1
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Brayer KJ, Hanson JA, Cingam S, Martinez C, Ness SA, Rabinowitz I. The inflammatory response of human pancreatic cancer samples compared to normal controls. PLoS One 2023; 18:e0284232. [PMID: 37910468 PMCID: PMC10619777 DOI: 10.1371/journal.pone.0284232] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/01/2023] [Indexed: 11/03/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a poor prognosis cancer with an aggressive growth profile that is often diagnosed at late stage and that has few curative or therapeutic options. PDAC growth has been linked to alterations in the pancreas microbiome, which could include the presence of the fungus Malassezia. We used RNA-sequencing to compare 14 matched tumor and normal (tumor adjacent) pancreatic cancer samples and found Malassezia RNA in both the PDAC and normal tissues. Although the presence of Malassezia was not correlated with tumor growth, a set of immune- and inflammatory-related genes were up-regulated in the PDAC compared to the normal samples, suggesting that they are involved in tumor progression. Gene set enrichment analysis suggests that activation of the complement cascade pathway and inflammation could be involved in pro PDAC growth.
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Affiliation(s)
- Kathryn J. Brayer
- Department of Internal Medicine, Molecular Medicine, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Joshua A. Hanson
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Shashank Cingam
- Division of Hematology- Oncology, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Cathleen Martinez
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Scott A. Ness
- Department of Internal Medicine, Molecular Medicine, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Ian Rabinowitz
- Division of Hematology- Oncology, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, United States of America
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2
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Brayer KJ, Hanson JA, Cingam S, Martinez C, Ness SA, Rabinowitz I. The immune response to a fungus in pancreatic cancer samples. bioRxiv 2023:2023.03.28.534606. [PMID: 37034706 PMCID: PMC10081247 DOI: 10.1101/2023.03.28.534606] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a poor prognosis cancer with an .aggressive growth profile that is often diagnosed at late stage and that has few curative or therapeutic options. PDAC growth has been linked to alterations in the pancreas microbiome, which could include the presence of the fungus Malassezia. We used RNA-sequencing to compare 14 paired tumor and normal (tumor adjacent) pancreatic cancer samples and found Malassezia RNA in both the PDAC and normal tissues. Although the presence of Malassezia was not correlated with tumor growth, a set of immune- and inflammatory-related genes were up-regulated in the PDAC compared to the normal samples, suggesting that they are involved in tumor progression. Gene set enrichment analysis suggests that activation of the complement cascade pathway and inflammation could be involved in pro PDAC growth.
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Affiliation(s)
- KJ Brayer
- Department of Internal Medicine / Molecular Medicine, University of New Mexico, Albuquerque, NM
| | - JA Hanson
- Department of Pathology, University of New Mexico, Albuquerque, NM
| | - S Cingam
- Department of Internal Medicine/ Division of Hematology- Oncology, University of New Mexico, Albuquerque, NM
| | - C Martinez
- Department of Pathology, University of New Mexico, Albuquerque, NM
| | - SA Ness
- Department of Internal Medicine / Molecular Medicine, University of New Mexico, Albuquerque, NM
| | - I Rabinowitz
- Department of Internal Medicine/ Division of Hematology- Oncology, University of New Mexico, Albuquerque, NM
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3
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Harari-Turquie M, Moturi KR, Horton DD, Rabinowitz I. The Equipoise Between the Treatment of Glioblastoma and the Risk of Secondary Acute Myelogenous Leukemia: An Illustrative Case Report. J Investig Med High Impact Case Rep 2023; 11:23247096231193266. [PMID: 37596951 PMCID: PMC10440052 DOI: 10.1177/23247096231193266] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/17/2023] [Accepted: 07/23/2023] [Indexed: 08/21/2023] Open
Abstract
We present a case report of a 56-year-old woman who was diagnosed with biopsy-proven left thalamic glioblastoma multiforme (GBM). She was treated with standard concurrent chemotherapy and radiation, as well as a 2-year period of adjuvant temozolomide. She relapsed 2 ½ years after starting her initial therapy and was treated with bevacizumab and lomustine, but she relapsed. She was then placed on a phase 1/2 clinical trial that included KHK2455 and mogamulizumab-kpkc individually and in combination for almost 4 years. She had a rapid demise due to the development of a neutropenic pneumonia and treatment-induced acute myeloid leukemia (AML) and elected for hospice care.
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4
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Shaheen MF, Tse JY, Sokol ES, Masterson M, Bansal P, Rabinowitz I, Tarleton CA, Dobroff AS, Smith TL, Bocklage TJ, Mannakee BK, Gutenkunst RN, Bischoff J, Ness SA, Riedlinger GM, Groisberg R, Pasqualini R, Ganesan S, Arap W. Genomic landscape of lymphatic malformations: a case series and response to the PI3Kα inhibitor alpelisib in an N-of-1 clinical trial. eLife 2022; 11:74510. [PMID: 35787784 PMCID: PMC9255965 DOI: 10.7554/elife.74510] [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: 10/07/2021] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Lymphatic malformations (LMs) often pose treatment challenges due to a large size or a critical location that could lead to disfigurement, and there are no standardized treatment approaches for either refractory or unresectable cases. Methods We examined the genomic landscape of a patient cohort of LMs (n = 30 cases) that underwent comprehensive genomic profiling using a large-panel next-generation sequencing assay. Immunohistochemical analyses were completed in parallel. Results These LMs had low mutational burden with hotspot PIK3CA mutations (n = 20) and NRAS (n = 5) mutations being most frequent, and mutually exclusive. All LM cases with Kaposi sarcoma-like (kaposiform) histology had NRAS mutations. One index patient presented with subacute abdominal pain and was diagnosed with a large retroperitoneal LM harboring a somatic PIK3CA gain-of-function mutation (H1047R). The patient achieved a rapid and durable radiologic complete response, as defined in RECIST1.1, to the PI3Kα inhibitor alpelisib within the context of a personalized N-of-1 clinical trial (NCT03941782). In translational correlative studies, canonical PI3Kα pathway activation was confirmed by immunohistochemistry and human LM-derived lymphatic endothelial cells carrying an allele with an activating mutation at the same locus were sensitive to alpelisib treatment in vitro, which was demonstrated by a concentration-dependent drop in measurable impedance, an assessment of cell status. Conclusions Our findings establish that LM patients with conventional or kaposiform histology have distinct, yet targetable, driver mutations. Funding R.P. and W.A. are supported by awards from the Levy-Longenbaugh Fund. S.G. is supported by awards from the Hugs for Brady Foundation. This work has been funded in part by the NCI Cancer Center Support Grants (CCSG; P30) to the University of Arizona Cancer Center (CA023074), the University of New Mexico Comprehensive Cancer Center (CA118100), and the Rutgers Cancer Institute of New Jersey (CA072720). B.K.M. was supported by National Science Foundation via Graduate Research Fellowship DGE-1143953. Clinical trial number NCT03941782.
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Affiliation(s)
- Montaser F Shaheen
- University of Arizona Cancer Center, Tucson, United States.,Division of Hematology/Oncology, Department of Medicine, University of Arizona College of Medicine, Tucson, United States
| | - Julie Y Tse
- Foundation Medicine, Inc, Cambridge, United States
| | | | - Margaret Masterson
- Rutgers Cancer Institute of New Jersey, New Brunswick, United States.,Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, United States
| | - Pranshu Bansal
- University of New Mexico Comprehensive Cancer Center, Albuquerque, United States.,Division of Hematology/Oncology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, United States
| | - Ian Rabinowitz
- University of New Mexico Comprehensive Cancer Center, Albuquerque, United States.,Division of Hematology/Oncology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, United States
| | - Christy A Tarleton
- University of New Mexico Comprehensive Cancer Center, Albuquerque, United States.,Division of Molecular Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, United States
| | - Andrey S Dobroff
- University of New Mexico Comprehensive Cancer Center, Albuquerque, United States.,Division of Molecular Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, United States
| | - Tracey L Smith
- Rutgers Cancer Institute of New Jersey, Newark, United States.,Division of Cancer Biology, Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, United States
| | - Thèrése J Bocklage
- University of New Mexico Comprehensive Cancer Center, Albuquerque, United States.,Department of Pathology, University of Kentucky College of Medicine and Markey Cancer Center, Lexington, United States
| | - Brian K Mannakee
- University of Arizona Cancer Center, Tucson, United States.,Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, United States
| | - Ryan N Gutenkunst
- University of Arizona Cancer Center, Tucson, United States.,Department of Molecular and Cellular Biology, College of Science, University of Arizona, Tucson, United States
| | - Joyce Bischoff
- Vascular Biology Program, Boston Children's Hospital, Boston, United States.,Department of Surgery, Harvard Medical School, Boston, United States
| | - Scott A Ness
- University of New Mexico Comprehensive Cancer Center, Albuquerque, United States.,Division of Molecular Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, United States
| | - Gregory M Riedlinger
- Rutgers Cancer Institute of New Jersey, New Brunswick, United States.,Department of Pathology, Rutgers Robert Wood Johnson Medical School, New Brunswick, United States
| | - Roman Groisberg
- Rutgers Cancer Institute of New Jersey, New Brunswick, United States.,Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, United States
| | - Renata Pasqualini
- Rutgers Cancer Institute of New Jersey, Newark, United States.,Division of Cancer Biology, Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, United States
| | - Shridar Ganesan
- Rutgers Cancer Institute of New Jersey, New Brunswick, United States.,Division of Medical Oncology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, United States
| | - Wadih Arap
- Rutgers Cancer Institute of New Jersey, Newark, United States.,Division of Hematology/Oncology, Department of Medicine, Rutgers New Jersey Medical School, Newark, United States
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5
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Sasankan S, Rebuck L, Darrah G, Harari Turquie M, Rabinowitz I. Metastatic Pancreatic Cancer with BRAF and P53 Mutations: Case Report of Therapeutic Response to Doublet Targeted Therapy. Case Rep Oncol 2020; 13:1239-1243. [PMID: 33250737 PMCID: PMC7670384 DOI: 10.1159/000510096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 12/23/2022] Open
Abstract
We report on the clinical history of a 49-year-old female with metastatic pancreatic cancer. She was initially treated with standard chemotherapy as per current guidelines. She was found to have both a BRAF and P53 mutation, and received dabrafenib and trametinib with deep responses, both radiographically and biochemically (CA19-9). Her response has been more clinically relevant than responses in previous case reports of patients with BRAF-positive pancreatic cancer treated with targeted therapy. To the best of our knowledge, this is the first case report showing a dramatic therapeutic response to combination therapy with dabrafenib and trametinib in metastatic pancreatic cancer.
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Affiliation(s)
- Shenthol Sasankan
- Hematology and Medical Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Lorraine Rebuck
- Hematology and Medical Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Gloria Darrah
- Hematology and Medical Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Moises Harari Turquie
- Hematology and Medical Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Ian Rabinowitz
- Hematology and Medical Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
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6
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Ready N, Hellmann MD, Awad MM, Otterson GA, Gutierrez M, Gainor JF, Borghaei H, Jolivet J, Horn L, Mates M, Brahmer J, Rabinowitz I, Reddy PS, Chesney J, Orcutt J, Spigel DR, Reck M, O'Byrne KJ, Paz-Ares L, Hu W, Zerba K, Li X, Lestini B, Geese WJ, Szustakowski JD, Green G, Chang H, Ramalingam SS. First-Line Nivolumab Plus Ipilimumab in Advanced Non-Small-Cell Lung Cancer (CheckMate 568): Outcomes by Programmed Death Ligand 1 and Tumor Mutational Burden as Biomarkers. J Clin Oncol 2019; 37:992-1000. [PMID: 30785829 PMCID: PMC6494267 DOI: 10.1200/jco.18.01042] [Citation(s) in RCA: 408] [Impact Index Per Article: 81.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE CheckMate 568 is an open-label phase II trial that evaluated the efficacy and safety of nivolumab plus low-dose ipilimumab as first-line treatment of advanced/metastatic non–small-cell lung cancer (NSCLC). We assessed the association of efficacy with programmed death ligand 1 (PD-L1) expression and tumor mutational burden (TMB). PATIENTS AND METHODS Two hundred eighty-eight patients with previously untreated, recurrent stage IIIB/IV NSCLC received nivolumab 3 mg/kg every 2 weeks plus ipilimumab 1 mg/kg every 6 weeks. The primary end point was objective response rate (ORR) in patients with 1% or more and less than 1% tumor PD-L1 expression. Efficacy on the basis of TMB (FoundationOne CDx assay) was a secondary end point. RESULTS Of treated patients with tumor available for testing, 252 patients (88%) of 288 were evaluable for PD-L1 expression and 98 patients (82%) of 120 for TMB. ORR was 30% overall and 41% and 15% in patients with 1% or greater and less than 1% tumor PD-L1 expression, respectively. ORR increased with higher TMB, plateauing at 10 or more mutations/megabase (mut/Mb). Regardless of PD-L1 expression, ORRs were higher in patients with TMB of 10 or more mut/Mb (n = 48: PD-L1, ≥ 1%, 48%; PD-L1, < 1%, 47%) versus TMB of fewer than 10 mut/Mb (n = 50: PD-L1, ≥ 1%, 18%; PD-L1, < 1%, 5%), and progression-free survival was longer in patients with TMB of 10 or more mut/Mb versus TMB of fewer than 10 mut/Mb (median, 7.1 v 2.6 months). Grade 3 to 4 treatment-related adverse events occurred in 29% of patients. CONCLUSION Nivolumab plus low-dose ipilimumab was effective and tolerable as a first-line treatment of advanced/metastatic NSCLC. TMB of 10 or more mut/Mb was associated with improved response and prolonged progression-free survival in both tumor PD-L1 expression 1% or greater and less than 1% subgroups and was thus identified as a potentially relevant cutoff in the assessment of TMB as a biomarker for first-line nivolumab plus ipilimumab.
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Affiliation(s)
- Neal Ready
- 1 Duke University Medical Center, Durham, NC
| | | | | | | | - Martin Gutierrez
- 5 John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | | | | | - Jacques Jolivet
- 8 St Jerome Medical Research Inc., Saint-Jérôme, Quebec, Canada
| | - Leora Horn
- 9 Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Mihaela Mates
- 10 Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Julie Brahmer
- 11 Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - Ian Rabinowitz
- 12 University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | | | - Jason Chesney
- 14 James Graham Brown Cancer Center, University of Louisville, Louisville, KY
| | - James Orcutt
- 15 Charleston Hematology Oncology Associates, Charleston, SC
| | - David R Spigel
- 16 Sarah Cannon Research Institute/Tennessee Oncology PLLC, Nashville, TN
| | - Martin Reck
- 17 LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | | | - Luis Paz-Ares
- 19 Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, CiberOnc, Madrid, Spain
| | - Wenhua Hu
- 20 Bristol-Myers Squibb, Princeton, NJ
| | - Kim Zerba
- 20 Bristol-Myers Squibb, Princeton, NJ
| | - Xuemei Li
- 20 Bristol-Myers Squibb, Princeton, NJ
| | | | | | | | | | - Han Chang
- 20 Bristol-Myers Squibb, Princeton, NJ
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7
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Inbal A, Seligsohn U, Kornbrot N, Brenner B, Harrison P, Randi A, Rabinowitz I, Sadler JE. Characterization of Three Mutations Causing von Willebrand Disease Type IIA in Five Unrelated Families. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1648511] [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: 10/28/2022]
Abstract
SummaryVon Willebrand disease (vWD) type IIA is characterized by decreased ristocetin-induced platelet aggregation, and by the absence from plasma of high molecular weight multimers of von Willebrand factor (vWF). Most mutations causing vWD type IIA are clustered within the A2 domain of the mature vWF subunit that is encoded by exon 28. Using the polymerase chain reaction (PCR), the entire exon 28 from patients with vWD type IIA and normal controls was amplified and sequenced. Three missense mutations were detected that result in the amino acid substitutions Arg(834)→Trp, Gly(742)→Glu, and Ser(743)→Leu. The first mutation occurred independently in three unrelated families; each of the latter mutations was found in one family. By restriction endonuclease analysis and allele-specific oligonucleotide (ASO) hybridization the mutations were confirmed in affected family members and excluded in unaffected members and 50 normal controls. The apparently high frequency of identical independent mutations among patients with vWD type IIA suggests that a precise diagnosis may be possible in a majority of patients using relatively simple recombinant DNA screening assays.
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Affiliation(s)
- Aida Inbal
- The Hematology Unit, Beilinson Medical Center, St.Thomas’Hospital, London, U. K
- Sackler School of Medicine, Israel, St.Thomas’Hospital, London, U. K
| | - Uri Seligsohn
- Institute of Hematology, Tel Aviv Medical Center, Ichilov Hospital, St.Thomas’Hospital, London, U. K
- Sackler School of Medicine, Israel, St.Thomas’Hospital, London, U. K
| | - Nurit Kornbrot
- The Hematology Unit, Beilinson Medical Center, St.Thomas’Hospital, London, U. K
- Sackler School of Medicine, Israel, St.Thomas’Hospital, London, U. K
| | | | - Paul Harrison
- Coagulation Research Unit, The Rayne Institute, St.Thomas’ Hospital, London, U. K
| | - Anna Randi
- Department of Medicine and of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO, U.S.A
| | - Ian Rabinowitz
- Howard Hughes Medical Institute, Washington University School of Medicine, St. Louis, MO, U. S. A
- Department of Medicine and of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO, U.S.A
| | - J Evan Sadler
- Howard Hughes Medical Institute, Washington University School of Medicine, St. Louis, MO, U. S. A
- Department of Medicine and of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO, U.S.A
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8
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Rabinowitz I. Risk for thrombosis in patients with myeloproliferative neoplasms was highest near the time of diagnosis. Ann Intern Med 2018; 168:JC57. [PMID: 29800433 DOI: 10.7326/acpjc-2018-168-10-057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ian Rabinowitz
- University of New Mexico Cancer CenterAlbuquerque, New Mexico, USA
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9
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Abstract
A 41-year-old woman was admitted for Candida fungemia. On hospital day 4, a routine complete blood count and peripheral smear showed circulating plasma cells. Initial workup showed an M-component on serum protein electrophoresis with 6% λ-predominate plasma cells by flow cytometry. The patient was treated with intravenous antifungal therapy. Her 6-month follow-up laboratory evaluation revealed resolution of the M-component and only rare polyclonal plasma cells in peripheral blood by flow cytometry. This case illustrates that transient monoclonal gammopathy can be induced by fungal infection. It is important to exclude a plasma cell neoplasm or a B-cell lymphoma and to follow the patient until resolution of abnormal findings.
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Affiliation(s)
- Joanna L Conant
- University of New Mexico, Department of Hematopathology, Albuquerque, NM 87102.
| | - Ian Rabinowitz
- University of New Mexico, Department of Hematology and Oncology, Albuquerque, NM 87106
| | - Qian-Yun Zhang
- University of New Mexico, Department of Hematopathology, Albuquerque, NM 87102
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10
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Abstract
692 Background: Cost of cancer care including colon cancer continues to rise. Most of the recent advances in colon cancer inlcude biologics and targeted agents which are adminstered in an oupatient setting and more commonly thought to be responsible for increasing economic burden. Cost of care for cancer patients in an inpatient setting however continues to be a significant factor that needs to be identified better to help adopt cost effective quality improvement in future. Methods: We used NIS to extract data for patients hospitalized with primary diagnosis of colon cancer using clinical classification software code 14, and corresponding ICD9 codes for the years 2003-2013. ICD codes for colorectal and rectal cancer were eliminated. NIS is a nationally representative survey of hospitalizations conducted by the Healthcare Cost and Utilization Project. It represents 20% of all hospital data in US. Trend of rate of hospitalization, mean length of stay (LOS), mean cost of hospitalization and mean cost of hospitalization based on owner type- government, private not for profit (PNFP) and private for profit (PFP) was performed. Results: From the year 2003 to 2013 rate of hospitalizations for colon cancer decreased from 37.4 to 28.1 per 100,000 hospital admissions. Mean LOS declined from 9.06 to 7.76 between 2003-2013. In the same time period the mean cost of hospital stay increased from $39,430 to $73,219. The mean cost of hospitalization based on owner type in 2003 was government $33,507; PNFP $33,735 and PFP was $55,553 and in 2013 the mean costs were $63,194; $68,555 and $107,428 respectively. Conclusions: In the decade of 2003-2013 the rate of hospitalization decreased by approximately 25%, LOS decreased by 14% but the mean cost of hospitalization continued to increase throughout the decade with a mean increase of approximately 85% in hospital costs. The increase was observed across the spectrum of all owner types with the maximum increase of 104% in PNFP followed by PFP owner type at 93%, national inflation rate was 26% during this time. Progress made in decreasing LOS has not directly translated into reducing hospital costs and further studies focusing on factors in addition to cost of biologic agents that contribute to cancer care costs should be considered.
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11
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Manda-Mapalo M, Khalili P, Quintana D, Rabinowitz I, Zhang Q. Chronic myelogenous leukemia with acquired t(11;14)(q13;q32) CCND1-IGH: A case report and literature review. Cancer Genet 2016; 209:481-485. [DOI: 10.1016/j.cancergen.2016.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/30/2016] [Accepted: 09/17/2016] [Indexed: 12/30/2022]
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12
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Abstract
Rituximab has considerably modified thetherapeutic strategy for B-cell lymphoproliferative malignancies, most notably non-Hodgkin’s lymphoma (NHL). Rituximab, alone or in combination with chemo-therapy, is being used to treat NHL with limited toxicity. We report two cases, one fatal, of necrotizing fasciitis following the use of rituximab in patients with NHL. No obvious predisposing factors were noted in either case. Practitioners need to beaware of this rare side effect and take prompt and aggressive action at the first onset of symptoms.
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Affiliation(s)
- Jim A Krieger
- University of New Mexico Health Sciences Center, Cancer Research and Treatment Center, Albuquerque, New Mexico
| | - Jan M Merin
- University of New Mexico Health Sciences Center, Cancer Research and Treatment Center, Albuquerque, New Mexico
| | - Ian Rabinowitz
- University of New Mexico Health Sciences Center, Cancer Research and Treatment Center, Albuquerque, New Mexico
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13
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Fajardo AM, MacKenzie DA, Olguin SL, Scariano JK, Rabinowitz I, Thompson TA. Antioxidants Abrogate Alpha-Tocopherylquinone-Mediated Down-Regulation of the Androgen Receptor in Androgen-Responsive Prostate Cancer Cells. PLoS One 2016; 11:e0151525. [PMID: 26986969 PMCID: PMC4795544 DOI: 10.1371/journal.pone.0151525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 02/28/2016] [Indexed: 01/27/2023] Open
Abstract
Tocopherylquinone (TQ), the oxidation product of alpha-tocopherol (AT), is a bioactive molecule with distinct properties from AT. In this study, AT and TQ are investigated for their comparative effects on growth and androgenic activity in prostate cancer cells. TQ potently inhibited the growth of androgen-responsive prostate cancer cell lines (e.g., LAPC4 and LNCaP cells), whereas the growth of androgen-independent prostate cancer cells (e.g., DU145 cells) was not affected by TQ. Due to the growth inhibitory effects induced by TQ on androgen-responsive cells, the anti-androgenic properties of TQ were examined. TQ inhibited the androgen-induced activation of an androgen-responsive reporter and inhibited the release of prostate specific antigen from LNCaP cells. TQ pretreatment was also found to inhibit AR activation as measured using the Multifunctional Androgen Receptor Screening assay. Furthermore, TQ decreased androgen-responsive gene expression, including TM4SF1, KLK2, and PSA over 5-fold, whereas AT did not affect the expression of androgen-responsive genes. Of importance, the antiandrogenic effects of TQ on prostate cancer cells were found to result from androgen receptor protein down-regulation produced by TQ that was not observed with AT treatment. Moreover, none of the androgenic endpoints assessed were affected by AT. The down-regulation of androgen receptor protein by TQ was abrogated by co-treatment with antioxidants. Overall, the biological actions of TQ were found to be distinct from AT, where TQ was found to be a potent inhibitor of cell growth and androgenic activity in androgen-responsive prostate cancer cells.
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Affiliation(s)
- Alexandra M. Fajardo
- Department of Pharmaceutical Sciences, University of New Mexico College of Pharmacy, Albuquerque, New Mexico, United States of America
| | - Debra A. MacKenzie
- Department of Pharmaceutical Sciences, University of New Mexico College of Pharmacy, Albuquerque, New Mexico, United States of America
| | - Sarah L. Olguin
- Department of Pharmaceutical Sciences, University of New Mexico College of Pharmacy, Albuquerque, New Mexico, United States of America
| | - John K. Scariano
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
| | - Ian Rabinowitz
- Division of Hematology/Oncology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
- University of New Mexico Comprehensive Cancer Center, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Todd A. Thompson
- Department of Pharmaceutical Sciences, University of New Mexico College of Pharmacy, Albuquerque, New Mexico, United States of America
- University of New Mexico Comprehensive Cancer Center, University of New Mexico, Albuquerque, New Mexico, United States of America
- * E-mail:
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Libby E, Garcia D, Quintana D, Fekrazad MH, Bauman J, Ebaid A, Hromas R, Rabinowitz I, Wiggins C. Disease-specific survival for patients with multiple myeloma: significant improvements over time in all age groups. Leuk Lymphoma 2014; 55:2850-7. [PMID: 24588734 DOI: 10.3109/10428194.2014.897700] [Citation(s) in RCA: 13] [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] [Indexed: 11/13/2022]
Abstract
This study analyzed the survival of patients with multiple myeloma. Surveillance, Epidemiology, and End Results (SEER) and Centers for Disease Control and Prevention (CDC) databases were queried to calculate myeloma cause-specific survival curves by the Kaplan and Meier product-limit method. The Cox proportional hazards model was used to assess univariate and multivariate predictors of myeloma cause-specific survival. The outcome of interest was death due to myeloma. Results from a Cox proportional hazards model restricted to age and time period at diagnosis demonstrated that the magnitude of improvement in survival by time period varied by age at diagnosis. Among patients under 60 years at diagnosis, hazard ratios for myeloma cause-specific death decreased by more 50% from the first interval of observation to the last. Hazard ratios decreased during the study period by 39% among patients 60-69 years of age and by 27% among patients who were 70 years of age and older. Survival is improving in patients with myeloma of all ages.
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Affiliation(s)
- Edward Libby
- Division of Medical Oncology, Department of Medicine, University of Washington , Seattle, WA , USA
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15
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Bauman J, Shaheen M, Verschraegen CF, Belinsky SA, Houman Fekrazad M, Lee FC, Rabinowitz I, Ravindranathan M, Jones DV. A Phase I Protocol of Hydralazine and Valproic Acid in Advanced, Previously Treated Solid Cancers. Transl Oncol 2014; 7:S1936-5233(14)00020-5. [PMID: 24746712 PMCID: PMC4792814 DOI: 10.1016/j.tranon.2014.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 03/11/2014] [Accepted: 03/14/2014] [Indexed: 01/08/2023] Open
Abstract
Smokers experience aberrant gene promoter methylation in their bronchial cells, which may predispose to the development of neoplasia. Hydralazine is a DNA demethylating agent, and valproic acid is a histone deacetylase inhibitor, and both have modest but synergistic anticancer activity in vitro. We conducted a phase I trial combining valproic acid and hydralazine to determine the maximally tolerated dose (MTD) of hydralazine in combination with a therapeutic dose of valproic acid in patients with advanced, unresectable, and previously treated solid cancers. Twenty females and nine males were enrolled, with a median age of 57 years and a median ECOG performance status of 0. Grade 1 lymphopenia and fatigue were the most common adverse effects. Three subjects withdrew for treatment-related toxicities occurring after the DLT observation period, including testicular edema, rash, and an increase in serum lipase accompanied by hyponatremia in one subject each. A true MTD of hydralazine in combination with therapeutic doses of valproic acid was not reached in this trial, and the planned upper limit of hydralazine investigated in this combination was 400 mg/day without grade 3 or 4 toxicities. A median number of two treatment cycles were delivered. One partial response by Response Evaluation Criteria In Solid Tumors criteria was observed, and five subjects experienced stable disease for 3 to 6 months. The combination of hydralazine and valproic acid is simple, nontoxic, and might be appropriate for chemoprevention or combination with other cancer treatments. This trial supports further investigation of epigenetic modification as a new therapeutic strategy.
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Affiliation(s)
- Julie Bauman
- University of Pittsburg Cancer Institute, Pittsburgh, PA
| | - Monte Shaheen
- University of New Mexico Cancer Center, Albuquerque, NM
| | | | | | | | - Fa-Chyi Lee
- University of New Mexico Cancer Center, Albuquerque, NM
| | | | | | - Dennie V Jones
- University of Kentucky Markey Cancer Center, Lexington, KY.
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Lauer RC, Rabinowitz I, Novak T, Edelman MJ. Results from a phase 2 trial of bortezomib (B) and sorafenib (S) in unresectable or metastatic renal cell cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.4_suppl.495] [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
495 Background: B is a small molecule proteasome inhibitor that affects multiple signaling pathways. S is an orally active multikinase inhibitor with known activity in renal cell cancer. In vitro data has shown that S and B interact synergistically in a number of neoplastic cell lines to cause apoptosis. A phase 1 trial of S and B demonstrated no unexpected toxicities. We now report the results of this phase 2 efficacy trial. Methods: Eligibility included cytologically confirmed clear cell cancer with no prior chemotherapy, PS 0-1, Cr < 1.5 mg/dl, normal LFTs. Regimen: S 200 mg PO BID and B 1mg/m2 IV days 1,4,8, & 11 every 21 days. Patients were treated until disease progression or unacceptable toxicity. The primary objective of the study was to achieve a PFS of 70 weeks. Results: Seventeen patients were enrolled between April of 2011 and January of 2013. Median age was 62y (range 44-75). Four of 17 patients had known brain metastasis on entry to the trial. Median number of cycles = 4 (range 1-45+). Response: CR/PR/SD/PD =0/1/12/4 (RR: 6%, 95% CI = 0%, 29%) Median progression free survival was 13.7 weeks; median overall survival was 110 weeks Toxicity: See table. Only 1 pts. treatment was stopped due to an AE of pancreatitis. There were no toxic deaths. The study was halted for futility. Conclusions: 1.The combination of S and B was well tolerated. 2. The RR of 6% and PFS of 13.7 weeks is not superior to S as a single agent. 3. The combination of SB is not recommended for further development. Clinical trial information: NCT 01100242.
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Affiliation(s)
| | | | - Terry Novak
- University of New Mexico Cancer Center, Albuquerque, NM
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17
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Mohyuddin G, Rabinowitz I. A patient with chronic lymphocytic leukemia and acquired angioedema: correlation of clinical and biochemical response to CLL therapy. Ecancermedicalscience 2013; 7:292. [PMID: 23441138 PMCID: PMC3575201 DOI: 10.3332/ecancer.2013.292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Indexed: 11/06/2022] Open
Abstract
Acquired angioedema (AAE) is a result of an acquired deficiency or inactivity of the C1 esterase inhibitor (C1-INH). There is a well-known link between AAE and lymphoplasmacytic disorders.A 65-year-old woman who was diagnosed with chronic lymphocytic leukemia (CLL), presented with recurrent episodes of angioedema. Although no association between the CLL and angioedema was initially recognized, further workup showed her to have low C1-INH levels. Chemotherapy helped prevent subsequent episodes, but three years later she redeveloped angioedema. She was then placed on ofatumumab maintenance and has since remained free of angioedema.Knowledge of this rare disease and anticipation of the link between CLL and AAE can prevent further attacks and associated morbidity.
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Affiliation(s)
- Gr Mohyuddin
- University of New Mexico Cancer Center, 1201 Camino de Salud NE, Albuquerque, NM 87131, USA
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Rabinowitz I. ACP Journal Club. Aspirin reduced recurrence of venous thromboembolism (VTE) after a first-ever, unprovoked VTE. Ann Intern Med 2012; 157:JC4-3. [PMID: 23070505 DOI: 10.7326/0003-4819-157-8-201210160-02003] [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: 11/22/2022] Open
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19
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Verschraegen CF, Arias-Pulido H, Lee SJ, Movva S, Cerilli LA, Eberhardt S, Schmit B, Quinn R, Muller CY, Rabinowitz I, Purdy M, Snyder D, Bocklage T. Phase IB study of the combination of docetaxel, gemcitabine, and bevacizumab in patients with advanced or recurrent soft tissue sarcoma: the Axtell regimen. Ann Oncol 2012; 23:785-790. [PMID: 21746804 DOI: 10.1093/annonc/mdr299] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To assess the response of patients with soft tissue sarcoma (STS) to the combination of docetaxel, bevacizumab, and gemcitabine. Vascular endothelial growth factor (VEGF)-A levels and expression of VEGF-A and VEGF receptors 1 and 2 were evaluated. PATIENTS AND METHODS Thirty-eight chemotherapy-naive patients with STS were enrolled. A dose-finding study for gemcitabine from 1000, 1250, then 1500 mg/m(2) was done in nine patients (three cohorts), followed by an expansion cohort of 27 patients. Dose of docetaxel was 50 mg/m(2), bevacizumab was 5 mg/kg, and gemcitabine was 1500 mg/m(2), every 2 weeks. Serum VEGF-A was measured by enzyme-linked immunosorbent assay and tissue VEGF-A and its receptors by immunohistochemistry. RESULTS The median follow-up was 36 months. The overall response rate observed was 31.4%, with 5 complete and 6 partial responses, and 18 stable diseases lasting for a median of 6 months. There was no significant hematologic toxicity. The adverse events with the highest grade were attributed to bevacizumab. There was no correlation of VEGF pathway biomarkers with outcome. CONCLUSIONS The combination of gemcitabine, docetaxel, and bevacizumab is safe and effective in patients with STS. The most concerning adverse events were consequences of bevacizumab administration. The benefit of bevacizumab in this patient population remains unclear.
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Affiliation(s)
| | | | - S-J Lee
- Departments of Hematology/Oncology
| | - S Movva
- Departments of Hematology/Oncology
| | | | | | | | - R Quinn
- Departments of Surgery, The University of New Mexico Cancer Center, Albuquerque
| | - C Y Muller
- Departments of Surgery, The University of New Mexico Cancer Center, Albuquerque
| | | | - M Purdy
- Department of Oncology, New Mexico Cancer Care Alliance, Albuquerque, USA
| | - D Snyder
- Department of Oncology, New Mexico Cancer Care Alliance, Albuquerque, USA
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Ravi-Kumar S, Sanaei O, Vasef M, Rabinowitz I, Fekrazad MH. Anaplastic large cell lymphoma associated with breast implants. World J Plast Surg 2012; 1:30-5. [PMID: 25734041 PMCID: PMC4344963] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A forty two years old woman with a history of bilateral breast augmentation for cosmetic reasons was presented for poor healing of the surgical site. Tissue and periprosthetic fluid were removed from the wound site revealing an atypical lymphoid infiltrate. Subsequently the patient developed axillary lymph adenopathy. Excisional biopsy was performed. Flow cytometry was non-diagnostic. She continued to heal poorly and eventually had removal of implant during a simple mastectomy. A nodular area in the breast specimen showed ALK negative anaplastic large cell lymphoma (ALCL). The patient was treated in the private section, with only a pathology consultation being done at our institution (Figures 1-3).
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Affiliation(s)
| | | | - Mohammad Vasef
- University of New Mexico Cancer Center, Albuquerque, NM, USA
| | - Ian Rabinowitz
- University of New Mexico Cancer Center, Albuquerque, NM, USA
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Libby E, Candelaria-Quintana D, Moualla H, Abdul-Jaleel M, Rabinowitz I. Durable complete remission of primary plasma cell leukemia with the bortezomib plus melphalan and prednisone (VMP) regimen. Am J Hematol 2010; 85:733-4. [PMID: 20669178 DOI: 10.1002/ajh.21790] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sela-Katz P, Rabinowitz I, Shugaev I, Shigorina G. Basic knowledge of the medication regimen correlates with performance on cognitive function tests and diagnosis of dementia in elderly patients referred to a geriatric assessment unit. Gerontology 2010; 56:491-5. [PMID: 20339299 DOI: 10.1159/000304738] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 02/04/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cognitive decline and dementia are highly prevalent amongst the elderly. Medication management problems are also prevalent in this population. Although both problems coexist, the quantitative association between them has not been comprehensively analyzed. METHOD A prospective cross-sectional study of a successive cohort of 425 patients was performed in a community-based geriatric assessment unit. Personal information, results of cognitive function tests, a diagnosis of dementia and an examination of basic knowledge of the medication regimen were recorded and entered into a patient register at the end of each patient's assessment. RESULTS Performance in cognitive function tests was significantly poorer in patients demonstrating lack of basic knowledge of the medication regimen. Mean Mini-Mental State Examination score: 19.1 versus 25.5 (p<0.001); mean number of words recalled on a 3-word recall test: 1.0 versus 1.84 (p<0.001); abnormal clock drawing test: 82 versus 57.7%, respectively (p<0.001). The number of patients diagnosed with dementia was greater among patients who demonstrated lack of basic knowledge of the medication regimen (46.8 vs. 6.9%, respectively; p<0.001). CONCLUSION A strong association between lack of basic knowledge of the medication regimen and cognitive dysfunction was demonstrated in elderly patients referred to a geriatric assessment unit, suggesting that lack of basic knowledge of the medication regimen is indicative of cognitive dysfunction and vice versa.
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Affiliation(s)
- P Sela-Katz
- Geriatric Assessment Unit, Haifa and Western Galilee District, Clalit Health Services, Haifa, Israel
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Cristofanilli M, Valero V, Mangalik A, Royce M, Rabinowitz I, Arena FP, Kroener JF, Curcio E, Watkins C, Bacus S, Cora EM, Anderson E, Magill PJ. Phase II, randomized trial to compare anastrozole combined with gefitinib or placebo in postmenopausal women with hormone receptor-positive metastatic breast cancer. Clin Cancer Res 2010; 16:1904-14. [PMID: 20215537 DOI: 10.1158/1078-0432.ccr-09-2282] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE This phase II randomized trial evaluated the efficacy and tolerability of anastrozole combined with gefitinib or anastrozole with placebo in women with hormone receptor-positive metastatic breast cancer (MBC). EXPERIMENTAL DESIGN Postmenopausal women with hormone receptor-positive measurable or evaluable MBC who had not received prior endocrine therapy for this disease stage or who developed metastatic disease during/after adjuvant tamoxifen were eligible. The primary response variable was progression-free survival (PFS) and secondary response variables included clinical benefit rate, objective response rate, overall survival, safety and tolerability, and pharmacokinetics. Tumor biomarker evaluation was an exploratory objective. RESULTS Forty-three patients were randomized to anastrozole plus gefitinib and 50 patients were randomized to anastrozole plus placebo of a planned total of 174 patients (enrollment was prematurely discontinued due to slow recruitment). PFS for patients receiving the combination of anastrozole and gefitinib was longer than for patients receiving anastrozole plus placebo [hazard ratio (gefitinib/placebo), 0.55; 95% confidence interval, 0.32-0.94; median PFS, 14.7 versus 8.4 months]. The clinical benefit rate was 49% versus 34%, and the objective response rate was 2% versus 12% with anastrozole plus gefitinib and anastrozole plus placebo, respectively. No evidence of interaction between baseline biomarker levels and relative treatment effect was found. No unexpected adverse events were observed. CONCLUSION This small randomized study showed that anastrozole in combination with gefitinib is associated with a marked advantage in PFS compared with anastrozole plus placebo, and that the combination was tolerated in postmenopausal women with hormone receptor-positive MBC. Further investigation of epidermal growth factor receptor inhibition in combination with endocrine therapy may be warranted.
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Affiliation(s)
- Massimo Cristofanilli
- Department of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030-1439, USA.
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Czuchlewski DR, Brackney M, Ewers C, Manna J, Fekrazad MH, Martinez A, Nolte KB, Hjelle B, Rabinowitz I, Curtis BR, McFarland JG, Baumbach J, Foucar K. Clinicopathologic features of agranulocytosis in the setting of levamisole-tainted cocaine. Am J Clin Pathol 2010; 133:466-72. [PMID: 20154286 DOI: 10.1309/ajcpopqnbp5thkp1] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Levamisole is a known contaminant of cocaine and, via this route, has been associated with otherwise unexplained agranulocytosis. Levamisole is currently present in the majority of cocaine samples seized by the US Drug Enforcement Agency. We identified 20 cases of unexplained agranulocytosis in our practice locations of Albuquerque, NM, and Vancouver, Canada. Epidemiologic investigation revealed recent or ongoing cocaine use in 14 cases (70%). Certain morphologic features, including circulating plasmacytoid lymphocytes, increased bone marrow plasma cells, and mild megakaryocytic hyperplasia, were associated with the cocaine-exposed group. Of 5 patients tested, 3 (60%) were HLA-B27+ and showed antineutrophil antibodies, consistent with known associations of levamisole-induced agranulocytosis. One patient, who was positive for cocaine and levamisole by toxicology testing, died of infectious complications. Inadvertent consumption of levamisole via cocaine is a severely under-appreciated risk factor for agranulocytosis, and specific laboratory features are suggestive of this etiology.
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Sayar H, Bunning JT, Bocklage TJ, Lee SJ, Libby E, Rabinowitz I. Tumor MET Expression May Not Predict the Risk of Venous Thromboembolism in Cancer Patients. Oncol Res 2010; 19:93-7. [DOI: 10.3727/096504010x12828372551786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Jaetao JE, Butler KS, Adolphi NL, Lovato DM, Bryant HC, Rabinowitz I, Winter SS, Tessier TE, Hathaway HJ, Bergemann C, Flynn ER, Larson RS. Enhanced leukemia cell detection using a novel magnetic needle and nanoparticles. Cancer Res 2009; 69:8310-6. [PMID: 19808954 DOI: 10.1158/0008-5472.can-09-1083] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acute leukemia is a hematopoietic malignancy for which the accurate measurement of minimal residual disease is critical to determining prognosis and treatment. Although bone marrow aspiration and light microscopy remain the current standard of care for detecting residual disease, these approaches cannot reliably discriminate less than 5% lymphoblast cells. To improve the detection of leukemia cells in the marrow, we developed a novel apparatus that utilizes antibodies conjugated to superparamagnetic iron oxide nanoparticles (SPION) and directed against the acute leukemia antigen CD34, coupled with a "magnetic needle" biopsy. Leukemia cell lines expressing high or minimal CD34 were incubated with anti-CD34-conjugated SPIONs. Three separate approaches including microscopy, superconducting quantum interference device magnetometry, and in vitro magnetic needle extraction were then used to assess cell sampling. We found that CD34-conjugated nanoparticles preferentially bind high CD34-expressing cell lines. Furthermore, the magnetic needle enabled identification of both cell line and patient leukemia cells diluted into normal blood at concentrations below those normally found in remission marrow samples. Finally, the magnetic needle enhanced the percentage of lymphoblasts detectable by light microscopy by 10-fold in samples of fresh bone marrow aspirate approximating minimal residual disease. These data suggest that bone marrow biopsy using antigen-targeted magnetic nanoparticles and a magnetic needle for the evaluation of minimal residual disease in CD34-positive acute leukemias can significantly enhance sensitivity compared with the current standard of care.
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Affiliation(s)
- Jason E Jaetao
- Department of Pathology, University of New Mexico and Cancer Research and Treatment Center, Albuquerque, New Mexico 87131, USA
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Rosenbaum L, Fekrazad MH, Rabinowitz I, Vasef MA. Epstein-Barr virus-associated inflammatory pseudotumor of the spleen: report of two cases and review of the literature. J Hematop 2009; 2:127-31. [PMID: 19669195 PMCID: PMC2725282 DOI: 10.1007/s12308-009-0030-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2008] [Accepted: 03/04/2009] [Indexed: 02/07/2023] Open
Abstract
We report two rare examples of Epstein–Barr virus (EBV)-associated inflammatory pseudotumor of the spleen. One patient presented with night sweats, abdominal pain, and weight loss and was found to have a splenic mass on CT scan suspected of lymphoma. The splenic mass in second patient was found incidentally at the time of work up for kidney stones. The pathologic examination of these splenectomy specimens showed similar histologic features. However, the spindle cells were composed of EBV-infected follicular dendritic cells in one case whereas the second case lacked significant follicular dendritic cell proliferation and showed only focal EBV-infected cells suggesting that these proliferations are heterogenous in nature.
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Affiliation(s)
- Lizabeth Rosenbaum
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM USA
| | - M. Houman Fekrazad
- Department of Internal Medicine, Division of Hematology/Oncology, University of New Mexico Health Sciences Center, Albuquerque, NM USA
| | - Ian Rabinowitz
- Department of Internal Medicine, Division of Hematology/Oncology, University of New Mexico Health Sciences Center, Albuquerque, NM USA
| | - Mohammad A. Vasef
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM USA
- Department of Pathology MSC08 4640, 1 University of New Mexico, Albuquerque, NM 87131 USA
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Sayar H, Shen Z, Lee SJ, Royce M, Rabinowitz I, Lee F, Smith H, Eberhardt S, Maestas A, Lu H, Verschraegen C. Phase I study of capecitabine in combination with cisplatin and irinotecan in patients with advanced solid malignancies. Invest New Drugs 2008; 27:153-8. [PMID: 18773144 DOI: 10.1007/s10637-008-9172-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 08/18/2008] [Indexed: 01/29/2023]
Abstract
PURPOSE This phase I trial assessed the safety and the maximum tolerated dose of capecitabine given for 10 days prior to a combination of cisplatin and irinotecan in patients with advanced solid malignancies. It also evaluated the changes in cisplatin DNA adducts induced by capecitabine. PATIENTS AND METHODS Patients with refractory solid tumors who had not failed 5-fluorouracil (5-FU) analogs or topoisomerase I inhibitors were eligible. All cohorts of patients first received a 28-day cycle of cisplatin and irinotecan. Both drugs were given at a dose of 50 mg/m(2) intravenously on day 1, followed by irinotecan on days 8 and 15 at the same dose. The first cycle served as an internal control. Starting from the second cycle, patients received increasing doses per cohort of capecitabine from day 1 to 10 of each cycle, followed by cisplatin on day 11 and irinotecan on days 11, 18 and 25, both at same doses as the first cycle. Cycles were repeated every 38 days. The starting dose of capecitabine was 500 mg/m(2)/day which was escalated by 250 mg/m(2)/day in the subsequent cohort of patients to reach the maximum tolerated dose (MTD). Later, additional patients were treated at the MTD of capecitabine to further evaluate the safety, pharmacodynamics, and tumor response. Patients blood was tested for cisplatin-DNA adducts to determine the impact of capecitabine on cisplatin-based therapy. RESULTS Fifteen patients received at least 2 cycles of treatment. At 1,250 mg/m(2), two DLT of prolonged neutropenia of grade > or =3 were observed. The MTD for capecitabine was thus determined to be 1000 mg/m(2)/day. Fatigue and diarrhea of grade 1 or 2 were the most frequent toxicities at this dose level. No significant hematologic toxicity was observed at the MTD. Two complete and three partial remissions were observed. Four of the responders had received a platinum agent and/or 5-FU in the past. CONCLUSIONS A sequential treatment with capecitabine followed by cisplatin and irinotecan is well tolerated and demonstrates clinical activity in patients with advanced solid malignancies. The influence of capecitabine, if any, on the efficacy of the cisplatin-irinotecan combination is not related to a variation in cisplatin-DNA adducts.
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Affiliation(s)
- H Sayar
- The University of Indiana Cancer Center, Indianapolis, IN, USA
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Verschraegen CF, Quinn R, Rabinowitz I, Arias-Pulido H, Muller C. Phase I/II study of docetaxel (D), gemcitabine (G), and bevacizumab (B) in patients (pts) with advanced or recurrent soft tissue sarcoma (STS). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.10534] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sayar H, Verschraegen CF, Smith H, Rabinowitz I, Lee FC, Shen Z. Phase I study of capecitabine (C) in combination with cisplatin (DDP) and irinotecan (IRI) in patients (pts) with advanced solid malignancies. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.13515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chiorean EG, Sweeney CJ, Verschraegen CF, Lee FC, Jones SF, Rabinowitz I, Tye L, Bello A, Chao R, Burris HA. Tolerability/safety of sunitinib (SU) on schedule 2/1 in combination with capecitabine (C) in patients (pts) with advanced solid tumors (STs): A phase I dose-finding study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.3562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Rabinowitz I, Sayar H, Bunning J, Bocklage T, Lee S, Libby E. Tumor c-MET expression does not predict the risk of venous thromboembolism in cancer patients. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.22114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cristofanilli M, Valero V, Mangalik A, Rabinowitz I, Arena FP, Kroener JF, Curcio E, Watkins C, Magill P. A phase II multicenter, double-blind, randomized trial to compare anastrozole plus gefinitib with anastrozole plus placebo in postmenopausal women with hormone receptor-positive (HR+) metastatic breast cancer (MBC). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.1012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pacheco AV, Rasila K, Lee SJ, Rabinowitz I, Elias L, Lee FC, Verschraegen CF. Phase II studies of antiangiogenic four drug regimens for the treatment of advanced renal cell carcinoma: FUNIL-retinoid and the FUNIL-thalidomide protocols. Urol Oncol 2008; 26:610-5. [PMID: 18367103 DOI: 10.1016/j.urolonc.2007.09.001] [Citation(s) in RCA: 4] [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] [Received: 05/18/2007] [Revised: 08/30/2007] [Accepted: 09/18/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE The objective of these studies was to determine the activity of two alternative 4- drug combinations using cis-retinoic acid or thalidomide administered with a previously developed combination of 5 fluorouracil, interferon-alpha, and interleukin 2 (FUNIL), for patients with metastatic renal cell carcinoma (RRC). METHODS Patients enrolled in these studies had progressive measurable metastatic renal cell cancer and signed an informed consent. Treatments included continuous infusions of 5-fluorouracil, interferon-alpha, 6 MIU/m2 given subcutaneous on days 1, 3, and 5 every week, interleukin-2 6 MIU/m2/day given by continuous infusion days 2 to 5 every week, and either cis-retinoic acid at a dose of 1 mg/kg/day orally in two divided doses or thalidomide given at an initial dose of 200 mg per day. Each cycle consisted of 6 or 4 weeks of the combinations, respectively, followed by a 2-week rest. Patients were evaluated for response prior to each successive cycle. A 2-step mini-max statistical design was used. RESULTS In the cis-retinoid study, 20 patients were enrolled. One patient was ineligible. There were 1 complete and 2 partial responses (one confirmed and one unconfirmed) (15.8%), 1 stable disease, and 15 disease progression. In the thalidomide combination study, 20 patients were enrolled, but only 19 are assessable. One patient progressed early and was never treated. There were 2 partial responses (10.5%), 4 stable disease, and 13 progressive disease. CONCLUSION Neither the FUNIL-cis-retinoid nor the FUNIL-thalidomide regimens met their primary objective first step endpoint of 3 confirmed responses. Both regimens had significant adverse effects and neither is considered promising for further study.
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Affiliation(s)
- Alonso V Pacheco
- The University of New Mexico, Cancer Research and Treatment Center, Albuquerque, NM 87131, USA
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Davis LM, Harris C, Tang L, Doherty P, Hraber P, Sakai Y, Bocklage T, Doeden K, Hall B, Alsobrook J, Rabinowitz I, Williams TM, Hozier J. Amplification patterns of three genomic regions predict distant recurrence in breast carcinoma. J Mol Diagn 2007; 9:327-36. [PMID: 17591932 PMCID: PMC1899419 DOI: 10.2353/jmoldx.2007.060079] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Currently used clinical and histopathological parameters imprecisely define the risk of distant recurrence in breast cancer, underscoring the need for more informative prognostic markers. In the present fluorescence in situ hybridization study of archived surgical specimens, we derived an algorithm for computing a prognostic index (PI) from DNA copy numbers of three genomic regions (CYP24, PDCD6IP, and BIRC5) for estrogen/progesterone receptor-positive (ER/PR+) cancers and a distinct PI (based on NR1D1, SMARCE1, and BIRC5) for estrogen/progesterone receptor-negative (ER/PR-) cancers. Among independent test cases stratified by PI, recurrence rates were significantly higher among high-risk patients than low-risk patients for both ER/PR+ (odds ratio = 9.52, 95% confidence interval >2.12, P = 0.0024) and ER/PR- (odds ratio = 12.3, 95% confidence interval >1.45, P = 0.0188) cancers. Among the entire population, recurrences were significantly more prevalent for cases with PI above the medians for both ER/PR+ (Fisher's exact, P = 1.19 x 10(-5)) and ER/PR- (P = 0.0025) patients and for the node-negative subsets (ER/PR+ node-negative, P = 0.042 and ER/PR- node-negative, P = 0.039). In conclusion, these markers perform well in comparison with other criteria for recurrence risk assessment and can be used with routinely formalin-fixed, paraffin-embedded surgical specimens.
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MESH Headings
- Biomarkers, Tumor/genetics
- Breast Neoplasms/diagnosis
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Disease-Free Survival
- Female
- Follow-Up Studies
- Gene Amplification
- Gene Dosage
- Genome, Human
- Humans
- In Situ Hybridization, Fluorescence
- Lymphatic Metastasis
- Middle Aged
- Prognosis
- Receptors, Estrogen/genetics
- Receptors, Progesterone/genetics
- Recurrence
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Verschraegen CF, Fekrazad HM, Rabinowitz I, Quinn R, Snyder D, Judson P, Purdy M, Lee FC. Phase I/II study of docetaxel (D), gemcitabine (G), and bevacizumab (B) in patients (pts) with advanced or recurrent soft tissue sarcoma (STS). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.10056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10056 Background: The combination of G and D has shown efficacy against refractory STS (Hensley, JCO 2002). STS have a high content of VEGF, which is associated with poor prognosis. This phase I/II study assesses the safety, tolerability, efficacy, and pharmacodynamics (PD) of B in combination with G+D, given on a two-weekly schedule to minimize adverse events (AEs). We are reporting the phase I results. Methods: Untreated pts with advanced or recurrent STS and ECOG PS =2 were eligible. Some pts were treated in a neoadjuvant setting, when surgically appropriate. Planned doses were G 1,000, 1,250, and 1,500 mg/m2, D 50 mg/m2, and B 5 mg/kg iv, every 2 wks. G doses were escalated in serial pt cohorts to determine the maximum tolerated dose (MTD) of G with fixed doses of D and B. MTD was assessed on the first 2 cycles (1 cycle = 2 wks). Treatment was continued until progression or unacceptable toxicity. For neoadjuvant therapy, B was given only for 4 cycles, followed by 4 cycles without B in anticipation of surgery and pts came off study at that point. PD and antitumor efficacy were also assessed. Results: Nine pts have been treated on the phase I escalation arm, including 3 in the neoadjuvant setting. There were no dose limiting toxicities. After 4 cycles with G at 1,500 mg/m2, there was 1 asymptomatic grade 4 bowel perforation at the site of the tumor in a pt with initially inoperable leiomyosarcoma (LMS). After emergency surgery, the pt is free of disease. Observed grade 1 and 2 AEs include alopecia, diarrhea, fatigue (5 each), rigors (4), nausea, dyspnea, headaches (3 each), chest pain, epistaxis, stomatitis, anemia (2 each), rash, hypertension, neuropathy, leukopenia (1 each). There were 1 CR (angiosarcoma), 2 PR, (myxoid sarcoma, undifferentiated sarcoma), 4 NC (2 LMS, liposarcoma, PNST), and 2 PD (myxoid sarcoma, PNST). Necrosis was observed, including in NC disease. Three pts are free of disease after surgery. Conclusions: The combination of G, D, and B given every 2 weeks is safe and has demonstrated some activity in pts with advanced or recurrent STS. The phase II arm is ongoing at G 1,500 mg/m2 with 4 pts already enrolled. Mature data including PD will be reported at the meeting. No significant financial relationships to disclose.
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Affiliation(s)
- C. F. Verschraegen
- Univ of New Mexico, Albuquerque, NM; New Mexico Cancer Care Associates, Santa Fe, NM; Hematology Oncology Associates, Albuquerque, NM
| | - H. M. Fekrazad
- Univ of New Mexico, Albuquerque, NM; New Mexico Cancer Care Associates, Santa Fe, NM; Hematology Oncology Associates, Albuquerque, NM
| | - I. Rabinowitz
- Univ of New Mexico, Albuquerque, NM; New Mexico Cancer Care Associates, Santa Fe, NM; Hematology Oncology Associates, Albuquerque, NM
| | - R. Quinn
- Univ of New Mexico, Albuquerque, NM; New Mexico Cancer Care Associates, Santa Fe, NM; Hematology Oncology Associates, Albuquerque, NM
| | - D. Snyder
- Univ of New Mexico, Albuquerque, NM; New Mexico Cancer Care Associates, Santa Fe, NM; Hematology Oncology Associates, Albuquerque, NM
| | - P. Judson
- Univ of New Mexico, Albuquerque, NM; New Mexico Cancer Care Associates, Santa Fe, NM; Hematology Oncology Associates, Albuquerque, NM
| | - M. Purdy
- Univ of New Mexico, Albuquerque, NM; New Mexico Cancer Care Associates, Santa Fe, NM; Hematology Oncology Associates, Albuquerque, NM
| | - F. C. Lee
- Univ of New Mexico, Albuquerque, NM; New Mexico Cancer Care Associates, Santa Fe, NM; Hematology Oncology Associates, Albuquerque, NM
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Abstract
PURPOSE/OBJECTIVES To evaluate the changes in reports of fatigue, sleep disturbances, and depressive symptoms and serum cortisol, melatonin, serotonin, and bilirubin during adjuvant chemotherapy in women with breast cancer and to determine whether any correlations exist between the symptom parameters and biomarkers. DESIGN Prospective longitudinal, correlational, repeated-measures pilot study. SETTING Large southwestern, university-based, National Cancer Institute-designated cancer center. SAMPLE 22 subjects (11 women with stage II breast cancer receiving adjuvant chemotherapy and 11 cancer-free women who were matched by age, ethnicity, and menopausal status). METHODS Questionnaires (fatigue, sleep, depressive symptoms), wrist sleep actigraphy, and laboratory analysis of serum samples. All subjects (i.e., women with breast cancer receiving chemotherapy and a comparison group of cancer-free women who were matched by age, ethnicity, and menopausal status) were admitted to a general clinical research center for two nights during cycles 1 and 4 for data collection. MAIN RESEARCH VARIABLES Biomarkers (serum cortisol, melatonin, serotonin, and bilirubin), fatigue, sleep, and depressive symptoms. FINDINGS Mean fatigue scores of the subjects with cancer were significantly higher than the healthy comparison group. Subjects with cancer had a significantly lower mean actual sleep time compared to the comparison group at cycle 1. No significant difference was found between the groups at cycle 4. Depression scores also differed significantly between the cancer group and comparison group. Select biomarkers changed over time and were associated with subjective parameters of fatigue, sleep, and depressive symptoms. CONCLUSIONS Findings suggest that fatigue, sleep, and depressive symptoms are more prevalent in women with cancer than a cancer-free comparison group. Biomarkers changed over time and provide a possible explanatory mechanism for the three related symptoms. IMPLICATIONS FOR NURSING Data help to explain a mechanism that may underlie fatigue, sleep, and depressive symptoms and provide a theoretical framework from which to establish evidence-based interventions for symptom management.
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Affiliation(s)
- Judith Payne
- School of Nursing, Duke University, Durham, NC, USA.
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40
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Roach M, Lee F, Rabinowitz I, Parasher G, Heywood G. Combination of irinotecan, oxaliplatin and cetuximab for patients with metastatic pancreatic cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14135 Background: Gemcitabine-based chemotherapy is considered standard approach for patients with metastatic pancreatic cancer but the results remain unsatisfactory with survival averaging about 6 to 10 months. Cell line study indicates more than 90% of pancreatic cancer cells express EGFR receptor. We therefore explore the use of non-gemcitabine-containing regimen and add an EGFR inhibitor. Method: We initiated a regimen with irinotecan 120 mg/m2, oxaliplatin 85 mg/m2, and cetuximab 400 mg/m2 first dose followed by 250 mg/m2 for all subsequent doses delivered every 14 days for patients with metastatic pancreatic cancer. Results: From 1/2005 to 12/2005, a total of 5 patients were treated. Two males and three females, age 59 to 78. Three presented with metastatic disease. One had Whipple’s procedure then had disease recur 2 months post-surgery. One had locally advanced disease and progressed 10 months after concurrent chemoradiation. Grade III/IV neutropenia, anemia developed in 1/5 patients. Grade III/IV diarrhea and nausea/vomiting developed in 3/5 patients. Grade III/IV fatigue, anorexia developed in 4/5 patients. The non-hematologic toxicity was the main reason for dose reduction. 4 had CT scan for response evaluation. The fifth patient completed first cycle of treatment on 1/3/2006 and had CA19–9 dropped from 15,900 to 9,398 u/ml (40% decline). By CT scan, partial response rate is 75% as shown in the table. So far, two patients have died, 5 and 10 months since initiating treatment, one from recurrent hepatic abscess and one from fungus infection. Conclusions: This combination delivered every other week appears promising for patients with metastatic pancreatic cancer. The planned phase II trial will adopt a lower dose approach with irinotecan 90 mg/m2, oxaliplatin 60 mg/m2, and cetuximab 250 mg/m2. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- M. Roach
- University of New Mexico, Albuquerque, NM
| | - F. Lee
- University of New Mexico, Albuquerque, NM
| | | | | | - G. Heywood
- University of New Mexico, Albuquerque, NM
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Rabinowitz I, Verschraegen CF, Lee FC, Smith HO, Royce M. A phase 1 study of flavopiridol in combination with gemcitabine and irinotecan in patients with metastatic cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.13099] [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
13099 Background: Flavopiridol is a cyclin-dependent kinase (CDK) inhibitor. The major toxicities are secretory diarrhea and neutropenia for the 72- and 1-hour infusion schedules, respectively, fatigue, and thrombosis. Gemcitabine or irinotecan (SN-38) followed by flavopiridol at concentrations that correlate with CDK inhibition, produce sequence-dependent cytotoxic synergy with increase in apoptosis by 10–15-fold in all the cell lines tested. Both gemcitabine and irinotecan have broad activity in a number of solid tumors and may be synergistic with flavopiridol. Methods: Eligibility criteria included: patients (pts) with any advanced solid tumors; >18 years old; PS ≤ 2; life expectancy > 3 months; and normal kidney, liver, and marrow functions. Treatment consisted in gemcitabine 800 mg/m2 and irinotecan 80 mg/m2 on day 1 and flavopiridol, starting dose of 30 mg/m2 on day 2 with increment of 15 mg/m2 per dose level, repeated on days 8 and 9 for the first 6 patients, then on days 15 and 16 for the other patients (protocol was amended for inability to redose after one week). Results: Fifteen pts (12 women and 3 men) were enrolled. Characteristics were: Median age, 49 (33–77) years; Median PS 1; ethnicities, 6 whites, 3 native americans, 3 hispanics, and 3 others; Median number of prior chemotherapies, 2 (0–9). Six pts were treated on the first schedule at the first dose level, which caused 1 neutropenic sepsis and death, 1 grade 3 diarrhea, and 5 neutropenia preventing retreatment. On the q 2 week schedule, we have reached the second dose level. Side effects at flavopiridol 30 mg/m2 were all grade 1: nausea (3/3), fatigue (2/3), anorexia (1/3), and neuropathy (1/3). At 45 mg/m2 one heavily pretreated pt had DLT of diarrhea and fatigue. The other 5 pts had grade 2 fatigue (2/5), nausea (2/5), diarrhea (1/5), anorexia (1/5). Additional grade 1 side effects include thrombocytopenia, pitting edema, and pain. Response were seen a small cell tumor of the ovary, and a leiomyosarcoma of the uterus. Conclusions: The every two week dosing is well tolerated and the MTD has not yet been reached. Main side effects are consistent with known toxicity profile for irinotecan and gemcitabine. Mild pitting edema and sensory neuropathy have been noted in 2 patients each. No significant financial relationships to disclose.
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Affiliation(s)
| | | | - F. C. Lee
- University of New Mexico, Albuquerque, NM
| | | | - M. Royce
- University of New Mexico, Albuquerque, NM
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Sayar H, Dietl CA, Helms A, Rabinowitz I. Fragmentation hemolytic anemia 8 years after replacement of ascending aorta with a sutureless intraluminal graft. Am J Hematol 2006; 81:175-7. [PMID: 16493616 DOI: 10.1002/ajh.20513] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 56-year-old man underwent replacement of the ascending aorta with a sutureless intraluminal graft, for a Stanford type A aortic dissection. Eight years after the operation, he developed gross hemoglobinuria, associated with an intravascular hemolytic anemia. Due to numerous schistocytes in the peripheral blood, the hemolysis was attributed to mechanical injury of the red blood cells at the site of the vascular graft. The patient's course was complicated by an infection of the aortic graft, which led to an urgent graft replacement. The hemolytic anemia resolved completely shortly after the reoperation. Physicians should consider this etiology in the differential diagnosis of fragmentation hemolytic anemia.
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Affiliation(s)
- Hamid Sayar
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, 87131, USA
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Bibb J, Hromas R, Rabinowitz I. A Bayesian approach to a patient with a residual mass after treatment for non-Hodgkin's lymphoma of the thyroid. J Clin Oncol 2006; 23:8911-3. [PMID: 16314654 DOI: 10.1200/jco.2005.02.7417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- John Bibb
- University of New Mexico Cancer Research and Treatment Center, University of New Mexico, 900 Camino de Salud, NE, Albuquerque, NM 87131, USA
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Stanford BL, Shah SR, Ballard EE, Jumper CA, Rabinowitz I, Dowell JE, Hunt WC, Krieger JA. A randomized trial assessing the utility of a test-dose program with taxanes. Curr Med Res Opin 2005; 21:1611-6. [PMID: 16238901 DOI: 10.1185/030079905x65411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Taxanes are commonly used anticancer agents with a potential of producing an allergic or hypersensitivity reaction (HSR). We performed a randomized study to evaluate the value of a test dose given prior to the full dose of either paclitaxel or docetaxel. RESEARCH DESIGN AND METHODS Patients were randomly assigned to either the administration of the full dose or to the prior administration of a 1 mg intravenous test dose of either paclitaxel or docetaxel. The primary endpoints were severity of the HSR and the cost of drug wastage due to a HSR. RESULTS Two hundred and eighteen patients were randomized from three different treatment sites. The overall incidence of HSR was 6.5% and there was no significant difference in the incidence of HSR in either group. The mean HSR severity grade was 2.8 for patients without a test dose and 2.3 for those receiving a test dose. There was, however, a reduction in the wastage of taxane in the test dose arm. Wastage avoided in the test dose arm was $1573 per patient who had a HSR and $104 per patient treated with a taxane. CONCLUSION Although a test dose may not reduce the severity of a HSR with the administration of a taxane, it does reduce the cost associated with drug wastage.
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Affiliation(s)
- B L Stanford
- Texas Tech University Health Sciences Center School of Pharmacy, Lubbock & Dallas, TX, USA
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45
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Sayar H, Lee FC, Rabinowitz I, Rasila KK, Hromas R. Preliminary results of a phase II study of low dose continuous chemotherapy for relapsed/refractory lymphoid malignancies. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- H. Sayar
- Cancer Research and Treatment Ctr, Univ o, Albuquerque, NM
| | - F. C. Lee
- Cancer Research and Treatment Ctr, Univ o, Albuquerque, NM
| | - I. Rabinowitz
- Cancer Research and Treatment Ctr, Univ o, Albuquerque, NM
| | - K. K. Rasila
- Cancer Research and Treatment Ctr, Univ o, Albuquerque, NM
| | - R. Hromas
- Cancer Research and Treatment Ctr, Univ o, Albuquerque, NM
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Amin CJ, Rabinowitz I. An unusual reoccurrence of Waldenstrom's macroglobulinemia as pleural effusions that had a discordant response with treatment. ACTA ACUST UNITED AC 2005; 27:200-2. [PMID: 15938727 DOI: 10.1111/j.1365-2257.2005.00666.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 77-year-old female with a past medical history of Waldenstrom's macroglobulinemia presented with progressive shortness of breath and a newly diagnosed left pleural effusion. Numerous diagnostic studies were performed on the patient and finally a pleural biopsy confirmed pulmonary involvement of Waldenstrom's macroglobulinemia. As past studies have shown, Waldenstrom's involvement as a pulmonary process is uncommon. Unexpectedly, treatment with rituximab and fludarabine did decrease the patient's serum immunoglobulin M levels, but her pleural effusions never improved.
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Affiliation(s)
- C J Amin
- Department of Internal Medicine, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, NM 87131-0001, USA.
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47
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Abstract
In order to improve the therapeutic index of camptothecin (CPT) analogues, alternative administration of CPT analogues is being evaluated. Topotecan, irinotecan, rubitecan, lurtotecan and 9-aminocamptothecin have been administered orally with response rates equivalent to that seen after intravenous administration, where applicable. Oral availability and administration of some of the newer CPT analogues, including diflomotecan (BN80915) and grimatecan (ST1481), have also shown promising results. Aerosolisation of liposomal 9-nitrocamptothecin has been studied in patients with advanced malignancies involving the lung, demonstrating systemic antitumour activity. Intrathecal administration of topotecan has been studied in children with refractory neoplastic meningitis. It is well tolerated and associated with some antitumour activity. Intraperitoneal administration of topotecan as consolidation therapy in patients with ovarian cancer has shown promising results. Transdermal administration of rubitecan has been studied in mice. So far, no CPT has been approved for an alternative route of administration.
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Affiliation(s)
- Ursa Glaberman
- University of New Mexico Cancer Research and Treatment Center, Albuquerque, 87131, USA
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48
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Rasila K, Lee FC, Rabinowitz I. A phase II trial of thalidomide, α-Interferon +/–octreotide in patients with advanced hepatocellular carcinoma. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- K. Rasila
- University of New Mexico, Albuquerque, NM
| | - F.-C. Lee
- University of New Mexico, Albuquerque, NM
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49
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Verschraegen CF, Lee FC, Rabinowitz I, Mangalik A, Jennings C, Maestas A, Shen Z. Phase I and translational study of capecitabine, cisplatin, and irinotecan in patients with solid tumors. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.2114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - F. C. Lee
- University of New Mexico, Albuquerque, NM
| | | | | | | | - A. Maestas
- University of New Mexico, Albuquerque, NM
| | - Z. Shen
- University of New Mexico, Albuquerque, NM
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50
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Rabinowitz MJ, Mangalik A, Lee FC, Cathcart C, Verschraegen C, Rabinowitz I. Phase I/II study of carboplatin, vinorelbine and capecitabine in metastatic breast cance. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - F.-C. Lee
- University of New Mexico, Albuquerque, NM
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