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Lawlor K, Clausen J, Johnston A, Edge A, Wolff K, Castrignanò E, Couchman L. A review of analytical parameters in 'rapid' liquid chromatographic methods for bioanalysis: Can we do better? J Chromatogr A 2024; 1721:464803. [PMID: 38547680 DOI: 10.1016/j.chroma.2024.464803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 02/22/2024] [Accepted: 03/06/2024] [Indexed: 04/13/2024]
Abstract
Rapid bioanalysis is beneficial to many applications. However, how 'rapid' a method is, or could be, is often an unanswered question. In this statistical review, the authors have assessed multiple pre-analytical (i.e. sample preparation), and analytical method parameters specifically for liquid chromatography to assist researchers in developing and validating 'rapid' bioanalytical methods. We restricted the search to urine and plasma matrices only. Data were extracted from over 2,000 recent studies and evaluated to assess how these parameters affected the 'on-instrument' analysis time. In addition to methods using ultra-violet (UV) detection, there were a large number of mass spectrometric (MS) methods, allowing additional review of the differences between high- and low-resolution MS on analysis time. We observed that most (N = 922, 70 %) methods used 5 or 10 cm columns, and that whilst uptake of ultra-high performance (U)HPLC columns was good, the use of sub-5 cm columns and/or flow rates in excess of 1 mL/min was incredibly rare (N = 25, 3 %). The detector of choice for quantitative (U)HPLC-MS remains the triple quadrupole, although a number of groups report the use of high-resolution MS for such methods.
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Affiliation(s)
- K Lawlor
- Department of Analytical, Environmental and Forensic Sciences, King's College London, London, SE1 9NH, UK; Analytical Services International, St. George's University of London, Cranmer Terrace, London, SW17 0RE, UK.
| | - J Clausen
- Analytical Services International, St. George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - A Johnston
- Analytical Services International, St. George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - A Edge
- Avantor Sciences, The Markham Centre, Station Road, Theale, Reading, RG7 4PE
| | - K Wolff
- Department of Analytical, Environmental and Forensic Sciences, King's College London, London, SE1 9NH, UK; Drug Control Centre, King's College London, London, SE1 9NH, UK
| | - E Castrignanò
- Department of Analytical, Environmental and Forensic Sciences, King's College London, London, SE1 9NH, UK; Drug Control Centre, King's College London, London, SE1 9NH, UK
| | - L Couchman
- Department of Analytical, Environmental and Forensic Sciences, King's College London, London, SE1 9NH, UK; Analytical Services International, St. George's University of London, Cranmer Terrace, London, SW17 0RE, UK
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Szlosarek PW, Creelan BC, Sarkodie T, Nolan L, Taylor P, Olevsky O, Grosso F, Cortinovis D, Chitnis M, Roy A, Gilligan D, Kindler H, Papadatos-Pastos D, Ceresoli GL, Mansfield AS, Tsao A, O’Byrne KJ, Nowak AK, Steele J, Sheaff M, Shiu CF, Kuo CL, Johnston A, Bomalaski J, Zauderer MG, Fennell DA. Pegargiminase Plus First-Line Chemotherapy in Patients With Nonepithelioid Pleural Mesothelioma: The ATOMIC-Meso Randomized Clinical Trial. JAMA Oncol 2024; 10:475-483. [PMID: 38358753 PMCID: PMC10870227 DOI: 10.1001/jamaoncol.2023.6789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/29/2023] [Indexed: 02/16/2024]
Abstract
Importance Arginine deprivation using ADI-PEG20 (pegargiminase) combined with chemotherapy is untested in a randomized study among patients with cancer. ATOMIC-Meso (ADI-PEG20 Targeting of Malignancies Induces Cytotoxicity-Mesothelioma) is a pivotal trial comparing standard first-line chemotherapy plus pegargiminase or placebo in patients with nonepithelioid pleural mesothelioma. Objective To determine the effect of pegargiminase-based chemotherapy on survival in nonepithelioid pleural mesothelioma, an arginine-auxotrophic tumor. Design, Setting, and Participants This was a phase 2-3, double-blind randomized clinical trial conducted at 43 centers in 5 countries that included patients with chemotherapy-naive nonepithelioid pleural mesothelioma from August 1, 2017, to August 15, 2021, with at least 12 months' follow-up. Final follow-up was on August 15, 2022. Data analysis was performed from March 2018 to June 2023. Intervention Patients were randomly assigned (1:1) to receive weekly intramuscular pegargiminase (36.8 mg/m2) or placebo. All patients received intravenous pemetrexed (500 mg/m2) and platinum (75-mg/m2 cisplatin or carboplatin area under the curve 5) chemotherapy every 3 weeks up to 6 cycles. Pegargiminase or placebo was continued until progression, toxicity, or 24 months. Main Outcomes and Measures The primary end point was overall survival, and secondary end points were progression-free survival and safety. Response rate by blinded independent central review was assessed in the phase 2 portion only. Results Among 249 randomized patients (mean [SD] age, 69.5 [7.9] years; 43 female individuals [17.3%] and 206 male individuals [82.7%]), all were included in the analysis. The median overall survival was 9.3 months (95% CI, 7.9-11.8 months) with pegargiminase-chemotherapy as compared with 7.7 months (95% CI, 6.1-9.5 months) with placebo-chemotherapy (hazard ratio [HR] for death, 0.71; 95% CI, 0.55-0.93; P = .02). The median progression-free survival was 6.2 months (95% CI, 5.8-7.4 months) with pegargiminase-chemotherapy as compared with 5.6 months (95% CI, 4.1-5.9 months) with placebo-chemotherapy (HR, 0.65; 95% CI, 0.46-0.90; P = .02). Grade 3 to 4 adverse events with pegargiminase occurred in 36 patients (28.8%) and with placebo in 21 patients (16.9%); drug hypersensitivity and skin reactions occurred in the experimental arm in 3 patients (2.4%) and 2 patients (1.6%), respectively, and none in the placebo arm. Rates of poststudy treatments were comparable in both arms (57 patients [45.6%] with pegargiminase vs 58 patients [46.8%] with placebo). Conclusions and Relevance In this randomized clinical trial of arginine depletion with pegargiminase plus chemotherapy, survival was extended beyond standard chemotherapy with a favorable safety profile in patients with nonepithelioid pleural mesothelioma. Pegargiminase-based chemotherapy as a novel antimetabolite strategy for mesothelioma validates wider clinical testing in oncology. Trial Registration ClinicalTrials.gov Identifier: NCT02709512.
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Affiliation(s)
- Peter W. Szlosarek
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
- The Mid and South Essex University Hospitals Group, Chelmsford, United Kingdom
- Barts Cancer Centre, St Bartholomew’s Hospital, London, United Kingdom
| | | | - Thomas Sarkodie
- The Mid and South Essex University Hospitals Group, Chelmsford, United Kingdom
| | - Luke Nolan
- Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom
| | - Paul Taylor
- Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Olga Olevsky
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Federica Grosso
- Mesothelioma Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Meenali Chitnis
- Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Amy Roy
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - David Gilligan
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Hedy Kindler
- University of Chicago Medicine, Chicago, Illinois
| | | | | | | | - Anne Tsao
- The University of Texas MD Anderson Cancer Center, Houston
| | - Kenneth J. O’Byrne
- Princess Alexandra Hospital and Queensland University of Technology, Brisbane, Australia
| | - Anna K. Nowak
- Medical School, The University of Western Australia and Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Jeremy Steele
- Barts Cancer Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Michael Sheaff
- Barts Cancer Centre, St Bartholomew’s Hospital, London, United Kingdom
| | | | | | | | | | - Marjorie G. Zauderer
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Dean A. Fennell
- University of Leicester & University Hospitals of Leicester NHS, United Kingdom
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3
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Tiong IS, Wall M, Bajel A, Kalro A, Fleming S, Roberts AW, Thiagarajah N, Chua CC, Latimer M, Yeung D, Marlton P, Johnston A, Enjeti A, Fong CY, Cull G, Larsen S, Kennedy G, Schwarer A, Kipp D, Ramanathan S, Verner E, Tiley C, Morris E, Hahn U, Moore J, Taper J, Purtill D, Warburton P, Stevenson W, Murphy N, Tan P, Beligaswatte A, Mutsando H, Hertzberg M, Shortt J, Szabo F, Dunne K, Wei AH. How comparable are patient outcomes in the "real-world" with populations studied in pivotal AML trials? Blood Cancer J 2024; 14:54. [PMID: 38531863 DOI: 10.1038/s41408-024-00996-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/21/2024] [Accepted: 01/24/2024] [Indexed: 03/28/2024] Open
Abstract
Despite an increasing desire to use historical cohorts as "synthetic" controls for new drug evaluation, limited data exist regarding the comparability of real-world outcomes to those in clinical trials. Governmental cancer data often lacks details on treatment, response, and molecular characterization of disease sub-groups. The Australasian Leukaemia and Lymphoma Group National Blood Cancer Registry (ALLG NBCR) includes source information on morphology, cytogenetics, flow cytometry, and molecular features linked to treatment received (including transplantation), response to treatment, relapse, and survival outcome. Using data from 942 AML patients enrolled between 2012-2018, we assessed age and disease-matched control and interventional populations from published randomized trials that led to the registration of midostaurin, gemtuzumab ozogamicin, CPX-351, oral azacitidine, and venetoclax. Our analyses highlight important differences in real-world outcomes compared to clinical trial populations, including variations in anthracycline type, cytarabine intensity and scheduling during consolidation, and the frequency of allogeneic hematopoietic cell transplantation in first remission. Although real-world outcomes were comparable to some published studies, notable differences were apparent in others. If historical datasets were used to assess the impact of novel therapies, this work underscores the need to assess diverse datasets to enable geographic differences in treatment outcomes to be accounted for.
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Affiliation(s)
- Ing Soo Tiong
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- The Alfred Hospital, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | - Meaghan Wall
- Monash University, Melbourne, VIC, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Ashish Bajel
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Royal Melbourne Hospital, Parkville, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
| | - Akash Kalro
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Andrew W Roberts
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Royal Melbourne Hospital, Parkville, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | | | - Chong Chyn Chua
- The Alfred Hospital, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
- The Northern Hospital, Epping, VIC, Australia
| | - Maya Latimer
- Canberra Hospital, Garran, ACT, Australia
- ACT Pathology, Garran, ACT, Australia
- Australian National University, Canberra, ACT, Australia
| | - David Yeung
- Royal Adelaide Hospital, Adelaide, SA, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Paula Marlton
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | | | - Anoop Enjeti
- Calvary Mater Newcastle, Waratah, NSW, Australia
| | | | - Gavin Cull
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- PathWest Laboratory Medicine, Nedlands, WA, Australia
- University of Western Australia, Perth, WA, Australia
| | - Stephen Larsen
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Glen Kennedy
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | | | | | | | | | - Campbell Tiley
- Gosford Hospital, Gosford, NSW, Australia
- University of Newcastle, Callaghan, NSW, Australia
| | - Edward Morris
- Townsville University Hospital, Douglas, QLD, Australia
| | - Uwe Hahn
- Royal Adelaide Hospital, Adelaide, SA, Australia
- The Queen Elizabeth Hospital, Woodville South, SA, Australia
- SA Pathology, Adelaide, SA, Australia
| | - John Moore
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - John Taper
- Nepean Hospital, Kingswood, NSW, Australia
| | - Duncan Purtill
- PathWest Laboratory Medicine, Nedlands, WA, Australia
- Fiona Stanley Hospital, Murdoch, WA, Australia
| | | | - William Stevenson
- Royal North Shore Hospital, St Leonards, NSW, Australia
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | | | - Peter Tan
- Royal Perth Hospital, Perth, WA, Australia
| | - Ashanka Beligaswatte
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Flinders Medical Centre, Bedford Park, SA, Australia
- Flinders University, Bedford Park, SA, Australia
| | | | | | - Jake Shortt
- Monash University, Melbourne, VIC, Australia
- Monash Medical Centre, Clayton, VIC, Australia
| | | | - Karin Dunne
- Australasian Leukaemia and Lymphoma Group (ALLG), Melbourne, VIC, Australia
| | - Andrew H Wei
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Royal Melbourne Hospital, Parkville, VIC, Australia.
- The University of Melbourne, Melbourne, VIC, Australia.
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.
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Mariappan P, Johnston A, Trail M, Hamid S, Hollins G, Dreyer B, Ramsey S, Padovani L, Guerrero Enriquez J, Simpson H, Hasan R, Sharpe C, Thomas B, Bhatt J, Ahmad I, Nandwani G, Chaudhry A, Boden A, Khan R, Maresca G, Dimitropoulos K, Graham C, Hendry D. Can repeat TURBT in patients presenting with High Grade Ta Urothelial Carcinoma be more nuanced? Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00752-2] [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: 02/12/2023]
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Johnston A, Rose B, Bilmen J, Fale A. 1295 CAN THE HOSPITAL FRAILTY RISK SCORE BE USED TO PREDICT POST-OPERATIVE OUTCOMES IN SPINAL SURGERY? Age Ageing 2023. [DOI: 10.1093/ageing/afac322.045] [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: 01/18/2023] Open
Abstract
Abstract
Introduction
Frailty is a syndrome associated with increasing numbers of elderly hospital admissions and prolonged inpatient stays (Archibald et al, Geriatrics, 2020, 20, 17). In 2015, an estimated 14% of inpatients in the UK were considered to have a degree of frailty, representing an approximate annual cost to the NHS of £5.8 billion (Soong et al, BMJ Open, 2015, 5, e008456; Han et al, Age and Aging, 2019, 48, 665-671). Frailty is poorly defined; there are discrepancies in existing literature on how to best quantify frailty. It is recognised there is a higher risk of adverse outcomes in this vulnerable population due to lack of physiological reserve (Clegg et al, The Lancet, 2013, 381, 752-762). The Hospital Frailty Risk Score (HFRS) is a recent development to measure frailty and identify patients at risk (Gilbert et al, The Lancet, 2018, 391, 1775-1782). This study sought to establish whether the HFRS could be used in patients with degenerative spinal disease, undergoing decompression surgery, to predict post-operative outcomes.
Methods
A retrospective service evaluation of eligible patients in Leeds Teaching Hospitals Trust between March 2018 - March 2020. The exposure was the patients’ HFRS; the outcome was the length of stay (LOS) until physiotherapy discharge. Data was sourced from electronic records.
Results
214 patients were identified with an available HFRS value. Patients were categorised as low, intermediate or high frailty. Kruskal-Wallis test for LOS and categorical HFRS: X2 =8.673, p<0.05. The median HFRS value was 1.25 (interquartile range 0.00 to 3.35). Mann-Whitney U test for LOS and numerical HFRS: W=29297, p<0.05.
Conclusions
The results of this study complement pre-existing studies of similar natures, evaluating frailty scoring and post-operative outcomes, thus, supporting the potential for standardised use of HFRS alongside holistic patient examination to streamline pre-assessment, improve outcomes and reduce the NHS frailty burden.
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Affiliation(s)
| | | | | | - A Fale
- Leeds Teaching Hospitals Trust
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6
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Huang Y, Jones CK, Zhang X, Johnston A, Waktola S, Aygun N, Witham TF, Bydon A, Theodore N, Helm PA, Siewerdsen JH, Uneri A. Multi-perspective region-based CNNs for vertebrae labeling in intraoperative long-length images. Comput Methods Programs Biomed 2022; 227:107222. [PMID: 36370597 DOI: 10.1016/j.cmpb.2022.107222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Effective aggregation of intraoperative x-ray images that capture the patient anatomy from multiple view-angles has the potential to enable and improve automated image analysis that can be readily performed during surgery. We present multi-perspective region-based neural networks that leverage knowledge of the imaging geometry for automatic vertebrae labeling in Long-Film images - a novel tomographic imaging modality with an extended field-of-view for spine imaging. METHOD A multi-perspective network architecture was designed to exploit small view-angle disparities produced by a multi-slot collimator and consolidate information from overlapping image regions. A second network incorporates large view-angle disparities to jointly perform labeling on images from multiple views (viz., AP and lateral). A recurrent module incorporates contextual information and enforce anatomical order for the detected vertebrae. The three modules are combined to form the multi-view multi-slot (MVMS) network for labeling vertebrae using images from all available perspectives. The network was trained on images synthesized from 297 CT images and tested on 50 AP and 50 lateral Long-Film images acquired from 13 cadaveric specimens. Labeling performance of the multi-perspective networks was evaluated with respect to the number of vertebrae appearances and presence of surgical instrumentation. RESULTS The MVMS network achieved an F1 score of >96% and an average vertebral localization error of 3.3 mm, with 88.3% labeling accuracy on both AP and lateral images - (15.5% and 35.0% higher than conventional Faster R-CNN on AP and lateral views, respectively). Aggregation of multiple appearances of the same vertebra using the multi-slot network significantly improved the labeling accuracy (p < 0.05). Using the multi-view network, labeling accuracy on the more challenging lateral views was improved to the same level as that of the AP views. The approach demonstrated robustness to the presence of surgical instrumentation, commonly encountered in intraoperative images, and achieved comparable performance in images with and without instrumentation (88.9% vs. 91.2% labeling accuracy). CONCLUSION The MVMS network demonstrated effective multi-perspective aggregation, providing means for accurate, automated vertebrae labeling during spine surgery. The algorithms may be generalized to other imaging tasks and modalities that involve multiple views with view-angle disparities (e.g., bi-plane radiography). Predicted labels can help avoid adverse events during surgery (e.g., wrong-level surgery), establish correspondence with labels in preoperative modalities to facilitate image registration, and enable automated measurement of spinal alignment metrics for intraoperative assessment of spinal curvature.
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Affiliation(s)
- Y Huang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, United States
| | - C K Jones
- Department of Computer Science, Johns Hopkins University, Baltimore MD, United States
| | - X Zhang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, United States
| | - A Johnston
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, United States
| | - S Waktola
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, United States
| | - N Aygun
- Department of Radiology, Johns Hopkins Medicine, Baltimore MD, United States
| | - T F Witham
- Department of Neurosurgery, Johns Hopkins Medicine, Baltimore MD, United States
| | - A Bydon
- Department of Neurosurgery, Johns Hopkins Medicine, Baltimore MD, United States
| | - N Theodore
- Department of Neurosurgery, Johns Hopkins Medicine, Baltimore MD, United States
| | - P A Helm
- Medtronic, Littleton MA, United States
| | - J H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, United States; Department of Computer Science, Johns Hopkins University, Baltimore MD, United States; Department of Radiology, Johns Hopkins Medicine, Baltimore MD, United States; Department of Neurosurgery, Johns Hopkins Medicine, Baltimore MD, United States; Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston TX, United States
| | - A Uneri
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, United States.
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Johnston A, Dancey SR, Tseung V, Skidmore B, Fell DB, Tanuseputro P, Smith GN, Coutinho T, Edwards JD. A systematic review of validated case-finding definitions to identify hypertensive disorders of pregnancy in administrative healthcare databases. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2504] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Administrative healthcare data are frequently used to study cardiovascular disease (CVD) risk in women with hypertensive disorders of pregnancy (HDP); however, little is known about the validity of case-finding definitions (CFDs, e.g., International Classification of Disease codes/algorithms) designed to identify these conditions in administrative databases.
Purpose
To systematically identify and summarize available evidence on the validity of administrative CFDs for HDP.
Methods
Four bibliographic databases and grey literature sources were searched for eligible studies. The titles/abstracts of all records were independently screened for eligibility by two reviewers, then assessed at full text. Study data (design and participant characteristics, validation statistics) were extracted by two independent reviewers and discrepancies resolved through consensus. Quality of reporting was assessed using checklists; risk of bias was assessed using a modified version of the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool, adapted for administrative validation studies.
Results
Twenty-five studies, published between 1998 and 2021, met the eligibility criteria. Nearly half (48%) were conducted in the United States. Ten studies validated CFDs for ≥1 HDP as a primary aim; most (60%) validated several maternal and infant morbidities, including ≥1 HDP. Preeclampsia (any, mild, moderate, serious, severe, superimposed) was the most validated HDP subtype. Only six studies reported gold standard definitions for all HDPs validated; definitions were heterogeneous with respect to blood pressure thresholds and timing of diagnosis. Seven studies (∼25%) reported all 2x2 table values (true positives/negatives, false positives/negatives) for ≥1 CFD, or they were calculable. The majority of CFDs reported in primary analyses (n=23) were highly specific (≥98%); however, sensitivity varied widely (3.2% to 100%; Figure 1). Nearly all (n=20, 87%) had a positive predictive value (PPV) of ≥70%, 13 of which had a PPV of >80% in combination with high specificity. Across studies, HDP prevalence ranged from 0.1% (eclampsia) to 37% (any maternal hypertensive disorder). Quality of reporting was generally poor to moderate, and all studies were judged to be at unclear or high risk of bias on ≥1 QUADAS-2 domain. Five studies were judged to be of “low concern” regarding study applicability (Figure 2).
Conclusions
Clinical understanding of CVD risk in women with HDP could be drastically impacted if there is low confidence that these conditions have been correctly identified from administrative data. Researchers should quantitatively explore the extent to which CVD risk estimates may be impacted by CFDs with low sensitivity and artificially inflated PPVs, influenced by greater study prevalence of HDP than would be expected in the general population. Higher quality validation studies that employ more rigorous methodology and improved reporting are needed.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Johnston
- School of Epidemiology and Public Health, University of Ottawa, & Brain and Heart Nexus Research Program, University of Ottawa Heart Institute , Ottawa , Canada
| | - S R Dancey
- University of Ottawa, School of Medicine , Ottawa , Canada
| | - V Tseung
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute , Ottawa , Canada
| | - B Skidmore
- Independent Information Specialist , Ottawa , Canada
| | - D B Fell
- School of Epidemiology and Public Health, University of Ottawa, Children's Hospital of Eastern Ontario Research Institute & ICES , Ottawa , Canada
| | - P Tanuseputro
- Ottawa Hospital Research Institute, University of Ottawa, Department of Medicine , Ottawa , Canada
| | - G N Smith
- Kingston Health Sciences Centre, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , Kingston , Canada
| | - T Coutinho
- University of Ottawa Heart Institute, Division of Cardiac Prevention and Rehabilitation, Division of Cardiology & Canadian Women's Heart Health Centre , Ottawa , Canada
| | - J D Edwards
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, School of Epidemiology and Public Health, University of Ottawa & ICES , Ottawa , Canada
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Dada O, Baig F, Johnston A. 1009 Severe Thoracic and Abdominal Surgical Emphysema in a Patient with COVID-19 Pneumonia. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.094] [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: 11/05/2022]
Abstract
Abstract
Introduction
Surgical emphysema is a relatively common occurrence in intensive care unit but its degree of spread in our patient is unusual. We present a case of a young adult with rapid widespread crepitus and worsening respiratory dynamics.
Case description
35-year-old male with hypertension, type 2 diabetes and obesity was invasively ventilated for severe COVID-19 pneumonia. He developed reduced chest compliance, required high driving pressures, and had persistent hypoxia despite a high fraction of inspired oxygen. He was ventilated using protocolised ARDSNet lung protective ventilation (LPV) including periods of ventilation in the prone position. After 19 days of ventilation, worsening surgical emphysema was noted following a tracheostomy. Chest radiography demonstrated extensive extra-pulmonary air. Subsequent computed tomography confirmed widespread surgical emphysema from the face to the scrotum, bilateral pneumothoraces and pneumoperitoneum. Bilateral intercostal drains were inserted and LPV was continued. The pneumoperitoneum resolved with conservative management. The patient was mechanically ventilated for 59 days and was discharged home on day 104.
Discussion
Pneumothorax, pneumomediastinum and surgical emphysema can occur following high-pressure ventilation and surgical tracheostomy. However, pneumoperitoneum with extra-alveolar air collections communicating via potential fascial planes, perivascular sheaths or trans-diaphragmatic extension is rare. The cytokine storm postulated to occur in COVID-19 infection may cause alveolar destruction, leading to Macklin's phenomenon whereby air tracks along peri-bronchial vascular sheaths towards the mediastinum following alveolar rupture. In this patient, prolonged ventilation and high airway pressures probably compounded this effect and led to the complications described.
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Affiliation(s)
- O Dada
- University Hospitals Birmingham NHS Foundation Trust , Birmingham , United Kingdom
| | - F Baig
- University Hospitals Birmingham NHS Foundation Trust , Birmingham , United Kingdom
| | - A Johnston
- University Hospitals Birmingham NHS Foundation Trust , Birmingham , United Kingdom
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Chan PY, Phillips MM, Ellis S, Johnston A, Feng X, Arora A, Hay G, Cohen VML, Sagoo MS, Bomalaski JS, Sheaff MT, Szlosarek PW. A Phase 1 study of ADI-PEG20 (pegargiminase) combined with cisplatin and pemetrexed in ASS1-negative metastatic uveal melanoma. Pigment Cell Melanoma Res 2022; 35:461-470. [PMID: 35466524 PMCID: PMC9322321 DOI: 10.1111/pcmr.13042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/30/2021] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 12/14/2022]
Abstract
Metastatic uveal melanoma (UM) is a devastating disease with few treatment options. We evaluated the safety, tolerability and preliminary activity of arginine depletion using pegylated arginine deiminase (ADI‐PEG20; pegargiminase) combined with pemetrexed (Pem) and cisplatin (Cis) chemotherapy in a phase 1 dose‐expansion study of patients with argininosuccinate synthetase (ASS1)‐deficient metastatic UM. Eligible patients received up to six cycles of Pem (500 mg/m2) and Cis (75 mg/m2) every 3 weeks plus weekly intramuscular ADI (36 mg/m2), followed by maintenance ADI until progression (NCT02029690). Ten of fourteen ASS1‐deficient patients with UM liver metastases and a median of one line of prior immunotherapy received ADIPemCis. Only one ≥ grade 3 adverse event of febrile neutropenia was reported. Seven patients had stable disease with a median progression‐free survival of 3.0 months (range, 1.3–8.1) and a median overall survival of 11.5 months (range, 3.2–36.9). Despite anti‐ADI‐PEG20 antibody emergence, plasma arginine concentrations remained suppressed by 18 weeks with a reciprocal increase in plasma citrulline. Tumour rebiopsies at progression revealed ASS1 re‐expression as an escape mechanism. ADIPemCis was well tolerated with modest disease stabilisation in metastatic UM. Further investigation of arginine deprivation is indicated in UM including combinations with immune checkpoint blockade and additional anti‐metabolite strategies.
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Affiliation(s)
- Pui Ying Chan
- Department of Medical Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Wellcome Sanger Institute, Hinxton, Cambridgeshire, UK
| | - Melissa M Phillips
- Department of Medical Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Stephen Ellis
- Department of Medical Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | | | - Xiaoxing Feng
- Polaris Pharmaceuticals Inc, San Diego, California, USA
| | - Amit Arora
- Department of Ocular Oncology, Moorfields Eye Hospital, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Gordon Hay
- Department of Ocular Oncology, Moorfields Eye Hospital, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Victoria M L Cohen
- Department of Ocular Oncology, Moorfields Eye Hospital, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Mandeep S Sagoo
- Department of Ocular Oncology, Moorfields Eye Hospital, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
| | | | - Michael T Sheaff
- Department of Histopathology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Peter W Szlosarek
- Department of Medical Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, UK
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Choo LY, Clark L, Daniels M, Goh J, Handa A, Hanna J, Huynh L, Jeon A, Kanbour A, Lee A, Lee J, Lee T, Leigh J, Ly D, McGregor F, Moss J, Nejatian M, O'Loughlin E, Ramos I, Sanchez B, Shrivathsa A, Sincari A, Sobhi S, Swart R, Trimboli J, Wignall P, Bourke E, Chong A, Clayton S, Dawson A, Hardy E, Iqbal R, Le L, Mao S, Marinelli I, Metcalfe H, Panicker D, R HH, Ridgway S, Tan HH, Thong S, Van M, Woon S, Woon-Shoo-Tong XS, Yu S, Ali K, Chee J, Chiu C, Chow YW, Duller A, Nagappan P, Ng S, Selvanathan M, Sheridan C, Temple M, Do JE, Dudi-Venkata NN, Humphries E, Li L, Mansour LT, Massy-Westropp C, Fang B, Farbood K, Hong H, Huang Y, Joan M, Koh C, Liu YHA, Mahajan T, Muller E, Park R, Tanudisastro M, Wu JJG, Chopra P, Giang S, Radcliffe S, Thach P, Wallace D, Wilkes A, Chinta SH, Li J, Phan J, Rahman F, Segaran A, Shannon J, Zhang M, Adams N, Bonte A, Choudhry A, Colterjohn N, Croyle JA, Donohue J, Feighery A, Keane A, McNamara D, Munir K, Roche D, Sabnani R, Seligman D, Sharma S, 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Langhorne B, Lund J, Lutchman I, McGuinness R, Neary M, Pampapathi S, Pang E, Podbicanin S, Rai N, Redhouse White G, Sujith J, Thomas P, Walker I, Winterton R, Anderson P, Barrington M, Bhadra K, Clark G, Fowler G, Gibson C, Hudson S, Kaminskaite V, Lawday S, Longshaw A, MacKrill E, McLachlan F, Murdeshwar A, Nieuwoudt R, Parker P, Randall R, Rawlins E, Reeves SA, Rye D, Sirkis T, Sykes B, Ventress N, Wosinska N, Akram B, Burton L, Coombs A, Long R, Magowan D, Ong C, Sethi M, Williams G, Chan C, Chan LH, Fernando D, Gaba F, Khor Z, Les JW, Mak R, Moin S, Ng Kee Kwong KC, Paterson-Brown S, Tew YY, Bardon A, Burrell K, Coldwell C, Costa I, Dexter E, Hardy A, Khojani M, Mazurek J, Raymond T, Reddy V, Reynolds J, Soma A, Agiotakis S, Alsusa H, Desai N, Peristerakis I, Adcock A, Ayub H, Bennett T, Bibi F, Brenac S, Chapman T, Clarke G, Clark F, Galvin C, Gwyn-Jones A, Henry-Blake C, Kerner S, Kiandee M, Lovett A, Pilecka A, Ravindran R, Siddique H, Sikand T, Treadwell K, Akmal K, Apata A, Barton O, Broad G, Darling H, Dhuga Y, Emms L, Habib S, Jain R, Jeater J, Kan CYP, Kathiravelupillai A, Khatkar H, Kirmani S, Kulasabanathan K, Lacey H, Lal K, Manafa C, Mansoor M, McDonald S, Mittal A, Mustoe S, Nottrodt L, Oliver P, Papapetrou I, Pattinson F, Raja M, Reyhani H, Shahmiri A, Small O, Soni U, Aguirrezabala Armbruster B, Bunni J, Hakim MA, Hawkins-Hooker L, Howell KA, Hullait R, Jaskowska A, Ottewell L, Thomas-Jones I, Vasudev A, Clements B, Fenton J, Gill M, Haider S, Lim AJM, Maguire H, McMullan J, Nicoletti J, Samuel S, Unais MA, White N, Yao PC, Yow L, Boyle C, Brady R, Cheekoty P, Cheong J, Chew SJHL, Chow R, Ganewatta Kankanamge D, Mamer L, Mohammed B, Ng Chieng Hin J, Renji Chungath R, Royston A, Sharrad E, Sinclair R, Tingle S, Treherne K, Wyatt F, Maniarasu VS, Moug S, Appanna T, Bucknall T, Hussain F, Owen A, Parry M, Parry R, Sagua N, Spofforth K, Yuen ECT, Bosley N, Hardie W, Moore T, Regas C, Abdel-Khaleq S, Ali N, Bashiti H, Buxton-Hopley R, Constantinides M, D'Afflitto M, Deshpande A, Duque Golding J, Frisira E, Germani Batacchi M, Gomaa A, Hay D, Hutchison R, Iakovou A, Iakovou D, Ismail E, Jefferson S, Jones L, Khouli Y, Knowles C, Mason J, McCaughan R, Moffatt J, Morawala A, Nadir H, Neyroud F, Nikookam Y, Parmar A, Pinto L, Ramamoorthy R, Richards E, Thomson S, Trainer C, Valetopoulou A, Vassiliou A, Wantman A, Wilde S, Dickinson M, Rockall T, Senn D, Wcislo K, Zalmay P, Adelekan K, Allen K, Bajaj M, Gatumbu P, Hang S, Hashmi Y, Kaur T, Kawesha A, Kisiel A, Woodmass M, Adelowo T, Ahari D, Alhwaishel K, Atherton R, Clayton B, Cockroft A, Curtis Lopez C, Hilton M, Ismail N, Kouadria M, Lee L, MacConnachie A, Monks F, Mungroo S, Nikoletopoulou C, Pearce L, Sara X, Shahid A, Suresh G, Wilcha R, Atiyah A, Davies E, Dermanis A, Gibbons H, Hyde A, Lawson A, Lee C, Leung-Tack M, Li Saw Hee J, Mostafa O, Nair D, Pattani N, Plumbley-Jones J, Pufal K, Ramesh P, Sanghera J, Saram S, Scadding S, See S, Stringer H, Torrance A, Vardon H, Wyn-Griffiths F, Brew A, Kaur G, Soni D, Tickle A, Akbar Z, Appleyard T, Figg K, Jayawardena P, Johnson A, Kamran Siddiqui Z, Lacy-Colson J, Oatham R, Rowlands B, Sludden E, Turnbull C, Allin D, Ansar Z, Azeez Z, Dale VH, Garg J, Horner A, Jones S, Knight S, McGregor C, McKenna J, McLelland T, Packham-Smith A, Rowsell K, Spector-Hill I, Adeniken E, Baker J, Bartlett M, Chikomba L, Connell B, Deekonda P, Dhar M, Elmansouri A, Gamage K, Goodhew R, Hanna P, Knight J, Luca A, Maasoumi N, Mahamoud F, Manji S, Marwaha PK, Mason F, Oluboyede A, Pigott L, Razaq AM, Richardson M, Saddaoui I, Wijeyendram P, Yau S, Atkins W, Liang K, Miles N, Praveen B, Ashai S, Braganza J, Common J, Cundy A, Davies R, Guthrie J, Handa I, Iqbal M, Ismail R, Jones C, Jones I, Lee KS, Levene A, Okocha M, Olivier J, Smith A, Subramaniam E, Tandle S, Wang A, Watson A, Wilson C, Chan XHF, Khoo E, Montgomery C, Norris M, Pugalenthi PP, Common T, Cook E, Mistry H, Shinmar HS, Agarwal G, Bandyopadhyay S, Brazier B, Carroll L, Goede A, Harbourne A, Lakhani A, Lami M, Larwood J, Martin J, Merchant J, Pattenden S, Pradhan A, Raafat N, Rothwell E, Shammoon Y, Sudarshan R, Vickers E, Wingfield L, Ashworth I, Azizi S, Bhate R, Chowdhury T, Christou A, Davies L, Dwaraknath M, Farah Y, Garner J, Gureviciute E, Hart E, Jain A, Javid S, Kankam HK, Kaur Toor P, Kaz R, Kermali M, Khan I, Mattson A, McManus A, Murphy M, Nair K, Ngemoh D, Norton E, Olabiran A, Parry L, Payne T, Pillai K, Price S, Punjabi K, Raghunathan A, Ramwell A, Raza M, Ritehnia J, Simpson G, Smith W, Sodeinde S, Studd L, Subramaniam M, Thomas J, Towey S, Tsang E, Tuteja D, Vasani J, Vio M, Badran A, Adams J, Anthony Wilkinson J, Asvandi S, Austin T, Bald A, Bix E, Carrick M, Chander B, Chowdhury S, Cooper Drake B, Crosbie S, D Portela S, Francis D, Gallagher C, Gillespie R, Gravett H, Gupta P, Ilyas C, James G, Johny J, Jones A, Kinder F, MacLeod C, Macrow C, Maqsood-Shah A, Mather J, McCann L, McMahon R, Mitham E, Mohamed M, Munton E, Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Liang B, Thapa R, Zhang G, Moffitt C, Zhang Y, Zhang L, Johnston A, Ruby HP, Barbera G, Wong PC, Zhang Z, Chen R, Lin DT, Li Y. Aberrant Neural Activity in Prefrontal Pyramidal Neurons Lacking TDP-43 Precedes Neuron loss. Prog Neurobiol 2022; 215:102297. [PMID: 35667630 PMCID: PMC9258405 DOI: 10.1016/j.pneurobio.2022.102297] [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: 01/23/2022] [Revised: 04/25/2022] [Accepted: 05/31/2022] [Indexed: 11/16/2022]
Abstract
Mislocalization of TAR DNA binding protein 43 kDa (TARDBP, or TDP-43) is a principal pathological hallmark identified in cases of neurodegenerative disorders such as amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). As an RNA binding protein, TDP-43 serves in the nuclear compartment to repress non-conserved cryptic exons to ensure the normal transcriptome. Multiple lines of evidence from animal models and human studies support the view that loss of TDP-43 leads to neuron loss, independent of its cytosolic aggregation. However, the underlying pathogenic pathways driven by the loss-of-function mechanism are still poorly defined. We employed a genetic approach to determine the impact of TDP-43 loss in pyramidal neurons of the prefrontal cortex (PFC). Using a custom-built miniscope imaging system, we performed repetitive in vivo calcium imaging from freely behaving mice for up to 7 months. By comparing calcium activity in PFC pyramidal neurons between TDP-43 depleted and TDP-43 intact mice, we demonstrated remarkably increased numbers of pyramidal neurons exhibiting hyperactive calcium activity after short-term TDP-43 depletion, followed by rapid activity declines prior to neuron loss. Our results suggest aberrant neural activity driven by loss of TDP-43 as the pathogenic pathway at early stage in ALS and FTD.
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Affiliation(s)
- Bo Liang
- School of Electrical Engineering & Computer Science, College of Engineering & Mines, University of North Dakota, 243 Centennial Drive Stop 7165, Grand Forks, ND 58202, USA.
| | - Rashmi Thapa
- Department of Zoology and Physiology, University of Wyoming, 1000 E University Avenue, Laramie, WY 82071, USA.
| | - Gracie Zhang
- Laramie High School, 1710 Boulder Drive, Laramie, WY 82070, USA.
| | - Casey Moffitt
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 333 Cassell Drive, Baltimore, MD 21224, USA.
| | - Yan Zhang
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 333 Cassell Drive, Baltimore, MD 21224, USA.
| | - Lifeng Zhang
- School of Electrical Engineering & Computer Science, College of Engineering & Mines, University of North Dakota, 243 Centennial Drive Stop 7165, Grand Forks, ND 58202, USA; Department of Zoology and Physiology, University of Wyoming, 1000 E University Avenue, Laramie, WY 82071, USA; Laramie High School, 1710 Boulder Drive, Laramie, WY 82070, USA; Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 333 Cassell Drive, Baltimore, MD 21224, USA; Department of Pathology, Johns Hopkins University School of Medicine, 725N. Wolfe Street, Baltimore, MD 21205, USA; Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 100N. Greene St., Baltimore, MD 21201, USA; The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, 725N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Amanda Johnston
- Department of Zoology and Physiology, University of Wyoming, 1000 E University Avenue, Laramie, WY 82071, USA.
| | - Hyrum P Ruby
- Department of Zoology and Physiology, University of Wyoming, 1000 E University Avenue, Laramie, WY 82071, USA.
| | - Giovanni Barbera
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 333 Cassell Drive, Baltimore, MD 21224, USA.
| | - Philip C Wong
- Department of Pathology, Johns Hopkins University School of Medicine, 725N. Wolfe Street, Baltimore, MD 21205, USA; The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, 725N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Zhaojie Zhang
- Department of Zoology and Physiology, University of Wyoming, 1000 E University Avenue, Laramie, WY 82071, USA.
| | - Rong Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 100N. Greene St., Baltimore, MD 21201, USA.
| | - Da-Ting Lin
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 333 Cassell Drive, Baltimore, MD 21224, USA; The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, 725N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Yun Li
- Department of Zoology and Physiology, University of Wyoming, 1000 E University Avenue, Laramie, WY 82071, USA.
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Bomalaski JS, Chen KT, Chuang MJ, Liau CT, Peng MT, Chen PY, Lee CC, Johnston A, Liu HF, Huang YLS, Kuo CL, Shiu CF, Hsu PW, Chuan CC, Lai DM, Wei KC. Phase IB trial of pegylated arginine deiminase (ADI-PEG 20) plus radiotherapy and temozolomide in patients with newly diagnosed glioblastoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2057] [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
2057 Background: ADI-PEG 20 exploits the different metabolic ability for synthesizing arginine (Arg) between normal and neoplastic cells to reduce tumor cell growth. Preclinical and clinical studies have shown that cancers which are either Arg auxotrophic, with silencing of argininosuccinate synthetase ( ASS1), or Arg non-auxotrophic, respond to ADI-PEG 20 monotherapy or ADI-PEG 20 combined with various chemotherapies, respectively. ADI-PEG 20 has shown efficacy as monotherapy in ASS1 negative mouse glioblastoma (GBM) models and the combination of ADI-PEG 20 with temozolomide (TMZ) and with radiation (RT) in both ASS1 negative and ASS1 positive mouse GBM models. Based on these rationales, ADI-PEG 20 was added to standard RT + TMZ in patients with newly diagnosed GBM. This is the first clinical trial combining ADI-PEG 20 with RT. Methods: This phase IB, open-label, single-arm, standard 3+3 dose escalation with a recommended phase 2 dose (RP2D) expansion study (NCT04587830) was initiated in June 2020. Weekly ADI-PEG 20 is added to concurrent RT + TMZ and to 6 cycles of adjuvant TMZ (Stupp protocol). ADI-PEG 20 could be continued for up to 2 years. RANO criteria are used to determine response by evaluating MRI at 1, 3 and 6 months after RT, and every 3 months thereafter. Major eligibility criteria are age 20-75 years with newly diagnosed, histologically confirmed GBM with Karnofsky performance status ≥ 60. Endpoints include safety, pharmacodynamics, immunogenicity, progression free survival (PFS) and overall survival (OS). Results: Cohorts 1 (18 mg/m2) and 2 (36 mg/m2) were completed without dose limiting toxicity (DLT). Enrollment to cohort 3 (RP2D phase, 36 mg/m2) is ongoing with 23/26 patients. The major adverse events (AEs) were fatigue (52%), constipation (39%) and neutrophil decrease (39%). Dermatologic or allergic reactions occurred in 12/23 (52%), and all were grade 1-2 except for anaphylactic shock in 1 and vasculitis/rash in 1. 22/23 are alive, with median PFS = 9.5 months. The first 6 study patients are all alive for at least 11 months, with the longest at 1.5 years. 10 are off treatment due to progressive disease in 6, severe AE in 2, consent withdrawal in 1, and medical decision in 1. Mean peripheral blood Arg levels were suppressed ( < 10uM) for 4-6 weeks in most subjects, with a reciprocal elevation of citrulline levels. Anti-ADI-PEG 20 antibodies tended to increase as peripheral Arg levels increased. Conclusions: The addition of ADI-PEG 20 to RT + TMX was safe, and no DLT was observed. The RP2D of ADI-PEG 20 was determined to be 36mg/m2. AEs were those typically seen with RT + TMZ, with perhaps an increase in rash reported with the addition of ADI-PEG 20. Anaphylaxis and vasculitis were seen (1 subject with each), and have been observed previously with ADI-PEG 20. The preliminary OS data are encouraging. A registration phase 2/3 trial of this triplet is being considered. Clinical trial information: NCT04587830.
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Affiliation(s)
| | - Ko-Ting Chen
- Linkou Chang Gung Memorial Hospital, Taipei, Taiwan
| | | | - Chi-Ting Liau
- Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | | | - Pin-Yuan Chen
- Chang Gung Memorial Hospital at Keelung, New Taipei, Taiwan
| | - Cheng-Chi Lee
- Chang Gung Memorial Hospital at Linkou,, Taoyuan, Taiwan
| | | | - Hui-Fen Liu
- Polaris Pharmaceuticals, Inc., Taipei, Taiwan
| | | | | | | | - Peng-Wei Hsu
- Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | | | - Dar-Ming Lai
- National Taiwan University Hospital, Taipei, Taiwan
| | - Kuo-Chen Wei
- New Taipei Municipal TuCheng Hospital, New Taipei, Taiwan
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Broussard LJ, Barrow JL, DeBeer-Schmitt L, Dennis T, Fitzsimmons MR, Frost MJ, Gilbert CE, Gonzalez FM, Heilbronn L, Iverson EB, Johnston A, Kamyshkov Y, Kline M, Lewiz P, Matteson C, Ternullo J, Varriano L, Vavra S. Experimental Search for Neutron to Mirror Neutron Oscillations as an Explanation of the Neutron Lifetime Anomaly. Phys Rev Lett 2022; 128:212503. [PMID: 35687456 DOI: 10.1103/physrevlett.128.212503] [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] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/25/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
An unexplained >4σ discrepancy persists between "beam" and "bottle" measurements of the neutron lifetime. A new model proposed that conversions of neutrons n into mirror neutrons n^{'}, part of a dark mirror sector, can increase the apparent neutron lifetime by 1% via a small mass splitting Δm between n and n^{'} inside the 4.6 T magnetic field of the National Institute of Standards and Technology Beam Lifetime experiment. A search for neutron conversions in a 6.6 T magnetic field was performed at the Spallation Neutron Source which excludes this explanation for the neutron lifetime discrepancy.
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Affiliation(s)
- L J Broussard
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - J L Barrow
- Department of Physics, University of Tennessee, Knoxville, Tennessee 37996, USA
| | | | - T Dennis
- Department of Physics and Astronomy, East Tennessee State University, Johnson City, Tennessee 37614, USA
| | - M R Fitzsimmons
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Department of Physics, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - M J Frost
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - C E Gilbert
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - F M Gonzalez
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - L Heilbronn
- Department of Nuclear Engineering, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - E B Iverson
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - A Johnston
- Department of Physics, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - Y Kamyshkov
- Department of Physics, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - M Kline
- Department of Physics, The Ohio State University, Columbus, Ohio 43210, USA
| | - P Lewiz
- Department of Physics, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - C Matteson
- Department of Physics, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - J Ternullo
- Department of Physics, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - L Varriano
- Department of Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - S Vavra
- Department of Physics, University of Tennessee, Knoxville, Tennessee 37996, USA
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Kraehenbuehl L, Holland A, Armstrong E, O’Shea S, Mangarin L, Chekalil S, Johnston A, Bomalaski JS, Erinjeri JP, Barker CA, Francis JH, Wolchok JD, Merghoub T, Shoushtari AN. Pilot Trial of Arginine Deprivation Plus Nivolumab and Ipilimumab in Patients with Metastatic Uveal Melanoma. Cancers (Basel) 2022; 14:cancers14112638. [PMID: 35681616 PMCID: PMC9179243 DOI: 10.3390/cancers14112638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Uveal melanoma is a rare subtype of malignant melanoma. It is known to rapidly metastasize, with the liver being the most frequently affected organ. Due to differences from melanoma arising in the skin, such as a lower number of mutations, it responds poorly to immune checkpoint blockade, a treatment approach reinvigorating the patient’s immune system to eliminate the cancer. We here investigated the safety and tolerability of a new combination treatment consisting of two established immunotherapy medications (ipilimumab and nivolumab) with the addition of an experimental arginine depleting medication, pegylated arginine deiminase (ADI-PEG 20), which is thought to make uveal melanoma more amenable to immunotherapy. This novel treatment approach was found to be safe and well-tolerated but did not improve the clinical outcome beyond the expected limited efficacy of approved immunotherapy alone. Abstract Metastatic uveal melanoma (UM) remains challenging to treat, with objective response rates to immune checkpoint blockade (ICB) being much lower than in primary cutaneous melanoma (CM). Besides a lower mutational burden, the overall immune-excluded tumor microenvironment of UM might contribute to the poor response rate. We therefore aimed at targeting deficiency in argininosuccinate synthase 1, which is a key metabolic feature of UM. This study aims at investigating the safety and tolerability of a triple combination consisting of ipilimumab and nivolumab immunotherapy and the metabolic therapy, ADI-PEG 20. Nine patients were enrolled in this pilot study. The combination therapy was safe and tolerable with an absence of immune-related adverse events (irAE) of special interest, but with four of nine patients experiencing a CTCAE grade 3 AE. No objective responses were observed. All except one patient developed anti-drug antibodies (ADA) within a month of the treatment initiation and therefore did not maintain arginine depletion. Further, an IFNg-dependent inflammatory signature was observed in metastatic lesions in patients pre-treated with ICB compared with patients with no pretreatment. Multiplex immunohistochemistry demonstrated variable presence of tumor infiltrating CD8 lymphocytes and PD-L1 expression at the baseline in metastases.
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Affiliation(s)
- Lukas Kraehenbuehl
- Ludwig Collaborative and Swim Across America Laboratory, Parker Institute for Cancer Immunotherapy, Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA; (L.K.); (A.H.); (L.M.); (S.C.); (J.D.W.); (T.M.)
| | - Aliya Holland
- Ludwig Collaborative and Swim Across America Laboratory, Parker Institute for Cancer Immunotherapy, Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA; (L.K.); (A.H.); (L.M.); (S.C.); (J.D.W.); (T.M.)
| | - Emma Armstrong
- Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA; (E.A.); (S.O.)
| | - Sirinya O’Shea
- Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA; (E.A.); (S.O.)
| | - Levi Mangarin
- Ludwig Collaborative and Swim Across America Laboratory, Parker Institute for Cancer Immunotherapy, Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA; (L.K.); (A.H.); (L.M.); (S.C.); (J.D.W.); (T.M.)
| | - Sara Chekalil
- Ludwig Collaborative and Swim Across America Laboratory, Parker Institute for Cancer Immunotherapy, Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA; (L.K.); (A.H.); (L.M.); (S.C.); (J.D.W.); (T.M.)
| | - Amanda Johnston
- Polaris Pharmaceuticals, Inc., San Diego, CA 92121, USA; (A.J.); (J.S.B.)
| | - John S. Bomalaski
- Polaris Pharmaceuticals, Inc., San Diego, CA 92121, USA; (A.J.); (J.S.B.)
| | - Joseph P. Erinjeri
- Department of Radiology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA;
| | - Christopher A. Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA;
| | - Jasmine H. Francis
- Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA;
| | - Jedd D. Wolchok
- Ludwig Collaborative and Swim Across America Laboratory, Parker Institute for Cancer Immunotherapy, Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA; (L.K.); (A.H.); (L.M.); (S.C.); (J.D.W.); (T.M.)
- Weill Cornell Medical College; New York, NY 10065, USA
| | - Taha Merghoub
- Ludwig Collaborative and Swim Across America Laboratory, Parker Institute for Cancer Immunotherapy, Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA; (L.K.); (A.H.); (L.M.); (S.C.); (J.D.W.); (T.M.)
- Weill Cornell Medical College; New York, NY 10065, USA
| | - Alexander N. Shoushtari
- Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA; (E.A.); (S.O.)
- Weill Cornell Medical College; New York, NY 10065, USA
- Correspondence: ; Tel.: +1-646-888-4161
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15
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Rundus A, Chancellor R, Nyandwi S, Johnston A. Factors Influencing Chimpanzee (Pan troglodytes schweinfurthii) Crop Foraging in Farmland Outside of Gishwati Forest, Rwanda. INT J PRIMATOL 2022. [DOI: 10.1007/s10764-022-00291-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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16
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Callaghan J, Taylor J, Baker E, Steel G, Coulson P, Johnston A, Wayne N, Brown J. Improving the recycling of medical nutrition product packaging in primary and secondary care: initial survey results and plans for implementation of educational support. Clin Nutr ESPEN 2022. [DOI: 10.1016/j.clnesp.2022.02.101] [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: 10/18/2022]
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17
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Mariappan P, Johnston A, Trail M, Hamid S, Hollins G, Dreyer B, Ramsey S, Padovani L, Garau R, Guerrero Enriquez J, Simpson H, Hasan R, Sharpe C, Thomas B, Bhatt J, Ahmad I, Nandwani G, Chaudhry A, Boden A, Khan R, Maresca G, Dimitropoulos K, Graham C, Hendry D. Multicentre real world long-term outcomes in 2773 primary Non-Muscle Invasive Bladder Cancer (NMIBC) patients managed within the Scottish Bladder Cancer Quality Performance Indicator programme. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00243-3] [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: 11/24/2022]
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18
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Mariappan P, Johnston A, Trail M, Hamid S, Hollins G, Dreyer B, Ramsey S, Padovani L, Garau R, Guerrero Enriquez J, Simpson H, Hasan R, Sharpe C, Thomas B, Bhatt J, Ahmad I, Nandwani G, Chaudhry A, Boden A, Khan R, Maresca G, Dimitropoulos K, Graham C, Hendry D, Paramananthan S, Loy G, Baker S, Grigor K, Smith G. Ceasing surveillance in low risk non-muscle invasive bladder cancer after only 12 months of being recurrence free is un-safe: A validation study from the Scottish bladder cancer Quality Performance Indicator (QPI) programme. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00244-5] [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: 11/16/2022]
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19
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Yao S, Janku F, Koenig K, Tsimberidou AM, Piha-Paul SA, Shi N, Stewart J, Johnston A, Bomalaski J, Meric-Bernstam F, Fu S. Phase 1 trial of ADI-PEG 20 and liposomal doxorubicin in patients with metastatic solid tumors. Cancer Med 2021; 11:340-347. [PMID: 34841717 PMCID: PMC8729058 DOI: 10.1002/cam4.4446] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 01/30/2023] Open
Abstract
Background Arginine depletion interferes with pyrimidine metabolism and DNA damage repair pathways. Preclinical data demonstrated that depletion of arginine by PEGylated arginine deiminase (ADI‐PEG 20) enhanced liposomal doxorubicin (PLD) cytotoxicity in cancer cells with argininosuccinate synthase 1 (ASS1) deficiency. The objective of this study was to assess safety and tolerability of ADI‐PEG 20 and PLD in patients with metastatic solid tumors. Methods Patients with advanced ASS1‐deficient solid tumors were enrolled in this phase 1 trial of ADI‐PEG 20 and PLD following a 3 + 3 design. Eligible patients were given intravenous PLD biweekly and intramuscular (IM) ADI‐PEG 20 weekly. Toxicity and efficacy were evaluated according to the Common Terminology Criteria for Adverse Events (version 4.0) and Response Evaluation Criteria in Solid Tumors (version 1.1), respectively. Results Of 15 enrolled patients, 9 had metastatic HER2‐negative breast carcinoma. We observed no dose‐limiting toxicities or treatment‐related deaths. One patient safely received 880 mg/m2 PLD in this study and 240 mg/m2 doxorubicin previously. Treatment led to stable disease in 9 patients and was associated with a median progression‐free survival time of 3.95 months in 15 patients. Throughout the duration of treatment, decreased arginine and increased citrulline levels in peripheral blood remained significant in a majority of patients. We detected no induction of anti‐ADI‐PEG 20 antibodies by week 8 in one third of patients. Conclusion Concurrent IM injection of ADI‐PEG 20 at 36 mg/m2 weekly and intravenous infusion of PLD at 20 mg/m2 biweekly had an acceptable safety profile in patients with advanced ASS1‐deficient solid tumors. Further evaluation of this combination is under discussion.
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Affiliation(s)
- Shuyang Yao
- Department of Investigational Cancer Therapeutics, Houston, Texas, USA.,Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Filip Janku
- Department of Investigational Cancer Therapeutics, Houston, Texas, USA
| | | | | | | | - Nai Shi
- Department of Investigational Cancer Therapeutics, Houston, Texas, USA
| | - John Stewart
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - John Bomalaski
- Polaris Pharmaceuticals, Inc., San Diego, California, USA
| | | | - Siqing Fu
- Department of Investigational Cancer Therapeutics, Houston, Texas, USA
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20
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Richmond JP, Kelly MG, Johnston A, Murphy PJ, Murphy AW. Current management of adults receiving oral anti-cancer medications: A scoping review. Eur J Oncol Nurs 2021; 54:102015. [PMID: 34500319 DOI: 10.1016/j.ejon.2021.102015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Oral anti-cancer medication (OAM) has revolutionised oncology care. Due to their potential toxicities and associated safety challenges ongoing assessment and monitoring is essential; currently generally performed in acute care settings. Internationally there exists a transformative vision to shift patient care from acute to primary care. A nurse-led integrated model of care could be developed for OAM patient management in primary care. The aim of this study was to examine international literature regarding current clinical management practices for assessment and monitoring of patients receiving OAM. METHODS Following PRISMA-ScR guidelines, databases MEDLINE, CINAHL and Web of Science were searched for English studies published between 2010 and 2020 using keywords: assessment, cancer, care, management, oral anticancer medications. Articles were screened and assessed for eligibility. From eligible studies, data were extracted to summarize, collate and make a narrative account of the findings. RESULTS 2261 papers were reviewed, 14 met inclusion criteria. Three phases of management are reported: 1. Patient treatment plan development; 2. Patient education; 3. Patient monitoring. Within these phases seven specific stages of care were identified broadly representing the patient's journey: (1) treatment decision, (2) prescribing of OAM, (3) OAM dispensing and administration, (4) maximising patient safety (5) ongoing patient assessment (6) patient support (7) communication with other health-care professionals. CONCLUSIONS Despite a paucity of international literature, a dedicated OAM clinic was endorsed as a means to achieve improved care. Nurses and pharmacists were identified as being of particular importance especially in education and ongoing management of patients receiving OAMs.
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Affiliation(s)
- J P Richmond
- Letterkenny University Hospital, Donegal, Ireland.
| | - M G Kelly
- Letterkenny University Hospital, Donegal, Ireland
| | - A Johnston
- Letterkenny University Hospital, Donegal, Ireland
| | - P J Murphy
- HRB Primary Care Clinical Trials Network Ireland, Discipline of General Practice, NUI Galway, Ireland
| | - A W Murphy
- HRB Primary Care Clinical Trials Network Ireland, Discipline of General Practice, NUI Galway, Ireland
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21
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Harding JJ, Yang TS, Chen YY, Feng YH, Yen CJ, Ho CL, Huang WT, El Dika I, Akce M, Tan B, Cohen SA, Meyer T, Sarker D, Lee DW, Ryoo BY, Lim HY, Johnston A, Bomalaski JS, O'Reilly EM, Qin S, Abou-Alfa GK. Assessment of pegylated arginine deiminase and modified FOLFOX6 in patients with advanced hepatocellular carcinoma: Results of an international, single-arm, phase 2 study. Cancer 2021; 127:4585-4593. [PMID: 34415578 DOI: 10.1002/cncr.33870] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/25/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Arginine starvation depletes the micronutrients required for DNA synthesis and interferes with both thymidylate synthetase activity and DNA repair pathways in preclinical models of hepatocellular carcinoma (HCC). Pegylated arginine deiminase (ADI-PEG 20), an arginine degrader, potentiates the cytotoxic activity of platinum and pyrimidine antimetabolites in HCC cellular and murine models. METHODS This was a global, multicenter, open-label, single-arm, phase 2 trial of ADI-PEG 20 and modified 5-fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6) in patients who had HCC with Child-Pugh A cirrhosis and disease progression on ≥2 prior lines of treatment. The primary objective was the objective response rate assessed according to Response Evaluation Criteria in Solid Tumors, version 1.1. Secondary objectives were to estimate progression-free survival, overall survival, safety, and tolerability. Eligible patients were treated with mFOLFOX6 intravenously biweekly at standard doses and ADI-PEG-20 intramuscularly weekly at 36 mg/m2 . RESULTS In total, 140 patients with advanced HCC were enrolled. The median patient age was 62 years (range, 30-85 years), 83% of patients were male, 76% were of Asian race, 56% had hepatitis B viremia, 10% had hepatitis C viremia, 100% had received ≥2 prior lines of systemic therapy, and 39% had received ≥3 prior lines of systemic therapy. The objective response rate was 9.3% (95% confidence interval [CI], 5.0%-15.4%), with a median response duration of 10.2 months (95% CI, 5.8 months to not reached). The median progression-free survival was 3.8 months (95% CI, 1.8-6.3 months), and the median overall survival was 14.5 months (95% CI, 13.6-20.9 months). The most common grade ≥3 treatment-related events were neutropenia (32.9%), white blood cell count decrease (20%), platelet count decrease (19.3%), and anemia (9.3%). CONCLUSIONS Concurrent mFOLFOX6 plus ADI-PEG 20 exhibited limited antitumor activity in patients with treatment-refractory HCC. The study was terminated early, and no further evaluation of the combination will be pursued. LAY SUMMARY Arginine is an important nutrient for hepatocellular carcinoma (HCC). The depletion of arginine with pegylated arginine deiminase (ADI-PEG 20), an arginine degrader, appeared to make chemotherapy (FOLFOX) work better in animal models of HCC and in patients with HCC on an early phase clinical trial. To formally test this hypothesis in the clinical setting, a large, global, phase 2 clinical trial was conducted of ADI-PEG 20 and FOLFOX in the treatment of patients with refractory HCC. The study showed limited activity of ADI-PEG 20 and FOLFOX in advanced HCC and was stopped early.
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Affiliation(s)
- James J Harding
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Tsai-Sheng Yang
- Internal Medicine, Linkou Chang Gung Medical Foundation, Taoyuan City, Taiwan
| | - Yen-Yang Chen
- College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Yin-Hsun Feng
- Internal Medicine, Chi Mei Medical Center, Tainan City, Taiwan
| | - Chia-Jui Yen
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ching-Liang Ho
- Division of Hematology, Department of Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei City, Taiwan
| | - Wen-Tsung Huang
- Department of Medicine, Chi Mei Medical Center-Liouying, Tainan City, Taiwan
| | - Imane El Dika
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Mehmet Akce
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Benjamin Tan
- Department of Medicine, Washington University in St Louis, St Louis, Missouri
| | | | - Timothy Meyer
- Oncology, Royal Free Hospital, London, United Kingdom
| | - Debashis Sarker
- Department of Medicine, Guys Hospital, London, United Kingdom
| | - Dae-Won Lee
- Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Baek-Yeol Ryoo
- Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Yeong Lim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Seoul, Korea
| | | | | | - Eileen M O'Reilly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Shukui Qin
- Cancer Center, Bayi Hospital of Nanjing Chinese Medicine University, Nanjing, China
| | - Ghassan K Abou-Alfa
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
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22
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Szlosarek PW, Wimalasingham AG, Phillips MM, Hall PE, Chan PY, Conibear J, Lim L, Rashid S, Steele J, Wells P, Shiu CF, Kuo CL, Feng X, Johnston A, Bomalaski J, Ellis S, Grantham M, Sheaff M. Phase 1, pharmacogenomic, dose-expansion study of pegargiminase plus pemetrexed and cisplatin in patients with ASS1-deficient non-squamous non-small cell lung cancer. Cancer Med 2021; 10:6642-6652. [PMID: 34382365 PMCID: PMC8495293 DOI: 10.1002/cam4.4196] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/19/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction We evaluated the arginine‐depleting enzyme pegargiminase (ADI‐PEG20; ADI) with pemetrexed (Pem) and cisplatin (Cis) (ADIPemCis) in ASS1‐deficient non‐squamous non‐small cell lung cancer (NSCLC) via a phase 1 dose‐expansion trial with exploratory biomarker analysis. Methods Sixty‐seven chemonaïve patients with advanced non‐squamous NSCLC were screened, enrolling 21 ASS1‐deficient subjects from March 2015 to July 2017 onto weekly pegargiminase (36 mg/m2) with Pem (500 mg/m2) and Cis (75 mg/m2), every 3 weeks (four cycles maximum), with maintenance Pem or pegargiminase. Safety, pharmacodynamics, immunogenicity, and efficacy were determined; molecular biomarkers were annotated by next‐generation sequencing and PD‐L1 immunohistochemistry. Results ADIPemCis was well‐tolerated. Plasma arginine and citrulline were differentially modulated; pegargiminase antibodies plateaued by week 10. The disease control rate was 85.7% (n = 18/21; 95% CI 63.7%–97%), with a partial response rate of 47.6% (n = 10/21; 95% CI 25.7%–70.2%). The median progression‐free and overall survivals were 4.2 (95% CI 2.9–4.8) and 7.2 (95% CI 5.1–18.4) months, respectively. Two PD‐L1‐expressing (≥1%) patients are alive following subsequent pembrolizumab immunotherapy (9.5%). Tumoral ASS1 deficiency enriched for p53 (64.7%) mutations, and numerically worse median overall survival as compared to ASS1‐proficient disease (10.2 months; n = 29). There was no apparent increase in KRAS mutations (35.3%) and PD‐L1 (<1%) expression (55.6%). Re‐expression of tumoral ASS1 was detected in one patient at progression (n = 1/3). Conclusions ADIPemCis was safe and highly active in patients with ASS1‐deficient non‐squamous NSCLC, however, survival was poor overall. ASS1 loss was co‐associated with p53 mutations. Therapies incorporating pegargiminase merit further evaluation in ASS1‐deficient and treatment‐refractory NSCLC.
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Affiliation(s)
- Peter W Szlosarek
- Center for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute (BCI) - A Cancer Research UK Center of Excellence, Queen Mary University of London, John Vane Science Center, London, UK.,Department of Medical Oncology, Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Akhila G Wimalasingham
- Department of Medical Oncology, Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Melissa M Phillips
- Department of Medical Oncology, Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Peter E Hall
- Department of Medical Oncology, Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Pui Ying Chan
- Department of Medical Oncology, Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - John Conibear
- Department of Clinical Oncology, Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Louise Lim
- Department of Medical Oncology, Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Sukaina Rashid
- Department of Medical Oncology, Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Jeremy Steele
- Department of Medical Oncology, Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Paula Wells
- Department of Clinical Oncology, Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | | | - Chih-Ling Kuo
- Polaris Pharmaceuticals, Inc., San Diego, California, USA
| | - Xiaoxing Feng
- Polaris Pharmaceuticals, Inc., San Diego, California, USA
| | | | - John Bomalaski
- Polaris Pharmaceuticals, Inc., San Diego, California, USA
| | - Stephen Ellis
- Department of Diagnostic Imaging, Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Marianne Grantham
- Cytogenetics and Molecular Haematology, Pathology and Pharmacy Building, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Michael Sheaff
- Department of Histopathology, Pathology and Pharmacy Building, Barts Health NHS Trust, Royal London Hospital, London, UK
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23
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Chang KY, Chiang NJ, Wu SY, Yen CJ, Chen SH, Yeh YM, Li CF, Feng X, Wu K, Johnston A, Bomalaski JS, Wu BW, Gao J, Subudhi SK, Kaseb AO, Blando JM, Yadav SS, Szlosarek PW, Chen LT. Phase 1b study of pegylated arginine deiminase (ADI-PEG 20) plus Pembrolizumab in advanced solid cancers. Oncoimmunology 2021; 10:1943253. [PMID: 34290906 PMCID: PMC8276661 DOI: 10.1080/2162402x.2021.1943253] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/11/2021] [Indexed: 02/08/2023] Open
Abstract
Background Pegylated arginine deiminase (ADI-PEG 20) is a metabolism-based strategy that depletes arginine, resulting in tumoral stress and cytotoxicity. Preclinically, ADI-PEG 20 modulates T-cell activity and enhances the therapeutic efficacy of programmed death-1 (PD-1) inhibition. Methods A phase 1b study, including a dose-escalation cohort and an expansion cohort, was undertaken to explore the effects of ADI-PEG 20 in combination with pembrolizumab, an anti-PD-1 antibody, for safety, pharmacodynamics, and response. CD3 levels and programmed death-ligand 1 (PD-L1) expression were assessed in paired biopsies collected prior to and after ADI-PEG 20 treatment but before pembrolizumab. Results Twenty-five patients, nine in the dose-escalation cohort and sixteen in the expansion cohort, were recruited. Treatment was feasible with adverse events consistent with those known for each agent, except for Grade 3/4 neutropenia which was higher than expected, occurring in 10/25 (40%) patients. Mean arginine levels were suppressed for 1-3 weeks, but increased gradually. CD3+ T cells increased in 10/12 (83.3%) subjects following ADI-PEG 20 treatment, including in three partial responders (p = .02). PD-L1 expression was low and increased in 3/10 (30%) of subjects. Partial responses occurred in 6/25 (24%) heavily pretreated patients, in both argininosuccinate synthetase 1 proficient and deficient subjects. Conclusions The immunometabolic combination was safe with the caveat that the incidence of neutropenia might be increased compared with either agent alone. ADI-PEG 20 treatment increased T cell infiltration in the low PD-L1 tumor microenvironment. The recommended phase 2 doses are 36 mg/m2 weekly for ADI-PEG 20 and 200 mg every 3 weeks for pembrolizumab.
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Affiliation(s)
- Kwang-Yu Chang
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Nai-Jung Chiang
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Shang-Yin Wu
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Jui Yen
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shang-Hung Chen
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Yu-Min Yeh
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Feng Li
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
- Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan
| | - Xiaoxing Feng
- Polaris Pharmaceuticals, Inc., San Diego, California, USA
| | - Katherine Wu
- Polaris Pharmaceuticals, Inc., San Diego, California, USA
| | | | | | - Bor-Wen Wu
- Polaris Pharmaceuticals, Inc., San Diego, California, USA
| | - Jianjun Gao
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sumit K. Subudhi
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ahmed O. Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jorge M. Blando
- The Immunotherapy Platform, The University of Texas MD Anderson Cancer Center, Houston, TXUSA
| | - Shalini S. Yadav
- The Immunotherapy Platform, The University of Texas MD Anderson Cancer Center, Houston, TXUSA
| | - Peter W. Szlosarek
- Center for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, UK
| | - Li-Tzong Chen
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Van Tine BA, Hirbe AC, Luo J, Oppelt PJ, Weiss MC, Eulo VA, Toeniskoetter J, Haarberg S, Abaricia S, Ruff T, Bomalaski JS, Johnston A, Kuo CL, Shiu CF, Ingham M, Bui N, Chawla SP, Schwartz GK, Ganjoo KN. Phase II trial of pegylated arginine deiminase in combination with gemcitabine and docetaxel for the treatment of soft tissue sarcoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.11508] [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
11508 Background: Soft tissue sarcoma (STS) is dependent on extracellular arginine as it often lacks expression of argininosuccinate synthase 1 (ASS1), the urea cycle enzyme needed to produce intracellular arginine. PEGylated arginine deiminase (ADI-PEG 20) is an extracellular arginine-degrading enzyme that causes ASS1 deficient tumors to enter the starvation state. Preclinical data demonstrated that addition of docetaxel (D) with ADI-PEG20 upregulates expression of the transporter for gemcitabine (G), overcoming transporter level resistance, and causing increased cell death. In vivo modeling demonstrated that the combination of ADI-PEG20 with G+D was superior to G+D alone. Therefore, we performed a phase 2 trial testing the addition of ADI-PEG20 to G+D. Methods: We performed an investigator-initiated, phase 2, multicenter, multi-arm clinical trial of ADI-PEG20 with G (90minute infusion)+D in STS, Ewing’s, osteosarcoma and small cell lung cancer. We are reporting Arm A, the STS arm. Eligible patients had STS that would be standardly treated with G+D that had progressed on at least one prior line of therapy with measurable disease by RECIST1.1 and had adequate organ function Based on a historic median PFS of 6.2 months for G+D, we targeted to enroll N = 75 patients in cohort A to detect a 2.8 month improvement with 80% power at a 5% alpha level. Primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), clinical benefit rate (CBR), safety, tolerability, cancer related mortality, and correlation with ASS1 expression by IHC. We evaluated PFS by Kaplan-Meier method and estimated overall response rate (ORR). Results: 75 patients were treated and deemed evaluable. The trial underwent two dose reductions by the data safety monitoring board due to prolonged neutropenia and thrombocytopenia preventing the use of day 8 G+D, consistent with preclinical mechanism of action data showing that ADI-PEG 20+D enhanced G uptake. Originally, the G dose was 900mg/m2 reduced first to 750mg/m2 then to 600mg/m2. D was dose reduced at the time of the second dose reduction from 75mg/m2 to 60mg/m2. ADI-PEG20 was given at a fixed intramuscular dose (36 mg/m2) weekly. The need for two dose reductions affected the PFS. The PFS/OS (months) were for the 600mg/m2 group (n = 31) was 6.0/N.D., leiomyosarcoma (LMS) (N = 33) 7.2/22.5, liposarcoma 5.1/17.4, and other (N = 36) 2.8/15.0. Responses were 8% complete (6/75) (3 LMS, 1 synovial and 2 angiosarcoma), 17% partial (13/75), and 43% stable disease (32/75), for an ORR of 25% (19/75) and CBR of 68% (51/75). There was a trend for ASS1 negative tumors to benefit more than ASS1 positive tumors. Conclusions: The combination of ADI-PEG20 with G+D can be safely and effectively given at a dose of 600mg/m2 G and 60mg/m2 D. Future randomized trials of ADI-PEG20 with G+D are planned. Clinical trial information: NCT03449901.
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Affiliation(s)
| | | | - Jingqin Luo
- Washington University in St. Louis, St. Louis, MO
| | | | - Mia C. Weiss
- Washington University School of Medicine, St. Louis, MO
| | | | | | | | | | - Tyler Ruff
- Washington University School of Medicine, St. Louis, MO
| | | | | | | | | | | | - Nam Bui
- Stanford University, Stanford, CA
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Batts T, Langhor I, Moeller C, Liu C, Sones J, Johnston A. Hepatic steatosis precedes pregnancy in the BPH/5 preeclampsia‐like mouse model. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.03307] [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: 11/11/2022]
Affiliation(s)
- T. Batts
- Veterinary Clinical SciencesLouisiana State UniversityBaton RougeLA
| | - I. Langhor
- Pathobiological SciencesLouisiana Animal Disease Diagnostic LaboratoryBaton RougeLA
| | - C. Moeller
- Veterinary Clinical SciencesLouisiana State UniversityBaton RougeLA
| | - C. Liu
- Veterinary Clinical SciencesLouisiana State UniversityBaton RougeLA
| | - J. Sones
- Veterinary Clinical SciencesLouisiana State UniversityBaton RougeLA
| | - A. Johnston
- Veterinary Clinical SciencesLouisiana State UniversityBaton RougeLA
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26
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VerMilyea M, Hall JMM, Diakiw SM, Johnston A, Nguyen T, Perugini D, Miller A, Picou A, Murphy AP, Perugini M. Development of an artificial intelligence-based assessment model for prediction of embryo viability using static images captured by optical light microscopy during IVF. Hum Reprod 2021; 35:770-784. [PMID: 32240301 PMCID: PMC7192535 DOI: 10.1093/humrep/deaa013] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [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: 10/13/2019] [Revised: 12/23/2019] [Accepted: 01/16/2020] [Indexed: 11/17/2022] Open
Abstract
STUDY QUESTION Can an artificial intelligence (AI)-based model predict human embryo viability using images captured by optical light microscopy? SUMMARY ANSWER We have combined computer vision image processing methods and deep learning techniques to create the non-invasive Life Whisperer AI model for robust prediction of embryo viability, as measured by clinical pregnancy outcome, using single static images of Day 5 blastocysts obtained from standard optical light microscope systems. WHAT IS KNOWN ALREADY Embryo selection following IVF is a critical factor in determining the success of ensuing pregnancy. Traditional morphokinetic grading by trained embryologists can be subjective and variable, and other complementary techniques, such as time-lapse imaging, require costly equipment and have not reliably demonstrated predictive ability for the endpoint of clinical pregnancy. AI methods are being investigated as a promising means for improving embryo selection and predicting implantation and pregnancy outcomes. STUDY DESIGN, SIZE, DURATION These studies involved analysis of retrospectively collected data including standard optical light microscope images and clinical outcomes of 8886 embryos from 11 different IVF clinics, across three different countries, between 2011 and 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS The AI-based model was trained using static two-dimensional optical light microscope images with known clinical pregnancy outcome as measured by fetal heartbeat to provide a confidence score for prediction of pregnancy. Predictive accuracy was determined by evaluating sensitivity, specificity and overall weighted accuracy, and was visualized using histograms of the distributions of predictions. Comparison to embryologists’ predictive accuracy was performed using a binary classification approach and a 5-band ranking comparison. MAIN RESULTS AND THE ROLE OF CHANCE The Life Whisperer AI model showed a sensitivity of 70.1% for viable embryos while maintaining a specificity of 60.5% for non-viable embryos across three independent blind test sets from different clinics. The weighted overall accuracy in each blind test set was >63%, with a combined accuracy of 64.3% across both viable and non-viable embryos, demonstrating model robustness and generalizability beyond the result expected from chance. Distributions of predictions showed clear separation of correctly and incorrectly classified embryos. Binary comparison of viable/non-viable embryo classification demonstrated an improvement of 24.7% over embryologists’ accuracy (P = 0.047, n = 2, Student’s t test), and 5-band ranking comparison demonstrated an improvement of 42.0% over embryologists (P = 0.028, n = 2, Student’s t test). LIMITATIONS, REASONS FOR CAUTION The AI model developed here is limited to analysis of Day 5 embryos; therefore, further evaluation or modification of the model is needed to incorporate information from different time points. The endpoint described is clinical pregnancy as measured by fetal heartbeat, and this does not indicate the probability of live birth. The current investigation was performed with retrospectively collected data, and hence it will be of importance to collect data prospectively to assess real-world use of the AI model. WIDER IMPLICATIONS OF THE FINDINGS These studies demonstrated an improved predictive ability for evaluation of embryo viability when compared with embryologists’ traditional morphokinetic grading methods. The superior accuracy of the Life Whisperer AI model could lead to improved pregnancy success rates in IVF when used in a clinical setting. It could also potentially assist in standardization of embryo selection methods across multiple clinical environments, while eliminating the need for complex time-lapse imaging equipment. Finally, the cloud-based software application used to apply the Life Whisperer AI model in clinical practice makes it broadly applicable and globally scalable to IVF clinics worldwide. STUDY FUNDING/COMPETING INTEREST(S) Life Whisperer Diagnostics, Pty Ltd is a wholly owned subsidiary of the parent company, Presagen Pty Ltd. Funding for the study was provided by Presagen with grant funding received from the South Australian Government: Research, Commercialisation and Startup Fund (RCSF). ‘In kind’ support and embryology expertise to guide algorithm development were provided by Ovation Fertility. J.M.M.H., D.P. and M.P. are co-owners of Life Whisperer and Presagen. Presagen has filed a provisional patent for the technology described in this manuscript (52985P pending). A.P.M. owns stock in Life Whisperer, and S.M.D., A.J., T.N. and A.P.M. are employees of Life Whisperer.
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Affiliation(s)
- M VerMilyea
- Laboratory Operations, Ovation Fertility, Austin, TX 78731, USA.,IVF Laboratory, Texas Fertility Center, Austin, TX 78731, USA
| | - J M M Hall
- Life Whisperer Diagnostics, Presagen Pty Ltd., Adelaide, SA 5000, Australia.,Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, The University of Adelaide, Adelaide, SA 5000, Australia
| | - S M Diakiw
- Life Whisperer Diagnostics, Presagen Pty Ltd., Adelaide, SA 5000, Australia
| | - A Johnston
- Life Whisperer Diagnostics, Presagen Pty Ltd., Adelaide, SA 5000, Australia.,Australian Institute for Machine Learning, School of Computer Science, The University of Adelaide, Adelaide, SA 5000, Australia
| | - T Nguyen
- Life Whisperer Diagnostics, Presagen Pty Ltd., Adelaide, SA 5000, Australia
| | - D Perugini
- Life Whisperer Diagnostics, Presagen Pty Ltd., Adelaide, SA 5000, Australia
| | - A Miller
- Laboratory Operations, Ovation Fertility, Austin, TX 78731, USA
| | - A Picou
- Laboratory Operations, Ovation Fertility, Austin, TX 78731, USA
| | - A P Murphy
- Life Whisperer Diagnostics, Presagen Pty Ltd., Adelaide, SA 5000, Australia
| | - M Perugini
- Life Whisperer Diagnostics, Presagen Pty Ltd., Adelaide, SA 5000, Australia.,Adelaide Medical School, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
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Tsai HJ, Hsiao HH, Hsu YT, Liu YC, Kao HW, Liu TC, Cho SF, Feng X, Johnston A, Bomalaski JS, Kuo MC, Chen TY. Phase I study of ADI-PEG20 plus low-dose cytarabine for the treatment of acute myeloid leukemia. Cancer Med 2021; 10:2946-2955. [PMID: 33787078 PMCID: PMC8085967 DOI: 10.1002/cam4.3871] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 06/22/2020] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022] Open
Abstract
Most acute myeloid leukemia (AML) cells are argininosuccinate synthetase‐deficient. Pegylated arginine deiminase (ADI‐PEG20) monotherapy depletes circulating arginine, thereby selectively inducing tumor cell death. ADI‐PEG20 was shown to induce complete responses in ~10% of relapsed/refractory or poor‐risk AML patients. We conducted a phase I, dose‐escalation study combining ADI‐PEG20 and low‐dose cytarabine (LDC) in AML patients. Patients received 20 mg LDC subcutaneously twice daily for 10 days every 28 days and ADI‐PEG20 at 18 or 36 mg/m2 (dose levels 1 and 2) intramuscularly weekly. An expansion cohort for the maximal tolerated dose of ADI‐PEG20 was planned to further estimate the toxicity and preliminary response of this regimen. The primary endpoints were safety and tolerability. The secondary endpoints were time on treatment, overall survival (OS), overall response rate (ORR), and biomarkers (pharmacodynamics and immunogenicity detection). Twenty‐three patients were included in the study, and seventeen patients were in the expansion cohort (dose level 2). No patients developed dose‐limiting toxicities. The most common grade III/IV toxicities were thrombocytopenia (61%), anemia (52%), and neutropenia (30%). One had an allergic reaction to ADI‐PEG20. The ORR in 18 evaluable patients was 44.4%, with a median OS of 8.0 (4.5‐not reached) months. In seven treatment‐naïve patients, the ORR was 71.4% and the complete remission rate was 57.1%. The ADI‐PEG20 and LDC combination was well‐tolerated and resulted in an encouraging ORR. Further combination studies are warranted. (This trial was registered in ClinicalTrials.gov as a Ph1 Study of ADI‐PEG20 Plus Low‐Dose Cytarabine in Older Patients With AML, NCT02875093).
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Affiliation(s)
- Hui-Jen Tsai
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan.,Department of Oncology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.,Division of Hematology/Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Hua Hsiao
- Division of Hematology/Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ya-Ting Hsu
- Division of Hematology, Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Chang Liu
- Division of Hematology/Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiao-Wen Kao
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan
| | - Ta-Chih Liu
- Division of Hematology/Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Hematology-Oncology and Cancer Center, Chang Bing Show Chwan Hospital, Changhua, Taiwan
| | - Shih-Feng Cho
- Division of Hematology/Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Xiaoxing Feng
- Polaris Pharmaceuticals, Inc, Polaris Group, San Diego, CA, USA
| | - Amanda Johnston
- Polaris Pharmaceuticals, Inc, Polaris Group, San Diego, CA, USA
| | | | - Ming-Chung Kuo
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan
| | - Tsai-Yun Chen
- Division of Hematology, Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
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Johnston A, Afra A, Liu P, Northoff G, Edwards J. Sex-specific effects of comorbid depression on mortality and risk of cognitive decline and dementia in heart failure: an analysis of the National Alzheimer’s Coordinating Centre prospective cohort. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2020.02.052] [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: 10/22/2022] Open
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Green L, Roberts N, Cooper J, Agarwal S, Brunskill SJ, Chang I, Gill R, Johnston A, Klein AA, Platton S, Rossi A, Sepehripour A, Stanworth S, Monk V, O'Brien B. Prothrombin complex concentrate vs. fresh frozen plasma in adult patients undergoing heart surgery - a pilot randomised controlled trial (PROPHESY trial). Anaesthesia 2020; 76:892-901. [PMID: 33285008 PMCID: PMC8246985 DOI: 10.1111/anae.15327] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 12/11/2022]
Abstract
There is equipoise regarding the use of prothrombin complex concentrate vs. fresh frozen plasma in bleeding patients undergoing cardiac surgery. We performed a pilot randomised controlled trial to determine the recruitment rate for a large trial, comparing the impact of prothrombin complex concentrate vs. fresh frozen plasma on haemostasis (1 h and 24 h post-intervention), and assessing safety. Adult patients who developed bleeding within 24 h of cardiac surgery that required coagulation factor replacement were randomly allocated to receive prothrombin complex concentrate (15 IU.kg-1 based on factor IX) or fresh frozen plasma (15 ml.kg-1 ). If bleeding continued after the first administration of prothrombin complex concentrate or fresh frozen plasma administration, standard care was administered. From February 2019 to October 2019, 180 patients were screened, of which 134 (74.4% (95%CI 67-81%)) consented, 59 bled excessively and 50 were randomly allocated; 25 in each arm, recruitment rate 35% (95%CI 27-44%). There were 23 trial protocol deviations, 137 adverse events (75 prothrombin complex concentrate vs. 62 fresh frozen plasma) and 18 serious adverse events (5 prothrombin complex concentrate vs. 13 fresh frozen plasma). There was no increase in thromboembolic events with prothrombin complex concentrate. No patient withdrew from the study, four were lost to follow-up and two died. At 1 h after administration of the intervention there was a significant increase in fibrinogen, Factor V, Factor XII, Factor XIII, α2 -antiplasmin and antithrombin levels in the fresh frozen plasma arm, while Factor II and Factor X were significantly higher in the prothrombin complex concentrate group. At 24 h, there were no significant differences in clotting factor levels. We conclude that recruitment to a larger study is feasible. Haemostatic tests have provided useful insight into the haemostatic changes following prothrombin complex concentrate or fresh frozen plasma administration. A definitive trial is needed to ascertain the benefits and safety for each.
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Affiliation(s)
- L Green
- Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK.,Department of Haematology, Barts Health NHS Trust, London, UK.,Department of Cardiac Surgery, Barts Health NHS Trust, London, UK
| | - N Roberts
- William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - J Cooper
- Department of Anaesthesia, Manchester Royal Infirmary, Manchester, UK
| | - S Agarwal
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - S J Brunskill
- Department of Anaesthesia, University Hospital Southampton, Southampton, UK
| | - I Chang
- Department of Anaesthesia, Manchester Royal Infirmary, Manchester, UK
| | - R Gill
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - A Johnston
- Department of Anaesthesia, Royal Papworth Hospital, Cambridge, UK
| | - A A Klein
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Platton
- Department of Cardiac Surgery, Barts Health NHS Trust, London, UK
| | - A Rossi
- William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - A Sepehripour
- William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - S Stanworth
- Department of Anaesthesia, Barts Health NHS Trust, London, UK.,NHS Blood and Transplant, Oxford, UK
| | - V Monk
- Department of Anaesthesia, Manchester Royal Infirmary, Manchester, UK
| | - B O'Brien
- Department of Anaesthesia, Barts Health NHS Trust, London, UK.,Outcomes Research Consortium, Cleveland Clinic, OH, USA
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Szlosarek PW, Phillips MM, Pavlyk I, Steele J, Shamash J, Spicer J, Kumar S, Pacey S, Feng X, Johnston A, Bomalaski J, Moir G, Lau K, Ellis S, Sheaff M. Expansion Phase 1 Study of Pegargiminase Plus Pemetrexed and Cisplatin in Patients With Argininosuccinate Synthetase 1-Deficient Mesothelioma: Safety, Efficacy, and Resistance Mechanisms. JTO Clin Res Rep 2020; 1:100093. [PMID: 34589965 PMCID: PMC8474273 DOI: 10.1016/j.jtocrr.2020.100093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Pegargiminase (ADI-PEG 20; ADI) degrades arginine and potentiates pemetrexed (Pem) cytotoxicity in argininosuccinate synthetase 1 (ASS1)-deficient malignant pleural mesothelioma (MPM). We conducted a phase 1 dose-expansion study at the recommended phase 2 dose of ADI-PEG 20 with Pem and cisplatin (ADIPemCis), to further evaluate arginine-lowering therapy in ASS1-deficient MPM and explore the mechanisms of resistance. METHODS A total of 32 patients with ASS1-deficient MPM (11 epithelioid; 10 biphasic;11 sarcomatoid) who were chemonaive received weekly intramuscular pegargiminase (36 mg/m2) with Pem (500 mg/m2) and cisplatin (75 mg/m2) intravenously, every 3 weeks (six cycles maximum). Maintenance pegargiminase was permitted until disease progression or withdrawal. Safety, pharmacodynamics, immunogenicity, and efficacy were determined. Biopsies were performed in progressing patients to explore the mechanisms of resistance to pegargiminase. RESULTS The treatment was well tolerated. Most adverse events were of grade 1/2, whereas four nonhematologic grade 3/4 adverse events related to pegargiminase were reversible. Plasma arginine decreased whereas citrulline increased; this was maintained by 18 weeks of ADIPemCis therapy. The disease control rate in 31 assessed patients was 93.5% (n = 29 of 31; 95% confidence interval [CI]: 78.6%-99.2%), with a partial response rate of 35.5% (n = 11 of 31; 95% CI: 19.2%-54.6%). The median progression-free and overall survivals were 5.6 (95% CI: 4.0-6.0) and 10.1 (95% CI: 6.1-11.1) months, respectively. Progression biopsies on pegargiminase revealed a statistically significant influx of macrophages (n = 6; p = 0.0255) and patchy tumoral ASS1 reexpression (n = 2 of 6). In addition, we observed increased tumoral programmed death-ligand 1-an ADI-PEG 20 inducible gene-and the formation of CD3-positive T lymphocyte aggregates on disease progression (n = 2 of 5). CONCLUSIONS The dose expansion of ADIPemCis confirmed the high clinical activity and good tolerability in ASS1-deficient poor-prognosis mesothelioma, underpinning an ongoing phase 3 study (ClinicalTrials.govNCT02709512). Notably, resistance to pegargiminase correlated with marked macrophage recruitment and-along with the tumor immune microenvironment-warrants further study to optimize arginine deprivation for the treatment of mesothelioma.
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Affiliation(s)
- Peter W. Szlosarek
- Center for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute (BCI)—A Cancer Research UK Center of Excellence, Queen Mary University of London, London, United Kingdom
| | - Melissa M. Phillips
- Center for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute (BCI)—A Cancer Research UK Center of Excellence, Queen Mary University of London, London, United Kingdom
- Department of Medical Oncology, Barts Health NHS Trust, St Bartholomew’s Hospital, London, United Kingdom
| | - Iuliia Pavlyk
- Center for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute (BCI)—A Cancer Research UK Center of Excellence, Queen Mary University of London, London, United Kingdom
| | - Jeremy Steele
- Department of Medical Oncology, Barts Health NHS Trust, St Bartholomew’s Hospital, London, United Kingdom
| | - Jonathan Shamash
- Department of Medical Oncology, Barts Health NHS Trust, St Bartholomew’s Hospital, London, United Kingdom
| | - James Spicer
- School of Cancer and Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Sanjeev Kumar
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Simon Pacey
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Xiaoxing Feng
- Polaris Pharmaceuticals, Inc., San Diego, California
| | | | | | - Graeme Moir
- Department of Plastic Surgery, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom
| | - Kelvin Lau
- Department of Cardiothoracic Surgery, Barts Health NHS Trust, St Bartholomew’s Hospital, London, United Kingdom
| | - Stephen Ellis
- Department of Diagnostic Imaging, Barts Health NHS Trust, St Bartholomew’s Hospital, London, United Kingdom
| | - Michael Sheaff
- Department of Histopathology, Pathology and Pharmacy Building, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom
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White D, MacDonald S, Bull T, Hayman M, de Monteverde-Robb R, Sapsford D, Lavinio A, Varley J, Johnston A, Besser M, Thomas W. Heparin resistance in COVID-19 patients in the intensive care unit. J Thromb Thrombolysis 2020; 50:287-291. [PMID: 32445064 PMCID: PMC7242778 DOI: 10.1007/s11239-020-02145-0] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Patients with COVID-19 have a coagulopathy and high thrombotic risk. In a cohort of 69 intensive care unit (ICU) patients we investigated for evidence of heparin resistance in those that have received therapeutic anticoagulation. 15 of the patients have received therapeutic anticoagulation with either unfractionated heparin (UFH) or low molecular weight heparin (LMWH), of which full information was available on 14 patients. Heparin resistance to UFH was documented in 8/10 (80%) patients and sub-optimal peak anti-Xa following therapeutic LMWH in 5/5 (100%) patients where this was measured (some patients received both anticoagulants sequentially). Spiking plasma from 12 COVID-19 ICU patient samples demonstrated decreased in-vitro recovery of anti-Xa compared to normal pooled plasma. In conclusion, we have found evidence of heparin resistance in critically unwell COVID-19 patients. Further studies investigating this are required to determine the optimal thromboprophylaxis in COVID-19 and management of thrombotic episodes.
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Affiliation(s)
- D White
- Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S MacDonald
- Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - T Bull
- Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Hayman
- Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - R de Monteverde-Robb
- Pharmacy Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D Sapsford
- Pharmacy Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Lavinio
- Department of Intensive Care Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J Varley
- Department of Intensive Care Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Johnston
- Department of Intensive Care Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Besser
- Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - W Thomas
- Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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Lawler J, Choynowski M, Bailey K, Bucholc M, Johnston A, Sugrue M. Meta-analysis of the impact of postoperative infective complications on oncological outcomes in colorectal cancer surgery. BJS Open 2020; 4:737-747. [PMID: 32525280 PMCID: PMC7528523 DOI: 10.1002/bjs5.50302] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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: 01/09/2020] [Revised: 02/26/2020] [Accepted: 05/02/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cancer outcomes are complex, involving prevention, early detection and optimal multidisciplinary care. Postoperative infection and surgical site-infection (SSI) are not only uncomfortable for patients and costly, but may also be associated with poor oncological outcomes. A meta-analysis was undertaken to assess the oncological effects of SSI in patients with colorectal cancer. METHODS An ethically approved PROSPERO-registered meta-analysis was conducted following PRISMA guidelines. PubMed and Scopus databases were searched for studies published between 2007 and 2017 reporting the effects of postoperative infective complications on oncological survival in colorectal cancer. Results were separated into those for SSI and those concerning anastomotic leakage. Articles with a Methodological Index for Non-Randomized Studies score of at least 18 were included. Hazard ratios (HRs) with 95 per cent confidence intervals were computed for risk factors using an observed to expected and variance fixed-effect model. RESULTS Of 5027 articles were reviewed, 43 met the inclusion criteria, with a total of 154 981 patients. Infective complications had significant negative effects on overall survival (HR 1·37, 95 per cent c.i. 1·28 to 1·46) and cancer-specific survival (HR 2·58, 2·15 to 3·10). Anastomotic leakage occurred in 7·4 per cent and had a significant negative impact on disease-free survival (HR 1·14, 1·09 to 1·20), overall survival (HR 1·34, 1·28 to 1·39), cancer-specific survival (HR 1·43, 1·31 to 1·55), local recurrence (HR 1·18, 1·06 to 1·32) and overall recurrence (HR 1·46, 1·27 to 1·68). CONCLUSION This meta-analysis identified a significant negative impact of postoperative infective complications on overall and cancer-specific survival in patients undergoing colorectal surgery.
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Affiliation(s)
- J Lawler
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - M Choynowski
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - K Bailey
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - M Bucholc
- EU INTERREG Centre for Personalized Medicine, Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Magee Campus, Derry, /Londonderry, UK
| | - A Johnston
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - M Sugrue
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland.,EU INTERREG Centre for Personalized Medicine, Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Magee Campus, Derry, /Londonderry, UK
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Thomas W, Varley J, Johnston A, Symington E, Robinson M, Sheares K, Lavinio A, Besser M. Thrombotic complications of patients admitted to intensive care with COVID-19 at a teaching hospital in the United Kingdom. Thromb Res 2020; 191:76-77. [PMID: 32402996 PMCID: PMC7182517 DOI: 10.1016/j.thromres.2020.04.028] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 02/06/2023]
Affiliation(s)
- W Thomas
- Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, United Kingdom.
| | - J Varley
- Intensive Care Medicine Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - A Johnston
- Intensive Care Medicine Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - E Symington
- Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, United Kingdom
| | - M Robinson
- Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, United Kingdom
| | - K Sheares
- Department of Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom; Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - A Lavinio
- Intensive Care Medicine Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - M Besser
- Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, United Kingdom
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Johnston A, Auer T, Fink D, Strimas-Mackey M, Iliff M, Rosenberg KV, Brown S, Lanctot R, Rodewald AD, Kelling S. Comparing abundance distributions and range maps in spatial conservation planning for migratory species. Ecol Appl 2020; 30:e02058. [PMID: 31838775 DOI: 10.1002/eap.2058] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 07/15/2019] [Accepted: 09/17/2019] [Indexed: 06/10/2023]
Abstract
Most spatial conservation planning for wide-ranging or migratory species is constrained by poor knowledge of species' spatiotemporal dynamics and is only based on static species' ranges. However, species have substantial variation in abundance across their range and migratory species have important spatiotemporal population dynamics. With growing ecological data and advancing analytics, both of these can be estimated and incorporated into spatial conservation planning. However, there is limited information on the degree to which including this information affects conservation planning. We compared the performance of systematic conservation prioritizations for different scenarios based on varying the input species' distributions by ecological metric (abundance distributions versus range maps) and temporal sampling resolution (weekly, monthly, or quarterly). We used the example of a community of 41 species of migratory shorebirds that breed in North America, and we used eBird data to produce weekly estimates of species' abundances and ranges. Abundance distributions at a monthly or weekly resolution led to prioritizations that most efficiently protected species throughout the full annual cycle. Conversely, spatial prioritizations based on species' ranges required more sites and left most species insufficiently protected for at least part of their annual cycle. Prioritizations with only quarterly species ranges were very inefficient as they needed to target 40% of species' ranges to include 10% of populations. We highlight the high value of abundance information for spatial conservation planning, which leads to more efficient and effective spatial prioritization for conservation. Overall, we provide evidence that spatial conservation planning for wide-ranging migratory species is most robust and efficient when informed by species' abundance information from the full annual cycle.
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Affiliation(s)
- A Johnston
- Cornell Lab of Ornithology, Cornell University, 159 Sapsucker Woods Road, Ithaca, New York, 14850, USA
- Conservation Science Group, Department of Zoology, University of Cambridge, The David Attenborough Building, Pembroke Street, Cambridge, CB2 3QZ, United Kingdom
| | - T Auer
- Cornell Lab of Ornithology, Cornell University, 159 Sapsucker Woods Road, Ithaca, New York, 14850, USA
| | - D Fink
- Cornell Lab of Ornithology, Cornell University, 159 Sapsucker Woods Road, Ithaca, New York, 14850, USA
| | - M Strimas-Mackey
- Cornell Lab of Ornithology, Cornell University, 159 Sapsucker Woods Road, Ithaca, New York, 14850, USA
| | - M Iliff
- Cornell Lab of Ornithology, Cornell University, 159 Sapsucker Woods Road, Ithaca, New York, 14850, USA
| | - K V Rosenberg
- Cornell Lab of Ornithology, Cornell University, 159 Sapsucker Woods Road, Ithaca, New York, 14850, USA
- American Bird Conservancy, The Plains, Virginia, 20198, USA
| | - S Brown
- Manomet Inc., P.O. Box 1770, Manomet, Massachusetts, 02345, USA
| | - R Lanctot
- U.S. Fish and Wildlife Service, 1011 East Tudor Road, MS 201, Anchorage, Alaska, 99503, USA
| | - A D Rodewald
- Cornell Lab of Ornithology, Cornell University, 159 Sapsucker Woods Road, Ithaca, New York, 14850, USA
- Department of Natural Resources, Cornell University, Ithaca, New York, 14853, USA
| | - S Kelling
- Cornell Lab of Ornithology, Cornell University, 159 Sapsucker Woods Road, Ithaca, New York, 14850, USA
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Broussard L, Bailey K, Bailey W, Barrow J, Berry K, Blose A, Crawford C, Debeer-Schmitt L, Frost M, Galindo-Uribarri A, Gallmeier F, Gilbert C, Heilbronn L, Iverson E, Johnston A, Kamyshkov Y, Lewiz P, Novikov I, Penttilä S, Vavra S, Young A. New search for mirror neutron regeneration. EPJ Web Conf 2019. [DOI: 10.1051/epjconf/201921907002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The possibility of relatively fast neutron oscillations into a mirror neutron state is not excluded experimentally when a mirror magnetic field is considered. Direct searches for the disappearance of neutrons into mirror neutrons in a controlled magnetic field have previously been performed using ultracold neutrons, with some anomalous results reported. We describe a technique using cold neutrons to perform a disappearance and regeneration search, which would allow us to unambiguously identify a possible oscillation signal. An experiment using the existing General Purpose-Small Angle Neutron Scattering instrument at the High Flux Isotope Reactor at Oak Ridge National Laboratory will have the sensitivity to fully explore the parameter space of prior ultracold neutron searches and confirm or refute previous claims of observation. This instrument can also conclusively test the validity of recently suggested oscillation-based explanations for the neutron lifetime anomaly.
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McClymont E, Johnston A, Albert A, Coutlée F, Lee M, Walmsley S, Lipsky N, Money D. A natural immune boosting effect among HPV-vaccinated women living with HIV. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.10.030] [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: 11/28/2022]
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Abou-Alfa GK, Qin S, Ryoo BY, Lu SN, Yen CJ, Feng YH, Lim HY, Izzo F, Colombo M, Sarker D, Bolondi L, Vaccaro G, Harris WP, Chen Z, Hubner RA, Meyer T, Sun W, Harding JJ, Hollywood EM, Ma J, Wan PJ, Ly M, Bomalaski J, Johnston A, Lin CC, Chao Y, Chen LT. Phase III randomized study of second line ADI-PEG 20 plus best supportive care versus placebo plus best supportive care in patients with advanced hepatocellular carcinoma. Ann Oncol 2019; 29:1402-1408. [PMID: 29659672 DOI: 10.1093/annonc/mdy101] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Arginine depletion is a putative target in hepatocellular carcinoma (HCC). HCC often lacks argininosuccinate synthetase, a citrulline to arginine-repleting enzyme. ADI-PEG 20 is a cloned arginine degrading enzyme-arginine deiminase-conjugated with polyethylene glycol. The goal of this study was to evaluate this agent as a potential novel therapeutic for HCC after first line systemic therapy. Methods and patients Patients with histologically proven advanced HCC and Child-Pugh up to B7 with prior systemic therapy, were randomized 2 : 1 to ADI-PEG 20 18 mg/m2 versus placebo intramuscular injection weekly. The primary end point was overall survival (OS), with 93% power to detect a 4-5.6 months increase in median OS (one-sided α = 0.025). Secondary end points included progression-free survival, safety, and arginine correlatives. Results A total of 635 patients were enrolled: median age 61, 82% male, 60% Asian, 52% hepatitis B, 26% hepatitis C, 76% stage IV, 91% Child-Pugh A, 70% progressed on sorafenib and 16% were intolerant. Median OS was 7.8 months for ADI-PEG 20 versus 7.4 for placebo (P = 0.88, HR = 1.02) and median progression-free survival 2.6 months versus 2.6 (P = 0.07, HR = 1.17). Grade 3 fatigue and decreased appetite occurred in <5% of patients. Two patients on ADI-PEG 20 had ≥grade 3 anaphylactic reaction. Death rate within 30 days of end of treatment was 15.2% on ADI-PEG 20 versus 10.4% on placebo, none related to therapy. Post hoc analyses of arginine assessment at 4, 8, 12 and 16 weeks, demonstrated a trend of improved OS for those with more prolonged arginine depletion. Conclusion ADI-PEG 20 monotherapy did not demonstrate an OS benefit in second line setting for HCC. It was well tolerated. Strategies to enhance prolonged arginine depletion and synergize the effect of ADI-PEG 20 are underway. Clinical Trial number www.clinicaltrials.gov (NCT 01287585).
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Affiliation(s)
- G K Abou-Alfa
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, USA.
| | - S Qin
- Department of Oncology, The Chinese People's Liberation Army 81 Hospital, Nanjing, China
| | - B-Y Ryoo
- Department of Oncology, Asan Medical Center, Seoul, South Korea
| | - S-N Lu
- Department of Medical Oncology, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Taiwan
| | - C-J Yen
- Department of Oncology, National Cheng Kung University Hospital, Taiwan
| | - Y-H Feng
- Department of Oncology, Chi Mei Medical Center-Yong Kang, Taiwan
| | - H Y Lim
- Department of Medical Oncology, Samsung Medical Center, Seoul, South Korea
| | - F Izzo
- Department of Medicine, Fondazione Giovanni Pascale, Napoli
| | - M Colombo
- Department of Medicine, Fondazione IRCCS Ca, Milan, Italy
| | - D Sarker
- Department of Medicine, King's College Hospital, London, UK
| | - L Bolondi
- Department of Medicine, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - G Vaccaro
- Department of Medicine, Oregon Health Sciences University, Portland
| | - W P Harris
- Department of Medicine, University of Washington Medical Center, Seattle, USA
| | - Z Chen
- Department of Oncology, 2nd Hospital of Anhui Medical University, Hefei, China
| | - R A Hubner
- Department of Medicine, The Christie NHS Foundation Trust, Manchester, UK
| | - T Meyer
- Department of Medicine, Royal Free Hospital and UCL Cancer Institute, London, UK
| | - W Sun
- Department of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - J J Harding
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, USA
| | - E M Hollywood
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - J Ma
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - P J Wan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M Ly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - J Bomalaski
- Department of Research and Development, Polaris Pharmaceuticals, Inc., San Diego, USA
| | - A Johnston
- Department of Research and Development, Polaris Pharmaceuticals, Inc., San Diego, USA
| | - C-C Lin
- Department of Medical Oncology, Chang Gung Medical Foundation LK, Taipei, Tainan
| | - Y Chao
- Department of Medicine, Veterans General Hospital-Taipei, Taipei, Tainan
| | - L-T Chen
- Chang Gung University College of Medicine, Taiwan; Department of Medical Oncology, National Institute of Cancer Research, National Health Research Institutes, Tainan; Department of Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Osei B, Xu L, Johnston A, Darko S, Darko J, Osei E. Retrospective study of patients radiation dose during cardiac catheterization procedures. Br J Radiol 2019; 92:20181021. [PMID: 31045448 PMCID: PMC6636266 DOI: 10.1259/bjr.20181021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Cardiac catheterization procedures provide tremendous benefits to modern healthcare and the benefit derived by the patient should far outweigh the radiation risk associated with a properly optimized procedure. With increasing utilization of such procedures, there is growing concern regarding the magnitude and variations of dose to patients associated with procedure complexity and techniques parameters. Therefore, this study investigated radiation dose to patients from six cardiac catheterization procedures at our facility and suggest possible initial dose values for benchmark for patient radiation dose from these procedures. This initial benchmark data will be used for clinical radiation dose management which is essential for assessing the impact of any quality improvement initiatives in the cardiac catheterization laboratory. METHODS We retrospectively analyzed the dose parameters of 1000 patients who underwent various cardiac catheterization procedures: left heart catheterization (LH), percutaneous coronary intervention (PCI), complex PCI, LH with complex PCI, LH with PCI and cardiac resynchronization therapy (CRT) pacemaker in our cardiac catheterization laboratories. Patient's clinical radiation dose data [kerma-area-product (KAP) and air-kerma at the interventional reference point (Ka,r)] and technique parameters (fluoroscopy time, tube potential, current, pulse width and number of cine images) along with demographic information (age, height and weight) were collected from the hospital's RIS (Synapse), Sensis/Syngo Dynamics and Siemens Sensis Stats Manager electronic database. Statistical analysis was performed with the IBM SPSS Modeler v. 18.1 software. RESULTS The overall patient median age was 67.0 (range: 26.0-97.0) years and the median body mass index (BMI) was 28.8 (range: 15.9-61.7) kg/m2 . The median KAP for the LH, PCI, LH with complex PCI, complex PCI, LH with PCI and CRT-pacemaker procedures are 44.4 (4.1-203.2), 80.2 (18.9-208.5), 83.7 (48.0-246.1), 113.8 (60.9-284.5), 91.7 (6.0-426.0) and 51.1 (7.0-175.9) Gy-cm2 . The median Ka,r for the LH, PCI, LH with complex PCI, complex PCI, LH with PCI and CRT-pacemaker procedures are 701.0 (35.3-3794.0), 1384.7 (291.7-4021.8), 1607.0 (883.5-4448.3), 2260.2 (867.4-5311.9), 1589.3 (100.2-7237.4) and 463.8 (67.7-1695.9) mGy respectively. CONCLUSION We have analyzed patient radiation doses from six commonly used procedures in our cardiac catheterization laboratories and suggested possible initial values for benchmark from these procedures for the fluoroscopy time, KAP and air-kerma at the interventional reference point based on our current practices. Our data compare well with published values reported in the literature by investigators who have also studied patient doses and established benchmark dose levels for their facilities. Procedure-specific benchmark dose data for various groups of patients can provide the motivation for monitoring practices to promote improvements in patient radiation dose optimization in the cardiac catheterization laboratories. ADVANCES IN KNOWLEDGE We have investigated local patients' radiation doses and established benchmark radiation data which are essential for assessing the impact of any quality improvement initiatives for radiation dose optimization.
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Affiliation(s)
| | | | | | - Sara Darko
- Department of Clinical Trials, Grand River Regional Cancer Centre, Kitchener, ON, Canada
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Pettitt A, Barrington S, Kalakonda N, Khan U, Jackson R, Carruthers S, Oates M, Lin K, Ardeshna K, Eyre T, Fox C, Kennedy B, Linton K, Malladi R, Menne T, Okosun J, Paneesha S, Rule S, Johnston A, Trotman J. NCRI PETREA TRIAL: A PHASE 3 EVALUATION OF PET-GUIDED, RESPONSE-ADAPTED THERAPY IN PATIENTS WITH PREVIOUSLY UNTREATED, ADVANCED-STAGE, HIGH-TUMOUR-BURDEN FOLLICULAR LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.35_2629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A.R. Pettitt
- Department of Molecular and Clinical Cancer Medicine; University of Liverpool, Liverpool Health Partners; Liverpool United Kingdom
| | - S. Barrington
- School of Biomedical Engineering and Imaging Sciences; St Thomas’ Hospital, Kings College London; London United Kingdom
| | - N. Kalakonda
- Department of Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - U.T. Khan
- Department of Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - R. Jackson
- CR-UK Liverpool Cancer Trials Unit; University of Liverpool; Liverpool United Kingdom
| | - S. Carruthers
- CR-UK Liverpool Cancer Trials Unit; University of Liverpool; Liverpool United Kingdom
| | - M. Oates
- Department of Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - K. Lin
- Haemato-Oncology Diagnostic Service; Liverpool Clinical Laboratories; Liverpool United Kingdom
| | - K. Ardeshna
- Department of Haematology; University College London; London United Kingdom
| | - T. Eyre
- Department of Haematology; Churchill Hospital; Oxford United Kingdom
| | - C.P. Fox
- Department of Clinical Haematology; Nottingham University Hospitals NHS Trust; Nottingham United Kingdom
| | - B. Kennedy
- Department of Haematology; University Hospital Leicester NHS Trust; Leicester United Kingdom
| | - K. Linton
- Department of Haemato-oncology; Manchester Cancer Research Centre; Manchester United Kingdom
| | - R. Malladi
- Department of Haematology; Queen Elizabeth Medical Centre; Birmingham United Kingdom
| | - T. Menne
- Department of Haematology; Royal Freeman Hospital; Newcastle Upon Tyne United Kingdom
| | - J. Okosun
- Centre for Haemato-Oncology; Barts Cancer Institute, Queen Mary University of London; London United Kingdom
| | - S. Paneesha
- Department of Haematology; Heartlands Hospital; Birmingham United Kingdom
| | - S. Rule
- Department of Haematology; Derriford Hospital; Plymouth United Kingdom
| | - A. Johnston
- School of Medicine & Department of Haematology; University of Tasmania & Royal Hobart Hospital; Hobart Australia
| | - J. Trotman
- University of Sydney; Concord Repatriation General Hospital; Concord New South Wales Australia
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Iqbal F, Johnston A, Wyse B, Mander P, Wu J, Li R, Szaraz P, Librach C. A novel combination cell therapy using first trimester human umbilical cord-derived mesenchymal stromal cells and endothelial progenitor cells significantly improves cardiac recovery after myocardial infarction. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.455] [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: 11/24/2022]
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Hall PE, Lewis R, Syed N, Shaffer R, Evanson J, Ellis S, Williams M, Feng X, Johnston A, Thomson JA, Harris FP, Jena R, Matys T, Jefferies S, Smith K, Wu BW, Bomalaski JS, Crook T, O'Neill K, Paraskevopoulos D, Khadeir RS, Sheaff M, Pacey S, Plowman PN, Szlosarek PW. A Phase I Study of Pegylated Arginine Deiminase (Pegargiminase), Cisplatin, and Pemetrexed in Argininosuccinate Synthetase 1-Deficient Recurrent High-grade Glioma. Clin Cancer Res 2019; 25:2708-2716. [PMID: 30796035 DOI: 10.1158/1078-0432.ccr-18-3729] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [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: 11/15/2018] [Revised: 12/30/2018] [Accepted: 02/12/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Patients with recurrent high-grade gliomas (HGG) are usually managed with alkylating chemotherapy ± bevacizumab. However, prognosis remains very poor. Preclinically, we showed that HGGs are a target for arginine depletion with pegargiminase (ADI-PEG20) due to epimutations of argininosuccinate synthetase (ASS1) and/or argininosuccinate lyase (ASL). Moreover, ADI-PEG20 disrupts pyrimidine pools in ASS1-deficient HGGs, thereby impacting sensitivity to the antifolate, pemetrexed. PATIENTS AND METHODS We expanded a phase I trial of ADI-PEG20 with pemetrexed and cisplatin (ADIPEMCIS) to patients with ASS1-deficient recurrent HGGs (NCT02029690). Patients were enrolled (01/16-06/17) to receive weekly ADI-PEG20 36 mg/m2 intramuscularly plus pemetrexed 500 mg/m2 and cisplatin 75 mg/m2 intravenously once every 3 weeks for up to 6 cycles. Patients with disease control were allowed ADI-PEG20 maintenance. The primary endpoints were safety, tolerability, and preliminary estimates of efficacy. RESULTS Ten ASS1-deficient heavily pretreated patients were treated with ADIPEMCIS therapy. Treatment was well tolerated with the majority of adverse events being Common Terminology Criteria for Adverse Events v4.03 grade 1-2. The best overall response was stable disease in 8 patients (80%). Plasma arginine was suppressed significantly below baseline with a reciprocal increase in citrulline during the sampling period. The anti-ADI-PEG20 antibody titer rose during the first 4 weeks of treatment before reaching a plateau. Median progression-free survival (PFS) was 5.2 months (95% confidence interval (CI), 2.5-20.8) and overall survival was 6.3 months (95% CI, 1.8-9.7). CONCLUSIONS In this recurrent HGG study, ADIPEMCIS was well tolerated and compares favorably to historical controls. Additional trials of ADI-PEG20 in HGG are planned.
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Affiliation(s)
- Peter E Hall
- Department of Oncology, Barts Health NHS Trust, London, United Kingdom
| | - Rachel Lewis
- Department of Oncology, Barts Health NHS Trust, London, United Kingdom
| | - Nelofer Syed
- Department of Medicine, Imperial College, London, United Kingdom
| | - Richard Shaffer
- St. Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Jane Evanson
- Department of Radiology, Barts Health NHS Trust, London, United Kingdom
| | - Stephen Ellis
- Department of Radiology, Barts Health NHS Trust, London, United Kingdom
| | - Matthew Williams
- Department of Oncology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | | | | | - Fiona P Harris
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Raj Jena
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Tomasz Matys
- Department of Radiology, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Sarah Jefferies
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Kate Smith
- Department of Oncology, Barts Health NHS Trust, London, United Kingdom
| | - Bor-Wen Wu
- Polaris Pharmaceuticals Inc., San Diego, California
| | | | - Timothy Crook
- St. Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Kevin O'Neill
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Ramsay S Khadeir
- Centre for Molecular Oncology, Queen Mary University of London, London, United Kingdom
| | - Michael Sheaff
- Department of Pathology, Barts Health NHS Trust, London, United Kingdom
| | - Simon Pacey
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Piers N Plowman
- Department of Oncology, Barts Health NHS Trust, London, United Kingdom
| | - Peter W Szlosarek
- Department of Oncology, Barts Health NHS Trust, London, United Kingdom.
- Centre for Molecular Oncology, Queen Mary University of London, London, United Kingdom
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Harding JJ, Qin S, Yang TS, Yen CJ, Chao Y, Wang TE, Do RKG, El Dika IH, Uhlitskykh K, Millang BM, Feng X, Swe W, Johnston A, Bomalaski JS, Li CF, O'Reilly EM, Ho CL, Chen YY, Abou-Alfa GK. A phase II study of ADI-PEG 20 and FOLFOX6 in patients (pts) with advanced hepatocellular carcinoma (HCC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.tps477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
TPS477 Background: Arginine depletion interferes with pyrimidine metabolism as well as DNA damage repair pathways, and preclinical data indicate that pairing pegylated arginine deiminase (ADI-PEG 20) with fluoropyrimidines or platinum enhances cytotoxicity in vitro and in vivo in HCC models. A prior phase 1 study of FOLFOX6 and ADI-PEG 20 established the safety and recommended phase 2 dose of the combination in pts with advanced gastrointestinal tumors (Harding et al. CCP 2018). For 23 treatment-refractory HCC pts who were treated at the recommended phase 2 dose on an expansion cohort of the phase 1, the objective response rate (ORR) was 21% (95% CI 7.5-43.7) and median progression-free survival (PFS) was 7.3 months. These data were favorable when compared to historic data for FOLFOX alone where the ORR was ~8% and PFS was 2.93 months and suggest greater clinical activity of the combination (Qin et al. JCO 2013). Prospective confirmation of these results is required. Methods: This is an international, multicenter, single-arm, open-label phase 2 trial of ADI-PEG 20 and FOLFOX6 for advanced HCC pts with Child-Pugh A liver function who progressed on ≥ 2 prior lines of prior systemic therapy (NCT02102022). The primary objective is to define the ORR by RECIST 1.1 as assessed by blinded independent central review. Secondary objectives include determination of safety, disease control rate (DCR), duration of response (DOR), PFS, overall survival (OS), serum arginine, citrulline and anti-ADI-PEG 20 levels over 24 weeks, and alpha-fetoprotein response. Eligible pts receive intravenous FOLFOX6 biweekly at standard doses and ADI-PEG 20 intramuscularly weekly at 36 mg/m.2 Cross-sectional imaging will be completed every 8 weeks until progression of disease. Based on a two-sided exact test of a one-sample proportion with an alpha of 0.05, under a presumed ORR of 22%, there is 80% power to yield 95% confidence interval of 15-26%, which will require 46 objective responses in 225 subjects. Futility will be assessed three times during the study based on having ORR data available for 56, 110, and 166 patients. This Phase 2 will be stopped for futility if the conditional power drops below 20% at any of these time points. Clinical trial information: NCT02102022.
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Affiliation(s)
- James J. Harding
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Shukui Qin
- PLA Cancer Center of Nanjing Bayi Hospital, Nanjing, China
| | | | - Chia-Jui Yen
- National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yee Chao
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | | | | | | | | | | | | | - Chien-Feng Li
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan
| | | | - Ching-Liang Ho
- Division of Hematology and Oncology, Tri-service General Hospital, National Defense Medical University, Taipei, Taiwan
| | - Yen-Yang Chen
- Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan
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Stephenson D, Perry A, Appleby MR, Lee D, Davison J, Johnston A, Jones AL, Nelson A, Bourke SJ, Thomas MF, De Soyza A, Lordan JL, Lumb J, Robb AE, Samuel JR, Walton KE, Perry JD. An evaluation of methods for the isolation of nontuberculous mycobacteria from patients with cystic fibrosis, bronchiectasis and patients assessed for lung transplantation. BMC Pulm Med 2019; 19:19. [PMID: 30665395 PMCID: PMC6341538 DOI: 10.1186/s12890-019-0781-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 09/15/2018] [Accepted: 01/07/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND RGM medium is an agar-based, selective culture medium designed for the isolation of nontuberculous mycobacteria (NTM) from the sputum of patients with cystic fibrosis (CF). We evaluated RGM medium for the detection of NTM in patients with CF (405 samples), bronchiectasis (323 samples) and other lung diseases necessitating lung transplantation (274 samples). METHODS In total, 1002 respiratory samples from 676 patients were included in the study. Direct culture on RGM medium, with incubation at two temperatures (30 °C and 37 °C), was compared with conventional culture of decontaminated samples for acid-fast bacilli (AFB) using both a solid medium (Löwenstein-Jensen medium) and a liquid medium (the Mycobacterial Growth Indicator Tube; MGIT). RESULTS For all three patient groups, significantly more isolates of NTM were recovered using RGM medium incubated at 30 °C than by any other method (sensitivity: 94.6% vs. 22.4% for conventional AFB culture; P < 0.0001). Significantly more isolates of Mycobacterium abscessus complex were isolated on RGM at 30 °C than by AFB culture (sensitivity: 96.1% vs. 58.8%; P < 0.0001). The recovery of Mycobacterium avium complex was also greater using RGM medium at 30 °C compared to AFB culture (sensitivity: 83% vs. 70.2%), although this difference was not statistically significant and a combination of methods was necessary for optimal recovery (P = 0.21). CONCLUSIONS In the largest study of RGM medium to date, we reaffirm its utility for isolation of NTM from patients with CF. Furthermore; we show that it also provides an effective tool for culture of respiratory samples from patients with bronchiectasis and other lung diseases.
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Affiliation(s)
- D Stephenson
- Microbiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK.,Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - A Perry
- Microbiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | - M R Appleby
- Microbiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | - D Lee
- Microbiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | - J Davison
- Adult Bronchiectasis Service, Freeman Hospital, Newcastle upon Tyne, UK
| | - A Johnston
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - A L Jones
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - A Nelson
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - S J Bourke
- Adult Cystic Fibrosis Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - M F Thomas
- Paediatric Respiratory Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - A De Soyza
- Adult Bronchiectasis Service, Freeman Hospital, Newcastle upon Tyne, UK
| | - J L Lordan
- Cardiopulmonary Transplant Service, Freeman Hospital, Newcastle upon Tyne, UK
| | - J Lumb
- Microbiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | - A E Robb
- Microbiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | - J R Samuel
- Microbiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | - K E Walton
- Microbiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | - J D Perry
- Microbiology Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK. .,Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
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McLean K, Glasbey J, Borakati A, Brooks T, Chang H, Choi S, Goodson R, Nielsen M, Pronin S, Salloum N, Sewart E, Vanniasegaram D, Drake T, Gillies M, Harrison E, Chapman S, Khatri C, Kong C, Claireaux H, Bath M, Mohan M, McNamee L, Kelly M, Mitchell H, Fitzgerald J, Bhangu A, Nepogodiev D, Antoniou I, Dean R, Davies N, Trecarten S, Henderson I, Holmes C, Wylie J, Shuttleworth R, Jindal A, Hughes F, Gouda P, Fleck R, Hanrahan M, Karunakaran P, Chen J, Sykes M, Sethi R, Suresh S, Patel P, Patel M, Varma R, Mushtaq J, Gundogan B, Bolton W, Khan T, Burke J, Morley R, Favero N, Adams R, Thirumal V, Kennedy E, Ong K, Tan Y, Gabriel J, Bakhsh A, Low J, Yener A, Paraoan V, Preece R, Tilston T, Cumber E, Dean S, Ross T, McCance E, Amin H, Satterthwaite L, Clement K, Gratton R, Mills E, Chiu S, Hung G, Rafiq N, Hayes J, Robertson K, Dynes K, Huang H, Assadullah S, Duncumb J, Moon R, Poo S, Mehta J, Joshi K, Callan R, Norris J, Chilvers N, Keevil H, Jull P, Mallick S, Elf D, Carr L, Player C, Barton E, Martin A, Ratu S, Roberts E, Phan P, Dyal A, Rogers J, Henson A, Reid N, Burke D, Culleton G, Lynne S, Mansoor S, Brennan C, Blessed R, Holloway C, Hill A, Goldsmith T, Mackin S, Kim S, Woin E, Brent G, Coffin J, Ziff O, Momoh Z, Debenham R, Ahmed M, Yong C, Wan J, Copley H, Raut P, Chaudhry F, Nixon G, Dorman C, Tan R, Kanabar S, Canning N, Dolaghan M, Bell N, McMenamin M, Chhabra A, Duke K, Turner L, Patel T, Chew L, Mirza M, Lunawat S, Oremule B, Ward N, Khan M, Tan E, Maclennan D, McGregor R, Chisholm E, Griffin E, Bell L, Hughes B, Davies J, Haq H, Ahmed H, Ungcharoen N, Whacha C, Thethi R, Markham R, Lee A, Batt E, Bullock N, Francescon C, Davies J, Shafiq N, Zhao J, Vivekanantham S, Barai I, Allen J, Marshall D, McIntyre C, Wilson H, Ashton A, Lek C, Behar N, Davis-Hall M, Seneviratne N, Esteve L, Sirakaya M, Ali S, Pope S, Ahn J, Craig-McQuaide A, Gatfield W, Leong S, Demetri A, Kerr A, Rees C, Loveday J, Liu S, Wijesekera M, Maru D, Attalla M, Smith N, Brown D, Sritharan P, Shah A, Charavanamuttu V, Heppenstall-Harris G, Ng K, Raghvani T, Rajan N, Hulley K, Moody N, Williams M, Cotton A, Sharifpour M, Lwin K, Bright M, Chitnis A, Abdelhadi M, Semana A, Morgan F, Reid R, Dickson J, Anderson L, McMullan R, Ahern N, Asmadi A, Anderson L, Boon Xuan JL, Crozier L, McAleer S, Lees D, Adebayo A, Das M, Amphlett A, Al-Robeye A, Valli A, Khangura J, Winarski A, Ali A, Woodward H, Gouldthrope C, Turner M, Sasapu K, Tonkins M, Wild J, Robinson M, Hardie J, Heminway R, Narramore R, Ramjeeawon N, Hibberd A, Winslow F, Ho W, Chong B, Lim K, Ho S, Crewdson J, Singagireson S, Kalra N, Koumpa F, Jhala H, Soon W, Karia M, Rasiah M, Xylas D, Gilbert H, Sundar-Singh M, Wills J, Akhtar S, Patel S, Hu L, Brathwaite-Shirley C, Nayee H, Amin O, Rangan T, Turner E, McCrann C, Shepherd R, Patel N, Prest-Smith J, Auyoung E, Murtaza A, Coates A, Prys-Jones O, King M, Gaffney S, Dewdney C, Nehikhare I, Lavery J, Bassett J, Davies K, Ahmad K, Collins A, Acres M, Egerton C, Cheng K, Chen X, Chan N, Sheldon A, Khan S, Empey J, Ingram E, Malik A, Johnstone M, Goodier R, Shah J, Giles J, Sanders J, McLure S, Pal S, Rangedara A, Baker A, Asbjoernsen C, Girling C, Gray L, Gauntlett L, Joyner C, Qureshi S, Mogan Y, Ng J, Kumar A, Park J, Tan D, Choo K, Raman K, Buakuma P, Xiao C, Govinden S, Thompson O, Charalambos M, Brown E, Karsan R, Dogra T, Bullman L, Dawson P, Frank A, Abid H, Tung L, Qureshi U, Tahmina A, Matthews B, Harris R, O'Connor A, Mazan K, Iqbal S, Stanger S, Thompson J, Sullivan J, Uppal E, MacAskill A, Bamgbose F, Neophytou C, Carroll A, Rookes C, Datta U, Dhutia A, Rashid S, Ahmed N, Lo T, Bhanderi S, Blore C, Ahmed S, Shaheen H, Abburu S, Majid S, Abbas Z, Talukdar S, Burney L, Patel J, Al-Obaedi O, Roberts A, Mahboob S, Singh B, Sheth S, Karia P, Prabhudesai A, Kow K, Koysombat K, Wang S, Morrison P, Maheswaran Y, Keane P, Copley P, Brewster O, Xu G, Harries P, Wall C, Al-Mousawi A, Bonsu S, Cunha P, Ward T, Paul J, Nadanakumaran K, Tayeh S, Holyoak H, Remedios J, Theodoropoulou K, Luhishi A, Jacob L, Long F, Atayi A, Sarwar S, Parker O, Harvey J, Ross H, Rampal R, Thomas G, Vanmali P, McGowan C, Stein J, Robertson V, Carthew L, Teng V, Fong J, Street A, Thakker C, O'Reilly D, Bravo M, Pizzolato A, Khokhar H, Ryan M, Cheskes L, Carr R, Salih A, Bassiony S, Yuen R, Chrastek D, Rosen O'Sullivan H, Amajuoyi A, Wang A, Sitta O, Wye J, Qamar M, Major C, Kaushal A, Morgan C, Petrarca M, Allot R, Verma K, Dutt S, Chilima C, Peroos S, Kosasih S, Chin H, Ashken L, Pearse R, O'Loughlin R, Menon A, Singh K, Norton J, Sagar R, Jathanna N, Rothwell L, Watson N, Harding F, Dube P, Khalid H, Punjabi N, Sagmeister M, Gill P, Shahid S, Hudson-Phillips S, George D, Ashwood J, Lewis T, Dhar M, Sangal P, Rhema I, Kotecha D, Afzal Z, Syeed J, Prakash E, Jalota P, Herron J, Kimani L, Delport A, Shukla A, Agarwal V, Parthiban S, Thakur H, Cymes W, Rinkoff S, Turnbull J, Hayat M, Darr S, Khan U, Lim J, Higgins A, Lakshmipathy G, Forte B, Canning E, Jaitley A, Lamont J, Toner E, Ghaffar A, McDowell M, Salmon D, O'Carroll O, Khan A, Kelly M, Clesham K, Palmer C, Lyons R, Bell A, Chin R, Waldron R, Trimble A, Cox S, Ashfaq U, Campbell J, Holliday R, McCabe G, Morris F, Priestland R, Vernon O, Ledsam A, Vaughan R, Lim D, Bakewell Z, Hughes R, Koshy R, Jackson H, Narayan P, Cardwell A, Jubainville C, Arif T, Elliott L, Gupta V, Bhaskaran G, Odeleye A, Ahmed F, Shah R, Pickard J, Suleman Y, North A, McClymont L, Hussain N, Ibrahim I, Ng G, Wong V, Lim A, Harris L, Tharmachandirar T, Mittapalli D, Patel V, Lakhani M, Bazeer H, Narwani V, Sandhu K, Wingfield L, Gentry S, Adjei H, Bhatti M, Braganza L, Barnes J, Mistry S, Chillarge G, Stokes S, Cleere J, Wadanamby S, Bucko A, Meek J, Boxall N, Heywood E, Wiltshire J, Toh C, Ward A, Shurovi B, Horth D, Patel B, Ali B, Spencer T, Axelson T, Kretzmer L, Chhina C, Anandarajah C, Fautz T, Horst C, Thevathasan A, Ng J, Hirst F, Brewer C, Logan A, Lockey J, Forrest P, Keelty N, Wood A, Springford L, Avery P, Schulz T, Bemand T, Howells L, Collier H, Khajuria A, Tharakan R, Parsons S, Buchan A, McGalliard R, Mason J, Cundy O, Li N, Redgrave N, Watson R, Pezas T, Dennis Y, Segall E, Hameed M, Lynch A, Chamberlain M, Peck F, Neo Y, Russell G, Elseedawy M, Lee S, Foster N, Soo Y, Puan L, Dennis R, Goradia H, Qureshi A, Osman S, Reeves T, Dinsmore L, Marsden M, Lu Q, Pitts-Tucker T, Dunn C, Walford R, Heathcote E, Martin R, Pericleous A, Brzyska K, Reid K, Williams M, Wetherall N, McAleer E, Thomas D, Kiff R, Milne S, Holmes M, Bartlett J, Lucas de Carvalho J, Bloomfield T, Tongo F, Bremner R, Yong N, Atraszkiewicz B, Mehdi A, Tahir M, Sherliker G, Tear A, Pandey A, Broyd A, Omer H, Raphael M, Chaudhry W, Shahidi S, Jawad A, Gill C, Fisher IH, Adeleja I, Clark I, Aidoo-Micah G, Stather P, Salam G, Glover T, Deas G, Sim N, Obute R, Wynell-Mayow W, Sait M, Mitha N, de Bernier G, Siddiqui M, Shaunak R, Wali A, Cuthbert G, Bhudia R, Webb E, Shah S, Ansari N, Perera M, Kelly N, McAllister R, Stanley G, Keane C, Shatkar V, Maxwell-Armstrong C, Henderson L, Maple N, Manson R, Adams R, Semple E, Mills M, Daoub A, Marsh A, Ramnarine A, Hartley J, Malaj M, Jewell P, Whatling E, Hitchen N, Chen M, Goh B, Fern J, Rogers S, Derbyshire L, Robertson D, Abuhussein N, Deekonda P, Abid A, Harrison P, Aildasani L, Turley H, Sherif M, Pandey G, Filby J, Johnston A, Burke E, Mohamud M, Gohil K, Tsui A, Singh R, Lim S, O'Sullivan K, McKelvey L, O'Neill S, Roberts H, Brown F, Cao Y, Buckle R, Liew Y, Sii S, Ventre C, Graham C, Filipescu T, Yousif A, Dawar R, Wright A, Peters M, Varley R, Owczarek S, Hartley S, Khattak M, Iqbal A, Ali M, Durrani B, Narang Y, Bethell G, Horne L, Pinto R, Nicholls K, Kisyov I, Torrance H, English W, Lakhani S, Ashraf S, Venn M, Elangovan V, Kazmi Z, Brecher J, Sukumar S, Mastan A, Mortimer A, Parker J, Boyle J, Elkawafi M, Beckett J, Mohite A, Narain A, Mazumdar E, Sreh A, Hague A, Weinberg D, Fletcher L, Steel M, Shufflebotham H, Masood M, Sinha Y, Jenvey C, Kitt H, Slade R, Craig A, Deall C, Reakes T, Chervenkoff J, Strange E, O'Bryan M, Murkin C, Joshi D, Bergara T, Naqib S, Wylam D, Scotcher S, Hewitt C, Stoddart M, Kerai A, Trist A, Cole S, Knight C, Stevens S, Cooper G, Ingham R, Dobson J, O'Kane A, Moradzadeh J, Duffy A, Henderson C, Ashraf S, McLaughin C, Hoskins T, Reehal R, Bookless L, McLean R, Stone E, Wright E, Abdikadir H, Roberts C, Spence O, Srikantharajah M, Ruiz E, Matthews J, Gardner E, Hester E, Naran P, Simpson R, Minhas M, Cornish E, Semnani S, Rojoa D, Radotra A, Eraifej J, Eparh K, Smith D, Mistry B, Hickling S, Din W, Liu C, Mithrakumar P, Mirdavoudi V, Rashid M, Mcgenity C, Hussain O, Kadicheeni M, Gardner H, Anim-Addo N, Pearce J, Aslanyan A, Ntala C, Sorah T, Parkin J, Alizadeh M, White A, Edozie F, Johnston J, Kahar A, Navayogaarajah V, Patel B, Carter D, Khonsari P, Burgess A, Kong C, Ponweera A, Cody A, Tan Y, Ng A, Croall A, Allan C, Ng S, Raghuvir V, Telfer R, Greenhalgh A, McKerr C, Edison M, Patel B, Dear K, Hardy M, Williams P, Hassan S, Sajjad U, O'Neill E, Lopes S, Healy L, Jamal N, Tan S, Lazenby D, Husnoo S, Beecroft S, Sarvanandan T, Weston C, Bassam N, Rabinthiran S, Hayat U, Ng L, Varma D, Sukkari M, Mian A, Omar A, Kim J, Sellathurai J, Mahmood J, O'Connell C, Bose R, Heneghan H, Lalor P, Matheson J, Doherty C, Cullen C, Cooper D, Angelov S, Drislane C, Smith A, Kreibich A, Palkhi E, Durr A, Lotfallah A, Gold D, Mckean E, Dhanji A, Anilkumar A, Thacoor A, Siddiqui Z, Lim S, Piquet A, Anderson S, McCormack D, Gulati J, Ibrahim A, Murray S, Walsh S, McGrath A, Ziprin P, Chua E, Lou C, Bloomer J, Paine H, Osei-Kuffour D, White C, Szczap A, Gokani S, Patel K, Malys M, Reed A, Torlot G, Cumber E, Charania A, Ahmad S, Varma N, Cheema H, Austreng L, Petra H, Chaudhary M, Zegeye M, Cheung F, Coffey D, Heer R, Singh S, Seager E, Cumming S, Suresh R, Verma S, Ptacek I, Gwozdz A, Yang T, Khetarpal A, Shumon S, Fung T, Leung W, Kwang P, Chew L, Loke W, Curran A, Chan C, McGarrigle C, Mohan K, Cullen S, Wong E, Toale C, Collins D, Keane N, Traynor B, Shanahan D, Yan A, Jafree D, Topham C, Mitrasinovic S, Omara S, Bingham G, Lykoudis P, Miranda B, Whitehurst K, Kumaran G, Devabalan Y, Aziz H, Shoa M, Dindyal S, Yates J, Bernstein I, Rattan G, Coulson R, Stezaker S, Isaac A, Salem M, McBride A, McFarlane H, Yow L, MacDonald J, Bartlett R, Turaga S, White U, Liew W, Yim N, Ang A, Simpson A, McAuley D, Craig E, Murphy L, Shepherd P, Kee J, Abdulmajid A, Chung A, Warwick H, Livesey A, Holton P, Theodoreson M, Jenkin S, Turner J, Entwisle J, Marchal S, O'Connor S, Blege H, Aithie J, Sabine L, Stewart G, Jackson S, Kishore A, Lankage C, Acquaah F, Joyce H, McKevitt K, Coffey C, Fawaz A, Dolbec K, O'Sullivan D, Geraghty J, Lim E, Bolton L, FitzPatrick D, Robinson C, Ramtoola T, Collinson S, Grundy L, McEnhill P, Harbhajan Singh G, Loughran D, Golding D, Keeling R, Williams R, Whitham R, Yoganathan S, Nachiappan R, Egan R, Owasil R, Kwan M, He A, Goh R, Bhome R, Wilson H, Teoh P, Raji K, Jayakody N, Matthams J, Chong J, Luk C, Greig R, Trail M, Charalambous G, Rocke A, Gardiner N, Bulley F, Warren N, Brennan E, Fergurson P, Wilson R, Whittingham H, Brown E, Khanijau R, Gandhi K, Morris S, Boulton A, Chandan N, Barthorpe A, Maamari R, Sandhu S, McCann M, Higgs L, Balian V, Reeder C, Diaper C, Sale T, Ali H, Archer C, Clarke A, Heskin J, Hurst P, Farmer J, O'Flynn L, Doan L, Shuker B, Stott G, Vithanage N, Hoban K, Nesargikar P, Kennedy H, Grossart C, Tan E, Roy C, Sim P, Leslie K, Sim D, Abul M, Cody N, Tay A, Woon E, Sng S, Mah J, Robson J, Shakweh E, Wing V, Mills H, Li M, Barrow T, Balaji S, Jordan H, Phillips C, Naveed H, Hirani S, Tai A, Ratnakumaran R, Sahathevan A, Shafi A, Seedat M, Weaver R, Batho A, Punj R, Selvachandran H, Bhatt N, Botchey S, Khonat Z, Brennan K, Morrison C, Devlin E, Linton A, Galloway E, McGarvie S, Ramsay N, McRobbie H, Whewell H, Dean W, Nelaj S, Eragat M, Mishra A, Kane T, Zuhair M, Wells M, Wilkinson D, Woodcock N, Sun E, Aziz N, Ghaffar MKA. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study. Br J Anaesth 2019; 122:42-50. [PMID: 30579405 DOI: 10.1016/j.bja.2018.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. METHODS This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. RESULTS Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. CONCLUSIONS After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
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Gray J, Winzor G, Mahdia N, Oppenheim B, Johnston A. Preventing healthcare-associated infection by sharing research, evidence and best practice. J Hosp Infect 2018; 101:117-119. [PMID: 30550770 DOI: 10.1016/j.jhin.2018.12.004] [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] [Received: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Affiliation(s)
- J Gray
- Healthcare Infection Society, UK.
| | - G Winzor
- Healthcare Infection Society, UK
| | - N Mahdia
- Healthcare Infection Society, UK
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Zadow E, Adams M, Wu S, Kitic C, Singh I, Kundur A, Bost N, Johnston A, Crilly J, Bulmer A, Halson S, Fell J. Too clot or not too clot? The influence of travel, marathon running and compression socks on blood clot risk. J Sci Med Sport 2018. [DOI: 10.1016/j.jsams.2018.09.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hall P, Lewis R, Syed N, Shaffer R, Evanson J, Ellis S, Williams M, Feng X, Johnston A, Thomson J, Harris F, Jena R, Jefferies S, Khadeir R, Wu BW, Bomalaski J, Crook T, Sheaff M, Pacey S, Plowman N, Szlosarek P. A PHASE I EXPANSION STUDY OF PEGARGIMINASE, CISPLATIN AND PEMETREXED IN ARGININOSUCCINATE SYNTHETASE 1-NEGATIVE RECURRENT HIGH GRADE GLIOMAS (HGGS). Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy129.003] [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: 11/14/2022] Open
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Phillips M, Szyszko T, Hall P, Rashid S, Khadeir R, Lim L, Steele J, Conibear J, Wells P, Ellis S, Feng X, Thomson J, Johnston A, Wu BW, Bomalaski J, Pacey S, Cook G, Szlosarek P. Abstract B33: Expansion study of pegylated arginine deiminase (ADI-PEG20), pemetrexed, and cisplatin in patients with ASS1-deficient non-squamous non-small cell lung cancer (TRAP). Clin Cancer Res 2018. [DOI: 10.1158/1557-3265.aacriaslc18-b33] [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: Loss of the metabolic tumor suppressor argininosuccinate synthetase 1 (ASS1) sensitizes non-squamous non-small cell lung cancer (NSCLC) cells to arginine deprivation with pegylated arginine deiminase (ADI-PEG20), which also disrupts thymidine pools and potentiates pemetrexed (Pem) cytotoxicity. In the phase I dose-escalation TRAP study (NCT02029690) we showed that ADI-PEG20 with first-line PEM and cisplatin (Cis) chemotherapy (ADIPemCis) produced a 100% disease control rate (DCR) (n = 9) of ASS1-deficient thoracic cancers, with no additional toxicity (Beddowes et al., 2017). Here, we present the TRAP expansion cohort experience in non-squamous NSCLC.
Methods: Good-performance (ECOG 0-1) NSCLC patients (pts) with nonresectable disease were enrolled in a phase I TRAP expansion cohort at the maximum tolerated dose (MTD) of ADIPemCis, using tumoral ASS1 loss as a selection biomarker. Pem (500mg/m2) and Cis (75mg/m2) were given every 3 weeks with weekly IM ADI-PEG20 (36mg/m2) for a maximum of 4 cycles with maintenance ADI-PEG20 or Pem in responding pts. Primary endpoint was tumor response rate (RECIST 1.1), with secondary endpoints including progression-free survival (PFS), overall survival (OS), and toxicity. We measured plasma arginine and citrulline concentrations, ADI-PEG20 antibodies, early molecular responses by 18-FLT-PET/CT, and biopsied pts on progression to explore resistance mechanisms.
Results: 21 ASS1-deficient non-squamous NSCLC pts (median age 60) were enrolled out of 70 screened pts; 14% (3/21) had stable brain metastases at entry. Plasma arginine decreased with a reciprocal increase in plasma citrulline. The partial response rate was 48% (n=10/21) with a DCR of 85.7% (n=18/21). Median PFS was 2.6 months and median OS was 5.3 months. 23.8% (n=5/21) pts experienced grade 3/4 treatment-related toxicities, the most common being non-febrile neutropenia (14.3%). A partial metabolic response was detected in 57.1% (n=4/7) pts by 24 hrs of arginine deprivation using 18-FLT-PET/CT with EORTC response criteria. Upregulation of ASS1 expression was observed in 1/3 biopsies on progression.
Conclusions: The ADIPemCis regimen is active in ASS1-deficient non-squamous NSCLC pts with a higher than expected response rate. However, the short survival (PFS and OS) compared with ASS1-agnostic historical controls indicates that ASS1 loss selects for a biologically more aggressive phenotype of NSCLC. Further studies are warranted exploring rationale combinations with ADIPemCis in patients with ASS1-deficient non-squamous NSCLC.
Citation Format: Melissa Phillips, Teresa Szyszko, Peter Hall, Sukaina Rashid, Ramsay Khadeir, Louise Lim, Jeremy Steele, John Conibear, Paula Wells, Stephen Ellis, Xiaoxing Feng, Jim Thomson, Amanda Johnston, Bor-Wen Wu, John Bomalaski, Simon Pacey, Gary Cook, Peter Szlosarek. Expansion study of pegylated arginine deiminase (ADI-PEG20), pemetrexed, and cisplatin in patients with ASS1-deficient non-squamous non-small cell lung cancer (TRAP) [abstract]. In: Proceedings of the Fifth AACR-IASLC International Joint Conference: Lung Cancer Translational Science from the Bench to the Clinic; Jan 8-11, 2018; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(17_Suppl):Abstract nr B33.
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Affiliation(s)
| | | | - Peter Hall
- 1Barts Cancer Institute, London, United Kingdom,
| | | | - Ramsay Khadeir
- 3Queen Mary University of London, London, United Kingdom,
| | - Louise Lim
- 1Barts Cancer Institute, London, United Kingdom,
| | | | | | - Paula Wells
- 1Barts Cancer Institute, London, United Kingdom,
| | | | | | - Jim Thomson
- 4Polaris Pharmaceuticals, Inc., San Diego, CA,
| | | | - Bor-Wen Wu
- 4Polaris Pharmaceuticals, Inc., San Diego, CA,
| | | | - Simon Pacey
- 5Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Gary Cook
- 3Queen Mary University of London, London, United Kingdom,
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Harding JJ, Do RKG, Hollywood E, Uhlitskykh K, Valentino E, Wan PJ, Hamilton CR, Frick J, Feng X, Johnston A, Bomalaski JS, Li CF, O'Reilly EM, Abou-Alfa GK. ADI-PEG 20 and FOLFOX6: A phase 1 study in pts (pts) with advanced hepatocellular carcinoma (HCC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.4085] [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)
- James J. Harding
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | | | | | | | | | | | | | | | | | | | | | - Chien-Feng Li
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan
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Chan PY, Phillips MM, Khadeir R, Ellis S, Thomson J, Johnston A, Feng X, Wu BW, Bomalaski JS, Sheaff M, Szlosarek PW. Phase 1 study of pegargiminase combined with cisplatin and pemetrexed in patients with ASS1-deficient uveal melanoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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)
| | | | - Ramsay Khadeir
- Queen Mary, University of London, London, United Kingdom
| | | | | | | | | | - Bor-Wen Wu
- Polaris Pharmaceuticals Inc., San Diego, CA
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