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Fanucci KA, Bai Y, Pelekanou V, Nahleh ZA, Shafi S, Burela S, Barlow WE, Sharma P, Thompson AM, Godwin AK, Rimm DL, Hortobagyi GN, Liu Y, Wang L, Wei W, Pusztai L, Blenman KRM. Image analysis-based tumor infiltrating lymphocytes measurement predicts breast cancer pathologic complete response in SWOG S0800 neoadjuvant chemotherapy trial. NPJ Breast Cancer 2023; 9:38. [PMID: 37179362 PMCID: PMC10182981 DOI: 10.1038/s41523-023-00535-0] [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: 04/25/2022] [Accepted: 04/11/2023] [Indexed: 05/15/2023] Open
Abstract
We assessed the predictive value of an image analysis-based tumor-infiltrating lymphocytes (TILs) score for pathologic complete response (pCR) and event-free survival in breast cancer (BC). About 113 pretreatment samples were analyzed from patients with stage IIB-IIIC HER-2-negative BC randomized to neoadjuvant chemotherapy ± bevacizumab. TILs quantification was performed on full sections using QuPath open-source software with a convolutional neural network cell classifier (CNN11). We used easTILs% as a digital metric of TILs score defined as [sum of lymphocytes area (mm2)/stromal area(mm2)] × 100. Pathologist-read stromal TILs score (sTILs%) was determined following published guidelines. Mean pretreatment easTILs% was significantly higher in cases with pCR compared to residual disease (median 36.1 vs.14.8%, p < 0.001). We observed a strong positive correlation (r = 0.606, p < 0.0001) between easTILs% and sTILs%. The area under the prediction curve (AUC) was higher for easTILs% than sTILs%, 0.709 and 0.627, respectively. Image analysis-based TILs quantification is predictive of pCR in BC and had better response discrimination than pathologist-read sTILs%.
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Affiliation(s)
- Kristina A Fanucci
- Department of Internal Medicine Section of Medical Oncology and Yale Cancer Center, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA
| | - Yalai Bai
- Department of Pathology, Yale School of Medicine, 310 Cedar St, New Haven, CT, 06520, USA
| | - Vasiliki Pelekanou
- Department of Pathology, Yale School of Medicine, 310 Cedar St, New Haven, CT, 06520, USA
- Bayer Pharmaceuticals, 245 First St Cambridge Science Center 100 and 200 Floors 1 and 2, Cambridge, MA, 02142, USA
| | - Zeina A Nahleh
- Department of Hematology/Oncology, Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Saba Shafi
- Department of Pathology, Yale School of Medicine, 310 Cedar St, New Haven, CT, 06520, USA
- Department of Pathology, Ohio State University, 6100 Optometry Clinic & Health Sciences Faculty Office Building, 1664 Neil Avenue, Columbus, OH, 43210, USA
| | - Sneha Burela
- Department of Pathology, Yale School of Medicine, 310 Cedar St, New Haven, CT, 06520, USA
| | - William E Barlow
- SWOG Statistics and Data Management Center, 1730 Minor Avenue Suite 1900, Seattle, WA, 98101, USA
| | - Priyanka Sharma
- Department of Medical Oncology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Alastair M Thompson
- Section of Breast Surgery, 1 Baylor Plaza, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Andrew K Godwin
- Department of Medical Oncology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - David L Rimm
- Department of Pathology, Yale School of Medicine, 310 Cedar St, New Haven, CT, 06520, USA
| | - Gabriel N Hortobagyi
- Department of Breast Medical Oncology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Yihan Liu
- Department of Biostatistics, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, USA
| | - Leona Wang
- Department of Biostatistics, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, USA
| | - Wei Wei
- Department of Biostatistics, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, USA
| | - Lajos Pusztai
- Department of Internal Medicine Section of Medical Oncology and Yale Cancer Center, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA
| | - Kim R M Blenman
- Department of Internal Medicine Section of Medical Oncology and Yale Cancer Center, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA.
- Department of Computer Science, Yale School of Engineering and Applied Science, 17 Hillhouse Avenue, New Haven, CT, 06520, USA.
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Fanucci KA, Yang A, Chambers A, Dizon D, Safran H, Niroula R. Objective Impact of Hematology-Oncology Hospitalist Care in an Inpatient Setting. JCO Oncol Pract 2022; 18:e1641-e1647. [DOI: 10.1200/op.22.00208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: The utilization of the hospitalist care model has increased over the past decade because of improved cost-effectiveness, quality of care, and value that it provides. Studies have shown that compared with the traditional care model, use of hospitalists provides cost-saving and improved value to hospital systems. However, the data for the use of oncology hospitalists (ONC Hosp) are sparse. In this study, we investigate the impact of inpatient ONC Hosp on 30-day readmissions, length of stay (LOS), discharge to hospice, and inpatient mortality when compared with a traditional model where outpatient oncologists manage the acute issues of hospitalized patients with cancer. METHODS: Rhode Island Hospital hired ONC Hosps to attend on the inpatient oncology service. To determine the impact of this new patient care model, we performed a retrospective review of oncology patients admitted to Rhode Island Hospital between July 1, 2012, and June 30, 2018, and compared quality outcomes of 30-day readmission, LOS, discharge to hospice, and inpatient mortality to those from the traditional care model. RESULTS: Compared with outpatient oncologists care, care by ONC Hosp was associated with a significant decrease in 30-day readmissions (23.0% v 29.6%, P = .019) and a significant increase in discharge to hospice (18.1% v 12.1%, P < .001). No significant difference was detected between LOS ( P = .833) or inpatient mortality ( P = .332). CONCLUSION: This study shows that compared with the traditional care model, the use of ONC Hosps has a positive impact on patient care and the potential to add value to the hospital system.
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Affiliation(s)
- Kristina A. Fanucci
- Yale University, New Haven, CT
- Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Andrew Yang
- Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Alison Chambers
- Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Don Dizon
- Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Howard Safran
- Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Rabin Niroula
- Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
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Fanucci KA, Fenton MA, Duffy C, Higel-McGovern C, Dizon D. Abstract P2-13-13: For women with bone-only metastatic breast cancer, is there a benefit to primary prevention? Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p2-13-13] [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 prognosis of patients with estrogen receptor positive (ER+) bone-only metastatic breast cancer (B-MBC) is good, with the average life expectancy extending years with contemporary management. In the general population, studies investigating the impact of screening programs designed to detect disease as early as possible in otherwise asymptomatic patients have consistently shown reduction in morbidity and mortality but outcomes among patients living with B-MBC has not been adequately addressed. This study aimed to investigate the rate at which patients with ER+ breast cancer metastatic only to bone underwent cholesterol, breast cancer, colon cancer, and lung cancer screening and to determine if this screening had any impact on overall survival and cause of death.
Methods: We conducted a retrospective chart review of patients treated for ER+ B-MBC at the Lifespan Cancer Institute in Providence, RI between 1/1/15 and 5/31/18. Each patient’s medical records and tumor registry information were reviewed. Data on these patients’ disease history were collected along with data on cholesterol, breast cancer, colon cancer, and lung cancer screening. Descriptive statistics were calculated using STATA statistical software.
Results: A total of 48 patients with ER+ B-MBC were identified. Median overall survival from initial diagnosis of breast cancer was 148 months; measured from the diagnosis of bone metastasis, it was 52.4 months. Twenty-nine out of the 48 patients received cholesterol screening (60%), 14/48 had mammograms (29%), and only 8/48 had colonoscopy (17%). No patients underwent screening lung CT (Table 1). Compared to those who did not undergo screening, patients who were screened for cholesterol had significantly longer median overall survival (175.4 vs 106 months, respectively, p=.02) and those undergoing mammogram had a trend towards longer survival (187 vs 131 months, p=.08). Screening was not associated with a difference in rates of death attributed to breast cancer. No deaths due to other malignancies were identified. Of those undergoing mammography, only one abnormal report was identified, and biopsy of the lesion was benign.
Table 1: Rate of abnormal screening results, median overall survival from index diagnosis, and death from index breast cancer.Abnormal screening resultMedian OS (months)95% CIp valueDeath from IBCp valueCholesterolscreened18/25175.4135 - 2160.02**1/20.30not screened10668 - 1445/6Mammogramscreened1/14187116 - 2590.08*3/40.60not screened131101 - 1626/10OS=overall survival. CI=confidence interval. IBC=index breast cancer. ** = p < 0.05. *= p < 0.1
Conclusions: A large proportion of patients with B-MBC undergo primary preventative screening measures, and of these, cholesterol screening is the most common. Screening was associated with longer overall survival, but did not change the rates of death due to breast cancer. These results suggest that clinicians are offering screening to a subgroup of women who are healthy despite B-MBC. However, our data suggest there is little benefit to screening, and this should be addressed in a larger dataset.
Citation Format: Kristina A Fanucci, Mary Anne Fenton, Christine Duffy, Camille Higel-McGovern, Don Dizon. For women with bone-only metastatic breast cancer, is there a benefit to primary prevention? [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-13-13.
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Sorensen EP, Fanucci KA, Saraiya A, Volf E, Au SC, Argobi Y, Mansfield R, Gottlieb AB. Tumor Necrosis Factor Inhibitor Primary Failure Predicts Decreased Ustekinumab Efficacy in Psoriasis Patients. J Drugs Dermatol 2015; 14:893-898. [PMID: 26267736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Additional studies are needed to examine the efficacy of ustekinumab in psoriasis patients who have previously been exposed to tumor necrosis factor inhibitors (TNFi). OBJECTIVE To examine the predictive effect of TNFi primary failure and the number of TNFi exposures on the efficacy of ustekinumab in psoriasis treatment. METHODS This retrospective study examined 44 psoriasis patients treated at the Tufts Medical Center Department of Dermatology between January 2008 and July 2014. Patients were selected if they were treated with ustekinumab and had ≥ 1 previous TNFi exposure. The following subgroups were compared: patients with vs without a previous TNFi primary failure, and patients with one vs multiple previous TNFi exposures. The efficacy measure used was the previously validated Simple Measure for Assessing Psoriasis Activity (S-MAPA), which is calculated by the product of the body surface area and physician global assessment. The primary outcome was the percentage improvement S-MAPA from course baseline at week 12 of ustekinumab treatment. Secondary outcomes were the psoriasis clearance, primary failure, and secondary failure rates with ustekinumab treatment. RESULTS Patients with a previous TNFi primary failure had a significantly lower percentage improvement in S-MAPA score at week 12 of ustekinumab treatment compared with patients without TNFi primary failure (36.2% vs 61.1%, P=.027). Multivariate analysis demonstrated that this relationship was independent of patient demographics and medical comorbidities. Patients with multiple TNFi exposures had a non-statistically significant lower percentage S-MAPA improvement at week 12 (40.5% vs 52.9%, P=.294) of ustekinumab treatment compared with patients with a single TNFi exposure. CONCLUSIONS Among psoriasis patients previously exposed to TNFi, a history of a previous TNFi primary failure predicts a decreased response to ustekinumab independent of patient demographics and medical comorbidities.
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