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da Silva Lopes AM, Colomer-Lahiguera S, Darnac C, Giacomini S, Bugeia S, Gutknecht G, Spurrier-Bernard G, Cuendet M, Muet F, Aedo-Lopez V, Mederos N, Michielin O, Addeo A, Latifyan S, Eicher M. Testing a Model of Care for Patients on Immune Checkpoint Inhibitors Based on Electronic Patient-Reported Outcomes: Protocol for a Randomized Phase II Controlled Trial. JMIR Res Protoc 2023; 12:e48386. [PMID: 37851498 PMCID: PMC10620631 DOI: 10.2196/48386] [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: 04/21/2023] [Revised: 07/26/2023] [Accepted: 08/30/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Management of severe symptomatic immune-related adverse events (IrAEs) related to immune checkpoint inhibitors (ICIs) can be facilitated by timely detection. As patients face a heterogeneous set of symptoms outside the clinical setting, remotely monitoring and assessing symptoms by using patient-reported outcomes (PROs) may result in shorter delays between symptom onset and clinician detection. OBJECTIVE We assess the effect of a model of care for remote patient monitoring and symptom management based on PRO data on the time to detection of symptomatic IrAEs from symptom onset. The secondary objectives are to assess its effects on the time between symptomatic IrAE detection and intervention, IrAE grade (severity), health-related quality of life, self-efficacy, and overall survival at 6 months. METHODS For this study, 198 patients with cancer receiving systemic treatment comprising ICIs exclusively will be recruited from 2 Swiss university hospitals. Patients are randomized (1:1) to a digital model of care (intervention) or usual care (control group). Patients are enrolled for 6 months, and they use an electronic app to complete weekly Functional Assessment of Cancer Therapy-General questionnaire and PROMIS (PROs Measurement Information System) Self-Efficacy to Manage Symptoms questionnaires. The intervention patient group completes a standard set of 37 items in a weekly PROs version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) questionnaire, and active symptoms are reassessed daily for the first 3 months by using a modified 24-hour recall period. Patients can add items from the full PRO-CTCAE item library to their questionnaire. Nurses call patients in the event of new or worsening symptoms and manage them by using a standardized triage algorithm based on the United Kingdom Oncology Nursing Society 24-hour triage tool. This algorithm provides guidance on deciding if patients should receive in-person care, if monitoring should be increased, or if self-management education should be reinforced. RESULTS The Institut Suisse de Recherche Expérimentale sur le Cancer Foundation and Kaiku Health Ltd funded this study. Active recruitment began since November 2021 and is projected to conclude in November 2023. Trial results are expected to be published in the first quarter of 2024 and will be disseminated through publications submitted at international scientific conferences. CONCLUSIONS This trial is among the first trials to use PRO data to directly influence routine care of patients treated with ICIs and addresses some limitations in previous studies. This trial collects a wider spectrum of self-reported symptom data daily. There are some methodological limitations brought by changes in evolving treatment standards for patients with cancer. This trial's results could entail further academic discussions on the challenges of diagnosing and managing symptoms associated with treatment remotely by providing further insights into the burden symptoms represent to patients and highlight the complexity of care procedures involved in managing symptomatic IrAEs. TRIAL REGISTRATION ClinicalTrials.gov NCT05530187; https://www.clinicaltrials.gov/study/NCT05530187. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48386.
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Affiliation(s)
- André Manuel da Silva Lopes
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sara Colomer-Lahiguera
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Célia Darnac
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stellio Giacomini
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sébastien Bugeia
- Department of Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Garance Gutknecht
- Department of Oncology, Geneva University Hospital, Geneva, Switzerland
| | | | - Michel Cuendet
- Precision Oncology Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Fanny Muet
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Nuria Mederos
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Michielin
- Department of Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Alfredo Addeo
- Department of Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Sofiya Latifyan
- Precision Oncology Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Manuela Eicher
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
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Bordry N, Mamez AC, Fedeli C, Cantero C, Jaksic C, Alonso PU, Rayroux C, Berra G, Portillo V, Puntel M, Yerly S, Bugeia S, Gutknecht G, Di Marco M, Mach N, Soccal PM, Chalandon Y, Calmy A, Addeo A. SARS-CoV-2 m-RNA Vaccine Response in Immunocompromised Patients: A Monocentric Study Comparing Cancer, People Living with HIV, Hematopoietic Stem Cell Transplant Patients and Lung Transplant Recipients. Vaccines (Basel) 2023; 11:1284. [PMID: 37631852 PMCID: PMC10459936 DOI: 10.3390/vaccines11081284] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
Immunocompromised patients (ICPs) have a higher risk of developing severe forms of COVID-19 and experience a higher burden of complications and mortality than the general population. However, recent studies have suggested that the antibody response to SARS-CoV-2 mRNA vaccines could be highly variable among different ICPs. Using a collaborative, monocentric, prospective cohort study, we assessed anti-SARS-CoV-2 spike protein antibody titers following two and three doses of mRNA vaccines in four groups of ICPs (cancer [n = 232]: hematopoietic stem cell transplant [HSCT; n = 126] patients; people living with HIV [PLWH; n = 131]; and lung transplant [LT; n = 39] recipients) treated at Geneva University Hospitals; and healthy individuals (n = 49). After primo-vaccination, the highest anti-S antibody geometric mean titer (IU/mL) was observed in healthy individuals (2417 IU/mL [95% CI: 2327-2500]), the PLWH group (2024 IU/mL [95% CI:1854-2209]) and patients with cancer (840 IU/mL [95% CI: 625-1129]), whereas patients in the HSCT and LT groups had weaker antibody responses (198 IU/mL [95% CI: 108-361] and 7.3 IU/mL [95% CI: 2.5-22]). The booster dose conferred a high antibody response after 1 month in both PLWH (2500 IU/mL) and cancer patients (2386 IU/mL [95% CI: 2182-2500]), a moderate response in HSCT patients (521 IU/mL [95% CI: 306-885]) and a poor response in LT recipients (84 IU/mL [95% CI: 18-389]). Contemporary treatment with immunosuppressive drugs used in transplantation or chemotherapy was associated with a poor response to vaccination. Our findings confirmed the heterogeneity of the humoral response after mRNA vaccines among different ICPs and the need for personalized recommendations for each of these different groups.
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Affiliation(s)
- Natacha Bordry
- Department of Oncology, Geneva University Hospitals, University of Geneva and Swiss Cancer Center Leman, 1205 Geneva, Switzerland; (N.B.)
| | - Anne-Claire Mamez
- Department of Haematology, Geneva University Hospitals and Faculty of Medicine University of Geneva, 1205 Geneva, Switzerland; (A.-C.M.)
| | - Chiara Fedeli
- Department of Infectious Diseases, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland (A.C.)
| | - Chloé Cantero
- Department of Pneumology, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland
| | - Cyril Jaksic
- CRC & Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva and Geneva University Hospital, 1205 Geneva, Switzerland
| | - Pilar Ustero Alonso
- Department of Infectious Diseases, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland (A.C.)
| | - Caroline Rayroux
- Department of Pneumology, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland
| | - Gregory Berra
- Department of Pneumology, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland
| | - Vera Portillo
- Department of Infectious Diseases, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland (A.C.)
| | - Maeva Puntel
- Department of Infectious Diseases, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland (A.C.)
| | - Sabine Yerly
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals & Faculty of Medicine, 1205 Geneva, Switzerland
| | - Sébastien Bugeia
- Department of Oncology, Geneva University Hospitals, University of Geneva and Swiss Cancer Center Leman, 1205 Geneva, Switzerland; (N.B.)
| | - Garance Gutknecht
- Department of Oncology, Geneva University Hospitals, University of Geneva and Swiss Cancer Center Leman, 1205 Geneva, Switzerland; (N.B.)
| | - Mariagrazia Di Marco
- Department of Oncology, Geneva University Hospitals, University of Geneva and Swiss Cancer Center Leman, 1205 Geneva, Switzerland; (N.B.)
| | - Nicolas Mach
- Department of Oncology, Geneva University Hospitals, University of Geneva and Swiss Cancer Center Leman, 1205 Geneva, Switzerland; (N.B.)
| | - Paola Marina Soccal
- Department of Pneumology, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland
| | - Yves Chalandon
- Department of Haematology, Geneva University Hospitals and Faculty of Medicine University of Geneva, 1205 Geneva, Switzerland; (A.-C.M.)
| | - Alexandra Calmy
- Department of Infectious Diseases, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland (A.C.)
| | - Alfredo Addeo
- Department of Oncology, Geneva University Hospitals, University of Geneva and Swiss Cancer Center Leman, 1205 Geneva, Switzerland; (N.B.)
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da Silva Lopes AM, Colomer-Lahiguera S, Darnac C, Giacomini S, Bugeia S, Gutknecht G, Spurrier-Bernard G, Aedo-Lopez V, Mederos N, Latifyan S, Addedo A, Michielin O, Eicher M. Development of an eHealth-enhanced model of care for the monitoring and management of immune-related adverse events in patients treated with immune checkpoint inhibitors. Support Care Cancer 2023; 31:484. [PMID: 37480546 PMCID: PMC10363070 DOI: 10.1007/s00520-023-07934-w] [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: 12/14/2022] [Accepted: 07/07/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE The use of electronic patient-reported outcome (ePRO) data in routine care has been tied to direct patient benefits such as improved quality of care and symptom control and even overall survival. The modes of action behind such benefits are seldom described in detail. Here, we describe the development of a model of care leveraging ePRO data to monitor and manage symptoms of patients treated with immune checkpoint inhibitors. METHODS Development was split into four stages: (1) identification of an underlying theoretical framework, (2) the selection of an ePRO measure (ePROM), (3) the adaptation of an electronic application to collect ePRO data, and (4) the description of an ePRO-oriented workflow. The model of care is currently evaluated in a bicentric longitudinal randomized controlled phase II trial, the IePRO study. RESULTS The IePRO model of care is grounded in the eHealth Enhanced Chronic Care Model. Patients are prompted to report symptoms using an electronic mobile application. Triage nurses are alerted, review the reported symptoms, and contact patients in case of a new or worsening symptom. Nurses use the UKONS 24-hour telephone triage tool to issue patient management recommendations to the oncology team. Adapted care coordinating procedures facilitate team collaboration and provide patients with timely feedback. CONCLUSION This report clarifies how components of care are created and modified to leverage ePRO to enhance care. The model describes a workflow that enables care teams to be proactive and provide patients with timely, multidisciplinary support to manage symptoms.
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Affiliation(s)
- André Manuel da Silva Lopes
- Institute for Higher Education and Research in Healthcare (IFS), Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne University Hospital (CHUV), Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Sara Colomer-Lahiguera
- Institute for Higher Education and Research in Healthcare (IFS), Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne University Hospital (CHUV), Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Célia Darnac
- Institute for Higher Education and Research in Healthcare (IFS), Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne University Hospital (CHUV), Route de la Corniche 10, CH-1010, Lausanne, Switzerland
- Department of Oncology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Stellio Giacomini
- Institute for Higher Education and Research in Healthcare (IFS), Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne University Hospital (CHUV), Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Sébastien Bugeia
- Department of Oncology, Geneva University Hospital (HUG), Rue Gabrielle-Perret-Gentil 4, 1211, Genève, Switzerland
| | - Garance Gutknecht
- Department of Oncology, Geneva University Hospital (HUG), Rue Gabrielle-Perret-Gentil 4, 1211, Genève, Switzerland
| | | | - Veronica Aedo-Lopez
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Medicine and Dentistry, Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Nuria Mederos
- Department of Oncology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Sofiya Latifyan
- Department of Oncology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Alfredo Addedo
- Department of Oncology, Geneva University Hospital (HUG), Rue Gabrielle-Perret-Gentil 4, 1211, Genève, Switzerland
| | - Olivier Michielin
- Department of Oncology, Geneva University Hospital (HUG), Rue Gabrielle-Perret-Gentil 4, 1211, Genève, Switzerland
| | - Manuela Eicher
- Institute for Higher Education and Research in Healthcare (IFS), Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne University Hospital (CHUV), Route de la Corniche 10, CH-1010, Lausanne, Switzerland.
- Department of Oncology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
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Sandoval JL, Bugeia S, Mentu S, Gutknecht G, Ekström J, Battagin A, Friedlaender A, Metso-Lintula M, Kataja VV, Dietrich PY, Mach N, Addeo A. Digital patient-reported outcomes and serological response to SARS-COV-2 vaccines in patients with cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e13606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13606 Background: SARS-CoV-2 vaccines have changed the course of the current global pandemic. Cancer patients were identified as highrisk of adverse infection outcomes. We have previously characterised the serological response to SARS-CoV-2 vaccines in 220 cancer patients treated at our institution. In addition these patients were given the possibility to report their symptoms (patient-reported outcomes, PROs) weekly using a digital platform (ePROs). We sought to determine if, in cancer patients, the prospectively recorded post-vaccination ePROs could predict the serological response to SARS-CoV-2 vaccines. Methods: We used a pre-existing digital platform that allows monitoring of PROs using weekly questionnaires sent to patients and available on their desktop computers, tablets or smartphones. Serial serologies were performed at 28, 50 and 115 days after vaccination. Results: We observed that at day 50 after the first vaccination dose, coinciding with three weeks after the second dose, patients could be divided into two groups according to their serological response (low – below 1500 U/ml and high – above or equal 1500 U/ml). A peak in symptom burden could be observed after the second dose, as previously described. Omitting ePRO features decreased prediction performance of all models, whereas omitting baseline symptom scores had inconsistent effects. Among all models and feature constructions, the top performance metrics were given by the nearest centroid model7 with baseline symptoms omitted and 20 features chosen with the aforementioned procedure. The model achieved an accuracy of 0.704, an F1-score of 0.759 and an MCC of 0.398. Conclusions: we were able to identify the patients who achieved higher antibody levels against SARS-COV-2 based on the symptom burden reported through ePROs. This represents the first model showing that symptoms, assessed through ePRO can be predictive of response to vaccines. Our results could also be useful information for patients, as they could assuage their fears about adverse -effects, through the knowledge that toxicity could predict better protection against SARS-COV-2. The same toxicity-based prediction of efficacy has been identified with immunotherapy in cancer and is now a routine part of clinical discussions with patients.
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Affiliation(s)
- Jose L. Sandoval
- Oncology department, University Hospital Geneva, Geneva, Switzerland
| | - Sebastien Bugeia
- Oncology department, University Hospital Geneva, Geneva, Switzerland
| | | | - Garance Gutknecht
- Oncology department, University Hospital Geneva, Geneva, Switzerland
| | | | - Anna Battagin
- Oncology department, University Hospital Geneva, Geneva, Switzerland
| | | | | | | | - Pierre-Yves Dietrich
- Oncology Department, Geneva Unversity Hospital; Department of Medicine, Faculty of Medicine; University of Geneva, Swiss Cancer Leman Center, Genève, Switzerland
| | - Nicolas Mach
- Department of Oncology, University Hospital Geneva, Geneva, Switzerland
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Bordry N, Addeo A, Jaksic C, Dutoit V, Roux-Lombard P, Shah DP, Shah PK, Gayet-Ageron A, Friedlaender A, Bugeia S, Gutknecht G, Battagin A, Di Marco M, Simand PF, Labidi-Galy I, Fertani S, Sandoval J, Dietrich PY, Mach N. Humoral and cellular immunogenicity two months after SARS-CoV-2 messenger RNA vaccines in patients with cancer. iScience 2022; 25:103699. [PMID: 34977496 PMCID: PMC8704782 DOI: 10.1016/j.isci.2021.103699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/15/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022] Open
Abstract
Little is known on the long-lasting humoral response and the T cell activation induced by SARS-CoV-2 mRNA vaccines in patients with cancer. The study assessed the efficacy of the SARS-CoV-2 mRNA vaccines through measuring the seroconversion rate at pre-specified time points and the effect on the T cell immunity in patients with cancers. The study included 131 adult patients with solid or hematological cancer, who received SARS-CoV-2 mRNA vaccines. 96.2% of them exhibited adequate antibody response to the SARS-CoV-2 mRNA vaccines 2 months after the booster dose. SARS-CoV-2 mRNA vaccines could induce T cell activation; however, this is more likely in patients who have a positive seroconversion (94%) compared with the patients who did not (50%). Further research into the clinical relevance of low antibodies titers and lack of T cell activity is required to set up an effective vaccination strategy within this group of patients. Seroconversion remains high at two months after the second vaccine dose in patients with cancer Two doses of mRNA vaccine allow effective protection, with a low infection incidence in our cohort mRNA vaccination induces T cell activation especially among patients who seroconverted
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Affiliation(s)
- Natacha Bordry
- Department of Oncology, Geneva University Hospital, University of Geneva and Swiss Cancer Center Leman, Rue Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Alfredo Addeo
- Department of Oncology, Geneva University Hospital, University of Geneva and Swiss Cancer Center Leman, Rue Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Cyril Jaksic
- CRC& Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva and Geneva University Hospital, Geneva, Switzerland
| | - Valérie Dutoit
- Department of Oncology, Geneva University Hospital, University of Geneva and Swiss Cancer Center Leman, Rue Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Pascale Roux-Lombard
- Immunology and Allergology Laboratory, Geneva University Hospital, University of Geneva, 1205 Geneva, Switzerland
| | - Dimpy P Shah
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, TX, USA
| | - Pankil K Shah
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, TX, USA
| | - Angèle Gayet-Ageron
- CRC& Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva and Geneva University Hospital, Geneva, Switzerland
| | - Alex Friedlaender
- Department of Oncology, Geneva University Hospital, University of Geneva and Swiss Cancer Center Leman, Rue Perret-Gentil 4, 1205 Geneva, Switzerland.,Oncology Department, University Hospital of Geneva, Switzerland, Clinique Générale Beaulieu, Geneva, Switzerland
| | - Sébastien Bugeia
- Department of Oncology, Geneva University Hospital, University of Geneva and Swiss Cancer Center Leman, Rue Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Garance Gutknecht
- Department of Oncology, Geneva University Hospital, University of Geneva and Swiss Cancer Center Leman, Rue Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Anna Battagin
- Department of Oncology, Geneva University Hospital, University of Geneva and Swiss Cancer Center Leman, Rue Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Maragrazia Di Marco
- Department of Oncology, Geneva University Hospital, University of Geneva and Swiss Cancer Center Leman, Rue Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Pierre-Francois Simand
- Department of Oncology, Geneva University Hospital, University of Geneva and Swiss Cancer Center Leman, Rue Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Intidhar Labidi-Galy
- Department of Oncology, Geneva University Hospital, University of Geneva and Swiss Cancer Center Leman, Rue Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Sarah Fertani
- Department of Oncology, Geneva University Hospital, University of Geneva and Swiss Cancer Center Leman, Rue Perret-Gentil 4, 1205 Geneva, Switzerland
| | - José Sandoval
- Department of Oncology, Geneva University Hospital, University of Geneva and Swiss Cancer Center Leman, Rue Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Pierre-Yves Dietrich
- Department of Oncology, Geneva University Hospital, University of Geneva and Swiss Cancer Center Leman, Rue Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Nicolas Mach
- Department of Oncology, Geneva University Hospital, University of Geneva and Swiss Cancer Center Leman, Rue Perret-Gentil 4, 1205 Geneva, Switzerland
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Chatzis O, Blanchard-Rohner G, Mondoulet L, Pelletier B, De Gea-Hominal A, Roux M, Huttner A, Hervé PL, Rohr M, Matthey A, Gutknecht G, Lemaître B, Hayem C, Pham HT, Wijagkanalan W, Lambert PH, Benhamou PH, Siegrist CA. Safety and immunogenicity of the epicutaneous reactivation of pertussis toxin immunity in healthy adults: a phase I, randomized, double-blind, placebo-controlled trial. Clin Microbiol Infect 2020; 27:878-885. [PMID: 32896653 DOI: 10.1016/j.cmi.2020.08.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Protection induced by acellular vaccines can be short, requiring novel immunization strategies. Objectives of this study were to evaluate safety and capacity of a recombinant pertussis toxin (PTgen) -coated Viaskin® epicutaneous patch to recall memory responses in healthy adults. METHODS This double-blind, placebo-controlled randomized trial (Phase I) assessed the safety and immunogenicity of PTgen administered on days 0 and 14 to healthy adults using Viaskin® patches applied directly or after epidermal laser-based skin preparation. Patch administration was followed by Boostrix®dTpa on day 42. Antibodies were assessed at days 0, 14, 28, 42 and 70. RESULTS Among 102 volunteers enrolled, 80 received Viaskin-PT (Viaskin-PT 25 μg (n = 25), Viaskin-PT 50 μg (n = 25), laser + Viaskin-PT 25 μg (n = 5), laser + Viaskin-PT 50 μg (n = 25)), Viaskin-placebo (n = 10) or laser + Viaskin-placebo (n = 2). Incidence of adverse events was similar across groups (any local event: 21/25 (84.0%), 24/25 (96.0%), 4/5 (80.0%), 24/25 (96.0%), 8/10 (80.0%), 10/12 (83.0%), respectively). Direct application induced no detectable response. On day 42, PT-IgG geometric mean concentrations were significantly higher following laser + Viaskin-PT 25 μg and 50 μg (139.87 (95% CI 87.30-224.10) and 121.76 (95% CI 95.04-156.00), respectively), than laser + Viaskin-placebo (59.49, 95% CI 39.37-89.90). Seroresponse rates were higher following laser + Viaskin-PT 25 μg (4/5 (80.0%), 95% CI 28.4-99.5) and 50 μg (22/25 (88.0%), 95% CI 68.8-97.5) than laser + Viaskin-placebo (0/12 (0.0%), 95% CI 0.0-26.5). CONCLUSIONS Viaskin-PT applied after laser-based epidermal skin preparation showed encouraging safety and immunogenicity results: anti-PT booster responses were not inferior to those elicited by Boostrix®dTpa. This study is registered at ClinicalTrials.gov (NCT03035370) and was funded by DBV Technologies.
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Affiliation(s)
- O Chatzis
- Centre for Vaccinology, University Hospitals of Geneva, Switzerland
| | - G Blanchard-Rohner
- Centre for Vaccinology, University Hospitals of Geneva, Switzerland; Division of General Paediatrics, Department of Paediatrics, University Hospitals of Geneva, Switzerland
| | | | | | - A De Gea-Hominal
- Centre for Vaccinology, University Hospitals of Geneva, Switzerland
| | - M Roux
- DBV Technologies, Montrouge, France
| | - A Huttner
- Centre for Vaccinology, University Hospitals of Geneva, Switzerland; Division of Infectious Diseases, University Hospitals of Geneva, Switzerland
| | | | - M Rohr
- Division of General Paediatrics, Department of Paediatrics, University Hospitals of Geneva, Switzerland
| | - A Matthey
- Centre for Clinical Research, University Hospitals of Geneva, Switzerland
| | - G Gutknecht
- Centre for Clinical Research, University Hospitals of Geneva, Switzerland
| | - B Lemaître
- Laboratory of Vaccinology, University Hospitals of Geneva, Switzerland
| | - C Hayem
- DBV Technologies, Montrouge, France
| | - H T Pham
- BioNet-Asia Co., Ltd, Bangkok, Thailand
| | | | - P H Lambert
- Centre for Vaccinology, University Hospitals of Geneva, Switzerland
| | | | - C A Siegrist
- Centre for Vaccinology, University Hospitals of Geneva, Switzerland; Division of General Paediatrics, Department of Paediatrics, University Hospitals of Geneva, Switzerland.
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Py C, Addeo A, Gutknecht G, Friedlander A, Vuilleumier A, Dietrich P. P1.04-26 Prospective Immuno-Biobank in NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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8
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Roux JF, Southern E, Gutknecht G. The effect of a 15(S)-15-methyl prostaglandin F2 alpha (methyl ester) suppository upon termination of early pregnancy. Contraception 1980; 22:57-61. [PMID: 7418407 DOI: 10.1016/0010-7824(80)90117-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The administration of prostaglandin vaginally to 15 pregnant patients in the first trimester caused abortion in 73% of the cases. Although other regimens have been reported to be effective and well tolerated, the single 3 mg. suppository of 15(S)-15-methyl prostaglandin F2 alpha (methyl ester) utilized in the present study was associated with a significant incidence of side effects and a relatively high failure rate. However, if an analogue or improved treatment regimen could be found which is more efficient, as well as more pleasant in its affects, the availability and the cost of early abortion would be improved with a concomitant effect on the incidence of late abortion and its complications.
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Weinstein L, Droegemueller W, Cornette J, Greer B, Gutknecht G. (15S)-15 methyl prostaglandin F2 alpha levels in amniotic fluid and blood in second trimester abortions. South Med J 1979; 72:1159-60. [PMID: 472844 DOI: 10.1097/00007611-197909000-00024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A single intra-amniotic injection of (15S)-15 methyl prostaglandin F2 alpha (THAM) was used to induce second trimester abortion in five patients. Serial levels of (15S)-15 methyl prostaglandin F2 alpha were subsequently measured in amniotic fluid and plasma by radioimmunoassay. The slow removal of this drug from the amniotic fluid was documented. Plasma levels of (15S)-15 methyl prostaglandin F2 alpha increased fourfold to sevenfold after clinical rupture of the membranes in three patients, supporting the fact that prostaglandins are well absorbed from the vagina. Because this analogue of prostaglandin can cause marked peripheral bronchoconstriction when administered systemically, it is best to avoid its use in patients with a history of asthma.
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Poor C, Fletcher C, Thielges J, Gutknecht G, Morgan C. Vocational potential assessment. Arch Phys Med Rehabil 1975; 56:33-6. [PMID: 1115591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Determination of employment potential will become increasingly important in the foreseeable future, largely due to pending Federal legislation which relates to welfare reform. The heretofore "permanently and totally disabled versus able-bodied" principle in welfare reforms is being abbandoned. Pending legislative proposals dealing with welfare reform provide for considering physically impaired persons as partially disabled and partially employable simultaneously. Thus, the need to systematically and effectively assess physically impaired citizens' capacities to participate in the job market will increase. Unquestionably, rehabilitation medicine in general, and the emerging art and science of vocational evaluation in particular, will contribute much to supplying these services. While it is widely acknowledged that the vocational potential of physically impaired persons should be evaluated in an organized manner, there are differences of opinion among professional evaluators as to which approach, or approaches, are the most meritorious; The four principal approaches are: (1) mental testing, (2) work sampling, (3) situational analysis, and (4) job tryouts. Each of these approaches is explained, contrasted, and evaluated in this paper.
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