1
|
Holubar M, Subramanian A, Purington N, Hedlin H, Bunning B, Walter KS, Bonilla H, Boumis A, Chen M, Clinton K, Dewhurst L, Epstein C, Jagannathan P, Kaszynski RH, Panu L, Parsonnet J, Ponder EL, Quintero O, Sefton E, Singh U, Soberanis L, Truong H, Andrews JR, Desai M, Khosla C, Maldonado Y. Favipiravir for Treatment of Outpatients With Asymptomatic or Uncomplicated Coronavirus Disease 2019: A Double-Blind, Randomized, Placebo-Controlled, Phase 2 Trial. Clin Infect Dis 2022; 75:1883-1892. [PMID: 35446944 PMCID: PMC9047233 DOI: 10.1093/cid/ciac312] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 11/18/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Favipiravir, an oral, RNA-dependent RNA polymerase inhibitor, has in vitro activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite limited data, favipiravir is administered to patients with coronavirus disease 2019 (COVID-19) in several countries. METHODS We conducted a phase 2, double-blind, randomized controlled outpatient trial of favipiravir in asymptomatic or mildly symptomatic adults with a positive SARS-CoV-2 reverse-transcription polymerase chain reaction assay (RT-PCR) within 72 hours of enrollment. Participants were randomized to receive placebo or favipiravir (1800 mg twice daily [BID] day 1, 800 mg BID days 2-10). The primary outcome was SARS-CoV-2 shedding cessation in a modified intention-to-treat (mITT) cohort of participants with positive enrollment RT-PCRs. Using SARS-CoV-2 amplicon-based sequencing, we assessed favipiravir's impact on mutagenesis. RESULTS We randomized 149 participants with 116 included in the mITT cohort. The participants' mean age was 43 years (standard deviation, 12.5 years) and 57 (49%) were women. We found no difference in time to shedding cessation overall (hazard ratio [HR], 0.76 favoring placebo [95% confidence interval {CI}, .48-1.20]) or in subgroups (age, sex, high-risk comorbidities, seropositivity, or symptom duration at enrollment). We detected no difference in time to symptom resolution (initial: HR, 0.84 [95% CI, .54-1.29]; sustained: HR, 0.87 [95% CI, .52-1.45]) and no difference in transition mutation accumulation in the viral genome during treatment. CONCLUSIONS Our data do not support favipiravir at commonly used doses in outpatients with uncomplicated COVID-19. Further research is needed to ascertain if higher favipiravir doses are effective and safe for patients with COVID-19. CLINICAL TRIALS REGISTRATION NCT04346628.
Collapse
Affiliation(s)
- Marisa Holubar
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Aruna Subramanian
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Natasha Purington
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Haley Hedlin
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Bryan Bunning
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Katharine S Walter
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Hector Bonilla
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Athanasia Boumis
- Stanford Center for Clinical Research, Stanford University, Stanford, California, USA
| | - Michael Chen
- Stanford Solutions, Stanford University School of Medicine, Stanford, California, USA
| | - Kimberly Clinton
- Stanford Center for Clinical Research, Stanford University, Stanford, California, USA
| | - Liisa Dewhurst
- Stanford Center for Clinical Research, Stanford University, Stanford, California, USA
| | - Carol Epstein
- Carol L. Epstein MD Consulting LLC, Wellington, Florida, USA
| | - Prasanna Jagannathan
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA.,Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California, USA
| | - Richard H Kaszynski
- Stanford Solutions, Stanford University School of Medicine, Stanford, California, USA
| | - Lori Panu
- Stanford Center for Clinical Research, Stanford University, Stanford, California, USA
| | - Julie Parsonnet
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA.,Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | | | - Orlando Quintero
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Upinder Singh
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA.,Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California, USA
| | - Luke Soberanis
- Stanford Center for Clinical Research, Stanford University, Stanford, California, USA
| | - Henry Truong
- Mariner Advanced Pharmacy Corporation, San Mateo, California, USA
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Manisha Desai
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Chaitan Khosla
- Stanford ChEM-H, Stanford University, Stanford, California, USA.,Departments of Chemistry and Chemical Engineering, Stanford University, Stanford, California, USA
| | - Yvonne Maldonado
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA.,Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
2
|
Peddi P, Shi R, Panu L, Ampil F, Nathan CA, Armaghany T, Mills GM, Jafri SHR. Cisplatin (CDDP) and radiation versus cetuximab (Cx) and radiation in locally advanced head and neck squamous cell cancer (SCHNC): A retrospective review. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e16009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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
e16009 Background: SCHNC is a common malignancy and approximately 60% of patients present with locally advanced disease. There is paucity of data directly comparing Cx and CDDP with concurrent radiation in locally advanced SCHNC. We retrospectively reviewed charts of patients treated with CDDP and/or Cx along with radiation in locally advanced SCHNC comparing efficacy and outcomes in an academic cancer center. Methods: Ninety-five patients with locally advanced SCHNC were treated with concurrent CDDP (100 mg/m2 day 1, 22, 43) or Cx (400mg/m2 on day -7 and 250mg/m2 weekly) at our institution between January 2006 and June 2011. Forty-four patients were treated with CDDP (group A), 24 with Cx (group B) and 27 were initially started on CDDP but were switched to Cx secondary to toxicity (group C). All patients received concurrent radiation treatments (66-70 Gy, 2.0 Gy/fraction). The selection of CDDP versus Cx was largely based on ECOG performance status (PS) and baseline renal function of the patients. Chi-square test, analysis of variance, and log-rank test was used for analysis. The three groups had similar baseline characteristics except for mean age of 61, 56 and 55 years in group A, B and C respectively; T4 tumors consisted of 44%, 75% and 41% in groups A, B and C respectively. Groups A, B and C had a combined ECOG 0 and I (PS) of 93%, 75% and 92%. Patients with ECOG III PS were excluded. Results: Oropharynx was the most common treated site (38%) followed by Larynx (35%). Complete response (CR) was seen in 77%, 17% and 67% in groups A, B and C respectively (P<0.001). Median progression free survival (PFS) was 16.6, 4.3 and 22.8 in groups A, B and C respectively (P<0.001) and median overall survival (OS) was >35, 11.6 and >32 months in groups A, B and C respectively (P<0.0001). Conclusions: Concurrent CDDP with radiation leads to better response rate PFS and OS as opposed to Cx though many patients treated with CDDP could not complete treatment due to toxicity. Randomized trial comparing the two should be considered.
Collapse
Affiliation(s)
- Prakash Peddi
- Lousiana State University Health Sciences Center, Shreveport, LA
| | - Runhua Shi
- Louisiana State University Health Sciences Center, Shreveport, LA
| | - Lori Panu
- Lousiana State University Health Science, Shreveport, LA
| | - Fred Ampil
- Louisiana State University Health Sciences Center, Shreveport, LA
| | | | - Tannaz Armaghany
- Louisiana State University Health-Feist Weiller Cancer Center, Shreveport, LA
| | | | | |
Collapse
|
3
|
Flowers A, Chu QD, Panu L, Meschonat C, Caldito G, Lowery-Nordberg M, Li BDL. Eukaryotic initiation factor 4E overexpression in triple-negative breast cancer predicts a worse outcome. Surgery 2009; 146:220-6. [PMID: 19628077 DOI: 10.1016/j.surg.2009.05.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [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: 01/08/2009] [Accepted: 05/07/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Triple-negative (estrogen receptor [ER], progesterone receptor [PR], and HER2/neu receptor negative) breast neoplasms are typically high grade and portend a higher risk for relapse. Not being amendable to ER, PR, or HER2-targeted therapy, adjuvant cytotoxic chemotherapy remains the only option. High eukaryotic Initiation Factor 4E (eIF4E) overexpression in tumor specimens is an independent predictor for relapse in breast cancer, perhaps secondary to tousled-like kinase 1B upregulation and subsequent doxorubicin resistance. In this prospective study, eIF4E elevation in triple-negative breast cancer (TNBC) specimens was studied to determine its effect on cancer outcome. METHODS A prospective study of 103 TNBC patients was initiated. Tumor specimens were quantified for eIF4E expression using Western blots. Clinical outcomes data were collected after standardized adjuvant treatment and surveillance protocols. Primary end points were cancer recurrence and cancer-related death. The eIF4E levels in cancer specimens were quantified as x-fold over benign samples from noncancer patients. Statistical procedures performed include survival analysis by Kaplan-Meier method, log-rank test, Cox proportional hazards regression model, and the chi-square test. RESULTS Levels of eIF4E were categorized into 3 tertiles. Among 103 patients, 36 were in the low group (< or =7.5-fold), 40 were in the intermediate group (7.5- to 15-fold), and 27 were in the high group (> or =15-fold). Patients with triple-negative neoplasms that were in the high eIF4E group had greater rates of cancer recurrence (P = .04) and cancer-related death (P = .02) than the low eIF4E group. Among patients with node-negative disease, high eIF4E overexpression in tumor specimens continues to portend a greater rate of cancer recurrence (P = .02), and a higher rate of cancer death (P = .03) than those in the low eIF4E group. CONCLUSION TNBC patients with high eIF4E overexpression are more likely to recur and die from cancer recurrence. High eIF4E seems to be a significant prognostic marker, even in TNBC patients.
Collapse
Affiliation(s)
- Anthony Flowers
- Department of School of Medicine, Louisiana State University Health Science Center in Shreveport and the Feist-Weiller Cancer Center, Shreveport, LA 71130, USA.
| | | | | | | | | | | | | |
Collapse
|
4
|
Chu QD, Smith MH, Williams M, Panu L, Johnson LW, Shi R, Li BDL, Glass J. Race/Ethnicity has no effect on outcome for breast cancer patients treated at an academic center with a public hospital. Cancer Epidemiol Biomarkers Prev 2009; 18:2157-61. [PMID: 19622718 DOI: 10.1158/1055-9965.epi-09-0232] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [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] Open
Abstract
BACKGROUND African American women have a higher breast cancer mortality rate than Caucasian women. To understand this difference, socioeconomic status (SES) needs to be controlled, which can be achieved by evaluating outcome within a population that is underinsured or low SES. We elected to examine the effect of race/ethnicity on outcome of patients with operable breast cancer by evaluating outcome in a population with low SES and similar access to care. METHODS From a prospective breast cancer database created in 1998, we examined outcome for 786 patients with stage 0 to III breast cancer treated up to September 2008. Patients were treated at Louisiana State University Health Sciences Center in Shreveport and E.A. Conway Hospital and the majority received standard definitive surgery as well as appropriate adjuvant treatment. Primary endpoints were cancer recurrence and death. Statistical analysis performed included Kaplan-Meier survival analysis, log-rank test, Cox proportional hazards model, independent-samples t test, and chi(2) test. P <or= 0.05 was considered statistically significant. RESULTS Sixty percent of patients were African American and over two thirds of patients were classified as either free care or Medicaid. The 5-year overall survival (OS) for African American and Caucasian patients was similar (81% and 84%, respectively; P = 0.23). On multivariate analysis, race/ethnicity was not an independent predictor of OS (P = 0.5); OS for the entire cohort was comparable with what was reported in the National Cancer Data Base. CONCLUSION In a predominantly indigent population, race/ethnicity had no effect on breast cancer outcome.
Collapse
Affiliation(s)
- Quyen D Chu
- Department of Surgery, Louisiana State University Health Sciences Center in Shreveport, Shreveport, LA 71130, USA.
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Hiller DJ, Chu Q, Meschonat C, Panu L, Burton G, Li BDL. Predictive value of eIF4E reduction after neoadjuvant therapy in breast cancer. J Surg Res 2009; 156:265-9. [PMID: 19665145 DOI: 10.1016/j.jss.2009.03.060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 02/24/2009] [Accepted: 03/23/2009] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Initiation factor 4E (eIF4E) overexpression has prognostic significance in breast cancer. Up-regulation of downstream gene products associated with high eIF4E overexpression has been linked to chemoresistance. We hypothesize patients whose tumors had eIF4E reduction after neoadjuvant chemotherapy will have lower cancer recurrence compared with those who did not. METHODS Seventeen locally advanced breast cancer patients were accrued, and tumor specimens were obtained before and after neoadjuvant therapy. eIF4E was quantified by Western blots. Primary end-point was cancer recurrence. RESULTS Low eIF4E was defined as < or =7.5-fold elevation and high eIF4E was >7.5-fold elevation. Of 17 patients, six tumors remained low after neoadjuvant therapy, six dropped from high to low eIF4E, and five remained high. With a median follow-up of 29 mo, four of five patients with tumors that remained high have recurred while only three of 12 patients in the low eIF4E post-therapy group have recurred (P=0.05, chi(2)). Survival analysis using the Kaplan-Meier method showed a higher rate of cancer recurrence in patients with post-treatment high eIF4E overexpression (P=0.026, log rank test). CONCLUSIONS Breast cancer patients whose tumors had low eIF4E overexpression after neoadjuvant chemotherapy had lower cancer recurrence compared with those who did not.
Collapse
Affiliation(s)
- David J Hiller
- Louisiana State University Health Sciences Center and Feist-Weiller Cancer Center, Shreveport, Louisiana 71130, USA
| | | | | | | | | | | |
Collapse
|