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Peddi P, Paryani B, Takalkar A, Bundrick P, Ponugupati J, Nair B, El-Osta H. Exceptional response to cetuximab monotherapy in a patient with metastatic oropharyngeal squamous cell carcinoma: a molecular insight. Onco Targets Ther 2016; 9:705-9. [PMID: 26929641 PMCID: PMC4755421 DOI: 10.2147/ott.s99667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Metastatic head and neck squamous cell carcinoma (HNSCC) carries a very poor prognosis. A better understanding of the molecular driver of the disease and the identification of biomarkers of response remain paramount for an effective personalized therapy. Case report We report an original case of a 56-year-old patient diagnosed with metastatic HNSCC to both kidneys, who experienced a long-lasting complete response to a single-agent cetuximab, a monoclonal antibody-targeting EGFR. Comprehensive multiplatform biomarker analysis of the tumor revealed the presence of phosphatidyl-inositol 3 kinase mutation, EGFR overexpression, and the absence of PD-1/PD-L1 expression. Since PI3K, a downstream effector of EGFR, is activated, the tumor regression may have occurred mainly through a cetuximab-induced immune-mediated response, rather than EGFR signal blockade. It is plausible that this effect was enhanced by the lack of PD-1 and PD-L1 expression. Conclusion Our case proposes that the absence of PD-1 and PD-L1 expression in conjunction with EGFR overexpression may correlate with better response to cetuximab in HNSCC. This hypothesis needs to be examined through a large clinical trial.
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Affiliation(s)
- Prakash Peddi
- Department of Medicine, Division of Hematology-Oncology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Bhavna Paryani
- Department of Radiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Amol Takalkar
- Department of Radiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Paige Bundrick
- Department of Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - John Ponugupati
- Oncology Department, Herbert J Thomas Memorial Hospital, South Charleston, WV, USA
| | - Binu Nair
- Baylor Scott & White Medical Center - Waxahachie, Waxahachie, TX, USA
| | - Hazem El-Osta
- Department of Medicine, Division of Hematology-Oncology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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Margel D, Urbach DR, Lipscombe LL, Bell CM, Kulkarni G, Baniel J, Fleshner N, Austin PC. Is pathology necessary to predict mortality among men with prostate-cancer? BMC Med Inform Decis Mak 2014; 14:114. [PMID: 25495664 PMCID: PMC4275978 DOI: 10.1186/s12911-014-0114-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 11/17/2014] [Indexed: 02/19/2023] Open
Abstract
Background Statistical models developed using administrative databases are powerful and inexpensive tools for predicting survival. Conversely, data abstraction from chart review is time-consuming and costly. Our aim was to determine the incremental value of pathological data obtained from chart abstraction in addition to information acquired from administrative databases in predicting all-cause and prostate cancer (PC)-specific mortality. Methods We identified a cohort of men with diabetes and PC utilizing population-based data from Ontario. We used the c-statistic and net-reclassification improvement (NRI) to compare two Cox- proportional hazard models to predict all-cause and PC-specific mortality. The first model consisted of covariates from administrative databases: age, co-morbidity, year of cohort entry, socioeconomic status and rural residence. The second model included Gleason grade and cancer volume in addition to all aforementioned variables. Results The cohort consisted of 4001 patients. The accuracy of the admin-data only model (c-statistic) to predict 5-year all-cause mortality was 0.7 (95% CI 0.69-0.71). For the extended model (including pathology information) it was 0.74 (95% CI 0.73-0.75). This corresponded to a change in category of predicted probability of survival among 14.8% in the NRI analysis. The accuracy of the admin-data model to predict 5-year PC specific mortality was 0.76 (95% CI 0.74-0.78). The accuracy of the extended model was 0.85 (95% CI 0.83-0.87). Corresponding to a 28% change in the NRI analysis. Conclusions Pathology chart abstraction, improved the accuracy in predicting all-cause and PC-specific mortality. The benefit is smaller for all-cause mortality, and larger for PC-specific mortality.
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Affiliation(s)
- David Margel
- Division of Urology, Rabin Medical Center, Beilinson Campus, 39 Jabotinsky, Petah Tikva, 4941492, Israel. .,Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.
| | - David R Urbach
- Departments of Surgery and Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. .,Division of Clinical Decision Making and Health Care, Toronto General Hospital Research Institute, Toronto, Canada. .,Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada. .,Cancer Care Ontario, Ontario, Canada. .,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Lorraine L Lipscombe
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada. .,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. .,Department of Medicine, Women's College Hospital and Research Institute, University of Toronto, Toronto, Canada.
| | - Chaim M Bell
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada. .,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. .,Department of Medicine and Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
| | - Girish Kulkarni
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada. .,Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
| | - Jack Baniel
- Division of Urology, Rabin Medical Center, Beilinson Campus, 39 Jabotinsky, Petah Tikva, 4941492, Israel.
| | - Neil Fleshner
- Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada. .,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
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