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Van Tine BA, Hirbe AC, Oppelt P, Frith AE, Rathore R, Mitchell JD, Wan F, Berry S, Landeau M, Heberton GA, Gorcsan J, Huntjens PR, Soyama Y, Vader JM, Alvarez-Cardona JA, Zhang KW, Lenihan DJ, Krone RJ. Interim Analysis of the Phase II Study: Noninferiority Study of Doxorubicin with Upfront Dexrazoxane plus Olaratumab for Advanced or Metastatic Soft-Tissue Sarcoma. Clin Cancer Res 2021; 27:3854-3860. [PMID: 33766818 PMCID: PMC8282681 DOI: 10.1158/1078-0432.ccr-20-4621] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/27/2020] [Revised: 01/22/2021] [Accepted: 03/18/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE To report the interim analysis of the phase II single-arm noninferiority trial, testing the upfront use of dexrazoxane with doxorubicin on progression-free survival (PFS) and cardiac function in soft-tissue sarcoma (STS). PATIENTS AND METHODS Patients with metastatic or unresectable STS who were candidates for first-line treatment with doxorubicin were deemed eligible. An interim analysis was initiated after 33 of 65 patients were enrolled. Using the historical control of 4.6 months PFS for doxorubicin in the front-line setting, we tested whether the addition of dexrazoxane affected the efficacy of doxorubicin in STS. The study was powered so that a decrease of PFS to 3.7 months would be considered noninferior. Secondary aims included cardiac-related mortality, incidence of heart failure/cardiomyopathy, and expansion of cardiac monitoring parameters including three-dimensional echocardiography. Patients were allowed to continue on doxorubicin beyond 600 mg/m2 if they were deriving benefit and were not demonstrating evidence of symptomatic cardiac dysfunction. RESULTS At interim analysis, upfront use of dexrazoxane with doxorubicin demonstrated a PFS of 8.4 months (95% confidence interval: 5.1-11.2 months). Only 3 patients were removed from study for cardiotoxicity, all on > 600 mg/m2 doxorubicin. No patients required cardiac hospitalization or had new, persistent cardiac dysfunction with left ventricular ejection fraction remaining below 50%. The median administered doxorubicin dose was 450 mg/m2 (interquartile range, 300-750 mg/m2). CONCLUSIONS At interim analysis, dexrazoxane did not reduce PFS in patients with STS treated with doxorubicin. Involvement of cardio-oncologists is beneficial for the monitoring and safe use of high-dose anthracyclines in STS.See related commentary by Benjamin and Minotti, p. 3809.
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Affiliation(s)
- Brian A Van Tine
- Division of Medical Oncology, Washington University in St. Louis, St. Louis, Missouri.
- Division of Pediatric Hematology and Oncology, St. Louis Children's Hospital, St. Louis, Missouri
- Siteman Cancer Center, St. Louis, Missouri
| | - Angela C Hirbe
- Division of Medical Oncology, Washington University in St. Louis, St. Louis, Missouri
- Division of Pediatric Hematology and Oncology, St. Louis Children's Hospital, St. Louis, Missouri
- Siteman Cancer Center, St. Louis, Missouri
| | - Peter Oppelt
- Division of Medical Oncology, Washington University in St. Louis, St. Louis, Missouri
- Siteman Cancer Center, St. Louis, Missouri
| | - Ashley E Frith
- Division of Medical Oncology, Washington University in St. Louis, St. Louis, Missouri
- Siteman Cancer Center, St. Louis, Missouri
| | - Richa Rathore
- Division of Medical Oncology, Washington University in St. Louis, St. Louis, Missouri
| | - Joshua D Mitchell
- Siteman Cancer Center, St. Louis, Missouri
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri
| | - Fei Wan
- Department of Biostatistics, Washington University in St. Louis, St. Louis, Missouri
| | - Shellie Berry
- Division of Medical Oncology, Washington University in St. Louis, St. Louis, Missouri
| | - Michele Landeau
- Division of Medical Oncology, Washington University in St. Louis, St. Louis, Missouri
| | | | - John Gorcsan
- Echocardiographic Core Laboratory, Washington University in St. Louis, St. Louis, Missouri
| | - Peter R Huntjens
- Echocardiographic Core Laboratory, Washington University in St. Louis, St. Louis, Missouri
| | - Yoku Soyama
- Echocardiographic Core Laboratory, Washington University in St. Louis, St. Louis, Missouri
| | - Justin M Vader
- Division of Cardiology, Washington University in St. Louis, St. Louis, Missouri
| | - Jose A Alvarez-Cardona
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri
| | - Kathleen W Zhang
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri
| | - Daniel J Lenihan
- Siteman Cancer Center, St. Louis, Missouri
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri
| | - Ronald J Krone
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri.
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John M, Post A, Burkland DA, Greet BD, Chaisson J, Heberton GA, Saeed M, Rasekh A, Razavi M. Confirming pericardial access by using impedance measurements from a micropuncture needle. Pacing Clin Electrophysiol 2020; 43:593-601. [PMID: 32333406 DOI: 10.1111/pace.13927] [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] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/03/2020] [Accepted: 04/19/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pericardial access is complicated by two difficulties: confirming when the needle tip is in the pericardial space, and avoiding complications during access, such as inadvertently puncturing other organs. Conventional imaging tools are inadequate for addressing these difficulties, as they lack soft-tissue markers that could be used as guidance during access. A system that can both confirm access and avoid inadvertent organ injury is needed. METHODS A 21G micropuncture needle was modified to include two small electrodes at the needle tip. With continuous bioimpedance monitoring from the electrodes, the needle was used to access the pericardium in porcine models (n = 4). The needle was also visualized in vivo by using an electroanatomical map (n = 2). Bioimpedance data from different tissues were analyzed retrospectively. RESULTS Bioimpedance data collected from the subcutaneous space (992.8 ± 13.1 Ω), anterior mediastinum (972.2 ± 14.2 Ω), pericardial space (323.2 ± 17.1 Ω), mid-myocardium (349.7 ± 87.6 Ω), right ventricular cavity (235.0 ± 9.7 Ω), lung (1142.0 ± 172.0 Ω), liver (575.0 ± 52.6 Ω), and blood (177.5 ± 1.9 Ω) differed significantly by tissue type (P < .01). Phase data in the frequency domain correlated well with the needle being in the pericardial space. A simple threshold analysis effectively separated lung (threshold = 1120.0 Ω) and blood (threshold = 305.9 Ω) tissues from the other tissue types. CONCLUSIONS Continuous bioimpedance monitoring from a modified micropuncture needle during pericardial access can be used to clearly differentiate tissues. Combined with traditional imaging modalities, this system allows for confirming access to the pericardial space while avoiding inadvertent puncture of other organs, creating a safer and more efficient needle-access procedure.
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Affiliation(s)
- Mathews John
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| | - Allison Post
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| | - David A Burkland
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Brian D Greet
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Jordan Chaisson
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - George A Heberton
- Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Mohammad Saeed
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Abdi Rasekh
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Mehdi Razavi
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
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Heberton GA, Nassif M, Bierhals A, Novak E, LaRue SJ, Lima B, Hall S, Silvestry S, Joseph SM. Usefulness of Psoas Muscle Area Determined by Computed Tomography to Predict Mortality or Prolonged Length of Hospital Stay in Patients Undergoing Left Ventricular Assist Device Implantation. Am J Cardiol 2016; 118:1363-1367. [PMID: 27622708 DOI: 10.1016/j.amjcard.2016.07.061] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 01/06/2023]
Abstract
The purpose of this study is to examine the association of sarcopenia as measured by psoas muscle area and outcomes in patients undergoing left ventricular assist device (LVAD) implantation. We retrospectively examined 333 consecutive patients who underwent implantation of a HeartMate II LVAD at our institution from June 2008 to August 2013. Patients were included if they had a perioperative computed tomography that spanned the L3-L4 vertebrae. Sarcopenia was defined as having the lowest tertile psoas muscle area by gender. The primary end point was the composite of inpatient death or prolonged length of stay of >30 days. One hundred patients met inclusion criteria. The psoas muscle area cut-off values for the lowest tertiles were 12.0 cm2 for men and 6.5 cm2 for women, resulting in 32 sarcopenic patients (32%). The primary outcome of inpatient death or prolonged length of stay occurred in 81% of patients in the sarcopenic versus 60% in the nonsarcopenic group (p = 0.043). There was a trend toward prolonged length of stay in sarcopenic patients but no difference in overall mortality. This demonstrates that sarcopenia as measured by psoas muscle area is associated with increased composite length of stay and mortality after LVAD implantation and may serve as correlate for frailty.
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Affiliation(s)
- George A Heberton
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Michael Nassif
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - Andrew Bierhals
- Division of Diagnostic Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Eric Novak
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - Shane J LaRue
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - Brian Lima
- Cardiology Division, Baylor University Medical Center, Dallas, Texas
| | - Shelley Hall
- Cardiology Division, Baylor University Medical Center, Dallas, Texas
| | - Scott Silvestry
- Florida Hospital Transplant Institute, Florida Hospital, Orlando, Florida
| | - Susan M Joseph
- Cardiology Division, Baylor University Medical Center, Dallas, Texas.
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Coverstone ED, Heberton GA, Lindman BR, Bach RG, Maniar H, Amin A, Kurz HI, Lasala J, Singh J, Zajarias A. TCT-326 Utility of Fractional Flow Reserve Assessment in Aortic Stenosis. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.372] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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