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Nasr HY, Friedlander P, Chiu ES. Supraclavicular Artery Island Flap for Head and Neck Oncologic Reconstruction: 15-year Experience, Past, Present, Future. Plast Reconstr Surg Glob Open 2023; 11:e5052. [PMID: 37342309 PMCID: PMC10278690 DOI: 10.1097/gox.0000000000005052] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/10/2023] [Indexed: 06/22/2023]
Abstract
Head and neck reconstruction poses unique challenges due to the complex structure of the region. Primary goals include soft-tissue coverage, adequate color and texture match, and minimal donor-site morbidity. Local and musculocutaneous regional flaps have largely been replaced with fasciocutaneous free flaps (FFF) over recent years. The supraclavicular artery island flap (SCAIF), a locoregional, fasciocutaneous, axially-based flap, has been shown to produce similar outcomes to FFF. We present our 15-year experience using the SCAIF for head and neck reconstruction, discuss its evolution, and provide case examples for its range of indications. Methods Retrospective chart review identified 128 patients who underwent reconstruction of the head and neck with the SCAIF between the years 2006-2021 at Tulane University Medical Center. Patient demographics, lengths of stay, operative times, surgical indications, and complications were recorded. Results The cohort mean age was 66.9 years. Mean lengths of stay and follow-up times were 6.9 days and 9.1 months, respectively. The most common indications for SCAIF reconstruction were recurrent radiated neck disease (n=27, 21.1%), pharyngeal wall defects (n=23, 18.0%), and parotidectomy defects (n=21, 16.4%). Overall complication rate was 17.2%. Partial thickness flap loss (5.5%), contained pharyngeal leak (3.2%), and distal tip necrosis (2.4%) were the most common complications. No functional donor site morbidity was encountered. Conclusions The SCAIF is a versatile, fasciocutaneous, axially-based flap able to produce similar outcomes to FFF in the reconstruction of the head and neck region while reducing costs, lengths of stay, operative times, and donor site morbidity.
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Affiliation(s)
- Hani Y. Nasr
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Paul Friedlander
- Department of Plastic Surgery, Tulane University Medical Center, New Orleans, La
| | - Ernest S. Chiu
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
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Abstract
IMPORTANCE Necrotizing fasciitis is a relatively uncommon and potentially life-threatening soft tissue infection, with morbidity and mortality approaching 25% to 35%, even with optimal treatment. The challenge of diagnosis for necrotizing soft tissue infections (NSTIs) is their rarity, with the incidence of approximately 1000 cases annually in the United States. Given the rapid progression of disease and its similar presentation to more benign processes, early and definitive diagnosis is imperative. FINDINGS Signs and symptoms of NSTIs in the early stages are virtually indistinguishable from those seen with abscesses and cellulitis, making definitive diagnosis difficult. The clinical presentation will depend on the pathogen and its virulence factors which ultimately determine the area and depth of invasion into tissue. There are multiple laboratory value scoring systems that have been developed to support the diagnosis of an NSTI. The scoring system with the highest positive (92%) and negative (96%) predictive value is the laboratory risk indicator for necrotizing fasciitis (LRINEC). The score is determined by 6 serologic markers: C-reactive protein (CRP), total white blood cell (WBC) count, hemoglobin, sodium, creatinine, and glucose. A score ≥ 6 is a relatively specific indicator of necrotizing fasciitis (specificity 83.8%), but a score <6 is not sensitive (59.2%) enough to rule out necrotizing fasciitis. In terms of imaging, computed tomography (CT) imaging, while more sensitive (80%) than plain radiography in detecting abnormalities, is just as nonspecific. Computed tomography imaging of NSTIs demonstrates fascial thickening (with potential fat stranding), edema, subcutaneous gas, and abscess formation. Magnetic resonance imaging (MRI) has demonstrated sensitivity of 100% and specificity of 86%, though MRI may not show early cases of fascial involvement of necrotizing fasciitis. CONCLUSIONS AND RELEVANCE Necrotizing soft tissue infections are rapidly progressive and potentially fatal infections that require a high index of clinical suspicion to promptly diagnose and aggressive surgical debridement of affected tissue in order to ensure optimal outcomes.Prompt surgical and infectious disease consultation is necessary for the treatment and management of these patients. While imaging is useful for further characterization, it should not delay surgical consultation. Necrotizing soft tissue infection remains a clinical diagnosis, although plain radiography, CT imaging, and ultrasound can provide useful clues. In general, the management of these patients should include rapid diagnosis, using a combination of clinical suspicion, laboratory data (LRINEC score), and imaging (MRI being the recommended imaging modality), prompt infectious disease and surgical consultation, surgical debridement, and delayed reconstruction. Laboratory findings that can more strongly suggest a diagnosis of NSTI include elevated CRP, elevated WBC, low hemoglobin, decreased sodium, and increased creatinine. Imaging findings include fascial thickening (with potential fat stranding), edema, subcutaneous gas, and abscess formation. Broad-spectrum antibiotics should be started in all cases of suspected NSTI. Surgical debridement, however, remains the lynchpin for treatment of cervical necrotizing fasciitis.
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Affiliation(s)
- Jack Hua
- Department of Radiology, Tulane University Medical School, New Orleans, LA, USA
| | - Paul Friedlander
- Department of Otolaryngology, Tulane University Medical School, New Orleans, LA, USA
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Mankowski N, Al-Qurayshi Z, Souza S, Campbell B, Beighley A, Denson J, Mauldin B, Bojanowski C, Friedlander P, Zifodya J. The effect of race, socioeconomic status, and comorbidity on patients afflicted with COVID 19: A Local Perspective. Ann Epidemiol 2021; 64:83-87. [PMID: 34562588 PMCID: PMC8457904 DOI: 10.1016/j.annepidem.2021.09.013] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE The aim of this study is to further examine the associations of race, socioeconomic factors, and comorbidity with COVID-19 health outcomes. METHODS This is a retrospective cohort study of 309 PCR confirmed COVID-19 positive adults who presented to Tulane Medical Center in New Orleans, LA, from March 9 to May 29, 2020. The primary outcomes investigated were need for invasive mechanical ventilation (IMV) and in-hospital mortality. A multivariate analysis was performed to determine socioeconomic and medical risk factors for IMV and in-hospital mortality. RESULTS Compared to white patients, Black patients were more likely to present younger, female, obese, unemployed, and underinsured. However, when controlled for common risk factors, Black and white patients had similar risk for IMV and mortality. Increased age (≥65 years), obesity, and increased comorbidity were associated with increased risk for IMV and mortality. CONCLUSIONS Race and socioeconomic factors may increase risk for COVID-19 infection but did not affect health outcomes within the hospital setting. Therefore, the higher rates of COVID-19 infection and mortality in vulnerable populations may be better explained by lower socioeconomic status, with subsequent higher comorbidity, in these populations. Community health initiatives should be prioritized in response to the COVID-19 pandemic.
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Affiliation(s)
| | - Zaid Al-Qurayshi
- Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Spenser Souza
- Department of Otolaryngology - Head & Neck Surgery, University of California-San Francisco School of Medicine, San Francisco, CA
| | | | - Adam Beighley
- Tulane University School of Medicine, New Orleans, LA
| | - Joshua Denson
- Section of Pulmonary Diseases, Critical Care and Environmental Medicine, Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Brandon Mauldin
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Christine Bojanowski
- Section of Pulmonary Diseases, Critical Care and Environmental Medicine, Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Paul Friedlander
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Jerry Zifodya
- Section of Pulmonary Diseases, Critical Care and Environmental Medicine, Department of Medicine, Tulane University School of Medicine, New Orleans, LA.
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DiBiase S, Weiner R, Mahmood T, Harris K, Baghian A, Kawauchi R, Devisetty K, Herman J, Bhandari M, Ware M, Friedlander P, Morgan L. Phase I Clinical Trial: Results From The Use Of 4-Demethyl-4-Cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN) Plus Radiation As Treatment For Cancers Involving The CNS. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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DiBiase SJ, Weiner RS, Mahmood T, Harris K, Kawauchi R, Devisetty K, Herman J, Bhandari M, Ware M, Friedlander P, Morgan LR, Baghian A. Abstract CT101: Phase I clinical trial: results from the use of 4-demethyl-4 cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN) plus radiation as treatment for cancers involving the CNS. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct101] [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
Purpose: 4-Demethyl-4-cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN) is a poly-chlorinated pyridine cholesteryl carbonate with a MOA via bis-alkylation of DNA @ N7-guanine and N4-cytosine that has completed Phase I/II studies [AACR, #CT129, 2017] in adult subjects with cancers involving the CNS. Four (4) subjects in the Phase I/II trials required surgery for persistent CNS lesions following DM-CHOC-PEN therapy with 39-98.8 mg/m2 of drug. DM-CHOC-PEN was identified in samples from all 4-subjects - 90-212 ng/g tumor. Thus, the drug penetrates the CNS and tumors and is available to act as a radiosensitizer; the latter has been supported with in vitro studies [AACR, #4746, 2017]. The current presentation reviews the long term Phase I clinical data that supports safety, dose-tolerance and use of DM-CHOC-PEN plus radiation in subjects with cancers involving the CNS - IND 68,876. Patients & Methods: DM-CHOC-PEN was administered as a 3-hr IV infusion once to subjects with advanced cancer involving the CNS. A single dose (39 mg/m2 to 98.7 mg/m2 in escalating Phase I scheme) was administered once anywhere from 48 hours to 3-weeks prior to receiving stereotactic radiosurgery (SRS) or whole brain radiation therapy (WBRT). Radiation was administered in doses of 15-30 Gy depending on the size and number of lesions. Results: Nineteen (19) subjects with cancer involving the CNS have been treated to date with DM-CHOC-PEN (6-NSCLC, 1-breast, 1-melanoma, 5-GBM, 3-sarcomas, 1-astrocytoma & 2-renal cell carcinomas). Subjects received 39, 50, 70, 86.8 or 98.7 mg/m2 of DM-CHOC-PEN. Five subjects received WBRT (30 Gy) and 14 subjects received SRS (15-24 Gy. One (1) subject with NSCLC did develop vasogenic edema and tumor necrosis which resolved and the subject is in complete remission 55+ mos. A second subject with a recurrent GBM developed Gr-3 confusion secondary to an enlarging lesion which was removed. Drug was present in ng/g of tumor conc.; confusion resolved. Ten (10) of the thirteen (13) subjects have had objective results (OS 8-58 mos.) Bioavailability for DM-CHOC-PEN revealed a rebound phenomenon @ ~ 50 hours post-infusion with a T-release of 26.7 h. and drug in the plasma (Cmax=17.5 µg/mL) until day 15 . The AUC was linear for all doses. Pre-clinical radiosensitization in vitro studies [AACR #1917, 2017] supported the present trial. Photon induced charge transfer reactions with DM-CHOC-PEN will be discussed as a MOA. Conclusion: Data is presented that documents effectiveness and safety of DM-CHOC-PEN plus radiation as therapy for subjects with cancers involving the CNS. Observations during this trial supported the drug's ability to penetrate human tumors involving the CNS and acceptability as a method to improving responses to radiation. Complete data on subject responses and observed toxicities will be presented. Supported by - NCI/SBIR grants - R43 CA213545-02 and NIH NIGMS 1 U54 GM104940 - the latter funds the Louisiana Clinical and Translational Science Center.
Citation Format: Steven J. DiBiase, Roy S. Weiner, Tallat Mahmood, Kendra Harris, Ronald Kawauchi, Kiran Devisetty, James Herman, Manish Bhandari, Marcus Ware, Paul Friedlander, Lee R. Morgan, Ali Baghian. Phase I clinical trial: results from the use of 4-demethyl-4 cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN) plus radiation as treatment for cancers involving the CNS [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT101.
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Affiliation(s)
| | - Roy S. Weiner
- 2Tulane University Health Sciences Center, New Orleans, LA
| | | | | | | | - Kiran Devisetty
- 6Karmanos Cancer Center Institute at McLaren Flint, Flint, MI
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6
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Souza S, Raggio B, Bareiss A, Friedlander P. Diffuse Idiopathic Skeletal Hyperostosis of the Cervical Spine: A Risk for Acute Airway Obstruction. Ear Nose Throat J 2020; 100:921S-923S. [PMID: 32469245 DOI: 10.1177/0145561320931212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Spenser Souza
- Department of Otolaryngology, UCSF Medical Center, San Francisco, CA, USA
| | - Blake Raggio
- Department of Otolaryngology, Tulane University Medical Center, New Orleans, LA, USA
| | - Anna Bareiss
- Department of Otolaryngology, Tulane University Medical Center, New Orleans, LA, USA
| | - Paul Friedlander
- Department of Otolaryngology, Tulane University Medical Center, New Orleans, LA, USA
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Selimovic D, Wahl RU, Ruiz E, Aslam R, Flanagan TW, Hassan SY, Santourlidis S, Haikel Y, Friedlander P, Megahed M, Kandil E, Hassan M. Tumor necrosis factor-α triggers opposing signals in head and neck squamous cell carcinoma and induces apoptosis via mitochondrial- and non-mitochondrial-dependent pathways. Int J Oncol 2019; 55:1324-1338. [PMID: 31638203 DOI: 10.3892/ijo.2019.4900] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/21/2018] [Indexed: 11/06/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) remains one of the most common malignancies worldwide. Although the treatment outcomes of HNSCC have improved in recent years, the prognosis of patients with advanced-stage disease remains poor. Current treatment strategies for HNSCC include surgery as a primary therapy, while radio-, chemo-, and biotherapeutics can be applied as second-line therapy. Although tumor necrosis factor-α (TNF-α) is a potent tumor suppressor cytokine, the stimulation of opposing signals impairs its clinical utility as an anticancer agent. The aim of this study was to elucidate the mechanisms regulating TNF-α‑induced opposing signals and their biological consequences in HNSCC cell lines. We determined the molecular mechanisms of TNF-α-induced opposing signals in HNSCC cells. Our in vitro analysis indicated that one of these signals triggers apoptosis, while the other induces both apoptosis and cell survival. The TNF-α-induced survival of HNSCC cells is mediated by the TNF receptor-associated factor 2 (TRAF2)/nuclear factor (NF)-κB-dependent pathway, while TNF-α-induced apoptosis is mediated by mitochondrial and non-mitochondrial-dependent mechanisms through FADD-caspase-8-caspase-3 and ASK-JNK-p53-Noxa pathways. The localization of Noxa protein to both the mitochondria and endoplasmic reticulum (ER) was found to cause mitochondrial dysregulation and ER stress, respectively. Using inhibitory experiments, we demonstrated that the FADD‑caspase-8‑caspase-3 pathway, together with mitochondrial dysregulation and ER stress-dependent pathways, are essential for the modulation of apoptosis, and the NF-κB pathway is essential for the modulation of anti-apoptotic effects/cell survival during the exposure of HNSCC cells to TNF-α. Our data provide insight into the mechanisms of TNF-α-induced opposing signals in HNSCC cells and may further help in the development of novel therapeutic approaches with which to minimize the systemic toxicity of TNF-α.
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Affiliation(s)
- Denis Selimovic
- INSERM UMR 1121, University of Strasbourg, 67000 Strasbourg, France
| | - Renate U Wahl
- Clinic of Dermatology, University Hospital οf Aachen, 52074 Aachen, Germany
| | - Emmanuelle Ruiz
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Rizwan Aslam
- Department of Otolaryngology, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Thomas W Flanagan
- Department of Pharmacology and Experimental Therapeutics, LSU Health Sciences Center, New Orleans, LA 70112, USA
| | | | - Simeon Santourlidis
- Epigenetics Core Laboratory, Institute of Transplantation Diagnostics and Cell Therapeutics, University Hospital of Düsseldorf, Heinrich-Heine-University of Düsseldorf, 40225 Düsseldorf, Germany
| | - Youssef Haikel
- INSERM UMR 1121, University of Strasbourg, 67000 Strasbourg, France
| | - Paul Friedlander
- Department of Otolaryngology, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Mosaad Megahed
- Clinic of Dermatology, University Hospital οf Aachen, 52074 Aachen, Germany
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Mohamed Hassan
- INSERM UMR 1121, University of Strasbourg, 67000 Strasbourg, France
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8
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Chesney J, Puzanov I, Collichio F, Singh P, Milhem M, Glaspy J, Hamid O, Ross M, Friedlander P, Garbe C, Logan T, Hauschild A, Lebbe C, Yi M, Sharma A, Mehnert J. Talimogene laherparepvec (T-VEC) in combination (combo) with ipilimumab (ipi) versus ipi alone for advanced melanoma: 3-year landmark analysis of a randomized, open-label, phase II trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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9
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Affiliation(s)
- Cameron Todd
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Sabrina Brody-Camp
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Paul Friedlander
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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10
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Weiner RS, Mahmood T, Morgan LR, Harris K, Baghian A, DiBiase SJ, Friedlander P, Ware ML, Kawauchi R, Herman J, Bhandari M. Abstract CT065: A Phase I clinical trial: Use of 4-demethyl-4-cholesteryl- oxycarbonyl-penclomedine (DM-CHOC-PEN) plus radiation as treatments for cancers involving the CNS. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-ct065] [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
Purpose: 4-Demethyl-4-cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN) is a poly-chlorinated pyridine cholesteryl carbonate with a MOA via bis-alkylation of DNA @ N7-guanine and N4-cytosine that has completed Phase II studies [AACR, #CT129, 2017] in subjects with cancers involving the CNS. Four (4) subjects in the Phase I/II trials required surgery for persistent CNS lesions following DM-CHOC-PEN therapy with 39-98.8 mg/m2 of drug. DM-CHOC-PEN was identified in samples from all 4-subjects - 90-212 ng/g tumor. Thus, the drug penetrates the CNS and tumors and is available to act as a radiosensitizer; the latter has been supported with in vitro studies [AACR, #4746, 2017]. The current presentation reviews Phase I clinical data that supports the safety, dose-tolerance and use for DM-CHOC-PEN plus radiation in subjects with cancers involving the CNS - IND 68,876.
Patients & Methods: DM-CHOC-PEN was administered as a 3-hr IV infusion once to subjects with advanced cancer involving the CNS. A single dose (39 mg/m2 to 98.7 mg/m2 in escalating Phase I scheme) was administered once 3-weeks prior to receiving stereotaxic radio-surgery (SRS), gamma knife or whole brain irradiation (WBRT) therapy. Radiation was administered in doses of 15-30 Gy depending on the size and number of lesions.
Results: Thirteen (13) subjects with cancer involving the CNS have been treated to date with DM-CHOC-PEN (6-NSCLC, 1-breast, 1-melanoma, 2-GBM & 3-sarcomas). Subjects received 39, 50, 70, 86.8 or 98.7 mg/m2 and 15-30 Gy of radiation. The drug/radiation combination was well tolerated. One (1) subject with NSCLC did develop vasogenic edema and tumor necrosis which resolved and the subject is in complete remission 42+ mos. A second subject with a recurrent GBM with confusion progressed - Gr-3. Ten (10) of the thirteen (13) subjects have had objective results (OS 8-54+ mos.) Bioavailability for DM-CHOC-PEN revealed a rebound phenomenon @ ~ 50 hours post-infusion with a T-release of 26.7 h. The same phenomenon was observed with RBCs (estimation using Monolix 3.2). DM-CHOC-PEN was detected bound to RBCs for 3-days (after 70 mg/m2) and was also detected in the urine (Cmax=17.5 µg/mL) until day 15. The AUC was linear for all doses. Pre-clinical radiosensitization in vitro studies [AACR #1917, 2017] support the present trial study result. Photon induced charge transfer reactions with DM-CHOC-PEN will be discussed as a MOA.
Conclusion: Data is presented that documents effectiveness and safety of DM-CHOC-PEN plus radiation as therapy for subjects with cancers involving the CNS. Observations during Phase I/II clinical trials with DM-CHOC-PEN alone supported the drug’s persistent presence in human tumors after systemic administration and possible positive effects on response to subsequent radiation. Complete data on subject responses and observed toxicities will be presented. Supported by - NCI/SBIR grants - R43 CA213545-02 and NIH NIGMS 1 U54 GM104940 - the latter funds the Louisiana Clinical and Translational Science Center.
Citation Format: RS Weiner, T Mahmood, Lee Roy Morgan, K. Harris, A. Baghian, SJ DiBiase, P. Friedlander, ML Ware, R. Kawauchi, J. Herman, M. Bhandari. A Phase I clinical trial: Use of 4-demethyl-4-cholesteryl- oxycarbonyl-penclomedine (DM-CHOC-PEN) plus radiation as treatments for cancers involving the CNS [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr CT065.
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Affiliation(s)
| | - T Mahmood
- 2Detriot Clinical Research Center, Lansing, MI
| | | | | | | | - SJ DiBiase
- 4New York - Presbyterian Queens, Flushing, NY
| | | | - ML Ware
- 6Ochsner Medical Center, New Orleans, LA
| | - R. Kawauchi
- 2Detriot Clinical Research Center, Lansing, MI
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Raggio BS, Friedlander P. Laryngeal Melanosis: A Worrisome Finding? Ear Nose Throat J 2019; 99:227-228. [PMID: 30961386 DOI: 10.1177/0145561319838724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Blake S Raggio
- Department of Otolaryngology, Tulane University Medical Center, New Orleans, LA, USA
| | - Paul Friedlander
- Department of Otolaryngology, Tulane University Medical Center, New Orleans, LA, USA
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12
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Affiliation(s)
- Blake Raggio
- Department of Otolaryngology, Tulane University Medical Center, New Orleans, LA, USA
| | - Scott Mayer
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Paul Friedlander
- Department of Otolaryngology, Tulane University Medical Center, New Orleans, LA, USA
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13
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Todd C, Brody-Camp S, Friedlander P. The Role of Otolaryngologists in Eradicating Human Papillomavirus-Reply. JAMA Otolaryngol Head Neck Surg 2018; 144:1186-1187. [PMID: 30286221 DOI: 10.1001/jamaoto.2018.2450] [Citation(s) in RCA: 0] [Impact Index Per Article: 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)
- Cameron Todd
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Sabrina Brody-Camp
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Paul Friedlander
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Morgan LR, Mahmood T, Weiner RS, Kawauchi R, Bhandari M, Devisitty K, Herman J, Summe R, Ware ML, Friedlander P, Rodgers AH. Abstract CT119: Early phase I clinical trial results for 4-demethyl-4-cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN) plus radiation in cancers involving the CNS. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-ct119] [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
Purpose:4-Demethyl-4-cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN) is a poly-chlorinated pyridine cholesteryl carbonate with a mechanism of action (MOA) via bis-alkylation of DNA @ N7-guanine and N4-cytosine that has completed Phase I/II studies [AACR, 58, #CT129, 2017] in subjects with cancers involving the CNS. Four (4) subjects in the Phase I/II trials required surgery for persistent CNS lesions following DM-CHOC-PEN therapy and DM-CHOC-PEN was identified in samples from all 4-subjects - 90-212 ng/g tumor [subjects had been treated with 39-98.8 mg/m2 of drug]. Thus, the drug penetrates the CNS and concentrates in tumors. It is available, therefore, to act as a radiosensitizer as demonstrated in in vitro studies [AACR, 58, #4746, 2017]. The current presentation reviews Phase I clinical data that supports the safety, dose-tolerance, and use of DM-CHOC-PEN with radiation in subjects with cancers involving the CNS - IND 68,876.
Patients & Methods: DM-CHOC-PEN was administered as a 3-hr IV infusion once every 21 days to subjects with advanced cancer involving the CNS. A single dose was administered prior to standard radiation therapy. The dose was escalated from 39 mg/m2 to 98.7 mg/m2 I.X1, then 3-weeks later the subject received stereotaxic radio-surgery (SRS) or whole brain irradiation (WBRT). Total radiation administered was 15-30 Gy depending on the size and number of lesions.
Results: Nine (9) subjects with cancer involving the CNS have been treated to date - (6-NSCLC, 1-breast, 1-melanoma & 1-sarcoma). Subjects received 39, 55, 70, 86.8 or 98.7 mg/m2 followed by 15-30 Gy of radiation. The drug/radiation combination was well tolerated. One (1) subject with NSCLC developed vasogenic edema and tumor necrosis which resolved; that subject is in complete remission 31+ mos. Six out of nine subjects have had objective responses (OS 4 - 42+ mos.) Bioavailability for DM-CHOC-PEN revealed a rebound phenomenon @ ~ 50 hours post-infusion with a T-release of 26.7 h. The same phenomenon was observed with RBCs (estimation using Monolix 3.2). DM-CHOC-PEN was detected bound to RBCs for 3-days (after 70 mg/m2); DM-CHOC-PEN was also detected in the urine (Cmax=17.5 µg/mL) until day 15. The AUC was linear for all doses. Pre-clinical in vitro studies supported the clinical data: NSCLC cells treated with DM-CHOC-PEN (0.1 -1.0 µg/mL) demonstrated 50 & 100% cytotoxicity @ 0.4 & 1.0 µg/mL. For radiation alone (6, 9 &12 Gy) - cell kill was 20 & 65% @ 6 & 12 Gy [100% kill was not observed at this dose range]; for DM-CHOC-PEN (0.25 µg/mL) plus radiation (6-12 Gy) - cell kill was 80 & 100% @ 6 & 12 Gy. Photon induced charge transfer reactions with DM-CHOC-PEN will be discussed.
Conclusion: Preliminary data is presented that supports enhanced cytotoxicity and safety of DM-CHOC-PEN plus radiation as therapy for subjects with cancers involving the CNS. Observations during Phase I/II clinical trials with DM-CHOC-PEN alone support the drug's persistent presence in human tumors after systemic administration and possible positive effects on response to subsequent radiation. Complete data on subject responses and observed toxicities will be presented. Supported by - NCI/SBIR grants - R43 CA213545-01 and NIH NIGMS 1 U54 GM104940 - the latter funds the Louisiana Clinical and Translational Science Center.
Citation Format: LR Morgan, T Mahmood, R S. Weiner, R Kawauchi, M Bhandari, K Devisitty, J Herman, R Summe, ML Ware, P Friedlander, AH Rodgers. Early phase I clinical trial results for 4-demethyl-4-cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN) plus radiation in cancers involving the CNS [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr CT119.
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Affiliation(s)
| | - T Mahmood
- 2Detroit Clinical Research Center, Lansing, MI
| | | | - R Kawauchi
- 2Detroit Clinical Research Center, Lansing, MI
| | | | - K Devisitty
- 5Karmanos Cancer Center Institute at McLaren Flint, Flint, MI
| | | | - R Summe
- 4The Christ Hospital, Cincinnati, OH
| | - ML Ware
- 7Ochsner Medical Center, New Orleans, LA
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Tsumagari K, Abd Elmageed ZY, Sholl AB, Green EA, Sobti S, Khan AR, Kandil A, Murad F, Friedlander P, Boulares AH, Kandil E. Bortezomib sensitizes thyroid cancer to BRAF inhibitor in vitro and in vivo. Endocr Relat Cancer 2018; 25:99-109. [PMID: 29269566 PMCID: PMC9048863 DOI: 10.1530/erc-17-0182] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/02/2017] [Indexed: 12/25/2022]
Abstract
Although overall survival rate for patients with thyroid cancer (TC) is high, there is an alarming 10-year recurrence rate of up to 30% conferring a ~50% survival among these high-risk patients. The BRAFV600E mutation is estimated to be present in over 50% of papillary thyroid cancer (PTC) cases besides being associated with carcinogenesis and poor prognosis. We assessed the status of NF-κB, Ki-67, cyclin D1 and BRAFV600E in TC tissues and TC cell lines using immunohistochemistry and Western blot analysis. Concurrently, we evaluated the outcomes of combined targeting of the proteasome pathway in addition to selective BRAF inhibitors in cases of PTC. In this study, BRAFV600E-bearing TC cells were treated with BRAFV600E inhibitor, Vemurafenib alone or in combination with the proteasome inhibitor, Bortezomib. The combination of both drugs showed synergistic effects as evidenced by cell growth inhibition (P < 0.05), increased G2-phase cell cycle arrest and induced apoptosis (P < 0.05). In our TC xenograft model, the combination of Vemurafenib and Bortezomib significantly reduced tumor size (P < 0.05) and expression of the markers of cell growth and proliferation, Ki-67 and cyclin D1 (P < 0.001), when compared to monotherapy. Further analysis demonstrated that treatment with Bortezomib sensitized TC cells to Vemurafenib via mitochondrial dysregulation and apoptosis of TC cells, as evidenced by the increase in the expression of p53, Noxa protein, the loss of mitochondrial membrane potential, cytochrome c release and Poly (ADP-ribose) polymerase cleavage. Our results demonstrate a strong clinical potential for the combination of the Bortezomib and the BRAF inhibitor Vemurafenib as an efficient therapeutic approach for the treatment of TC.
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Affiliation(s)
- Koji Tsumagari
- Department of SurgeryTulane University School of Medicine, New Orleans, Louisiana, USA
| | | | - Andrew B Sholl
- Department of PathologyTulane University School of Medicine, New Orleans, Louisiana, USA
| | - Erik A Green
- Department of SurgeryTulane University School of Medicine, New Orleans, Louisiana, USA
| | - Saboori Sobti
- Department of SurgeryTulane University School of Medicine, New Orleans, Louisiana, USA
| | - Abdul Razzaq Khan
- Department of SurgeryTulane University School of Medicine, New Orleans, Louisiana, USA
| | - Abdulrahman Kandil
- Department of SurgeryTulane University School of Medicine, New Orleans, Louisiana, USA
| | - Fadi Murad
- Department of SurgeryTulane University School of Medicine, New Orleans, Louisiana, USA
| | - Paul Friedlander
- Department of OtolaryngologyTulane University School of Medicine, New Orleans, Louisiana, USA
| | - A Hamid Boulares
- The Stanley Scott Cancer CenterLouisiana State University Health Science Center, New Orleans, Louisiana, USA
- Department of PharmacologyLouisiana State University Health Science Center, New Orleans, Louisiana, USA
| | - Emad Kandil
- Department of SurgeryTulane University School of Medicine, New Orleans, Louisiana, USA
- Department of OtolaryngologyTulane University School of Medicine, New Orleans, Louisiana, USA
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Smith AA, Darden M, Al-Qurayshi Z, Paramesh AS, Killackey M, Kandil E, Parker G, Balart L, Friedlander P, Buell JF. Liver transplantation in New Orleans: parity in a world of disparity? HPB (Oxford) 2017. [PMID: 28647164 DOI: 10.1016/j.hpb.2017.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Racial disparity in access to liver transplantation among African Americans (AA) compared to Caucasians (CA) has been well described. The aim of this investigation was to examine the presentation of AA liver transplant recipients in a socioeconomically challenged region. METHODS 680 adult liver transplant candidates and 233 resultant recipients between 2007 and 2015 were analyzed using univariate and multivariate analyses to evaluate factors significant for transplantation. RESULTS Percentages of wait list patients transplanted were similar between CA and AA (34.9% vs. 32.2%, p = 0.5205). AA were younger (50.4 ± 1.8 vs. 56.3 ± 0.7 yrs, p = 0.0003) with higher average MELD scores (22.9 ± 1.6 vs. 19.4 ± 0.7, p = 0.0230). Overall patient mortality was similar (AA 22.7% vs. CA 26.3%, p = 0.5931). A multiple linear regression showed that male gender was strongly associated with transplantation. CONCLUSIONS Equal access to liver transplantation remains challenging for racial minorities. At our institution, AA were accepted and transplanted at an equivalent rate as CA despite a higher AA population, HCV rate and diagnosed HCC. AA were younger and sicker at the time of transplant, but overall had similar outcomes compared to CA. Our study highlights the need for studies to delineate the underpinnings of disparity in transplantation access.
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Affiliation(s)
- Alison A Smith
- Tulane University School of Medicine, Louisiana State University School of Medicine, USA
| | - Michael Darden
- Department of Economics, Tulane University, New Orleans, LA, USA
| | - Zaid Al-Qurayshi
- Tulane University School of Medicine, Louisiana State University School of Medicine, USA
| | - Anil S Paramesh
- Tulane University School of Medicine, Louisiana State University School of Medicine, USA
| | - Mary Killackey
- Tulane University School of Medicine, Louisiana State University School of Medicine, USA
| | - Emad Kandil
- Tulane University School of Medicine, Louisiana State University School of Medicine, USA
| | - Geoffrey Parker
- Tuck School of Business Administration at Dartmouth, Hannover, NH, USA
| | - Luis Balart
- Tulane University School of Medicine, Louisiana State University School of Medicine, USA
| | - Paul Friedlander
- Tulane University School of Medicine, Louisiana State University School of Medicine, USA
| | - Joseph F Buell
- Tulane University School of Medicine, Louisiana State University School of Medicine, USA; Department of Economics, Tulane University, New Orleans, LA, USA.
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Al-Qurayshi Z, Hauch A, Srivastav S, Aslam R, Friedlander P, Kandil E. A National Perspective of the Risk, Presentation, and Outcomes of Pediatric Thyroid Cancer. JAMA Otolaryngol Head Neck Surg 2017; 142:472-8. [PMID: 27031884 DOI: 10.1001/jamaoto.2016.0104] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Thyroid cancer is the most common endocrine malignant neoplasm in children and adolescents. Despite a more advanced presentation of thyroid cancer, younger patients tend to have a more favorable prognosis and a lower mortality rate than adults with thyroid cancer. OBJECTIVE To examine the presentation and outcomes of thyroid cancer in pediatric patients. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional weighted analysis was performed using data from the Nationwide Inpatient Sample from January 1, 2003, to December 31, 2010. Patient data were derived from a sample of 20% of community hospitals in the United States. Six hundred forty-four children and adolescents (age, <18 years; hereinafter referred to as children) with thyroid cancer were compared with 43 536 adults (age, ≥18 years) with thyroid cancer. Data were analyzed from December 7, 2014, to November 19, 2015. EXPOSURES Thyroid cancer and thyroidectomy. MAIN OUTCOMES AND MEASURES Presentation and management characteristics of thyroid cancer and thyroidectomy outcomes in relation to surgeon volume and specialty. RESULTS A total of 644 cases of pediatric thyroid cancer were included (female, 77.3%; mean [SEM] age, 13.8 [0.2] years), corresponding to a weighted sample of 32 563. Compared with adults with thyroid cancer, children were more likely to present with cervical lymph node involvement (31.5% vs 14.7%; odds ratio [OR], 2.29; 95% CI, 1.76-2.97; P < .001) and lung metastases (5.7% vs 2.2%; OR, 2.79; 95% CI, 1.82-4.28; P < .001), whereas bone metastases were more frequent in adults (0.3% vs 1.1%; OR, 0.23; 95% CI, 0.06-0.90; P = .04). Children were more likely to be treated by a low-volume surgeon (26.9% vs 16.0%; OR, 2.09; 95% CI, 1.26-3.48; P = .005) or a pediatric surgeon (14.5% vs 9.6%; OR, 1.66; 95% CI, 1.04-2.67; P = .04) and in a low-volume hospital (20.5% vs 15.2%; OR, 2.97; 95% CI, 1.60-5.54; P < .001) or a teaching hospital (81.7% vs 63.1%; OR, 3.61; 95% CI, 2.33-5.60; P < .001). Compared with those treated by low-volume surgeons, children treated by high-volume surgeons were less likely to experience postoperative complications (14.3% vs 35.9%; OR, 0.16; 95% CI, 0.05-0.51; P = .002) or a hospital stay of more than 1 day (49.8% vs 67.9%; OR, 0.36; 95% CI, 0.15-0.90; P = .03). Management by pediatric surgeons did not significantly alter the risk for postoperative complications compared with other specialties (21.3% vs 18.5%; OR, 1.71; 95% CI, 0.64-4.53, P = .28). Management of thyroid cancer in children was significantly more costly (>$10 067.08/case) compared with adults (P = .04). CONCLUSIONS AND RELEVANCE Compared with thyroid cancer in adults, pediatric thyroid cancer is more likely to present as advanced disease and to be managed by low-volume or pediatric surgeons. In addition, within the United States, surgeon volume appears to be more crucial in determining thyroidectomy outcomes than the surgeon's field of specialization.
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Affiliation(s)
- Zaid Al-Qurayshi
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Adam Hauch
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Sudesh Srivastav
- Department of Biostatistics and Bioinformatics, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Rizwan Aslam
- Department of Otolaryngology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Paul Friedlander
- Department of Otolaryngology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Abd Elmageed ZY, Sholl AB, Tsumagari K, Al-Qurayshi Z, Basolo F, Moroz K, Boulares AH, Friedlander P, Miccoli P, Kandil E. Immunohistochemistry as an accurate tool for evaluating BRAF-V600E mutation in 130 samples of papillary thyroid cancer. Surgery 2017; 161:1122-1128. [DOI: 10.1016/j.surg.2016.06.081] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/21/2016] [Accepted: 06/27/2016] [Indexed: 02/07/2023]
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Blanchard A, Nguyen JB, Daroca P, Friedlander P, Lewin E, Vu J, Palacios E. Rare primary mucosal melanoma of the larynx. Ear Nose Throat J 2016; 95:E28-E31. [PMID: 27929604] [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: 06/06/2023] Open
Abstract
Few cases of primary mucosal melanoma of the larynx have been documented in the literature, so only a limited amount of data exists regarding its diagnosis and treatment. The prognosis is poor, as patients often present at a late stage with regional or distant metastases. We describe the case of a 66-year-old man who presented with hoarseness and dysphagia. Laryngoscopy identified a dark discoloration of the supraglottic larynx and incomplete mobility of the right vocal fold; an excisional biopsy confirmed the diagnosis. We discuss the epidemiology, clinical features, diagnosis, interpretation of imaging findings, and management of this rare malignant melanoma.
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Affiliation(s)
- Adam Blanchard
- Department of Radiology, Tulane University School of Medicine, 1415 Tulane Ave., New Orleans, LA 70121, USA
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Moore RF, Sholl AB, Kidd L, Al-Qurayshi Z, Tsumagari K, Emejulu OM, Kholmatov R, Friedlander P, Abd Elmageed ZY, Kandil E. Metadherin Expression is Associated with Extrathyroidal Extension in Papillary Thyroid Cancer Patients. Ann Surg Oncol 2016; 23:2883-8. [DOI: 10.1245/s10434-016-5245-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Indexed: 12/13/2022]
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21
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Al-Qurayshi Z, Randolph GW, Srivastav S, Aslam R, Friedlander P, Kandil E. Outcomes in thyroid surgery are affected by racial, economic, and healthcare system demographics. Laryngoscope 2016; 126:2194-9. [DOI: 10.1002/lary.25871] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 12/16/2015] [Accepted: 12/18/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Zaid Al-Qurayshi
- Department of Surgery; Tulane University School of Medicine; New Orleans Louisiana
| | - Gregory W. Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Sudesh Srivastav
- Department of Biostatistics and Bioinformatics; Tulane University School of Public Health and Tropical Medicine; New Orleans Louisiana
| | - Rizwan Aslam
- Department of Otolaryngology; Tulane University School of Medicine; New Orleans Louisiana
| | - Paul Friedlander
- Department of Otolaryngology; Tulane University School of Medicine; New Orleans Louisiana
| | - Emad Kandil
- Department of Surgery; Tulane University School of Medicine; New Orleans Louisiana
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Ohlstein JF, Brody-Camp S, Friedman S, Levy JM, Buell JF, Friedlander P. Initial Experience of a Patient Navigation Model for Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2015; 141:804-9. [PMID: 26313895 DOI: 10.1001/jamaoto.2015.1467] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Specific temporal goals for treatment of head and neck cancer (HNC) are common in Europe but not in the United States. We implemented a patient-centric navigation model with an aspirational goal that all patients will receive treatment recommendations within 2 weeks of presentation as a means to improve outcomes in our patients with HNC. OBJECTIVE To assess the temporal impact of using an aspirational goal in a patient-centric navigation system on the time from presentation to formulation of treatment planning for patients with HNC. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of 100 consecutive patients treated for squamous cell carcinoma of the head and neck at a tertiary referral center between 2011 and 2014. Patients were assessed to determine the efficiency of a patient-centric navigational model in delivering cancer treatment recommendations. This model was designed with an aspirational goal of providing treatment recommendations within a 2-week period. EXPOSURE Starting in 2011, patient-centric navigation model including the assignment of a nurse who acts as a patient navigator. MAIN OUTCOMES AND MEASURES The time interval between presentation to clinic and definitive treatment recommendations, as well as factors associated with delay. RESULTS Of the 93 patients who met inclusion requirements, most were white (81 [87%]) males (74 [80%]) with a mean (SD) age of 63.4 (10.8) years insured by Medicare or Medicaid (64 [69%]). Forty-seven (51%) received treatment recommendations within the 2-week period, with median and mode values of 15 and 14 days, respectively. The mean (SD) interval was 18.8 (18.6) days. Outliers included 2 patients with synchronous lung nodules (72 and 85 days) and 2 patients with psychosocial barriers (107 and 86 days). There were no significant differences seen for the mean (SD) time interval with respect to patient race (blacks, 17.6 [15.7] vs whites, 22.5 [30.0]; P = .20), sex (males, 18.3 [18.1] vs females, 20.4 [19.7]; P = .13), insurance status (insured, 16.3 [10.2] vs uninsured, 19.8 [21.0]; P = .24), and stage at presentation (stage I, 14.4 [17.0] vs stage II, 11.0 [5.3] vs stage III, 14.7 [8.6] vs stage IV, 21.2 [20.2]; P = .40). CONCLUSIONS AND RELEVANCE The goal of treatment recommendations for HNC within 2 weeks was shown to be reasonable and attainable. Further research should address the delays encountered by patients with psychosocial barriers and those with synchronous lung nodules.
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Affiliation(s)
- Jason F Ohlstein
- Department of Otolaryngology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Sabrina Brody-Camp
- Department of Otolaryngology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Starr Friedman
- Department of Otolaryngology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Joshua M Levy
- Department of Otolaryngology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Joseph F Buell
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Paul Friedlander
- Department of Otolaryngology, Tulane University School of Medicine, New Orleans, Louisiana
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Ware M, Weiner R, Friedlander P, Mahmood T, Hormigo A, Gordon C, Saenger Y, Thirukonda V, Cosgriff T, Patel V, Rogers A, Bastian G, Zhu JJ, Hsu S, Morgan LR. ATCT-33RESULTS FROM EARLY CLINICAL TRIALS FOR 4-DEMETHYL-4-CHOLESTERYLOXYCARBONYLPENCLOMEDINE (DM-CHOC-PEN). Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov206.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bhatia P, Abd Elmageed ZY, Friedlander P, Aslam R, Kandil E. The utility of molecular markers in pre-operative assessment of thyroid nodules. Future Oncol 2015; 11:2343-50. [PMID: 26260812 DOI: 10.2217/fon.15.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The pre-operative diagnosis of thyroid tumors is determined by gold standard fine needle aspiration (FNA) biopsy. This has been widely accepted and offers the most cost-effective approach for evaluation of thyroid nodules. However, its diagnostic accuracy can pose a challenging scenario to surgeons. These diagnostic difficulties may subject patients to unnecessary thyroidectomies for benign thyroid nodules. Thus, additional molecular tests are needed to improve the sensitivity and specificity of FNA. The role of molecular markers is being proposed to predict the type and risk of malignancy to abate the need for diagnostic thyroidectomies. This review discusses their utility and validity in pre-operative diagnosis of thyroid nodules and how these markers can enhance the accuracy of FNA cytology.
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Affiliation(s)
- Parisha Bhatia
- Department of Surgery, Tulane University School of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Zakaria Y Abd Elmageed
- Department of Surgery, Tulane University School of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Paul Friedlander
- Department of Otolaryngology, Tulane University School of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Rizwan Aslam
- Department of Otolaryngology, Tulane University School of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA.,Department of Otolaryngology, Tulane University School of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA
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Weiner RS, Friedlander P, Mahmood T, Hormigo A, Gordon C, Saenger Y, Ware ML, Thirukonda VK, Patel VM, Cosgriff TJ, Rodgers AH, Morgan LR, Bastian G. Abstract CT218: Results from the early cancer clinical trials for 4-demethyl-4-cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN). Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-ct218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: 4-Demethyl-4-cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN), is a poly-chlorinated pyridine cholesteryl carbonate whose MOA is via alkylation of DNA @ N7 - guanine and N6 - cytosine and via oxidative stress. DM-CHOC-PEN underwent a phase I study in patients with advanced cancer +/- CNS involvement and is being evaluated in a phase II trial in patients with primary brain cancer and brain metastases from melanoma, breast, and lung cancers. The aims are to assess clinical responses when DM-CHOC-PEN is administered I.V, at maximum tolerated dose (MTD) and to monitor safety/toxicities, pharmacokinetics, and cardiac functions - IND 68,876.
Patients & Methods: In phase I, DM-CHOC-PEN was administered as a 3-hr IV infusion once every 21-days to patients with advanced cancer - melanoma (n = 3), colorectal CA (n = 4), breast (n = 3), lung (n = 8) and glioblastoma multiforme (GBM) (n = 9) - the most common tumor treated. Cohorts were treated with escalating doses from 39 to 111 mg/m2. The phase II dose schedule is 2-tiered: 85.8 mg/m2 for patients with liver involvement and 98.7 mg/m2 for patients with normal livers.
Results: Forty (40) patients have been treated to date - 27 in phase I and 13 in phase II. The drug was well tolerated; the most common adverse effects were fatigue (n = 2), liver dysfunction - elevated bilirubin (Gr-3, n = 3; Gr-2, n = 1), ALT/AST (Gr-2, n = 3), alk phos (Gr-2, n = 3), nausea (Gr-1/2, n = 5) and an allergic reaction (Gr-2, n = 1). Three (3) patients with liver metastasis had hyperbilirubinemia (Gr-3 SLT) - two (2) at 98.7 mg/m2 and one (1) at 111 mg/m2 levels. No neuro/psychological, hematological, cardiac or renal toxicities were observed. PK studies revealed the following profile for DM-CHOC-PEN 98.7 mg/m2: AUC o-t = 1850 mg.h/L, CL - 3.0 L/h, T1/2 α - 3.3 h & Tβ - 79.1 h. DM-CHOC PEN and DM-PEN (metabolite) showed a rebound phenomenon at ∼50 hours post-infusion with a T release of 26.7 h for plasma and rbcs. DM-CHOC-PEN and DM-PEN were detected 3 and 15 days bound to RBCs (70 - 111 mg/m2); DM-CHOC-PEN was also detected in the urine (Cmax = 17.5 μg/mL) until day 21. The AUC was linear for all doses. DM-CHOC-PEN was detected in spinal sarcoma and in lung cancer tissues (75 & 190 ng/g, resp.) surgically obtained from patients 21-days post single injection of 39 & 98.7 mg/m2, resp. Patients receiving dexamethasone demonstrated lower blood levels of DM-CHOC-PEN along with induction of steroid esterase activities. After multiple doses, DM-CHOC-PEN also induced steroid esterase levels, which reversed within 4 weeks. Steroid esterase assays may be a valuable companion assay.
Conclusion: DM-CHOC-PEN is safe at the presented dose levels and shows a favorable PK profile. To date, 15 patients have had responses with significant PFS/OS, including 10 with CNS involvement. DM-CHOC-PEN is well tolerated with manageable toxicities. Complete patient responses/toxicities will be presented. Supported by NCI/SBIR grant - R43/44CA132257
Citation Format: Roy S. Weiner, P Friedlander, T Mahmood, Adilia Hormigo, C Gordon, Y Saenger, ML Ware, VK Thirukonda, VM Patel, TJ Cosgriff, AH Rodgers, LR Morgan, G Bastian. Results from the early cancer clinical trials for 4-demethyl-4-cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN). [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr CT218. doi:10.1158/1538-7445.AM2015-CT218
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Affiliation(s)
| | - P Friedlander
- 2Mount Sinai Medical School Tisch Cancer Institute, New York, NY
| | - T Mahmood
- 3Detroit Clinical Research Center, Lansing, MI
| | - Adilia Hormigo
- 2Mount Sinai Medical School Tisch Cancer Institute, New York, NY
| | - C Gordon
- 4Detroit Clinical Research Center, Farmington Hills, MI
| | - Y Saenger
- 2Mount Sinai Medical School Tisch Cancer Institute, New York, NY
| | - ML Ware
- 5Ochsner Medical Center, New Orleans, LA
| | | | - VM Patel
- 7Crescent City Research Consortium, Marrero, LA
| | - TJ Cosgriff
- 7Crescent City Research Consortium, Marrero, LA
| | | | | | - G Bastian
- 9Service de Pharmacologie, Paris, France
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Middleton MR, Friedlander P, Hamid O, Daud A, Plummer R, Falotico N, Chyla B, Jiang F, McKeegan E, Mostafa NM, Zhu M, Qian J, McKee M, Luo Y, Giranda VL, McArthur GA. Randomized phase II study evaluating veliparib (ABT-888) with temozolomide in patients with metastatic melanoma. Ann Oncol 2015. [PMID: 26202595 DOI: 10.1093/annonc/mdv308] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Veliparib (ABT-888) is a potent, orally bioavailable, small-molecule inhibitor of the DNA repair enzymes poly ADP-ribose polymerase-1 and -2. Veliparib enhances the efficacy of temozolomide (TMZ) and other cytotoxic agents in preclinical tumor models. PATIENTS AND METHODS In this multicenter, double-blind trial, adults with unresectable stage III or IV metastatic melanoma were randomized 1:1:1 to TMZ plus veliparib 20 or 40 mg, or placebo twice daily. Efficacy end points included progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). RESULTS Patients (N = 346) were randomized between February 2009 and January 2010. Median [95% confidence interval (CI)] PFS was 3.7 (3.0-5.5), 3.6 (1.9-4.1), and 2 (1.9-3.7) months in the 20-mg, 40-mg, and placebo arms, respectively. Median (95% CI) OS was 10.8 (9.0-13.1), 13.6 (11.4-15.9), and 12.9 (9.8-14.3) months, respectively; ORR was 10.3%, 8.7%, and 7.0%. Exploratory analyses showed patients with low ERCC1 expression had longer PFS when TMZ was combined with veliparib. Toxicities were as expected for TMZ. The frequencies of thrombocytopenia, neutropenia, and leukopenia were significantly increased in the veliparib groups. Grade 3 or 4 adverse events, mainly hematologic toxicities, were seen in 55%, 63%, and 41% of patients in the 20-mg, 40-mg, and placebo arms, respectively. CONCLUSIONS Median PFS with 20 and 40 mg veliparib almost doubled numerically compared with placebo, but the improvements did not reach statistical significance. OS was not increased with veliparib. Toxicities were similar to TMZ monotherapy, but with increased frequency.
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Affiliation(s)
- M R Middleton
- Department of Oncology, University of Oxford, Churchill Hospital, Oxford, UK
| | - P Friedlander
- Hematology and Medical Oncology, The Mount Sinai Medical Center, New York
| | - O Hamid
- Experimental Therapeutics/Immunotherapy, The Los Angeles Clinic and Research Institute, Los Angeles
| | - A Daud
- University of California San Francisco Medical Center, University of California, San Francisco, USA
| | - R Plummer
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | | | - B Chyla
- AbbVie Inc., North Chicago, USA
| | - F Jiang
- AbbVie Inc., North Chicago, USA
| | | | | | - M Zhu
- AbbVie Inc., North Chicago, USA
| | - J Qian
- AbbVie Inc., North Chicago, USA
| | - M McKee
- AbbVie Inc., North Chicago, USA
| | - Y Luo
- AbbVie Inc., North Chicago, USA
| | | | - G A McArthur
- Divisions of Cancer Medicine/Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
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Tsumagari K, Abd Elmageed ZY, Sholl AB, Friedlander P, Abdraboh M, Xing M, Boulares AH, Kandil E. Simultaneous suppression of the MAP kinase and NF-κB pathways provides a robust therapeutic potential for thyroid cancer. Cancer Lett 2015. [PMID: 26208433 DOI: 10.1016/j.canlet.2015.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The MAP kinase and NF-κB signaling pathways play an important role in thyroid cancer tumorigenesis. We aimed to examine the therapeutic potential of dually targeting the two pathways using AZD6244 and Bortezomib in combination. We evaluated their effects on cell proliferation, cell-cycle progression, apoptosis, cell migration assay, and the activation of the MAPK pathway in vitro and the in vivo using tumor size and immunohistochemical changes of Ki67 and ppRB. We found inhibition of cell growth rate by 10%, 20%, and 56% (p <0.05), migration to 55%, 61%, and 29% (p <0.05), and induction of apoptosis to 10%, 15%, and 38% (p <0.05) with AZD6244, Bortezomib, or combination, respectively. Induction of cell cycle arrest occurred only with drug combination. Dual drug treatment in the xenograft model caused a 94% reduction in tumor size (p <0.05) versus 15% with AZD6244 and 34% with Bortezomib (p < 0.05) and also reduced proliferative marker Ki67, and increased pRb dephosphorylation. Our results demonstrate a robust therapeutic potential of combining AZD6244 and Bortezomib as an effective strategy to overcome drug resistance encountered in monotherapy in the treatment of thyroid cancer, strongly supporting clinical trials to further test this strategy.
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Affiliation(s)
- Koji Tsumagari
- Departments of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA; Tulane Cancer Center, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Zakaria Y Abd Elmageed
- Departments of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA; Tulane Cancer Center, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Andrew B Sholl
- Departments of Pathology, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Paul Friedlander
- Departments of Otolaryngology, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Mohamed Abdraboh
- Departments of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Mingzhao Xing
- Division of Endocrinology and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Hamid Boulares
- The Stanley Scott Cancer Center, Department of Pharmacology, Louisiana State University Health Science Center, New Orleans, LA 70112, USA
| | - Emad Kandil
- Departments of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA; Tulane Cancer Center, Tulane University School of Medicine, New Orleans, LA 70112, USA.
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Ibrahim Y, Mohamed SEH, Deniwar A, Al-Qurayshi ZH, Khan AN, Moroz K, Friedlander P, Kandil E. The impact of thyroid nodule size on the risk of malignancy in follicular neoplasms. Anticancer Res 2015; 35:1635-1639. [PMID: 25750321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM Studies have shown that the risk of malignancy in follicular neoplasms is as high as 30%. Often, surgery is recommended for such lesions, not for therapeutic purposes but as a diagnostic method, leading to increased hospital costs and related morbidities. Recent studies have suggested that tumor size predicts malignant potential of these follicular neoplasms. Our aim was to identify the impact of nodule size on the risk of malignancy for such lesions. PATIENTS AND METHODS A retrospective medical chart review was undertaken for patients who underwent thyroid surgery at a single academic North American Institution. A total of 120 follicular lesions, follicular neoplasms (Bethesda category IV) or follicular lesions of undetermined significance (Bethesda category III) in 110 patients undergoing thyroid surgery were evaluated. Nodule size as measured by ultrasound, fine-needle aspiration cytological results, and final histopathology reports were reviewed. Analysis was performed by classification according to nodule size: <3 cm, ≥3 cm, <4 cm and ≥4 cm. RESULTS Out of the 120 nodules, 48 (40%) were reported to be malignant on final pathological examination. The malignancy rate in nodules<3 cm and ≥ 3cm was 41% and 37.8%, respectively (p=0.84). When 4 cm was used as the cut-off, the rate in nodules<4 cm and ≥4 cm was 40.6% and 37.5%, respectively (p=0.82). CONCLUSION Increased thyroid nodule size does not increase the malignancy rate for follicular neoplasms. Hence, we recommend against routine total thyroidectomy for patients with follicular neoplasms based on the size criteria.
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Affiliation(s)
- Yasin Ibrahim
- Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A
| | - Salah Eldin H Mohamed
- Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A
| | - Ahmed Deniwar
- Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A
| | - Zaid H Al-Qurayshi
- Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A
| | - Amna N Khan
- Division of Endocrine, Department of Medicine, Tulane University School of Medicine, New Orleans, LA, U.S.A
| | - Krzysztof Moroz
- Department of Pathology, Tulane University School of Medicine, New Orleans, LA, U.S.A
| | - Paul Friedlander
- Department of Otolaryngology, Tulane University School of Medicine, New Orleans, LA, U.S.A
| | - Emad Kandil
- Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A.
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Bhatia P, Deniwar A, Friedlander P, Aslam R, Kandil E. Diagnostic potential of ancillary molecular testing in differentiation of benign and malignant thyroid nodules. Anticancer Res 2015; 35:1237-1241. [PMID: 25750270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Fine needle aspiration (FNA) cytology, being the mainstay to diagnose thyroid nodules, does not provide definitive results in a subset of patients. The use of molecular markers testing has been described as a useful aid in differentiation of thyroid nodules that present with an indeterminate cytodiagnosis. Molecular tests, such as the Afirma gene classifier, mutational assay and immunohistochemical markers have been increasingly used to further increase the accuracy and defer unnecessary surgeries for benign thyroid nodules. However, in light of the current literature, their emerging roles in clinical practice are limited due to financial and technical limitations. Nevertheless, their synergistic implementation can predict the risk of malignancy and yield an accurate diagnosis. This review discusses the clinical utility of various molecular tests done on FNA indeterminate nodules to avoid diagnostic thyroidectomies and warrant the need of future multi-Institutional studies.
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Affiliation(s)
- Parisha Bhatia
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A
| | - Ahmed Deniwar
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A
| | - Paul Friedlander
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A
| | - Rizwan Aslam
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A. Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA, U.S.A.
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Ibrahim Y, Crawford BE, Murci M, Masoodi H, Khan AN, Hu T, Kandil E, Friedlander P. Thyroid Cancer in Black Thyroid Glands: The Effect of Age and Race. ORL J Otorhinolaryngol Relat Spec 2015; 77:33-8. [DOI: 10.1159/000363188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 04/24/2014] [Indexed: 11/19/2022]
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Bhatia P, Friedlander P, Zakaria EA, Kandil E. Impact of BRAF mutation status in the prognosis of cutaneous melanoma: an area of ongoing research. Ann Transl Med 2015; 3:24. [PMID: 25738144 PMCID: PMC4322160 DOI: 10.3978/j.issn.2305-5839.2014.12.05] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 11/24/2014] [Indexed: 12/21/2022]
Abstract
This review is intended to provide an updated role of molecular genetics and various targeted therapies that have been developed to treat advanced stages of melanoma. Because of the declining success in melanoma therapy, the curative treatment for advanced stage melanoma has been a challenge for clinicians. Several mutations such as N-RAS, p53, BRAF including mutant-BRAF that lead to activation of kinase pathway, are implicated in the development of malignant melanoma. However, the current literature depicts that the prognostic role of BRAF mutation in disease progression is still controversial. While its higher level in advanced stage disease is associated with decreased overall survival (OS), some studies show that it failed to confer as an independent prognostic predictor of the disease. This has also led researchers to accomplish newer therapeutic strategies that lead to improved disease-response and grant survival benefits. Vemurafenib, a BRAF inhibitor agent, is one of the few available targeted therapies that is FDA approved and provides promising results in metastatic disease. However, its resistance at an early stage is of great concern. Recent implementation of combinational therapies including "targeted therapy", immunotherapy, and biological agents has appealed many researchers to define the adjunctive role of available therapies and their limitations in advanced stage and metastatic melanoma. This commends the need for future multi-institutional studies to confirm the clinical validity of different therapeutic strategies on a large scale population.
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Kandil E, Mohamed SE, Deniwar A, Mohamed H, Friedlander P, Aslam R, Saeed A, Musa I, Randolph G. Electrophysiologic identification and monitoring of the external branch of superior laryngeal nerve during thyroidectomy. Laryngoscope 2015; 125:1996-2000. [DOI: 10.1002/lary.25139] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 11/23/2014] [Accepted: 12/10/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Emad Kandil
- Division of Endocrine and Oncologic Surgery; Department of Surgery; Tulane University School of Medicine; New Orleans Louisiana U.S.A
| | - Salah Eldin Mohamed
- Division of Endocrine and Oncologic Surgery; Department of Surgery; Tulane University School of Medicine; New Orleans Louisiana U.S.A
| | - Ahmed Deniwar
- Division of Endocrine and Oncologic Surgery; Department of Surgery; Tulane University School of Medicine; New Orleans Louisiana U.S.A
| | - Hossam Mohamed
- Division of Endocrine and Oncologic Surgery; Department of Surgery; Tulane University School of Medicine; New Orleans Louisiana U.S.A
| | - Paul Friedlander
- Division of Endocrine and Oncologic Surgery; Department of Otolaryngology Surgery; Tulane University School of Medicine; New Orleans Louisiana U.S.A
| | - Rizwan Aslam
- Division of Endocrine and Oncologic Surgery; Department of Otolaryngology Surgery; Tulane University School of Medicine; New Orleans Louisiana U.S.A
| | - Ahmad Saeed
- Division of Endocrine and Oncologic Surgery; Department of Surgery; Tulane University School of Medicine; New Orleans Louisiana U.S.A
| | - Ibrahim Musa
- Division of Endocrine and Oncologic Surgery; Department of Surgery; Tulane University School of Medicine; New Orleans Louisiana U.S.A
| | - Gregory Randolph
- Massachusetts General Hospital; Division of Surgical Oncology; Endocrine Surgical Service, Harvard Medical School; Cambridge Massachusetts U.S.A
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Hauch A, Al-Qurayshi Z, Friedlander P, Kandil E. Association of Socioeconomic Status, Race, and Ethnicity With Outcomes of Patients Undergoing Thyroid Surgery. JAMA Otolaryngol Head Neck Surg 2014; 140:1173-83. [DOI: 10.1001/jamaoto.2014.1745] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [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)
- Adam Hauch
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Zaid Al-Qurayshi
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Paul Friedlander
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana2Department of Otolaryngology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana2Department of Otolaryngology, Tulane University School of Medicine, New Orleans, Louisiana
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Bhatia P, Tsumagari K, Abd Elmageed ZY, Friedlander P, Buell JF, Kandil E. Stem cell biology in thyroid cancer: Insights for novel therapies. World J Stem Cells 2014; 6:614-619. [PMID: 25426258 PMCID: PMC4178261 DOI: 10.4252/wjsc.v6.i5.614] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 09/17/2014] [Accepted: 09/17/2014] [Indexed: 02/06/2023] Open
Abstract
Currently, thyroid cancer is one of the most common endocrine cancer in the United States. A recent involvement of sub-population of stem cells, cancer stem cells, has been proposed in different histological types of thyroid cancer. Because of their ability of self-renewal and differentiation into various specialized cells in the body, these putative cells drive tumor genesis, metastatic activity and are responsible to provide chemo- and radioresistant nature to the cancer cells in the thyroid gland. Our Review was conducted from previously published literature to provide latest apprises to investigate the role of embryonic, somatic and cancer stem cells, and discusses the hypothesis of epithelial-mesenchymal transition. Different methods for their identification and isolation through stemness markers using various in vivo and in vitro methods such as flow cytometry, thyrosphere formation assay, aldehyde dehydrogenase activity and ATP-binding cassette sub-family G member 2 efflux-pump mediated Hoechst 33342 dye exclusion have been discussed. The review also outlines various setbacks that still remain to target these tumor initiating cells. Future perspectives of therapeutic strategies and their potential to treat advanced stages of thyroid cancer are also disclosed in this review.
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Affiliation(s)
- Tatyana E Fontenot
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - John M Carter
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Paul Friedlander
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Ware M, Weiner R, Friedlander P, Gordon C, Saenger Y, Mahmood T, Rodgers A, Bastian G, Urien S, Lee, Morgan R. DD-08 * PHASE I CANCER CLINICAL TRIAL FOR 4-DEMETHYL-4-CHOLESTERYLOXYCARBONYLPENCLOMEDINE (DM-CHOC-PEN). Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou246.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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37
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Mathias T, Carter J, Friedlander P. Spinal lesions and retropharyngeal fluid in an immunocompetent patient. Spinal tuberculosis (TB): Pott disease. JAMA Otolaryngol Head Neck Surg 2014; 140:473-4. [PMID: 24676674 DOI: 10.1001/jamaoto.2014.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 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)
- Tiffany Mathias
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, Louisiana
| | - John Carter
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, Louisiana
| | - Paul Friedlander
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, Louisiana
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Noureldine SI, Abbas A, Tufano RP, Srivastav S, Slakey DP, Friedlander P, Kandil E. The impact of surgical volume on racial disparity in thyroid and parathyroid surgery. Ann Surg Oncol 2014; 21:2733-9. [PMID: 24633666 DOI: 10.1245/s10434-014-3610-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Indexed: 12/27/2022]
Abstract
PURPOSE The aim of this study was to evaluate the association between surgeon volume and patient outcomes among different race ethnicities undergoing thyroid or parathyroid surgery. METHODS The nationwide inpatient sample was used to identify all thyroidectomy and parathyroidectomy admissions from 2003 to 2009, using International Classification of Diseases, 9th Clinical Modification (ICD-9-CM) procedure codes. Race, demographic, and clinical characteristics of patients were collected, along with surgeon volume, to predict the length of stay (LOS), complication rates, mortality, and total charges by racial group, using univariate and multivariate analyses. RESULTS A total of 106,314 thyroid and parathyroid surgeries were included in the current analysis. Of these patients, 54 % were Caucasian, 11 % African American, 7 % Hispanic, and 3 % Asian. Mean LOS was longer for African American patients (4 ± 8.7 days) than for Caucasians (2.3 ± 5.5 days) [p < 0.001]. African Americans had higher overall complications (16.8 %) compared with Caucasians (11 %), Hispanics (13.5 %), and Asians (12 %) [p < 0.001]. In-hospital mortality was higher for African Americans (0.8 %) compared with that from other race groups (0.3 %) [p < 0.001]. Mean total charges were significantly higher for African Americans ($33,292 ± $67,387) compared with those for Caucasians ($22,855 ± $40,167) (p < 0.001). African Americans had less access to intermediate- (10-99 cases) and high- (>100 cases) volume surgeons compared with Caucasians-45 versus 49 %, and 16 versus 19 %, respectively (p < 0.001). Higher surgeon volume was associated with improved outcomes (p < 0.001). Racial disparity in all investigated outcomes was still significantly evident even after stratification by surgeon volume. CONCLUSION Higher surgeon volume is associated with improved patient outcomes. However, our data suggests that the observed racial disparities in thyroid and parathyroid surgery go beyond access to quality healthcare providers.
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Affiliation(s)
- Salem I Noureldine
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA,
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Kandil E, Hauch A, Friedlander P, Sheng M, Tsumagari K, Saeed A, Gimble JM, Rowan BG. A novel mouse model of metastatic thyroid carcinoma using human adipose tissue-derived stromal/stem cells. Anticancer Res 2013; 33:4213-4217. [PMID: 24122984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND/AIM Scientists have been in quest for the best in vivo model to evaluate chemotherapies for radioiodine-resistant metastatic thyroid carcinomas. Human adipose tissue-derived stromal/stem cells (ASCs) have been found to promote in vitro growth and in vivo tumorigenesis. In the present study, we describe a novel model of metastatic human thyroid carcinoma by combining ASCs with the papillary thyroid cancer, K1 cell line. MATERIALS AND METHODS Three groups of severe combined immunodefecient mice were investigated. The first group was injected subcutaneously with K1 cells plus ASCs, the second group with K1 cell only, and the last group with ASCs only. Mean tumor volumes and standard deviations were calculated and compared. RESULTS Concomitant injection of ASCs with the K1 cell line led to the development of significantly larger tumors compared to the other groups (p<0.05). In addition, the lungs of this group demonstrated gross tumor metastasis and pathological features of high-grade neoplasms. CONCLUSION In the present study we describe a novel mouse model using ASCs with the potential to be used for assessment of new treatments for the management of metastatic thyroid carcinomas.
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Affiliation(s)
- Emad Kandil
- FACS. Department of Surgery, Tulane University School of Medicine 1430 Tulane Ave. SL-22, New Orleans, LA 70112, U.S.A.
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Carter JM, Lipin R, Chastant R, Friedlander P, Vigne KM, Hebert A. Submandibular swelling. JAMA Otolaryngol Head Neck Surg 2013; 139:853-4. [PMID: 23949365 DOI: 10.1001/jamaoto.2013.3830] [Citation(s) in RCA: 0] [Impact Index Per Article: 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)
- John M Carter
- Department of Otolaryngology–Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA 70112 (
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Friedlander P, Balart L, Shores NJ, Cannon RM, Saggi B, Jan T, Buell JF. Racial disparity in New Orleans: a faith-based approach to an age-old problem. Surgery 2012; 153:439-42. [PMID: 23261027 DOI: 10.1016/j.surg.2012.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 11/08/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Paul Friedlander
- Department of Head and Neck Surgery, Tulane University, New Orleans, LA, USA
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Affiliation(s)
| | - Rosa B. Lipin
- Department of Otolaryngology, Tulane University
Hospital and Clinics
| | - Enrique Palacios
- Tulane University School of Medicine, New Orleans; and
the Department of Radiology, Tulane University Hospital and Clinics
| | - Paul Friedlander
- Department of Otolaryngology, Tulane University
Hospital and Clinics
| | - Harold Neitzschman
- Tulane University School of Medicine, New Orleans; and
the Department of Radiology, Tulane University Hospital and Clinics
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Rosenblatt DO, Lipin RB, Palacios E, Friedlander P, Neitzschman H. Unusual maxillary chondrosarcoma. Ear Nose Throat J 2012; 91:355-359. [PMID: 22996705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- Daniel O Rosenblatt
- Department of Otolaryngology, Tulane University School of Medicine, New Orleans, USA
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Kandil E, Noureldine S, Abdel Khalek M, Alrasheedi S, Aslam R, Friedlander P, Holsinger F, Bellows C. Initial experience using robot- assisted transaxillary thyroidectomy for Graves’ disease. J Visc Surg 2011; 148:e447-51. [DOI: 10.1016/j.jviscsurg.2011.10.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kandil E, Friedlander P, Noureldine S, Islam T, Tufano RP. Impact of Extensive Neck Dissection on Survival from Papillary Thyroid Cancer. ORL J Otorhinolaryngol Relat Spec 2011; 73:330-5. [DOI: 10.1159/000330047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 06/08/2011] [Indexed: 11/19/2022]
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Morgan L, Benes E, Rodgers A, Jursic B, Struck R, Waud W, Weiner R, Ware M, Friedlander P. PP 57 Interaction of 4-demethyl-4-cholesteryloxycarbonylpenclomedine (DM-CHOC-PEN) with melanoma melanin metabolism and cell death. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72681-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kandil E, Noureldine S, Khalek MA, Daroca P, Friedlander P. Ectopic secretion of parathyroid hormone in a neuroendocrine tumor: a case report and review of the literature. Int J Clin Exp Med 2011; 4:234-240. [PMID: 21977238 PMCID: PMC3182517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 08/19/2011] [Indexed: 05/31/2023]
Abstract
Very few cases have been reported in which the production and secretion of intact PTH by a non-parathyroid tumor has been authenticated. This paper describes the case of a 73 year old white female with a clinical and biochemical profile characteristic of primary hyperparathyroidism. Sestamibi scan and comprehensive neck ultrasono-graphy failed to localize a cervical lesion. Because the clinical manifestations were striking, neck exploration was performed. Dissection of the central compartment identified a lesion. PTH levels dropped to normal within ten minutes after its removal. Intraoperative parathyroid hormone assays facilitated the successful surgical removal of the lesion. Pathological examination yielded a diagnosis of a neuroendocrine tumor. These results document the ectopic production of intact PTH by a neuroendocrine tumor and present a novel neoplastic cause of primary hyperparathyroidism. This is the second report of an ectopic neuroendocrine tumor in the head and neck which secreted intact PTH.
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Affiliation(s)
- Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of MedicineNew Orleans, LA
| | - Salem Noureldine
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of MedicineNew Orleans, LA
| | - Mohamed Abdel Khalek
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of MedicineNew Orleans, LA
| | - Philip Daroca
- Department of Pathology, Tulane University School of MedicineNew Orleans, LA
| | - Paul Friedlander
- Department of Otolaryngology; Tulane University School of MedicineNew Orleans, LA, USA
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Kandil E, Khalek MA, Alabbas H, Moroz K, Islam T, Friedlander P, Jaffe BM. Comparison of ultrasound-guided biopsy technique for thyroid nodules with respect to adequacy of cytological material. ORL J Otorhinolaryngol Relat Spec 2011; 73:177-81. [PMID: 21625193 DOI: 10.1159/000323005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 10/26/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ultrasound-guided fine-needle aspiration cytology (FNAC) sampling of the thyroid represents a standard diagnostic procedure in the evaluation of thyroid nodules. The specimen can be acquired using either of two different techniques. In the first, the short axis is used with observation only of the tip of the needle whilst in the nodule. In the second technique, the long axis is used with the observation of the entire length of the needle. The decision to sample utilizing either technique was done randomly. This study is a retrospective review performed to compare these two techniques with regard to specimen adequacy. METHODS Ultrasound-guided FNACs were performed in 80 thyroid nodules between May 2008 and February 2009. One physician acquired the cytology specimens using one of these two methods after localization. Data on the type of technique and its diagnostic accuracy were collected. RESULTS Forty-nine of 80 thyroid nodules were sampled using the long-axis technique. The overall and deep-lesion diagnostic adequacies of specimens were significantly higher using this technique (93.9 and 95.1%, respectively, p < 0.01) than the short-axis technique. When comparing the long and short axes for superficial lesions, there was no significant difference in adequacy of the samples (p = 0.92). CONCLUSIONS This is the first study to compare long- and short-axis techniques with regard to specimen adequacy for thyroid nodules. The long-axis technique decreased the rate of inadequate material and provided more accurate cytological evaluation for deeper lesions.
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Affiliation(s)
- Emad Kandil
- Department of Surgery, Endocrine and Oncological Surgery Division, Tulane University School of Medicine, New Orleans, LA, USA.
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Kandil E, Khalek MA, Ibrahim WG, Alabbas H, Yau CL, Friedlander P, Crawford B, Jaffe BM. Papillary thyroid carcinoma in black thyroids. Head Neck 2011; 33:1735-8. [DOI: 10.1002/hed.21656] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2010] [Indexed: 11/09/2022] Open
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Kandil E, Winters R, Aslam R, Friedlander P, Bellows C. Transaxillary gasless robotic thyroid surgery with nerve monitoring: Initial two experince in a North American center. MINIM INVASIV THER 2011; 21:90-5. [DOI: 10.3109/13645706.2011.561862] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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