1
|
Berger JM, Alany A, Berchtold L, Puhr R, Friedrich A, Scheiner B, Prager GW, Preusser M, Berghoff AS, Bergen ES. Prognosticators of survival in patients with metastatic pancreatic cancer and ascites. ESMO Open 2023; 8:102048. [PMID: 37977000 PMCID: PMC10774951 DOI: 10.1016/j.esmoop.2023.102048] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Identification of factors associated with survival after ascites diagnosis in metastatic pancreatic cancer (mPC) patients may guide treatment decisions and help to maintain quality of life in this highly symptomatic patient collective. PATIENTS AND METHODS All patients treated for mPC at the Medical University of Vienna between 2010 and 2019 developing ascites throughout their course of disease were identified by retrospective chart review. General risk factors, metastatic sites, systemic inflammation and liver function parameters, as well as type of treatment after ascites diagnosis were investigated for associations with survival. RESULTS One hundred and seventeen mPC patients with ascites were included in this study. Median time from mPC to ascites diagnosis was 8.9 months (range 0-99 months) and median overall survival (OS) after ascites diagnosis was 27.4 days (range 21.3-42.6 days). Identified prognostic factors at ascites diagnosis independently associated with an impaired OS were presence of liver metastases [hazard ratio (HR): 2.07, 95% confidence interval (CI) 1.13-3.79, P = 0.018), peritoneal carcinomatosis (HR: 1.74, 95% CI 1.11-2.71, P = 0.015), and portal vein obstruction (HR: 2.52, 95% CI 1.29-4.90, P = 0.007). Compared with best supportive care, continuation of systemic therapy after ascites diagnosis was independently associated with survival (HR: 0.35, 95% CI 0.20-0.61, P < 0.001) with a median OS of 62 days (95% CI 51-129 days, P < 0.001) versus 16 days (95% CI 11-24 days), respectively. CONCLUSIONS Liver and peritoneal metastases as well as portal vein obstruction were found to be prognostic factors after ascites diagnosis in mPC patients. Continuation of systemic therapy after ascites diagnosis was associated with a longer OS, which needs to be evaluated in larger clinical trials including quality-of-life assessment.
Collapse
Affiliation(s)
- J M Berger
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna
| | - A Alany
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna
| | - L Berchtold
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna
| | - R Puhr
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna
| | - A Friedrich
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna
| | - B Scheiner
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - G W Prager
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna
| | - M Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna
| | - A S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna
| | - E S Bergen
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna.
| |
Collapse
|
2
|
Tomasich E, Steindl A, Paiato C, Hatziioannou T, Kleinberger M, Berchtold L, Puhr R, Hainfellner JA, Müllauer L, Widhalm G, Eckert F, Bartsch R, Heller G, Preusser M, Berghoff AS. Frequent Overexpression of HER3 in Brain Metastases from Breast and Lung Cancer. Clin Cancer Res 2023; 29:3225-3236. [PMID: 37036472 DOI: 10.1158/1078-0432.ccr-23-0020] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/24/2023] [Accepted: 04/06/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE HER3 belongs to a family of receptor tyrosine kinases with oncogenic properties and is targeted by a variety of novel anticancer agents. There is a huge unmet medical need for systemic treatment options in patients with brain metastases (BM). Therefore, we aimed to investigate HER3 expression in BM of breast (BCa) and non-small cell lung cancer (NSCLC) as the basis for future clinical trial design. EXPERIMENTAL DESIGN We analyzed 180 BM samples of breast cancer or NSCLC and 47 corresponding NSCLC extracranial tissue. IHC was performed to evaluate protein expression of HER3, and immune cells based on CD3, CD8, and CD68. To identify dysregulated pathways based on differential DNA methylation patterns, we used Infinium MethylationEPIC microarrays. RESULTS A total of 99/132 (75.0%) of BCa-BM and 35/48 (72.9%) of NSCLC-BM presented with HER3 expression. Among breast cancer, HER2-positive and HER2-low BM showed significantly higher rates of HER3 coexpression than HER2-negative BM (87.1%/85.7% vs. 61.0%, P = 0.004). Among NSCLC, HER3 was more abundantly expressed in BM than in matched extracranial samples (72.9% vs. 41.3%, P = 0.003). No correlation of HER3 expression and intratumoral immune cell density was observed. HER3 expression did not correlate with overall survival from BM diagnosis. Methylation signatures differed according to HER3 status in BCa-BM samples. Pathway analysis revealed subtype-specific differences, such as TrkB and Wnt signaling pathways dysregulated in HER2-positive and triple-negative breast cancer BM, respectively. CONCLUSIONS HER3 is highly abundant in BM of breast cancer and NSCLC. Given the promising results of antibody-drug conjugates in extracranial disease, BM-specific trials that target HER3 are warranted. See related commentary by Kabraji and Lin, p. 2961.
Collapse
Affiliation(s)
- Erwin Tomasich
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ariane Steindl
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Christina Paiato
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Teresa Hatziioannou
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Markus Kleinberger
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Luzia Berchtold
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Rainer Puhr
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Johannes A Hainfellner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Leonhard Müllauer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Franziska Eckert
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Rupert Bartsch
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Gerwin Heller
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Anna Sophie Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
3
|
Berger J, Alany A, Puhr R, Berchtold L, Friedrich A, Scheiner B, Prager G, Berghoff A, Preusser M, Bergen E. Clinical risk factors for ascites in metastatic pancreatic cancer. ESMO Open 2023; 8:101200. [PMID: 36989885 PMCID: PMC10163163 DOI: 10.1016/j.esmoop.2023.101200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Malignant ascites is common in metastatic pancreatic cancer (mPC) and its management still remains a clinical challenge. Early identification of patients at risk for ascites development may support and guide treatment decisions. MATERIALS AND METHODS Data of patients treated for mPC at the Medical University of Vienna between 2010 and 2019 were collected by retrospective chart review. Ascites was defined as clinically relevant accumulation of intraperitoneal fluid diagnosed by ultrasound or computer tomography scan of the abdomen. We investigated the association between general risk factors, metastatic sites, liver function, systemic inflammation as well as portal vein obstruction (PVO) and ascites development. RESULTS Among 581 patients with mPC included in this study, 122 (21.0%) developed ascites after a median of 8.7 months after diagnosis of metastatic disease. The occurrence of ascites led to an 8.9-fold increased risk of death [confidence interval (CI) 7.2-11, P < 0.001] with a median overall survival of 1 month thereafter. Clinical risk factors for ascites were male sex [hazard ratio (HR) 1.71, CI 1.00-2.90, P = 0.048], peritoneal carcinomatosis (HR 6.79, CI 4.09-11.3, P < 0.001), liver metastases (HR 2.16, CI 1.19-3.91, P = 0.011), an albumin-bilirubin (ALBI) score grade 3 (HR 6.79, CI 2.11-21.8, P = 0.001), PVO (HR 2.28, CI 1.15-4.52, P = 0.019), and an elevated C-reactive protein (CRP) (HR 4.19, CI 1.58-11.1, P = 0.004). CONCLUSIONS Survival after diagnosis of ascites is very limited in mPC patients. Male sex, liver and peritoneal metastases, impaired liver function, PVO, as well as systemic inflammation were identified as independent risk factors for ascites development in this uniquely large real-life patient cohort.
Collapse
|
4
|
Mair MJ, Maj-Hes A, Nussbaumer-Pröll A, Puhr R, Christenheit A, Troch M, Puhr HC, Starzer AM, Steindl A, Eberl S, Haslacher H, Perkmann T, Minichsdorfer C, Prager GW, Lamm WW, Berghoff AS, Kiesewetter B, Zeitlinger M, Preusser M, Raderer M. Prophylactic treatment with oral azithromycin in cancer patients during the COVID-19 pandemic (OnCoVID): a randomized, single-blinded, placebo-controlled phase 2 trial. Infect Agent Cancer 2023; 18:9. [PMID: 36782325 PMCID: PMC9924847 DOI: 10.1186/s13027-023-00487-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Patients with cancer are at high risk for severe courses of COVID-19. Based on (pre-)clinical data suggesting a potential protective effect due to the immunomodulating properties of azithromycin, we have initiated a prospective randomized trial. METHODS This randomized, single-center, single-blinded, placebo-controlled phase 2 trial included adult patients with cancer undergoing systemic treatment. Patients were 1:1 randomized to oral azithromycin (1500 mg once weekly for 8 weeks) or placebo. The primary endpoint was the cumulative number of SARS-CoV-2 infections 12 weeks after treatment initiation. RESULTS In total, 523 patients were screened, 68 patients were randomized, and 63 patients received at least one dose of the study drug. Due to low acceptance and a lack of SARS-CoV-2 infections in the study cohort, the study was prematurely closed. With no reported grade III-IV possibly treatment-related adverse events, azithromycin was generally well tolerated. Overall survival (OS) rates after 12 months were 83.5% and 70.3% in the azithromycin and placebo group, respectively (p = 0.37). Non-SARS-CoV-2 infections occurred in 4/32 (12.5%) in the azithromycin and 3/31 (9.7%) in the placebo group (p = 1). No emergence of azithromycin-resistant S. aureus strains could be observed. According to treatment group, longitudinal alterations in systemic inflammatory parameters were detected for neutrophil/lymphocyte and leukocyte/lymphocyte ratios. CONCLUSION Although efficacy could not be assessed due to premature closure and low incidence of SARS-CoV-2 infections, azithromycin was associated with a favorable side effect profile in patients with cancer. As other prophylactic treatments are limited, SARS-CoV-2 vaccination remains a high priority in oncological patients. CLINICALTRIALS gov registration number and date (dd/mm/yyyy): NCT04369365, 30/04/2020.
Collapse
Affiliation(s)
- Maximilian J. Mair
- grid.22937.3d0000 0000 9259 8492Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Agnieszka Maj-Hes
- grid.22937.3d0000 0000 9259 8492Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Alina Nussbaumer-Pröll
- grid.22937.3d0000 0000 9259 8492Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Rainer Puhr
- grid.22937.3d0000 0000 9259 8492Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Agnieszka Christenheit
- grid.22937.3d0000 0000 9259 8492Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Marlene Troch
- grid.22937.3d0000 0000 9259 8492Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Hannah C. Puhr
- grid.22937.3d0000 0000 9259 8492Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Angelika M. Starzer
- grid.22937.3d0000 0000 9259 8492Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Ariane Steindl
- grid.22937.3d0000 0000 9259 8492Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Sabine Eberl
- grid.22937.3d0000 0000 9259 8492Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Helmuth Haslacher
- grid.22937.3d0000 0000 9259 8492Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Perkmann
- grid.22937.3d0000 0000 9259 8492Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph Minichsdorfer
- grid.22937.3d0000 0000 9259 8492Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Gerald W. Prager
- grid.22937.3d0000 0000 9259 8492Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Wolfgang W. Lamm
- grid.22937.3d0000 0000 9259 8492Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Anna S. Berghoff
- grid.22937.3d0000 0000 9259 8492Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Barbara Kiesewetter
- grid.22937.3d0000 0000 9259 8492Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Markus Zeitlinger
- grid.22937.3d0000 0000 9259 8492Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- grid.22937.3d0000 0000 9259 8492Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Markus Raderer
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
5
|
Mair MJ, Leibetseder A, Heller G, Puhr R, Tomasich E, Goldberger S, Hatziioannou T, Wöhrer A, Widhalm G, Dieckmann K, Aichholzer M, Weis S, von Oertzen T, Furtner J, Pichler J, Preusser M, Berghoff AS. Early Postoperative Treatment versus Initial Observation in CNS WHO Grade 2 and 3 Oligodendroglioma: Clinical Outcomes and DNA Methylation Patterns. Clin Cancer Res 2022; 28:4565-4573. [PMID: 35998208 DOI: 10.1158/1078-0432.ccr-22-1133] [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] [Received: 04/08/2022] [Revised: 06/13/2022] [Accepted: 08/04/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The treatment of oligodendroglioma consists of tumor resection and radiochemotherapy. The timing of radiochemotherapy remains unclear, and predictive biomarkers are limited. EXPERIMENTAL DESIGN Adult patients diagnosed with isocitrate dehydrogenase (IDH)-mutated, 1p/19q-codeleted CNS WHO grade 2 and 3 oligodendroglioma at the Medical University of Vienna and the Kepler University Hospital Linz (Austria) in 1992 to 2019 were included. Progression-free (PFS) and overall survival (OS) between early postoperative treatment and initial observation were compared using propensity score-weighted Cox regression models. DNA methylation analysis of tumor tissue was performed using Illumina MethylationEPIC 850k microarrays. RESULTS One hundred thirty-one out of 201 (65.2%) patients with CNS WHO grade 2 and 70 of 201 (34.8%) with grade 3 oligodendroglioma were identified. Eighty-three of 201 (41.3%) patients underwent early postoperative treatment, of whom 56 of 83 (67.5%) received radiochemotherapy, 15 of 84 (18.1%) radiotherapy (RT) only and 12 of 83 (14.5%) chemotherapy only. Temozolomide-based treatment was administered to 64 of 68 (94.1%) patients, whereas RT + procarbazine, lomustine (CCNU), and vincristine (PCV) were applied in 2 of 69 (3.5%) patients. Early treatment was not associated with PFS [adjusted hazard ratio (HR) 0.74; 95% CI, 0.33-1.65, P = 0.459] or OS (adjusted HR: 2.07; 95% CI, 0.52-8.21, P = 0.302) improvement. Unsupervised clustering analysis of DNA methylation profiles from patients receiving early treatment revealed two methylation clusters correlating with PFS, whereas no association of clustering with O6-methylguanine methyltransferase (MGMT) promoter methylation, CNS WHO grade, extent of resection, and treating center could be observed. CONCLUSIONS In this retrospective study, early postoperative treatment was not associated with improved PFS/OS in oligodendroglioma. The potentially predictive value of whole-genome methylation profiling should be validated in prospective trials.
Collapse
Affiliation(s)
- Maximilian J Mair
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Annette Leibetseder
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Gerwin Heller
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Rainer Puhr
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Erwin Tomasich
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Sebastian Goldberger
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Teresa Hatziioannou
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Adelheid Wöhrer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Martin Aichholzer
- Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Serge Weis
- Division of Neuropathology, Department of Pathology and Molecular Pathology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Tim von Oertzen
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Julia Furtner
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Josef Pichler
- Department of Internal Medicine and Neurooncology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Anna S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
6
|
Berghoff AS, Bartsch R, Furtner J, Marhold M, Bergen ES, Roider-Schur S, Starzer AM, Forstner H, Rottenmanner B, Dieckmann K, Bago-Horvath Z, Widhalm G, Ilhan-Mutlu A, Minichsdorfer C, Fuereder T, Singer CF, Weltermann A, Haslacher H, Szekeres T, Puhr R, Preusser M. OS01.5.A Neuron-specific enolase (NSE) and S100 serum levels in patients with active brain metastases from HER2-positive breast cancer treated with trastuzumab-deruxtecan (T-DXd): A biomarker analysis from the TUXEDO-1 trial. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.030] [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: 11/14/2022] Open
Abstract
Abstract
Background
T-DXd is a novel antibody-drug conjugate with high activity in HER2-positive metastatic breast cancer. The prospective, single-arm, single-centre phase II TUXEDO-1 trial showed clinically relevant activity of T-DXd in HER2-positive BC pts with active BM with an intracranial response rate of 73.3%. This biomarker sub-study of TUXEDO-1 aimed to investigate changes in the extent of metastases-induced brain damage in patients with and without response to therapy by measuring the serum levels of two proteins constitutively expressed in the human brain and measurable upon brain damage in the blood serum: NSE and S100.
Material and Methods
We assessed serum NSE (sNSE) and serum S100 (sS100) levels in a total of 37 blood samples drawn at cycles 1, 4 and end of treatment (EOT) in all patients of the intent-to-treat population of the TUXEDO-1 trial using commercially available ELISA assays. Intracranial radiological response was centrally assessed by a board-certified neuro-radiologist using RANO criteria. sNSE and sS100 levels were compared between responders and non-responders using the Mann Whitney U test and a significance level of 0.05.
Results
At baseline, we detected no significant difference of sNSE or sS100 levels between T-DXd responders and non-responders, respectively. Baseline median sNSE level was 10.6 ng/ml (interquartile range (IQR) 8.6-12.2) in T-DXd responders as compared with median 12.5 ng/ml (IQR 12.2-12.9) in the non-responder group (n.s.). At cycle 4, corresponding numbers were 8.1 ng/ml in responding patients (IQR 7-11.2) and 12.7 ng/ml (IQR 12.2-12.9) in non-responders, respectively (p=0.009). No differences in sS100 levels were observed between the groups at any time point.
Conclusion
In patients showing intracranial objective response to T-Dxd, sNSE levels were significantly lower at cycle 4 as compared with non-responders, suggesting a reduction in metastases-induced brain damage as a direct treatment effect. sNSE may be a clinically useful biomarker for longitudinal assessment of brain metastasis burden.
Collapse
Affiliation(s)
- A S Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - R Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - J Furtner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna , Vienna , Austria
| | - M Marhold
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - E S Bergen
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - S Roider-Schur
- Department of Medicine I, Oncology, St. Josef Krankenhaus , Vienna , Austria
| | - A M Starzer
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - H Forstner
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - B Rottenmanner
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - K Dieckmann
- Department of Radiotherapy, Medical University of Vienna , Vienna , Austria
| | - Z Bago-Horvath
- Department of Pathology, Medical University of Vienna , Vienna , Austria
| | - G Widhalm
- Department of Neurosurgery, Medical University of Vienna , Vienna , Austria
| | - A Ilhan-Mutlu
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - C Minichsdorfer
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - T Fuereder
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - C F Singer
- Departments of Gynaecology, Medical University of Vienna , Vienna , Austria
| | - A Weltermann
- Department of Medicine 1, Academic Teaching Hospital Elisabethinen Linz , Vienna , Austria
| | - H Haslacher
- Department of Laboratory Medicine, Medical University of Vienna , Vienna , Austria
| | - T Szekeres
- Department of Laboratory Medicine, Medical University of Vienna , Vienna , Austria
| | - R Puhr
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| | - M Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna , Austria
| |
Collapse
|
7
|
Mair MJ, Leibetseder A, Heller G, Puhr R, Tomasich E, Hatziioannou T, Woehrer A, Widhalm G, Dieckmann K, Aichholzer M, Weis S, von Oertzen T, Pichler J, Preusser M, Berghoff AS. P11.27.B Whole genome DNA methylation as predictive biomarker in CNS WHO grade 2 and 3 oligodendroglioma patients receiving early postoperative treatment. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.216] [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: 11/14/2022] Open
Abstract
Abstract
Background
Oligodendrogliomas are glial tumors with a relatively favorable survival prognosis of >10 years. While immediate postoperative treatment prolongs survival, long-term toxicities of adjuvant radio-chemotherapy remain a concern. Predictive biomarkers guiding postoperative treatment decisions are limited.
Material and Methods
In this retrospective study, we included patients treated for a newly diagnosed oligodendroglioma (isocitrate dehydrogenase (IDH)-mutated, 1p/19q-codeleted, CNS WHO grades 2 and 3) in 1992 - 2019 at the Medical University of Vienna or the Kepler University Hospital Linz (Austria). Early treatment was defined as radiotherapy, chemotherapy, or both within 6 months after resection, whereas benefit from early treatment was defined as progression-free survival (PFS) above the median in the overall cohort. DNA methylation analysis was performed using Illumina MethylationEPIC 850k microarrays.
Results
Of all 201 eligible patients, sufficient tumor tissue for DNA methylation analysis was available in 46 patients. Of these, 25/46 (54.3%) were diagnosed with CNS WHO grade 2 and 21/46 (45.6%) with grade 3 oligodendroglioma. Median age at diagnosis was 41 years (range: 23-70). In total, 21/46 (45.6%) patients received early treatment, of whom 13/21 (61.9%) received radio-chemotherapy, 6/21 (28.6%) radiotherapy only and 2/21 (9.5%) chemotherapy only. Median PFS was 134.0 months (95%CI: 78.3 - not reached) in patients receiving early treatment versus 87.2 months (95%CI: 66.8 - 150) in patients who did not. In patients receiving early treatment, differences in DNA methylation profiles could be detected between patients who drew benefit from postoperative treatment (group 1) versus those who did not (group 2). Based on the top 1000 differentially methylated CpG sites between both groups, two clusters were detected which comprised either patients of group 1 or 2. Clustering was independent from gender, WHO grade, extent of resection, type of postoperative treatment, treating center, and O6-methylguanine-methyltransferease (MGMT) promoter methylation status. Gene set enrichment analysis of the top 1000 differentially methylated gene sites mapped to 694 genes showed differential methylation in genes involved in fibroblast growth receptor 1 (FGFR1) signaling, Wnt signaling, integrin signaling, and actin cytoskeleton regulation. Conversely, in patients not receiving early treatment, PFS did neither correlate with DNA methylation clustering nor with MGMT promoter methylation.
Conclusion
In our cohort, whole genome DNA methylation was associated with PFS in patients who received early postoperative treatment, suggesting a predictive but not prognostic role. As the predictive value of MGMT promoter methylation is limited in oligodendroglioma, whole genome DNA methylation should be considered in future clinical trials.
Collapse
Affiliation(s)
- M J Mair
- Division of Oncology, Department of Medicine I, Medical University of Vienna , Vienna , Austria
| | - A Leibetseder
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz , Linz , Austria
| | - G Heller
- Division of Oncology, Department of Medicine I, Medical University of Vienna , Vienna , Austria
| | - R Puhr
- Division of Oncology, Department of Medicine I, Medical University of Vienna , Vienna , Austria
| | - E Tomasich
- Division of Oncology, Department of Medicine I, Medical University of Vienna , Vienna , Austria
| | - T Hatziioannou
- Division of Oncology, Department of Medicine I, Medical University of Vienna , Vienna , Austria
| | - A Woehrer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna , Vienna , Austria
| | - G Widhalm
- Department of Neurosurgery, Medical University of Vienna , Vienna , Austria
| | - K Dieckmann
- Department of Radiation Oncology, Medical University of Vienna , Vienna , Austria
| | - M Aichholzer
- Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz , Linz , Austria
| | - S Weis
- Division of Neuropathology, Department of Pathology and Molecular Pathology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz , Linz , Austria
| | - T von Oertzen
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz , Linz , Austria
| | - J Pichler
- Department of Internal Medicine and Neurooncology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University Linz , Linz , Austria
| | - M Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna , Vienna , Austria
| | - A S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna , Vienna , Austria
| |
Collapse
|
8
|
Puhr HC, Puhr R, Kuchling DA, Jahic L, Takats J, Reiter TJ, Paireder M, Jomrich G, Schoppmann SF, Berghoff AS, Preusser M, Ilhan-Mutlu A. Development of an alarm symptom-based risk prediction score for localized oesophagogastric adenocarcinoma (VIOLA score). ESMO Open 2022; 7:100519. [PMID: 35759854 PMCID: PMC9434169 DOI: 10.1016/j.esmoop.2022.100519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/19/2022] [Accepted: 05/22/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Gastroesophageal adenocarcinoma is a major contributor to global disease burden with poor prognosis even in resectable, regionally limited stages. Feasible prognostic tools are crucial to improve patient management, yet scarce. PATIENTS AND METHODS Disease-related symptoms, patient, tumour, treatment as well as laboratory parameters at initial diagnosis and overall survival (OS) of patients with stage II and III gastroesophageal adenocarcinoma, who were treated between 1990 and 2020 at the Medical University of Vienna, were evaluated in a cross-validation model to develop a feasible risk prediction score. RESULTS In total, 628 patients were included in this single-centre analysis. The final score ranked from 0 to 10 and included the factors sex (female +1), age, years (30-59 +1, >60 +2), underweight classified by body mass index (+2), location of the tumour (stomach +1), stage (III +2), stenosis in endoscopy (+1) and weight loss (+1). The score was grouped into low- (0-3), medium- (4-6) and high-risk (7+) subgroups. The median OS were 70.3 [95% confidence interval (CI) 51.2-111.8], 23.4 (95% CI 21.2-26.7) and 12.6 (7.0-16.1) months, respectively. The 1-year survival probabilities were 0.88 (95% CI 0.83-0.93), 0.75 (95% CI 0.70-0.79) and 0.54 (95% CI 0.39-0.74), whereas the 5-year survival probabilities were 0.57 (95% CI 0.49-0.66), 0.24 (95% CI 0.20-0.28) and 0.09 (95% CI 0.03-0.28), respectively. CONCLUSIONS The VIennese risk prediction score for Oesophagogastric Localized Adenocarcinoma (VIOLA) risk prediction score poses a feasible tool for the estimation of OS in patients with regionally limited gastroesophageal adenocarcinoma and, thus, may improve patient management in clinical routine. Prospective analyses should be carried out to confirm our findings.
Collapse
Affiliation(s)
- H C Puhr
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - R Puhr
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria; Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - D A Kuchling
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - L Jahic
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - J Takats
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - T J Reiter
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - M Paireder
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - G Jomrich
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - S F Schoppmann
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - A S Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - M Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - A Ilhan-Mutlu
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
9
|
Bartsch R, Berghoff A, Furtner J, Marhold M, Bergen E, Roider-Schur S, Starzer A, Forstner H, Rottenmanner B, Dieckmann K, Bago-Horvath Z, Widhalm G, Ilhan-Mutlu A, Minichsdorfer C, Fuereder T, Singer C, Weltermann A, Puhr R, Preusser M. 165MO Trastuzumab-deruxtecan (T-DXd) in HER2-positive breast cancer patients (pts) with active brain metastases: Primary outcome analysis from the TUXEDO-1 trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.184] [Citation(s) in RCA: 4] [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: 11/01/2022] Open
|
10
|
Herbert S, Puhr R, Petoumenos K, Lewis DA, Varma R, Couldwell DL, Law M, Templeton DJ. Characteristics of heterosexually-acquired compared to homosexually-acquired HIV and implications for clinical practice: results from the Australian HIV Observational Database. AIDS Care 2021; 34:626-632. [PMID: 33856950 DOI: 10.1080/09540121.2021.1884181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Heterosexuals living with HIV report feeling additional HIV stigma compared to homosexual men, which may affect clinical outcomes. Yet, beyond routinely collected surveillance data, little is known about the characteristics of individuals who acquire HIV heterosexually and clinical outcomes by mode of sexual acquisition have not been directly compared. Using data from the Australian HIV Observational Database, we compared clinical characteristics of those with heterosexually-acquired (Het-HIV) to homosexually-acquired HIV (Hom-HIV) to investigate any differences and their implications for clinical management. 513 Het-HIV and 1467 Hom-HIV patients were included and contributed 3,127 and 9,457 person-years of follow-up, respectively. Compared with Hom-HIV, Het-HIV were more often born outside Australia (62.5% vs 39.9%, p<0.001), less likely to have Hepatitis C (4.8% vs 7.8%, p=0.029) and had lower median CD4 counts at diagnosis (292 vs 450 cells/µL, p<0.001) and cART initiation (270 vs 340 cells/µL, p<0.001). Despite these lower CD4 counts, there were no significant differences between groups for time to the major clinical endpoints of cART initiation, viral suppression, virological failure or all-cause mortality. Het-HIV had a lower risk of loss-to-follow-up than Hom-HIV (aHR 0.78; 95% CI 0.64-0.95). Further studies examining factors associated with, and interventions to inform retention in care are required.
Collapse
Affiliation(s)
- S Herbert
- Department of Sexual Health Medicine, Sydney Local Health District, Sydney, Australia
| | - R Puhr
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - K Petoumenos
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - D A Lewis
- Western Sydney Sexual Health Centre, Parramatta, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
| | - R Varma
- The Kirby Institute, UNSW Sydney, Sydney, Australia.,Sydney Sexual Health Centre, South Eastern Sydney Local Health District, Sydney, Australia
| | - D L Couldwell
- Western Sydney Sexual Health Centre, Parramatta, Australia
| | - M Law
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - D J Templeton
- Department of Sexual Health Medicine, Sydney Local Health District, Sydney, Australia.,The Kirby Institute, UNSW Sydney, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
| |
Collapse
|
11
|
Hutchinson JL, Lewis DA, Law M, Bavinton BR, Puhr R, Petoumenos K. Clinical characteristics of overseas-born men who have sex with men (MSM) in the AHOD cohort and implications for clinical practice. Sex Transm Infect 2020; 96:469-470. [PMID: 31907328 DOI: 10.1136/sextrans-2019-054364] [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] [Received: 11/11/2019] [Revised: 11/28/2019] [Accepted: 12/12/2019] [Indexed: 11/03/2022] Open
Affiliation(s)
- Jolie L Hutchinson
- Biostatistics and Database Program, The Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - David A Lewis
- Western Sydney Sexual Health Centre, Sydney, New South Wales, Australia.,Centre for Infectious diseases & Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Clinical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Matthew Law
- Biostatistics and Database Program, The Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - Benjamin R Bavinton
- HIV Epidemiology and Prevention Program, The Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - Rainer Puhr
- Biostatistics and Database Program, The Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - Kathy Petoumenos
- Biostatistics and Database Program, The Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
| |
Collapse
|
12
|
Cheung J, Puhr R, Petoumenos K, Cooper DA, Woolley I, Gunathilake M, Raymond N, Varma R, O'Connor CC, Gracey DM. Chronic kidney disease in Australian Human Immunodeficiency Virus-infected patients: Analysis of the Australian HIV Observational Database. Nephrology (Carlton) 2019; 23:778-786. [PMID: 28703924 DOI: 10.1111/nep.13100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2017] [Indexed: 11/29/2022]
Abstract
AIM The aim of the present study was to examine data from the Australian HIV Observational Database (AHOD), and firstly, to describe the incidence of chronic kidney disease (CKD) and the rate of loss of renal function in HIV-infected individuals living in Australia, and then to examine the risk factors contributing to CKD in this population. METHODS AHOD patients over 18 years of age were eligible if they had at least two serum creatinine measurements from 1 April 2008 until 31 March 2016 and an initial estimated glomerular filtration rate (eGFR) greater than 60 mL/min per 1.73 m3 . Cox proportional hazards models were used to assess risk factors for CKD, which included key patient demographic data and antiretroviral therapy (ART) exposure. RESULTS Of 1924 patients included in the analysis between April 2008 and March 2016, 81 (4.2%) developed CKD (confirmed eGFR of less than 60 mL/min per 1.73 m3 through two consecutive eGFR measurements at least 3 months apart). Of the examined risk factors, baseline age, baseline eGFR, and the route of HIV acquisition were statistically significant predictors of development of CKD. ART exposure, viral hepatitis co-infection, high viral load and low CD4 lymphocyte count were not found to be significant risk factors for CKD. CONCLUSION This is the first study to investigate the risk factors for development of CKD among Australian HIV-infected patients using cohort data. It highlights the need for awareness of renal risk factors, particularly among older patients or in those with pre-existing renal dysfunction. Further research is required to explore the discrepancy between patients who have acquired HIV through different means of exposure.
Collapse
Affiliation(s)
- Jason Cheung
- Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Rainer Puhr
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | | | - David A Cooper
- Kirby Institute, UNSW Sydney, New South Wales, Australia.,HIV, Immunology and Infectious Disease Unit, St Vincent's Hospital, St Vincent's Health Network Sydney, New South Wales, Australia
| | - Ian Woolley
- Monash Infectious Diseases, Monash University, Melbourne, Victoria, Australia
| | - Manoji Gunathilake
- Kirby Institute, UNSW Sydney, New South Wales, Australia.,Sexual Health & Blood Bourne Virus Unit, Centre for Disease Control, Department of Health, Darwin, Northern Territory, Australia
| | - Nigel Raymond
- Infection Service, Capital & Coast DHB, Wellington, New Zealand
| | - Rick Varma
- Kirby Institute, UNSW Sydney, New South Wales, Australia.,Sydney Sexual Health Centre, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Catherine C O'Connor
- Kirby Institute, UNSW Sydney, New South Wales, Australia.,Sexual Health Service, Sydney Local Health District, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - David M Gracey
- Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
13
|
Puhr R, Wright ST, Hoy JF, Templeton DJ, Durier N, Matthews GV, Russell D, Law MG. Retrospective study of hepatitis C outcomes and treatment in HIV co-infected persons from the Australian HIV Observational Database. Sex Health 2019; 14:345-354. [PMID: 28482168 DOI: 10.1071/sh16151] [Citation(s) in RCA: 4] [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: 08/11/2016] [Accepted: 03/18/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND The widespread availability of direct-acting antivirals (DAAs) is expected to drastically improve the treatment uptake and cure rate of hepatitis C virus (HCV). In this paper, rates of and factors associated with HCV treatment uptake and cure in the HIV co-infected population in Australia were assessed before access to DAAs. METHODS The medical records of patients in the Australian HIV Observational Database who were reported to be HCV antibody positive from 1999 to 2014 were reviewed for HCV treatment data. Patients with detectable HCV RNA were included in this analysis. Logistic regression models were applied to identify factors associated with treatment uptake and HCV sustained virological response (SVR) 24 weeks' post treatment. RESULTS The median follow-up time of those with chronic HCV/HIV co-infection was 103 months (interquartile range 51-166 months). Of 179 HCV viraemic patients, 79 (44.1%) began treatment. In the adjusted model, a higher METAVIR score was the only significant factor associated with treatment uptake (odds ratio (OR) 8.87, 95% confidence interval (CI) 2.00-39.3, P=0.004). SVR was achieved in 37 (50%) of 74 treated patients. HCV genotypes 2/3 compared with 1/4 remained the only significant factor for SVR in an adjusted multivariable setting (OR 5.44, 95% CI 1.53-19.4, P=0.009). CONCLUSIONS HCV treatment uptake and SVR have been relatively low in the era of interferon-containing regimens, in Australian HIV/HCV coinfected patients. With new and better tolerated DAAs, treatment of HCV is likely to become more accessible, and identification and treatment of HCV in co-infected patients should become a priority.
Collapse
Affiliation(s)
- Rainer Puhr
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - Stephen T Wright
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | | | - David J Templeton
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - Nicolas Durier
- TREAT Asia, amfAR-The Foundation for AIDS Research, Bangkok 10110, Thailand
| | - Gail V Matthews
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - Darren Russell
- Cairns Sexual Health Service, Cairns, Qld 4870, Australia
| | - Matthew G Law
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| |
Collapse
|
14
|
Hughes C, Puhr R, Ojaimi S, Petoumenos K, Bartlett AW, Templeton DJ, O'Connor CC, Gunathilake M, Woolley I. Human immunodeficiency virus-infected young people in Australia: data from the Australian HIV Observational Database. Intern Med J 2019; 48:1447-1456. [PMID: 30043439 DOI: 10.1111/imj.14040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/15/2018] [Accepted: 07/15/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Individuals aged 13-24 years undergo vast physical, cognitive, social and psychological changes. Australian data regarding clinical outcomes of those diagnosed with HIV in this age are sparse. AIM We aimed to describe demographic factors, virologic and clinical outcomes of individuals aged 13-24 years diagnosed with human immunodeficiency virus (HIV). METHODS Patients diagnosed with HIV after 1997 in the Australian HIV Observational Database were divided into young adults, diagnosed at age <25 years (n = 223), and older adults (n = 1957). Demographic and clinical factors were compared between groups. RESULTS Young adults had a median age at diagnosis of 22 years (inter quartile range (IQR) 20-24) and median age at treatment initiation of 24 years (IQR 22-26). They were more likely to be female than the older cohort (21.1 vs 10.8%; P < 0.001). Men who have sex with men was the most common exposure category in both groups. CD4 count at diagnosis was significantly higher in younger than older adults (median 460 vs 400 cells/mm3 , P = 0.006), whereas HIV viral load at diagnosis was lower (35 400 vs 61 659 copies/mL, P = 0.011). The rate of loss to follow up (LTFU) was higher in young adults (8.0 vs 4.3 per 100PY, P < 0.001). Young adults were more likely to have a treatment interruption compared to older adults (5.3 vs 4.0 per 100PY, P = 0.039). Rates of treatment switch, time to treatment change, and CD4 and viral load responses to treatment were similar between groups. CONCLUSIONS Young adults were diagnosed with HIV at higher CD4 counts and lower viral loads than their older counterparts. LTFU and treatment interruption were more common highlighting the need for extra efforts directed towards retention in care and education regarding the risks of treatment interruptions.
Collapse
Affiliation(s)
- Carly Hughes
- Monash Infectious Diseases, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
| | - Rainer Puhr
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Samar Ojaimi
- Monash Infectious Diseases, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.,Infection and Immunity, Monash Children's Hospital, Monash Health, Melbourne, Victoria, Australia.,Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kathy Petoumenos
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Adam W Bartlett
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - David J Templeton
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,Sexual Health Service, Sydney Local Health District, Sydney, New South Wales, Australia.,Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Catherine C O'Connor
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,Sexual Health Service, Sydney Local Health District, Sydney, New South Wales, Australia.,Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Manoji Gunathilake
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,Sexual Health & BBV Unit, Centre for Disease Control, Darwin, Northwest Territory, Australia
| | - Ian Woolley
- Monash Infectious Diseases, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.,Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
15
|
Puhr R, Petoumenos K, Huang R, Templeton DJ, Woolley I, Bloch M, Russell D, Law MG, Cooper DA. Cardiovascular disease and diabetes in HIV-positive and HIV-negative gay and bisexual men over the age of 55 years in Australia: insights from the Australian Positive & Peers Longevity Evaluation Study. HIV Med 2018; 20:121-130. [PMID: 30474916 DOI: 10.1111/hiv.12689] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES As HIV-positive people age, diagnosis and management of comorbidities associated with ageing are of increasing concern. In this study, we aimed to compare the self-reported prevalences of heart disease, stroke, thrombosis and diabetes in older Australian HIV-positive and HIV-negative gay and bisexual men (GBM). METHODS We analysed data from the Australian Positive & Peers Longevity Evaluation Study (APPLES), a study of a prospectively recruited cross-sectional sample of 228 (51.1%) HIV-positive and 218 (48.9%) HIV-negative GBM, aged ≥ 55 years. Regression methods were used to assess the association of HIV status with self-reported comorbidities. RESULTS Of 446 patients, 389 [200 (51.4%) HIV-positive] reported their disease history. The reported prevalence of comorbidities was higher in the HIV-positive group than in the HIV-negative group: heart disease, 19.5 versus 12.2%; stroke, 7.5 versus 4.2%; thrombosis, 10.5 versus 4.2%; and diabetes, 15.0 versus 9.0%, respectively. In adjusted analyses, HIV-positive GBM had significantly increased odds of reporting heart disease [adjusted odds ratio (aOR) 1.99; P = 0.03] and thrombosis (aOR 2.87; P = 0.01). In our analysis, HIV status was not significantly associated with either age at diagnosis of heart disease (median 53 years for HIV-positive GBM versus 55 years for HIV-negative GBM; P = 0.64) or 5-year cardiovascular disease (CVD) risk estimated using the Framingham risk score. CONCLUSIONS HIV-positive GBM more commonly reported heart disease and thrombosis compared with their HIV-negative peers. These results further highlight the need to understand the impact of HIV on age-related comorbidities in GBM, to guide optimal screening and treatment strategies to reduce the risk of these comorbidities among the HIV-positive population.
Collapse
Affiliation(s)
- R Puhr
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - K Petoumenos
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - R Huang
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - D J Templeton
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,RPA Sexual Health, Sydney Local Health District, Camperdown, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - I Woolley
- Monash Infectious Diseases, Monash Health and Monash University, Clayton, Vic, Australia
| | - M Bloch
- Holdsworth House Medical Practice, Sydney, NSW, Australia
| | - D Russell
- Cairns Sexual Health Service, Cairns North, QLD, Australia.,James Cook University, Cairns, QLD, Australia
| | - M G Law
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - D A Cooper
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| |
Collapse
|
16
|
Judd A, Zangerle R, Touloumi G, Warszawski J, Meyer L, Dabis F, Mary Krause M, Ghosn J, Leport C, Wittkop L, Reiss P, Wit F, Prins M, Bucher H, Gibb D, Fätkenheuer G, Julia DA, Obel N, Thorne C, Mocroft A, Kirk O, Stephan C, Pérez-Hoyos S, Hamouda O, Bartmeyer B, Chkhartishvili N, Noguera-Julian A, Antinori A, d’Arminio Monforte A, Brockmeyer N, Prieto L, Rojo Conejo P, Soriano-Arandes A, Battegay M, Kouyos R, Mussini C, Tookey P, Casabona J, Miró JM, Castagna A, Konopnick D, Goetghebuer T, Sönnerborg A, Quiros-Roldan E, Sabin C, Teira R, Garrido M, Haerry D, de Wit S, Miró JM, Costagliola D, d’Arminio-Monforte A, Castagna A, del Amo J, Mocroft A, Raben D, Chêne G, Judd A, Pablo Rojo C, Barger D, Schwimmer C, Termote M, Wittkop L, Campbell M, Frederiksen CM, Friis-Møller N, Kjaer J, Raben D, Salbøl Brandt R, Berenguer J, Bohlius J, Bouteloup V, Bucher H, Cozzi-Lepri A, Dabis F, d’Arminio Monforte A, Davies MA, del Amo J, Dorrucci M, Dunn D, Egger M, Furrer H, Grabar S, Guiguet M, Judd A, Kirk O, Lambotte O, Leroy V, Lodi S, Matheron S, Meyer L, Miro JM, Mocroft A, Monge S, Nakagawa F, Paredes R, Phillips A, Puoti M, Rohner E, Schomaker M, Smit C, Sterne J, Thiebaut R, Thorne C, Torti C, van der Valk M, Wittkop L, Tanser F, Vinikoor M, Macete E, Wood R, Stinson K, Garone D, Fatti G, Giddy J, Malisita K, Eley B, Fritz C, Hobbins M, Kamenova K, Fox M, Prozesky H, Technau K, Sawry S, Benson CA, Bosch RJ, Kirk GD, Boswell S, Mayer KH, Grasso C, Hogg RS, Richard Harrigan P, Montaner JSG, Yip B, Zhu J, Salters K, Gabler K, Buchacz K, Brooks JT, Gebo KA, Moore RD, Moore RD, Rodriguez B, Horberg MA, Silverberg MJ, Thorne JE, Rabkin C, Margolick JB, Jacobson LP, D’Souza G, Klein MB, Rourke SB, Rachlis AR, Cupido P, Hunter-Mellado RF, Mayor AM, John Gill M, Deeks SG, Martin JN, Patel P, Brooks JT, Saag MS, Mugavero MJ, Willig J, Eron JJ, Napravnik S, Kitahata MM, Crane HM, Drozd DR, Sterling TR, Haas D, Rebeiro P, Turner M, Bebawy S, Rogers B, Justice AC, Dubrow R, Fiellin D, Gange SJ, Anastos K, Moore RD, Saag MS, Gange SJ, Kitahata MM, Althoff KN, Horberg MA, Klein MB, McKaig RG, Freeman AM, Moore RD, Freeman AM, Lent C, Kitahata MM, Van Rompaey SE, Crane HM, Drozd DR, Morton L, McReynolds J, Lober WB, Gange SJ, Althoff KN, Abraham AG, Lau B, Zhang J, Jing J, Modur S, Wong C, Hogan B, Desir F, Liu B, You B, Cahn P, Cesar C, Fink V, Sued O, Dell’Isola E, Perez H, Valiente J, Yamamoto C, Grinsztejn B, Veloso V, Luz P, de Boni R, Cardoso Wagner S, Friedman R, Moreira R, Pinto J, Ferreira F, Maia M, Célia de Menezes Succi R, Maria Machado D, de Fátima Barbosa Gouvêa A, Wolff M, Cortes C, Fernanda Rodriguez M, Allendes G, William Pape J, Rouzier V, Marcelin A, Perodin C, Tulio Luque M, Padgett D, Sierra Madero J, Crabtree Ramirez B, Belaunzaran P, Caro Vega Y, Gotuzzo E, Mejia F, Carriquiry G, McGowan CC, Shepherd BE, Sterling T, Jayathilake K, Person AK, Rebeiro PF, Giganti M, Castilho J, Duda SN, Maruri F, Vansell H, Ly PS, Khol V, Zhang FJ, Zhao HX, Han N, Lee MP, Li PCK, Lam W, Chan YT, Kumarasamy N, Saghayam S, Ezhilarasi C, Pujari S, Joshi K, Gaikwad S, Chitalikar A, Merati TP, Wirawan DN, Yuliana F, Yunihastuti E, Imran D, Widhani A, Tanuma J, Oka S, Nishijima T, Na S, Choi JY, Kim JM, Sim BLH, Gani YM, David R, Kamarulzaman A, Syed Omar SF, Ponnampalavanar S, Azwa I, Ditangco R, Uy E, Bantique R, Wong WW, Ku WW, Wu PC, Ng OT, Lim PL, Lee LS, Ohnmar PS, Avihingsanon A, Gatechompol S, Phanuphak P, Phadungphon C, Kiertiburanakul S, Sungkanuparph S, Chumla L, Sanmeema N, Chaiwarith R, Sirisanthana T, Kotarathititum W, Praparattanapan J, Kantipong P, Kambua P, Ratanasuwan W, Sriondee R, Nguyen KV, Bui HV, Nguyen DTH, Nguyen DT, Cuong DD, An NV, Luan NT, Sohn AH, Ross JL, Petersen B, Cooper DA, Law MG, Jiamsakul A, Boettiger DC, Ellis D, Bloch M, Agrawal S, Vincent T, Allen D, Smith D, Rankin A, Baker D, Templeton DJ, O’Connor CC, Thackeray O, Jackson E, McCallum K, Ryder N, Sweeney G, Cooper D, Carr A, Macrae K, Hesse K, Finlayson R, Gupta S, Langton-Lockton J, Shakeshaft J, Brown K, Idle S, Arvela N, Varma R, Lu H, Couldwell D, Eswarappa S, Smith DE, Furner V, Smith D, Cabrera G, Fernando S, Cogle A, Lawrence C, Mulhall B, Boyd M, Law M, Petoumenos K, Puhr R, Huang R, Han A, Gunathilake M, Payne R, O’Sullivan M, Croydon A, Russell D, Cashman C, Roberts C, Sowden D, Taing K, Marshall P, Orth D, Youds D, Rowling D, Latch N, Warzywoda E, Dickson B, Donohue W, Moore R, Edwards S, Boyd S, Roth NJ, Lau H, Read T, Silvers J, Zeng W, Hoy J, Watson K, Bryant M, Price S, Woolley I, Giles M, Korman T, Williams J, Nolan D, Allen A, Guelfi G, Mills G, Wharry C, Raymond N, Bargh K, Templeton D, Giles M, Brown K, Hoy J. Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study. Clin Infect Dis 2017; 65:1316-1326. [PMID: 28531260 PMCID: PMC5850623 DOI: 10.1093/cid/cix480] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/19/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We compared Kaposi sarcoma (KS) risk in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America. METHODS We included cohort data of human immunodeficiency virus (HIV)-positive adults who started ART after 1995 within the framework of 2 large collaborations of observational HIV cohorts. We present incidence rates and adjusted hazard ratios (aHRs). RESULTS We included 208140 patients from 57 countries. Over a period of 1066572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100000 person-years were 52 in the Asia-Pacific and ranged between 180 and 280 in the other regions. KS risk was 5 times higher in South African women (aHR, 4.56; 95% confidence intervals [CI], 2.73-7.62) than in their European counterparts, and 2 times higher in South African men (2.21; 1.34-3.63). In Europe, Latin, and North America KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95% CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell counts ≥700 cells/µL with those whose counts were <50 cells/µL, the KS risk was halved in South Africa (aHR, 0.53; 95% CI, .17-1.63) but reduced by ≥95% in other regions. CONCLUSIONS Despite important ART-related declines in KS incidence, men and women in South Africa and men who have sex with men remain at increased KS risk, likely due to high human herpesvirus 8 coinfection rates. Early ART initiation and maintenance of high CD4 cell counts are essential to further reducing KS incidence worldwide, but additional measures might be needed, especially in Southern Africa.
Collapse
|
17
|
Puhr R, Heinze G, Nold M, Lusa L, Geroldinger A. Firth's logistic regression with rare events: accurate effect estimates and predictions? Stat Med 2017; 36:2302-2317. [DOI: 10.1002/sim.7273] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 02/14/2017] [Accepted: 02/14/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Rainer Puhr
- The Kirby Institute; University of New South Wales; Sydney Australia
| | - Georg Heinze
- Center for Medical Statistics, Informatics and Intelligent Systems; Medical University of Vienna; Vienna Austria
| | - Mariana Nold
- Institute of Medical Statistics, Computer Sciences and Documentation; University Hospital Jena; Jena Germany
| | - Lara Lusa
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine; University of Ljubljana; Ljubljana Slovenia
| | - Angelika Geroldinger
- Center for Medical Statistics, Informatics and Intelligent Systems; Medical University of Vienna; Vienna Austria
| |
Collapse
|
18
|
Puhr R, Petoumenos K, Youds D, Law MG, Templeton DJ. The impact of changes in HIV management guidelines on time to treatment initiation in Australia. HIV Med 2017; 18:701-703. [PMID: 28224755 DOI: 10.1111/hiv.12504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R Puhr
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - K Petoumenos
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - D Youds
- Gladstone Road Medical Centre, Highgate Hill, QLD, Australia
| | - M G Law
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - D J Templeton
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,RPA Sexual Health, Sydney Local Health District and Central Clinical School, University of Sydney, Sydney, NSW, Australia
| | | |
Collapse
|
19
|
|
20
|
Buchta C, Körmöczi G, Heinze G, Puhr R, Kompatscher M, Jüngling G, List J, Macher M, Höcker P, Watkins-Riedel T, Dettke M. Lack of impact of ABO blood group or corresponding isoantibodies on the immune response after rabies vaccination. Wien Klin Wochenschr 2005; 117:412-6. [PMID: 16053197 DOI: 10.1007/s00508-005-0366-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Demand for rabies hyperimmunoglobulin has increased recently, requiring optimization of vaccination schemes for immunized plasma donors. Possible resemblance of rabies vaccine to blood group antigens and consequential association of the immune response to rabies vaccine and blood group or corresponding isoantibodies has not yet been investigated. We analyzed antirabies antibodies after rabies vaccination and ABO blood group in 142 individuals, and isoantibody titers in 92 of those individuals. We did not find any correlation of the immune response with blood group or isoantibody levels. There was also no correlation with the sex of individuals, but there was a weak correlation between age and rabies-specific antibody level. Rabies vaccination schemes for immunized donors cannot be optimized on the basis of blood groups or isoantibody titers.
Collapse
Affiliation(s)
- Christoph Buchta
- University Clinic for Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|