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Li Y, Flavell RR, Juarez R, Chow M, Wu C, Tsai K, Daud A, Behr SC. Retrospective study of the incidence of sarcoidosis-like reaction in patients treated with immunotherapy. Clin Radiol 2023; 78:e131-e136. [PMID: 36344282 DOI: 10.1016/j.crad.2022.09.127] [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: 06/22/2022] [Revised: 09/06/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
AIM To assess the frequency of radiographically evident drug-induced sarcoidosis-like reaction (DISR) in patients treated with anti-cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) therapy, anti-programmed cell death protein 1 (PD-1) therapy, or a combination of both in a single centre. MATERIALS AND METHODS The images and medical records of 457 patients with metastatic melanoma or head and neck cancer treated with either anti-CTLA-4 therapy, anti-PD-1 therapy, or a combination of both at University of California medical centre were reviewed retrospectively and the incidence of radiological manifestations of DISR was assessed among these treatment groups. RESULTS Radiological manifestations of DISR were found in 19/457 patients (4.1%). The mean interval from the initiation of immunotherapy to development of DISR was 5.5 months (range 2.3-13.5 months). Mean interval from radiological detection of DISR to imaging evidence of resolution was 5.8 months (range 1.6-18.3 months). Three patients out of 81 (3.7%), 11/297 (3.7%), and 5/79 (6.3%) developed sarcoidosis-like reaction after treatment with anti-CTLA-4 antibody, anti-PD-1 antibody, and a combination of both, respectively. Most patients with DISR were asymptomatic and did not require systemic therapy. Most patients did not demonstrate concomitant increased maximum standardised uptake value (SUVmax) in other organs on their integrated 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET)/computed tomography (CT). CONCLUSIONS In the present retrospective study of patients treated with immune checkpoint inhibitors (ICIs), DISR occurred in approximately 3.7% of patients treated with either anti-CTLA-4 or anti-PD-1 antibody and 6.3% of patients treated with a combination of both.
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Affiliation(s)
- Y Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, USA
| | - R R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, USA
| | - R Juarez
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, USA
| | - M Chow
- Department of Medicine, University of California, San Francisco, 1825 5(th) St, San Francisco, CA 94143, USA
| | - C Wu
- Department of Medicine, University of California, San Francisco, 1825 5(th) St, San Francisco, CA 94143, USA
| | - K Tsai
- Department of Medicine, University of California, San Francisco, 1825 5(th) St, San Francisco, CA 94143, USA
| | - A Daud
- Department of Medicine, University of California, San Francisco, 1825 5(th) St, San Francisco, CA 94143, USA
| | - S C Behr
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, USA.
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Lebbe C, Long G, Robert C, Hamid O, Atkinson V, Shoushtari A, Daud A, Bechter O, Schadendorf D, Sullivan R, Dummer R, Grob J, Lewis N, Fan L, Basu S, Caponigro G, Cooke V, Lau A, Amaria R. LBA40 Phase II study of multiple LXH254 drug combinations in patients (pts) with unresectable/metastatic, BRAF V600- or NRAS-mutant melanoma. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.038] [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: 11/01/2022] Open
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Daud A, Kesete B, Sriranjan S, Britton E, Steel C, Lewin J. Evaluation of efficiency and quality of the multi-disciplinary team handover process in a mother and baby inpatient setting. Eur Psychiatry 2021. [PMCID: PMC9475588 DOI: 10.1192/j.eurpsy.2021.1339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction At Coombe Wood Mother and Baby unit (MBU) there are daily multi-disciplinary team (MDT) handover meetings and a weekly MDT ward round attended by 7-8 team members. There are concerns that the handover is too time consuming, utilising time which could be spent on other clinical duties, and concerns regarding the relevance of information that is handed over. Objectives To perform a service evaluation to determine the efficiency and quality of MDT handover meetings in an MBU setting. Methods Data was collected from September to October 2020. A checklist was designed listing information felt to be relevant to handover and contained the following data points – ‘current situation’, ‘mental health’, ‘level of observations’, ‘risk’, ‘physical health’, ‘baby care’, ‘baby supervision levels’ and ‘tasks and responsibilities’. The start and stop times of each MDT handover meeting were noted and a record was made as to whether these topics were discussed. Results Mean meeting duration was 32.2 minutes (range: 13 – 45 minutes) and amounted to 2.68 hours spent in MDT handover over a 5-day working week. This equates to 21.4 person-hours (based on 8 staff) a week. 928 data points were generated. 50.7% (468) data points were recorded and commonly omitted data points were – ‘tasks and responsibilities’, ‘risk’, ‘level of observations’ and ‘physical health’. On all occasions, ‘current situation’, ‘mental health’ and ‘baby care’ were handed over. Conclusions The results of this service evaluation provide compelling evidence for a wider improvement project. Involving MDT staff in designing interventions will make handover meetings more meaningful.
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Eggermont A, Carlino M, Hauschild A, Ascierto P, Arance A, Daud A, O’Day S, Taylor M, Smith A, Rodgers A, Moreno BH, Diede S, Kluger H. Pembrolizumab (pembro) plus lenvatinib (len) for first-line treatment of patients (pts) with advanced melanoma: Phase III LEAP-003 study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz255.063] [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: 11/13/2022] Open
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Hamid O, Robert C, Daud A, Hodi FS, Hwu WJ, Kefford R, Wolchok JD, Hersey P, Joseph R, Weber JS, Dronca R, Mitchell TC, Patnaik A, Zarour HM, Joshua AM, Zhao Q, Jensen E, Ahsan S, Ibrahim N, Ribas A. Five-year survival outcomes for patients with advanced melanoma treated with pembrolizumab in KEYNOTE-001. Ann Oncol 2019; 30:582-588. [PMID: 30715153 PMCID: PMC6503622 DOI: 10.1093/annonc/mdz011] [Citation(s) in RCA: 562] [Impact Index Per Article: 112.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pembrolizumab demonstrated robust antitumor activity and safety in the phase Ib KEYNOTE-001 study (NCT01295827) of advanced melanoma. Five-year outcomes in all patients and treatment-naive patients are reported herein. Patients whose disease progressed following initial response and who received a second course of pembrolizumab were also analyzed. PATIENTS AND METHODS Patients aged ≥18 years with previously treated or treatment-naive advanced/metastatic melanoma received pembrolizumab 2 mg/kg every 3 weeks, 10 mg/kg every 3 weeks, or 10 mg/kg every 2 weeks until disease progression, intolerable toxicity, or patient/investigator decision to withdraw. Kaplan-Meier estimates of overall survival (OS) and progression-free survival (PFS) were calculated. Objective response rate and PFS were based on immune-related response criteria by investigator assessment (data cut-off, September 1, 2017). RESULTS KEYNOTE-001 enrolled 655 patients with melanoma; median follow-up was 55 months. Estimated 5-year OS was 34% in all patients and 41% in treatment-naive patients; median OS was 23.8 months (95% CI, 20.2-30.4) and 38.6 months (95% CI, 27.2-not reached), respectively. Estimated 5-year PFS rates were 21% in all patients and 29% in treatment-naive patients; median PFS was 8.3 months (95% CI, 5.8-11.1) and 16.9 months (95% CI, 9.3-35.5), respectively. Median response duration was not reached; 73% of all responses and 82% of treatment-naive responses were ongoing at data cut-off; the longest response was ongoing at 66 months. Four patients [all with prior response of complete response (CR)] whose disease progressed during observation subsequently received second-course pembrolizumab. One patient each achieved CR and partial response (after data cut-off). Treatment-related AEs (TRAEs) occurred in 86% of patients and resulted in study discontinuation in 7.8%; 17% experienced grade 3/4 TRAE. CONCLUSIONS This 5-year analysis of KEYNOTE-001 represents the longest follow-up for pembrolizumab to date and confirms the durable antitumor activity and tolerability of pembrolizumab in advanced melanoma. CLINICAL TRIAL REGISTRY ClinicalTrials.gov, NCT01295827.
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Affiliation(s)
- O Hamid
- Medical Oncology, The Angeles Clinic and Research Institute, Los Angeles, USA.
| | - C Robert
- Department of Dermatology, Gustave Roussy, Villejuif; Department of Medicine, University of Paris-Sud, Paris, France
| | - A Daud
- Department of Medicine, University of California, San Francisco, San Francisco
| | - F S Hodi
- Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - W J Hwu
- Department of Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - R Kefford
- Medical Oncology, Westmead Hospital, Westmead; Medical Oncology, Melanoma Institute Australia, Sydney; Medical Oncology, Macquarie University, Macquarie Park; Medical Oncology, University of Sydney, Sydney, Australia
| | - J D Wolchok
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - P Hersey
- Medical Oncology, University of Sydney, Sydney, Australia; Department of Medicine, Centenary Institute, Sydney, Australia
| | - R Joseph
- Medical Oncology, Mayo Clinic Cancer Center-Florida, Jacksonville
| | - J S Weber
- Department of Medicine, Perlmutter Cancer Center, NYU Langone Health, New York
| | - R Dronca
- Medical Oncology, Mayo Clinic Cancer Center-Florida, Jacksonville
| | - T C Mitchell
- Division of Hematology Oncology, Abramson Cancer Center, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
| | - A Patnaik
- Medical Oncology, South Texas Accelerated Research Therapeutics, San Antonio
| | - H M Zarour
- Department of Immunology, University of Pittsburgh Cancer Institute, Pittsburgh, USA
| | - A M Joshua
- Medical Oncology, Melanoma Institute Australia, Sydney; Medical Oncology, University of Sydney, Sydney, Australia; Kinghorn Cancer Centre, St. Vincent's Hospital, Medical Oncology, Garvan Institute of Medical Research, Sydney; Medical Oncology, University of New South Wales, Sydney, Australia
| | - Q Zhao
- Merck & Co., Inc., Kenilworth
| | | | - S Ahsan
- Merck & Co., Inc., Kenilworth
| | | | - A Ribas
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA
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Hamid O, Ribas A, Daud A, Butler M, Carlino M, Hwu WJ, Long G, Ancell K, Hodi F, Khushalani N, Blank C, Loquai C, Lin J, Diede S, Robert C. Efficacy of pembrolizumab (Pembro) in patients (Pts) with advanced melanoma with stable brain metastases (BM) at baseline: A pooled retrospective analysis. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy289.004] [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: 11/13/2022] Open
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Guo J, Carvajal RD, Dummer R, Hauschild A, Daud A, Bastian BC, Markovic SN, Queirolo P, Arance A, Berking C, Camargo V, Herchenhorn D, Petrella TM, Schadendorf D, Sharfman W, Testori A, Novick S, Hertle S, Nourry C, Chen Q, Hodi FS. Efficacy and safety of nilotinib in patients with KIT-mutated metastatic or inoperable melanoma: final results from the global, single-arm, phase II TEAM trial. Ann Oncol 2018; 28:1380-1387. [PMID: 28327988 PMCID: PMC5452069 DOI: 10.1093/annonc/mdx079] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [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] [Indexed: 01/27/2023] Open
Abstract
Background The single-arm, phase II Tasigna Efficacy in Advanced Melanoma (TEAM) trial evaluated the KIT-selective tyrosine kinase inhibitor nilotinib in patients with KIT-mutated advanced melanoma without prior KIT inhibitor treatment. Patients and methods Forty-two patients with KIT-mutated advanced melanoma were enrolled and treated with nilotinib 400 mg twice daily. TEAM originally included a comparator arm of dacarbazine (DTIC)-treated patients; the design was amended to a single-arm trial due to an observed low number of KIT-mutated melanomas. Thirteen patients were randomized to DTIC before the protocol amendment removing this study arm. The primary endpoint was objective response rate (ORR), determined according to Response Evaluation Criteria In Solid Tumors. Results ORR was 26.2% (n = 11/42; 95% CI, 13.9%–42.0%), sufficient to reject the null hypothesis (ORR ≤10%). All observed responses were partial responses (PRs; median response duration, 7.1 months). Twenty patients (47.6%) had stable disease and 10 (23.8%) had progressive disease; 1 (2.4%) response was unknown. Ten of the 11 responding patients had exon 11 mutations, four with an L576P mutation. The median progression-free survival and overall survival were 4.2 and 18.0 months, respectively. Three of the 13 patients on DTIC achieved a PR, and another patient had a PR following switch to nilotinib. Conclusion Nilotinib activity in patients with advanced KIT-mutated melanoma was similar to historical data from imatinib-treated patients. DTIC treatment showed potential activity, although the low patient number limits interpretation. Similar to previously reported results with imatinib, nilotinib showed greater activity among patients with an exon 11 mutation, including L576P, suggesting that nilotinib may be an effective treatment option for patients with specific KIT mutations. Clinical Trial Registration ClinicalTrials.gov, NCT01028222.
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Affiliation(s)
- J Guo
- Department of Renal Cancer & Melanona, Peking University Cancer Hospital & Institute, Beijing, China
| | - R D Carvajal
- Division of Hematology/Oncology, Columbia University Medical Center, New York, USA
| | - R Dummer
- Skin Cancer Center, University Hospital of Zurich, Zurich, Switzerland
| | - A Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - A Daud
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco
| | - B C Bastian
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco
| | - S N Markovic
- Department of Hematology/Oncology, Mayo Clinic Cancer Center, Rochester, USA
| | - P Queirolo
- Department of Medical Oncology, National Research Institute for Cancer, Genova, Italy
| | - A Arance
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - C Berking
- Department of Dermatology & Allergology, University Hospital Munich (LMU), Munich, Germany
| | - V Camargo
- Department of Medical Oncology, Cancer Institute of São Paulo, São Paulo
| | - D Herchenhorn
- Department of Clinical Oncology, National Institute of Cancer, Rio de Janeiro, Brazil
| | - T M Petrella
- Department of Medical Oncology, Sunnybrook Health Sciences Center, Toronto, Canada
| | - D Schadendorf
- Department of Dermatology, Essen University Hospital, Essen, Germany
| | - W Sharfman
- Department of Oncology & Dermatology, Sidney Kimmel Comprehensive Cancer Center/Johns Hopkins Medicine, Lutherville, USA
| | - A Testori
- Melanoma and Muscle Cutaneous Sarcoma Division, European Institute of Oncology, Milano, Italy
| | - S Novick
- Oncology Business Unit, Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - S Hertle
- Oncology Business Unit, Novartis Pharma AG, Basel, Switzerland
| | - C Nourry
- Oncology Business Unit, Novartis Pharma AG, Basel, Switzerland
| | - Q Chen
- Oncology Business Unit, Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - F S Hodi
- Melanoma Center, Dana-Farber Cancer Institute, Boston, USA
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Andtbacka R, Ross M, Agarwala S, Taylor M, Vetto J, Neves R, Daud A, Khong H, Ungerleider R, Tanaka M, Grossmann K. Subgroup analysis of a phase II multicenter trial of HF10, oncolytic virus immunotherapy, and ipilimumab combination treatment in unresectable or metastatic melanoma patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx667] [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: 11/14/2022] Open
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Xu W, Frederickson J, Callahan J, Ribas A, Gonzalez R, Pavlick A, Hamid O, Gajewski T, Puzanov I, Daud A, Colburn D, Choong N, Wongchenko M, Hicks R, McArthur G. Prognostic impact of early complete metabolic response on FDG-PET, in BRAF V600 mutant metastatic melanoma patients treated with combination vemurafenib & cobimetinib. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx377.012] [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: 11/13/2022] Open
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Daud A, Puzanov I, Dummer R, Schadendorf D, Hamid O, Robert C, Hodi F, Schachter J, Sosman J, Pavlick A, Gonzalez R, Blank C, Cranmer L, O’Day S, Salama A, Margolin K, Yang J, Homet Moreno B, Ibrahim N, Ribas A. Analysis of response and survival in patients (pts) with ipilimumab (ipi)-refractory melanoma treated with pembrolizumab (pembro) in KEYNOTE-002. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx377.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Powderly J, Patel M, Lee J, Brody J, Meric-Bernstam F, Hamilton E, Ponce Aix S, Garcia-Corbacho J, Bang YJ, Ahn MJ, Rha S, Kim KP, Gil Martin M, Wang H, Lazorchak A, Wyant T, Ma A, Agarwal S, Tuck D, Daud A. CA-170, a first in class oral small molecule dual inhibitor of immune checkpoints PD-L1 and VISTA, demonstrates tumor growth inhibition in pre-clinical models and promotes T cell activation in Phase 1 study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx376.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Olszanski A, Gonzalez R, Corrie P, Pavlick A, Middleton M, Lorigan P, Plummer R, Skaria S, Herbert C, Gore M, Agarwala S, Daud A, Zhang S, Bahamon B, Rangachari L, Hoberman E, Kneissl M, Rasco D. Phase I study of the investigational, oral pan-RAF kinase inhibitor TAK-580 (MLN2480) in patients with advanced solid tumors (ST) or melanoma (MEL): Final analysis. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx367.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Affiliation(s)
- A Daud
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei
| | - S Johar
- Department of Medicine, Division of Cardiology, RIPAS Hospital, Bandar Seri Begawan, Brunei
| | - K C Lim
- Department of Radiology, RIPAS Hospital, Bandar Seri Begawan, Brunei
| | - V H Chong
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei
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Andtbacka R, Ross M, Agarwala S, Taylor M, Vetto J, Neves R, Daud A, Khong H, Ungerleider R, Welden S, Tanaka M, Grossmann K. Tumor response from phase II study of combination treatment with intratumoral HF10, a replication-competent HSV-1 oncolytic virus, and ipilimumab in patients with stage IIIB, IIIC, or IV unresectable or metastatic melanoma. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw379.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hamid O, Puzanov I, Dummer R, Schachter J, Daud A, Schadendorf D, Blank C, Cranmer L, Robert C, Pavlick A, Gonzalez R, Hodi F, Ascierto P, Salama A, Margolin K, Gangadhar T, Wei Z, Ebbinghaus S, Ibrahim N, Ribas A. Final overall survival for KEYNOTE-002: pembrolizumab (pembro) versus investigator-choice chemotherapy (chemo) for ipilimumab (ipi)-refractory melanoma. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw379.02] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Yap LB, Nguyen STB, Qadir F, Ma SK, Muhammad Z, Koh KW, Ali Z, Tay GS, Daud A, Said A, Sahat N, Rebo R, Tamin SS, Hussin A, Kaur S, Omar R. A comparison of long-term outcomes between narrow and broad QRS complex patients treated with cardiac resynchronization therapy. Acta Cardiol 2016; 71:323-330. [PMID: 27594128 DOI: 10.2143/ac.71.3.3152093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Thomas S, Aggarwal R, Jahan T, Ryan C, Troung T, Cripps AM, Raha P, Thurn KT, Chen S, Grabowsky JA, Park J, Hwang J, Daud A, Munster PN. A phase I trial of panobinostat and epirubicin in solid tumors with a dose expansion in patients with sarcoma. Ann Oncol 2016; 27:947-52. [PMID: 26903311 DOI: 10.1093/annonc/mdw044] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 09/14/2015] [Accepted: 01/27/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Treatment options for sarcoma are limited. Histone deacetylase inhibitors increase the efficacy of topoisomerase II inhibitors by promoting access to chromatin and by down-regulating DNA repair. Thus, combined panobinostat and epirubicin therapy was evaluated to treat refractory sarcoma. PATIENTS AND METHODS Patients with advanced solid tumors were enrolled in a 3 + 3 dose-escalation phase I trial of panobinostat given on days 1, 3, and 5 followed by 75 mg/m(2) of epirubicin on day 5 in 21-day cycles, with a dose expansion at maximum tolerated dose (MTD) in 20 sarcoma patients. Peripheral blood mononucleocyte histone acetylation was also evaluated. RESULTS Forty patients received 20-60 mg panobinostat. Dose-limiting toxicities included thrombocytopenia, febrile neutropenia, and fatigue at 60 mg, defining a panobinostat MTD at 50 mg. Four responses were seen in 37 assessable patients, all after progression on prior topoisomerase II inhibitors. For those with sarcoma, 12 of 20 derived clinical benefit (1 partial response and 11 stable disease, median overall survival 8.3 months), including 8 of 14 previously progressed on topoisomerase II therapy. Treatment benefits correlated with increased histone acetylation and decreased neutrophil count on day 5. CONCLUSIONS Panobinostat and epirubicin treatment is well tolerated and may reverse anthracycline resistance. Changes in histone acetylation and associated decrease in neutrophil count correlated with clinical benefit and warrant investigation as predictive biomarkers. CLINICAL TRIAL This trial is registered at www.Clinicaltrials.gov, Identifier: NCT00878904.
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Affiliation(s)
- S Thomas
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - R Aggarwal
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - T Jahan
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - C Ryan
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - T Troung
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - A M Cripps
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - P Raha
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - K T Thurn
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - S Chen
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - J A Grabowsky
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - J Park
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - J Hwang
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - A Daud
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
| | - P N Munster
- Department of Medicine/Hematology and Oncology, University of California, San Francisco, San Francisco, USA
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McElroy LM, Woods DM, Yanes AF, Skaro AI, Daud A, Curtis T, Wymore E, Holl JL, Abecassis MM, Ladner DP. Applying the WHO conceptual framework for the International Classification for Patient Safety to a surgical population. Int J Qual Health Care 2016; 28:166-74. [PMID: 26803539 DOI: 10.1093/intqhc/mzw001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Efforts to improve patient safety are challenged by the lack of universally agreed upon terms. The International Classification for Patient Safety (ICPS) was developed by the World Health Organization for this purpose. This study aimed to test the applicability of the ICPS to a surgical population. DESIGN A web-based safety debriefing was sent to clinicians involved in surgical care of abdominal organ transplant patients. A multidisciplinary team of patient safety experts, surgeons and researchers used the data to develop a system of classification based on the ICPS. Disagreements were reconciled via consensus, and a codebook was developed for future use by researchers. RESULTS A total of 320 debriefing responses were used for the initial review and codebook development. In total, the 320 debriefing responses contained 227 patient safety incidents (range: 0-7 per debriefing) and 156 contributing factors/hazards (0-5 per response). The most common severity classification was 'reportable circumstance,' followed by 'near miss.' The most common incident types were 'resources/organizational management,' followed by 'medical device/equipment.' Several aspects of surgical care were encompassed by more than one classification, including operating room scheduling, delays in care, trainee-related incidents, interruptions and handoffs. CONCLUSIONS This study demonstrates that a framework for patient safety can be applied to facilitate the organization and analysis of surgical safety data. Several unique aspects of surgical care require consideration, and by using a standardized framework for describing concepts, research findings can be compared and disseminated across surgical specialties. The codebook is intended for use as a framework for other specialties and institutions.
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Affiliation(s)
- L M McElroy
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - D M Woods
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A F Yanes
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A I Skaro
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A Daud
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - T Curtis
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - E Wymore
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J L Holl
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - M M Abecassis
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - D P Ladner
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Bhatia S, Iyer J, Ibrani D, Blom A, Byrd D, Parvathaneni U, Diep T, Le M, Pierce R, Heller R, Daud A, Nghiem P. 504 Intratumoral delivery of Interleukin-12 DNA via in vivo electroporation leads to regression of injected and non-injected tumors in Merkel cell carcinoma: Final Results of a phase 2 study. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30306-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Middleton MR, Friedlander P, Hamid O, Daud A, Plummer R, Falotico N, Chyla B, Jiang F, McKeegan E, Mostafa NM, Zhu M, Qian J, McKee M, Luo Y, Giranda VL, McArthur GA. Randomized phase II study evaluating veliparib (ABT-888) with temozolomide in patients with metastatic melanoma. Ann Oncol 2015. [PMID: 26202595 DOI: 10.1093/annonc/mdv308] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Veliparib (ABT-888) is a potent, orally bioavailable, small-molecule inhibitor of the DNA repair enzymes poly ADP-ribose polymerase-1 and -2. Veliparib enhances the efficacy of temozolomide (TMZ) and other cytotoxic agents in preclinical tumor models. PATIENTS AND METHODS In this multicenter, double-blind trial, adults with unresectable stage III or IV metastatic melanoma were randomized 1:1:1 to TMZ plus veliparib 20 or 40 mg, or placebo twice daily. Efficacy end points included progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). RESULTS Patients (N = 346) were randomized between February 2009 and January 2010. Median [95% confidence interval (CI)] PFS was 3.7 (3.0-5.5), 3.6 (1.9-4.1), and 2 (1.9-3.7) months in the 20-mg, 40-mg, and placebo arms, respectively. Median (95% CI) OS was 10.8 (9.0-13.1), 13.6 (11.4-15.9), and 12.9 (9.8-14.3) months, respectively; ORR was 10.3%, 8.7%, and 7.0%. Exploratory analyses showed patients with low ERCC1 expression had longer PFS when TMZ was combined with veliparib. Toxicities were as expected for TMZ. The frequencies of thrombocytopenia, neutropenia, and leukopenia were significantly increased in the veliparib groups. Grade 3 or 4 adverse events, mainly hematologic toxicities, were seen in 55%, 63%, and 41% of patients in the 20-mg, 40-mg, and placebo arms, respectively. CONCLUSIONS Median PFS with 20 and 40 mg veliparib almost doubled numerically compared with placebo, but the improvements did not reach statistical significance. OS was not increased with veliparib. Toxicities were similar to TMZ monotherapy, but with increased frequency.
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Affiliation(s)
- M R Middleton
- Department of Oncology, University of Oxford, Churchill Hospital, Oxford, UK
| | - P Friedlander
- Hematology and Medical Oncology, The Mount Sinai Medical Center, New York
| | - O Hamid
- Experimental Therapeutics/Immunotherapy, The Los Angeles Clinic and Research Institute, Los Angeles
| | - A Daud
- University of California San Francisco Medical Center, University of California, San Francisco, USA
| | - R Plummer
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | | | - B Chyla
- AbbVie Inc., North Chicago, USA
| | - F Jiang
- AbbVie Inc., North Chicago, USA
| | | | | | - M Zhu
- AbbVie Inc., North Chicago, USA
| | - J Qian
- AbbVie Inc., North Chicago, USA
| | - M McKee
- AbbVie Inc., North Chicago, USA
| | - Y Luo
- AbbVie Inc., North Chicago, USA
| | | | - G A McArthur
- Divisions of Cancer Medicine/Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
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Robert C, Mateus C, Hodi S, Kefford R, Hamid O, Daud A, Wolchok JD, Hwu WJ, Gangadhar TC, Patnaik A, Joshua AM, Hersey P, Weber J, Dronca R, Zarour H, Gergich K, Li XN, Lannone R, Kang SP, Ebbinghaus S, Ribas A. Traitement par anticorps anti-PD-1 : pembrolizumab (MK-3475) chez 411 patients (pts) atteints de mélanome métastatique. Ann Dermatol Venereol 2014. [DOI: 10.1016/j.annder.2014.09.084] [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: 10/24/2022]
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22
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Menzies AM, Ashworth MT, Swann S, Kefford RF, Flaherty K, Weber J, Infante JR, Kim KB, Gonzalez R, Hamid O, Schuchter L, Cebon J, Sosman JA, Little S, Sun P, Aktan G, Ouellet D, Jin F, Long GV, Daud A. Characteristics of pyrexia in BRAFV600E/K metastatic melanoma patients treated with combined dabrafenib and trametinib in a phase I/II clinical trial. Ann Oncol 2014; 26:415-21. [PMID: 25411413 DOI: 10.1093/annonc/mdu529] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pyrexia is a frequent adverse event with combined dabrafenib and trametinib therapy (CombiDT), but little is known of its clinical associations, etiology, or appropriate management. PATIENTS AND METHODS All patients on the BRF133220 phase I/II trial of CombiDT treated at the standard dose (150/2) were included for assessment of pyrexia (n = 201). BRAF and MEK inhibitor-naïve patients (n = 117) were included for efficacy analyses. Pyrexia was defined as temperature ≥38°C (≥100.4(°)F) or related symptoms. RESULTS Fifty-nine percent of patients developed pyrexia during treatment, 24% of which had pyrexia symptoms without a recorded elevation in body temperature. Pyrexia was grade 2+ in 60% of pyrexia patients. Median time to onset of first pyrexia was 19 days, with a median duration of 9 days. Pyrexia patients had a median of two pyrexia events, but 21% had three or more events. Various pyrexia management approaches were conducted in this study. A trend was observed between dabrafenib and hydroxy-dabrafenib exposure and pyrexia. No baseline clinical characteristics predicted pyrexia, and pyrexia was not statistically significantly associated with treatment outcome. CONCLUSIONS Pyrexia is a frequent and recurrent toxicity with CombiDT treatment. No baseline features predict pyrexia, and it is not associated with clinical outcome. Dabrafenib and metabolite exposure may contribute to the etiology of pyrexia. The optimal secondary prophylaxis for pyrexia is best studied in a prospective trial.
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Affiliation(s)
- A M Menzies
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia
| | - M T Ashworth
- University of California San Francisco, San Francisco
| | - S Swann
- Clinical Statistics, GlaxoSmithKline, Collegeville, USA
| | - R F Kefford
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia Westmead Hospital, University of Sydney, Sydney Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - K Flaherty
- Massachusetts General Hospital Center, Boston
| | - J Weber
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa
| | - J R Infante
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville
| | - K B Kim
- California Pacific Medical Center, San Francisco
| | - R Gonzalez
- Department of Medical Oncology, The University of Colorado Cancer Center, Aurora
| | - O Hamid
- Department of Oncology, The Angeles Clinic and Research Institute, Santa Monica
| | - L Schuchter
- Penn Medicine, The University of Pennsylvania, Philadelphia, USA
| | - J Cebon
- Oncology Unit, Ludwig Institute for Cancer Research, Heidelberg, Australia
| | - J A Sosman
- Department of Oncology, Vanderbilt University Medical Centre, Nashville, USA
| | - S Little
- Clinical Statistics, GlaxoSmithKline, Collegeville, USA
| | - P Sun
- Clinical Statistics, GlaxoSmithKline, Collegeville, USA
| | - G Aktan
- Clinical Statistics, GlaxoSmithKline, Collegeville, USA
| | - D Ouellet
- Clinical Statistics, GlaxoSmithKline, Collegeville, USA
| | - F Jin
- Clinical Statistics, GlaxoSmithKline, Collegeville, USA
| | - G V Long
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - A Daud
- University of California San Francisco, San Francisco
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Daud A, Hamid O, Robert C, Hodi F, Wolchok J, Hwu W, Weber J, Kefford R, Hersey P, Joshua A, Joseph R, Gangadhar T, Dronca R, Patnaik A, Zarour H, Gerigich K, Lunceford J, Emancipator K, Dolled-Filhart M, Li X, Kang P, Ebbinghaus S, Ribas A. 140 Relationship between programmed death ligand 1 (PD-L1) expression and clinical outcome in patients (pts) with melanoma (MEL) treated with pembrolizumab (pembro; MK-3475). Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70266-7] [Citation(s) in RCA: 2] [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: 10/24/2022]
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24
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Robert C, Joshua A, Weber J, Ribas A, Hodi F, Kefford R, Daud A, Wolchok J, Hwu WJ, Gangadhar T, Patnaik A, Hersey P, Dronca R, Zarour H, Ge Y, Lindia J, Giannotti M, Ebbinghaus S, Kang S, Hamid O. Pembrolizumab (Pembro; Mk-3475) for Advanced Melanoma (Mel): Randomized Comparison of Two Dosing Schedules. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.42] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mohamad S, Khan I, Muddaiah A, Shakeel M, Daud A. Epiglottic hypoplasia: a natural model for supraglottic laryngoplasty. J Coll Physicians Surg Pak 2014; 24:528-9. [PMID: 25052981 DOI: 07.2014/jcpsp.528529] [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] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 07/06/2013] [Indexed: 11/15/2022]
Abstract
Non-syndromic hypoplasia of the epiglottis presenting without symptoms at middle age is an extremely rare entity. We report a 50 years female who presented with oral ulcers and incidentally was found to have an asymptomatic rudimentary epiglottis and thickened bilateral aryepiglottic folds forming an inverted funnel shaped supraglottis protecting the airway from any aspiration. This case demonstrated a functional model of natural supraglottic laryngoplasty which can be used in treating intractable aspiration, similar to the Steam boat modification of Biller's technique of supraglottic laryngoplasty. This natural example can be used to design or scrutinize the existing models of supraglottic laryngoplasty in the treatment of intractable aspiration.
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Affiliation(s)
- Shwan Mohamad
- Department of ENT, Monklands Hospital, Airdrie, Scotland, ML6 0JS
| | - Imran Khan
- Department of ENT, Monklands Hospital, Airdrie, Scotland, ML6 0JS
| | - Anand Muddaiah
- Department of ENT, ST Helens and Knowsley NHS Trust, Marshalls Cross Road, St. Helens, Merseyside, England, WA9 3DA
| | - Muhammad Shakeel
- Department of ENT, Aberdeen Royal Infirmary Aberdeen, Scotland, AB25 2ZN
| | - Amer Daud
- Department of ENT, ST Helens and Knowsley NHS Trust, Marshalls Cross Road, St. Helens, Merseyside, England, WA9 3DA
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Grippo JF, Zhang W, Heinzmann D, Yang KH, Wong J, Joe AK, Munster P, Sarapa N, Daud A. A phase I, randomized, open-label study of the multiple-dose pharmacokinetics of vemurafenib in patients with BRAF V600E mutation-positive metastatic melanoma. Cancer Chemother Pharmacol 2013; 73:103-11. [DOI: 10.1007/s00280-013-2324-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 10/11/2013] [Indexed: 10/26/2022]
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Munster P, van der Noll R, Voest E, Specht J, Werner T, Dees E, Tan A, Daud A, Schellens J, Lolkema M, Griffin M, Agarwal N, Falchook G, Kleha J, Durante M, Smith D, Adams L, Greshock J, Morris S, Kurzrock R. PI3K Kinase Inhibitor GSK2126458 (GSK458): Clinical Activity in Select Patient (PT) Populations Defined by Predictive Markers (STUDY P3K112826). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33038-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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28
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Gonzalez R, Ribas A, Daud A, Pavlick A, Gajewski T, Puzanov I, Teng M, Chan I, Choong N, McArthur G. Phase IB Study of Vemurafenib in Combination with the Mek Inhibitor, GDC-0973, in Patients (PTS) with Unresectable or Metastatic BRAFV600 Mutated Melanoma (BRIM7). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)34336-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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29
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Munster PN, van der Noll R, Voest EE, Dees EC, Tan AR, Specht JM, Falchook GS, Daud A, Lolkema MP, Grilley-Olson JE, Yu EY, Fu S, Bergsland EK, Kleha J, Peng S, Smith DA, Lampkin TA, Schellens JHM, Morris SR, Kurzrock R. Phase I first-in-human study of the PI3 kinase inhibitor GSK2126458 (GSK458) in patients with advanced solid tumors (study P3K112826). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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30
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Gordon MS, Vogelzang NJ, Schoffski P, Daud A, Spira AI, O'Keeffe BA, Rafferty T, Lee Y, Berger R, Shapiro G. Activity of cabozantinib (XL184) in soft tissue and bone: Results of a phase II randomized discontinuation trial (RDT) in patients (pts) with advanced solid tumors. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Moore AP, Thomas S, Ryan CJ, Jahan TM, DuBois SG, Chan JK, Thurn KT, Collisson EA, Reinert A, Daud A, Munster PN. A phase I trial of the histone deacetylase inhibitor panobinostat (LBH589) and epirubicin in patients with solid tumor malignancies. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3036] [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: 11/20/2022] Open
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Algazi AP, Cha E, Soon C, Ortiz-Urda S, Cortez B, Ziani L, Coakley FV, Daud A. A phase II clinical/translational trial of sequential axitinib/carboplatin/paclitaxel in melanoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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33
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Cha E, Daud A, McNeel DG, Heller R, Fong L. Systemic immune responses induced by intratumoral plasmid IL-12 electroporation in patients with melanoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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34
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Moore A, Thomas S, Ryan C, Jahan T, DuBois S, Chan J, Thurn K, Reinhert A, Daud A, Munster P. 411 A phase I trial of the histone deacetylase inhibitor panobinostat (LBH589) and epirubicin in patients with solid tumor malignancies. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)72118-2] [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: 10/18/2022] Open
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Daud A, Springett GM, Mendelson DS, Munster PN, Goldman JW, Strosberg JR, Kato G, Nesheiwat T, Isaacs R, Rosen LS. A phase I dose-escalation study of SCH 900776, a selective inhibitor of checkpoint kinase 1 (CHK1), in combination with gemcitabine (Gem) in subjects with advanced solid tumors. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.3064] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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37
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Algazi AP, Weber JS, Andrews S, Urbas P, Arimura E, Hwang J, Sondak VK, Bastian B, Daud A. A phase I/II trial of DTIC and dasatinib in metastatic melanoma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Munster PN, Petrou P, Ryan CJ, Jahan TM, DuBois SG, Rugo HS, Chan JK, Thurn KT, Reinert A, Daud A. A phase I trial of the histone deacetylase inhibitor panobinostat (LBH589) and epirubicin in patients with solid tumor malignancies. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e13140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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39
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Munster PN, Marchion D, Thomas S, Egorin M, Minton S, Springett G, Lee JH, Simon G, Chiappori A, Sullivan D, Daud A. Phase I trial of vorinostat and doxorubicin in solid tumours: histone deacetylase 2 expression as a predictive marker. Br J Cancer 2009; 101:1044-50. [PMID: 19738609 PMCID: PMC2768109 DOI: 10.1038/sj.bjc.6605293] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: Histone deacetylase inhibitors (HDACi) can sensitise cancer cells to topoisomerase inhibitors by increasing their access and binding to DNA. Methods: This phase I trial was designed to determine the toxicity profile, tolerability, and recommended phase II dose of escalating doses of the HDACi vorinostat, with weekly doxorubicin. Results: In total, 32 patients were treated; vorinostat was dosed at 400, 600, 800, or 1000 mg day−1 on days 1–3, followed by doxorubicin (20 mg m−2) on day 3 for 3 of 4 weeks. Maximal tolerated dose was determined to be 800 mg day−1 of vorinostat. Dose-limiting toxicities were grade 3 nausea/vomiting (two out of six) and fatigue (one out of six) at 1000 mg day−1. Non-dose-limiting grade 3/4 toxicities included haematological toxicity and venous thromboembolism. Antitumor activity in 24 evaluable patients included two partial responses (breast and prostate cancer). Two patients with melanoma had stable disease for ⩾8 months. Histone hyperacetylation changes in peripheral blood mononuclear and tumour cells were comparable. Histone hyperacetylation seemed to correlate with pre-treatment HDAC2 expression. Conclusion: These findings suggest that vorinostat can be combined with weekly doxorubicin in this schedule at a dose of 800 mg day−1. The HDAC2 expression may be a marker predictive of HDAC inhibition. Antitumor activity of this regimen in breast cancer, prostate cancer, and melanoma seems interesting.
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Affiliation(s)
- P N Munster
- Division of Hematology and Oncology, University of California, San Francisco, CA 94143, USA.
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Daud A, Weber J, Urbas P, Andrews S, Maker N, Sondak VK, DeConti RC. Phase II trial of sagopilone (ZK-EPO), a novel synthetic epothilone, with significant activity in metastatic melanoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
9031 Background: Sagopilone (ZK-Epothilone) is a novel, fully synthetic epothilone with promising preclinical activity in several cancer models. This phase II study aims to define the efficacy and safety of sagopilone in patients with metastatic melanoma, as well as perform pharmacokinetic evaluation of this dose and schedule. Methods: Patients with unresectable stage III or IV malignant melanoma, with up to 2 prior chemotherapy and any prior immunotherapy regimens with measurable disease were eligible. Sagopilone was administered at 16 mg/m2 as a 3-hour IV infusion every 21 days. The primary end point of the trial was response rate, and secondary endpoints included time to progression, overall survival, and tolerability. Pharmacokinetic analysis was done on the first 10 patients. A total of 37 patients were to be accrued to have 33 evaluable patients. The trial had a 0.90 power and assumed α of 0.03. Results: Thirty four patients have been enrolled to date. Sagopilone appears to be well tolerated: The most common side effects seen have been sensory neuropathy, (55%, 19/34, 5 Grade 2, 14Grade 1) motor neuropathy (23%, 8/34, All Grade 1); anemia (26 %, 9/34) neutropenia (14%, 5/34 1 Grade 2, 4 Grade 1) thrombocytopenia (14%, 5/34) and fatigue (38%, 13/34). Two patients have shown grade 3 events (syncope and mental status changes, respectively, possibly related to therapy), both of which resolved and an additional patient had a pulmonary embolism which was considered unlikely to be related to therapy. Responses have been seen in 4 patients (3 RECIST confirmed PR, 1 unconfirmed PR). Stable disease was seen for at least 12 weeks in an additional 10 patients for a clinical benefit rate (CR+PR+SD) of 44%. No grade 4 events have been reported. Conclusions: Unlike the epothilone analogs patupilone or ixabepilone, sagopilone appears to be an active drug in advanced melanoma. The side effect profile seen to date at 16 mg/m2 given over 3 hours repeated every 3 weeks appears to be notably free of myelosuppression indicating that it could be combined with other drugs active in melanoma. Pharmacokinetic studies show a prolonged terminal half life, probably due to release from deep tissue compartments. [Table: see text]
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Affiliation(s)
- A. Daud
- University of California, San Francisco, San Francisco, CA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - J. Weber
- University of California, San Francisco, San Francisco, CA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - P. Urbas
- University of California, San Francisco, San Francisco, CA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - S. Andrews
- University of California, San Francisco, San Francisco, CA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - N. Maker
- University of California, San Francisco, San Francisco, CA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - V. K. Sondak
- University of California, San Francisco, San Francisco, CA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - R. C. DeConti
- University of California, San Francisco, San Francisco, CA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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Milone L, Daud A, Durak E, Olivero-Rivera L, Schrope B, Inabnet WB, Davis D, Bessler M. Esophageal dilation after laparoscopic adjustable gastric banding. Surg Endosc 2007; 22:1482-6. [PMID: 18027041 DOI: 10.1007/s00464-007-9651-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [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: 05/18/2007] [Revised: 07/09/2007] [Accepted: 08/29/2007] [Indexed: 01/28/2023]
Abstract
BACKGROUND Esophageal dilation can occur after laparoscopic adjustable gastric banding (LAGB). There are few studies in the literature that describe the outcomes of patients with esophageal dilation. The aim of this article is to evaluate weight loss and symptomatic outcome in patients with esophageal dilation after LAGB. METHODS We performed a retrospective chart review of all LAGBs performed at Columbia University Medical Center from March 2001 to December 2006. Patients with barium swallow (BaSw) at 1 year after surgery were evaluated for esophageal diameter. A diameter of 35 mm or greater was considered to be dilated. Data collected before surgery and at 6 months and 1, 2 and 3 years after surgery were weight, body mass index (BMI), status of co-morbidities, eating parameters, and esophageal dilation as evaluated by BaSw. RESULTS Of 440 patients, 121 had follow-up with a clinic visit and BaSw performed at 1 year. Seventeen patients (10 women and 7 men) (14%) were found to have esophageal dilation with an average diameter of 40.9 +/- 4.6 mm. There were no significant differences in percent of excess weight lost at any time point; however, GERD symptoms and emesis were more frequent in patients with dilated esophagus than in those without dilation. Intolerance of bread, rice, meat, and pasta was not different at any time during the study. CONCLUSIONS In our experience the incidence of esophageal dilation at 1 year after LAGB was 14%. The presence of dilation did not affect percent excess weight loss (%EWL). GERD symptoms and emesis are more frequent in patients who develop esophageal dilation.
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Affiliation(s)
- L Milone
- Department of Surgery, Minimal Access Surgery Center, Columbia University College of Physician and Surgeons, 630 West 168 Street, New York, New York 10032, USA
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Homsi J, Kim LC, Goetz D, Chen D, Fishman M, Daud A. High-dose bolus interleukin-2 in elderly patients (>60 years old) with metastatic melanoma or renal cell cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.19559] [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
19559 Background: Although durable complete responses have been reported from using high-dose bolus interleukin-2 (HDB IL-2) in a small number of patients with metastatic melanoma and renal cell cancer (RCC), IL-2 toxicity limits its use especially in the elderly. Methods: the medical records of patients older than 60 years old with melanoma or renal cell carcinoma who received HDB IL-2 at the Moffitt Cancer Center between 2000–2005 were reviewed. The effect of increased age, primary diagnosis, and the HDB IL-2 regimen used on the side effects, number of administered doses, and survival was analyzed. Results: 55 cycles were administered to 35 patients (23 RCC, 12 melanoma, 26 men). Median age was 67 years old (range: 61–77). 17 patients received a traditional regimen (one cycle: 600,000 IU/Kg intravenously every 8 hours for 14 doses repeated in 2 weeks, maximum of 28 doses) and 18 received a clinical trial regimen (one cycle: 600,000 IU/Kg intravenously every 8 hours for 5 doses repeated weekly, maximum of 20 doses). Median number of administered cycles was 1 (range 1–4) and median number of total doses was 24 (range 3–79). Increased age was not related to total number of administered doses. Median percentage of IL-2 administered in a cycle was 75% of planned (range 11%-100%). Reasons to discontinue therapy were: oliguria (35%), hypotension (25%), and arrhythmia (15%). Side effects in all cycles were: hypotension (71%), oliguria (67%), Arrhythmia (18%), Myocardial infarction (7%), pulmonary edema (7%), hypothyroidism (4%), confusion (4%), seizures (2%) and stroke (2%). Pressors were used in 58% of all cycles. 20 patients died within a year from starting treatment and 5 lived more than 2 years (4 had RCC). Conclusions: 1) HDB IL-2 has multiple and life-threatening side effects in the elderly and caution is needed when selecting these patients to such therapy 2) the number of doses administered is comparable to that general population 3) more studies are needed to identify the population that would mostly benefit from HDB IL2. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- J. Homsi
- H. Lee Moffitt Cancer Center, Tampa, FL
| | - L. C. Kim
- H. Lee Moffitt Cancer Center, Tampa, FL
| | - D. Goetz
- H. Lee Moffitt Cancer Center, Tampa, FL
| | - D. Chen
- H. Lee Moffitt Cancer Center, Tampa, FL
| | | | - A. Daud
- H. Lee Moffitt Cancer Center, Tampa, FL
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Munster PN, Marchion DC, Schmitt M, Bicaku E, Lacevic M, Minton S, Carter W, Daud A. Phase I/II trial combining the HDAC inhibitor, valproic acid (VPA) and FEC100 (5-fluorouracil, epirubicin and cyclophosphamide) in locally advanced/metastatic breast cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.1065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
1065 Background: Cell culture and xenograft studies suggest a synergistic interaction between histone deacetylase inhibitors (HDACi) and topoisomerase (topo) inhibitors, as well as other DNA targeting agents. Methods: In this phase I/II study, we determined the effects of escalating doses of VPA on the clinical efficacy and tolerability of epirubicin. The phase I part was open to patients will all solid tumors. A limited phase II part at the maximum tolerated dose (MTD) of VPA enrolled 10 breast cancer patients and incorporated the breast cancer regimen FEC100 (5-fluorouracil, epirubicin, cyclophosphamide (600/100/600 mg/m2)). VPA was given on days 1–3 prior to epirubicin/FEC100 in 3-week cycles. HDAC expression, histone acetylation and topo II expression were evaluated in pre-and post-VPA peripheral blood mononuclear cells and tumor samples. Results: Fifty-four (44 in phase I and 10 in phase II) patients [median age 55 (39–78)] received VPA (mg/kg/day): 15, 30, 45, 60, 75, 90, 100, 120, 140 and 160. Tumor types included: breast (10+10), melanoma (11), lung (6), sarcoma (2), GYN (2), GI (5) and others (8). Dose-limiting toxicities included somnolence, confusion and febrile neutropenia. No exacerbation of FEC100/epirubicin-related toxicities was observed. Objective responses in the phase I part 9/41 (22%) were seen across different tumor types despite a median number of 3 (0–6) prior regimens with stable disease/minor response in 16/41 (39%). In the breast-specific phase II part, partial responses to date were seen in 4/8 (50%) and stable disease in 2/8 (25%), progression in 1/8 (12.5%), 1/8 (12.5%) patients withdrew consent. All breast cancer patients with a response/stable disease received the maximal number of seven cycles. VPA plasma concentrations correlated with VPA dose. There was a positive correlation between histone acetylation and VPA dose as well as plasma levels in PBMC and further correlated with those in tumors. Conclusion: A sequence-specific combination of VPA and FEC100 in breast cancer is highly active without exacerbation of chemotherapy-induced toxicities. A neoadjuvant phase II trial using VPA (120 mg/kg) -> FEC100 in patients with early stage breast cancer is ongoing. [Table: see text]
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Affiliation(s)
| | | | - M. Schmitt
- H Lee Moffitt Cancer Ctr and Rsrch Inst, Tampa, FL
| | - E. Bicaku
- H Lee Moffitt Cancer Ctr and Rsrch Inst, Tampa, FL
| | - M. Lacevic
- H Lee Moffitt Cancer Ctr and Rsrch Inst, Tampa, FL
| | - S. Minton
- H Lee Moffitt Cancer Ctr and Rsrch Inst, Tampa, FL
| | - W. Carter
- H Lee Moffitt Cancer Ctr and Rsrch Inst, Tampa, FL
| | - A. Daud
- H Lee Moffitt Cancer Ctr and Rsrch Inst, Tampa, FL
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Daud A, Schmitt M, Marchion D, Bicaku E, Minton S, Egorin M, Zwiebel J, Chiappori A, Sullivan D, Munster P. Phase I trial of a sequence-specific combination of the HDAC inhibitor, vorinostat (SAHA) followed by doxorubicin in advanced solid tumor malignancies. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.3502] [Citation(s) in RCA: 6] [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
3502 Background: Preclinical cell culture and xenograft studies suggest that pre-exposure of cancer cells to a histone deacetylase inhibitor (HDACi) may potentiate topoisomerase (topo) inhibitors. The HDACi-induced histone acetylation and chromatin modulation facilitates DNA access and target recruitment for topo II inhibitors. Methods: This Phase I trial explores the safety, tolerability and maximum tolerated dose (MTD) of a weekly schedule of escalating vorinostat doses (twice daily days 1–3) followed by doxorubicin (20 mg/m2) on day 3 (3 out of 4 weeks). Histone acetylation and topo II expression are evaluated in pre-and post-vorinostat peripheral blood mononuclear cells and in tumor cells of the 30 patients treated at the MTD. Results: To date, 15 patients [median age 54 (38–73)] have been treated in 4 vorinostat cohorts: 200, 300, 400, 500 mg bid. Tumor types included: breast (3), melanoma (3), pancreatic (2) and one each of SCLC, sarcoma, endometrial, colon, prostate, renal cell and bladder cancer. Dose-limiting toxicities included a grade 3 thrombocytopenia (1/6) at the 400 mg bid dose. Non-dose limiting Grade 3 and 4 toxicities include neutropenia, thrombocytopenia, fatigue, pulmonary embolus, and anemia (1 pt each). Currently, vorinostat doses of 500 mg bid are being evaluated. One confirmed partial response in a breast cancer patient, as well as minor responses in a melanoma and a prostate cancer patient were seen in 10 evaluable patients. Patients received a median number of 2 (1–9+) treatment cycles. Doxorubicin is stopped after 6 cycles and patients continue on vorinostat alone. H3 and H4 histone acetylation and topo II expression will be correlated with vorinostat dose, plasma concentration and response. Conclusion: A sequence-specific combination of vorinostat and doxorubicin is active without exacerbation of doxorubicin toxicity. The tolerated vorinostat dose exceeds the proposed single agent dose for vorinostat derived from patients with hematological malignancies. Histone hyperacetylation occurs in peripheral blood mononuclear cells at all levels. The anti-tumor activity in breast cancer and melanoma will be further explored. No significant financial relationships to disclose.
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Affiliation(s)
- A. Daud
- H. Lee Moffitt Cancer Center, Tampa, FL; University of Pittsburgh, Pittsburgh, PA; NCI, Bethesda, MD
| | - M. Schmitt
- H. Lee Moffitt Cancer Center, Tampa, FL; University of Pittsburgh, Pittsburgh, PA; NCI, Bethesda, MD
| | - D. Marchion
- H. Lee Moffitt Cancer Center, Tampa, FL; University of Pittsburgh, Pittsburgh, PA; NCI, Bethesda, MD
| | - E. Bicaku
- H. Lee Moffitt Cancer Center, Tampa, FL; University of Pittsburgh, Pittsburgh, PA; NCI, Bethesda, MD
| | - S. Minton
- H. Lee Moffitt Cancer Center, Tampa, FL; University of Pittsburgh, Pittsburgh, PA; NCI, Bethesda, MD
| | - M. Egorin
- H. Lee Moffitt Cancer Center, Tampa, FL; University of Pittsburgh, Pittsburgh, PA; NCI, Bethesda, MD
| | - J. Zwiebel
- H. Lee Moffitt Cancer Center, Tampa, FL; University of Pittsburgh, Pittsburgh, PA; NCI, Bethesda, MD
| | - A. Chiappori
- H. Lee Moffitt Cancer Center, Tampa, FL; University of Pittsburgh, Pittsburgh, PA; NCI, Bethesda, MD
| | - D. Sullivan
- H. Lee Moffitt Cancer Center, Tampa, FL; University of Pittsburgh, Pittsburgh, PA; NCI, Bethesda, MD
| | - P. Munster
- H. Lee Moffitt Cancer Center, Tampa, FL; University of Pittsburgh, Pittsburgh, PA; NCI, Bethesda, MD
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Daud A, Habib N, Riera AS. Anti-inflammatory, anti-nociceptive and antipyretic effects of extracts of Phrygilanthus acutifolius flowers. J Ethnopharmacol 2006; 108:198-203. [PMID: 16797151 DOI: 10.1016/j.jep.2006.05.002] [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] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Revised: 04/24/2006] [Accepted: 05/08/2006] [Indexed: 05/10/2023]
Abstract
This study was intended to evaluate the anti-inflammatory, antipyretic and analgesic activities of aqueous and ethanol extracts of Phrygilanthus acutifolius flowers in several experimental standard models in rats, following oral administration. The results showed that the aqueous extract significantly reduced the oedema induced by carrageenan within 1-5 h post-dosing at all dose levels used. On the analgesia property, acetic acid-induced writhing was significantly reduced. In the formalin test, the extract also significantly decreased the painful stimulus in both phases of the test. The tail immersion confirms central acting analgesic property of the extracts. Overall, the analgesic tests conducted revealed that the extract had central and peripheral properties. Its effects on pyresis were also appreciable. It significantly reduced fever at doses greater than 200 mg/kg within 2 h on yeast-induced hyperthermia in rats.
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MESH Headings
- Acetic Acid
- Administration, Oral
- Analgesics, Non-Narcotic/administration & dosage
- Analgesics, Non-Narcotic/isolation & purification
- Analgesics, Non-Narcotic/pharmacology
- Animals
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Anti-Inflammatory Agents, Non-Steroidal/isolation & purification
- Anti-Inflammatory Agents, Non-Steroidal/pharmacology
- Argentina
- Carrageenan
- Diclofenac/pharmacology
- Dose-Response Relationship, Drug
- Edema/chemically induced
- Edema/prevention & control
- Female
- Fever/prevention & control
- Flowers/chemistry
- Formaldehyde
- Indomethacin/pharmacology
- Loranthaceae/chemistry
- Male
- Medicine, Traditional
- Neuralgia/chemically induced
- Neuralgia/prevention & control
- Pain Measurement/methods
- Phytotherapy
- Plant Extracts/administration & dosage
- Plant Extracts/isolation & purification
- Plant Extracts/pharmacology
- Rats
- Rats, Wistar
- Water
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Affiliation(s)
- A Daud
- Departamento de Biología del Desarrollo, Instituto Superior de Investigaciones Biológicas y Universidad Nacional de Tucumán, Chacabuco 461, 4000-San Miguel de Tucumán, Tucumán, Argentina
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Daud A, Gump J, Neuger A, DeConti R, Bastine S, Mintz M, Hausheer F, Lush R, Sullivan D, Munster P. 293 POSTER Phase I trial of the histone deacetylase inhibitor valproic acid with the topoisomerase I inhibitor, karenitecin in advanced melanoma. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)70298-1] [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: 10/23/2022] Open
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Schrope BA, Daud A, Bessler M. Unintentional creation of reverse peristaltic alimentary limb during Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 2006; 2:478-82. [PMID: 16925386 DOI: 10.1016/j.soard.2006.04.231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2006] [Revised: 04/20/2006] [Accepted: 04/20/2006] [Indexed: 11/26/2022]
Affiliation(s)
- B A Schrope
- Center for Obesity Surgery, New York-Presbyterian Hospital and Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
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48
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Lew JI, Daud A, DiGorgi MF, Olivero-Rivera L, Davis DG, Bessler M. Preoperative esophageal manometry and outcome of laparoscopic adjustable silicone gastric banding. Surg Endosc 2006; 20:1242-7. [PMID: 16858533 DOI: 10.1007/s00464-005-0589-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [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: 08/25/2005] [Accepted: 02/23/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Laparoscopic adjustable silicone gastric banding (LASGB) for morbid obesity has been reported to provide long-term weight loss with a low risk of operative complications. Nevertheless, esophageal dilation leading to achalasia-like and reflux symptoms is a feared complication of LASGB. This study evaluates the clinical benefit of routine preoperative esophageal manometry in predicting outcome after LASGB in morbidly obese patients. METHOD A review of prospectively collected data on 77 patients who underwent routine esophageal manometry prior to LASGB for morbid obesity from February 2001 to September 2003 was performed. Aberrant motility, abnormal lower esophageal sphincter (LES) pressures, and other nonspecific esophageal motility disorders noted on preoperative esophageal manometry defined patients of the abnormal manometry group. Outcome differences in weight loss, emesis, band complications, and gastroesophageal reflux disease (GERD) resolution or improvement were compared between patients of the abnormal and normal manometry groups after LASGB. Analysis of variance (ANOVA) and chi-square tests were performed to determine the significance of these outcomes. RESULTS Of the patients tested, 14 had abnormal esophageal manometry results, whereas 63 had normal manometry results before LASGB. There was no significant difference in percent excess weight loss (%EWL) at 6 and 12 months between the groups after gastric banding. Severe postoperative emesis occurred more frequently in patients with abnormal manometry results than in those with normal manometry results. There were two band-related complications, both of which occurred in patients of the normal manometry group. CONCLUSIONS Preoperative esophageal manometry does not predict weight loss or GERD outcomes after LASGB in morbidly obese patients. Postoperative emesis was more common in patients with abnormal manometry findings, but such symptoms were manageable and did not lead to poor weight loss or to band removal or increased band-related complications.
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Affiliation(s)
- J I Lew
- Center for Obesity Surgery, New York-Presbyterian Hospital and Columbia University, College of Physicians and Surgeons, 161 Fort Washington Avenue, 6th Floor, Room 620, New York, New York 10032, USA
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Daud A, Garrett C, Simon GR, Munster P, Sullivan D, Stromatt S, Allevi C, Bernareggi B. Phase I trial of CT-2106 (polyglutamated camptothecin) administered weekly in patients (pts) with advanced solid tumors. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.2015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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
2015 Background: CT-2106, a camptothecin (CPT) conjugate, is a topoisomerase I inhibitor. Covalent binding through the hydroxyl group of CPT to polyglutamate, a biodegradable polymer of glutamic acid, enhances CPT aqueous solubility and prevents opening of the lactone ring and subsequent CPT binding to albumin. Responses were observed in a Q3 week dosing study in which the maximum tolerated dose (MTD) was 75 mg/m2. Objectives of this study are to determine the MTD and pharmacokinetics (PK) of CT-2106 given weekly to pts with advanced cancer. Methods: Pts received CT-2106 (10 min IV infusion) on days 1, 8, and 15 of each 28 day cycle. Toxicity (NCI CTC v3) and tumor response (RECIST) were assessed. Plasma was analyzed for conjugated and unconjugated CPT by liquid chromatography and tandem mass spectrometry. Results: Enrollment is complete with 21 evualuable pts. Dose limiting toxicities (DLT) are shown in the table . Median age = 60 years (range 36–83), median doses = 6 (1–9), median prior therapies = 3 (1–6). Most pts (12) had melanoma. In a Q3 week study assessments of conjugated and unconjugated CPT demonstrated that CT-2106 provides prolonged exposure to conjugated CPT and slow, progressive release of active CPT from the polymeric backbone. The PK of unconjugated CPT is dependent on the disposition profile of conjugated CPT; unconjugated CPT elimination is formation rate limited. The distribution of conjugated CPT appears to be restricted to extracellular body fluids. Total clearance includes renal excretion documented by substantial urinary excretion levels and CPT cleavage via metabolic pathways. Accumulation of conjugated or unconjugated CPT was not observed with repeated Q3 week dosing. PK in this weekly dosing study will be presented. Conclusions: CT-2106 is generally well tolerated without the toxicities normally associated with CPT, specifically hemorrhagic cystitis and severe diarrhea. The MTD is 25–35 mg/m2 in these heavily pretreated pts. [Table: see text] [Table: see text]
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Affiliation(s)
- A. Daud
- H. Lee Moffitt Cancer Center, Tampa, FL; Cell Therapeutics, Inc., Seattle, WA
| | - C. Garrett
- H. Lee Moffitt Cancer Center, Tampa, FL; Cell Therapeutics, Inc., Seattle, WA
| | - G. R. Simon
- H. Lee Moffitt Cancer Center, Tampa, FL; Cell Therapeutics, Inc., Seattle, WA
| | - P. Munster
- H. Lee Moffitt Cancer Center, Tampa, FL; Cell Therapeutics, Inc., Seattle, WA
| | - D. Sullivan
- H. Lee Moffitt Cancer Center, Tampa, FL; Cell Therapeutics, Inc., Seattle, WA
| | - S. Stromatt
- H. Lee Moffitt Cancer Center, Tampa, FL; Cell Therapeutics, Inc., Seattle, WA
| | - C. Allevi
- H. Lee Moffitt Cancer Center, Tampa, FL; Cell Therapeutics, Inc., Seattle, WA
| | - B. Bernareggi
- H. Lee Moffitt Cancer Center, Tampa, FL; Cell Therapeutics, Inc., Seattle, WA
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50
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Abstract
8025 Background: The Src/Stat 3 pathway has been implicated in the pathogenesis of several malignancies including melanoma. In the current study we evaluated the prevalence of Src and Stat3 activation in human melanoma and the effect of Src inhibitors alone or in combination with chemotherapeutic agents on melanoma cell lines. Methods: Activation of Src was measured by staining for Src-phosphotyrosine 416 (P-Src) and Stat3 by phosphotyrosine 705 Stat3 (P-Stat3). Immunohistochemistry was performed with anti-pStat3-Y705 and anti-pSrc-Y416 antibodies (Cell Signaling, Beverly, MA) on 3 melanoma subtypes. Staining of tumor cells for P-Stat3 was scored by percentage of stained cells as follows: 0 (no staining), 1 (1–25%), 2 (26–50%), 3 (>50%), and intensity 0–3 (0: absent, 1: low, 2: moderate, and 3: high). The sum of these was the composite P-Stat3 score: 0 (0), 1 (1–2), 2 (3–4), and 3 (5–6). P-Src staining was scored by intensity. Melanoma cell lines, A-375, SK-Mel-5 and SK-Mel-28 were exposed to Src inhibitors, SKI-606, PD 180970 and BMS 354825 alone or in combination with standard chemotherapy agents and IC-50 was determined by MTT assay at 24 and 72 hours. Results: 35 biopsies were stained. Median age was 66 years (range 23–90); 60% were women. 48% of all melanoma stained express P-Src; all samples express pStat3. We found a positive correlation between P-Src and P-Stat3 (Spearman coefficient=0.346, p=0.042). 46% stained only for pStat3 and 6% did not stain for either P-Src or P-Stat3. Most positively stained biopsies stained weakly for P-Src and moderately or strongly for pStat3. Src inhibitors inhibited the proliferation of melanoma cell lines; furthermore Src inhibitor treatment synergized with platinum and topoisomerase I inhibitors but not temozolomide. Conclusions: 1) Immunohistochemistry shows variable expression of P-Src and P-Stat3 in human melanoma 2) All tumors staining for P-Src also stain for P-Stat3 and the strength of staining is significantly related. 3) This data may be useful in planning future clinical trials with Src inhibitors in melanoma. [Table: see text] [Table: see text]
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Affiliation(s)
- J. Homsi
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL; University of Illinois, Chicago, IL; Mayo Clinic, Rochester, MN; City of Hope, Duarte, CA
| | - J. Messina
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL; University of Illinois, Chicago, IL; Mayo Clinic, Rochester, MN; City of Hope, Duarte, CA
| | - C. Cubutt
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL; University of Illinois, Chicago, IL; Mayo Clinic, Rochester, MN; City of Hope, Duarte, CA
| | - S. Maunglay
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL; University of Illinois, Chicago, IL; Mayo Clinic, Rochester, MN; City of Hope, Duarte, CA
| | - L. Scalf
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL; University of Illinois, Chicago, IL; Mayo Clinic, Rochester, MN; City of Hope, Duarte, CA
| | - A. Komarla
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL; University of Illinois, Chicago, IL; Mayo Clinic, Rochester, MN; City of Hope, Duarte, CA
| | - H. Yu
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL; University of Illinois, Chicago, IL; Mayo Clinic, Rochester, MN; City of Hope, Duarte, CA
| | - R. Jove
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL; University of Illinois, Chicago, IL; Mayo Clinic, Rochester, MN; City of Hope, Duarte, CA
| | - A. Daud
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL; University of Illinois, Chicago, IL; Mayo Clinic, Rochester, MN; City of Hope, Duarte, CA
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