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Caron JM, Han X, Lary CW, Sathyanarayana P, Remick SC, Ernstoff MS, Herlyn M, Brooks PC. Targeting the secreted RGDKGE collagen fragment reduces PD‑L1 by a proteasome‑dependent mechanism and inhibits tumor growth. Oncol Rep 2023; 49:44. [PMID: 36633146 PMCID: PMC9868893 DOI: 10.3892/or.2023.8481] [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: 08/19/2022] [Accepted: 11/16/2022] [Indexed: 01/13/2023] Open
Abstract
Structural alterations of collagen impact signaling that helps control tumor progression and the responses to therapeutic intervention. Integrins represent a class of receptors that include members that mediate collagen signaling. However, a strategy of directly targeting integrins to control tumor growth has demonstrated limited activity in the clinical setting. New molecular understanding of integrins have revealed that these receptors can regulate both pro‑ and anti‑tumorigenic functions in a cell type‑dependent manner. Therefore, designing strategies that block pro‑tumorigenic signaling, without impeding anti‑tumorigenic functions, may lead to development of more effective therapies. In the present study, evidence was provided for a novel signaling cascade in which β3‑integrin‑mediated binding to a secreted RGDKGE‑containing collagen fragment stimulates an autocrine‑like signaling pathway that differentially governs the activity of both YAP and (protein kinase‑A) PKA, ultimately leading to alterations in the levels of immune checkpoint molecule PD‑L1 by a proteasome dependent mechanism. Selectively targeting this collagen fragment, reduced nuclear YAP levels, and enhanced PKA and proteasome activity, while also exhibiting significant antitumor activity in vivo. The present findings not only provided new mechanistic insight into a previously unknown autocrine‑like signaling pathway that may provide tumor cells with the ability to regulate PD‑L1, but our findings may also help in the development of more effective strategies to control pro‑tumorigenic β3‑integrin signaling without disrupting its tumor suppressive functions in other cellular compartments.
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Affiliation(s)
- Jennifer M. Caron
- MaineHealth Institute for Research, Center for Molecular Medicine, Scarborough, ME 04074, USA
| | - Xianghua Han
- MaineHealth Institute for Research, Center for Molecular Medicine, Scarborough, ME 04074, USA
| | - Christine W. Lary
- MaineHealth Institute for Research, Center for Molecular Medicine, Scarborough, ME 04074, USA
| | - Pradeep Sathyanarayana
- MaineHealth Institute for Research, Center for Molecular Medicine, Scarborough, ME 04074, USA
| | - Scot C. Remick
- MaineHealth Institute for Research, Center for Molecular Medicine, Scarborough, ME 04074, USA
| | - Marc S. Ernstoff
- Division of Cancer Treatment and Diagnosis, Developmental Therapeutics Program, National Cancer Institute, Bethesda, MD 20892, USA
| | | | - Peter C. Brooks
- MaineHealth Institute for Research, Center for Molecular Medicine, Scarborough, ME 04074, USA,Correspondence to: Dr Peter C. Brooks, MaineHealth Institute for Research, Center for Molecular Medicine, 81 Research Drive, Scarborough, ME 04074, USA, E-mail:
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Strother RM, Gopal S, Wirth M, Chadburn A, Noy A, Cesarman E, Lee JY, Remick SC, Busakhala N, Kaimila B, Mberi E, Ndlovu N, Omoding A, Krown SE. Challenges of HIV Lymphoma Clinical Trials in Africa: Lessons From the AIDS Malignancy Consortium 068 Study. JCO Glob Oncol 2021; 6:1034-1040. [PMID: 32634068 PMCID: PMC7392773 DOI: 10.1200/go.20.00152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 01/31/2023] Open
Abstract
The purpose of this article is to describe lessons from the first lymphoma clinical trial conducted by the AIDS Malignancy Consortium (AMC) in sub-Saharan Africa (SSA). AMC-068 was a randomized phase II comparison of intravenous versus oral chemotherapy for HIV-positive diffuse large B-cell lymphoma. Opening in 2016, AMC-068 planned to enroll 90 patients (45 per arm) in Kenya, Malawi, Uganda, and Zimbabwe over 24 months and follow patients for 24 months to assess overall survival. In 2018, the study closed after screening 42 patients but enrolling only 7. Challenges occurred during protocol development, pre-activation, and postactivation. During protocol development (2011-2012), major obstacles were limited baseline data to inform study design; lack of consensus among investigators and approving bodies regarding appropriateness of the oral regimen and need for randomized comparison with cyclophosphamide, doxorubicin, vincristine, and prednisone; and heterogeneity across sites in local standards for diagnosis, staging, and treatment. During pre-activation (2012-2016), challenges included unexpected length and layers of regulatory approval across multiple countries, need to upgrade pathology capacity at sites, need to augment existing chemotherapy infusion capacity at sites, and procurement issues for drugs and supplies. Finally, during postactivation (2016-2018), challenges included long delays between symptom onset and screening entry for many patients, leading to compromised performance status and organ function; other patient characteristics that frequently led to exclusion, including high tumor proliferative index or other pathologic features that were disallowed; and costs of routine diagnostic procedures often being borne by patients, which also contributed to pre-enrollment delays. Lessons from AMC-068 are being applied to the design and conduct of new AMC lymphoma trials in SSA, and the study has contributed to a strong operational foundation that will support innovative clinical trials in the future.
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Affiliation(s)
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD
| | | | | | - Ariela Noy
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jeannette Y Lee
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - Scot C Remick
- Maine Medical Center, Portland, ME, and Tufts University, Boston, MA
| | | | - Bongani Kaimila
- University of North Carolina Project-Malawi, Lilongwe, Malawi
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Hassett MJ, Hazard H, Osarogiagbon RU, Wong SL, Bian JJ, Dizon DS, Wedge J, Basch EM, Mallow J, McCleary NJ, Dougherty DW, Remick SC, Brooks GA, Mecchella J, Solberg P, Tasker L, Faris N, Pacheco A, Cronin C, Schrag D. Design of eSyM: An ePRO-based symptom management tool fully integrated in the electronic health record (Epic) to foster patient/clinician engagement, sustainability, and clinical impact. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
164 Background: Chemotherapy and surgery can cause distressing symptoms, which can be a burden for health systems to address. Programs that directly engage patients, including electronic tracking of patient-reported outcomes (ePROs), can improve symptom control and decrease the need for acute care. Previous ePRO programs have relied on third party vendors with limited EHR integration, constraining their clinical utility and scalability. An integrated solution could offer distinct advantages. Methods: As part of NCI’s Moonshot-funded IMPACT consortium, 6 health systems and Epic built an electronic symptom management program (eSyM) based on the PRO-CTCAE questionnaire that is fully integrated into the EHR. The agile, user-centered design process engaged patients, clinicians, and institutions. The core functional components include: 1) symptom surveys in the postoperative period or between chemotherapy visits, 2) self-management tip sheets, 3) clinician alerts, and 4) dashboards for population management. Critical points of integration with supporting EHR functions and workflow impacts were identified; and major challenges of integration and implementation were described. Results: eSyM, which was implemented at two health systems (Baptist Memorial in Tennessee and Mississippi and West Virginia University Health) in the fall of 2019, required multiple supporting EHR functions: 1) access a secure, HIPPA-compliant patient portal/messaging system (MyChart); 2) record diagnosis, procedure and chemotherapy treatment plan data; 3) identify target populations and track metrics/events; 4) define and execute autonomous logic-based workflow rules; 5) generate reports for clinicians/patients; and 6) documentation. Major challenges included: 1) working within pre-existing EHR system standards and capabilities, which limited the ability to customize interfaces and workflows specifically for the eSyM use case; and 2) adapting to different EHR configurations and polices across multiple health systems. Conclusions: The eSyM build leveraged many existing EHR capabilities and overcame regulatory hurdles; but it required design and workflow compromise. Integration of ePRO-based symptom management programs into the EHR could help overcome barriers, consolidate clinical workflows, and foster scalability/sustainability. Ongoing efforts include launching eSyM at four more sites and evaluating its adoption, usability, and impact on clinical outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | - Ethan M. Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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4
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Hassett MJ, Hazard H, Osarogiagbon RU, Wong SL, Bian JJ, Dizon DS, Wedge J, Basch EM, Mallow J, McCleary NJ, Dougherty DW, Remick SC, Brooks GA, Mecchella J, Solberg P, Tasker L, Faris NR, Pacheco A, Cronin C, Schrag D. Design of eSyM: An ePRO-based symptom management tool fully integrated in the electronic health record (Epic) to foster patient/clinician engagement, sustainability, and clinical impact. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e14120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14120 Background: Chemotherapy and surgery can cause distressing symptoms, which can be a burden for health system to address. Programs that directly engage patients, including electronic tracking of patient-reported outcomes (ePROs), can improve symptom control and decrease the need for acute care. Previous ePRO programs have relied on third party vendors with limited EHR integration, constraining their clinical utility and scalability. An integrated solution could offer distinct advantages. Methods: As part of NCI’s Moonshot-funded IMPACT consortium, 6 health systems and Epic built an electronic symptom management program (eSyM) based on the PRO-CTCAE questionnaire that is fully integrated into the EHR. The agile, user-centered design process engaged patients, clinicians, and institutions. The core functional components include: 1) symptom surveys in the postoperative period or between chemotherapy visits, 2) self-management tip sheets, 3) clinician alerts, and 4) dashboards for population management. Critical points of integration with supporting EHR functions and workflow impacts were identified; and major challenges of integration and implementation were described. Results: eSyM, which was implemented at two health systems (Baptist Memorial in Tennessee and Mississippi and West Virginia University Health) in the fall of 2019, required multiple supporting EHR functions: 1) access a secure, HIPPA-compliant patient portal/messaging system (MyChart); 2) record diagnosis, procedure and chemotherapy treatment plan data; 3) identify target populations and track metrics/events; 4) define and execute autonomous logic-based workflow rules; 5) generate reports for clinicians/patients; and 6) documentation. Major challenges included: 1) working within pre-existing EHR system standards and capabilities, which limited the ability to customize interfaces and workflows specifically for the eSyM use case; and 2) adapting to different EHR configurations and polices across multiple health systems. Conclusions: The eSyM build leveraged many existing EHR capabilities and addressed regulatory hurdles; but it required design and workflow compromise. Integration of ePRO-based symptom management programs into the EHR could help overcome barriers, consolidate clinical workflows, and foster scalability/sustainability. Ongoing efforts include launching eSyM at four more sites and evaluating its adoption, usability, and impact on clinical outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | - Ethan M. Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Hazard H, Osarogiagbon RU, Wong SL, Bian JJ, Dizon DS, Wedge J, Mallow J, Basch EM, Enzinger AC, Wright AA, Remick SC, Bradford LS, Cass I, Phillips JD, Ivatury SJ, Bandera CA, Faris NR, Cronin C, Hassett MJ, Schrag D. Self-reported overall wellbeing (OWb), physical function (PFn), and PRO-CTCAE symptom scores in post-operative and chemotherapy patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.2064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2064 Background: A standardized, validated tool for capturing symptoms from cancer patients, PRO-CTCAE, has been used to reduce symptom burden, decrease acute care needs, and preserve quality of life. The association between specific PRO-CTCAE symptom scores and single item measures of OWb and PFn were characterized to understand symptom constellations. Methods: A novel Epic-based symptom management program (eSyM) was deployed for GI, GYN, and thoracic cancer patients starting chemotherapy (Memphis Baptist) or having surgery (WVU Medicine). Patients received automated prompts to complete surveys via the patient portal (MyChart) on a fixed schedule, approximately twice/week. Each survey included one OWb item, one PFn item, and at least 6 PRO-CTCAE items (pain, nausea, vomiting, fatigue, anxiety, insomnia). The OWb and PFn items, which were created de novo, included 5 ordinal response options with corresponding pictograms (emojis from very happy to very sad for OWb; a figure walking to one prone in bed for PFn). Composite scores were generated: 0 for no symptoms, 1-2 for mild/moderate symptoms, and 3 for severe symptoms. We describe OWb and PFn and analyze associations between these items and PRO-CTCAE symptom scores. Results: Between 9/10/19-1/22/20, we collected 908 eSyM responses from 166 chemotherapy patients at Baptist (Age, M = 65), and 480 eSyM responses from 97 postoperative patients at WVU (Age, M = 57). The OWb and PFn scores demonstrated moderate correlation with PRO-CTCAE symptom scores (Baptist r = 0.63; WVU r = 0.75), and moderate correlation with mean symptom scores among surgery patients at WVU (r = 0.74); but lower correlation among chemotherapy patients at Baptist (r = 0.53-0.55). Scores improved over time following surgery, but not after initiation of chemotherapy. Among the 730 eSyM responses with none/mild values for both OWb and PFn (52.9% of all responses), only 4.5% reported any severe symptom; among 651 responses with impairment of OWb and/or PFn, 45.2% reported at least one severe symptom. Conclusions: Integration of eSyM into the Epic EHR enabled tracking of OWb, PFn, and PRO-CTCAE items. When asked alongside PRO-CTCAE symptom items, two single item OWb and PFn measures provided distinct information and correlated with symptom burden. These results demonstrate the feasibility of integrating ePRO collection into routine post-operative and medical oncology care and that PRO-CTCAE items provide information that is distinct from that obtained from global metrics of well-being. Clinical trial information: NCT03850912.
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Affiliation(s)
| | | | | | | | | | | | | | - Ethan M. Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | | | | | - Ilana Cass
- Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Kaduka L, Muniu E, Mbui J, Oduor Owuor C, Gakunga R, Kwasa J, Wabwire S, Okerosi N, Korir A, Remick SC. Disability-Adjusted Life-Years Due to Stroke in Kenya. Neuroepidemiology 2019; 53:48-54. [PMID: 30986786 DOI: 10.1159/000498970] [Citation(s) in RCA: 5] [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] [Received: 08/24/2018] [Accepted: 02/18/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is little information on stroke morbidity in Kenya to inform health care planning. The disability-adjusted life-years (DALYs) are a time-based measure of health status that incorporates both disability and mortality. METHODS This was a multicenter prospective study in Kenya's public tertiary hospitals conducted in 2015-2017. Data on sex, age, and global disability outcome were collected and used to calculate the sum of years of life lost prematurely due to stroke (YLL), the years of healthy life lost due to disability (YLD), and the DALYs. RESULTS Up to 719 adult stroke patients participated in the study. The peak age group for stroke was 60-64 years, with ischemic stroke accounting for 56.1% of the stroke cases. After 1-year follow-up, the YLD were 2,402.50, YLL were 5,335.99, and the DALYs were 7,738.49. YLD contributed 31% of the total DALYs. The DALYs varied by sex (male: 2,835.79; female: 4,902.70 years) and by stroke type (ischemic stroke: 4,652.98; hemorrhagic stroke: 3,085.51). The young age group (< 45 years) bore a greater burden accounting for 35.6% of the total DALYs. CONCLUSION The YLD, YLL, and DALYs observed reinforce the need for targeted prevention of risk factors and comprehensive stroke care initiatives in Kenya.
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Affiliation(s)
- Lydia Kaduka
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya,
| | - Erastus Muniu
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Jane Mbui
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Chrispine Oduor Owuor
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | | | - Judith Kwasa
- Department of Clinical Medicine and Therapeutics, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Nathan Okerosi
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Anne Korir
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Scot C Remick
- Maine Medical Center Research Institute, Portland, Oregon, USA
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Kaduka L, Korir A, Oduor CO, Kwasa J, Mbui J, Wabwire S, Gakunga R, Okerosi N, Opanga Y, Kisiang'ani I, Chepkurui MR, Muniu E, Remick SC. Stroke distribution patterns and characteristics in Kenya's leading public health tertiary institutions: Kenyatta National Hospital and Moi Teaching and Referral Hospital. Cardiovasc J Afr 2019; 29:68-72. [PMID: 29745965 PMCID: PMC6008906 DOI: 10.5830/cvja-2017-046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 06/02/2016] [Accepted: 11/07/2017] [Indexed: 12/02/2022] Open
Abstract
Background Cardiovascular diseases are the second leading cause of morbidity and mortality in Kenya. However, there is limited clinico-epidemiological data on stroke to inform decision making. This study sought to establish stroke distribution patterns and characteristics in patients seeking care at Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH), with the ultimate aim of establishing the first national stroke registry in Kenya. Methods This was a prospective multicentre cohort study among stroke patients. The study used a modified World Health Organisation STEP-wise approach to stroke surveillance tool in collecting data on incidence, major risk factors and mortality rate. The Cochran’s Mantel–Haenszel chisquared test of conditional independence was used with p-value set at 0.05. Results A total of 691 patients with confirmed stroke were recruited [KNH 406 (males: 40.9%; females: 59.1%); MTRH 285 (males: 44.6%; females: 55.4%)] and followed over a 12-month period. Overall, ischaemic stroke accounted for 55.6% of the stroke cases, with women being the most affected (57.5%). Mortality rate at day 10 was 18.0% at KNH and 15.5% at MTRH, and higher in the haemorrhagic cases (20.3%). The most common vascular risk factors were hypertension at 77.3% (males: 75.7%; females: 78.5%), smoking at 16.1% (males: 26.6%; females: 8.3%) and diabetes at 14.9% (males: 15.7%; females: 14.4%). Ischaemic stroke was conditionally independent of gender after adjusting for age. Conclusions To our knowledge this is the first pilot demonstration establishing a stroke registry in sub-Saharan Africa and clearly establishes feasibility for this approach. It also has utility to both inform and potentially guide public policy and public health measures on stroke in Kenya. Important and unexpected observations included the preponderance of women affected by cerebrovascular disease and that cigarette smoking was the second most common risk factor. The latter, over time, will further impact on the clinico-epidemiological profile of cerebrovascular disease in Kenya.
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Affiliation(s)
- Lydia Kaduka
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya.
| | - Anne Korir
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Chrispine Owuor Oduor
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Judith Kwasa
- Department of Clinical Medicine and Therapeutics, Kenyatta National Hospital, Nairobi, Kenya
| | - Jane Mbui
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | | | - Yvonne Opanga
- School of Public Health, Moi University, Eldoret, Kenya
| | - Isaac Kisiang'ani
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Mercy Rotich Chepkurui
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Erastus Muniu
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Scot C Remick
- Maine Medical Center Research Institute, Portland, ME, USA
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Okinyi FO, Dower J, Serubuga Makory G, Orndorff C, Gallegos J, Indalo E, Musau H, Adhiambo C, Wangechi C, Rochford R, Sirengo B, Remick SC, Mwanda W. Integration and delivery of palliative and supportive care. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.34_suppl.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
97 Background: Pediatric palliative care (PC) and end-of-life (EoL) planning and support for children, families, and providers are under-developed in Kenya. PC providers in Kenya want to build advocacy and teams to support children with life-threatening or limiting diseases and their families. Methods: KEHPCA in collaboration with UoN/KNH and US pediatric PC providers solicited applications from across the country to participate in a weeklong “train-the-trainer” workshop. The program was entirely devoted to pediatric PC and EoL care and is the “first-like” workshop to our knowledge. The program incorporated a variety of teaching and training tools that were used to support children, their families and caregivers suitable for the Kenyan setting. The cases of 7 children (7 mos. to 11 yrs) served as the focal point for training including extensive role-play scenarios. Results: The workshop convened 9-13th July 2018 in Nairobi. KEHPCA selected 31 providers from among 130 across Kenya to participate and included medical officers, nurses, pharmacists, psychosocial workers, spiritual care, and a school teacher. Expectations were identified by participants at the start, pre- and post-conference surveys were completed, and the identical survey was submitted twice to more than 5,000 physicians listed in the Kenya Board of Medicine directory. There is a lack of awareness of the importance of PC by physicians listed in the directory responding to the same survey. The workshop was well received and ways forward identified. Conclusions: There is consensus among participants that there are five critical gaps in pediatric PC in Kenya: 1) PC requires an interdisciplinary team; 2) interdisciplinary family visits are seldom done; 3) there is a need to facilitate EoL and serious illness conversations with families/guardians and children as appropriate (adolescents in particular); 4) identify ways to support the legacy of infants and young children who pass away; and 5) a clear desire to support the healthcare team. These observations will form a solid departure point for developing programs and ways forward for Kenyan children with life-threatening illnesses. [Supported in part by: KEHPCA and NIH grant nos.: D43 TW009333.]
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Affiliation(s)
| | | | | | | | | | - Edwin Indalo
- University of Nairobi & Kenyatta National Hospital, Nairobi, Kenya
| | | | | | | | | | - Brigid Sirengo
- Kenya Hospices and Palliative Care Association, Nairobi, Kenya
| | | | - Walter Mwanda
- University of Nairobi & Kenyatta National Hospital, Nairobi, Kenya
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9
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Doroshow DB, Deshpande HA, Remick SC, Bhatia AK. Hypothyroidism to predict for long term survival in patients with fosbretabulin treated anaplastic thyroid carcinoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18108] [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: 11/20/2022] Open
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10
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Park J, Kim S, Joh J, Remick SC, Miller DM, Yan J, Kanaan Z, Chao JH, Krem MM, Basu SK, Hagiwara S, Kenner L, Moriggl R, Bunting KD, Tse W. MLLT11/AF1q boosts oncogenic STAT3 activity through Src-PDGFR tyrosine kinase signaling. Oncotarget 2018; 7:43960-43973. [PMID: 27259262 PMCID: PMC5190071 DOI: 10.18632/oncotarget.9759] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/29/2016] [Indexed: 01/05/2023] Open
Abstract
Constitutive STAT3 activation by tyrosine phosphorylation of mutated or amplified tyrosine kinases (pYSTAT3) is critical for cancer initiation, progression, invasion, and motility of carcinoma cells. We showed that AF1q is associated with STAT3 signaling in breast cancer cells. In xenograft models, enhanced AF1q expression activated STAT3 and promoted tumor growth and metastasis in immunodeficient NSG mice. The cytokine secretory phenotype of MDA-MB-231LN breast cancer cells with altered AF1q expression revealed changes in expression of platelet-derived growth factor subunit B (PDGF-B). AF1q-induced PDGF-B stimulated motility, migration, and invasion of MDA-MB-231LN cells, and AF1q up-regulated platelet-derived growth factor receptor (PDGFR) signaling. Further, AF1q-induced PDGFR signaling enhanced STAT3 activity through Src kinase activation, which could be blocked by the Src kinase inhibitor PP1. Moreover, AF1q up-regulated tyrosine kinase signaling through PDGFR signaling, which was blockable by imatinib. In conclusion, we demonstrated that enhanced AF1q expression contributes to persistent and oncogenic pYSTAT3 levels in invasive carcinoma cells by activating Src kinase through activation of the PDGF-B/PDGFR cascade. Therefore, AF1q plays an essential role as a cofactor in PDGF-B-driven STAT3 signaling.
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Affiliation(s)
- Jino Park
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA.,Division of Blood and Bone Marrow Transplantation, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Soojin Kim
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA.,Division of Blood and Bone Marrow Transplantation, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Joongho Joh
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA
| | - Scot C Remick
- Maine Medical Center Research Institute, Portland, ME, USA
| | - Donald M Miller
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA
| | - Jun Yan
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA.,Department of Medicine and Department of Microbiology and Immunology, University of Louisville, Louisville, KY, USA
| | - Zeyad Kanaan
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA
| | - Ju-Hsien Chao
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA.,Division of Blood and Bone Marrow Transplantation, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Maxwell M Krem
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA.,Division of Blood and Bone Marrow Transplantation, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Soumit K Basu
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA.,Division of Blood and Bone Marrow Transplantation, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Shotaro Hagiwara
- Division of Hematology, Internal Medicine, National Center for Global Health and Medicine, Shinjuku, Japan
| | - Lukas Kenner
- Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria.,Clinical Institute for Pathology, Medical University of Vienna, Vienna, Austria.,Unit of Pathology of Laboratory Animals (UPLA), University of Veterinary Medicine, Vienna, Austria
| | - Richard Moriggl
- Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria.,Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Medical University of Vienna, Vienna, Austria
| | - Kevin D Bunting
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
| | - William Tse
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA.,Division of Blood and Bone Marrow Transplantation, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
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Foreman L, Green DA, Thorpe B, Haddock M, Burns W, Roberts M, Remick SC. A demonstration project: Providing colon cancer screening to homeless people—Capitalizing on community partnerships. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e18009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18009 Background: Homeless people encounter many barriers to healthcare and preventative services, while having an increased prevalence of most risk factors for cancer. A group of homeless adults (40) receiving services from Preble Street in Portland Maine were successfully provided access, support and coaching to participate in colon cancer screening using Fecal Immunochemical Test (FIT) over a period of six weeks. Maine Medical Center Cancer Institute (MMCCI) recruited a Physician champion, while Preble Street gathered multiple internal and external community partners and together help plan the project identify resources needed, plan for data collection and address potential barriers for participation. Methods: Community partners (MMCCI, Preble Street, Casco Bay Surgery, NorDx, MaineHealth Care Partners and Homeless Health Partners Case Managers, Me Health LRC, and Maine Medical Center Magnet Council) created a detailed protocol to be used to overcome barriers and facilitate screening. The combination of a simple screening tool and caseworker relationship proved to be an effective strategy. Community Partners were used to identify barriers in the process, monitor all test results and navigate patients testing positive to colonoscopy. Small incentives of $10 food cards were provided for those participating in the screening event. Results: Of the 40 participants who were screened 8 (20%) tested positive and are in colonoscopy follow-up, with ages ranging from 50-74 years. The majority of participants 28 (70%) reported never having a provider conversation about colon cancer screening. Conclusions: Providing cancer prevention education and access to screening can have a positive impact on early detection in the homeless population. Identifying practical barriers and solutions are essential to improving cancer screening participation for homeless people.
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Dittrich C, Kosty M, Jezdic S, Pyle D, Berardi R, Bergh J, El-Saghir N, Lotz JP, Österlund P, Pavlidis N, Purkalne G, Awada A, Banerjee S, Bhatia S, Bogaerts J, Buckner J, Cardoso F, Casali P, Chu E, Close JL, Coiffier B, Connolly R, Coupland S, De Petris L, De Santis M, de Vries EGE, Dizon DS, Duff J, Duska LR, Eniu A, Ernstoff M, Felip E, Fey MF, Gilbert J, Girard N, Glaudemans AWJM, Gopalan PK, Grothey A, Hahn SM, Hanna D, Herold C, Herrstedt J, Homicsko K, Jones DV, Jost L, Keilholz U, Khan S, Kiss A, Köhne CH, Kunstfeld R, Lenz HJ, Lichtman S, Licitra L, Lion T, Litière S, Liu L, Loehrer PJ, Markham MJ, Markman B, Mayerhoefer M, Meran JG, Michielin O, Moser EC, Mountzios G, Moynihan T, Nielsen T, Ohe Y, Öberg K, Palumbo A, Peccatori FA, Pfeilstöcker M, Raut C, Remick SC, Robson M, Rutkowski P, Salgado R, Schapira L, Schernhammer E, Schlumberger M, Schmoll HJ, Schnipper L, Sessa C, Shapiro CL, Steele J, Sternberg CN, Stiefel F, Strasser F, Stupp R, Sullivan R, Tabernero J, Travado L, Verheij M, Voest E, Vokes E, Von Roenn J, Weber JS, Wildiers H, Yarden Y. ESMO / ASCO Recommendations for a Global Curriculum in Medical Oncology Edition 2016. ESMO Open 2016; 1:e000097. [PMID: 27843641 PMCID: PMC5070299 DOI: 10.1136/esmoopen-2016-000097] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/10/2016] [Indexed: 12/05/2022] Open
Abstract
The European Society for Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO) are publishing a new edition of the ESMO/ASCO Global Curriculum (GC) thanks to contribution of 64 ESMO-appointed and 32 ASCO-appointed authors. First published in 2004 and updated in 2010, the GC edition 2016 answers to the need for updated recommendations for the training of physicians in medical oncology by defining the standard to be fulfilled to qualify as medical oncologists. At times of internationalisation of healthcare and increased mobility of patients and physicians, the GC aims to provide state-of-the-art cancer care to all patients wherever they live. Recent progress in the field of cancer research has indeed resulted in diagnostic and therapeutic innovations such as targeted therapies as a standard therapeutic approach or personalised cancer medicine apart from the revival of immunotherapy, requiring specialised training for medical oncology trainees. Thus, several new chapters on technical contents such as molecular pathology, translational research or molecular imaging and on conceptual attitudes towards human principles like genetic counselling or survivorship have been integrated in the GC. The GC edition 2016 consists of 12 sections with 17 subsections, 44 chapters and 35 subchapters, respectively. Besides renewal in its contents, the GC underwent a principal formal change taking into consideration modern didactic principles. It is presented in a template-based format that subcategorises the detailed outcome requirements into learning objectives, awareness, knowledge and skills. Consecutive steps will be those of harmonising and implementing teaching and assessment strategies.
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Affiliation(s)
- Christian Dittrich
- 3rd Medical Department , Centre for Oncology and Haematology, Kaiser Franz Josef-Spital , Vienna , Austria
| | - Michael Kosty
- Division of Hematology/Oncology , Scripps Green Cancer Center, Scripps Clinic , La Jolla, California , USA
| | - Svetlana Jezdic
- European Society for Medical Oncology (ESMO) , Lugano , Switzerland
| | - Doug Pyle
- American Society of Clinical Oncology (ASCO) , Alexandria, Virginia , USA
| | - Rossana Berardi
- Department of Medical Oncology , Università Politecnica delle Marche, Ospedali Riuniti Ancona , Ancona , Italy
| | - Jonas Bergh
- The Strategic Research Programme in Cancer, Karolinska Institutet and University Hospital , Stockholm , Sweden
| | - Nagi El-Saghir
- Department of Internal Medicine , NK Basile Cancer Institute, American University of Beirut Medical Center , Beirut , Lebanon
| | - Jean-Pierre Lotz
- Department of Medical Oncology and Cellular Therapy, Medical Oncology Department , Tenon Assistance Publique-Hôpitaux de Paris , Paris , France
| | - Pia Österlund
- Department of Oncology , HUCH Helsinki University Central Hospital and University of Helsinki , Helsinki, Finland
| | - Nicholas Pavlidis
- Department of Medical Oncology , University of Ioannina , Ioannina , Greece
| | - Gunta Purkalne
- Clinic of Oncology , Pauls Stradins Clinical University Hospital , Riga , Latvia
| | - Ahmad Awada
- Medical Oncology Clinic , Jules Bordet Institute, Université Libre de Bruxelles , Brussels , Belgium
| | | | - Smita Bhatia
- Division of Pediatric Hematology/Oncology, Department of Pediatrics , Institute of Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, UAB Comprehensive Cancer Center , Birmingham, Alabama , USA
| | - Jan Bogaerts
- The European Organisation for Research and Treatment of Cancer (EORTC) , Brussels , Belgium
| | - Jan Buckner
- Department of Oncology , Cancer Practice-Mayo Clinic Cancer Center , Rochester, Minnesota , USA
| | - Fatima Cardoso
- Breast Unit , Champalimaud Clinical Center , Lisbon , Portugal
| | - Paolo Casali
- Medical Oncology Unit 2 (Adult Mesenchymal Tumours and Rare Cancers) , Fondazione IRCCS Istituto Nazionale Tumori , Milan , Italy
| | - Edward Chu
- University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania , USA
| | - Julia Lee Close
- UF Department of Medicine Division of Hematology/Oncology, UF Hematology/Oncology Fellowship Program, Gainesville, Florida, USA; Medical Service, Malcom Randall VA Medical Center, Gainesville, Florida, USA
| | - Bertrand Coiffier
- Department of Hematology , University Claude Bernard Lyon 1, Centre Hospitalier Lyon-Sud , Lyon , France
| | - Roisin Connolly
- Breast and Ovarian Cancer Program , Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University , Baltimore, Maryland , USA
| | - Sarah Coupland
- Pathology, Molecular and Clinical Cancer Medicine , University of Liverpool , Liverpool , UK
| | - Luigi De Petris
- Department of Oncology , Radiumhemmet, Karolinska Institutet and University Hospital , Stockholm , Sweden
| | - Maria De Santis
- University of Warwick, Cancer Research Centre , Coventry , UK
| | - Elisabeth G E de Vries
- Department of Medical Oncology , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Don S Dizon
- The Oncology Sexual Health Clinic, Harvard Medical School, Department of Medicine , Massachusetts General Hospital , Boston, Massachusetts , USA
| | - Jennifer Duff
- Department of Medicine , University of Florida , Gainesville, Florida , USA
| | - Linda R Duska
- Division of Gynecologic Oncology , University of Virginia School of Medicine , Charlottesville, Virginia , USA
| | - Alexandru Eniu
- Department of Breast Tumors , Cancer Institute "Ion Chiricuta" , Cluj-Napoca , Romania
| | - Marc Ernstoff
- Department of Medicine , Roswell Park Cancer Institute , Buffalo, New York , USA
| | - Enriqueta Felip
- Medical Oncology Department , Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona , Spain
| | - Martin F Fey
- Inselspital and University Hospital of Bern , Bern , Switzerland
| | - Jill Gilbert
- Vanderbilt University School of Medicine , Nashville, Tennessee , USA
| | - Nicolas Girard
- Department of Respiratory Medicine, Thoracic Oncology , Institute of Oncology, Hospices Civils de Lyon , Lyon , France
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine & Molecular Imaging , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Priya K Gopalan
- Department of Medicine , University of Florida and Section of Medicine, Malcom Randall VA Medical Center , Gainesville, Florida , USA
| | - Axel Grothey
- Mayo Clinic Rochester , Rochester, Minnesota , USA
| | - Stephen M Hahn
- Division of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Diana Hanna
- Division of Medical Oncology , University of Southern California, Hoag Family Cancer Institute , Newport Beach, California , USA
| | - Christian Herold
- Department of Biomedical Imaging and Image-guided Therapy , Medical University Vienna, Vienna General Hospital , Vienna , Austria
| | - Jørn Herrstedt
- Department of Oncology , Odense University Hospital, University of Southern Denmark , Odense , Denmark
| | - Krisztian Homicsko
- Department of Oncology , University Hospital of Lausanne , Lausanne , Switzerland
| | - Dennie V Jones
- Department of Medicine, Division of Hematology/Oncology/Stem Cell Transplant, University of Florida, Gainesville, Florida, USA; Section of Hematology and Oncology, Malcom Randall VA Medical Center, Gainesville, Florida, USA
| | - Lorenz Jost
- Cantonal Hospital Baselland , Bruderholz , Switzerland
| | | | - Saad Khan
- Hematology and Oncology, Internal Medicine , UT Southwestern Medical Center , Dallas, Texas , USA
| | - Alexander Kiss
- Department of Psychosomatic Division , University Hospital Basel , Basel , Switzerland
| | - Claus-Henning Köhne
- University Clinic for Internal Medicine-Oncology and Hematology, Klinikum Oldenburg , Oldenburg , Germany
| | - Rainer Kunstfeld
- Clinic of Dermatology/Vienna General Hospital, Medical University Vienna , Vienna , Austria
| | - Heinz-Josef Lenz
- Department of Medical Oncology , Norris Comprehensive Cancer Center, University of Southern California , Los Angeles, California , USA
| | - Stuart Lichtman
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College , New York, New York , USA
| | | | - Thomas Lion
- Division for Molecular Microbiology, Children'sCancer Research Institute (CCRI), Vienna, Austria; LabDia Laboratoriumsdiagnostik GmbH, Vienna, Austria
| | - Saskia Litière
- The European Organisation for Research and Treatment of Cancer (EORTC) , Brussels , Belgium
| | - Lifang Liu
- Department of Statistics , The European Organisation for Research and Treatment of Cancer (EORTC) , Brussels , Belgium
| | - Patrick J Loehrer
- Indiana University Melvin and Bren Simon Cancer Center, Indiana University School of Medicine , Indianapolis, Indiana , USA
| | - Merry Jennifer Markham
- Division of Hematology & Oncology , University of Florida College of Medicine , Gainesville, Florida , USA
| | - Ben Markman
- Monash Cancer Centre, Monash Health , Melbourne , Australia
| | - Marius Mayerhoefer
- Department of Biomedical Imaging and Image-guided Therapy , Medical University of Vienna, Vienna General Hospital , Vienna , Austria
| | - Johannes G Meran
- Internal Department, Krankenhaus Barmherzige Brüder , Vienna , Austria
| | | | | | | | - Timothy Moynihan
- Department of Medical Oncology , Mayo Clinic , Rochester, Minnesota , USA
| | - Torsten Nielsen
- University of British Columbia , Vancouver, British Columbia , Canada
| | - Yuichiro Ohe
- Department of Thoracic Oncology , National Cancer Center Hospital , Tokyo , Japan
| | - Kjell Öberg
- Department of Endocrine Oncology, Uppsala University Hospital, Uppsala, Sweden; Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | | | - Fedro Alessandro Peccatori
- Fertility & Procreation Unit, Gynecologic Oncology Department , European Institute of Oncology , Milan , Italy
| | | | - Chandrajit Raut
- Division of Surgical Oncology, Department of Surgery , Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital , Boston, Massachusetts , USA
| | - Scot C Remick
- Department of Medicine , Maine Medical Center Cancer Institute , Scarborough, Maine , USA
| | - Mark Robson
- Clinical Genetics Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York, New York , USA
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma , Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology , Warsaw , Poland
| | - Roberto Salgado
- Breast Cancer Translational Research Laboratory, Jules Bordet Institute, Brussels, Belgium; Department of Pathology, TCRU, GZA Antwerp, Antwerp, Belgium
| | - Lidia Schapira
- Harvard Medical School , Massachusetts General Hospital , Boston, Massachusetts , USA
| | - Eva Schernhammer
- Department of Epidemiology , Center for Public Health, Medical University of Vienna , Vienna , Austria
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology , Institut Gustave Roussy, Université Paris-Sud , Villejuif , France
| | - Hans-Joachim Schmoll
- Division Clinical Oncology Research , University Clinic Halle (Saale), Martin-Luther-University, Halle-Wittenberg , Halle , Germany
| | - Lowell Schnipper
- Department of Medicine , Beth Israel Deaconess Medical Center , Boston, Massachusetts , USA
| | - Cristiana Sessa
- Oncology Institute of Southern Switzerland , Bellinzona , Switzerland
| | - Charles L Shapiro
- Dubin Breast Center, Division of Hematology/Medical Oncology , Tisch Cancer Center, Mount Sinai Health System , New York, New York , USA
| | - Julie Steele
- Anatomic Pathology, Scripps Clinic Department of Pathology , Scripps Green Hospital , La Jolla, California , USA
| | - Cora N Sternberg
- Department of Medical Oncology , San Camillo Forlanini Hospital , Rome , Italy
| | - Friedrich Stiefel
- Psychiatric Liaison Service, Department of Psychiatry , University Hospital of Lausanne-CHUV , Lausanne , Switzerland
| | - Florian Strasser
- Oncological Palliative Medicine, Clinic Oncology/Hematology, Department Internal Medicine & Palliative Centre , Cantonal Hospital St.Gallen , St. Gallen , Switzerland
| | - Roger Stupp
- University Hospital Zürich , Zürich , Switzerland
| | - Richard Sullivan
- Institute of Cancer Policy, Conflict & Health Research Program, London , UK
| | - Josep Tabernero
- Medical Oncology Department , Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona , Spain
| | - Luzia Travado
- Psycho-Oncology Service, Clinical Centre of the Champalimaud Centre for the Unknown, Champalimaud Foundation , Lisbon , Portugal
| | - Marcel Verheij
- Department of Radiation Oncology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Emile Voest
- The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Everett Vokes
- Department of Medicine , University of Chicago Medical Center , Chicago, Illinois , USA
| | - Jamie Von Roenn
- Education, Science, and Professional Development, American Society of Clinical Oncology (ASCO) , Alexandria, Virginia , USA
| | - Jeffrey S Weber
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center , New York, New York , USA
| | - Hans Wildiers
- Department of General Medical Oncology , University Hospitals Leuven , Leuven , Belgium
| | - Yosef Yarden
- Department of General Medical Oncology , University Hospitals Leuven , Leuven , Belgium
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13
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Buckle G, Maranda L, Skiles J, Ong'echa JM, Foley J, Epstein M, Vik TA, Schroeder A, Lemberger J, Rosmarin A, Remick SC, Bailey JA, Vulule J, Otieno JA, Moormann AM. Factors influencing survival among Kenyan children diagnosed with endemic Burkitt lymphoma between 2003 and 2011: A historical cohort study. Int J Cancer 2016; 139:1231-40. [PMID: 27136063 PMCID: PMC5489240 DOI: 10.1002/ijc.30170] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 04/19/2016] [Indexed: 12/23/2022]
Abstract
Discovering how to improve survival and establishing clinical reference points for children diagnosed with endemic Burkitt lymphoma (eBL) in resource-constrained settings has recaptured international attention. Using multivariate analyses, we evaluated 428 children with eBL in Kenya for age, gender, tumor stage, nutritional status, hemoglobin, lactate dehydrogenase (LDH), Epstein-Barr virus (EBV) and Plasmodium falciparum prior to induction of chemotherapy (cyclophosphamide, vincristine, methotrexate and doxorubicin) to identify predictive and prognostic biomarkers of survival. During this 10 year prospective study period, 22% died in-hospital and 78% completed six-courses of chemotherapy. Of those, 16% relapsed or died later; 31% achieved event-free-survival; and 31% were lost to follow-up; the overall one-year survival was 45%. After adjusting for covariates, low hemoglobin (<8 g/dL) and high LDH (>400 mU/ml) were associated with increased risk of death (adjusted Hazard Ratio (aHR) = 1.57 [0.97-2.41]) and aHR = 1.84, [0.91-3.69], respectively). Anemic children with malaria were 3.55 times more likely to die [1.10-11.44] compared to patients without anemia or malarial infection. EBV load did not differ by tumor stage nor was it associated with survival. System-level factors can also contribute to poor outcomes. Children were more likely to die when inadvertently overdosed by more than 115% of the correct dose of cyclophosphamide (a HR = 1.43 [0.84-2.43]) or doxorubicin (a HR = 1.25, [0.66-2.35]), compared with those receiving accurate doses of the respective agent in this setting. This study codifies risk factors associated with poor outcomes for eBL patients in Africa and provides a benchmark by which to assess improvements in survival for new chemotherapeutic approaches.
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Affiliation(s)
- Geoffrey Buckle
- Molecular Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655
| | - Louise Maranda
- Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue North, ASC6.1063, Worcester, MA 01655
| | - Jodi Skiles
- Pediatrics, Hemotology/Oncology, Indiana University School of Medicine, Full address: 705 Riley Hospital Drive, RI 2629, Indianapolis, IN 46202
| | - John Michael Ong'echa
- Center for Global, Health Research Kenya Medical Research Institute, P. O. Box 1578-40100, Kisumu, Kenya
| | - Joslyn Foley
- Molecular Medicine, University of Massachusetts Medical School, 373 Plantation St. Biotech 2, Suite 318, Worcester, MA 01605
| | - Mara Epstein
- Quantitative Health Sciences, University of Massachusetts Medical School, 365 Plantation St. Biotech 1, Suite 100, Worcester, MA 01605
| | - Terry A. Vik
- Pediatrics, Hemotology/Oncology, Indiana University School of Medicine, Full address: 705 Riley Hospital Drive, ROC 4340, Indianapolis, IN 46202
| | | | | | - Alan Rosmarin
- Medicine, Hematology/Oncology, University of Massachusetts Medical School, 55 Lake Avenue North, H8-533, Worcester, MA 01655
| | - Scot C. Remick
- Physician Leader, Oncology and Senior Scientist, Maine Medical Center and Maine Medical Center Research Institute, Portland, ME 04074
| | - Jeffrey A. Bailey
- Medicine, Bioinformatics, University of Massachusetts Medical School, 55 Lake Avenue North, ASC4.1077, Worcester, MA 01655
| | - John Vulule
- Center for Global Health Research, Kenya Medical Research Institute, P. O. Box 1578-40100, Kisumu, Kenya
| | - Juliana A. Otieno
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Kenya Ministry of Health, P.O. Box 849-40100, Kisumu, Kenya
| | - Ann M. Moormann
- Molecular Medicine, University of Massachusetts Medical School, 373 Plantation Street, Biotech 2, Suite 318, Worcester MA, 01605 USA
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Barta SK, Samuel MS, Xue X, Wang D, Lee JY, Mounier N, Ribera JM, Spina M, Tirelli U, Weiss R, Galicier L, Boue F, Little RF, Dunleavy K, Wilson WH, Wyen C, Remick SC, Kaplan LD, Ratner L, Noy A, Sparano JA. Changes in the influence of lymphoma- and HIV-specific factors on outcomes in AIDS-related non-Hodgkin lymphoma. Ann Oncol 2015; 26:958-966. [PMID: 25632071 DOI: 10.1093/annonc/mdv036] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 01/12/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We undertook the present analysis to examine the shifting influence of prognostic factors in HIV-positive patients diagnosed with aggressive non-Hodgkin lymphoma (NHL) over the last two decades. PATIENTS AND METHODS We carried out a pooled analysis from an existing database of patients with AIDS-related lymphoma. Individual patient data had been obtained prior from prospective phase II or III clinical trials carried out between 1990 until 2010 in North America and Europe that studied chemo(immuno)therapy in HIV-positive patients diagnosed with AIDS-related lymphomas. Studies had been identified by a systematic review. We analyzed patient-level data for 1546 patients with AIDS-related lymphomas using logistic regression and Cox proportional hazard models to identify the association of patient-, lymphoma-, and HIV-specific variables with the outcomes complete response (CR), progression-free survival, and overall survival (OS) in different eras: pre-cART (1989-1995), early cART (1996-2000), recent cART (2001-2004), and contemporary cART era (2005-2010). RESULTS Outcomes for patients with AIDS-related diffuse large B-cell lymphoma and Burkitt lymphoma improved significantly over time, irrespective of baseline CD4 count or age-adjusted International Prognostic Index (IPI) risk category. Two-year OS was best in the contemporary era: 67% and 75% compared with 24% and 37% in the pre-cART era (P < 0.001). While the age-adjusted IPI was a significant predictor of outcome in all time periods, the influence of other factors waxed and waned. Individual HIV-related factors such as low CD4 counts (<50/mm(3)) and prior history of AIDS were no longer associated with poor outcomes in the contemporary era. CONCLUSIONS Our results demonstrate a significant improvement of CR rate and survival for all patients with AIDS-related lymphomas. Effective HIV-directed therapies reduce the impact of HIV-related prognostic factors on outcomes and allow curative antilymphoma therapy for the majority of patients with aggressive NHL.
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Affiliation(s)
- S K Barta
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia.
| | - M S Samuel
- Department of Medical Oncology, Montefiore Medical Center, Bronx
| | - X Xue
- Department of Epidemiology and Population Health, Albert Einstein Cancer Center, Bronx
| | - D Wang
- Department of Epidemiology and Population Health, Albert Einstein Cancer Center, Bronx
| | - J Y Lee
- Department of Biostatistics, University of Arkansas, Little Rock, USA
| | - N Mounier
- Groupe d'Etude des Lymphomes de l'Adulte (GELA), France
| | - J-M Ribera
- ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute and PETHEMA Group, Badalona, Spain
| | - M Spina
- Department of Medical Oncology, National Cancer Institute, Aviano, Italy
| | - U Tirelli
- Department of Medical Oncology, National Cancer Institute, Aviano, Italy
| | - R Weiss
- Private Practice for Hematology and Oncology, Bremen, Germany
| | - L Galicier
- Department of Immunology, Hopital St Louis, Assistance Publique-Hopitaux de Paris, Paris
| | - F Boue
- Department of Internal Medicine and Immunology, Hopital Antoine Beclere, Clamart, France
| | | | - K Dunleavy
- Department of Medical Oncology, National Cancer Institute, Bethesda, USA
| | - W H Wilson
- Department of Medical Oncology, National Cancer Institute, Bethesda, USA
| | - C Wyen
- Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - S C Remick
- Mary Babb Randolph Cancer Center, West Virginia University, Morgantown
| | - L D Kaplan
- Department of Hematology and Oncology, University of California San Francisco, San Francisco
| | - L Ratner
- Division of Oncology, Washington University School of Medicine, St Louis
| | - A Noy
- Memorial Sloan-Kettering Cancer Center and Weill Cornell, Lymphoma Service, New York, USA
| | - J A Sparano
- Department of Medical Oncology, Montefiore Medical Center, Bronx
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15
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Abstract
The emergence of serine-threonine small molecule, multi-targeted kinase inhibitors over the past decade is greatly impacting the therapeutic armamentarium for numerous malignancies, especially thyroid carcinoma. Chief among them are a class of agents referred to as vascular endothelial growth factor signal pathway inhibitors. Sorafenib is a lead compound that has been recently approved by the US FDA for radioactive iodine-refractory differentiated thyroid cancer (DTC). Sorafenib clearly is altering the natural history of DTC. In the largest randomized Phase III study ever conducted in DTC, sorafenib significantly improved progression-free survival compared to placebo (10.8 vs 5.8 months) and had an acceptable and manageable safety profile, though commonly attributed side effects of hand-foot skin reaction, diarrhea and hypertension were more frequent than in other settings. This agent represents a new treatment option for patients with progressive radioactive iodine-refractory DTC.
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Affiliation(s)
- Chandler Park
- a Section of Hematology/Oncology, Robert C. Byrd Health Science Center, West Virginia University, 1 Medical Center Drive, P.O. Box 9162, Morgantown, WV26506-9162, USA
| | - Jessica Perini
- b Department of Medicine, Section of Endocrinology, Robert C. Byrd Health Science Center, West Virginia University, 1 Medical Center Drive, P.O. Box 9162, Morgantown, WV26506-9162, USA
- c Mary Babb Randolph Cancer Center and the Multidisciplinary Head and Neck Cancer Team, West Virginia University, 1801 Health Sciences South P.O. Box 9300, Morgantown, WV26506, USA
| | - Roger W Farmer
- c Mary Babb Randolph Cancer Center and the Multidisciplinary Head and Neck Cancer Team, West Virginia University, 1801 Health Sciences South P.O. Box 9300, Morgantown, WV26506, USA
- d Department of Otolaryngology and Head and Neck Surgery, Robert C. Byrd Health Science Center, West Virginia University, 1 Medical Center Drive, P.O. Box 9162, Morgantown, WV26506-9162, USA
| | - Tanya Fancy
- c Mary Babb Randolph Cancer Center and the Multidisciplinary Head and Neck Cancer Team, West Virginia University, 1801 Health Sciences South P.O. Box 9300, Morgantown, WV26506, USA
- d Department of Otolaryngology and Head and Neck Surgery, Robert C. Byrd Health Science Center, West Virginia University, 1 Medical Center Drive, P.O. Box 9162, Morgantown, WV26506-9162, USA
| | - Manish Monga
- a Section of Hematology/Oncology, Robert C. Byrd Health Science Center, West Virginia University, 1 Medical Center Drive, P.O. Box 9162, Morgantown, WV26506-9162, USA
- c Mary Babb Randolph Cancer Center and the Multidisciplinary Head and Neck Cancer Team, West Virginia University, 1801 Health Sciences South P.O. Box 9300, Morgantown, WV26506, USA
| | - Scot C Remick
- a Section of Hematology/Oncology, Robert C. Byrd Health Science Center, West Virginia University, 1 Medical Center Drive, P.O. Box 9162, Morgantown, WV26506-9162, USA
- c Mary Babb Randolph Cancer Center and the Multidisciplinary Head and Neck Cancer Team, West Virginia University, 1801 Health Sciences South P.O. Box 9300, Morgantown, WV26506, USA
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16
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Shelburne N, Adhikari B, Brell J, Davis M, Desvigne-Nickens P, Freedman A, Minasian L, Force T, Remick SC. Cancer treatment-related cardiotoxicity: current state of knowledge and future research priorities. J Natl Cancer Inst 2014; 106:dju232. [PMID: 25210198 PMCID: PMC4176042 DOI: 10.1093/jnci/dju232] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 06/27/2014] [Accepted: 07/01/2014] [Indexed: 12/31/2022] Open
Abstract
Cardiotoxicity resulting from direct myocyte damage has been a known complication of cancer treatment for decades. More recently, the emergence of hypertension as a clinically significant side effect of several new agents has been recognized as adversely affecting cancer treatment outcomes. With cancer patients living longer, in part because of treatment advances, these adverse events have become increasingly important to address. However, little is known about the cardiovascular pathogenic mechanisms associated with cancer treatment and even less about how to optimally prevent and manage short- and long-term cardiovascular complications, leading to improved patient safety and clinical outcomes. To identify research priorities, allocate resources, and establish infrastructure required to address cardiotoxicity associated with cancer treatment, the National Cancer Institute (NCI) and National Heart, Lung and Blood Institute (NHLBI) sponsored a two-day workshop, "Cancer treatment-related cardiotoxicity: Understanding the current state of knowledge and future research priorities," in March 2013 in Bethesda, MD. Participants included leading oncology and cardiology researchers and health professionals, patient advocates and industry representatives, with expertise ranging from basic to clinical science. Attendees were charged with identifying research opportunities to advance the understanding of cancer treatment-related cardiotoxicity across basic and clinical science. This commentary highlights the key discussion points and overarching recommendations from that workshop.
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Affiliation(s)
- Nonniekaye Shelburne
- Division of Cancer Control and Population Sciences (NS, AF) and Division of Cancer Prevention (JB, LM) and Division of Cancer Treatment and Diagnosis (MD), National Cancer Institute, Rockville, MD; Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, MD (BA, PDN); Cancer Center, MetroHealth Medical Center and Casewestern Reserve University, Cleveland, OH (JB); Vanderbilt Heart and Vascular Institute, Vanderbilt University School of Medicine, Nashville, TN (TF); Mary Babb Randolph Cancer Center, West Virginia University (SCR), Morgantown, WV.
| | - Bishow Adhikari
- Division of Cancer Control and Population Sciences (NS, AF) and Division of Cancer Prevention (JB, LM) and Division of Cancer Treatment and Diagnosis (MD), National Cancer Institute, Rockville, MD; Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, MD (BA, PDN); Cancer Center, MetroHealth Medical Center and Casewestern Reserve University, Cleveland, OH (JB); Vanderbilt Heart and Vascular Institute, Vanderbilt University School of Medicine, Nashville, TN (TF); Mary Babb Randolph Cancer Center, West Virginia University (SCR), Morgantown, WV
| | - Joanna Brell
- Division of Cancer Control and Population Sciences (NS, AF) and Division of Cancer Prevention (JB, LM) and Division of Cancer Treatment and Diagnosis (MD), National Cancer Institute, Rockville, MD; Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, MD (BA, PDN); Cancer Center, MetroHealth Medical Center and Casewestern Reserve University, Cleveland, OH (JB); Vanderbilt Heart and Vascular Institute, Vanderbilt University School of Medicine, Nashville, TN (TF); Mary Babb Randolph Cancer Center, West Virginia University (SCR), Morgantown, WV
| | - Myrtle Davis
- Division of Cancer Control and Population Sciences (NS, AF) and Division of Cancer Prevention (JB, LM) and Division of Cancer Treatment and Diagnosis (MD), National Cancer Institute, Rockville, MD; Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, MD (BA, PDN); Cancer Center, MetroHealth Medical Center and Casewestern Reserve University, Cleveland, OH (JB); Vanderbilt Heart and Vascular Institute, Vanderbilt University School of Medicine, Nashville, TN (TF); Mary Babb Randolph Cancer Center, West Virginia University (SCR), Morgantown, WV
| | - Patrice Desvigne-Nickens
- Division of Cancer Control and Population Sciences (NS, AF) and Division of Cancer Prevention (JB, LM) and Division of Cancer Treatment and Diagnosis (MD), National Cancer Institute, Rockville, MD; Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, MD (BA, PDN); Cancer Center, MetroHealth Medical Center and Casewestern Reserve University, Cleveland, OH (JB); Vanderbilt Heart and Vascular Institute, Vanderbilt University School of Medicine, Nashville, TN (TF); Mary Babb Randolph Cancer Center, West Virginia University (SCR), Morgantown, WV
| | - Andrew Freedman
- Division of Cancer Control and Population Sciences (NS, AF) and Division of Cancer Prevention (JB, LM) and Division of Cancer Treatment and Diagnosis (MD), National Cancer Institute, Rockville, MD; Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, MD (BA, PDN); Cancer Center, MetroHealth Medical Center and Casewestern Reserve University, Cleveland, OH (JB); Vanderbilt Heart and Vascular Institute, Vanderbilt University School of Medicine, Nashville, TN (TF); Mary Babb Randolph Cancer Center, West Virginia University (SCR), Morgantown, WV
| | - Lori Minasian
- Division of Cancer Control and Population Sciences (NS, AF) and Division of Cancer Prevention (JB, LM) and Division of Cancer Treatment and Diagnosis (MD), National Cancer Institute, Rockville, MD; Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, MD (BA, PDN); Cancer Center, MetroHealth Medical Center and Casewestern Reserve University, Cleveland, OH (JB); Vanderbilt Heart and Vascular Institute, Vanderbilt University School of Medicine, Nashville, TN (TF); Mary Babb Randolph Cancer Center, West Virginia University (SCR), Morgantown, WV
| | - Thomas Force
- Division of Cancer Control and Population Sciences (NS, AF) and Division of Cancer Prevention (JB, LM) and Division of Cancer Treatment and Diagnosis (MD), National Cancer Institute, Rockville, MD; Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, MD (BA, PDN); Cancer Center, MetroHealth Medical Center and Casewestern Reserve University, Cleveland, OH (JB); Vanderbilt Heart and Vascular Institute, Vanderbilt University School of Medicine, Nashville, TN (TF); Mary Babb Randolph Cancer Center, West Virginia University (SCR), Morgantown, WV
| | - Scot C Remick
- Division of Cancer Control and Population Sciences (NS, AF) and Division of Cancer Prevention (JB, LM) and Division of Cancer Treatment and Diagnosis (MD), National Cancer Institute, Rockville, MD; Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, MD (BA, PDN); Cancer Center, MetroHealth Medical Center and Casewestern Reserve University, Cleveland, OH (JB); Vanderbilt Heart and Vascular Institute, Vanderbilt University School of Medicine, Nashville, TN (TF); Mary Babb Randolph Cancer Center, West Virginia University (SCR), Morgantown, WV
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Chi A, Nguyen NP, Welsh JS, Tse W, Monga M, Oduntan O, Almubarak M, Rogers J, Remick SC, Gius D. Strategies of dose escalation in the treatment of locally advanced non-small cell lung cancer: image guidance and beyond. Front Oncol 2014; 4:156. [PMID: 24999451 PMCID: PMC4064255 DOI: 10.3389/fonc.2014.00156] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 06/04/2014] [Indexed: 12/25/2022] Open
Abstract
Radiation dose in the setting of chemo-radiation for locally advanced non-small cell lung cancer (NSCLC) has been historically limited by the risk of normal tissue toxicity and this has been hypothesized to correlate with the poor results in regard to local tumor recurrences. Dose escalation, as a means to improve local control, with concurrent chemotherapy has been shown to be feasible with three-dimensional conformal radiotherapy in early phase studies with good clinical outcome. However, the potential superiority of moderate dose escalation to 74 Gy has not been shown in phase III randomized studies. In this review, the limitations in target volume definition in previous studies; and the factors that may be critical to safe dose escalation in the treatment of locally advanced NSCLC, such as respiratory motion management, image guidance, intensity modulation, FDG-positron emission tomography incorporation in the treatment planning process, and adaptive radiotherapy, are discussed. These factors, along with novel treatment approaches that have emerged in recent years, are proposed to warrant further investigation in future trials in a more comprehensive and integrated fashion.
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Affiliation(s)
- Alexander Chi
- Department of Radiation Oncology, Mary Babb Randolph Cancer Center of West Virginia University , Morgantown, WV , USA
| | - Nam Phong Nguyen
- The International Geriatric Radiotherapy Group , Tucson, AZ , USA
| | - James S Welsh
- Northern Illinois University Institute for Neutron Therapy at Fermilab , Batavia, IL , USA
| | - William Tse
- Division of Hematology and Oncology, Mary Babb Randolph Cancer Center of West Virginia University , Morgantown, WV , USA
| | - Manish Monga
- Division of Hematology and Oncology, Mary Babb Randolph Cancer Center of West Virginia University , Morgantown, WV , USA
| | - Olusola Oduntan
- Thoracic Surgery, Mary Babb Randolph Cancer Center of West Virginia University , Morgantown, WV , USA
| | - Mohammed Almubarak
- Division of Hematology and Oncology, Mary Babb Randolph Cancer Center of West Virginia University , Morgantown, WV , USA
| | - John Rogers
- Division of Hematology and Oncology, Mary Babb Randolph Cancer Center of West Virginia University , Morgantown, WV , USA
| | - Scot C Remick
- Division of Hematology and Oncology, Mary Babb Randolph Cancer Center of West Virginia University , Morgantown, WV , USA
| | - David Gius
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University , Chicago, IL , USA
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18
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Nagaiah G, Curley BF, Truong QV, Khimani F, Provenzano AP, Wen S, Zinn Z, Kurian S, Auber ML, Almubarak M, Monga M, Remick SC. 1% topical pimecrolimus cream for the prevention of rash associated with the use of the EGFR antagonist cetuximab. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e17037] [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: 11/20/2022] Open
Affiliation(s)
| | - Brendan F. Curley
- Mary Babb Randolph Cancer Center at West Virginia University, Morgantown, WV
| | - Quoc Van Truong
- Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV
| | | | | | - Sijin Wen
- West Virginia University Health Science Center, Morgantown, WV
| | | | | | | | - Mohammed Almubarak
- Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV
| | - Manish Monga
- Mary Babb Randolph Cancer Center at West Virginia University, Morgantown, WV
| | - Scot C. Remick
- Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV
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19
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Sosa JA, Elisei R, Jarzab B, Balkissoon J, Lu SP, Bal C, Marur S, Gramza A, Yosef RB, Gitlitz B, Haugen BR, Ondrey F, Lu C, Karandikar SM, Khuri F, Licitra L, Remick SC. Randomized safety and efficacy study of fosbretabulin with paclitaxel/carboplatin against anaplastic thyroid carcinoma. Thyroid 2014; 24:232-40. [PMID: 23721245 DOI: 10.1089/thy.2013.0078] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Anaplastic thyroid cancer (ATC), a rare highly vascularized tumor, has a dismal outcome. We conducted an open-label study of doublet carboplatin/paclitaxel chemotherapy with or without fosbretabulin in patients with ATC. METHODS Patients were randomly assigned in a 2:1 ratio to 6 cycles of paclitaxel 200 mg/m(2) followed by carboplatin AUC 6 on day 1 every 3 weeks (CP), or these drugs were given on day 2 after fosbretabulin 60 mg/m(2) (CP/fosbretabulin) on days 1, 8 and 15. After 6 cycles, patients on the fosbretabulin arm without progression could continue to receive fosbretabulin on days 1 and 8 of a 3-week schedule until progression. The primary end point was overall survival (OS). RESULTS Eighty patients were assigned (planned, 180) when enrollment was stopped due to rarity of disease and very low accrual. Median OS was 5.2 months [95% confidence interval (CI) 3.1, 9.0] for the CP/fosbretabulin arm (n=55; hazard ratio 0.73 [95% CI 0.44, 1.21]) and 4.0 months [95% CI 2.8, 6.2] for the CP arm (n=25; p=0.22 [log rank test]). One-year survival for CP/fosbretabulin versus CP was 26% versus 9%, respectively. There was no significant difference in progression-free survival between the two arms. Grade 1-2 hypertension and grade 3-4 neutropenia were more common with CP/fosbretabulin. There were no significant adverse cardiovascular side effects. CONCLUSIONS Although the study did not meet statistical significance in improvement in OS with the addition of fosbretabulin to carboplatin/paclitaxel, it represents the largest prospective randomized trial ever conducted in ATC. The regimen is well tolerated, with AEs and deaths primarily related to ATC and disease progression.
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Affiliation(s)
- Julie A Sosa
- 1 Department of Surgery, Duke University School of Medicine , Durham, North Carolina
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20
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Korir A, Mauti N, Moats P, Gurka MJ, Mutuma G, Metheny C, Mwamba PM, Oyiro PO, Fisher M, Ayers LW, Rochford R, Mwanda WO, Remick SC. Developing clinical strength-of-evidence approach to define HIV-associated malignancies for cancer registration in Kenya. PLoS One 2014; 9:e85881. [PMID: 24465764 PMCID: PMC3900436 DOI: 10.1371/journal.pone.0085881] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 12/06/2013] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Sub-Saharan Africa cancer registries are beset by an increasing cancer burden further exacerbated by the AIDS epidemic where there are limited capabilities for cancer-AIDS match co-registration. We undertook a pilot study based on a "strength-of-evidence" approach using clinical data that is abstracted at the time of cancer registration for purposes of linking cancer diagnosis to AIDS diagnosis. METHODS/FINDINGS The standard Nairobi Cancer Registry form was modified for registrars to abstract the following clinical data from medical records regarding HIV infection/AIDS in a hierarchal approach at time of cancer registration from highest-to-lowest strength-of-evidence: 1) documentation of positive HIV serology; 2) antiretroviral drug prescription; 3) CD4+ lymphocyte count; and 4) WHO HIV clinical stage or immune suppression syndrome (ISS), which is Kenyan terminology for AIDS. Between August 1 and October 31, 2011 a total of 1,200 cancer cases were registered. Of these, 171 cases (14.3%) met clinical strength-of-evidence criteria for association with HIV infection/AIDS; 69% (118 cases were tumor types with known HIV association - Kaposi's sarcoma, cervical cancer, non-Hodgkin's and Hodgkin's lymphoma, and conjunctiva carcinoma) and 31% (53) were consistent with non-AIDS defining cancers. Verifiable positive HIV serology was identified in 47 (27%) cases for an absolute seroprevalence rate of 4% among the cancer registered cases with an upper boundary of 14% among those meeting at least one of strength-of-evidence criteria. CONCLUSIONS/SIGNIFICANCE This pilot demonstration of a hierarchal, clinical strength-of-evidence approach for cancer-AIDS registration in Kenya establishes feasibility, is readily adaptable, pragmatic, and does not require additional resources for critically under staffed cancer registries. Cancer is an emerging public health challenge, and African nations need to develop well designed population-based studies in order to better define the impact and spectrum of malignant disease in the backdrop of HIV infection.
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Affiliation(s)
- Anne Korir
- Kenya Medical Research Institute, Nairobi Cancer Registry, Nairobi, Kenya
- * E-mail: (AK); (SCR)
| | - Nathan Mauti
- Kenya Medical Research Institute, Nairobi Cancer Registry, Nairobi, Kenya
| | - Pamela Moats
- West Virginia University Hospitals, Health Information Management–Cancer Registry, Morgantown, West Virginia, United States of America
| | - Matthew J. Gurka
- Department of Biostatistics, West Virginia University School of Public Health, Morgantown, West Virginia, United States of America
| | - Geoffrey Mutuma
- Kenya Medical Research Institute, Nairobi Cancer Registry, Nairobi, Kenya
| | - Christine Metheny
- West Virginia University Hospitals, Health Information Management–Cancer Registry, Morgantown, West Virginia, United States of America
| | - Peter M. Mwamba
- University of Nairobi Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi College of Health Sciences, and Kenyatta National Hospital, Nairobi, Kenya
| | - Peter O. Oyiro
- University of Nairobi Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi College of Health Sciences, and Kenyatta National Hospital, Nairobi, Kenya
| | - Melanie Fisher
- Department of Medicine, Global Health Program (MF) and Mary Babb Randolph Cancer Center (SCR), West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Leona W. Ayers
- Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Rosemary Rochford
- Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, New York, United States of America
| | - Walter O. Mwanda
- University of Nairobi Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi College of Health Sciences, and Kenyatta National Hospital, Nairobi, Kenya
| | - Scot C. Remick
- Department of Medicine, Global Health Program (MF) and Mary Babb Randolph Cancer Center (SCR), West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- * E-mail: (AK); (SCR)
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21
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Yan BX, Ma JX, Zhang J, Guo Y, Mueller MD, Remick SC, Yu JJ. Prostasin may contribute to chemoresistance, repress cancer cells in ovarian cancer, and is involved in the signaling pathways of CASP/PAK2-p34/actin. Cell Death Dis 2014; 5:e995. [PMID: 24434518 PMCID: PMC4043260 DOI: 10.1038/cddis.2013.523] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 10/22/2013] [Revised: 11/18/2013] [Accepted: 11/20/2013] [Indexed: 02/07/2023]
Abstract
Ovarian cancer is the deadliest of gynecologic cancers, largely due to the development of drug resistance in chemotherapy. Prostasin may have an essential role in the oncogenesis. In this study, we show that prostasin is decreased in an ovarian cancer drug-resistant cell line and in ovarian cancer patients with high levels of excision repair cross-complementing 1, a marker for chemoresistance. Our cell cultural model investigation demonstrates prostasin has important roles in the development of drug resistance and cancer cell survival. Forced overexpression of prostasin in ovarian cancer cells greatly induces cell death (resulting in 99% cell death in a drug-resistant cell line and 100% cell death in other tested cell lines). In addition, the surviving cells grow at a much lower rate compared with non-overexpressed cells. In vivo studies indicate that forced overexpression of prostasin in drug-resistant cells greatly inhibits the growth of tumors and may partially reverse drug resistance. Our investigation of the molecular mechanisms suggests that prostasin may repress cancer cells and/or contribute to chemoresistance by modulating the CASP/P21-activated protein kinase (PAK2)-p34 pathway, and thereafter PAK2-p34/JNK/c-jun and PAK2-p34/mlck/actin signaling pathways. Thus, we introduce prostain as a potential target for treating/repressing some ovarian tumors and have begun to identify their relevant molecular targets in specific signaling pathways.
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Affiliation(s)
- B-x Yan
- 1] Department of Biochemistry, School of Medicine, Department of Basic Pharmaceutical Sciences, School of Pharmacy, and Mary Babb Randolph Cancer Center, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA [2] IcesnowYanyan Bioscience Association, Beijing 00094, China
| | - J-x Ma
- 1] Department of Biochemistry, School of Medicine, Department of Basic Pharmaceutical Sciences, School of Pharmacy, and Mary Babb Randolph Cancer Center, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA [2] Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - J Zhang
- 1] IcesnowYanyan Bioscience Association, Beijing 00094, China [2] Beijing Animal Science Institute, Beijing 00097, China
| | - Y Guo
- Department of Biochemistry, School of Medicine, Department of Basic Pharmaceutical Sciences, School of Pharmacy, and Mary Babb Randolph Cancer Center, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA
| | - M D Mueller
- Department of Biochemistry, School of Medicine, Department of Basic Pharmaceutical Sciences, School of Pharmacy, and Mary Babb Randolph Cancer Center, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA
| | - S C Remick
- Department of Biochemistry, School of Medicine, Department of Basic Pharmaceutical Sciences, School of Pharmacy, and Mary Babb Randolph Cancer Center, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA
| | - J J Yu
- Department of Biochemistry, School of Medicine, Department of Basic Pharmaceutical Sciences, School of Pharmacy, and Mary Babb Randolph Cancer Center, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA
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Yu JJ, Yang X, Song Q, Mueller MD, Remick SC. Dicycloplatin, a novel platinum analog in chemotherapy: synthesis of chinese pre-clinical and clinical profile and emerging mechanistic studies. Anticancer Res 2014; 34:455-463. [PMID: 24403501] [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: 06/03/2023]
Abstract
Dicycloplatin (DCP) has better solubility and stability than both cisplatin and carboplatin. Pre-clinical and phase I studies demonstrated significant antitumor activity and fewer adverse events than carboplatin. Phase II clinical trials in advanced non-small cell lung cancer found efficacy and safety of DCP-plus-paclitaxel comparable to carboplatin-plus-paclitaxel but better tolerability. This article summarizes and reviews pre-clinical and clinical data for dicycloplatin from the Chinese medical literature. We also report on new mechanistic findings in our laboratory in West Virginia, USA. Patient blood samples were collected for DCP-prototype determination by liquid chromatography mass spectrometry (LC-MS/MS). Molecular studies of ovarian cancer cells treated with DCP or cisplatin were carried out for gene-signature profiling using immunoblotting. Pharmacokinetic mass-spectrometry showed different spectrum profiles of DCP and carboplatin in plasma. Plasma concentration of DCP prototype was 17.1 μg/ml 2h after administration, with a peak concentration of 26.9 μg/ml at 0.5 h. Immunoblotting showed DCP-induced activation of DNA damage pathways, including double-phosphorylated checkpoint kinase 2 (CHK2) and breast cancer 1 (BRCA1) and triple-phosphorylated p53, compared to controls. Cisplatin produced a similar profile, with increased p53 protein. DCP and cisplatin activate DNA-damage response through similar pathways. DCP may be more soluble and stable, and better-tolerated.
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Affiliation(s)
- Jing Jie Yu
- MBRCC, West Virginia University, 2312 HSC, P.O. Box 9300, Morgantown, WV 26506-9300, U.S.A.
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23
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Hamadani M, Gibson LF, Remick SC, Wen S, Petros W, Tse W, Brundage KM, Vos JA, Cumpston A, Bunner P, Craig MD. Sibling donor and recipient immune modulation with atorvastatin for the prophylaxis of acute graft-versus-host disease. J Clin Oncol 2013; 31:4416-23. [PMID: 24166529 PMCID: PMC3842909 DOI: 10.1200/jco.2013.50.8747] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Graft-versus-host disease (GVHD) is major cause of morbidity and mortality after allogeneic hematopoietic cell transplantation (HCT). Atorvastatin is a potent immunomodulatory agent that holds promise as a novel and safe agent for acute GVHD prophylaxis. PATIENTS AND METHODS We conducted a phase II trial to evaluate the safety and efficacy of atorvastatin administration for GVHD prophylaxis in both adult donors and recipients of matched sibling allogeneic HCT. Atorvastatin (40 mg per day orally) was administered to sibling donors, starting 14 to 28 days before the anticipated first day of stem-cell collection. In HCT recipients (n = 30), GVHD prophylaxis consisted of tacrolimus, short-course methotrexate, and atorvastatin (40 mg per day orally). RESULTS Atorvastatin administration in healthy donors and recipients was not associated with any grade 3 to 4 adverse events. Cumulative incidence rates of grade 2 to 4 acute GVHD at days +100 and +180 were 3.3% (95% CI, 0.2% to 14.8%) and 11.1% (95% CI, 2.7% to 26.4%), respectively. One-year cumulative incidence of chronic GVHD was 52.3% (95% CI, 27.6% to 72.1%). Viral and fungal infections were infrequent. One-year cumulative incidences of nonrelapse mortality and relapse were 9.8% (95% CI, 1.4% to 28%) and 25.4% (95% CI, 10.9% to 42.9%), respectively. One-year overall survival and progression-free survival were 74% (95% CI, 58% to 96%) and 65% (95% CI, 48% to 87%), respectively. Compared with baseline, atorvastatin administration in sibling donors was associated with a trend toward increased mean plasma interleukin-10 concentrations (5.6 v 7.1 pg/mL; P = .06). CONCLUSION A novel two-pronged strategy of atorvastatin administration in both donors and recipients of matched sibling allogeneic HCT seems to be a feasible, safe, and potentially effective strategy to prevent acute GVHD.
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Affiliation(s)
| | | | | | - Sijin Wen
- All authors: West Virginia University, Morgantown, WV
| | | | - William Tse
- All authors: West Virginia University, Morgantown, WV
| | | | | | | | - Pamela Bunner
- All authors: West Virginia University, Morgantown, WV
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Basu SK, Remick SC, Monga M, Gibson LF. Breaking and entering into the CNS: clues from solid tumor and nonmalignant models with relevance to hematopoietic malignancies. Clin Exp Metastasis 2013; 31:257-67. [PMID: 24306183 DOI: 10.1007/s10585-013-9623-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 11/01/2013] [Indexed: 12/16/2022]
Abstract
Various malignancies invade the CNS sanctuary site, accounting for the vast majority of CNS neoplastic foci and contributing to significant morbidity as well as mortality. The blood-brain barrier (BBB) exhibits considerable impermeability to chemotherapeutic agents, severely limiting therapeutic options available for patients developing metastatic CNS involvement, accounting for poor outcomes. The mechanisms by which malignant cells breach the highly exclusive BBB and subsequently survive in this unique anatomical site remain poorly understood, with most of the current knowledge stemming from nonmalignant and solid malignancy models. While solid and hematologic malignancies may face different challenges once within the CNS (e.g., solid tumor parenchymal metastasis compared to masses/nodules/leptomeningeal disease in hematologic malignancies), commonality exists in the process of migrating across the BBB from the circulation. Specifically considering this last point, this review aims to survey the current mechanistic knowledge regarding malignant migration across the BBB, necessarily emphasizing the better studied solid tumor and nonmalignant models with the intention of highlighting both the current knowledge gap and additional work required to effectively consider how hematopoietic malignancies breach the CNS.
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Affiliation(s)
- Soumit K Basu
- Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program, Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV, USA,
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25
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Mwanda OW, Fu P, Collea R, Whalen C, Remick SC. Kaposi's sarcoma in patients with and without human immunodeficiency virus infection, in a tertiary referral centre in Kenya. Annals of Tropical Medicine & Parasitology 2013; 99:81-91. [PMID: 15701259 DOI: 10.1179/136485905x19928] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The clinical features of Kaposi's sarcoma (KS), in patients with and without HIV infection, were investigated in a tertiary referral centre in Kenya between 1997 and 1999. Although 186 cases were identified prospectively, the data analysis was restricted to the 91 (49%) cases who had pathological confirmation of Kaposi's sarcoma and documented HIV serostatus. Among these 91 subjects (58% of whom were male), the age-group holding the largest number of KS cases was that of individuals aged 31-40 years; most of the paediatric cases were aged 6-10 years. The ratio of HIV-seropositives to HIV-seronegatives was 8.5:1 for the adult cases and 0.9:1 for the paediatric. Of the signs and symptoms of Kaposi's sarcoma seen at presentation, only peripheral lympadenopathy was found to be significantly associated with underlying HIV infection (P = 0.05). The median survival was 104 days. It is apparent that, as the HIV epidemic advances in regions of the world with endemic KS, the clinical presentation and natural history of the endemic KS are blending with those of the epidemic or AIDS-associated disease, leading to a reduction in the mean age of the cases and a nearly identical incidence in men and women. In regions of the world where patients have ready access to such chemotherapy, the impact of treatment with highly active antiretroviral drugs on the incidence and natural history of KS has been dramatic. It will be important to monitor the clinico-pathological features of KS in the developing world, as more active antiretroviral regimens become available in clinical practice there.
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Affiliation(s)
- O W Mwanda
- Department of Haematology and Blood Transfusion, College of Health Sciences, University of Nairobi, Kenyatta National Hospital, P. O. Box 19676, Nairobi, Kenya.
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Barta SK, Xue X, Wang D, Tamari R, Lee JY, Mounier N, Kaplan LD, Ribera JM, Spina M, Tirelli U, Weiss R, Galicier L, Boue F, Wilson WH, Wyen C, Oriol A, Navarro JT, Dunleavy K, Little RF, Ratner L, Garcia O, Morgades M, Remick SC, Noy A, Sparano JA. Treatment factors affecting outcomes in HIV-associated non-Hodgkin lymphomas: a pooled analysis of 1546 patients. Blood 2013; 122:3251-62. [PMID: 24014242 PMCID: PMC3821722 DOI: 10.1182/blood-2013-04-498964] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 08/27/2013] [Indexed: 12/27/2022] Open
Abstract
Limited comparative data exist for the treatment of HIV-associated non-Hodgkin lymphoma. We analyzed pooled individual patient data for 1546 patients from 19 prospective clinical trials to assess treatment-specific factors (type of chemotherapy, rituximab, and concurrent combination antiretroviral [cART] use) and their influence on the outcomes complete response (CR), progression free survival (PFS), and overall survival (OS). In our analysis, rituximab was associated with a higher CR rate (odds ratio [OR] 2.89; P < .001), improved PFS (hazard ratio [HR] 0.50; P < .001), and OS (HR 0.51; P < .0001). Compared with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), initial therapy with more dose-intense regimens resulted in better CR rates (ACVBP [doxorubicin, cyclophosphamide, vindesine, bleomycin and prednisolone]: OR 1.70; P < .04), PFS (ACVBP: HR 0.72; P = .049; "intensive regimens": HR 0.35; P < .001) and OS ("intensive regimens": HR 0.54; P < .001). Infusional etoposide, prednisone, infusional vincristine, infusional doxorubicin, and cyclophosphamide (EPOCH) was associated with significantly better OS in diffuse large B-cell lymphoma (HR 0.33; P = .03). Concurrent use of cART was associated with improved CR rates (OR 1.89; P = .005) and trended toward improved OS (HR 0.78; P = .07). These findings provide supporting evidence for current patterns of care where definitive evidence is unavailable.
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MESH Headings
- Anti-HIV Agents/therapeutic use
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antiretroviral Therapy, Highly Active
- Clinical Trials as Topic
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Drug Administration Schedule
- Etoposide/therapeutic use
- HIV/drug effects
- HIV Infections/complications
- HIV Infections/drug therapy
- HIV Infections/mortality
- HIV Infections/virology
- Humans
- Infusions, Intravenous
- Lymphoma, AIDS-Related/complications
- Lymphoma, AIDS-Related/drug therapy
- Lymphoma, AIDS-Related/mortality
- Lymphoma, AIDS-Related/virology
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/mortality
- Lymphoma, Non-Hodgkin/virology
- Prednisone/therapeutic use
- Rituximab
- Survival Analysis
- Treatment Outcome
- Vincristine/therapeutic use
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Yan BX, Ma JX, Zhang J, Guo Y, Riedel H, Mueller MD, Remick SC, Yu JJ. PSP94 contributes to chemoresistance and its peptide derivative PCK3145 represses tumor growth in ovarian cancer. Oncogene 2013; 33:5288-94. [DOI: 10.1038/onc.2013.466] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 09/05/2013] [Accepted: 09/16/2013] [Indexed: 12/13/2022]
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Yu JJ, Yang X, Song Q, Mueller MD, Remick SC. Abstract B71: DNA damage responses to cisplatin and dicycloplatin, a new platinum analog. Mol Cancer Ther 2013. [DOI: 10.1158/1535-7163.targ-13-b71] [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
Background: Dicycloplatin (DCP), a new platinum compound approved by the Chinese FDA in March of 2012, shows better water solubility, greater stability, and lower toxicity, compared to cisplatin and carboplatin. Preclinical in vitro and in vivo studies and a Phase I clinical trial demonstrated that DCP possesses strong antitumor activity and lower adverse events than carboplatin. Phase II clinical trials using dicycloplatin plus paclitaxel in chemotherapy-naïve patients with advanced NSCLC found that efficacy and safety of DCP plus paclitaxel regimen were comparable to those of carboplatin plus paclitaxel regimen, with slightly better tolerance. Materials and Methods: Pharmacokinetic study of DCP characteristics was conducted using AP-4000TM LC-MS/MS System in patient blood samples. Molecular mechanism studies of dicycloplatin-induced gene-signature profiling were determined by Immunoblotting and compared to cisplatin profiling in human ovarian cancer cells. Results: Pharmacokinetic mass spectrometry shows different spectrums of dicycloplatin and of carboplatin in plasma. Two hours after administration, plasma concentration of dicycloplatin prototype is still high (17.1 μg/ml), following a peak concentration of 26.9 µg/ml at 0.5-h. Molecular mechanism investigation showed DCP-induced activation of several kinases including phosphorylations of Chk2 at threonine 68, p53 at serine 15 and BRCA1 at serine 1497. The increases in p-Chk2 and p-BRCA1 showed that the amount of DCP-induced phosphorylation doubled at 48-h and tripled for p-p53 at 24-h, compared to controls. Conclusion: Dicycloplatin appears to activate DNA damage-repair pathways through mechanisms similar to cisplatin.
Citation Information: Mol Cancer Ther 2013;12(11 Suppl):B71.
Citation Format: Jing Jie Yu, Xuqing Yang, Qinhua Song, Michael D. Mueller, Scot C. Remick. DNA damage responses to cisplatin and dicycloplatin, a new platinum analog. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr B71.
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Affiliation(s)
| | - Xuqing Yang
- 2Sopo-Xingda Pharmaceutical, Inc., Beijing, China
| | - Qinhua Song
- 3Sopo-Xingda Pharmaceutical, Inc., Jiang-Su, China
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Abstract
PURPOSE The National Cancer Institute estimates that less than 5% of adult patients with cancer participate in clinical trials. This statistic has to improve in order for clinical trials to be more accurate and generalizable. Several studies have looked into the barriers to accrual among various patient subgroups. However, there are scant data regarding factors that act as barriers to accrual of rural patients. Our study aims to identify these barriers. PATIENTS AND METHODS Among patients seen at the Mary Babb Randolph Cancer Center at West Virginia University, 1,000 were randomly selected to receive a questionnaire by mail. Data obtained consisted of demographic and clinical information, as well as awareness about clinical trials, willingness to participate, and factors influencing participation. Patients had 6 weeks to respond. RESULTS Two hundred forty-one (24.1%) patients responded to the survey. Of these, 66.9% had heard about clinical trials, 19.6% reported that their health care team had discussed clinical trials, and 9.1% had participated in clinical trials. Respondents were more likely to be willing to participate in cancer prevention/screening trials than therapeutic trials. Regarding the decision not to participate in a clinical trial, patients cited discouragement from their oncologist, monetary burden, discouragement from family physician, commute, and lack of information as strongly or extremely influential factors. CONCLUSION Our findings specify the need for patient and physician education through community outreach programs. Oncologists should be trained to discuss clinical trials and to address concerns regarding their availability, utility, and accessibility. Financial counseling may play an important role in improving accrual rates as well.
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Affiliation(s)
- Shamsuddin Virani
- Mary Babb Randolph Cancer Center, Department of Medicine and School of Medicine, West Virginia University
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Barta SK, Samuel M, Xue X, Lee JY, Mounier N, Kaplan LD, Ribera JM, Spina M, Tirelli U, Weiss R, Galicier L, Boue F, Wilson WH, Wyen C, Dunleavy K, Little RF, Remick SC, Goldfinger M, Noy A, Sparano JA. A pooled analysis of 1,546 patients with AIDS-related lymphoma (ARL): An assessment of prognostic factors by treatment era. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.8524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8524 Background: Management of ARL evolved in the last 2 decades. We previously reported prognostic factors in a pooled analysis of 1,546 patients with ARL, and here present analysis of these factors over time to determine if their prognostic significance has changed. Methods: Following a systematic review, we assembled individual patient data from 19 prospective phase 2/3 clinical trials (published 1993-2010) for ARL (n=1,546). Factors analyzed include age, sex, histology, CD4 count, prior history of (h/o) AIDS, & age-adjusted (aa) IPI. The endpoint was overall survival (OS) expressed as the hazard ratio (HR) for death. We used separate Cox proportional hazard models adjusted for the other covariates to determine the significance of each variable in the following time periods: pre-cART [combination antiretroviral therapy] (<1996; n=388), early cART (‘96-‘00; n=694), modern cART (‘01-‘04; n=282) & current era (‘05-‘10; n=182). We also combined all enrollments in one Cox model to test for difference in association with OS over enrollment periods. Results: Rituximab use was limited in the early cART (20%) compared with the modern cART (83%) and current (93%) eras. Histology & sex were not significantly associated with OS in any time period. Increasing age was associated with worse OS in the pre-cART (HR 1.02; p<0.01) and current (HR 1.05, p=0.04) eras. A prior h/o AIDS increased risk of death during early cART (HR 1.31, p=0.047) but was not significant after 2000. Meanwhile, baseline CD4 count <50 was a poor prognostic factor during early (HR 1.78, p<0.01) and modern cART (HR 2.76, p=0.001) eras, but not in the current era. The aaIPI predicted worse OS in each time period (pre-cART: HR 1.54, p<0.0001; early cART: HR 1.49, p<0.0001; modern cART: HR 1.52, p<0.01; current era: HR 2.34, p<0.0001). No significant interaction between each prognostic factor with enrollment was found. Conclusions: In this pooled analysis of 1,546 patients with ARL, aaIPI was the only consistently significant prognostic factor and its effect was magnified in the current era. HIV-related factors gained prognostic relevance in the early and modern cART era but may not be as relevant with current treatment strategies.
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Affiliation(s)
- Stefan K. Barta
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | | | - Xiaonan Xue
- Albert Einstein College of Medicine, Bronx, NY
| | - Jeanette Y. Lee
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | | | | | | | | | - Rudolf Weiss
- Private Practice for Hematology, Oncology, and Infectious Diseases, Bremen, Germany
| | - Lionel Galicier
- Hopital St Louis, Assistance Publique-Hopitaux de Paris, Paris, France
| | | | | | | | - Kieron Dunleavy
- Metabolism Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Scot C. Remick
- Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV
| | | | - Ariela Noy
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Joseph A. Sparano
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
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Savvides P, Nagaiah G, Lavertu P, Fu P, Wright JJ, Chapman R, Wasman J, Dowlati A, Remick SC. Phase II trial of sorafenib in patients with advanced anaplastic carcinoma of the thyroid. Thyroid 2013; 23:600-4. [PMID: 23113752 PMCID: PMC3643255 DOI: 10.1089/thy.2012.0103] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Anaplastic thyroid cancer (ATC) is a rare but highly aggressive malignancy with a median survival of 3-5 months. The BRAF oncogene is mutated to its active form in up to 24% of ATC cases. Sorafenib is a tyrosine kinase inhibitor that acts on the RAF-1 serine/threonine kinase. In preclinical mouse models, sorafenib inhibits the growth of ATC xenografts and improves survival. No study of sorafenib in ATC has been conducted. We conducted a multi-institutional phase II trial of sorafenib in patients with ATC who had failed up to two previous therapies. METHODS The primary endpoint of the trial was the Response Evaluation Criteria In Solid Tumors (RECIST)-defined imaging response rate. Twenty patients with ATC were treated with sorafenib 400 mg twice daily. RESULTS Two of the 20 patients had a partial response (10%) and an additional 5 of 20 (25%) had stable disease. The duration of response in the two responders was 10 and 27 months, respectively. For the patients with stable disease, the median duration was 4 months (range 3-11 months). The overall median progression-free survival was 1.9 months with a median and a 1-year survival of 3.9 months and 20%, respectively. Toxicity was manageable and as previously described for sorafenib, including hypertension and skin rash. CONCLUSION Sorafenib has activity in ATC, but at a low frequency and similar to our previous experience with fosbretabulin. One patient with a response had previously progressed on fosbretabulin. Toxicities were both predictable and manageable.
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Affiliation(s)
- Panayiotis Savvides
- Division of Hematology/Oncology, Seidman Cancer Center, University Hospitals, Cleveland, Ohio
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Govardhanan Nagaiah
- Division of Hematology/Oncology, Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, West Virginia
| | - Pierre Lavertu
- Division of Hematology/Oncology, Seidman Cancer Center, University Hospitals, Cleveland, Ohio
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Pingfu Fu
- Division of Hematology/Oncology, Seidman Cancer Center, University Hospitals, Cleveland, Ohio
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - John J. Wright
- Cancer Therapy and Evaluation Program, National Cancer Institute, Bethesda, Maryland
| | - Robert Chapman
- Division of Hematology/Oncology, Henry Ford Hospital Health System, Detroit, Michigan
| | - Jay Wasman
- Division of Hematology/Oncology, Seidman Cancer Center, University Hospitals, Cleveland, Ohio
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Afshin Dowlati
- Division of Hematology/Oncology, Seidman Cancer Center, University Hospitals, Cleveland, Ohio
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Scot C. Remick
- Division of Hematology/Oncology, Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, West Virginia
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Hamadani M, Gibson LF, Remick SC, Petros W, Abraham J, Basu S, Tse W, Cumpston A, Bunner P, Craig M. Prospective Evaluation of A ‘Two-Pronged’ Strategy of Atorvastatin Administration As Acute Graft-Versus-Host Disease (aGVHD) Prophylaxis, to Both Donors and Recipients of Matched Related Donor (MRD) Allogeneic Hematopoietic Cell Transplantation (alloHCT). Biol Blood Marrow Transplant 2013. [DOI: 10.1016/j.bbmt.2012.11.077] [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: 10/27/2022]
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Apisarnthanarax N, Wood GS, Stevens SR, Carlson S, Chan DV, Liu L, Szabo SK, Fu P, Gilliam AC, Gerson SL, Remick SC, Cooper KD. Phase I clinical trial of O6-benzylguanine and topical carmustine in the treatment of cutaneous T-cell lymphoma, mycosis fungoides type. ACTA ACUST UNITED AC 2012; 148:613-20. [PMID: 22250189 DOI: 10.1001/archdermatol.2011.2797] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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
OBJECTIVES To evaluate the toxic effects and maximum tolerated dose of topical carmustine [1,3-bis(2-chloroethyl)-1-nitrosourea] following intravenous O6-benzylguanine in the treatment of cutaneous T-cell lymphoma (CTCL), and to determine pharmacodynamics of O6-alkylguanine DNA alkyltransferase activity in treated CTCL lesions. DESIGN Open-label, dose-escalation, phase I trial. SETTING Dermatology outpatient clinic and clinical research unit at a university teaching hospital. PATIENTS A total of 21 adult patients (11 male, 10 female)with early-stage (IA-IIA) refractory CTCL, mycosis fungoides type, treated with topical carmustine following intravenous O6-benzylguanine. INTERVENTION Treatment once every 2 weeks with 120 mg/m(2) intravenous O6-benzylguanine followed 1 hour later by whole-body, low-dose topical carmustine starting at 10 mg, with 10-mg incremental dose-escalation in 3 patient cohorts. Cutaneous T-cell lymphoma lesional skin biopsy specimens were taken at baseline and 6 hours, 24 hours, and 1 week after the first O6-benzylguanine infusion for analysis of O6-alkylguanine-DNA alkyltransferase activity. MAIN OUTCOME MEASURES Clinical response measured by physical examination and severity-weighted assessment tool measurements, safety data acquired by review of adverse events at study visits, and O6-alkylguanine-DNA alkyltransferase activity in treated lesion skin biopsy specimens. RESULTS A minimal toxic effect was observed through the 40-mg carmustine dose level with 76% of adverse events being grade 1 based on the National Cancer Institute Common Terminology Criteria for Adverse Events. Mean baseline O6-alkylguanine-DNA alkyltransferase activity in CTCL lesions was 3 times greater than in normal controls and was diminished by a median of 100% at 6 and 24 hours following O6-benzylguanine with recovery at 1 week. Clinical disease reduction correlated positively with O6-alkylguanine-DNA alkyltransferase activity at 168 hours (P=.02) and inversely with area under the curve of O6-alkylguanine-DNA alkyltransferase over 1 week (P=.01). Twelve partial responses and 4 complete responses were observed (overall response, 76% [95% CI, 0.55-0.89]). Five patients discontinued therapy owing to adverse events with a possible, probable, or definite relationship to the study drug. CONCLUSION O6-benzylguanine significantly depletes O6-alkylguanine-DNA alkyltransferase in CTCL lesions and in combination with topical carmustine is well tolerated and shows meaningful clinical responses in CTCL at markedly reduced total carmustine treatment doses.
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Bhanegaonkar A, Madhavan SS, Khanna R, Remick SC. Declining mammography screening in a state Medicaid Fee-for-Service program: 1999-2008. J Womens Health (Larchmt) 2012; 21:821-9. [PMID: 22568434 PMCID: PMC3411332 DOI: 10.1089/jwh.2011.2748] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To evaluate and compare annual and biennial mammography screening rates across age, race, and geographic location (rural-urban) and to determine mammography screening persistence over 10 years among women enrolled in the West Virginia (WV) Medicaid Fee-for-Service (FFS) program. METHODS The WV Medicaid FFS administrative claims data for women recipients aged 40-64 from 1999 to 2008 were used for study purposes. Annual and biennial screening rates and persistence with screening were determined for women who were continuously enrolled in the WV Medicaid FFS program for respective calendar years. RESULTS A steady decline in the annual and biennial screening rates over a 10-year period (1999-2008) was observed among women recipients aged 40-64 years in the WV Medicaid FFS program, and screening persistence was also lower. Both annual and biennial screening rates and persistence varied by different demographic characteristics. CONCLUSIONS Although mammography screening services are covered under Medicaid programs, underuse persists as a major concern. The results of this study emphasize the need to identify and address barriers to mammography screening in low-income rural populations.
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Affiliation(s)
- Abhijeet Bhanegaonkar
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia 26506, USA.
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Fu P, Hughes J, Zeng G, Hanook S, Orem J, Mwanda OW, Remick SC. A comparative investigation of methods for longitudinal data with limits of detection through a case study. Stat Methods Med Res 2012; 25:153-66. [PMID: 22504231 DOI: 10.1177/0962280212444800] [Citation(s) in RCA: 9] [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] [Indexed: 11/15/2022]
Abstract
The statistical analysis of continuous longitudinal data may be complicated since quantitative levels of bioassay cannot always be determined. Values beyond the limits of detection (LOD) in the assays may not be observed and thus censored, rendering complexity to the analysis of such data. This article examines how both left-censoring and right censoring of HIV-1 plasma RNA measurements, collected for the study on AIDS-related Non-Hodgkin’s lymphoma (AR-NHL) in East Africa, affects the quantification of viral load and explores the natural history of viral load measurements over time in AR-NHL patients receiving anticancer chemotherapy. Data analyses using Monte Carlo EM algorithm (MCEM) are compared to analyses where the LOD or LOD/2 (left censoring) value is substituted for the censored observations, and also to other methods such as multiple imputation, and maximum likelihood estimation for censored data (generalized Tobit regression). Simulations are used to explore the sensitivity of the results to changes in the model parameters. In conclusion, the antiretroviral treatment was associated with a significant decrease in viral load after controlling the effects of other covariates. A simulation study with finite sample size shows MCEM is the least biased method and the estimates are least sensitive to the censoring mechanism.
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Affiliation(s)
- P Fu
- Case Western Reserve University School of Medicine, Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - J Hughes
- University of Washington, School of Public health, Seattle, Washington, USA
| | - G Zeng
- Texas A&M University Corpus Christi, College of Education, Corpus Christi, Texas, USA
| | - S Hanook
- Case Western Reserve University School of Medicine, Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - J Orem
- Makerere University School of Medicine and Uganda Cancer Institute, Kampala, Uganda
| | - OW Mwanda
- University of Nairobi College of Health Sciences and Kenyatta National Hospital, Nairobi, Kenya
| | - SC Remick
- West Virginia University, School of Medicine, Mary Babb Randolph Cancer Center, Morgantown, West Virginia, USA
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Mwamba PM, Mwanda WO, Busakhala N, Strother RM, Loehrer PJ, Remick SC. AIDS-Related Non-Hodgkin's Lymphoma in Sub-Saharan Africa: Current Status and Realities of Therapeutic Approach. Lymphoma 2012; 2012:10.1155/2012/904367. [PMID: 24205439 PMCID: PMC3817848 DOI: 10.1155/2012/904367] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Today AIDS-related non-Hodgkin's lymphoma (AR-NHL) is a significant cause of morbidity and mortality in HIV-infected patients the world over, and especially in sub-Saharan Africa. While the overall incidence of AR-NHL since the emergence of combination antiretroviral therapy (cART) era has declined, the occurrence of this disease appears to have stabilized. In regions of the world where access to cART is challenging, the impact on disease incidence is less clear. In the resource-rich environment it is clinically well recognized that it is no longer appropriate to consider AR-NHL as a single disease entity and rather treatment of AIDS lymphoma needs to be tailored to lymphoma subtype. While intensive therapeutic strategies in the resource-rich world are clearly improving outcome, in AIDS epicenters of the world and especially in sub-Saharan Africa there is a paucity of data on treatment and outcomes. In fact, only one prospective study of dose-modified oral chemotherapy and limited retrospective studies with sufficient details provide a window into the natural history and clinical management of this disease. The scarcities and challenges of treatment in this setting provide a backdrop to review the current status and realities of the therapeutic approach to AR-NHL in sub-Saharan Africa. More pragmatic and risk-adapted therapeutic approaches are needed.
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Affiliation(s)
- Peter M. Mwamba
- Section Haematology and Blood Transfusion, Department of Human Pathology University of Nairobi College of Health Sciences Nairobi, Kenya
| | - Walter O. Mwanda
- Section Haematology and Blood Transfusion, Department of Human Pathology University of Nairobi College of Health Sciences Nairobi, Kenya
| | - NaftaliW. Busakhala
- Departments of Oncology and Pharmacology Moi University School of Medicine Eldoret, Kenya
| | | | - Patrick J. Loehrer
- Melvin and Bren Simon Cancer Center Indiana University, Indianapolis, IN, USA
| | - Scot C. Remick
- Mary Babb Randolph Cancer Center West Virginia University, Morgantown, WV, USA
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Guo Y, Fu P, Zhu H, Reed E, Remick SC, Petros W, Mueller MD, Yu JJ. Correlations among ERCC1, XPB, UBE2I, EGF, TAL2 and ILF3 revealed by gene signatures of histological subtypes of patients with epithelial ovarian cancer. Oncol Rep 2011; 27:286-92. [PMID: 21971700 DOI: 10.3892/or.2011.1483] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 09/12/2011] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to better understand the mechanisms of tumor development and disease progression in human epithelial ovarian cancer. Fifty genes were screened for gene signature; 20 expressed genes were assessed in tumor and normal samples of EOC patients by RT-PCR. Expression of UBE2I, EGF, TAL2 and ILF3 was validated by qPCR on the ABI Prism 7000 Detection System. ERCC1 and XPB expression was previously determined by RT-PCR in these specimens. Statistical analyses include two-sided Kruskal-Wallis test, pairwise comparison, Pearson correlation coefficient and paired t-test. In comparison to normal samples, 6 genes demonstrated distinct expression patterns in tumor tissues, with high expression observed for ERCC1, XPB and ILF3 (p=0.001, 0.0007 and 0.002, respectively) and low expression observed for TAL2 and EGF (both p<0.0001). This differential expression pattern between normal and tumor tissues may reflect in part the development of ovarian cancer. Significant differences in expression patterns of these genes in clear cell, endometrioid, mucinous and serous ovarian cancer were observed. Comparison of expression of any two EOC subtypes revealed multiple gene involvement in histopathological differentiation and cancer progression. A positive association was found between ERCC1 and XPB expression (r=0.53, p<0.0001) and between TAL2 and EGF expression (r=0.817, p<0.0001) suggesting the existence of gene linkage in these tumors. The differences in expression patterns of studied genes between tumors and normal specimens, between histological subtypes and correlations among studied genes, may indicate their involvement in tumor growth and disease progression in human epithelial ovarian cancer. Further investigation of these genes may enable better understanding of the molecular mechanism of tumorigenesis and identification of potential biomarkers.
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Affiliation(s)
- Yi Guo
- Mary Babb Randolph Cancer Center, Department of Biochemistry, School of Medicine, West Virginia University, Morgantown, WV, USA
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Kinsella TJ, Baron ED, Colussi VC, Cooper KD, Hoppel CL, Ingalls ST, Kenney ME, Li X, Oleinick NL, Stevens SR, Remick SC. Preliminary clinical and pharmacologic investigation of photodynamic therapy with the silicon phthalocyanine photosensitizer pc 4 for primary or metastatic cutaneous cancers. Front Oncol 2011; 1:14. [PMID: 22649754 PMCID: PMC3355859 DOI: 10.3389/fonc.2011.00014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 06/19/2011] [Indexed: 01/08/2023] Open
Abstract
Photodynamic therapy (PDT) for cutaneous malignancies has been found to be an effective treatment with a range of photosensitizers. The phthalocyanine Pc 4 was developed initially for PDT of primary or metastatic cancers in the skin. A Phase I trial was initiated to evaluate the safety and pharmacokinetic profiles of systemically administered Pc 4 followed by red light (Pc 4-PDT) in cutaneous malignancies. A dose-escalation study of Pc 4 (starting dose 0.135 mg/m(2)) at a fixed light fluence (135 J/cm(2) of 675-nm light) was initiated in patients with primary or metastatic cutaneous malignancies with the aim of establishing the maximum tolerated dose (MTD). Blood samples were taken at intervals over the first 60 h post-PDT for pharmacokinetic analysis, and patients were evaluated for toxicity and tumor response. A total of three patients (two females with breast cancer and one male with cutaneous T-cell lymphoma) were enrolled and treated over the dose range of 0.135 mg/m(2) (first dose level) to 0.54 mg/m(2) (third dose level). Grade 3 erythema within the photoirradiated area was induced in patient 2, and transient tumor regression in patient 3, in spite of the low photosensitizer doses. Pharmacokinetic observations fit a three-compartment exponential elimination model with an initial rapid distribution phase (∼0.2 h) and relatively long terminal elimination phase (∼28 h), Because of restrictive exclusion criteria and resultant poor accrual, the trial was closed before MTD could be reached. While the limited accrual to this initial Phase I study did not establish the MTD nor establish a complete pharmacokinetic and safety profile of intravenous Pc 4-PDT, these preliminary data support further Phase I testing of this new photosensitizer.
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Affiliation(s)
- Timothy James Kinsella
- Department of Radiation Oncology, University Hospitals Case Medical CenterCleveland, OH, USA
- Case Comprehensive Cancer Center, Case Western Reserve UniversityCleveland, OH, USA
| | - Elma D. Baron
- Case Comprehensive Cancer Center, Case Western Reserve UniversityCleveland, OH, USA
- Department of Dermatology, Case Western Reserve UniversityCleveland, OH, USA
- Department of Dermatology, University Hospitals Case Medical CenterCleveland, OH, USA
- Dermatology Service, Louis Stokes Cleveland Department of Veterans Affairs Medical CenterCleveland, OH, USA
| | - Valdir C. Colussi
- Department of Radiation Oncology, University Hospitals Case Medical CenterCleveland, OH, USA
| | - Kevin D. Cooper
- Case Comprehensive Cancer Center, Case Western Reserve UniversityCleveland, OH, USA
- Department of Dermatology, Case Western Reserve UniversityCleveland, OH, USA
- Department of Dermatology, University Hospitals Case Medical CenterCleveland, OH, USA
- Dermatology Service, Louis Stokes Cleveland Department of Veterans Affairs Medical CenterCleveland, OH, USA
| | - Charles L. Hoppel
- Case Comprehensive Cancer Center, Case Western Reserve UniversityCleveland, OH, USA
- Department of Pharmacology, Case Western Reserve UniversityCleveland, OH, USA
| | - Stephen T. Ingalls
- Department of Pharmacology, Case Western Reserve UniversityCleveland, OH, USA
| | - Malcolm E. Kenney
- Department of Chemistry, Case Western Reserve UniversityCleveland, OH, USA
| | - Xiaolin Li
- Department of Pharmacology, Case Western Reserve UniversityCleveland, OH, USA
| | - Nancy L. Oleinick
- Case Comprehensive Cancer Center, Case Western Reserve UniversityCleveland, OH, USA
- Department of Radiation Oncology, Case Western Reserve UniversityCleveland, OH, USA
| | - Seth R. Stevens
- Case Comprehensive Cancer Center, Case Western Reserve UniversityCleveland, OH, USA
- Department of Dermatology, Case Western Reserve UniversityCleveland, OH, USA
- Department of Dermatology, University Hospitals Case Medical CenterCleveland, OH, USA
- Dermatology Service, Louis Stokes Cleveland Department of Veterans Affairs Medical CenterCleveland, OH, USA
| | - Scot C. Remick
- Department of Medicine, University Hospitals Case Medical CenterCleveland, OH, USA
- Department of Medicine, Case Western Reserve UniversityCleveland, OH, USA
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Hamadani M, Craig MD, Gibson LF, Remick SC. The evolving role of statins in hematopoietic stem and progenitor cell transplantation. Am J Blood Res 2011; 1:57-64. [PMID: 22432066 PMCID: PMC3301410] [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] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 05/27/2011] [Indexed: 05/31/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation is the sole curative modality for a variety of malignant and benign hematological disorders. Despite advances in supportive care and transplant conditioning regimens graft-versus-host disease (GVHD), infectious complications and end organ toxicity remain the leading causes of transplant related mortality (TRM). Development of safe and effective strategies to mitigate these significant complications associated with HSCT, are urgently needed. Statins are lipid lowering drugs, which reduce cholesterol production by inhibiting HMG-CoA reductase, with a well defined toxicity profile. Statins have pleiotropic immunomodulatory effects which are relevant in the context of treating and preventing GVHD. In addition to GVHD statins may possess several other effects that might have clinical benefit in the setting of hematopoietic cell transplantation, such as treatment of bronchiolitis obliterans and antineoplastic activity. Herein we review the emerging role of statins in improving the outcomes of patients undergoing HSCT.
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Affiliation(s)
- Mehdi Hamadani
- Osborn Hematopoietic Malignancy and Transplantation Program, MBRCC, West Virginia University Morgantown, WV, USA
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Hossain A, Chen A, Ivy P, Lenihan DJ, Kaltman J, Taddei-Peters W, Remick SC. The importance of clinical grading of heart failure and other cardiac toxicities during chemotherapy: updating the common terminology criteria for clinical trial reporting. Heart Fail Clin 2011; 7:373-84. [PMID: 21749889 DOI: 10.1016/j.hfc.2011.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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: 11/27/2022]
Abstract
Although the use of chemotherapy and targeted therapy has improved the clinical benefit, progression-free survival, and overall survival of various cancers in recent years, old and new toxicities have limited their use. To balance the risk with the benefit of treatment, Common Toxicity Criteria and now Common Terminology Criteria for Adverse Events (CTCAE) have been used by the oncology community for more than 20 years to assess toxicity from cancer treatment. This article details the description and grading of cardiac toxicities reported in association with cancer treatment and the use of CTCAE to assess them.
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Affiliation(s)
- Akm Hossain
- Departments of Medicine, Hematology and Oncology, Ellis Fischel Cancer Center, University of Missouri, 15 Business Loop 70 West, DC 116.71 Columbia, MO 65203, USA
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Leal TB, Remick SC, Takimoto CH, Ramanathan RK, Davies A, Egorin MJ, Hamilton A, LoRusso PA, Shibata S, Lenz HJ, Mier J, Sarantopoulos J, Mani S, Wright JJ, Ivy SP, Neuwirth R, von Moltke L, Venkatakrishnan K, Mulkerin D. Dose-escalating and pharmacological study of bortezomib in adult cancer patients with impaired renal function: a National Cancer Institute Organ Dysfunction Working Group Study. Cancer Chemother Pharmacol 2011; 68:1439-47. [PMID: 21479634 DOI: 10.1007/s00280-011-1637-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 03/17/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the toxicities, pharmacokinetics, pharmacodynamics, and maximum tolerated dose of bortezomib in patients with renal impairment and to develop dosing guidelines for such a patient population. PATIENTS AND METHODS Sixty-two adult cancer patients received intravenous bortezomib at 0.7-1.5 mg/m(2) on days 1, 4, 8, and 11 every 3 weeks. Patients were stratified by 24-h creatinine clearance (CrCl) normalized to body surface area (BSA) 1.73 m(2) into five cohorts: normal renal function (≥ 60 ml/min/1.73 m(2)); mild dysfunction (40-59 ml/min/1.73 m(2)); moderate dysfunction (20-39 ml/min/1.73 m(2)); severe dysfunction (<20 ml/min/1.73 m(2)); and dialysis. Dose escalation was planned for the four cohorts with renal dysfunction. Plasma bortezomib concentrations and blood 20S proteasome inhibition were assayed. RESULTS Bortezomib escalation to the standard 1.3 mg/m(2) dose was well tolerated in all patients with CrCl ≥ 20 ml/min/1.73 m(2); 0.7 mg/m(2) was tolerated in three patients with severe renal dysfunction (<20 ml/min/1.73 m(2)). Bortezomib dose escalation was well tolerated in nine dialysis patients, including to 1.3 mg/m(2) in four patients. Decreased CrCl did not affect bortezomib pharmacokinetics or pharmacodynamics. Bortezomib-related side-effects were neither more common nor severe in patients with renal dysfunction versus those with normal renal function. CONCLUSION Bortezomib 1.3 mg/m(2) is well tolerated, and dose reductions are not necessary in patients with renal dysfunction. Extrapolation from clinical and pharmacologic data suggests patients with severe renal dysfunction, including dialysis patients, can receive bortezomib at the full dose established to be clinically effective in the general patient population.
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Affiliation(s)
- Ticiana B Leal
- University of Wisconsin Carbone Cancer Center, 600 Highland Ave, Madison, WI 53792, USA
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Khanna R, Madhavan SS, Bhanegaonkar A, Remick SC. Prevalence, healthcare utilization, and costs of breast cancer in a state Medicaid fee-for-service program. J Womens Health (Larchmt) 2011; 20:739-47. [PMID: 21417935 DOI: 10.1089/jwh.2010.2298] [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] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence, medical services and treatment utilization, and costs associated with breast cancer in a socioeconomically underprivileged population covered by a state Medicaid fee-for-service (FFS) program. METHODS We analyzed the West Virginia (WV) Medicaid FFS administrative claims data for women recipients 21-64 years of age enrolled continuously in the program during the calendar year 2005. Breast cancer-related medical services and treatment use and costs were calculated for women recipients with breast cancer. The excess burden of breast cancer was calculated by comparing the all-cause healthcare utilization and costs among women recipients with breast cancer to a matched control group of women recipients without breast cancer. Healthcare costs incurred during the 1-year study period were calculated from the perspective of state Medicaid. Cost estimates in the study excluded out-of-pocket expenses and indirect costs of breast cancer. RESULTS In 2005, the prevalence of breast cancer in the WV Medicaid FFS program was 22.7/1000. More than 98% of breast cancer-related medical services utilization occurred in the office setting. Approximately 73% of women recipients with breast cancer had at least one claim for breast cancer treatment, with hormone therapy being the most common (55.1%) treatment. The all-cause healthcare costs were significantly higher for women recipients with breast cancer compared to those without breast cancer ($16,345 vs. $13,027, p<0.001). CONCLUSIONS Consistent with our expectations, breast cancer diagnosis among women recipients in the WV Medicaid FFS program was found to be associated with higher all-cause healthcare use and costs compared to women recipients in the matched control group. The excess cost burden associated with breast cancer could be attributed to higher office visit, emergency room visit, and prescription medication use among recipients with breast cancer.
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Affiliation(s)
- Rahul Khanna
- Department of Pharmacy Administration, The University of Mississippi, University, MS 38677, USA.
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Hamadani M, Craig M, Phillips GS, Abraham J, Tse W, Cumpston A, Gibson L, Remick SC, Bunner P, Leadmon S, Elder P, Hofmeister C, Penza S, Efebera Y, Andritsos L, Garzon R, Benson DM, Blum W, Devine SM. Higher busulfan dose intensity does not improve outcomes of patients undergoing allogeneic haematopoietic cell transplantation following fludarabine, busulfan-based reduced toxicity conditioning. Hematol Oncol 2011; 29:202-10. [PMID: 21360728 DOI: 10.1002/hon.985] [Citation(s) in RCA: 12] [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] [Received: 01/24/2011] [Accepted: 01/30/2011] [Indexed: 01/02/2023]
Abstract
We evaluated the impact of busulfan dose intensity in patients undergoing reduced toxicity/intensity conditioning allogeneic transplantation in a multicenter retrospective study of 112 consecutive patients. Seventy-five patients were conditioned with busulfan (0.8 mg/kg/dose IV × 8 doses), fludarabine (30 mg/m(2) /day, days -7 to -3), and 6 mg/kg of ATG [reduced intensity conditioning (RIC) group], while 37 patients received a more-intense conditioning with busulfan (130 mg/m(2) /day IV, days -6 to -3), fludarabine (40 mg/m(2) /day, days -6 to -3) and 6 mg/kg of ATG [reduced toxicity conditioning (RTC) group]. At baseline both groups were matched for median age, unrelated donor allografts, and human leukocyte antigen-mismatched allografts. More patients in RIC group had high-risk disease, and higher median comorbidity index. There were no graft rejections. Median time to neutrophil (17 days vs. 15 days; p = 0.003) and platelet engraftment (16 days vs. 11 days; p < 0.001) was significantly longer in the RIC group. RTC group had significantly more bacterial (62.2% vs. 32%; p = 0.004) and fungal infections (13.5% vs. 1.3% p = 0.01). For RIC and RTC groups rates of grades II-IV acute GVHD (34% vs. 40%; p-value = 0.54), and chronic GVHD (45% vs. 57%; p-value = 0.30) were not significantly different. In similar order at 1 year the cumulative-incidence of non-relapse mortality (NRM; 12% vs. 21%; p-value = 0.21) and relapse rates (38% vs. 39%; p = 0.96) were not significantly different. Patients in RIC and RTC groups had similar 1-year overall survival (61% vs. 50%, p = 0.11) and progression-free survival (50% vs. 36%, p-value = 0.39). Our data suggest that the merits of higher busulfan dose intensity in the context of fludarabine/busulfan-based RTC may be offset by higher early morbidity.
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Affiliation(s)
- Mehdi Hamadani
- Osborn Hematopoietic Malignancy and Transplantation Program, MBRCC, West Virginia University, Morgantown, USA.
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Awan FT, Osman S, Kochuparambil ST, Gibson L, Remick SC, Abraham J, Craig M, Jillella A, Hamadani M. Impact of response to thalidomide-, lenalidomide- or bortezomib- containing induction therapy on the outcomes of multiple myeloma patients undergoing autologous transplantation. Bone Marrow Transplant 2011; 47:146-8. [DOI: 10.1038/bmt.2011.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Putila J, Remick SC, Guo NL. Combining clinical, pathological, and demographic factors refines prognosis of lung cancer: a population-based study. PLoS One 2011; 6:e17493. [PMID: 21364765 PMCID: PMC3045456 DOI: 10.1371/journal.pone.0017493] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 02/07/2011] [Indexed: 11/18/2022] Open
Abstract
Background In the treatment of lung cancer, an accurate estimation of patient clinical outcome is essential for choosing an appropriate course of therapy. It is important to develop a prognostic stratification model which combines clinical, pathological and demographic factors for individualized clinical decision making. Methodology/Principal Findings A total of 234,412 patients diagnosed with adenocarcinomas or squamous cell carcinomas of the lung or bronchus between 1988 and 2006 were retrieved from the SEER database to construct a prognostic model. A model was developed by estimating a Cox proportional hazards model on 500 bootstrapped samples. Two models, one using stage alone and another comprehensive model using additional covariates, were constructed. The comprehensive model consistently outperformed the model using stage alone in prognostic stratification and on Harrell's C, Nagelkerke's R2, and Brier Scores in the whole patient population as well as in specific treatment modalities. Specifically, the comprehensive model generated different prognostic groups with distinct post-operative survival (log-rank P<0.001) within surgical stage IA and IB patients in Kaplan-Meier analyses. Two additional patient cohorts (n = 1,991) were used as an external validation, with the comprehensive model again outperforming the model using stage alone with regards to prognostic stratification and the three evaluated metrics. Conclusion/Significance These results demonstrate the feasibility of constructing a precise prognostic model combining multiple clinical, pathologic, and demographic factors. The comprehensive model significantly improves individualized prognosis upon AJCC tumor staging and is robust across a range of treatment modalities, the spectrum of patient risk, and in novel patient cohorts.
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Affiliation(s)
- Joseph Putila
- Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, West Virginia, United States of America
- Department of Community Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - Scot C. Remick
- Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, West Virginia, United States of America
- Department of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - Nancy Lan Guo
- Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, West Virginia, United States of America
- Department of Community Medicine, West Virginia University, Morgantown, West Virginia, United States of America
- * E-mail:
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Ricart AD, Ashton EA, Cooney MM, Sarantopoulos J, Brell JM, Feldman MA, Ruby KE, Matsuda K, Munsey MS, Medina G, Zambito A, Tolcher AW, Remick SC. A phase I study of MN-029 (denibulin), a novel vascular-disrupting agent, in patients with advanced solid tumors. Cancer Chemother Pharmacol 2011; 68:959-70. [DOI: 10.1007/s00280-011-1565-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 01/16/2011] [Indexed: 10/18/2022]
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Remick SC, Yu JJ, Fu P, Pink JJ, Dawson D, Wasman J, Orem J, Mwanda WO, Guo Y, Liang X, Petros WP, Mitsuyasu RT, Wabinga H. HPV genotype and EGFR activation in conjunctival carcinoma among HIV patients in East Africa. Infect Agent Cancer 2010. [PMCID: PMC3002694 DOI: 10.1186/1750-9378-5-s1-a35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
Combretastatin A4 phosphate (CA4P) is the lead compound of a relatively new class of agents termed vascular disrupting agents that target existing tumor blood vessels. Rapid tumor blood flow shutdown has been demonstrated in preclinical models and patients by various techniques such as dynamic contrast-enhanced MRI, perfusion computed tomography and PET scans following CA4P infusion. CA4P typically induces rapid tumor necrosis in the center of the tumor and leaves a rim of viable cells in the periphery. In oncology, CA4P does not appear to be that active by itself, but may be more efficacious when combined with chemotherapy, antiangiogenic therapy and radiation therapy. Studies are currently underway, which combine CA4P with antiangiogenic agents. Side effects have included hypertension, tumor pain and occasional cardiovascular toxicity, without any significant myelosuppression or disabling systemic symptoms. The utility of CA4P for conditions other than cancer, which involves neovascularization such as macular degeneration, is also being explored.
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Affiliation(s)
- Govardhanan Nagaiah
- Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, 1801 Health Sciences South, PO Box 9300, Morgantown, WV 26506, USA
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Bhakta S, Flick SM, Cooney MM, Greskovich JF, Gilkeson RC, Remick SC, Ortiz J. Myocardial stunning following combined modality combretastatin-based chemotherapy: two case reports and review of the literature. Clin Cardiol 2010; 32:E80-4. [PMID: 20014213 DOI: 10.1002/clc.20685] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Myocardial stunning, known as stress cardiomyopathy, broken-heart syndrome, transient left ventricular apical ballooning, and Takotsubo cardiomyopathy, has been reported after many extracardiac stressors, but not following chemotherapy. We report 2 cases with characteristic electrocardiographic and echocardiographic features following combined modality therapy with combretastatin, a vascular-disrupting agent being studied for treatment of anaplastic thyroid cancer. In 1 patient, an ECG performed per protocol 18 hours after drug initiation showed deep, symmetric T-wave inversions in limb leads I and aVL and precordial leads V(2) through V(6). Echocardiography showed mildly reduced overall left ventricular systolic function with akinesis of the entire apex. The patient had mild elevations of troponin I. Coronary angiography revealed no epicardial coronary artery disease. The electrocardiographic and echocardiographic abnormalities resolved after several weeks. The patient remains stable from a cardiovascular standpoint and has not had a recurrence during follow-up. An electrocardiogram performed per protocol in a second patient showed deep, symmetric T-wave inversions throughout the precordial leads and a prolonged QT interval. Echocardiography showed mildly reduced left ventricular function with hypokinesis of the apical-septal wall. Acute coronary syndrome was ruled out, and both the electrocardiographic and echocardiographic changes resolved at follow-up. Although the patient remained pain-free without recurrence of anginal symptoms during long-term follow-up, the patient developed progressive malignancy and died.
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Affiliation(s)
- Shyam Bhakta
- Harrington-McLaughlin Heart and Vascular Institute, Ireland Cancer Center, and Department of Radiology, University Hospitals-Case Medical Center, Cleveland, Ohio 44106, USA
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Maitland ML, Bakris GL, Black HR, Chen HX, Durand JB, Elliott WJ, Ivy SP, Leier CV, Lindenfeld J, Liu G, Remick SC, Steingart R, Tang WHW. Initial assessment, surveillance, and management of blood pressure in patients receiving vascular endothelial growth factor signaling pathway inhibitors. J Natl Cancer Inst 2010; 102:596-604. [PMID: 20351338 PMCID: PMC2864290 DOI: 10.1093/jnci/djq091] [Citation(s) in RCA: 285] [Impact Index Per Article: 20.4] [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] [Indexed: 01/27/2023] Open
Abstract
Hypertension is a mechanism-based toxic effect of drugs that inhibit the vascular endothelial growth factor signaling pathway (VSP). Substantial evidence exists for managing hypertension as a chronic condition, but there are few prospectively collected data on managing acute hypertension caused by VSP inhibitors. The Investigational Drug Steering Committee of the National Cancer Institute convened an interdisciplinary cardiovascular toxicities expert panel to evaluate this problem, to make recommendations to the Cancer Therapy Evaluation Program on further study, and to structure an approach for safe management by treating physicians. The panel reviewed: the published literature on blood pressure (BP), hypertension, and specific VSP inhibitors; abstracts from major meetings; shared experience with the development of VSP inhibitors; and established principles of hypertension care. The panel generated a consensus report including the recommendations on clinical concerns summarized here. To support the greatest possible number of patients to receive VSP inhibitors safely and effectively, the panel had four recommendations: 1) conduct and document a formal risk assessment for potential cardiovascular complications, 2) recognize that preexisting hypertension will be common in cancer patients and should be identified and addressed before initiation of VSP inhibitor therapy, 3) actively monitor BP throughout treatment with more frequent assessments during the first cycle of treatment, and 4) manage BP with a goal of less than 140/90 mmHg for most patients (and to lower, prespecified goals in patients with specific preexisting cardiovascular risk factors). Proper agent selection, dosing, and scheduling of follow-up should enable maintaining VSP inhibition while avoiding the complications associated with excessive or prolonged elevation in BP.
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Affiliation(s)
- Michael L Maitland
- Department of Medicine, University of Chicago Medical Center, 5841Chicago, IL 60637, USA.
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