USA
| | - Jennifer Girard
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| | | | - Balazs Halmos
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | | | - Jaymin M Patel
- Beth Israel Deaconess Medical Center (BIDMC), Boston, Massachusetts, USA
| | | | | | - Amro Elshoury
- Leukemia Service, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Gilbero de Lima Lopes
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Daniel G Stover
- Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Petros Grivas
- University of Washington, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Brian I Rini
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, Tennessee, USA
| | - Corrie A Painter
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Sanjay Mishra
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, Tennessee, USA
| | - Jean M Connors
- Division of Hematology, Brigham and Women's Hospital Boston, Boston, Massachusetts, USA
| | - Gary H Lyman
- University of Washington, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Rachel P Rosovsky
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
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13
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Bhalla S, Bakouny Z, Schmidt AL, Labaki C, Steinharter JA, Tremblay DA, Awad MM, Kessler AJ, Haddad RI, Evans M, Busser F, Wotman M, Curran CR, Zimmerman BS, Bouchard G, Jun T, Nuzzo PV, Qin Q, Hirsch L, Feld J, Kelleher KM, Seidman D, Huang HH, Anderson-Keightly HM, El Zarif T, Abou Alaiwi S, Rosenbloom TD, Stewart PS, Galsky MD, Choueiri TK, Doroshow DB. Care disruptions among patients with lung cancer: A COVID-19 and cancer outcomes study. Lung Cancer 2021; 160:78-83. [PMID: 34461400 PMCID: PMC8284065 DOI: 10.1016/j.lungcan.2021.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/07/2021] [Accepted: 07/09/2021] [Indexed: 12/29/2022]
Abstract
Introduction Patients with lung cancer (LC) are susceptible to severe outcomes from COVID-19. This study evaluated disruption to care of patients with LC during the COVID-19 pandemic. Methods The COVID-19 and Cancer Outcomes Study (CCOS) is a prospective cohort study comprised of patients with a current or past history of hematological or solid malignancies with outpatient visits between March 2 and March 6, 2020, at two academic cancer centers in the Northeastern United States (US). Data was collected for the three months prior to the index week (baseline period) and the following three months (pandemic period). Results 313 of 2365 patients had LC, 1578 had other solid tumors, and 474 had hematological malignancies. Patients with LC were not at increased risk of COVID-19 diagnosis compared to patients with other solid or hematological malignancies. When comparing data from the pandemic period to the baseline period, patients with LC were more likely to have a decrease in in-person visits compared to patients with other solid tumors (aOR 1.94; 95% CI, 1.46–2.58), but without an increase in telehealth visits (aOR 1.13; 95% CI 0.85–1.50). Patients with LC were more likely to experience pandemic-related treatment delays than patients with other solid tumors (aOR 1.80; 95% CI 1.13–2.80) and were more likely to experience imaging/diagnostic procedure delays than patients with other solid tumors (aOR 2.59; 95% CI, 1.46–4.47) and hematological malignancies (aOR 2.01; 95% CI, 1.02–3.93). Among patients on systemic therapy, patients with LC were also at increased risk for decreased in-person visits and increased treatment delays compared to those with other solid tumors. Discussion Patients with LC experienced increased cancer care disruption compared to patients with other malignancies during the early phase of the COVID-19 pandemic. Focused efforts to ensure continuity of care for this patient population are warranted.
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Affiliation(s)
- Sheena Bhalla
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Ziad Bakouny
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Andrew L Schmidt
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Chris Labaki
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - John A Steinharter
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Douglas A Tremblay
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Mark M Awad
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Alaina J Kessler
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Robert I Haddad
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Michelle Evans
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fiona Busser
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Michael Wotman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Catherine R Curran
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Brittney S Zimmerman
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Gabrielle Bouchard
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Tomi Jun
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Pier V Nuzzo
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Qian Qin
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Laure Hirsch
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Jonathan Feld
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Kaitlin M Kelleher
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Danielle Seidman
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Hsin-Hui Huang
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Heather M Anderson-Keightly
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Talal El Zarif
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Sarah Abou Alaiwi
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Talia D Rosenbloom
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Penina S Stewart
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Matthew D Galsky
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Deborah B Doroshow
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
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Grivas P, Khaki AR, Wise-Draper TM, French B, Hennessy C, Hsu CY, Shyr Y, Li X, Choueiri TK, Painter CA, Peters S, Rini BI, Thompson MA, Mishra S, Rivera DR, Acoba JD, Abidi MZ, Bakouny Z, Bashir B, Bekaii-Saab T, Berg S, Bernicker EH, Bilen MA, Bindal P, Bishnoi R, Bouganim N, Bowles DW, Cabal A, Caimi PF, Chism DD, Crowell J, Curran C, Desai A, Dixon B, Doroshow DB, Durbin EB, Elkrief A, Farmakiotis D, Fazio A, Fecher LA, Flora DB, Friese CR, Fu J, Gadgeel SM, Galsky MD, Gill DM, Glover MJ, Goyal S, Grover P, Gulati S, Gupta S, Halabi S, Halfdanarson TR, Halmos B, Hausrath DJ, Hawley JE, Hsu E, Huynh-Le M, Hwang C, Jani C, Jayaraj A, Johnson DB, Kasi A, Khan H, Koshkin VS, Kuderer NM, Kwon DH, Lammers PE, Li A, Loaiza-Bonilla A, Low CA, Lustberg MB, Lyman GH, McKay RR, McNair C, Menon H, Mesa RA, Mico V, Mundt D, Nagaraj G, Nakasone ES, Nakayama J, Nizam A, Nock NL, Park C, Patel JM, Patel KG, Peddi P, Pennell NA, Piper-Vallillo AJ, Puc M, Ravindranathan D, Reeves ME, Reuben DY, Rosenstein L, Rosovsky RP, Rubinstein SM, Salazar M, Schmidt AL, Schwartz GK, Shah MR, Shah SA, Shah C, Shaya JA, Singh SRK, Smits M, Stockerl-Goldstein KE, Stover DG, Streckfuss M, Subbiah S, Tachiki L, Tadesse E, Thakkar A, Tucker MD, Verma AK, Vinh DC, Weiss M, Wu JT, Wulff-Burchfield E, Xie Z, Yu PP, Zhang T, Zhou AY, Zhu H, Zubiri L, Shah DP, Warner JL, Lopes G. Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium. Ann Oncol 2021; 32:787-800. [PMID: 33746047 PMCID: PMC7972830 DOI: 10.1016/j.annonc.2021.02.024] [Citation(s) in RCA: 202] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/18/2021] [Accepted: 02/28/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients with cancer may be at high risk of adverse outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed a cohort of patients with cancer and coronavirus 2019 (COVID-19) reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anticancer therapies. PATIENTS AND METHODS Patients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between 17 March and 18 November 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients). RESULTS A total of 4966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2872 (58%) were hospitalized and 695 (14%) died; 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis. Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, non-Hispanic black race, Hispanic ethnicity, worse Eastern Cooperative Oncology Group performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count; high absolute neutrophil count; low platelet count; abnormal creatinine; troponin; lactate dehydrogenase; and C-reactive protein were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anticancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality. CONCLUSIONS Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anticancer therapies. CLINICAL TRIAL IDENTIFIER NCT04354701.
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Affiliation(s)
- P Grivas
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA.
| | - A R Khaki
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA; Stanford University, Stanford, USA
| | | | - B French
- Vanderbilt University Medical Center, Nashville, USA
| | - C Hennessy
- Vanderbilt University Medical Center, Nashville, USA
| | - C-Y Hsu
- Vanderbilt University Medical Center, Nashville, USA
| | - Y Shyr
- Vanderbilt University Medical Center, Nashville, USA
| | - X Li
- Vanderbilt University School of Medicine, Nashville, USA
| | | | - C A Painter
- Broad Institute, Cancer Program, Cambridge, USA
| | - S Peters
- Lausanne University, Lausanne, Switzerland
| | - B I Rini
- Vanderbilt University Medical Center, Nashville, USA
| | | | - S Mishra
- Vanderbilt University Medical Center, Nashville, USA
| | - D R Rivera
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, USA
| | - J D Acoba
- University of Hawaii Cancer Center, Honolulu, USA
| | - M Z Abidi
- University of Colorado School of Medicine, Aurora, USA
| | - Z Bakouny
- Dana-Farber Cancer Institute, Boston, USA
| | - B Bashir
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | | | - S Berg
- Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, USA
| | | | - M A Bilen
- Winship Cancer Institute of Emory University, Atlanta, USA
| | - P Bindal
- Beth Israel Deaconess Medical Center, Boston, USA
| | - R Bishnoi
- University of Florida, Gainesville, USA
| | - N Bouganim
- McGill University Health Centre, Montréal, Canada
| | - D W Bowles
- University of Colorado School of Medicine, Aurora, USA
| | - A Cabal
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - P F Caimi
- University Hospitals Seidman Cancer Center, Cleveland, USA; Case Western Reserve University, Cleveland, USA
| | - D D Chism
- Thompson Cancer Survival Center, Knoxville, USA
| | - J Crowell
- St. Elizabeth Healthcare, Edgewood, USA
| | - C Curran
- Dana-Farber Cancer Institute, Boston, USA
| | - A Desai
- Mayo Clinic Cancer Center, Rochester, USA
| | - B Dixon
- St. Elizabeth Healthcare, Edgewood, USA
| | - D B Doroshow
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - E B Durbin
- Markey Cancer Center, University of Kentucky, Lexington, USA
| | - A Elkrief
- McGill University Health Centre, Montréal, Canada
| | - D Farmakiotis
- The Warren Alpert Medical School of Brown University, Providence, USA
| | - A Fazio
- Tufts Medical Center Cancer Center, Boston and Stoneham, USA
| | - L A Fecher
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - D B Flora
- St. Elizabeth Healthcare, Edgewood, USA
| | - C R Friese
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - J Fu
- Tufts Medical Center Cancer Center, Boston and Stoneham, USA
| | - S M Gadgeel
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - M D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - D M Gill
- Intermountain Healthcare, Salt Lake City, USA
| | | | - S Goyal
- George Washington University, Washington DC, USA
| | - P Grover
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - S Gulati
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - S Gupta
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | | | | | - B Halmos
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - D J Hausrath
- Vanderbilt University School of Medicine, Nashville, USA
| | - J E Hawley
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, USA
| | - E Hsu
- Hartford HealthCare, Hartford, USA; University of Connecticut, Farmington, USA
| | - M Huynh-Le
- George Washington University, Washington DC, USA
| | - C Hwang
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - C Jani
- Mount Auburn Hospital, Cambridge, USA
| | | | - D B Johnson
- Vanderbilt University Medical Center, Nashville, USA
| | - A Kasi
- University of Kansas Medical Center, Kansas City, USA
| | - H Khan
- The Warren Alpert Medical School of Brown University, Providence, USA
| | - V S Koshkin
- University of California, San Francisco, San Francisco, USA
| | - N M Kuderer
- Advanced Cancer Research Group, LLC, Kirkland, USA
| | - D H Kwon
- University of California, San Francisco, San Francisco, USA
| | | | - A Li
- Baylor College of Medicine, Houston, USA
| | | | - C A Low
- Intermountain Healthcare, Salt Lake City, USA
| | | | - G H Lyman
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - R R McKay
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - C McNair
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | - H Menon
- Penn State Health/Penn State Cancer Institute/St. Joseph Cancer Center, Hershey, USA
| | - R A Mesa
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | - V Mico
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | - D Mundt
- Advocate Aurora Health, Milwaukee, USA
| | - G Nagaraj
- Loma Linda University Cancer Center, Loma Linda, USA
| | - E S Nakasone
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - J Nakayama
- Case Western Reserve University, Cleveland, USA; University Hospitals Cleveland Medical Center, Cleveland, USA
| | - A Nizam
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | - N L Nock
- University Hospitals Seidman Cancer Center, Cleveland, USA; Case Western Reserve University, Cleveland, USA
| | - C Park
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - J M Patel
- Beth Israel Deaconess Medical Center, Boston, USA
| | - K G Patel
- University of California Davis Comprehensive Cancer Center, Sacramento, USA
| | - P Peddi
- Willis-Knighton Cancer Center, Shreveport, USA
| | - N A Pennell
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | | | - M Puc
- Virtua Health, Marlton, USA
| | | | - M E Reeves
- Loma Linda University Cancer Center, Loma Linda, USA
| | - D Y Reuben
- Medical University of South Carolina, Charleston, USA
| | | | - R P Rosovsky
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | | | - M Salazar
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | | | - G K Schwartz
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, USA
| | - M R Shah
- Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - S A Shah
- Stanford University, Stanford, USA
| | - C Shah
- University of Florida, Gainesville, USA
| | - J A Shaya
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - S R K Singh
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - M Smits
- ThedaCare Regional Cancer Center, Appleton, USA
| | | | - D G Stover
- The Ohio State University, Columbus, USA
| | | | - S Subbiah
- Stanley S. Scott Cancer Center, LSU Health Sciences Center, New Orleans, USA
| | - L Tachiki
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - E Tadesse
- Advocate Aurora Health, Milwaukee, USA
| | - A Thakkar
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - M D Tucker
- Vanderbilt University Medical Center, Nashville, USA
| | - A K Verma
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - D C Vinh
- McGill University Health Centre, Montréal, Canada
| | - M Weiss
- ThedaCare Regional Cancer Center, Appleton, USA
| | - J T Wu
- Stanford University, Stanford, USA
| | | | - Z Xie
- Mayo Clinic Cancer Center, Rochester, USA
| | - P P Yu
- Hartford HealthCare, Hartford, USA
| | - T Zhang
- Duke University, Durham, USA
| | - A Y Zhou
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, USA
| | - H Zhu
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - L Zubiri
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - D P Shah
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | - J L Warner
- Vanderbilt University Medical Center, Nashville, USA
| | - GdL Lopes
- University of Miami/Sylvester Comprehensive Cancer Center, Miami, USA
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15
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Bakouny Z, Paciotti M, Schmidt AL, Lipsitz SR, Choueiri TK, Trinh QD. Cancer Screening Tests and Cancer Diagnoses During the COVID-19 Pandemic. JAMA Oncol 2021; 7:458-460. [PMID: 33443549 DOI: 10.1001/jamaoncol.2020.7600] [Citation(s) in RCA: 156] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ziad Bakouny
- Lank Center for Genitourinary Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Marco Paciotti
- Division of Urological Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Urology, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Andrew L Schmidt
- Lank Center for Genitourinary Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
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16
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Paciotti M, Schmidt AL, Ravi P, McKay RR, Trinh QD, Choueiri TK. Temporal Trends and Predictors in the Use of Stereotactic Body Radiotherapy for Treatment of Metastatic Renal Cell Carcinoma in the U.S. Oncologist 2021; 26:e905-e906. [PMID: 33650184 DOI: 10.1002/onco.13736] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/12/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Marco Paciotti
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Urology, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Andrew L Schmidt
- Lank Center for Genitourinary Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Praful Ravi
- Lank Center for Genitourinary Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Rana R McKay
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, California, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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17
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Bhalla S, Bakouny Z, Schmidt AL, Steinharter JA, Tremblay DA, Awad MM, Kessler AJ, Haddad RI, Evans M, Busser F, Wotman M, Curran CR, Zimmerman BS, Bouchard G, Jun T, Nuzzo PV, Qin Q, Hirsch L, Feld J, Kelleher KM, Seidman D, Huang HH, Labaki C, Anderson-Keightly HM, Alaiwi SA, Rosenbloom TD, Stewart PS, Galsky MD, Choueiri TK, Doroshow DB. Abstract S06-02: Disruption to care of patients with thoracic malignancies: A COVID-19 and cancer outcomes study. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.covid-19-21-s06-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Patients with thoracic malignancies are susceptible to severe outcomes from coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the disruption to care of patients with thoracic malignancies during the COVID-19 pandemic. Methods: The COVID-19 and Cancer Outcomes Study (CCOS) is a multicenter prospective cohort study comprised of adult patients with a current or past history of hematological malignancy or invasive solid tumor who had an outpatient medical oncology visit on the index week between March 2 and March 6, 2020 at the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai in New York, NY (MSSM) or the Dana-Farber Cancer Institute in Boston, MA (DFCI). An electronic data capture platform was used to collect patient-, cancer-, and treatment-related variables during the three months prior to the index week (the baseline period) and the following three months (the pandemic period). Two-by-three contingency tables with Fisher’s exact tests were computed. All tests were two-tailed and considered statistically significant for p<0.05. All analyses were done in the R statistical environment (v3.6.1). Results: The overall cohort included 2365 patients, of which 313 had thoracic malignancies, 1578 had other solid tumors, and 474 had hematological malignancies. At a median follow-up of 84 days (95% confidence interval, 82-84), 13 patients with thoracic malignancies (4.1%) had developed COVID-19 (vs. other solid: 63 [4.0%] and hematological: 52 [11.0%]; p<0.001). When comparing data from the pandemic period to the baseline period, patients with thoracic malignancies had a decrease in the number of in-person outpatient visits (thoracic: 209 [66.8%] vs. other solid: 749 [47.5%] vs. hematological: 260 [54.9%]; p<0.001) and an increase in the number of telehealth visits (thoracic: 126 [40.3%] vs. other solid: 465 [29.5%] vs. hematological: 168 [35.4%]; p<0.001). During the pandemic period, 33 (10.5%) patients with thoracic malignancies experienced treatment delays due to the pandemic (vs. other solid: 127 [8.0%] and hematological: 79 [16.7%]; p<0.001), and 26 (8.3%) patients with thoracic malignancies experienced delays in cancer imaging or diagnostic procedures (vs. other solid: 63 [4.0%] and hematological: 26 [5.5%]; p=0.003). Discussion: In this prospective cohort study, patients with thoracic malignancies were not at increased risk of developing COVID-19 compared to patients with other cancers, but experienced significant cancer care disruption during the COVID-19 pandemic with a higher likelihood of decreased in-person visits and increased telehealth visits compared to patients with other malignancies. Focused efforts to ensure continuity of care for this vulnerable patient population are warranted.
Citation Format: Sheena Bhalla, Ziad Bakouny, Andrew L. Schmidt, John A. Steinharter, Douglas A. Tremblay, Mark M. Awad, Alaina J. Kessler, Robert I. Haddad, Michelle Evans, Fiona Busser, Michael Wotman, Catherine R. Curran, Brittney S. Zimmerman, Gabrielle Bouchard, Tomi Jun, Pier V. Nuzzo, Qian Qin, Laure Hirsch, Jonathan Feld, Kaitlin M Kelleher, Danielle Seidman, Hsin-Hui Huang, Chris Labaki, Heather M. Anderson-Keightly, Sarah Abou Alaiwi, Talia D. Rosenbloom, Penina S. Stewart, Matthew D. Galsky, Toni K. Choueiri, Deborah B. Doroshow. Disruption to care of patients with thoracic malignancies: A COVID-19 and cancer outcomes study [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S06-02.
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Affiliation(s)
- Sheena Bhalla
- 1Icahn School of Medicine at Mount Sinai, New York, NY,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tomi Jun
- 1Icahn School of Medicine at Mount Sinai, New York, NY,
| | | | - Qian Qin
- 1Icahn School of Medicine at Mount Sinai, New York, NY,
| | | | - Jonathan Feld
- 1Icahn School of Medicine at Mount Sinai, New York, NY,
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Schmidt AL, Tabakin AL, Singer EA, Choueiri TK, McKay RR. Next Steps: Sequencing Therapies in Metastatic Kidney Cancer in the Contemporary Era. Am Soc Clin Oncol Educ Book 2021; 41:1-11. [PMID: 33793313 DOI: 10.1200/edbk_320785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Systemic therapy for first-line metastatic renal cell carcinoma has evolved toward immune checkpoint blockade combinations incorporating a PD-1/L1 inhibitor along with CTLA-4 inhibition or VEGF-targeted therapy. The new treatment paradigm that integrates immunotherapy for treatment-naïve advanced metastatic renal cell carcinoma creates a new therapeutic challenge for clinicians including the optimal way to integrate multidisciplinary care involving surgery, radiotherapy, and application of contemporaneous systemic treatment in subsequent lines of therapy following discontinuation of combination therapy. We outline the available data for the multidisciplinary management of metastatic renal cell carcinoma, systemic therapy options in the post-immune checkpoint blockade setting, and novel therapies in development for advanced renal cell carcinoma. We provide practical considerations to assist clinicians in treatment choice and map future directions for progress.
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Affiliation(s)
- Andrew L Schmidt
- Lank Centre for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Alexandra L Tabakin
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Eric A Singer
- Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Toni K Choueiri
- Lank Centre for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Rana R McKay
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, CA
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19
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Abstract
Background: Treatments for metastatic clear cell renal carcinoma (mccRCC) are evolving with multiple targeted and immune therapy drugs currently approved by regulatory agencies as single agents or in combination. Developing predictive biomarkers to determine which patients derive a differential benefit from a particular treatment is an area of ongoing clinical research. Objective: We sought to systematically evaluate the role of tumour tissue-based biomarkers that assist in selection of therapy for mccRCC. Methods: Literature addressing the role of biomarkers in mccRCC was identified through a search of the electronic databases MEDLINE, Embase, and the Web of Science and a hand search of major conference abstracts (from Jan 2010 –Sep 2020). Abstracts were screened to identify papers meriting full-text review. Studies with a comparison arm were included to assess biomarker relevance. A narrative review of studies was performed. Results: The literature search yielded 6784 potentially relevant articles. 133 articles met criteria for full text review, and 10 articles were identified by scanning bibliographies of relevant studies. A total of 33 articles (involving 13 studies) were selected for data extraction and subsequent review. Conclusions: Predictive biomarkers for immediate use in the clinic are lacking, and embedding their evaluation and validation in future clinical trials is needed to refine practice and patient selection.
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Affiliation(s)
- Andrew L. Schmidt
- Lark Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Paul A. Bain
- Countway Library, Harvard Medical School, Boston, MA, USA
| | - Bradley A. McGregor
- Lark Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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20
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Schmidt AL, Bakouny Z, Bhalla S, Steinharter JA, Tremblay DA, Awad MM, Kessler AJ, Haddad RI, Evans M, Busser F, Wotman M, Curran CR, Zimmerman BS, Bouchard G, Jun T, Nuzzo PV, Qin Q, Hirsch L, Feld J, Kelleher KM, Seidman D, Huang HH, Anderson-Keightly HM, Abou Alaiwi S, Rosenbloom TD, Stewart PS, Galsky MD, Choueiri TK, Doroshow DB. Cancer Care Disparities during the COVID-19 Pandemic: COVID-19 and Cancer Outcomes Study. Cancer Cell 2020; 38:769-770. [PMID: 33176161 PMCID: PMC7609043 DOI: 10.1016/j.ccell.2020.10.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Andrew L Schmidt
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Ziad Bakouny
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Sheena Bhalla
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - John A Steinharter
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Douglas A Tremblay
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Mark M Awad
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Alaina J Kessler
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Robert I Haddad
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Michelle Evans
- Department of Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA
| | - Fiona Busser
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Michael Wotman
- Department of Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA
| | - Catherine R Curran
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Brittney S Zimmerman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Gabrielle Bouchard
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Tomi Jun
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Pier V Nuzzo
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Qian Qin
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Laure Hirsch
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Jonathan Feld
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Kaitlin M Kelleher
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Danielle Seidman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Hsin-Hui Huang
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | | | - Sarah Abou Alaiwi
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Talia D Rosenbloom
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Penina S Stewart
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Matthew D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Deborah B Doroshow
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA.
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21
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McGregor BA, Campbell MT, Xie W, Farah S, Bilen MA, Schmidt AL, Sonpavde GP, Kilbridge KL, Choudhury AD, Mortazavi A, Shah AY, Venkatesan AM, Bubley GJ, Siefker-Radtke AO, McKay RR, Choueiri TK. Results of a multicenter, phase 2 study of nivolumab and ipilimumab for patients with advanced rare genitourinary malignancies. Cancer 2020; 127:840-849. [PMID: 33216356 DOI: 10.1002/cncr.33328] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In this multicenter, single-arm, multicohort, phase 2 trial, the efficacy of nivolumab and ipilimumab was evaluated in patients with advanced rare genitourinary cancers, including bladder and upper tract carcinoma of variant histology (BUTCVH), adrenal tumors, platinum-refractory germ cell tumors, penile carcinoma, and prostate cancer of variant histology (NCT03333616). METHODS Patients with rare genitourinary malignancies and no prior immune checkpoint inhibitor exposure were enrolled. Patients received nivolumab at 3 mg/kg and ipilimumab at 1 mg/kg intravenously every 3 weeks for 4 doses, and this was followed by 480 mg of nivolumab intravenously every 4 weeks. The primary endpoint was the objective response rate (ORR) by the Response Evaluation Criteria in Solid Tumors (version 1.1). RESULTS Fifty-five patients were enrolled at 6 institutions between April 2018 and July 2019 in 3 cohorts: BUTCVH (n = 19), adrenal tumors (n = 18), and other tumors (n = 18). The median follow-up was 9.9 months (range, 1 to 21 months). Twenty-eight patients (51%) received 4 doses of nivolumab and ipilimumab; 25 patients received nivolumab maintenance for a median of 4 cycles (range, 1-18 cycles). The ORR for the entire study was 16% (80% confidence interval, 10%-25%); the ORR in the BUTCVH cohort, including 2 complete responses, was 37%, and it was 6% in the other 2 cohorts. Twenty-two patients (40%) developed treatment-related grade 3 or higher toxicities; 24% (n = 13) required high-dose steroids (≥40 mg of prednisone or the equivalent). Grade 5 events occurred in 3 patients; 1 death was treatment related. CONCLUSIONS Nivolumab and ipilimumab resulted in objective responses in a subset of patients with rare genitourinary malignancies, especially those with BUTCVH. An additional cohort exploring their activity in genitourinary tumors with neuroendocrine differentiation is ongoing. LAY SUMMARY Patients with rare cancers are often excluded from studies and have limited treatment options. Fifty-five patients with rare tumors of the genitourinary system were enrolled from multiple sites and were treated with nivolumab and ipilimumab, a regimen used for kidney cancer. The regimen showed activity in some patients, particularly those with bladder or upper tract cancers of unusual or variant histology; 37% of those patients responded to therapy. Additional studies are ongoing to better determine who benefits the most from this combination.
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Affiliation(s)
| | | | - Wanling Xie
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Atlanta, Georgia
| | | | | | | | | | | | - Amishi Y Shah
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Glenn J Bubley
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Rana R McKay
- University of California San Diego, San Diego, California
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Abstract
Therapies for genitourinary malignancies have evolved considerably in the past five years. Combination treatment targeting biologically relevant immune and angiogenic pathways is improving patient survival in metastatic renal cell carcinoma (RCC), whereas immune checkpoint blockade (ICB), novel targeted therapy, and antibody drug conjugates have changed the landscape of urothelial cancer (UC) treatment. A daily challenge for clinicians is identifying patients who derive a preferential benefit from the available therapeutic options. The completion of large-scale genomics projects has yielded comprehensive descriptions of the molecular heterogeneity present in RCC and UC, although clinical applications of these data continue to evolve. Major molecular subtypes of RCC align well with histology subtype, and although some molecular characteristics appear to carry prognostic information, biomarkers predicting benefit from tyrosine kinase inhibitor (TKI) or immunotherapy are generally lacking. Unexpectedly, similar work has demonstrated that UC can be grouped into "molecular subtypes" that share properties with those found in breast cancer and other solid tumors. Furthermore, this molecular subtype classification is prognostic and potentially predictive of differential benefit from conventional and targeted therapies. This article provides an update on the current state of molecular biomarker development and potential clinical utility in RCC and UC.
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Affiliation(s)
| | | | - David McConkey
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD
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23
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McIver R, Cullain N, Schmidt AL, Lotze HK. Linking eutrophication indicators in eelgrass habitats to nitrogen loading and mitigating site characteristics in eastern New Brunswick, Canada. Mar Environ Res 2019; 144:141-153. [PMID: 30665766 DOI: 10.1016/j.marenvres.2018.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 11/10/2018] [Accepted: 11/18/2018] [Indexed: 06/09/2023]
Abstract
Nitrogen loading has been linked to eutrophication and seagrass bed declines worldwide, yet early warning signs and potential mitigating factors are often less clear. Our objective was to use published nitrogen loading model results together with eelgrass habitat surveys from 7 bays in Atlantic Canada to assess linkages between nitrogen loading, tidal flushing and bivalve aquaculture on observed eutrophication indicators in eelgrass habitats. Field surveys revealed significant differences in primary indicators (annual algae, tissue nitrogen) and secondary changes in eelgrass bed structure, yet no large loss of eelgrass cover or biomass. Multivariate analyses found positive correlations between nitrogen loading and eutrophication indicators, with distinct clusters of high- and low-impact sites, and the mitigating effects of flushing time and aquaculture. Our results highlight that combining measures of nitrogen loading, eutrophication indicators and mitigating factors can help detect early warning signs and assess eutrophication risk to inform management and conservation of coastal ecosystems before significant losses of seagrass occurs.
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Affiliation(s)
- R McIver
- Department of Biology, Dalhousie University, 1355 Oxford Street, P.O. Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada.
| | - N Cullain
- Department of Biology, Dalhousie University, 1355 Oxford Street, P.O. Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada; Marine Action Research, Zavora Marine Lab, Break Beach Road, Zavora, Mozambique
| | - A L Schmidt
- Department of Biology, Dalhousie University, 1355 Oxford Street, P.O. Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
| | - H K Lotze
- Department of Biology, Dalhousie University, 1355 Oxford Street, P.O. Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
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24
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Schmidt AL, Brunetto AL, Schwartsmann G, Roesler R, Abujamra AL. Recent therapeutic advances for treating medulloblastoma: focus on new molecular targets. CNS Neurol Disord Drug Targets 2010; 9:335-48. [PMID: 20438440 DOI: 10.2174/187152710791292602] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 02/01/2010] [Indexed: 11/22/2022]
Abstract
Medulloblastoma is the most common malignant brain tumor in children. This malignant tumor of the cerebellum commonly affects children and is believed to arise from the precursor cells of the external granule layer or neuroepithelial cells from the cerebellar ventricular zone of the developing cerebellum. The standard treatment, consisting of surgery, craniospinal radiotherapy and chemotherapy, still provides a poor overall survival for infants and young children. Furthermore, the dose of radiation that can be safely given without causing extensive neurocognitive and endocrinologic sequelae is limited. Therefore, understanding the oncogenic pathways that lead to medulloblastoma, as well as the identification of specific molecular targets with significant therapeutic implications in order to develop new strategies for therapy, is crucial to improve patient survival without substantially increasing toxicity. In this review, we discuss recent therapeutics for treating medulloblastoma, focusing on new molecular targets, as well as advances in translational studies for the treatment of this malignancy.
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Affiliation(s)
- A L Schmidt
- Center for Biotechnology, Federal University of Rio Grande do Sul, 91501-970 Porto Alegre, RS, Brazil
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25
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Hale LV, Galvin RJS, Risteli J, Ma YL, Harvey AK, Yang X, Cain RL, Zeng Q, Frolik CA, Sato M, Schmidt AL, Geiser AG. PINP: a serum biomarker of bone formation in the rat. Bone 2007; 40:1103-9. [PMID: 17258520 DOI: 10.1016/j.bone.2006.11.027] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Revised: 11/21/2006] [Accepted: 11/30/2006] [Indexed: 11/28/2022]
Abstract
Serum PINP has emerged as a reliable marker of bone turnover in humans and is routinely used to monitor bone formation. However, the effects of PTH (1-34) on bone turnover have not been evaluated following short-term treatment. We present data demonstrating that PINP is an early serum biomarker in the rat for assessing bone anabolic activity in response to treatment with PTH (1-38). Rat serum PINP levels were found to increase following as few as 6 days of treatment with PTH (1-38) and these increases paralleled expression of genes associated with bone formation, as well as, later increases in BMD. Additionally, PINP levels were unaffected by treatment with an antiresorptive bisphosphonate. PINP may be used to detect PTH-induced early bone formation in the rat and may be more generally applicable for preclinical testing of potential bone anabolic drugs.
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Affiliation(s)
- L V Hale
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
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26
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Schmidt AL, Taggart DA, Holz P, Temple-Smith PD, Bradley AJ. Plasma steroids and steroid-binding capacity in male semelparous dasyurid marsupials (Phascogale tapoatafa) that survive beyond the breeding season in captivity. Gen Comp Endocrinol 2006; 149:236-43. [PMID: 16884721 DOI: 10.1016/j.ygcen.2006.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 05/28/2006] [Accepted: 06/08/2006] [Indexed: 11/16/2022]
Abstract
The semelparous dasyurids display a unique life history, in that all males die within a few weeks of the completion of the breeding season. Studies of several semelparous species have revealed that the male die-off is stress-related, and accompanied by increased plasma androgen and cortisol levels and decreased corticosteroid binding capacity, resulting in suppression of immune and inflammatory responses. This study examines the endocrine profile of male brush-tailed phascogales (Phascogale tapoatafa) that survive beyond the breeding season in captivity. Plasma cortisol, corticosteroid binding globulin and albumin levels were monitored in both males and females and steroid partitioning calculated. Captive males surviving beyond the breeding season did not show the elevation in plasma cortisol and decrease in corticosteroid binding capacity reported in wild males. Plasma albumin concentrations also remained constant during the sampling period. These data indicate that captive males do not undergo the same stress response described in wild populations.
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Affiliation(s)
- A L Schmidt
- Department of Anatomical Sciences, School of Biomedical Sciences, The University of Queensland, St. Lucia, Qld 4072, Australia
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27
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Hinrichs K, Schmidt AL. Meiotic competence in horse oocytes: interactions among chromatin configuration, follicle size, cumulus morphology, and season. Biol Reprod 2000; 62:1402-8. [PMID: 10775193 DOI: 10.1095/biolreprod62.5.1402] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Horse oocytes were collected from an abattoir over a 15-mo period. After classification of follicle size and cumulus morphology, oocytes were either fixed immediately (0 h) or matured in vitro (24 h). There was no effect of season on the number of antral follicles present on the ovaries, or on oocyte maturation rate for any class of oocyte. The proportion of oocytes having condensed chromatin at 0 h increased with increasing follicle size. The oocyte maturation rate also increased with follicle size, and for follicles </= 20-mm diameter, was higher for oocytes initially having expanded cumuli than for those having compact cumuli. The maturation rate was strongly correlated (r(2) = 0.92) with the proportion of oocytes having condensed chromatin at 0 h. Oocytes with diffuse chromatin were found essentially only in follicles </= 20-mm diameter that yielded compact granulosa, indicating follicle viability. Presence of diffuse chromatin was inversely related to maturation rate. We conclude that the major signal for chromatin condensation, and thus acquisition of meiotic competence, occurs in viable follicles after 20-mm diameter in the horse. Condensation of chromatin in oocytes in smaller apparently viable follicles, while associated with acquisition of meiotic competence, may represent a pre-atretic change.
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Affiliation(s)
- K Hinrichs
- Tufts University School of Veterinary Medicine, North Grafton, Massachusetts 01536, USA.
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28
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Machado MT, Machado TM, Yoshikae RM, Schmidt AL, Faria RDC, Paschoalotti MA, Barata RDC, Chieffi PP. Ascariasis in the subdistrict of Cavacos, municipality of alterosa (MG), Brazil: effect of mass treatment with albendazole on the intensity of infection. Rev Inst Med Trop Sao Paulo 1996; 38:265-71. [PMID: 9216107 DOI: 10.1590/s0036-46651996000400005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The clinical and epidemiologic aspects of infection with Ascaris lumbricoides were studied in a random stratified sample of the population of the subdistrict of Cavacos, municipality of Alterosa (Minas Gerais, Brazil). The effect of mass treatment with a single dose of albendazole on the prevalence and intensity of infection was also studied six months later in the same population. During the first phase of the study, a questionnaire was applied to 248 individuals to obtain information about the socioeconomic, sanitary and clinical conditions of the population surveyed. A total of 230 fecal samples were also examined by the Kato-Katz technique in order to determine the intensity of A. lumbricoides infection. Two hundred and two individuals were simultaneously submitted to blood counts and 70 children aged 12 years or less were evaluated for nutritional status. The presence of A. lumbricoides and other helminth eggs was also determined in 22 soil samples collected in the urban zone of Cavacos. Infection with enteroparasitic helminths was detected in 29.1% of the sample, with a predominance of A. lumbricoides (23.9%). Parasitism and/or intensity of A. lumbricoides infection were significantly correlated with age range (15 years or less), social class, sanitary and living conditions (water, sewage and domiciliary area per person), and presence of abdominal pain. However, these parameters were not correlated with nutritional status or hematocrit levels. During the second phase of the study, a slight but not statistically significant decrease in the prevalence of A. lumbricoides infection was detected after treatment with albendazole. However, an important and significant reduction in the amount of A. lumbricoides eggs eliminated through the feces was detected, indicating that the intensity of A. lumbricoides infection was lower in all the age ranges of the Cavacos population, especially among younger individuals, even six months after administration of the anthelminthic agent.
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Affiliation(s)
- M T Machado
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, Brasil
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29
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Hinrichs K, Martin MG, Schmidt AL, Friedman PP. Effect of follicular components on meiotic arrest and resumption in horse oocytes. J Reprod Fertil 1995; 104:149-56. [PMID: 7636796 DOI: 10.1530/jrf.0.1040149] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Two experiments were conducted to evaluate the effect of follicular components on the maintenance of meiotic arrest in horse oocytes. In Expt 1, oocytes were incubated for 24 h with follicular fluid, or with granulosa cells suspended either in medium or in follicular fluid at 25 x 10(6) cells ml-1. None of the treatments resulted in significant maintenance of the germinal vesicle stage over that of non-suppressive control. Culture with follicular fluid plus granulosa cells resulted in a significantly higher proportion of oocytes at metaphase I compared with controls. In Expt 2, oocytes were divided into those originally having compact or expanded cumuli. Oocytes were cultured with sheets of mural granulosa or sections of follicle wall, or after injection into intact dissected follicles. After incubation, half of the oocytes from each suppressive treatment were matured for 24 h. All three suppressive treatments were effective in maintaining oocytes at the germinal vesicle stage (no significant difference from control oocytes fixed directly after removal from the follicle). However, no treatment maintained normal viability of oocytes, as significantly fewer oocytes were at metaphase II after all the suppression-maturation treatments compared with the maturation control. The highest rate of post-suppression maturation was found in the mural granulosa treatment. Within this treatment, the proportion of oocytes in metaphase II was significantly higher for oocytes with expanded than for oocytes with compact cumuli (31% versus 11%, respectively; P < 0.05). Suppression by injection into an intact follicle was associated with a lack of progression to metaphase II during subsequent maturation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- K Hinrichs
- Tufts University School of Veterinary Medicine, North Grafton, MA 01536, USA
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30
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Abstract
The reversal of the tonoplast H(+)-ATPase to mediate ATP synthesis was investigated in tonoplast vesicles isolated from red beet (Beta vulgaris L.) storage tissue. Our approach involved use of the H(+)-PP(i)ase to establish a proton electrochemical gradient (delta muH+) across the tonoplast vesicle membrane to drive the H(+)-ATPase in reverse. However, an initial problem with this approach was the presence of an adenylate kinase activity in the tonoplast fraction that interfered with measurement of ATP synthesis as a coupling between the H(+)-ATPase and H(+)-PP(i)ase. Inclusion of the adenylate kinase inhibitor p1p5-di(adenosine)pentaphosphate (Ap5A) in assays at 50 microM led to a complete inhibition of this activity and allowed measurement of ATP synthesis coupled to PPi hydrolysis. When measured in the presence of Ap5A, PPi-dependent ATP synthesis was blocked by Triton X-100 and inhibited by gramicidin D, imidodiphosphate, nitrate, and bafilomycin A. These results are consistent with PPi-dependent ATP synthesis occurring as a coupled process involving a delta muH+ established across the membrane. Furthermore, the observation that ATP synthesis is inhibited by inhibitors of the tonoplast H(+)-ATPase (nitrate and bafilomycin A) would suggest that this enzyme is involved in the synthetic reaction and can operate in reverse to synthesize ATP from ADP and Pi. A thermodynamic analysis of coupling between the H(+)-PP(i)ase and H(+)-ATPase suggests that PPi-driven ATP synthesis could only occur under these reaction conditions if the H+/substrate stoichiometries for the H(+)-PP(i)ase and H(+)-ATPase were 1 and 2, respectively. These values are consistent with transport stoichiometries previously determined for these enzymes in red beet tonoplast vesicles using kinetic methods.
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Affiliation(s)
- A L Schmidt
- Department of Agronomy, University of Illinois, Urbana 61801
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31
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Schmidt AL, Briskin DP. Energy transduction in tonoplast vesicles from red beet (Beta vulgaris L.) storage tissue: H+/substrate stoichiometries for the H(+)-ATPase and H(+)-PPase. Arch Biochem Biophys 1993; 301:165-73. [PMID: 8382906 DOI: 10.1006/abbi.1993.1129] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The H+/substrate stoichiometries of the tonoplast H(+)-ATPase and H(+)-PPase were determined by a kinetic approach. Using red beet (Beta vulgaris L.) tonoplast vesicles, rates of substrate-dependent H+ transport were estimated by (I) a mathematical model describing the time course of delta pH formation, (II) the rate of H+ leakage following H+ pump inhibition at a steady state delta pH, and (III) the initial rate of alkalinization of the external medium. When compared with rates of substrate hydrolysis measured under identical conditions, all three methods yielded an H+/ATP stoichiometry of 2 while the H+/PPi stoichiometry was determined to be 1 using methods I and II. Experimental limitations did not permit an analysis of the H+/PPi stoichiometry by method III. From these results and the estimated level of substrate and product typically found in the cytoplasm of plant cells, it is suggested that the H(+)-ATPase and H(+)-PPase as primary H(+)-pumps are poised toward net substrate hydrolysis under in vivo conditions thereby operating in parallel to generate a proton electrochemical gradient across the tonoplast.
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Affiliation(s)
- A L Schmidt
- Department of Agronomy, University of Illinois, Urbana 61801
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Hinrichs K, Schmidt AL, Friedman PP, Selgrath JP, Martin MG. In vitro maturation of horse oocytes: characterization of chromatin configuration using fluorescence microscopy. Biol Reprod 1993; 48:363-70. [PMID: 8439626 DOI: 10.1095/biolreprod48.2.363] [Citation(s) in RCA: 117] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The chromatin configuration of resting horse oocytes and the time course of in vitro oocyte maturation was characterized using a fluorescent, DNA-specific label. Oocytes were classified as having either compact (CP) or expanded (EX) cumuli at the time of collection. Centrifugation of oocytes was effective in allowing visualization of the germinal vesicle. Two main chromatin configurations were found in oocytes known to have a germinal vesicle: condensed chromatin (CC), in which the chromatin formed a dense mass surrounding the nucleolus; and fluorescing nucleus (FN), in which the entire nucleus, containing diffuse or spotty chromatin, was visible. The proportion of CC to FN was higher for oocytes with EX cumuli. At time 0, 78% of CP oocytes and 73% of EX oocytes were in the germinal vesicle stage. Significantly more EX than CP oocytes were in metaphase I or II at time 0. In both CP and EX groups, maturation had not begun after 8 h of incubation. Maximal maturation occurred after 24 h for oocytes in the EX group, whereas CP oocytes continued to mature between 24 and 32 h. The percentage of EX oocytes in metaphase I did not change between 24 and 32 h, indicating a possible arrest of some EX oocytes at metaphase I. There was no difference in the percentage of oocytes at metaphase II between the CP and EX groups after 32 h of incubation.
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Affiliation(s)
- K Hinrichs
- Department of Medicine, Tufts University School of Veterinary Medicine North Grafton, Massachusetts 01536
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Hinrichs K, Schmidt AL, Memon MA, Selgrath JP, Ebert KM. Culture of 5-day horse embryos in microdroplets for 10 to 20 days. Theriogenology 1990; 34:643-53. [PMID: 16726869 DOI: 10.1016/0093-691x(90)90020-t] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/1990] [Accepted: 08/08/1990] [Indexed: 11/19/2022]
Abstract
Embryos were recovered from the uteri of mares 5 d after ovulation. Six embryos, all morulae, were placed singly in 200-ul droplets of Ham's F-12 with 10% fetal calf serum and cultured at 37 degrees C in a 5% CO(2) atmosphere. The embryos expanded to form blastocysts by the third day of culture. The blastocysts hatched from their zona pellucida, rather than the zona thinning and flaking off, as occurs in vivo. Hatching from the zona pellucida began on the third day of culture and was complete in five of six embryos by the sixth day. The embryonic capsule, normally present in equine embryos after Day 6, was not seen in the cultured embryos. The blastocysts continued to expand until 15 to 17 d of age (10 to 12 d in culture), reaching an average diameter (+/- SD) of 2052 +/- 290 um, after which time they either collapsed or contracted. These results demonstrate that equine embryos can be maintained in long-term culture in vitro, exhibiting continued growth and expansion in the absence of the embryonic capsule.
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Affiliation(s)
- K Hinrichs
- Tufts University School of Veterinary Medicine 200 Westboro Road, North Grafton, MA 01536 USA
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Coles GC, Tritschler JP, Giordano DJ, Laste NJ, Schmidt AL. Larval development test for detection of anthelmintic resistant nematodes. Res Vet Sci 1988; 45:50-3. [PMID: 3222553] [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: 01/04/2023]
Abstract
The growth, using freshly cultured Escherichia coli with ampicillin or heat-treated lyophilised E coli as a food source, of the larvae of the mouse nematode Nematospiroides dubius and the infectivity of resulting third stage larvae were determined. Concentrations of E coli between 0.5 and 1 mg dry weight ml-1 permitted optimal larval development for both N dubius and Trichostrongylus colubriformis. Development of larvae of susceptible and cambendazole-resistant strains of Haemonchus contortus in thiabendazole solutions showed clear differences between the strains and the larval development test was more sensitive than the egg hatch test. The test also detected a levamisole resistant strain of H contortus, although the degree of resistance could not be adequately measured. It is concluded that the test can be run with any anthelmintic to which resistance is suspected.
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Affiliation(s)
- G C Coles
- Department of Zoology, University of Massachusetts, Amherst 01003
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Abstract
Event-related potentials (ERPs) were recorded from a group of men with (FH+) and without (FH-) a family history of alcoholism. ERPs were recorded over the left and right cerebral hemispheres and over midline locations while subjects performed a letter rhyming task. The ERPs to the letters displayed major group differences in a negative component with a latency of 430 msec (N430). The amplitude of N430 was significantly smaller in the FH+ as compared to the FH- subjects. These group differences were more pronounced in ERPs recorded from over the right than the left hemisphere. In addition, in the FH+ group only the latency of N430 was linearly related to personal drinking habits. These results suggest that (1) certain brain functions associated with the language processing required in this task are different in men at high and low risk for the development of alcoholism and (2) moderate social use of ethanol may have more pronounced effects on language-relevant brain functions in FH+ than in FH- individuals.
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Abstract
An excised teat protocol was modified to evaluate persistence of germicidal activity of teat dips over 8 h. Five teat dip formulations, iodophor (1%), chlorhexidine gluconate (.55%), linear dodecyl benzene sulfonic acid (1.94%), sodium chlorite-lactic acid in a water base, and sodium chlorite-lactic acid in a gel base were tested against Escherichia coli and Klebsiella oxytoca. Iodophor and chlorhexidine had high germicidal activity throughout 8 h, whereas dodecyl benzene sulfonic acid had little activity. Germicidal activity of both sodium chlorite-lactic acid teat dips was high initially but declined with time. The gel base dip, however, remained more germicidal than the water base dip. Results were similar for either organism for most teat dips. However, chlorhexidine was less effective and the gel base dip more effective against Klebsiella oxytoca than Escherichia coli. Standard errors often appeared higher for Klebsiella oxytoca than for Escherichia coli. These assays may prove useful for laboratory screening of teat dips to determine germicidal persistence over time.
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Abstract
An experimental teat dip containing sodium chlorite and lactic acid, diluted in water, was evaluated by excised teat protocol. The teat dip was tested against 21 microorganisms. Included were: Staphylococcus aureus, Streptococcus agalactiae, Streptococcus dysgalactiae, Streptococcus uberis, Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Numerous strains were tested for strain differences. Environmental bacteria were included because of their increasing importance as a cause of bovine mastitis. All excised teats were dipped in a bacterial suspension containing about 1 X 10(8) cfu/ml. Negative control teats were not dipped in a germicidal compound. Positive controls were dipped in 1% iodophor. Effectiveness of the experimental teat dip was expressed as the percent reduction in mean log of bacteria recovered from dipped teats as compared to numbers recovered from control teats. The sodium chlorite - lactic acid dip caused a greater percent log reduction than iodophor for 14 of 21 strains tested. However, differences were generally slight. The experimental teat dip appeared effective against Gram-negative bacteria. Some differences in percent log reduction were observed between strains of the same species. Lowest effectiveness and greatest strain variation were observed with Staphylococcus aureus for both dips tested.
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Abstract
Evoked potentials (EPs) to a probe tone stimulus were recorded simultaneously at the temporal and parietal areas of the left and right hemisphere of dextral adults engaged in either an arithmetic or a visuospatial task. The probe EP amplitude was attenuated in the left temporal area during the arithmetic task and in the left temporal and both parietal areas, but significantly more in the right, during the visuospatial task, indicating distinct patterns of regional cerebral engagement for the two types of cognitive activity.
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Schmidt AL. Obtaining timely accounting information. Hospitals 1975; 49:25, 109. [PMID: 1126686] [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: 12/25/2022]
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Riggin RM, Schmidt AL, Kissinger PT. Determination of acetaminophen in pharmaceutical preparations and body fluids by high-performance liquid chromatography with electrochemical detection. J Pharm Sci 1975; 64:680-3. [PMID: 1142080 DOI: 10.1002/jps.2600640423] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A sensitive and very rapid assay for acetaminophen was developed based on the combination of high-performance chromatographic columns with a thin-layer electrochemical detector. Application to liquid and solid dosage forms and body fluids has been demonstrated. Great advantage derives from the detector selectivity, which permits discrimination against many potentially interfering substances without need for extensive separations or formation of derivatives. As little as 0.005% of the hydrolysis product, p-aminophenol, can be detected in the presence of the intact drug following cation-exchange chromatography. Acetaminophen can be quantitatively determined in serum on the 50-ng/ml level by liquid chromatography using a pellicular polyamide packing.
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Schmidt AL. Management information from accounting records. Dev Biol 1975; 43:44. [PMID: 1149924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Schmidt AL. [Cytological findings and oral contraceptives]. Ned Tijdschr Verloskd Gynaecol 1970; 70:539-45. [PMID: 5533395] [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: 01/15/2023]
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Schmidt AL. [Constriction ring dystocia]. Ned Tijdschr Geneeskd 1970; 114:1-3. [PMID: 5410018] [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: 01/15/2023]
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Schmidt AL, Huysinga WT. [Intrauterine heart block]. Ned Tijdschr Geneeskd 1969; 113:1871-2. [PMID: 5388042] [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: 01/15/2023]
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Schmidt AL. [The viewpoint on indications for induced abortion]. Ned Tijdschr Geneeskd 1969; 113:1361. [PMID: 5801087] [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: 01/16/2023]
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Schmidt AL. [The treatment of extrauterine pregnancy]. Ned Tijdschr Geneeskd 1969; 113:145-8. [PMID: 5767918] [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: 01/16/2023]
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Gielen JL, Schmidt AL, Megens PH. Multipolar registration of the fetal electrocardiogram: technic and comparison with bipolar method. Obstet Gynecol 1968; 31:534-42. [PMID: 5643131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Schmidt AL, Christiaans AP. [Exfoliative cytology of portio carcinoma and pregnancy]. Ned Tijdschr Verloskd Gynaecol 1967; 67:390-4. [PMID: 6078671] [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: 01/18/2023]
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Schmidt AL. [The influence of the physician's psychological attitude on the course of delivery]. Ned Tijdschr Geneeskd 1967; 111:481-3. [PMID: 6040181] [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: 01/18/2023]
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Schmidt AL, Christiaans AP. [On puncture cytology in gynacology]. Ned Tijdschr Verloskd Gynaecol 1966; 66:506-11. [PMID: 5980323] [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: 01/17/2023]
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