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Johns AC, Yang M, Wei L, Grogan M, Patel SH, Li M, Husain M, Kendra KL, Otterson GA, Burkart JT, Spakowicz D, Hoyd R, Owen DH, Presley CJ. Association of medical comorbidities and cardiovascular disease with toxicity and survival among patients receiving checkpoint inhibitor immunotherapy. Cancer Immunol Immunother 2023; 72:2005-2013. [PMID: 36738310 PMCID: PMC10992740 DOI: 10.1007/s00262-023-03371-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/06/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Medical comorbidities (MC) are highly prevalent among patients with cancer and predict worse outcomes for traditional therapies. This association is poorly understood for checkpoint inhibitor immunotherapy (IO). We aimed to explore the relationship between common MC including cardiovascular disease (CVD), immune-related adverse events (irAEs), and overall survival (OS) among patients receiving IO for advanced cancer. METHODS This is a retrospective cohort study of 671 patients with any cancer who received IO at our institution from 2011 to 2018. Clinical data were abstracted via chart review and query of ICD-10 codes and used to calculate modified Charlson comorbidity index (mCCI) scores. The primary outcomes were the association of individual MC with irAEs and OS using bivariate and multivariable analyses. Secondary outcomes included association of mCCI score with irAEs and OS. RESULTS Among 671 patients, 62.1% had a mCCI score ≥ 1. No individual MC were associated with irAEs or OS. Increased CCI score was associated with decreased OS (p < 0.01) but not with irAEs. Grade ≥ 3 irAEs were associated with increased OS among patients without CVD (HR 0.37 [95% CI: 0.25, 0.55], p < 0.01), but not among patients with CVD. CONCLUSIONS No specific MC predicted risk of irAEs or OS for patients receiving IO. Increased CCI score did not predict risk of irAEs but was associated with shorter OS. This suggests IO is safe for patients with MC, but MC may limit survival benefits of IO. CVD may predict shorter OS in patients with irAEs and should be evaluated among patients receiving IO.
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Affiliation(s)
- Andrew C Johns
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mike Yang
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Lai Wei
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Madison Grogan
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sandipkumar H Patel
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mingjia Li
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Marium Husain
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kari L Kendra
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Gregory A Otterson
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jarred T Burkart
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel Spakowicz
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rebecca Hoyd
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Dwight H Owen
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- The James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, 1335 Lincoln Tower, 1800 Cannon Dr, Columbus, OH, 43210, USA.
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Li M, Zhao S, Lopez G, Secor A, Das P, Surya N, Grogan M, Patel S, Chakravarthy K, Miah A, Spakowicz D, Tinoco G, Li Z, Wei L, He K, Bertino E, Alahmadi A, Memmott R, Kaufman J, Shields PG, Carbone DP, Presley CJ, Otterson GA, Owen DH. Mean platelet volume, thrombocytosis, and survival in non-small cell lung cancer patients treated with first-line pembrolizumab alone or with chemotherapy. Cancer Immunol Immunother 2023; 72:2067-2074. [PMID: 36795122 PMCID: PMC10991400 DOI: 10.1007/s00262-023-03392-9] [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] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/29/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Patients treated with immune checkpoint inhibitors (ICIs) may not response to treatment and are at risk for immune-related adverse events (irAEs). Platelet function has been linked to both oncogenesis and immune evasion. We studied the association between the change in mean platelet volume (MPV), platelet count, survival, and the risk of developing irAEs in patients with metastatic non-small cell lung cancer (NSCLC) who have received first-line ICI. METHODS In this retrospective study, delta (∆) MPV was defined as the difference between cycle 2 and baseline MPV. Patient data were collected via chart review, and Cox proportional hazard and Kaplan-Meier method were used to assess the risk and estimate median overall survival. RESULTS We identified 188 patients treated with first-line pembrolizumab, with or without concurrent chemotherapy. There were 80 (42.6%) patients received pembrolizumab monotherapy, and 108 (57.4%) received pembrolizumab in combination with platinum-based chemotherapy. Patients whose MPV (∆MPV ≤ 0) decreased had hazard ratio (HR) = 0.64 (95% CI 0.43-0.94) for death with p = 0.023. Patients with ∆MPV ≤ - 0.2 fL (median), there was a 58% increase in the risk of developing irAE (HR = 1.58, 95% CI 1.04-2.40, p = 0.031). Thrombocytosis at baseline and cycle 2 was associated with shorter OS with p = 0.014 and 0.039, respectively. CONCLUSION Change in MPV after 1 cycle of pembrolizumab-based treatment was significantly associated with overall survival as well as the occurrence of irAEs in patients with metastatic NSCLC in the first-line setting. In addition, thrombocytosis was associated with poor survival.
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Affiliation(s)
- Mingjia Li
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, USA.
| | - Songzhu Zhao
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, USA
| | - Gabrielle Lopez
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, USA
| | - Austin Secor
- College of Medicine, The Ohio State University, Columbus, USA
| | - Parthib Das
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, USA
| | - Nitya Surya
- College of Medicine, The Ohio State University, Columbus, USA
| | - Madison Grogan
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, USA
| | - Sandip Patel
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, USA
| | - Karthik Chakravarthy
- College of Medicine Medical Scientist Training Program, The Ohio State University, Columbus, USA
- Pelotonia Institute for Immuno-Oncology, The Ohio State University, Columbus, USA
| | - Abdul Miah
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, USA
| | - Daniel Spakowicz
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, USA
- Pelotonia Institute for Immuno-Oncology, The Ohio State University, Columbus, USA
| | - Gabriel Tinoco
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, USA
| | - Zihai Li
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, USA
- Pelotonia Institute for Immuno-Oncology, The Ohio State University, Columbus, USA
| | - Lai Wei
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, USA
| | - Kai He
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, USA
- Pelotonia Institute for Immuno-Oncology, The Ohio State University, Columbus, USA
| | - Erin Bertino
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, USA
| | - Asrar Alahmadi
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, USA
| | - Regan Memmott
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, USA
| | - Jacob Kaufman
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, USA
- Pelotonia Institute for Immuno-Oncology, The Ohio State University, Columbus, USA
| | - Peter G Shields
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, USA
- Pelotonia Institute for Immuno-Oncology, The Ohio State University, Columbus, USA
| | - David P Carbone
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, USA
- Pelotonia Institute for Immuno-Oncology, The Ohio State University, Columbus, USA
| | - Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, USA
- Pelotonia Institute for Immuno-Oncology, The Ohio State University, Columbus, USA
| | - Gregory A Otterson
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, USA
| | - Dwight H Owen
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, USA
- Pelotonia Institute for Immuno-Oncology, The Ohio State University, Columbus, USA
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Miah A, Tinoco G, Zhao S, Wei L, Johns A, Patel S, Li M, Grogan M, Lopez G, Husain M, Hoyd R, Mumtaz K, Meara A, Bertino EM, Kendra K, Spakowicz D, Otterson GA, Presley CJ, Owen DH. Immune checkpoint inhibitor-induced hepatitis injury: risk factors, outcomes, and impact on survival. J Cancer Res Clin Oncol 2023; 149:2235-2242. [PMID: 36070148 PMCID: PMC10191203 DOI: 10.1007/s00432-022-04340-3] [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] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Immune checkpoint inhibitors (ICIs) are associated with a unique set of immune-related adverse events (irAEs). Few studies have evaluated the risk factors and outcomes of patients who develop ICI-induced hepatitis (ICIH). METHODS We utilized an institutional database of patients with advanced cancers treated with ICI to identify patients with ICIH. irAEs were graded using the Common Terminology Criteria for Adverse Events v4. Overall survival (OS) was calculated from the date of ICI to death from any cause or the date of the last follow-up. OS with 95% confidence intervals were estimated using the Kaplan-Meier method and stratified by the occurrence of ICIH. RESULTS We identified 1096 patients treated with ICI. The most common ICIs were PD1/L1 (n = 774) and CTLA-4 inhibitors (n = 195). ICIH occurred among 64 (6%) patients: severity was < grade 3 in 30 and ≥ grade 3 in 24 patients (3.1% overall). Median time to ICIH was 63 days. ICIH was more frequent in women (p = 0.038), in patients treated with combination ICIs (p < 0.001), and when given as first-line therapy (p = 0.018). Occurrence of ICIH was associated with significantly longer OS, median 37.0 months (95% CI 21.4, NR) compared to 11.3 months (95% CI 10, 13, p < 0.001); there was no difference in OS between patients with ≥ grade 3 ICIH vs grade 1-2. CONCLUSIONS Female sex, combination immunotherapy, and the first line of immunotherapy were associated with ICIH. Patients with ICIH had improved clinical survival compared to those that did not develop ICIH. There is a need for prospective further studies to confirm our findings.
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Affiliation(s)
- Abdul Miah
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1810 Cannon Drive, Suite 1240C, Columbus, OH, 43210, USA
| | - Gabriel Tinoco
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1810 Cannon Drive, Suite 1240C, Columbus, OH, 43210, USA.
| | - Songzhu Zhao
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Lai Wei
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Andrew Johns
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1810 Cannon Drive, Suite 1240C, Columbus, OH, 43210, USA
| | - Sandip Patel
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1810 Cannon Drive, Suite 1240C, Columbus, OH, 43210, USA
| | - Mingjia Li
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1810 Cannon Drive, Suite 1240C, Columbus, OH, 43210, USA
| | - Madison Grogan
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1810 Cannon Drive, Suite 1240C, Columbus, OH, 43210, USA
| | - Gabrielle Lopez
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1810 Cannon Drive, Suite 1240C, Columbus, OH, 43210, USA
| | - Marium Husain
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1810 Cannon Drive, Suite 1240C, Columbus, OH, 43210, USA
| | - Rebecca Hoyd
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1810 Cannon Drive, Suite 1240C, Columbus, OH, 43210, USA
| | - Khalid Mumtaz
- Division of Gastroenterology Hepatology and Nutrition, The Ohio State University, Columbus, OH, USA
| | - Alexa Meara
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1810 Cannon Drive, Suite 1240C, Columbus, OH, 43210, USA
- Division of Rheumatology and Immunology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Erin M Bertino
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1810 Cannon Drive, Suite 1240C, Columbus, OH, 43210, USA
| | - Kari Kendra
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1810 Cannon Drive, Suite 1240C, Columbus, OH, 43210, USA
| | - Daniel Spakowicz
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1810 Cannon Drive, Suite 1240C, Columbus, OH, 43210, USA
| | - Gregory A Otterson
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1810 Cannon Drive, Suite 1240C, Columbus, OH, 43210, USA
| | - Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1810 Cannon Drive, Suite 1240C, Columbus, OH, 43210, USA
| | - Dwight H Owen
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1810 Cannon Drive, Suite 1240C, Columbus, OH, 43210, USA
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Johns AC, Yang M, Wei L, Grogan M, Spakowicz D, Patel SH, Li M, Husain M, Kendra KL, Otterson GA, Rosko AE, Andersen BL, Carbone DP, Owen DH, Presley CJ. Risk Factors for Immune Checkpoint Inhibitor Immunotherapy Toxicity Among Older Adults with Cancer. Oncologist 2023:7135996. [PMID: 37085156 PMCID: PMC10400153 DOI: 10.1093/oncolo/oyad097] [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: 07/29/2022] [Accepted: 03/09/2023] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES Immune checkpoint inhibitor immunotherapy (IO) is revolutionizing cancer care but can lead to significant toxicity. This study seeks to describe potential risk factors for immune-related adverse events (irAEs) specifically among older adults. MATERIALS AND METHODS This was a retrospective study at a single academic comprehensive cancer center based on chart review data abstracted by physicians. For patients aged ≥70 years, frequency, type, and grade of irAEs and their association with baseline patient demographics, comorbidities, mobility, and functional status were characterized using bivariate analysis. Based on those results, multivariable logistic regressions were constructed to model the association between these characteristics with any grade and grade 3 or higher irAEs. RESULTS Data were analyzed for 238 patients aged ≥70 years who received IO for mostly (≥90%) advanced cancer between 2011 and 2018. Thirty-nine percent of older adults experienced an irAE and 13% experienced one that was grade 3 or higher. In the multivariable analysis, depression was associated with an increased incidence of any grade irAE, while decreased life-space mobility was associated with an increased incidence of grade ≥3 irAEs. CONCLUSION Most characteristics of special interest among older adults, include fall risk, weight loss, cognitive limitations, and hearing loss, were not associated with irAEs in our study. However, decreased life-space mobility and depression are potential risk factors for IO toxicity among older adults with advanced cancer. Interventions designed to evaluate and mitigate modifiable risk factors for treatment-related toxicity are needed, and the results of this study may be useful for guiding those efforts.
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Affiliation(s)
- Andrew C Johns
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mike Yang
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Lai Wei
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Madison Grogan
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Daniel Spakowicz
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Sandipkumar H Patel
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mingjia Li
- Division of Hospital Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Marium Husain
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Kari L Kendra
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Gregory A Otterson
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Ashley E Rosko
- Division of Hematology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - David P Carbone
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Dwight H Owen
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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Secor A, Zhao S, Wei L, Das P, Haddad T, Miah A, Spakowicz D, Lopez G, Husain M, Grogan M, Li M, Schweitzer C, Pilcher C, Uribe D, Cheng G, Phelps M, Guo J, Shields P, He K, Bertino E, Carbone D, Otterson G, Presley C, Owen D. PP01.25 Incidence and Timing of Immune-Related Adverse Events in Patients With Non-Small Cell Lung Cancer Treated With Immune Checkpoint Inhibitor as Monotherapy or in Combination With Chemotherapy. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.051] [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: 01/29/2023]
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Spakowicz D, Hoyd R, Wheeler CE, Williams N, Bibi A, Husain M, Rajamouli S, Suman S, Amann J, Grogan M, Vibhakar P, Owen DH, Carbone DP, Rosko A, Burd CE, Presley CJ. Abstract A021: Older adult-specific microbes correlate with treatment response and markers of T-cell senescence in NSCLC. Cancer Res 2023. [DOI: 10.1158/1538-7445.agca22-a021] [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: 01/19/2023]
Abstract
Abstract
This abstract is being presented as a short talk in the scientific program. A full abstract is available in the Short Talks from Proffered Abstracts section (PR004) of the Conference Proceedings.
Citation Format: Daniel Spakowicz, Rebecca Hoyd, Caroline E. Wheeler, Nyelia Williams, Amna Bibi, Marium Husain, Srichandhana Rajamouli, Shankar Suman, Joseph Amann, Madison Grogan, Pooja Vibhakar, Dwight H. Owen, David P. Carbone, Ashley Rosko, Christin E. Burd, Carolyn J. Presley. Older adult-specific microbes correlate with treatment response and markers of T-cell senescence in NSCLC [abstract]. In: Proceedings of the AACR Special Conference: Aging and Cancer; 2022 Nov 17-20; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2022;83(2 Suppl_1):Abstract nr A021.
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Affiliation(s)
| | | | | | | | - Amna Bibi
- 1The Ohio State University, Columbus, OH
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Spakowicz D, Hoyd R, Wheeler CE, Williams N, Bibi A, Husain M, Rajamouli S, Suman S, Amann J, Grogan M, Vibhakar P, Owen DH, Carbone DP, Rosko A, Burd CE, Presley CJ. Abstract PR004: Older adult-specific microbes correlate with treatment response and markers of T-cell senescence in NSCLC. Cancer Res 2023. [DOI: 10.1158/1538-7445.agca22-pr004] [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: 01/19/2023]
Abstract
Abstract
The gut microbiome changes with age and affects many aspects of human health, including response to cancer treatments. Cancer survival rates have improved with new treatment options, including immune checkpoint blockade (ICB); however, the objective response rate remains low. Manipulation of the microbiome is a promising approach to improving cancer outcomes, but the effect of age is understudied. Here, we sought to understand whether (1) specific microbes are associated with treatment response in older adults with non-small cell lung cancer (NSCLC) and (2) whether these microbes are the same as for younger adults. Next, we explored the causal effects of the microbiome on ICB response in mouse models and the relationship with blood-based markers of T-cell senescence. We conducted a prospective cohort study of adults ≥60 years with a new diagnosis of NSCLC who received any treatment modality. Stool was collected, and metagenomic whole-genome shotgun sequencing was performed. Blood T-cells were isolated, the RNA purified and then assessed for markers of senescence by nanostring. Response to treatment was determined by RECIST v1.1 criteria. Generalized linear regression was used to relate baseline microbiome abundances to treatment response and non-parametric correlations associated with CDKN2A (p16) expression to microbe abundances. To assess the causal role of the gut microbiome in ICB response, we gavaged gut microbiome samples from responders and non-responders into C57BL/6 mice to create human-microbiome avatar models. The mice were then injected with MC38 cancer cells and treated with anti-PD1 or isotype control antibodies, and tumor volume was measured over time. Biospecimens and best response data at three months were captured from 23 patients, of which five had a complete response, eight had a partial response, eight had stable disease, and two had progressive disease. Over 50 microbes were associated with a response after p-value adjustment. Responder stool was enriched for microbes associated with youth and ICB response (Bifidobacterium adolescentis, p = 2.64e-20). However, microbial taxa associated with response differed from those reported in younger populations (Firmicutes sp. CAG 145, p = 1.58e-20, Oscillibacter sp. 57-20, p = 7.96e-24). Stool from non-responders (NRs) was enriched in taxa previously linked to treatment-related toxicities and shorter progression-free survival (Streptococcus lutetiensis, p = 4.55E-24) but also contained microbes previously linked to response in younger adults (e.g., Roseburia sp. CAG 309, p = 5.16e-15). The T cell senescence marker, p16, correlated with the most enriched taxon in non-responders NRs (Streptococcus thermophilus, r = 0.45, p = 0.02), suggesting a connection between immune aging and the microbiome. Preliminary fecal transplant studies in mice showed improved ICB response in mice engrafted with stool from responders versus non-responders. Together, these data identify potential differences in the gut microbiomes of young and older adult NSCLC patients who respond to ICB.
Citation Format: Daniel Spakowicz, Rebecca Hoyd, Caroline E. Wheeler, Nyelia Williams, Amna Bibi, Marium Husain, Srichandhana Rajamouli, Shankar Suman, Joseph Amann, Madison Grogan, Pooja Vibhakar, Dwight H. Owen, David P. Carbone, Ashley Rosko, Christin E. Burd, Carolyn J. Presley. Older adult-specific microbes correlate with treatment response and markers of T-cell senescence in NSCLC [abstract]. In: Proceedings of the AACR Special Conference: Aging and Cancer; 2022 Nov 17-20; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2022;83(2 Suppl_1):Abstract nr PR004.
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Affiliation(s)
| | | | | | | | - Amna Bibi
- 1The Ohio State University, Columbus, OH
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Nandy S, Hajra A, Malik A, Bandyopadhyay D, Abou-Ezzeddine O, Grogan M, Mankad R, Klarich KW. Trends in the prevalence of infiltrative cardiomyopathy among patients with in-hospital cardiac arrest – insight from the US national inpatient sample database. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1783] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Sarcoidosis, amyloidosis, hemochromatosis and scleroderma are the most common systemic disorders leading to infiltrative cardiomyopathy (InCM). Each of them has been associated with conduction abnormalities and sudden cardiac death. In patients who undergo in-hospital cardiac arrest, a high index of suspicion is required to rule out InCM as an underlying contributor.
Purpose
We aimed to analyse the temporal trend in the prevalence of InCM among patients with in-hospital cardiac arrest and identify factors associated with increased mortality in this population.
Methods
We analysed data from the National Inpatient Sample (NIS), which is the largest publicly available database of in-hospital patients in the Unites States. Using ICD-10 coding, we identified patients who were hospitalized across 10 years from 2010–2019. Patients with diagnosis codes for both cardiac arrest and a subtype of InCM were included. Demographic characteristics and co-morbidity data were collected. Statistical analysis was performed using STATA.
Results
The total number of patients with a diagnosis of in-hospital cardiac arrest was 19,34,260. Of these, the total number with InCM was 14,803 (0.77%), which comprised our study population. Mean age was 63 years. The overall prevalence of InCM across the years ranged between 0.75 to 0.9%, with a significant temporal increase (p<0.01). Prevalence of females ranged between 51% to 62% and significantly outnumbered males across the time period. (p=0.011). Incidence of in-hospital mortality ranged between 61% to 76% for females and 30 to 38% for males. Race based analysis showed that prevalence of Caucasians ranged from 51% to 62% while that of African Americans (AA) ranged from 57% to 73%. The incidence of mortality was similar in both populations. Sarcoidosis was the most prevalent form of InCM, accounting for nearly two-fifths of all cases while amyloidosis and scleroderma both accounted for nearly 20% each. Haemochromatosis was present in 10% of the population. Overall mortality rate in our study population was 60.6%. The following co-morbidities were more prevalent in patients with InCM than those without: history of heart failure, chronic obstructive pulmonary disease (COPD), chronic kidney disease, anaemia, malignancy, coagulopathy, ventricular tachycardia, acute kidney injury and stroke. The following factors were independent predictors of in-hospital mortality-age (p=0.001), female gender (p=0.016), Hispanic race (p=0.039), history of COPD (p<0.001) and presence of malignancy (p=0.042).
Conclusion
The prevalence of infiltrative cardiomyopathy in patients with in-hospital cardiac arrest is increasing. Females, older patients and Hispanic population are at an increased risk of mortality. Sex and race based disparities in the prevalence of InCM in patients with in-hospital cardiac arrest is an area of further research.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Nandy
- Albert Einstein College of Medicine , New York City , United States of America
| | - A Hajra
- Albert Einstein College of Medicine , New York City , United States of America
| | - A Malik
- New York Medical College , New York , United States of America
| | - D Bandyopadhyay
- New York Medical College , New York , United States of America
| | - O Abou-Ezzeddine
- Mayo Clinic, Cardiovascular Diseases , Rochester , United States of America
| | - M Grogan
- Mayo Clinic, Cardiovascular Diseases , Rochester , United States of America
| | - R Mankad
- Mayo Clinic, Cardiovascular Diseases , Rochester , United States of America
| | - K W Klarich
- Mayo Clinic, Cardiovascular Diseases , Rochester , United States of America
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9
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Fontana M, Buchholtz K, Engelmann MDM, Grogan M, Hovingh GK, Kristen AV, Poulsen P, Shah SJ, Maurer MS. NNC6019–0001, a humanized monoclonal antibody, in patients with transthyretin amyloid cardiomyopathy (ATTR-CM): rationale and study design of a phase 2, randomized, placebo-controlled trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1767] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Transthyretin amyloid cardiomyopathy (ATTR-CM) is a chronic condition associated with progressive heart failure, resulting from extracellular deposition of misfolded transthyretin (TTR) protein as amyloid fibrils in the myocardium. Currently, there are few disease-modifying treatments. NNC6019–0001 is a humanized monoclonal antibody designed to deplete amyloid via antibody-mediated phagocytosis by targeting a unique epitope that is exposed only on misfolded monomeric and aggregated forms of TTR. In a phase 1, open-label, 3-month dose escalation trial, NNC6019–0001 was well tolerated at all doses tested (up to and including 30 mg/kg).1 The maximum tolerated dose was not reached. Exploratory cardiac endpoints were stable or indicated a possible benefit.
Purpose
To evaluate the effect of NNC6019–0001 30 mg/kg and 100 mg/kg on cardiac functional endpoints and predictive biomarkers in patients with ATTR-CM, and to assess pharmacokinetics, safety and tolerability, to establish the optimal dose for a phase 3 trial.
Methods
This is a randomized, double-blind, placebo-controlled trial recruiting 99 patients with hereditary or wild-type ATTR-CM (Figure). Inclusion criteria are New York Heart Association (NYHA) class II or III heart failure, left ventricle wall thickening (LVWT) ≥12 mm, N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels ≥650 pg/mL in sinus rhythm and >1000 pg/mL in atrial fibrillation, and a 6-minute walk test (6MWT) distance of 150–450 m. Patients will be randomly assigned to receive intravenous NNC6019–0001 30 mg/kg or 100 mg/kg or placebo, each in addition to standard of care, every 4 weeks for 52 weeks, followed by a 12-week follow-up. In a sentinel dosing phase, three patients per arm will receive the study drug or placebo, in combination with 24-hour inpatient cardiac monitoring and 7 days of continuous cardiac (tele-) monitoring. The primary endpoints are change from baseline to week 52 in 6MWT and in NT-proBNP levels. Secondary endpoints include cardiac measures: extracellular volume on cardiac magnetic resonance imaging, global longitudinal strain, troponin T levels, hospitalization due to cardiovascular events, and urgent visits due to heart failure. Quality of life will be assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ). All-cause mortality, pharmacokinetics and treatment-emergent adverse events will also be assessed.
Results
The trial will start mid-2022 with global recruitment.
Conclusion
Disease-modifying treatments are needed for patients with ATTR-CM, where treatment is often limited to managing symptoms and best supportive care; the first disease-modifying therapies recently became available. This phase 2 trial will be used to determine the appropriate dose for the phase 3 trial of NNC6019–0001, a novel antibody therapy designed to deplete amyloid in patients with ATTR-CM.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This trial was funded by Novo Nordisk A/S. Medical writing support was provided by Johanna Scheinost PhD, PharmaGenesis Oxford Central, Oxford, UK, with funding from Novo Nordisk A/S.
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Affiliation(s)
- M Fontana
- National Amyloidosis Centre, University College London, Royal Free Campus , London , United Kingdom
| | | | | | - M Grogan
- Mayo Clinic , Rochester , United States of America
| | | | - A V Kristen
- Department of Cardiology, Amyloidosis Center, Heidelberg University , Heidelberg , Germany
| | | | - S J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine , Chicago , United States of America
| | - M S Maurer
- Cardiac Amyloidosis Program, Department of Medicine, Columbia University Irving Medical Center , New York , United States of America
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10
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Presley C, Grogan M, Hoyd R, Compston A, Hock K, Knauss B, Redder E, Arrato N, Lo S, Benedict J, Janse S, Hayes S, Williams N, Wheeler C, Carbone D, Paskett E, Andersen B, Spakowicz D. Resiliency among Older Adults Receiving Lung Cancer Treatment (ROAR-LCT, NCT04229381): The feasibility of a novel supportive care intervention with collection of longitudinal gut microbiome specimens and activity tracking during the COVID-19 Pandemic. J Geriatr Oncol 2022. [DOI: 10.1016/s1879-4068(22)00320-4] [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: 11/07/2022]
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11
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Li M, Zhao S, Guo J, Gauntner T, Schafer J, Chakravarthy K, Lopez G, Secor A, Das P, Surya N, Husain M, Patel S, Grogan M, Spakowicz D, Miah A, Wei L, He K, Bertino E, Alahmadi A, Memmott R, Kaufman J, Presley C, Shields P, Carbone D, Otterson G, Owen D. EP08.01-062 Body Mass Index, Immune Related Adverse Events, and Survival in Patients with Metastatic Non-small Cell Lung Cancer Treated with Immunotherapy. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.634] [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: 11/16/2022]
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12
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Bibi A, Pallerla A, Williams N, Wheeler C, Hoyd R, Suman S, Amann J, Goruganthu M, Okimoto T, Liu Y, Bittoni M, Shi N, Zhang S, Anand A, Heitman K, Mendelson M, Grainger EM, Grogan M, Presley CJ, Tabung FK, Li L, Vodovotz Y, Zhu J, Carbone DP, Chen T, Clinton SK, Spakowicz D. Abstract 3523: A Black Raspberry dietary intervention to modify the gut microbiome and improve the response to immune checkpoint inhibitors. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3523] [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
Lung cancer kills more people annually worldwide than any other cancer. Outcomes have improved with the use of immune checkpoint inhibitor (ICI) treatment, however, only about 20% of tumors respond. Emerging data demonstrate that responses to ICI may depend on the host microbiome. The challenge is to identify strategies to manipulate the gut microbiome to improve response to ICIs. Here we explore a targeted dietary intervention to modify the microbiome and determine the response to ICIs. Studies in a preclinical murine model showed that freeze-dried black raspberry powder (AIN-76A synthetic diet containing 5% lyophilized black raspberry powder) increased the abundance of Akkermansia muciniphila, which has been associated with improved response to ICIs in melanoma. Next, we conducted a human intervention trial called the BEWELL Study (Black raspberry nEctar Working to prEvent Lung cancer NCT04267874). This placebo-controlled, randomized, cross-over trial examined the impact of 2x 80 mL black raspberry (BRB) nectar drink boxes per day for 4 weeks. There were 96 participants recruited and classified as being at high risk of developing lung cancer (eligibility criteria: >30 pack-year smoking history and 55-77 years old) in an attempt to match the phenotype of typical lung cancer patients but allowing us to clearly assess the impact of the intervention on the microbiome. Pre- and post-dietary intervention gut microbiome, blood, and urine samples were collected. Black raspberry dietary supplementation was not associated with a significant change in A. muciniphila (logistic regression with negative binomial Wald test p-value 0.056), however, changes in other taxa were observed. Finally, stool from participants in the BEWELL study was gavaged into C57BL/6J mice to create human microbiome avatar models. Mouse colon cancer cells (mc38) were injected subcutaneously and treated with anti-PD1 Ab (5mg/kg mouse; clone RMP1-14) or isotype control (clone 2A3). Preliminary experiments using avatar mice with post-BRB human microbiomes showed smaller tumors relative to mice receiving stool from that same individual pre-BRB dietary intervention, relative to isotype control (t-test, p-value 0.05). These results suggest that black raspberry nectar may modify the human gut microbiome in a way that promotes an improved response to immunotherapy.
Citation Format: Amna Bibi, Aaditya Pallerla, Nyelia Williams, Caroline Wheeler, Rebecca Hoyd, Shankar Suman, Joseph Amann, Mounika Goruganthu, Tamio Okimoto, Yangyang Liu, Marisa Bittoni, Ni Shi, Shiqi Zhang, Alvin Anand, Kristen Heitman, Maxine Mendelson, Elizabeth M. Grainger, Madison Grogan, Carolyn J. Presley, Fred K. Tabung, Lang Li, Yael Vodovotz, Jiangjiang Zhu, David P. Carbone, Tong Chen, Steven K. Clinton, Daniel Spakowicz. A Black Raspberry dietary intervention to modify the gut microbiome and improve the response to immune checkpoint inhibitors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3523.
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Affiliation(s)
- Amna Bibi
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Aaditya Pallerla
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Nyelia Williams
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Caroline Wheeler
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Rebecca Hoyd
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Shankar Suman
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Joseph Amann
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Tamio Okimoto
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Yangyang Liu
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Marisa Bittoni
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Ni Shi
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Shiqi Zhang
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Alvin Anand
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Kristen Heitman
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Maxine Mendelson
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Madison Grogan
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Fred K. Tabung
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Lang Li
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Yael Vodovotz
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Jiangjiang Zhu
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - David P. Carbone
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Tong Chen
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Steven K. Clinton
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Daniel Spakowicz
- 1The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Guo Y, Wei L, Patel SH, Lopez G, Grogan M, Li M, Haddad T, Johns A, Ganesan LP, Yang Y, Spakowicz DJ, Shields PG, He K, Bertino EM, Otterson GA, Carbone DP, Presley C, Kulp SK, Mace TA, Coss CC, Phelps MA, Owen DH. Serum Albumin: Early Prognostic Marker of Benefit for Immune Checkpoint Inhibitor Monotherapy But Not Chemoimmunotherapy. Clin Lung Cancer 2022; 23:345-355. [PMID: 35131184 PMCID: PMC9149057 DOI: 10.1016/j.cllc.2021.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 12/07/2021] [Accepted: 12/28/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cancer cachexia exhibits decreased albumin and associates with short overall survival (OS) in patients with non-small cell lung cancer (NSCLC), but whether on-treatment albumin changes associate with OS in NSCLC patients treated with immune checkpoint inhibitors (ICIs) and combination chemoimmunotherapy has not been thoroughly evaluated. PATIENTS AND METHODS We conducted a single-center retrospective study of patients with advanced NSCLC who received first-line ICI with or without chemotherapy between 2013 and 2020. The association of pretreatment albumin and early albumin changes with OS was evaluated using Kaplan-Meier method and Cox regression models. RESULTS A total of 210 patients were included: 109 in ICI cohort and 101 in ICI + Chemo cohort. Within a median of 21 days from treatment initiation, patients with ≥ 10% of albumin decrease had significantly shorter OS compared to patients without albumin decrease in ICI cohort. Pretreatment albumin and albumin decrease within the first or second cycle of treatment were significantly and independently associated with OS in ICI cohort, but not in ICI + Chemo cohort. The lack of association between albumin and OS with the addition of chemotherapy was more pronounced among patients with ≥ 1% PD-L1 expression in subgroup analysis. CONCLUSION Pretreatment serum albumin and early albumin decrease in ICI monotherapy was significantly associated with OS in advanced NSCLC. Early albumin change, as a routine lab value tested in clinic, may be combined with established biomarkers to improve outcome predictions of ICI monotherapy. The underlying mechanism of the observed association between decreased albumin and ICI resistance warrants further investigation.
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Affiliation(s)
- Yizhen Guo
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH
| | - Lai Wei
- Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
| | - Sandip H Patel
- Division of Medical Oncology, Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Gabrielle Lopez
- Division of Medical Oncology, Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Madison Grogan
- Division of Medical Oncology, Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Mingjia Li
- Department of Internal Medicine, Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Tyler Haddad
- Department of Internal Medicine, Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Andrew Johns
- Department of Internal Medicine, Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Latha P Ganesan
- Department of Internal Medicine, Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Yiping Yang
- Division of Hematology, Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Daniel J Spakowicz
- Division of Medical Oncology, Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Peter G Shields
- Division of Medical Oncology, Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Kai He
- Division of Medical Oncology, Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Erin M Bertino
- Division of Medical Oncology, Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Gregory A Otterson
- Division of Medical Oncology, Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - David P Carbone
- Division of Medical Oncology, Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Carolyn Presley
- Division of Medical Oncology, Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Samuel K Kulp
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH
| | - Thomas A Mace
- Division of Medical Oncology, Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Christopher C Coss
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH
| | - Mitch A Phelps
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH.
| | - Dwight H Owen
- Division of Medical Oncology, Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH.
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14
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Gast KC, Benedict JA, Grogan M, Janse S, Saphire M, Kumar P, Bertino EM, Agne JL, Presley CJ. Impact of an Embedded Palliative Care Clinic on Healthcare Utilization for Patients With a New Thoracic Malignancy. Front Oncol 2022; 12:835881. [PMID: 35295997 PMCID: PMC8919515 DOI: 10.3389/fonc.2022.835881] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Palliative care is beneficial for patients with advanced lung cancer, but the optimal model of palliative care delivery is unknown. We investigated healthcare utilization before and after embedding a palliative care physician within a thoracic medical oncology "onco-pall" clinic. Methods This is a retrospective cross-sectional cohort study comparing healthcare outcomes in two cohorts: "pre-cohort" 12 months prior to and "post-cohort" 12-months after the onco-pall clinic start date. Patients were included if they had a new diagnosis of lung cancer and received care at The Ohio State University Thoracic Oncology Center, and resided in Franklin County or 6 adjacent counties. During the pre-cohort time period, access to palliative care was available at a stand-alone palliative care clinic. Palliative care intervention in both cohorts included symptom assessment and management, advance care planning, and goals of care discussion as appropriate. Outcomes evaluated included rates of emergency department (ED) visits, hospital admissions, 30-day readmissions, and intensive care unit (ICU) admissions. Estimates were calculated in rates per-person-years and with Poisson regression models. Results In total, 474 patients met criteria for analysis (214 patients included in the pre-cohort and 260 patients in the post-cohort). Among all patients, 52% were male and 48% were female with a median age of 65 years (range 31-92). Most patients had non-small cell lung cancer (NSCLC - 17% stage 1-2, 20% stage 3, 47% stage 4) and 16% had small cell lung cancer. The post-cohort was older [median age 66 years vs 63 years in the pre-cohort (p-value: < 0.01)]. The post-cohort had a 26% reduction in ED visits compared to the pre-cohort, controlling for age, race, marital status, sex, county, Charlson score at baseline, cancer type and stage (adjusted relative risk: aRR: 0.74, 95% CI: 0.58-0.94, p-value = 0.01). Although not statistically significant, there was a 29% decrease in ICU admissions (aRR: 0.71, 95% CI: 0.41-1.21, p-value = 0.21) and a 15% decrease in hospital admissions (aRR: 0.85, 95% CI: 0.70-1.03, p-value = 0.10). There was no difference in 30-day readmissions (aRR: 1.03, 95% CI: 0.73-1.45, p-value = 0.85). Conclusions Embedding palliative care clinics within medical oncology clinics may decrease healthcare utilization for patients with thoracic malignancies. Further evaluation of this model is warranted.
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Affiliation(s)
- Kelly C Gast
- Division of Medical Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, United States
| | - Jason A Benedict
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Madison Grogan
- Division of Medical Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, United States
| | - Sarah Janse
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Maureen Saphire
- Department of Pharmacy, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, United States
| | - Pooja Kumar
- Department of Pharmacy, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, United States
| | - Erin M Bertino
- Division of Medical Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, United States
| | - Julia L Agne
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Carolyn J Presley
- Division of Medical Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, United States
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15
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Spakowicz D, Hoyd R, Williams N, Grogan M, Mrofchak R, Benedict J, Janse S, Carbone D, Rosko A, Presley C. The gut microbiome correlates with common geriatric assessments in the context of lung cancer treatment for older adults. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00440-9] [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: 11/25/2022]
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16
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Dasari S, Chiu A, Theis J, Vrana JA, Kurtin PJ, Rech KL, Dao LN, Howard MT, McPhail ED, Dispenzieri A, Grogan M. Bone marrow involvement by ATTR amyloid is common in cardiac amyloidosis patients and may signal advanced-stage disease. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.200] [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: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
Amyloidosis encompasses a heterogeneous group of disorders characterized by abnormal deposition of misfolded proteins leading to progressive organ failure. Accurate amyloid typing is essential for proper patient management, as treatment regimens vary dramatically across different types. Bone marrow (BM) biopsy, in conjunction with fat pad aspiration/biopsy, is often the first step in patients with suspected amyloidosis. Although BM involvement by AL amyloid has been previously characterized, little is known about the incidence, morphology and clinical phenotype of non-AL amyloid in BM.
Methods/Case Report
We retrospectively identified 1469 BM biopsies by querying our reference laboratory database of 19,298 specimens from myriad anatomic sites typed by mass spectrometry-based proteomics (LC-MS/MS). These were reviewed for frequency of amyloid types (N=1469), distribution of amyloid deposits (N=139), and clinical phenotypes (N=345), with particular emphases on cardiac involvement.
Results (if a Case Study enter NA)
We identified the following amyloid types: AL (N=1172; 79.8%), ATTR (transthyretin) (N=240; 16.3%), AH (immunoglobulin heavy chain) (N=38; 2.6%), AA (serum amyloid A) (N=17; 1.2%), and Aβ2M (β2-microglobulin) (N=2; 0.1%). ATTR deposits showed striking predilection for periosteal soft tissue and/or periosteal vessels, and rarely involved BM stroma and/or interstitial vessels, while AL variably involved these compartments. AA primarily involved interstitial vessels. Both AL and ATTR cases commonly had a monoclonal gammopathy (AL: 92.9%; ATTR: 62.5%) with concomitant cardiac amyloidosis (AL: 91.6%; ATTR: 100%). Compared to AL, ATTR patients had higher stage cardiac amyloidosis and lower overall survival.
Conclusion
ATTR is common in BM, constituting16.3% of cases in our cohort. Rarer amyloid types, such as AA, AH and AB2M can also occur in BM. ATTR was frequently identified in patients with concomitant monoclonal gammopathy, in whom AL may have been suspected. Although ATTR deposits have distinctive morphologic distribution, primarily involving periosteal soft tissue and/or periosteal vessels and rarely involving BM stroma and/or interstitial vessels, there is considerable morphologic overlap with AL. Therefore, it is imperative to type BM amyloidosis, preferably by LC-MS/MS, to ensure proper patient management. Furthermore, BM involvement by ATTR may be a marker for advanced stage of disease.
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Affiliation(s)
- S Dasari
- Qualitative Health Sciences, Mayo Clinic, Rochester, Minnesota, UNITED STATES
| | - A Chiu
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, UNITED STATES
| | - J Theis
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, UNITED STATES
| | - J A Vrana
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, UNITED STATES
| | - P J Kurtin
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, UNITED STATES
| | - K L Rech
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, UNITED STATES
| | - L N Dao
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, UNITED STATES
| | - M T Howard
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, UNITED STATES
| | - E D McPhail
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, UNITED STATES
| | - A Dispenzieri
- Medicine, Mayo Clinic, Rochester, Minnesota, UNITED STATES
| | - M Grogan
- Medicine, Mayo Clinic, Rochester, Minnesota, UNITED STATES
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Tan T, Grogan M, Borgeson D, Pislaru S, Dispenzieri A, Garvan K, Oguz D, Lin G. RV free wall longitudinal strain as an independent predictor of survival in wtATTR-CA patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Wild type transthyretin cardiac amyloidosis (wtATTR-CA) is increasingly recognized as a cause of heart failure with preserved ejection fraction (HFpEF) but prognosis is often limited due to late or misdiagnosis.Longitudinal left ventricular strain and biomarkers are established as markers of disease severity, but the role of RV free wall strain, reflecting RV contractility, is less well understood.
Purpose
We sought to determine whether RV free wall strain might add incremental prognostic value in wtATTR-CA.
Methods
Consecutive patients diagnosed with wtATTR-CA with tissue confirmation at Mayo clinic between 2013 and 2015 were included. Patients with TTR gene mutations were excluded. Baseline characteristics and transthoracic echocardiography measurements were obtained from the medical records. Speckle tracking RV free wall longitudinal 2D strain and peak LA longitudinal 2D strain were measured using Tom Tec Imaging System. Survival was determined using Kaplan Meier estimates and using the cox proportional hazard ratio, univariate and multivariable analysis were performed to identify predictors of mortality in patients with wtATTR.
Results
The study group comprised 139 patients (mean age 74.9±8.6, 92.8% male), of which 102 had adequate image quality for RV strain, and 99 for LA strain. Amongst these, 102 (73.3%) had AF and 118 patients (84.8%) had HF. During 3.23±2.0 years of follow up, 66 patients died. Both mean RV and LA strain were impaired at baseline: RV free wall strain was −14.7±4.9, and peak atrial longitudinal strain (PALS) was 13.2±8.8%. Using ROC analysis, RV strain of −16.8% was an independent predictor of all-cause mortality. In univariate modeling, higher levels of NT-proBNP (HR: 1.1 per 1000 pg.ml; 95%, CI 1.05–1.15, p<0.001) and Troponin T (HR: 2.0 per 0.1ng/ml; 95% CI 1.49–2.61, p<0.001) were associated with increased all-cause mortality. In addition, LV GLS (HR: 1.13 per 1%; 95% CI1.04–1.24, p=0.003), RV free wall LS (HR: 2.16 per 5%; 95%, CI 1.57–3.03, p<0.0001), and PALS (HR: 0.91 per1%; 95% CI 0.85–0.96, p<0.0001) were univariate predictors of all-cause mortality. In multivariate analysis using a stepwise regression model, RV free wall longitudinal strain (HR: 1.81; 95% CI 1.29–2.62, p<0.001) and Troponin T (HR: 1.7; 95% CI 1.25–2.26, p=0.001) remained independent predictors. Kaplan-Meier survival analysis demonstrated a higher mortality rate above −16.8 RV strain cut-off (Wilcoxon <0.0001). All stages were divided into two groups by −16.8% RV strain, and survival in individual stages analyzed. Stage 1 and 2 with <−16.8 RV free wall strain value had higher mortality than ≤-16.8% RV strain (Stage 1: Wilcoxon = 0.0041 and Stage 2: Wilcoxon = 0.023). However, there was not a survival difference between two RV strain groups in stage3 (Wilcoxon = 0.34)
Conclusion
RV free wall strain is an independent predictor of survival in wtATTR patients and may add incremental prognostic value to NT-proBNP and Troponin.
Funding Acknowledgement
Type of funding sources: None. Kaplan-Meier curve of all patientsKaplan-Meier curve of stages
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Affiliation(s)
- T.S Tan
- Mayo Clinic, Cardiology Department, Rochester, United States of America
| | - M Grogan
- Mayo Clinic, Cardiology Department, Rochester, United States of America
| | - D Borgeson
- Mayo Clinic, Cardiology Department, Rochester, United States of America
| | - S.V Pislaru
- Mayo Clinic, Cardiology Department, Rochester, United States of America
| | - A Dispenzieri
- Mayo Clinic, Internal Medicine, Rochester, United States of America
| | - K Garvan
- Mayo Clinic, Cardiology Department, Rochester, United States of America
| | - D Oguz
- Mayo Clinic, Cardiology Department, Rochester, United States of America
| | - G Lin
- Mayo Clinic, Cardiology Department, Rochester, United States of America
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18
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Haddad TC, Zhao S, Li M, Patel SH, Johns A, Grogan M, Lopez G, Miah A, Wei L, Tinoco G, Riesenberg B, Li Z, Meara A, Bertino EM, Kendra K, Otterson G, Presley CJ, Owen DH. Immune checkpoint inhibitor-related thrombocytopenia: incidence, risk factors and effect on survival. Cancer Immunol Immunother 2021; 71:1157-1165. [PMID: 34618180 PMCID: PMC9015999 DOI: 10.1007/s00262-021-03068-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 06/02/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICI) are associated with unique immune-related adverse events (irAEs). Immune-related thrombocytopenia (irTCP) is an understudied and poorly understood toxicity; little data are available regarding either risk of irTCP or the effect of irTCP on clinical outcomes of patients treated with ICI. METHODS We conducted a retrospective review of sequential cancer patients treated with ICI between 2011 and 2017 at our institution. All patients who received ICI alone or in combination with other systemic therapy in any line of treatment were included; those with thrombocytopenia ≥ grade 3 at baseline were excluded. We calculated the incidence of ≥ grade 3 irTCP and overall survival (OS). Patient factors associated with irTCP were assessed. RESULTS We identified 1,038 patients that met eligibility criteria. Overall, 89 (8.6%) patients developed grade ≥ 3 thrombocytopenia; eighteen were attributed to ICI (1.73% overall). Patients who developed grade ≥ 3 irTCP had worse overall survival compared to those whose thrombocytopenia was unrelated to ICI (4.17 vs. 10.8 month; HR. 1.94, 95% CI 1.13, 3.33; log-rank p = 0.0164). Patients with grade ≥ 3 irTCP also had worse survival compared to those without thrombocytopenia (4.17 vs. 13.31 months; HR 2.22, 95% CI 1.36, 3.62; log-rank p = 0.001). The incidence of irTCP appeared lowest among those treated with PD-1/L1 monotherapy (p = 0.059) and was not associated with cancer type, smoking status, age, gender, race, or line of therapy. CONCLUSIONS Unlike other irAEs, we found that irTCP was associated with worse overall survival. The incidence of irTCP appeared lowest among those treated with PD-1/L1 monotherapy.
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Affiliation(s)
- Tyler C Haddad
- Division of Medical Oncology, Department of Internal Medicine , The Ohio State University - James Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1335, Columbus, OH, 43210, USA
| | - Songzhu Zhao
- Center for Biostatistics, The Ohio State University - James Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1335, Columbus, OH, 43210, USA
| | - Mingjia Li
- Division of Medical Oncology, Department of Internal Medicine , The Ohio State University - James Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1335, Columbus, OH, 43210, USA
| | - Sandip H Patel
- Division of Medical Oncology, Department of Internal Medicine , The Ohio State University - James Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1335, Columbus, OH, 43210, USA
| | - Andrew Johns
- Division of Medical Oncology, Department of Internal Medicine , The Ohio State University - James Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1335, Columbus, OH, 43210, USA
| | - Madison Grogan
- Division of Medical Oncology, Department of Internal Medicine , The Ohio State University - James Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1335, Columbus, OH, 43210, USA
| | - Gabriella Lopez
- Division of Medical Oncology, Department of Internal Medicine , The Ohio State University - James Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1335, Columbus, OH, 43210, USA
| | - Abdul Miah
- Division of Medical Oncology, Department of Internal Medicine , The Ohio State University - James Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1335, Columbus, OH, 43210, USA
| | - Lai Wei
- Center for Biostatistics, The Ohio State University - James Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1335, Columbus, OH, 43210, USA
| | - Gabriel Tinoco
- Division of Medical Oncology, Department of Internal Medicine , The Ohio State University - James Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1335, Columbus, OH, 43210, USA
| | - Brian Riesenberg
- Division of Medical Oncology, Department of Internal Medicine , The Ohio State University - James Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1335, Columbus, OH, 43210, USA
| | - Zihai Li
- Division of Medical Oncology, Department of Internal Medicine , The Ohio State University - James Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1335, Columbus, OH, 43210, USA
| | - Alexa Meara
- Division of Rheumatology and Immunology, The Ohio State University - James Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1335, Columbus, OH, 43210, USA
| | - Erin M Bertino
- Division of Medical Oncology, Department of Internal Medicine , The Ohio State University - James Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1335, Columbus, OH, 43210, USA
| | - Kari Kendra
- Division of Medical Oncology, Department of Internal Medicine , The Ohio State University - James Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1335, Columbus, OH, 43210, USA
| | - Gregory Otterson
- Division of Medical Oncology, Department of Internal Medicine , The Ohio State University - James Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1335, Columbus, OH, 43210, USA
| | - Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine , The Ohio State University - James Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1335, Columbus, OH, 43210, USA
| | - Dwight H Owen
- Division of Medical Oncology, Department of Internal Medicine , The Ohio State University - James Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1335, Columbus, OH, 43210, USA.
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19
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Grogan M, Benedict J, Janse S, Hoyd R, Williams N, Naughton M, Andersen B, Carbone D, Paskett E, Rosko A, Spakowicz D, Presley C. P54.06 The FITNESS Study: Geriatric Assessment, Treatment Toxicity, and Biospecimen Collection Among Older Adults With Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.563] [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: 10/20/2022]
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20
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Husain M, Xu M, Patel S, Johns A, Grogan M, Li M, Lopez G, Miah A, Hoyd R, Liu Y, Muniak M, Haddad T, Tinoco G, Kendra K, Otterson G, Presley C, Spakowicz D, Owen D. P40.15 Proton Pump Inhibitors, Prior Therapy and Survival in Patients Treated With Immune Checkpoint Inhibitors for Advanced NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.452] [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: 10/20/2022]
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21
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Agne J, Presley C, Bertino E, Grogan M, Benedict J, Janse S. OA05.03 Onco-Pall Clinic: An Embedded Care Model for Thoracic Malignancy. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.049] [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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22
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Nashed A, Zhang S, Chiang CW, Zitu M, Otterson GA, Presley CJ, Kendra K, Patel SH, Johns A, Li M, Grogan M, Lopez G, Owen DH, Li L. Comparative assessment of manual chart review and ICD claims data in evaluating immunotherapy-related adverse events. Cancer Immunol Immunother 2021; 70:2761-2769. [PMID: 33625533 PMCID: PMC10992210 DOI: 10.1007/s00262-021-02880-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/01/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of this retrospective study was to demonstrate that irAEs, specifically gastrointestinal and pulmonary, examined through International Classification of Disease (ICD) data leads to underrepresentation of true irAEs and overrepresentation of false irAEs, thereby concluding that ICD claims data are a poor approach to electronic health record (EHR) data mining for irAEs in immunotherapy clinical research. METHODS This retrospective analysis was conducted in 1,063 cancer patients who received ICIs between 2011 and 2017. We identified irAEs by manual review of medical records to determine the incidence of each of our endpoints, namely colitis, hepatitis, pneumonitis, other irAE, or no irAE. We then performed a secondary analysis utilizing ICD claims data alone using a broad range of symptom and disease-specific ICD codes representative of irAEs. RESULTS 16% (n = 174/1,063) of the total study population was initially found to have either pneumonitis 3% (n = 37), colitis 7% (n = 81) or hepatitis 5% (n = 56) on manual review. Of these patients, 46% (n = 80/174) did not have ICD code evidence in the EHR reflecting their irAE. Of the total patients not found to have any irAEs during manual review, 61% (n = 459/748) of patients had ICD codes suggestive of possible irAE, yet were not identified as having an irAE during manual review. DISCUSSION Examining gastrointestinal and pulmonary irAEs through the International Classification of Disease (ICD) data leads to underrepresentation of true irAEs and overrepresentation of false irAEs.
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Affiliation(s)
- Andrew Nashed
- Department of Internal Medicine, The Ohio State University, A450B Starling Loving Hall Columbus, Columbus, OH, 43210, USA.
| | - Shijun Zhang
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, A450B Starling Loving Hall Columbus, Columbus, OH, 43210, USA
| | - Chien-Wei Chiang
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, A450B Starling Loving Hall Columbus, Columbus, OH, 43210, USA
| | - M Zitu
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, A450B Starling Loving Hall Columbus, Columbus, OH, 43210, USA
| | - Gregory A Otterson
- Division of Medical Oncology, The Ohio State University, A450B Starling Loving Hall ColumbusA450B Starling Loving Hall Columbus, Columbus, OH, 43210, USA
| | - Carolyn J Presley
- Division of Medical Oncology, The Ohio State University, A450B Starling Loving Hall ColumbusA450B Starling Loving Hall Columbus, Columbus, OH, 43210, USA
| | - Kari Kendra
- Division of Medical Oncology, The Ohio State University, A450B Starling Loving Hall ColumbusA450B Starling Loving Hall Columbus, Columbus, OH, 43210, USA
| | - Sandip H Patel
- Division of Medical Oncology, The Ohio State University, A450B Starling Loving Hall ColumbusA450B Starling Loving Hall Columbus, Columbus, OH, 43210, USA
| | - Andrew Johns
- Department of Internal Medicine, The Ohio State University, A450B Starling Loving Hall Columbus, Columbus, OH, 43210, USA
| | - Mingjia Li
- Department of Internal Medicine, The Ohio State University, A450B Starling Loving Hall Columbus, Columbus, OH, 43210, USA
| | - Madison Grogan
- Division of Medical Oncology, The Ohio State University, A450B Starling Loving Hall ColumbusA450B Starling Loving Hall Columbus, Columbus, OH, 43210, USA
| | - Gabrielle Lopez
- Division of Medical Oncology, The Ohio State University, A450B Starling Loving Hall ColumbusA450B Starling Loving Hall Columbus, Columbus, OH, 43210, USA
| | - Dwight H Owen
- Division of Medical Oncology, The Ohio State University, A450B Starling Loving Hall ColumbusA450B Starling Loving Hall Columbus, Columbus, OH, 43210, USA
| | - Lang Li
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, A450B Starling Loving Hall Columbus, Columbus, OH, 43210, USA
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23
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Vaxman I, Kumar SK, Buadi F, Lacy MQ, Dingli D, Hwa Y, Fonder A, Hobbs M, Hayman S, Kourelis T, Warsame R, Muchtar E, Leung N, Kapoor P, Grogan M, Go R, Lin Y, Gonsalves W, Siddiqui M, Kyle RA, Rajkumar SV, Gertz MA, Dispenzieri A. Outcomes among newly diagnosed AL amyloidosis patients with a very high NT-proBNP: implications for trial design. Leukemia 2021; 35:3604-3607. [PMID: 34021252 PMCID: PMC8632659 DOI: 10.1038/s41375-021-01297-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/30/2021] [Accepted: 05/10/2021] [Indexed: 12/14/2022]
Affiliation(s)
- I Vaxman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - S K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - F Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Y Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S Hayman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - T Kourelis
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - E Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Grogan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - R Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Y Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - W Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Siddiqui
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S V Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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24
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Haddad T, Zhao S, Li M, Patel SH, Johns A, Grogan M, Lopez G, Miah A, Wei L, Tinoco G, Riesenberg BP, Li Z, Bertino EM, Kendra KL, Otterson GA, Presley CJ, Owen DH. Immune checkpoint inhibitor-related thrombocytopenia: Incidence, risk factors, and effect on overall survival. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e14549] [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
e14549 Background: Immune checkpoint inhibitors (ICI) are a standard of care therapy for patients with many different cancers. ICI are generally well tolerated but are associated with unique immune-related adverse events (irAEs). Immune-related thrombocytopenia (irTCP) is an understudied and poorly understood toxicity and risk factors for irTCP are unknown. Although other irAE have been associated with clinical benefit, little data is available regarding either risk of irTCP or the effect of irTCP on clinical outcomes of patients treated with ICI. Methods: We conducted a retrospective review of sequential patients with any solid or hematologic cancer treated with ICI between 2011 and 2017 at The Ohio State University Comprehensive Cancer Center. All patients who received ICI alone or in combination with other systemic therapy in any line of treatment were included; those with thrombocytopenia ≥ grade 3 at baseline were excluded. Thrombocytopenia grading was performed utilizing the Common Terminology Criteria for Adverse Events version 5.0. Attribution to ICI was defined as timing after ICI initiation, lack of alternative causes, and improvement with either holding treatment or use of immune suppressive therapy. Overall survival (OS) was calculated from the date of initiation of ICI to death from any cause or date of the last follow-up examination. Cox proportional hazard models were used to examine the associations between platelet categories with OS. Median OS was estimated using Kaplan-Meier method with 95% CI. Results: We identified 1,038 patients treated with ICI therapy after excluding patients with baseline thrombocytopenia. The median age was 61.4; 613 (59.1%) were male and 613 (59.1%) had history of smoking. The most common cancer types were melanoma (n = 337, 32.5%), lung (n = 213, 20.5%), and renal cell carcinoma (n = 114, 11%). The most common ICI were PD1/L1 (n = 729, 70.2%) and CTLA4 (n = 191, 18.4%). Overall, 89 (8.6%) patients developed grade ≥3 thrombocytopenia; twenty were attributed to ICI (1.93% overall). Patients who developed ≥3 irTCP had worse overall survival compared to those whose thrombocytopenia was unrelated to ICI (5.45 vs 11.3 months; HR. 2.077, 95% CI 1.231, 3.503; log-rank p = 0.005). Patients with ≥3 irTCP also had shorter survival compared to those without thrombocytopenia of any etiology (5.45 vs 13.3 months; HR 2.247, 95% CI: 1.414, 3.571; p < 0.001). irTCP was more common among those treated with PD1/L1 (p = 0.03) but was not associated with cancer type, smoking status, age, gender, race, or line of therapy. Conclusions: Type of immunotherapy is related to irTCP, whereas cancer type and line of therapy are not. Unlike other irAEs, we found that irTCP was associated with shorter overall survival. These findings provide important insight into a poorly understood and rare toxicity. irTCP should be evaluated in more extensive studies to better inform clinical decision making.
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Affiliation(s)
| | - Songzhu Zhao
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - Mingjia Li
- The Ohio State University Wexner Medical Center, Division of Hospital Medicine, Columbus, OH
| | - Sandip H. Patel
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Division of Medical Oncology, Columbus, OH
| | - Andrew Johns
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Madison Grogan
- Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Abdul Miah
- The Ohio State University Wexner Medical Center, Division of Medical Oncology, Columbus, OH
| | - Lai Wei
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | | | | | - Zihai Li
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | | | - Kari Lynn Kendra
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Columbus, OH
| | | | | | - Dwight Hall Owen
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus, OH
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25
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Das P, Zhao S, Wei L, Miah A, Li M, Lopez G, Patel SH, Johns A, Grogan M, Bertino EM, He K, Shields PG, Carbone DP, Otterson GA, Presley CJ, Owen DH. Bone modifying agents and skeletal related events in patients with metastatic non-small cell lung cancer treated with immune checkpoint inhibitors. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18593] [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
e18593 Background: Bone metastases and skeletal related events (SREs) are a common cause of morbidity among patients with metastatic non-small cell lung cancer (mNSCLC). SREs include pathologic bone fractures, spinal cord compression, orthopedic surgery/stabilization, and palliative radiation to bone. Bone modifying agents (BMA) such as bisphosphonates and RANK ligand inhibitors are often used for mNSCLC patients with bone metastases to reduce the incidence of SRE. Data on the associations between BMA use and overall survival (OS) and the development of SRE among patients with mNSCLC treated with immune checkpoint inhibitors (ICI) is limited. Methods: We conducted a retrospective study of patients with mNSCLC treated with first line pembrolizumab or pembrolizumab plus chemotherapy at The Ohio State University from 2017-2020. The associations between SRE and categorical variables were studied using Fisher’s exact test and with continuous variables using the Kruskal-Wallis test. The association between BMA and risk of osseous progression was studied using Fisher’s exact test. The association between BMA and OS was examined using a Cox proportional hazard model. Median OS was estimated using the Kaplan-Meier method with 95% CI. OS was calculated from date of ICI initiation to death from any cause or last follow up. Results: We identified a cohort of 228 patients: 107 (47%) treated with pembrolizumab and 121 (53%) treated with pembrolizumab plus chemotherapy; 48 (21%) had squamous histology and 179 (79%) had nonsquamous histology (1 had NSCLC histology not specified); median age 62.6 years; median OS was 26.8 months (95% CI: 17.2 – 34.5 months). A total of 95/228 (42%) patients had bone metastases at time of ICI initiation; 45/95 (42%) had treatment with BMA and 50/95 (58%) were not treated with BMA. Among patients with bone metastases at time of ICI, 45 (42%) developed SRE after ICI initiation and BMA use was not associated with risk of SRE (p = 1). BMA use was not significantly associated with risk of osseous progression (p = 0.21). For patients with baseline bone metastases prior to ICI, the use of BMA was not associated with OS (p = 0.24); the type of BMA used (bisphosphonate vs RANK ligand inhibitor) was also not associated with OS (p = 0.13). Conclusions: In patients with metastatic NSCLC treated with first line pembrolizumab alone or with chemotherapy, bone modifying agents were not associated with OS, decreased risk of osseous progression, or development of SRE in patients with baseline bone metastases prior to ICI initiation. The type of BMA used was also not associated with survival. Further studies evaluating the utility and impact of BMA use in this patient population are needed.
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Affiliation(s)
- Parthib Das
- Ohio State University Wexner Medical Center, Columbus, OH
| | - Songzhu Zhao
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - Lai Wei
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - Abdul Miah
- The Ohio State University Wexner Medical Center, Division of Medical Oncology, Columbus, OH
| | - Mingjia Li
- The Ohio State University Wexner Medical Center, Division of Hospital Medicine, Columbus, OH
| | | | - Sandip H. Patel
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Division of Medical Oncology, Columbus, OH
| | - Andrew Johns
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Madison Grogan
- Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Kai He
- Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - Peter G. Shields
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | - Dwight Hall Owen
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus, OH
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26
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Miah A, Zhao S, Patel SH, Johns A, Grogan M, Li M, Lopez G, Haddad T, Husain M, Kendra KL, Otterson GA, Wei L, Presley CJ, Owen DH. Immune checkpoint inhibitor induced hepatitis: Risk factors, outcomes, and impact on survival. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e14525] [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
e14525 Background: Immune checkpoint inhibitors (ICIs) have improved the survival of patients with multiple cancer types, however ICI treatment is associated with a unique set of immune-related adverse events (irAEs) that can affect any organ. Few studies have evaluated the risk factors and outcomes of ICI induced hepatitis (ICIH). Methods: We utilized an institutional database of patients with advanced cancers treated with ICI between 2011 and 2017 at The OSU Comprehensive Cancer Center to identify patients with ICIH. Any patient who received at least one dose of ICI alone or in combination with other systemic therapies either as part of clinical trial or standard of care were included. Clinical data were extracted through chart abstraction. irAEs were graded using the Common Terminology Criteria for Adverse Events v5. Overall survival (OS) was calculated from the date of ICI initiation to death from any cause or the date of the last follow-up. OS with 95% confidence intervals were estimated using the Kaplan–Meier method. OS was also evaluated by occurrence of ICIH using the log-rank test. Results: We identified 1,096 patients treated with at least one dose of ICI. Most common cancers included lung (n=224, 20%) and melanoma (n=342, 31%). The most common ICIs were PD1/L1 (n=774, 71%) and CTLA-4 inhibitors (n=195, 18%). ICIH of any grade occurred in 64 (6%) patients. Overall, 46 (71%) were male and median age was 60 years. Severity of hepatitis was grade 1-2 in 30 patients (47%) (Table 1). The incidence of ≥grade 3 ICIH in the entire cohort was 3.1%. Median time to ICIH diagnosis was 63 days. ICIH occurred alone in 24 patients, and co-occurred with other irAEs in 40 patients. The most common co-occurring irAEs were pneumonitis (n=7); colitis (n=15), thyroid abnormality (n=14); and dermatitis (n=15). ICIH was more common in women (p=0.038), in patients treated with combination ICIs (p<0.001), and among patients receiving first line therapy (p=0.018). Patients who developed ICIH had significantly longer OS than patients who did not develop ICIH; there was no difference in OS between patients with ≥grade 3 ICIH vs grade 1-2 (Table). 33 out of 34 patients with ≥grade3 ICIH were treated with steroids; 3 received mycophenolate and one received infliximab. Of patients with ≥grade 3 ICIH, 11 resumed ICI therapy without recurrent ICIH. Conclusions: Female sex, combination immunotherapy, and line of therapy were associated with ICIH. Patients with ICIH had improved clinical outcomes compared to those that did not develop ICIH, even those with higher grade toxicity. Further study is needed to assist in developing risk stratification models and optimal treatment for ICIH. OS of patients with and without immune checkpoint inhibitor hepatitis.[Table: see text]
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Affiliation(s)
- Abdul Miah
- The Ohio State University Wexner Medical Center, Division of Medical Oncology, Columbus, OH
| | - Songzhu Zhao
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - Sandip H. Patel
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Division of Medical Oncology, Columbus, OH
| | | | - Madison Grogan
- Ohio State University Wexner Medical Center, Columbus, OH
| | - Mingjia Li
- The Ohio State University Wexner Medical Center, Division of Hospital Medicine, Columbus, OH
| | | | | | - Marium Husain
- The Ohio State University Medical Center, Columbus, OH
| | - Kari Lynn Kendra
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Columbus, OH
| | | | - Lai Wei
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | | | - Dwight Hall Owen
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus, OH
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Husain M, Xu M, Patel S, Johns A, Grogan M, Li M, Lopez G, Miah A, Hoyd R, Liu Y, Muniak M, Haddad T, Tinoco G, Kendra KL, Otterson GA, Presley CJ, Spakowicz D, Owen DH. Proton pump inhibitor use (PPI) in patients treated with immune checkpoint inhibitors (ICI) for advanced cancer: Survival and prior therapy. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.2633] [Citation(s) in RCA: 3] [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] [Indexed: 11/20/2022] Open
Abstract
2633 Background: Emerging data suggest that concomitant medications (CM) influence response to ICI. CM impact the host microbiome which may mitigate tumor-immune responsiveness. PPI use in patients treated with ICI has been associated with worse survival. Few data exist regarding the effects of PPI use in terms of prior chemotherapy or in risk for immune related adverse events (irAE) (e.g., colitis). Methods: This retrospective study of patients with advanced cancer treated with ICI between 2011 and 2019 was conducted at The Ohio State University. Patients who received ICI as either single agent or combination were included. Clinical data was abstracted from chart review, including CM, toxicity, and survival. Overall survival (OS) was evaluated to date of death or last contact. Associations between OS and proton pump inhibitor (PPI) use were studied using log-rank tests and Cox regression analyses overall and by the groups of whether prior chemotherapy was administered and timing from chemotherapy to ICI. The associations between PPI and incidence of irAE (overall and colitis) were assessed by chi-square tests. Results: We identified 1,091 patients treated with ICI, of whom 415 (38%) received PPI at time of ICI. Most common cancers were NSCLC and melanoma; most common therapy was PD1/L1 (Table). PPI use was associated with shorter OS in patients treated as first line therapy (HR = 1.46, 95% CI = [1.11, 1.91], p=0.006) and in second line and beyond (HR = 1.30, 95% CI = [1.10, 1.53], p=0.002). PPI use was associated with shorter OS in patients treated with ICI for those without prior chemotherapy (HR = 1.47, 95% CI = [1.17, 1.86], p=0.001). When evaluated by timing from chemotherapy to ICI, PPI use was associated with shorter OS only in patients where last chemotherapy was > 1 year from ICI (HR = 1.99, 95% CI [1.15, 3.45], p=0.014) but not for patients with chemotherapy within 1 year of ICI (HR = 1.01, 95% CI = [0.79, 1.29], p=0.960). The use of PPI was not associated with incidence of irAE (p=0.317) or colitis in particular (p=0.781). Conclusions: PPI use was associated with shorter survival in patients treated with ICI across a broad variety of cancers and in first line of therapy or beyond. In patients with recent chemotherapy (<1 year), PPI use was not associated with survival, which may be due to disruption of the microbiome by chemotherapy. Further study is needed to determine the impact of CM (e.g, PPI), on outcomes of patients treated with ICI.[Table: see text]
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Affiliation(s)
- Marium Husain
- The Ohio State University Medical Center, Columbus, OH
| | - Menglin Xu
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Sandipkumar Patel
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Madison Grogan
- Ohio State University Wexner Medical Center, Columbus, OH
| | - Mingjia Li
- The Ohio State University Wexner Medical Center, Division of Hospital Medicine, Columbus, OH
| | | | - Abdul Miah
- The Ohio State University Wexner Medical Center, Division of Medical Oncology, Columbus, OH
| | - Rebecca Hoyd
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - YunZhou Liu
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | | | - Kari Lynn Kendra
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Columbus, OH
| | | | | | - Daniel Spakowicz
- Division of Medical Oncology, Department of Internal Medicine & Department of Biomedical Informatics, Ohio State University, Columbus, OH
| | - Dwight Hall Owen
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus, OH
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Kumar PS, Saphire ML, Grogan M, Benedict J, Janse S, Agne JL, Bertino EM, Presley CJ. Substance Abuse Risk and Medication Monitoring in Patients with Advanced Lung Cancer Receiving Palliative Care. J Pain Palliat Care Pharmacother 2021; 35:91-99. [PMID: 34010103 DOI: 10.1080/15360288.2021.1920545] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Oncology and Palliative Medicine lack guidance on routine opioid risk screening and compliance monitoring. This study explored relationships among risk screening and aberrant medication related behaviors in patients with advanced lung cancer receiving embedded palliative care. This was a single center, prospective study and data was collected from December 2018 to March 2020. At the initial palliative visit, patients provided a baseline urine drug screen (UDS) test and completed the Screener and Opioid Assessment for Patients with Pain - Revised (SOAPP-R) self-assessment. Clinical pharmacists provided comprehensive review and interpretation of UDS results. Among 39 patients, 12 (30.8%) scored positive for risk of aberrant medication behaviors on the SOAPP-R. Only 34 of 39 patients provided a baseline UDS test and were included in further analysis. Prior to pharmacist review, 11/11 (100%) baseline UDS results in the positive-risk group and 13/23 (56.5%) in the negative-risk group appeared unexpected (p = 0.01). After pharmacist review, aberrant baseline UDS results were confirmed for 5/11 (45.5%) positive-risk and 4/23 (17.4%) negative-risk patients (p = 0.11). Overall, the SOAPP-R alone may be inadequate in this population and clinical pharmacists play an important role in comprehensive UDS result interpretation. Future studies are needed to validate this risk-screening tool in palliative cancer populations.
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Affiliation(s)
- Pooja S Kumar
- Pooja S. Kumar, PharmD, and Maureen L. Saphire, PharmD, are with the Department of Pharmacy, The Ohio State University, Columbus, Ohio, USA. Madison Grogan is with the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA. Jason Benedict, MS, and Sarah Janse, PhD, are with the Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA. Julia L. Agne, MD, is with the Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA. Erin M. Bertino, MD, and Carolyn J. Presley, MD, MHS, are with the Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Maureen L Saphire
- Pooja S. Kumar, PharmD, and Maureen L. Saphire, PharmD, are with the Department of Pharmacy, The Ohio State University, Columbus, Ohio, USA. Madison Grogan is with the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA. Jason Benedict, MS, and Sarah Janse, PhD, are with the Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA. Julia L. Agne, MD, is with the Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA. Erin M. Bertino, MD, and Carolyn J. Presley, MD, MHS, are with the Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Madison Grogan
- Pooja S. Kumar, PharmD, and Maureen L. Saphire, PharmD, are with the Department of Pharmacy, The Ohio State University, Columbus, Ohio, USA. Madison Grogan is with the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA. Jason Benedict, MS, and Sarah Janse, PhD, are with the Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA. Julia L. Agne, MD, is with the Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA. Erin M. Bertino, MD, and Carolyn J. Presley, MD, MHS, are with the Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Jason Benedict
- Pooja S. Kumar, PharmD, and Maureen L. Saphire, PharmD, are with the Department of Pharmacy, The Ohio State University, Columbus, Ohio, USA. Madison Grogan is with the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA. Jason Benedict, MS, and Sarah Janse, PhD, are with the Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA. Julia L. Agne, MD, is with the Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA. Erin M. Bertino, MD, and Carolyn J. Presley, MD, MHS, are with the Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Sarah Janse
- Pooja S. Kumar, PharmD, and Maureen L. Saphire, PharmD, are with the Department of Pharmacy, The Ohio State University, Columbus, Ohio, USA. Madison Grogan is with the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA. Jason Benedict, MS, and Sarah Janse, PhD, are with the Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA. Julia L. Agne, MD, is with the Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA. Erin M. Bertino, MD, and Carolyn J. Presley, MD, MHS, are with the Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Julia L Agne
- Pooja S. Kumar, PharmD, and Maureen L. Saphire, PharmD, are with the Department of Pharmacy, The Ohio State University, Columbus, Ohio, USA. Madison Grogan is with the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA. Jason Benedict, MS, and Sarah Janse, PhD, are with the Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA. Julia L. Agne, MD, is with the Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA. Erin M. Bertino, MD, and Carolyn J. Presley, MD, MHS, are with the Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Erin M Bertino
- Pooja S. Kumar, PharmD, and Maureen L. Saphire, PharmD, are with the Department of Pharmacy, The Ohio State University, Columbus, Ohio, USA. Madison Grogan is with the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA. Jason Benedict, MS, and Sarah Janse, PhD, are with the Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA. Julia L. Agne, MD, is with the Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA. Erin M. Bertino, MD, and Carolyn J. Presley, MD, MHS, are with the Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Carolyn J Presley
- Pooja S. Kumar, PharmD, and Maureen L. Saphire, PharmD, are with the Department of Pharmacy, The Ohio State University, Columbus, Ohio, USA. Madison Grogan is with the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA. Jason Benedict, MS, and Sarah Janse, PhD, are with the Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA. Julia L. Agne, MD, is with the Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA. Erin M. Bertino, MD, and Carolyn J. Presley, MD, MHS, are with the Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
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29
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Agne JL, Bertino EM, Grogan M, Benedict J, Janse S, Naughton M, Eastep C, Callahan M, Presley CJ. Too Many Appointments: Assessing Provider and Nursing Perception of Barriers to Referral for Outpatient Palliative Care. Palliat Med Rep 2021; 2:137-145. [PMID: 34223513 PMCID: PMC8241388 DOI: 10.1089/pmr.2020.0114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Accepted: 04/12/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Integration of early outpatient palliative care for patients with advanced cancer requires overcoming logistical constraints as well as attitudinal barriers of referring providers. This pilot study assessed provider perception of logistical and attitudinal barriers to outpatient palliative care referral as well as provider acceptability of an embedded onco-palliative clinic model. Methods: This was a cross-sectional survey-based study of medical oncologists, palliative care physicians, advanced practice providers (APP), and oncology nurses at a large U.S. academic center. Participants were invited to participate through anonymous online survey. Participants rank ordered logistical barriers influencing referral to an outpatient palliative clinic. Respondents indicated level of agreement with attitudinal perception of palliative care and acceptability of an embedded palliative clinic model through five-item Likert-like scales. Results: There were a total of 54 study participants (28 oncology physicians/APPs, 15 palliative physicians/APPs, and 11 oncology nurses). Across the three cohorts, most survey respondents ranked "time burden to patients" as the primary logistical barrier to outpatient palliative care referral. Both oncology and palliative providers indicated comfort with primary palliative care skills although palliative providers were more comfortable with symptom management compared with oncology providers (93.3% vs. 32.2%). A majority of participants (94.9%) were willing to refer to a palliative care provider embedded within an oncology clinic. Conclusion: Additional health care time cost to patients is a major barrier to outpatient palliative care referral. Embedding a palliative care provider in an oncology clinic may be an acceptable model to increase patient access to outpatient palliative care while supporting the oncology team.
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Affiliation(s)
- Julia L Agne
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Erin M Bertino
- Division of Medical Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Madison Grogan
- Division of Medical Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Jason Benedict
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sarah Janse
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michelle Naughton
- Cancer Control and Prevention, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Christine Eastep
- Department of Oncology Nursing, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Michael Callahan
- Department of Oncology Nursing, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Carolyn J Presley
- Division of Medical Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
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30
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Dickie G, Chan P, Cheuk R, Grogan M, Tripcony, L. PO-0174 Cervix cancer treated with PDR brachytherapy boost. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06333-7] [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: 11/16/2022]
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31
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Qin A, Zhao S, Miah A, Wei L, Patel S, Johns A, Grogan M, Bertino EM, He K, Shields PG, Kalemkerian GP, Gadgeel SM, Ramnath N, Schneider BJ, Hassan KA, Szerlip N, Chopra Z, Journey S, Waninger J, Spakowicz D, Carbone DP, Presley CJ, Otterson GA, Green MD, Owen DH. Bone Metastases, Skeletal-Related Events, and Survival in Patients With Metastatic Non-Small Cell Lung Cancer Treated With Immune Checkpoint Inhibitors. J Natl Compr Canc Netw 2021; 19:915-921. [PMID: 33878726 DOI: 10.6004/jnccn.2020.7668] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bone metastases and skeletal-related events (SREs) are a frequent cause of morbidity in patients with metastatic non-small cell lung cancer (mNSCLC). Data are limited on bone metastases and SREs in patients with mNSCLC treated using immune checkpoint inhibitors (ICIs), and on the efficacy of bone-modifying agents (BMAs) in this setting. Here we report the incidence, impact on survival, risk factors for bone metastases and SREs, and impact of BMAs in patients with mNSCLC treated with ICIs in a multi-institutional cohort. PATIENTS AND METHODS We conducted a retrospective study of patients with mNSCLC treated with ICIs at 2 tertiary care centers from 2014 through 2017. Overall survival (OS) was compared between patients with and without baseline bone metastases using a log-rank test. A Cox regression model was used to evaluate the association between OS and the presence of bone metastases at ICI initiation, controlling for other confounding factors. RESULTS We identified a cohort of 330 patients who had received ICIs for metastatic disease. Median patient age was 63 years, most patients were treated in the second line or beyond (n=259; 78%), and nivolumab was the most common ICI (n=211; 64%). Median OS was 10 months (95% CI, 8.4-12.0). In our cohort, 124 patients (38%) had baseline bone metastases, and 43 (13%) developed SREs during or after ICI treatment. Patients with bone metastases had a higher hazard of death after controlling for performance status, histology, line of therapy, and disease burden (hazard ratio, 1.57; 95% CI, 1.19-2.08; P=.001). Use of BMAs was not associated with OS or a decreased risk of SREs. CONCLUSIONS Presence of bone metastases at baseline was associated with a worse prognosis for patients with mNSCLC treated with ICI after controlling for multiple clinical characteristics. Use of BMAs was not associated with reduced SREs or a difference in survival.
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Affiliation(s)
- Angel Qin
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Sandipkumar Patel
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Andrew Johns
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | | | | | - Kai He
- Division of Medical Oncology, and
| | | | | | - Shirish M Gadgeel
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan.,Division of Hematology and Oncology, Henry Ford Cancer Center, Detroit, Michigan
| | - Nithya Ramnath
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Bryan J Schneider
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Khaled A Hassan
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan.,Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio; and
| | | | | | | | | | | | | | | | | | - Michael D Green
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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32
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Loh KP, Lam V, Webber K, Padam S, Sedrak MS, Musinipally V, Grogan M, Presley CJ, Grandi J, Sanapala C, Castillo DA, DiGiovanni G, Mohile SG, Walter LC, Wong ML. Characteristics Associated With Functional Changes During Systemic Cancer Treatments: A Systematic Review Focused on Older Adults. J Natl Compr Canc Netw 2021; 19:1055-1062. [PMID: 33857918 DOI: 10.6004/jnccn.2020.7684] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/12/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Maintaining functional status is important to older adults with cancer, but data are limited on how systemic treatments affect functional status. We systematically reviewed changes in functional status during systemic cancer treatments and identified characteristics associated with functional decline and improvement. METHODS We searched PubMed, Embase, Web of Science, and Cochrane Register of Controlled Trials for articles examining characteristics associated with functional changes in older adults during systemic cancer treatment published in English between database inception and January 11, 2019 (PROSPERO CRD42019123125). Findings were summarized with descriptive statistics. Study characteristics between older adult-specific and non-older adult-specific studies were compared using the Fisher exact test. RESULTS We screened 15,244 titles/abstracts and 519 full texts. The final analysis included 44 studies, which enrolled >8,400 patients; 39% of studies focused on older adults (1 study enrolled adults aged ≥60 years, 10 enrolled adults aged ≥65 years, and 6 enrolled adults aged ≥70 years). Almost all studies (98%) used patient-reported outcomes to measure functional status; only 20% used physical performance tests. Reporting of functional change was heterogeneous, with 48% reporting change scores. Older adult-specific studies were more likely to analyze functional change dichotomously (29% vs 4%; P=.008). Functional decline ranged widely, from 6% to 90%. The most common patient characteristics associated with functional decline were older age (n=7 studies), worse performance status (n=4), progressive disease status (n=4), pain (n=4), anemia (n=4), and worse nutritional status (n=4). Twelve studies examined functional improvement and identified 11 unique associated characteristics. CONCLUSIONS Functional decline is increasingly recognized as an important outcome in older adults with cancer, but definitions and analyses are heterogeneous, leading to a wide range of prevalence. To identify patients at highest risk of functional decline during systemic cancer treatments, trials need to routinely analyze functional outcomes and measure characteristics associated with decline (eg, nutrition).
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Affiliation(s)
- Kah Poh Loh
- 1Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Vivian Lam
- 2Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - Katey Webber
- 3School of Public Health, University of California, Berkeley, Berkeley, California
| | - Simran Padam
- 4Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California
| | - Mina S Sedrak
- 4Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California
| | - Vivek Musinipally
- 5Department of Adult and Family Medicine, Kaiser Permanente, San Francisco, California
| | - Madison Grogan
- 6Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Carolyn J Presley
- 6Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Janice Grandi
- 2Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - Chandrika Sanapala
- 1Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Daniel A Castillo
- 7Edward G. Miner Library, University of Rochester School of Medicine and Dentistry, Rochester, New York; and
| | - Grace DiGiovanni
- 1Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Supriya G Mohile
- 1Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Louise C Walter
- 8Division of Geriatrics, University of California, San Francisco, and.,9San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Melisa L Wong
- 2Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California.,8Division of Geriatrics, University of California, San Francisco, and.,9San Francisco Veterans Affairs Medical Center, San Francisco, California
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Arrato N, Grogan M, Benedict J, Janse S, Naughton M, Andersen B, Carbone D, Paskett E, Rosko A, Presley C. MA10.03 The FITNESS Study: An Innovative Approach to Assessing Disability in Older Adults with Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.240] [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: 11/29/2022]
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Muchtar E, Dispenzieri A, Magen H, Grogan M, Mauermann M, McPhail ED, Kurtin PJ, Leung N, Buadi FK, Dingli D, Kumar SK, Gertz MA. Systemic amyloidosis from A (AA) to T (ATTR): a review. J Intern Med 2021; 289:268-292. [PMID: 32929754 DOI: 10.1111/joim.13169] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [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: 05/05/2020] [Accepted: 07/15/2020] [Indexed: 01/09/2023]
Abstract
Systemic amyloidosis is a rare protein misfolding and deposition disorder leading to progressive organ failure. There are over 15 types of systemic amyloidosis, each caused by a different precursor protein which promotes amyloid formation and tissue deposition. Amyloidosis can be acquired or hereditary and can affect various organs, including the heart, kidneys, liver, nerves, gastrointestinal tract, lungs, muscles, skin and soft tissues. Symptoms are usually insidious and nonspecific resulting in diagnostic delay. The field of amyloidosis has seen significant improvements over the past decade in diagnostic accuracy, prognosis prediction and management. The advent of mass spectrometry-based shotgun proteomics has revolutionized amyloid typing and has led to the discovery of new amyloid types. Accurate typing of the precursor protein is of paramount importance as the type dictates a specific management approach. In this article, we review each type of systemic amyloidosis to provide the practitioner with practical tools to improve diagnosis and management of these rare disorders.
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Affiliation(s)
- E Muchtar
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - H Magen
- Hematology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - M Grogan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - M Mauermann
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - E D McPhail
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - P J Kurtin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - F K Buadi
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S K Kumar
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- From the, Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Surya N, Li M, Zhao S, Wei L, Patel S, Lopez G, Johns A, Grogan M, Bertino E, He K, Shields P, Carbone D, Otterson G, Presley C, Owen D. P75.12 Prognostic Value of Neutrophil to Lymphocyte Ratio in NSCLC Patients Receiving First Line Immune Checkpoint Inhibitor Therapy. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1046] [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: 10/21/2022]
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Johns AC, Wei L, Grogan M, Hoyd R, Bridges JFP, Patel SH, Li M, Husain M, Kendra KL, Otterson GA, Burkart JT, Rosko AE, Andersen BL, Carbone DP, Owen DH, Spakowicz DJ, Presley CJ. Checkpoint inhibitor immunotherapy toxicity and overall survival among older adults with advanced cancer. J Geriatr Oncol 2021; 12:813-819. [PMID: 33627226 DOI: 10.1016/j.jgo.2021.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 08/03/2020] [Revised: 10/13/2020] [Accepted: 02/01/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Despite growing evidence that checkpoint inhibitor immunotherapy (IO) toxicity is associated with improved treatment response, the relationship between immune-related adverse events (irAEs) and overall survival (OS) among older adults [age ≥ 70 years (y)] remains unknown. The study goal was to determine differences in OS based on age and ≥ grade 3 (G3) irAEs. MATERIALS AND METHODS This was a retrospective cohort study of 673 patients with advanced cancer. Patients who received ≥1 dose of IO at our institution from 2011 to 2018 were eligible. The primary outcome was OS from the start of first line of IO treatment, compared between four patient groups stratified by age and ≥ G3 irAEs with adjustment for patient characteristics using a Cox proportional hazards model. RESULTS AND CONCLUSION Among all 673 patients, 35.4% were ≥ 70y, 39.8% had melanoma, and 45.6% received single-agent nivolumab. Incidence and types of ≥G3 irAEs did not differ by age. Median OS was significantly longer for all patients with ≥G3 irAEs (unadjusted 21.7 vs. 11.9 months, P = 0.007). There was no difference in OS among patients ≥70y with ≥G3 irAEs (HR 0.94, 95% CI 0.61-1.47, P = 0.79) in the multivariable analysis. Patients <70y with ≥G3 irAEs had significantly increased OS (HR 0.33, 95% CI 0.21-0.52, P < 0.001). Younger patients, but not older adults, with high-grade irAEs experience strong survival benefit. This difference may be due to the toll of irAEs themselves or the effects of treatments for irAEs, such as corticosteroids. Factors impacting OS of older adults after irAEs must be determined and optimized.
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Affiliation(s)
- Andrew C Johns
- Dept. of Internal Medicine, The Ohio State University Wexner Medical Center, USA
| | - Lai Wei
- Dept. of Biomedical Informatics, The Ohio State University, USA
| | - Madison Grogan
- Div. of Medical Oncology, Dept. of Internal Medicine, The Ohio State University Wexner Medical Center, USA
| | - Rebecca Hoyd
- Dept. of Biomedical Informatics, The Ohio State University, USA; Div. of Medical Oncology, Dept. of Internal Medicine, The Ohio State University Wexner Medical Center, USA
| | - John F P Bridges
- Dept. of Biomedical Informatics, The Ohio State University, USA; Dept. of Surgery, The Ohio State University Wexner Medical Center, USA
| | - Sandipkumar H Patel
- Div. of Medical Oncology, Dept. of Internal Medicine, The Ohio State University Wexner Medical Center, USA
| | - Mingjia Li
- Div. of Hospital Medicine, Dept. of Internal Medicine, The Ohio State University Wexner Medical Center, USA
| | - Marium Husain
- Div. of Medical Oncology, Dept. of Internal Medicine, The Ohio State University Wexner Medical Center, USA
| | - Kari L Kendra
- Div. of Medical Oncology, Dept. of Internal Medicine, The Ohio State University Wexner Medical Center, USA
| | - Gregory A Otterson
- Div. of Medical Oncology, Dept. of Internal Medicine, The Ohio State University Wexner Medical Center, USA
| | | | - Ashley E Rosko
- Div. of Hematology, Dept. of Internal Medicine, The Ohio State University Wexner Medical Center, USA
| | | | - David P Carbone
- Div. of Medical Oncology, Dept. of Internal Medicine, The Ohio State University Wexner Medical Center, USA
| | - Dwight H Owen
- Div. of Medical Oncology, Dept. of Internal Medicine, The Ohio State University Wexner Medical Center, USA
| | - Daniel J Spakowicz
- Dept. of Biomedical Informatics, The Ohio State University, USA; Div. of Medical Oncology, Dept. of Internal Medicine, The Ohio State University Wexner Medical Center, USA
| | - Carolyn J Presley
- Div. of Medical Oncology, Dept. of Internal Medicine, The Ohio State University Wexner Medical Center, USA.
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Kumar P, Saphire M, Grogan M, Benedict J, Agne SJJ, Bertino E, Presley C. RS8: Substance Abuse Risk and Monitoring in Patients with Lung Cancer Receiving Palliative Care. J Pain Palliat Care Pharmacother 2020. [DOI: 10.1080/15360288.2020.1846429] [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: 10/21/2022]
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38
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Li M, Spakowicz D, Zhao S, Patel SH, Johns A, Grogan M, Miah A, Husain M, He K, Bertino EM, Shields PG, Wei L, Carbone DP, Otterson GA, Presley CJ, Owen DH. Brief report: inhaled corticosteroid use and the risk of checkpoint inhibitor pneumonitis in patients with advanced cancer. Cancer Immunol Immunother 2020; 69:2403-2408. [PMID: 32728772 DOI: 10.1007/s00262-020-02674-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/16/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Checkpoint inhibitor pneumonitis (CIP) is an immune-related adverse event that may complicate treatment with immune checkpoint inhibitors (ICI) and can cause significant morbidity. We sought to identify predictors for the development of CIP, and whether the use of inhaled corticosteroids (ICS) at time of ICI may be protective. METHODS Patients with advanced cancer treated with ICI from 2011 and 2018 were included in this study. CIP attribution to ICI was determined by treating physician at time of diagnosis. Predictors were assessed by univariate and multivariable Cox proportional hazard models. RESULTS We identified 837 pts treated with ICI, of whom 30 (3.6%) developed grade 2 or higher CIP. 82 patients (9.8%) were receiving ICS at time of ICI and had increased risk of developing CIP with hazard ration (HR) of 4.22 (95% CI 1.93-9.21, p < 0.001) compared to those patients not receiving ICS. Patients with age ≥ 65 years had increased risk of developing CIP (HR 2.12, 95% CI 1.02-4.40, p = 0.044), as did 209 patients with lung cancer (198 NSCLC and 11 SCLC) compared to other types of cancers (HR 3.15, 95% CI 1.54-6.46, p = 0.002). In multivariable analysis, age ≥ 65 years, lung cancer diagnosis, and ICS use remained statistically associated with the development of CIP, with adjusted HR for ICS 3.09 (95% CI 1.32-7.24, p = 0.009). CONCLUSIONS Patients treated with ICS at time of ICI initiation had an increased risk of developing CIP. We further identified older adults with age ≥ 65 years and lung cancers as independent risk factors for CIP.
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Affiliation(s)
- Mingjia Li
- Division of Hospital Medicine, The Ohio State University, Columbus, OH, USA
| | - Daniel Spakowicz
- Division of Medical Oncology, The Ohio State University, 320 W 10th Ave, Columbus, OH, USA
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Songzhu Zhao
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Sandip H Patel
- Division of Medical Oncology, The Ohio State University, 320 W 10th Ave, Columbus, OH, USA
| | - Andrew Johns
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Madison Grogan
- Division of Medical Oncology, The Ohio State University, 320 W 10th Ave, Columbus, OH, USA
| | - Abdul Miah
- Division of Medical Oncology, The Ohio State University, 320 W 10th Ave, Columbus, OH, USA
| | - Marium Husain
- Division of Medical Oncology, The Ohio State University, 320 W 10th Ave, Columbus, OH, USA
| | - Kai He
- Division of Medical Oncology, The Ohio State University, 320 W 10th Ave, Columbus, OH, USA
| | - Erin M Bertino
- Division of Medical Oncology, The Ohio State University, 320 W 10th Ave, Columbus, OH, USA
| | - Peter G Shields
- Division of Medical Oncology, The Ohio State University, 320 W 10th Ave, Columbus, OH, USA
| | - Lai Wei
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - David P Carbone
- Division of Medical Oncology, The Ohio State University, 320 W 10th Ave, Columbus, OH, USA
| | - Gregory A Otterson
- Division of Medical Oncology, The Ohio State University, 320 W 10th Ave, Columbus, OH, USA
| | - Carolyn J Presley
- Division of Medical Oncology, The Ohio State University, 320 W 10th Ave, Columbus, OH, USA
| | - Dwight H Owen
- Division of Medical Oncology, The Ohio State University, 320 W 10th Ave, Columbus, OH, USA.
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Zhao S, Li M, Spakowicz D, Patel SH, Johns A, Grogan M, Miah A, Husain M, He K, Bertino EM, Shields PG, Wei L, Carbone DP, Otterson GA, Presley CJ, Owen DH. Neutrophil-lymphocyte score: A novel prognostic scoring system that utilized the dynamic change of neutrophil, lymphocyte, and albumin and its comparison to other indices. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.3048] [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
3048 Background: Indications for immune checkpoint inhibitor (ICI) in cancer care are expanding rapidly. There is increasing need for accurate decision tool to better guide treatment. We have constructed a new prognostic scoring system, neutrophil-lymphocyte score (NRS), based on the nonlinear dynamic change of neutrophil to lymphocyte ratio (NLR) in relation to survival over the first cycle of ICI treatment. We compared this novel system to existing indices such as NLR, lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR), Advanced Lung Cancer Inflammation Index (ALI), and Systemic Immune-inflammation Index (SII). Methods: This is a retrospective analysis of 837 patients at Ohio State University from 2011-18. Neutrophil (ANC), lymphocyte (ALC), platelet (plt), monocyte (AMC), albumin (alb), and body mass index (BMI) were collected at baseline. Repeat labs were collected at cycle 2. NLR = ANC/ALC, ALI = BMI x alb / NLR, LMR = ALC/AMC, SII = platelet x NLR, PLR = plt/ALC. NLR Ratio = baseline NLR / repeat NLR. Based on the association between NLR and the overall survival, we assigned 1 point (p) for baseline NLR < 0.7, 6p for 0.7 to < 2, 5p for 2 to < 3, 4 p for 3 to < 4, 3 for 4 to 5, 2p for 5 to < 9, and 1p for ≥9. We also assigned 1p for NLR ratio < 0.6, 2p for 0.6 to < 0.8, 3p for 0.8 to < 1.2, 5p for 1.25 to < 1.4, 3p for 1.4 to < 1.6, and 2p for ≥1.6. NLS = sum of these 2 scores . NLS_A = NLS*alb. Time-dependent receiver operator characteristic (ROC) curves with integrated time-dependent area under the curve (TD AUC) values were used to evaluate the predictive accuracy of each index for survival. Results: For baseline and repeat values, all indices were statistically significant (P < 0.001) in predicting survival. Baseline integrated TD AUC were: ALI 0.704, NLR 0.692, SII 0.663, LMR 0.645, and PLR 0.612. All of the repeat indices at cycle 2 had higher prognostic value than their baseline counterparts. Integrated TD AUC for indices at cycle 2 were: ALI 0.740 (with baseline BMI), NLR 0.729, SII 0.694, LMR 0.671, and PLR 0.652. NLS_A was a composite score based on the dynamic change of NLR from cycle 1 to 2 and the treatment alb with integrated TD-AUC at 0.754. Conclusions: Indices constructed from ANC, ALC, AMC, Plt, alb, and BMI can be obtained inexpensively and provide great prognostic value for pts on ICI. We have constructed a novel scoring system (NLS_A) and demonstrated its improvement over the current prognostic indices. Studies with a larger cohort are needed to further improve and validate this system.
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Affiliation(s)
- Songzhu Zhao
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - Mingjia Li
- The Ohio State University Wexner Medical Center, Division of Hospital Medicine, Columbus, OH
| | - Daniel Spakowicz
- Division of Medical Oncology, Department of Internal Medicine & Department of Biomedical Informatics, Ohio State University, Columbus, OH
| | - Sandip H. Patel
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Division of Medical Oncology, Columbus, OH
| | - Andrew Johns
- Dept. of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Madison Grogan
- Ohio State University Wexner Medical Center, Columbus, OH
| | - Abdul Miah
- The Ohio State University Wexner Medical Center, Division of Medical Oncology, Columbus, OH
| | - Marium Husain
- The Ohio State University Medical Center, Columbus, OH
| | - Kai He
- Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | | | - Peter G. Shields
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Lai Wei
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | | | | | | | - Dwight Hall Owen
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus, OH
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Li M, Spakowicz D, Zhao S, Patel SH, Johns A, Grogan M, Miah A, Husain M, He K, Bertino EM, Shields PG, Wei L, Carbone DP, Otterson GA, Presley CJ, Owen DH. Inhaled corticosteroid use and risk of pneumonitis in patients treated with immune checkpoint inhibitors. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.3140] [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
3140 Background: The identification of risk factors for immune-related adverse events (irAEs) is an important area of research. Among irAEs, pneumonitis carries one of the highest morbidities. There is a lack of strong predictors for pneumonitis in patients (pts) treated with ICI. We sought to identify predictors for the development of pneumonitis, and whether the use of inhaled corticosteroids (ICS) at time of ICI could be protective. Methods: Pts with advanced cancer treated with ICI from 2011 and 2018 were included in this retrospective study. Pneumonitis attribution to ICI was determined by treating physician at time of diagnosis. Time to pneumonitis was defined as days from the start of ICI to pneumonitis diagnosis. Pts who never had pneumonitis were censored at the time of last follow up or death. Predictors of pneumonitis were assessed by univariate Cox proportional hazard models at a significance threshold of alpha = 0.05. Results: A total of 837 pts were identified, and 30 (3.6%) pts developed any grade pneumonitis (12 grade 2, 14 grade 3, 1 grade 4, 3 grade 5) after receiving ICI (Table). Pts with age ≥65 years (y) had increased risk of developing pneumonitis over pts with age < 65y (HR 2.1, 95 CI: 1.02-4.4, p=0.041). 82 (9.7%) of the total cohort were on inhaled corticosteroid (ICS) at time of ICI, and 9 (11%) developed pneumonitis. Rather than being protective, pts on ICS had higher risk of pneumonitis (HR 4.2, 95 CI: 1.9-9.2, p=0.001). Pts with lung cancer had an increased risk for pneumonitis compared to pts with other cancers (HR 3.2, 95 CI: 1.5-6.4, p =0.003). Other risk factors included performance status, smoking history, line of therapy, or prior treatment including radiation were not statistically significant. Conclusions: Rather than a protective effect of ICS, our analysis found a higher risk of pneumonitis in pts treated with ICS. We confirmed an increased risk of pneumonitis for lung cancer pts compared to pts with other cancers, and higher risk of pneumonitis in pts age >65y. We hypothesize that the increased inflammatory status in chronic lung inflammation may predispose pts to pneumonitis that was not ameliorated by ICS. Future study is needed in prospective cohorts to further clarify the underlying inflammatory mechanism. [Table: see text]
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Affiliation(s)
- Mingjia Li
- The Ohio State University Wexner Medical Center, Division of Hospital Medicine, Columbus, OH
| | - Daniel Spakowicz
- Division of Medical Oncology, Department of Internal Medicine & Department of Biomedical Informatics, Ohio State University, Columbus, OH
| | - Songzhu Zhao
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - Sandip H. Patel
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Division of Medical Oncology, Columbus, OH
| | - Andrew Johns
- Dept. of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Madison Grogan
- Ohio State University Wexner Medical Center, Columbus, OH
| | - Abdul Miah
- The Ohio State University Wexner Medical Center, Division of Medical Oncology, Columbus, OH
| | - Marium Husain
- The Ohio State University Medical Center, Columbus, OH
| | - Kai He
- Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | | | - Peter G. Shields
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Lai Wei
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | | | | | | | - Dwight Hall Owen
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus, OH
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Riesenberg BP, Li M, Spakowicz D, Hoyd R, Beane J, Yang Y, Oezkan F, He K, Patel SH, Johns A, Grogan M, Miah A, Husain M, Bertino EM, Otterson GA, Kendra KL, Presley CJ, Carbone DP, Li Z, Owen DH. Platelets impact the responsiveness of immune checkpoint blockade therapy in solid tumors. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e15023] [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
e15023 Background: A growing body of evidence has linked platelets (plts) with immune suppression in the tumor microenvironment (TME). Our group has demonstrated, plts are the dominant source for TGF-β in TME and pharmacologic inhibition of plt function enhances multiple forms of immunotherapy (Sc Immunol 2017 PMID 28763790; J Immunol 2019 PMID 31358658; Sci Transl Med 2020 PMID 31915300). To further delineate this relationship, we examined the roles of plts on T cell exhaustion in a preclinical model and on response to immune checkpoint inhibitors (ICI) in a large cohort of patients (pts) with stage 4 cancers. Methods: The mouse MC-38 colon adenocarcinoma model was used in age-matched female C57Bl/6J mice. Antiplatelet therapy (APT) consisting of aspirin and clopidogrel (both at 30 mg/kg daily) was delivered p.o. and anti-PD-1 antibody (100 mg/mouse every 3 days) was administered i.p. starting on days 5 and 9 respectively. TME analysis via multispectral histology or flow cytometry was performed. Retrospective analysis was carried out on 826 pts who received ICI from 2011-2017 at the Ohio State University. Baseline plt count was collected within 7 days before initiating ICI. Repeat plt count was obtained prior to initiation of cycle 2. Normal plt counts were defined as 150,000 – 450,000/µl blood, and thrombocytosis as plt ≥450,000/µl blood. Kaplan Meier and log-rank analysis were performed to estimate median survival and determine the association with plt count. Results: In pre-clinical models, pretreatment with APT (1) synergized with PD-1 blockade to enhance T cell infiltration into MC-38 tumors resulting in immediate tumor reduction, and (2) decreased tumor infiltrating CD8+ T cell TOX expression, a transcription factor associated with T cell exhaustion (Nat Immunol 2019 PMID: 31427776). Among pts receiving ICIs, 46 (5.6%) pts with thrombocytosis had a significantly reduced median OS vs pts with normal plt counts: 6.0 (95 CI: 1.5—10.6) months (mos) vs 11.6 (95 CI: 9.7—13.4) mos (p = 0.002). Fluctuations ≥50,000 plt/mL in either direction between cycle 1 and 2 were associated with a significant reduction in median OS: 8.3 (95 CI: 6.4—10.1) mos vs 13.6 (95 CI: 11.2-16.1) mos (p < 0.001). Conclusions: There is a strong association between plts and failure of ICI in both the preclinical and clinical settings, likely via modifying the amount of active CD8+ T cells infiltrating into tumors. These findings merit further study to delineate the underlying mechanism for plt-mediated immune suppression and strategies to overcome it.
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Affiliation(s)
| | - Mingjia Li
- The Ohio State University Wexner Medical Center, Division of Hospital Medicine, Columbus, OH
| | - Daniel Spakowicz
- Division of Medical Oncology, Department of Internal Medicine & Department of Biomedical Informatics, Ohio State University, Columbus, OH
| | - Rebecca Hoyd
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
| | | | - Yuanquan Yang
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Filiz Oezkan
- The Ohio State University, OE 698/1-1 DFS, Columbus, OH
| | - Kai He
- Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - Sandip H. Patel
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Division of Medical Oncology, Columbus, OH
| | - Andrew Johns
- Dept. of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Madison Grogan
- Ohio State University Wexner Medical Center, Columbus, OH
| | - Abdul Miah
- The Ohio State University Wexner Medical Center, Division of Medical Oncology, Columbus, OH
| | - Marium Husain
- The Ohio State University Medical Center, Columbus, OH
| | | | | | - Kari Lynn Kendra
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Columbus, OH
| | | | | | - Zihai Li
- Pelotonia Institute for Immuno-Oncology, OSUCC-James, Columbus, OH
| | - Dwight Hall Owen
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus, OH
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Johns A, Wei L, Grogan M, Patel S, Li M, Husain M, Kendra KL, Otterson GA, Burkart JT, Owen DH, Presley CJ. Association of medical comorbidities and cardiovascular disease with toxicity and survival in patients receiving checkpoint inhibitor immunotherapy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.7039] [Citation(s) in RCA: 3] [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] [Indexed: 11/20/2022] Open
Abstract
7039 Background: Checkpoint inhibitor immunotherapy (IO) is widely used to treat advanced cancer in pts. with medical comorbidities (MC), but the effect of MC on outcomes is poorly understood. Methods: We performed a single institution retrospective cohort study of pts. who received IO from 2011-2018. Immune-related adverse events (irAEs) were graded by Common Terminology for Adverse Events criteria, v4.0. MC were abstracted by query of ICD-10 codes corresponding to diagnoses in the Charlson Comorbidity Index (CCI) at any time prior to IO start. Modified CCI scores excluding points for cancer were calculated for each pt. Bivariate analysis with chi-squared statistics was used to describe characteristics and MC of pts. with vs. without irAEs. Overall survival (OS) was estimated by the Kaplan-Meier method (from start of first-line IO) and compared using the log-rank test. The association of CCI score and individual MC with irAEs and OS was tested with regression models adjusted for pt. characteristics. Results: Among 671 pts. with advanced cancer (39.6% melanoma; 21.8% non-small cell lung) treated with IO, median age 65 (IQR 55-74) years, the most common MC were COPD (24%) and diabetes (20%). 33.8% of pts. had CCI score ≥2. Neither CCI score nor any specific MC were associated with any grade or ≥G3 irAEs (P > 0.05). Increasing CCI score was significantly associated with decreased OS (P = 0.002). CHF (13.9 vs. 8.1 months, P = 0.008) and previous MI (14.2 vs. 10.1 months, P = 0.009) were associated with decreased median OS but did not remain significant in the regression model. Among pts. without cardiovascular disease (CVD), pts. with ≥G3 irAEs had longer OS than pts. with no ≥G3 irAEs (P < 0.001). This OS benefit for ≥G3 irAEs was not seen in pts. with CVD (P = 0.94). See table for adjusted HR. Conclusions: Risk for irAEs does not appear to be impacted by MC. Pts. with MC have shorter OS, but no specific MC are associated with OS after adjustment for pt. characteristics. OS is significantly increased among pts. without CVD who experience ≥G3 irAEs. CVD may be an important predictor of OS in pts. with irAEs and should be evaluated in patients receiving IO. [Table: see text]
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Affiliation(s)
- Andrew Johns
- Dept. of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Lai Wei
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - Madison Grogan
- Ohio State University Wexner Medical Center, Columbus, OH
| | - Sandipkumar Patel
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Mingjia Li
- The Ohio State University Wexner Medical Center, Division of Hospital Medicine, Columbus, OH
| | - Marium Husain
- The Ohio State University Medical Center, Columbus, OH
| | - Kari Lynn Kendra
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Columbus, OH
| | | | - Jarred Thomas Burkart
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus, OH
| | - Dwight Hall Owen
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus, OH
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Lam V, Loh KP, Webber KR, Padam S, Sedrak MS, Musinipally V, Grogan M, Presley CJ, Grandi J, Sanapala C, Digiovanni G, Castillo D, Walter LC, Wong ML. Patient factors associated with changes in functional status during systemic cancer therapy in older adults: A systematic review. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e24022] [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
e24022 Background: Maintaining function and preventing functional decline during cancer treatment is critically important to older adults. This systematic review characterized and identified patient factors associated with functional change during systemic cancer therapy in older adults. Methods: Following PRISMA guidelines, we searched PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials for articles examining changes in function during systemic cancer treatment published in English through 1/11/19. Studies were eligible if they included adults age >65 and analyzed associations between patient factors and change in function. At least two independent investigators reviewed each article with discrepancies resolved by consensus. Major findings were summarized; no meta-analysis was planned a priori given the heterogeneity in studies. Results: We screened 15,244 titles/abstracts and 519 full texts. The final analysis included 69 studies, which enrolled > 11,000 patients with cancer. Most studies enrolled adults of all ages; 20% included only adults age >65 and 13% only adults age >70. A quarter of studies enrolled patients with lung cancer while 22% included all solid tumors and hematologic malignancies. The majority of studies evaluated function during chemotherapy (96%) with 9% including targeted therapy and 4% immunotherapy. Function was primarily measured with patient-reported outcomes (93% of studies). Reporting of functional change was heterogeneous with many reporting change scores or means at multiple time points. Among studies that reported the percentage of patients who developed functional decline, results ranged widely from 6% to 90%. Functional improvement occurred among 2% to 57% of patients. The most common patient factors associated with functional decline during systemic cancer therapy were older age (n = 8 studies), fatigue (n = 8), worse baseline performance status (n = 8) and physical activity (n = 5), and anemia (n = 5). Only 10 studies examined factors associated with functional recovery, identifying 12 unique patient factors. Conclusions: Among older adults with cancer, functional changes during systemic cancer therapy are common. Interventions to target modifiable patient factors associated with functional decline are needed to help patients maintain or improve function during treatment. Additionally, evaluating both functional decline and improvement is necessary to better characterize functional trajectories during systemic cancer therapy.
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Affiliation(s)
- Vivian Lam
- University of California, San Francisco, San Francisco, CA
| | | | | | - Simran Padam
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | | | - Janice Grandi
- University of California, San Francisco, San Francisco, CA
| | | | | | | | - Louise Christie Walter
- University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA
| | - Melisa L. Wong
- UCSF Helen Diller Comprehensive Cancer Center, San Francisco, CA
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Spakowicz D, Hoyd R, Muniak M, Husain M, Bassett JS, Wang L, Tinoco G, Patel SH, Burkart J, Miah A, Li M, Johns A, Grogan M, Carbone DP, Verschraegen CF, Kendra KL, Otterson GA, Li L, Presley CJ, Owen DH. Inferring the role of the microbiome on survival in patients treated with immune checkpoint inhibitors: causal modeling, timing, and classes of concomitant medications. BMC Cancer 2020; 20:383. [PMID: 32375706 PMCID: PMC7201618 DOI: 10.1186/s12885-020-06882-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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] [Received: 09/16/2019] [Accepted: 04/21/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The microbiome has been shown to affect the response to Immune Checkpoint Inhibitors (ICIs) in a small number of cancers and in preclinical models. Here, we sought to broadly survey cancers to identify those in which the microbiome may play a prognostic role using retrospective analyses of patients with advanced cancer treated with ICIs. METHODS We conducted a retrospective analysis of 690 patients who received ICI therapy for advanced cancer. We used a literature review to define a causal model for the relationship between medications, the microbiome, and ICI response to guide the abstraction of electronic health records. Medications with precedent for changes to the microbiome included antibiotics, corticosteroids, proton pump inhibitors, histamine receptor blockers, non-steroid anti-inflammatories and statins. We tested the effect of medication timing on overall survival (OS) and evaluated the robustness of medication effects in each cancer. Finally, we compared the size of the effect observed for different classes of antibiotics to taxa that have been correlated to ICI response using a literature review of culture-based antibiotic susceptibilities. RESULTS Of the medications assessed, only antibiotics and corticosteroids significantly associated with shorter OS. The hazard ratios (HRs) for antibiotics and corticosteroids were highest near the start of ICI treatment but remained significant when given prior to ICI. Antibiotics and corticosteroids remained significantly associated with OS even when controlling for multiple factors such as Eastern Cooperative Oncology Group performance status, Charlson Comorbidity Index score, and stage. When grouping antibiotics by class, β-lactams showed the strongest association with OS across all tested cancers. CONCLUSIONS The timing and strength of the correlations with antibiotics and corticosteroids after controlling for confounding factors are consistent with the microbiome involvement with the response to ICIs across several cancers.
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Affiliation(s)
- Daniel Spakowicz
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA.
| | | | - Mitchell Muniak
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Marium Husain
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - James S Bassett
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Lei Wang
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Gabriel Tinoco
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Sandip H Patel
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jarred Burkart
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Abdul Miah
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mingjia Li
- Division of Hospital Medicine, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, USA
| | - Andrew Johns
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Madison Grogan
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - David P Carbone
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Claire F Verschraegen
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Kari L Kendra
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Gregory A Otterson
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Lang Li
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Dwight H Owen
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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Wall SA, Huang Y, Jones D, Grogan M, Bittoni AM, Compston A, Custer A, Erdeljac HP, Foster S, Holt K, Johns H, Mitchell K, Owens R, Redder E, Ricketts W, Yager S, Rosko A. Not So Fast: Geriatric Syndromes Can Be Identified and Intervened upon Prior to Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.627] [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: 11/29/2022]
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Garcia-Pavia P, Grogan M, Dispenzieri A, Mundayat R, Amass L, Rapezzi C. P336A descriptive analysis of patients with wild-type ATTR cardiomyopathy from the transthyretin amyloidosis outcomes survey. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0170] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Transthyretin amyloidosis (ATTR amyloidosis) is a rare, life-threatening disorder caused by the deposition of amyloid fibrils composed of misfolded transthyretin (TTR). ATTR amyloidosis may arise from mutations in TTR or from aggregation of wild-type TTR (ATTRwt). ATTR amyloidosis with predominantly symptoms of cardiomyopathy (ATTR-CM) includes both hereditary and wild-type forms of the disease.
Purpose
To describe clinical history and disease presentation in a large population of patients with wild-type ATTR-CM from the Transthyretin Amyloidosis Outcomes Survey (THAOS). THAOS is an ongoing, global, longitudinal, observational survey of patients with ATTR amyloidosis, including both inherited and wild-type disease, and asymptomatic patients with TTR mutations.
Methods
Data from ATTRwt patients were extracted from THAOS (cut-off date: January 16, 2019) and demographic and clinical characteristics reported using descriptive statistics.
Results
There were 758 ATTRwt patients in THAOS (95% male). The majority of patients (69.3%) were in the United States, with the remainder in Italy (11.1%), Germany (7.3%), Spain (5.3%), and other countries (7.1%). Most patients (86.3%) were Caucasian, with 3.3% being of African Descent and 3.1% being of other races/ethnicities (7.4% missing data). The median (10–90th percentile) age at symptom onset was 69.7 (54.0–81.3) years and the median (10–90th percentile) time from symptom onset to diagnosis was 3.9 (0.1–17.8) years. Median (10–90th percentile) age at enrollment in THAOS was 76.4 (67.2–85.2) years. Nearly all subjects had either a cardiac (59.6%) or mixed cardiac and neurologic (36.5%) phenotype. At enrollment, 97.1% (577 of 594 patients assessed) had an abnormal ECG, with the prevalence of low voltage being 20.8% (115 of 552) and prevalence of left-ventricular hypertrophy being 2.1% (16 of 758). Atrial fibrillation was documented in 55% of patients (208 of 378). The mean (standard deviation [SD]) left-ventricular septum thickness was 17.5 (3.5) mm (n=505; 94.9% with thickness >12 mm) and mean (SD) left-ventricular ejection fraction (LVEF) was 48.3% (13.2) (n=511; 48.0% with LVEF <50.0%). Other signs and symptoms at enrollment were compatible with a sensory neuropathy in 54.2% of patients, autonomic neuropathy in 33.5% of patients, and motor neuropathy in 29.1% of patients. Gastrointestinal symptoms related to ATTR amyloidosis were present in 10.4% of patients.
Conclusions
Although patients with wild-type ATTR-CM tend to be older Caucasian men with a mostly cardiac disease phenotype, the clinical spectrum of ATTRwt is heterogeneous and differs from the classic phenotype. Our findings show that ATTRwt should not be considered an exclusively cardiac disease and there is a need for both cardiologic and neurologic assessment of these patients. Further study is needed to determine if the non-cardiac manifestations are due to amyloidosis or more common causes in this older population.
Acknowledgement/Funding
This study was sponsored by Pfizer.
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Affiliation(s)
- P Garcia-Pavia
- University Hospital Puerta de Hierro Majadahonda, Department of Cardiology, Madrid, Spain
| | - M Grogan
- Mayo Clinic, Department of Cardiovascular Diseases, Rochester, United States of America
| | - A Dispenzieri
- Mayo Clinic, Division of Hematology, Rochester, United States of America
| | - R Mundayat
- Pfizer Inc, New York, United States of America
| | - L Amass
- Pfizer Inc, Collegeville, United States of America
| | - C Rapezzi
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
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Arrato NA, Lo SB, Grogan M, Stec NJ, Eastep C, Tenney KM, Palmer SA, Andersen BL, Presley CJ. Improving biobehavioral outcomes with progressive muscle relaxation in patients with advanced lung cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.292] [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] [Indexed: 11/20/2022] Open
Abstract
292 Background: Advanced lung cancer involves severe and distressing symptoms, especially anxiety, breathlessness, insomnia, and pain. Progressive muscle relaxation (PMR) is an empirically supported treatment for reducing stress and the emotional, cognitive, and physiological concomitants of anxiety. Methods: A quality improvement effort involved enhancing standard of care (SOC) by offering patients with newly diagnosed lung cancer one brief (20-minute) PMR session during a clinic visit for treatment determination. A static group comparison design was used. The PMR group ( n= 40) received PMR with pre (initial visit) and post (3-4 week follow-up) assessments of anxiety (Generalized Anxiety Disorder-7 Scale), breathlessness (American Thoracic Society for the Division of Lung Diseases Questionnaire), insomnia (Medical Outcomes Study Sleep Scale), and pain (Brief Pain Inventory). The static group ( n= 32) was assessed on one occasion only, during the 3-4 week follow-up visit. Pre/post analyses for the PMR group used paired samples t-tests. Linear regressions compared post data between the two groups. An alpha of .10 determined significance. Results: Analyses showed pre- to post-PMR differences in pain ( p= .036, d= .309) and breathlessness ( p= .084, d= .663), with null effects for anxiety ( p= .149, d= .178) and insomnia ( p= .811, d= .067). Controlling for performance status, smoking history, and toxicities, regression showed that the PMR group reported significantly less pain ( p= .046, b= 2.48). Conclusions: PMR effectively reduced symptoms of breathlessness and pain among patients with advanced lung cancer. Interventions based on the education and training of PMR may provide an improvement to SOC lung cancer treatment.
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Affiliation(s)
| | | | - Madison Grogan
- Ohio State University Wexner Medical Center, Columbus, OH
| | - Nathan J. Stec
- Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | - Sara A. Palmer
- Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Carolyn J Presley
- Ohio State Comprehensive Cancer Center/The James Cancer Hospital, Columbus, OH
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Johns A, Grogan M, Hoyd R, Bridges JF, Wei L, Patel S, Li M, Husain M, Kendra KL, Otterson GA, Burkart JT, Rosko AE, Andersen BL, Carbone DP, Owen DH, Spakowicz D, Presley CJ. Is immunotherapy toxicity associated with improved overall survival among older adults with advanced cancer? J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.6580] [Citation(s) in RCA: 1] [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
6580 Background: There is growing evidence that checkpoint inhibitor immunotherapy (IO) toxicity is associated with improved treatment response. There is a paucity of evidence examining the relationship between toxicity and overall survival (OS) in older adults. Methods: We performed a single institution retrospective cohort study of adults who received IO for advanced cancer from 2011-2017. Baseline clinical characteristics were abstracted from the electronic health record. Immune-related toxicities were graded by physicians based on Common Terminology for Adverse Events criteria, v4.0. Bivariate analysis with chi-squared statistics was used to describe baseline characteristics of patients ≥70 years (y) vs. <70y. Survival outcomes were estimated by the Kaplan-Meier method (time zero = start of first-line IO) and compared using the log-rank test. The association of age and ≥ grade 3 toxicity with OS was tested with a Cox proportional hazards model. Results: Among 676 patients treated with IO, 238 (35.4%) were ≥70y. There was no difference in baseline characteristics of each age group except cancer type (P<0.01). The incidence of ≥ grade 3 toxicity did not differ by age (<70y: 14.5% vs. ≥70y: 13.5%, P=0.71). Median OS was significantly longer for adults <70y (16.4 vs. 13.2 months, P<0.01) or those with ≥ grade 3 toxicity (18.3 vs. 14.7 months, P<0.01). When stratified by age and toxicity, patients <70y with ≥ grade 3 toxicity had longer OS vs. those without ≥ grade 3 toxicity (P<0.01). However, there was no OS difference among adults ≥70y with vs. without ≥ grade 3 toxicity (P=0.78). Adjusted hazard ratios with an interaction term are below. Conclusions: Though the incidence of ≥ grade 3 toxicity did not significantly differ by age, there was no significant OS advantage for older adults with ≥ grade 3 toxicity as compared to younger adults. Caution should be used in considering a toxicity-survival relationship in older adults.[Table: see text]
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Affiliation(s)
- Andrew Johns
- Dept. of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Madison Grogan
- Ohio State University Wexner Medical Center, Columbus, OH
| | - Rebecca Hoyd
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
| | | | - Lai Wei
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - Sandipkumar Patel
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Mingjia Li
- The Ohio State University Wexner Medical Center, Division of Hospital Medicine, Columbus, OH
| | - Marium Husain
- The Ohio State University Medical Center, Columbus, OH
| | - Kari Lynn Kendra
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Columbus, OH
| | - Gregory Alan Otterson
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus, OH
| | - Jarred Thomas Burkart
- Division of Medical Oncology, Department of Internal Medicine,Ohio State University, Columbus, OH
| | | | | | | | - Dwight Hall Owen
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus, OH
| | - Daniel Spakowicz
- Division of Medical Oncology, Department of Internal Medicine & Department of Biomedical Informatics, Ohio State University, Columbus, OH
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El-Am E, Dispenzieri A, Grogan M, Ammash N, Melduni R, White R, Hodge D, Noseworthy P, Lin G, Pislaru S, Nkomo V. P2925Outcomes of direct current cardioversion in adults with cardiac amyloidosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E El-Am
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - A Dispenzieri
- Mayo Clinic, Hematology, Rochester, United States of America
| | - M Grogan
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - N Ammash
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - R Melduni
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - R White
- Mayo Clinic, Anesthesiology and Perioperative Medicine, Rochester, United States of America
| | - D Hodge
- Mayo Clinic, Biomedical Statistics and Informatics, Jacksonville, United States of America
| | - P Noseworthy
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - G Lin
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - S Pislaru
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - V Nkomo
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
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Mihalcea D, Bergler-Klein J, Grogan M, Pagourelias E, Faber L, Ciampi Q, Debonnaire P, Saberniak J, Florescu M, Vladareanu AM, Mihaila S, Vinereanu D, Spannbauer A, Zlabinger K, Macejovska D, Maurer G, Gyongyosi M, Scott C, Lin G, Klarich K, Miller W, Dispenzieri A, Mirea OC, Duchenne J, Vovas G, Van Aelst L, Claus P, Van Cleemput J, Delforge M, Bogaert J, Voigt JU, Burghardt A, Seggewiss H, Van Buuren F, Horstkotte D, Olivotto I, Gardini C, Monserrat L, Peteiro J, Lopes L, Cotrim C, Losi MA, Lazzeroni DE, Picano E, Joyce E, Van Den Brink OVW, Bax JJ, Delgado V, Ajmone Marsan N, Leren IS, Haland TF, Hopp E, Edvardsen T, Haugaa KH. Rapid Fire Abstract session: new insights in cardiomyopthies434The role of 4D echocardiography and cardiac biomarkers for early detection of chemotherapy induced cardiotoxicity in nonHodgkin lymphoma patients435Identification of proto-oncogenes and genes responsible for myocardial fibrosis and diastolic dysfunction after anticancer treatment under experimental conditions436Wild type transthyretin cardiac amyloidosis: clinical characteristics, echocardiographic findings, and predictors of outcome437A novel echocardiographic index for detection of cardiac amyloidosis.438Left ventricular outflow obstruction is a treatable feature rather than a risk marker in patients with hypertrophic cardiomyopathy439The international stress echo registry in hypertrophic cardiomyopathy440Value of left atrial size and function to risk stratify for new onset atrial fibrillation in hypertrophic cardiomyopathy441Right ventricle ejection fraction by cardiac resonance imaging is superior in discrimination between early phase ARVC and right ventricular outflow tract ventricular tachycardia. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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