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Trinh JQ, Abughanimeh O. Current management of uncommon EGFR mutations in non-small cell lung cancer. Curr Probl Cancer 2024:101064. [PMID: 38311523 DOI: 10.1016/j.currproblcancer.2024.101064] [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: 11/07/2023] [Revised: 01/07/2024] [Accepted: 01/22/2024] [Indexed: 02/06/2024]
Abstract
Epidermal growth factor receptor (EGFR) mutations are frequently implicated in non-small cell lung cancer (NSCLC). Though these typically involve exon 19 in-frame deletions or L858R mutations in exon 21, uncommon EGFR mutations comprise 10-15 % of all EGFR mutations. These most frequently include G719X mutations in exon 18, L861Q mutations in exon 21, S768I mutations in exon 20, and in-frame insertions and/or duplications in exon 20. It is crucial to understand these distinct variants and their specific responses to active treatment options to optimize care. In this review, we discuss these uncommon mutations in depth and dissect the current literature regarding their treatment outcomes and subsequent evidence-based management guidelines.
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Affiliation(s)
- Jonathan Q Trinh
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States.
| | - Omar Abughanimeh
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska, United States
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Trinh JQ, Xiong Y, Smith LM, Abughanimeh O, Marr AS, Ganti AK. Durvalumab Outcomes in Stage III Non-small Cell Lung Cancer: A Single-institution Study. Anticancer Res 2024; 44:605-612. [PMID: 38307589 DOI: 10.21873/anticanres.16849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND/AIM The PACIFIC trial demonstrated improved survival in patients with unresectable stage III non-small cell lung cancer (NSCLC) treated with durvalumab following definitive concurrent chemoradiotherapy (CRT). This study sought to explore real-world outcomes with durvalumab consolidation therapy at our institution. PATIENTS AND METHODS We retrospectively identified patients diagnosed with stage III NSCLC at our institution from January 2012 to January 2022. We created two cohorts: one who received durvalumab following definitive CRT and a historical one who did not. Primary outcomes of interest included median progression-free survival (PFS) and overall survival (OS). Additionally, we performed subgroup analysis on the durvalumab cohort to explore the associations between survival and time to durvalumab initiation, PD-L1 expression, and neutrophil-to-lymphocyte ratio (NLR). RESULTS We identified 79 patients with locally advanced NSCLC who were not surgical candidates. Patients treated with durvalumab (n=44) had significantly improved survival compared to the historical cohort (n=35) including a median PFS of 17.4 months versus 8.0 months (p=0.0019) and a median OS of 37.0 months versus 17.0 months (log-rank p-value=0.07, Wilcoxon p-value=0.02). Within the durvalumab group, outcomes did not significantly differ between those who initiated therapy before or after 42 days of finishing CRT, between various PD-L1 expression levels, or between high or low NLR. CONCLUSION Patients who received durvalumab as consolidation therapy following definitive CRT demonstrated significantly improved survival compared to a historical cohort who did not receive durvalumab. Furthermore, durvalumab appears to benefit patients regardless of time to initiation, PD-L1 expression, or NLR.
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Affiliation(s)
- Jonathan Q Trinh
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, U.S.A.;
| | - Ying Xiong
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, U.S.A
| | - Lynette M Smith
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, U.S.A
| | - Omar Abughanimeh
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, U.S.A
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, U.S.A
| | - Alissa S Marr
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, U.S.A
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, U.S.A
| | - Apar K Ganti
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, U.S.A
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, U.S.A
- Department of Internal Medicine, VA Nebraska Western Iowa Health System, Omaha, NE, U.S.A
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Adnan D, Trinh JQ, Sharma D, Alsayid M, Bishehsari F. Early-onset Colon Cancer Shows a Distinct Intestinal Microbiome and a Host-Microbe Interaction. Cancer Prev Res (Phila) 2024; 17:29-38. [PMID: 37967575 PMCID: PMC10842926 DOI: 10.1158/1940-6207.capr-23-0091] [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: 03/22/2023] [Revised: 09/29/2023] [Accepted: 11/14/2023] [Indexed: 11/17/2023]
Abstract
The incidence rate of colorectal cancer in younger adults has been rising in developed countries. This trend may be attributed to environmental exposures as a result of lifestyle changes. Many of the lifestyle factors that promote colorectal cancer can also affect the gut microbiome, which may be associated with colorectal cancer risks. The role of the microbiome in the ongoing rise of early-onset colorectal cancer is unknown. Here, we aimed to investigate age-related differences in the gut microbiome of patients with colorectal cancer and healthy individuals by examining both the fecal and tumor microbiomes. We utilized the publicly accessible data on fecal shotgun metagenomics from CuratedMetagenomeData and TCGA via the GDC Data Portal. Comparison of 701 colorectal cancer and 693 controls revealed that microbial features were age dependent, with a significant difference in species enrichment between early-onset (<50 years) and late-onset (>65 years) patients with colorectal cancer. Analysis of the tumor-associated microbiome in a separate dataset of 85 patients with colorectal cancer verified age-specific differences in taxon abundance between early- and late-onset patients with colorectal cancer. Finally, using host gene expression data, we found a stronger microbe-host interaction in early- vs. late-onset colorectal cancers. Altogether, these findings indicate that microbial features were age-dependent with stronger microbial-host interactions at the tumor site in early-onset colorectal cancers, suggesting a direct role of microbes in tumorigenesis via interaction with cancer-related pathways in this age group. PREVENTION RELEVANCE Early-onset colorectal cancer is on the rise, presumably because of changes in environmental exposures. Lifestyle changes may contribute to colorectal cancer via alterations in gut microbes. Here, we show that microbial association with colorectal cancer is age-dependent, and microbe interactions with tumor pathways are stronger in young versus older colorectal cancers.
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Affiliation(s)
- Darbaz Adnan
- Rush Center for Integrated Microbiome and Chronobiology Research, Rush Medical College, Rush University Medical Center, Chicago, IL 60612, USA
| | - Jonathan Q. Trinh
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Deepak Sharma
- Rush Center for Integrated Microbiome and Chronobiology Research, Rush Medical College, Rush University Medical Center, Chicago, IL 60612, USA
| | - Muhammad Alsayid
- Department of Internal Medicine, Division of Gastroenterology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Faraz Bishehsari
- Rush Center for Integrated Microbiome and Chronobiology Research, Rush Medical College, Rush University Medical Center, Chicago, IL 60612, USA
- Department of Internal Medicine, Division of Gastroenterology, Rush University Medical Center, Chicago, IL 60612, USA
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA
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Trinh JQ, Acosta C, Easwar A, Galamaga R, Tan A. Durable and dramatic response to checkpoint inhibition combined with COX-2 inhibitor celecoxib in a patient with p16+ metastatic sinonasal undifferentiated carcinoma: A case study. Cancer Rep (Hoboken) 2024; 7:e1915. [PMID: 37867289 PMCID: PMC10809189 DOI: 10.1002/cnr2.1915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/01/2023] [Accepted: 10/08/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Sinonasal undifferentiated carcinoma (SNUC) is an exceedingly rare head and neck malignancy. No consensus exists on treatment for metastatic disease. CASE A 56-year-old female was diagnosed with SNUC after endorsing sinus congestion, diplopia, and right orbital pain. Initially treated with surgery and radiation, she later developed significant metastatic disease. She demonstrated progression of her hepatic metastases under pembrolizumab therapy. However, the addition of ipilimumab and a COX-2 inhibitor resulted in significant improvement in her lesions as well as an ongoing durable response. Her regimen was complicated by immune-related adverse events successfully treated with steroids. CONCLUSION Dual checkpoint inhibition deserves consideration when treating metastatic SNUC, especially after single agent therapy has failed. The positive effect of this treatment may be augmented by IDO1 inhibition.
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Affiliation(s)
- Jonathan Q. Trinh
- Department of Internal MedicineUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Cassaundra Acosta
- Department of Medical Oncology and HematologyCity of HopeGoodyearArizonaUSA
| | - Arti Easwar
- Department of Pathology and Laboratory MedicineCity of HopeGoodyearArizonaUSA
| | - Robert Galamaga
- Department of Medical Oncology and HematologyCity of HopeGoodyearArizonaUSA
| | - Alan Tan
- Department of Internal MedicineRush University Medical CenterChicagoIllinoisUSA
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Upadhyay Banskota S, Houlihan C, Trinh JQ, Asif S, Abughanimeh O, Teply BA. HSR23-102: Diagnosis of Metastatic Non–Small Cell Lung Cancer During Hospitalization: Missed Opportunity for Optimal Supportive Care? J Natl Compr Canc Netw 2023. [DOI: 10.6004/jnccn.2022.7173] [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: 04/03/2023]
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Trinh JQ, Lele SM, Teply BA. A case of metastatic adenoid cystic (basal cell) carcinoma of the prostate: Systemic therapy for a rare disease. Prostate 2023; 83:814-819. [PMID: 36967482 DOI: 10.1002/pros.24521] [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: 11/14/2022] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Metastatic adenoid cystic (basal cell) carcinoma of the prostate is an exceedingly rare disease entity. As a result, no current consensus exists for optimal systemic therapy. METHODS We present a patient with metastatic adenoid cystic (basal cell) carcinoma of the prostate who subsequently received systemic treatment, including chemotherapy and immunotherapy. We comprehensively reviewed all published data on therapy outcomes in advanced disease. RESULTS Our patient benefited from combination chemotherapy (carboplatin and paclitaxel), with objective radiographic response and reduction in cancer-related pain. However, chemotherapy was stopped due to cumulative neurotoxicity, and subsequent immunotherapy with atezolizumab did not produce any response. Our literature review revealed inconsistent outcomes with various treatments but showed most promise with chemotherapy. Targeted therapy and immunotherapy seem to benefit specific cases, and androgen deprivation therapy had minimal evidence of benefit. CONCLUSION Based on the findings of our case report and literature review, we suggest platinum-based chemotherapy doublets as first-line treatment for metastatic cases of adenoid cystic (basal cell) carcinoma of the prostate, reserving targeted therapy or immunotherapy for select cases based upon molecular profiles.
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Affiliation(s)
- Jonathan Q Trinh
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Subodh M Lele
- Department of Pathology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Benjamin A Teply
- Division of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Trinh JQ, Ellithi M, Shonka N, Bergan RC. FDA Approval Summary: Belzutifan for VHL Disease Tumors-Letter. Clin Cancer Res 2023; 29:684. [PMID: 36722140 PMCID: PMC10124993 DOI: 10.1158/1078-0432.ccr-22-2968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/07/2022] [Accepted: 11/17/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Jonathan Q Trinh
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Moataz Ellithi
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska
| | - Nicole Shonka
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska
| | - Raymond C Bergan
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska
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Trinh JQ, Bishehsari F. Could “Eating Behavior” be a novel lifestyle factor that modulates risk of gastrointestinal cancers? Hepatobiliary Surg Nutr 2022; 11:430-432. [DOI: 10.21037/hbsn-22-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/15/2022] [Indexed: 11/06/2022]
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Trinh JQ, Carender CN, An Q, Noiseux NO, Otero JE, Brown TS. Patient Resilience Influences Opioid Consumption in Primary Total Joint Arthroplasty Patients. Iowa Orthop J 2022; 42:112-117. [PMID: 36601223 PMCID: PMC9769347] [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] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Resilience and depression may influence opioid consumption in patients undergoing primary hip and knee arthroplasty (TJA); however, data evaluating these relationships are limited. Methods We retrospectively identified 119 patients undergoing TJA who completed preoperative questionnaires to measure resilience (Brief Resilience Scale) and depression (PHQ-9) from 2017 to 2018 at a single institution. Patients were stratified into high, normal, and low resilience groups as well as no, mild, and major depression groups. Opioid use was recorded in morphine milligram equivalents (MMEs). Nonparametric statistical testing was performed with significance level at P < 0.05. Results Higher levels of resilience correlated with less postoperative inpatient opioid use (P = 0.003). Patients with high resilience were less likely to use preoperative opioids compared to those with low resilience (OR = 6.08, 95% CI [1.230.5]). There was no difference in postoperative outpatient opioid prescriptions between resilience groups. Lower levels of depression correlated with less postoperative inpatient opioid use, though this did not reach statistical significance (P = 0.058). Additionally, there was no significant difference in preoperative opioid use or postoperative outpatient opioid prescriptions between depression groups. Conclusion Patients with higher levels of resilience are less likely to use opioids before TJA and utilize lower amounts of opioids while inpatient following surgery. Depression correlated with higher postoperative inpatient opioid use; however, the present findings regarding this relationship are inconclusive. Resilience is a psychological trait that may impact opioid use in patients undergoing TJA and should be viewed as a modifiable risk factor. Level of Evidence: III.
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Affiliation(s)
- Jonathan Q Trinh
- University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA
| | - Christopher N Carender
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Qiang An
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Nicolas O Noiseux
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jesse E Otero
- OrthoCarolina Hip and Knee Center, Charlotte, North Carolina, USA
| | - Timothy S Brown
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
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Trinh JQ, Carender CN, An Q, Noiseux NO, Otero JE, Brown TS. Resilience and Depression Influence Clinical Outcomes Following Primary Total Joint Arthroplasty. J Arthroplasty 2021; 36:1520-1526. [PMID: 33334640 DOI: 10.1016/j.arth.2020.11.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 09/25/2020] [Revised: 11/13/2020] [Accepted: 11/23/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Resilience and depression may impact clinical outcomes following primary total joint arthroplasty (TJA). This study aimed to quantify baseline resilience and depression prevalence in patients undergoing primary TJA and evaluate their influence on patient-reported clinical outcomes. METHODS We prospectively enrolled 98 patients undergoing primary TJA. Exclusion criteria included patients under 18 years of age, undergoing surgery for fracture, or who underwent additional surgery during the study period. Patients completed the Brief Resilience Scale to measure resilience, Patient Health Questionnaire-9 to measure depression, and Patient-Reported Outcomes Measurement Information System-10 to measure global physical and mental health preoperatively and 1 year postoperatively. RESULTS Preoperatively, 22% and 15% of patients demonstrated major and mild depression, respectively. High resilience was identified in 34% of patients, normal resilience in 55%, and low resilience in 11%. Preoperative depression correlated with lower resilience, global physical health, and global mental health scores preoperatively as well as at 1 year after surgery (P < .001). Higher levels of preoperative resilience correlated with higher global physical and mental health scores preoperatively and at 1 year postoperatively (P < .001). CONCLUSION Depression symptoms are common among patients undergoing primary TJA and are associated with worse patient-reported outcomes. Patients with higher levels of resilience have higher global physical and mental health scores before and after TJA. Psychological traits and depression impact clinical outcomes following TJA.
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Affiliation(s)
- Jonathan Q Trinh
- Department of Orthopedics & Rehabilitation, University of Iowa Hospital & Clinics, Iowa City, IA
| | - Christopher N Carender
- Department of Orthopedics & Rehabilitation, University of Iowa Hospital & Clinics, Iowa City, IA
| | - Qiang An
- Department of Orthopedics & Rehabilitation, University of Iowa Hospital & Clinics, Iowa City, IA
| | - Nicolas O Noiseux
- Department of Orthopedics & Rehabilitation, University of Iowa Hospital & Clinics, Iowa City, IA
| | | | - Timothy S Brown
- Department of Orthopedics & Rehabilitation, University of Iowa Hospital & Clinics, Iowa City, IA
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