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Monge C, Xie C, Myojin Y, Coffman K, Hrones DM, Wang S, Hernandez JM, Wood BJ, Levy EB, Juburi I, Hewitt SM, Kleiner DE, Steinberg SM, Figg WD, Redd B, Homan P, Cam M, Ruf B, Duffy AG, Greten TF. Phase I/II study of PexaVec in combination with immune checkpoint inhibition in refractory metastatic colorectal cancer. J Immunother Cancer 2023; 11:jitc-2022-005640. [PMID: 36754451 PMCID: PMC9923269 DOI: 10.1136/jitc-2022-005640] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Oncolytic immunotherapy represents a unique therapeutic platform for the treatment of cancer. Here, we evaluated the safety and efficacy of the combination of pexastimogene devacirepvec (PexaVec) plus durvalumab (anti-programmed death ligand 1) with and without tremelimumab (anti-cytotoxic T-lymphocyte associated protein 4) in patients with standard chemotherapy refractory mismatch repair proficient (pMMR) metastatic colorectal cancer (mCRC) in a phase I/II trial. METHODS Adult patients with histologically confirmed advanced pMMR mCRC, who had progressed on at least two prior lines of systemic chemotherapy were studied in four cohorts. Patients received four doses of PexaVec IV at a dose of 3×108 plaque forming units (pfu) (dose level 1) or 1×109 pfu (dose level 2) every 2 weeks. Twelve days after the first PexaVec administration, patients received either 1500 mg of durvalumab every 28 days alone or an additional single dose of 300 mg tremelimumab on day 1. Responses were assessed every 8 weeks by CT or MRI. AEs were recorded. The primary endpoints were safety and feasibility. Secondary endpoints included progression-free survival (PFS) and overall survival. Paired tumor samples and peripheral blood were collected to perform immune monitoring. RESULTS Thirty-four patients with mCRC enrolled on to the study: 16 patients in the PexaVec/durvalumab cohorts and 18 patients in the PexaVec/durvalumab/tremelimumab cohorts. Overall, the combination of PexaVec plus immune checkpoint inhibitors did not result in any unexpected toxicities. Most common toxicities observed were fever and chills after PexaVec infusion. Two cases of grade 3 colitis, one case of a grade 2 myositis and one case of grade 3 hypotension resulted in discontinuation of immune checkpoint inhibitor and PexaVec treatment, respectively. The median PFS in the PexaVec/durvalumab/tremelimumab cohorts was 2.3 months (95% CI: 2.2 to 3.2 months) vs 2.1 months (95% CI: 1.7 to 2.8 months; p=0.57) in the PexaVec/durvalumab cohorts. Flow cytometry analysis of peripheral blood mononuclear cells revealed an increase in Ki67+CD8+ T cells on treatment. CONCLUSION PexaVec in combination with durvalumab and tremelimumab is safe and tolerable. No unexpected toxicities were observed. The combination of PexaVec/durvalumab/tremelimumab demonstrated potential clinical activity in patients with pMMR mCRC, but further studies are needed to identify the predictive biomarkers. TRIAL REGISTRATION NUMBER NCT03206073.
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Affiliation(s)
- Cecilia Monge
- Gastrointestinal Malignancies Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Changqing Xie
- Gastrointestinal Malignancies Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Yuta Myojin
- Gastrointestinal Malignancies Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kelley Coffman
- Gastrointestinal Malignancies Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Donna Mabry Hrones
- Gastrointestinal Malignancies Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sophie Wang
- Gastrointestinal Malignancies Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jonathan M Hernandez
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center & Center for Cancer Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Elliot B Levy
- Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center & Center for Cancer Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Israa Juburi
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Stephen M Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - David E Kleiner
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - William D Figg
- Molecular Pharmacology Section, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Bernadette Redd
- Radiology and Imaging Sciences, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Philip Homan
- Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Maggie Cam
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Benjamin Ruf
- Gastrointestinal Malignancies Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Austin G Duffy
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Tim F Greten
- Gastrointestinal Malignancies Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
- Liver Cancer Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Raj N, Coffman K, Le T, Kinh Gian Do R, Rafailov J, Choi Y, Chou JF, Capanu M, Dunphy M, Fox JJ, Grewal RK, Reddy RP, Riedl C, Schoder H, Bodei L, Reidy-Lagunes D. Treatment Response and Clinical Outcomes of Well-Differentiated High-Grade Neuroendocrine Tumors to Lutetium-177-DOTATATE. Neuroendocrinology 2022; 112:1177-1186. [PMID: 35609558 PMCID: PMC9671816 DOI: 10.1159/000525216] [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: 02/04/2022] [Accepted: 05/16/2022] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Lutetium-177 (177Lu)-DOTATATE received FDA approval in 2018 to treat somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (NETs). Little data are available on response and outcomes for well-differentiated (WD) high-grade (HG) NETs treated with 177Lu-DOTATATE. MATERIALS AND METHODS Patients with WD HG NETs treated with 177Lu-DOTATATE at MSK from 2018 to 2020 were identified. Demographics, response (RECIST 1.1), and progression-free survival (PFS) were determined. Next-generation sequencing (NGS) was performed in the archival tumor. RESULTS Nineteen patients, all with progressive, heavily treated disease, were identified. Sites of tumor origin were: pancreas (74%), small bowel (11%), rectum (11%), and lung (5%); median Ki-67 was 32% (range 22-56). Thirteen patients (68%) completed all four 177Lu-DOTATATE cycles. Best response (N = 18 evaluable) was: 5/18 (28%) partial response, 8/18 (44%) stable disease, and 5/18 (28%) disease progression. Median PFS was 13.1 months (95% CI: 8.7-20.9). Most common treatment-related toxicities were thrombocytopenia (9 patients, 47%; G3/4, 1 patient, 5%), anemia (7 patients, 37%; G3/4, 2 patients, 11%), leukopenia (6 patients, 32%; G3/4, 0 patients), and liver function test elevation (4 patients, 21%; G3/4, 0 patients). NGS results were available from 13/19 tumors (68%). The most observed alterations were in MEN1 (6/13, 46%) and DAXX (4/13, 31%). No RB1 alterations identified. CONCLUSION We observed a meaningful disease control rate of 72% during treatment of WD HG NETs with 177Lu-DOTATATE. In this heavily pre-treated population, more than half of patients received all four treatment cycles with toxicities largely bone marrow-related. As would be expected in WD NETs, the vast majority had alterations in chromatin remodeling genes and no RB1 alterations.
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Affiliation(s)
- Nitya Raj
- Department of Medicine, Division of Gastrointestinal Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Kelley Coffman
- Department of Medicine, Division of Gastrointestinal Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Tiffany Le
- Department of Medicine, Division of Gastrointestinal Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Richard Kinh Gian Do
- Department of Medicine, Division of Gastrointestinal Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Johnathan Rafailov
- Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Ye Choi
- Department of Radiology, Division of Nuclear Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Joanne F. Chou
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Marinela Capanu
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Mark Dunphy
- Department of Radiology, Division of Nuclear Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Josef J. Fox
- Department of Radiology, Division of Nuclear Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Ravinder K. Grewal
- Department of Radiology, Division of Nuclear Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Ryan P. Reddy
- Department of Radiology, Division of Nuclear Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Christopher Riedl
- Department of Radiology, Division of Nuclear Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Heiko Schoder
- Department of Radiology, Division of Nuclear Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Lisa Bodei
- Department of Radiology, Division of Nuclear Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Diane Reidy-Lagunes
- Department of Medicine, Division of Gastrointestinal Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY USA
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Coffman K, Chen XJC, Okamura C, Louie E. IVIG - A cure to severe refractory NAP-1 Clostridium difficile colitis? A case of successful treatment of severe infection, which failed standard therapy including fecal microbiota transplants and fidaxomicin. IDCases 2017; 8:27-28. [PMID: 28331803 PMCID: PMC5348590 DOI: 10.1016/j.idcr.2017.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 01/15/2017] [Revised: 03/02/2017] [Accepted: 03/02/2017] [Indexed: 02/04/2023] Open
Abstract
The mainstay treatment of Clostridium difficile infections (CDI) is antimicrobials with growing support for fecal microbiota transplants. We report the first case of an elderly man with severe refractory NAP-1 pseudomembranous CDI who failed all medical therapy and two fecal transplants with response only seen after administration of intravenous immunoglobulin.
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Affiliation(s)
- Kelley Coffman
- Department of Medicine, NYU Langone Medical Center, New York, NY, USA
| | | | - Charles Okamura
- Department of Medicine, NYU Lutheran Medical Center, Brooklyn, NY, USA
| | - Eddie Louie
- Department of Medicine, Department of Infectious Diseases & Immunology, NYU Langone Medical Center, New York, NY, USA
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Deierlein A, Coffman K, Claudio L. Analysis of the Caloric and Macronutrient Content of Meal Options Offered to Children at Popular Restaurant Chains. Int J Child Health Nutr 2014. [DOI: 10.6000/1929-4247.2014.03.02.6] [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: 11/01/2022]
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Mohammed SI, Coffman K, Glickman NW, Hayek MG, Waters DJ, Schlittler D, DeNicola DB, Knapp DW. Prostaglandin E2 concentrations in naturally occurring canine cancer. Prostaglandins Leukot Essent Fatty Acids 2001; 64:1-4. [PMID: 11161579 DOI: 10.1054/plef.2000.0231] [Citation(s) in RCA: 52] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to determine the PGE2 concentration in naturally-occurring cancer in pet dogs and in canine cancer cell lines in order to identify specific types of canine cancer with high PGE2 production which could serve as preclinical models to evaluate anticancer strategies targeting PGE2. PGE2 concentrations were measured by enzyme immunoassay in canine melanoma, soft tissue sarcoma, transitional cell carcinoma, osteosarcoma, and prostatic carcinoma cell lines; in 80 canine tumor tissue samples including oral melanoma (MEL), oral squamous cell carcinoma (SCC), transitional cell carcinoma of the urinary bladder (TCC), lymphoma (LSA), mammary carcinoma (MCA), osteosarcoma (OSA), prostatic carcinoma (PCA); and in corresponding normal organ tissues. High concentrations of PGE(2)(range 400-3300 pg/10(4)cells) were present in cell culture medium from the transitional cell carcinoma, prostatic carcinoma, and osteosarcoma cell lines. PGE2 concentrations in tumor tissues were elevated (tumor PGE2 concentration>mean+2X sd PGE(2)concentration of normal organ tissue) in 21/22 TCC, 5/6 PCA, 7/10 SCC, 5/10 MEL, 3/8 MCA, 4/15 OSA, and 0/9 LSA. Results of this study will help guide future investigations of anticancer therapies that target cyclooxygenase and PGE2.
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Affiliation(s)
- S I Mohammed
- Department of Veterinary Clinical Sciences, Purdue University, West Lafayette, IN 47907-1248, USA
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Mansfield JF, Adamson A, Coffman K. Development of a System to Provide Full, Real-time Remote Control of a Scanning Electron Microscope across the Second Generation Internet: The Teaching SEM. Microsc Microanal 2000; 6:31-41. [PMID: 10675441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The development and makeup of a real-time full remote control system for the University of Michigan, Department of Materials Science and Engineering Teaching SEM is described. The instrument was initially controlled via the campus local area Ethernet network and cable TV network. The latest implementation employs Fast Ethernet, Asynchronous Transfer Mode (ATM) networks, and moving picture experts group (MPEG) video encoding to effect the remote control via the computer network alone. Remote control demonstrations from Washington, DC, Dearborn, MI, and Emerson School, Ann Arbor, MI are described.
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Affiliation(s)
- JF Mansfield
- North Campus Electron Microbeam Analysis Laboratory, 417 SRB, University of Michigan, 2455 Hayward, Ann Arbor, MI 48109-2143
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Abstract
BACKGROUND Molecules that are highly expressed by human prostate cancers may serve as therapeutically relevant targets or tumor markers. Tyrosine kinases are frequently overexpressed in metastatic tumor cells and this prompted us to screen for tyrosine kinases that are overexpressed in prostate cancer cells. METHODS Expression levels of the EphA2 receptor tyrosine kinase were determined by Western blot analysis in canine and human prostate cancer cell lines and in immortalized and transformed variants of 267B1 prostatic epithelial cells. EphA2 levels in benign human prostate and prostate cancers were also determined in formalin-fixed, paraffin-embedded tissues using immunohistochemical staining. RESULTS Metastatic prostate cancer cells overexpressed EphA2 by 10-100 fold as compared with non-invasive prostatic epithelial cells. EphA2 immunoreactivity in vivo was also significantly greater in human prostate cancers as compared with benign prostate epithelium. CONCLUSIONS The EphA2 receptor tyrosine kinase is differentially expressed in human and canine prostate cancer cell lines and overexpressed in human prostate cancers as compared with benign prostate tissues. Metastasis-derived canine prostate carcinoma cell lines overexpress EphA2 and may provide pre-clinical models to further evaluate the role of EphA2 in prostate carcinogenesis. Further investigations are needed to determine the utility of EphA2 as a tumor marker and a novel target in human prostate cancer.
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Affiliation(s)
- J Walker-Daniels
- Department of Basic Medical Sciences, Purdue University, West Lafayette, Indiana 47907-1246, USA
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Affiliation(s)
- A K Shetty
- Department of Pediatrics, Louisiana State University Medical Center, Children's Hospital, New Orleans, USA
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Beresford TP, Turcotte JG, Merion R, Burtch G, Blow FC, Campbell D, Brower KJ, Coffman K, Lucey M. A rational approach to liver transplantation for the alcoholic patient. Psychosomatics 1990; 31:241-54. [PMID: 2095755 DOI: 10.1016/s0033-3182(90)72160-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- T P Beresford
- Department of Psychiatry, University of Michigan Alcohol Research Center, Ann Arbor 48104
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Roberton DM, Carlsson B, Coffman K, Hahn-Zoric M, Jalil F, Jones C, Hanson LA. Avidity of IgA antibody to Escherichia coli polysaccharide and diphtheria toxin in breast milk from Swedish and Pakistani mothers. Scand J Immunol 1988; 28:783-9. [PMID: 3068790 DOI: 10.1111/j.1365-3083.1988.tb01512.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The avidity of breast milk IgA antibody was studied with the aid of thiocyanate elution of antibody from solid-phase bound E.coli polysaccharides and diphtheria toxoid. The relative avidity index for each sample was determined by the molarity of thiocyanate required to elute 50% of the bound IgA antibody under conditions of antigen excess. Milk samples collected from Pakistani mothers during early lactation (2-4 weeks after delivery; n = 12) had a significantly lower median relative avidity index of IgA antibody to E.coli antigens than did early lactation samples from Swedish mothers (n = 11; avidity indices 1.78 M and 2.65 M; P less than 0.02). Samples collected from Pakistani mothers in mid-lactation showed a significant rise in the relative avidity index to a median of 2.50 M (P less than 0.01), with a subsequent fall in late lactation (28-36 weeks after delivery) to 1.75 M (P less than 0.01). Milk samples from Pakistani mothers in mid-lactation (n = 12) also had a lower median relative avidity index of IgA antibody to diphtheria toxoid than did samples from Swedish mothers (n = 14; avidity indices 2.35 M and 4.30 M; P less than 0.002). The lower avidity of breast milk IgA in Pakistani mothers in comparison with Swedish mothers may arise from differences in antigen exposure or nutritional status or could possibly be genetically determined.
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Affiliation(s)
- D M Roberton
- Department of Clinical Immunology, University of Gothenburg, Sweden
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12
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Abstract
We explored the history in two children who had bizarre, hyperpigmented skin lesions suggestive of child abuse. A final diagnosis of phytophotodermatitis was established. The lesions resulted from inadvertent application of squeezed lime juice to the children's skin by their parents during the routine preparation of drinks, followed by sun exposure, which activated the applied plant psoralens (furocoumarins). Phytophotodermatitis can be induced by a number of plants, and, when unrecognized, may lead to inappropriate investigation of child abuse.
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Coffman K. Dr. R. Gordon Bell: Canada's compassionate pioneer in alcohol treatment. Can Doct 1982; 48:25-8. [PMID: 10316010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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Abstract
In an extensive series of experiments Sternberg, Monsell, Knoll, and Wright (1978) reported that simple RT increased as a linear function of the number of items to be pronounced or typed. The present experiments replicate a portion of these results, but show that the effect is less general than may have been supposed. Since the effect does not occur in every case in which a response programming interpretation would predict it, this interpretation must be rejected. This conclusion is consistent with the viewpoint that response programming should be investigated in a choice- rather than simple-RT paradigm. In this view, motivated subjects can program responses in advance of the simple-RT interval because the particular response to be made has been precued. Effects of response parameters which are observed for motivated subjects in the simple-RT paradigm, such as those reported by Sternberg et al. (1978), should be attributed to processes other than programming motor responses.
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Affiliation(s)
- S Klapp
- Department of Psychology, California State University, Hayward, CA 94542, USA
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