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Rimel BJ, Enserro D, Bender DP, Jackson CG, Tan A, Alluri N, Borowsky M, Moroney J, Hendrickson AW, Backes F, Swisher E, Powell M, MacKay H. NRG-GY012: Randomized phase 2 study comparing olaparib, cediranib, and the combination of cediranib/olaparib in women with recurrent, persistent, or metastatic endometrial cancer. Cancer 2024; 130:1234-1245. [PMID: 38127487 DOI: 10.1002/cncr.35151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE This paper reports the efficacy of the poly (ADP-ribose) polymerase inhibitor olaparib alone and in combination with the antiangiogenesis agent cediranib compared with cediranib alone in patients with advanced endometrial cancer. METHODS This was open-label, randomized, phase 2 trial (NCT03660826). Eligible patients had recurrent endometrial cancer, received at least one (<3) prior lines of chemotherapy, and were Eastern Cooperative Oncology Group performance status 0 to 2. Patients were randomly assigned (1:1:1), stratified by histology (serous vs. other) to receive cediranib alone (reference arm), olaparib, or olaparib and cediranib for 28-day cycles until progression or unacceptable toxicity. The primary end point was progression-free survival in the intention-to-treat population. Homologous repair deficiency was explored using the BROCA-GO sequencing panel. RESULTS A total of 120 patients were enrolled and all were included in the intention-to-treat analysis. Median age was 66 (range, 41-86) years and 47 (39.2%) had serous histology. Median progression-free survival for cediranib was 3.8 months compared with 2.0 months for olaparib (hazard ratio, 1.45 [95% CI, 0.91-2.3] p = .935) and 5.5 months for olaparib/cediranib (hazard ratio, 0.7 [95% CI, 0.43-1.14] p = .064). Four patients receiving the combination had a durable response lasting more than 20 months. The most common grade 3/4 toxicities were hypertension in the cediranib (36%) and olaparib/cediranib (33%) arms, fatigue (20.5% olaparib/cediranib), and diarrhea (17.9% cediranib). The BROCA-GO panel results were not associated with response. CONCLUSION The combination of cediranib and olaparib demonstrated modest clinical efficacy; however, the primary end point of the study was not met. The combination was safe without unexpected toxicity.
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Affiliation(s)
- Bobbie J Rimel
- Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Danielle Enserro
- Clinical Trials Development Division, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - David P Bender
- University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Camille Gunderson Jackson
- University of Oklahoma Health Sciences Center, Mercy Hospital Gynecologic Oncology, Oklahoma City, Oklahoma, USA
| | - Annie Tan
- Minnesota Oncology, Coon Rapids, Minnesota, USA
| | | | - Mark Borowsky
- Hackensack Meridian Health, Neptune, New Jersey, USA
| | - John Moroney
- University of Chicago Medicine, Schererville, Indiana, USA
| | | | - Floor Backes
- The Ohio State University Comprehensive Cancer Center, Ohio State Internal Medicine, Hilliard, Ohio, USA
| | | | - Matthew Powell
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Helen MacKay
- Division of Medical Oncology & Hematology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
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O'Cearbhaill RE, Miller A, Soslow RA, Lankes HA, DeLair D, Segura S, Chavan S, Zamarin D, DeBernardo R, Moore K, Moroney J, Shahin M, Thaker PH, Wahner-Hendrickson AE, Aghajanian C. A phase 2 study of dasatinib in recurrent clear cell carcinoma of the ovary, fallopian tube, peritoneum or endometrium: NRG oncology/gynecologic oncology group study 0283. Gynecol Oncol 2023; 176:16-24. [PMID: 37418832 PMCID: PMC10529107 DOI: 10.1016/j.ygyno.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE Gynecologic cancers are traditionally managed according to their presumed site of origin, without regard to the underlying histologic subtype. Clear cell histology is associated with chemotherapy refractoriness and poor survival. Mutations in SWI/SNF chromatin remodeling complex member ARID1A, which encodes for BAF250a protein, are common in clear cell and endometriosis-associated endometrioid carcinomas. High-throughput cell-based drug screening predicted activity of dasatinib, a tyrosine kinase inhibitor, in ARID1A-mutant clear cell carcinoma. METHODS We conducted a phase 2 clinical trial of dasatinib 140 mg once daily by mouth in patients with recurrent or persistent ovarian and endometrial clear cell carcinoma. Patients with measurable disease were enrolled and then assigned to biomarker-defined populations based on BAF250a immunohistochemistry. The translational endpoints included broad next-generation sequencing to assess concordance of protein expression and treatment outcomes. RESULTS Twenty-eight patients, 15 of whom had tumors with retained BAF250a and 13 with loss of BAF250a were evaluable for treatment response and safety. The most common grade 3 adverse events were anemia, fatigue, dyspnea, hyponatremia, pleural effusion, and vomiting. One patient had a partial response, eight (28%) had stable disease, and 15 (53.6%) had disease progression. Twenty-three patients had next-generation sequencing results; 13 had a pathogenic ARID1A alteration. PIK3CA mutations were more prevalent in ARID1A-mutant tumors, while TP53 mutations were more prevalent in ARID1A wild-type tumors. CONCLUSIONS Dasatinib was not an effective single-agent treatment for recurrent or persistent ovarian and endometrial clear cell carcinoma. Studies are urgently needed for this rare gynecologic subtype.
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Affiliation(s)
| | - Austin Miller
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America.
| | - Robert A Soslow
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
| | - Heather A Lankes
- NRG Oncology, Operations Center-Philadelphia East, Philadelphia, PA, United States of America; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America.
| | - Deborah DeLair
- Northwell Health, Greenvale, New York, NY, United States of America.
| | - Sheila Segura
- Indiana University School of Medicine, Indianapolis, IN, United States of America.
| | - Shweta Chavan
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
| | - Dmitriy Zamarin
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
| | | | - Kathleen Moore
- University of Oklahoma, Oklahoma City, OK, United States of America.
| | - John Moroney
- University of Chicago, Chicago, IL, United States of America.
| | - Mark Shahin
- Abington Memorial Hospital, Willow Grove, PA, United States of America.
| | - Premal H Thaker
- Washington University, St. Louis, MO, United States of America.
| | | | - Carol Aghajanian
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
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Moroney J, Yeku O, Fleming G, Emens L, Vaena D, Dumbrava E, Rasco D, Sharma M, Papadopoulos K, Patnaik A, Sullivan R, Adewoye H, Ophir E, Cojocaru G, Ferre P, Izar B, Gaillard S. 158P Triple blockade of the DNAM-axis with COM701 + BMS-986207 + nivolumab demonstrates preliminary antitumor activity in patients with platinum-resistant OVCA. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Konstantinopoulos PA, Gockley AA, Xiong N, Krasner C, Horowitz N, Campos S, Wright AA, Liu JF, Shea M, Yeku O, Castro C, Polak M, Lee EK, Sawyer H, Bowes B, Moroney J, Cheng SC, Tayob N, Bouberhan S, Spriggs D, Penson RT, Fleming GF, Nucci MR, Matulonis UA. Evaluation of Treatment With Talazoparib and Avelumab in Patients With Recurrent Mismatch Repair Proficient Endometrial Cancer. JAMA Oncol 2022; 8:1317-1322. [PMID: 35900726 PMCID: PMC9335244 DOI: 10.1001/jamaoncol.2022.2181] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Question Is treatment with combined polyadenosine diphosphate-ribose polymerase and immune checkpoint inhibition active and safe in patients with recurrent mismatch repair proficient endometrial cancer (MMRP EC)? Findings In this single-arm, phase 2, 2-stage, nonrandomized clinical trial of treatment with avelumab and talazoparib in recurrent MMRP EC that included 35 patients, the confirmed objective response rate was 11.4%, and the progression-free survival at 6 months rate was 22.9%. No patients discontinued therapy because of toxic effects, and immunogenomic profiling provided insights into subsets of patients who may derive benefit from this combination. Meaning These study findings suggest that treatment with avelumab and talazoparib has a favorable toxic effects profile and support further investigation in certain subsets of patients with recurrent MMRP EC. Importance Although the activity of pembrolizumab and lenvatinib (the only US Food and Drug Administration–approved immunotherapy for mismatch repair proficient endometrial cancer [MMRP EC]) is compelling, there are no biomarkers of response and most patients do not tolerate, do not respond to, or develop resistance to this regimen, highlighting the need for additional, potentially biomarker-driven therapeutic approaches for patients with recurrent MMRP EC. Objective To assess the potential positive outcomes and safety of the combination of the polyadenosine diphosphate-ribose polymerase inhibitor talazoparib and the programmed cell death ligand 1 (PD-L1) inhibitor avelumab in recurrent MMRP EC. Design, Settings, and Participants This investigator-initiated, open-label, single-arm, 2-stage, phase 2 study nonrandomized controlled trial patients at 4 institutions in the US. Key eligibility criteria included measurable disease, unlimited prior therapies, and all endometrial cancer histologies. Interventions Talazoparib, 1 mg, orally, daily, and avelumab, 10 mg/kg, intravenously, every 2 weeks, were administered until disease progression or unacceptable toxic effects. Main Outcomes and Measures Statistical considerations were developed for 2 coprimary objectives of objective response rate and rate of progression-free survival at 6 months, with a 2-stage design that allowed for early discontinuation for futility. Prespecified exploratory objectives included the association of immunogenomic features (determined by targeted-panel next-generation sequencing and immunohistochemistry) with activity. Results Thirty-five female patients (mean [SD] age, 67.9 [8.41] years) received protocol therapy; 9 (25.7%) derived clinical benefit after meeting at least 1 of the 2 coprimary end points. Four patients (11.4%) exhibited confirmed objective response rates (4 partial responses), and 8 (22.9%) survived progression free at 6 months. The most common grade 3 and 4 treatment-related toxic effects were anemia (16 [46%]), thrombocytopenia (10 [29%]), and neutropenia (4 [11%]); no patient discontinued receipt of therapy because of toxic effects. Tumors with homologous recombination repair alterations were associated with clinical benefit from treatment with avelumab and talazoparib. Tumor mutational burden, tumor-infiltrating lymphocytes, and PD-L1 status were not associated with clinical benefit. Conclusions and Relevance The results of this nonrandomized controlled trial suggest that treatment with avelumab and talazoparib demonstrated a favorable toxic effect profile and met the predetermined criteria to be considered worthy of further evaluation in MMRP EC. Immunogenomic profiling provided insights that may inform ongoing and future studies of polyadenosine diphosphate-ribose polymerase and PD-L1 inhibitor combinations in endometrial cancer. Trial Registration ClinicalTrials.gov Identifier: NCT02912572
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Affiliation(s)
| | | | - Niya Xiong
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | | | | | - Joyce F Liu
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Meghan Shea
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
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O'Cearbhaill RE, Clark L, Eskander RN, Gaillard S, Moroney J, Pereira E, Pothuri B. Immunotherapy toxicities: An SGO clinical practice statement. Gynecol Oncol 2022; 166:25-35. [PMID: 35597686 PMCID: PMC10566626 DOI: 10.1016/j.ygyno.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/23/2022]
Affiliation(s)
- R E O'Cearbhaill
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA.
| | - L Clark
- University of North Carolina, Chapel Hill, NC, USA
| | - R N Eskander
- University of California, San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - S Gaillard
- Johns Hopkins University, Baltimore, MD, USA
| | - J Moroney
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
| | | | - B Pothuri
- New York University School of Medicine, New York, NY, USA
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Liu J, Gaillard S, Hendrickson AW, Moroney J, Yeku O, Diver E, Gunderson C, Arend R, Ratner E, Samnotra V, Gupta D, Evilevitch L, Wang S, Wang P, Tang J, Bacque E, Liu X, Konecny G. An open-label phase II study of dostarlimab (TSR-042), bevacizumab (bev), and niraparib combination in patients (pts) with platinum-resistant ovarian cancer (PROC): cohort A of the OPAL trial. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00680-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Liu J, Gunderson C, Hendrickson AW, Ratner E, Diver E, Moroney J, Arend RC, Louie-Gao M, Wang S, Luptakova K, Konecny GE. Abstract CT157: An open-label Phase II study of combination of TSR-042, bevacizumab, and niraparib in patients with platinum-resistant ovarian cancer (OC): Cohort A of the OPAL trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-ct157] [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: 11/16/2022]
Abstract
Abstract
Background: Most patients with advanced OC relapse after initial standard platinum-based chemotherapy, and eventually the disease becomes platinum-resistant. Niraparib (ZEJULA®) was the first selective poly(ADP-ribose) polymerase inhibitor (PARPi) approved in the United States and Europe for maintenance treatment in patients with recurrent OC regardless of BRCA mutation status. Preclinical evidence suggests that niraparib activates the stimulator of interferon genes pathway to increase immune cell infiltration and synergizes with anti-PD-1 therapy. Additionally, hypoxia induces contextual synthetic lethality by impairing homologous recombination, and therefore induction of hypoxia by inhibition of angiogenesis could lead to synergy with PARPi. In the TOPACIO/KEYNOTE-162 trial, niraparib in combination with pembrolizumab has shown efficacy in recurrent, platinum-resistant OC. Niraparib in combination with the anti-angiogenic agent bevacizumab is under study for the treatment of recurrent platinum-sensitive OC (AVANOVA trial) and advanced OC following response on frontline platinum-based chemotherapy (OVARIO trial). TSR-042 is an anti-PD-1 humanized monoclonal antibody that has shown clinical activity as monotherapy in early phase trials. Cohort A of the OPAL trial will evaluate the novel triple combination of the PARPi niraparib, angiogenesis inhibitor bevacizumab, and PD-1 inhibitor TSR-042 in patients with platinum-resistant OC who are naïve to PARPi therapy.
Methods: Eligible patients will have high-grade recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer of the ovary and progressed ≤6 months from completion of ≥4 cycles of platinum-based chemotherapy. Additional key eligibility criteria include 1-2 prior lines of anticancer therapy for OC, no prior therapy with an anti-PD-1 or anti-PD-L1 antibody, and no prior therapy for OC with a PARPi. Patients will receive a combination regimen of 500 mg TSR-042 on day 1 of each 3-week cycle for 4 cycles, then 1000 mg on day 1 of every other cycle beginning on cycle 5 until progression or toxicity, 15 mg/kg bevacizumab on day 1 of each 3-week cycle for up to 15 months, and niraparib 300 mg or 200 mg (for patients <77 kg or platelet count <150,000/µL at screening) daily until disease progression or toxicity. The primary endpoint is to evaluate treatment efficacy by confirmed objective response rate per investigator-assessed RECIST v1.1 criteria. Secondary objectives are evaluation of progression-free survival, overall survival, duration of response, and disease control rate. Exploratory objectives are to identify potential biomarkers of tumor response, including BRCA status and homologous recombination repair gene status and to evaluate the evolution of the molecular profile of the tumor and tumor microenvironment in response to treatment.
Clinical trial identification: NCT03574779
Citation Format: Joyce Liu, Camille Gunderson, Andrea Wahner Hendrickson, Elena Ratner, Elisabeth Diver, John Moroney, Rebecca C. Arend, Melinda Louie-Gao, Sarah Wang, Katarina Luptakova, Gottfried E. Konecny. An open-label Phase II study of combination of TSR-042, bevacizumab, and niraparib in patients with platinum-resistant ovarian cancer (OC): Cohort A of the OPAL trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr CT157.
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Affiliation(s)
- Joyce Liu
- 1Dana-Farber Cancer Institute, Boston, MA
| | - Camille Gunderson
- 2Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | - Elena Ratner
- 4Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Elisabeth Diver
- 5Department of Obstetrics and Gynecology, Stanford University Medical School, Stanford, CA
| | - John Moroney
- 6Department of Obstetrics and Gynecology, University of Chicago Medicine, Chicago, IL
| | - Rebecca C. Arend
- 7Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
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Luke JJ, Lemons JM, Karrison TG, Pitroda SP, Melotek JM, Zha Y, Al-Hallaq HA, Arina A, Khodarev NN, Janisch L, Chang P, Patel JD, Fleming GF, Moroney J, Sharma MR, White JR, Ratain MJ, Gajewski TF, Weichselbaum RR, Chmura SJ. Safety and Clinical Activity of Pembrolizumab and Multisite Stereotactic Body Radiotherapy in Patients With Advanced Solid Tumors. J Clin Oncol 2018; 36:1611-1618. [PMID: 29437535 DOI: 10.1200/jco.2017.76.2229] [Citation(s) in RCA: 403] [Impact Index Per Article: 67.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose Stereotactic body radiotherapy (SBRT) may stimulate innate and adaptive immunity to augment immunotherapy response. Multisite SBRT is an emerging paradigm for treating metastatic disease. Anti-PD-1-treatment outcomes may be improved with lower disease burden. In this context, we conducted a phase I study to evaluate the safety of pembrolizumab with multisite SBRT in patients with metastatic solid tumors. Patients and Methods Patients progressing on standard treatment received SBRT to two to four metastases. Not all metastases were targeted, and metastases > 65 mL were partially irradiated. SBRT dosing varied by site and ranged from 30 to 50 Gy in three to five fractions with predefined dose de-escalation if excess dose-limiting toxicities were observed. Pembrolizumab was initiated within 7 days after completion of SBRT. Pre- and post-SBRT biopsy specimens were analyzed in a subset of patients to quantify interferon-γ-induced gene expression. Results A total of 79 patients were enrolled; three patients did not receive any treatment and three patients only received SBRT. Patients included in the analysis were treated with SBRT and at least one cycle of pembrolizumab. Most (94.5%) of patients received SBRT to two metastases. Median follow-up for toxicity was 5.5 months (interquartile range, 3.3 to 8.1 months). Six patients experienced dose-limiting toxicities with no radiation dose reductions. In the 68 patients with imaging follow-up, the overall objective response rate was 13.2%. Median overall survival was 9.6 months (95% CI, 6.5 months to undetermined) and median progression-free survival was 3.1 months (95% CI, 2.9 to 3.4 months). Expression of interferon-γ-associated genes from post-SBRT tumor biopsy specimens significantly correlated with nonirradiated tumor response. Conclusion Multisite SBRT followed by pembrolizumab was well tolerated with acceptable toxicity. Additional studies exploring the clinical benefit and predictive biomarkers of combined multisite SBRT and PD-1-directed immunotherapy are warranted.
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Affiliation(s)
- Jason J Luke
- Jason J. Luke, Jeffrey M. Lemons, Theodore G. Karrison, Sean P. Pitroda, James M. Melotek, Yuanyuan Zha, Hania A. Al-Hallaq, Ainhoa Arina, Nikolai N. Khodarev, Linda Janisch, Paul Chang, Jyoti D. Patel, Gini F. Fleming, John Moroney, Manish R. Sharma, Mark J. Ratain, Thomas F. Gajewski, Ralph R. Weichselbaum, and Steven J. Chmura, The University of Chicago, Chicago, IL; Julia R. White, The Ohio State University, Columbus, OH
| | - Jeffrey M Lemons
- Jason J. Luke, Jeffrey M. Lemons, Theodore G. Karrison, Sean P. Pitroda, James M. Melotek, Yuanyuan Zha, Hania A. Al-Hallaq, Ainhoa Arina, Nikolai N. Khodarev, Linda Janisch, Paul Chang, Jyoti D. Patel, Gini F. Fleming, John Moroney, Manish R. Sharma, Mark J. Ratain, Thomas F. Gajewski, Ralph R. Weichselbaum, and Steven J. Chmura, The University of Chicago, Chicago, IL; Julia R. White, The Ohio State University, Columbus, OH
| | - Theodore G Karrison
- Jason J. Luke, Jeffrey M. Lemons, Theodore G. Karrison, Sean P. Pitroda, James M. Melotek, Yuanyuan Zha, Hania A. Al-Hallaq, Ainhoa Arina, Nikolai N. Khodarev, Linda Janisch, Paul Chang, Jyoti D. Patel, Gini F. Fleming, John Moroney, Manish R. Sharma, Mark J. Ratain, Thomas F. Gajewski, Ralph R. Weichselbaum, and Steven J. Chmura, The University of Chicago, Chicago, IL; Julia R. White, The Ohio State University, Columbus, OH
| | - Sean P Pitroda
- Jason J. Luke, Jeffrey M. Lemons, Theodore G. Karrison, Sean P. Pitroda, James M. Melotek, Yuanyuan Zha, Hania A. Al-Hallaq, Ainhoa Arina, Nikolai N. Khodarev, Linda Janisch, Paul Chang, Jyoti D. Patel, Gini F. Fleming, John Moroney, Manish R. Sharma, Mark J. Ratain, Thomas F. Gajewski, Ralph R. Weichselbaum, and Steven J. Chmura, The University of Chicago, Chicago, IL; Julia R. White, The Ohio State University, Columbus, OH
| | - James M Melotek
- Jason J. Luke, Jeffrey M. Lemons, Theodore G. Karrison, Sean P. Pitroda, James M. Melotek, Yuanyuan Zha, Hania A. Al-Hallaq, Ainhoa Arina, Nikolai N. Khodarev, Linda Janisch, Paul Chang, Jyoti D. Patel, Gini F. Fleming, John Moroney, Manish R. Sharma, Mark J. Ratain, Thomas F. Gajewski, Ralph R. Weichselbaum, and Steven J. Chmura, The University of Chicago, Chicago, IL; Julia R. White, The Ohio State University, Columbus, OH
| | - Yuanyuan Zha
- Jason J. Luke, Jeffrey M. Lemons, Theodore G. Karrison, Sean P. Pitroda, James M. Melotek, Yuanyuan Zha, Hania A. Al-Hallaq, Ainhoa Arina, Nikolai N. Khodarev, Linda Janisch, Paul Chang, Jyoti D. Patel, Gini F. Fleming, John Moroney, Manish R. Sharma, Mark J. Ratain, Thomas F. Gajewski, Ralph R. Weichselbaum, and Steven J. Chmura, The University of Chicago, Chicago, IL; Julia R. White, The Ohio State University, Columbus, OH
| | - Hania A Al-Hallaq
- Jason J. Luke, Jeffrey M. Lemons, Theodore G. Karrison, Sean P. Pitroda, James M. Melotek, Yuanyuan Zha, Hania A. Al-Hallaq, Ainhoa Arina, Nikolai N. Khodarev, Linda Janisch, Paul Chang, Jyoti D. Patel, Gini F. Fleming, John Moroney, Manish R. Sharma, Mark J. Ratain, Thomas F. Gajewski, Ralph R. Weichselbaum, and Steven J. Chmura, The University of Chicago, Chicago, IL; Julia R. White, The Ohio State University, Columbus, OH
| | - Ainhoa Arina
- Jason J. Luke, Jeffrey M. Lemons, Theodore G. Karrison, Sean P. Pitroda, James M. Melotek, Yuanyuan Zha, Hania A. Al-Hallaq, Ainhoa Arina, Nikolai N. Khodarev, Linda Janisch, Paul Chang, Jyoti D. Patel, Gini F. Fleming, John Moroney, Manish R. Sharma, Mark J. Ratain, Thomas F. Gajewski, Ralph R. Weichselbaum, and Steven J. Chmura, The University of Chicago, Chicago, IL; Julia R. White, The Ohio State University, Columbus, OH
| | - Nikolai N Khodarev
- Jason J. Luke, Jeffrey M. Lemons, Theodore G. Karrison, Sean P. Pitroda, James M. Melotek, Yuanyuan Zha, Hania A. Al-Hallaq, Ainhoa Arina, Nikolai N. Khodarev, Linda Janisch, Paul Chang, Jyoti D. Patel, Gini F. Fleming, John Moroney, Manish R. Sharma, Mark J. Ratain, Thomas F. Gajewski, Ralph R. Weichselbaum, and Steven J. Chmura, The University of Chicago, Chicago, IL; Julia R. White, The Ohio State University, Columbus, OH
| | - Linda Janisch
- Jason J. Luke, Jeffrey M. Lemons, Theodore G. Karrison, Sean P. Pitroda, James M. Melotek, Yuanyuan Zha, Hania A. Al-Hallaq, Ainhoa Arina, Nikolai N. Khodarev, Linda Janisch, Paul Chang, Jyoti D. Patel, Gini F. Fleming, John Moroney, Manish R. Sharma, Mark J. Ratain, Thomas F. Gajewski, Ralph R. Weichselbaum, and Steven J. Chmura, The University of Chicago, Chicago, IL; Julia R. White, The Ohio State University, Columbus, OH
| | - Paul Chang
- Jason J. Luke, Jeffrey M. Lemons, Theodore G. Karrison, Sean P. Pitroda, James M. Melotek, Yuanyuan Zha, Hania A. Al-Hallaq, Ainhoa Arina, Nikolai N. Khodarev, Linda Janisch, Paul Chang, Jyoti D. Patel, Gini F. Fleming, John Moroney, Manish R. Sharma, Mark J. Ratain, Thomas F. Gajewski, Ralph R. Weichselbaum, and Steven J. Chmura, The University of Chicago, Chicago, IL; Julia R. White, The Ohio State University, Columbus, OH
| | - Jyoti D Patel
- Jason J. Luke, Jeffrey M. Lemons, Theodore G. Karrison, Sean P. Pitroda, James M. Melotek, Yuanyuan Zha, Hania A. Al-Hallaq, Ainhoa Arina, Nikolai N. Khodarev, Linda Janisch, Paul Chang, Jyoti D. Patel, Gini F. Fleming, John Moroney, Manish R. Sharma, Mark J. Ratain, Thomas F. Gajewski, Ralph R. Weichselbaum, and Steven J. Chmura, The University of Chicago, Chicago, IL; Julia R. White, The Ohio State University, Columbus, OH
| | - Gini F Fleming
- Jason J. Luke, Jeffrey M. Lemons, Theodore G. Karrison, Sean P. Pitroda, James M. Melotek, Yuanyuan Zha, Hania A. Al-Hallaq, Ainhoa Arina, Nikolai N. Khodarev, Linda Janisch, Paul Chang, Jyoti D. Patel, Gini F. Fleming, John Moroney, Manish R. Sharma, Mark J. Ratain, Thomas F. Gajewski, Ralph R. Weichselbaum, and Steven J. Chmura, The University of Chicago, Chicago, IL; Julia R. White, The Ohio State University, Columbus, OH
| | - John Moroney
- Jason J. Luke, Jeffrey M. Lemons, Theodore G. Karrison, Sean P. Pitroda, James M. Melotek, Yuanyuan Zha, Hania A. Al-Hallaq, Ainhoa Arina, Nikolai N. Khodarev, Linda Janisch, Paul Chang, Jyoti D. Patel, Gini F. Fleming, John Moroney, Manish R. Sharma, Mark J. Ratain, Thomas F. Gajewski, Ralph R. Weichselbaum, and Steven J. Chmura, The University of Chicago, Chicago, IL; Julia R. White, The Ohio State University, Columbus, OH
| | - Manish R Sharma
- Jason J. Luke, Jeffrey M. Lemons, Theodore G. Karrison, Sean P. Pitroda, James M. Melotek, Yuanyuan Zha, Hania A. Al-Hallaq, Ainhoa Arina, Nikolai N. Khodarev, Linda Janisch, Paul Chang, Jyoti D. Patel, Gini F. Fleming, John Moroney, Manish R. Sharma, Mark J. Ratain, Thomas F. Gajewski, Ralph R. Weichselbaum, and Steven J. Chmura, The University of Chicago, Chicago, IL; Julia R. White, The Ohio State University, Columbus, OH
| | - Julia R White
- Jason J. Luke, Jeffrey M. Lemons, Theodore G. Karrison, Sean P. Pitroda, James M. Melotek, Yuanyuan Zha, Hania A. Al-Hallaq, Ainhoa Arina, Nikolai N. Khodarev, Linda Janisch, Paul Chang, Jyoti D. Patel, Gini F. Fleming, John Moroney, Manish R. Sharma, Mark J. Ratain, Thomas F. Gajewski, Ralph R. Weichselbaum, and Steven J. Chmura, The University of Chicago, Chicago, IL; Julia R. White, The Ohio State University, Columbus, OH
| | - Mark J Ratain
- Jason J. Luke, Jeffrey M. Lemons, Theodore G. Karrison, Sean P. Pitroda, James M. Melotek, Yuanyuan Zha, Hania A. Al-Hallaq, Ainhoa Arina, Nikolai N. Khodarev, Linda Janisch, Paul Chang, Jyoti D. Patel, Gini F. Fleming, John Moroney, Manish R. Sharma, Mark J. Ratain, Thomas F. Gajewski, Ralph R. Weichselbaum, and Steven J. Chmura, The University of Chicago, Chicago, IL; Julia R. White, The Ohio State University, Columbus, OH
| | - Thomas F Gajewski
- Jason J. Luke, Jeffrey M. Lemons, Theodore G. Karrison, Sean P. Pitroda, James M. Melotek, Yuanyuan Zha, Hania A. Al-Hallaq, Ainhoa Arina, Nikolai N. Khodarev, Linda Janisch, Paul Chang, Jyoti D. Patel, Gini F. Fleming, John Moroney, Manish R. Sharma, Mark J. Ratain, Thomas F. Gajewski, Ralph R. Weichselbaum, and Steven J. Chmura, The University of Chicago, Chicago, IL; Julia R. White, The Ohio State University, Columbus, OH
| | - Ralph R Weichselbaum
- Jason J. Luke, Jeffrey M. Lemons, Theodore G. Karrison, Sean P. Pitroda, James M. Melotek, Yuanyuan Zha, Hania A. Al-Hallaq, Ainhoa Arina, Nikolai N. Khodarev, Linda Janisch, Paul Chang, Jyoti D. Patel, Gini F. Fleming, John Moroney, Manish R. Sharma, Mark J. Ratain, Thomas F. Gajewski, Ralph R. Weichselbaum, and Steven J. Chmura, The University of Chicago, Chicago, IL; Julia R. White, The Ohio State University, Columbus, OH
| | - Steven J Chmura
- Jason J. Luke, Jeffrey M. Lemons, Theodore G. Karrison, Sean P. Pitroda, James M. Melotek, Yuanyuan Zha, Hania A. Al-Hallaq, Ainhoa Arina, Nikolai N. Khodarev, Linda Janisch, Paul Chang, Jyoti D. Patel, Gini F. Fleming, John Moroney, Manish R. Sharma, Mark J. Ratain, Thomas F. Gajewski, Ralph R. Weichselbaum, and Steven J. Chmura, The University of Chicago, Chicago, IL; Julia R. White, The Ohio State University, Columbus, OH
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Moulder S, Helgason T, Janku F, Wheler J, Moroney J, Booser D, Albarracin C, Morrow PK, Atkins J, Koenig K, Gilcrease M, Kurzrock R. Inhibition of the phosphoinositide 3-kinase pathway for the treatment of patients with metastatic metaplastic breast cancer. Ann Oncol 2015; 26:1346-52. [PMID: 25878190 DOI: 10.1093/annonc/mdv163] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 03/16/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Mesenchymal/metaplastic breast cancers (MpBCs) are often triple-negative (TNBC), and chemo-refractory, and can harbor phosphoinositide 3-kinase (PI3kinase) alterations; thus, therapy with mTor inhibitors may demonstrate activity. PATIENTS AND METHODS Patients with mesenchymal/MpBC treated with temsirolimus-based regimens were evaluated. Mutational analyses [polymerase chain reaction (PCR)-based DNA sequencing method, mass spectrometric detection (Sequenom MassARRAY), or next-generation sequencing] as well as loss of phosphatase and tensin homolog (PTEN) (immunohistochemistry) were performed (archived tissue when available). RESULTS Twenty-three patients (one of whom was on two separate trials) were treated using temsirolimus-containing regimens: temsirolimus alone (n = 1 patient) or combined with the following: liposomal doxorubicin and bevacizumab (DAT, n = 18); liposomal doxorubicin (DT, n = 1); paclitaxel and bevacizumab (TAT, n = 2); paclitaxel (TT, n = 1); carboplatin and bevacizumab (CAT, n = 1). Response rate [complete response (CR) + partial response (PR)] was 25% across all regimens; 32% in the anthracycline-based regimens [DAT and DT (CR = 2, PR = 4; N = 19)]. An additional two patients achieved stable disease (SD) ≥6 months [total SD ≥6 months/CR/PR = 8 (33%)]. Molecular aberrations in the PI3K pathway were common: PIK3CA mutation = 6/15 (40%), PTEN mutation = 3/11 (27%), and PTEN loss = 2/11 (18%). A point mutation in the NF2 gene (K159fs*16; NF2 alterations can activate mTor) was found in one patient who attained CR (3+ years). Of the eight patients who achieved SD ≥6 months/CR/PR, all 4 patients with available tissue had a molecular aberration that activate the PIK3CA/Akt/mTOR axis: PIK3CA mutation = 2; PTEN loss = 1; NF2 aberration = 1. CONCLUSIONS DAT has activity in MpBCs including complete CRs. Molecular aberrations that can activate the PI3 K/Akt/mTOR axis are common in MpBC.
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Affiliation(s)
- S Moulder
- Department of Investigational Cancer Therapeutics (Phase I), The University of Texas, M.D. Anderson Cancer Center, Houston Department of Breast Medical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston
| | - T Helgason
- Department of Investigational Cancer Therapeutics (Phase I), The University of Texas, M.D. Anderson Cancer Center, Houston
| | - F Janku
- Department of Investigational Cancer Therapeutics (Phase I), The University of Texas, M.D. Anderson Cancer Center, Houston
| | - J Wheler
- Department of Investigational Cancer Therapeutics (Phase I), The University of Texas, M.D. Anderson Cancer Center, Houston
| | - J Moroney
- Department of Investigational Cancer Therapeutics (Phase I), The University of Texas, M.D. Anderson Cancer Center, Houston
| | - D Booser
- Department of Breast Medical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston
| | - C Albarracin
- Department of Pathology, The University of Texas, M.D. Anderson Cancer Center, Houston
| | - P K Morrow
- Department of Breast Medical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston
| | - J Atkins
- Department of Investigational Cancer Therapeutics (Phase I), The University of Texas, M.D. Anderson Cancer Center, Houston
| | - K Koenig
- Department of Breast Medical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston
| | - M Gilcrease
- Department of Pathology, The University of Texas, M.D. Anderson Cancer Center, Houston
| | - R Kurzrock
- Department of Hematology and Oncology, UCSD Moores Cancer Center, San Diego, USA
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Moroney J, Fu S, Moulder S, Falchook G, Helgason T, Levenback C, Hong D, Naing A, Wheler J, Kurzrock R. Phase I study of the antiangiogenic antibody bevacizumab and the mTOR/hypoxia-inducible factor inhibitor temsirolimus combined with liposomal doxorubicin: tolerance and biological activity. Clin Cancer Res 2012; 18:5796-805. [PMID: 22927482 DOI: 10.1158/1078-0432.ccr-12-1158] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Preclinical data suggest that combining the mTOR/hypoxia-inducible factor (HIF) inhibitor temsirolimus and the antiangiogenesis antibody bevacizumab may augment antitumor activity as well as resensitize cells to anthracyclines. EXPERIMENTAL DESIGN We initiated a phase I study of bevacizumab and temsirolimus plus liposomal doxorubicin in patients with advanced malignancies. Patients (N = 136) were enrolled according to a modified 3 + 3 design plus dose expansion in responsive tumor types. RESULTS The most common cancers were breast (n = 29), epithelial ovarian (n = 23), and colorectal cancer (n = 17). The median number of prior chemotherapy regimens was four (range: 0-16). Grade 3 or higher adverse events (> 5%) included pancytopenia, mucositis, hand-foot syndrome, hypertension, and fistula. This regimen led to a 21% (n = 28) stable disease (SD) ≥ 6 months and 21% (n = 29) rate of partial or complete remission [PR/CR; (total SD ≥ 6 months/PR/CR = 42% (n = 57)]. PR/CR was most common in parotid gland adenocarcinoma (4/6, 67%), metaplastic breast cancer (5/12, 42%), endometrial endometrioid carcinoma (6/15, 40%), and in patients with a PIK3CA mutation and/or a PTEN mutation/loss (11/28, 39%). The maximum tolerated dose was liposomal doxorubicin 30 mg/m(2) and bevacizumab 15 mg/kg every three weeks with temsirolimus 25 mg weekly. CONCLUSIONS Patients tolerated bevacizumab and temsirolimus together with liposomal doxorubicin. Further evaluation, especially in patients with parotid, metaplastic breast, and endometrial endometrioid cancer, and in patients with PIK3CA and/or PTEN aberrations is warranted.
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Affiliation(s)
- John Moroney
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), MD Anderson Cancer Center, Houston, Texas 77030, USA
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McNicholas S, McDermott H, Power L, Johnson EM, Moroney J, Humphreys H, Smyth EG. Sporobolomyces roseus in the cerebrospinal fluid of an immunocompetent patient – to treat or not to treat? J Med Microbiol 2012; 61:295-296. [DOI: 10.1099/jmm.0.036293-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- S. McNicholas
- Department of Microbiology, Beaumont Hospital, Dublin 9, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin 9, Ireland
| | - H. McDermott
- Department of Microbiology, Beaumont Hospital, Dublin 9, Ireland
| | - L. Power
- Department of Microbiology, Beaumont Hospital, Dublin 9, Ireland
| | - E. M. Johnson
- Mycology Reference Laboratory, Southwest HPA Laboratory, Myrtle Road, Kingsdown, Bristol, UK
| | - J. Moroney
- Department of Neurology, Beaumont Hospital, Dublin 9, Ireland
| | - H. Humphreys
- Department of Microbiology, Beaumont Hospital, Dublin 9, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin 9, Ireland
| | - E. G. Smyth
- Department of Microbiology, Beaumont Hospital, Dublin 9, Ireland
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Marnane M, Ni Chroinin D, Callaly E, Sheehan OC, Merwick A, Hannon N, Horgan G, Kyne L, Moroney J, McCormack PME, Dolan E, Duggan J, Williams D, Crispino-O'Connell G, Kelly PJ. Stroke recurrence within the time window recommended for carotid endarterectomy. Neurology 2011; 77:738-43. [PMID: 21849640 DOI: 10.1212/wnl.0b013e31822b00cf] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In the North Dublin Population Stroke Study, we investigated the risk of recurrent stroke within the 14-day time window recommended for endarterectomy. METHODS In a population-based prospective cohort study, all ischemic stroke patients were identified over 1 year and categorized into those with (CS-positive) and without (CS-negative) ipsilateral carotid stenosis (CS) (≥50% lumen narrowing). Nonprocedural stroke recurrence was determined at 72 hours and 7 and 14 days. RESULTS Of 365 ischemic stroke patients with carotid imaging, 51 were excluded due to posterior circulation or nonlateralizing stroke, ipsilateral carotid occlusion, or intracranial stenosis, leaving 314 included for analysis (36 CS-positive and 278 CS-negative). Recurrent stroke occurred in 5.6% (2/36) CS-positive and 0.4% (1/278) CS-negative patients by 72 hours of symptom onset (p =0.003), 5.6% (2/36) CS-positive and 0.7% (2/278) CS-negative patients (p =0.01) by 7 days, and in 8.3% (3/36) CS-positive and 1.8% (5/278) CS-negative patients by 14 days (p =0.02). On multivariable Cox regression analysis, CS was the only independent predictor of recurrence at 72 hours (adjusted hazard ratio [HR] 36.1, 95% confidence interval [CI] 1.6-837.5, p =0.03), and 7 days (HR 9.1, 1.1-79.2, p =0.05), with a trend at 14 days (HR 4.6, 0.9-22.8, p =0.06). CONCLUSIONS Although only a minority of patients with symptomatic CS had a recurrent stroke within 14 days, early recurrent stroke risk was high, particularly within the first 72 hours. Earlier carotid revascularization or improved acute medical treatment may reduce recurrence in this high-risk group.
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Affiliation(s)
- M Marnane
- Neurovascular Clinical Science Unit, Mater University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin, Ireland.
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Moulder S, Moroney J, Helgason T, Wheler J, Booser D, Albarracin C, Morrow PK, Koenig K, Kurzrock R. Responses to liposomal Doxorubicin, bevacizumab, and temsirolimus in metaplastic carcinoma of the breast: biologic rationale and implications for stem-cell research in breast cancer. J Clin Oncol 2011; 29:e572-5. [PMID: 21482991 DOI: 10.1200/jco.2010.34.0604] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Stacy Moulder
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Frumovitz M, Greer M, Soliman P, Schmeler K, Moroney J, Bodurka D, Ramirez P. Laparoscopic Training and Projected Practice Among Fellows-in-Training in Gynecologic Oncology. J Minim Invasive Gynecol 2008. [DOI: 10.1016/j.jmig.2008.09.347] [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: 10/21/2022]
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Frumovitz M, Greer M, Soliman P, Schmeler K, Moroney J, Ramirez P. Robotic Surgery Practice and Training in Gynecologic Oncology. J Minim Invasive Gynecol 2008. [DOI: 10.1016/j.jmig.2008.09.473] [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: 10/21/2022]
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Frumovitz M, Soliman PT, Greer M, Schmeler KM, Moroney J, Bodurka DC, Ramirez PT. Laparoscopy training in gynecologic oncology fellowship programs. Gynecol Oncol 2008; 111:197-201. [DOI: 10.1016/j.ygyno.2008.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 08/10/2008] [Accepted: 08/12/2008] [Indexed: 10/21/2022]
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Leong S, Abbas S, Galvin L, Moroney J, Brennan P, Thornton J. Emergency stenting of an acute internal carotid artery occlusion from spontaneous dissection. Interv Neuroradiol 2008; 14:69-72. [PMID: 20557788 DOI: 10.1177/159101990801400109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Accepted: 02/29/2008] [Indexed: 12/21/2022] Open
Abstract
SUMMARY Internal carotid artery (ICA) dissection is an important cause of stroke in the younger population. Carotid stenting with or without angioplasty is usually the preferred treatment for symptomatic patients who have failed medical therapy. We report a case of a symptomatic internal carotid artery dissection at the petrous segment of the ICA initially treated conservatively with anticoagulation and antiplatlet agents. Due to early clinical deterioration from near complete carotid occlusion without adequate cross over flow, the patient underwent emergency stenting of the ICA. Post procedure angiography demonstrated no residual stenosis of the ICA. The patient progressively improved and at six months followup, the patient had no further symptoms, a normal neurological examination and improvement in the imaging findings. The successful clinical result in our case of ICA stenting for dissection as a 'hemispheric rescue' contributes to the growing literature of endovascular management of carotid dissection. The excellent mid term follow-up confirms the efficacy of this treatment for a dominant ICA.
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Affiliation(s)
- S Leong
- Department of Radiology, Beaumont Hospital, Dublin, Ireland -
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18
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Murphy S, Thornton J, Brennan P, Moroney J. ID: 214 Recurrent stroke due to intra-luminal carotid thrombus in a patient with active multiple myeloma. J Thromb Haemost 2006. [DOI: 10.1111/j.1538-7836.2006.00214.x] [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: 11/30/2022]
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Lin F, Murphy R, White B, Kelly J, Feighery C, Doyle R, Pittock S, Moroney J, Smith O, Livingstone W, Keenan C, Jackson J. Circulating levels of beta2-glycoprotein I in thrombotic disorders and in inflammation. Lupus 2006; 15:87-93. [PMID: 16539279 DOI: 10.1191/0961203306lu2270oa] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Beta2-glycoprotein I (beta2GPI) is a plasma protein suspected to have a role in inhibition of thrombosis. This suspicion is reinforced by the observation that beta2GPI is the major target for autoantibodies in the antiphospholipid syndrome. However, little is known about its circulating levels in common thrombotic diseases or inflammation. We measured beta2GPI levels in 344 healthy controls, 58 normal pregnancies, 102 patients with non-haemorrhagic stroke, 121 patients with acute coronary syndrome and 200 patients with elevated C-reactive protein (CRP). In healthy individuals, we found a strong positive correlation between age and beta2GPI concentration (r = 0.274, P < 0.001) and that beta2GPI levels fall significantly after the eighth week of pregnancy (P = 0.002). We also found significantly reduced levels of beta2GPI in patients with stroke and in elderly patients with myocardial syndrome (P = 0.013 and 0.043). However, in neither group did beta2GPI levels change in the following six months, suggesting that the reduced levels were not a transient post-event phenomenon. In patients with inflammation, beta2GPI levels showed a significant negative correlation with CRP (r = -0.284, P < 0.001) and positively correlated with albumin and transferrin (r = 0.372 and 0.453, respectively with P < 0.001 for both). Furthermore, the largest reduction in beta2GPI levels occurred in patients with the highest CRP values (P < 0.001).
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Affiliation(s)
- F Lin
- Department of Biological Sciences, Dublin Institute of Technology, St James's Hospital, Dublin, Republic of Ireland
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20
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Gibbs AN, Moroney J, Foley-Nolan D, O'Connell PG. Neuromyelitis optica (Devic's syndrome) in systemic lupus erythematosus: a case report. Rheumatology (Oxford) 2002; 41:470-1. [PMID: 11961183 DOI: 10.1093/rheumatology/41.4.470] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
A patient with homocystinuria due to cystathionine beta-synthase deficiency developed severe progressive polymyoclonus and ataxia. To our knowledge, this is the first time polymyoclonus and ataxia have been reported in association with homocystinuria. Although cerebrovascular thrombosis is usually thought to be responsible for neurologic dysfunction in homocystinuric patients, no infarctions were demonstrated on magnetic resonance imaging scans in our case. We have previously reported that baclofen dramatically improved the polymyoclonus and ataxia in a patient with Unvericht-Lundborg disease. Baclofen given to our patient reversed the polymyoclonus and the ataxia as well. This suggests that patients with polymyoclonus and ataxia, no matter what the etiology, may benefit from the use of baclofen.
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Affiliation(s)
- Y Awaad
- Department of Neurology, New York University Medical Center, NY, USA
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Bazil CW, Kothari M, Luciano D, Moroney J, Song S, Vasquez B, Weinreb HJ, Devinsky O. Provocation of nonepileptic seizures by suggestion in a general seizure population. Epilepsia 1994; 35:768-70. [PMID: 8082620 DOI: 10.1111/j.1528-1157.1994.tb02509.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Nonepileptic seizures (NES) are common and are often diagnosed at epilepsy centers by video-EEG recording of both spontaneous and suggestion-induced episodes, but no study has evaluated provocative testing in a general seizure population. We studied consecutive patients with a tentative diagnosis of epilepsy using saline provocation during video-EEG recording, suggesting that this could produce a typical seizure. Of 52 patients, 40% had no response, 23% had responses unlike their seizures, and 37% had typical episodes (positive test). Patients whose usual episodes resembled complex partial seizures (CPS) were more likely to have NES than were patients with a history of generalized tonic-clonic seizures (GTC). Of patients with positive provocations, the primary physician predicted NES in 68% of cases. This preliminary study suggests that NES are frequent in a general neurology setting, and that saline provocation is a sensitive method of identifying NES.
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Affiliation(s)
- C W Bazil
- New York University Medical Center, New York
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Moroney J, Smith A, Tomei LD, Wenner CE. Stimulation of 86Rb+ and 32Pi movements in 3T3 cells by prostaglandins and phorbol esters. J Cell Physiol 1978; 95:287-94. [PMID: 649665 DOI: 10.1002/jcp.1040950306] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The potent tumor promoter tetradecanoyl phorbol acetate (TPA) induces early changes in ion movements analogous to those induced by prostaglandins E1 and F 2alpha. Among the earliest changes induced by TPA is a significant increase in 32Pi incorporation within 15 minutes incubation of TPA (10(-8)-10(-6) M) with post-confluent Swiss 3T3 mouse embryonic fibroblasts. Similarly, the active phorbol ester homolog 4-beta-OH phorbol didecanoate but not the inactive stereoisomeric 4-alpha-OH phorbol didecanoate stimulated 32Pi incorporation. Also, TPA at the above concentrations stimulated 86Rb+ influx shortly after administration. Both fluxes were ouabain-sensitive in accord with the idea that an early effect of TPA is to alter (Na+ + K+)-ATPase activity. Further, prostaglandin E1 (10(-7)-10(-6) M) and prostaglandin F 2alpha (3 X 10(-9)-10(-7) M) caused a similar stimulation of 86Rb+ and 32Pi uptake. The finding that water-soluble prostaglandin F 2alpha also exhibited stimulatory effects indicated that those hormone-induced responses are not mediated by solvent interactions. The similar responses of phorbol esters and prostaglandin derivatives suggests that phorbol esters and prostaglandin derivatives may act at common membrane sites. The finding that stimulatory effects were observed at discrete times in the logarithmic phase of growth suggests that the activation of membrane receptors may be cell-cycle dependent.
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Darnell D, Abrams BM, Moroney J. Multiple sclerosis: an overview, with some observations on the spinal fluid protein. J Am Osteopath Assoc 1974; 73:450-4. [PMID: 4360489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Temple LJ, Alty H, Bickford BJ, Campbell J, Cook WHR, Davidson J, Duncan G, Florence AM, Heron JP, Honey G, MacLeod T, McConnell RB, Meade JB, Moroney J, Morrison IM, Parry E, Richardson JC, Scott LB, Shepherd J, Waddington JKB, Walker GP. New Consultant Contract. West J Med 1972. [DOI: 10.1136/bmj.4.5831.54-b] [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: 11/04/2022]
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Moroney J. Treatment and End-results of Acute Appendicitis. West J Med 1945. [DOI: 10.1136/bmj.2.4429.729-a] [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: 11/04/2022]
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Moroney J. Treatment and End-results of Acute Appendicitis. Br Med J 1945; 2:729. [PMID: 20786416 PMCID: PMC2060300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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