1
|
Nowakowska MK, Li Y, Mohr C, Smith B, Ferris LK, Wehner MR. Prevalence of Total Body Skin Examinations among Dermatology Encounters in Medicare Data: A Retrospective Cohort Study. J Invest Dermatol 2024; 144:905-908.e16. [PMID: 37757914 DOI: 10.1016/j.jid.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Affiliation(s)
| | - Yao Li
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cassandra Mohr
- McGovern Medical School, UTHealth Houston, Houston, Texas, USA
| | - Brandon Smith
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mackenzie R Wehner
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| |
Collapse
|
2
|
Khalfe N, Navsaria LJ, Li Y, Nowakowska MK, Stender CF, Hinkston CL, Giordano SH, Shete SS, Wehner MR. Repeated Encounters for Actinic Keratoses in Medicare Patients: A Retrospective Cohort Study. J Invest Dermatol 2023; 143:2532-2535.e6. [PMID: 37436334 PMCID: PMC10865929 DOI: 10.1016/j.jid.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Nasim Khalfe
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Lucy J Navsaria
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yao Li
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Carly F Stender
- McGovern Medical School, UTHealth Houston, Houston, Texas, USA
| | - Candice L Hinkston
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanjay S Shete
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mackenzie R Wehner
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| |
Collapse
|
3
|
Nowakowska MK, Ortega RM, Wehner MR, Nead KT. Association of Second-generation Antiandrogens With Cognitive and Functional Toxic Effects in Randomized Clinical Trials: A Systematic Review and Meta-analysis. JAMA Oncol 2023; 9:930-937. [PMID: 37227736 PMCID: PMC10214180 DOI: 10.1001/jamaoncol.2023.0998] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/13/2023] [Indexed: 05/26/2023]
Abstract
Importance The use of second-generation antiandrogens (AAs) in the treatment of prostate cancer is increasing. Retrospective evidence suggests an association between second-generation AAs and adverse cognitive and functional outcomes, but further data from prospective trials are needed. Objective To examine whether evidence from randomized clinical trials (RCTs) in prostate cancer supports an association between second-generation AAs and cognitive or functional toxic effects. Data Sources PubMed, EMBASE, and Scopus (inception to September 12, 2022). Study Selection Randomized clinical trials of second-generation AAs (abiraterone, apalutamide, darolutamide, or enzalutamide) among individuals with prostate cancer that reported cognitive toxic effects, asthenic toxic effects (eg, fatigue, weakness), or falls were evaluated. Data Extraction and Synthesis Study screening, data abstraction, and bias assessment were completed independently by 2 reviewers following the Preferred Reporting Items for Systematic Reviews and Meta-analyses and Enhancing the Quality and Transparency of Health Research reporting guidelines. Tabular counts for all-grade toxic effects were determined to test the hypothesis formulated before data collection. Main Outcomes and Measures Risk ratios (RRs) and SEs were calculated for cognitive toxic effects, asthenic toxic effects, and falls. Because fatigue was the asthenic toxic effect extracted from all studies, data on fatigue are specified in the results. Meta-analysis and meta-regression were used to generate summary statistics. Results The systematic review included 12 studies comprising 13 524 participants. Included studies had a low risk of bias. An increased risk of cognitive toxic effects (RR, 2.10; 95% CI, 1.30-3.38; P = .002) and fatigue (RR, 1.34; 95% CI, 1.16-1.54; P < .001) was noted among individuals treated with second-generation AAs vs those in the control arms. The findings were consistent in studies that included traditional hormone therapy in both treatment arms for cognitive toxic effects (RR, 1.77; 95% CI, 1.12-2.79; P = .01) and fatigue (RR, 1.32; 95% CI, 1.10-1.58; P = .003). Meta-regression supported that, across studies, increased age was associated with a greater risk of fatigue with second-generation AAs (coefficient, 0.75; 95% CI, 0.04-0.12; P < .001). In addition, the use of second-generation AAs was associated with an increased risk of falls (RR, 1.87; 95% CI, 1.27-2.75; P = .001). Conclusions and Relevance The findings of this systematic review and meta-analysis suggest that second-generation AAs carry an increased risk of cognitive and functional toxic effects, including when added to traditional forms of hormone therapy.
Collapse
Affiliation(s)
| | | | - Mackenzie R. Wehner
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Kevin T. Nead
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston
| |
Collapse
|
4
|
Nowakowska MK, Sierro T, Cruz PD. Teaching Patients to Teach Themselves (Not by Rote but) via Repeated Open Application Test. Dermatitis 2023; 34:154-155. [PMID: 36917523 DOI: 10.1089/derm.2022.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
| | - Tiffany Sierro
- From the School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Ponciano D Cruz
- From the School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
5
|
Nowakowska MK, Rodriguez ED, Gurney NT, Chang JY, Hunt RD, Yen KG, Kim EJ, Metry DW. Green nail syndrome complicated by pseudomonal keratitis in a teenager with artificial nails. Pediatr Dermatol 2023; 40:216-218. [PMID: 36002400 DOI: 10.1111/pde.15112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/31/2022] [Indexed: 01/25/2023]
Abstract
Green nail syndrome (GNS) is a pseudomonal nail infection that presents with characteristic green nail discoloration. It typically affects patients with preexisting nail conditions or chronic exposure to wet environments but can also be seen with local trauma. Our patient presented with a pseudomonal corneal ulcer of the left eye and was incidentally found to have GNS, which developed after home artificial nail application. This unusual case of extensive pediatric GNS illustrates a rare and serious infectious complication of prolonged artificial nails.
Collapse
Affiliation(s)
| | - Edgar D Rodriguez
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
| | - Nicholas T Gurney
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Jack Y Chang
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Raegan D Hunt
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA.,Division of Pediatric Dermatology, Texas Children's Hospital, Houston, Texas, USA
| | - Kimberly G Yen
- Department of Ophthalmology, Texas Children's Hospital, Houston, Texas, USA
| | - Eric J Kim
- Department of Ophthalmology, Texas Children's Hospital, Houston, Texas, USA
| | - Denise W Metry
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA.,Division of Pediatric Dermatology, Texas Children's Hospital, Houston, Texas, USA
| |
Collapse
|
6
|
Wehner MR, Li Y, Sethi AA, Hinkston CL, Khalfe N, Stender CF, Nowakowska MK, Cohen OG, Giordano SH, Linos E. Utilization of Indoor Tanning: A Cross-Sectional Study Using Mobile Device Data. J Invest Dermatol 2022; 143:874-878.e1. [PMID: 36496197 DOI: 10.1016/j.jid.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Mackenzie R Wehner
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Yao Li
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ashna A Sethi
- School of Public Health & Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Candice L Hinkston
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nasim Khalfe
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Carly F Stender
- McGovern Medical School, The University of Texas McGovern Medical School, Houston, Texas, USA
| | | | - Olivia G Cohen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eleni Linos
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California, USA
| |
Collapse
|
7
|
Nowakowska MK, Rodriguez ED, Hunt RD, Rialon KL, Jadhav SP, Metry DW. An infant with LUMBAR syndrome complicated by severe perineal ulceration managed with diverting colostomy. Pediatr Dermatol 2022; 40:355-357. [PMID: 36373214 DOI: 10.1111/pde.15174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/16/2022] [Indexed: 11/16/2022]
Abstract
Infantile hemangiomas are the most common childhood vascular lesions. LUMBAR syndrome (lower body hemangioma, urogenital abnormalities/ulceration, myelopathy, bony deformities, anorectal malformations/arterial anomalies, and rectal anomalies) warrants special treatment considerations. Here we describe a case of an infant with LUMBAR syndrome who presented with severe perineal ulceration refractory to standard medical therapy and was managed with a temporary diverting sigmoid colostomy. This case demonstrates that adjunctive surgical management can be considered in infants with aggressive perineal wounds refractory to standard medical therapy.
Collapse
Affiliation(s)
| | - Edgar D Rodriguez
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
| | - Raegan D Hunt
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA.,Department of Dermatology, Texas Children's Hospital, Houston, Texas, USA
| | - Kristy L Rialon
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Texas, USA
| | - Siddharth P Jadhav
- Department of Radiology, Baylor College of Medicine, Houston, Texas, USA.,Department of Radiology, Texas Children's Hospital, Houston, Texas, USA
| | - Denise W Metry
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA.,Department of Dermatology, Texas Children's Hospital, Houston, Texas, USA
| |
Collapse
|
8
|
Navsaria LJ, Li Y, Nowakowska MK, Hinkston CL, Wheless L, Giordano SH, Wehner MR. Incidence and Treatment of Actinic Keratosis in Older Adults With Medicare Coverage. JAMA Dermatol 2022; 158:1076-1078. [PMID: 35895043 PMCID: PMC9330251 DOI: 10.1001/jamadermatol.2022.2555] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This cohort study evaluates 10 years of Medicare claims data for outpatient encounters related to actinic keratosis.
Collapse
Affiliation(s)
- Lucy J. Navsaria
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
| | - Yao Li
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
| | | | - Candice L. Hinkston
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
| | - Lee Wheless
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sharon H. Giordano
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
| | - Mackenzie R. Wehner
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston,Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston
| |
Collapse
|
9
|
Nowakowska MK, Kim T, Thompson MT, Bolton KL, Deswal A, Lin SH, Scheet P, Wehner MR, Nead KT. Association of clonal hematopoiesis mutations with clinical outcomes: A systematic review and meta-analysis. Am J Hematol 2022; 97:411-420. [PMID: 35015316 PMCID: PMC9284564 DOI: 10.1002/ajh.26465] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 12/19/2022]
Abstract
Clonal hematopoiesis (CH) mutations are common among individuals without known hematologic disease. CH mutations have been associated with numerous adverse clinical outcomes across many different studies. We systematically reviewed the available literature for clinical outcomes associated with CH mutations in patients without hematologic disease. We searched PubMed, EMBASE, and Scopus for eligible studies. Three investigators independently extracted the data, and each study was verified by a second author. Risk of bias was assessed using the Newcastle-Ottawa Scale. We identified 32 studies with 56 cohorts that examine the association between CH mutations and clinical outcomes. We conducted meta-analyses comparing outcomes among individuals with and without detectable CH mutations. We conducted meta-analyses for cardiovascular diseases (nine studies; HR = 1.61, 95% CI = 1.26-2.07, p = .0002), hematologic malignancies (seven studies; HR = 5.59, 95% CI = 3.31-9.45, p < .0001), therapy-related myeloid neoplasms (four studies; HR = 7.55, 95% CI = 4.3-13.57, p < .001), and death (nine studies; HR = 1.34, 95% CI = 1.2-1.5, p < .0001). The cardiovascular disease analysis was further stratified by variant allele fraction (VAF) and gene, which showed a statistically significant association only with a VAF of ≥ 10% (HR = 1.42, 95% CI = 1.24-1.62, p < .0001), as well as statistically significant associations for each gene examined with the largest magnitude of effect found for CH mutations in JAK2 (HR = 3.5, 95% CI = 1.84-6.68, p < .0001). Analysis of the association of CH mutations with hematologic malignancy demonstrated a numeric stepwise increase in risk with increasing VAF thresholds. This analysis strongly supports the association of CH mutations with a clinically meaningful increased risk of adverse clinical outcomes among individuals without hematologic disease, particularly with increasing VAF thresholds.
Collapse
Affiliation(s)
| | - Taebeom Kim
- Department of Epidemiology University of Texas MD Anderson Cancer Center
| | | | - Kelly L. Bolton
- Division of Oncology, Department of Medicine Washington University School of Medicine in St. Louis
| | - Anita Deswal
- Department of Cardiology University of Texas MD Anderson Cancer Center
| | - Steven H. Lin
- Department of Radiation Oncology University of Texas MD Anderson Cancer Center
| | - Paul Scheet
- Department of Epidemiology University of Texas MD Anderson Cancer Center
| | - Mackenzie R. Wehner
- Department of Health Services Research University of Texas MD Anderson Cancer Center
- Department of Dermatology University of Texas MD Anderson Cancer Center
| | - Kevin T. Nead
- Department of Epidemiology University of Texas MD Anderson Cancer Center
- Department of Radiation Oncology University of Texas MD Anderson Cancer Center
| |
Collapse
|
10
|
Sturgis EM, Nowakowska MK, Ferrell JK. Is 2045 Optimistic?-Concerns Regarding Rising Vaccine Hesitancy. JAMA Oncol 2022; 8:481-482. [PMID: 35050315 DOI: 10.1001/jamaoncol.2021.7163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Erich M Sturgis
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Jay K Ferrell
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, Texas
| |
Collapse
|
11
|
Abstract
IMPORTANCE Previous studies have shown a consistent association between hormone therapy (HT), such as androgen deprivation therapy, to treat prostate cancer and depression risk. However, the association between second-generation antiandrogens (AAs) and depression is unknown. OBJECTIVE To test the a priori hypothesis that second-generation AAs are associated with an increased risk of depression, including compared with traditional forms of HT. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study analyzed patients aged 66 years and older who were diagnosed with prostate cancer without a second cancer in 12 months from January 2011 to December 2015. Patients with continuous Medicare Parts A, B, and D coverage were included. Individuals who received any form of HT prior to prostate cancer diagnosis and those previously diagnosed with depression were excluded. Data were collected from the Surveillance, Epidemiology, and End Results-Medicare and Texas Cancer Registry-Medicare linked databases. Data were analyzed from February to May 2021. EXPOSURES The following treatment groups were compared: (1) no HT group, (2) traditional HT group (HT without second-generation AA exposure), and (3) second-generation AA group. MAIN OUTCOMES AND MEASURES Risk of depression in the second-generation AA group compared with the no HT and traditional HT groups, determined prior to data collection, stratified by diagnosis stage. RESULTS Of 210 804 patients diagnosed with prostate cancer during the study window, 30 069 men (11 484 [38%] aged 66-70 years; 22 594 [75%] White) who met inclusion criteria were identified. Overall, 17 710 (59%) received no HT, 11 311 (38%) received traditional HT only, and 1048 (3%) received a second-generation AA. Those receiving a second-generation AA were more likely to be older (aged ≥81 years: second-generation AA group, 246 [24%]; traditional HT group, 1997 [18%]; no HT group, 1173 [7%]) and present with advanced disease (eg, distant disease: second-generation AA group, 562 [24%]; traditional HT group, 876 [8%]; no HT group, 129 [0.7%]). Multivariable Cox proportional hazards analysis showed that the second-generation AA group had an increased risk of depression compared with the no HT group (hazard ratio [HR], 2.15; 95% CI, 1.79-2.59; P < .001) and the traditional HT group (HR, 2.26; 95% CI, 1.88-2.73; P < .001), including specifically among those with metastatic disease at diagnosis (HR, 2.40; 95% CI, 1.38-4.15; P = .002). CONCLUSIONS AND RELEVANCE In this cohort study, patients with prostate cancer who received a second-generation AA had a large and clinically significant increased risk of depression compared with patients who received traditional HT alone or no HT, including when limiting our analysis to individuals with metastatic disease at diagnosis.
Collapse
Affiliation(s)
| | - Xiudong Lei
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
| | - Mackenzie R. Wehner
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston
| | - Paul G. Corn
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Sharon H. Giordano
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Kevin T. Nead
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston
- Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston
| |
Collapse
|
12
|
Nowakowska MK, Li Y, Garner DC, Stender CF, Hinkston CL, Giordano SH, Wehner MR. Clinical Settings and Demographic Characteristics of Patients With Sunburn. JAMA Dermatol 2021; 157:1122-1125. [PMID: 34379105 DOI: 10.1001/jamadermatol.2021.2923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Yao Li
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
| | - Desmond C Garner
- School of Medicine, Vanderbilt University, Nashville, Tennessee.,Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Carly F Stender
- McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Candice L Hinkston
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
| | - Sharon H Giordano
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
| | - Mackenzie R Wehner
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston.,Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston
| |
Collapse
|
13
|
Nowakowska MK, Lei X, Thompson MT, Shaitelman SF, Wehner MR, Woodward WA, Giordano SH, Nead KT. Association of statin use with clinical outcomes in patients with triple-negative breast cancer. Cancer 2021; 127:4142-4150. [PMID: 34342892 DOI: 10.1002/cncr.33797] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Previous studies have examined the association of statin therapy and breast cancer outcomes with mixed results. The objective of this study was to investigate the clinical effects of incident statin use among individuals with triple-negative breast cancer (TNBC). METHODS Data from the Surveillance, Epidemiology, and End Results-Medicare and Texas Cancer Registry-Medicare databases were used, and women aged ≥66 years who had stage I, II, and III breast cancer were identified. Multivariable Cox proportional hazards regression models were used to examine the association of new statin use in the 12 months after a breast cancer diagnosis with overall survival (OS) and breast cancer-specific survival (BCSS). RESULTS When examining incident statin use, defined as the initiation of statin therapy in the 12 months after breast cancer diagnosis, a significant association was observed between statin use and improved BCSS (standardized hazard ratio, 0.42; 95% confidence interval [CI], 0.20-0.88; P = .022) and OS (hazard ratio, 0.70; 95% CI, 0.50-0.99; P = .046) among patients with TNBC (n = 1534). No association was observed with BCSS (standardized hazard ratio, 0.99; 95% CI, 0.71-1.39; P = .97) or OS (hazard ratio, 1.04; 95% CI, 0.92-1.17; P = .55) among those without TNBC (n = 15,979). The results were consistent when examining statin exposure as a time-varying variable. CONCLUSIONS Among women with I, II, and III TNBC, initiation of statin therapy in the 12 months after breast cancer diagnosis was associated with an OS and BCSS benefit. Statins may have a role in select patients with breast cancer, and further investigation is warranted.
Collapse
Affiliation(s)
| | - Xiudong Lei
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mikayla T Thompson
- School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Simona F Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mackenzie R Wehner
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wendy A Woodward
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kevin T Nead
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
14
|
Valli E, Harriett AJ, Nowakowska MK, Baudier RL, Provosty WB, McSween Z, Lawson LB, Nakanishi Y, Norton EB. LTA1 is a safe, intranasal enterotoxin-based adjuvant that improves vaccine protection against influenza in young, old and B-cell-depleted (μMT) mice. Sci Rep 2019; 9:15128. [PMID: 31641151 PMCID: PMC6805908 DOI: 10.1038/s41598-019-51356-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 01/10/2019] [Accepted: 09/19/2019] [Indexed: 01/17/2023] Open
Abstract
Enterotoxin-based adjuvants including cholera toxin and heat-labile toxin (LT) are powerful manipulators of mucosal immunity; however, past clinical trials identified unacceptable neurological toxicity when LT or mutant AB5 adjuvant proteins were added to intranasal vaccines. Here, we examined the isolated enzymatic A1 domain of LT (LTA1) for intranasal safety and efficacy in combination with influenza (flu) vaccination. LTA1-treated mice exhibited no neurotoxicity, as measured by olfactory system testing and H&E staining of nasal tissue in contrast with cholera toxin. In vaccination studies, intranasal LTA1 enhanced immune responses to inactivated virus antigen and subsequent protection against H1N1 flu challenge in mice (8-week or 24-months). In addition, lung H1N1 viral titers post-challenge correlated to serum antibody responses; however, enhanced protection was also observed in μMT mice lacking B-cells while activation and recruitment of CD4 T-cells into the lung was apparent. Thus, we report that LTA1 protein is a novel, safe and effective enterotoxin adjuvant that improves protection of an intranasal flu vaccination by a mechanism that does not appear to require B-cells.
Collapse
Affiliation(s)
- E Valli
- Department of Microbiology & Immunology, Tulane University School of Medicine, New Orleans, USA
| | - A J Harriett
- Department of Microbiology & Immunology, Tulane University School of Medicine, New Orleans, USA
| | - M K Nowakowska
- Department of Microbiology & Immunology, Tulane University School of Medicine, New Orleans, USA
| | - R L Baudier
- Department of Microbiology & Immunology, Tulane University School of Medicine, New Orleans, USA
| | - W B Provosty
- Department of Microbiology & Immunology, Tulane University School of Medicine, New Orleans, USA
| | - Z McSween
- Department of Microbiology & Immunology, Tulane University School of Medicine, New Orleans, USA
| | - L B Lawson
- Department of Microbiology & Immunology, Tulane University School of Medicine, New Orleans, USA
| | - Y Nakanishi
- Department of Pathology & Laboratory Medicine, Tulane University School of Medicine, New Orleans, USA
| | - E B Norton
- Department of Microbiology & Immunology, Tulane University School of Medicine, New Orleans, USA.
| |
Collapse
|