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Chawla SP, Olevsky O, Iyengar G, Brigham DA, Omelchenko N, Thomas S, Suryamohan K, Foshag L, Hall FL, Gordon EM. Early-stage CCNG1+ HR+ HER2+ Invasive Breast Carcinoma in Older Women: Current Treatment and Future Perspectives for DeltaRex-G, a CCNG1 Inhibitor. Anticancer Res 2023; 43:2383-2391. [PMID: 37247916 DOI: 10.21873/anticanres.16406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/11/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023]
Abstract
Women with HR+HER2+ early-stage breast cancer are disadvantaged by the lack of clinical trials focused on women ≥70 years of age. In the past years, there has been increasing controversy on the use of toxic chemotherapy as standard of care treatment for early- stage HR+ HER2+ breast carcinoma in older women. With precision medicine coming of age, molecular profiling of tumors and circulating tumor DNA has identified target oncogenes that could be used in designing an optimal treatment for this group of women. This article reviews the current treatment of early-stage triple receptor positive breast cancer, the risks of chemotherapy in older women, and CCNG1, a novel biomarker in development for the use of DeltaRex-G, a CCNG1 inhibitor. Further, future perspectives for DeltaRex-G in older women with early stage CCNG1+ HR+ HER2+ breast cancer are discussed.
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Affiliation(s)
- Sant P Chawla
- Cancer Center of Southern California, Santa Monica, CA, U.S.A
| | - Olga Olevsky
- UCLA David Geffen School of Medicine, Santa Monica, CA, U.S.A
| | - Geeta Iyengar
- Medical Imaging Center of Southern California, Santa Monica, CA, U.S.A
| | - Don A Brigham
- Cancer Center of Southern California, Santa Monica, CA, U.S.A
- Aveni Foundation, Santa Monica, CA, U.S.A
| | | | - Sonu Thomas
- Cancer Center of Southern California, Santa Monica, CA, U.S.A
| | | | - Leland Foshag
- Saint John's Cancer Institute, Santa Monica, CA, U.S.A
| | | | - Erlinda M Gordon
- Cancer Center of Southern California, Santa Monica, CA, U.S.A.;
- Aveni Foundation, Santa Monica, CA, U.S.A
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Nassoiy S, Christopher W, Marcus R, Keller J, Weiss J, Chang SC, Essner R, Foshag L, Fischer T, Goldfarb M. Evolving management of early stage pancreatic adenocarcinoma in older patients. Am J Surg 2023; 225:212-219. [PMID: 36058752 DOI: 10.1016/j.amjsurg.2022.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Due to the aging population, the number of older patients diagnosed with pancreatic ductal adenocarcinoma (PDAC) will continue to rise. STUDY DESIGN Utilizing the NCDB from 2010 to 2016, patients with early stage, clinically node negative PDAC who were ≥70 years old and had a Whipple were identified. Multivariable logistic regressions were used to determine independent factors for R0 resection and NAT. Cox-proportional-hazards regression analyses examined for the impact of NAT on the risk of death. RESULTS Of 5086 patients, 51.7% received upfront surgery + adjuvant therapy (UFS + AT), followed by 29.9% UFS only, and the remainder NAT. NAT significantly improved OS compared to a combined cohort of those that had UFS ± AT. NAT retained its independent survival benefit when compared to only patients that had UFS + AT. CONCLUSION For older patients diagnosed with early stage PDAC, NAT was associated with improved R0 resection rates and a significant survival benefit when compared to the current standard of care.
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Affiliation(s)
- Sean Nassoiy
- Providence St. John's Cancer Institute, Santa Monica, CA, USA
| | | | - Rebecca Marcus
- Providence St. John's Cancer Institute, Santa Monica, CA, USA
| | - Jennifer Keller
- Providence St. John's Cancer Institute, Santa Monica, CA, USA
| | - Jessica Weiss
- Providence St. John's Cancer Institute, Santa Monica, CA, USA
| | | | - Richard Essner
- Providence St. John's Cancer Institute, Santa Monica, CA, USA
| | - Leland Foshag
- Providence St. John's Cancer Institute, Santa Monica, CA, USA
| | - Trevan Fischer
- Providence St. John's Cancer Institute, Santa Monica, CA, USA
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Nassoiy S, Christopher W, Marcus R, Keller J, Weiss J, Chang SC, Foshag L, Essner R, Fischer T, Goldfarb M. Treatment Utilization and Outcomes for Locally Advanced Rectal Cancer in Older Patients. JAMA Surg 2022; 157:e224456. [PMID: 36169964 PMCID: PMC9520439 DOI: 10.1001/jamasurg.2022.4456] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/18/2022] [Indexed: 12/14/2022]
Abstract
Importance The number of older patients (80 years and older) diagnosed with locally advanced rectal cancer (LARC) is expected to increase. Although current guidelines recommend neoadjuvant chemoradiation therapy (NACRT) followed by resection, little is known about management and outcomes in this older population. Objective To assess the trends in management of older patients diagnosed with LARC who had a surgical resection. Design, Setting, and Participants Patients 80 years and older who had a surgical resection for LARC were identified in the 2004-2016 National Cancer Database. Patients were grouped based on therapy sequence: (1) surgery followed by adjuvant therapy (AT), ie, chemotherapy or radiation; (2) surgery alone; or (3) NACRT followed by surgical resection. Data were analyzed in May 2021. Exposures NACRT followed by surgery, and surgery with or without AT. Main Outcomes and Measures Overall survival (OS) was assessed using Kaplan-Meier analyses with inverse probability of treatment weighting (IPTW) and Cox proportional hazards regression were performed to examine the association of NACRT with the risk of death. Results Of 3868 patients with LARC who underwent surgical resection, 2042 (52.8%) were male, and the mean (SD) age was 83.4 (3.0) years. A total of 2273 (58.8%) received NACRT followed by surgical resection. Factors independently associated with NACRT were more recent diagnosis, age 80 to 85 years (vs 86 years and older), fewer comorbidities, larger tumors, and node-positive disease. The Kaplan-Meier analyses with IPTW showed that 3-year and 5-year OS for NACRT (3-year: 68.9%; 95% CI, 67.0-70.8; 5-year: 51.1%; 95% CI, 49.0-53.4) vs surgery with AT (3-year: 64.4%; 95% CI, 59.0-70.2; 5-year: 43.0%; 95% CI, 37.4-49.5) vs surgery alone (3-year: 55.8%; 95% CI, 52.0-60.0; 5-year: 34.7%; 95% CI, 30.8-39.0) was significantly different (P < .001). After adjusting for confounders, patients who received NACRT were more likely to undergo an R0 resection (adjusted odds ratio, 2.16; 95% CI, 1.62-2.88), which independently improved OS (P < .001). Moreover, receipt of NACRT was independently associated with a 25% decreased risk of death (adjusted hazard ratio, 0.75; 95% CI, 0.69-0.82) compared with alternative treatment sequences. Conclusions and Relevance Approximately 40% of older patients with LARC did not receive the current standard of care. In this cohort, NACRT was associated with a higher likelihood of an R0 resection and improved OS. Clinicians should advocate for receipt of NACRT in older patients with LARC.
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Affiliation(s)
- Sean Nassoiy
- Providence St John’s Cancer Institute, Santa Monica, California
| | | | - Rebecca Marcus
- Providence St John’s Cancer Institute, Santa Monica, California
| | - Jennifer Keller
- Providence St John’s Cancer Institute, Santa Monica, California
| | - Jessica Weiss
- Providence St John’s Cancer Institute, Santa Monica, California
| | | | - Leland Foshag
- Providence St John’s Cancer Institute, Santa Monica, California
| | - Richard Essner
- Providence St John’s Cancer Institute, Santa Monica, California
| | - Trevan Fischer
- Providence St John’s Cancer Institute, Santa Monica, California
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Ramos RI, Shaw MA, Foshag L, Stern SL, Rahimzadeh N, Elashoff D, Hoon DSB. Genetic Variants in Immune Related Genes as Predictors of Responsiveness to BCG Immunotherapy in Metastatic Melanoma Patients. Cancers (Basel) 2020; 13:cancers13010091. [PMID: 33396862 PMCID: PMC7795941 DOI: 10.3390/cancers13010091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/12/2020] [Accepted: 12/25/2020] [Indexed: 02/05/2023] Open
Abstract
Simple Summary The study objective was to determine if an SNP (single nucleotide polymorphism)-based immune multi-gene panel has the ability to predict adjuvant BCG (Bacillus Calmette–Guérin) immunotherapy responsiveness post-tumor resection in AJCC (American Joint Committee on Cancer) stages III and IV metastatic melanoma patients. A pilot study followed by further verification and control melanoma patient cohorts involving three phase III multicenter clinical trials was used to verify if an immune gene SNP panel could identify if adjuvant BCG therapy correlates with disease outcomes. We found a specific immune gene SNP panel that could identify which patients would respond to adjuvant BCG immunotherapy, but it was not applicable in the control non-immunotherapy treated patients. These studies provide evidence that SNP immune-gene assessment has utility in predicting melanoma patient’s immunotherapy responses to adjuvant BCG immunotherapy. Abstract Adjuvant immunotherapy in melanoma patients improves clinical outcomes. However, success is unpredictable due to inherited heterogeneity of immune responses. Inherent immune genes associated with single nucleotide polymorphisms (SNPs) may influence anti-tumor immune responses. We assessed the predictive ability of 26 immune-gene SNPs genomic panels for a clinical response to adjuvant BCG (Bacillus Calmette-Guérin) immunotherapy, using melanoma patient cohorts derived from three phase III multicenter clinical trials: AJCC (American Joint Committee on Cancer) stage IV patients given adjuvant BCG (pilot cohort; n = 92), AJCC stage III patients given adjuvant BCG (verification cohort; n = 269), and AJCC stage III patients that are sentinel lymph node (SLN) positive receiving no immunotherapy (control cohort; n = 80). The SNP panel analysis demonstrated that the responder patient group had an improved disease-free survival (DFS) (hazard ratio [HR] 1.84, 95% CI 1.09–3.13, p = 0.021) in the pilot cohort. In the verification cohort, an improved overall survival (OS) (HR 1.67, 95% CI 1.07–2.67, p = 0.025) was observed. No significant differences of SNPs were observed in DFS or OS in the control patient cohort. This study demonstrates that SNP immune genes can be utilized as a predictive tool for identifying melanoma patients that are inherently responsive to BCG and potentially other immunotherapies in the future.
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Affiliation(s)
- Romela Irene Ramos
- Department of Translational Molecular Medicine, John Wayne Cancer Institute, Santa Monica, CA 90404, USA; (R.I.R.); (M.A.S.); (N.R.)
| | - Misa A. Shaw
- Department of Translational Molecular Medicine, John Wayne Cancer Institute, Santa Monica, CA 90404, USA; (R.I.R.); (M.A.S.); (N.R.)
| | - Leland Foshag
- Division of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, CA 90404, USA;
| | - Stacey L. Stern
- Department of Biostatistics, John Wayne Cancer Institute, Santa Monica, CA 90404, USA;
| | - Negin Rahimzadeh
- Department of Translational Molecular Medicine, John Wayne Cancer Institute, Santa Monica, CA 90404, USA; (R.I.R.); (M.A.S.); (N.R.)
| | - David Elashoff
- Department of Medicine Statistics Core, UCLA School of Medicine, Los Angeles, CA 90024, USA;
| | - Dave S. B. Hoon
- Department of Translational Molecular Medicine, John Wayne Cancer Institute, Santa Monica, CA 90404, USA; (R.I.R.); (M.A.S.); (N.R.)
- Correspondence:
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Uppal A, Stern S, Thompson JF, Foshag L, Mizzollo N, Nieweg OE, Hoekstra HJ, Roses DF, Sondak VK, Kashani-Sabet M, Coventry BJ, Cochran AJ, Fujita M, Sim-Shin M, Elashoff D, Elashoff RM, Faries MB. Regional Node Basin Recurrence in Melanoma Patients: More Common After Node Dissection for Macroscopic Rather than Clinically Occult Nodal Disease. Ann Surg Oncol 2019; 27:1970-1977. [PMID: 31863416 DOI: 10.1245/s10434-019-08086-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recommended treatment for patients with sentinel lymph node (SLN)-positive melanoma has recently changed. Randomized trials demonstrated equivalent survival with close observation versus completion lymph node dissection (CLND), but increased regional node recurrence. We evaluated factors related to in-basin nodal recurrence after lymphadenectomy (LND) for SLN-positive or macroscopic nodal metastases. METHODS An institutional database and the first Multicenter Selective Lymphadenectomy Trial (MSLT-I) were analyzed independently. Exclusions were multiple primaries, multi-basin involvement, or in-transit metastases. Patient demographics, primary tumor thickness and ulceration, lymph nodes retrieved, and use of adjuvant radiotherapy were analyzed. Multivariate analyses were performed to determine factors predicting in-basin nodal recurrence (significance p ≤ 0.05). RESULTS The retrospective cohort (577 patients) showed an in-basin failure rate of 6.6% after CLND for a positive SLN and 13.1% after LND for palpable disease (p = 0.001). This recurrence risk persisted after adjustment for patient, tumor, and LND factors [hazard ratio (HR) 2.32; p = 0.004]. In the MSLT-I cohort (326 patients), the failure rate after CLND following SLNB was 6.2%, but 10.1% after LND for palpable recurrence in observation patients. After adjustment for other factors, macroscopic disease was associated with an increased risk of recurrence after LND (HR 2.24; p = 0.05). CONCLUSION After LND for melanoma, in-basin recurrence is infrequent, but a clinically significant fraction will fail. Failure is less likely if dissection is performed for clinically occult disease. Further research is warranted to evaluate the long-term regional control and quality of life associated with nodal basin observation, which has now become standard practice.
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Affiliation(s)
| | - Stacey Stern
- John Wayne Cancer Institute, Santa Monica, CA, USA
| | - John F Thompson
- Melanoma Institute Australia and The University of Sydney, Sydney, NSW, Australia
| | | | | | - Omgo E Nieweg
- Melanoma Institute Australia and The University of Sydney, Sydney, NSW, Australia
| | | | - Daniel F Roses
- New York University School of Medicine, New York, NY, USA
| | | | | | - Brendon J Coventry
- Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | | | | | - Myung Sim-Shin
- University of California Los Angeles, Los Angeles, CA, USA
| | - David Elashoff
- University of California Los Angeles, Los Angeles, CA, USA
| | | | - Mark B Faries
- Cedars-Sinai Medical Center, The Angeles Clinic and Research Institute, Los Angeles, CA, USA.
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Vuong B, Dehal A, Graff-Baker AN, Chang SC, Foshag L, Bilchik A, Goldfarb MR. Effect of palliative surgery, chemotherapy, and radiation in stage IV pancreatic cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e15707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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
e15707 Background: Despite significant advances in multi-modality treatment for pancreatic adenocarcinoma (PC), prognosis for stage IV PC remains poor. While reducing suffering and optimizing quality of life are the primary goals of palliative therapies, these interventions may extend overall survival. We examined the impact on survival when aggressive palliative treatments including surgery, chemotherapy, or radiation were employed in end-of-life care. Methods: The 2004-2014 National Cancer Data Base (NCDB) was queried to identify patients with stage IV PC that did not undergo primary surgical resection. Univariate (Kaplan Meier and log-rank) and multivariable (Cox proportional hazard) analyses were used to assess the associations between patient characteristics, use of palliative therapies, and overall survival. Results: Of 72,736 patients identified with metastatic stage IV PC, 2,097 (3%) underwent surgical palliation (ST), 5,615 (8%) received palliative chemotherapy (CT), 940 (1%) received palliative radiation (RT), 1,163 (2%) received multimodality treatment (MMT), and 62,921 (87%) had no aggressive palliative intervention (NT). The choice of palliative therapy, if any, was influenced by all demographic and tumor variables except for gender (all p < 0.001). Median OS was greatest after CT (5.09 months, p < 0.001) compared to any other modality (NT: 3.45months, ST: 3.71months, RT: 3.25months, MMT: 4.47months). This remained true regardless of age, gender, race/ethnicity, insurance, and facility type. After adjusting for all demographic and tumor factors, use of CT decreased the annual risk of death by 20% (HR = 0.8; 95%CI [0.77, 0.82]) and MMT by 10% (HR = 0.9; 95%CI [0.84, 0.96]). Employment of RT increased risk of death by 9% (HR = 1.09; 95%CI [1.01, 1.17]) and ST did not affect OS (HR = 1.01; 95%CI [0.96,1.06]). Conclusions: Despite advances in palliative treatments, Stage IV PC arries a dismal prognosis. Palliative RT may shorten survival. Equivalent survival for ST versus NT suggests that this may be beneficial in the appropriate patient. Palliative CT independently improved survival by approximately 6 weeks and should be considered in patients that want to extend survival and can tolerate the toxicity.
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Affiliation(s)
| | - Ahmed Dehal
- John Wayne Cancer Institute, Santa Monica, CA
| | | | - Shu-Ching Chang
- Medical Data Research Center, Providence Health and Services, Portland, OR
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Deutsch GB, Kirchoff DD, Flaherty DC, Lee J, Foshag L, Faries MB, Bilchik AJ. A 45-Year Experience with Abdominal Melanoma Metastases: Is Surgical Cure Still Relevant in the Era of Modern Systemic Therapy? J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.07.325] [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: 10/23/2022]
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8
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Ramos R, Lee A, Chan A, Bahjat KS, Foshag L, Faries M, Lee D, Sieling P. γδ T cell activation may contribute to antitumor immunity stimulated by intralesional BCG immune therapy for cutaneous melanoma metastases. J Immunother Cancer 2015. [PMCID: PMC4649296 DOI: 10.1186/2051-1426-3-s2-p312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kuhns S, Ill CR, Zhang L, Buckman D, Nguyen JT, Thomas J, van Epps D, Essner R, Hsueh E, Foshag L, Faries M. Invasive melanoma patients treated with Canvaxin specific active immunotherapy show serconversion for both IgG and IgM antibody responses to numerous protein and glycolipid tumor antigens. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.2574] [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)
- S. Kuhns
- CancerVax Corp, Carlsbad, CA; John Wayne Cancer Institute, Santa Monica, CA
| | - C. R. Ill
- CancerVax Corp, Carlsbad, CA; John Wayne Cancer Institute, Santa Monica, CA
| | - L. Zhang
- CancerVax Corp, Carlsbad, CA; John Wayne Cancer Institute, Santa Monica, CA
| | - D. Buckman
- CancerVax Corp, Carlsbad, CA; John Wayne Cancer Institute, Santa Monica, CA
| | - J. T. Nguyen
- CancerVax Corp, Carlsbad, CA; John Wayne Cancer Institute, Santa Monica, CA
| | - J. Thomas
- CancerVax Corp, Carlsbad, CA; John Wayne Cancer Institute, Santa Monica, CA
| | - D. van Epps
- CancerVax Corp, Carlsbad, CA; John Wayne Cancer Institute, Santa Monica, CA
| | - R. Essner
- CancerVax Corp, Carlsbad, CA; John Wayne Cancer Institute, Santa Monica, CA
| | - E. Hsueh
- CancerVax Corp, Carlsbad, CA; John Wayne Cancer Institute, Santa Monica, CA
| | - L. Foshag
- CancerVax Corp, Carlsbad, CA; John Wayne Cancer Institute, Santa Monica, CA
| | - M. Faries
- CancerVax Corp, Carlsbad, CA; John Wayne Cancer Institute, Santa Monica, CA
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Kim J, Takeuchi H, Lam ST, Turner RR, Wang HJ, Kuo C, Foshag L, Bilchik AJ, Hoon DSB. Chemokine receptor CXCR4 expression in colorectal cancer patients increases the risk for recurrence and for poor survival. J Clin Oncol 2005; 23:2744-53. [PMID: 15837989 DOI: 10.1200/jco.2005.07.078] [Citation(s) in RCA: 289] [Impact Index Per Article: 15.2] [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] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Liver metastasis is the predominant cause of colorectal cancer (CRC) related mortality. Chemokines, soluble factors that orchestrate hematopoetic cell movement, have been implicated in directing cancer metastasis, although their clinical relevance in CRC has not been defined. Our hypothesis was that the chemokine receptor CXCR4 expressed by CRC is a prognostic factor for poor disease outcome. METHODS CRC cell lines (n = 6) and tumor specimens (n = 139) from patients with different American Joint Committee on Cancer (AJCC) stages of CRC were assessed. Microarray screening of select specimens and cell lines identified CXCR4 as a prominent chemokine receptor. CXCR4 expression in tumor and benign specimens was assessed by quantitative real-time reverse transcription polymerase chain reaction and correlated with disease recurrence and overall survival. RESULTS High CXCR4 expression in tumor specimens (n = 57) from AJCC stage I/II patients was associated with increased risk for local recurrence and/or distant metastasis (risk ratio, 1.35; 95% CI, 1.09 to 1.68; P = .0065). High CXCR4 expression in primary tumor specimens (n = 35) from AJCC stage IV patients correlated with worse overall median survival (9 months v 23 months; RR, 2.53; 95% CI, 1.19 to 5.40; P = .016). CXCR4 expression was significantly higher in liver metastases (n = 39) compared with primary CRC tumors (n = 100; P < .0001). CONCLUSION CXCR4, a well-characterized chemokine receptor for T-cells, is differentially expressed in CRC. CXCR4 gene expression in primary CRC demonstrated significant associations with recurrence, survival, and liver metastasis. The CXCR4-CXCL12 signaling mechanism may be clinically relevant for patients with CRC and represents a potential novel target for disease-directed therapy.
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Affiliation(s)
- Joseph Kim
- Department of Molecular Oncology, John Wayne Cancer Institute, 2200 Santa Monica Blvd., Santa Monica, CA 90404, USA
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11
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Gulec SA, Daghighian F, Foshag L, Edwards K, Essner R. Clinical evaluation of a novel surgical probe designed for PET radio-isotopes (PET-Probe) in patients with metastatic melanoma. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7521] [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)
- S. A. Gulec
- John Wayne Cancer Institute, Santa Monica; Intramedical Imaging, LLC, Los Angeles, CA; John Wayne Cancer Institute, Santa Monica, CA
| | - F. Daghighian
- John Wayne Cancer Institute, Santa Monica; Intramedical Imaging, LLC, Los Angeles, CA; John Wayne Cancer Institute, Santa Monica, CA
| | - L. Foshag
- John Wayne Cancer Institute, Santa Monica; Intramedical Imaging, LLC, Los Angeles, CA; John Wayne Cancer Institute, Santa Monica, CA
| | - K. Edwards
- John Wayne Cancer Institute, Santa Monica; Intramedical Imaging, LLC, Los Angeles, CA; John Wayne Cancer Institute, Santa Monica, CA
| | - R. Essner
- John Wayne Cancer Institute, Santa Monica; Intramedical Imaging, LLC, Los Angeles, CA; John Wayne Cancer Institute, Santa Monica, CA
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12
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Kim J, Takeuchi H, Foshag L, Bilchik A, Hoon DSB. Colorectal cancer expression of chemokine receptor CXCR4 promotes liver metastasis. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3582] [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)
- J. Kim
- John Wayne Cancer Institute, Santa Monica, CA
| | - H. Takeuchi
- John Wayne Cancer Institute, Santa Monica, CA
| | - L. Foshag
- John Wayne Cancer Institute, Santa Monica, CA
| | - A. Bilchik
- John Wayne Cancer Institute, Santa Monica, CA
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13
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Bostick P, Essner R, Sarantou T, Kelley M, Glass E, Foshag L, Stern S, Morton D. Intraoperative lymphatic mapping for early-stage melanoma of the head and neck. Am J Surg 1997; 174:536-9. [PMID: 9374232 DOI: 10.1016/s0002-9610(97)00150-5] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.0] [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] [Indexed: 02/05/2023]
Abstract
BACKGROUND We previously reported dye-directed intraoperative lymphatic mapping and selective sentinel lymphadenectomy for primary cutaneous melanomas draining to the neck lymph nodes. In this study we determined whether combining the dye with a radiopharmaceutical agent would enhance our rate of sentinel node detection. METHODS One hundred seventeen patients with primary cutaneous melanomas of the upper chest and head and neck underwent preoperative cutaneous lymphoscintigraphy to confirm lymphatic drainage to neck nodes, followed by intraoperative lymphatic mapping and sentinel lymphadenectomy. In 94 cases, isosulfan blue dye was injected at the primary site; in the remaining 23 cases, a 1:3 mixture of radiopharmaceutical and dye was injected, and a hand-held probe was used to determine the radioactive counts. RESULTS Preoperative cutaneous lymphoscintigraphy identified 129 drainage basins; 12 patients (10%) had dual-basin drainage. During intraoperative lymphatic mapping and sentinel lymphadenectomy, 183 sentinel nodes were identified and excised from 120 basins (1.5 nodes/basin). The blue dye alone identified sentinel nodes in 93 of 101 basins (92%). The probe identified sentinel nodes in 28 of 28 basins, only one of which failed to reveal blue-staining sentinel nodes; thus, the probe plus dye identified sentinel nodes in 27 of 28 basins (96%). Histopathologic analysis revealed metastasis in sentinel nodes from 11 patients (12%) who underwent sentinel lymphadenectomy with blue dye alone and in 3 patients (13%) who underwent sentinel lymphadenectomy with dye plus probe. There were no same-basin recurrences over a mean follow-up of 46 months (range 1 to 125). CONCLUSIONS Selective sentinel lymphadenectomy is a highly accurate method of staging the regional nodes in patients with primary tumors of the head and neck. Although we initially demonstrated the utility of this technique with blue dye alone, our results now suggest that the combination of dye and radiopharmaceutical may be a more sensitive method to detect sentinel nodes.
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Affiliation(s)
- P Bostick
- Roy E. Coats Research Laboratories of John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California 90404, USA
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14
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Al-Kawas FH, Murgo A, Foshag L, Shiels W. Lymphadenopathy in celiac disease: not always a sign of lymphoma. Am J Gastroenterol 1988; 83:301-3. [PMID: 3344733] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A patient with celiac disease and mesenteric adenopathy discovered on computerized scanning of the abdomen is described. Lymphadenopathy resolved more than 6 months after the institution of a gluten-free diet. Adenopathy without evidence of lymphoma may be part of the clinical manifestations of patients with celiac disease. Follow-up with computerized tomography may be an option in patients with low clinical suspicion for lymphoma.
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Affiliation(s)
- F H Al-Kawas
- Department of Medicine, West Virginia University School of Medicine, Morgantown
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Riggs T, Foshag L, Vargish T, Zimmerman B. Biliary tract injuries following routine cholecystectomy. Am Surg 1986; 52:312-4. [PMID: 3717776] [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: 01/07/2023]
Abstract
This retrospective study was done to review the epidemiology, etiology, method of treatment, and results of repairs of biliary tract injuries following routine cholecystectomy. Fourteen patients have been treated at our hospital for biliary tract injuries during a 10-year period (January 1974-December 1983). One injury occurred at our institution. During this same time span, 941 cholecystectomies were performed at our hospital giving an incidence of 0.11 per cent for the injury. Trained surgeons were responsible for nine injuries, family practitioners for two injuries, and a surgery resident for one injury. Two injuries were caused by individuals whose level of training could not be determined. In only one case was massive hemorrhage associated with the injury. Four patients had their injuries diagnosed and treated at the time of their original surgery. Two had successful initial repairs. The other two required further reconstructive surgery with good results. Ten patients had a delay in diagnosis, and nine required biliary tract reconstruction. Four of these had good results. Combining both groups, 13 patients required 20 procedures. Stents were used in 14 procedures with good results in 43 per cent. Stents were left in place 6.9 months. Five procedures were done without stents and four resulted in failure. Biliary tract injuries are devastating problems caused by trained surgeons through lack of attention. Better results can be obtained if the injury is recognized early and treated. The overall success rate was 62 per cent. The use of stents improved the success rate.
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Dowling K, Watne A, Foshag L, Vargish T. Management of nonfamilial adenomatous polyps and colon cancers. Surgery 1985; 98:684-8. [PMID: 4049244] [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: 01/08/2023]
Abstract
There is evidence that patients with adenocarcinoma of the colon and synchronous adenomatous polyps are at an increased risk for developing metachronous colon cancer. A retrospective study was made of all patients with colon cancer at our institution and the associated Veterans Administration Hospital between 1974 and 1983 to help assess the need for more extensive colon resection in patients with colon cancer and synchronous adenomatous polyps. At our hospitals 470 new cases of colon cancer were identified. Nine percent (44/470) had colon cancer and concurrent adenomatous polyps. Seven (16%) of these 44 patients developed metachronous colon cancer, as compared with four of 426 patients without polyps at the initial surgery (p less than 0.001). Four patients without polyps at the initial surgery developed polyps at a later date; three of the four patients developed metachronous colon cancer. We believe that more extensive colon resection, such as total colectomy and ileoproctostomy, may play a role in preventing the occurrence of metachronous colon cancer in patients with colon cancer and synchronous adenomatous polyps. In addition, if adenomatous polyps develop after colon surgery, close endoscopic follow-up is required.
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