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Stokes SM, Haider M, Vadaparampil ST, Levitt C, Hardy O, Kim R, Castillo DL, Denbo J, Fleming JB, Anaya DA. Patient's informational needs and outreach preferences: A cross-sectional survey study in patients with hepatobiliary malignancies. PEC Innov 2024; 4:100248. [PMID: 38292078 PMCID: PMC10825679 DOI: 10.1016/j.pecinn.2023.100248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 02/01/2024]
Abstract
Objective Hepatobiliary tumors have evolving management guidelines. Patient educational needs and interest in community engagement are unknown. This study serves as a needs assessment. Methods A prospective, needs assessment, survey study of hepatobiliary patients was performed (2016-2019). Surveys (n = 169) were distributed covering three domains of interest: informational needs, interest in outreach, and engagement preferences. Results Seventy patients completed the survey (response rate = 41.4%). Most patients had completed surgical treatment (84.3%). Cancer treatment was ranked as their primary topic of interest (n = 39, 55.7bold%), followed by symptom management, nutrition, and survivorship. Most patients did not participate in screening (n = 57, 81.4%), though were interested in learning more about these programs. Thirty-nine patients (55.7%) stated they would want to receive more education. Only 17 (24.3%) were interested in attending in-person events. Patients preferred online methods for education (n = 49, 70%). While patients were aware of their case presentation at tumor board, only 38 (54.3%) felt well-informed about recommendations. Conclusion Multidisciplinary care is complex and difficult for patients to navigate. Most patients have interest in educational resources and prefer online modalities. Patients understand multidisciplinary tumor boards, but communication could be improved. Innovation These data inform a new, innovative, approach to outreach efforts in this population.
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Affiliation(s)
- Sean M. Stokes
- Department of GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States
| | - Mintallah Haider
- Department of GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States
| | - Susan T. Vadaparampil
- Office of Community Outreach Engagement & Equity, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States
| | - Catherine Levitt
- Morsani College of Medicine, University of South Florida, 560 Channelside Drive, Tampa, FL 33602, United States
| | - Olivia Hardy
- Morsani College of Medicine, University of South Florida, 560 Channelside Drive, Tampa, FL 33602, United States
| | - Richard Kim
- Department of GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States
| | - Diana L. Castillo
- Department of GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States
| | - Jason Denbo
- Department of GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States
| | - Jason B. Fleming
- Department of GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States
| | - Daniel A. Anaya
- Department of GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States
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Al-Toubah T, Schell MJ, Morse B, Haider M, Valone T, Strosberg J. Phase II study of pembrolizumab and lenvatinib in advanced well-differentiated neuroendocrine tumors. ESMO Open 2024; 9:102386. [PMID: 38507897 DOI: 10.1016/j.esmoop.2024.102386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/15/2023] [Accepted: 01/25/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (CPIs) have not been shown to be active in well-differentiated neuroendocrine tumors (NETs), with response rates <5%. Lenvatinib is a multitargeted tyrosine kinase inhibitor which binds to vascular endothelial growth factor and fibroblast growth factor receptors and has demonstrated efficacy in pancreatic and gastrointestinal NETs [44% and 16% objective radiographic response rate (ORR), respectively]. The combination of antiangiogenic and CPI therapies can be synergistic. We therefore evaluated the combination of lenvatinib and pembrolizumab in well-differentiated gastrointestinal (GI) and thoracic NETs. PATIENTS AND METHODS A prospective, phase II trial evaluated patients with advanced GI/thoracic NETs (pancreatic NETs were excluded due to high response rate of lenvatinib monotherapy in this patient population), with evidence of progression within 8 months of study entry and at least two prior lines of systemic therapy. Patients received lenvatinib 20 mg daily and pembrolizumab 200 mg intravenously every 3 weeks until unacceptable toxicity or progression of disease. Primary endpoint was objective response rate, and an interim analysis was planned once 20 patients were enrolled. Four ORRs were required to continue enrollment. RESULTS Twenty patients were enrolled on protocol from April 2021 to January 2022 (nine small intestine, five lung, two thymic, two unknown primary, one cecal, one presacral primaries). Two patients (10%) achieved a partial response (atypical lung and small intestinal primaries). Median progression-free survival (PFS) was 8 months (95% confidence interval 5.8-10.2 months). Twelve (60%) patients experienced probably or definitely associated grade 3 adverse events (10 hypertension). Fourteen patients (70%) required dose reductions or discontinued one of the medications. Two patients discontinued treatment before radiographic assessment. CONCLUSIONS The combination of pembrolizumab and lenvatinib did not show sufficient response in patients with NETs to warrant continued enrollment on trial.
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Affiliation(s)
- T Al-Toubah
- Department of GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - M J Schell
- Department of Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - B Morse
- Department of Diagnostic Imaging, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - M Haider
- Department of GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - T Valone
- Department of GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - J Strosberg
- Department of GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA.
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3
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Laber DA, Patel PC, Logothetis CN, Patel AK, Jaglal M, Haider M, Visweshwar N, Rajasekaran-Rathnakumar G, Eatrides J. Complement-mediated thrombotic microangiopathy treated with anticomplement protein 5 therapy, a retrospective study. Eur J Haematol 2024; 112:450-457. [PMID: 37984551 DOI: 10.1111/ejh.14136] [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: 07/25/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Complement-mediated thrombotic microangiopathy (CM-TMA), also called atypical hemolytic uremic syndrome (aHUS), is a difficult-to-diagnose rare disease that carries severe morbidity and mortality. Anti-C5 monoclonal antibodies (aC5-mab) are standard treatments, but large studies and long-term data are scarce. Here, we report our single institution experience to augment the knowledge of CM-TMA treated with aC5-mab therapy. METHODS We aimed to assess the short and long-term effects of aC5-mab in patients diagnosed with CM-TMA treated outside of a clinical trial. This was a retrospective study. We included all patients diagnosed with CM-TMA and treated with aC5-mab at our institution. There were no exclusion criteria. Endpoints included complete TMA response (CR) defined as normalization of hematological parameters and ≥25% improvement in serum creatinine (Cr) from baseline in patients with renal disease, relapse defined as losing the previously achieved CR, morbidity, adverse events, and survival. RESULTS We found 28 patients with CM-TMA treated with aC5-mab. The median age was 50 years. Baseline laboratories: platelet counts 93 × 109 /L, hemoglobin 8.6 g/dL, lactate dehydrogenase 1326 U/L, serum Cr 4.7 mg/dL, and estimated glomerular filtration rate 19 mL/min. One individual was on renal replacement therapy (RRT) and 10 initiated RRT within 5 days of the first dose of aC5-mab. Genetic variants associated with CM-TMA included mutations in C3, CFB, CFH, CFHR1/3, CFI, and MCP. The mean duration of hospitalization was 24 days. The median time to initiation of aC5-mab was 10 days. Sixteen subjects received RRT. At the time of hospital discharge, 27 were alive, 14 remained on RRT, and 4 had a CR. At 6 months, 23 patients were alive, 18 continued aC5-mab, 8 remained on RRT, and 9 had a CR. At the last follow-up visit past 6 months, 20 were alive, 14 continued aC5-mab, 5 remained on RRT, 12 had a CR, and 1 was lost to follow-up. CONCLUSIONS Our study provides real-world experience and insight into the long-term outcomes of CM-TMA treated with aC5-mab. Our findings validate that CM-TMA is an aggressive disease with significant morbidity and mortality, and confirm that aC5-mab is a relatively effective therapy for CM-TMA. Our study adds practical, real-world experience to the literature, but future research remains imperative.
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Affiliation(s)
- Damian A Laber
- Department of Satellite and Community Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Parth C Patel
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Constantine N Logothetis
- Divisions of Hematology and Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ankita K Patel
- Department of Satellite and Community Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Michael Jaglal
- Department of Satellite and Community Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Mintallah Haider
- Department of Satellite and Community Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Nathan Visweshwar
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Geetha Rajasekaran-Rathnakumar
- Department of Satellite and Community Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Jennifer Eatrides
- Department of Satellite and Community Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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Al-Toubah T, Montilla-Soler J, El-Haddad G, Haider M, Strosberg J. Somatostatin Receptor Expression in Lung Neuroendocrine Tumors: An Analysis of DOTATATE PET Scans. J Nucl Med 2023; 64:1895-1898. [PMID: 37797976 DOI: 10.2967/jnumed.123.266185] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/16/2023] [Indexed: 10/07/2023] Open
Abstract
Somatostatin receptor (SSTR) expression in metastatic lung neuroendocrine tumors (NETs) has not been well characterized using PET imaging. Understanding the degree and uniformity of SSTR expression is important to establish the role of SSTR-targeted treatments in lung NETs. Methods: A retrospective institutional review of patients with metastatic lung NETs who underwent DOTATATE PET imaging from March 2017 to February 2023 was performed. Results: In total, 48 patients with metastatic lung NETs who underwent 68Ga- or 64Cu-DOTATATE PET imaging were identified. Four had completely negative SSTR expression, and 10 had very weak expression (less than in a normal liver). Among the remaining 34 patients, 21 had uniformly positive DOTATATE PET scans, and 13 had heterogeneous expression. Only 44% had uniformly positive receptor expression, identifying them as candidates for peptide receptor radionuclide therapy. Conclusion: Most metastatic lung NETs lack uniform SSTR expression and are thus suboptimal candidates for SSTR-targeted therapy. SSTR imaging in lung NETs should be evaluated carefully for uniformity of expression.
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Affiliation(s)
- Taymeyah Al-Toubah
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; and
| | - Jaime Montilla-Soler
- Department of Diagnostic Imaging, Nuclear Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Ghassan El-Haddad
- Department of Diagnostic Imaging, Nuclear Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Mintallah Haider
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; and
| | - Jonathan Strosberg
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; and
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Al-Toubah T, Pelle E, Hallanger-Johnson J, Haider M, Strosberg J. ACTH-secreting pancreatic neuroendocrine neoplasms: A case-series. J Neuroendocrinol 2023; 35:e13336. [PMID: 37688510 DOI: 10.1111/jne.13336] [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: 03/07/2023] [Revised: 07/29/2023] [Accepted: 08/15/2023] [Indexed: 09/11/2023]
Abstract
Ectopic Cushing's syndrome (CS) occurs rarely in patients with pancreatic neuroendocrine neoplasms. Early recognition of symptoms is critical given the high morbidity and mortality associated with CS. A database of pancreatic neuroendocrine neoplasms (NENs) seen at the Moffitt Cancer Center between 1/2008 and 4/2022 was reviewed and cases of ectopic CS were identified. Information was extracted on tumor characteristics, clinical signs and symptoms, therapies, and outcomes. Thirteen cases were identified, ranging in age from 16 to 65 years at the initial time of diagnosis (median 42). Twelve of 13 patients had metastatic tumors at presentation. All were well-differentiated at diagnosis although two were described as transformed to poorly differentiated on rebiopsy. A total of 4 patients also experienced Zollinger-Ellison syndrome. Three patients underwent bilateral adrenalectomy to manage uncontrolled CS. Median overall survival of was 56 months from the time of initial cancer diagnosis but only 18 months from diagnosis of CS. Our study showed that ectopic CS is a highly morbid condition when occurring in pancreatic NENs and is associated with aggressive disease. Bilateral adrenalectomy can be considered for syndrome control. To our knowledge, this is the largest institutional case-series of ACTH-secreting metastatic pancreatic NEN.
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Affiliation(s)
- Taymeyah Al-Toubah
- Department of GI Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Eleonora Pelle
- Department of GI Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Julie Hallanger-Johnson
- Department of Endocrine Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Mintallah Haider
- Department of GI Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Jonathan Strosberg
- Department of GI Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
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Raman S, Arora S, Macura K, Oto A, Futterer J, Staruch R, Tirkes T, Bonekamp D, Haider M, Cool D, Nandalur K, Nicolau C, Costa D, Persigehl T, Clarke G, Chin J, Klotz L, Eggener S. Abstract No. 9 ▪ FEATURED ABSTRACT Pivotal Study of Magnetic Resonance Imaging-Guided Transurethral Ultrasound Ablation (TULSA) of the Prostate: 4-year Follow-up. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.048] [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: 02/27/2023] Open
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Sinnamon AJ, Wood AC, Satyadi MA, Levitt CV, Hardy O, Haider M, Kim RD, Anaya DA, Denbo JW. Anatomic patterns of recurrence in biliary tract cancers: does primary tumor site matter? J Gastrointest Oncol 2022; 13:1413-1422. [PMID: 35837169 DOI: 10.21037/jgo-21-868] [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: 12/10/2021] [Accepted: 04/07/2022] [Indexed: 11/06/2022] Open
Abstract
Background Recommendations for postoperative surveillance and adjuvant therapy following curative-intent resection for biliary tract cancers-including intrahepatic and extrahepatic cholangiocarcinoma (IHCCA and EHCCA) and primary gallbladder cancer (GBC)-are uniform across primary tumor site. However, these tumors may have distinct patterns of recurrence. Methods A retrospective observational cohort study was performed at a specialty cancer center. Patients undergoing resection of IHCCA, EHCCA, and GBC were identified (2005-2020). Recurrence-free survival (RFS) was estimated using Kaplan-Meier and Cox proportional hazard methods. Anatomic patterns of initial site of recurrence were described and compared. Results There were 142 patients included; 50 IHCCA, 32 EHCCA, and 60 GBC. Median RFS was 30.8 months, which was not significantly different between IHCCA, EHCCA, or GBC in univariate analysis or after adjustment. Nodal positivity was significantly associated with poor RFS (HR 3.92, P≤0.001). The most common initial site of recurrence overall was intrahepatic (n=49/64, 77%), in isolation (n=32) or synchronous with other site of recurrence (n=17). Significant differences in anatomic pattern of recurrence were observed (P=0.049) with IHCCAs more commonly recurring with simultaneous hepatic-pulmonary disease (n=5/22, 23%; EHCCA n=2/19, 10%; GBC n=1/23, 4%), GBC more commonly recurring within the porta (n=7/23, 30%; IHCCA n=0; EHCCA n=1/19, 5%), and EHCCA more commonly recurring within the peritoneum (n=5/19, 26%; IHCCA n=2/22, 9%, GBC n=2/23, 9%). Conclusions Patterns of initial recurrence appear to differ between primary tumor site, likely reflecting underlying differences in anatomy and biology. These data could help inform future studies for adjuvant therapy as well as timing and anatomic focus for surveillance imaging.
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Affiliation(s)
- Andrew J Sinnamon
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.,University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Anthony C Wood
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Megan A Satyadi
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | | | - Olivia Hardy
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Mintallah Haider
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Richard D Kim
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Daniel A Anaya
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Jason W Denbo
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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Salinas-Miranda E, Barragan C, Miranda ES, Classen M, Ivanics T, Haider M, Sapisochin G. Abstract No. 533 Prognostic value of muscle mass for HCC recurrence in pre-transplant patients undergoing bridging therapy. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.515] [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: 11/28/2022] Open
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9
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Powers BD, Ahmad Y, Diaz G, Tarhan O, Al-Toubah TE, Haider M, Fleming JB, Strosberg JR, Anaya DA. A natural history of gastroenteropancreatic neuroendocrine tumors evaluated at a tertiary cancer center: An observational study of 2,067 cases. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.508] [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
508 Background: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are the second most prevalent digestive cancer and are increasing in incidence. With relatively indolent tumor growth, survival is often long, even for patients with metastatic disease. However, few studies have assessed long-term survival. Therefore, we analyzed the overall survival (OS) of a cohort of GEP-NET patients at a tertiary cancer center from 2000-2015. Methods: 2,707 patients with a pathologic diagnosis of GEP-NET were identified. 640 patients presented for second-opinion visits and were excluded, leaving 2,067 patients, of whom, 2,053 had vital status data for analysis. Primary sites included jejunum/ileum (small bowel), pancreas, gastric, colorectum, appendix, duodenum, and unknown. OS time was calculated from the date of pathologic diagnosis to the date of last follow-up or death. The reverse Kaplan-Meier method was used to calculate follow-up time. Vital status was identified through linkage to the Florida Cancer Registry. Kaplan-Meier (KM) curves and log-rank test were used for OS analyses. Results: The median age of the cohort was 60.7 years. The median follow-up time was 148.9 months (12.4 years). 1,431 (69.2%) patients presented with distant metastatic disease. Most patients, 1,351 (65.5%), underwent treatment at another facility before presentation. The median OS was 132.2 months (11.0 years) for the cohort and was 108.0 and 245.5 months for patients presenting with and without metastasis, respectively (p < 0.001). For metastatic patients, unknown primary tumor site was associated with the worst median OS (55 months), followed by rectal (77 months), gastric (84 months) and pancreatic (85 months; p < 0.001). Duodenal and small bowel had the longest median OS at 147 and 143 months, respectively. Surgery for metastatic disease had an OS benefit (155.7 months) compared to no surgery (98.3 months). Conclusions: In a large cohort of predominantly metastatic GEP-NET patients with extended follow-up time, median OS was over 11 years and 9 years for patients with metastatic disease. These results suggest that OS at a tertiary cancer center may be greater than historical national administrative analyses when given adequate follow-up time, which is important to avoid bias in survival estimates.[Table: see text]
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Affiliation(s)
| | - Yaser Ahmad
- Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Gabriel Diaz
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL
| | - Ozlem Tarhan
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL
| | | | | | - Jason B. Fleming
- Department of Surgical Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Perlis N, Finelli A, Lovas M, Lund A, Di Meo A, Lajkosz K, Berlin A, Papadakos J, Ghai S, Deniffel D, Meng E, Wiljer D, Alibhai S, Bakas V, Badzynski A, Lee O, Cafazzo J, Haider M. Exploring the value of using patient-oriented mri reports in clinical practice. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00558-9] [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: 11/04/2022]
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11
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Corkum M, Morton G, Loblaw D, Tseng C, Murgic J, Ravi A, Davidson M, Wronski M, Haider M, Chung H. A Prospective Study of MR-Guided Focal Salvage High Dose-Rate Brachytherapy for Radiorecurrent Prostate Cancer: Updated Results of 30 Patients. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.876] [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: 11/15/2022]
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12
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Ehab J, Powers B, Kim R, Haider M, Utuama O, Chin A, Denbo J, Kis B, Frakes J, Jeong D, Lauwers G, Vadaparampil S, Fleming JB, Anaya DA. ASO Visual Abstract: Integrating a Disease-Focused Tumor Board as a Delivery-of-Care Model to Expedite Treatment Initiation for Patients with Liver Malignancies. Ann Surg Oncol 2021. [PMID: 34716839 DOI: 10.1245/s10434-021-10952-9] [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: 11/18/2022]
Affiliation(s)
- Jasmina Ehab
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Benjamin Powers
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Richard Kim
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Mintallah Haider
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ovie Utuama
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Alicia Chin
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jason Denbo
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Bela Kis
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jessica Frakes
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Daniel Jeong
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Gregory Lauwers
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Susan Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jason B Fleming
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Daniel A Anaya
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
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Ehab J, Powers B, Kim R, Haider M, Utuama O, Chin A, Denbo J, Kis B, Frakes J, Jeong D, Lauwers G, Vadaparampil S, Fleming JB, Anaya DA. Integrating a Disease-Focused Tumor Board as a Delivery-of-Care Model to Expedite Treatment Initiation for Patients With Liver Malignancies. Ann Surg Oncol 2021; 29:2371-2380. [PMID: 34671878 DOI: 10.1245/s10434-021-10909-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/03/2021] [Accepted: 08/18/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with hepatobiliary malignancies are especially vulnerable to treatment delays. This study sought to evaluate the impact of implementing a new delivery-of-care model centered around a hepatobiliary multidisciplinary tumor board (HB-MTB) and integrated with an optimized patient workflow process to expedite treatment initiation. METHODS A hybrid type 2 study (effectiveness-implementation) was performed. Implementation measures were examined prospectively using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) approach during 5 years after the HB-MTB program deployment (2015-2020). The primary outcome was effectiveness, measured as time to treatment initiation (TTI) using a before and after design (1 year each). The patients were grouped into before (BP) and after (AP) categories based on date of HB-MTB program implementation. Multivariable Cox and linear regression analyses were performed to examine and compare time to treatment initiation between groups. RESULTS The HB-MTB program enrolled 2457 patients (reach). The RE-AIM measures were favorable and improved over time (P < 0.01 for all). The median TTI was lower for the AP group than for the BP group (17 vs 24 days; P < 0.01). In the multivariable Cox and linear regressions, treatment in the AP group was associated with a faster TTI (hazard ratio, 1.75; 95 % confidence interval, 1.31-2.35; p < 0.01), and a mean of 13 days faster treatment initiation than the BP group (P < 0.01). CONCLUSIONS Implementation of an HB-MTB program integrated with an optimized patient workflow was successful and led to faster treatment initiation. This delivery-of-care model can serve as a blueprint to expedite treatment of patients with cancer.
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Affiliation(s)
- Jasmina Ehab
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Benjamin Powers
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Richard Kim
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Mintallah Haider
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Ovie Utuama
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Alicia Chin
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Jason Denbo
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Bela Kis
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.,Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jessica Frakes
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.,Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Daniel Jeong
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.,Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Gregory Lauwers
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.,Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Susan Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jason B Fleming
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Daniel A Anaya
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA. .,Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
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Scandinaro A, Haider M, Saef J, Farwati M, Allende D, Ghobrial J, Zahka K, O'Shea R, Fares M. Hematologic abnormalities as a marker of cirrhosis after Fontan completion. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1885] [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
More patients with functioning single ventricle are living into adulthood due to improved survival with the Fontan procedure. Therefore, screening and detection of late-stage complications such as Fontan Associated Liver Disease (FALD) has become increasingly important to improve outcomes. The role of hematologic abnormalities as a marker of cirrhosis in this population is evolving.
Purpose
We aimed to evaluate the value of hematologic parameters in predicting the presence of cirrhosis in the context of FALD.
Methods
This was a retrospective study of patients after Fontan completion who underwent liver biopsy between 2007 and 2019 at our institution. Biopsy slides were evaluated for the presence of cirrhosis by a single pathologist. Laboratory testing was recorded within 12 months of the liver biopsy. Univariable analysis was conducted with an alpha level of 0.05 for hypothesis testing.
Results
A total of 31 Fontan patients with liver biopsies were identified, of whom 7 patients were found to have cirrhosis (Table 1). Compared to patients with no cirrhosis on biopsy, cirrhotic patients tended to have lower hematologic counts including absolute lymphocyte count (0.78 vs 1.02, p=0.019), hemoglobin (12.5 vs 15.1, p=0.018), and platelets (131 vs 194, p=0.025). Notably, the MELD-XI score (Model for End-stage Liver Disease excluding INR) as well as its individual components, creatinine and total bilirubin, were not different between the groups.
Conclusion
Our data suggests that hematologic parameters including absolute lymphocyte count might be of value in predicting cirrhosis on liver biopsy following Fontan completion. Further research to validate these findings in other cohorts is warranted.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Scandinaro
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Haider
- Tulane University, New Orleans, United States of America
| | - J Saef
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Farwati
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - D Allende
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - J Ghobrial
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - K Zahka
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - R O'Shea
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Fares
- Cleveland Clinic Foundation, Cleveland, United States of America
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15
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Al-Toubah T, Pelle E, Valone T, Haider M, Strosberg JR. Efficacy and Toxicity Analysis of Capecitabine and Temozolomide in Neuroendocrine Neoplasms. J Natl Compr Canc Netw 2021; 20:29-36. [PMID: 34433130 DOI: 10.6004/jnccn.2021.7017] [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: 08/03/2020] [Accepted: 01/27/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The capecitabine/temozolomide (CAPTEM) regimen has significant activity in advanced neuroendocrine tumors (NETs). Questions exist regarding activity in pancreatic versus nonpancreatic NETs, risk of opportunistic infections, long-term myelotoxicity, and safety of prolonged treatment duration. Analysis of large patient cohorts is needed for the evaluation of rare toxicities and assessment of risk factors. METHODS We conducted a retrospective study of all patients with advanced NETs seen at Moffitt Cancer Center between January 2008 and June 2019 who received treatment with CAPTEM. RESULTS A total of 462 patients were eligible. The objective radiographic response rate was 46%, and the disease control rate was 81%. Median progression-free survival (PFS) was 18 months (95% CI, 14.0-21.9 months) and median overall survival was 51 months (95% CI, 42.8-59.2 months): 62 months in well-differentiated NETs versus 14 months in poorly differentiated neuroendocrine carcinomas (P<.0001). Patients with primary pancreatic tumors had the highest partial response rates and longest median PFS. Incidences of grade 4 thrombocytopenia and neutropenia were 7% and 3%, respectively, and substantially higher in women than men (P=.02 and P=.004, respectively). Only 1 case (0.2%) of suspected Pneumocystis pneumonia (PCP) was observed in a patient receiving corticosteroids. Three patients developed myelodysplastic disease, all of whom had received prior peptide receptor radiotherapy (PRRT). There were no acute treatment-related deaths; 1 patient died 2 months after a thrombocytopenic bleed. CONCLUSIONS The CAPTEM regimen is exceptionally safe. Efficacy is particularly robust in well-differentiated pancreatic NETs. Severe myelotoxicity is rare; the risk of grade 4 cytopenias is significantly increased in women, and therefore sex-based dosing should be considered. There were no cases of myelodysplastic syndromes, except among patients who had received PRRT, a known risk factor. The risk of PCP is negligible.
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Affiliation(s)
- Taymeyah Al-Toubah
- 1Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Eleonora Pelle
- 1Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Tiffany Valone
- 1Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Mintallah Haider
- 1Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jonathan R Strosberg
- 1Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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16
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Logothetis CN, Patel A, Eatrides J, Jaglal M, Haider M, Visweshwar N, Laber DA. Post Approval Experience with Caplacizumab for Acquired Thrombotic Thrombocytopenic Purpura at a Single Institution. J Clin Med 2021; 10:jcm10153418. [PMID: 34362201 PMCID: PMC8347784 DOI: 10.3390/jcm10153418] [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: 05/15/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
Caplacizumab prevents platelet adhesion and has been approved for acquired thrombotic thrombocytopenic purpura (aTTP). This study was retrospective, including all patients diagnosed with aTTP and treated with caplacizumab since commercial availability in 2019 until 28 February 2021 at a single academic hospital with no exclusion criteria. Results used definitions for outcomes in aTTP from the International Working Group Consensus. Ten patients with aTTP received caplacizumab. The median age was 52 years. Six (60%) patients had refractory aTTP while 4 (40%) had newly diagnosed aTTP. The median laboratory values prior to therapy demonstrated: platelet count (PC) 29/uL, LDH 518 U/L (182-1850), ADAMTS13 activity 3% and ADAMTS13 inhibitor 1.4 BU. Everyone received glucocorticoids, rituximab, therapeutic plasma exchange (TPE) and caplacizumab. The median number of TPE was 12 days. Caplacizumab was started at a median of 5 days after the first TPE and the median treatment duration was 31 days. Normalization of PC, LDH and ADAMTS13 activity in days were 5, 3.5, and 32.5, respectively. Six (60%) patients achieved complete response, 3 (30%) had refractory disease and 1 (10%) had relapsed aTTP. No subject suffered abnormal bleeding, or thrombotic event. There were no deaths. Caplacizumab with TPE, glucocorticoids and rituximab was a safe and effective therapy for aTTP.
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Affiliation(s)
- Constantine N. Logothetis
- Division of Hematology/Oncology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA; (A.P.); (J.E.); (M.J.); (M.H.); (N.V.); (D.A.L.)
- Correspondence: ; Tel.: +1-813-259-0670
| | - Ankita Patel
- Division of Hematology/Oncology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA; (A.P.); (J.E.); (M.J.); (M.H.); (N.V.); (D.A.L.)
- Section of Satellite and Community Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Jennifer Eatrides
- Division of Hematology/Oncology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA; (A.P.); (J.E.); (M.J.); (M.H.); (N.V.); (D.A.L.)
- Section of Satellite and Community Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Michael Jaglal
- Division of Hematology/Oncology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA; (A.P.); (J.E.); (M.J.); (M.H.); (N.V.); (D.A.L.)
- Section of Satellite and Community Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Mintallah Haider
- Division of Hematology/Oncology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA; (A.P.); (J.E.); (M.J.); (M.H.); (N.V.); (D.A.L.)
- Section of Satellite and Community Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Nathan Visweshwar
- Division of Hematology/Oncology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA; (A.P.); (J.E.); (M.J.); (M.H.); (N.V.); (D.A.L.)
| | - Damian A. Laber
- Division of Hematology/Oncology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA; (A.P.); (J.E.); (M.J.); (M.H.); (N.V.); (D.A.L.)
- Section of Satellite and Community Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
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Chung H, Loblaw A, Tseng C, Murgic J, D'Alimonte L, Ravi A, Davidson M, Wronski M, Haider M, Morton G. PP-0162 MR-assisted whole salvage HDR prostate brachytherapy with intra-prostatic boost: a prospective study. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06454-9] [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: 10/21/2022]
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18
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Haider M, Das S, Al-Toubah T, Pelle E, El-Haddad G, Strosberg J. Somatostatin receptor radionuclide therapy in neuroendocrine tumors. Endocr Relat Cancer 2021; 28:R81-R93. [PMID: 33608483 PMCID: PMC8118168 DOI: 10.1530/erc-20-0360] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 12/28/2022]
Abstract
Peptide receptor radionuclide therapy (PRRT) using 177Lu-DOTATATE has been approved for the treatment of gastroenteropancreatic NETs. An understanding of benefits and risks is important for the appropriate implementation of this therapy. This review summarizes study data supporting the use of radiolabeled somatostatin analogs for the treatment of advanced NETs and highlights risks, including potential toxicities in specific populations. Key ongoing clinical trials, including randomized studies, are designed to better define the position of PRRT within the broader therapeutic landscape. Preclinical and early-phase human studies are focused on the development of novel somatostatin-receptor agonists and antagonists, new radionuclides, and radiosensitizing combination therapies.
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Affiliation(s)
- Mintallah Haider
- Moffitt Cancer Center, Department of GI Oncology, Tampa, Florida, USA
| | - Satya Das
- Department of GI Oncology, Vanderbilt University, Nashville, Tennessee, USA
| | | | - Eleonora Pelle
- Department of Oncology, University of Bari, Bari, Puglia, Italy
| | - Ghassan El-Haddad
- Moffitt Cancer Center, Department of Diagnostic Imaging and Interventional Radiology, Tampa, Florida, USA
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19
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Anaya DA, Dogra P, Wang Z, Haider M, Ehab J, Jeong DK, Ghayouri M, Lauwers GY, Thomas K, Kim R, Butner JD, Nizzero S, Ramírez JR, Plodinec M, Sidman RL, Cavenee WK, Pasqualini R, Arap W, Fleming JB, Cristini V. A Mathematical Model to Estimate Chemotherapy Concentration at the Tumor-Site and Predict Therapy Response in Colorectal Cancer Patients with Liver Metastases. Cancers (Basel) 2021; 13:cancers13030444. [PMID: 33503971 PMCID: PMC7866038 DOI: 10.3390/cancers13030444] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/21/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary It is known that drug transport barriers in the tumor determine drug concentration at the tumor site, causing disparity from the systemic (plasma) drug concentration. However, current clinical standard of care still bases dosage and treatment optimization on the systemic concentration of drugs. Here, we present a proof of concept observational cohort study to accurately estimate drug concentration at the tumor site from mathematical modeling using biologic, clinical, and imaging/perfusion data, and correlate it with outcome in colorectal cancer liver metastases. We demonstrate that drug concentration at the tumor site, not in systemic circulation, can be used as a credible biomarker for predicting chemotherapy outcome, and thus our mathematical modeling approach can be applied prospectively in the clinic to personalize treatment design to optimize outcome. Abstract Chemotherapy remains a primary treatment for metastatic cancer, with tumor response being the benchmark outcome marker. However, therapeutic response in cancer is unpredictable due to heterogeneity in drug delivery from systemic circulation to solid tumors. In this proof-of-concept study, we evaluated chemotherapy concentration at the tumor-site and its association with therapy response by applying a mathematical model. By using pre-treatment imaging, clinical and biologic variables, and chemotherapy regimen to inform the model, we estimated tumor-site chemotherapy concentration in patients with colorectal cancer liver metastases, who received treatment prior to surgical hepatic resection with curative-intent. The differential response to therapy in resected specimens, measured with the gold-standard Tumor Regression Grade (TRG; from 1, complete response to 5, no response) was examined, relative to the model predicted systemic and tumor-site chemotherapy concentrations. We found that the average calculated plasma concentration of the cytotoxic drug was essentially equivalent across patients exhibiting different TRGs, while the estimated tumor-site chemotherapeutic concentration (eTSCC) showed a quadratic decline from TRG = 1 to TRG = 5 (p < 0.001). The eTSCC was significantly lower than the observed plasma concentration and dropped by a factor of ~5 between patients with complete response (TRG = 1) and those with no response (TRG = 5), while the plasma concentration remained stable across TRG groups. TRG variations were driven and predicted by differences in tumor perfusion and eTSCC. If confirmed in carefully planned prospective studies, these findings will form the basis of a paradigm shift in the care of patients with potentially curable colorectal cancer and liver metastases.
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Affiliation(s)
- Daniel A. Anaya
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (M.H.); (J.E.); (R.K.); (J.B.F.)
- Correspondence: (D.A.A.); (V.C.); Tel.: +1-813-745-1432 (D.A.A.); +1-505-934-1813 (V.C.); Fax: +1-813-745-7229 (D.A.A.)
| | - Prashant Dogra
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX 77030, USA; (P.D.); (Z.W.); (J.D.B.); (S.N.); (J.R.R.)
| | - Zhihui Wang
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX 77030, USA; (P.D.); (Z.W.); (J.D.B.); (S.N.); (J.R.R.)
| | - Mintallah Haider
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (M.H.); (J.E.); (R.K.); (J.B.F.)
| | - Jasmina Ehab
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (M.H.); (J.E.); (R.K.); (J.B.F.)
| | - Daniel K. Jeong
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (D.K.J.); (M.G.); (G.Y.L.); (K.T.)
| | - Masoumeh Ghayouri
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (D.K.J.); (M.G.); (G.Y.L.); (K.T.)
| | - Gregory Y. Lauwers
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (D.K.J.); (M.G.); (G.Y.L.); (K.T.)
| | - Kerry Thomas
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (D.K.J.); (M.G.); (G.Y.L.); (K.T.)
| | - Richard Kim
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (M.H.); (J.E.); (R.K.); (J.B.F.)
| | - Joseph D. Butner
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX 77030, USA; (P.D.); (Z.W.); (J.D.B.); (S.N.); (J.R.R.)
| | - Sara Nizzero
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX 77030, USA; (P.D.); (Z.W.); (J.D.B.); (S.N.); (J.R.R.)
| | - Javier Ruiz Ramírez
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX 77030, USA; (P.D.); (Z.W.); (J.D.B.); (S.N.); (J.R.R.)
| | - Marija Plodinec
- Biozentrum and the Swiss Nanoscience Institute & ARTIDIS AG, University of Basel, 4056 Basel, Switzerland;
| | - Richard L. Sidman
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA;
| | - Webster K. Cavenee
- Ludwig Institute for Cancer Research, University of California-San Diego, La Jolla, CA 92093, USA;
| | - Renata Pasqualini
- Rutgers Cancer Institute of New Jersey & Division of Cancer Biology, Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA;
| | - Wadih Arap
- Rutgers Cancer Institute of New Jersey & Division of Hematology/Oncology, Department of Medicine Rutgers New Jersey Medical School, Newark, NJ 07103, USA;
| | - Jason B. Fleming
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (M.H.); (J.E.); (R.K.); (J.B.F.)
| | - Vittorio Cristini
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX 77030, USA; (P.D.); (Z.W.); (J.D.B.); (S.N.); (J.R.R.)
- Correspondence: (D.A.A.); (V.C.); Tel.: +1-813-745-1432 (D.A.A.); +1-505-934-1813 (V.C.); Fax: +1-813-745-7229 (D.A.A.)
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Desai R, Sachdeva S, Singh S, Rajan S, Shaik A, Haider M, Fong H, Gangani K, Sachdeva R, Kumar G. Rates and causes of readmissions following index admissions for Takotsubo syndrome-a meta-analysis of 118,941 index hospitalizations. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1246] [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
Rising trends in takotsubo syndrome (TTS)-related complications warrant data to identify the rate, causes and predictors of readmission on a large scale. We conducted the first-ever meta-analysis to evaluate the pooled rate of short-term and long-term readmissions after index TTS admissions.
Methods
PubMed/Medline, EMBASE and SCOPUS databases were systematically reviewed to find studies through October 2019 reporting rates and causes of readmission following index TTS admissions. Random effects models were used to estimate pooled rates and causes of readmissions and I2 statistics were used to report inter-study heterogeneity.
Results
A total of 16 cohorts with 118,941 TTS index admissions (mean age 65–75 yrs; female >85%, median follow-up 272.5 days) revealed a 16.6% [95% CI-13.2%-20.3%, I2=99%] pooled rate of readmission. Short-term and long-term pooled readmission rates are displayed in Fig.1. The readmission rate was higher in cohorts with young patients (<70 vs. >70 yrs), smaller sample size (n<100 vs. n>100) and single-centres vs. multicentres. Studies published from the USA (16.4% vs. 14.9%) had a higher readmission rate as compared to Italy. The most frequent causes were cardiac (40.6%), respiratory (15.7%) and renal (7.0%). Among readmissions with cardiac diagnoses, heart failure was most common (40.1%).
Conclusions
This global meta-analysis revealed that the pooled rate of readmission following index TTS admissions was ∼17% and causes were mainly cardiac or respiratory.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- R Desai
- Atlanta Veterans Affairs Medical Centre, Division of Cardiology, Atlanta, United States of America
| | - S Sachdeva
- Lady Hardinge Medical college and hospitals, Delhi, India
| | - S Singh
- Amsterdam University Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, Netherlands (The)
| | - S.K Rajan
- Medical City Plano, Department of Medicine, plano, Texas, United States of America
| | - A.S Shaik
- Silver Lane Medical Centre, Department of Medicine, East Hartford, Connecticut, United States of America
| | - M Haider
- New York-Presbyterian Hospital, Department of Internal Medicine, New York, United States of America
| | - H.K Fong
- UC Davis Medical Centre, Division of Cardiovascular Medicine, Sacramento, United States of America
| | - K Gangani
- Texas Health Arlington Memorial Hospital, Department of Internal Medicine, Arlington, Texas, United States of America
| | - R Sachdeva
- Morehouse School of Medicine, Atlanta VA Medical centre & Medical College of Georgia, Division of Cardiology, Augusta,Georgia, United States of America
| | - G Kumar
- Emory University & Atlanta VA Medical Centre, Division of Cardiology, Atlanta, Georgia, United States of America
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Klotz L, Chin J, Hatiboglu G, Koch M, Penson D, Pavlovich C, Raman S, Oto A, Fütterer J, Relle J, Lotan Y, Heidenreich A, Serrallach M, Haider M, Bonekamp D, Tirkes T, Arora S, Pantuck A, Zagaja G, Sedelaar M, Macura K, Costa D, Persigehl T, Eggener S. Pivotal trial of MRI-guided transurethral ultrasound ablation in men with localized prostate cancer: Two-year follow-up. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33481-9] [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: 10/23/2022] Open
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Strosberg JR, Al-Toubah T, Pellè E, Smith J, Haider M, Hutchinson T, Fleming JB, El-Haddad G. Risk of Bowel Obstruction in Patients with Mesenteric or Peritoneal Disease Receiving Peptide Receptor Radionuclide Therapy. J Nucl Med 2020; 62:69-72. [DOI: 10.2967/jnumed.120.242875] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/29/2020] [Indexed: 11/16/2022] Open
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Abstract
4614 Background: The capecitabine/temozolomide regimen has significant activity in advanced NETs. Concerns exist regarding risk of opportunistic infections and long-term myelotoxicity. Analysis of large patient cohorts is needed for evaluation of rare toxicities and for assessment of risk factors. Methods: Retrospective study of all patients with advanced neuroendocrine neoplasms seen at the Moffitt Cancer Center between 1/2008 and 6/2019 who received treatment with CAPTEM. Patients who initiated treatment at outside institutions were included if they were prescribed treatment at appropriate doses and if complete records were available. Results: 462 patients met eligibility criteria for evaluation: 210 (45%) females and 252 (55%) males with a median age of 59. Median starting doses of CAP and TEM were 658mg/m2 and 180mg/m2 respectively. Median duration on treatment was 8 months. 25% of patients required a dose reduction and 16% discontinued due to toxicity of any grade. Incidence of grade 4 thrombocytopenia was 7%: 10% in females and 5% in males (p = 0.02). 4 cases were complicated by bleeding (0.8%). Incidence of grade 4 neutropenia was 3%: 5% in females and 1% in males (p = 0.004). Incidence of grade 4 lymphopenia was 2%. Only one case (0.2%) of suspected PCP was observed in a patient taking corticosteroids. There were 5 cases of herpes zoster and no other opportunistic infections. 3 patients developed myelodysplastic or myeloproliferative disease, all of whom had also received prior PRRT with Lutetium-Dotatate. There were no acute treatment related deaths, although one patient died 2 months after a thrombocytopenic bleed. Conclusions: Severe myelotoxicity is rare, but risks of grade 4 thrombocytopenia and neutropenia are significantly increased in females compared to males. Gender-based dosing should be considered. While alkylating agents are often associated with MDS, there were no cases except among patients who also had received PRRT, a known risk factor. PCP is not a significant risk with this regimen in patients not concurrently on corticosteroids.
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Affiliation(s)
| | - Eleonora Pelle
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Raman S, Futterer J, Oto A, Arora S, Tirkes T, Macura K, Bonekamp D, Haider M, Cool D, Nandalur K, Nicolau C, Costa D, Persigehl T, Purysko A, Staruch R, Burtnyk M, Chin J, Klotz L, Eggener S. 3:45 PM Abstract No. 341 Pivotal study of magnetic resonance imaging–guided transurethral ultrasound ablation in men with localized prostate cancer: 12-month clinical and imaging outcomes. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.398] [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] Open
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Al-Toubah T, Strosberg J, Halfdanarson TR, Oleinikov K, Gross DJ, Haider M, Sonbol MB, Almquist D, Grozinsky-Glasberg S. Somatostatin Analogs Improve Respiratory Symptoms in Patients With Diffuse Idiopathic Neuroendocrine Cell Hyperplasia. Chest 2020; 158:401-405. [PMID: 32059961 DOI: 10.1016/j.chest.2020.01.031] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/30/2019] [Accepted: 01/26/2020] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare lung disease associated with proliferation of neuroendocrine cells in the lung and multifocal neuroendocrine tumorlets/tumors. Although usually considered an indolent condition, DIPNECH causes chronic, progressive cough and dyspnea which can adversely impact quality of life. There is very limited information on the treatment of this condition. The objective of this study was to assess changes in symptoms and pulmonary function tests (PFTs) in response to somatostatin analog (SSA) treatment. METHODS Patients with clinical and/or pathologic diagnosis of DIPNECH and chronic respiratory symptoms were treated with SSAs at the H. Lee Moffitt Cancer Center and Research Institute, Hadassah-Hebrew University Medical Center, and Mayo Clinic Cancer Center. Their charts were reviewed to assess changes in symptoms and PFTs. RESULTS Forty-two patients were identified who had either chronic cough or dyspnea because of proven or suspected DIPNECH and who had received treatment with an SSA. Thirty-three patients experienced symptomatic improvement. Additionally, 14 of 15 patients in whom PFTs were checked were noted to have an improvement in FEV1 after treatment. CONCLUSIONS SSA treatment can improve chronic respiratory symptoms and PFTs in patients with DIPNECH.
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Affiliation(s)
- Taymeyah Al-Toubah
- Department of GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Jonathan Strosberg
- Department of GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
| | | | - Kira Oleinikov
- Neuroendocrine Tumor Unit, ENETS Center of Excellence, Endocrinology & Metabolism Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David J Gross
- Neuroendocrine Tumor Unit, ENETS Center of Excellence, Endocrinology & Metabolism Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Mintallah Haider
- Department of GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Daniel Almquist
- Department of Hematology and Oncology, Mayo Clinic Cancer Center, Phoenix, AZ
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, ENETS Center of Excellence, Endocrinology & Metabolism Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Abstract
PURPOSE OF REVIEW Neuroendocrine tumors are heterogeneous neoplasms with variable prognoses and clinical behaviors. The majority of well differentiated NETs express somatostatin receptors. Identification of these receptors has contributed to advancements in molecular and targeted radiotherapies. RECENT FINDINGS Molecular scans provide important diagnostic, staging, and prognostic data. Somatostatin-receptor imaging aids in selection of patients who are eligible for somatostatin-receptor-targeting therapies. Peptide receptor radionuclide therapy has recently demonstrated robust efficacy in a phase III study of progressive midgut NETs. Current studies are investigating novel receptor agonists and antagonists, new classes of radioactive isotopes, and radiosensitizing combination treatments. SUMMARY The sophistication of molecular imaging is improving and its importance is increasing as a diagnostic, predictive, and prognostic tool. Theranostics, the coupling of molecular imaging with receptor-targeted therapy, represents a novel approach to cancer treatment.
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Affiliation(s)
- Mintallah Haider
- Department of GI Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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Hartel P, Gerheim V, Linck M, Müller H, Uhlemann S, Zach Z, Haider M. On the residual six-fold astigmatism in DCOR/ASCOR. Ultramicroscopy 2019; 206:112821. [PMID: 31437673 DOI: 10.1016/j.ultramic.2019.112821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 06/28/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 11/30/2022]
Abstract
After the introduction of the hexapole Cs-correctors for scanning transmission electron microscopes (STEM), the next big step forward was the strong reduction of the six-fold astigmatism A5 by means of an advanced hexapole design (DCOR/ASCOR). As a result all axial aberrations up to fifth order are sufficiently small to allow for large semi-aperture angles beyond 40 mrad for electron energies in the range of 30 to 300 kV without deterioration of the STEM resolution. In this paper we derive simple expressions for the optimum hexapole strength for minimum A5 and the size of the residual A5. Both quantities are intrinsic properties of the hexapoles and the transfer lens doublet in between. The optimum hexapole strength scales with the inverse of the electron wavelength, while the residual A5 does not depend on the electron energy directly, but on the spherical aberration Cs of the pole piece. With the given properties of the DCOR/ASCOR and typical values of Cs in the range of 0.5 to 2.7 mm, at all acceleration voltages A5 remains in the range from 0.03 to 0.4 mm, the latter even for a large-gap pole piece.
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Affiliation(s)
- P Hartel
- Corrected Electron Optical Systems GmbH, Englerstr. 28, Heidelberg 69126, Germany.
| | - V Gerheim
- Corrected Electron Optical Systems GmbH, Englerstr. 28, Heidelberg 69126, Germany
| | - M Linck
- Corrected Electron Optical Systems GmbH, Englerstr. 28, Heidelberg 69126, Germany
| | - H Müller
- Corrected Electron Optical Systems GmbH, Englerstr. 28, Heidelberg 69126, Germany
| | - S Uhlemann
- Corrected Electron Optical Systems GmbH, Englerstr. 28, Heidelberg 69126, Germany
| | - Z Zach
- Corrected Electron Optical Systems GmbH, Englerstr. 28, Heidelberg 69126, Germany
| | - M Haider
- Corrected Electron Optical Systems GmbH, Englerstr. 28, Heidelberg 69126, Germany
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Haider M, Chaudhury A, Jaglal M. Tumor Lysis Syndrome. Handbook of Hematologic Malignancies 2018. [DOI: 10.1891/9781617052705.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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Klotz L, Loblaw A, Van Der Kwast T, Fleshner N, Ghai S, Chin J, Pond G, Haider M. Active surveillance magnetic resonance imaging study (ASIST): Results of a prospective, multicentre, randomized trial. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/s1569-9056(18)32038-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
In a previous paper (Dixon, 1958b) one of the authors reported an experiment which suggested that apparent changes in the threshold for one eye occur as a function of the emotionality of stimulus material presented below threshold to the other eye. The following experiment describes an attempt to investigate further the validity of this conclusion. The results are consistent with those from the previous research.
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Affiliation(s)
- N. F. Dixon
- Department of Psychology, University College, London
| | - M. Haider
- Department of Psychology, University College, London
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Haider M, Duncavage EJ, Afaneh KF, Bejar R, List AF. New Insight Into the Biology, Risk Stratification, and Targeted Treatment of Myelodysplastic Syndromes. Am Soc Clin Oncol Educ Book 2017; 37:480-494. [PMID: 28561687 DOI: 10.1200/edbk_175397] [Citation(s) in RCA: 3] [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: 12/22/2022]
Abstract
In myelodysplastic syndromes (MDS), somatic mutations occur in five major categories: RNA splicing, DNA methylation, activated cell signaling, myeloid transcription factors, and chromatin modifiers. Although many MDS cases harbor more than one somatic mutation, in general, there is mutual exclusivity of mutated genes within a class. In addition to the prognostic significance of individual somatic mutations, more somatic mutations in MDS have been associated with poor prognosis. Prognostic assessment remains a critical component of the personalization of care for patient with MDS because treatment is highly risk adapted. Multiple methods for risk stratification are available with the revised International Prognostic Scoring System (IPSS-R), currently considered the gold standard. Increasing access to myeloid gene panels and greater evidence for the diagnostic and predictive value of somatic mutations will soon make sequencing part of the standard evaluation of patients with MDS. In the absence of formal guidelines for their prognostic use, well-validated mutations can still refine estimates of risk made with the IPSS-R. Not only are somatic gene mutations advantageous in understanding the biology of MDS and prognosis, they also offer potential as biomarkers and targets for the treatment of patients with MDS. Examples include deletion 5q, spliceosome complex gene mutations, and TP53 mutations.
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Affiliation(s)
- Mintallah Haider
- From the Department of Hematology and Medical Oncology, Moffitt Cancer Center and the University of South Florida, Tampa, FL; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO; Moores Cancer Center, Division of Hematology and Oncology, University of California, San Diego, CA; Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | - Eric J Duncavage
- From the Department of Hematology and Medical Oncology, Moffitt Cancer Center and the University of South Florida, Tampa, FL; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO; Moores Cancer Center, Division of Hematology and Oncology, University of California, San Diego, CA; Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | - Khalid F Afaneh
- From the Department of Hematology and Medical Oncology, Moffitt Cancer Center and the University of South Florida, Tampa, FL; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO; Moores Cancer Center, Division of Hematology and Oncology, University of California, San Diego, CA; Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | - Rafael Bejar
- From the Department of Hematology and Medical Oncology, Moffitt Cancer Center and the University of South Florida, Tampa, FL; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO; Moores Cancer Center, Division of Hematology and Oncology, University of California, San Diego, CA; Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | - Alan F List
- From the Department of Hematology and Medical Oncology, Moffitt Cancer Center and the University of South Florida, Tampa, FL; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO; Moores Cancer Center, Division of Hematology and Oncology, University of California, San Diego, CA; Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
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Haider M, Al Ali N, Padron E, Epling-Burnette P, Lancet J, List A, Komrokji R. Immunosuppressive Therapy: Exploring an Underutilized Treatment Option for Myelodysplastic Syndrome. Clin Lymphoma Myeloma Leuk 2017; 16 Suppl:S44-8. [PMID: 27521323 DOI: 10.1016/j.clml.2016.02.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Immunosuppressive therapy (IST) in low risk myelodysplastic syndrome (MDS) is known to achieve hematologic improvement but remains an underutilized treatment option. We report our experience using antithymocyte globulin (ATG) and cyclosporine A (CSA) to explore clinical predictive response factors. PATIENTS AND METHODS Patients treated with IST identified in the Moffitt Cancer Center MDS database were analyzed using baseline data, IST details, and response rates. RESULTS Sixty-six patients treated with IST were identified. The median age was 61 years; the majority were at low risk and had a good karyotype. The median time to start IST was 1 year. All patients received ATG, 60% rabbit (r-ATG), 32% equine ATG (e-ATG), and 60% received CSA. Overall hematologic improvement was 42% with a trend favoring e-ATG over r-ATG (52% vs. 39%; P = .09). Erythroid improvement was evaluated in 30 patients, and 60% responded; neutrophil improvement was evaluated in 15, and 39% responded; platelet improvement was evaluated in 18, and 57% responded. Six of 18 pancytopenic patients experienced trilineage response. Mean time from ATG to next therapy was 12 months. None of the patients with very high risk or high risk revised International Prognostic Scoring System (IPSS-R) responded. Poor karyotype had a lower response rate, 25%, compared to 41% for intermediate and 44% for good karyotype. No difference in predicting response was found based on the National Institutes of Health Response Model; 38% with low and 45% with high probability responded. A trend favored treatment within 2 years from diagnosis, with 46% responding compared to 33% treated after 2 years. First-line ATG or after lenalidomide responded better than after azacitidine or third-line therapy. CSA provided an advantage: the disease of 51% responded compared to 27% with ATG alone (P = .05). Ten patients experienced transformation to acute myeloid leukemia, 7% with disease that responded to therapy and 24% with disease that did not respond to therapy (P = .08). Overall survival was 67.2 months without difference between those with and without response. Adverse events were reported in 55 patients. Infusion reactions occurred in 85% but was similar between ATG types. Infection rate was 25% and higher with e-ATG. Serum sickness was reported in 18% and significantly higher with r-ATG. CONCLUSION IST has a hematologic improvement response rate in the range of other therapies approved for lower risk MDS. High risk IPSS-R, poor karyotype, and treatment after 2 years from diagnosis have unfavorable response trend. ATG with CSA has higher response than ATG alone. First-line ATG or after lenalidomide had better response trend compared to third-line therapy or azacitidine therapy.
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Affiliation(s)
| | - Najla Al Ali
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Eric Padron
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Jeffrey Lancet
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Alan List
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Rami Komrokji
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Loblaw A, Souter LH, Canil C, Breau RH, Haider M, Jamnicky L, Morash R, Surchin M, Matthew A. Follow-up Care for Survivors of Prostate Cancer - Clinical Management: a Program in Evidence-Based Care Systematic Review and Clinical Practice Guideline. Clin Oncol (R Coll Radiol) 2017; 29:711-717. [PMID: 28928084 DOI: 10.1016/j.clon.2017.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 11/03/2016] [Revised: 07/11/2017] [Accepted: 07/19/2017] [Indexed: 11/26/2022]
Abstract
AIMS This clinical practice guideline was developed to provide evidence-based guidance on the frequency by which prostate-specific antigen (PSA) levels should be tested in men after curative-intent treatment for prostate cancer and to define the most appropriate diagnostic testing if biochemical recurrence occurs. MATERIALS AND METHODS An electronic search using OVID was used to systematically search the MEDLINE and EMBASE databases for systematic reviews and primary literature. A systematic review and practice guideline was written, reviewed and approved by the Guideline Development Group (GDG) and Program in Evidence-Based Care Report Approval Panel. External review by three prostate experts was completed, as well as an online consultation with healthcare professionals who were intended users of the guideline. RESULTS Three systematic reviews and seven primary studies were included in the evidence base. All identified literature reported on diagnostic imaging properties of diagnostic tests following biochemical recurrence. CONCLUSIONS Due to a lack of empirical research, few evidenced-based recommendations could be made with respect to a follow-up schedule of PSA testing for prostate cancer survivors following curative-intent treatment, or detailing diagnostic testing upon detection of biochemical recurrence. Accordingly, the GDG focused substantial effort on critical examination of the identified evidence, existing clinical practice guidelines and on obtaining clinical expertise consensus using a modified Delphi method. Overall, the recommendations embedded in this guideline reflect the best practice to date for the efficient and effective clinical follow-up care of prostate cancer survivors.
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Affiliation(s)
- A Loblaw
- Odette Cancer Centre, Toronto, Ontario, Canada
| | - L H Souter
- Program in Evidence-Based Care, Cancer Care Ontario, Toronto, Ontario, Canada; Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - C Canil
- Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - R H Breau
- Ottawa Hospital Research Institution, Ottawa, Ontario, Canada
| | - M Haider
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - L Jamnicky
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - R Morash
- Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | | | - A Matthew
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
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Ammar HO, Haider M, Ibrahim M, El Hoffy NM. In vitro and in vivo investigation for optimization of niosomal ability for sustainment and bioavailability enhancement of diltiazem after nasal administration. Drug Deliv 2017; 24:414-421. [PMID: 28165822 PMCID: PMC8241015 DOI: 10.1080/10717544.2016.1259371] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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] [Indexed: 10/27/2022] Open
Abstract
Diltiazem hydrochloride (DTZ) is a calcium channel antagonist depicted by extensive first pass metabolism and low oral bioavailability. The aim of this work was to develop niosomes for potential nasal delivery of DTZ. Niosomes protect hydrophilic drugs inside their core while nasal route offers both rapid onset and evasion of first-pass metabolism. Niosomes were prepared using a combination of Span 60 or Brij-52 with cholesterol (CHOL) in different molar ratios followed by determination of entrapment efficiency, particle size and in vitro drug release. A parallel design was adopted to evaluate the pharmacokinetic performance of DTZ-loaded niosomes in male Wistar rats. Non-compartmental analysis was performed where Cmax, Tmax, t1/2, MRT, area under the release curve (AUC) and Ke were assessed. The prepared niosomes were spherical with mean particle size 0.82-1.59 μm. Span 60-cholesterol niosomes (1:1 molar ratio) showed the highest entrapment and release efficiencies. In vivo study revealed an increase in MRT, t1/2 and AUC with a decrease in Ke. In conclusion, nasal niosomal formulation of DTZ expressed suitable pharmacokinetic parameters and bioavailability through prolonged duration of action inside the body as well as low rate of elimination depicting a promising alternate to the conventional oral route.
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Affiliation(s)
- H O Ammar
- a Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt , Cairo , Egypt
| | - M Haider
- b Sharjah Institute for Medical Research, Department of Pharmaceutics and Pharmaceutical Technology, College of Pharmacy, University of Sharjah , Sharjah , UAE , and.,c Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University , Giza, Egypt
| | - M Ibrahim
- c Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University , Giza, Egypt
| | - N M El Hoffy
- a Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt , Cairo , Egypt
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Ahmed S, Sinha A, Haider M, Craddock H. Community Perception of Solid Waste Management (SWM) in Dhaka,
Bangladesh. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.197] [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: 11/28/2022] Open
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Horgan AM, Darling G, Wong R, Guindi M, Liu G, Jonker DJ, Lister J, Xu W, MacKay HM, Dinniwell R, Kim J, Pierre A, Shargall Y, Asmis TR, Agboola O, Seely AJ, Ringash J, Wells J, Marginean EC, Haider M, Knox JJ. Adjuvant sunitinib following chemoradiotherapy and surgery for locally advanced esophageal cancer: a phase II trial. Dis Esophagus 2016; 29:1152-1158. [PMID: 26663741 DOI: 10.1111/dote.12444] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Indexed: 12/11/2022]
Abstract
The prognosis for locally advanced esophageal cancer is poor despite the use of trimodality therapy. In this phase II study, we report the feasibility, tolerability and efficacy of adjuvant sunitinib. Included were patients with stage IIa, IIB or III cancer of the thoracic esophagus or gastroesophageal junction. Neoadjuvant therapy involved Irinotecan (65 mg/m2 ) + Cisplatin (30 mg/m2 ) on weeks 1 and 2, 4 and 5, 7 and 8 with concurrent radiation (50Gy/25 fractions) on weeks 4-8. Sunitinib was commenced 4-13 weeks after surgery and continued for one year. Sixty-one patients were included in the final analysis, 36 patients commenced adjuvant sunitinib. Fourteen patients discontinued sunitinib due to disease recurrence (39%) within the 12-month period, 12 (33%) discontinued due to toxicity, and 3 (8%) requested cessation of therapy. In the overall population, median survival was 26 months with a 2 and 3-year survival rate of 52% and 35%, respectively. The median survival for the 36 patients treated with sunitinib was 35 months and 2-year survival probability of 68%. In a historical control, a prior phase II study with the same trimodality therapy (n = 43), median survival was 36 months, with a 2-year survival of 67%. Initiation of adjuvant sunitinib is feasible, but poorly tolerated, with no signal of additional benefit over trimodality therapy for locally advanced esophageal cancer.
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Affiliation(s)
- A M Horgan
- Department of Medical Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - G Darling
- Department of Surgical Oncology, Division of Thoracic Surgery, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - R Wong
- Department of Radiation Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - M Guindi
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - G Liu
- Department of Medical Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - D J Jonker
- Department of Medical Oncology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - J Lister
- Department of Surgical Oncology, Division of Thoracic Surgery, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - W Xu
- Department of Biostatistics, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - H M MacKay
- Department of Medical Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - R Dinniwell
- Department of Radiation Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - J Kim
- Department of Radiation Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - A Pierre
- Department of Surgical Oncology, Division of Thoracic Surgery, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - Y Shargall
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - T R Asmis
- Department of Medical Oncology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - O Agboola
- Department of Thoracic Surgery, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - A J Seely
- Department of Pathology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - J Ringash
- Department of Radiation Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - J Wells
- Department of Radiation Oncology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - E C Marginean
- Department of Pathology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - M Haider
- Department of Medical Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - J J Knox
- Department of Medical Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
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Khom S, Hintersteiner J, Luger D, Haider M, Pototschnig G, Mihovilovic MD, Schwarzer C, Hering S. Analysis of β-Subunit-dependent GABAA Receptor Modulation and Behavioral Effects of Valerenic Acid Derivatives. J Pharmacol Exp Ther 2016; 357:580-90. [PMID: 27190170 PMCID: PMC4885513 DOI: 10.1124/jpet.116.232983] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 04/06/2016] [Indexed: 12/30/2022] Open
Abstract
Valerenic acid (VA)-a β2/3-selective GABA type A (GABAA) receptor modulator-displays anxiolytic and anticonvulsive effects in mice devoid of sedation, making VA an interesting drug candidate. Here we analyzed β-subunit-dependent enhancement of GABA-induced chloride currents (IGABA) by a library of VA derivatives and studied their effects on pentylenetetrazole (PTZ)-induced seizure threshold and locomotion. Compound-induced IGABA enhancement was determined in oocytes expressing α1β1γ2S, α1β2γ2S, or α1β3γ2S receptors. Effects on seizure threshold and locomotion were studied using C57BL/6N mice and compared with saline-treated controls. β2/3-selective VA derivatives such as VA-amide (VA-A) modulating α1β3γ2S (VA-A: Emax = 972 ± 69%, n = 6, P < 0.05) and α1β2γ2S receptors (Emax = 1119 ± 72%, n = 6, P < 0.05) more efficaciously than VA (α1β3γ2S: VA: Emax = 632 ± 88%, n = 9 versus α1β2γ2S: VA: Emax = 721 ± 68%, n = 6) displayed significantly more pronounced seizure threshold elevation than VA (saline control: 40.4 ± 1.4 mg/kg PTZ versus VA 10 mg/kg: 49.0 ± 1.8 mg/kg PTZ versus VA-A 3 mg/kg: 57.9 ± 1.9 mg/kg PTZ, P < 0.05). Similarly, VA's methylamide (VA-MA) enhancing IGABA through β3-containing receptors more efficaciously than VA (Emax = 1043 ± 57%, P < 0.01, n = 6) displayed stronger anticonvulsive effects. Increased potency of IGABA enhancement and anticonvulsive effects at lower doses compared with VA were observed for VA-tetrazole (α1β3γ2S: VA-TET: EC50 = 6.0 ± 1.0 μM, P < 0.05; VA-TET: 0.3 mg/kg: 47.3 ± 0.5 mg/kg PTZ versus VA: 10 mg/kg: 49.0 ± 1.8 mg/kg PTZ, P < 0.05). At higher doses (≥10 mg/kg), VA-A, VA-MA, and VA-TET reduced locomotion. In contrast, unselective VA derivatives induced anticonvulsive effects only at high doses (30 mg/kg) or did not display any behavioral effects. Our data indicate that the β2/3-selective compounds VA-A, VA-MA, and VA-TET induce anticonvulsive effects at low doses (≤10 mg/kg), whereas impairment of locomotion was observed at doses ≥10 mg/kg.
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Affiliation(s)
- S Khom
- Department of Pharmacology and Toxicology, University of Vienna, Vienna, Austria (S.K., J.H., D.L., S.H.); Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria (M.H., G.P., M.D.M.); and Department of Pharmacology, Medical University of Innsbruck, Innsbruck, Austria (C.S.)
| | - J Hintersteiner
- Department of Pharmacology and Toxicology, University of Vienna, Vienna, Austria (S.K., J.H., D.L., S.H.); Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria (M.H., G.P., M.D.M.); and Department of Pharmacology, Medical University of Innsbruck, Innsbruck, Austria (C.S.)
| | - D Luger
- Department of Pharmacology and Toxicology, University of Vienna, Vienna, Austria (S.K., J.H., D.L., S.H.); Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria (M.H., G.P., M.D.M.); and Department of Pharmacology, Medical University of Innsbruck, Innsbruck, Austria (C.S.)
| | - M Haider
- Department of Pharmacology and Toxicology, University of Vienna, Vienna, Austria (S.K., J.H., D.L., S.H.); Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria (M.H., G.P., M.D.M.); and Department of Pharmacology, Medical University of Innsbruck, Innsbruck, Austria (C.S.)
| | - G Pototschnig
- Department of Pharmacology and Toxicology, University of Vienna, Vienna, Austria (S.K., J.H., D.L., S.H.); Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria (M.H., G.P., M.D.M.); and Department of Pharmacology, Medical University of Innsbruck, Innsbruck, Austria (C.S.)
| | - M D Mihovilovic
- Department of Pharmacology and Toxicology, University of Vienna, Vienna, Austria (S.K., J.H., D.L., S.H.); Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria (M.H., G.P., M.D.M.); and Department of Pharmacology, Medical University of Innsbruck, Innsbruck, Austria (C.S.)
| | - C Schwarzer
- Department of Pharmacology and Toxicology, University of Vienna, Vienna, Austria (S.K., J.H., D.L., S.H.); Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria (M.H., G.P., M.D.M.); and Department of Pharmacology, Medical University of Innsbruck, Innsbruck, Austria (C.S.)
| | - S Hering
- Department of Pharmacology and Toxicology, University of Vienna, Vienna, Austria (S.K., J.H., D.L., S.H.); Institute of Applied Synthetic Chemistry, TU Wien, Vienna, Austria (M.H., G.P., M.D.M.); and Department of Pharmacology, Medical University of Innsbruck, Innsbruck, Austria (C.S.)
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Haider M, Yessayan L, Venkat KK, Goggins M, Patel A, Karthikeyan V. Incidence of contrast-induced nephropathy in kidney transplant recipients. Transplant Proc 2015; 47:379-83. [PMID: 25769577 DOI: 10.1016/j.transproceed.2015.01.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 01/14/2015] [Indexed: 12/14/2022]
Abstract
UNLABELLED Contrast-induced nephropathy (CIN) is responsible for one-third of acute kidney injuries (AKI) in the hospital setting. The incidence of CIN varies from 3% to 30%, depending on the preexisting risk factors, with higher incidence noted with diabetes mellitus, chronic kidney disease, and older age. Though CIN risk factors are common in kidney transplant recipients (KTRs), data about incidence of CIN in this population are sparse. METHODS We retrospectively analyzed 124 consecutive patients transplanted at our center between January 2002 and December 2013 and received iodinated intravascular contrast with stable kidney function prior to contrast administration. CIN was defined as either an absolute rise in serum creatinine of ≥ 0.5 mg/dL or a ≥ 25% drop in estimated glomerular filtration rate (eGFR) after contrast administration. RESULTS Seven of 124 (5.64%) patients developed CIN. Kidney function returned to baseline in 5 of the 7 patients within 3 weeks. In 2 patients serum creatinine remained elevated due to recurrent AKI episodes from other causes. Dialysis was not required in any patient. Calcineurin inhibitors (CNIs) were being used in 95% patients at the time of contrast administration. Diabetes mellitus, baseline serum creatinine, age, race, gender, and the use of ACE inhibitor, angiotensin receptor blocker, diuretic, or prophylaxis with intravenous hydration ± N-acetylcysteine did not affect the incidence of CIN. CONCLUSION Incidence of CIN in KTRs was low in our study (5.6%), much less than previously reported. This low incidence may be related to the high baseline eGFR (>70 mL/min/1.73 m(2)) and use of hypo-osmolar contrast in our patients. In KTRs with baseline eGFR >70 mL/min, the incidence of CIN is low despite the concurrent use of nephrotoxic CNI.
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Affiliation(s)
- M Haider
- Division of Nephrology and Transplantation, Henry Ford Hospital, Detroit, MI, United States
| | - L Yessayan
- Division of Nephrology and Transplantation, Henry Ford Hospital, Detroit, MI, United States
| | - K K Venkat
- Division of Nephrology and Transplantation, Henry Ford Hospital, Detroit, MI, United States
| | - M Goggins
- Division of Nephrology and Transplantation, Henry Ford Hospital, Detroit, MI, United States
| | - A Patel
- Division of Nephrology and Transplantation, Henry Ford Hospital, Detroit, MI, United States
| | - V Karthikeyan
- Division of Nephrology and Transplantation, Henry Ford Hospital, Detroit, MI, United States.
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Haider M, Holt C. Nexus between global and local health. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.580] [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] Open
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Haider M, Satpathy A, Thawder P, Abou-Samra W. 134. Mycobacterium abscesses infection following mastectomy and immediate implant based, acellular dermal matrix assisted breast reconstruction: Case report and literature review. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.131] [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: 10/24/2022] Open
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Aldoss I, Ji L, Haider M, Pullarkat V. The combination of fludarabine, cytarabine and etoposide is an active and well-tolerated regimen in relapsed/refractory acute myeloid leukemia. Acta Haematol 2013; 131:202-7. [PMID: 24296475 DOI: 10.1159/000354820] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 07/01/2013] [Indexed: 01/01/2023]
Abstract
We retrospectively reviewed the outcome of 20 consecutive subjects with refractory/relapsed acute myeloid leukemia (AML; 9 refractory and 11 relapsed) treated at our institution with a fludarabine, cytarabine and etoposide (FCE) salvage regimen. Of 20 patients with refractory/relapsed AML, 15 (75%) achieved complete remission (CR)/CR with incomplete peripheral blood count recovery (CRi), including 14 CR and 1 CRi. The 4- and 8-week treatment-related mortality (TRM) for all patients during reinduction was 0 and 5%, respectively. Eight of 15 patients (53%) who successfully achieved CR were able to undergo allogeneic hematopoietic stem cell transplantation with a 0% non-relapse mortality rate. FCE is a new, well-tolerated, anthracycline-free regimen, which has a promising activity in relapsed/refractory AML and is associated with low TRM in this high-risk population.
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Affiliation(s)
- Ibrahim Aldoss
- Jane Ann Nohl Division of Hematology, University of Southern California Keck School of Medicine, Los Angeles, Calif., USA
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Abstract
Acute hemorrhagic leukoencephalitis (AHLE, Hurst's disease) is a rare hyperacute variant of acute disseminated encephalomyelitis (ADEM) characterized by severe, rapidly progressive clinical illness and hemorrhagic necrosis of white matter. Like ADEM, it is often preceded by viral illness or vaccination. Plasmodium vivax infection is usually uncomplicated and non-fatal with only a handful of reports of central nervous system complications. In this article, we report a previously unknown association between AHLE and P. vivax infection.
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Affiliation(s)
- V Venugopal
- Department of Radio diagnosis, JN Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Rose H, Haider M, Urban K. Elektronenmikroskopie mit atomarer Auflösung: Ein Durchbruch bei der Korrektur von auflösungsbegrenzenden Linsenfehlern. ACTA ACUST UNITED AC 2013. [DOI: 10.1002/phbl.19980540506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jewett M, Finelli A, Kollmannsberger C, Wood L, Legere L, Basiuk J, Canil C, Heng D, Reaume N, Tanguay S, Atkins M, Bjarnason G, Dancey J, Evans M, Fleshner N, Haider M, Kapoor A, Uzzo R, Maskens D, Soulieres D, Yousef G, Basappa N, Bendali N, Black P, Blais N, Cagiannos I, Care M, Chow R, Chung H, Czaykowski P, Derosa D, Durrant K, Ellard S, Farquharson G, Filion-Brulotte C, Gingerich J, Godbout L, Grant R, Hamilton W, Kassouf W, Kurban G, Lane K, Lattouf J, Lau D, Leveridge M, McCarthy J, Moore R, North S, O'brien P, Pituskin E, Racine P, Rendon R, So A, Sridhar S, Stubbs K, Su Z, Taylor L, Udall T, Venner P, Vogel W, Yap S, Yau P, Cooper M, Giroux N, Miron D, Mosher D, Ross K, Willacy J. Management of kidney cancer: canadian kidney cancer forum consensus update 2011. Can Urol Assoc J 2012; 6:16-22. [PMID: 22396361 DOI: 10.5489/cuaj.11273] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
OBJECTIVE To explore how amantadine transitioned from an anti-flu drug to antiparkinsonian agent. METHODS A review of the historical literature on the use of amantadine from 1966 to the present was performed. RESULTS Amantadine was originally introduced and utilized as an antiviral medication. A single patient noticed relief in her Parkinson disease (PD) symptoms after taking amantadine for a flu infection, and this observation sparked an interest, and several important studies that eventually led to a new drug indication. CONCLUSION Amantadine has over the years fallen out of favor as a drug to address influenza infection; however, it has become part of the arsenal utilized for early symptomatic treatment of PD, as well an option for treating dyskinesia.
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Affiliation(s)
- G Hubsher
- Department of Neurology, Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA
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Henrion T, Werber A, Kitzber R, Haider M. Dynamic Simulation as a tool to improve the efficiency of Energy Sytems. Applications in the Steel Industry. EPJ Web of Conferences 2012. [DOI: 10.1051/epjconf/20123305001] [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: 11/14/2022] Open
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Barton B, Rhinow D, Walter A, Schröder R, Benner G, Majorovits E, Matijevic M, Niebel H, Müller H, Haider M, Lacher M, Schmitz S, Holik P, Kühlbrandt W. In-focus electron microscopy of frozen-hydrated biological samples with a Boersch phase plate. Ultramicroscopy 2011; 111:1696-705. [DOI: 10.1016/j.ultramic.2011.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 09/05/2011] [Accepted: 09/12/2011] [Indexed: 11/30/2022]
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Warde P, O'Malley M, Jewett M, Panzarella T, Hogg D, Moore M, Anson-Cartwright L, Haider M, Gospodarowicz M, Chung P. 7108 POSTER DISCUSSION Surveillance in Stage I Testicular Cancer – Safety of Low Dose CT Scans. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72023-8] [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: 10/17/2022]
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