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Zamirpour S, Xuan Y, Wang Z, Gomez A, Leach J, Mitsouras D, Saloner DA, Guccione JM, Ge L, Tseng EE. Aortic area/height ratio, peak wall stresses, and outcomes in veterans with tricuspid versus bicuspid aortic valve-associated ascending thoracic aortic aneurysms. J Thorac Cardiovasc Surg 2023; 166:1583-1593.e2. [PMID: 37295642 DOI: 10.1016/j.jtcvs.2023.05.031] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND In ascending thoracic aortic aneurysm risk stratification, aortic area/height ratio is a reasonable alternative to maximum diameter. Biomechanically, aortic dissection may be initiated by wall stress exceeding wall strength. Our objective was to evaluate the association between aortic area/height and peak aneurysm wall stresses in relation to valve morphology and 3-year all-cause mortality. METHODS Finite element analysis was performed on 270 ascending thoracic aortic aneurysms (46 associated with bicuspid and 224 with tricuspid aortic valves) in veterans. Three-dimensional aneurysm geometries were reconstructed from computed tomography and models developed accounting for prestress geometries. Fiber-embedded hyperelastic material model was applied to obtain aneurysm wall stresses during systole. Correlations of aortic area/height ratio and peak wall stresses were compared across valve types. Area/height ratio was evaluated across peak wall stress thresholds obtained from proportional hazards models of 3-year all-cause mortality, with aortic repair treated as a competing risk. RESULTS Aortic area/height 10 cm2/m or greater coincided with 23/34 (68%) 5.0 to 5.4 cm and 20/24 (83%) 5.5 cm or greater aneurysms. Area/height correlated weakly with peak aneurysm stresses: for tricuspid valves, r = 0.22 circumferentially and r = 0.24 longitudinally; and for bicuspid valves, r = 0.42 circumferentially and r = 0.14 longitudinally. Age and peak longitudinal stress, but not area/height, were independent predictors of all-cause mortality (age: hazard ratio, 2.20 per 9-year increase, P = .013; peak longitudinal stress: hazard ratio, 1.78 per 73-kPa increase, P = .035). CONCLUSIONS Area/height was more predictive of high circumferential stresses in bicuspid than tricuspid valve aneurysms, but similarly less predictive of high longitudinal stresses in both valve types. Peak longitudinal stress, not area/height, independently predicted all-cause mortality. VIDEO ABSTRACT.
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Affiliation(s)
- Siavash Zamirpour
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco and San Francisco Veterans Affairs Health Care System, San Francisco, Calif; Joint Medical Program, School of Public Health, University of California Berkeley, Berkeley, Calif, and School of Medicine, University of California, San Francisco, San Francisco, Calif
| | - Yue Xuan
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco and San Francisco Veterans Affairs Health Care System, San Francisco, Calif
| | - Zhongjie Wang
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco and San Francisco Veterans Affairs Health Care System, San Francisco, Calif
| | - Axel Gomez
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco and San Francisco Veterans Affairs Health Care System, San Francisco, Calif
| | - Joseph Leach
- Department of Radiology and Biomedical Imaging, University of California San Francisco and San Francisco Veterans Affairs Health Care System, San Francisco, Calif
| | - Dimitrios Mitsouras
- Department of Radiology and Biomedical Imaging, University of California San Francisco and San Francisco Veterans Affairs Health Care System, San Francisco, Calif
| | - David A Saloner
- Department of Radiology and Biomedical Imaging, University of California San Francisco and San Francisco Veterans Affairs Health Care System, San Francisco, Calif
| | - Julius M Guccione
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco and San Francisco Veterans Affairs Health Care System, San Francisco, Calif
| | - Liang Ge
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco and San Francisco Veterans Affairs Health Care System, San Francisco, Calif
| | - Elaine E Tseng
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco and San Francisco Veterans Affairs Health Care System, San Francisco, Calif.
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Gulati A, Zamirpour S, Leach J, Khan A, Wang Z, Xuan Y, Hope MD, Saloner DA, Guccione JM, Ge L, Tseng EE. Ascending Thoracic Aortic Aneurysm Elongation Occurs in Parallel with Dilatation in a Nonsurgical Population. Eur J Cardiothorac Surg 2023:ezad241. [PMID: 37354525 PMCID: PMC10301688 DOI: 10.1093/ejcts/ezad241] [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: 06/16/2022] [Revised: 04/09/2023] [Accepted: 06/22/2023] [Indexed: 06/26/2023] Open
Abstract
OBJECTIVES Rapid diameter growth is a criterion for ascending thoracic aortic aneurysm repair; however, there is sparse data on aneurysm elongation rate. The purpose of this study was to assess aortic elongation rates in nonsyndromic, nonsurgical aneurysms to understand length dynamics and correlate with aortic diameter over time. METHODS Patients with <5.5 cm aneurysms and computed tomography angiography imaging at baseline and 3-5 years follow-up underwent patient-specific three-dimensional aneurysm reconstruction using MeVisLab. Aortic length was measured along the vessel centerline between the annulus and aortic arch. Maximum aneurysm diameter was determined from imaging in a plane normal to the vessel centerline. Average rates of aneurysm growth were evaluated using longest available follow-up. RESULTS Over the follow-up period, mean aortic length for 67 identified patients increased from 118.2(95% confidence interval: 115.4-121.1)mm to 120.2(117.3- 123.0)mm (p = 0.02) and 15 patients(22%) experienced a change in length of ≥ 5% from baseline. Mean annual growth rate for length (0.38[95% confidence interval : 0.11-0.65]mm/year) was correlated with annual growth rate for diameter (0.1[0.03-0.2]mm/year) (rho = 0.30, p = 0.01). Additionally, annual percentage change in length (0.3[0.1-0.5]%/year) was similar to percentage change in diameter (0.2[0.007-0.4]%/year, p = 0.95). CONCLUSIONS Aortic length increases in parallel with aortic diameter at a similar percentage rate. Further work is needed to identify whether elongation rate is associated with dissection risk. Such studies may provide insight into why patients with aortic diameters smaller than surgical guidelines continue to experience dissection events.
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Affiliation(s)
- Arushi Gulati
- Department of Surgery, University of California San Francisco (UCSF) and San Francisco VA Medical Center, San Francisco, CA
| | - Siavash Zamirpour
- Department of Surgery, University of California San Francisco (UCSF) and San Francisco VA Medical Center, San Francisco, CA
| | - Joseph Leach
- Department of Radiology, University of California San Francisco (UCSF) and San Francisco VA Medical Center, San Francisco, CA
| | - Amir Khan
- Department of Surgery, University of California San Francisco (UCSF) and San Francisco VA Medical Center, San Francisco, CA
| | - Zhongjie Wang
- Department of Surgery, University of California San Francisco (UCSF) and San Francisco VA Medical Center, San Francisco, CA
| | - Yue Xuan
- Department of Surgery, University of California San Francisco (UCSF) and San Francisco VA Medical Center, San Francisco, CA
| | - Michael D Hope
- Department of Radiology, University of California San Francisco (UCSF) and San Francisco VA Medical Center, San Francisco, CA
| | - David A Saloner
- Department of Radiology, University of California San Francisco (UCSF) and San Francisco VA Medical Center, San Francisco, CA
| | - Julius M Guccione
- Department of Surgery, University of California San Francisco (UCSF) and San Francisco VA Medical Center, San Francisco, CA
| | - Liang Ge
- Department of Surgery, University of California San Francisco (UCSF) and San Francisco VA Medical Center, San Francisco, CA
| | - Elaine E Tseng
- Department of Surgery, University of California San Francisco (UCSF) and San Francisco VA Medical Center, San Francisco, CA
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Hall DL, Levine BJ, Jeter E, Chandler A, Tooze JA, Duffecy J, Victorson D, Gradishar W, Leach J, Saphner T, Smith ML, Penedo F, Mohr DC, Cella D, Wagner LI. A spotlight on avoidance coping to manage fear of recurrence among breast cancer survivors in an eHealth intervention. J Behav Med 2022; 45:771-781. [PMID: 35930212 PMCID: PMC9362703 DOI: 10.1007/s10865-022-00349-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022]
Abstract
Background Fear of recurrence (FoR) is prevalent among breast cancer survivors (BCS) and may be exacerbated by avoidance coping. This study examined BCS with avoidance coping and their engagement in a FoR eHealth intervention (FoRtitude). Methods BCS (N = 196) with elevated FoR participated in FoRtitude. Patient-reported measures assessed avoidance coping with FoR and baseline emotional and behavioral health. Intervention engagement was measured quantitatively (e.g., website logins, telecoaching attendance) and qualitatively (i.e., telecoaching notes). Results 38 BCS (19%) endorsed avoidance coping, which was associated with more severe post-traumatic anxiety-related symptoms and worse global mental health (ps < .05), but not anxiety (p = .19), depression (p = .11), physical health (p = .12), alcohol consumption (p = .85), or physical activity (p = .39). Avoidance coping was not associated with engagement levels (ps > .05) but did characterize engagement-related motivators and barriers. Conclusions Avoidance coping was not a barrier to FoRtitude engagement. eHealth delivery is a promising modality for engaging survivors with avoidance coping in FoR interventions.
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Affiliation(s)
- Daniel L Hall
- Harvard Medical School, Massachusetts General Hospital, 100 Cambridge St., 16th floor, Boston, MA, 02114, USA.
| | - Beverly J Levine
- Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Elizabeth Jeter
- Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Allison Chandler
- Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Janet A Tooze
- Wake Forest University School of Medicine, Winston Salem, NC, USA
| | | | | | | | | | | | | | | | | | | | - Lynne I Wagner
- Wake Forest University School of Medicine, Winston Salem, NC, USA
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Zamirpour S, Xuan Y, Wang Z, Gomez A, Hope MD, Leach J, Mitsouras D, Saloner DA, Guccione JM, Ge L, Tseng EE. Association of 3-Year All-Cause Mortality and Peak Wall Stresses of Ascending Thoracic Aortic Aneurysms in Veterans. Semin Thorac Cardiovasc Surg 2022; 35:447-456. [PMID: 35690227 DOI: 10.1053/j.semtcvs.2022.06.002] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/02/2022] [Indexed: 11/11/2022]
Abstract
Risk of aortic dissection in ascending thoracic aortic aneurysms is not sufficiently captured by size-based metrics. From a biomechanical perspective, dissection may be initiated when wall stress exceeds wall strength. Our objective was to assess the association between aneurysm peak wall stresses and 3-year all-cause mortality. Finite element analysis was performed in 273 veterans with chest computed tomography for surveillance of ascending thoracic aortic aneurysms. Three-dimensional geometries were reconstructed and models developed accounting for prestress geometries. A fiber-embedded hyperelastic material model was applied to obtain circumferential and longitudinal wall stresses under systolic pressure. Patients were followed up to 3 years following the scan to assess aneurysm repair and all-cause mortality. Fine-Gray subdistribution hazards were estimated for all-cause mortality based on age, aortic diameter, and peak wall stresses, treating aneurysm repair as a competing risk. When accounting for age, subdistribution hazard of mortality was not significantly increased by peak circumferential stresses (p = 0.30) but was significantly increased by peak longitudinal stresses (p = 0.008). Aortic diameter did not significantly increase subdistribution hazard of mortality in either model (circumferential model: p = 0.38; longitudinal model: p = 0.30). The effect of peak longitudinal stresses on subdistribution hazard of mortality was maximized at a binary threshold of 355kPa, which captured 34 of 212(16%) patients with diameter <5 cm, 11 of 36(31%) at 5.0-5.4 cm, and 11 of 25(44%) at ≥5.5 cm. Aneurysm peak longitudinal stresses stratified by age and diameter were associated with increased hazard of 3-year all-cause mortality in a veteran cohort. Risk prediction may be enhanced by considering peak longitudinal stresses.
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Affiliation(s)
- Siavash Zamirpour
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA; Joint Medical Program, School of Public Health, University of California, Berkeley, and School of Medicine, University of California, San Francisco, CA, USA
| | - Yue Xuan
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA
| | - Zhongjie Wang
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA
| | - Axel Gomez
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA
| | - Joseph Leach
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA
| | - Dimitrios Mitsouras
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA
| | - David A Saloner
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA
| | - Julius M Guccione
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA
| | - Liang Ge
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA
| | - Elaine E Tseng
- Department of Surgery, Division of Adult Cardiothoracic Surgery, University of California, San Francisco, and San Francisco Veterans Affairs Health Care System, CA, USA.
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Raymonda MH, Ciesla JH, Monaghan M, Leach J, Asantewaa G, Smorodintsev-Schiller LA, Lutz MM, Schafer XL, Takimoto T, Dewhurst S, Munger J, Harris IS. Pharmacologic profiling reveals lapatinib as a novel antiviral against SARS-CoV-2 in vitro. Virology 2022; 566:60-68. [PMID: 34871905 PMCID: PMC8626825 DOI: 10.1016/j.virol.2021.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 07/27/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 01/04/2023]
Abstract
The emergence of SARS-CoV-2 virus has resulted in a worldwide pandemic, but effective antiviral therapies are not widely available. To improve treatment options, we conducted a high-throughput screen to uncover compounds that block SARS-CoV-2 infection. A minimally pathogenic human betacoronavirus (OC43) was used to infect physiologically-relevant human pulmonary fibroblasts (MRC5) to facilitate rapid antiviral discovery in a preclinical model. Comprehensive profiling was conducted on more than 600 compounds, with each compound arrayed across 10 dose points. Our screening revealed several FDA-approved agents that can attenuate both OC43 and SARS-CoV-2 viral replication, including lapatinib, doramapimod, and 17-AAG. Importantly, lapatinib inhibited SARS-CoV-2 RNA replication by over 50,000-fold. Further, both lapatinib and doramapimod could be combined with remdesivir to improve antiviral activity in cells. These findings reveal novel therapeutic avenues that could limit SARS-CoV-2 infection.
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Affiliation(s)
- M H Raymonda
- Department of Biochemistry and Biophysics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA; Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - J H Ciesla
- Department of Biochemistry and Biophysics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA; Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - M Monaghan
- Department of Biochemistry and Biophysics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA; Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - J Leach
- Department of Microbiology and Immunology, University of Rochester, Rochester, NY, USA
| | - G Asantewaa
- Department of Biochemistry and Biophysics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA; Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY, USA; Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - L A Smorodintsev-Schiller
- Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY, USA; Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - M M Lutz
- Department of Microbiology and Immunology, University of Rochester, Rochester, NY, USA
| | - X L Schafer
- Department of Biochemistry and Biophysics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA; Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - T Takimoto
- Department of Microbiology and Immunology, University of Rochester, Rochester, NY, USA
| | - S Dewhurst
- Department of Microbiology and Immunology, University of Rochester, Rochester, NY, USA
| | - J Munger
- Department of Biochemistry and Biophysics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA; Department of Microbiology and Immunology, University of Rochester, Rochester, NY, USA; Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - I S Harris
- Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY, USA; Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
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Gulati A, Leach J, Wang Z, Xuan Y, Hope MD, Saloner DA, Ge L, Tseng EE. Ascending thoracic aortic aneurysm growth is minimal at sizes that do not meet criteria for surgical repair. Quant Imaging Med Surg 2022; 12:333-340. [PMID: 34993082 DOI: 10.21037/qims-21-55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/14/2021] [Accepted: 06/17/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Historic studies of nonsyndromic ascending thoracic aortic aneurysms (aTAAs) reported that the typical aTAA growth rate was approximately 0.6 mm/year, but data were limited due to relatively few studies using computed tomography (CT) imaging. Our purpose was to reevaluate the annual growth rate of nonsyndromic aTAAs that do not meet criteria for surgical repair in veterans in the contemporary era, using modern CT imaging suitable for highly accurate and reproducible aneurysm measurement. METHODS Nonsurgical patients (diameter <5.5 cm) undergoing aneurysm surveillance at a Veterans Affairs Medical Center with repeat CT imaging performed 3 to 5 years apart were identified. Maximum diameter was determined by a single radiologist using multiplanar reformat-based measurements. Average rate of aneurysm growth was evaluated based on longest available follow-up. RESULTS Sixty-seven patients were included. Average follow-up time was 4.06±0.83 years. Patients were exclusively male, with average age of 68.1±6.0 years, and the majority had a history of smoking (n=52, 78%), hypertension (n=52, 78%), and dyslipidemia (n=48, 72%). Average baseline aneurysm diameter was 44.0±3.2 mm and average growth rate was 0.11±0.31 mm/year, with no difference in growth rate between patients with initial diameter ≤45 vs. >45 mm. Only 3 patients experienced clinically significant changes in diameter with magnitude greater than 5% of baseline. CONCLUSIONS In this veteran population, most patients did not experience significant annual aneurysm growth over up to 5 years of follow-up, regardless of initial diameter. Thus, in the modern era, aTAAs may not grow as quickly as previously described, which will be important in determining appropriate intervals for aneurysm surveillance based upon risk-benefit ratio.
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Affiliation(s)
- Arushi Gulati
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco Medical Center and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Joseph Leach
- Department of Radiology, University of California San Francisco Medical Center and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Zhongjie Wang
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco Medical Center and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Yue Xuan
- Department of Radiology, University of California San Francisco Medical Center and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Michael D Hope
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco Medical Center and San Francisco VA Medical Center, San Francisco, CA, USA
| | - David A Saloner
- Department of Radiology, University of California San Francisco Medical Center and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Liang Ge
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco Medical Center and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Elaine E Tseng
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco Medical Center and San Francisco VA Medical Center, San Francisco, CA, USA
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Garon EB, Spira AI, Johnson M, Bazhenova L, Leach J, Cummings AL, Candia A, Coffman RL, Janatpour MJ, Janssen R, Gamelin E, Chow LQM. A Phase Ib Open-Label, Multicenter Study of Inhaled DV281, a TLR9 Agonist, in Combination with Nivolumab in Patients with Advanced or Metastatic Non-small Cell Lung Cancer. Clin Cancer Res 2021; 27:4566-4573. [PMID: 34108179 DOI: 10.1158/1078-0432.ccr-21-0263] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/10/2021] [Accepted: 06/02/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Although PD-(L)1 inhibitors have shown efficacy in advanced/metastatic non-small cell lung cancer (NSCLC), many patients do not respond to this treatment and more effective combinations with acceptable toxicities are needed. To assess the potential benefit of combining localized innate immune stimulation with checkpoint blockade, the TLR9 agonist DV281 was combined with nivolumab in a phase Ib study. PATIENTS AND METHODS Patients after one or two prior lines of systemic therapy were enrolled in a dose-escalation study with a 3+3 design. DV281 was administered via inhalation in five dose cohorts at 1 to 25 mg; nivolumab 240 mg was administered intravenously every 2 weeks. Safety, tolerability, pharmacodynamics, and response to treatment were assessed. RESULTS Twenty-six patients with advanced NSCLC enrolled. Baseline programmed death ligand 1 (PD-L1) expression was present in 16 patients (61.5%); 21 (80.7%) had received previous anti-PD-1/PD-L1. Thirteen patients (50%) had stable disease, nine (34.6%) had progressive disease, and four (15.4%) were not evaluable. Median duration of disease control was 124 days. Adverse events were seen in 16 patients (61.5%), mostly grade 1/2 chills, fatigue, flu-like symptoms, diarrhea, and rash; there was only one grade 3 adverse event (dyspnea). Pharmacodynamic assessment, measured by IFN- inducible gene expression, showed target engagement in all dose cohorts. Systemic pharmacodynamic responses plateaued in the 2 highest dose cohorts. CONCLUSIONS DV281 with nivolumab was well tolerated with target engagement observed at every dose. Pharmacodynamic advantages at doses above 10 mg were unclear. The long duration of disease control in 50% of patients suggests clinically relevant activity in this population of heavily pretreated patients.
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Affiliation(s)
- Edward B Garon
- Department of Medicine, David Geffen School of Medicine at UCLA, Santa Monica, California.
| | - Alexander I Spira
- Department of Medicine, Virginia Cancer Specialists, Fairfax, Virginia
| | | | | | - Joseph Leach
- Allina Health Virginia Piper Cancer Institute, Minneapolis, Minnesota
| | - Amy L Cummings
- Department of Medicine, David Geffen School of Medicine at UCLA, Santa Monica, California
| | - Albert Candia
- Dynavax Technologies Corporation, Emeryville, California
| | | | | | - Robert Janssen
- Dynavax Technologies Corporation, Emeryville, California
| | - Erick Gamelin
- Dynavax Technologies Corporation, Emeryville, California
| | - Laura Q M Chow
- Department of Medicine, University of Washington, Seattle, Washington
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Wagner LI, Tooze JA, Hall DL, Levine BJ, Beaumont J, Duffecy J, Victorson D, Gradishar W, Leach J, Saphner T, Sturtz K, Smith ML, Penedo F, Mohr DC, Cella D. Targeted eHealth Intervention to Reduce Breast Cancer Survivors' Fear of Recurrence: Results from the FoRtitude Randomized Trial. J Natl Cancer Inst 2021; 113:1495-1505. [PMID: 34057469 PMCID: PMC8244801 DOI: 10.1093/jnci/djab100] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 11/25/2020] [Revised: 03/04/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background Fear of recurrence (FoR) is a prevalent concern among breast cancer survivors (BCS), yet few accessible interventions exist. This study evaluated a targeted eHealth intervention, “FoRtitude,” to reduce FoR using cognitive behavioral skills training and telecoaching. Methods BCS (N = 196) were recruited from an academic medical center and 3 National Cancer Institute Community Oncology Research Program community sites, had stage 0-III breast cancer, were 1-10 years postprimary treatment, with moderate to high FoR and familiarity with the internet. Using the Multiphase Optimization Strategy, participants were independently randomly assigned to 3 cognitive behavioral skills (relaxation, cognitive restructuring, worry practice) vs an attention control condition (health management content [HMC]) and to telecoaching (motivational interviewing) vs no telecoaching. Website content was released across 4 weeks and included didactic lessons, interactive tools, and a text-messaging feature. BCS completed the Fear of Cancer Recurrence Inventory at baseline and at 4 and 8 weeks. Fear of Cancer Recurrence Inventory scores over time were compared using mixed-effects models. All statistical tests were 2-sided. Results FCRI scores [SD] decreased statistically significantly from baseline to postintervention (T0 = 53.1 [17.4], T2 = 41.9 [16.2], P < .001). The magnitude of reduction in FCRI scores was comparable across cognitive behavior therapy (CBT) and attention control HMC conditions and was predicted by increased self-efficacy. Telecoaching was associated with lower attrition and greater website use (mean adherence score [SD] = 26.6 [7.2] vs 21.0 [10.5], P < .001). Conclusions BCS experienced statistically significant reductions in FoR postintervention, but improvements were comparable between CBT and attention controls. Telecoaching improved adherence and retention. Future research is needed on optimal integration of CBT and HMC, dose, and features of eHealth delivery that contributed to reducing FoR. In the COVID-19 era, remote delivery has become even more essential for reaching survivors struggling with FoR.
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Affiliation(s)
- Lynne I Wagner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC
| | - Daniel L Hall
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Beverly J Levine
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC
| | | | - Jenna Duffecy
- Department of Psychiatry, University of Illinois, Chicago, IL
| | - David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - William Gradishar
- Department of Medicine/Division of Hematology & Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | - Frank Penedo
- Departments of Medicine and Psychology, University of Miami, Coral Gables, FL
| | - David C Mohr
- Department of Preventive Medicine and Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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Gulati A, Wang Z, Xuan Y, Leach J, Saloner DA, Guccione JM, Ge L, Tseng EE. Wall Stress Changes in Ascending Thoracic Aortic Aneurysms Do Not Correlate with Changes in Diameter over Time. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.076] [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: 11/27/2022]
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Wang Y, Zhu C, Leach J, Gasper W, Saloner D, Hope M. Growth of common iliac artery aneurysms coexisting with abdominal aortic aneurysms: associated factors and potential role of intraluminal thrombus. Quant Imaging Med Surg 2020; 10:703-712. [PMID: 32269930 PMCID: PMC7136736 DOI: 10.21037/qims.2020.02.12] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/07/2020] [Indexed: 08/30/2023]
Abstract
BACKGROUND The factors influencing common iliac artery aneurysm (CIA) growth are not fully known. Intraluminal thrombus (ILT) has been studied as a marker of growth in abdominal aortic aneurysms (AAA), but its role in CIAs is unknown. This study aims to examine the factors associated with growth of CIAs coexistent with AAA using serial cross-sectional imaging (CT and MRI) with multiplanar reconstruction (MPR). METHODS Patients with synchronous AAA and CIA observed at contrast-enhanced CT or MRI were included. The maximal diameters of both CIA and AAA were measured using MPR. Correlation of the baseline aneurysm diameter and growth rate between CIA and AAA was evaluated. Multivariate regression analysis was used to investigate the factors associated with CIA growth. RESULTS Seventy-five AAA patients (age 74±9 years; all male) with 100 CIAs were followed for an average of 2.2±1.2 years. CIA and AAA growth were positively correlated (r=0.39, P<0.001). Multivariate analysis showed that CIA baseline diameter, AAA baseline diameter, and smoking were positively related to CIA growth. In 2-3 cm CIAs (n=59), ILT tends to be an independent predictor of AAA growth (P=0.076), and CIAs with ILT grow at more than twice the rate of CIAs without ILT (1.7 vs. 0.8 mm/year, P=0.036), despite similar baseline diameters. CONCLUSIONS CIA baseline diameter, coexisting AAA baseline diameter, and smoking are associated with CIA growth. In CIAs measuring 2-3 cm, the presence of ILT is associated with faster growth, and should be taken into account when determining surveillance intervals and timing of intervention for patients being considered for AAA repair.
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Affiliation(s)
- Yuting Wang
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Chengcheng Zhu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Joseph Leach
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Warren Gasper
- Department of Surgery, University of California, San Francisco, CA, USA
| | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Michael Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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Thaker D, Bryant G, Wyld D, Leach J, Wheatley H, Garth V. OUR EXPERIENCE OF NURSING/ALLIED HEALTH PRACTITIONER-LED GERIATRIC SCREENING AND ASSESSMENT OF ELDERLY ONCOLOGY PATIENTS: A HIGHLY ACCESSIBLE MODEL OF CARE. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31222-6] [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: 10/25/2022]
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12
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Hrinczenko B, Spigel D, Iannotti N, Safran H, Taylor M, Bennouna J, Goel S, Leach J, Wong D, Kelly K, Verschraegen C, Bajars M, Manitz J, Ruisi M, Gulley J. Long-term avelumab treatment in patients with advanced non-small cell lung cancer (NSCLC): Post hoc analyses from JAVELIN solid tumour. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.015] [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: 11/12/2022] Open
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13
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Sethi G, Aljawadi A, Choudhry MN, Fischer B, Divecha HM, Leach J, Arnall F, Verma R, Yasin N, Mohammad S, Siddique I. Concomitant back pain as a predictor of outcome after single level lumbar micro-decompressive surgery - A study of 995 patients. J Orthop 2019; 16:478-482. [PMID: 31680735 DOI: 10.1016/j.jor.2019.08.013] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/11/2019] [Indexed: 11/29/2022] Open
Abstract
Objective To determine if preoperative leg pain and low back pain severity affected postoperative outcome. Method Prospectively collected Spine-Tango data was analysed for 995 consecutive patients who underwent a primary, single level, lumbar micro-decompression/microdiscectomy at a single tertiary spinal centre. Result At 3 months, 72% of patients were satisfied with the outcome of surgery. Pre-operative low back pain was a significant predictor of poor outcome (P < 0.01). Conclusion Our study has shown that patients with a low back pain VAS of 6 or more have a significantly greater chance of a poor outcome following primary lumbar microdecompressive/microdiscectomy surgery.
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Affiliation(s)
- G Sethi
- Trauma and Orthopaedics- Spinal, University of Salford, Salford, Manchester, UK.,School of Health Sciences Allerton Building, University of Salford, Fredrick Road Campus, M6 6PU, UK
| | - A Aljawadi
- Trauma and Orthopaedics, University of Salford, Salford, Fredrick Road Campus, M6 6PU, UK
| | - M N Choudhry
- Spinal Registrar, Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | | | - H M Divecha
- StR Trauma & Orthopaedics, North Western Deanery, UK
| | - J Leach
- Consultant Neurosurgeon, Department of Neutosurgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - F Arnall
- Consultant Physiotherapist. Lecturer Fellow Higher Education Academy, MSc Trauma & Orthopaedics Academic Module Lead, School of Health Sciences Allerton Building C711, University of Salford, Fredrick Road Campus, M6 6PU, UK
| | - R Verma
- Consultant Spinal Surgeon, Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - N Yasin
- Consultant Spinal Surgeon, Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - S Mohammad
- Consultant Spinal Surgeon, Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - I Siddique
- Consultant Spinal Surgeon, Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
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Garon E, Spira AI, Johnson M, Bazhenova L, Leach J, Candia A, Coffman R, Janatpour M, Gamelin E, Janssen R, Chow LQ. Abstract CT224: Phase Ib/II, open label, multicenter study of inhaled DV281, a Toll-like receptor 9 agonist, in combination with nivolumab in patients with advanced or metastatic non small cell lung cancer (NSCLC). Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-ct224] [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 and Objectives: DV281 is a synthetic CpG-ODN agonist of TLR9 that stimulates dendritic cells to release IFN-alpha and mature into antigen presenting cells to activate T cell anti-tumor responses. Nivolumab is a PD-1 inhibitor that has demonstrated activity in advanced/metastatic NSCLC. Study DV9- NSC-01 (NCT03326752) is a phase 1b/2 study to assess safety and pharmacodynamic activity of DV281 in combination with nivolumab in patients with advanced or metastatic NSCLC and to determine the recommended dose for expansion.
Methods: Anti-PD-1/L1 experienced or naïve patients were enrolled in 2L or 3L NSCLC in the escalation phase, 3+3 design: 5 dose cohorts, with intra-patient dose escalation between the first 2 monotherapy doses: cohort 1: 1 mg; cohort 2: 1 to 3 mg; cohort 3: 3 to 10 mg; cohort 4: 10 to 15 mg; cohort 5: 15 to 25 mg. Nivolumab was administered at 240 mg Q2w. Safety was primary objective and pharmacodynamic effects including IFN-inducible gene expression were key secondary objective. DV281 is administered via inhalation, first alone, weekly for 2 doses, then 6 doses weekly with nivolumab, followed by a 5 week off period of DV281, while continuing nivolumab, then DV281 with intravenous nivolumab Q2w for an additional 24 weeks.
Preliminary Results from the Escalation phase: 22 patients have been enrolled to date: Cohort (C) 1: 4 patients; C 2: 3 pts; C3: 7 pts; C 4: 7 pts; C 5: 1pt, ongoing. Median age 67 y/o; male 50%; all ECOG PS0-1 (27.3/72.7%); non squamous 15 (68%), squamous 7 (32%); locally advanced 4 (18%), metastatic 18 (82%); PD-L1 expression: positive 12 pts (52%), negative 10 pts (48%); prior lines of therapy - 1 line: 10 pts (45.5%), 2 lines:12 (54.5%). Previous treatment with PD-1/PD-L1 inhibitors: 18 pts (9 as single agent, 9 in combination). Median treatment duration 11.5 weeks (1 to 38). Eighteen patients discontinued DV281: adverse event 2, PD 14, other 2. Safety profile of DV281 alone and combined with nivolumab with a median number of 5 doses (1.0 to 18.0): grade 1/ 2 chills (18%), fatigue (13.6%), flu-like symptoms (4.5%), diarrhea (13.6%) and rash (13.6%); no grade ≥3 DV281/nivolumab treatment related AE; no immune-related AEs. Pharmacodynamic (PD) assessment (IFN-induced genes) shows target engagement in all dose cohorts, with every patient showing evidence of target engagement in cohorts 3 and 4. A dose dependent increase in PD activity appears to begin to plateau at the 15 mg dose.
Conclusions: In this population of heavily pretreated patients, DV281 in monotherapy and in combination with nivolumab was well tolerated. Target engagement was observed at all dose levels. The expansion phase will use a modified dosing schedule, evaluating several groups of patients: non squamous resistant to PD-1/PD-L1 or to EGFR inhibitors; squamous experienced or naïve to anti PD-1/PD-L1.
Citation Format: Edward Garon, Alexander I. Spira, Melissa Johnson, Lyudmila Bazhenova, Joseph Leach, Albert Candia, Robert Coffman, Mary Janatpour, Erick Gamelin, Robert Janssen, Laura Q. Chow. Phase Ib/II, open label, multicenter study of inhaled DV281, a Toll-like receptor 9 agonist, in combination with nivolumab in patients with advanced or metastatic non small cell lung cancer (NSCLC) [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 CT224.
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Affiliation(s)
- Edward Garon
- 1David Geffen School of Medicine at UCLA, Santa Monica, CA
| | | | | | | | - Joseph Leach
- 5Allina Health Virginia Piper Cancer Institute, Minneapolis, MN
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Leach J, Kao E, Zhu C, Saloner D, Hope MD. On the relative impact of intraluminal thrombus heterogeneity on abdominal aortic aneurysm mechanics. J Biomech Eng 2019; 141:2737715. [PMID: 31253989 DOI: 10.1115/1.4044143] [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] [Received: 02/07/2019] [Indexed: 01/31/2023]
Abstract
Intraluminal thrombus (ILT) is present in the majority of abdominal aortic aneurysms (AAA) of a size warranting consideration for surgical or endovascular intervention. The rupture risk of AAAs is thought to be related to the balance of vessel wall strength and the mechanical stress caused by systemic blood pressure. Previous finite element analyses of AAAs have shown that ILT can reduce and homogenize aneurysm wall stress. These works have largely considered ILT to be homogeneous in mechanical character or have idealized a stiffness distribution through the thrombus thickness. In this work, we use MRI to delineate the heterogeneous composition of ILT in 7 AAAs and perform patient-specific finite element analysis under multiple conditions of ILT layer stiffness disparity. We find that explicit incorporation of ILT heterogeneity in the finite element analysis is unlikely to substantially alter major stress analysis predictions regarding aneurysm rupture risk in comparison to models assuming a homogenous thrombus, provided that the maximal ILT stiffness is the same between models. Our results also show that under a homogeneous ILT assumption, the choice of ILT stiffness from values common in the literature can result in significantly larger variations in stress predictions compared to the effects of thrombus heterogeneity.
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Affiliation(s)
- Joseph Leach
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, 513 Parnassus Ave, Suite S-261, Box 0628, San Francisco, CA 94143
| | - Evan Kao
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA 94143
| | - Chengcheng Zhu
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA 94143
| | - David Saloner
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA 94143
| | - Michael D Hope
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA 94143
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Leach J, Wright AJ, Götte JB, Girkin JM, Allen L, Franke-Arnold S, Barnett SM, Padgett MJ. Leach et al. Reply. Phys Rev Lett 2019; 122:139402. [PMID: 31012621 DOI: 10.1103/physrevlett.122.139402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Indexed: 06/09/2023]
Affiliation(s)
- J Leach
- Department of Physics & Astronomy, SUPA, University of Glasgow, Glasgow, United Kingdom
| | - A J Wright
- Institute of Photonics, SUPA, University of Strathclyde, Glasgow, United Kingdom
| | - J B Götte
- Department of Physics & Astronomy, SUPA, University of Glasgow, Glasgow, United Kingdom
| | - J M Girkin
- Institute of Photonics, SUPA, University of Strathclyde, Glasgow, United Kingdom
| | - L Allen
- Department of Physics & Astronomy, SUPA, University of Glasgow, Glasgow, United Kingdom
| | - S Franke-Arnold
- Department of Physics & Astronomy, SUPA, University of Glasgow, Glasgow, United Kingdom
| | - S M Barnett
- Department of Physics, SUPA, University of Strathclyde, Glasgow, United Kingdom
| | - M J Padgett
- Department of Physics & Astronomy, SUPA, University of Glasgow, Glasgow, United Kingdom
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17
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Amans MR, Haraldsson H, Kao E, Kefayati S, Meisel K, Khangura R, Leach J, Jani ND, Faraji F, Ballweber M, Smith W, Saloner D. MR Venous Flow in Sigmoid Sinus Diverticulum. AJNR Am J Neuroradiol 2018; 39:2108-2113. [PMID: 30309843 DOI: 10.3174/ajnr.a5833] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 03/27/2018] [Accepted: 08/20/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Case reports demonstrate that coiling of a sigmoid sinus diverticulum can treat pulsatile tinnitus. We hypothesized that MR imaging 4D flow and computational fluid dynamics would reveal distinct blood flow patterns in the venous outflow tract in these patients. MATERIALS AND METHODS Patients with pulsatile tinnitus of suspected venous etiology underwent MR imaging at 3T, using venous phase contrast-enhanced MR angiography, 4D flow, and 2D phase contrast. The contrast-enhanced MRA contours were evaluated to determine the presence and extent of a sigmoid sinus diverticulum. Computational fluid dynamics analysis was performed using the 4D flow inlet flow and the luminal contours from contrast-enhanced MRA as boundary conditions. In addition, computational fluid dynamics was performed for the expected post treatment conditions by smoothing the venous geometry to exclude the sigmoid sinus diverticulum from the anatomic boundary conditions. Streamlines were generated from the 4D flow and computational fluid dynamics velocity maps, and flow patterns were examined for the presence of rotational components. RESULTS Twenty-five patients with pulsatile tinnitus of suspected venous etiology and 10 control subjects were enrolled. Five (20%) of the symptomatic subjects had sigmoid sinus diverticula, all associated with an upstream stenosis. In each of these patients, but none of the controls, a stenosis-related flow jet was directed toward the opening of the sigmoid sinus diverticulum with rotational flow patterns in the sigmoid sinus diverticulum and parent sigmoid sinus on both 4D flow and computational fluid dynamics. CONCLUSIONS Consistent patterns of blood flow can be visualized in a sigmoid sinus diverticulum and the parent sinus using 4D flow and computational fluid dynamics. Strong components of rotational blood flow were seen in subjects with sigmoid sinus diverticula that were absent in controls.
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Affiliation(s)
- M R Amans
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - H Haraldsson
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - E Kao
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - S Kefayati
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - K Meisel
- Neurology (K.M., W.S.), University of California, San Francisco, San Francisco, California
| | - R Khangura
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - J Leach
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - N D Jani
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - F Faraji
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - M Ballweber
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
| | - W Smith
- Neurology (K.M., W.S.), University of California, San Francisco, San Francisco, California
| | - D Saloner
- From the Departments of Radiology and Biomedical Imaging (M.R.A., H.H., E.K., S.K., R.K., J.L., N.D.J., F.F., M.B., D.S.)
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Abstract
Twenty-three adult patients evaluated at a university medical center for severe refractory sinusitis were found to have a primary immunodeficiency on the basis of total immunoglobulin, IgG subclass, and vaccine response determinations. The most common finding was IgG3 deficiency with antibody hyporesponsiveness to pneumococcal vaccine. Treatment options included prophylactic antibiotics and aggressive management of associated allergies with intravenous immunoglobulin reserved for severely affected patients who failed more conservative therapy.
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Affiliation(s)
- Scott C. Manning
- Department of Otolaryngology, University of Texas Southwestern Medical at Dallas, 5323 Harry Hines Boulevard, Dallas, Texas 75235-9035
| | | | | | - John Truelson
- Department of Otolaryngology, University of Texas Southwestern Medical at Dallas, 5323 Harry Hines Boulevard, Dallas, Texas 75235-9035
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McAllister A, Leach J, West H, Jones B, Zhang B, Serai S. Quantitative Synthetic MRI in Children: Normative Intracranial Tissue Segmentation Values during Development. AJNR Am J Neuroradiol 2017; 38:2364-2372. [PMID: 28982788 DOI: 10.3174/ajnr.a5398] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/03/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Synthetic MR imaging is a new technique to create absolute R1 relaxivity (1/T1), R2 relaxivity (1/T2), and proton-density maps using a single multiple-spin-echo saturation recovery sequence. These relaxivity maps allow rapid automated intracranial segmentation of tissue types. To assess its utility in children, we created a normative data base of intracranial volume and brain parenchymal, GM, WM, CSF, and myelin volumes in a pediatric population with normal brain MRI findings using synthetic MR imaging. MATERIALS AND METHODS All multiple-spin-echo saturation recovery sequences containing brain MR imaging examinations performed during 34 months were retrospectively reviewed. Abnormal examination findings were excluded following a detailed radiographic and clinical chart review. The remaining normal examination findings were then quantitatively analyzed with synthetic MR imaging. Intracranial, brain parenchymal, GM, WM, CSF, and myelin volumes were plotted versus age. Qualitative assessment of segmentation accuracy was performed. Selected abnormal examination findings were compared with these normative curves. RESULTS One hundred twenty-two MRI examinations with normal findings were included of individuals ranging from 0.1 to 21.5 years of age (median, 11.8 years). Resulting normative data plots compared favorably with previously published data obtained using more onerous techniques. Differentiation from pathologic states was possible using quantitative values in select cases. CONCLUSIONS A pediatric data base of normal intracranial tissue volumes using a single sequence and rapid software analysis has been compiled and correlates with previously published data. This provides a framework for clinical interpretation of quantitative synthetic MR images during development. Improved age-based segmentation algorithms in young children are needed.
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Affiliation(s)
- A McAllister
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - J Leach
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - H West
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - B Jones
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - B Zhang
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - S Serai
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Vachani A, Atalay M, Bremner R, Broussard B, Copeland K, Egressy K, Ferguson J, Friedman L, Harris R, Leach J, McQuary P, O'Brien T, Sarkar S, Sheibani N, Shuff J, Siler T, Southwell C, Hesterberg L. A Blood-Based Multi-Gene Expression Classifier to Distinguish Benign From Malignant Pulmonary Nodules. Chest 2017. [DOI: 10.1016/j.chest.2017.08.661] [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: 11/27/2022] Open
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21
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Lonardi S, Andre T, Wong K, Morse M, McDermott R, Hill A, Hendlisz A, Lenz H, Leach J, Moss R, Cao Z, Ledeine J, Kopetz S, Overman M. Combination of nivolumab (nivo) + ipilimumab (ipi) in the treatment of patients (pts) with deficient DNA mismatch repair (dMMR)/high microsatellite instability (MSI-H) metastatic colorectal cancer (mCRC): CheckMate 142 Study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx422.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Monk BJ, Brady MF, Aghajanian C, Lankes HA, Rizack T, Leach J, Fowler JM, Higgins R, Hanjani P, Morgan M, Edwards R, Bradley W, Kolevska T, Foukas P, Swisher EM, Anderson KS, Gottardo R, Bryan JK, Newkirk M, Manjarrez KL, Mannel RS, Hershberg RM, Coukos G. A phase 2, randomized, double-blind, placebo- controlled study of chemo-immunotherapy combination using motolimod with pegylated liposomal doxorubicin in recurrent or persistent ovarian cancer: a Gynecologic Oncology Group partners study. Ann Oncol 2017; 28:996-1004. [PMID: 28453702 PMCID: PMC5406764 DOI: 10.1093/annonc/mdx049] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [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] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A phase 2, randomized, placebo-controlled trial was conducted in women with recurrent epithelial ovarian carcinoma to evaluate the efficacy and safety of motolimod-a Toll-like receptor 8 (TLR8) agonist that stimulates robust innate immune responses-combined with pegylated liposomal doxorubicin (PLD), a chemotherapeutic that induces immunogenic cell death. PATIENTS AND METHODS Women with ovarian, fallopian tube, or primary peritoneal carcinoma were randomized 1 : 1 to receive PLD in combination with blinded motolimod or placebo. Randomization was stratified by platinum-free interval (≤6 versus >6-12 months) and Gynecologic Oncology Group (GOG) performance status (0 versus 1). Treatment cycles were repeated every 28 days until disease progression. RESULTS The addition of motolimod to PLD did not significantly improve overall survival (OS; log rank one-sided P = 0.923, HR = 1.22) or progression-free survival (PFS; log rank one-sided P = 0.943, HR = 1.21). The combination was well tolerated, with no synergistic or unexpected serious toxicity. Most patients experienced adverse events of fatigue, anemia, nausea, decreased white blood cells, and constipation. In pre-specified subgroup analyses, motolimod-treated patients who experienced injection site reactions (ISR) had a lower risk of death compared with those who did not experience ISR. Additionally, pre-treatment in vitro responses of immune biomarkers to TLR8 stimulation predicted OS outcomes in patients receiving motolimod on study. Immune score (tumor infiltrating lymphocytes; TIL), TLR8 single-nucleotide polymorphisms, mutational status in BRCA and other DNA repair genes, and autoantibody biomarkers did not correlate with OS or PFS. CONCLUSIONS The addition of motolimod to PLD did not improve clinical outcomes compared with placebo. However, subset analyses identified statistically significant differences in the OS of motolimod-treated patients on the basis of ISR and in vitro immune responses. Collectively, these data may provide important clues for identifying patients for treatment with immunomodulatory agents in novel combinations and/or delivery approaches. TRIAL REGISTRATION Clinicaltrials.gov, NCT 01666444.
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Affiliation(s)
- B. J. Monk
- Arizona Oncology (US Oncology Network), University of Arizona, College of Medicine, Creighton University School of Medicine at St. Joseph's Hospital, Phoenix
| | - M. F. Brady
- GOG Foundation Statistical and Data Center, Roswell Park Cancer Institute, Buffalo
| | - C. Aghajanian
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York
| | - H. A. Lankes
- GOG Foundation Statistical and Data Center, Roswell Park Cancer Institute, Buffalo
| | - T. Rizack
- Women & Infants Hospital, Alpert Medical School of Brown University, Providence
| | - J. Leach
- Metro-Minnesota Community Oncology Research Consortium, Minneapolis
| | | | - R. Higgins
- Carolinas Medical Center Levine Cancer Institute, Charlotte
| | - P. Hanjani
- Hanjani Institute for Gynecologic Oncology, Abington Memorial Hospital, Abington
| | - M. Morgan
- University of Pennsylvania Health System, Philadelphia
| | - R. Edwards
- University of Pittsburgh Medical Center, Pittsburgh
| | - W. Bradley
- The Medical College of Wisconsin, Milwaukee
| | - T. Kolevska
- Kaiser Permanente Medical Center–Vallejo, Vallejo
| | - P. Foukas
- Ludwig Institute for Cancer Research, Lausanne
| | | | | | - R. Gottardo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle
| | | | | | | | - R. S. Mannel
- The Oklahoma University College of Medicine, Oklahoma City, USA
| | | | - G. Coukos
- Ludwig Institute for Cancer Research, Lausanne
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23
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Gulley JL, Rajan A, Spigel DR, Iannotti N, Chandler J, Wong DJL, Leach J, Edenfield WJ, Wang D, Grote HJ, Heydebreck AV, Chin K, Cuillerot JM, Kelly K. Avelumab for patients with previously treated metastatic or recurrent non-small-cell lung cancer (JAVELIN Solid Tumor): dose-expansion cohort of a multicentre, open-label, phase 1b trial. Lancet Oncol 2017. [PMID: 28373005 DOI: 10.1016/s1470-2045(17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Avelumab, a human Ig-G1 monoclonal antibody targeting PD-L1 and approved in the USA for the treatment of metastatic Merkel cell carcinoma, has shown antitumour activity and an acceptable safety profile in patients with advanced solid tumours in a dose-escalation phase 1a trial. In this dose-expansion cohort of that trial, we assess avelumab treatment in a cohort of patients with advanced, platinum-treated non-small-cell lung cancer (NSCLC). METHODS In this dose-expansion cohort of a multicentre, open-label, phase 1 study, patients with progressive or platinum-resistant metastatic or recurrent NSCLC were enrolled at 58 cancer treatment centres and academic hospitals in the USA. Eligible patients had confirmed stage IIIB or IV NSCLC with squamous or non-squamous histology, measurable disease by Response Evaluation Criteria In Solid Tumors version 1.1 (RECIST v1.1), tumour biopsy or archival sample for biomarker assessment, and Eastern Cooperative Oncology Group performance status 0 or 1, among other criteria. Patient selection was not based on PD-L1 expression or expression of other biomarkers, including EGFR or KRAS mutation or ALK translocation status. Patients received infusional avelumab monotherapy 10 mg/kg every 2 weeks until disease progression or toxicity. The primary objective was to assess safety and tolerability. This trial is registered with ClinicalTrials.gov, number NCT01772004; enrolment in this cohort is closed and the trial is ongoing. FINDINGS Between Sept 10, 2013, and June 24, 2014, 184 patients were enrolled and initiated treatment with avelumab. Median follow-up duration was 8·8 months (IQR 7·2-11·9). The most common treatment-related adverse events of any grade were fatigue (46 [25%] of 184 patients), infusion-related reaction (38 [21%]), and nausea (23 [13%]). Grade 3 or worse treatment-related adverse events occurred in 23 (13%) of 184 patients; the most common (occurring in more than two patients) were infusion-related reaction (four [2%] patients) and increased lipase level (three [2%]). 16 (9%) of 184 patients had a serious adverse event related to treatment with avelumab, with infusion-related reaction (in four [2%] patients) and dyspnoea (in two [1%]) occurring in more than one patient. Serious adverse events irrespective of cause occurred in 80 (44%) of 184 patients. Those occurring in more than five patients (≥3%) were dyspnoea (ten patients [5%]), pneumonia (nine [5%]), and chronic obstructive pulmonary disease (six [3%]). Immune-related treatment-related events occurred in 22 patients (12%). Of 184 patients, 22 (12% [95% CI 8-18]) achieved a confirmed objective response, including one complete response and 21 partial responses. 70 (38%) had stable disease. Overall, 92 (50%) of 184 patients achieved disease control (they had a confirmed response or stable disease as their best overall response). One patient was initially thought to have died from grade 5 radiation pneumonitis during the study; however, this adverse event was subsequently regraded to grade 3 and the death was attributed to disease progression. INTERPRETATION Avelumab showed an acceptable safety profile and antitumour activity in patients with progressive or treatment-resistant NSCLC, providing a rationale for further studies of avelumab in this disease setting. FUNDING Merck KGaA and Pfizer.
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Affiliation(s)
- James L Gulley
- Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Arun Rajan
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - David R Spigel
- Sarah Cannon Research Institute Tennessee Oncology, North Nashville, TN, USA
| | - Nicholas Iannotti
- Hematology Oncology Associates of the Treasure Coast, Port St Lucie, FL, USA
| | | | - Deborah J L Wong
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Joseph Leach
- Virginia Piper Cancer Institute, Minneapolis, MN, USA
| | - W Jeff Edenfield
- Institute for Translational Oncology Research, Greenville, SC, USA
| | - Ding Wang
- Henry Ford Hospital, Detroit, MI, USA
| | | | | | | | | | - Karen Kelly
- University of California-Davis, Comprehensive Cancer Center, Sacramento, CA, USA
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24
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Wakelee HA, Gettinger S, Engelman J, Jänne PA, West H, Subramaniam DS, Leach J, Wax M, Yaron Y, Miles DR, Lara PN. A phase Ib/II study of cabozantinib (XL184) with or without erlotinib in patients with non-small cell lung cancer. Cancer Chemother Pharmacol 2017; 79:923-932. [PMID: 28352985 PMCID: PMC5403837 DOI: 10.1007/s00280-017-3283-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/09/2017] [Indexed: 01/23/2023]
Abstract
PURPOSE Cabozantinib is a multi-kinase inhibitor that targets MET, AXL, and VEGFR2, and may synergize with EGFR inhibition in NSCLC. Cabozantinib was assessed alone or in combination with erlotinib in patients with progressive NSCLC and EGFR mutations who had previously received erlotinib. METHODS This was a phase Ib/II study (NCT00596648). The primary objectives of phase I were to assess the safety, pharmacokinetics, and pharmacodynamics and to determine maximum tolerated dose (MTD) of cabozantinib plus erlotinib in patients who failed prior erlotinib treatment. In phase II, patients with prior response or stable disease with erlotinib who progressed were randomized to single-agent cabozantinib 100 mg qd vs cabozantinib 100 mg qd and erlotinib 50 mg qd (phase I MTD), with a primary objective of estimating objective response rate (ORR). RESULTS Sixty-four patients were treated in phase I. Doses of 100 mg cabozantinib plus 50 mg erlotinib, or 40 mg cabozantinib plus 150 mg erlotinib were determined to be MTDs. Diarrhea was the most frequent dose-limiting toxicity and the most frequent AE (87.5% of patients). The ORR for phase I was 8.2% (90% CI 3.3-16.5). In phase II, one patient in the cabozantinib arm (N = 15) experienced a partial response, for an ORR of 6.7% (90% CI 0.3-27.9), with no responses for cabozantinib plus erlotinib (N = 13). There was no evidence that co-administration of cabozantinib markedly altered erlotinib pharmacokinetics or vice versa. CONCLUSIONS Despite responses with cabozantinib/erlotinib in phase I, there were no responses in the combination arm of phase II in patients with acquired resistance to erlotinib. Cabozantinib did not appear to re-sensitize these patients to erlotinib.
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Affiliation(s)
- Heather A Wakelee
- Stanford Cancer Institute, 875 Blake Wilbur Drive, Rm 2233, Stanford, CA, 94305-5826, USA.
| | | | | | - Pasi A Jänne
- Lowe Center for Thoracic Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | | | - Deepa S Subramaniam
- Department of Hematology and Oncology, Georgetown University Hospital, Washington, DC, USA
| | - Joseph Leach
- Park Nicollet Cancer Center, Minneapolis, MN, USA
| | - Michael Wax
- Summit Medical Group, Berkeley Heights, NJ, USA
| | | | | | - Primo N Lara
- University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
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25
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Gulley JL, Rajan A, Spigel DR, Iannotti N, Chandler J, Wong DJL, Leach J, Edenfield WJ, Wang D, Grote HJ, Heydebreck AV, Chin K, Cuillerot JM, Kelly K. Avelumab for patients with previously treated metastatic or recurrent non-small-cell lung cancer (JAVELIN Solid Tumor): dose-expansion cohort of a multicentre, open-label, phase 1b trial. Lancet Oncol 2017; 18:599-610. [PMID: 28373005 DOI: 10.1016/s1470-2045(17)30240-1] [Citation(s) in RCA: 228] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/20/2017] [Accepted: 01/24/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Avelumab, a human Ig-G1 monoclonal antibody targeting PD-L1 and approved in the USA for the treatment of metastatic Merkel cell carcinoma, has shown antitumour activity and an acceptable safety profile in patients with advanced solid tumours in a dose-escalation phase 1a trial. In this dose-expansion cohort of that trial, we assess avelumab treatment in a cohort of patients with advanced, platinum-treated non-small-cell lung cancer (NSCLC). METHODS In this dose-expansion cohort of a multicentre, open-label, phase 1 study, patients with progressive or platinum-resistant metastatic or recurrent NSCLC were enrolled at 58 cancer treatment centres and academic hospitals in the USA. Eligible patients had confirmed stage IIIB or IV NSCLC with squamous or non-squamous histology, measurable disease by Response Evaluation Criteria In Solid Tumors version 1.1 (RECIST v1.1), tumour biopsy or archival sample for biomarker assessment, and Eastern Cooperative Oncology Group performance status 0 or 1, among other criteria. Patient selection was not based on PD-L1 expression or expression of other biomarkers, including EGFR or KRAS mutation or ALK translocation status. Patients received infusional avelumab monotherapy 10 mg/kg every 2 weeks until disease progression or toxicity. The primary objective was to assess safety and tolerability. This trial is registered with ClinicalTrials.gov, number NCT01772004; enrolment in this cohort is closed and the trial is ongoing. FINDINGS Between Sept 10, 2013, and June 24, 2014, 184 patients were enrolled and initiated treatment with avelumab. Median follow-up duration was 8·8 months (IQR 7·2-11·9). The most common treatment-related adverse events of any grade were fatigue (46 [25%] of 184 patients), infusion-related reaction (38 [21%]), and nausea (23 [13%]). Grade 3 or worse treatment-related adverse events occurred in 23 (13%) of 184 patients; the most common (occurring in more than two patients) were infusion-related reaction (four [2%] patients) and increased lipase level (three [2%]). 16 (9%) of 184 patients had a serious adverse event related to treatment with avelumab, with infusion-related reaction (in four [2%] patients) and dyspnoea (in two [1%]) occurring in more than one patient. Serious adverse events irrespective of cause occurred in 80 (44%) of 184 patients. Those occurring in more than five patients (≥3%) were dyspnoea (ten patients [5%]), pneumonia (nine [5%]), and chronic obstructive pulmonary disease (six [3%]). Immune-related treatment-related events occurred in 22 patients (12%). Of 184 patients, 22 (12% [95% CI 8-18]) achieved a confirmed objective response, including one complete response and 21 partial responses. 70 (38%) had stable disease. Overall, 92 (50%) of 184 patients achieved disease control (they had a confirmed response or stable disease as their best overall response). One patient was initially thought to have died from grade 5 radiation pneumonitis during the study; however, this adverse event was subsequently regraded to grade 3 and the death was attributed to disease progression. INTERPRETATION Avelumab showed an acceptable safety profile and antitumour activity in patients with progressive or treatment-resistant NSCLC, providing a rationale for further studies of avelumab in this disease setting. FUNDING Merck KGaA and Pfizer.
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Affiliation(s)
- James L Gulley
- Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Arun Rajan
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - David R Spigel
- Sarah Cannon Research Institute Tennessee Oncology, North Nashville, TN, USA
| | - Nicholas Iannotti
- Hematology Oncology Associates of the Treasure Coast, Port St Lucie, FL, USA
| | | | - Deborah J L Wong
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Joseph Leach
- Virginia Piper Cancer Institute, Minneapolis, MN, USA
| | - W Jeff Edenfield
- Institute for Translational Oncology Research, Greenville, SC, USA
| | - Ding Wang
- Henry Ford Hospital, Detroit, MI, USA
| | | | | | | | | | - Karen Kelly
- University of California-Davis, Comprehensive Cancer Center, Sacramento, CA, USA
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26
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Schütte W, Barlesi F, Park K, Ciardiello F, Pawel J, Gadgeel S, Hida T, Kowalski D, Cobo Dols M, Cortinovis D, Leach J, Polikoff J, Gandara DR, Barrios C, Chen DS, He P, Ballinger M, Waterkamp D, Sandler A, Rittmeyer A. Efficacy, safety and predictive biomarker results from OAK, a randomized phase III study comparing atezolizumab with docetaxel in patients with advanced NSCLC. Pneumologie 2017. [DOI: 10.1055/s-0037-1598278] [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: 10/20/2022]
Affiliation(s)
- W Schütte
- Klinik für Innere Medizin, Klinik für Innere Medizin II, Städtisches Krankenhaus Martha Maria, Halle (Saale)
| | - F Barlesi
- Assistance Publique Hôpitaux de Marseille, Aix Marseille University
| | - K Park
- Sungkyunkwan University School of Medicine
| | | | - J Pawel
- Asklepios-Fachkliniken München-Gauting
| | - S Gadgeel
- Karmanos Cancer Institute/Wayne State University
| | - T Hida
- Aichi Cancer Center Hospital
| | - D Kowalski
- Oncology Centre, Institute M. Sklodowska – Curie
| | - M Cobo Dols
- Medical Oncology Section, Hospital Regional Universitario Carlos Haya
| | | | | | - J Polikoff
- Southern California Permanente Medical Group
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27
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Rittmeyer A, Barlesi F, Waterkamp D, Park K, Ciardiello F, von Pawel J, Gadgeel SM, Hida T, Kowalski DM, Dols MC, Cortinovis DL, Leach J, Polikoff J, Barrios C, Kabbinavar F, Frontera OA, De Marinis F, Turna H, Lee JS, Ballinger M, Kowanetz M, He P, Chen DS, Sandler A, Gandara DR. Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): a phase 3, open-label, multicentre randomised controlled trial. Lancet 2017. [PMID: 27979383 DOI: 10.1016/s0140-6736(16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Atezolizumab is a humanised antiprogrammed death-ligand 1 (PD-L1) monoclonal antibody that inhibits PD-L1 and programmed death-1 (PD-1) and PD-L1 and B7-1 interactions, reinvigorating anticancer immunity. We assessed its efficacy and safety versus docetaxel in previously treated patients with non-small-cell lung cancer. METHODS We did a randomised, open-label, phase 3 trial (OAK) in 194 academic or community oncology centres in 31 countries. We enrolled patients who had squamous or non-squamous non-small-cell lung cancer, were 18 years or older, had measurable disease per Response Evaluation Criteria in Solid Tumors, and had an Eastern Cooperative Oncology Group performance status of 0 or 1. Patients had received one to two previous cytotoxic chemotherapy regimens (one or more platinum based combination therapies) for stage IIIB or IV non-small-cell lung cancer. Patients with a history of autoimmune disease and those who had received previous treatments with docetaxel, CD137 agonists, anti-CTLA4, or therapies targeting the PD-L1 and PD-1 pathway were excluded. Patients were randomly assigned (1:1) to intravenously receive either atezolizumab 1200 mg or docetaxel 75 mg/m2 every 3 weeks by permuted block randomisation (block size of eight) via an interactive voice or web response system. Coprimary endpoints were overall survival in the intention-to-treat (ITT) and PD-L1-expression population TC1/2/3 or IC1/2/3 (≥1% PD-L1 on tumour cells or tumour-infiltrating immune cells). The primary efficacy analysis was done in the first 850 of 1225 enrolled patients. This study is registered with ClinicalTrials.gov, number NCT02008227. FINDINGS Between March 11, 2014, and April 29, 2015, 1225 patients were recruited. In the primary population, 425 patients were randomly assigned to receive atezolizumab and 425 patients were assigned to receive docetaxel. Overall survival was significantly longer with atezolizumab in the ITT and PD-L1-expression populations. In the ITT population, overall survival was improved with atezolizumab compared with docetaxel (median overall survival was 13·8 months [95% CI 11·8-15·7] vs 9·6 months [8·6-11·2]; hazard ratio [HR] 0·73 [95% CI 0·62-0·87], p=0·0003). Overall survival in the TC1/2/3 or IC1/2/3 population was improved with atezolizumab (n=241) compared with docetaxel (n=222; median overall survival was 15·7 months [95% CI 12·6-18·0] with atezolizumab vs 10·3 months [8·8-12·0] with docetaxel; HR 0·74 [95% CI 0·58-0·93]; p=0·0102). Patients in the PD-L1 low or undetectable subgroup (TC0 and IC0) also had improved survival with atezolizumab (median overall survival 12·6 months vs 8·9 months; HR 0·75 [95% CI 0·59-0·96]). Overall survival improvement was similar in patients with squamous (HR 0·73 [95% CI 0·54-0·98]; n=112 in the atezolizumab group and n=110 in the docetaxel group) or non-squamous (0·73 [0·60-0·89]; n=313 and n=315) histology. Fewer patients had treatment-related grade 3 or 4 adverse events with atezolizumab (90 [15%] of 609 patients) versus docetaxel (247 [43%] of 578 patients). One treatment-related death from a respiratory tract infection was reported in the docetaxel group. INTERPRETATION To our knowledge, OAK is the first randomised phase 3 study to report results of a PD-L1-targeted therapy, with atezolizumab treatment resulting in a clinically relevant improvement of overall survival versus docetaxel in previously treated non-small-cell lung cancer, regardless of PD-L1 expression or histology, with a favourable safety profile. FUNDING F. Hoffmann-La Roche Ltd, Genentech, Inc.
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Affiliation(s)
| | - Fabrice Barlesi
- Aix Marseille Universite, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | | | - Keunchil Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | | | | | - Manuel Cobo Dols
- Medical Oncology Section, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | | | | | | | | | | | | | | | - Hande Turna
- Istanbul University Cerrahpasa Medical Faculty Hospital, Medical Oncology, Istanbul, Turkey
| | - Jong-Seok Lee
- Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | | | | | - Pei He
- Genentech, Inc., South San Francisco, CA, USA
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28
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Rittmeyer A, Barlesi F, Waterkamp D, Park K, Ciardiello F, von Pawel J, Gadgeel SM, Hida T, Kowalski DM, Dols MC, Cortinovis DL, Leach J, Polikoff J, Barrios C, Kabbinavar F, Frontera OA, De Marinis F, Turna H, Lee JS, Ballinger M, Kowanetz M, He P, Chen DS, Sandler A, Gandara DR. Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): a phase 3, open-label, multicentre randomised controlled trial. Lancet 2017; 389:255-265. [PMID: 27979383 PMCID: PMC6886121 DOI: 10.1016/s0140-6736(16)32517-x] [Citation(s) in RCA: 3358] [Impact Index Per Article: 479.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Atezolizumab is a humanised antiprogrammed death-ligand 1 (PD-L1) monoclonal antibody that inhibits PD-L1 and programmed death-1 (PD-1) and PD-L1 and B7-1 interactions, reinvigorating anticancer immunity. We assessed its efficacy and safety versus docetaxel in previously treated patients with non-small-cell lung cancer. METHODS We did a randomised, open-label, phase 3 trial (OAK) in 194 academic or community oncology centres in 31 countries. We enrolled patients who had squamous or non-squamous non-small-cell lung cancer, were 18 years or older, had measurable disease per Response Evaluation Criteria in Solid Tumors, and had an Eastern Cooperative Oncology Group performance status of 0 or 1. Patients had received one to two previous cytotoxic chemotherapy regimens (one or more platinum based combination therapies) for stage IIIB or IV non-small-cell lung cancer. Patients with a history of autoimmune disease and those who had received previous treatments with docetaxel, CD137 agonists, anti-CTLA4, or therapies targeting the PD-L1 and PD-1 pathway were excluded. Patients were randomly assigned (1:1) to intravenously receive either atezolizumab 1200 mg or docetaxel 75 mg/m2 every 3 weeks by permuted block randomisation (block size of eight) via an interactive voice or web response system. Coprimary endpoints were overall survival in the intention-to-treat (ITT) and PD-L1-expression population TC1/2/3 or IC1/2/3 (≥1% PD-L1 on tumour cells or tumour-infiltrating immune cells). The primary efficacy analysis was done in the first 850 of 1225 enrolled patients. This study is registered with ClinicalTrials.gov, number NCT02008227. FINDINGS Between March 11, 2014, and April 29, 2015, 1225 patients were recruited. In the primary population, 425 patients were randomly assigned to receive atezolizumab and 425 patients were assigned to receive docetaxel. Overall survival was significantly longer with atezolizumab in the ITT and PD-L1-expression populations. In the ITT population, overall survival was improved with atezolizumab compared with docetaxel (median overall survival was 13·8 months [95% CI 11·8-15·7] vs 9·6 months [8·6-11·2]; hazard ratio [HR] 0·73 [95% CI 0·62-0·87], p=0·0003). Overall survival in the TC1/2/3 or IC1/2/3 population was improved with atezolizumab (n=241) compared with docetaxel (n=222; median overall survival was 15·7 months [95% CI 12·6-18·0] with atezolizumab vs 10·3 months [8·8-12·0] with docetaxel; HR 0·74 [95% CI 0·58-0·93]; p=0·0102). Patients in the PD-L1 low or undetectable subgroup (TC0 and IC0) also had improved survival with atezolizumab (median overall survival 12·6 months vs 8·9 months; HR 0·75 [95% CI 0·59-0·96]). Overall survival improvement was similar in patients with squamous (HR 0·73 [95% CI 0·54-0·98]; n=112 in the atezolizumab group and n=110 in the docetaxel group) or non-squamous (0·73 [0·60-0·89]; n=313 and n=315) histology. Fewer patients had treatment-related grade 3 or 4 adverse events with atezolizumab (90 [15%] of 609 patients) versus docetaxel (247 [43%] of 578 patients). One treatment-related death from a respiratory tract infection was reported in the docetaxel group. INTERPRETATION To our knowledge, OAK is the first randomised phase 3 study to report results of a PD-L1-targeted therapy, with atezolizumab treatment resulting in a clinically relevant improvement of overall survival versus docetaxel in previously treated non-small-cell lung cancer, regardless of PD-L1 expression or histology, with a favourable safety profile. FUNDING F. Hoffmann-La Roche Ltd, Genentech, Inc.
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Affiliation(s)
| | - Fabrice Barlesi
- Aix Marseille Universite, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | | | - Keunchil Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | | | | | - Manuel Cobo Dols
- Medical Oncology Section, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | | | | | | | | | | | | | | | - Hande Turna
- Istanbul University Cerrahpasa Medical Faculty Hospital, Medical Oncology, Istanbul, Turkey
| | - Jong-Seok Lee
- Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | | | | | - Pei He
- Genentech, Inc., South San Francisco, CA, USA
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Park K, Barlesi F, Ciardiello F, von Pawel J, Gadgeel S, Hida T, Kowalski D, Cobo Dols M, Cortinovis D, Leach J, Polikoff J, Gandara D, Barrios C, Chen D, He P, Kowanetz M, Ballinger M, Waterkamp D, Sandler A, Rittmeyer A. 438O Primary analysis from OAK, a randomized phase III study comparing atezolizumab with docetaxel in 2L/3L NSCLC. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw594.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Antonia S, Brahmer J, Khleif S, Balmanoukian A, Ou SH, Gutierrez M, Kim DW, Kim SW, Ahn MJ, Leach J, Jamal R, Jaeger D, Jerusalem G, Jin X, Gupta A, Antal J, Segal N. Phase 1/2 study of the safety and clinical activity of durvalumab in patients with non-small cell lung cancer (NSCLC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw383.16] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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Overman M, Kopetz S, Lonardi S, McDermott R, Leone F, Leach J, Lenz HJ, Hendlisz A, Morse M, Garcia-Alfonso P, Desai J, Hill A, Moss R, Goldberg M, Lin CS, Tang H, André T. Nivolumab ± ipilimumab treatment (Tx) efficacy, safety, and biomarkers in patients (Pts) with metastatic colorectal cancer (mCRC) with and without high microsatellite instability (MSI-H): results from the CheckMate-142 study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.27] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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32
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Barlesi F, Park K, Ciardiello F, von Pawel J, Gadgeel S, Hida T, Kowalski D, Dols M, Cortinovis D, Leach J, Polikoff J, Gandara D, Barrios C, Chen D, He P, Kowanetz M, Ballinger M, Waterkamp D, Sandler A, Rittmeyer A. Primary analysis from OAK, a randomized phase III study comparing atezolizumab with docetaxel in 2L/3L NSCLC. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw435.43] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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33
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Parzefall B, De Decker S, Carvalho S, Terry R, Leach J, Smith KC, Lara-Garcia A. Axial Multicentric Osteosarcoma in an English Cocker Spaniel. J Vet Intern Med 2016; 30:1720-1725. [PMID: 27519845 PMCID: PMC5032862 DOI: 10.1111/jvim.14555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/01/2016] [Accepted: 07/05/2016] [Indexed: 11/27/2022] Open
Affiliation(s)
- B Parzefall
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - S De Decker
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - S Carvalho
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - R Terry
- Department of Pathology and Pathogen Biology, Royal Veterinary College, University of London, Hatfield, UK
| | - J Leach
- Veterinary Diagnostic Services, School of Veterinary Medicine, University of Glasgow, Glasgow, UK
| | - K C Smith
- Department of Pathology and Pathogen Biology, Royal Veterinary College, University of London, Hatfield, UK
| | - A Lara-Garcia
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK.
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Kelly K, Patel M, Infante JR, Iannotti N, Nikolinakos P, Leach J, Wang D, Chandler J, Jerusalem G, Gurtler J, Arkenau HT, Bajars M, von Heydebreck A, Speit I, Heery CR, Gulley JL. Abstract CT132: Safety of avelumab (MSB0010718C), an anti-PD-L1 antibody: updated analysis from the phase Ib JAVELIN Solid Tumor trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-ct132] [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: The programmed death-1 receptor (PD-1) and its ligand (PD-L1) are key therapeutic targets in the reactivation of the immune response against multiple cancers. Avelumab* (MSB0010718C) is a fully human anti-PD-L1 IgG1 antibody currently being investigated in clinical trials. The primary objective of this phase Ib, open-label expansion study (NCT01772004) was to assess the safety and tolerability of avelumab in patients (pts) with locally advanced or metastatic (LA/M) solid tumors.
Methods: Pts from 16 different expansion cohorts (including NSCLC, gastric, ovarian, urothelial, and breast; ECOG performance status [PS] of 0-1 at trial entry) and unselected for PD-L1 expression were treated with avelumab at 10 mg/kg IV, Q2W until confirmed progression, unacceptable toxicity, or any criteria for withdrawal occurred. Adverse events (AEs) were graded by NCI-CTCAE v4.0.
Results: As of Aug 4, 2015, 900 pts were treated with avelumab and followed for ?4 wks. Median age was 62 years (range, 23-91), ECOG PS was 0 (39.1%), 1 (60.6%), or 2-3 (0.2%), and median number of prior lines of anticancer therapy was 2 (range, 1-13). Median duration of treatment with avelumab and number of administrations were 10.0 wks (range, 2-92) and 5 infusions (range, 1-43), respectively. Treatment-related (TR) AEs of any grade occurred in 585 pts (65.0%). Grade ?3 TRAEs occurred in 91 pts (10.1%). The most frequent (?0.5%) grade ?3 TRAEs were IRRs (n = 8, 0.9%), GGT elevation (n = 7, 0.8%), lipase elevation (n = 7, 0.8%), anemia (n = 7, 0.8%), and fatigue (n = 6, 0.7%). Seventy-five pts (8.3%) experienced potential immune-related (ir) TRAEs, with hypothyroidism (n = 34, 3.8%) and pneumonitis (n = 8, 0.9%) occurring most frequently (?0.5%). Grade ?3 potential irTRAEs were reported for 17 pts (1.9%); the most frequent (?0.3%) were autoimmune hepatitis (n = 4; 0.4%), colitis (n = 3; 0.3%), and pneumonitis (n = 3; 0.3%). TRAEs resulted in permanent treatment discontinuation for 64 pts (7.1%); 2.6% (n = 23) discontinued due to an IRR and 1.3% (n = 12) discontinued due to a potential irTRAE. TRAEs were considered the primary cause of death by the investigator for 4 pts (0.4%): radiation pneumonitis (1), autoimmune hepatitis (1), acute liver failure (1), and respiratory distress (1).
Conclusion: Single-agent avelumab shows an acceptable safety profile in a heavily pretreated population of pts with LA/M malignancies. To date, >1,500 pts have been enrolled in the JAVELIN Solid Tumor clinical trial. Additional safety and efficacy analyses from this study are ongoing, and recruitment to several phase III trials is underway. *Proposed INN.
Citation Format: Karen Kelly, Manish Patel, Jeffrey R. Infante, Nicholas Iannotti, Petros Nikolinakos, Joseph Leach, Ding Wang, Jason Chandler, Guy Jerusalem, Jayne Gurtler, Henrik-Tobias Arkenau, Marcis Bajars, Anja von Heydebreck, Isabell Speit, Christopher R. Heery, James L. Gulley. Safety of avelumab (MSB0010718C), an anti-PD-L1 antibody: updated analysis from the phase Ib JAVELIN Solid Tumor trial. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr CT132.
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Affiliation(s)
- Karen Kelly
- 1UC Davis Comprehensive Cancer Center, Sacramento, CA
| | - Manish Patel
- 2Florida Cancer Specialists/Sarah Cannon Research Institute, Sarasota, FL
| | - Jeffrey R. Infante
- 3Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN
| | - Nicholas Iannotti
- 4Hematology Oncology Associates of the Treasure Coast, Port St. Lucie, FL
| | | | - Joseph Leach
- 6Virginia Piper Cancer Institute, Minneapolis, MN
| | | | | | - Guy Jerusalem
- 9CHU Sart Tilman Liege and Liege University, Liege, Belgium
| | | | | | | | | | | | - Christopher R. Heery
- 14Laboratory of Tumor Immunology and Biology, National Cancer Institute, Bethesda, MD
| | - James L. Gulley
- 15Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, and Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
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van Zanten SV, Baugh J, Chaney B, Lane A, Heijmans M, Hoffman L, Doughman R, Jansen M, Sanchez E, Vandertop W, Kaspers G, van Vuurden D, Fouladi M, Leach J, Jones B. HG-106A NOVEL TOOL TO PREDICT THE SURVIVAL OF DIFFUSE INTRINSIC PONTINE GLIOMA PATIENTS: EXTERNAL VALIDATION OF THE SURVIVAL PREDICTION MODEL USING THE INTERNATIONAL DIPG REGISTRY. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now073.102] [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: 11/13/2022] Open
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Hassan R, Thomas A, Patel MR, Nemunaitis JJ, Bennouna J, Powderly JD, Taylor MH, Dowlati A, Chen F, Leach J, Vaishampayan UN, Verschraegen CF, Delord JP, Grote HJ, von Heydebreck A, Cuillerot JM, Gulley JL. Avelumab (MSB0010718C; anti-PD-L1) in patients with advanced unresectable mesothelioma from the JAVELIN solid tumor phase Ib trial: Safety, clinical activity, and PD-L1 expression. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.8503] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Raffit Hassan
- Thoracic and Gastrointestinal Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Anish Thomas
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Manish R. Patel
- Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL
| | | | - Jaafar Bennouna
- Institut de Cancérologie de l'Ouest – site René Gauducheau, Saint Herblain, France
| | | | - Matthew H. Taylor
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Afshin Dowlati
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Franklin Chen
- Novant Health Oncology Specialists, Winston-Salem, NC
| | - Joseph Leach
- Virginia Piper Cancer Institute, Minneapolis, MN
| | | | | | | | | | | | | | - James L. Gulley
- Genitourinary Malignancies Branch, National Cancer Institute at the National Institutes of Health, Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Edelman MJ, Hu C, Le QT, Donington J, D'Souza WD, Dicker A, Loo BW, Gore E, Videtic GM, Evans NR, Leach J, Diehn M, Feigenberg SJ, Chen Y, Bradley JD. Randomized phase II study of preoperative chemoradiotherapy (CRT)+/- Panitumumab (P) followed by consolidation chemotherapy (C) in potentially operable locally advanced (stage IIIa, N2+) non-small cell lung cancer (LANSCLC): Nrg oncology/RTOG 0839. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.8510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Chen Hu
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - Quynh-Thu Le
- Stanford University Medical Center, Stanford, CA
| | | | | | - Adam Dicker
- Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | | | | | | | | | - Joseph Leach
- Virginia Piper Cancer Institute, Minneapolis, MN
| | | | | | - Yuhchyau Chen
- University of Rochester Medical Center, Rochester, NY
| | - Jeffrey D Bradley
- Washington University School of Medicine in St. Louis, St. Louis, MO
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Overman MJ, Kopetz S, McDermott RS, Leach J, Lonardi S, Lenz HJ, Morse MA, Desai J, Hill A, Axelson MD, Moss RA, Lin CS, Goldberg M, Andre T. Nivolumab ± ipilimumab in treatment (tx) of patients (pts) with metastatic colorectal cancer (mCRC) with and without high microsatellite instability (MSI-H): CheckMate-142 interim results. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3501] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Scott Kopetz
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Sara Lonardi
- Istituto Oncologico Veneto IOV-IRCSS, Padova, Italy
| | | | | | | | - Andrew Hill
- Tasman Oncology Research Pty Ltd, Southport, Queensland, Australia
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Kosnik-Infinger L, Carroll C, Greiner H, Leach J, Mangano FT. Management of cerebral cavernous malformations in the pediatric population: a literature review and case illustrations. J Neurosurg Sci 2015; 59:283-294. [PMID: 25998208] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Cavernous malformations (CM) are vascular malformations of the central nervous system that may occur in the brain and spinal cord. They are one of the four major types of vascular malformations that also includes developmental venous anomalies (DVA)s, arteriovenous malformations (AVMs), and capillary telangiectasias. CMs are a common vascular malformation, and 25% of them occur in the pediatric age group. They can present with acute or chronic symptoms including headache, neurologic deficits secondary to hemorrhage, mass effect, or epilepsy. This review will focus on the neurosurgical management of intracranial cavernous malformations in children. Pediatric CMs have special considerations different from CM that occur in the adult population which are highlighted throughout this review. Characteristics specific to pediatric CM epidemiology, genetics, presentation, pathology, location, size, epilepsy, and management will be discussed. Specific considerations must be entertained with the diagnosis of pediatric CM in that management needs to include consideration of the lifetime risk of hemorrhage, as well as the possibility of development of epilepsy. If in an accessible location, most cavernomas should be surgically removed in a timely fashion to provide lifelong cure for pediatric patients. The review closes with the discussion of two interesting cavernous malformation cases occurring in a 12-year old male and a 12-year old female that exhibit many of the important aspects specific to the management of a pediatric patient with CM, highlighting the importance of a multidisciplinary approach to treatment.
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Affiliation(s)
- L Kosnik-Infinger
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital, Cincinnati, OH, USA -
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Picozzi VJ, Leach J, Larson T, Nishikubo CY, Anthony SP, Lin BS, Bolejack V, Stoll AC, Von Hoff DD, Ramanathan RK. Phase II study of nab-paclitaxel/gemcitabine (NabP-Gem) alternating with FOLFIRI as 1st line therapy ( Rx) in patients (pts) with metastatic pancreatic cancer (mPC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e15277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Joseph Leach
- Virginia Piper Cancer Institute, Minneapolis, MN
| | | | | | | | | | | | | | - Daniel D. Von Hoff
- Clinical Trials, Virginia G. Piper Cancer Center at Scottsdale Healthcare/TGen, Scottsdale, AZ
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Gulley JL, Spigel D, Kelly K, Chandler JC, Rajan A, Hassan R, Wong DJL, Leach J, Edenfield WJ, Wang D, Vrindavanam N, Weiss GJ, Gurtler JS, Grote HJ, von Heydebreck A, Chin KM, Iannotti N. Avelumab (MSB0010718C), an anti-PD-L1 antibody, in advanced NSCLC patients: A phase 1b, open-label expansion trial in patients progressing after platinum-based chemotherapy. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8034] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- James L. Gulley
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - David Spigel
- Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Nashville, TN
| | - Karen Kelly
- UC Davis Comprehensive Cancer Center, Sacramento, CA
| | | | - Arun Rajan
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Raffit Hassan
- Thoracic and Gastrointestinal Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | | | - Joseph Leach
- Virginia Piper Cancer Institute, Minneapolis, MN
| | | | - Ding Wang
- Henry Ford Health Systems, Detroit, MI
| | | | - Glen J. Weiss
- Western Regional Medical Center, Cancer Treatment Centers of America, Goodyear, AZ
| | | | | | | | | | - Nicholas Iannotti
- Hematology Oncology Associates of the Treasure Coast, Port Saint Lucie, FL
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Kelly K, Patel MR, Infante JR, Iannotti N, Nikolinakos P, Leach J, Wang D, Chandler JC, Jerusalem GHM, Gurtler JS, Arkenau HT, Speit I, von Heydebreck A, Chin KM, Heery CR, Gulley JL. Avelumab (MSB0010718C), an anti-PD-L1 antibody, in patients with metastatic or locally advanced solid tumors: assessment of safety and tolerability in a phase I, open-label expansion study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.3044] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Karen Kelly
- UC Davis Comprehensive Cancer Center, Sacramento, CA
| | - Manish R. Patel
- Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL
| | | | - Nicholas Iannotti
- Hematology Oncology Associates of the Treasure Coast, Port Saint Lucie, FL
| | | | - Joseph Leach
- Virginia Piper Cancer Institute, Minneapolis, MN
| | - Ding Wang
- Henry Ford Health Systems, Detroit, MI
| | | | | | | | | | | | | | | | | | - James L. Gulley
- Genitourinary Malignancies Branch, National Cancer Institute at the National Institutes of Health, Bethesda, MD
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Hoffman LM, Geller J, Leach J, Boue D, Drissi R, Chen L, Krailo M, Panandiker AP, Chow L, Haas-Kogan D, Jogal S, Nelson M, Jakacki R, Kieran M, Cohen K, Pollack I, Gajjar A, Fouladi M. TR-14 * A FEASIBILITY AND RANDOMIZED PHASE II STUDY OF VORINOSTAT, BEVACIZUMAB, OR TEMOZOLOMIDE DURING RADIATION FOLLOWED BY MAINTENANCE CHEMOTHERAPY IN NEWLY-DIAGNOSED PEDIATRIC HIGH-GRADE GLIOMA: CHILDREN'S ONCOLOGY GROUP STUDY ACNS0822. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov061.159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Simpson RG, Leach J. The General Practitioner and the military veteran. J ROY ARMY MED CORPS 2014; 161:106-8. [DOI: 10.1136/jramc-2013-000243] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 05/15/2014] [Indexed: 11/03/2022]
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Faller K, Leach J, Gutierrez-Quintana R, Finck M, Hammond G, Penderis J, Marchesi F. Diagnostic Exercise: Circling and Behavioral Changes in a Cat. Vet Pathol 2014; 52:696-9. [PMID: 25161208 DOI: 10.1177/0300985814547390] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A 4-year old spayed male domestic shorthair cat was presented with a history of circling and behavioral changes. Neurologic examination showed mild proprioceptive deficits. The lesion was localized in the forebrain, and magnetic resonance imaging revealed the presence of a large midline intracranial mass extending from the frontal lobe to the tentorial region of the brain. Euthanasia was elected due to poor prognosis. Histopathologic evaluation confirmed the presence of a mass composed by sheets and aggregates of large round/polygonal cells and multinucleate cells associated with deposits of cholesterol clefts, scattered hemorrhages and hemosiderin-laden macrophages. Immunohistochemistry showed that the round/polygonal cells and multinucleate cells were strongly positive for major histocompatibility complex class II antigen, variably positive for CD18, and occasionally positive for S100. Subsets of spindle cells showing variable expression of vimentin, S100, and neuron-specific enolase were also present. The final diagnosis was cholesterol granuloma. Differential diagnosis with meningioma is discussed.
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Affiliation(s)
- K Faller
- Neurology Unit, Small Animal Hospital, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, United Kingdom
| | - J Leach
- Veterinary Diagnostic Services, Department of Veterinary Biosciences, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, United Kingdom
| | - R Gutierrez-Quintana
- Neurology Unit, Small Animal Hospital, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, United Kingdom
| | - M Finck
- Diagnostic Imaging Unit, Small Animal Hospital, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, United Kingdom
| | - G Hammond
- Diagnostic Imaging Unit, Small Animal Hospital, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, United Kingdom
| | - J Penderis
- Neurology Unit, Small Animal Hospital, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, United Kingdom
| | - F Marchesi
- Veterinary Diagnostic Services, Department of Veterinary Biosciences, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, United Kingdom
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Gruzelier J, Hirst L, Holmes P, Leach J. Immediate effects of alpha/theta and sensory-motor rhythm feedback on music performance. Int J Psychophysiol 2014; 93:96-104. [DOI: 10.1016/j.ijpsycho.2014.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 03/09/2014] [Accepted: 03/19/2014] [Indexed: 11/30/2022]
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Abstract
IMPORTANCE Auricular reconstruction is a unique blend of cosmesis and functionality. The choice of the optimal framework material to use is an important decision for the patient with microtia. OBJECTIVE To evaluate and compare the outcomes of reconstruction of microtia using porous polyethylene implants and rib cartilage grafts. DESIGN, SETTING, AND PARTICIPANTS Retrospective medical record review from January 1, 2001, through December 31, 2012, at a tertiary academic institution. Thirty-five patients (36 ears) undergoing microtia repair were divided into groups using high-density porous polyethylene (17 ears), rib cartilage (17 ears), and both materials (2 ears). Only patients with completed repair were included in the analysis. EXPOSURES Reconstructive surgery for microtia. MAIN OUTCOME AND MEASURES We compared groups in terms of mean number of operations, age at treatment initiation, and complications (infection, extrusion, cartilage exposure, and pneumothorax). Photographs were graded by blinded observers to give each patient a score on protrusion, definition, shape, size, location, and color match. RESULTS The cartilage group was older than the polyethylene group (mean age, 8.0 vs 6.9 years; P = .23). The mean number of operations was 4.88 for the cartilage group vs 3.35 for the polyethylene group (P = .004). Two patients in the polyethylene group had postoperative infections and implant extrusion and underwent subsequent reconstruction with cartilage grafts. Patients in the cartilage group had no infection or extrusion; 1 had a minor cartilage exposure. No patient had pneumothorax. Patients in the polyethylene group had significantly better grades for ear definition and size match, whereas those in the cartilage group had a significantly better color match. Patients in the cartilage group had better protrusion and location outcomes, although the difference was not significant. CONCLUSIONS AND RELEVANCE Comparison of reconstruction with porous polyethylene implants and rib cartilage grafts showed neither material to be clearly superior. Polyethylene implants may achieve a better cosmetic outcome in the categories of ear definition, shape, and size with a higher risk for infection and extrusion. Patients in the cartilage group were older and underwent significantly more surgical procedures, which should factor into the decision on which technique to choose. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Kristin K Constantine
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
| | - Jim Gilmore
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
| | - Kenneth Lee
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
| | - Joseph Leach
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
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Tippelt S, Mikasch R, Warmuth-Metz M, Pietsch T, Hilger RA, Kwiecien R, Faldum A, Rutkowski S, Bode U, Siegler N, Fleischhack G, Dufour C, Delisle MB, Geoffray A, Laplanche A, Frappaz D, Icher C, Bertozzi AI, Leblond P, Doz F, Andre N, Schneider P, De Carli E, Berger C, Lejars O, Chastagner P, Soler C, Entz-Werle N, Valteau-Couanet D, Burzynski S, Janicki T, Burzynski G, Marszalek A, Deiss A, Korshunov A, Capper D, Witt H, van Tilburg C, von Deimling A, Kulozik AE, Pfister SM, Witt O, Milde T, Dhall G, Haley K, Finlay J, Rushing T, Sposto R, Seeger R, Lulla RR, Goldman S, Beattie C, DasGupta TK, Pollack I, Fisher PG, Wu S, Boyett JM, Fouladi M, Meijer L, Veal G, Walker D, Grundy R, Meijer L, Veal G, Grundy R, Konczalik W, Ivanov D, Garnett M, Parker T, Kearns P, Walker D, Grundy R, Garnett M, Rahman R, Smith S, Meijer L, Walker D, Kimpo M, Yan B, Ning C, Villegas M, Alcasabas AP, Juh YE, Chong QT, Lin TP, Dewire M, Fouladi M, Drissi R, Chow L, Goldman S, Pai A, Leach J, Lane A, Backus L, Grimme L, Tabares J, Kumar S, Sobo M, Hummel TR, Alharbi M, Abdullah S, Alharbi Q, Alshahrani M, Mosleh O, Balbaid A, Alkofide A, Alkhayat N, AlFar K, Banyhamdan A, Ahmed O, El-Badawy S, Bouffet E, Jiang MW, Zhou RH, Zhou Q, Yuan XJ, Ma J, Turner D, Wright K, Broniscer A, Robinson G, Qaddoumi I, Armstrong G, Gajjar A, Stewart C, Misra SN, Misra AK, Michalski A, Stiller C. CLINICAL TRIALS. Neuro Oncol 2014; 16:i10-i13. [PMCID: PMC4046282 DOI: 10.1093/neuonc/nou066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023] Open
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Classen CF, William D, Linnebacher M, Farhod A, Kedr W, Elsabe B, Fadel S, Van Gool S, De Vleeschouwer S, Koks C, Garg A, Ehrhardt M, Riva M, De Vleeschouwer S, Agostinis P, Graf N, Van Gool S, Yao TW, Yoshida Y, Zhang J, Ozawa T, James D, Nicolaides T, Kebudi R, Cakir FB, Gorgun O, Agaoglu FY, Darendeliler E, Van Gool S, De Vleeschouwer S, Al-Kofide A, Al-Shail E, Khafaga Y, Al-Hindi H, Dababo M, Haq AU, Anas M, Barria MG, Siddiqui K, Hassounah M, Ayas M, van Zanten SV, Jansen M, van Vuurden D, Huisman M, Vugts D, Hoekstra O, van Dongen G, Kaspers G, Cockle J, Ilett E, Scott K, Bruning-Richardson A, Picton S, Short S, Melcher A, Benesch M, Warmuth-Metz M, von Bueren AO, Hoffmann M, Pietsch T, Kortmann RD, Eyrich M, Graf N, Rutkowski S, Fruhwald MC, Faber J, Kramm C, Porkholm M, Valanne L, Lonnqvist T, Holm S, Lannering B, Riikonen P, Wojcik D, Sehested A, Clausen N, Harila-Saari A, Schomerus E, Thorarinsdottir HK, Lahteenmaki P, Arola M, Thomassen H, Saarinen-Pihkala UM, Kivivuori SM, 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HIGH GRADE GLIOMAS AND DIPG. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou071] [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: 11/14/2022] Open
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Morales H, Lu A, Kurosawa Y, Clark JF, Leach J, Weiss K, Tomsick T. Decreased infarct volume and intracranial hemorrhage associated with intra-arterial nonionic iso-osmolar contrast material in an MCA occlusion/reperfusion model. AJNR Am J Neuroradiol 2014; 35:1885-91. [PMID: 24812016 DOI: 10.3174/ajnr.a3953] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Infarct volume and intracranial hemorrhage after reperfusion with nonionic low-osmolar and iso-osmolar iodinated IRCM has not been previously compared. We postulated that iso-osmolar and low-osmolar iodinated contrast media exert varied effects on cerebral infarct after intra-arterial injection. We compared infarct volume and hemorrhagic changes following intra-arterial infusion of iodixanol, iopamidol, or normal saline in a rat MCA occlusion/reperfusion model. MATERIALS AND METHODS Infarct was induced in 30 rats by a previously validated method of MCA suture occlusion. Reperfusion was performed after 5 hours with either iodixanol (n = 9), iopamidol (n = 12), or saline (n = 9). MR images were obtained at both 6 and 24 hours after ischemia, followed by sacrifice. Infarct volume was measured with T2WI and DWI by semiautomatic segmentation. Incidence and area of hemorrhage were measured on brain sections postmortem. RESULTS T2WI mean infarct volumes were 242 ± 89, 324 ± 70, and 345 ± 92 mm(3) at 6 hours, and 341 ± 147,470 ± 91, and 462 ± 71 mm(3) at 24 hours in the iodixanol, iopamidol, and saline groups, respectively. Differences in infarct volume among groups were significant at 6 hours (P < .03) and 24 hours (P < .05). In the iodixanol, iopamidol, and saline groups, mean areas for cortical intracranial hemorrhage were 0.8, 18.2, and 25.7 mm(2); and 28, 31, and 56.7 mm(2), respectively, for deep intracranial hemorrhage. The differences in intracranial hemorrhage area among groups were statistically significant for cortical intracranial hemorrhage (P < .01). CONCLUSIONS Intra-arterial infusion of nonionic iso-osmolar iodixanol showed reduced infarct volume and reduced cortical intracranial hemorrhage areas in comparison with nonionic low-osmolar iopamidol and saline. Our results may be relevant in the setting of intra-arterial therapy for acute stroke in humans, warranting further investigation.
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Affiliation(s)
- H Morales
- From the Departments of Radiology (H.M., J.L., T.T.)
| | - A Lu
- Neurology (A.L., Y.K., J.F.C.), University of Cincinnati, Cincinnati, Ohio
| | - Y Kurosawa
- Neurology (A.L., Y.K., J.F.C.), University of Cincinnati, Cincinnati, Ohio
| | - J F Clark
- Neurology (A.L., Y.K., J.F.C.), University of Cincinnati, Cincinnati, Ohio
| | - J Leach
- From the Departments of Radiology (H.M., J.L., T.T.)
| | - K Weiss
- Department of Radiology (K.W.), University of Mississippi, Oxford, Mississippi
| | - T Tomsick
- From the Departments of Radiology (H.M., J.L., T.T.)
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