26
|
Garrido-Torres N, Fernandez S, Rodríguez A, Reina M, Prieto I, Viedma A, González C, Hernandez L. Antipsychotics and women: Yes, prolactin is important. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2016.01.2331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionThe hormonal imbalance produced by antipsychotics can be detected by symptoms, such as: infertility, acne, hirsutism, sexual dysfunction and galactorrhea. We consider especially important the study of women's diseases, which may develop due to hyperprolactinemia, specifically: breast cancer, endometrial cancer and osteoporosis.ObjectiveTo undertake a systematic review about the relationship between hyperprolactinemia as a result of the treatment with antipsychoticsand endometrial and breast cancer.MethodAn exhaustive search was performed on PUBMED and COCHRANE (from 2006 to 2015).Fifteen papers were selected including comparative studies, clinical trials and clinical reviews.ResultsWith respect to endometrial carcinoma, there is no direct relationship with the use of antipsychotics. However, most papers have suggested that the blood prolactin elevation is a risk factor in the development of endometrial engrossment, which could lead to endometrial hyperplasia, polyps and endometrial cancer. Related to the use of antipsychotics as a treatment for schizophrenic women and breast carcinoma, a significant association was found and this association is strengthened through the interaction of other factors like the fact that women with schizophrenia are less worried about going to the clinical screening reviews in their health centre, smoking, and lower physical activity than healthy women.ConclusionsAripiprazolis associated with a low prevalence of hyperprolactinemia. Menopausal women, the obese, and women who smoke receiving antipsychotics that produce hyperprolactinemia have the greatest risk of developing endometrial pathology. Schizophrenic women with hyperprolactinemia due to antipsychotics and loss of motivation to go to screening activities have a greater risk of breast cancer. Sexual dysfunction could be a non-adherence treatment factor.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Collapse
|
27
|
Alayo QA, Ito H, Passaro C, Zdioruk M, Mahmoud AB, Grauwet K, Zhang X, Lawler SE, Reardon DA, Goins WF, Fernandez S, Chiocca EA, Nakashima H. Glioblastoma infiltration of both tumor- and virus-antigen specific cytotoxic T cells correlates with experimental virotherapy responses. Sci Rep 2020; 10:5095. [PMID: 32198420 PMCID: PMC7083912 DOI: 10.1038/s41598-020-61736-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/20/2020] [Indexed: 02/05/2023] Open
Abstract
The mode of action for oncolytic viruses (OVs) in cancer treatment is thought to depend on a direct initial cytotoxic effect against infected tumor cells and subsequent activation of immune cell responses directed against the neoplasm. To study both of these effects in a mouse model of glioblastoma (GBM), we employed murine GBM cells engineered to constitutively express the type I Herpes Simplex Virus (HSV1) HSV-1 receptor, nectin-1, to allow for more efficient infection and replication by oncolytic HSV (oHSV). These cells were further engineered with a surrogate tumor antigen to facilitate assays of T cell activity. We utilized MRI-based volumetrics to measure GBM responses after injection with the oHSV and bioluminescent imaging (BLI) to determine oHSV replicative kinetics in the injected tumor mass. We found increased infiltration of both surrogate tumor antigen- and oHSV antigen-specific CD8+ T cells within 7 days after oHSV injection. There was no increase in tumor infiltrating CD8+ T cells expressing “exhaustion” markers, yet oHSV infection led to a reduction in PD-1+ CD8+ T cells in injected GBMs and an increase in IFNγ+ CD8+ T cells. There was a significant direct correlation between oHSV-mediated reduction in GBM volume and increased infiltration of both viral and tumor antigen-specific CD8+ T cells, as well as oHSV intratumoral gene activity. These findings imply that CD8+ T cell cytotoxicity against both tumor and viral antigens as well as intratumoral oHSV gene expression are important in oHSV-mediated GBM therapy.
Collapse
|
28
|
Fernandez S, Fernández P, Fernandez S, Fernández C. SUN-449 PATIENT WITH FABRY DISEASE IN CHRONIC HEMODIALYSIS FOR 7 YEARS AND 9 YEARS OF ENZYME REPLACEMENT THERAPY (ERT) IN TOTAL. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
29
|
Banda A, Cohen E, Lynskey G, Fernandez S, Hsu C, Kim A. 4:12 PM Abstract No. 325 Transjugular intrahepatic portosystemic shunt improves liver function in patients with alcohol-induced cirrhosis. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
30
|
Passaro C, Alayo Q, DeLaura I, McNulty J, Grauwet K, Ito H, Bhaskaran V, Mineo M, Lawler SE, Shah K, Speranza MC, Goins W, McLaughlin E, Fernandez S, Reardon DA, Freeman GJ, Chiocca EA, Nakashima H. Correction: Arming an Oncolytic Herpes Simplex Virus Type 1 with a Single-chain Fragment Variable Antibody against PD-1 for Experimental Glioblastoma Therapy. Clin Cancer Res 2020; 26:758. [PMID: 32014888 DOI: 10.1158/1078-0432.ccr-19-4091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
31
|
Yu L, Zhang J, Brock G, Fernandez S. Fully moderated t-statistic in linear modeling of mixed effects for differential expression analysis. BMC Bioinformatics 2019; 20:675. [PMID: 31861977 PMCID: PMC6923909 DOI: 10.1186/s12859-019-3248-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Gene expression profiling experiments with few replicates lead to great variability in the estimates of gene variances. Toward this end, several moderated t-test methods have been developed to reduce this variability and to increase power for testing differential expression. Most of these moderated methods are based on linear models with fixed effects where residual variances are smoothed under a hierarchical Bayes framework. However, they are inadequate for designs with complex correlation structures, therefore application of moderated methods to linear models with mixed effects are needed for differential expression analysis. RESULTS We demonstrated the implementation of the fully moderated t-statistic method for linear models with mixed effects, where both residual variances and variance estimates of random effects are smoothed under a hierarchical Bayes framework. We compared the proposed method with two current moderated methods and show that the proposed method can control the expected number of false positives at the nominal level, while the two current moderated methods fail. CONCLUSIONS We proposed an approach for testing differential expression under complex correlation structures while providing variance shrinkage. The proposed method is able to improve power by moderation and controls the expected number of false positives properly at the nominal level.
Collapse
|
32
|
Zhang X, Li J, Ghoshal K, Fernandez S, Li L. Identification of a Subtype of Hepatocellular Carcinoma with Poor Prognosis Based on Expression of Genes within the Glucose Metabolic Pathway. Cancers (Basel) 2019; 11:E2023. [PMID: 31847435 PMCID: PMC6966574 DOI: 10.3390/cancers11122023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 12/13/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the most prevalent primary cancer and a highly aggressive liver malignancy. Liver cancer cells reprogram their metabolism to meet their needs for rapid proliferation and tumor growth. In the present study, we investigated the alterations in the expression of the genes involved in glucose metabolic pathways as well as their association with the clinical stage and survival of HCC patients. We found that the expressions of around 30% of genes involved in the glucose metabolic pathway are consistently dysregulated with a predominant down-regulation in HCC tumors. Moreover, the differentially expressed genes are associated with an advanced clinical stage and a poor prognosis. More importantly, unsupervised clustering analysis with the differentially expressed genes that were also associated with overall survival (OS) revealed a subgroup of patients with a worse prognosis including reduced OS, disease specific survival, and recurrence-free survival. This aggressive subtype had significantly increased expression of stemness-related genes and down-regulated metabolic genes, as well as increased immune infiltrates that contribute to a poor prognosis. Collectively, this integrative study indicates that expressions of the glucose metabolic genes could be used as potential prognostic markers and/or therapeutic targets, which might be helpful in developing precise treatment for patients with HCC.
Collapse
|
33
|
Powell JR, Murray L, Burnet NG, Fernandez S, Lingard Z, McParland L, O'Hara DJ, Whitfield GA, Short SC. Patient Involvement in the Design of a Randomised Trial of Proton Beam Radiotherapy Versus Standard Radiotherapy for Good Prognosis Glioma. Clin Oncol (R Coll Radiol) 2019; 32:89-92. [PMID: 31607613 DOI: 10.1016/j.clon.2019.09.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/02/2019] [Accepted: 08/14/2019] [Indexed: 11/12/2022]
|
34
|
Gill G, Fernandez S, Soud M, Mete M, Malhotra N, Garcia-Garcia HM. P6391Major acute cardiovascular events in patients with inflammatory bowel disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Traditional risk factors for coronary heart disease have been reported in around 85% patients who present with myocardial infarction. More recently, inflammation and immune mediated diseases have been associated with ischemic heart disease.
Inflammatory Bowel Disease (IBD) is an immune mediated disorder which comprises of ulcerative colitis and Crohn's disease. Estimated prevalence of IBD in the United States in 2004 was 1.4 million people. These patients have an overall increased risk of thrombotic complications with microvascular thrombosis hypothesized to contribute in disease pathogenesis.
Results from a recent meta-analysis were consistent with increased risk of ischemic heart disease among IBD patients, with risk greater in females and younger patients, although heterogeneity was considerable in overall data. Also, in a recent study, IBD was found to be associated with an increased risk of acute myocardial infarction and heart failure despite lower prevalence of coronary risk factors in IBD patients.
IBD pathogenesis involves sustained activation of immune responses with upregulation of cytokines including but not limited to IL-1 beta, IL-6 and TNF-alpha. Upregulation of these cytokines has also been reported in coronary atherosclerosis.
Based on above information, we explored incidence of MACE (Major Adverse Cardiac Event) in this patient population from our health system data-base.
Methods
Propensity scores were estimated for all 15,292 (0.4%) patients with inflammatory bowel disease from a total patient pool of 3,917,894 patients in our health system to assemble a 1:1 matched cohort balanced for age, gender, race and known cardiovascular risk factors including hypertension, hyperlipidemia, diabetes mellitus and smoking (current and former). ICD-9 and ICD-10 codes were used to identify cardiovascular risk factors and outcomes.
Results
Matched patients (n=30,584) had a mean age of 51 years, with 58% of all being women, and 63% Caucasian. During the median follow up of 4.4 years all-cause mortality was observed in 1.7% and 1.2% of patients from IBD and non-IBD groups respectively (hazard ratio {HR}, 1.31; 95% confidence interval {CI}, 1.08–1.58; p=0.005). Combined outcome for myocardial infarction or all-cause mortality was noted in 4.1% and 3.4% from IBD and non-IBD groups respectively (HR, 1.16; 95% CI, 1.03–1.30; p=0.014) while HRs for cardiovascular mortality, myocardial infarction and unstable angina independently were 1.04 (0.74–1.47; p=0.833), 1.05 (0.89–1.23; p=0.591) and 1.10 (0.83–1.46; p=0.524) respectively.
Conclusion
Inflammatory bowel disease did not show association with myocardial infarction, cardiovascular mortality or unstable angina when matched for known cardiovascular risk factors, but was associated with increased all-cause mortality and combined end-point of all-cause mortality or myocardial infarction.
Collapse
|
35
|
Rincon LM, Sanmartin M, Alonso GL, Rodriguez JA, Muriel A, Casas E, Navarro M, Carbonell A, Lazaro C, Fernandez S, Jimenez Mena M, Fernandez Golfin C, Esteban A, Garcia Bermejo ML, Zamorano JL. P1551A genetic risk score predicts recurrent events after myocardial infarction in young adults. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
To evaluate whether a genetic risk score (GRS) improves the prediction of recurrent events in young non-diabetic patients presenting with an acute myocardial infarction and identifies a more aggressive form of atherosclerosis in this population.
Methods and results
We performed a prospective study including 81 consecutive non-diabetic patients aged below 55 y.o. presenting with an acute myocardial infarction (48±6 y.o., 89% male). A comprehensive study including serum biomarkers, genetic testing and cardiac CT was performed. We studied the association of a GRS composed of 11 genetic variants with a primary composite end-point (all-cause mortality, recurrent acute coronary syndrome, and cardiac re-hospitalisation). After a median follow-up of 4.1 (3.5 - 4.4) years 24 recurrent events were documented. A significantly higher prevalence of 9 out of 11 risk alleles was noted compared with general population. The GRS was significantly associated with recurrent events, especially when baseline LDL-cholesterol levels were elevated. Compared with the low-risk GRS category, the multivariate-adjusted hazard ratio for recurrent events for the intermediate-risk GRS category was 10.2 (95% CI 1.1–100.3, p=0.04) and for the high-risk GRS was 20.7 (2.4–181.0, p=0.006) when LDL-C ≥2.8 mmol/L. Inclusion of the GRS improved the C statistic (ΔC statistic =0.086), the continuous Net Reclassification Index (30%) and the Integrated Discrimination Improvement (0.05) compared with a multivariate clinical risk model. Cardiac CT detected coronary calcified atherosclerosis and numerous plaques but it had a limited value for prediction of recurrences. No association was observed between extracellular matrix metabolism biomarkers and GRS or recurrent events in this population.
Cox regression analysis between GRS terciles and LDL-C Univariate analysis Multivariate analysis* HR (95% CI) p-value HR (95% CI) p-value* Low GRS 1 1 Intermediate GRS 2.0 (0.7–5.8) 0.21 LDL-C≤110 mg/dL (≤2.8 mmol/L) 1.0 (0.3–4.0) >110 mg/dL (>2.8 mmol/L) 10.2 (1.1–100.3) 0.04 High GRS 3.0 (1.0–9.2) 0.05 LDL-C≤110 mg/dL (≤2.8 mmol/L) 0.3 (0.1–1.9) >110 mg/dL (>2.8 mmol/L) 20.7 (2.4–181.0) 0.006 *Multivariate model adjusted for GRACE risk score and LDL-C and interaction. There was a strong interaction between GRS terciles and LDL-C (p<0.01).
Recurrent events based on genetic risk
Conclusions
A multilocus genetic risk score identified non-diabetic young patients at increased risk for recurrent events after a myocardial infarction. The significance of LDL-cholesterol in relation to genetic predisposition for recurrences merits further evaluation.
Acknowledgement/Funding
Instituto de Salud Carlos III (PI12/0564, PI14/01152 and PI15/00667), the CIBERCV and the Spanish Society of Cardiology (2015/CC)
Collapse
|
36
|
Sillero I, lopetegui lia N, Gonzalez P, Sánchez-Cousido L, López Flores M, Rojas Piedra M, Medina S, López González A, Pedraza Lorenzo M, Rodríguez Sánchez Á, Nieto Mangudo B, Castañón González C, De Sande L, Diz Tain P, García-Palomo A, Fernandez S, Ramos F, Escalante F. Diffuse large B cell lymphoma in the elderly. A retrospective analysis of standard versus alternative treatments. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz251.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
37
|
Garcia Torralba E, Castellano Gauna D, Sobrevilla N, Guma J, Luengo M, Aparicio J, Sanchez-Muñoz A, Mellado B, Saenz A, Valverde C, Fernández A, Margeli M, Duran I, Fernandez S, Sastre J, Ros S, Maroto P, Aguilar J, Garcia del Muro X, Gonzalez Billalabeitia E. Prognosis of anaemia in disseminated testicular germ cell tumours. On behalf of the Spanish Germ Cell Cancer Group (SGCCG). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz249.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
38
|
Bobot M, Hache G, Fernandez S, Balasse L, Brige P, Chopinet S, Thomas L, Mckay N, Burtey S, Guillet B. L’atteinte cognitive est associée à une rupture de la barrière hémato-encéphalique et aux concentrations d’indoxyl sulfate dans deux modèles de maladie rénale chronique chez le rat. Nephrol Ther 2019. [DOI: 10.1016/j.nephro.2019.07.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
39
|
Fernandez S. 7ESSENTIAL PHARMACY ROLE IN POLYPHARMACY REVIEW AND DEPRESCRIBING FOR FRAIL OLDER PATIENTS. Age Ageing 2019. [DOI: 10.1093/ageing/afz055.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
40
|
Benito J, Fernandez S, Gendive M, Santiago P, Perez-Garay R, Arana-Arri E, Mintegi S. A new clinical score to identify children at low risk for appendicitis. Am J Emerg Med 2019; 38:554-561. [PMID: 31171439 DOI: 10.1016/j.ajem.2019.05.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/17/2019] [Accepted: 05/27/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Besides clinical signs and imaging, in recent years, biomarkers have proven to be a viable diagnostic resource for acute appendicitis (AA). OBJECTIVE The objective of this study was to develop a clinical score including clinical signs and a combination of biomarkers to identify children with abdominal pain at low risk of AA. DESIGN/METHODS We prospectively included children 2 to 14 years of age with abdominal pain suggestive of AA who presented to the emergency department between July 2016 and September 2017. A new score, the Pediatric Appendicitis Laboratory Score (PALabS) including clinical signs, leucocyte (WBC) and neutrophil (ANC) counts and plasma C-reactive protein (CRP) and calprotectin (CP) levels was developed and validated through secondary analyses of two distinct cohorts The validation sample included visits to a single pediatric emergency department from 2012 to 2013 and 2016 to 2017. RESULTS The derivation sample included 278 children, 35.9% of whom had AA and the validation sample included 255 children, 49% of whom had AA. Using logistic regression, we created a 6-part score that consisted of nausea (3 points), history of focal right lower quadrant pain (4 points), ANC of ≥7500/μL (7 points), WBC of ≥10,000/μL (4 points), CRP ≥ 10.0 mg/L (2 points) and CP ≥ 0.50 ≥ ng/mL (3 points). This score exhibited a high discriminatory power (area under the curve: 0.88; 95% confidence interval: 0.84 to 0.92) and outperformed the PAS and Kharbanda scores (area under the curve: 0.76; 95% confidence interval: 0.71 to 0.82 and 0.82; 95% confidence interval: 0.77 to 0.87, respectively). A PALabS ≤6 had a sensitivity of 99.2% (95% confidence interval [CI]: 95.6-99.9), negative predictive value of 97.6% (95% CI: 87.7-99.6), and negative likelihood ratio of 0.03 (95% CI: 0.00-0.18) in the validation set. CONCLUSION In our validation cohort of patients with acute abdominal pain, the new score can accurately predict which children are at low risk of appendicitis and could be safely managed with close observation.
Collapse
|
41
|
Cebulla CM, Stevenson W, Van Law H, Heisler-Taylor T, Hamadmad S, Shah MH, Kim B, Davidorf FH, Ohr M, Wells M, Yanoga F, Chang S, Terrell W, Miller DM, Klisovic D, Allen JB, Shah N, Geraymovych E, Tarabishy AB, Kondapalli SS, Brewington BY, Inman A, Williams D, Kusibati R, Mathias J, Vedat Y, Fernandez S, Wisely CE, Pilarski R, Abdel-Rahman MH. MIF promoter polymorphisms are associated with epiretinal membrane but not retinal detachment with PVR in an american population. Exp Eye Res 2019; 185:107667. [PMID: 31108057 DOI: 10.1016/j.exer.2019.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/22/2019] [Accepted: 05/13/2019] [Indexed: 11/18/2022]
|
42
|
Fernandez S, Garcia A, Vethencourt A, Vazquez S, Petit A, Pla MJ, Ortega R, Pérez J, Gil M, Ponce J, Pernas S, Lopez A, Falo C. Abstract P2-08-58: Prognostic factors of survival in node positive breast cancer patients after neoadjuvant chemotherapy in a large series after 5y follow-up: Can response overcome the poor prognosis of nodal stage? Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-08-58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Status of the axilla is one of the most significant prognostic factors in breast cancer (BC) patients. On the other hand, response to neoadjuvant chemotherapy (NACT) is related to survival. The aim of the present study is to analyze which prognostic factors impact most on Node positive (N+) BC patient survival after NATC. Material and methods: Retrospective analyses on a series of N+ BC patients treated with NATC based on anthracyclines and taxanes +/- trastuzumab if HER2 positive tumors, between June 2008 and December 2016. Clinical, radiological and pathological outcomes have been evaluated. Residual cancer burden (RCB) 1 and the neoadjuvant response index (INR) 2 have been recorded. Survival was calculated with Kaplan-Meier survival curve since the start of NATC to the first documented disease recurrence (DFS) or death (OS). Hazard ratios (HRs) with 95% CIs were estimated with cox proportional hazards regression analysis and subgroups were compared with a two-sided log-rank test. Results: A total of 345 N+ BC patients were included. Pathological complete response was achieved in 72 (20.8%) patients. After NACT, 137 (39.6%) become ypN0, 9 (2.6%) ypN1 mic, 113 (32.7%) ypN1, 60 (17.3%) ypN2 and 26 (7.6%) N3. Those independent predictive factor of ypN0 were molecular subtype (TN and Her2+) with OR: 7.7, p<0.001 and clinical response with OR 6.88, p: 0.04. At a mean follow-up of 58 months there have been 73 (21.1%) recurrences: 9 (2.3%) local, 45 (13%) systemic, 15 (4.3%) systemic+ local, 3 (0.9%) axilla, 1 (0.3%) supraclavicular. The estimated 5y OS was 87.8%. The univariate analysis according to DSF is detailed in Table1.
Adjusted univariate anaalysis cox regression of clinical and pathological factors of desease free survivalBMI10.989-1.010.963AGE0.9960.953-1.0420.876Dose NATC0.9940.979-1.0080.402Clinical Stage1.4021.077-1.8260.012Rx Image1.260.803-1.9940.311Rx size1.0090.995-1.0240.217Number suspicious ALN1.0950.801-1.4970.57Molecular subtype TN,HER20.8800.534-1.450.616Nottinghan grade1.0460.753-1.4530.789Histological subtype1.4651.044-2.0570.27MOlecular subtype1.1510.956-1.3850.137Vascular invasion1.6761.137-24710.009Clinical response2.3691.709-3.284<0.001Fibrosis tumor bed0.980.972-0.989<0.001Nodal fibrosis>50%1.7950.874-3.6860.111Pathological tumoral response1.6861.175-2.4180.005ypN03.561.853-6.838<0.001NRI0.330.192-0.565<0.001RCB1.2741.106-1.4680.001
In the multivariate model those parameters that were independently prognostic were clinical response HR: 5.44 (IC95% 2.275-13.042, p<0.001) and clinical stage HR: 2.364 (IC95% 1.018-5.490, p: 0.045). Conclusions: The most significant prognostic factor in our N+ series was response to NATC, followed by clinical stage. Those independently predictive factors of axillar response (ypN0) were molecular subtype (TN and Her2+) and clinical response. In conclusion, in those patients with chemo sensitive tumors, lymphadenectomy could be safely spared with a more selective axillary approach.
Citation Format: Fernandez S, Garcia A, Vethencourt A, Vazquez S, Petit A, Pla MJ, Ortega R, Pérez J, Gil M, Ponce J, Pernas S, Lopez A, Falo C. Prognostic factors of survival in node positive breast cancer patients after neoadjuvant chemotherapy in a large series after 5y follow-up: Can response overcome the poor prognosis of nodal stage? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-58.
Collapse
|
43
|
Hunsawong T, Suthangkornkul R, Ong-Ajchaowlerd P, Thaisomboonsuk B, Klungtong C, Poolpanichupatam Y, Phonpakobsin T, Macareo L, Srikiatkhachorn A, Fernandez S, Ellison D. Potential immune-mediated genes expression induced by dengue antibodies enhance zika virus infection in THP-1 cell line. Int J Infect Dis 2019. [DOI: 10.1016/j.ijid.2018.11.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
44
|
Cho YK, Irby DJ, Li J, Sborov DW, Mould DR, Badawi M, Dauki A, Lamprecht M, Rosko AE, Fernandez S, Hade EM, Hofmeister CC, Poi M, Phelps MA. Pharmacokinetic-Pharmacodynamic Model of Neutropenia in Patients With Myeloma Receiving High-Dose Melphalan for Autologous Stem Cell Transplant. CPT Pharmacometrics Syst Pharmacol 2018; 7:748-758. [PMID: 30343510 PMCID: PMC6263666 DOI: 10.1002/psp4.12345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
High-dose melphalan (HDM) is part of the conditioning regimen in patients with multiple myeloma (MM) receiving autologous stem cell transplantation (ASCT). However, individual sensitivity to melphalan varies, and many patients experience severe toxicities. Prolonged severe neutropenia is one of the most severe toxicities and contributes to potentially life-threatening infections and failure of ASCT. Granulocyte-colony stimulating factor (G-CSF) is given to stimulate neutrophil proliferation after melphalan administration. The aim of this study was to develop a population pharmacokinetic/pharmacodynamic (PK/PD) model capable of predicting neutrophil kinetics in individual patients with MM undergoing ASCT with high-dose melphalan and G-CSF administration. The extended PK/PD model incorporated several covariates, including G-CSF regimen, stem cell dose, hematocrit, sex, creatinine clearance, p53 fold change, and race. The resulting model explained portions of interindividual variability in melphalan exposure, therapeutic effect, and feedback regulation of G-CSF on neutrophils, thus enabling simulation of various doses and prediction of neutropenia duration.
Collapse
|
45
|
Demircioglu G, Mirza A, Fernandez S, Morgenstern J, Murray A, Haas J, Oliveri M, Aime S, Blacksburg S. Addressing Billing Errors: Results of a Prospective Quality Assurance Initiative to Optimize the Accuracy of Radiation Oncology Patient Charges. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
46
|
Passaro C, Alayo Q, De Laura I, McNulty J, Grauwet K, Ito H, Bhaskaran V, Mineo M, Lawler SE, Shah K, Speranza MC, Goins W, McLaughlin E, Fernandez S, Reardon DA, Freeman GJ, Chiocca EA, Nakashima H. Arming an Oncolytic Herpes Simplex Virus Type 1 with a Single-chain Fragment Variable Antibody against PD-1 for Experimental Glioblastoma Therapy. Clin Cancer Res 2018; 25:290-299. [PMID: 30279232 DOI: 10.1158/1078-0432.ccr-18-2311] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/27/2018] [Accepted: 09/28/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE Glioblastoma (GBM) is resistant to standard of care. Immune checkpoints inhibitors (such as anti-PD-1 mAbs) efficiently restore antitumor T-cell activity. We engineered a new oncolytic herpes simplex virus (oHSV) expressing a single-chain antibody against PD-1 (scFvPD-1) to evaluate its efficacy in mouse models of GBM. EXPERIMENTAL DESIGN NG34scFvPD-1 expresses the human GADD34 gene transcriptionally controlled by the Nestin promoter to allow replication in GBM cells and a scFvPD-1 cDNA transcriptionally controlled by the CMV promoter. ELISA assays were performed to detect binding of scFvPD-1 to mouse and human PD-1. In vitro cytotoxicity and replication assays were performed to measure NG34scFvPD-1 oncolysis, and scFvPD-1 expression and secretion were determined. In vivo survival studies using orthotopic mouse GBM models were performed to evaluate the therapeutic potency of NG34scFvPD-1. RESULTS NG34scFvPD-1-infected GBM cells express and secrete scFvPD-1 that binds mouse PD-1. The introduction of the scFvPD-1 sequence in the viral backbone does not alter the oncolytic properties of NG34scFvPD-1. In situ NG34scFvPD-1 treatment improved the survival with a tail of durable survivorship in 2 syngeneic immunocompetent mouse models of GBM. Mice that survived the first GBM challenge rejected the second challenge of GBM when implanted in the contralateral hemisphere. However, this was not true when athymic mice were employed as the recipients of the second challenge, consistent with the need for an intact immune system to obtain a memory response. CONCLUSIONS NG34scFvPD-1 treatment induces a durable antitumor response in 2 preclinical mouse models of GBM with evidence for antitumor memory.
Collapse
|
47
|
Martín M, de la Torre-Montero JC, López-Tarruella S, Pinilla K, Casado A, Fernandez S, Jerez Y, Puente J, Palomero I, González Del Val R, Del Monte-Millan M, Massarrah T, Vila C, García-Paredes B, García-Sáenz JA, Lluch A. Persistent major alopecia following adjuvant docetaxel for breast cancer: incidence, characteristics, and prevention with scalp cooling. Breast Cancer Res Treat 2018; 171:627-634. [PMID: 29923063 PMCID: PMC6133184 DOI: 10.1007/s10549-018-4855-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/13/2018] [Indexed: 11/29/2022]
Abstract
Background Persistent alopecia (PA) after docetaxel has been recently described. The aim of our study is to establish the incidence and characteristics of PA following adjuvant docetaxel for breast cancer (BC) and to test the ability of scalp cooling in prevention. Patients and methods BC patients receiving adjuvant chemotherapy followed or not by endocrine therapy (and a control group receiving only endocrine therapy) were interviewed in a single institution at 1.5 to 5 years following primary diagnosis searching for PA. A confirmatory prevalence study was later performed in other two institutions. Finally, a prevention study using prophylactic scalp cooling (PSC) with ELASTO-GEL hypothermia caps in patients receiving adjuvant docetaxel was performed. Results In the initial prevalence study (492 patients), minor forms of PA (grade 1) were recorded with all chemotherapy regimens and aromatase inhibitors. Patients receiving docetaxel regimens at cumulative dose (CD) ≥ 400 mmg/m2 presented a significantly higher prevalence of grades 1 PA (33–52%) and 2 PA (5–12%). Prevalence of grade 2 PA with docetaxel CD ≥ 400 mmg/m2 was confirmed in two other institutions. Overall, grade 2 PA was seen in 10.06% (95% CI 7.36–13.61) of 358 patients with docetaxel regimens reaching CD ≥ 400 mmg/m2, but not in patients with lower docetaxel CD, other chemotherapy regimens, or endocrine therapy alone. In prevention trial, no grade 2 PA occurred among 116 patients receiving adjuvant docetaxel (≥ 400 mmg/m2) and PSC followed-up after a 96 months median time. PSC was well tolerated. No scalp relapses were seen among 30 patients (22% of all inclusions) having disease relapse. Conclusion Adjuvant treatment with docetaxel (CD ≥ 400 mmg/m2) is associated with a significant rate of grade 2 PA, leading to wearing a wig, in around 10% of patients. This toxicity was completely prevented with scalp cooling. Clinical Trial Reference: NCT00515762. Electronic supplementary material The online version of this article (10.1007/s10549-018-4855-2) contains supplementary material, which is available to authorized users.
Collapse
|
48
|
Rivero Viera Y, Esparza Martin N, Suria Gonzalez S, Bosch Benitez-Parodi E, Guerra Rodriguez R, Ramirez Puga A, Rodenas Galvez AC, Fernandez S, Perez Suarez G, Garcia-Canton C. P382Factors related to cardiovascular event after two years of follow-up of stage 3 chronic kidney disease patient's. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
49
|
Cordero RR, Damiani A, Jorquera J, Sepúlveda E, Caballero M, Fernandez S, Feron S, Llanillo PJ, Carrasco J, Laroze D, Labbe F. Ultraviolet radiation in the Atacama Desert. Antonie van Leeuwenhoek 2018; 111:1301-1313. [PMID: 29605897 DOI: 10.1007/s10482-018-1075-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
The world's highest levels of surface ultraviolet (UV) irradiance have been measured in the Atacama Desert. This area is characterized by its high altitude, prevalent cloudless conditions, and a relatively low total ozone column. In this paper, we provide estimates of the surface UV (monthly UV index at noon and annual doses of UV-B and UV-A) for all sky conditions in the Atacama Desert. We found that the UV index at noon during the austral summer is expected to be greater than 11 in the whole desert. The annual UV-B (UV-A) doses were found to range from about 3.5 kWh/m2 (130 kWh/m2) in coastal areas to 5 kWh/m2 (160 kWh/m2) on the Andean plateau. Our results confirm significant interhemispherical differences. Typical annual UV-B doses in the Atacama Desert are about 40% greater than typical annual UV-B doses in northern Africa. Mostly due to seasonal changes in the ozone, the differences between the Atacama Desert and northern Africa are expected to be about 60% in the case of peak UV-B levels (i.e. the UV-B irradiances at noon close to the summer solstice in each hemisphere). Interhemispherical differences in the UV-A are significantly lower since the effect of the ozone in this part of the spectrum is minor.
Collapse
|
50
|
Ulrich S, Lehner A, Fernandez S, Birnbaum J, Hakami L, Fischer M, Dalla R, Haas N. Cardiac Allograft Vasculopathy Is Reversible: Also in Higher Stages. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|