1
|
Arnett A, Siegel DA, Dai S, Thompson TD, Foster J, di Pierro EJ, Momin B, Lupo PJ, Heczey A. Incidence and survival of pediatric and adult hepatocellular carcinoma, United States, 2001-2020. medRxiv 2024:2024.03.25.24304564. [PMID: 38633779 PMCID: PMC11023662 DOI: 10.1101/2024.03.25.24304564] [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] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Importance Hepatocellular carcinoma accounts for approximately 80% of liver neoplasms. Globally, hepatocellular carcinoma ranks as the third most lethal cancer, with the number of deaths expected to further increase by 2040. In adults, disparities in incidence and survival are well described while pediatric epidemiology is not well characterized. Objective To describe incidence and survival for pediatric (ages 0-19 years) hepatocellular carcinoma cases and compare these measures to adults (ages ≥20 years) diagnosed with hepatocellular carcinoma. We evaluated demographic factors and clinical characteristics that influence incidence and outcomes. Design Population-based cohort study. Setting Incidence data from the US Cancer Statistics database from 2003 to 2020 and 5-year relative survival from the National Program of Cancer Registries from 2001 to 2019, covering 97% and 83% of the US population, respectively. Participants 355,349 US Cancer Statistics and 257,406 the National Program of Cancer Registries patients were identified using ICD-O-3 C22.0 and 8170-5 codes. Main Outcomes and Measures Incidence annual percent change (APC) and average APC (AAPC) using joinpoint regression. Five-year relative survival. All-cause survival estimated using multivariate Cox modeling. Corresponding 95% confidence intervals (CI) were calculated. Results Incidence rate per 100,000 persons was 0.056 (95%CI:0.052-0.060) for pediatric cases and 7.793 (7.767-7.819) for adults. Incidence was stable in the pediatric population (0.3 AAPC, -1.1-1.7). In contrast, after periods of increase, incidence declined in adults after 2015 (-1.5 APC). Relative survival increased over time for both pediatric and adult ages and was higher for children and adolescents (46.4%, 95%CI:42.4-50.3) than adults (20.7%, 95%CI:20.5-20.9) overall and when stratified by stage. Regression modeling showed that non-Hispanic Black race and ethnicity was associated with higher risk of death in children and adolescents (1.48, 95%CI:1.07-2.05) and adults (1.11, 95%CI:1.09-1.12) compared to non-Hispanic white race and ethnicity. Conclusions and Relevance Between 2003 and 2020 in the United States, pediatric incidence was stable while incidence in adults began to decline after 2015. Survival was higher across all stages for children and adolescents compared to adults. Non-Hispanic Black race and ethnicity showed a higher risk of death for both age groups. Further studies could explore the factors that influence these outcome disparities.
Collapse
Affiliation(s)
- Azlann Arnett
- Cancer and Hematology Centers, Texas Children’s Hospital, Houston, Texas
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - David A. Siegel
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shifan Dai
- Cyberdata Technologies, Inc., Herndon, Virginia
| | - Trevor D. Thompson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Foster
- Cancer and Hematology Centers, Texas Children’s Hospital, Houston, Texas
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Erika J. di Pierro
- Cancer and Hematology Centers, Texas Children’s Hospital, Houston, Texas
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Behnoosh Momin
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Philip J. Lupo
- Cancer and Hematology Centers, Texas Children’s Hospital, Houston, Texas
- Cnter for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Andras Heczey
- Cancer and Hematology Centers, Texas Children’s Hospital, Houston, Texas
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
2
|
Sharps K, Foster J, Vieno M, Beck R, Hayes F. Ozone pollution contributes to the yield gap for beans in Uganda, East Africa, and is co-located with other agricultural stresses. Sci Rep 2024; 14:8026. [PMID: 38580752 PMCID: PMC10997645 DOI: 10.1038/s41598-024-58144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/26/2024] [Indexed: 04/07/2024] Open
Abstract
Air quality negatively impacts agriculture, reducing the yield of staple food crops. While measured data on African ground-level ozone levels are scarce, experimental studies demonstrate the damaging impact of ozone on crops. Common beans (Phaseolus vulgaris), an ozone-sensitive crop, are widely grown in Uganda. Using modelled ozone flux, agricultural surveys, and a flux-effect relationship, this study estimates yield and production losses due to ozone for Ugandan beans in 2015. Analysis at this scale allows the use of localised data, and results can be presented at a sub-regional level. Soil nutrient stress, drought, flood risk, temperature and deprivation were also mapped to investigate where stresses may coincide. Average bean yield losses due to ozone were 17% and 14% (first and second growing season respectively), equating to 184 thousand tonnes production loss. However, for some sub-regions, losses were up to 27.5% and other crop stresses also coincided in these areas. This methodology could be applied widely, allowing estimates of ozone impact for countries lacking air quality and/or experimental data. As crop productivity is below its potential in many areas of the world, changing agricultural practices to mitigate against losses due to ozone could help to reduce the crop yield gap.
Collapse
Affiliation(s)
- K Sharps
- UK Centre for Ecology & Hydrology, Environment Centre Wales, Deiniol Road, Bangor, Gwynedd, LL57 2UW, UK.
| | - J Foster
- UK Centre for Ecology & Hydrology, Environment Centre Wales, Deiniol Road, Bangor, Gwynedd, LL57 2UW, UK
| | - M Vieno
- UK Centre for Ecology & Hydrology, Bush Estate, Penicuik, Midlothian, EH26 0QB, UK
| | - R Beck
- UK Centre for Ecology & Hydrology, Bush Estate, Penicuik, Midlothian, EH26 0QB, UK
| | - F Hayes
- UK Centre for Ecology & Hydrology, Environment Centre Wales, Deiniol Road, Bangor, Gwynedd, LL57 2UW, UK
| |
Collapse
|
3
|
Jain S, Foster J, Mauksar MM. Chronic vulvar aphthous ulcer in Crohn's disease. Am J Obstet Gynecol 2024:S0002-9378(24)00373-9. [PMID: 38423448 DOI: 10.1016/j.ajog.2024.02.293] [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] [Received: 12/22/2023] [Revised: 02/09/2024] [Accepted: 02/24/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Shivani Jain
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jennifer Foster
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Melissa M Mauksar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX; Departments of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
| |
Collapse
|
4
|
Brousseau M, Foster J, Adam D, Boggs S, Burgess S, Johnson L, McMullen S, Krmpotic K. Pediatric intensive care unit admissions in children with respiratory technology dependence. Pediatr Pulmonol 2023; 58:2976-2978. [PMID: 37493124 DOI: 10.1002/ppul.26615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 07/27/2023]
Affiliation(s)
- Marc Brousseau
- Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Jennifer Foster
- Department of Pediatric Critical Care, IWK Health, Halifax, Canada
- Department of Critical Care, Dalhousie University, Halifax, Canada
| | - Danielle Adam
- Division of Respirology, IWK Health, Halifax, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Samantha Boggs
- Division of Pediatric Critical Care, Alberta Children's Hospital, Alberta, Canada
| | | | - Liane Johnson
- Division of Otolaryngology-Head and Neck Surgery, IWK Health, Halifax, Canada
- Department of Surgery, Dalhousie University, Halifax, Canada
| | - Sarah McMullen
- Department of Critical Care, Dalhousie University, Halifax, Canada
- Department of Critical Care, Nova Scotia Health, Halifax, Canada
| | - Kristina Krmpotic
- Department of Pediatric Critical Care, IWK Health, Halifax, Canada
- Department of Critical Care, Dalhousie University, Halifax, Canada
| |
Collapse
|
5
|
Suarez ZK, Finke AC, Hospedales E, Perez E, Sharifzadeh A, Foster J, Ferris A. An unusual case of checkpoint-inhibitor-induced pleuropericarditis. J Oncol Pharm Pract 2023; 29:1525-1528. [PMID: 37254508 DOI: 10.1177/10781552231179369] [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] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Pembrolizumab is an immune checkpoint inhibitor that promotes effector T-cell functions on malignant cells by binding to programmed cell death protein 1 (PD-1). Pembrolizumab is well tolerated in most cases with an adverse event profile consisting mainly of pruritus, fatigue, and anorexia. Cardiotoxicity comprises 1% of the total adverse events. CASE REPORT We present a case of a 64-year-old female with non-small cell lung cancer (NSCLC) who developed pleuropericarditis following pembrolizumab therapy. MANAGEMENT & OUTCOME The patient was successfully managed with colchicine, furosemide, and timely initiation of methylprednisolone with the improvement of her symptoms. The decision to discontinue pembrolizumab was made, and six months after this intervention, the patient has remained asymptomatic. DISCUSSION Clinicians should recognize these potential immune-mediated adverse effects to provide effective and timely management and optimize patient care.
Collapse
Affiliation(s)
- Zoilo K Suarez
- Internal Medicine Department, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Ana C Finke
- Internal Medicine Department, Universidad Iberoamericana, Santo Domingo, Dominican Republic
| | - Emilio Hospedales
- Internal Medicine Department, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Ernesto Perez
- Internal Medicine Department, Kendall Regional Medical Center, Kendall, FL, USA
| | - Arya Sharifzadeh
- Internal Medicine Department, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Jennifer Foster
- Internal Medicine Department, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Allison Ferris
- Internal Medicine Department, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| |
Collapse
|
6
|
Stevens H, Gallant J, Foster J, Horne D, Krmpotic K. Extubation to High-Flow Nasal Cannula in Infants Following Cardiac Surgery: A Retrospective Cohort Study. J Pediatr Intensive Care 2023; 12:167-172. [PMID: 37565014 PMCID: PMC10411109 DOI: 10.1055/s-0041-1730933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/21/2021] [Indexed: 10/21/2022] Open
Abstract
High-flow nasal cannula (HFNC) therapy is commonly used in the pediatric intensive care unit (PICU) for postextubation respiratory support. This hypothesis-generating retrospective cohort study aimed to compare postextubation PICU length of stay in infants extubated to HFNC and low flow oxygen (LF) in PICU following cardiac surgery. Of 136 infants (newborn to 1 year) who were intubated and mechanically ventilated in PICU following cardiac surgery, 72 (53%) were extubated to HFNC and 64 (47%) to LF. Compared with patients extubated to LF, those extubated to HFNC had significantly longer durations of cardiopulmonary bypass (152 vs. 109 minutes; p = 0.002), aortic cross-clamp (90 vs. 63 minutes; p = 0.003), and invasive mechanical ventilation (3.2 vs. 1.6 days; p < 0.001), although demographic and preoperative clinical variables were similar. No significant difference was observed in postextubation PICU length of stay between HFNC and LF groups in unadjusted analysis (3.3 vs. 2.6 days, respectively; p = 0.19) and after controlling for potential confounding variables (F [1,125] = 0.17, p = 0.68, R 2 = 0.16). Escalation of therapy was similar between HFNC and LF groups (8.3 vs. 14.1%; p = 0.41). HFNC was effective as rescue therapy for six patients in the LF group requiring escalation of therapy. Need for reintubation was similar between HFNC and LF groups (8.3 vs. 4.7%; p = 0.5). Although extubation to HFNC was associated with a trend toward longer postextubation PICU length of stay and was successfully used as rescue therapy for several infants extubated to LF, our results must be interpreted with caution given the limitations of our study.
Collapse
Affiliation(s)
- Hannah Stevens
- Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Julien Gallant
- Department of Pediatric Critical Care, IWK Health, Halifax, Canada
| | - Jennifer Foster
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Department of Pediatric Critical Care, IWK Health, Halifax, Canada
- Department of Critical Care, Dalhousie University, Halifax, Canada
| | - David Horne
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Division of Pediatric Congenital Cardiac Surgery, IWK Health, Halifax, Canada
- Department of Surgery, Dalhousie University, Halifax, Canada
| | - Kristina Krmpotic
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Department of Pediatric Critical Care, IWK Health, Halifax, Canada
- Department of Critical Care, Dalhousie University, Halifax, Canada
| |
Collapse
|
7
|
Foster J, Goldman S, Hughes PG, Iragavarapu V, Drowos J. Launching a Teaching Academy (Virtually) During a Pandemic: Silver Linings to a Challenge. Cureus 2023; 15:e37245. [PMID: 37168201 PMCID: PMC10166416 DOI: 10.7759/cureus.37245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 05/13/2023] Open
Abstract
The pandemic disrupted our plans to launch a Teaching Academy to formally support medical educators. Moving forward virtually provided a collaborative and supportive network to plan and deliver professional development activities to navigate pandemic challenges. Through sharing and practicing new teaching technologies together, the social connection and engagement with colleagues helped navigate pandemic challenges.
Collapse
Affiliation(s)
- Jennifer Foster
- Department of Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Stuart Goldman
- Department of Clinical Neuroscience, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Patrick G Hughes
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Vijaya Iragavarapu
- Department of Biomedical Sciences, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Joanna Drowos
- Department of Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| |
Collapse
|
8
|
Chen A, Sharon E, Van Tine B, Moore N, Foster J, Glod J, Hu J, Rosenberger C, O'Sullivan Coyne G, Doroshow J. 49MO Atezolizumab and bevacizumab in patients treated with prior atezolizumab in alveolar soft tissue sarcoma (ASPS). ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101086] [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: 04/05/2023] Open
|
9
|
Muacevic A, Adler JR, Danforth D, Fine L, Foster J, Jacomino M, Johnson M, Keller B, Mendez P, Saunders JM, Scalese R, Schocken DM, Stalvey C, Stevens M, Suchak N, Syms S, Uchiyama E, Velazquez M. The Florida Clinical Skills Collaborative: A New Regional Consortium for the Assessment of Clinical Skills. Cureus 2022; 14:e31263. [PMID: 36514606 PMCID: PMC9733824 DOI: 10.7759/cureus.31263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022] Open
Abstract
Discontinuation of the United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) exam and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 2 Performance Evaluation (2-PE) raised questions about the ability of medical schools to ensure the clinical skills competence of graduating students. In February 2021, representatives from all Florida, United States, allopathic and osteopathic schools initiated a collaboration to address this critically important issue in the evolving landscape of medical education. A 5-point Likert scale survey of all members (n=18/20 individuals representing 10/10 institutions) reveals that initial interest in joining the collaboration was high among both individuals (mean 4.78, SD 0.43) and institutions (mean 4.69, SD 0.48). Most individuals (mean 4.78, SD 0.55) and institutions (mean 4.53, SD 0.72) are highly satisfied with their decision to join. Members most commonly cited a "desire to establish a shared assessment in place of Step 2 CS/2-PE" as their most important reason for joining. Experienced benefits of membership were ranked as the following: 1) Networking, 2) Shared resources for curriculum implementation, 3) Scholarship, and 4) Work towards a shared assessment in place of Step 2 CS/2-PE. Challenges of membership were ranked as the following: 1) Logistics such as scheduling and technology, 2) Agreement on common goals, 3) Total time commitment, and 4) Large group size. Members cited the "administration of a joint assessment pilot" as the highest priority for the coming year. Florida has successfully launched a regional consortium for the assessment of clinical skills competency with high levels of member satisfaction which may serve as a model for future regional consortia.
Collapse
|
10
|
Mistry PK, Kishnani P, Wanner C, Dong D, Bender J, Batista JL, Foster J. Rare lysosomal disease registries: lessons learned over three decades of real-world evidence. Orphanet J Rare Dis 2022; 17:362. [PMID: 36244992 PMCID: PMC9573793 DOI: 10.1186/s13023-022-02517-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/04/2022] [Indexed: 12/24/2022] Open
Abstract
Lysosomal storage disorders (LSD) are rare diseases, caused by inherited deficiencies of lysosomal enzymes/transporters, that affect 1 in 7000 to 1 in 8000 newborns. Individuals with LSDs face long diagnostic journeys during which debilitating and life-threatening events can occur. Clinical trials and classical descriptions of LSDs typically focus on common manifestations, which are not representative of the vast phenotypic heterogeneity encountered in real-world experience. Additionally, recognizing that there was a limited understanding of the natural history, disease progression, and real-world clinical outcomes of rare LSDs, a collaborative partnership was pioneered 30 years ago to address these gaps. The Rare Disease Registries (RDR) (for Gaucher, Fabry, Mucopolysaccharidosis type I, and Pompe), represent the largest observational database for these LSDs. Over the past thirty years, data from the RDRs have helped to inform scientific understanding and the development of comprehensive monitoring and treatment guidelines by creating a framework for data collection and establishing a standard of care, with an overarching goal to improve the quality of life of affected patients. Here, we highlight the history, process, and impact of the RDRs, and discuss the lessons learned and future directions.
Collapse
Affiliation(s)
- P K Mistry
- Department of Medicine, Yale Liver Center, Yale University School of Medicine, 333 Cedar Street, PO Box 208019, New Haven, CT, 06520, USA.
| | - P Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University, Durham, USA
| | - C Wanner
- University Hospital of Würzburg, Würzburg, Germany
| | - D Dong
- Global Operations and Advocacy Lead, Rare Disease Registries, Sanofi, Cambridge, MA, USA
| | - J Bender
- Head of Global Rare Disease Registries, Sanofi, Cambridge, MA, USA
| | - J L Batista
- Epidemiology/Biostatistics, Sanofi, Cambridge, MA, USA
| | - J Foster
- Data Management, Sanofi, Cambridge, MA, USA
| |
Collapse
|
11
|
Termeie O, Fiedler L, Martinez L, Foster J, Perumareddi P, Levine RS, Hennekens CH. Alarming Trends: Mortality from Alcoholic Cirrhosis in the United States. Am J Med 2022; 135:1263-1266. [PMID: 35636480 DOI: 10.1016/j.amjmed.2022.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Alcoholic cirrhosis is an advanced form of alcohol-related liver disease. In the United States, between 2010 and 2016, alcohol-related liver disease was the primary cause of nearly 1 in 3 liver transplants, surpassing hepatitis C. METHODS We utilized the US Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research database to compare trends in mortality from alcoholic cirrhosis in the United States in 1999 and 2019. We defined mortality from alcoholic cirrhosis as International Classification of Diseases code K70.3 (alcoholic cirrhosis of liver). We calculated mortality rates and mortality rate ratios (MRRs) per 100,000 from alcoholic cirrhosis in 10-year age groups from 25 to 85+ as measures of effect and 95% confidence intervals to test for significance. RESULTS In 1999, there were 6007 deaths from alcoholic cirrhosis among 180,408,769 aged 25-85+ years, yielding a mortality rate of 3.3 per 100,000. In 2019, there were 23,780 deaths from alcoholic cirrhosis among 224,981,167 aged 25-85+ years, yielding a mortality rate of 10.6 per 100,000. The overall MRR of 3.2 was statistically significant. (P < .001), and was apparent in each 10-year age group. CONCLUSIONS These alarming trends in mortality from alcoholic cirrhosis in the United States contribute to the formulation of many hypotheses. These require testing in analytic studies designed a priori to do so. Meanwhile, clinical and public health efforts are necessary to curb the epidemics of heavy alcohol consumption and overweight and obesity in the United States that may be contributing to these alarming trends.
Collapse
Affiliation(s)
- Orly Termeie
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Lawrence Fiedler
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Lisa Martinez
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Jennifer Foster
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | | | - Robert S Levine
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Charles H Hennekens
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton.
| |
Collapse
|
12
|
Lerman B, Li Y, Granger M, Cash T, Sadanand A, Somers K, Ranavaya A, Choe M, Foster J, Morgenstern DA, Rafael MS, Streby KA, Zeno R, Mody R, Yazdani S, Desai AV, Macy ME, Shusterman S, Federico SM, Bagatell R. Progression-free survival and patterns of response in patients with high-risk neuroblastoma (HR-NB) treated with irinotecan/temozolomide/dinutuximab/granulocyte-macrophage colony-stimulating factor (I/T/DIN/GM-CSFS) chemoimmunotherapy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.10025] [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
10025 Background: Encouraging responses to chemoimmunotherapy with I/T/DIN/GM-CSF have been observed in trials for patients (pts) with relapsed/refractory HR-NBL, but factors associated with response have not been identified and duration of response has not been assessed. We aimed to evaluate timing and duration of response among pts with relapsed HR-NBL treated with I/T/DIN/GM-CSF and identify factors associated with response. Methods: We performed a multicenter retrospective cohort study of pts treated with I/T/DIN/GM-CSF. Eligibility criteria included: diagnosis of relapsed HR-NBL prior to age 30; objective response [OR; complete, partial, or minor response (CR, PR, or MR) by International Neuroblastoma Response Criteria (INRC)] or stable disease (SD) after initial therapy; receipt of I/T/DIN/GM-CSF for relapse or progression outside a clinical trial from 1/1/15-6/1/20. Logistic regression was used to identify factors associated with OR. Kaplan Meier analysis was used to determine progression-free survival (PFS). Results: We enrolled 143 pts with a median age at diagnosis of 51 months. Tumors were MYCN amplified in 52 (36%) and ALK was wild type in 73/94 (78% of tumors in which ALK status was known). 79 (55%) had received prior anti-GD2 therapy. I/T/DIN/GM-CSF comprised first relapse therapy in 96 pts (67%), second relapse therapy in 23 (16%) and subsequent therapy in 24 (17%). 70 (49%) achieved OR following I/T/DIN/GM-CSF therapy [29% CR, 15% PR, 5% MR], 30 (21%) achieved SD and 43 (30%) progressed. Median cycles received was 5 (range 1-31). 121 patients (85%) had their best response upon first disease evaluation. Later disease evaluations showed improved INRC classification in 14% of pts with initial SD, 33% with MR, and 41% with PR. Median time to OR was 2 months (range 1-21). Of the 105 relapse/progression events after starting I/T/DIN/GM-CSF (73% of pts), 59 (56%) occurred during therapy. Of the 42 pts who achieved CR with I/T/DIN/GM-CSF, 5 (12%) relapsed during I/T/DIN/GM-CSF and 17 (40%) relapsed after discontinuation. I/T/DIN/GM-CSF was discontinued in 83 pts (58%) due to suboptimal response or PD, and in 19 (13%) for toxicity. Median PFS among objective responders was 15.5 months. Among those in CR, median PFS after discontinuation of I/T/DIN/GM-CSF was 11.8 months (range 0.7-70.6). Multivariable models did not identify clinical or biologic factors associated with OR. Conclusions: 49% of pts receiving I/T/DIN/GM-CSF for relapsed HR-NBL achieved OR. Among responders, median response duration was 15.5 months. Pts with SD on first disease evaluation were unlikely to achieve OR, but > 1/3 of pts with MR/PR on first evaluation ultimately achieved CR. No identifiable clinical or biologic factors were associated with OR.
Collapse
Affiliation(s)
| | - Yimei Li
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Thomas Cash
- Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Arhanti Sadanand
- Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | | | - Aeesha Ranavaya
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | | | | | - Keri A. Streby
- Nationwide Children's Hospital/The Ohio State University, Columbus, OH
| | | | | | | | | | | | - Suzanne Shusterman
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA
| | | | | |
Collapse
|
13
|
Jackson L, Mcneeley E, Techarukpong NC, Mugeta F, Aaron K, Mudano A, Merchant J, Warren K, Foster J, Saag K, Danila M. POS1147 CHALLENGES IN CONDUCTING PRAGMATIC CARE STRATEGY STUDIES IN OSTEOPOROSIS: PATIENT PERCEPTIONS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundLarge pragmatic osteoporosis studies to improve outcomes are needed. Direct-to-patient studies have highest generalizability but achieving sufficient sample size is difficult; recruitment challenges represent an important consideration given limited participant eligibility and interest. The Fracture Liaison Service (FLS), a team approach to post-fracture care, is a secondary fracture prevention method that has significantly improved outcomes internationally.ObjectivesOur goal was to evaluate the interest, barriers, and lessons learned in recruiting participants for a future trial assessing remote FLS approaches for post-fracture care.MethodsWe used ICD10 fracture codes to identify patients > 50 years of age with a documented hip/pelvis, spine, humerus, or wrist fracture in the previous 1 year. We excluded patients with i) prescriptions for osteoporosis medications (e.g., bisphosphonates, parathyroid hormone analogs, denosumab, romosozumab, raloxifene) in the prior 1 year; ii) an ICD10 code for end-stage renal disease, non-osteoporotic metabolic bone disease, malignant neoplasm, or motor vehicle accident. In December 2021, research assistants reviewed electronic health records (EHR) of potentially eligible patients for evidence of additional serious illness limiting life expectancy to < 1 year or non-ambulatory status prior to fracture. Research assistants called preliminary eligible patients that met inclusion and exclusion criteria and asked them to complete a survey by phone. Interest in a FLS future clinical trial was evaluated using a Likert scale (1=“Definitely would not volunteer”, to 5=“Definitely would volunteer”). We used descriptive statistics to analyze baseline demographic, clinical characteristics, and interest. This pilot was approved by the UAB Institutional Review Board (IRB-300008310-005).ResultsWe identified 1,577 patients > 50 years of age with a fracture. After applying exclusion criteria, we identified 869 preliminary eligible patients. Over 3 weeks, we screened the medical records of a random sample of half of the preliminary eligible patient cohort (n=414), of whom we contacted 271 patients determined potentially eligible, and successfully reached 141 (52% of those contacted) by phone. A total of 108 (77% of those reached) persons, mean (SD) age 69.5 (11.5) years, 40% men, 21% Black or non-white Hispanics completed the survey. Among those contacted, 68 (63%, interest rate) said they would be very or highly interested in participating in a future clinical trial evaluating FLS approaches. Among the 40 (37%) people who said they were not sure, unlikely or very unlikely to volunteer the most common reasons cited were “I don’t want to participate in a study” (33%); “I don’t feel well enough to participate” (10%); “I don’t understand what the study is for” (3%). From this pilot, we calculated a refined eligibility/interest rate of 9.1% among those patients preliminarily identified as eligible using administrative data alone.ConclusionBased on our pilot, we estimate that approximately 9% of eligible patients with fractures will be interested in enrolling in a future comparative effectiveness study to prevent recurrent fragility fractures. We identified several potential modifiable barriers to clinical trial recruitment. Patient perceptions collected from this pilot will inform enrollment strategies, which can be incorporated early when planning direct-to-patient pragmatic osteoporosis studies to achieve recruitment goals.Disclosure of InterestsLesley Jackson: None declared, Ellen McNeeley: None declared, Norma C. Techarukpong: None declared, Faith Mugeta: None declared, Kiara Aaron: None declared, Amy Mudano: None declared, Jeanne Merchant: None declared, Kellie Warren: None declared, Jeff Foster: None declared, Kenneth Saag Grant/research support from: Amgen, Horizon, LG Chem, Radius, SOBI, Maria Danila Grant/research support from: Pfizer, Horizon
Collapse
|
14
|
Berges M, Foster K, Foster J, Martinez L, Martinez S, Fiedler B, DeMets DL, Maki DG, Hennekens CH. Updates for Health Providers on Monoclonal Antibodies for COVID-19: Less Promising Adjunct and Never an Alternative to Vaccinations. Am J Med 2022; 135:547-549. [PMID: 35114173 PMCID: PMC8802166 DOI: 10.1016/j.amjmed.2021.12.019] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Maja Berges
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Keith Foster
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Jennifer Foster
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Lisa Martinez
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Sean Martinez
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Benjamin Fiedler
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - David L DeMets
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Dennis G Maki
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Charles H Hennekens
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton.
| |
Collapse
|
15
|
Poole S, Ambardekar E, Gablehouse B, Joslyn L, Jaramillo S, Hegarty T, Foster J, Peters C, Lamb M, Armon C, Schmitt B, Todd J. Office "Phone First" Systems Reduce Emergency Department/Urgent Care Utilization by Medicaid-Enrolled Children. Acad Pediatr 2022; 22:606-613. [PMID: 34902565 DOI: 10.1016/j.acap.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 11/30/2021] [Accepted: 12/08/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Emergency department and urgent care (ED/UC) visits for common conditions can be more expensive with less continuity than office care provided by primary care physicians. METHODS We used quality-improvement methods to enhance telephone triage for pediatric patients by adding additional "Phone First" services including: 1) enhanced office-hours telephone triage and advice with available same-day appointments, 2) follow-up calls to parents of children self-referred to an ED/UC, and 3) parent education to telephone the office for advice prior to seeking acute care. We hypothesized that enhanced office services would reduce ED/UC utilization and cost. We compared changes in ED/UC encounter rates between intervention and regional practices for 4 years (2014-2017) using general linear models, and evaluated balancing measures (after-hour phone calls, acute care phone calls, acute care visits, well child visits) for Medicaid-enrolled and commercially-insured children. RESULTS The study practices dramatically increased office-hours acute care phone triage and advice which correlated with 23.8% to 80.5% (P < 0.001) reductions in ED/UC rates for Medicaid-enrolled children. Office acute care visits decreased modestly. ED/UC visits did not decrease for children in the comparison region. In phone surveys, 94% of parents indicated satisfaction with the ED/UC follow-up call. The decrease in ED/UC visits resulted in an estimated annual cost of care savings for Medicaid-enrolled children in 2017 of $12.61 per member per month which projected to $169 million cost of care savings in Colorado and $6.8 billion in the United States. CONCLUSION "Phone First" services in pediatric practices during office-hours reduced ED/UC encounters and cost of care for Medicaid-enrolled children.
Collapse
Affiliation(s)
- Steven Poole
- Children's Hospital Colorado (S Poole, T Hegarty, C Armon, B Schmitt, and J Todd), Aurora, Colo; University of Colorado (S Poole, C Peters, M Lamb, B Schmitt, and J Todd), Aurora, Colo
| | - Erin Ambardekar
- Children's Medical Center (E Ambardekar, L Joslyn, and S Jaramillo), Denver, Colo
| | | | - Lorie Joslyn
- Children's Medical Center (E Ambardekar, L Joslyn, and S Jaramillo), Denver, Colo
| | - Shannon Jaramillo
- Children's Medical Center (E Ambardekar, L Joslyn, and S Jaramillo), Denver, Colo
| | - Teresa Hegarty
- Children's Hospital Colorado (S Poole, T Hegarty, C Armon, B Schmitt, and J Todd), Aurora, Colo
| | - Jennifer Foster
- Rocky Mountain Heath Centers Pediatrics (J Foster), Aurora, Colo
| | - Chelsea Peters
- University of Colorado (S Poole, C Peters, M Lamb, B Schmitt, and J Todd), Aurora, Colo
| | - Molly Lamb
- University of Colorado (S Poole, C Peters, M Lamb, B Schmitt, and J Todd), Aurora, Colo
| | - Carl Armon
- Children's Hospital Colorado (S Poole, T Hegarty, C Armon, B Schmitt, and J Todd), Aurora, Colo
| | - Barton Schmitt
- Children's Hospital Colorado (S Poole, T Hegarty, C Armon, B Schmitt, and J Todd), Aurora, Colo; University of Colorado (S Poole, C Peters, M Lamb, B Schmitt, and J Todd), Aurora, Colo
| | - James Todd
- Children's Hospital Colorado (S Poole, T Hegarty, C Armon, B Schmitt, and J Todd), Aurora, Colo; University of Colorado (S Poole, C Peters, M Lamb, B Schmitt, and J Todd), Aurora, Colo.
| |
Collapse
|
16
|
Omer B, Shum T, Foster J, Parikh K, Tat C, Shekar M, Vivekananthan A, Mehta B, Zhang H, Thakkar SG, Naik S, Heslop HE, Brenner MK, Rooney CM. Phase I Trial of GD2.CAR T Cells Combined with a Novel Interleukin-7 Signal Modulator. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00290-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
17
|
Daignault C, Sauer HE, Lindsay H, Alonzo A, Foster J. Investigating Potential Drug-Drug Interactions in Pediatric and Adolescent Patients Receiving Chemotherapy. J Oncol Pharm Pract 2022; 28:904-909. [PMID: 35179058 DOI: 10.1177/10781552221079786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Pediatric and adolescent oncology patients admitted to receive chemotherapy are at risk for drug-drug interactions (DDI). While adult literature has quoted this risk to be as high as 95% of encounters, the literature in pediatrics is limited. This is a single-center, retrospective chart review of DDI in hospitalized pediatric oncology patients. METHODS All patients admitted to Texas Children's Hospital for chemotherapy were included. Medications ordered during the hospitalization were evaluated by Lexicomp® Drug Interactions Tool. Interactions classified as D or X or interactions rated a C including a chemotherapeutic agent were independently reviewed by three clinicians for clinical relevance. Medications associated with central nervous system (CNS) depression or QTc prolongation were counted separately. RESULTS Of 100 admissions evaluated, 100% had a flagged interaction. There were a total of 12 X-rated interactions, 8 D-rated interactions, and 12 C-rated interactions with a chemotherapeutic agent found to be clinically relevant. Thirty-three percent of admissions had 4 or more QTc prolonging medications ordered. Twenty-four percent of admissions had 3 or more prescribed CNS depressants. In total 49% of admissions were found to have at least 1 clinically-significant DDI. CONCLUSIONS This study exemplifies the risk of drug-drug interactions in children and young adults admitted to the hospital for chemotherapy. We demonstrated a high rate of flagged interactions with about half of admissions found to have a potentially clinically-significant DDI. Concomitant use of multiple QTc prolonging and CNS depressant medications was also prevalent, indicating a need to evaluate monitoring practices.
Collapse
Affiliation(s)
- Chelsea Daignault
- 506057Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States
| | - Hannah E Sauer
- Department of Pharmacy, 3984Texas Children's Hospital, Houston, TX, United States
| | - Holly Lindsay
- 506057Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States
| | - Amy Alonzo
- Department of Pharmacy, 3984Texas Children's Hospital, Houston, TX, United States
| | - Jennifer Foster
- 506057Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States
| |
Collapse
|
18
|
Miller L, Richard M, Krmpotic K, Kennedy A, Seabrook J, Slumkoski C, Walls M, Foster J. Parental presence at the bedside of critically ill children in the pediatric intensive care unit: A scoping review. Eur J Pediatr 2022; 181:823-831. [PMID: 34626225 PMCID: PMC8501356 DOI: 10.1007/s00431-021-04279-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/14/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
Parental presence at the bedside (PPB) of critically ill children in the pediatric intensive care unit (PICU) is necessary for operationalizing family-centred care. Previous evidence syntheses emphasize parent-healthcare provider interactions at rounds and resuscitation; our focus is the parent-child dyad. Prior to embarking on further study, we performed a scoping review to determine the breadth and scope of the literature addressing PPB of critically ill children in the PICU. We searched five online databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, and PSYCHINFO) and the grey literature to identify English and French reports from January 1960 to June 2020 addressing physical parental presence with children (birth to 18 years) in intensive care units, without limitation by methodology. Screening, reference selection, and data extraction were performed by two independent reviewers. Data were extracted into a researcher-designed tool. We identified 204 publications (81 quantitative, 68 qualitative, 22 mixed methods, and 9 descriptive case or practice change studies, and a further 24 non-study reports). PPB was directly assessed in 78 (38%) reports, and was the primary objective in 64 (31%). Amount or quality of presence was addressed by 114 reports, barriers and enablers by 152 sources, and impacts and outcomes by 134 sources. While only 6 reports were published in the first two decades of our search (1960-1980), 17 reports were published in 2019 alone. Conclusions: A relatively large body of literature exists addressing PPB of critically ill children. Separate systematic evidence syntheses to assess each element of PPB are warranted. Scoping review protocol registration: Open science framework, protocol nx6v3, registered 9-September-2019. What is Known: • Parental presence at the bedside of critically ill children must be enabled to facilitate family centeredness in care. • Systematic evidence syntheses have focused on parental presence at rounds or resuscitation, rather than with the child throughout the intensive care journey. What is New: • Many reports (n=204) address parental presence at the bedside in the pediatric intensive care unit, though most do as incidental findings • Identifies studies addressing key elements of parental presence in the PICU including barriers and enablers to, amount and quality of, and impact and outcomes of parental presence, and demonstrates trends over time and geography.
Collapse
Affiliation(s)
- Lauren Miller
- Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Monique Richard
- Department of Pediatric Critical Care, IWK Health, Halifax, NS Canada
| | - Kristina Krmpotic
- Department of Pediatric Critical Care, IWK Health, Halifax, NS Canada
- Department of Critical Care, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Anne Kennedy
- School of Education, Acadia University, Wolfville, NS Canada
| | - Jamie Seabrook
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, ON Canada
- Department of Pediatrics and Department of Epidemiology & Biostatistics, Western University, London, ON Canada
- Children’s Health Research Institute and Lawson Health Research Institute, London, ON Canada
| | - Corey Slumkoski
- Department of Pediatric Critical Care Parent Partner, IWK Health, Halifax, NS Canada
| | - Martha Walls
- Department of Pediatric Critical Care Parent Partner, IWK Health, Halifax, NS Canada
| | - Jennifer Foster
- Department of Pediatric Critical Care, IWK Health, Halifax, NS Canada
- Department of Critical Care, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
- Children’s Health Research Institute and Lawson Health Research Institute, London, ON Canada
| |
Collapse
|
19
|
Peterson C, Kim YC, Ensign LM, Jun AS, Foster J. Induction of the integrated stress response in the rat cornea. Exp Eye Res 2021; 210:108722. [PMID: 34370978 DOI: 10.1016/j.exer.2021.108722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/13/2021] [Accepted: 08/05/2021] [Indexed: 11/19/2022]
Abstract
Keratoconus (KC), a progressive, degenerative corneal disease, represents the second leading indication for corneal transplantation globally. We have previously demonstrated that components of the Integrated Stress Response (ISR) are upregulated in human keratoconic donor tissue, and treatment of normal tissue with ISR agonists attenuates collagen production. With no consistently accepted animal models available for translational KC research, we sought to establish an in vivo model based on ISR activation to elucidate its role in the development of the KC phenotype. Four-week-old female SD rats were treated with topical SAL003 formulated as a nanosuspension or vehicle every 48 h for four doses. Animals were subject to monitoring for ocular inflammation and discomfort before being euthanized at 1, 14, or 28 days after treatment was withdrawn. Schirmer's tear test, intraocular pressure, and body weight measurements were obtained at baseline and prior to euthanasia. Globes were subject to routine histopathology, immunohistochemistry for ATF4, and qPCR for Col1a1 expression. ANOVAs and Student's t tests were used to assess statistical significance (α = 0.05). SAL003 treatment did not produce any adverse ocular or systemic phenotype but did result in decreased keratocyte density. Col1a1 transcripts were reduced, corresponding to nuclear ATF4 expression within the axial cornea. In vivo topical treatment with a gel-formulated ISR agonist recapitulates key features of the activated ISR including nuclear ATF4 expression and decreased extracellular matrix (ECM) production. Exogenous ISR agonists may present one approach to establishing a rodent model for keratoconus, a charge essential for future evaluations of pathogenesis and therapeutic interventions.
Collapse
Affiliation(s)
- C Peterson
- Department of Molecular & Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Y C Kim
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - L M Ensign
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A S Jun
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Foster
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
20
|
Parsons A, Unaka NI, Stewart C, Foster J, Perez V, Jones NY, Kahn R, Beck AF, Riley C. Seven practices for pursuing equity through learning health systems: Notes from the field. Learn Health Syst 2021; 5:e10279. [PMID: 34277945 PMCID: PMC8278437 DOI: 10.1002/lrh2.10279] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 12/16/2020] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Despite learning health systems' focus on improvement in health outcomes, inequities in outcomes remain deep and persistent. To achieve and sustain health equity, it is critical that learning health systems (LHS) adapt and function in ways that directly prioritize equity. METHODS We present guidance, including seven core practices, borne from theory, evidence, and experience, for actors within LHS pursuing equity. RESULTS We provide a foundational definition of equity. We then offer seven core practices for how LHS may effectively pursue equity in health: establish principle, measure for equity, lead from lived experience, co-produce, redistribute power, practice a growth mindset, and engage beyond the healthcare system. We include three use cases that illustrate ways in which we have begun to center equity in the work of our own LHS. CONCLUSION The achievement of equity requires real transformation at individual, institutional, and structural levels and requires sustained and persistent effort.
Collapse
Affiliation(s)
- Allison Parsons
- Division of Critical CareCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Ndidi I. Unaka
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Division of Hospital MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Constance Stewart
- James M Anderson Center for Health Systems ExcellenceCincinnatiOhioUSA
| | | | | | - Nana‐Hawa Yayah Jones
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Division of EndocrinologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Robert Kahn
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Division of General and Community PediatricsCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Andrew F. Beck
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Division of Hospital MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Division of General and Community PediatricsCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Carley Riley
- Division of Critical CareCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| |
Collapse
|
21
|
Thompson S, Cassidy C, McKibbon S, Sangster M, Foster J. Barriers and enablers to the development and implementation of early mobility programs for children in the pediatric intensive care unit: a scoping review protocol. JBI Evid Synth 2021; 19:1735-1741. [PMID: 33851943 DOI: 10.11124/jbies-20-00142] [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: 01/06/2023]
Abstract
OBJECTIVE The objective of this scoping review is to gather and map the current literature associated with barriers and enablers related to the development and implementation of an early mobility program in pediatric intensive care units. INTRODUCTION As care for critically ill patients has evolved, strategies to optimize patient outcomes and reduce the side effects of treatment have become a rising priority for clinicians, patients, and their families. Early mobilization of patients with critical illness is the only evidence-based intervention that decreases intensive care unit-acquired weakness; it may also minimize intensive care unit-acquired delirium. Early mobility in the pediatric setting has many obstacles, and routine uptake of early mobility practice has lagged. INCLUSION CRITERIA This review will consider literature related to the barriers and enablers to the development and/or implementation of early mobility programs in pediatric intensive care units. The review will target programs designed for children and youth from birth to 18 years who have been admitted to a pediatric intensive care unit. METHODS This scoping review will search six databases and several sources of unpublished/gray literature. Studies published in English and French will be included. The search will be restricted to publications after 1980. Data will be extracted using a tool developed by the reviewers. The data extracted will be presented in a tabular manner and highlight the key findings related to the objectives of this review.
Collapse
Affiliation(s)
- Shanna Thompson
- Pediatric Critical Care, IWK Health Centre, Halifax, NS, Canada.,School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Christine Cassidy
- School of Nursing, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs and Evidence for Transformation Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada
| | - Shelley McKibbon
- Aligning Health Needs and Evidence for Transformation Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada.,WK Kellogg Health Science Library, Dalhousie University, Halifax, NS, Canada
| | - Michael Sangster
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada.,Professional Practice and Complex Pain, IWK Health Centre, Halifax, NS, Canada
| | - Jennifer Foster
- Pediatric Critical Care, IWK Health Centre, Halifax, NS, Canada.,Department of Critical Care, Dalhousie University, Halifax, NS, Canada.,Department of Pediatrics, Western University, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada
| |
Collapse
|
22
|
Shadbolt T, Sainsbury AW, Foster J, Bernhard T. Risks from poorly planned conservation translocations. Vet Rec 2021; 188:269. [PMID: 33835551 DOI: 10.1002/vetr.373] [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: 11/06/2022]
Affiliation(s)
- T Shadbolt
- Disease Risk Analysis and Health Surveillance, Institute of Zoology, Zoological Society of London, London, NW1 4RY
| | - A W Sainsbury
- Disease Risk Analysis and Health Surveillance, Institute of Zoology, Zoological Society of London, London, NW1 4RY
| | - J Foster
- Amphibian and Reptile Conservation, Witley Centre, Witley, Godalming, Surrey, GU8 5QA
| | - T Bernhard
- Natural England, Eastleigh House, Upper Market Street, Eastleigh, Hampshire, SO50 9YN
| |
Collapse
|
23
|
Khanna P, Khanna D, Cutter G, Foster J, Melnick J, Jaafar S, Biggers S, Rahman F, Kuo HC, Feese M, Saag K. POS0135 REDUCING IMMUNOGENICITY OF PEGLOTICASE (RECIPE) WITH CONCOMITANT USE OF MYCOPHENOLATE MOFETIL IN PATIENTS WITH REFRACTORY GOUT: A PHASE II RANDOMIZED CONTROLLED TRIAL. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Pegloticase is a recombinant, pegylated uricase, used for treatment of gout patients who fail oral urate lowering therapy (ULT). Its use has been limited due to immunogenicity leading to infusion reactions.1Objectives:We evaluated if co-administration of an immunomodulatory agent could prolong the efficacy of pegloticase.Methods:Participants were recruited in a Phase II, double-blind, placebo-controlled trial over 18 months and randomized in a 3:1 ratio by site. Inclusion criteria were: a) Age ≥ 18 years who met 2015 ACR/EULAR gout classification criteria and b) chronic refractory gout defined as symptoms inadequately controlled with ULT or contraindications. After a 2-week run-in of mycophenolate mofetil (MMF) 1000 mg twice daily or matching placebo (PBO), they received a combination of pegloticase 8 mg biweekly with MMF or PBO for 12 weeks. Subsequent to this MMF or PBO were discontinued but pegloticase was continued for another 12 weeks. The primary endpoint was proportion of patients who sustained a serum urate (SU) level of ≤ 6 mg/dl at 12 weeks. Secondary endpoints included 24-week durability of SU ≤ 6 mg/dl and rate of adverse events (AEs). Fisher’s exact test and Wilcoxon two-sample test were used for analyses along with Kaplan-Meier estimates and log-rank tests to compare survival curves between groups. Hypothesis tests were two-tailed and p-value (p) < 0.05 indicated statistical significance.Results:Of 42 subjects screened, 35 were randomized, and 32 who received at least one dose of pegloticase were included in modified intention to treat analyses. Subjects were predominantly men (88%), mean age of 55.2 years (SD=9.7). Mean duration of gout was 13.4 years (SD=9.0), mean baseline sUA was 9.2 mg/dL (SD=1.6). Tophi were present in 88% and majority were on optimized ULT - 59% on allopurinol and 16% on febuxostat, with 63% reporting > 1 flare in the past year. At baseline both arms (MMF vs. PBO) had similar comorbidities – (82% vs 70%), diabetes mellitus/metabolic syndrome (14% vs 20%), coronary artery disease/peripheral vascular disease (41% vs.70%), BMI>30 (86% vs. 90%) and renal insufficiency (defined as eGFR < 90 mL/min; 73% vs. 70%). At 12 weeks, 19 of 22 (86%) in the MMF arm achieved SU ≤ 6 mg/dl compared to 4 of 10 (40%) in PBO arm (p-value = 0.01). At 24 weeks, the SU was ≤ 6 mg/dl in 68% of MMF arm vs. 30% in PBO (p-value = 0.06), and rates of AEs per month were similar between groups with the PBO arm having more infusion reactions (30% vs. 0%). The MMF arm had higher AEs compared to placebo: musculoskeletal (41% vs. 10%), gastrointestinal (18% vs. 10%), and infections (9% vs. 0%). Figure 1 shows that the percentage of subjects maintaining a sUA < 6 mg/dL at 12 weeks was significantly higher (p=0.02) in the MMF arm, and a significant difference (p=0.03) at 24 weeks indicates sustained benefit from MMF.Conclusion:To our knowledge this is the first randomized-controlled proof of concept trial to demonstrate the ability of an immunomodulatory agent in prolonging the efficacy of pegloticase. Short-term concomitant use of MMF therapy with pegloticase was well tolerated and showed a clinically meaningful improvement in the targeted SU ≤6 mg/dL at 12 and 24 weeks. This study suggests an innovative approach to utilize pegloticase therapy in patients with chronic gout.References:[1]Sundy et al. Efficacy and tolerability of pegloticase for the treatment of chronic gout in patients refractory to conventional treatment: two randomized controlled trials. JAMA. 2011;306(7):711-20.Figure 1.Proportion of subjects maintaining serum urate (SU) ≤ 6 mg/dL over 24 week study period in mycophenolate mofetil + pegloticase vs. placebo + pegloticaseDisclosure of Interests:Puja Khanna Consultant of: Horizon Pharmaceuticals, Swedish Orphan Biovitrum A, Grant/research support from: Selecta, 2)DYVE, Dinesh Khanna Consultant of: Horizon Pharmaceuticals, Gary Cutter: None declared, Jeff Foster: None declared, Josh Melnick: None declared, Sara Jaafar: None declared, Stephanie Biggers: None declared, Fazlur Rahman: None declared, Hui-Chen Kuo: None declared, Michelle Feese: None declared, Kenneth Saag Consultant of: AbbVie, Inc., Bayer, Daiichi Sankyo Company LTD, Gilead Services, Inc., Horizon Pharma plc, Mallinkrodt, Radius Health, Inc., Roche/Genentech, Shanton Pharma Co., LTD, Teijin, Dyve Bioscience, LG Chem, Regeneron Pharmaceuticals., Swedish Orphan Biovitrum AB, Takeda Pharmaceuticals America, Inc.,
Collapse
|
24
|
Foster J, Reid JM, Minard CG, Isikwei E, Liu X, Berg SL, Injac SG, Fox E, Weigel B. Phase 1 study of pevonedistat (MLN4924) a NEDD8 activating enzyme inhibitor, in combination with temozolomide (TMZ) and irinotecan (IRN) in pediatric patients with recurrent or refractory solid tumors (ADVL1615). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.10019] [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
10019 Background: Pevonedistat (PEV), a first in class inhibitor of NEDD8 activating enzyme (NAE), prevents the activation of Cullin-RING ligases (CRL) necessary for proteasome mediated degradation of key regulatory proteins important in cell survival. In adults with solid tumors, the maximum tolerated dose (MTD) in combination with chemotherapy is 20-25 mg/m2. Antitumor activity of PEV has been demonstrated in preclinical models of childhood cancer. In vivo additive activity has been demonstrated for PEV in combination with IRN and alkylating agents. The objectives of this study are to determine the MTD and recommended Phase 2 dose of PEV in combination with IRN and TMZ and describe the toxicities, pharmacokinetic (PK), and pharmacodynamics (PD) properties of this combination. Methods: We conducted a phase 1 trial of PEV in combination with IRN and TMZ in pediatric patients (pts) with recurrent or refractory solid tumors and brain tumors. During cycle 1, PEV was administered intravenously on days 1, 8, 10, and 12, with IRN (IV, 50mg/m2) and TMZ (orally, 100mg/m2), on days 8-12 of a 28 day cycle. In subsequent cycles, PEV was administered on days 1, 3, and 5, with IRN and TMZ on days 1-5 of a 21 day cycle. Dose escalation was determined using the Rolling 6 Design. Results: 30 pts enrolled. All pts were eligible and evaluable for cycle 1 dose limiting toxicity (DLT) assessment. Median (range) age was 13 (1-21) years; 19 (63%) were male. Eleven pts had brain tumors, and 19 pts had solid tumors. Six pts each enrolled on PEV dose levels (DL) 1 (15mg/m2), 2 (20mg/m2), 3 (25mg/m2) and 4 (35mg/m2) as well as an expanded PK cohort at DL4. Cycle 1 grade 3/4 toxicities include lymphopenia (n = 5), leukopenia (n = 4), neutropenia (n = 2), elevated ALT (n = 2), elevated AST (n = 1), diarrhea (n = 1), flu-like symptoms (n = 1). The most frequent non-dose limiting AEs in cycle 1 were anemia (87%), WBC decreased (77%), nausea (57%), diarrhea (53%), ALT increased (50%), AST increased (50%), and vomiting (50%). PK analyses showed the mean area under the curve at the 25 mg/m2 dose level on day 8 (in combination with irinotecan and temozolomide) was 1300 hr•ng/mL, half-life (T ½) was 5-6 hours, time to maximum concentration (Tmax) was 1 hour, and mean clearance was 20 L/hr/m2. There were 3 DLTs, 2 of which were related to protocol therapy (diarrhea and thrombocytopenia), among 12 patients on DL4. Thus the MTD was not exceeded at any dose level. PK at the 25 mg/m2 dose level are comparable to those in adult patients. PK from the 12 patients on DL4 (35mg/m2) as well as responses of all patients are pending. Conclusions: PEV in combination with IRN and TMZ is well tolerated in children with solid or brain tumors. PEV PK was not altered by the addition of irinotecan and temozolomide. Further PK and PD analyses are ongoing to establish the recommended phase 2 dose. Clinical trial information: NCT03323034.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Elizabeth Fox
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | |
Collapse
|
25
|
Gray S, Foster J, Revilla M, Pantoja Manzanarez L, Medina CM, Rizzieri A, Binfa L. Midwives' experiences with screening for intimate partner violence in Santiago, Chile. Health Care Women Int 2020; 43:746-762. [PMID: 33316202 DOI: 10.1080/07399332.2020.1797033] [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: 10/22/2022]
Abstract
Although intimate partner violence (IPV) is well-established as a highly prevalent global issue, research examining the experience of health providers who screen women at risk for IPV is scarce. We aimed to explore the experience of midwives in primary health care centers in Santiago, Chile, regarding identification of at-risk women and barriers to screening. We highlight the intersection of complex issues of global relevance, such as culture, language, provider-patient relationships, and allocation of time and resources. In our results, we illustrate the importance of providing midwives extended time, interpreter services, and cross-cultural education to address IPV in their transcultural context.
Collapse
Affiliation(s)
- Savannah Gray
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Jennifer Foster
- Clinical Professor Emerita, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Matthew Revilla
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Loreto Pantoja Manzanarez
- Department of Women's and Newborn's Health Promotion, School of Midwifery, University of Chile, Santiago, Chile
| | | | - Ashley Rizzieri
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lorena Binfa
- Department of Women's and Newborn's Health Promotion, School of Midwifery, University of Chile, Santiago, Chile
| |
Collapse
|
26
|
Robinson G, Desai A, Basu E, Foster J, Gauvain K, Sabnis A, Shusterman S, Macy M, Mease L, Yoon J, Cash T, Abdelbaki M, Nazemi K, Pratilas C, Weiss B, Chohan S, Cardenas A, Hutchinson K, Bergthold G, Gajjar A. HGG-01. ENTRECTINIB IN RECURRENT OR REFRACTORY SOLID TUMORS INCLUDING PRIMARY CNS TUMORS: UPDATED DATA IN CHILDREN AND ADOLESCENTS. Neuro Oncol 2020. [PMCID: PMC7715329 DOI: 10.1093/neuonc/noaa222.293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STARTRK-NG (phase 1/2) is evaluating entrectinib, a CNS-penetrant oral, TRK/ROS1/ALK tyrosine kinase inhibitor, in patients <21 years with recurrent/refractory solid tumors, including primary CNS tumors. After determining the recommended dose, 550mg/m2/day, in all-comers, expansion cohorts with gene-fusion-positive CNS/solid tumors (NTRK1/2/3, ROS1) are being enrolled. As of 5Nov2019 (data cut-off), 39 patients (4.9m–20y; median 7y) have been evaluated for response, classified as complete (CR) or partial response (PR), stable (SD) or progressive disease (PD) using RANO (CNS), RECIST (solid tumors), or Curie score (neuroblastoma). Responses in patients with fusion-positive tumors were Investigator-assessed (BICR assessments are ongoing) and occurred at doses ≥400mg/m2. Best responses in fusion-positive CNS tumors (n=14) were: 4 CR (GKAP1-NTRK2, ETV6-NTRK3 [n=2], EML1-NTRK2); 5 PR (KANK1-NTRK2, GOPC-ROS1, ETV6-NTRK3, TPR-NTRK1, EEF1G-ROS1); 3 SD (BCR-NTRK2, ARHGEF2-NTRK1, KIF21B-NTRK1); 2 PD (PARP6-NTRK3, EML4-ALK); and in fusion-positive solid tumors (n=8) were: 3 CR (ETV6-NTRK3 [n=2], DCTN1-ALK); 5 PR (EML4-NTRK3, TFG-ROS1 [n=3], KIF5B-ALK). Responses (Investigator-assessed) in non-fusion tumors (n=17) were: 1 CR (ALK F1174L mutation), 3 SD, 10 PD, 3 no data/unevaluable. The objective response rate (CR+PR/total) in patients with fusion-positive tumors was 77% (17/22) versus 6% (1/17) in those with non-fusion tumors. All 39 patients experienced ≥1 adverse event (AE); the most frequent AEs included weight gain and anemia (both 48.7%); increased ALT, increased AST, cough and pyrexia (all 46.2%); increased creatinine and vomiting (both 43.6%); and bone fractures (n=10, in 9 patients). Entrectinib has produced striking, rapid, and durable responses in solid tumors with target gene fusions, especially high-grade CNS neoplasms.
Collapse
Affiliation(s)
| | - Ami Desai
- University of Chicago Medical Center, Chicago, IL, USA
| | - Ellen Basu
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Karen Gauvain
- Washington University School of Medicine, St, Louis, MO, USA
| | - Amit Sabnis
- University of California San Francisco, Benioff Children’s Hospital, San Francisco, CA, USA
| | - Suzanne Shusterman
- Dana Farber Cancer Institute, Boston Children’s Cancer and Blood Disorders Center, Boston, MA, USA
| | - Margaret Macy
- Children’s Hospital Colorado, Department of Hematology- Oncology & Bone Marrow Transplantation, Aurora, CO, USA
| | - Luke Mease
- University of Utah/Huntsman Cancer Institute, Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Janet Yoon
- Rady Children’s Hospital, San Diego, CA, USA
| | - Thomas Cash
- Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Kellie Nazemi
- Oregon Health & Science University, Doernbecher Children’s Hospital, Portland, OR, USA
| | - Christine Pratilas
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brian Weiss
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Saibah Chohan
- F. Hoffmann-La Roche Limited, Mississauga, ON, Canada
| | | | | | | | - Amar Gajjar
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| |
Collapse
|
27
|
Zafar A, Wang W, Liu G, Wang X, Xian W, McKeon F, Foster J, Zhou J, Zhang R. Molecular targeting therapies for neuroblastoma: Progress and challenges. Med Res Rev 2020; 41:961-1021. [PMID: 33155698 PMCID: PMC7906923 DOI: 10.1002/med.21750] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/25/2020] [Accepted: 10/28/2020] [Indexed: 01/09/2023]
Abstract
There is an urgent need to identify novel therapies for childhood cancers. Neuroblastoma is the most common pediatric solid tumor, and accounts for ~15% of childhood cancer‐related mortality. Neuroblastomas exhibit genetic, morphological and clinical heterogeneity, which limits the efficacy of existing treatment modalities. Gaining detailed knowledge of the molecular signatures and genetic variations involved in the pathogenesis of neuroblastoma is necessary to develop safer and more effective treatments for this devastating disease. Recent studies with advanced high‐throughput “omics” techniques have revealed numerous genetic/genomic alterations and dysfunctional pathways that drive the onset, growth, progression, and resistance of neuroblastoma to therapy. A variety of molecular signatures are being evaluated to better understand the disease, with many of them being used as targets to develop new treatments for neuroblastoma patients. In this review, we have summarized the contemporary understanding of the molecular pathways and genetic aberrations, such as those in MYCN, BIRC5, PHOX2B, and LIN28B, involved in the pathogenesis of neuroblastoma, and provide a comprehensive overview of the molecular targeted therapies under preclinical and clinical investigations, particularly those targeting ALK signaling, MDM2, PI3K/Akt/mTOR and RAS‐MAPK pathways, as well as epigenetic regulators. We also give insights on the use of combination therapies involving novel agents that target various pathways. Further, we discuss the future directions that would help identify novel targets and therapeutics and improve the currently available therapies, enhancing the treatment outcomes and survival of patients with neuroblastoma.
Collapse
Affiliation(s)
- Atif Zafar
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, Texas, USA
| | - Wei Wang
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, Texas, USA.,Drug Discovery Institute, University of Houston, Houston, Texas, USA
| | - Gang Liu
- Department of Pharmacology and Toxicology, Chemical Biology Program, University of Texas Medical Branch, Galveston, Texas, USA
| | - Xinjie Wang
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, Texas, USA
| | - Wa Xian
- Department of Biology and Biochemistry, Stem Cell Center, University of Houston, Houston, Texas, USA
| | - Frank McKeon
- Department of Biology and Biochemistry, Stem Cell Center, University of Houston, Houston, Texas, USA
| | - Jennifer Foster
- Department of Pediatrics, Texas Children's Hospital, Section of Hematology-Oncology Baylor College of Medicine, Houston, Texas, USA
| | - Jia Zhou
- Department of Pharmacology and Toxicology, Chemical Biology Program, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ruiwen Zhang
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, Texas, USA.,Drug Discovery Institute, University of Houston, Houston, Texas, USA
| |
Collapse
|
28
|
Whittle S, Smith V, Silverstein A, Parmeter M, Minard CG, Bernhardt MB, Zage P, Venkatramani R, Nuchtern J, Heczey A, Russell H, Shohet J, Foster J. Is high-risk neuroblastoma induction chemotherapy possible without G-CSF? A pilot study of safety and treatment delays in the absence of primary prophylactic hematopoietic growth factors. Pediatr Blood Cancer 2020; 67:e28417. [PMID: 32729196 PMCID: PMC7722106 DOI: 10.1002/pbc.28417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND/OBJECTIVES Standard supportive care during induction therapy for high-risk neuroblastoma (HR-NBL) includes primary prophylactic granulocyte colony-stimulating factor (G-CSF) aimed at limiting duration of neutropenia, reducing infection risk, and minimizing treatment delays. Preclinical models suggest that G-CSF promotes maintenance of neuroblastoma cancer stem cells and may reduce the efficacy of chemotherapy. This study's objective was to determine the safety and feasibility of administering induction chemotherapy without routine use of prophylactic G-CSF. DESIGN/METHODS Children with newly diagnosed HR-NBL received six-cycle induction chemotherapy regimen without prophylactic G-CSF in four cycles. G-CSF was administered for stem cell mobilization after cycle 3 and granulocyte-monocyte colony-stimulating factor after cycle 5 prior to surgical resection of primary disease. The primary outcome measure was the incidence of grade 3 or higher infection. We hypothesized that the per patient infection rate would be comparable to our institutional baseline rate of 58% in patients with HR-NBL receiving induction chemotherapy with prophylactic growth factor support. The trial used an A'Hern single-stage design. RESULTS Twelve patients with HR-NBL received 58 cycles of chemotherapy on study. Three patients completed the entire six-cycle regimen with no infections. Nine patients experienced grade 3 infections (bacteremia four, urinary tract infection two, skin/soft tissue infection three). No patients experienced grade 4 infections or required intensive care treatment for infection. CONCLUSION A greater than expected number of serious bacterial infections were observed during administration of induction chemotherapy for HR-NBL without primary prophylactic G-CSF. These results support continued prophylactic administration growth factor during induction chemotherapy.
Collapse
Affiliation(s)
- Sarah Whittle
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX,Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Valeria Smith
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX,Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | | | - Margaret Parmeter
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX,Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Charles G. Minard
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX
| | - M Brooke Bernhardt
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX,Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Peter Zage
- Department of Pediatrics, Division of Hematology-Oncology, University of California San Diego, La Jolla, CA
| | - Rajkumar Venkatramani
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX,Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Jed Nuchtern
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX,Center for Medical Ethics and Health Policy, Baylor College of Medicine Houston TX
| | - Andras Heczey
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX,Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Heidi Russell
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX,Department of Pediatrics, Baylor College of Medicine, Houston, TX,Center for Medical Ethics and Health Policy, Baylor College of Medicine Houston TX
| | - Jason Shohet
- Division of Pediatric Oncology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA
| | - Jennifer Foster
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX,Department of Pediatrics, Baylor College of Medicine, Houston, TX
| |
Collapse
|
29
|
Desai AV, Robinson GW, Basu EM, Foster J, Gauvain K, Sabnis A, Shusterman S, Macy ME, Maese L, Yoon J, Cash T, Abdelbaki M, Nazemi K, Weiss BD, Chohan S, Cardenas A, Hutchinson K, Bergthold G, Gajjar AJ, Fox E. Updated entrectinib data in children and adolescents with recurrent or refractory solid tumors, including primary CNS tumors. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.107] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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
107 Background: The phase 1/2 STARTRK-NG trial (NCT02650401) is evaluating entrectinib, a CNS-penetrant oral inhibitor of TRK, ROS1 and ALK tyrosine kinases, in children and adolescents < 21 years old with recurrent/refractory solid tumors, including primary CNS tumors. Methods: After determining the recommended dose as 550mg/m2/day in all-comers, expansion cohorts with gene-fusion-positive CNS/solid tumors ( NTRK1/2/3 and ROS1) are being enrolled. Results: As of 1 July 2019 (data cut-off), 34 patients (4.9 months to 20 years old; median age 7 years) have been evaluated for response to treatment with entrectinib. Responses were classified as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD) using RANO for CNS tumors, RECISTv1.1 for solid tumors, or Curie score for neuroblastomas. Responses in fusion-positive patients were assessed by blinded independent central review (BICR), and occurred at doses ≥400mg/m2. Best responses in patients with fusion-positive CNS tumors (n = 8) were four CR ( ETV6-NTRK3, EML1-NTRK2, GOPC-ROS1, and TPR-NTRK1), two PR ( KANK1-NTRK2 and EEF1G-ROS1), and two PD ( EML4-ALK and PARP6-NTRK3). In patients with fusion-positive solid tumors (n = 6) best responses were three CR ( DCTN1-ALK, ETV6-NTRK3, and ETV6-NTRK3), and three PR ( TFG-ROS1, EML4-NTRK3, and KIF5B-ALK). Responses (Investigator-assessed) in patients with non-fusion tumors (n = 20) were one CR ( ALK F1174L mutation), four SD, ten PD, and five patients were unevaluable or had no data. The objective response rate (defined as the total number of CR and PR) in fusion-positive patients was 86% (12/14) versus 5% (1/20) in non-fusion patients. Similarly, PFS was 17.5 months (95% CI 7.4–NE) in fusion-positive patients versus 1.9 months (1.8–5.7; p = 0.0002) in non-fusion patients. Most commonly reported treatment-related adverse events included weight gain (n = 14 [5 Grade 3/4]), elevated creatinine (n = 13), anemia (n = 13), nausea (n = 11), increased ALT (n = 10 [1 Grade 3/4]), increased AST (n = 10 [1 Grade 3/4]), decreased neutrophils (n = 9 [6 Grade 3/4]), and bone fractures (n = 7, of which 4 were treatment related). Conclusions: In children and adolescents < 21 years old, entrectinib has produced striking, rapid, and durable responses in solid tumors with target gene fusions, especially in high-grade CNS neoplasms. Clinical trial information: NCT02650401.
Collapse
Affiliation(s)
| | | | - Ellen M. Basu
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Karen Gauvain
- Washington University School of Medicine, St. Louis, MO
| | - Amit Sabnis
- University of California San Francisco, Benioff Children’s Hospital, San Francisco, CA
| | - Suzanne Shusterman
- Dana Farber Cancer Institute, Boston Children’s Cancer and Blood Disorders Center, Boston, MA
| | - Margaret E Macy
- Children’s Hospital Colorado, Department of Hematology-Oncology & Bone Marrow Transplantation, Aurora, CO
| | - Luke Maese
- University of Utah/Huntsman Cancer Institute, Primary Children's Hospital, Salt Lake City, UT
| | | | - Thomas Cash
- Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | | | - Kellie Nazemi
- Oregon Health & Science University, Doernbecher Children’s Hospital, Portland, OR
| | - Brian D. Weiss
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | | | | | | | - Elizabeth Fox
- Children's Hospital of Philadelphia, Philadelphia, PA
| |
Collapse
|
30
|
Siddiqui AB, Oppong A, Yuan C, Gao G, Bagatell R, Berg K, Sokol E, MacQuarrie K, Pinto NR, Gollapudi A, Mody R, Wolfe I, Shusterman S, Foster J, Smith V, Cohn SL, Desai AV. Outcome in patients with refractory high-risk neuroblastoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.10537] [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
10537 Background: Outcome for high-risk neuroblastoma (HRNBL) patients (pts) with refractory disease at end of induction (EOI) is poor. The impact of therapies such as I-131-MIBG or irinotecan/temozolomide/dinutuximab (I/T/DIN) prior to autologous stem cell transplant (ASCT) on outcome is unknown. Methods: A multi-center, retrospective study of HRNBL pts diagnosed between 2008-2018 with refractory disease at EOI was conducted. Demographics, tumor biology, treatment response, and outcomes were abstracted. 3-year (yr) EFS and OS from time of diagnosis were estimated by the Kaplan-Meier method. Results: 3-yr EFS and OS were 54% and 79% for the 136 pts analyzed. 91 pts received no additional therapy prior to ASCT (Cohort 1); 32 pts received post-induction therapy prior to ASCT (Cohort 2); and 13 pts did not undergo ASCT (Cohort 3). The prevalence of metastatic disease in Cohort 1, 2, and 3 was 65%, 97%, and 85%. 3-yr EFS and OS were not statistically different between Cohort 1 (3-yr EFS and OS; 62% and 81%) and Cohort 2 [3-yr EFS and OS; 49% (p = 0.48) and 82% (p = 0.19)]. Outcome for Cohort 3 pts was significantly worse than Cohort 1 [3-yr EFS: 15% vs. 62% (p < .001); and 3-yr OS: 48% vs. 81% (p = 0.003)] and Cohort 2 [3-yr EFS: 15% vs. 49% (p < .001); and 3-yr OS 48% vs. 82% (p = 0.035)]. For Cohort 2 pts with metastatic disease, post-induction therapy included I/T/DIN (n = 12), MIBG (n = 16), MIBG plus I/T/DIN (n = 1), and other (n = 2). Metastatic disease response was observed in 10/12 (83%) pts who received I/T/DIN and 9/16 (56%) who received MIBG. MIBG plus I/T/DIN (n = 1) or MIBG with chemotherapy (n = 1) also induced response. Among the 21 pts with metastatic disease response, 3-yr EFS and OS were 69% and 94%; significantly better than Cohort 2 patients who did not respond to post-induction therapy [3-yr EFS and OS: 11% (p = 0.016) and 66% (p = 0.2)]. 6 Cohort 2 pts achieved a complete response (CR) in metastatic sites following I/T/DIN (n = 5) or MIBG (n = 1), and all are alive without relapse with median follow-up of 3.4 years (range 2.7-8.1). The single Cohort 3 patient who achieved a metastatic CR with I/T/DIN and did not undergo ASCT remains disease-free 2.4 years from diagnosis. Conclusions: Patient characteristics differed in the 3 Cohorts, reflecting the influence of refractory disease on treatment decisions. For Cohort 2 pts, outcome was better for those with metastatic disease at EOI who responded to post-induction therapy compared to those who did not. Pts who achieved a metastatic CR of refractory disease had excellent survival. Prospective studies testing the efficacy of I/T/DIN in pts with refractory metastatic disease at EOI are warranted.
Collapse
Affiliation(s)
| | | | - Cindy Yuan
- University of Chicago Medical Center, Chicago, IL
| | - Guimin Gao
- University of Chicago Medical Center, Chicago, IL
| | | | | | | | - Kyle MacQuarrie
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | | | | | | | - Ian Wolfe
- University of Michigan, Ann Arbor, MI
| | - Suzanne Shusterman
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA
| | | | | | | | | |
Collapse
|
31
|
Tay SY, Foster J, Heczey A, Sitton M. Pediatric Oncology Patients With Vincristine-Induced Recurrent Laryngeal Nerve Palsy: Two Case Reports and a Brief Review of Literature. Ear Nose Throat J 2020; 100:NP459-NP463. [PMID: 32425060 DOI: 10.1177/0145561320924868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Vincristine (VCR) is a chemotherapeutic agent used widely in the treatment of hematologic and solid tumors, known to result in neurotoxicity, especially with cumulative administrations. Bilateral vocal fold palsy (VFP) is a rare but life-threatening complication of VCR. We report 2 patients with hepatoblastoma presenting with stridor following VCR treatment and propose a management plan. METHODS Electronic medical records of oncology patients treated at a tertiary hospital with VCR-induced VFP were reviewed. Literature review was performed in PubMed using the terms: hoarseness, VFP, stridor, vincristine. RESULTS A total of 23 children with VCR-induced VFP were identified from the literature review and adding on our 2 cases. Seventeen (77.3%) were male and 5 (22.7%) were female. The median presenting age was 36.0 months (5-204 months). Acute lymphoblastic leukemia, 15 of 23 (65.2%), was the most common malignancy. Eighteen patients (78.3%) had bilateral VFP and 5 (21.7%) had unilateral VFP. The mean time to VF function recovery was 167.3 days (median: 200.5 days, range: 7-270 days) in the intervention group versus 72.1 days (median: 31.5 days, range: 3-240 days) in the conservative group. One patient in the intervention group had persistent VFP. Sixteen patients (69.6%) were observed, 4 (17.4%) underwent tracheostomy, 1 (4.35%) was intubated, 1 (4.35%) underwent cordectomy, and 1 (4.35%) required positive pressure support. Vincristine was restarted in 12 patients (54.5%), of which 4 developed recurrence of airway symptoms and had to stop VCR. CONCLUSION A new-onset hoarseness or stridor in a child on VCR should raise the suspicions of VFP. The assumption of an upper respiratory-induced hoarseness or stridor should be avoided. Decisions regarding readministration of VCR and possible airway interventions should be made via a multidisciplinary team approach.
Collapse
Affiliation(s)
- Sok Yan Tay
- Department of Pediatric Otolaryngology, Texas Children's Hospital, Houston, TX, USA
| | - Jennifer Foster
- Texas Children's Hospital, Section of Oncology-Hematology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Andras Heczey
- Texas Children's Hospital, Section of Oncology-Hematology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Matthew Sitton
- Department of Pediatric Otolaryngology, Texas Children's Hospital, Houston, TX, USA
| |
Collapse
|
32
|
Foster J, Diedrich V, Leonard T, Shahlapour M, Horani MH. MON-444 The Case of a Rare Anaplastic Thyroid Cancer Variant with Rhabdoid Features. J Endocr Soc 2020. [PMCID: PMC7208724 DOI: 10.1210/jendso/bvaa046.169] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: We present a very rare case of a variant of anaplastic carcinoma, a high-grade thyroid carcinoma with rhabdoid features. Less than 15 cases have been reported in English literature over the last 20 years. The prognosis of thyroid cancer with this variant phenotype is unfortunately very poor with a mean survival time of only 6 months after diagnosis. Treatment includes surgery, often a total thyroidectomy due to the rapid rate of growth of this tumor type. The benefits of chemotherapy and radiation are not yet apparent. Case presentation: A 49 year old female with history of breast cancer status-post recent chemoradiation therapy presented to the emergency department for a rapidly enlarging, right-sided neck mass. The mass had been present for approximately one month, but it was estimated to have grown from 3cm to 5cm within the two weeks prior. The patient was being followed by her ENT specialist and had a recent outpatient CT scan done. The results of the CT revealed a large thyroid tumor partially obstructing the esophagus and given the rapid progression of symptoms, she was instructed to go straight to the ED for emergent admission. Upon arrival, the patient reported not having consumed any solids or liquids for the past day due to concerns of aspiration and increasing neck pain. She had complaints of worsening dysphagia. Initial lab work revealed low thyroglobulin (1.4 ng/mL), elevated T4 (15.42 nmol/L) presumably due to Tamoxifen exposure, and elevated PTH (96.9 pg/mL), likely primary hyperparathyroidism. She was admitted and endocrine was consulted for further evaluation. The patient underwent a fine-needle aspiration biopsy showing high-grade anaplastic carcinoma with extensive necrosis and rhabdoid features. The tumor was eventually classified as stage 4B with gross extra thyroidal extension to the adventitial layers of the esophagus, thus it was determined to be unresectable. It was recommended at that time she have a percutaneous tracheostomy and feeding tube to protect her airway. However, the patient requested to be discharged so that she could obtain a second opinion regarding treatment options and prognosis. She subsequently underwent a total thyroidectomy at another hospital. Conclusion: It remains unclear whether this patient’s history of breast cancer treated with chemoradiation therapy played a role in the development of this rare thyroid carcinoma. Some cases of the rhabdoid phenotype are documented to have transformed from papillary thyroid carcinoma, for which radiation therapy is a well-known risk factor. Future studies should use molecular markers, such as BRAF V600E mutations common to papillary and anaplastic thyroid carcinomas, to help differentiate between types of thyroid cancers and avoid delayed treatment options for rapidly metastasizing thyroid tumors.
Collapse
|
33
|
Diedrich V, Foster J, Leonard T, Shahlapour M, Horani MH. SUN-499 Extragonadal Germ Cell Tumor Induced Thyrotoxicosis. J Endocr Soc 2020. [PMCID: PMC7209245 DOI: 10.1210/jendso/bvaa046.168] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Extragonadal Germ Cell Tumors (EGCTs) are extremely rare, with an incidence of around 1/1,000,000 and highly variable prognosis dependent on subclassification as seminomatous or non-seminomatous. Non-seminomatous germ cell tumors can cause significant enough elevations in hCG to induce thyrotoxicosis via structural homology allowing for cross-reactivity with the TSH-receptor. Limited cases involving EGCTs inducing thyrotoxicosis have been studied. Case: A 27-year-old male presented to the emergency department with intractable abdominal and back pain. He reported night sweats, nausea, dizziness, and a 10 lb weight loss in 1 week. He was resting comfortably and only complaining of pain. He was moderately tachycardic, tachypneic and hypertensive, with a physical exam only remarkable for tenderness to palpation of the abdomen. Abdominal CT revealed mesenteric and retroperitoneal lymphadenopathy, bilateral adrenal enlargement, a mass in the head of the pancreas, as well as gallbladder and common bile duct distention. Lymph node biopsy was conducted for a suspected lymphoma; however, pathology found a poorly differentiated carcinoma. A diagnosis of a non-seminomatous EGCT was made when ultrasound of the testes was negative for masses and labs revealed elevations in hCG (74842 mIU/ml), and LDH (1421 U/L) with normal AFP (6.98 ng/mL). Further workup showed a slightly elevated T4 Free Thyroxine (1.55 ng/dl) with normal TSH (0.555 mIU/L); thus his thyrotoxicosis was secondary to the high HCG. Treatment for thyrotoxicosis was deferred with the expectation that symptoms would resolve when the tumor burden was decreased. Our patient had numerous other complications requiring management from nephrology, GI and urology teams in addition to endocrinology and hematology-oncology. Bleomycin, Etoposide and Cisplatin (BEP) combination chemotherapy was initiated after recovery from acute complications. Further pathology evaluation suggested tumor susceptibility to the biologics nivolumab and pembrolizumab. Conclusion: Patients with thyrotoxicosis secondary to metastatic non-seminomatous germ cell tumors often present with widespread metastasis and relatively few symptoms of thyrotoxicosis that resolve as the hCG levels decrease with chemotherapy without specific antithyroid medication. This case highlights the importance of considering clinically occult thyrotoxicosis in patients who have elevated hCG secondary to germ cell tumors. Early detection of germ cell tumor and recurrence is crucial for chemotherapeutic success. Thus, patients should be closely followed for thyrotoxicosis relapse which could potentially herald a carcinoma relapse and aid in early diagnosis.
Collapse
|
34
|
MacNally S, Smith C, Spaulding J, Foster J, Oliver JB. Glancing-angle-deposited silica films for ultraviolet wave plates. Appl Opt 2020; 59:A155-A161. [PMID: 32225368 DOI: 10.1364/ao.59.00a155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Abstract
Birefringent silica films are formed by glancing-angle deposition to fabricate quarter- and half-wave plates at a wavelength of 351 nm. A multilayer design is implemented to achieve low-loss transmittance with a high 351-nm laser-induced damage threshold.
Collapse
|
35
|
Robinson G, Desai A, Gauvain K, Basu E, Dorris K, Maese L, Sabnis A, Foster J, Shusterman S, Yoon J, Weiss B, Abdelbaki M, Farid-Kapadia M, Meneses-Lorente G, Cardenas A, Hutchinson K, Bergthold G, Chow Maneval E, Fox E, Gajjar A. PDCT-13. ENTRECTINIB IN CHILDREN AND ADOLESCENTS WITH RECURRENT OR REFRACTORY SOLID TUMORS INCLUDING PRIMARY CNS TUMORS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.774] [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: 11/13/2022] Open
Abstract
Abstract
The phase 1/2 STARTRK-NG trial is evaluating entrectinib, a CNS-penetrant oral inhibitor of TRK, ROS1 and ALK tyrosine kinases, in children with solid tumors, including primary CNS tumors. Eligible patients are ≤22y with recurrent/refractory solid tumors. The recommended dose was determined in all-comers, and then expansion cohorts of CNS and solid tumors with NTRK1/2/3, ROS1 or ALK gene fusions, and neuroblastomas (NBL) regardless of mutation spectrum, were enrolled. Investigator-assessed response was classified as complete (CR) or partial response (PR), stable (SD) or progressive disease using RANO (CNS), RECIST (solid tumors), or Curie score (NBL). By the clinical data cut-off, 01 April 2019, 32 patients were enrolled. As of 31 Oct 2018 (enrollment data cut-off), 29 patients were enrolled and included in the evaluable population. Median age was 7y (range 4.9m to 20y). Entrectinib was well tolerated; phase 1 dose-limiting toxicities were: elevated creatinine, dysgeusia, fatigue, and pulmonary edema. The recommended dose was 550mg/m2 daily; all responses occurred at doses ≥400mg/m2. In 6 patients with high-grade CNS tumors, all gene-fusion-positive, ORR was 100% (Investigator-assessed responses): 2 CR (ETV6-NTRK3, EML1-NTRK2); 4 PR (TPR-NTRK1, KANK1-NTRK2, EEF1G-ROS1, GOPC-ROS1). In extracranial solid tumors 6/8 had a fusion; of these, 2 achieved a confirmed CR (DCTN1-ALK, ETV6-NTRK3), and 4 achieved PR (ETV6-NTRK3, EML4-NTRK3, TFG1-ROS1, KIF5B-ALK). Central imaging review is being performed and will be provided. Duration of therapy ranged from 0.2 to 22.2 months for all 32 patients. In responding patients, time to response ranged from 1 to 8.3 months. In children with refractory CNS tumors harboring NTRK1/2/3 or ROS1 fusions, entrectinib produced striking, rapid, and durable responses. No responses were seen in tumors lacking target gene fusions. These results support the continued evaluation of entrectinib in solid tumors with target gene fusions, especially high-grade CNS neoplasms.
Collapse
Affiliation(s)
| | - Ami Desai
- University of Chicago Medical Center, Chicago, IL, USA
| | - Karen Gauvain
- Washington University School of Medicine, St. Louis, MO, USA
| | - Ellen Basu
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathleen Dorris
- University of Colorado School of Medicine/Children’s Hospital Colorado, Aurora, CO, USA
| | - Luke Maese
- University of Utah/Huntsman Cancer Institute, Primary Children’s Hospital, Salt Lake City, TX, USA
| | - Amit Sabnis
- University of California San Francisco, Benioff Children’s Hospital, San Francisco, CA, USA
| | | | - Suzanne Shusterman
- Dana Farber Cancer Institute, Boston Children’s Cancer and Blood Disorders Center, Boston, MA, USA
| | - Janet Yoon
- Rady Children’s Hospital, San Diego, CA, USA
| | - Brian Weiss
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | | | | | | | | | - Elizabeth Fox
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Amar Gajjar
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| |
Collapse
|
36
|
Schneller N, Grimes A, Muscal J, Quintanilla N, Mittal A, Paulino A, Foster J. Successful treatment of metachronous contralateral intratubular germ cell neoplasia with partial orchiectomy and low-dose radiation in a patient previously treated for testicular carcinoma. Pediatr Blood Cancer 2019; 66:e27872. [PMID: 31179623 DOI: 10.1002/pbc.27872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/11/2019] [Accepted: 05/20/2019] [Indexed: 11/12/2022]
Abstract
Intratubular germ cell neoplasia (ITGCN) of the testis is a precursor to testicular germ cell tumor (TGCT), which can lead to the development of invasive cancer. In patients with a history of previously treated unilateral TGCT, treatment for ITGCN of the contralateral testis needs to be balanced with the risks of subsequent infertility. Here, we present a 17- year- old patient with ITGCN diagnosed after treatment of contralateral nonseminomatous TGCT who was successfully treated with a partial orchiectomy followed by low-dose radiation with preservation of his testosterone production.
Collapse
Affiliation(s)
- Netta Schneller
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Amanda Grimes
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Jodi Muscal
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Angela Mittal
- Department of Urology, Baylor College of Medicine, Houston, Texas
| | - Arnold Paulino
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer Foster
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
37
|
Parker S, Foster J, Whiddon C, Pacholke H. Optimizing Skin Dose for Post-Mastectomy Chestwall VMAT Radiation Therapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
38
|
Bagley AF, Grosshans DR, Philip NV, Foster J, McAleer MF, McGovern SL, Lassen-Ramshad Y, Mahajan A, Paulino AC. Efficacy of proton therapy in children with high-risk and locally recurrent neuroblastoma. Pediatr Blood Cancer 2019; 66:e27786. [PMID: 31050179 PMCID: PMC6588416 DOI: 10.1002/pbc.27786] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 03/11/2019] [Accepted: 04/15/2019] [Indexed: 11/11/2022]
Abstract
PURPOSE Proton therapy is currently used in the management of pediatric tumors to decrease late toxicities. However, one of the criticisms of proton therapy is the limited data regarding efficacy on disease control. The purpose of this study was to examine local and distant control rates after proton therapy for neuroblastoma. METHODS AND MATERIALS Eighteen patients with high-risk (n = 16) and locally recurrent neuroblastoma (n = 2) were treated with curative intent and received proton therapy to the primary site and up to three post-induction MIBG-avid metastatic sites. Primary sites (n = 18) were treated to 21-36 Gy (relative biological effectiveness [RBE]), and metastatic sites (n = 16) were treated to 21-24 Gy (RBE). Local control and survival rates were calculated using the Kaplan-Meier method. RESULTS With a median follow-up of 60.2 months, two- and five-year local control rates at the irradiated primary site were 94% and 87%, respectively. No failures at irradiated distant metastatic sites were observed. The five-year progression-free survival (PFS) was 64%, and the five-year overall survival (OS) was 94%. The extent of surgical resection was not associated with local control, PFS, or OS. No radiation-related nephropathy or hepatopathy was reported. CONCLUSIONS Excellent local control was achieved using proton therapy to the primary and post-induction MIBG-positive distant sites. The predominant site of failure is progression in post-induction non-MIBG-avid distant sites. Although proton therapy provides high rates of local control with acceptable toxicity for neuroblastoma, further advances in systemic therapy are needed for the improved control of systemic disease.
Collapse
Affiliation(s)
- Alexander F. Bagley
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David R. Grosshans
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nancy V. Philip
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jennifer Foster
- Department of Pediatrics, Texas Children’s Hospital, Houston, TX
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Susan L. McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Arnold C. Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
39
|
Foster J, Muscal JA, Minard CG, Liu X, Reid JM, Berg SL, Fox E, Weigel B. Phase 1 study of pevonedistat (MLN4924) in combination with temozolomide (TMZ) and irinotecan (IRN) in pediatric patients with recurrent or refractory solid tumors (ADVL1615). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e21521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21521 Background: Pevonedistat, a first in class inhibitor of NEDD8 activating enzyme (NAE), prevents the activation of Cullin-RING ligases (CRL) necessary for proteasome mediated degradation of key regulatory proteins important in cell survival. In adults with solid tumors, the maximum tolerated dose (MTD) in combination with chemotherapy is 20-25 mg/m2. Antitumor activity of pevonedistat has been demonstrated in preclinical models of childhood cancer. In vivo additive activity has been demonstrated for pevonedistat in combination with IRN and alkylating agents. The objectives of this study are to determine the MTD and recommended phase 2 dose of pevonedistat in combination with IRN and TMZ and describe the toxicities, pharmacokinetic (PK), and pharmacodynamics (PD) properties of this combination. Methods: Using a rolling six design, we conducted a phase 1 trial of pevonedistat in combination with IRN and TMZ in pediatric patients (pts) with recurrent or refractory solid tumors and brain tumors. During cycle 1, pevonedistat was administered intravenously on days 1, 8, 10, and 12, with IRN (IV, 50mg/m2) and TMZ (orally, 100mg/m2), on days 8-12 of a 28 day cycle. In subsequent cycles, pevonedistat was administered on days 1, 3, and 5, with IRN and TMZ on days 1-5 of a 21 day cycle. Results: 18 pts enrolled. All pts were eligible and evaluable for cycle 1 dose limiting toxicity (DLT) assessment. Median (range) age was 13 (1-21) years; 11 (61%) were male. Six pts had brain tumors, and 12 pts had solid tumors. Six pts each enrolled on pevonedistat dose levels 1 (15mg/m2), 2 (20mg/m2), and 3 (25mg/m2). There were no DLTs; DLT assessment is pending for 1 pt on dose level 3. Grade 3/4 toxicities included grade 4 lymphocyte count decreased (n = 2), grade 3 white blood cell decreased (n = 2), and 1 pt each with grade 3 anemia, elevated AST, and elevated ALT. The most frequent AEs were anemia (83%), nausea (61%), elevated AST (61%), and diarrhea (61%). Pharmacokinetic analysis is pending. Conclusions: Pevonedistat in combination with IRN and TMZ is well tolerated in pts with solid or brain tumors. PK and PD analyses are ongoing to establish the recommended dose. Clinical trial information: NCT03323034.
Collapse
Affiliation(s)
| | - Jodi Ann Muscal
- Baylor College of Medicine Texas Children's Hospital, Bellaire, TX
| | | | | | - Joel M. Reid
- Department of Oncology, Mayo Clinic, Rochester, MN
| | | | - Elizabeth Fox
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | |
Collapse
|
40
|
White TG, Oliver MT, Mabey P, Kühn-Kauffeldt M, Bott AFA, Döhl LNK, Bell AR, Bingham R, Clarke R, Foster J, Giacinti G, Graham P, Heathcote R, Koenig M, Kuramitsu Y, Lamb DQ, Meinecke J, Michel T, Miniati F, Notley M, Reville B, Ryu D, Sarkar S, Sakawa Y, Selwood MP, Squire J, Scott RHH, Tzeferacos P, Woolsey N, Schekochihin AA, Gregori G. Supersonic plasma turbulence in the laboratory. Nat Commun 2019; 10:1758. [PMID: 30988285 PMCID: PMC6465398 DOI: 10.1038/s41467-019-09498-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 03/08/2019] [Indexed: 11/13/2022] Open
Abstract
The properties of supersonic, compressible plasma turbulence determine the behavior of many terrestrial and astrophysical systems. In the interstellar medium and molecular clouds, compressible turbulence plays a vital role in star formation and the evolution of our galaxy. Observations of the density and velocity power spectra in the Orion B and Perseus molecular clouds show large deviations from those predicted for incompressible turbulence. Hydrodynamic simulations attribute this to the high Mach number in the interstellar medium (ISM), although the exact details of this dependence are not well understood. Here we investigate experimentally the statistical behavior of boundary-free supersonic turbulence created by the collision of two laser-driven high-velocity turbulent plasma jets. The Mach number dependence of the slopes of the density and velocity power spectra agree with astrophysical observations, and supports the notion that the turbulence transitions from being Kolmogorov-like at low Mach number to being more Burgers-like at higher Mach numbers.
Collapse
Affiliation(s)
- T G White
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK.
- Department of Physics, University of Nevada, Reno, NV, 89557, USA.
| | - M T Oliver
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
- Department of Physics, University of Nevada, Reno, NV, 89557, USA
| | - P Mabey
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
- LULI-CNRS, Ecole Polytechnique, CEA: Université Paris-Saclay; UPMC Univ Paris 06: Sorbonne Universitiés, F-91128, Palaiseau cedex, France
| | | | - A F A Bott
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - L N K Döhl
- York Plasma Institute, Department of Physics, University of York, Heslington, York, YO10 5DD, UK
| | - A R Bell
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - R Bingham
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Harwell Oxford, Didcot, OX11 0QX, UK
- Department of Physics, SUPA, University of Strathclyde, Glasgow, G4 0NG, UK
| | - R Clarke
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Harwell Oxford, Didcot, OX11 0QX, UK
| | - J Foster
- AWE, Aldermaston, Reading, West Berkshire, RG7 4PR, UK
| | - G Giacinti
- Max-Planck-Institut für Kernphysik, Postfach 103980, 69029, Heidelberg, Germany
| | - P Graham
- AWE, Aldermaston, Reading, West Berkshire, RG7 4PR, UK
| | - R Heathcote
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Harwell Oxford, Didcot, OX11 0QX, UK
| | - M Koenig
- LULI-CNRS, Ecole Polytechnique, CEA: Université Paris-Saclay; UPMC Univ Paris 06: Sorbonne Universitiés, F-91128, Palaiseau cedex, France
- Graduate School of Engineering, Osaka University, Suita, Osaka, 564-0871, Japan
| | - Y Kuramitsu
- Graduate School of Engineering, Osaka University, Suita, Osaka, 564-0871, Japan
| | - D Q Lamb
- Department of Astronomy and Astrophysics, University of Chicago, 5640S. Ellis Ave, Chicago, IL, 60637, USA
| | - J Meinecke
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - Th Michel
- LULI-CNRS, Ecole Polytechnique, CEA: Université Paris-Saclay; UPMC Univ Paris 06: Sorbonne Universitiés, F-91128, Palaiseau cedex, France
| | - F Miniati
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - M Notley
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Harwell Oxford, Didcot, OX11 0QX, UK
| | - B Reville
- School of Mathematics and Physics, Queens University Belfast, Belfast, BT7 1NN, UK
| | - D Ryu
- Department of Physics, School of Natural Sciences, UNIST, Ulsan, 44919, Korea
| | - S Sarkar
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - Y Sakawa
- Institute of Laser Engineering, Osaka, 565-0871, Japan
| | - M P Selwood
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Harwell Oxford, Didcot, OX11 0QX, UK
| | - J Squire
- Theoretical Astrophysics, 350-17, California Institute of Technology, Pasadena, CA, 91125, USA
- Physics Department, University of Otago, Dunedin, 9016, New Zealand
| | - R H H Scott
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Harwell Oxford, Didcot, OX11 0QX, UK
| | - P Tzeferacos
- Department of Astronomy and Astrophysics, University of Chicago, 5640S. Ellis Ave, Chicago, IL, 60637, USA
| | - N Woolsey
- York Plasma Institute, Department of Physics, University of York, Heslington, York, YO10 5DD, UK
| | - A A Schekochihin
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - G Gregori
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK.
| |
Collapse
|
41
|
Krmpotic K, Foster J. Paediatric RRTs belong in tertiary care, paediatric hospitals. Paediatr Child Health 2019; 24:170-172. [PMID: 31110457 DOI: 10.1093/pch/pxz041] [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: 11/12/2022] Open
Affiliation(s)
- Kristina Krmpotic
- Department of Paediatric Critical Care, IWK Health Centre and Department of Critical Care, Dalhousie University, Halifax, Nova Scotia
| | - Jennifer Foster
- Department of Paediatric Critical Care, IWK Health Centre and Department of Critical Care, Dalhousie University, Halifax, Nova Scotia
| |
Collapse
|
42
|
Duffton A, McCrea I, Allwood-Spiers S, Hay L, Devlin L, Sankaralingam M, Thomson M, McLoone P, McJury M, Foster J, Paterson C. OC-0415 MERINO study: Defining a standardised delineation method for repeated GTV assessment using DW MRI. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30835-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
43
|
Paterson C, McCrea I, Hay L, Allwood-Speirs S, Devlin L, Sankaralingam M, McLoone P, Wilson C, Grose D, James A, Lamb C, Rizwanullah M, Schipani S, Nixon I, Thomson M, McJury M, Foster J, Duffton A. EP-1137 DW MRI as biomarker of response during RT for intermed/high risk SCC oropharynx: a feasibility study. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31557-9] [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: 11/29/2022]
|
44
|
Pantoja L, Weeks FH, Ortiz J, Cavada G, Foster J, Binfa L. Dimensions of childbirth care associated with maternal satisfaction among low-risk Chilean women. Health Care Women Int 2019; 41:89-100. [PMID: 30913000 DOI: 10.1080/07399332.2019.1590360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The authors of this study aimed to describe the level of maternal satisfaction during labor reported by a national sample of low-risk childbearing women in Chile by identifying the dimensions of intrapartum care most determinant for overall satisfaction. Maternal satisfaction was measured in the postpartum period with an instrument previously validated in Chile. Almost half of the participants (49.4%) reported having optimal satisfaction, 29% adequate, and 22% worse. Treatment of women by professionals and the physical environment were the most important dimension predicting of maternal satisfaction, consistent with findings from developing countries emphasizing patient-provider interaction during labor as a key component of birth care quality.
Collapse
Affiliation(s)
- Loreto Pantoja
- Department of Women's and Newborns Health Promotion, School of Midwifery University of Chile, Santiago, Chile
| | - Fiona H Weeks
- Maternal and Child Health Epidemiologist Wisconsin Division of Public Health, Madison, Wisconsin, USA
| | - Jovita Ortiz
- Department of Women's and Newborns Health Promotion, School of Midwifery University of Chile, Santiago, Chile
| | - Gabriel Cavada
- School of Public Health, University of Chile, Santiago, Chile
| | - Jennifer Foster
- Atlanta, Emeritus Associate Professor Emory University, Atlanta, Georgia, USA
| | - Lorena Binfa
- Department of Women's and Newborns Health Promotion, School of Midwifery University of Chile, Santiago, Chile
| |
Collapse
|
45
|
Haldar P, Agrawal P, Bhatnagar P, Tandon R, McGray S, Zehrung D, Jarrahian C, Foster J. Fractional-dose inactivated poliovirus vaccine, India. Bull World Health Organ 2019; 97:328-334. [PMID: 31551629 PMCID: PMC6747033 DOI: 10.2471/blt.18.218370] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 06/29/2018] [Revised: 01/04/2019] [Accepted: 01/23/2019] [Indexed: 11/27/2022] Open
Abstract
In 2016, the World Health Organization (WHO) announced a global shortage of inactivated poliovirus vaccine that was expected to last until 2020 at least. In response, WHO’s Strategic Advisory Group of Experts on Immunization recommended that countries consider a strategic shift to fractional-dose inactivated poliovirus vaccine, which involves a new dosing schedule (i.e. administered at 6 and 14 weeks of age) and has a different mode of delivery than full-dose inactivated poliovirus vaccine (i.e. intradermal rather than intramuscular). Introduction of fractional-dosing requires careful planning and management to ensure adequate vaccine supplies, to prevent wastage, to provide training for health workers, and to ensure accurate record-keeping. In early 2016, given the global vaccine shortage and a limited supply from domestic manufacturers, India’s Expert Advisory Group on polio recommended the staggered introduction of fractional-dosing. India was the first country to introduce fractional-dose inactivated poliovirus vaccine into routine immunization, initially in eight states in 2016. Following a rapid assessment of its initial implementation, fractional-dosing was extended and, by June 2017, all Indian states were covered. Here we summarize India’s experience with the introduction, discuss the challenges faced and the strategies used to address them, and report on the outcomes achieved. We also describe the lessons learnt, especially managing vaccine supplies and wastage, monitoring and supervision, and training needs. As the use of fractional-dose inactivated poliovirus vaccine is dose-sparing and reduces the cost of the immunization programme, it will remain an important part of India’s long-term strategy for polio vaccination.
Collapse
Affiliation(s)
| | - Pankaj Agrawal
- National Polio Surveillance Project, World Health Organization Country Office for India, New Delhi, India
| | - Pankaj Bhatnagar
- National Polio Surveillance Project, World Health Organization Country Office for India, New Delhi, India
| | - Rajiv Tandon
- PATH, Suite 200, 2201 Westlake Avenue, Seattle, Washington, 98121, United States of America
| | - Sarah McGray
- PATH, Suite 200, 2201 Westlake Avenue, Seattle, Washington, 98121, United States of America
| | - Darin Zehrung
- PATH, Suite 200, 2201 Westlake Avenue, Seattle, Washington, 98121, United States of America
| | - Courtney Jarrahian
- PATH, Suite 200, 2201 Westlake Avenue, Seattle, Washington, 98121, United States of America
| | - Jennifer Foster
- PATH, Suite 200, 2201 Westlake Avenue, Seattle, Washington, 98121, United States of America
| |
Collapse
|
46
|
Norris A, Crossland W, Tedeschi L, Foster J, Muir J, Pinchak W. 419 Effect of Differing Rates of Quebracho (Schinopsis balansae) Extract provided in a Limit-Fed High Roughage Total Mixed Ration Upon Digestibility and Nitrogen Balance. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.448] [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: 11/13/2022] Open
Affiliation(s)
- A Norris
- Texas A&M University, College Station,College Station, TX, United States
| | - W Crossland
- Texas Tech University,Lubbock, TX, United States
| | - L Tedeschi
- Department of Animal Science, Texas A&M University-College Station,College Station, TX, United States
| | - J Foster
- Texas A&M AgriLife Research,Beeville, College station, TX, United States
| | - J Muir
- Texas A&M AgriLife Research,Stephenville, TX, United States
| | - W Pinchak
- Texas A&M AgriLife Research,Beeville, College station, TX, United States
| |
Collapse
|
47
|
Durham CG, Thotakura D, Sager L, Foster J, Herrington JD. Cetirizine versus diphenhydramine in the prevention of chemotherapy-related hypersensitivity reactions. J Oncol Pharm Pract 2018; 25:1396-1401. [PMID: 30419768 DOI: 10.1177/1078155218811505] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study evaluated the role of cetirizine compared to diphenhydramine as premedications for patients receiving paclitaxel, cetuximab, and rituximab infusions. Historically, diphenhydramine has been linked with more sedation in comparison to cetirizine; however, it is unknown if cetirizine can replace diphenhydramine in the prevention of hypersensitivity reactions in patients receiving chemotherapy. METHODS This is a retrospective study designed to assess infusion reactions occurring in patients receiving diphenhydramine or cetirizine premedication for rituximab, paclitaxel, or cetuximab therapies. Infusion reactions were defined as various symptoms such as flushing, itching, alterations in heart rate and blood pressure, and dyspnea plus the clinical setting of a concurrent or very recent infusion. RESULTS A total of 207 patients were evaluated in this study with 83 patients receiving cetirizine and 124 diphenhydramine patients. Overall, the percentage of patients with at least one chemotherapy-related infusion event in the cetirizine group was 19.3% (95% CI 11.4-29.4) compared to diphenhydramine group 24.2% (95% CI 17.0-32.7), P = 0.40. Of the patients who received cetirizine and then experienced an event in the first cycle, 41.7% (95% CI 13.7-74.3) of the events were due to paclitaxel, 50.0% (95% CI 19.4-80.6) were due to rituximab, and 8.3% (95% CI 0.1-43.6) were due to cetuximab. Of the patients who received diphenhydramine and then experienced an event in the first cycle, 26.1% (95% CI 5.7-51.4) were due to paclitaxel, 73.9% (95% CI 48.6-94.3) were due to rituximab and none due to cetuximab. CONCLUSION Cetirizine appears to be a viable substitute for diphenhydramine for the prevention of infusions reactions with cetuximab, paclitaxel, and rituximab infusions in adults. Prospective studies are needed to determine the efficacy and safety of cetirizine compared with diphenhydramine in the prevention of chemotherapy-related infusion reactions.
Collapse
Affiliation(s)
- Charis G Durham
- Baylor Scott & White Medical Center - Temple and Scott & White Vasicek Cancer Treatment Center, Temple, TX, USA
| | - Deepthi Thotakura
- Baylor Scott & White Medical Center - Temple and Scott & White Vasicek Cancer Treatment Center, Temple, TX, USA
| | - Lauren Sager
- Baylor Scott & White Medical Center - Temple and Scott & White Vasicek Cancer Treatment Center, Temple, TX, USA
| | - Jennifer Foster
- Baylor Scott & White Medical Center - Temple and Scott & White Vasicek Cancer Treatment Center, Temple, TX, USA
| | - Jon D Herrington
- Baylor Scott & White Medical Center - Temple and Scott & White Vasicek Cancer Treatment Center, Temple, TX, USA
| |
Collapse
|
48
|
Campagna G, Rosenfeld E, Foster J, Vasudevan S, Nuchtern J, Kim E, Commander S, Naik-Mathuria B. Evolving biopsy techniques for the diagnosis of neuroblastoma in children. J Pediatr Surg 2018; 53:2235-2239. [PMID: 29753525 DOI: 10.1016/j.jpedsurg.2018.04.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/09/2018] [Accepted: 04/08/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND/PURPOSE To compare the adequacy and safety of percutaneous core needle biopsy and surgical wedge biopsy of neuroblastoma in children. METHODS A retrospective review of patients who underwent biopsy for intermediate- or high-risk neuroblastoma at our institution between 2011 and 2015 was performed (recent cohort). Procedure details and outcomes were collected and analyzed using descriptive statistics and Wilcoxon rank tests; P < 0.05 was considered significant. Published data from 2002 to 2010 were compared (historic cohort). RESULTS Since 2011, percutaneous, ultrasound-guided, core needle biopsy has been more commonly utilized (47% (16/34) recent vs. 25% (7/28) historic; P = 0.07), and the number of core needle samples increased from median 7 (historic) to 25 (recent). Complications decreased (21% (7/34) recent vs. 64% (18/28) historic; P < 0.01). Biopsy adequacy in the recent cohort was similar (94% percutaneous vs. 89% surgical; P = 1.00), which is improved from the historic cohort (71% percutaneous vs. 100% surgical; P = 0.06). Larger tumors were more likely to have a percutaneous biopsy (82 ± 37 cm percutaneous vs. 47 ± 29 cm surgical; P = 0.04). CONCLUSIONS When multiple cores are obtained, percutaneous core needle biopsy is adequate for complete tissue diagnosis of neuroblastoma and can be safely performed. This can be considered as an alternative to open surgical biopsy. TYPE OF STUDY Treatment Study. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
| | - Eric Rosenfeld
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer Foster
- Department of Pediatric Hematology-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Sanjeev Vasudevan
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Jed Nuchtern
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Eugene Kim
- Department of Pediatric Surgery, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Sarah Commander
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Bindi Naik-Mathuria
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
| |
Collapse
|
49
|
Bagley A, Grosshans D, Philip N, McAleer M, McGovern S, Foster J, Mahajan A, Paulino A. Efficacy of Proton Therapy on Locoregional Control in Neuroblastoma. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
50
|
Rudran B, Reader C, Foster J, Hodivala-Dilke K, Sosabowski J, Marshall J. P1.03-19 Antibody Blockade of Integrin Alpha-V-Beta-6 (avb6) as a Novel Treatment for NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|