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Pal SK, Tran B, Haanen JBAG, Hurwitz ME, Sacher A, Tannir NM, Budde LE, Harrison SJ, Klobuch S, Patel SS, Meza L, Dequeant ML, Ma A, He QA, Williams LM, Keegan A, Gurary EB, Dar H, Karnik S, Guo C, Heath H, Yuen RR, Morrow PK, Agarwal N, Srour SA. CD70-Targeted Allogeneic CAR T-Cell Therapy for Advanced Clear Cell Renal Cell Carcinoma. Cancer Discov 2024:OF1-OF14. [PMID: 38583184 DOI: 10.1158/2159-8290.cd-24-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/08/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024]
Abstract
Therapeutic approaches for clear cell renal cell carcinoma (ccRCC) remain limited; however, chimeric antigen receptor (CAR) T-cell therapies may offer novel treatment options. CTX130, an allogeneic CD70-targeting CAR T-cell product, was developed for the treatment of advanced or refractory ccRCC. We report that CTX130 showed favorable preclinical proliferation and cytotoxicity profiles and completely regressed RCC xenograft tumors. We also report results from 16 patients with relapsed/refractory ccRCC who received CTX130 in a phase I, multicenter, first-in-human clinical trial. No patients encountered dose-limiting toxicity, and disease control was achieved in 81.3% of patients. One patient remains in a durable complete response at 3 years. Finally, we report on a next-generation CAR T construct, CTX131, in which synergistic potency edits to CTX130 confer improved expansion and efficacy in preclinical studies. These data represent a proof of concept for the treatment of ccRCC and other CD70+ malignancies with CD70-targeted allogeneic CAR T cells. SIGNIFICANCE Although the role of CAR T cells is well established in hematologic malignancies, the clinical experience in solid tumors has been disappointing. This clinical trial demonstrates the first complete response in a patient with RCC, reinforcing the potential benefit of CAR T cells in the treatment of solid tumors.
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Affiliation(s)
- Sumanta K Pal
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Ben Tran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - John B A G Haanen
- Netherlands Cancer Institute, Amsterdam, the Netherlands
- Leiden University Medical Center, Leiden, the Netherlands
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Adrian Sacher
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Departments of Medicine and Immunology, University of Toronto, Toronto, Canada
| | - Nizar M Tannir
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lihua E Budde
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Simon J Harrison
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Sagar S Patel
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Luis Meza
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | | | - Anna Ma
- CRISPR Therapeutics, Boston, Massachusetts
| | | | | | | | - Ellen B Gurary
- Formerly employed by CRISPR Therapeutics, Boston, Massachusetts
| | - Henia Dar
- CRISPR Therapeutics, Boston, Massachusetts
| | | | - Changan Guo
- Formerly employed by CRISPR Therapeutics, Boston, Massachusetts
| | | | | | - Phuong K Morrow
- Formerly employed by CRISPR Therapeutics, Boston, Massachusetts
| | - Neeraj Agarwal
- Division of Medical Onco-logy, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Samer A Srour
- University of Texas MD Anderson Cancer Center, Houston, Texas
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Malloy J, Berry E, Correia A, Fragala-Pinkham M, Coucci S, Riley S, Spratt J, Knight Pfaffinger J, Massaro J, Ehrbar R, D'Agostino R, Gurary EB, Gordon LB, Kleinman ME. Baseline Range of Motion, Strength, Motor Function, and Participation in Youth with Hutchinson-Gilford Progeria Syndrome. Phys Occup Ther Pediatr 2023; 43:482-501. [PMID: 36628480 PMCID: PMC10496152 DOI: 10.1080/01942638.2022.2158054] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 11/17/2022] [Accepted: 12/05/2022] [Indexed: 01/12/2023]
Abstract
AIMS Limited information is available on impairments, activity limitations and participation restrictions in youth with Hutchinson-Gilford progeria syndrome (HGPS), a rare genetic premature aging disease. The purposes were to: (1) describe range of motion (ROM), grip, pinch and quadriceps strength, functional balance, walking endurance, and gross motor limitations and participation restrictions; (2) evaluate the association between ROM impairments and age; and (3) evaluate the association between the Gross Motor Function Measure-88 (GMFM) scores and lower extremity (LE) ROM, quadriceps strength, and age. METHODS Upper and LE ROM, grip, pinch and quadriceps strength, Timed Up and Go (TUG), Six Minute Walk Test, GMFM-88, and Canadian Occupational Performance Measure data were recorded for 38 participants with HGPS. RESULTS All youth exhibited ROM impairments and most displayed decreased grip and pinch strength, walking endurance, and gross motor skills when compared to same-aged peers. However, the majority had good functional balance with TUG scores in the normal range. Participation restrictions included difficulty keeping up with peers when walking and difficulty completing activities of daily living. Some ROM measurements were negatively associated with age indicating that older participants had more extensive ROM limitation than younger participants. CONCLUSIONS Physical and occupational therapists can use this information when evaluating youth with HGPS, designing a plan of care, and providing treatment interventions.
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Affiliation(s)
- Julie Malloy
- Department of Physical and Occupational Therapy Services, Boston Children's Hospital, Boston, MA, USA
| | - Emily Berry
- Department of Physical and Occupational Therapy Services, Boston Children's Hospital, Boston, MA, USA
| | - Annette Correia
- Department of Physical and Occupational Therapy Services, Boston Children's Hospital, Boston, MA, USA
| | - Maria Fragala-Pinkham
- Department of Physical and Occupational Therapy Services, Boston Children's Hospital, Boston, MA, USA
| | - Sarah Coucci
- Department of Physical and Occupational Therapy Services, Boston Children's Hospital, Boston, MA, USA
| | - Susan Riley
- Department of Physical and Occupational Therapy Services, Boston Children's Hospital, Boston, MA, USA
| | - Jessica Spratt
- Department of Physical and Occupational Therapy Services, Boston Children's Hospital, Boston, MA, USA
| | - Jessica Knight Pfaffinger
- Department of Physical and Occupational Therapy Services, Boston Children's Hospital, Boston, MA, USA
| | - Joe Massaro
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Rachel Ehrbar
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Ralph D'Agostino
- Department of Mathematics and Statistics, Boston University, Boston, MA, USA
| | - Ellen B Gurary
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Leslie B Gordon
- Department of Anesthesiology, Preoperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Hasbro Children's Hospital and Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Monica E Kleinman
- Department of Anesthesiology, Preoperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
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Kudo M, Finn RS, Edeline J, Cattan S, Ogasawara S, Palmer DH, Verslype C, Zagonel V, Fartoux L, Vogel A, Sarker D, Verset G, Chan SL, Knox J, Daniele B, Yau T, Gurary EB, Siegel AB, Wang A, Cheng AL, Zhu AX. Updated efficacy and safety of KEYNOTE-224: a phase II study of pembrolizumab in patients with advanced hepatocellular carcinoma previously treated with sorafenib. Eur J Cancer 2022; 167:1-12. [PMID: 35364421 DOI: 10.1016/j.ejca.2022.02.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [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: 07/26/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Pembrolizumab, a PD-1 inhibitor, demonstrated anti-tumour activity and tolerability in patients treated with sorafenib and with advanced hepatocellular carcinoma in KEYNOTE-224. Longer-term efficacy and safety after ∼2.5 years of additional follow-up are reported. PATIENTS AND METHODS Adults with confirmed hepatocellular carcinoma who experienced progression after or intolerance to sorafenib treatment received pembrolizumab 200 mg every 3 weeks for ≤35 cycles or until confirmed progression, unacceptable toxicity, withdrawal of consent or investigator decision. The primary end-point was objective response rate assessed by blinded independent central review per Response Evaluation Criteria in Solid Tumours v1.1. The secondary end-points included duration of response, disease control rate, time to progression, progression-free survival, overall survival and adverse events. RESULTS Efficacy and safety were assessed in 104 patients. The median time from first dose to data cutoff was 45.1 months (range, 41.3-49.3). Objective response rate was 18.3% (95% CI: 11.4-27.1), and median duration of response was 21.0 months (range, 3.1 to 39.5+). Disease control rate was 61.5%, and median time to progression was 4.8 months (95% CI: 3.9-7.0). Median progression-free survival was 4.9 months (95% CI: 3.5-6.7) and median overall survival was 13.2 months (95% CI: 9.7-15.3). Of 104 patients, 76 (73.1%) patients reported treatment-related adverse events; most were low grade in severity (grade 3-4, n = 26 [25.0%]; grade 5, n = 1 [1.0%]). Immune-mediated hepatitis occurred in 3 patients (all grade 3). No viral-induced hepatitis flares occurred. CONCLUSIONS After ∼2.5 years of additional follow-up, pembrolizumab continued to provide durable anti-tumour activity and no new safety concerns were identified. CLINICALTRIALS GOV IDENTIFIER NCT02702414.
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Affiliation(s)
- Masatoshi Kudo
- Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan.
| | - Richard S Finn
- University of California, 10833 Le Conte Avenue, Los Angeles, CA, USA.
| | - Julien Edeline
- Centre Eugene Marquis, Avenue de la Bataille Flandres-Dunkerque, Rennes, France.
| | | | - Sadahisa Ogasawara
- Chiba University Graduate School of Medicine, Inohana Campus 1-8-1, Inohana, Chuo-ku, Chiba, Japan.
| | - Daniel H Palmer
- CR UK Liverpool Experimental Cancer Medicine Centre, 5 Pembroke Place, Liverpool, UK; Clatterbridge Cancer Centre, Liverpool, UK.
| | - Chris Verslype
- University Hospitals Leuven, Herestraat 49, Leuven, Belgium.
| | - Vittorina Zagonel
- Istituto Oncologico Veneto IOV-IRCCS, Via Gattamelata, 64, Padua, Italy.
| | - Laetitia Fartoux
- The Hospital Group Saint Joseph, 47-83 Boulevard de l'Hôpital, Paris, France.
| | - Arndt Vogel
- Medizinische Hochschule, Carl-Neuberg-Strasse 1, Hannover, Germany.
| | | | - Gontran Verset
- Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, Brussels, Belgium.
| | - Stephen L Chan
- State Key Laboratory of Oncology in South China, The Chinese University of Hong Kong, Shatin, LG, LKS Specialist Clinic (North Wing), Hong Kong, China.
| | - Jennifer Knox
- Princess Margaret Cancer Centre and University of Toronto, 610 University Avenue, Toronto, Ontario, Canada.
| | | | - Thomas Yau
- University of Hong Kong, Queen Mary Hospital, Hong Kong, 102 Pok Fu Lam Rd, Hong Kong, China.
| | - Ellen B Gurary
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, USA.
| | - Abby B Siegel
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, USA.
| | - Anran Wang
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, USA.
| | - Ann-Lii Cheng
- National Taiwan University Cancer Center, No. 57, Lane 155, Keelung 3rd Road, Taipei, Taiwan.
| | - Andrew X Zhu
- Massachusetts General Hospital Cancer Center and Harvard Medical School, 55 Fruit Street, Boston, MA, USA; Jiahui International Cancer Center, Jiahui Health, Shanghai, China.
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Kim TW, Taieb J, Gurary EB, Lerman N, Cui K, Yoshino T. Olaparib with or without bevacizumab or bevacizumab and 5-fluorouracil in advanced colorectal cancer: Phase III LYNK-003. Future Oncol 2021; 17:5013-5022. [PMID: 34779646 DOI: 10.2217/fon-2021-0899] [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: 12/24/2022] Open
Abstract
Oxaliplatin-based chemotherapy with a regimen such as FOLFOX with or without targeted therapy is a standard of care option for advanced colorectal cancer; however, long-term exposure to oxaliplatin is associated with cumulative toxicity. Growing evidence suggests maintenance therapy with a less intensive regimen after platinum-based induction therapy can provide continuing benefit with reduced toxicity. We describe the rationale and design of the Phase III LYNK-003 trial, which will evaluate the efficacy and safety of olaparib with or without bevacizumab compared with 5-fluoruracil plus bevacizumab in patients with unresectable or metastatic colorectal cancer that has not progressed on an induction course of FOLFOX plus bevacizumab. The primary end point is progression-free survival by independent central review; secondary end points include overall survival, objective response, duration of response and safety. Clinical trial registration: NCT04456699.
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Affiliation(s)
- Tae Won Kim
- Department of Oncology, Asan Medical Center, University of Ulsan, Seoul 05505, South Korea
| | - Julien Taieb
- Georges Pompidou European Hospital, SIRIC-CARPEM, Université de Paris, Paris 75015, France
| | - Ellen B Gurary
- Oncology Late Stage Development, Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - Nati Lerman
- Oncology Late Stage Development, Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - Karen Cui
- Late Development Oncology, Oncology R&D, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Takayuki Yoshino
- Department of Gastrointestinal Medicine, National Cancer Center Hospital East, Kashiwa 277-8577, Japan
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Mayo CA, Gurary EB, Marinello P. Olaparib ± bevacizumab versus bevacizumab + fluorouracil in patients with unresectable or metastatic colorectal cancer not progressing on first-line FOLFOX + bevacizumab: Phase III LYNK-003 study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.tps156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS156 Background: Patients with metastatic colorectal cancer (CRC) often receive intensive platinum-based regimens, such as FOLFOX (fluorouracil [5-FU], leucovorin, oxaliplatin), as first-line (1L) therapy. For patients who do not progress during 1L platinum-based induction therapy, maintenance with a less intensive regimen can enhance clinical benefit and reduce toxicity. The CAIRO3 study showed a progression-free survival (PFS) benefit and a trend toward overall survival (OS) benefit in patients who received maintenance treatment with a fluoropyrimidine and bevacizumab versus observation following induction treatment of six cycles of platinum-based therapy. Olaparib is an oral PARP inhibitor that has efficacy in platinum-sensitive cancers. The randomized, open-label, phase 3 LYNK-003 trial will investigate the efficacy and safety of olaparib, alone or with bevacizumab, compared with bevacizumab plus 5-FU in advanced CRC that has not progressed during 1L induction treatment with FOLFOX plus bevacizumab. Methods: Patients aged ≥18 years with histologically confirmed metastatic or unresectable CRC that has not progressed after 1L induction of ≥6 cycles of FOLFOX plus bevacizumab and who can no longer tolerate oxaliplatin are eligible. Patients must have an ECOG performance status of 0-1, adequate organ function, and provide tumor tissue for biomarker analysis. Patients will be randomly assigned 1:1:1 to olaparib 300 mg twice-daily (BID), olaparib 300 mg BID plus bevacizumab 5 mg/kg every 2 weeks (Q2W), or bevacizumab 5 mg/kg Q2W plus 5-FU 2400 mg/m2 over 46-48 hours Q2W. Randomization will be stratified by response to prior FOLFOX plus bevacizumab (stable disease vs partial response/complete response), mutation status ( BRAFmut and/or Rasmut vs BRAFwt plus Raswt), and number of prior FOLFOX plus bevacizumab cycles (6-8 vs > 8 cycles). Response will be assessed by computed tomography or contrast-enhanced magnetic resonance imaging per RECIST 1.1 by blinded independent central review (BICR) every 8 weeks for the first 12 months and every 12 weeks thereafter. Treatment will continue until documented disease progression, unacceptable toxicity, investigator’s decision to discontinue, or patient withdrawal. The primary endpoint is PFS per RECIST 1.1 by BICR. Secondary endpoints are OS, objective response rate, duration of response, and safety. Approximately 525 patients will be enrolled. Currently, patients are being enrolled at 18 locations in 4 countries. Clinical trial information: NCT04456699.
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Kudo M, Finn RS, Edeline J, Cattan S, Ogasawara S, Palmer DH, Verslype C, Zagonel V, Fartoux L, Vogel A, Sarker D, Verset G, Chan SL, Knox JJ, Daniele B, Gurary EB, Siegel AB, Jain L, Cheng AL, Zhu AX. Updated efficacy and safety of KEYNOTE-224: A phase II study of pembrolizumab (pembro) in patients with advanced hepatocellular carcinoma (HCC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.518] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
518 Background: Pembro received accelerated approval in pts with advanced HCC in the second-line setting based on results of the KEYNOTE-224 trial. Results of a 2 y follow-up analysis of the efficacy and safety in this trial are presented here. Methods: Eligible pts had histologically confirmed HCC, radiographic progression on/intolerance to sorafenib and disease not amenable to curative treatment, Child Pugh A, ECOG PS 0-1 and BCLC stage C or B. Pts received pembro 200 mg IV Q3W for 2 y or until disease progression, unacceptable toxicity, consent withdrawal or investigator decision. Response was assessed every 9 wk. Primary endpoint was ORR (RECIST v1.1, central review). Secondary endpoints were DOR, DCR, PFS, OS and safety. Results: Efficacy and safety were assessed in 104 pts. The median time from randomization to data cutoff (Jun 05, 2019) was 31.2 mo (27.5-35.5 mo). Pt characteristics were: median age 68 y (43-87), 21.2% HBV+, 25% HCV+, 94.2% Child Pugh A, 79.8% had PD on sorafenib, 17.3% had MVI and 64.4% had extrahepatic disease. ORR was 18.3% (95% CI 11.4-27.1) and was similar across subgroups. Median DOR was 21.0 mo (3.1-28+ mo); 77% had responses lasting ≥12 mo (Kaplan Meier). Best overall responses were 4 (3.8%) CRs, 15 (14.4%) PRs, 45 (43.3%) SDs and 34 (32.7%) PDs; DCR was 61.5%. The median PFS (95% CI) was 4.9 mo (3.5-6.7) and OS was 13.2 mo (9.7-15.3). PFS 24 mo rate was 11.3% and OS 24 mo rate was 30.8%. ORR was shown to be a predictor of longer OS by landmark analysis. Treatment-related AEs occurred in 76 (73.1%) pts; the most common AEs were fatigue, increased aspartate aminotransferase, pruritus and diarrhea observed in ≥10% pts. Grade ≥3 treatment related AEs occurred in 27 (26.0%) pts. Immune-mediated hepatitis occurred in 3 (2.9%) pts; no cases of HBV/HCV flare were identified. Conclusions: At 2 y follow-up, pembro continued to provide durable anti-tumor activity and prolonged survival (30.8% OS, 24 mo rate), further supporting its use in previously treated pts with advanced HCC. With longer follow-up, increases in ORR (18.3% vs 17.0%), DOR ≥12 mo (77.0% vs 61.4%) and CR rates (3.8% vs 1%) were seen. The safety profile was similar to the primary analysis. Clinical trial information: NCT02702414.
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Affiliation(s)
| | | | | | | | | | | | | | - Vittorina Zagonel
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | | | | | - Debashis Sarker
- King's College Hospital, Institute of Liver Studies, London, United Kingdom
| | | | - Stephen Lam Chan
- State Key Laboratory in Oncology of South China, The Chinese University of Hong Kong, Shatin, China
| | - Jennifer J. Knox
- Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | | | | | | | | | - Ann-Lii Cheng
- National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Andrew X. Zhu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
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Prakash A, Gordon LB, Kleinman ME, Gurary EB, Massaro J, D'Agostino R, Kieran MW, Gerhard-Herman M, Smoot L. Cardiac Abnormalities in Patients With Hutchinson-Gilford Progeria Syndrome. JAMA Cardiol 2019; 3:326-334. [PMID: 29466530 DOI: 10.1001/jamacardio.2017.5235] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Hutchinson-Gilford progeria syndrome (HGPS) is an ultrarare disorder associated with premature death due to cardiovascular events during the second decade of life. However, because of its rarity (107 identified living patients), the natural history of cardiac disease remains uncharacterized. Therefore, meaningful cardiac end points for clinical trials have been difficult to establish. Objective To examine the course of appearance of cardiac abnormalities in patients with HGPS to identify meaningful cardiac end points for use in future clinical trials. Design, Setting, and Participants In this prospective, cross-sectional, observational study, 27 consecutive patients with clinically and genetically confirmed classic HGPS were evaluated at a single center for 1 visit from July 1, 2014, through February 29, 2016, before initiation of treatment. Exposure Classic HGPS. Main Outcomes and Measures Echocardiography was used to assess ventricular and valve function using standard techniques. Diastolic left ventricular (LV) function was assessed using tissue Doppler imaging. Previously published normative data were used to adjust findings to age and body size. Results This study included 27 patients (median age, 5.6 years; age range, 2-17 years; 15 [56%] male). Among echocardiographic indicators, LV diastolic dysfunction, defined as a tissue Doppler septal or lateral early velocity z score less than -2, was the most prevalent abnormality, seen in 16 patients (59%). Diastolic dysfunction was seen in all age groups, and its prevalence increased with age, mirroring findings seen during normal aging. Indicators of LV diastolic function were more abnormal in older patients. The z scores for lateral and septal early velocities were lower (r = -0.77, P < .001; and r = -0.66, P < .001, respectively), whereas those for the ratio of early mitral inflow velocity to early diastolic tissue Doppler myocardial velocity were higher (r = 0.80, P < .001; and r = 0.72, P < .001, respectively) in older patients. Other echocardiographic findings, including LV hypertrophy, LV systolic dysfunction, and valve disease, were less prevalent in the first decade and were seen more frequently in the second decade. Conclusions and Relevance In this largest-to-date cohort of patients with HGPS, LV diastolic dysfunction was the most prevalent echocardiographic abnormality and its prevalence increased with aging. Echocardiographic indicators of LV diastolic function may be useful end points in future clinical trials in this patient population.
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Affiliation(s)
- Ashwin Prakash
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Leslie B Gordon
- Department of Anesthesiology, Preoperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Pediatrics, Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Monica E Kleinman
- Department of Anesthesiology, Preoperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Critical Care Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ellen B Gurary
- Department of Mathematics and Statistics, Boston University, Harvard Clinical Research Institute, Boston, Massachusetts
| | - Joseph Massaro
- Department of Mathematics and Statistics, Boston University, Harvard Clinical Research Institute, Boston, Massachusetts
| | - Ralph D'Agostino
- Department of Mathematics and Statistics, Boston University, Harvard Clinical Research Institute, Boston, Massachusetts
| | - Mark W Kieran
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marie Gerhard-Herman
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Leslie Smoot
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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8
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Long MT, Gurary EB, Massaro JM, Ma J, Hoffmann U, Chung RT, Benjamin EJ, Loomba R. Parental non-alcoholic fatty liver disease increases risk of non-alcoholic fatty liver disease in offspring. Liver Int 2019; 39:740-747. [PMID: 30179294 PMCID: PMC6758911 DOI: 10.1111/liv.13956] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 05/10/2018] [Accepted: 08/24/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Little is known regarding the risk of hepatic steatosis (HS) among adult children of affected parents. We examined the association between parental and offspring HS in the multigenerational Framingham Heart Study, which characterized HS using computed tomography. METHODS We performed multivariable logistic regression models adjusted for age, sex, alcohol use, and body mass index to generate the odds of HS according to parental HS. We determined the proportion of participants with HS according to parental HS and the presence or absence of hypertension, diabetes, or obesity (BMI ≥30 kg/m2 ). After excluding heavy alcohol use (n = 126) and missing covariates (n = 1), 785 offspring with at least one parent were included. RESULTS Approximately 23% (183/785) had at least one parent with HS and 1.1% had two affected parents (9/785). In adjusted models, participants with at least one parent with HS had a nearly two-fold increased odds of HS compared to participants without a parental history of HS (OR 1.86, 95% confidence interval 1.15-3.03). Among participants without hypertension, diabetes, or obesity, a higher proportion had HS if they had a parental history of HS compared to those without (16.1% vs 5.2%, P < 0.001). However, for participants with cardiometabolic risk factors, we did not observe a difference in HS among those with and without parental HS (30.3% vs 28.5%, P = 0.78). CONCLUSIONS Individuals with a parental history of HS are at increased risk for HS. Specifically, a parental history of HS may be an important factor among those that are otherwise metabolically healthy.
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Affiliation(s)
- Michelle T. Long
- Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Ellen B. Gurary
- Department of Biostatistics, Boston University, Boston, Massachusetts
| | - Joseph M. Massaro
- Department of Biostatistics, Boston University, Boston, Massachusetts
| | - Jiantao Ma
- Population Sciences Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Udo Hoffmann
- Radiology Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raymond T. Chung
- Liver Center, Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emelia J. Benjamin
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts,Evans Department of Medicine, Whitaker Cardiovascular Institute and Cardiology Section, Boston University School of Medicine, Boston, Massachusetts
| | - Rohit Loomba
- Division of Gastroenterology, Department of Medicine and Division of Epidemiology, Department of Family and Preventive, University of California at San Diego, La Jolla, California
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9
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Rubin SJ, Gurary EB, Qureshi MM, Salama AR, Ezzat WH, Jalisi S, Truong MT. Stage II Oral Tongue Cancer: Survival Impact of Adjuvant Radiation Based on Depth of Invasion. Otolaryngol Head Neck Surg 2018; 160:77-84. [DOI: 10.1177/0194599818779907] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective To determine if adjuvant radiation therapy for patients with pT2N0 oral cavity tongue cancer affects overall survival. Study Design Retrospective cohort study. Setting National Cancer Database. Subjects and Methods Cases diagnosed between 2004 and 2013 with pathologic stage pT2N0 oral cavity tongue cancer with negative surgical margins were extracted from the National Cancer Database. Data were stratified by treatment received, including surgery only and surgery + postoperative radiation therapy. Univariate analysis was performed with a 2-sample t test, chi-square test, or Fisher exact test and log-rank test, while multivariate analysis was performed with Cox regression models adjusted for individual variables as well as a propensity score. Results A total of 934 patients were included in the study, with 27.5% of patients receiving surgery with postoperative radiation therapy (n = 257). In univariate analysis, there was no significant difference in 3-year overall survival between the patient groups ( P = .473). In multivariate analysis, there was no significant difference in survival between the treatment groups, with adjuvant radiation therapy having a hazard ratio of 0.93 (95% CI, 0.60-1.44; P = .748). Regarding tumors with a depth of invasion >5 mm, there was no survival benefit for the patients who received postoperative radiation therapy as compared with those who received surgery alone (hazard ratio = 0.93; 95% CI, 0.57-1.53; P = .769). Conclusion An overall survival benefit was not demonstrated for patients who received postoperative radiation therapy versus surgery alone for pT2N0 oral cavity tongue cancer, irrespective of depth of tumor invasion.
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Affiliation(s)
- Samuel J. Rubin
- Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Ellen B. Gurary
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Muhammad M. Qureshi
- Department of Radiation Oncology, Boston Medical Center, Boston, Massachusetts, USA
| | - Andrew R. Salama
- Department of Oral Maxillofacial Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Waleed H. Ezzat
- Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Scharukh Jalisi
- Department of Otolaryngology–Head and Neck Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Minh Tam Truong
- Department of Radiation Oncology, Boston Medical Center, Boston, Massachusetts, USA
- School of Medicine, Boston University, Boston, Massachusetts, USA
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10
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Fox CS, Gurary EB, Ryan J, Bonaca M, Barry K, Loscalzo J, Massaro J. Randomized Controlled Trial of Social Media: Effect of Increased Intensity of the Intervention. J Am Heart Assoc 2016; 5:JAHA.115.003088. [PMID: 27121850 PMCID: PMC4889182 DOI: 10.1161/jaha.115.003088] [Citation(s) in RCA: 46] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background A prior randomized controlled trial of social media exposure at Circulation determined that social media did not increase 30‐day page views. Whether insufficient social media intensity contributed to these results is uncertain. Methods and Results Original article manuscripts were randomized to social media exposure compared with no social media exposure (control) at Circulation beginning in January 2015. Social media exposure consisted of Facebook and Twitter posts on the journal's accounts. To increase social media intensity, a larger base of followers was built using advertising and organic growth, and posts were presented in triplicate and boosted on Facebook and retweeted on Twitter. The primary outcome was 30‐day page views. Stopping rules were established at the point that 50% of the manuscripts were randomized and had 30‐day follow‐up to compare groups on 30‐day page views. The trial was stopped for futility on September 26, 2015. Overall, 74 manuscripts were randomized to receive social media exposure, and 78 manuscripts were randomized to the control arm. The intervention and control arms were similar based on article type (P=0.85), geographic location of the corresponding author (P=0.33), and whether the manuscript had an editorial (P=0.80). Median number of 30‐day page views was 499.5 in the social media arm and 450.5 in the control arm; there was no evidence of a treatment effect (P=0.38). There were no statistically significant interactions of treatment by manuscript type (P=0.86), by corresponding author (P=0.35), by trimester of publication date (P=0.34), or by editorial status (P=0.79). Conclusions A more intensive social media strategy did not result in increased 30‐day page views of original research.
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Affiliation(s)
| | - Ellen B Gurary
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - John Ryan
- Circulation Editorial Offices, Boston, MA Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, UT
| | - Marc Bonaca
- Circulation Editorial Offices, Boston, MA Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | | | - Joseph Loscalzo
- Circulation Editorial Offices, Boston, MA Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Joseph Massaro
- Circulation Editorial Offices, Boston, MA Department of Biostatistics, Boston University School of Public Health, Boston, MA
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11
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Nwachukwu BU, Gurary EB, Lerner V, Collins JE, Thornhill TS, Losina E, Katz JN. Effect of smoking and soft tissue release on risk of revision after total knee arthroplasty: a case- control study. BMC Musculoskelet Disord 2015; 16:245. [PMID: 26353801 PMCID: PMC4564968 DOI: 10.1186/s12891-015-0694-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/21/2015] [Indexed: 11/10/2022] Open
Abstract
Background Increasing utilization of primary total knee arthroplasty (TKA) is projected to expand demand for revision TKA. Revision TKAs are procedurally complex and incur high costs on our financially constrained healthcare system. The purpose of this study was to use a case-control design to identify factors predisposing to revision TKA, particularly demographic, clinical and perioperative technical factors. Methods We conducted a case control study to investigate patient, surgical and perioperative factors associated with greater risk of revision TKA. We included patients who received TKA at a tertiary center between 1996 and 2009. Cases (patients that had primary and revision TKA) were matched to controls (patients with primary TKA that was not revised) in a 1:2 ratio and risk of revision examined using conditional logistic regression. Results We identified 146 cases and 290 controls. Patient factors independently associated with revision included male sex (OR 1.73; 95 % CI 1.06-2.81) and smoking (OR 2.87; 1.33-6.19). Older age was associated with decreased risk (OR 0.83 per 5-year increment; 95 % CI 0.75-0.92). Lateral release was the only technical factor associated with revision (OR 1.92; 1.07-3.43). Conclusions In this case control study younger patient age, male gender, soft tissue release and active smoking status were associated with increased revision risk. Although we do not know whether the risk of smoking arises from short- or long-term exposure, smoking cessation prior to TKA should be considered as an intervention for decreasing revision risk.
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Affiliation(s)
- Benedict U Nwachukwu
- The Department of Orthopedic Surgery, Hospital for Special Surgery, New York, USA.
| | - Ellen B Gurary
- Department of Orthopedic Surgery, Boston, USA. .,Department of Biostatistics, Boston University School of Public Health, Boston, USA.
| | - Vladislav Lerner
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, USA.
| | | | | | - Elena Losina
- Department of Orthopedic Surgery, Boston, USA. .,Division of Rheumatology, Immunology and Allergy, Boston, USA. .,Department of Biostatistics, Boston University School of Public Health, Boston, USA.
| | - Jeffrey N Katz
- Department of Orthopedic Surgery, Boston, USA. .,Division of Rheumatology, Immunology and Allergy, Boston, USA. .,Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis Street, BC-4016, Boston, MA, 02115, USA.
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