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Phillips MC, Thotathil Z, Dass PH, Ziad F, Moon BG. Ketogenic metabolic therapy in conjunction with standard treatment for glioblastoma: A case report. Oncol Lett 2024; 27:230. [PMID: 38586213 PMCID: PMC10996027 DOI: 10.3892/ol.2024.14363] [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: 01/31/2024] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Glioblastoma (GBM) is the most common primary malignant brain tumour in adults. The standard of care consists of surgical resection and concurrent chemoradiation, followed by adjuvant temozolomide chemotherapy. This protocol is associated with a median survival of 12-15 months, and <5% of patients survive >3 years. Ketogenic metabolic therapy (KMT) targets cancer cell metabolism by restricting glucose availability and evoking differential stress resistance and sensitization, which may augment the standard treatments and lead to therapeutic benefit. The present study reports the case of a 64-year-old woman with isocitrate dehydrogenase (IDH)-wildtype GBM who pursued the standard treatment protocol in conjunction with an intensive, multimodal KMT program for 3 years. The KMT program consisted of a series of prolonged (7-day, fluid-only) fasts, which were specifically timed to maximize the tolerability and efficacy of the standard treatments, combined with a time-restricted ketogenic diet on all other days. During the first and second treatment years the patient sustained a glucose ketone index (GKI) of 1.65 and 2.02, respectively, which coincided with complete clinical improvement, a healthy body-mass index and a high quality of life, with no visible progressive tumour detected on imaging at the end of the second year. In the setting of the death of an immediate family member leading to increased life stress, slightly relaxed KMT adherence, and a higher GKI of 3.20, slow cancer progression occurred during the third year. The adverse effects attributed to KMT were mild. Despite the limitations of this case report, it highlights the feasibility of implementing the standard treatment protocol for GBM in conjunction with an intensive, long-term, multimodal and specifically timed KMT program, the potential therapeutic efficacy of which may depend upon achieving as low a GKI as possible.
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Affiliation(s)
| | - Ziad Thotathil
- Department of Radiation Oncology, Waikato Hospital, Hamilton 3204, New Zealand
| | | | - Fouzia Ziad
- Department of Pathology, Waikato Hospital, Hamilton 3204, New Zealand
| | - Ben G. Moon
- Midland MRI, Waikato Hospital, Hamilton 3204, New Zealand
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Davis EJ, Martin-Liberal J, Kristeleit R, Cho DC, Blagden SP, Berthold D, Cardin DB, Vieito M, Miller RE, Hari Dass P, Orcurto A, Spencer K, Janik JE, Clark J, Condamine T, Pulini J, Chen X, Mehnert JM. First-in-human phase I/II, open-label study of the anti-OX40 agonist INCAGN01949 in patients with advanced solid tumors. J Immunother Cancer 2022; 10:jitc-2021-004235. [PMID: 36316061 PMCID: PMC9628691 DOI: 10.1136/jitc-2021-004235] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND OX40 is a costimulatory receptor upregulated on antigen-activated T cells and constitutively expressed on regulatory T cells (Tregs). INCAGN01949, a fully human immunoglobulin G1κ anti-OX40 agonist monoclonal antibody, was designed to promote tumor-specific immunity by effector T-cell activation and Fcγ receptor-mediated Treg depletion. This first-in-human study was conducted to determine the safety, tolerability, and preliminary efficacy of INCAGN01949. METHODS Phase I/II, open-label, non-randomized, dose-escalation and dose-expansion study conducted in patients with advanced or metastatic solid tumors. Patients received INCAGN01949 monotherapy (7-1400 mg) in 14-day cycles while deriving benefit. Safety measures, clinical activity, pharmacokinetics, and pharmacodynamic effects were assessed and summarized with descriptive statistics. RESULTS Eighty-seven patients were enrolled; most common tumor types were colorectal (17.2%), ovarian (8.0%), and non-small cell lung (6.9%) cancers. Patients received a median three (range 1-9) prior therapies, including immunotherapy in 24 patients (27.6%). Maximum tolerated dose was not reached; one patient (1.1%) receiving 350 mg dose reported dose-limiting toxicity of grade 3 colitis. Treatment-related adverse events were reported in 45 patients (51.7%), with fatigue (16 (18.4%)), rash (6 (6.9%)), and diarrhea (6 (6.9%)) being most frequent. One patient (1.1%) with metastatic gallbladder cancer achieved a partial response (duration of 6.3 months), and 23 patients (26.4%) achieved stable disease (lasting >6 months in one patient). OX40 receptor occupancy was maintained over 90% among all patients receiving doses of ≥200 mg, while no treatment-emergent antidrug antibodies were detected across all dose levels. Pharmacodynamic results demonstrated that treatment with INCAGN01949 did not enhance proliferation or activation of T cells in peripheral blood or reduce circulating Tregs, and analyses of tumor biopsies did not demonstrate any consistent increase in effector T-cell infiltration or function, or decrease in infiltrating Tregs. CONCLUSION No safety concerns were observed with INCAGN01949 monotherapy in patients with metastatic or advanced solid tumors. However, tumor responses and pharmacodynamic effects on T cells in peripheral blood and post-therapy tumor biopsies were limited. Studies evaluating INCAGN01949 in combination with other therapies are needed to further evaluate the potential of OX40 agonism as a therapeutic approach in patients with advanced solid tumors. TRIAL REGISTRATION NUMBER NCT02923349.
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Affiliation(s)
| | | | | | - Daniel C Cho
- Perlmutter Cancer Center, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
| | | | - Dominik Berthold
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Dana B Cardin
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Maria Vieito
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Prashanth Hari Dass
- Early Phase Clinical Trials Unit, Churchill Hospital, University of Oxford, Oxford, UK
| | - Angela Orcurto
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | | | - Jason Clark
- Incyte Corporation, Wilmington, Delaware, USA
| | | | | | - Xuejun Chen
- Incyte Corporation, Wilmington, Delaware, USA
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Camburn L, Hari Dass P. Patterns of presentation among New Zealand Māori with pancreatic cancer at Lakes District Health Board. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18553] [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
e18553 Background: New Zealand (NZ) Māori have higher rates of pancreatic cancer than other ethnic groups in NZ. Lakes District Health board (LDHB) has one of the highest proportion of Māori patients within New Zealand, 34.7% compared to 15.7% nationally. We aimed to review the patterns of presentation of patients diagnosed with pancreatic cancer at LDHB between ethnicities. Methods: Patients diagnosed with pancreatic cancer at LDHB between 01 Jul 2014 to 31 Mar 2020 were identified using the faster cancer treatment data and regional hospice referral data. This was cross checked against surgical and oncology referrals. Electronic notes were reviewed to collect data on ethnicity, patient demographics, & presentation. Results: 69 patients were identified; 25 Māori patients and 44 New Zealand European (NZE) patients. The mean age at diagnosis was 63.4 years for Māori and 73.4 years for NZE patients. 22 (88%) Māori patients were below the age of 75 at diagnosis compared to 24 (55%) NZE patients. In both groups there were more affected males than females. Risk factors such as positive smoking history, obesity and diabetes were more prevalent in Māori patients (80% v 43%, 40% v 16%, 44% v 20% respectively). Māori were more likely to present with metastatic disease compared to non-Māori at presentation (64% v 52%). Conclusions: Māori pancreatic cancer patients in our region were more likely to present younger with metabolic syndrome and more advanced disease compared to NZE patients.
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Camburn L, Hari Dass P. Health disparities in New Zealand Māori with pancreatic cancer at Lakes District health board. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18554] [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
e18554 Background: Global health disparities between ethnicities have been well documented in pancreatic cancer treatment & outcomes. However, pancreatic cancer treatment & survival outcomes between ethnicities, particularly NZ Māori have been poorly documented in our region. Aim to review whether health disparities existed between Māori and New Zealand European patients (NZE) treated with pancreatic cancer. Methods: Patients diagnosed with pancreatic cancer at LDHB between 01 Jul 2014 to 31 Mar 2020 were identified using the faster cancer treatment data. This was cross checked against surgical and Oncology referrals. Electronic notes were reviewed to collect data on ethnicity, patient demographics, presentation, treatment and survival. Results: A total of 69 patients; 25 identified as Māori and 44 NZE. Performance status at presentation was similar between Māori and NZE patients; 64% and 61% respectively, having ECOG 0-1. Majority of patients presented with unresectable locally advanced or metastatic disease (Māori 92% vs NZE 82%). 9% presented with resectable disease, 4% were borderline resectable, only 4 (6%) patients underwent surgical resection. Median overall survival was 34 days for Māori versus 94 days for NZE patients. 72% of Māori patients had an OS < 60 days compared to 39% of NZE, however OS at 6 months was similar in both groups (28% Māori v 27% NZE). For locally advanced disease, similar rates of receipt of chemotherapy (71% vs 62%) were documented between Māori and NZE respectively. Of the 16 Māori patients with metastatic disease at presentation none received palliative chemotherapy compared to 6 / 23 (26%) NZE. Conclusions: Regardless of ethnicity relatively small numbers of our patients have curative surgery which is of concern. Despite adequate performance status at presentation and comparable outcomes in the locally advanced setting, NZ Māori were less likely to receive palliative chemotherapy in the metastatic setting. Further research is warranted to explain and reduce this disparity.
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Watkinson GE, Hari Dass P. Tumour Lysis Syndrome in Occult Breast Cancer Treated With Letrozole - A Rare Occurrence. A Case Report and Review. Breast Cancer (Auckl) 2021; 15:11782234211006677. [PMID: 33911874 PMCID: PMC8047824 DOI: 10.1177/11782234211006677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/10/2021] [Indexed: 11/22/2022]
Abstract
Tumour lysis syndrome (TLS) is a medical emergency occurring when large numbers of cancer cells rapidly undergo cell death. The resultant metabolic abnormalities results in significant morbidity and mortality. Tumour lysis syndrome most commonly occurs in 5% of haematological malignancies and is less commonly described in solid organ cancers. In breast cancer, TLS has been reported to occur both spontaneously and as a result of cancer chemotherapy, targeted therapy, or radiotherapy. However, only 1 TLS case in a breast cancer patient has been reported as a consequence of aromatase inhibitor letrozole. With the increased recent use of CDK4/6 inhibitors, 2 cases of hyperuricaemia in patients with breast cancer treated with palbociclib/letrozole combination treatment have also been reported. We present the second case of letrozole-induced TLS in a 74-year-old woman with occult breast adenocarcinoma. Despite treatment with recombinant urate oxidase and intravenous fluids, the patient deteriorated and was discharged with hospice care. Although rare, this life-threatening condition should be considered in an acutely unwell patient commencing treatment for solid malignant tumours.
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Hari Dass P, B. Jameson M. Testicular cancer: a 13‐year retrospective review of ethnic disparities in the Waikato region, New Zealand. Intern Med J 2020; 50:1344-1349. [DOI: 10.1111/imj.14681] [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] [Received: 09/13/2019] [Revised: 11/01/2019] [Accepted: 11/02/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Michael B. Jameson
- Waikato District Health Board Hamilton New Zealand
- Waikato Clinical Campus, University of Auckland Hamilton New Zealand
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Plummer ER, Lolkema MP, Aerts JG, De Vos FYFL, Forster M, ANGEVIN ERIC, Kristeleit RS, Perera T, Clack G, Meulemans A, Libouban M, Hari Dass P, Drew Y, Tinsley N, Balaratnam S, Blagden SP, Krebs M. A modular, multi-arm, multi-part, first time in patient study to evaluate the safety and tolerability of the dual MET kinase/OCT2 inhibitor, OMO-1, alone and in combination with anti-cancer treatments, in patients with locally advanced, unresectable or metastatic solid malignancies. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps2614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Elizabeth Ruth Plummer
- Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | - Yvette Drew
- Newcastle University, Northern Institute for Cancer Research, Newcastle-upon-Tyne, United Kingdom
| | | | | | | | - Matthew Krebs
- The Christie NHS Foundation Trust and The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
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Morotti M, Dass PH, Harris AL, Lord S. Pharmacodynamic and Pharmacokinetic Markers For Anti-angiogenic Cancer Therapy: Implications for Dosing and Selection of Patients. Eur J Drug Metab Pharmacokinet 2018; 43:137-153. [PMID: 29019020 DOI: 10.1007/s13318-017-0442-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Angiogenesis is integral to tumour growth and invasion, and is a key target for cancer therapeutics. However, for many of the licensed indications, only a modest clinical benefit has been observed for both monoclonal antibody and small-molecule tyrosine kinase inhibitor anti-angiogenic therapy. Pre-clinical and clinical studies have attempted to evaluate circulating, imaging, genomic, pharmacokinetic, and pharmacodynamic markers that may aid both the selection of patients for treatment and define dosing. Correct dosing is likely to be critical in the context of vascular normalization to allow better delivery of concomitant anti-cancer therapy and novel imaging techniques hold much promise in the early evaluation of pharmacodynamic response to improve efficacy.
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Affiliation(s)
- Matteo Morotti
- Hypoxia and Angiogenesis Group, Cancer Research UK Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DS, UK.
- Department of Gynaecology Oncology, University of Oxford, Oxford, UK.
- Department of Oncology, Churchill Hospital, University of Oxford, Oxford, OX3 9DU, UK.
| | - Prashanth Hari Dass
- Department of Oncology, Churchill Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - Adrian L Harris
- Hypoxia and Angiogenesis Group, Cancer Research UK Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DS, UK
- Department of Oncology, Churchill Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - Simon Lord
- Hypoxia and Angiogenesis Group, Cancer Research UK Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DS, UK
- Department of Oncology, Churchill Hospital, University of Oxford, Oxford, OX3 9DU, UK
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Dass PH, Kuper-Hommel MJ. A review of squamous cell vulvar cancers in Waikato region, New Zealand. N Z Med J 2017; 130:19-28. [PMID: 29121621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Squamous cell vulvar cancers (SCVC) are rare. Although management guidelines have recently been published, New Zealand studies presenting "real world" outcomes are limited. METHODS Retrospective single-centre review of SCVC diagnosed between 1 January 2000 and 31 August 2015. Clinical characteristics and outcomes were reviewed. RESULTS Among 47 cases reviewed, 38 were ethnically European and 9 Māori. Cases identified as Stage 1 (16), Stage 2 (5), Stage 3 (17), Stage 4 (9). For Stages 1, 2, 3 and 4, (16, 4, 17 and 6) were managed by local excision; (9, 1, 14 and 2) by node dissection and (2, 1, 3 and 5) by chemoradiotherapy respectively. Wound cellulitis (10) and lymphedema (8) were the commonest acute and late complication, respectively. Seven patients were treated with 5-Fluorouracil and Mitomycin, and four received weekly Cisplatin. Grade 3 toxicities seen in five cases treated with 5-Fluorouracil and Mitomycin versus none in the Cisplatin group. No local recurrences observed in patients treated with chemoradiation. Patients with Age Adjusted Charlson Comorbid Index Score (ACCIS) <5 had better overall survival (OS) compared to scores ≥5 (60% versus 41%) with 33 months median follow-up. Five-year OS and disease-free specific survival was 73% and 94% (Stage 1), 40% and 60% (Stage 2), 44% and 59% (Stage 3) and 29% (Stage 4) respectively. CONCLUSIONS We present "real world" outcomes of vulvar cancers in this older and comorbid population. Larger, prospective multi-centre studies are proposed.
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Affiliation(s)
- Prashanth Hari Dass
- Medical Oncology Clinical Trial and Research Fellow, University of Oxford, United Kingdom
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Hari Dass P, Jameson MB. Testicular cancer ethnic disparities in the Waikato region, New Zealand. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e18065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hari Dass P, Kuper-Hommel M. A Review of Squamous Cell Vulvar Cancers in Waikato Region, New Zealand. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e17032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Dass PH. Post lumbar puncture leg weakness mimicking cauda equina syndrome. N Z Med J 2015; 128:59-62. [PMID: 26370757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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