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Amboree TL, Montealegre JR, Parker SL, Garg A, Damgacioglu H, Schmeler KM, Chiao EY, Hill EG, Sonawane K, Deshmukh AA, Adsul P. National Breast, Cervical, and Colorectal Cancer Screening Use in Federally Qualified Health Centers. JAMA Intern Med 2024:2818024. [PMID: 38683574 PMCID: PMC11059050 DOI: 10.1001/jamainternmed.2024.0693] [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] [Received: 09/09/2023] [Accepted: 01/07/2024] [Indexed: 05/01/2024]
Abstract
Importance Federally qualified health centers (FQHCs) deliver health care to nearly 30 million underserved persons across the US, yet nationwide and state-level breast, cervical, and colorectal cancer screening use in FQHCs is not described. Furthermore, it is unknown how the underscreened FQHC population contributes to the total underscreened population at national and state levels. Objective To describe national- and state-level breast, cervical, and colorectal cancer screening use among individuals served by FQHCs in the US and to estimate the percentage of underscreened individuals in the general population served by FQHCs. Design, Setting, and Participants This cross-sectional analysis of cancer screening used data from January 1 through December 31, 2020, from the FQHC Uniform Data System, reported by 1364 FQHCs across the US, and self-reported estimates from the Behavioral Risk Factor Surveillance System. Participants were 16 696 692 US adults served by FQHCs who were eligible for breast (age, 50-74 years), cervical (age, 21-64 years), and colorectal (age, 50-75 years) cancer screening. Analyses were conducted between January 1 and June 30, 2023. Exposures Breast, cervical, and colorectal cancer screening. Main Outcomes and Measures Percentages of breast, cervical, and colorectal cancer screening-eligible individuals up to date on screening. Results A total of 3 162 882 breast, 7 444 465 cervical, and 6 089 345 colorectal screening-eligible individuals were served by FQHCs in 2020. Nationally, screening use in FQHCs was 45.4% (95% CI, 45.4%-45.5%) for breast cancer, 51.0% (95% CI, 51.0%-51.1%) for cervical cancer, and 40.2% (95% CI, 40.1%-40.2%) for colorectal cancer. Screening use among the US general population was 78.2% (95% CI, 77.6%-78.9%) for breast cancer, 82.9% (95% CI, 82.3%-83.4%) for cervical cancer, and 72.3% (95% CI, 71.7%-72.8%) for colorectal cancer. The contribution of the underscreened population served by FQHCs to the national underscreened general population was 16.9% (95% uncertainty interval [UI], 16.4%-17.4%) for breast cancer, 29.7% (95% UI, 28.8%-30.7%) for cervical cancer, and 14.7% (95% UI, 14.4%-15.0%) for colorectal cancer. Conclusions and Relevance Findings from this national cross-sectional study indicated major gaps in cancer screening use in FQHCs in the US. Improved prevention is urgently needed to address screening disparities.
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Affiliation(s)
- Trisha L. Amboree
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston
| | - Jane R. Montealegre
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston
| | - Susan L. Parker
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston
| | - Ashvita Garg
- Department of Public Health Science, Medical University of South Carolina, Charleston
- Hollings Cancer Center, Medical University of South Carolina, Charleston
| | - Haluk Damgacioglu
- Department of Public Health Science, Medical University of South Carolina, Charleston
- Hollings Cancer Center, Medical University of South Carolina, Charleston
| | - Kathleen M. Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Elizabeth Y. Chiao
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Elizabeth G. Hill
- Department of Public Health Science, Medical University of South Carolina, Charleston
- Hollings Cancer Center, Medical University of South Carolina, Charleston
| | - Kalyani Sonawane
- Department of Public Health Science, Medical University of South Carolina, Charleston
- Hollings Cancer Center, Medical University of South Carolina, Charleston
| | - Ashish A. Deshmukh
- Department of Public Health Science, Medical University of South Carolina, Charleston
- Hollings Cancer Center, Medical University of South Carolina, Charleston
| | - Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque
- Cancer Control and Population Sciences Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque
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2
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Graboyes EM, Cagle JL, Ramadan S, Prasad K, Yan F, Pearce J, Mazul AL, Anoma JS, Hill EG, Chera BS, Puram SV, Jackson R, Sandulache VC, Tam S, Topf MC, Kahmke R, Osazuwa-Peters N, Nussenbaum B, Alberg AJ, Sterba KR, Halbert CH. Neighborhood-Level Disadvantage and Delayed Adjuvant Therapy in Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2024:2818081. [PMID: 38662392 PMCID: PMC11046410 DOI: 10.1001/jamaoto.2024.0424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/07/2024] [Indexed: 04/26/2024]
Abstract
Importance For patients with head and neck squamous cell carcinoma (HNSCC), initiation of postoperative radiation therapy (PORT) within 6 weeks of surgery is recommended by the National Comprehensive Cancer Network Guidelines and the Commission on Cancer. Although individual-level measures of socioeconomic status are associated with receipt of timely, guideline-adherent PORT, the role of neighborhood-level disadvantage has not been examined. Objective To characterize the association of neighborhood-level disadvantage with delays in receiving PORT. Design, Setting, and Participants This retrospective cohort study included 681 adult patients with HNSCC undergoing curative-intent surgery and PORT from 2018 to 2020 at 4 US academic medical centers. The data were analyzed between June 21, 2023, and March 5, 2024. Main Outcome Measures and Measures The primary outcome was delay in initiating guideline-adherent PORT (ie, >6 weeks after surgery). Time-to-PORT (TTP) was a secondary outcome. Census block-level Area Deprivation Index (ADI) scores were calculated and reported as national percentiles (0-100); higher scores indicate greater deprivation. The association of ADI scores with PORT delay was assessed using multivariable logistic regression adjusted for demographic, clinical, and institutional characteristics. PORT initiation across ADI score population quartiles was evaluated with cumulative incidence plots and Cox models. Results Among 681 patients with HNSCC undergoing surgery and PORT (mean [SD] age, 61.5 [11.2] years; 487 [71.5%] men, 194 [29.5%] women) the PORT delay rate was 60.8% (414/681) and median (IQR) TTP was 46 (40-56) days. The median (IQR) ADI score was 62.0 (44.0-83.0). Each 25-point increase in ADI score was associated with a corresponding 32% increase in the adjusted odds ratio (aOR) of PORT delay (aOR, 1.32; 95% CI, 1.07-1.63) on multivariable regression adjusted for institution, age, race and ethnicity, insurance, comorbidity, cancer subsite, stage, postoperative complications, care fragmentation, travel distance, and rurality. Increasing ADI score population quartiles were associated with increasing TTP (hazard ratio of PORT initiation, 0.71; 95% CI, 0.53-0.96; 0.59; 95% CI, 0.44-0.77; and 0.54; 95% CI, 0.41-0.72; for ADI quartiles 2, 3, and 4 vs ADI quartile 1, respectively). Conclusions and Relevance Increasing neighborhood-level disadvantage was independently associated with a greater likelihood of PORT delay and longer TTP in a dose-dependent manner. These findings indicate a critical need for the development of multilevel strategies to improve the equitable delivery of timely, guideline-adherent PORT.
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Affiliation(s)
- Evan M. Graboyes
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Joshua Lee Cagle
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Salma Ramadan
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Kavita Prasad
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Flora Yan
- Department of Otolaryngology–Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - John Pearce
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Angela L. Mazul
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jean-Sebastien Anoma
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Elizabeth G. Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Bhisham S. Chera
- Hollings Cancer Center, Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Sidharth V. Puram
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri
| | - Ryan Jackson
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Vlad C. Sandulache
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
- ENT Section, Operative CareLine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Samantha Tam
- Department of Otolaryngology–Head and Neck Surgery, Henry Ford Health, Detroit, Michigan
| | - Michael C. Topf
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Russel Kahmke
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina
- Deputy Editor, Diversity, Equity, and Inclusion, JAMA Otolaryngology–Head & Neck Surgery
| | - Brian Nussenbaum
- American Board of Otolaryngology–Head and Neck Surgery, Houston, Texas
| | - Anthony J. Alberg
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia
| | - Katherine R. Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles
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Duckett KA, Kassir MF, Nguyen SA, Brennan EA, Chera BS, Sterba KR, Hughes Halbert C, Hill EG, McCay J, Puram SV, Sandulache VC, Kahmke R, Ramadan S, Nussenbaum B, Alberg AJ, Graboyes EM. Delays Starting Postoperative Radiotherapy Among Head and Neck Cancer Patients: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2024; 170:320-334. [PMID: 37731255 PMCID: PMC10840985 DOI: 10.1002/ohn.538] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/10/2023] [Accepted: 09/02/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE Initiating postoperative radiotherapy (PORT) within 6 weeks (42 days) of surgery is the first and only Commission on Cancer (CoC) approved quality metric for head and neck squamous cell carcinoma (HNSCC). No study has systematically reviewed nor synthesized the literature to establish national benchmarks for delays in starting PORT. DATA SOURCES Following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we performed a systematic review of PubMed, Scopus, and CINAHL. REVIEW METHODS Studies that described time-to-PORT or PORT delays in patients with HNSCC treated in the United States after 2003 were included. Meta-analysis of proportions and continuous measures was performed on nonoverlapping datasets to examine the pooled frequency of PORT delays and time-to-PORT. RESULTS Thirty-six studies were included in the systematic review and 14 in the meta-analysis. Most studies utilized single-institution (n = 17; 47.2%) or cancer registry (n = 16; 44.4%) data. Twenty-five studies (69.4%) defined PORT delay as >6 weeks after surgery (the definition utilized by the CoC and National Comprehensive Cancer Network Guidelines), whereas 4 (11.1%) defined PORT delay as a time interval other than >6 weeks, and 7 (19.4%) characterized time-to-PORT without defining delay. Meta-analysis revealed that 48.6% (95% confidence interval [CI], 41.4-55.9) of patients started PORT > 6 weeks after surgery. Median and mean time-to-PORT were 45.8 (95% CI, 42.4-51.4 days) and 47.4 days (95% CI, 43.4-51.4 days), respectively. CONCLUSION Delays in initiating guideline-adherent PORT occur in approximately half of patients with HNSCC. These meta-analytic data can be used to set national benchmarks and assess progress in reducing delays.
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Affiliation(s)
- Kelsey A Duckett
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mohamed Faisal Kassir
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily A Brennan
- MUSC Libraries, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bhishamjit S Chera
- Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Elizabeth G Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jessica McCay
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Vlad C Sandulache
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
- ENT Section, Operative CareLine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Russel Kahmke
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
| | - Salma Ramadan
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Brian Nussenbaum
- American Board of Otolaryngology-Head and Neck Surgery, Houston, Texas, USA
| | - Anthony J Alberg
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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4
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Garand KL(F, Armeson K, Hill EG, Blair J, Pearson W, Martin-Harris B. Quantifying Oropharyngeal Swallowing Impairment in Response to Bolus Viscosity. Am J Speech Lang Pathol 2024; 33:460-467. [PMID: 37902448 PMCID: PMC11001168 DOI: 10.1044/2023_ajslp-23-00082] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/28/2023] [Accepted: 09/10/2023] [Indexed: 10/31/2023]
Abstract
PURPOSE The purpose of this study was to test the feasibility for quantifying changes in oropharyngeal swallowing impairment in response to alteration in bolus viscosity using a reliable and valid method of observational measurement-the Modified Barium Swallow Impairment Profile (MBSImP). METHOD This retrospective analysis included a heterogeneous cohort of 119 patients with suspected dysphagia that underwent a videofluoroscopic swallowing study as part of clinical care. Using consensus scoring, two expert clinicians assigned MBSImP scores to components related to oropharyngeal swallowing function between two bolus viscosities (thin liquid and pudding): epiglottic movement, laryngeal elevation, anterior hyoid excursion, tongue base retraction, pharyngeal stripping wave, and pharyngoesophageal segment opening (PESO). Comparisons between the two bolus viscosities were investigated for each component. RESULTS Higher (worse) scores were observed in the thin-liquid trial compared with the pudding trial for the following MBSImP components: anterior hyoid excursion (p = .03), epiglottic movement (p < .001), pharyngeal stripping wave (p < .001), and PESO (p = .002). Lower (better) scores were observed in the liquid trial compared with the pudding trial for one component-tongue base retraction (Component 15) only (p < .001). CONCLUSION These findings provide further evidence for positive influences of viscosity on the swallow mechanism, including influences of sensory feedback on the sensorimotor swallow program.
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Affiliation(s)
| | - Kent Armeson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Elizabeth G. Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Julie Blair
- Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston
| | - William Pearson
- Department of Biomedical Sciences (Anatomy), Edward Via College of Osteopathic Medicine, Auburn, AL
| | - Bonnie Martin-Harris
- Department of Communication Sciences Disorders, Northwestern University, Evanston, IL
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5
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Graboyes EM, Kistner-Griffin E, Hill EG, Maurer S, Balliet W, Williams AM, Padgett L, Yan F, Rush A, Johnson B, McLeod T, Dahne J, Ruggiero KJ, Sterba KR. Mechanism underlying a brief cognitive behavioral treatment for head and neck cancer survivors with body image distress. Support Care Cancer 2023; 32:32. [PMID: 38102496 PMCID: PMC10798060 DOI: 10.1007/s00520-023-08248-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Body image distress (BID) among head and neck cancer (HNC) survivors is a debilitating toxicity associated with depression, anxiety, stigma, and poor quality of life. BRIGHT (Building a Renewed ImaGe after Head & neck cancer Treatment) is a brief cognitive behavioral therapy (CBT) that reduces BID for these patients. This study examines the mechanism underlying BRIGHT. METHODS In this randomized clinical trial, HNC survivors with clinically significant BID were randomized to receive five weekly psychologist-led video tele-CBT sessions (BRIGHT) or dose-and delivery matched survivorship education (attention control [AC]). Body image coping strategies, the hypothesized mediators, were assessed using the Body Image Coping Skills Inventory (BICSI). HNC-related BID was measured with the Inventory to Measure and Assess imaGe disturbancE-Head and Neck (IMAGE-HN). Causal mediation analyses were used to estimate the mediated effects of changes in BICSI scores on changes in IMAGE-HN scores. RESULTS Among 44 HNC survivors with BID allocated to BRIGHT (n = 20) or AC (n = 24), mediation analyses showed that BRIGHT decreased avoidant body image coping (mean change in BICSI-Avoidance scale score) from baseline to 1-month post-intervention relative to AC (p = 0.039). Decreases in BICSI-Avoidance scores from baseline to 1-month resulted in decreases in IMAGE-HN scores from baseline to 3 months (p = 0.009). The effect of BRIGHT on IMAGE-HN scores at 3 months was partially mediated by a decrease in BICSI-Avoidance scores (p = 0.039). CONCLUSIONS This randomized trial provides preliminary evidence that BRIGHT reduces BID among HNC survivors by decreasing avoidant body image coping. Further research is necessary to confirm these results and enhance the development of interventions targeting relevant pathways to reduce BID among HNC survivors. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03831100 .
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
- Hollings Cancer Center, MUSC, Charleston, SC, USA.
| | - Emily Kistner-Griffin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Elizabeth G Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Stacey Maurer
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Wendy Balliet
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Amy M Williams
- Office of Physician Well-Being and Professionalism, Corewell Health, Detroit, MI, USA
| | - Lynne Padgett
- Veteran Affairs Office of Research and Development, Washington, DC, USA
| | - Flora Yan
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, USA
| | - Angie Rush
- Head and Neck Cancer Alliance, Charleston, SC, USA
| | - Brad Johnson
- Head and Neck Cancer Alliance, Charleston, SC, USA
| | - Taylor McLeod
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer Dahne
- Hollings Cancer Center, MUSC, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth J Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, MUSC, Charleston, SC, USA
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Graboyes EM, Chappell M, Duckett KA, Sterba K, Halbert CH, Hill EG, Chera B, McCay J, Puram SV, Ramadan S, Sandulache VC, Kahmke R, Nussenbaum B, Alberg AJ, Paskett ED, Calhoun E. Patient Navigation for Timely, Guideline-Adherent Adjuvant Therapy for Head and Neck Cancer: A National Landscape Analysis. J Natl Compr Canc Netw 2023; 21:1251-1259.e5. [PMID: 38081134 PMCID: PMC10846494 DOI: 10.6004/jnccn.2023.7061] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/24/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Aligned with the NCCN Clinical Practice Guidelines in Oncology for Head and Neck Cancers, in November 2021 the Commission on Cancer approved initiation of postoperative radiation therapy (PORT) within 6 weeks of surgery for head and neck cancer (HNC) as its first and only HNC quality metric. Unfortunately, >50% of patients do not commence PORT within 6 weeks, and delays disproportionately burden racial and ethnic minority groups. Although patient navigation (PN) is a potential strategy to improve the delivery of timely, equitable, guideline-adherent PORT, the national landscape of PN for this aspect of care is unknown. MATERIALS AND METHODS From September through November 2022, we conducted a survey of health care organizations that participate in the American Cancer Society National Navigation Roundtable to understand the scope of PN for delivering timely, guideline-adherent PORT for patients with HNC. RESULTS Of the 94 institutions that completed the survey, 89.4% (n=84) reported that at least part of their practice was dedicated to navigating patients with HNC. Sixty-eight percent of the institutions who reported navigating patients with HNC along the continuum (56/83) reported helping them begin PORT. One-third of HNC navigators (32.5%; 27/83) reported tracking the metric for time-to-PORT at their facility. When estimating the timeframe in which the NCCN and Commission on Cancer guidelines recommend commencing PORT, 44.0% (37/84) of HNC navigators correctly stated ≤6 weeks; 71.4% (60/84) reported that they did not know the frequency of delays starting PORT among patients with HNC nationally, and 63.1% (53/84) did not know the frequency of delays at their institution. CONCLUSIONS In this national landscape survey, we identified that PN is already widely used in clinical practice to help patients with HNC start timely, guideline-adherent PORT. To enhance and scale PN within this area and improve the quality and equity of HNC care delivery, organizations could focus on providing better education and support for their navigators as well as specialization in HNC.
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Affiliation(s)
- Evan M. Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Michelle Chappell
- American Cancer Society National Navigation Roundtable, Cincinnati, Ohio
| | - Kelsey A. Duckett
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Katherine Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
| | - Elizabeth G. Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Bhishamjit Chera
- Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Jessica McCay
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Sidharth V. Puram
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri
| | - Salma Ramadan
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Vlad C. Sandulache
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
- ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Russel Kahmke
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina
| | - Brian Nussenbaum
- American Board of Otolaryngology - Head and Neck Surgery, Houston, Texas
| | - Anthony J. Alberg
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, South Carolina
| | - Electra D. Paskett
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
- Division of Cancer Prevention Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Elizabeth Calhoun
- Department of Population Health, University of Illinois Chicago, Chicago, Illinois
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7
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Graboyes EM, Kistner-Griffin E, Hill EG, Maurer S, Balliet W, Williams AM, Padgett L, Yan F, Rush A, Johnson B, McLeod T, Dahne J, Ruggiero KJ, Sterba KR. Mechanism Underlying a Brief Cognitive Behavioral Treatment for Head and Neck Cancer Survivors with Body Image Distress. Res Sq 2023:rs.3.rs-3303379. [PMID: 37720013 PMCID: PMC10503855 DOI: 10.21203/rs.3.rs-3303379/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Purpose Body image distress (BID) among head and neck cancer (HNC) survivors is a debilitating toxicity associated with depression, anxiety, stigma, and poor quality of life. BRIGHT (Building a Renewed ImaGe after Head & neck cancer Treatment) is a brief cognitive behavioral therapy (CBT) that reduces BID for these patients. This study examines the mechanism underlying BRIGHT. Methods In this randomized clinical trial, HNC survivors with clinically significant BID were randomized to receive 5 weekly psychologist-led video tele-CBT sessions (BRIGHT) or dose-and delivery matched survivorship education (attention control [AC]). Body image coping strategies, the hypothesized mediators, were assessed using the Body Image Coping Skills Inventory (BICSI). HNC-related BID was measured with the IMAGE-HN. Causal mediation analyses were used to estimate the mediated effects of changes in BICSI scores on changes in IMAGE-HN scores. Results Among 44 HNC survivors with BID, mediation analyses showed that BRIGHT decreased avoidant body image coping (mean change in BICSI-Avoidance scale score) from baseline to 1-month post-intervention relative to AC (p = 0.039). Decreases in BICSI-Avoidance scores from baseline to 1-month decreased IMAGE-HN scores from baseline to 3-months (p = 0.009). The effect of BRIGHT on IMAGE-HN scores at 3-months was partially mediated by a decrease in BICSI-Avoidance scores (p = 0.039). Conclusions This randomized trial provides preliminary evidence that BRIGHT reduces BID among HNC survivors by decreasing avoidant body image coping. Further research is necessary to confirm these results and enhance the development of interventions targeting relevant pathways to reduce BID among HNC survivors. Trial Registration This trial was registered on ClinicalTrials.gov identifier NCT03831100 on February 5, 2019.
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8
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Graboyes EM, Kistner-Griffin E, Hill EG, Maurer S, Balliet W, Williams AM, Padgett L, Yan F, Rush A, Johnson B, McLeod T, Dahne J, Ruggiero KJ, Sterba KR. Efficacy of a brief cognitive behavioral therapy for head and neck cancer survivors with body image distress: secondary outcomes from the BRIGHT pilot randomized clinical trial. J Cancer Surviv 2023:10.1007/s11764-023-01454-6. [PMID: 37644354 PMCID: PMC10902187 DOI: 10.1007/s11764-023-01454-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Body image distress (BID) among head and neck cancer (HNC) survivors leads to depression, social isolation, stigma, and poor quality of life. BRIGHT (Building a Renewed ImaGe after Head and neck cancer Treatment) is a brief, tailored cognitive behavioral therapy (CBT) that reduces HNC-related BID. This trial examines the effect of BRIGHT on psychosocial outcomes among HNC survivors with BID. METHODS In this pilot randomized trial, HNC survivors with clinically significant BID were randomized to 5 weekly psychologist-led tele-CBT sessions (BRIGHT) or dose and delivery-matched survivorship education (attention control [AC]). Secondary psychosocial outcomes were assessed using validated patient-reported outcomes at baseline and 1 and 3-month post-intervention. RESULTS Among 44 HNC survivors with BID, BRIGHT resulted in a greater reduction in depression relative to AC (mean model-based 1-month difference in Δ PROMIS SF v1.0-Depression 8a score, -3.4; 90% CI, -6.4 to -0.4; 3-month difference, -4.3; 90% CI, -7.8 to -0.8). BRIGHT also decreased shame and stigma relative to AC (mean model-based 3-month difference in Δ Shame and Stigma Scale score, -9.7; 90% CI, -15.2 to -4.2) and social isolation (mean model-based 3-month difference in Δ PROMIS SF v2.0 Social Isolation 8a score, -2.9; 90% CI, -5.8 to -0.1). CONCLUSIONS In this planned secondary analysis of a pilot RCT, BRIGHT improved a broad array of psychosocial outcomes among HNC survivors with BID. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03831100 . IMPLICATIONS FOR CANCER SURVIVORS These promising preliminary data suggest the need for a large efficacy trial evaluating the effect of BRIGHT on psychosocial outcomes among HNC survivors with BID.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.
| | - Emily Kistner-Griffin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth G Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Stacey Maurer
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Wendy Balliet
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Amy M Williams
- Office of Physician Well-Being and Professionalism, Corewell Health, Detroit, MI, USA
| | - Lynne Padgett
- Veteran Affairs Office of Research and Development, Washington, DC, USA
| | - Flora Yan
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, USA
| | - Angie Rush
- Head and Neck Cancer Alliance, Charleston, SC, USA
| | - Brad Johnson
- Head and Neck Cancer Alliance, Charleston, SC, USA
| | - Taylor McLeod
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer Dahne
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth J Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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9
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Graboyes EM, Kistner-Griffin E, Hill EG, Maurer S, Balliet W, Williams AM, Padgett L, Yan F, Rush A, Johnson B, McLeod T, Dahne J, Ruggiero KJ, Sterba KR. Efficacy of a Brief Cognitive Behavioral Therapy for Head and Neck Cancer Survivors with Body Image Distress: Secondary Outcomes from the BRIGHT Pilot Randomized Clinical Trial. Res Sq 2023:rs.3.rs-3222601. [PMID: 37609318 PMCID: PMC10441452 DOI: 10.21203/rs.3.rs-3222601/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Purpose: Body image distress (BID) among head and neck cancer (HNC) survivors leads to depression, social isolation, stigma, and poor quality of life. BRIGHT ( B uilding a R enewed I ma G e after H ead & neck cancer T reatment) is a brief, tailored cognitive behavioral therapy (CBT) that reduces HNC-related BID. This trial examines the effect of BRIGHT on psychosocial outcomes among HNC survivors with BID. Methods: In this pilot randomized trial, HNC survivors with clinically significant BID were randomized to 5 weekly psychologist-led tele-CBT sessions (BRIGHT) or dose-and delivery matched survivorship education (attention control [AC]). Secondary psychosocial outcomes were assessed using validated patient-reported outcomes at baseline and 1- and 3-months post-intervention. Results: Among 44 HNC survivors with BID, BRIGHT resulted in a greater reduction in depression relative to AC (mean model-based 1-month difference in Δ PROMIS SF v1.0-Depression 8a score, -3.4; 90% CI, -6.4 to -0.4; 3-month difference, -4.3; 90% CI, -7.8 to -0.8). BRIGHT also decreased shame and stigma relative to AC (mean model-based 3-month difference in Δ Shame and Stigma Scale score, -9.7; 90% CI, -15.2 to -4.2) and social isolation (mean model-based 3-month difference in Δ PROMIS SF v2.0 Social Isolation 8a score, -2.9; 90% CI, -5.8 to -0.1). Conclusions: In this planned secondary analysis of a pilot RCT, BRIGHT improved a broad array of psychosocial outcomes among HNC survivors with BID. Implications for Cancer Survivors: These promising preliminary data suggest the need for a large efficacy trial evaluating the effect of BRIGHT on psychosocial outcomes among HNC survivors with BID. Trial Registration: ClinicalTrials.gov identifier: NCT03831100.
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10
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McClure EA, Walters KJ, Tomko RL, Dahne J, Hill EG, McRae-Clark AL. Cannabis use prevalence, patterns, and reasons for use among patients with cancer and survivors in a state without legal cannabis access. Support Care Cancer 2023; 31:429. [PMID: 37382737 DOI: 10.1007/s00520-023-07881-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/10/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE Cannabis use among patients with cancer is common, yet data are limited regarding use patterns, reasons for use, and degree of benefit, which represents an unmet need in cancer care delivery. This need is salient in states without legal cannabis programs, where perceptions and behavior among providers and patients may be affected. METHODS A cross-sectional survey of patients with cancer and survivors at the Hollings Cancer Center at the Medical University of South Carolina (no legal cannabis marketplace in SC) was completed as part of the NCI Cannabis Supplement. Patients (ages 18 +) were recruited using probability sampling from patient lists (N = 7749 sampled; N = 1036 completers). Weight-adjusted Chi-square tests compared demographics and cancer details among patients using cannabis since diagnosis versus those not using cannabis, while weighted descriptives are presented for cannabis use prevalence, consumption, symptom management, and legalization beliefs. RESULTS Weighted prevalence of cannabis use since diagnosis was 26%, while current cannabis use was 15%. The most common reasons for cannabis use after diagnosis were difficulty sleeping (50%), pain (46%), and mood changes and stress, anxiety, or depression (45%). Symptom improvement was endorsed for pain (57%), stress/anxiety/depression (64%), difficulty sleeping (64%), and loss of appetite (40%). CONCLUSIONS Among patients with cancer and survivors at a NCI-designated cancer center within SC, a state without legal access to medical cannabis, prevalence rates, and reasons for cannabis use are consistent with emerging literature in oncology populations. These findings have implications for care delivery, and work is needed to inform recommendations for providers and patients.
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Affiliation(s)
- Erin A McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.
| | - Kyle J Walters
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Rachel L Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth G Hill
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Aimee L McRae-Clark
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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11
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Riesenberg BP, Hunt EG, Tennant MD, Hurst KE, Andrews AM, Leddy LR, Neskey DM, Hill EG, Rivera GOR, Paulos CM, Gao P, Thaxton JE. Stress-Mediated Attenuation of Translation Undermines T-cell Activity in Cancer. Cancer Res 2022; 82:4386-4399. [PMID: 36126165 PMCID: PMC9722626 DOI: 10.1158/0008-5472.can-22-1744] [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: 05/26/2022] [Revised: 08/06/2022] [Accepted: 09/15/2022] [Indexed: 01/24/2023]
Abstract
Protein synthesis supports robust immune responses. Nutrient competition and global cell stressors in the tumor microenvironment (TME) may impact protein translation in T cells and antitumor immunity. Using human and mouse tumors, we demonstrated here that protein translation in T cells is repressed in solid tumors. Reduced glucose availability to T cells in the TME led to activation of the unfolded protein response (UPR) element eIF2α (eukaryotic translation initiation factor 2 alpha). Genetic mouse models revealed that translation attenuation mediated by activated p-eIF2α undermines the ability of T cells to suppress tumor growth. Reprograming T-cell metabolism was able to alleviate p-eIF2α accumulation and translational attenuation in the TME, allowing for sustained protein translation. Metabolic and pharmacological approaches showed that proteasome activity mitigates induction of p-eIF2α to support optimal antitumor T-cell function, protecting from translation attenuation and enabling prolonged cytokine synthesis in solid tumors. Together, these data identify a new therapeutic avenue to fuel the efficacy of tumor immunotherapy. SIGNIFICANCE Proteasome function is a necessary cellular component for endowing T cells with tumor killing capacity by mitigating translation attenuation resulting from the unfolded protein response induced by stress in the tumor microenvironment.
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Affiliation(s)
- Brian P. Riesenberg
- Immunotherapy Program, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Chapel Hill, NC 27514; USA
| | - Elizabeth G. Hunt
- Immunotherapy Program, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Chapel Hill, NC 27514; USA,Department of Cell Biology & Physiology, University of North Carolina at Chapel Hill; Chapel Hill, NC 27514; USA
| | - Megan D. Tennant
- Department of Microbiology & Immunology, Medical University of South Carolina, Charleston, SC 29425; USA
| | - Katie E. Hurst
- Immunotherapy Program, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Chapel Hill, NC 27514; USA
| | - Alex M. Andrews
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425; USA
| | - Lee R. Leddy
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425; USA
| | - David M. Neskey
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425; USA
| | - Elizabeth G. Hill
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425; USA,Department of Public Health Sciences, Hollings Cancer Center Biostatistics Shared Resource; Director, Medical University of South Carolina, Charleston, SC 29425; USA
| | - Guillermo O. Rangel Rivera
- Department of Microbiology & Immunology, Medical University of South Carolina, Charleston, SC 29425; USA,Department of Surgery and Microbiology & Immunology, Winship Cancer Institute, Emory University, Atlanta, GA, 30322; USA
| | - Chrystal M. Paulos
- Department of Microbiology & Immunology, Medical University of South Carolina, Charleston, SC 29425; USA,Department of Surgery and Microbiology & Immunology, Winship Cancer Institute, Emory University, Atlanta, GA, 30322; USA
| | - Peng Gao
- Department of Medicine, Metabolomics Core Facility; Director, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611; USA
| | - Jessica E. Thaxton
- Immunotherapy Program, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Chapel Hill, NC 27514; USA,Department of Cell Biology & Physiology, University of North Carolina at Chapel Hill; Chapel Hill, NC 27514; USA,Correspondence: Dr. Jessica Thaxton, Department of Cell Biology & Physiology, Immunotherapy Program, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 125 Mason Farm Road, Chapel Hill, NC 27514, 919-966-4913,
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12
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Hazelwood RJ, Armeson KE, Hill EG, Bonilha HS, Martin-Harris B. Relating Physiologic Swallowing Impairment, Functional Swallowing Ability, and Swallow-Specific Quality of Life. Dysphagia 2022:10.1007/s00455-022-10532-3. [PMID: 36229718 PMCID: PMC10097835 DOI: 10.1007/s00455-022-10532-3] [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: 05/22/2021] [Accepted: 10/03/2022] [Indexed: 11/24/2022]
Abstract
Many studies include functional swallowing ability and quality of life information to indicate a response to a specific swallowing intervention or to describe the natural history of dysphagia across diseases and conditions. Study results are difficult to interpret because the association between these factors and actual swallowing impairment is not understood. We set out to test the associations between components of physiologic swallowing impairment, functional swallowing ability, and swallow-specific quality of life using standardized and validated measurement tools: Modified Barium Swallow Impairment Profile (MBSImP), Functional Oral Intake Scale (FOIS), Eating Assessment Tool (EAT-10), and Dysphagia Handicap Index (DHI). We specifically aimed to understand which factors may contribute to the overall relationships between these measurement tools when analyzed using total scores and item-level scores. This study included a heterogeneous cohort of 273 outpatients who underwent a modified barium swallow study (MBSS). We found significant correlations between MBSImP total scores and FOIS scores and DHI total scores, but not between MBSImP total scores and EAT-10 total scores. Significant correlations were also found between MBSImP item-level component scores and FOIS scores, EAT-10 total scores, and DHI total scores. Detailed item-level analyses revealed the MBSImP components of bolus transport/lingual motion, oral residue, and tongue base retraction were correlated with EAT-10 item-level scores and DHI item-level scores. The clinically modest associations between physiologic swallowing impairment, functional swallowing ability, and swallow-specific quality of life reveal different factors that uniquely contribute to patients' overall dysphagic profile, emphasizing the clinical impact of a comprehensive swallowing assessment.
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Affiliation(s)
- R Jordan Hazelwood
- Department of Rehabilitation Sciences, Beaver College of Health Sciences, Appalachian State University, Boone, NC, USA.
| | - Kent E Armeson
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth G Hill
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Heather Shaw Bonilha
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA.,Department of Otolaryngology-Head and Neck Surgery and Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Edward Hines, Jr. VA Hospital, Hines, IL, USA
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13
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Bray AW, Duan R, Malalur P, Drusbosky LM, Gourdin TS, Hill EG, Lilly MB. Elevated serum CEA is associated with liver metastasis and distinctive circulating tumor DNA alterations in patients with castration-resistant prostate cancer. Prostate 2022; 82:1264-1272. [PMID: 35766303 PMCID: PMC9388585 DOI: 10.1002/pros.24400] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/14/2022] [Accepted: 06/01/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Elevated serum carcinoembryonic antigen (CEA) is used to identify "treatment emergent" forms of castration-resistant prostate cancer (CRPC) such as aggressive variant prostate cancer (AVPC). However, its individual utility as a prognostic marker and the genetic alterations associated with its expression have not been extensively studied in CRPC. METHODS This study retrospectively analyzed clinical outcomes and circulating tumor DNA profiles in 163 patients with CRPC and elevated or normal serum CEA. These same patients were then classified as AVPC or non-AVPC and compared to determine the uniqueness of CEA-associated gene alterations. RESULTS Patients with elevated CEA demonstrated higher rates of liver metastasis (37.5% vs. 19.1%, p = 0.02) and decreased median overall survival from CRPC diagnosis (28.7 vs. 73.2 mo, p < 0.0001). In addition, patients with elevated CEA were more likely to harbor copy number amplifications (CNAs) in AR, PIK3CA, MYC, BRAF, CDK6, MET, CCNE1, KIT, RAF1, and KRAS. Based on variant allele frequency we also defined "clonal" single-nucleotide variants (SNVs) thought to be driving disease progression in each patient and found that CEA expression was negatively correlated with clonal AR SNVs and positively correlated with clonal TP53 SNVs. Of these genetic associations, only the increases in clonal TP53 SNVs and KRAS amplifications were recapitulated among patients with AVPC when compared to patients without AVPC. CONCLUSIONS Together these findings suggest that CEA expression in CRPC is associated with aggressive clinical behavior and gene alterations distinct from those in AVPC.
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Affiliation(s)
- Alexander W. Bray
- Department of MedicineMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Rong Duan
- Department of Public Health SciencesMedical University of South CarolinaCharlestonSouth CarolinaUSA
- Hollings Cancer CenterMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Pannaga Malalur
- The Ohio State University Wexner Medical CenterColumbusOhioUSA
| | | | - Theodore S. Gourdin
- Department of MedicineMedical University of South CarolinaCharlestonSouth CarolinaUSA
- Hollings Cancer CenterMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Elizabeth G. Hill
- Department of Public Health SciencesMedical University of South CarolinaCharlestonSouth CarolinaUSA
- Hollings Cancer CenterMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Michael B. Lilly
- Department of MedicineMedical University of South CarolinaCharlestonSouth CarolinaUSA
- Hollings Cancer CenterMedical University of South CarolinaCharlestonSouth CarolinaUSA
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14
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Rubinstein MP, Williams C, Mart C, Beall J, MacPherson L, Azar J, Swiderska-Syn M, Manca P, Gibney BC, Robinson MD, Krieg C, Hill EG, Taha SA, Rock AD, Lee JH, Soon-Shiong P, Wrangle J. Phase I Trial Characterizing the Pharmacokinetic Profile of N-803, a Chimeric IL-15 Superagonist, in Healthy Volunteers. J Immunol 2022; 208:1362-1370. [PMID: 35228263 DOI: 10.4049/jimmunol.2100066] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 01/03/2022] [Indexed: 12/24/2022]
Abstract
The oncotherapeutic promise of IL-15, a potent immunostimulant, is limited by a short serum t 1/2 The fusion protein N-803 is a chimeric IL-15 superagonist that has a >20-fold longer in vivo t 1/2 versus IL-15. This phase 1 study characterized the pharmacokinetic (PK) profile and safety of N-803 after s.c. administration to healthy human volunteers. Volunteers received two doses of N-803, and after each dose, PK and safety were assessed for 9 d. The primary endpoint was the N-803 PK profile, the secondary endpoint was safety, and immune cell levels and immunogenicity were measures of interest. Serum N-803 concentrations peaked 4 h after administration and declined with a t 1/2 of ∼20 h. N-803 did not cause treatment-emergent serious adverse events (AEs) or grade ≥3 AEs. Injection site reactions, chills, and pyrexia were the most common AEs. Administration of N-803 was well tolerated and accompanied by proliferation of NK cells and CD8+ T cells and sustained increases in the number of NK cells. Our results suggest that N-803 administration can potentiate antitumor immunity.
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Affiliation(s)
- Mark P Rubinstein
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH
- Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Cameron Williams
- Department of Surgery, Medical University of South Carolina, Charleston, SC
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Caroline Mart
- Department of Surgery, Medical University of South Carolina, Charleston, SC
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Jonathan Beall
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Linda MacPherson
- Department of Surgery, Medical University of South Carolina, Charleston, SC
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Joseph Azar
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH
- Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Marzena Swiderska-Syn
- Department of Surgery, Medical University of South Carolina, Charleston, SC
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Paolo Manca
- Department of Medical Oncology, IRCCS Foundation - National Cancer Institute, Milan, Italy
| | - Barry C Gibney
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Mark D Robinson
- Department of Molecular Life Sciences and SIB Swiss Institute of Bioinformatics, University of Zurich, Zurich, Switzerland
| | - Carsten Krieg
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Elizabeth G Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | | | | | | | | | - John Wrangle
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC;
- Division of Hematology and Oncology, Department of Medicine, Medical University of South Carolina, Charleston, SC
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15
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Liu L, Dai X, Yin S, Liu P, Hill EG, Wei W, Gan W. DNA-PK promotes activation of the survival kinase AKT in response to DNA damage through an mTORC2-ECT2 pathway. Sci Signal 2022; 15:eabh2290. [PMID: 34982576 DOI: 10.1126/scisignal.abh2290] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Liu Liu
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, SC 29425, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Xiaoming Dai
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Shasha Yin
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, SC 29425, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Pengda Liu
- Lineberger Comprehensive Cancer Center and Department of Biochemistry and Biophysics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Elizabeth G Hill
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Wenyi Wei
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Wenjian Gan
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, SC 29425, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA
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16
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Garand KL, Beall J, Hill EG, Davidson K, Blair J, Pearson W, Martin-Harris B. Effects of Presbyphagia on Oropharyngeal Swallowing Observed during Modified Barium Swallow Studies. J Nutr Health Aging 2022; 26:973-980. [PMID: 36437764 PMCID: PMC10324474 DOI: 10.1007/s12603-022-1854-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Understanding how aging impacts swallowing can help differentiate typical from atypical behaviors. This study aimed to quantify age-related swallowing alterations observed during a modified barium swallow study. DESIGN Cross-sectional study. SETTING Adult fluoroscopy suite in a metropolitan hospital at an academic center. PARTICIPANTS 195 healthy adults distributed across 3 age categories: 21-39; 40-59; 60+ years. MEASUREMENTS 17 physiologic components of swallowing across three functional domains (oral, pharyngeal, esophageal), including summed composite scores (Oral Total [OT] and Pharyngeal Total [PT]), from the validated and standardized Modified Barium Swallow Impairment Profile. RESULTS Most components (65%) demonstrated no impairment (scores of "0"). The odds of a worse (higher) score increased significantly with age for: Tongue Control during Bolus Hold, Hyolaryngeal Movement, Laryngeal Closure, Pharyngeal Contraction, and Pharyngoesophageal Segment Opening. OT and PT scores for 40-59-year-olds were worse than the youngest group (p=.01 and p <.001, respectively). Adults 60+ years had significantly worse PT scores among all groups (p-values <.01). CONCLUSION Oropharyngeal swallowing physiology evolves as healthy adults age and should be considered during clinical decision-making.
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Affiliation(s)
- K L Garand
- Kendrea Garand, University of South Alabama, Mobile, AL, USA,
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17
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Wallace K, El Nahas GJ, Bookhout C, Thaxton JE, Lewin DN, Nikolaishvili-Feinberg N, Cohen SM, Brazeal JG, Hill EG, Wu JD, Baron JA, Alekseyenko AV. Immune Responses Vary in Preinvasive Colorectal Lesions by Tumor Location and Histology. Cancer Prev Res (Phila) 2021; 14:885-892. [PMID: 34341013 PMCID: PMC8811707 DOI: 10.1158/1940-6207.capr-20-0592] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/30/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022]
Abstract
Immune responses vary in colorectal cancers, which strongly influence prognosis. However, little is known about the variance in immune response within preinvasive lesions. The study aims to investigate how the immune contexture differs by clinicopathologic features (location, histology, dysplasia) associated with progression and recurrence in early carcinogenesis. We performed a cross-sectional study using preinvasive lesions from the surgical pathology laboratory at the Medical University of South Carolina. We stained the tissues with immunofluorescence antibodies, then scanned and analyzed expression using automated image analysis software. We stained CD117 as a marker of mast cells, CD4/RORC to indicate Th17 cells, MICA/B as a marker of NK-cell ligands, and also used antibodies directed against cytokines IL6, IL17A, and IFNγ. We used negative binomial regression analysis to compare analyte density counts by location, histology, degree of dysplasia adjusted for age, sex, race, and batch. All immune markers studied (except IL17a) had significantly higher density counts in the proximal colon than distal colon and rectum. Increases in villous histology were associated with significant decreases in immune responses for IL6, IL17a, NK ligand, and mast cells. No differences were observed in lesions with low- and high-grade dysplasia, except in mast cells. The lesions of the proximal colon were rich in immune infiltrate, paralleling the responses observed in normal mucosa and invasive disease. The diminishing immune response with increasing villous histology suggests an immunologically suppressive tumor environment. Our findings highlight the heterogeneity of the immune responses in preinvasive lesions, which may have implications for prevention strategies. PREVENTION RELEVANCE: Our study is focused on immune infiltrate expression in preinvasive colorectal lesions; our results suggest important differences by clinicopathologic features that have implications for immune prevention research.
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Affiliation(s)
- Kristin Wallace
- Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston, South Carolina.
- Department of Public Health Sciences, MUSC, Charleston, South Carolina
| | - Georges J El Nahas
- Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston, South Carolina
- Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, South Carolina
| | - Christine Bookhout
- Department of Pathology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jessica E Thaxton
- Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston, South Carolina
- Department of Microbiology and Immunology, MUSC, Charleston, South Carolina
- Department of Orthopedics and Physical Medicine, MUSC, Charleston, South Carolina
| | - David N Lewin
- Department of Pathology and Laboratory Medicine, MUSC, Charleston, South Carolina
| | | | - Stephanie M Cohen
- Lineberger Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - J Grant Brazeal
- Department of Public Health Sciences, MUSC, Charleston, South Carolina
| | - Elizabeth G Hill
- Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston, South Carolina
- Department of Public Health Sciences, MUSC, Charleston, South Carolina
| | - Jennifer D Wu
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - John A Baron
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Alexander V Alekseyenko
- Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston, South Carolina
- Department of Public Health Sciences, MUSC, Charleston, South Carolina
- Department of Oral Health Sciences, The Biomedical Informatics Center, MUSC, Charleston, South Carolina
- Department of Healthcare Leadership and Management, MUSC, Charleston, South Carolina
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18
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Williams CB, Phelps-Polirer K, Dingle IP, Williams CJ, Rhett MJ, Eblen ST, Armeson K, Hill EG, Yeh ES. Correction: HUNK phosphorylates EGFR to regulate breast cancer metastasis. Oncogene 2021; 40:3635-3636. [PMID: 33958726 PMCID: PMC8134055 DOI: 10.1038/s41388-021-01797-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Carly B Williams
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, USA
| | - Kendall Phelps-Polirer
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, USA
| | - Ivan P Dingle
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, USA
| | - Christina J Williams
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew J Rhett
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, USA
| | - Scott T Eblen
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, USA
| | - Kent Armeson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth G Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth S Yeh
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, USA. .,Department of Pharmacology and Toxicology, Indiana University School of Medicine, Simon Cancer Center, Indianapolis, IN, USA.
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19
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Yan P, Patel HJ, Sharma S, Corben A, Wang T, Panchal P, Yang C, Sun W, Araujo TL, Rodina A, Joshi S, Robzyk K, Gandu S, White JR, de Stanchina E, Modi S, Janjigian YY, Hill EG, Liu B, Erdjument-Bromage H, Neubert TA, Que NLS, Li Z, Gewirth DT, Taldone T, Chiosis G. Molecular Stressors Engender Protein Connectivity Dysfunction through Aberrant N-Glycosylation of a Chaperone. Cell Rep 2021; 31:107840. [PMID: 32610141 PMCID: PMC7372946 DOI: 10.1016/j.celrep.2020.107840] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 02/12/2020] [Revised: 05/04/2020] [Accepted: 06/09/2020] [Indexed: 01/08/2023] Open
Abstract
Stresses associated with disease may pathologically remodel the proteome by both increasing interaction strength and altering interaction partners, resulting in proteome-wide connectivity dysfunctions. Chaperones play an important role in these alterations, but how these changes are executed remains largely unknown. Our study unveils a specific N-glycosylation pattern used by a chaperone, Glucose-regulated protein 94 (GRP94), to alter its conformational fitness and stabilize a state most permissive for stable interactions with proteins at the plasma membrane. This "protein assembly mutation' remodels protein networks and properties of the cell. We show in cells, human specimens, and mouse xenografts that proteome connectivity is restorable by inhibition of the N-glycosylated GRP94 variant. In summary, we provide biochemical evidence for stressor-induced chaperone-mediated protein mis-assemblies and demonstrate how these alterations are actionable in disease.
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Affiliation(s)
- Pengrong Yan
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Hardik J Patel
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Sahil Sharma
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Adriana Corben
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Currently at Mount Sinai Hospital, New York, NY 10029, USA
| | - Tai Wang
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Palak Panchal
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Chenghua Yang
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Currently at Shanghai Institutes for Biological Sciences, University of Chinese Academy of Sciences, Shanghai 200031, China
| | - Weilin Sun
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Thais L Araujo
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Anna Rodina
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Suhasini Joshi
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Kenneth Robzyk
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Srinivasa Gandu
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Julie R White
- Comparative Pathology Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Elisa de Stanchina
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Shanu Modi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Yelena Y Janjigian
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Elizabeth G Hill
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Bei Liu
- Pelotonia Institute for Immuno-Oncology, The Ohio State University, Columbus, OH 43210, USA
| | - Hediye Erdjument-Bromage
- Department of Cell Biology and Kimmel Center for Biology and Medicine of the Skirball Institute, New York University School of Medicine, New York, NY 10016, USA
| | - Thomas A Neubert
- Department of Cell Biology and Kimmel Center for Biology and Medicine of the Skirball Institute, New York University School of Medicine, New York, NY 10016, USA
| | - Nanette L S Que
- Hauptman-Woodward Medical Research Institute, Buffalo, NY 14203, USA
| | - Zihai Li
- Pelotonia Institute for Immuno-Oncology, The Ohio State University, Columbus, OH 43210, USA
| | - Daniel T Gewirth
- Hauptman-Woodward Medical Research Institute, Buffalo, NY 14203, USA
| | - Tony Taldone
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Gabriela Chiosis
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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20
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Wallace K, Nahhas GJ, Bookhout C, Lewin DN, Paulos CM, Nikolaishvili-Feinberg N, Cohen SM, Guglietta S, Bakhtiari A, Camp ER, Hill EG, Baron JA, Wu JD, Alekseyenko AV. Preinvasive Colorectal Lesions of African Americans Display an Immunosuppressive Signature Compared to Caucasian Americans. Front Oncol 2021; 11:659036. [PMID: 33987094 PMCID: PMC8112239 DOI: 10.3389/fonc.2021.659036] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/29/2021] [Indexed: 12/31/2022] Open
Abstract
Background African Americans (AAs) have higher colorectal cancer (CRC) incidence and mortality rate than Caucasian Americans (CAs). Recent studies suggest that immune responses within CRCs contribute to the disparities. If racially distinct immune signatures are present in the early phases of carcinogenesis, they could be used to develop interventions to prevent or slow disease. Methods We selected a convenience sample of 95 patients (48 CAs, 47 AAs) with preinvasive colorectal adenomas from the surgical pathology laboratory at the Medical University of South Carolina. Using immunofluorescent-conjugated antibodies on tissue slides from the lesions, we quantified specific immune cell populations: mast cells (CD117+), Th17 cells (CD4+RORC+), and NK cell ligand (MICA/B) and inflammatory cytokines, including IL-6, IL-17A, and IFN-γ. We compared the mean density counts (MDCs) and density rate ratios (RR) and 95% CI of immune markers between AAs to CAs using negative binomial regression analysis. We adjusted our models for age, sex, clinicopathologic characteristics (histology, location, dysplasia), and batch. Results We observed no racial differences in age or sex at the baseline endoscopic exam. AAs compared to CAs had a higher prevalence of proximal adenomas (66% vs. 40%) and a lower prevalence of rectal adenomas (11% vs. 23%) (p =0.04) but no other differences in pathologic characteristics. In age, sex, and batch adjusted models, AAs vs. CAs had lower RRs for cells labeled with IFNγ (RR 0.50 (95% CI 0.32-0.81); p=0.004) and NK cell ligand (RR 0.67 (0.43-1.04); p=0.07). In models adjusted for age, sex, and clinicopathologic variables, AAs had reduced RRs relative to CAs for CD4 (p=0.02), NK cell ligands (p=0.01), Th17 (p=0.005), mast cells (p=0.04) and IFN-γ (p< 0.0001). Conclusions Overall, the lower RRs in AAs vs. CAs suggests reduced effector response capacity and an immunosuppressive (‘cold’) tumor environment. Our results also highlight the importance of colonic location of adenoma in influencing these differences; the reduced immune responses in AAs relative to CAs may indicate impaired immune surveillance in early carcinogenesis. Future studies are needed to understand the role of risk factors (such as obesity) in influencing differences in immune responses by race.
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Affiliation(s)
- Kristin Wallace
- Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston, SC, United States.,Department of Public Health Sciences, MUSC, Charleston, SC, United States
| | - Georges J Nahhas
- Department of Public Health Sciences, MUSC, Charleston, SC, United States.,Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC, United States
| | - Christine Bookhout
- Department of Pathology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - David N Lewin
- Department of Pathology and Laboratory Medicine, MUSC, Charleston, SC, United States
| | - Chrystal M Paulos
- Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston, SC, United States.,Department of Microbiology/Immunology, Emory University School of Medicine, Atlanta, GA, United States.,Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Stephanie M Cohen
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Silvia Guglietta
- Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston, SC, United States
| | - Ali Bakhtiari
- Department of Public Health Sciences, MUSC, Charleston, SC, United States
| | - E Ramsay Camp
- Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston, SC, United States
| | - Elizabeth G Hill
- Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston, SC, United States.,Department of Public Health Sciences, MUSC, Charleston, SC, United States
| | - John A Baron
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Jennifer D Wu
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Alexander V Alekseyenko
- Department of Public Health Sciences, MUSC, Charleston, SC, United States.,Bioinformatics Center, MUSC, Charleston, SC, United States.,Department of Oral Health Sciences, MUSC, Charleston, SC, United States.,Department of Healthcare Leadership and Management, MUSC, Charleston, SC, United States
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21
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Somaiah N, Van Tine BA, Wahlquist AE, Milhem MM, Hill EG, Garrett-Mayer E, Armeson KE, Schuetze SM, Meyer CF, Reuben DY, Elias AD, Read WL, Chawla SP, Kraft AS. A randomized, open-label, phase 2, multicenter trial of gemcitabine with pazopanib or gemcitabine with docetaxel in patients with advanced soft-tissue sarcoma. Cancer 2020; 127:894-904. [PMID: 33231866 DOI: 10.1002/cncr.33216] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/10/2020] [Accepted: 08/20/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Therapeutic options for patients with advanced soft-tissue sarcoma (STS) are limited. The goal of the current phase 2 study was to examine the clinical activity and safety of the combination of gemcitabine plus pazopanib, a multityrosine kinase inhibitor with activity in STS. METHODS The current randomized, phase 2 trial enrolled patients with advanced nonadipocytic STS who had received prior anthracycline-based therapy. Patients were assigned 1:1 to receive gemcitabine at a dose of 1000 mg/m2 on days 1 and 8 with pazopanib at a dose of 800 mg daily (G+P) or gemcitabine at a dose of 900 mg/m2 on days 1 and 8 and docetaxel at a dose of 100 mg/m2 on day 8 (G+T) every 3 weeks. Crossover was allowed at the time of disease progression. The study used a noncomparative statistical design based on the precision of 95% confidence intervals for reporting the primary endpoints of median progression-free survival (PFS) and rate of grade ≥3 adverse events (AEs) for these 2 regimens based on the intent-to-treat patient population (AEs were graded using version 4.0 of the National Cancer Institute Common Terminology Criteria for Adverse Events). RESULTS A total of 90 patients were enrolled: 45 patients on each treatment arm. The median PFS was 4.1 months for each arm (P = .3, log-rank test). The best overall response of stable disease or better (complete response + partial response + stable disease) was the same for both treatment arms (64% for both the G+T and G+P arms). The rate of related grade ≥3 AEs was 82% for the G+T arm and 78% for the G+P arm. Related grade ≥3 AEs occurring in ≥10% of patients in the G+T and G+P arms were anemia (36% and 20%, respectively), fatigue (29% and 13%, respectively), thrombocytopenia (53% and 49%, respectively), neutropenia (20% and 49%, respectively), lymphopenia (13% and 11%, respectively), and hypertension (2% and 20%, respectively). CONCLUSIONS The data from the current study have demonstrated the safety and efficacy of G+P as an alternative to G+T for patients with nonadipocytic STS.
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Affiliation(s)
- Neeta Somaiah
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brian Andrew Van Tine
- Department of Medicine, Sarcoma Program Director, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Amy E Wahlquist
- Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Mohammed M Milhem
- Chief Section of Oncology, Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Elizabeth G Hill
- Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Elizabeth Garrett-Mayer
- Center for Research and Analytics, American Society of Clinical Oncology, Alexandria, Virginia
| | - Kent E Armeson
- Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Scott M Schuetze
- Division of Medical Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Christian F Meyer
- Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland
| | - Daniel Y Reuben
- Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Anthony D Elias
- Department of Internal Medicine, University of Colorado Comprehensive Cancer Center, Aurora, Colorado
| | - William L Read
- Division of Hematology/Oncology, Department of Medicine, , Emory Clinic, Atlanta, Georgia
| | - Sant P Chawla
- Sarcoma Oncology Research Center, Santa Monica, California
| | - Andrew S Kraft
- Department of Internal Medicine, University of Arizona Cancer Center, Tucson, Arizona
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22
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Small J, Wallace K, Hill EG, Thiers BH, Leach BC, Alberg AJ. A cohort study of personal and family history of skin cancer in relation to all-cause and cancer-specific mortality. Cancer Causes Control 2020; 32:75-82. [PMID: 33123854 DOI: 10.1007/s10552-020-01359-0] [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: 02/10/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Even though the fatality rate from skin cancers is low, evidence from a few cohort studies has raised the possibility that people with a personal history of skin cancer may have a higher all-cause mortality rate compared with those without a personal history of skin cancer. The purpose of the present study was to investigate the potential links between a personal history or family history of skin cancer and all-cause and cancer-specific mortality METHODS: A prospective cohort (n = 8,622) was assembled within the NHANES I follow-up study. Cox Proportional Hazard Regression analysis was used to estimate the hazard ratios (HR) and 95% confidence intervals (CI) for the association for personal and family history of skin cancer and all-cause and cancer-specific mortality. RESULTS After adjustment for several potential confounding variables, a personal history of skin cancer was associated with decreased risk for all-cause mortality (HR 0.72, 95% CI 0.61-0.85), whereas the results for cancer-specific mortality were consistent with a null association (HR 0.97, 95% CI 0.74-1.27). A family history of skin cancer was not significantly associated with all-cause mortality (HR 0.97, 95% CI 0.76-1.24) or cancer-specific mortality (HR 0.69, 95% CI 0.38-1.24). CONCLUSION The results of the present study do not support the hypothesis that a personal history or family history of skin cancer is associated with an increased risk of all-cause or cancer-specific mortality. The high prevalence of skin cancer adds to the public health significance of this question, providing a strong rationale for further research to resolve this question.
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Affiliation(s)
- James Small
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Kristin Wallace
- Department of Public Health Sciences, Medical University of South Carolina, BE 103, 68 President Street, Charleston, SC, 29425, USA.
| | - Elizabeth G Hill
- Department of Public Health Sciences, Medical University of South Carolina, 86 Jonathan Lucas St, Charleston, SC, 29425, USA
| | - Bruce H Thiers
- Dermatology and Dermatologic Surgery, Medical University of South Carolina, 135 Rutledge Ave, Charleston, SC, 29425, USA
| | - Brian C Leach
- The Skin Surgery Center of Charleston, 180 Wingo Way, Mount Pleasant, SC, 29464, USA
| | - Anthony J Alberg
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Discovery I, 915 Greene Street, Columbia, SC, 29201, USA
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Beall J, Hill EG, Armeson K, Garand KL(F, Davidson K(H, Martin-Harris B. Classification of Physiologic Swallowing Impairment Severity: A Latent Class Analysis of Modified Barium Swallow Impairment Profile Scores. Am J Speech Lang Pathol 2020; 29:1001-1011. [PMID: 32650665 PMCID: PMC7844335 DOI: 10.1044/2020_ajslp-19-00080] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/12/2019] [Accepted: 02/03/2020] [Indexed: 05/20/2023]
Abstract
Purpose Our objectives were to (a) identify oral and pharyngeal physiologic swallowing impairment severity classes based on latent class analyses (LCAs) of the Modified Barium Swallow Impairment Profile (MBSImP) swallow task scores and (b) quantify the probability of severity class membership given composite MBSImP oral total (OT) and pharyngeal total (PT) scores. Method MBSImP scores were collected from a patient database of 319 consecutive modified barium swallow studies. Because of missing swallow task scores, LCA was performed using 25 multiply imputed data sets. Results LCA revealed a three-class structure for both oral and pharyngeal models. We identified OT and PT score intervals to assign subjects to oral and pharyngeal impairment latent severity classes, respectively, with high probability (probability of class membership ≥ 0.9 given OT or PT scores within specified ranges) and high confidence (95% credible interval [CI] widths ≤ 0.24 for all total scores within specified ranges). OT scores ranging from 0 to 10 and from 14 to 18 yielded assignments in Oral Latent Classes 1 and 2, respectively, while OT = 22 was assigned to Oral Latent Class 3. PT scores ranging from 0 to 13 and from 18 to 24 yielded assignments in Pharyngeal Latent Classes 1 and 2, respectively, while PT = 26 was assigned to Pharyngeal Latent Class 3. Conclusions LCA of MBSImP task-level data revealed significant underlying oral and pharyngeal ordinal class structures representing increasingly severe gradations of physiologic swallow impairment. Clinically meaningful OT and PT score ranges were derived facilitating latent class assignment. Supplemental Material https://doi.org/10.23641/asha.12315677.
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Affiliation(s)
- Jonathan Beall
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Elizabeth G. Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Kent Armeson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | | | | | - Bonnie Martin-Harris
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
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24
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Ford ME, Bryant DC, Cartmell KB, Sterba K, Burshell DR, Hill EG, Kim J, De Toma A, Knight KD, Reed T, Weaver K, Calhoun E, Esnaola NF. Abstract A085: Challenges and successes in recruiting African Americans with early-stage, non-small cell lung cancer to an NIMHD-funded, NCORP-based patient navigation trial. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-a085] [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] Open
Abstract
Abstract
Background: Enrollment of early-stage lung cancer patients to randomized trials has historically been challenging. The STARS Trial enrolled 36 of 1,030 intended patients from 28 sites, while the ROSEL Trial recruited 22 of 960 intended patients from 10 sites. Unfortunately, evidence shows African Americans with early-stage NSCLC are significantly less likely than their European American counterparts to undergo resection and may also be less likely to participate in lung cancer trials as well.
Purpose: The purpose of this research is to describe interim recruitment results from an NIMHD-funded, NCI NCORP-based patient navigation trial conducted with African Americans with early-stage, probable/proven non-small cell lung cancer (NSCLC).
Design: The protocol-driven, barriers-focused patient navigation intervention is being conducted in the context of a two-arm cluster-randomized trial testing the effectiveness of the intervention in increasing rates of lung-directed curative-intent therapy (surgery and SBRT) in African Americans with Stage I-II NSCLC. The 2 study arms consist of the protocol-driven, intensive navigation intervention vs. usual care. The trial includes 20 study sites in 11 US states. Specific activities to enhance recruitment in the present trial include reaching out to referring physicians (e.g., primary care, pulmonologists, radiologists) to increase referrals of African American patients to the participating NCORP sites, and partnering with the leaders of community engagement activities at the sites to raise community-level awareness of the trial.
Results/Conclusions: To date, 200 African American patients have been recruited and the trial is now on target to meet its expected accrual goal of 222 patients. The majority of potential participants were ineligible due to receipt of surgical resection or radiation therapy prior to enrollment (24%), not having been told that they had probable/proven NSCLC prior to study contact (22%), or a previous history of lung cancer (10%). The median age of the 200 participants is 65 years (range 40-86 years). Most are unmarried (70%) and have a high school diploma or less (71%). The number of enrolled-to-date African American participants in this ongoing trial exceeds the total number of participants recruited to the STARS Trial or to the ROSEL Trial.
Citation Format: Marvella E. Ford, Debbie C. Bryant, Kathleen B. Cartmell, Katherine Sterba, Dana R. Burshell, Elizabeth G. Hill, Joanne Kim, Allan De Toma, Kendrea D. Knight, Ta'Myiah Reed, Kathryn Weaver, Elizabeth Calhoun, Nestor F. Esnaola. Challenges and successes in recruiting African Americans with early-stage, non-small cell lung cancer to an NIMHD-funded, NCORP-based patient navigation trial [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A085.
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Affiliation(s)
| | | | | | | | | | | | - Joanne Kim
- 1Medical University of South Carolina, Charleston, SC,
| | | | | | - Ta'Myiah Reed
- 1Medical University of South Carolina, Charleston, SC,
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Janakiraman H, Zhu Y, Becker SA, Wang C, Cross A, Curl E, Lewin D, Hoffman BJ, Warren GW, Hill EG, Timmers C, Findlay VJ, Camp ER. Modeling rectal cancer to advance neoadjuvant precision therapy. Int J Cancer 2020; 147:1405-1418. [PMID: 31989583 DOI: 10.1002/ijc.32876] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/11/2019] [Accepted: 12/20/2019] [Indexed: 01/06/2023]
Abstract
Progress in rectal cancer therapy has been hindered by the lack of effective disease-specific preclinical models that account for the unique molecular profile and biology of rectal cancer. Thus, we developed complementary patient-derived xenograft (PDX) and subsequent in vitro tumor organoid (PDTO) platforms established from preneoadjuvant therapy rectal cancer specimens to advance personalized care for rectal cancer patients. Multiple endoscopic samples were obtained from 26 Stages 2 and 3 rectal cancer patients prior to receiving 5FU/RT and implanted subcutaneously into NSG mice to generate 15 subcutaneous PDXs. Second passaged xenografts demonstrated 100% correlation with the corresponding human cancer histology with maintained mutational profiles. Individual rectal cancer PDXs reproduced the 5FU/RT response observed in the corresponding human cancers. Similarly, rectal cancer PDTOs reproduced significant heterogeneity in cellular morphology and architecture. PDTO in vitro 5FU/RT treatment response replicated the clinical 5FU/RT neoadjuvant therapy pathologic response observed in the corresponding patient tumors (p < 0.05). The addition of cetuximab to the 5FU/RT regiment was significantly more sensitive in the rectal cancer PDX and PDTOs with wild-type KRAS compared to mutated KRAS (p < 0.05). Considering the close relationship between the patient's cancer and the corresponding PDX/PDTO, rectal cancer patient-derived research platforms represent powerful translational research resources as population-based tools for biomarker discovery and experimental therapy testing. In addition, our findings suggest that cetuximab may enhance RT effectiveness by improved patient selection based on mutational profile in addition to KRAS or by developing a protocol using PDTOs to identify sensitive patients.
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Affiliation(s)
- Harinarayanan Janakiraman
- Department of Surgery, Medical University of South Carolina, Charleston, SC.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Yun Zhu
- Department of Surgery, Medical University of South Carolina, Charleston, SC.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Scott A Becker
- Department of Surgery, Medical University of South Carolina, Charleston, SC.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Cindy Wang
- Department of Surgery, Medical University of South Carolina, Charleston, SC.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Ashley Cross
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
| | - Emily Curl
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
| | - David Lewin
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
| | - Brenda J Hoffman
- Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - Elizabeth G Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Cynthia Timmers
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.,Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Victoria J Findlay
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.,Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
| | - Ernest R Camp
- Department of Surgery, Medical University of South Carolina, Charleston, SC.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.,Ralph H. Johnson VA Medical Center, Charleston, SC
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Graboyes EM, Hill EG, Marsh CH, Maurer S, Day TA, Hornig JD, Lentsch EJ, Neskey DM, Skoner J, Sterba KR. Temporal Trajectory of Body Image Disturbance in Patients with Surgically Treated Head and Neck Cancer. Otolaryngol Head Neck Surg 2020; 162:304-312. [PMID: 31906788 DOI: 10.1177/0194599819898861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 11/17/2022]
Abstract
OBJECTIVES To characterize the temporal trajectory of body image disturbance (BID) in patients with surgically treated head and neck cancer (HNC). STUDY DESIGN Prospective cohort study. SETTING Academic medical center. SUBJECTS AND METHODS Patients with HNC who were undergoing surgery completed the Body Image Scale (BIS), a validated patient-reported outcome measure of BID, pretreatment and 1, 3, 6, 9, and 12 months posttreatment. Changes in BIS scores (ΔBIS) relative to pretreatment (primary endpoint) were analyzed with a linear mixed model. Associations between demographics, clinical characteristics, psychosocial attributes, and persistently elevated BIS scores and increases in BIS scores ≥5 points relative to pretreatment (secondary endpoints) were analyzed through logistic regression. RESULTS Of the 68 patients, most were male (n = 43), had oral cavity cancer (n = 37), and underwent microvascular reconstruction (n = 45). Relative to baseline, mean ΔBIS scores were elevated at 1 month postoperatively (2.9; 95% CI, 1.3-4.4) and 3 (3.2; 95% CI, 1.5-4.9) and 6 (1.8; 95% CI, 0.02-3.6) months posttreatment before returning to baseline at 9 months posttreatment (0.9; 95% CI, -0.8 to 2.5). Forty-three percent of patients (19 of 44) had persistently elevated BIS scores at 9 months posttreatment relative to baseline, and 51% (31 of 61) experienced an increase in BIS scores ≥5 relative to baseline. CONCLUSIONS In this cohort of patients surgically treated for HNC, BID worsens posttreatment before returning to pretreatment (baseline) levels at 9 months posttreatment. However, 4 in 10 patients will experience a protracted course with persistent posttreatment body image concerns, and half will experience a significant increase in BIS scores relative to pretreatment levels.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elizabeth G Hill
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Courtney H Marsh
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stacey Maurer
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joshua D Hornig
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Eric J Lentsch
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David M Neskey
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Judith Skoner
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Katherine R Sterba
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Focht Garand KL, Hill EG, Armeson K, Martin-Harris B. Aging Effects on Eating Assessment Tool-10 (EAT-10) Total Scores in Healthy, Community-Dwelling Adults. Can J Speech Lang Pathol Audiol 2020; 44:1-8. [PMID: 33708276 PMCID: PMC7946383] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to examine how aging and sex impacted scores on the Eating Assessment Tool-10 in a large sample of healthy, non-dysphagic adults. Differences in Eating Assessment Tool-10 total normal (< 3) and abnormal (≥ 3) scores were examined across four age categories (21-39 years, 40-59 years, 60-79 years, 80 years and older) and between sexes. The mean (± SD) Eating Assessment Tool-10 total score for this healthy cohort of 167 individuals was 0.6 (± 1.6), with the majority of participants (75%) earning a score of zero. No significant differences were found in Eating Assessment Tool-10 total scores across age categories (p = .53) or between sexes (p = .79). Post-hoc analyses further explored relationships between Eating Assessment Tool-10 total scores and swallow performance measures as observed during videofluoroscopy. All participants (n = 15) scoring 3 and greater on the Eating Assessment Tool-10 passed an aspiration screen (i.e., 3-ounce water swallow challenge). Nine participants scoring less than 3 and failing the aspiration screen were not observed to have airway invasion as measured by the Penetration-Aspiration Scale during videofluoroscopy. A significant relationship was not observed between Eating Assessment Tool-10 total scores and highest Penetration-Aspiration Scale score. Eating Assessment Tool-10 total scores reported in the current study for patients with gastroesophageal reflux disease were significantly lower (p < .001) than total scores reported in the Eating Assessment Tool-10 validation study by Belafsky et al. (2008). In summary, aging or sex effects did not appear to impact self-report of dysphagia-related symptoms as measured by the Eating Assessment Tool-10. The Eating Assessment Tool-10, therefore, may not demonstrate the sensitivity needed to capture sub-clinical changes of the aging swallowing mechanism.
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Affiliation(s)
| | | | - Kent Armeson
- Medical University of South Carolina, Charleston, SC, USA
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Garcia D, Nasarre P, Bonilla IV, Hilliard E, Peterson YK, Spruill L, Broome AM, Hill EG, Yustein JT, Mehrotra S, Klauber-DeMore N. Development of a Novel Humanized Monoclonal Antibody to Secreted Frizzled-Related Protein-2 That Inhibits Triple-Negative Breast Cancer and Angiosarcoma Growth In Vivo. Ann Surg Oncol 2019; 26:4782-4790. [PMID: 31515721 DOI: 10.1245/s10434-019-07800-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND We previously reported that secreted frizzled-related protein-2 (SFRP2) is expressed in a variety of tumors, including sarcoma and breast carcinoma, and stimulates angiogenesis and inhibits tumor apoptosis. Therefore, we hypothesized that a humanized SFRP2 monoclonal antibody (hSFRP2 mAb) would inhibit tumor growth. METHODS The lead hSFRP2 antibody was tested against a cohort of 22 healthy donors using a time course T-cell assay to determine the relative risk of immunogenicity. To determine hSFRP2 mAb efficacy, nude mice were subcutaneously injected with SVR angiosarcoma cells and treated with hSFRP2 mAb 4 mg/kg intravenously every 3 days for 3 weeks. We then injected Hs578T triple-negative breast cells into the mammary fat pad of nude mice and treated for 40 days. Control mice received an immunoglobulin (Ig) G1 control. The SVR and Hs578T tumors were then stained using a TUNEL assay to detect apoptosis. RESULTS Immunogenicity testing of hSFRP2 mAb did not induce proliferative responses using a simulation index (SI) ≥ 2.0 (p < 0.05) threshold in any of the healthy donors. SVR angiosarcoma tumor growth was inhibited in vivo, evidenced by significant tumor volume reduction in the hSFRP2 mAb-treated group, compared with controls (n = 10, p < 0.001). Likewise, Hs578T triple-negative breast tumors were smaller in the hSFRP2 mAb-treated group compared with controls (n = 10, p < 0.001). The hSFRP2 mAb treatment correlated with an increase in tumor cell apoptosis (n = 11, p < 0.05). Importantly, hSFRP2 mAb treatment was not associated with any weight loss or lethargy. CONCLUSION We present a novel hSFRP2 mAb with therapeutic potential in breast cancer and sarcoma that has no effect on immunogenicity.
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Affiliation(s)
- Denise Garcia
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Patrick Nasarre
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Ingrid V Bonilla
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Eleanor Hilliard
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Yuri K Peterson
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - Laura Spruill
- Department of Pathology, Medical University of South Carolina, Charleston, SC, USA
| | - Anne-Marie Broome
- Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth G Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jason T Yustein
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, TX, USA
| | - Shikhar Mehrotra
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Nancy Klauber-DeMore
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
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Dobbie AM, Ward RC, Oyer SL, Overton LJ, Hill EG, Patel KG. Conscious Perception of Facial Asymmetry in a Unilateral Cleft Lip Model. Cleft Palate Craniofac J 2019; 55:213-219. [PMID: 29351035 DOI: 10.1177/1055665617718824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/17/2022] Open
Abstract
OBJECTIVE Lip asymmetry after a unilateral cleft lip repair can be perceived as an unsatisfactory result. The objective of this study is to determine the degree of upper lip asymmetry and/or nasal alar hooding required for recognition of asymmetry in a simulated model of unilateral cleft lip. DESIGN A model of unilateral cleft lip was created using digital morphing software to simulate asymmetries in vermilion height and nasal hooding in photographs of children. Volunteers were shown photographs for different time intervals and with varying degrees of asymmetry. Ability to detect facial asymmetry was recorded and analyzed. SETTING This study was conducted by surveying layperson volunteers in public community settings. PARTICIPANTS 108 layperson volunteers were randomly surveyed. MAIN OUTCOME MEASURES The primary outcome measure was a reported lip or nose asymmetry by the volunteers. Proportions and corresponding 95% confidence intervals were obtained to estimate the probability of reporting an asymmetry at 3- and 10-second intervals. RESULTS After 3- and 10-second exposure, labial asymmetry was perceived by ≥50% of subjects at 2 mm (62%, P = .001) and 1 mm (89%, P < .0001), respectively. Nasal asymmetry was detected by <50% of subjects at 3 seconds, but ≥50% perceived a 3-mm alteration at 10 seconds (64%, P < .0001). Photographs with combined nasal and labial modification did not lower the threshold for asymmetry perception compared to either deformity alone. CONCLUSIONS This study is the first to determine a predictable millimeter threshold for perceived asymmetry in cleft lip deformity using a digital model.
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Affiliation(s)
- Allison M Dobbie
- 1 Department of Otolaryngology, University of Colorado School of Medicine, Colorado Springs, CO, USA
| | - Ralph C Ward
- 2 Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Samuel L Oyer
- 3 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Lewis J Overton
- 4 Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Elizabeth G Hill
- 2 Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Krishna G Patel
- 3 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Herrera H, Dilday T, Uber A, Scott D, Zambrano JN, Wang M, Angel PM, Mehta AS, Drake RR, Hill EG, Yeh ES. Core-Fucosylated Tetra-Antennary N-Glycan Containing A Single N-Acetyllactosamine Branch Is Associated with Poor Survival Outcome in Breast Cancer. Int J Mol Sci 2019; 20:E2528. [PMID: 31126011 PMCID: PMC6566954 DOI: 10.3390/ijms20102528] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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] [Received: 04/15/2019] [Revised: 05/07/2019] [Accepted: 05/20/2019] [Indexed: 01/26/2023] Open
Abstract
(1) Glycoproteins account for ~80% of proteins located at the cell surface and in the extracellular matrix. A growing body of evidence indicates that α-L-fucose protein modifications contribute to breast cancer progression and metastatic disease. (2) Using a combination of techniques, including matrix-assisted laser desorption/ionization imaging mass spectrometry (MALDI-IMS) based in cell and on tissue imaging and glycan sequencing using exoglycosidase analysis coupled to hydrophilic interaction ultra-high performance liquid chromatography (HILIC UPLC), we establish that a core-fucosylated tetra-antennary glycan containing a single N-acetyllactosamine (F(6)A4G4Lac1) is associated with poor clinical outcomes in breast cancer, including lymph node metastasis, recurrent disease, and reduced survival. (3) This study is the first to identify a single N-glycan, F(6)A4G4Lac1, as having a correlation with poor clinical outcomes in breast cancer.
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Affiliation(s)
- Harmin Herrera
- Graduate School of Biomedical Sciences and Professional Studies, Microbiology and Immunology Graduate Program, Drexel University College of Medicine, Philadelphia, PA 19129, USA.
| | - Tinslee Dilday
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Allison Uber
- Department of Pediatrics, Division of Hematology/Oncology, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Danielle Scott
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Joelle N Zambrano
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Mengjun Wang
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Peggi M Angel
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Anand S Mehta
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Richard R Drake
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Elizabeth G Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Elizabeth S Yeh
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC 29425, USA.
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Chakraborty P, Chatterjee S, Kesarwani P, Thyagarajan K, Iamsawat S, Dalheim A, Nguyen H, Selvam SP, Nasarre P, Scurti G, Hardiman G, Maulik N, Ball L, Gangaraju V, Rubinstein MP, Klauber-DeMore N, Hill EG, Ogretmen B, Yu XZ, Nishimura MI, Mehrotra S. Thioredoxin-1 improves the immunometabolic phenotype of antitumor T cells. J Biol Chem 2019; 294:9198-9212. [PMID: 30971427 DOI: 10.1074/jbc.ra118.006753] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 11/16/2018] [Revised: 03/25/2019] [Indexed: 12/16/2022] Open
Abstract
Adoptive transfer of tumor epitope-reactive T cells has emerged as a promising strategy to control tumor growth. However, chronically-stimulated T cells expanded for adoptive cell transfer are susceptible to cell death in an oxidative tumor microenvironment. Because oxidation of cell-surface thiols also alters protein functionality, we hypothesized that increasing the levels of thioredoxin (Trx), an antioxidant molecule facilitating reduction of proteins through cysteine thiol-disulfide exchange, in T cells will promote their sustained antitumor function. Using pre-melanosome protein (Pmel)-Trx1 transgenic mouse-derived splenic T cells, flow cytometry, and gene expression analysis, we observed here that higher Trx expression inversely correlated with reactive oxygen species and susceptibility to T-cell receptor restimulation or oxidation-mediated cell death. These Trx1-overexpressing T cells exhibited a cluster of differentiation 62Lhi (CD62Lhi) central memory-like phenotype with reduced glucose uptake (2-NBDGlo) and decreased effector function (interferon γlo). Furthermore, culturing tumor-reactive T cells in the presence of recombinant Trx increased the dependence of T cells on mitochondrial metabolism and improved tumor control. We conclude that strategies for increasing the antioxidant capacity of antitumor T cells modulate their immunometabolic phenotype leading to improved immunotherapeutic control of established tumors.
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Affiliation(s)
| | | | | | | | | | - Annika Dalheim
- the Department of Surgery, Loyola University, Maywood, Illinois 60153, and
| | | | | | | | - Gina Scurti
- the Department of Surgery, Loyola University, Maywood, Illinois 60153, and
| | | | - Nilanjana Maulik
- the Department of Surgery, University of Connecticut Health Center, Farmington, Connecticut 06030
| | | | | | | | | | - Elizabeth G Hill
- Public Health, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina 29425
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Ellis MA, Sterba KR, Day TA, Marsh CH, Maurer S, Hill EG, Graboyes EM. Body Image Disturbance in Surgically Treated Head and Neck Cancer Patients: A Patient-Centered Approach. Otolaryngol Head Neck Surg 2019; 161:278-287. [PMID: 30961419 DOI: 10.1177/0194599819837621] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 11/16/2022]
Abstract
OBJECTIVE To promote patient-centered oncology care through an in-depth analysis of the patient experience of body image disturbance (BID) following surgery for head and neck cancer (HNC). STUDY DESIGN Qualitative methods approach using semistructured key informant interviews. SETTING Academic medical center. SUBJECTS AND METHODS Participants with surgically treated HNC underwent semistructured key informant interviews and completed a sociodemographic survey. Recorded interviews were transcribed, coded, and analyzed using template analysis to inform creation of a conceptual model. RESULTS Twenty-two participants with surgically treated HNC were included, of whom 16 had advanced stage disease and 15 underwent free tissue transfer. Five key themes emerged characterizing the participants' lived experiences with BID following HNC treatment: personal dissatisfaction with appearance, other-oriented appearance concerns, appearance concealment, distress with functional impairments, and social avoidance. The participant's perceived BID severity was modified by preoperative patient expectations, social support, and positive rational acceptance. These 5 key themes and 3 experiential modifiers form the basis of a novel, patient-centered conceptual model for understanding BID in HNC survivors. CONCLUSION A patient-centered approach to HNC care reveals that dissatisfaction with appearance, other-oriented appearance concerns, appearance concealment, distress with functional impairments, and social avoidance are key conceptual domains characterizing HNC-related BID. Recognition of these psychosocial dimensions of BID in HNC patients can inform development of HNC-specific BID patient-reported outcome measures to facilitate quantitative assessment of BID as well as the development of novel preventative and therapeutic strategies for those at risk for, or suffering from, BID.
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Affiliation(s)
- Mark A Ellis
- 1 Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Katherine R Sterba
- 2 Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.,3 Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Terry A Day
- 1 Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Courtney H Marsh
- 1 Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stacy Maurer
- 2 Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.,4 Department of Psychiatry and Behavioral Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elizabeth G Hill
- 2 Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.,3 Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Evan M Graboyes
- 1 Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,2 Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
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Graboyes EM, Hill EG, Marsh CH, Maurer S, Day TA, Sterba KR. Body Image Disturbance in Surgically Treated Head and Neck Cancer Patients: A Prospective Cohort Pilot Study. Otolaryngol Head Neck Surg 2019; 161:105-110. [PMID: 30857488 DOI: 10.1177/0194599819835534] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 11/17/2022]
Abstract
This prospective cohort pilot study sought to characterize the short-term temporal trajectory of, and risk factors for, body image disturbance (BID) in patients with head and neck cancer (HNC). Most patients were male (35/56), had oral cavity cancer (33/56), and underwent microvascular reconstruction (37/56). Using the Body Image Scale (BIS), a validated patient-reported outcome measure of BID, the prevalence of BID (BIS ≥10) increased from 11% preoperatively to 25% at 1 month postoperatively and 27% at 3 months posttreatment (P < .001 and P = .0014 relative to baseline, respectively). Risk factors for BID included female sex (odds ratio [OR], 4.8; 95% confidence interval [CI], 1.3-19.8), pT 3 to 4 tumors (OR, 8.9; 95% CI, 2.0-63.7), and more severe baseline shame and stigma (OR, 1.06; 95% CI, 1.01-1.13), depression (OR, 1.25; 95% CI, 1.06-1.51), and social isolation (OR, 1.21; 95% CI, 1.01-1.49). The prevalence and severity of BID increase immediately posttreatment. Demographic, oncologic, and psychosocial characteristics identify high-risk patients for targeted interventions.
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Affiliation(s)
- Evan M Graboyes
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,2 Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elizabeth G Hill
- 2 Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.,3 Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Courtney H Marsh
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stacey Maurer
- 2 Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.,4 Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Terry A Day
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Katherine R Sterba
- 2 Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.,3 Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Ellis MA, Sterba KR, Brennan EA, Maurer S, Hill EG, Day TA, Graboyes EM. A Systematic Review of Patient-Reported Outcome Measures Assessing Body Image Disturbance in Patients with Head and Neck Cancer. Otolaryngol Head Neck Surg 2019; 160:941-954. [PMID: 30744514 DOI: 10.1177/0194599819829018] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To synthesize published literature describing the severity of body image disturbance (BID) in patients with head and neck cancer (HNC) over time, its psychosocial and functional associations, and treatment strategies as assessed by patient-reported outcome measures (PROMs). DATA SOURCE PubMed/MEDLINE, Scopus, PsycINFO, Web of Science, and Google Scholar. REVIEW METHODS A systematic review of the English-language literature was performed to identify studies of BID in patients with HNC using psychometrically validated PROMs to assess (1) severity of BID over time, (2) psychosocial and functional associations, and (3) management strategies. RESULTS A total of 17 studies met inclusion criteria. BID was assessed via 10 different PROMs, none of which were HNC-specific measures of BID. Two of 2 longitudinal studies (100%) reported that BID improved from pretreatment to posttreatment, and 2 of 3 longitudinal studies (67%) showed that the severity of BID decreased over time as survivors got further out from treatment. Seven of 17 studies (41%) described negative functional and psychosocial associations with BID, although study methodology limited conclusions about cause and effect. None of the studies assessing interventions to manage BID (0/2, 0%) demonstrated an improvement in BID relative to control. CONCLUSION BID in patients with HNC has negative functional and psychosocial associations and lacks evidence-based treatment. Research is limited by the lack of an HNC-specific BID PROM. Further research should address knowledge gaps related to the lack of an HNC-specific BID PROM, longitudinal course of BID in patients with HNC, confusion with regards to risk factors and outcomes, and lack of prevention and treatment strategies.
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Affiliation(s)
- Mark A Ellis
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Katherine R Sterba
- 2 Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.,3 Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily A Brennan
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stacey Maurer
- 2 Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.,4 Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elizabeth G Hill
- 2 Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.,3 Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Terry A Day
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Evan M Graboyes
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,2 Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
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Garand KLF, Hill EG, Amella E, Armeson K, Brown A, Martin-Harris B. Bolus Airway Invasion Observed During Videofluoroscopy in Healthy, Non-dysphagic Community-Dwelling Adults. Ann Otol Rhinol Laryngol 2019; 128:426-432. [PMID: 30700098 DOI: 10.1177/0003489419826141] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 11/17/2022]
Abstract
OBJECTIVES Typical aging may result in subclinical swallowing alterations (presbyphagia), which can place an individual at risk for dysphagia-related conditions, such as aspiration pneumonia, secondary to loss of functional reserve and rising incidence of age-related diseases associated with dysphagia. The purpose of this study was to investigate occurrence of airway invasion among healthy, nondysphagic community-dwelling adults. Further, we tested for differences of airway invasion across age categories and between sexes. METHODS Each eligible participant underwent a videofluoroscopic swallow study using a standardized approach of various volumes and viscosities. Ten swallows observed in the lateral viewing plane was assessed for observation of bolus airway invasion using the Penetration-Aspiration Scale (PAS) scoring system. Eligible participants (N = 195) were categorized according to 1 of 3 age categories (21-39 years, 40-59 years, 60 years and older) and sex (male, female) for analyses. RESULTS Out of 1936 swallows analyzed, we observed penetration in 113 swallows (5.8%) and aspiration in 6 swallows (0.3%). Majority (98%) of bolus airway invasion events occurred during the swallow. Mean or worst PAS scores did not significantly differ across age categories or between sexes. The odds ratios of PAS impairment between age categories did not reveal any significant differences. Males were more likely to have impaired PAS scores relative to females (odds ratio [OR] = 3.5; P = .01). CONCLUSIONS Entrance of ingested material into the airway observed during videofluoroscopy is uncommon in healthy adults, which helps support the notion that aging may not directly correlate with increased risk of aspiration. Rather, the increased risk of aspiration observed in the aging population may result from the increased incidence of neurological and other diseases with dysphagia as common sequelae with advancing age. Future investigations should compare age-matched healthy controls with a diseased population (eg, cerebral vascular accident) to further explore the relationship between aspiration risk as a function of age compared to consequence of disease/injury.
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Affiliation(s)
- Kendrea L Focht Garand
- 1 Department of Speech Pathology and Audiology, University of South Alabama, Mobile, Alabama, USA
| | - Elizabeth G Hill
- 2 Biostatistics Shared Resource, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elaine Amella
- 3 College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kent Armeson
- 2 Biostatistics Shared Resource, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alonna Brown
- 1 Department of Speech Pathology and Audiology, University of South Alabama, Mobile, Alabama, USA
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Janz TA, Kim J, Hill EG, Sterba K, Warren G, Sharma AK, Day TA, Hughes-Halbert C, Graboyes EM. Association of Care Processes With Timely, Equitable Postoperative Radiotherapy in Patients With Surgically Treated Head and Neck Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg 2018; 144:1105-1114. [PMID: 30347012 PMCID: PMC6472989 DOI: 10.1001/jamaoto.2018.2225] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Indexed: 11/14/2022]
Abstract
Importance Delays in initiation of postoperative radiotherapy (PORT) after surgery for head and neck squamous cell carcinoma (HNSCC) are common, predominantly affect racial minorities, and are associated with decreased survival. Details regarding the care processes that contribute to timely, equitable PORT remain unknown. Objective To determine care processes associated with timely, equitable PORT. Design, Setting, and Participants This retrospective cohort study included patients 18 years or older undergoing surgery for HNSCC at the Medical University of South Carolina (MUSC), Charleston, followed by PORT (at MUSC or elsewhere) with or without chemotherapy from January 1, 2014, through December 31, 2016. Data were analyzed from September 15, 2017, through June 28, 2018. Main Outcomes and Measures The main outcome measure was the proportion of timely, guideline-adherent initiation of PORT (≤6 weeks postoperatively). Secondary outcome measures included care processes associated with timely PORT. The association between process variables with timely PORT was explored using multivariable logistic regression analysis. Effect modification of the association between receipt of care processes and timely PORT by race was explored using interaction effects. Results A total of 197 patients were included in the analysis; they were predominantly white (157 [79.7%]) and male (136 [69.0%]) with a mean age of 59 years (range, 28-89 years). Overall, 89 patients (45.2%) experienced a delay initiating PORT. African American patients had a 13.5% absolute increase in the rate of delayed PORT relative to white patients (21 of 37 [56.8%] vs 68 of 157 [43.3%]). The adjusted multivariable regression showed that the following care processes were associated with timely PORT: preoperative radiotherapy consultation (odds ratio [OR], 8.94; 95% CI, 1.64-65.53), PORT at MUSC (OR, 6.21; 95% CI, 1.85-24.75), pathology report within 7 postoperative days (OR, 4.14; 95% CI, 1.21-15.86), time from surgery to PORT referral of no longer than 10 days (OR, 12.14; 95% CI, 3.14-63.00), time from PORT referral to consultation of no longer than 10 days (OR, 10.76; 95% CI, 3.01-49.70), and time from PORT consultation to its start of no longer than 21 days (OR, 4.80; 95% CI 1.41-18.44). Analysis of interactions revealed no statistically significant differences between African American and white patients in receipt of key processes associated with timely PORT. Conclusions and Relevance Specific care processes are associated with guideline-adherent initiation of PORT. Novel strategies appear to be needed to ensure that these processes are performed for all patients with HNSCC, thereby facilitating timely, equitable PORT.
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Affiliation(s)
- Tyler A Janz
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Joanne Kim
- Hollings Cancer Center, Medical University of South Carolina, Charleston
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Elizabeth G Hill
- Hollings Cancer Center, Medical University of South Carolina, Charleston
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Katherine Sterba
- Hollings Cancer Center, Medical University of South Carolina, Charleston
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Graham Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston
- Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston
| | - Anand K Sharma
- Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Chanita Hughes-Halbert
- Hollings Cancer Center, Medical University of South Carolina, Charleston
- Department of Psychiatry, Medical University of South Carolina, Charleston
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
- Hollings Cancer Center, Medical University of South Carolina, Charleston
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Zambrano JN, Williams CJ, Williams CB, Hedgepeth L, Burger P, Dilday T, Eblen ST, Armeson K, Hill EG, Yeh ES. Staurosporine, an inhibitor of hormonally up-regulated neu-associated kinase. Oncotarget 2018; 9:35962-35973. [PMID: 30542510 PMCID: PMC6267597 DOI: 10.18632/oncotarget.26311] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 04/16/2018] [Accepted: 10/21/2018] [Indexed: 01/27/2023] Open
Abstract
HUNK is a protein kinase that is implicated in HER2-positive (HER2+) breast cancer progression and resistance to HER2 inhibitors. Though prior studies suggest there is therapeutic potential for targeting HUNK in HER2+ breast cancer, pharmacological agents that target HUNK are yet to be identified. A recent study showed that the broad-spectrum kinase inhibitor staurosporine binds to the HUNK catalytic domain, but the effect of staurosporine on HUNK enzymatic activity was not tested. We now show that staurosporine inhibits the kinase activity of a full length HUNK protein. Our findings further suggest that inhibiting HUNK with staurosporine has a strong effect on suppressing cell viability of HER2/neu mammary and breast cancer cells, which express high levels of HUNK protein and are dependent on HUNK for survival. Significantly, we use in vitro and in vivo methods to show that staurosporine synergizes with the HER2 inhibitor lapatinib to restore sensitivity toward HER2 inhibition in a HER2 inhibitor resistant breast cancer model. Collectively, these studies indicate that pharmacological inhibition of HUNK kinase activity has therapeutic potential for HER2+ breast cancers, including HER2+ breast cancers that have developed drug resistance.
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Affiliation(s)
- Joelle N Zambrano
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Christina J Williams
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Carly Bess Williams
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Lonzie Hedgepeth
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Pieter Burger
- Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.,Department of Chemistry, Emory University, Atlanta, GA 30322, USA
| | - Tinslee Dilday
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Scott T Eblen
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Kent Armeson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Elizabeth G Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Elizabeth S Yeh
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC 29425, USA
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Chatterjee S, Chakraborty P, Daenthanasanmak A, Iamsawat S, Andrejeva G, Luevano LA, Wolf M, Baliga U, Krieg C, Beeson CC, Mehrotra M, Hill EG, Rathmell JC, Yu XZ, Kraft AS, Mehrotra S. Targeting PIM Kinase with PD1 Inhibition Improves Immunotherapeutic Antitumor T-cell Response. Clin Cancer Res 2018; 25:1036-1049. [PMID: 30327305 DOI: 10.1158/1078-0432.ccr-18-0706] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/29/2018] [Accepted: 10/10/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE Adoptive T-cell therapy (ACT) of cancer, which involves the infusion of ex vivo-engineered tumor epitope reactive autologous T cells into the tumor-bearing host, is a potential treatment modality for cancer. However, the durable antitumor response following ACT is hampered either by loss of effector function or survival of the antitumor T cells. Therefore, strategies to improve the persistence and sustain the effector function of the antitumor T cells are of immense importance. Given the role of metabolism in determining the therapeutic efficacy of T cells, we hypothesize that inhibition of PIM kinases, a family of serine/threonine kinase that promote cell-cycle transition, cell growth, and regulate mTORC1 activity, can improve the potency of T cells in controlling tumor. EXPERIMENTAL DESIGN The role of PIM kinases in T cells was studied either by genetic ablation (PIM1-/-PIM2-/-PIM3-/-) or its pharmacologic inhibition (pan-PIM kinase inhibitor, PimKi). Murine melanoma B16 was established subcutaneously and treated by transferring tumor epitope gp100-reactive T cells along with treatment regimen that involved inhibiting PIM kinases, anti-PD1 or both. RESULTS With inhibition of PIM kinases, T cells had significant reduction in their uptake of glucose, and upregulated expression of memory-associated genes that inversely correlate with glycolysis. In addition, the expression of CD38, which negatively regulates the metabolic fitness of the T cells, was also reduced in PimKi-treated cells. Importantly, the efficacy of antitumor T-cell therapy was markedly improved by inhibiting PIM kinases in tumor-bearing mice receiving ACT, and further enhanced by adding anti-PD1 antibody to this combination. CONCLUSIONS This study highlights the potential therapeutic significance of combinatorial strategies where ACT and inhibition of signaling kinase with checkpoint blockade could improve tumor control.
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Affiliation(s)
- Shilpak Chatterjee
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Paramita Chakraborty
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Anusara Daenthanasanmak
- Department of Microbiology & Immunology, Medical University of South Carolina, Charleston, South Carolina
| | - Supinya Iamsawat
- Department of Microbiology & Immunology, Medical University of South Carolina, Charleston, South Carolina
| | - Gabriela Andrejeva
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Libia A Luevano
- University of Arizona Cancer Center, University of Arizona, Tucson, Arizona
| | - Melissa Wolf
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Uday Baliga
- Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Carsten Krieg
- Department of Microbiology & Immunology, Medical University of South Carolina, Charleston, South Carolina
| | - Craig C Beeson
- Department of Pharmaceutical and Biomedical Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Meenal Mehrotra
- Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Elizabeth G Hill
- Department of Public Health, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Jeffery C Rathmell
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Xue-Zhong Yu
- Department of Microbiology & Immunology, Medical University of South Carolina, Charleston, South Carolina
| | - Andrew S Kraft
- University of Arizona Cancer Center, University of Arizona, Tucson, Arizona
| | - Shikhar Mehrotra
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.
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Garand KL(F, Armeson KE, Hill EG, Martin-Harris B. Identification of Phenotypic Patterns of Dysphagia: A Proof of Concept Study. Am J Speech Lang Pathol 2018; 27:988-995. [PMID: 29800022 PMCID: PMC6195027 DOI: 10.1044/2018_ajslp-17-0173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/02/2018] [Accepted: 02/12/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE The purpose of the current project was to explore the feasibility for subtyping dysphagia traits or patterns of scores in a subset of data from the Modified Barium Swallow Impairment Profile global registry in patients referred to videofluoroscopic swallowing studies across 5 common medical categories: (a) cardiothoracic, (b) gastroenterology, (c) head and neck cancer, (d) neurology, and (e) pulmonary. METHOD Videofluoroscopic swallowing study imaging and Modified Barium Swallow Impairment Profile metrics were used to evaluate 235 patients with dysphagia grouped into 1 of the 5 categories. Two summative domain scores (oral total [OT] and pharyngeal total [PT]) and 17 component scores were tested for differences among the categories. RESULTS When compared with the gastroenterology category, significantly higher OT/PT scores were observed in neurology and pulmonary categories (all p values < .05). Four oral and 6 pharyngeal domain components significantly differed across medical categories: tongue control during bolus hold (all p values < .04). CONCLUSIONS The results of this feasibility study demonstrate that summative scores of swallowing physiology alone are not sufficiently robust to distinguish subtypes of dysphagia in broad, heterogeneous medical categories. Using OT/PT as subtypes only separated gastroenterology from the other categories, suggesting overlap in OT/PT scores between the latter categories.
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Affiliation(s)
| | - Kent E. Armeson
- Biostatistics Shared Resource, Hollings Cancer Center, Medical University of South Carolina, Charleston
| | - Elizabeth G. Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
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Ford ME, Bryant DC, Cartmell KB, Sterba K, Burshell DR, Hill EG, Toma AD, Knight KD, Weaver K, Calhoun E, Esnaola NF. Abstract A23: Interim Recruitment Outcomes in an NCORP-Based Patient Navigation Trial for African Americans with Early Stage Lung Cancer. Cancer Epidemiol Biomarkers Prev 2018. [DOI: 10.1158/1538-7755.disp17-a23] [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] Open
Abstract
Abstract
Background: Enrollment of early-stage lung cancer patients to randomized trials has historically been challenging. The STARS Trial enrolled 36 of 1,030 intended patients from 28 sites, while the ROSEL Trial recruited 22 of 960 intended patients from 10 sites. Unfortunately, evidence shows African Americans with early-stage non-small cell lung cancer (NSCLC) are significantly less likely than their European American counterparts to undergo resection and may also be less likely to participate in lung cancer trials as well.
Purpose: The purpose of this research is to describe interim recruitment results from an NIMHD-funded, NCI NCORP-based patient navigation trial conducted with African Americans with early-stage, probable/proven NSCLC.
Design: The protocol-driven, barriers-focused patient navigation intervention is being conducted in the context of a two-arm cluster-randomized trial testing the effectiveness of the intervention in increasing rates of lung-directed curative-intent therapy (surgery and SBRT) in African Americans with Stage I-II NSCLC. The two study arms consist of the protocol-driven, intensive navigation intervention vs. usual care. The trial includes 24 study sites in 13 U.S. states. Specific activities to enhance recruitment in the present trial include reaching out to referring physicians (e.g., primary care, pulmonologists, radiologists) to increase referrals of African American patients to the participating NCORP sites, and partnering with the leaders of community-engagement activities at the sites to raise community-level awareness of the trial.
Results/Conclusions: To date, 90 African American patients have been recruited and the trial is now on target to meet its expected accrual goal of 200 patients. The majority of potential participants were ineligible due to receipt of surgical resection or radiation therapy prior to enrollment (27%), not having been told that they had probable/proven NSCLC prior to study contact (32%), or a previous history of lung cancer (10%). Only 13 potential participants have refused trial participation. The median age of the 90 participants is 66 years (range 51-86 years). Most are unmarried (64%) and have a high school diploma or less (73%). Only 10 of the participants (24%) have no comorbidities. The number of enrolled-to-date African American participants in this ongoing trial exceeds the total number of participants recruited to the STARS Trial or to the ROSEL Trial.
Citation Format: Marvella E. Ford, Debbie C. Bryant. Kathleen B. Cartmell, Katherine Sterba, Dana R. Burshell, Elizabeth G. Hill, Allan De Toma, Kendrea D. Knight, Kathryn Weaver Elizabeth Calhoun, Nestor F. Esnaola. Interim Recruitment Outcomes in an NCORP-Based Patient Navigation Trial for African Americans with Early Stage Lung Cancer [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A23.
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Affiliation(s)
- Marvella E. Ford
- 1Medical University of South Carolina (MUSC), Charleston, SC,
- 2MUSC Hollings Cancer Center, Charleston, SC,
| | - Debbie C. Bryant
- 1Medical University of South Carolina (MUSC), Charleston, SC,
- 2MUSC Hollings Cancer Center, Charleston, SC,
- 3MUSC College of Nursing, Charleston, SC,
| | - Kathleen B. Cartmell
- 1Medical University of South Carolina (MUSC), Charleston, SC,
- 2MUSC Hollings Cancer Center, Charleston, SC,
- 3MUSC College of Nursing, Charleston, SC,
| | - Katherine Sterba
- 1Medical University of South Carolina (MUSC), Charleston, SC,
- 2MUSC Hollings Cancer Center, Charleston, SC,
| | - Dana R. Burshell
- 1Medical University of South Carolina (MUSC), Charleston, SC,
- 2MUSC Hollings Cancer Center, Charleston, SC,
- 3MUSC College of Nursing, Charleston, SC,
| | - Elizabeth G. Hill
- 1Medical University of South Carolina (MUSC), Charleston, SC,
- 2MUSC Hollings Cancer Center, Charleston, SC,
| | - Allan De Toma
- 1Medical University of South Carolina (MUSC), Charleston, SC,
- 2MUSC Hollings Cancer Center, Charleston, SC,
| | - Kendrea D. Knight
- 1Medical University of South Carolina (MUSC), Charleston, SC,
- 2MUSC Hollings Cancer Center, Charleston, SC,
- 3MUSC College of Nursing, Charleston, SC,
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Wallace K, Lewin DN, Sun S, Spiceland CM, Rockey DC, Alekseyenko AV, Wu JD, Baron JA, Alberg AJ, Hill EG. Tumor-Infiltrating Lymphocytes and Colorectal Cancer Survival in African American and Caucasian Patients. Cancer Epidemiol Biomarkers Prev 2018; 27:755-761. [PMID: 29769214 PMCID: PMC6449046 DOI: 10.1158/1055-9965.epi-17-0870] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 09/28/2017] [Revised: 12/08/2017] [Accepted: 05/08/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Compared with Caucasian Americans (CAs), African Americans (AAs) with colorectal cancer have poorer survival, especially younger-age patients. A robust lymphocytic reaction within colorectal cancers is strongly associated with better survival, but whether immune response impacts the disparity in colorectal cancer survival is unknown.Methods: The study population was comprised of 211 histologically confirmed colorectal cancers at the Medical University of South Carolina (Charleston, SC; 159 CAs and 52 AAs) diagnosed between Jan 01, 2000, and June 30, 2013. We constructed a lymphocyte score based on blinded pathologic assessment of the four different types of lymphocytic reactions. Cox proportional hazards regression was used to evaluate the association between the lymphocyte score and risk of death by race.Results: Colorectal cancers in AAs (vs. CAs) had a stronger lymphocytic reaction at diagnosis. A high lymphocyte score (vs. the lowest) was associated with better survival in AAs [HR 0.19; 95% confidence interval (CI), 0.04-0.99] and CAs (HR 0.47; 95% CI, 0.15-1.45). AAs with no lymphocytic reaction (vs. other categories) had poor survival HR 4.48 (1.58-12.7) whereas no difference was observed in CAs. The risk of death in AAs (vs. CA) was more pronounced in younger patients (HR 2.92; 95% CI, 1.18-7.22) compared with older (HR 1.20; 95% CI, 0.54-2.67), especially those with lymphocytic poor colorectal cancers.Conclusions: The lymphocytic reaction in tumor impacted the racial disparity in survival.Impact: Our results confirm the importance of the lymphocytic score on survival and highlight the need to fully characterize the immune environment of colorectal cancers by race. Cancer Epidemiol Biomarkers Prev; 27(7); 755-61. ©2018 AACR.
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Affiliation(s)
- Kristin Wallace
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina.
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - David N Lewin
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Shaoli Sun
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Clayton M Spiceland
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Don C Rockey
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Alexander V Alekseyenko
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Jennifer D Wu
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - John A Baron
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Anthony J Alberg
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Elizabeth G Hill
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
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White S, Irwin R, Warwick JR, Gribakin GF, Sarri G, Keenan FP, Riley D, Rose SJ, Hill EG, Ferland GJ, Han B, Wang F, Zhao G. Production of photoionized plasmas in the laboratory with x-ray line radiation. Phys Rev E 2018; 97:063203. [PMID: 30011508 DOI: 10.1103/physreve.97.063203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Indexed: 06/08/2023]
Abstract
In this paper we report the experimental implementation of a theoretically proposed technique for creating a photoionized plasma in the laboratory using x-ray line radiation. Using a Sn laser plasma to irradiate an Ar gas target, the photoionization parameter, ξ=4πF/N_{e}, reached values of order 50ergcms^{-1}, where F is the radiation flux in ergcm^{-2}s^{-1}. The significance of this is that this technique allows us to mimic effective spectral radiation temperatures in excess of 1 keV. We show that our plasma starts to be collisionally dominated before the peak of the x-ray drive. However, the technique is extendable to higher-energy laser systems to create plasmas with parameters relevant to benchmarking codes used to model astrophysical objects.
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Affiliation(s)
- S White
- School of Mathematics and Physics, Queen's University Belfast, University Road, Belfast BT7 1NN, United Kingdom
| | - R Irwin
- School of Mathematics and Physics, Queen's University Belfast, University Road, Belfast BT7 1NN, United Kingdom
| | - J R Warwick
- School of Mathematics and Physics, Queen's University Belfast, University Road, Belfast BT7 1NN, United Kingdom
| | - G F Gribakin
- School of Mathematics and Physics, Queen's University Belfast, University Road, Belfast BT7 1NN, United Kingdom
| | - G Sarri
- School of Mathematics and Physics, Queen's University Belfast, University Road, Belfast BT7 1NN, United Kingdom
| | - F P Keenan
- School of Mathematics and Physics, Queen's University Belfast, University Road, Belfast BT7 1NN, United Kingdom
| | - D Riley
- School of Mathematics and Physics, Queen's University Belfast, University Road, Belfast BT7 1NN, United Kingdom
| | - S J Rose
- Plasma Physics Group, Blackett Laboratory, Prince Consort Road, London SW7 2AZ, United Kingdom
- Clarendon Laboratory, University of Oxford, Parks Road, Oxford OX1 3PU, United Kingdom
| | - E G Hill
- Plasma Physics Group, Blackett Laboratory, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - G J Ferland
- Department of Physics and Astronomy, University of Kentucky, Lexington, Kentucky 40506, USA
| | - B Han
- Department of Astronomy, Beijing Normal University, Beijing 100875, People's Republic of China
| | - F Wang
- Key Laboratory of Optical Astronomy, National Astronomical Observatories, Chinese Academy of Sciences, Beijing 100012, People's Republic of China
| | - G Zhao
- Key Laboratory of Optical Astronomy, National Astronomical Observatories, Chinese Academy of Sciences, Beijing 100012, People's Republic of China
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Daenthanasanmak A, Wu Y, Iamsawat S, Nguyen HD, Bastian D, Zhang M, Sofi MH, Chatterjee S, Hill EG, Mehrotra S, Kraft AS, Yu XZ. PIM-2 protein kinase negatively regulates T cell responses in transplantation and tumor immunity. J Clin Invest 2018; 128:2787-2801. [PMID: 29781812 DOI: 10.1172/jci95407] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 03/29/2018] [Indexed: 01/03/2023] Open
Abstract
PIM kinase family members play a crucial role in promoting cell survival and proliferation via phosphorylation of their target substrates. In this study, we investigated the role of the PIM kinases with respect to T cell responses in transplantation and tumor immunity. We found that the PIM-2 isoform negatively regulated T cell responses to alloantigen, in contrast to the PIM-1 and PIM-3 isoforms, which acted as positive regulators. T cells deficient in PIM-2 demonstrated increased T cell differentiation toward Th1 subset, proliferation, and migration to target organs after allogeneic bone marrow transplantation, resulting in dramatically accelerated graft-versus-host disease (GVHD) severity. Restoration of PIM-2 expression markedly attenuated the pathogenicity of PIM-2-deficient T cells to induce GVHD. On the other hand, mice deficient in PIM-2 readily rejected syngeneic tumor, which was primarily dependent on CD8+ T cells. Furthermore, silencing PIM-2 in polyclonal or antigen-specific CD8+ T cells substantially enhanced their antitumor response in adoptive T cell immunotherapy. We conclude that PIM-2 kinase plays a prominent role in suppressing T cell responses, and provide a strong rationale to target PIM-2 for cancer immunotherapy.
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Affiliation(s)
| | - Yongxia Wu
- Department of Microbiology and Immunology
| | | | | | | | | | | | | | - Elizabeth G Hill
- Department of Public Health Science, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Andrew S Kraft
- University of Arizona Cancer Center, Tucson, Arizona, USA
| | - Xue-Zhong Yu
- Department of Microbiology and Immunology.,Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Wrangle JM, Velcheti V, Patel MR, Garrett-Mayer E, Hill EG, Ravenel JG, Miller JS, Farhad M, Anderton K, Lindsey K, Taffaro-Neskey M, Sherman C, Suriano S, Swiderska-Syn M, Sion A, Harris J, Edwards AR, Rytlewski JA, Sanders CM, Yusko EC, Robinson MD, Krieg C, Redmond WL, Egan JO, Rhode PR, Jeng EK, Rock AD, Wong HC, Rubinstein MP. ALT-803, an IL-15 superagonist, in combination with nivolumab in patients with metastatic non-small cell lung cancer: a non-randomised, open-label, phase 1b trial. Lancet Oncol 2018; 19:694-704. [PMID: 29628312 DOI: 10.1016/s1470-2045(18)30148-7] [Citation(s) in RCA: 281] [Impact Index Per Article: 46.8] [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: 12/02/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Immunotherapy with PD-1 or PD-L1 blockade fails to induce a response in about 80% of patients with unselected non-small cell lung cancer (NSCLC), and many of those who do initially respond then develop resistance to treatment. Agonists that target the shared interleukin-2 (IL-2) and IL-15Rβγ pathway have induced complete and durable responses in some cancers, but no studies have been done to assess the safety or efficacy of these agonists in combination with anti-PD-1 immunotherapy. We aimed to define the safety, tolerability, and activity of this drug combination in patients with NSCLC. METHODS In this non-randomised, open-label, phase 1b trial, we enrolled patients (aged ≥18 years) with previously treated histologically or cytologically confirmed stage IIIB or IV NSCLC from three academic hospitals in the USA. Key eligibility criteria included measurable disease, eligibility to receive anti-PD-1 immunotherapy, and an Eastern Cooperative Oncology Group performance status of 0 or 1. Patients received the anti-PD-1 monoclonal antibody nivolumab intravenously at 3 mg/kg (then 240 mg when US Food and Drug Administration [FDA]-approved dosing changed) every 14 days (either as new treatment or continued treatment at the time of disease progression) and the IL-15 superagonist ALT-803 subcutaneously once per week on weeks 1-5 of four 6-week cycles for 6 months. ALT-803 was administered at one of four escalating dose concentrations: 6, 10, 15, or 20 μg/kg. The primary endpoint was to define safety and tolerability and to establish a recommended phase 2 dose of ALT-803 in combination with nivolumab. Analyses were per-protocol and included any patients who received at least one dose of study treatment. This trial is registered with ClinicalTrials.gov, number NCT02523469; phase 2 enrolment of patients is ongoing. FINDINGS Between Jan 18, 2016, and June 28, 2017, 23 patients were enrolled and 21 were treated at four dose levels of ALT-803 in combination with nivolumab. Two patients did not receive treatment because of the development of inter-current illness during enrolment, one patient due to leucopenia and one patient due to pulmonary dysfunction. No dose-limiting toxicities were recorded and the maximum tolerated dose was not reached. The most common adverse events were injection-site reactions (in 19 [90%] of 21 patients) and flu-like symptoms (15 [71%]). The most common grade 3 adverse events, occurring in two patients each, were lymphocytopenia and fatigue. A grade 3 myocardial infarction occurred in one patient. No grade 4 or 5 adverse events were recorded. The recommended phase 2 dose of ALT-803 is 20 μg/kg given once per week subcutaneously in combination with 240 mg intravenous nivolumab every 2 weeks. INTERPRETATION ALT-803 in combination with nivolumab can be safely administered in an outpatient setting. The promising clinical activity observed with the addition of ALT-803 to the regimen of patients with PD-1 monoclonal antibody relapsed and refractory disease shows evidence of anti-tumour activity for a new class of agents in NSCLC. FUNDING Altor BioScience (a NantWorks company), National Institutes of Health, and Medical University of South Carolina Hollings Cancer Center.
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Affiliation(s)
- John M Wrangle
- Department of Medicine, Division of Hematology and Oncology, and Department of Surgery Medical University of South Carolina, Charleston, SC, USA
| | | | - Manish R Patel
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Elizabeth Garrett-Mayer
- Department of Medicine, Division of Hematology and Oncology, and Department of Surgery Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth G Hill
- Department of Medicine, Division of Hematology and Oncology, and Department of Surgery Medical University of South Carolina, Charleston, SC, USA
| | - James G Ravenel
- Department of Medicine, Division of Hematology and Oncology, and Department of Surgery Medical University of South Carolina, Charleston, SC, USA
| | - Jeffrey S Miller
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | | | - Kate Anderton
- Department of Medicine, Division of Hematology and Oncology, and Department of Surgery Medical University of South Carolina, Charleston, SC, USA
| | - Kathryn Lindsey
- Department of Medicine, Division of Hematology and Oncology, and Department of Surgery Medical University of South Carolina, Charleston, SC, USA
| | - Michele Taffaro-Neskey
- Department of Medicine, Division of Hematology and Oncology, and Department of Surgery Medical University of South Carolina, Charleston, SC, USA
| | - Carol Sherman
- Department of Medicine, Division of Hematology and Oncology, and Department of Surgery Medical University of South Carolina, Charleston, SC, USA
| | - Samantha Suriano
- Department of Medicine, Division of Hematology and Oncology, and Department of Surgery Medical University of South Carolina, Charleston, SC, USA
| | - Marzena Swiderska-Syn
- Department of Medicine, Division of Hematology and Oncology, and Department of Surgery Medical University of South Carolina, Charleston, SC, USA
| | - Amy Sion
- Department of Medicine, Division of Hematology and Oncology, and Department of Surgery Medical University of South Carolina, Charleston, SC, USA
| | - Joni Harris
- Department of Medicine, Division of Hematology and Oncology, and Department of Surgery Medical University of South Carolina, Charleston, SC, USA
| | - Andie R Edwards
- Department of Medicine, Division of Hematology and Oncology, and Department of Surgery Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | - Mark D Robinson
- Institute of Molecular Life Sciences, University of Zurich, Zurich, Switzerland
| | - Carsten Krieg
- Department of Medicine, Division of Hematology and Oncology, and Department of Surgery Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | | | | | | | - Mark P Rubinstein
- Department of Medicine, Division of Hematology and Oncology, and Department of Surgery Medical University of South Carolina, Charleston, SC, USA.
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Peterson YK, Nasarre P, Bonilla IV, Hilliard E, Samples J, Morinelli TA, Hill EG, Klauber-DeMore N. Frizzled-5: a high affinity receptor for secreted frizzled-related protein-2 activation of nuclear factor of activated T-cells c3 signaling to promote angiogenesis. Angiogenesis 2017; 20:615-628. [PMID: 28840375 DOI: 10.1007/s10456-017-9574-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 01/30/2017] [Accepted: 08/15/2017] [Indexed: 11/30/2022]
Abstract
Secreted frizzled-related protein 2 (SFRP2) is a pro-angiogenic factor expressed in the vasculature of a wide variety of human tumors, and modulates angiogenesis via the calcineurin-dependent nuclear factor of activated T-cells cytoplasmic 3 (NFATc3) pathway in endothelial cells. However, until now, SFRP2 receptor for this pathway was unknown. In the present study, we first used amino acid alignments and molecular modeling to demonstrate that SFRP2 interaction with frizzled-5 (FZD5) is typical of Wnt/FZD family members. To confirm this interaction, we performed co-immunofluorescence, co-immunoprecipitation, and ELISA binding assays, which demonstrated SFRP2/FZD5 binding. Functional knock-down studies further revealed that FZD5 is necessary for SFRP2-induced tube formation and intracellular calcium flux in endothelial cells. Using protein analysis on endothelial cell nuclear extracts, we also discovered that FZD5 is required for SFRP2-induced activation of NFATc3. Our novel findings reveal that FZD5 is a receptor for SFRP2 and mediates SFRP2-induced angiogenesis via calcineurin/NFATc3 pathway in endothelial cells.
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Affiliation(s)
- Yuri K Peterson
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Patrick Nasarre
- Department of Surgery, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Ingrid V Bonilla
- Department of Surgery, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Eleanor Hilliard
- Department of Surgery, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Jennifer Samples
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Thomas A Morinelli
- Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Elizabeth G Hill
- Department of Public Health Science, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Nancy Klauber-DeMore
- Department of Surgery, Medical University of South Carolina, Charleston, SC, 29425, USA.
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Jordan Hazelwood R, Armeson KE, Hill EG, Bonilha HS, Martin-Harris B. Identification of Swallowing Tasks From a Modified Barium Swallow Study That Optimize the Detection of Physiological Impairment. J Speech Lang Hear Res 2017; 60:1855-1863. [PMID: 28614846 PMCID: PMC5831085 DOI: 10.1044/2017_jslhr-s-16-0117] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 12/29/2016] [Indexed: 05/04/2023]
Abstract
PURPOSE The purpose of this study was to identify which swallowing task(s) yielded the worst performance during a standardized modified barium swallow study (MBSS) in order to optimize the detection of swallowing impairment. METHOD This secondary data analysis of adult MBSSs estimated the probability of each swallowing task yielding the derived Modified Barium Swallow Impairment Profile (MBSImP™©; Martin-Harris et al., 2008) Overall Impression (OI; worst) scores using generalized estimating equations. The range of probabilities across swallowing tasks was calculated to discern which swallowing task(s) yielded the worst performance. RESULTS Large-volume, thin-liquid swallowing tasks had the highest probabilities of yielding the OI scores for oral containment and airway protection. The cookie swallowing task was most likely to yield OI scores for oral clearance. Several swallowing tasks had nearly equal probabilities (≤ .20) of yielding the OI score. CONCLUSIONS The MBSS must represent impairment while requiring boluses that challenge the swallowing system. No single swallowing task had a sufficiently high probability to yield the identification of the worst score for each physiological component. Omission of swallowing tasks will likely fail to capture the most severe impairment for physiological components critical for safe and efficient swallowing. Results provide further support for standardized, well-tested protocols during MBSS.
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Affiliation(s)
- R. Jordan Hazelwood
- Medical University of South Carolina, College of Health Professions, Department of Health Sciences and Research, Charleston
- Medical University of South Carolina, College of Medicine, Department of Otolaryngology–Head and Neck Surgery, Charleston
- Appalachian State University, Beaver College of Heath Sciences, Department of Communication Sciences and Disorders, Boone, NC
| | - Kent E. Armeson
- Medical University of South Carolina, College of Medicine, Department of Public Health Sciences, Charleston
| | - Elizabeth G. Hill
- Medical University of South Carolina, College of Medicine, Department of Public Health Sciences, Charleston
| | - Heather Shaw Bonilha
- Medical University of South Carolina, College of Health Professions, Department of Health Sciences and Research, Charleston
- Medical University of South Carolina, College of Medicine, Department of Otolaryngology–Head and Neck Surgery, Charleston
| | - Bonnie Martin-Harris
- Medical University of South Carolina, College of Health Professions, Department of Health Sciences and Research, Charleston
- Medical University of South Carolina, College of Medicine, Department of Otolaryngology–Head and Neck Surgery, Charleston
- Northwestern University, School of Communication, Department of Communication Sciences and Disorders, Evanston, IL
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McGrattan KE, McGhee H, DeToma A, Hill EG, Zyblewski SC, Lefton-Greif M, Halstead L, Bradley SM, Martin-Harris B. Dysphagia in infants with single ventricle anatomy following stage 1 palliation: Physiologic correlates and response to treatment. CONGENIT HEART DIS 2017; 12:382-388. [PMID: 28244680 DOI: 10.1111/chd.12456] [Citation(s) in RCA: 20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/17/2016] [Accepted: 02/03/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Deficits in swallowing physiology are a leading morbidity for infants with functional single ventricles and systemic outflow tract obstruction following stage 1 palliation. Despite the high prevalence of this condition, the underlying deficits that cause this post-operative impairment remain poorly understood. OBJECTIVE Identify the physiologic correlates of dysphagia in infants with functional single ventricles and systemic outflow tract obstruction following stage 1 palliative surgery. METHODS Postoperative fiberoptic laryngoscopies and videofluoroscopic swallow studies (VFSS) were conducted sequentially on infants with functional single ventricles following stage 1 palliative surgery. Infants were dichotomized as having normal or impaired laryngeal function based on laryngoscopy findings. VFSS were evaluated frame-by-frame using a scale that quantifies performance within 11 components of swallowing physiology. Physiologic attributes within each component were categorized as high functioning or low functioning based on their ability to support milk ingestion without bolus airway entry. RESULTS Thirty-six infants (25 male) were included in the investigation. Twenty-four underwent the Norwood procedure and twelve underwent the Hybrid procedure. Low function physiologic patterns were observed within multiple swallowing components during the ingestion of thin barium as characterized by ≥4 sucks per swallow (36%), initiation of pharyngeal swallow below the level of the valleculae (83%), and incomplete late laryngeal vestibular closure (56%) at the height of the swallow. Swallowing deficits contributed to aspiration in 50% of infants. Although nectar thick liquids reduced the rate of aspiration (P = .006), aspiration rates remained high (27%). No differences in rates of penetration or aspiration were observed between infants with normal and impaired laryngeal function. CONCLUSIONS Deficits in swallowing physiology contribute to penetration and aspiration following stage 1 palliation among infants with normal and impaired laryngeal function. Although thickened liquids may improve airway protection for select infants, they may inhibit their ability to extract the bolus and meet nutritional needs.
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Affiliation(s)
- Katlyn Elizabeth McGrattan
- Department of Otolaryngology Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.,Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, South Carolina.,Department of Speech Language Pathology, Medical University of South Carolina, Charleston, South Carolina.,Department of Health Sciences and Research, Medical University of South Carolina, Charleston, South Carolina
| | - Heather McGhee
- Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, South Carolina.,Department of Speech Language Pathology, Medical University of South Carolina, Charleston, South Carolina
| | - Allan DeToma
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Elizabeth G Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Sinai C Zyblewski
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Maureen Lefton-Greif
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lucinda Halstead
- Department of Otolaryngology Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.,Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, South Carolina
| | - Scott M Bradley
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Bonnie Martin-Harris
- Department of Otolaryngology Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.,Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, South Carolina.,Department of Speech Language Pathology, Medical University of South Carolina, Charleston, South Carolina.,Department of Health Sciences and Research, Medical University of South Carolina, Charleston, South Carolina
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Ford ME, Bryant DC, Cartmell KB, Sterba K, Burshell DR, Hill EG, Toma AD, Knight KD, Weaver K, Calhoun E, Esnaola NF. Abstract A72: Interim Recruitment Outcomes in an NCORP-Based Patient Navigation Trial for African Americans with Early Stage Lung Cancer. Cancer Epidemiol Biomarkers Prev 2017. [DOI: 10.1158/1538-7755.disp16-a72] [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] Open
Abstract
Abstract
BACKGROUND: Enrollment of early stage lung cancer patients to randomized trials has historically been challenging. The STARS Trial enrolled 36 of 1,030 intended patients from 28 sites, while the ROSEL Trial recruited 22 of 960 intended patients from 10 sites. Unfortunately, evidence shows African Americans with early stage, NSCLC are significantly less likely than their European American counterparts to undergo resection and may also be less likely to participate in lung cancer trials as well.
PURPOSE: The purpose of this research is to describe interim recruitment results from an NIMHD-funded, NCI NCORP-based patient navigation trial conducted with African Americans with early stage, probable/proven non-small cell lung cancer (NSCLC).
DESIGN: The protocol-driven, barriers-focused patient navigation intervention is being conducted in the context of a two-arm cluster-randomized trial testing the effectiveness of the intervention in increasing rates of lung-directed curative-intent therapy (surgery and SBRT) in African Americans with Stage I-II NSCLC. The 2 study arms consist of the protocol-driven, intensive navigation intervention vs. usual care. The trial includes 24 study sites in 13 US states. Specific activities to enhance recruitment in the present trial include reaching out to referring physicians (e.g., primary care, pulmonologists, radiologists) to increase referrals of African American patients to the participating NCORP sites, and partnering with the leaders of community engagement activities at the sites to raise community-level awareness of the trial.
RESULTS/CONCLUSIONS: To date, 64 African American patients have been recruited and the trial is now on target to meet its expected accrual goal of 200 patients. The majority of potential participants were ineligible due to receipt of surgical resection or radiation therapy prior to enrollment (32%), not having been told that they had probable/proven NSCLC prior to study contact (13%) or a previous history of lung cancer (13%). Only 9 potential participants have refused trial participation. The median age of the 64 participants is 64 years (range 37-86 years). Most are unmarried (64%) and have a high school diploma or less (72%). Only 13 of the participants (20%) have no comorbidities. The number of enrolled-to-date African American participants in this ongoing trial exceeds the total number of participants recruited to the STARS Trial or to the ROSEL Trial.
Citation Format: Marvella E. Ford, Debbie C. Bryant, Kathleen B. Cartmell, Katherine Sterba, Dana R. Burshell, Elizabeth G. Hill, Allan De Toma, Kendrea D. Knight, Kathryn Weaver, Elizabeth Calhoun, Nestor F. Esnaola. Interim Recruitment Outcomes in an NCORP-Based Patient Navigation Trial for African Americans with Early Stage Lung Cancer. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A72.
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Affiliation(s)
- Marvella E. Ford
- 1Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | - Debbie C. Bryant
- 2Medical University of South Carolina (MUSC) College of Nursing, Charleston, SC,
| | - Kathleen B. Cartmell
- 2Medical University of South Carolina (MUSC) College of Nursing, Charleston, SC,
| | - Katherine Sterba
- 1Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | - Dana R. Burshell
- 2Medical University of South Carolina (MUSC) College of Nursing, Charleston, SC,
| | - Elizabeth G. Hill
- 1Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | - Allan De Toma
- 1Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
| | - Kendrea D. Knight
- 1Medical University of South Carolina (MUSC) Hollings Cancer Center, Charleston, SC,
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Abstract
PURPOSE The purpose of this study was to explore the relationship among health literacy, patients' readiness to take health actions, and diabetes knowledge among individuals with type 2 diabetes. METHODS Sixty-eight patients with type 2 diabetes receiving care in an academic general internal medicine clinic were administered the Rapid Estimate of Adult Literacy in Medicine (REALM) literacy instrument prior to completing the Diabetes Health Belief Model (DHBM) scale and Diabetes Knowledge Test (DKT). Multivariable linear regression was used to assess the association between REALM literacy level, DKT score, DHBM scale score, and most recent hemoglobin A1C level while controlling for other covariates of interest. RESULTS After controlling for other covariates of interest, no significant association between DHBM scale score and REALM literacy level was found (P = .29). However, both DKT score and most recent hemoglobin A1Clevel were found to be significantly associated with patient literacy (P = .004 and P = .02, respectively). Based on the multivariable model, patients with less than a fourth-grade literacy level had 13% lower DKT scores (95% confidence interval [CI], -28% to -2%; P = .08) and 1.36% higher most recent hemoglobin A1Clevels (95% CI, 1.06% to 1.73%; P = .02) relative to those with a high school literacy level. CONCLUSIONS Low health literacy is a problem faced by many patients that affects their ability to navigate the health care system and manage their chronic illnesses. While low health literacy was significantly associated with worse glycemic control and poorer disease knowledge in patients with type 2 diabetes, there was no significant relationship with their readiness to take action in disease management.
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Affiliation(s)
- Caroline K Powell
- The Department of Medicine, Medical University of South Carolina, Charleston (Dr Powell, Dr Clancy)
| | - Elizabeth G Hill
- The Department of Biostatistics, Bioinformatics and Epidemiology, Medical University of South Carolina, Charleston (Dr Hill)
| | - Dawn E Clancy
- The Department of Medicine, Medical University of South Carolina, Charleston (Dr Powell, Dr Clancy)
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50
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Wallace K, DeToma A, Lewin DN, Sun S, Rockey D, Britten CD, Wu JD, Ba A, Alberg AJ, Hill EG. Racial Differences in Stage IV Colorectal Cancer Survival in Younger and Older Patients. Clin Colorectal Cancer 2016; 16:178-186. [PMID: 28065664 DOI: 10.1016/j.clcc.2016.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 07/21/2016] [Revised: 09/24/2016] [Accepted: 11/14/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION African Americans (AAs) compared with European Americans (EAs) have poorer stage-specific survival from colorectal cancer (CRC). Recent reports have indicated that the racial difference in survival has worsened over time, especially among younger patients. To better characterize this association, we used population-based Surveillance, Epidemiology, and End Results registry data to evaluate the effect of race on stage IV CRC survival in patients aged < 50 and ≥ 50 years. PATIENTS AND METHODS The population included 16,782 patients diagnosed with stage IV colon and rectal adenocarcinoma from January 1, 2004 and December 31, 2011. Cox proportional hazards regression was used to evaluate the association between race and other prognostic factors and the risk of death in each age group. RESULTS Younger AAs compared with EAs had a greater prevalence of proximal CRC at diagnosis, a factor associated with a significantly greater risk of death in both races. Among patients < 50 years old, AAs had a greater risk of death compared with EAs (hazard ratio, 1.35; 95% confidence interval, 1.20-1.51), which was attenuated in patients ≥ 50 years of age (hazard ratio, 1.10; 95% confidence interval, 1.04-1.16); P for interaction = .01. CONCLUSION The results revealed poor overall survival for AAs compared with EAs, especially for those < 50 years of age. The greater prevalence of proximal CRC at diagnosis among younger AAs (vs. EAs) might contribute to the racial difference in survival. Future studies are needed to understand how the colonic location affects the efficacy of treatment regimens.
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Affiliation(s)
- Kristin Wallace
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.
| | - Allan DeToma
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - David N Lewin
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
| | - Shaoli Sun
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
| | - Don Rockey
- Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Carolyn D Britten
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Division of Hematology and Oncology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Jennifer D Wu
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Aissatou Ba
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Anthony J Alberg
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Elizabeth G Hill
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
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