Abstract 28: Identification of multisite real-world patient cohorts to enable immunotherapy utilization and safety assessment

Currently, five classes of Immunotherapy (IT) agents are available for over 20 cancer types, including a powerful new class utilizing T cells genetically engineered to express a chimeric antigen receptor (CAR-T). Additional classes include bi-specific T-cell engagers (BiTEs), immune checkpoint inhibitors (ICIs), cancer vaccines, and oncolytic viruses. Despite promising antitumor activity, significant immune-related adverse events (irAE) have been reported. The most common CAR-T toxicity is cytokine release syndrome (CRS), and management typically includes supportive care and immunosuppression with corticosteroids or the IL-6 inhibitor tocilizumab. Documented CRS and tocilizumab use outside of CAR-T is rare, but recent evidence suggests that tocilizumab is emerging for management of other steroid-refractory irAE. Given the rapid evolution of this field, there remains a need to understand the utilization of IT and the pathophysiology of irAE in real-world settings. To identify cohorts of interest, a retrospective, multicenter review was conducted using Health Catalyst’s extended real-world data database, Touchstone, which includes >300 sources of data and over 70 multipayer and geographically diverse provider clients. Cohorts were selected from representative provider networks, including large and specialty academic medical centers (AMCs), integrated delivery networks, accountable care organizations, and community hospitals in the US. A total of 10 clients’ de-identified electronic medical records were searched for presence of cancer-associated diagnosis codes. The cohort was then restricted by the presence of medication order or administration of any IT-class drug, and among these, first administration of tocilizumab within 21 days. Across ten provider networks containing data for ~5.6 million cancer patients, 9,029 patients were identified: CAR-T, 116 patients (0-102); BiTEs, 112 patients (0-64); ICIs, 8,402 patients (0-4520); cancer vaccines, 182 patients (0-143); and oncolytic viruses, 217 patients (0-214). As expected, CAR-T administration was limited to approved treatment centers. Among the other classes, an average of 26% of identified patients were from the community setting. Additionally, of the 116 patients receiving CAR-T therapy, 75 patients (64.7%) were administered tocilizumab within 21 days. Evidence of tocilizumab use outside of CAR-T irAE was also identified, occurring in 21 patients (0.3%) receiving another class of IT within AMCs, and did not occur at other provider types. Together this analysis identified several real-world IT patient cohorts comprising diverse populations from a range of provider types, with corresponding access to rich patient-level clinical, molecular, and financial real-world data (RWD) elements. Immediate downstream applications will involve developing integrated methods for the real-time identification of patients who may be at risk for adverse events and standardization of toxicity management guidelines.

Citation Format: Catherine Del Vecchio Fitz, Elizabeth Eldridge, Alyssa Antonopoulos, Paula Petrone, Will Caldwell, Ed Corbett, Amy Flaster, Holly Rimmasch, Adem Albayrak, Dale Sanders, Sadiqa Mahmood, Elia Stupka. Identification of multisite real-world patient cohorts to enable immunotherapy utilization and safety assessment [abstract]. In: Proceedings of the AACR Special Conference on Advancing Precision Medicine Drug Development: Incorporation of Real-World Data and Other Novel Strategies; Jan 9-12, 2020; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_1):Abstract nr 28.

Soft Drugs VI. The Application of the Inactive Metabolite Approach for Design of Soft β-Blockers1?2

The "inactive metabolite approach" was used to design β-blockers. The acidic inactive metabolite of metoprolol [4-(2-hydroxy-3-isopropylamino) propoxyphenylacetic acid] was used as the lead compound. Its esters (alkyl and cycloalkyl) were found active in vivo while reverting quantitatively to the same inactive metabolite in plasma. The cyclohexyl ester showed the best activity, which was cardioselective, similar to the parent compound metoprolol. Although most esters had a plasma half-life of approximately 1 min, their activity (antagonism of isoproterenol induced increase in heart rate) following intravenous administration lasted 45-90 minutes, and the maximum β-blockade was observed at 45-60 minutes in both rats and dogs.

A new drip infusion solution monitoring system with a free-flow detection function

A new drip infusion solution monitoring system has been developed for hospital and care facility use. The system detects the fall of each drip chamber drop of fluid and also a free-flow situation. Three non-contacting copper foil electrodes are used. The electrodes are wrapped around the infusion supply polyvinyl chloride (PVC) tube from the solution bag, the drip chamber, and the infusion PVC tube from the drip chamber. Drip infusion fluids have electrical conductivity, so a capacitor is formed between the infusion fluid and each electrode. A thirty kHz sine wave is applied to the electrode wrapped around the infusion supply PVC tube from the solution bag. The capacity-coupled signal on the drip chamber electrode is the transducer output. When an infusion fluid drop is forming, its length and diameter, and therefore the drip chamber capacitance, are increasing, causing change in the output signal. The drip chamber electrode can detect the fall of each drip chamber drop of fluid. When the infusion solution becomes free-flow, an infusion fluid drop is not forming and the infusion fluid flows continuously. Therefore, the capacitance of the electrode around drip chamber does not change the output signal. On the other hand, the electrode wrapped around the infusion supply polyvinyl chloride tube under the drip chamber detects the thirty kHz sine wave conducted by the infusion fluid. The drip chamber electrodes and the infusion supply PVC tube under the drip chamber detect each drop of fluid and free-flow, respectively.

A new bed-exiting alarm system for welfare facility residents

A newly developed alarm system detects welfare facility residents leaving their beds, and does not respond to the care staff, who wear shoes or slippers. It employs a stainless steel tape electrode, several linear integrated circuits and a low-power 8-bit single chip microcomputer. The electrode, which is used as a bed-exiting detection sensor, is attached to the floor mat to record changes in the always-present AC (alternating current) voltage induced on the patient's body by electrostatic coupling from the standard 100 volt, 60 Hz AC utility power wiring in the room walls and ceiling. The resident's body movements, before trying to get out of bed and after leaving the bed, are detected by the microcomputer from changes in the induced AC voltage. The microcomputer alerts the care staff station, via a power line communication system or PHS (personal handy phone System).

Relationship of changes in helplessness and depression to disease activity in rheumatoid arthritis

We investigated the relationship between changes in helplessness and depression to disease activity in rheumatoid arthritis (RA). Sixty-three men with RA were examined at baseline, 3 months, and 6 months. Joint counts, immunophenotypic analyses of peripheral blood lymphocytes, and measures of psychological status were obtained at each examination. Zero-order correlations between psychological change and disease activity change from baseline to 6 months were not significant, but hierarchical multiple regression analyses revealed that changes in affective state were significantly related to joint counts at 6 months. Additionally, changes in absolute numbers of HLA-DR+ (human leukocyte antigen DR type) cells were significantly related to joint counts at 6 months. When absolute numbers of HLA-DR+ cells were entered prior to affective state in a hierarchical multiple regression, affective state was only marginally statistically significant. The study shows that longitudinal relationships between affective changes and disease activity are moderated by intervening variables such as immunologic activation.

Pharmacokinetics of a new inotropic catecholamine in dog plasma using solid phase extraction technology

The pharmacokinetics of a new inotropic catecholamine, N-[2-(3,4-dihydroxyphenyl)-ethyl]-1-methyl-3-(3-carbomylphenyl)-pr opylamine HCL (KM-13), was studied following i.v. injection of 50 and 100 micrograms/kg doses to dogs. KM-13 was extracted from plasma using Bond-Elut CN columns and quantitated by HPLC with electro-chemical detection. The plasma concentration--time profile of KM-13 following an i.v. bolus was best fitted with a bi-exponential equation and the terminal elimination phase had a half life of about 20 min. The analytical method, with a limit of sensitivity of 2 ng/ml, would appear to have general applicability in studying the pharmacokinetics of synthetic catecholamines.

A proposed alveolar model for adult human lungs: the regular dodecahedron

In an endeavor to delineate an alveolar configuration that would reasonably mirror the natural state, polygonal shapes of normal alveoli were tabulated in histological sections from inflation-fixed specimens of 16 men aged 16-48 years. The resulting alveolar population varied from three- to ten-sided polygons with a preponderance of tetragons, pentagons, and hexagons. These observations were compared with the possible combinations of polygonal sections through various polyhedral models proposed by other workers and the five classical regular polyhedrons. The potential types of sections through the regular dodecahedron, i.e., a twelve-sided shape with faces consisting of pentagons, seemed to fit best with present findings, and this is suggested as an idealized configuration that might be useful in various geometric determinations, e.g., estimates of alveolar surface area and volume.

Cardiotonic agents: a simple HPLC procedure for the quantitation of dobutamine and a new congener in plasma

A simple high performance-liquid chromatographic procedure employing electrochemical detection (LC-EC) has been developed for the quantitation of the cardiotonic agent dobutamine and a new pharmacologically active congener. The drugs were extracted from plasma by adsorption on to alumina, eluted from the adsorbent with dilute perchloric acid and the eluate subjected to LC-EC. The method had a limit of sensitivity of 1 ng/ml of plasma for each drug. The applicability of the LC-EC procedure was demonstrated by determining steady-state plasma concentration profiles of dobutamine and its congener in man and dog, respectively, following i.v. infusion of the drugs.

Aggressive combined modality therapy for advanced local-regional breast carcinoma

Thirty-two women with advanced local regional breast carcinoma, including nine patients with histologically diagnosed inflammatory cancer, were entered on a prospective pilot study. They were treated aggressively with initial surgery, two courses of induction chemotherapy with cyclophosphamide, methotrexate, 5-fluorouracil, +/- prednisone, +/- tamoxifen (CMF [P] [T]), local-regional radiotherapy, and then maintenance chemotherapy with CMF(P) (T) alternating with doxorubicin, vincristine, +/- tamoxifen (AV[T]). The patients have been followed for 19-70 months from the time of mastectomy and their actuarial three-year survival is 65% with a median survival that has not yet been reached. Median disease-free survival (time to progression) is currently 29.5 months. Women whose gross disease could not be totally resected surgically had shorter disease-free survivals than those rendered surgically free of disease (p = 0.01). Clinically evident cardiotoxicity was seen in 25% of the patients and was felt to be primarily due to the combination of doxorubicin and radiation therapy. It was significantly more common (Plt less than 0.05) in patients with left chest irradiation (seven of 18 women) as opposed to those with right-sided irradiation (one of 14).

Heating patterns produced by 434 MHz erbotherm UHF 69

Thermal distributions of 434 MHz Erbotherm H 69 hyperthermia/diathermy generators in tissue-equivalent medium have been investigated. Thermocouples were used to measure temperatures at a set of grid points. Cylindrical and abdominal phantoms were heated and sectioned after heating to measure the temperatures at depth. Results indicate that there is potential for heating deep-seated tumors. The distributions were influenced by the number, shape and geometry of the applicators employed.

Low-dose radiation pneumonitis

A case demonstrating fulminant radiation pneumonitis following a course of prophylactic whole lung irradiation at doses below 2000 rads, resulting in death, is presented. The importance of predisposing factors and the suspected "sensitizing" factor in this case are discussed.