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Chang SS. Urologic Oncology: Bladder, Penis, and Urethral Cancer, and Basic Principles of Oncology. J Urol 2024; 211:720-721. [PMID: 38591696 DOI: 10.1097/ju.0000000000003870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 04/10/2024]
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Holzbeierlein J, Bixler BR, Buckley DI, Chang SS, Holmes RS, James AC, Kirkby E, McKiernan JM, Schuckman A. Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/SUO GUIDELINE (2017; Amended 2020, 2024). J Urol 2024:101097JU0000000000003981. [PMID: 38661067 DOI: 10.1097/ju.0000000000003981] [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: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE Although representing approximately 25% of patients diagnosed with bladder cancer, muscle-invasive bladder cancer (MIBC) carries a significant risk of death that has not significantly changed in decades. Increasingly, clinicians and patients recognize the importance of multidisciplinary collaborative efforts that take into account survival and quality of life concerns. This guideline provides a risk-stratified, clinical framework for the management of muscle-invasive urothelial bladder cancer. METHODOLOGY/METHODS In 2024, the MIBC guideline was updated through the AUA amendment process in which newly published literature is reviewed and integrated into previously published guidelines in an effort to maintain currency. The amendment allowed for the incorporation of additional literature released since the previous 2020 amendment. The updated search gathered literature from May 2020 to November 2023. This review identified 3739 abstracts, of which 46 met inclusion criteria.When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. RESULTS Updates were made regarding neoadjuvant/adjuvant chemotherapy, radical cystectomy, pelvic lymphadenectomy, multi-modal bladder preserving therapy, and future directions. Further revisions were made to the methodology and reference sections as appropriate. CONCLUSIONS This guideline seeks to improve clinicians' ability to evaluate and treat patients with MIBC based on currently available evidence. Future studies will be essential to further support or refine these statements to improve patient care.
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Affiliation(s)
| | | | - David I Buckley
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rebecca S Holmes
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Andrew C James
- Department of Urology, Texas Urology Group, San Antonio, Texas
| | - Erin Kirkby
- American Urological Association, Linthicum, Maryland
| | | | - Anne Schuckman
- Department of Urology, University of Southern California, Los Angeles, California
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Chang SS. Urologic Oncology: Bladder, Penis, and Urethral Cancer, and Basic Principles of Oncology. J Urol 2024:101097JU0000000000003900. [PMID: 38648615 DOI: 10.1097/ju.0000000000003900] [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] [Received: 02/09/2024] [Accepted: 02/18/2024] [Indexed: 04/25/2024]
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Holzbeierlein JM, Bixler BR, Buckley DI, Chang SS, Holmes R, James AC, Kirkby E, McKiernan JM, Schuckman AK. Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guideline: 2024 Amendment. J Urol 2024; 211:533-538. [PMID: 38265030 DOI: 10.1097/ju.0000000000003846] [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: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE The purpose of this American Urological Association (AUA)/Society of Urologic Oncology (SUO) guideline amendment is to provide a useful reference on the effective evidence-based treatment strategies for non-muscle invasive bladder cancer (NMIBC). MATERIALS AND METHODS In 2023, the NMIBC guideline was updated through the AUA amendment process in which newly published literature is reviewed and integrated into previously published guidelines in an effort to maintain currency. The amendment allowed for the incorporation of additional literature released since the previous 2020 amendment. The updated search gathered literature from July 2019 to May 2023. This review identified 1918 abstracts, of which 75 met inclusion criteria.When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) in support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. RESULTS Updates were made to statements on variant histologies, urine markers after diagnosis of bladder cancer, intravesical therapy, BCG maintenance, enhanced cystoscopy, and future directions. Further revisions were made to the methodology and reference sections as appropriate. CONCLUSIONS This guideline seeks to improve clinicians' ability to evaluate and treat patients with NMIBC based on currently available evidence. Future studies will be essential to further support or refine these statements to improve patient care.
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Affiliation(s)
| | | | - David I Buckley
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rebecca Holmes
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Andrew C James
- Department of Urology, Texas Urology Group, San Antonio, Texas
| | - Erin Kirkby
- American Urological Association, Linthicum, Maryland
| | | | - Anne K Schuckman
- Department of Urology, University of Southern California Urological Oncology, Los Angeles, California
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Chang SS. Urological Oncology: Bladder, Penis and Urethra Cancer, and Basic Principles of Oncology. J Urol 2024; 211:638-639. [PMID: 38241220 DOI: 10.1097/ju.0000000000003839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/21/2024]
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Chang SS. Urological Oncology: Bladder, Penis and Urethra Cancer, and Basic Principles of Oncology. J Urol 2024; 211:500-501. [PMID: 38095197 DOI: 10.1097/ju.0000000000003806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 02/09/2024]
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Chamie K, Chang SS, Kramolowsky EV, Gonzalgo ML, Huang M, Bhar P, Spilman P, Sender L, Reddy SK, Soon-Shiong P. Quality of Life in the Phase 2/3 Trial of N-803 Plus Bacillus Calmette-Guérin in Bacillus Calmette-Guérin‒Unresponsive Nonmuscle-Invasive Bladder Cancer. Urol Pract 2024; 11:367-375. [PMID: 38226931 DOI: 10.1097/upj.0000000000000517] [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: 10/02/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION In the phase 2/3 study QUILT-3.032 (NCT03022825), the ability of the IL-15RαFc superagonist N-803 (nogapendekin alfa inbakicept) plus bacillus Calmette-Guérin (BCG) to elicit durable complete responses in patients with BCG-unresponsive nonmuscle-invasive bladder cancer (NMIBC) was demonstrated. As a secondary end point, patient-reported outcomes (PROs) were assessed. METHODS Both cohort A patients with carcinoma in situ with or without Ta/T1 disease and cohort B patients with high-grade Ta/T1 papillary disease who received N-803 plus BCG therapy completed the EORTC (European Organization for Research and Treatment of Cancer) Core 30 and Quality of Life NMIBC-Specific 24 questionnaires at baseline and months 6, 12, 18, and 24 on study. Scores were analyzed using descriptive statistics, and multivariable analyses were performed to identify baseline variables associated with PROs. RESULTS On study, mean physical function (PF) and global health (GH) scores remained relatively stable from baseline for cohorts A (n = 86) and B (n = 78). At month 6, cohort A patients with a complete response reported higher PF scores than those without (P = .0659); at month 12, > 3 as compared with ≤ 3 prior transurethral resections of bladder tumor was associated (P = .0729) with lower GH scores. In cohort B, baseline disease type was associated (P = .0738) with PF and race was significantly associated (P = .0478) with GH at month 6. NMIBC-Specific 24 summary scores also remained stable on study for both cohorts. CONCLUSIONS The overall stability of PROs scores, taken together with the efficacy findings, indicates a favorable risk-benefit ratio and quality of life following N-803 plus BCG.
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Affiliation(s)
- Karim Chamie
- Department of Urology, University of California, Los Angeles Medical Center, Los Angeles, California
| | - Sam S Chang
- Department of Urology, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Mark L Gonzalgo
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Paul Bhar
- ImmunityBio, Inc, Culver City, California
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Chang SS. Urological Oncology: Bladder, Penis and Urethra Cancer, and Basic Principles of Oncology. J Urol 2024; 211:334-335. [PMID: 37975491 DOI: 10.1097/ju.0000000000003784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
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Chang SS. Urologic Oncology: Bladder, Penis, and Urethral Cancer, and Basic Principles of Oncology. J Urol 2024; 211:199-200. [PMID: 37850557 DOI: 10.1097/ju.0000000000003735] [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] [Received: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/19/2023]
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Cully G, Corcoran P, Gunnell D, Chang SS, McElroy B, O'Connell S, Arensman E, Perry IJ, Griffin E. Evaluation of a national clinical programme for the management of self-harm in hospital emergency departments: impact on patient outcomes and the provision of care. BMC Psychiatry 2023; 23:917. [PMID: 38062378 PMCID: PMC10701986 DOI: 10.1186/s12888-023-05340-4] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/02/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Emergency departments are important points of intervention, to reduce the risk of further self-harm and suicide. A national programme to standardise the management of people presenting to the emergency department with self-harm and suicidal ideation (NCPSHI) was introduced in Ireland in 2014. The aim of this study was to evaluate the impact of the NCPSHI on patient outcomes and provision of care. METHODS Data on self-harm presentations were obtained from the National Self-Harm Registry Ireland from 2012 to 2017. The impacts of the NCPSHI on study outcomes (3-month self-harm repetition, biopsychosocial assessment provision, admission, post-discharge referral, and self-discharge) were examined at an individual and aggregate (hospital) level, using a before and after study design and interrupted time series analyses, respectively. The 15 hospitals that implemented the programme by January 2015 (of a total of 24 between 2015 and 2017) were included in the analyses. RESULTS There were 31,970 self-harm presentations during the study period. In hospitals with no service for self-harm (n = 4), risk of patients not being assessed reduced from 31.8 to 24.7% following the introduction of the NCPSHI. Mental health referral in this hospital group increased from 42.2 to 59.0% and medical admission decreased from 27.5 to 24.3%. Signs of a reduction in self-harm repetition were observed for this hospital group, from 35.1 to 30.4% among individuals with a history of self-harm, but statistical evidence was weak. In hospitals with a pre-existing liaison psychiatry service (n = 7), risk of self-discharge was lower post-NCPSHI (17.8% vs. 14.8%). In hospitals with liaison nurse(s) pre-NCPSHI (n = 4), medical admission reduced (27.5% vs. 24.3%) and there was an increase in self-harm repetition (from 5.2 to 7.8%. for those without a self-harm history). CONCLUSION The NCPSHI was associated with improvements in the provision of care across hospital groups, particularly those with no prior service for self-harm, highlighting the need to consider pre-existing context in implementation planning. Our evaluation emphasises the need for proper resourcing to support the implementation of clinical guidelines on the provision of care for people presenting to hospital with self-harm.
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Affiliation(s)
- G Cully
- School of Public Health, University College Cork, Cork, Ireland.
- National Suicide Research Foundation, Cork, Ireland.
| | - P Corcoran
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | - D Gunnell
- NIHR Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - S S Chang
- Institute of Health Behaviors and Community Sciences, and Global Health Program, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - B McElroy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - S O'Connell
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | - E Arensman
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
- School of Applied Psychology, Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, QLD, Australia
| | - I J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - E Griffin
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
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Chang S, Bermoy ME, Chang SS, Scarpato KR, Luckenbaugh AN, Kolouri S, Bowden AK. Enhancing the image quality of blue light cystoscopy through green-hue correction and fogginess removal. Sci Rep 2023; 13:21484. [PMID: 38057491 PMCID: PMC10700554 DOI: 10.1038/s41598-023-48882-z] [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: 09/13/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023] Open
Abstract
Blue light cystoscopy (BLC) is a guideline-recommended endoscopic tool to detect bladder cancer with high sensitivity. Having clear, high-quality images during cystoscopy is crucial to the sensitive, efficient detection of bladder tumors; yet, important diagnostic information is often missed or poorly visualized in images containing illumination artifacts or impacted by impurities in the bladder. In this study, we introduce computational methods to remove two common artifacts in images from BLC videos: green hue and fogginess. We also evaluate the effect of artifact removal on the perceptual quality of the BLC images through a survey study and computation of Blind/Referenceless Image Spatial Quality Evaluator scores on the original and enhanced images. We show that corrections and enhancements made to cystoscopy images resulted in a better viewing experience for clinicians during BLC imaging and reliably restored lost tissue features that were important for diagnostics. Incorporating these enhancements during clinical and OR procedures may lead to more comprehensive tumor detection, fewer missed tumors during TURBT procedures, more complete tumor resection and shorter procedure time. When used in off-line review of cystoscopy videos, it may also better guide surgical planning and allow more accurate assessment and diagnosis.
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Affiliation(s)
- Shuang Chang
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37232, USA
| | - Micha E Bermoy
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37232, USA
| | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Kristen R Scarpato
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Amy N Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Soheil Kolouri
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, 37232, USA
| | - Audrey K Bowden
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37232, USA.
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, 37232, USA.
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Chang SS. Urologic Oncology: Bladder, Penis, and Urethral Cancer, and Basic Principles of Oncology. J Urol 2023; 210:928-930. [PMID: 37747154 DOI: 10.1097/ju.0000000000003719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023]
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Cabo JJS, Koch GE, Tallman JE, Thavaseelan S, Oberle M, Terris M, Kronenberg DG, Buckley JC, Scarpato KR, Chang SS. The Role of Alumni Networks and Career Advising in Early Career Stability of Urologists: Results of a Multi-institutional Study. Urology 2023; 182:48-54. [PMID: 37716454 DOI: 10.1016/j.urology.2023.08.035] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/06/2023] [Accepted: 08/01/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE To characterize training program and early career factors that impact decision-making and job retention following graduation in a diverse population of urologists. MATERIALS AND METHODS We performed a computer-based survey distributed to residency graduates from 25 urology training programs. Five focus institutions were identified with a goal >30% response rate. The survey included questions about training program specifics and post-training employment characteristics. RESULTS We obtained 180 responses from urology residency graduates of 25 programs. Overall, 72% (N = 129) remain in their initial post-training position at a median of 6years postgraduation (Interquartile Range (IQR) 3-10). On Cox-regression analysis stronger trainee-rated formal career advising was associated with lower risk of changing jobs (HR 0.77, 0.60-0.99, P = .048). Location/proximity to family was the most consistently cited as the top reason for selecting a job (41%). Sixty-three respondents (35%) joined practices employing graduates of the same residency program. Cox regression analysis showed that joining a practice with alumni of the same program was associated with lower risk of changing jobs from one's initial post-training position (HR 0.39, 95% CI 0.17-0.91, P = .03). CONCLUSION In this multi-institutional study of urologists, we observed a high rate of job retention out to a median of 6years following completion of training, with formal career advising and joining alumni in practice being associated with job retention. Collectively, our data highlights that training programs should emphasize advising programs and alumni networking in guiding their graduates in the job search process.
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Affiliation(s)
- Jackson J S Cabo
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN.
| | - George E Koch
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Jacob E Tallman
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | | | - Michael Oberle
- Department of Urology, Medical College of Georgia, Augusta University, Augusta, GA
| | - Martha Terris
- Department of Urology, Medical College of Georgia, Augusta University, Augusta, GA
| | | | - Jill C Buckley
- Department of Urology, University of California, San Diego, San Diego, CA
| | - Kristen R Scarpato
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
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Gore JL, Wolff EM, Comstock BA, Follmer KM, Nash MG, Basu A, Chisolm S, MacLean DB, Lee JR, Lotan Y, Porten SP, Steinberg GD, Chang SS, Gilbert SM, Kessler LG, Smith AB. Protocol of the Comparison of Intravesical Therapy and Surgery as Treatment Options (CISTO) study: a pragmatic, prospective multicenter observational cohort study of recurrent high-grade non-muscle invasive bladder cancer. BMC Cancer 2023; 23:1127. [PMID: 37980511 PMCID: PMC10657633 DOI: 10.1186/s12885-023-11605-8] [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: 08/31/2023] [Accepted: 11/02/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Bladder cancer poses a significant public health burden, with high recurrence and progression rates in patients with non-muscle-invasive bladder cancer (NMIBC). Current treatment options include bladder-sparing therapies (BST) and radical cystectomy, both with associated risks and benefits. However, evidence supporting optimal management decisions for patients with recurrent high-grade NMIBC remains limited, leading to uncertainty for patients and clinicians. The CISTO (Comparison of Intravesical Therapy and Surgery as Treatment Options) Study aims to address this critical knowledge gap by comparing outcomes between patients undergoing BST and radical cystectomy. METHODS The CISTO Study is a pragmatic, prospective observational cohort trial across 36 academic and community urology practices in the US. The study will enroll 572 patients with a diagnosis of recurrent high-grade NMIBC who select management with either BST or radical cystectomy. The primary outcome is health-related quality of life (QOL) at 12 months as measured with the EORTC-QLQ-C30. Secondary outcomes include bladder cancer-specific QOL, progression-free survival, cancer-specific survival, and financial toxicity. The study will also assess patient preferences for treatment outcomes. Statistical analyses will employ targeted maximum likelihood estimation (TMLE) to address treatment selection bias and confounding by indication. DISCUSSION The CISTO Study is powered to detect clinically important differences in QOL and cancer-specific survival between the two treatment approaches. By including a diverse patient population, the study also aims to assess outcomes across the following patient characteristics: age, gender, race, burden of comorbid health conditions, cancer severity, caregiver status, social determinants of health, and rurality. Treatment outcomes may also vary by patient preferences, health literacy, and baseline QOL. The CISTO Study will fill a crucial evidence gap in the management of recurrent high-grade NMIBC, providing evidence-based guidance for patients and clinicians in choosing between BST and radical cystectomy. The CISTO study will provide an evidence-based approach to identifying the right treatment for the right patient at the right time in the challenging clinical setting of recurrent high-grade NMIBC. TRIAL REGISTRATION ClinicalTrials.gov, NCT03933826. Registered on May 1, 2019.
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Affiliation(s)
- John L Gore
- Department of Urology, University of Washington, Seattle, WA, USA.
| | - Erika M Wolff
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Bryan A Comstock
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Michael G Nash
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Anirban Basu
- Departments of Pharmacy, Health Services, and Economics, University of Washington, Seattle, WA, USA
| | | | | | - Jenney R Lee
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sima P Porten
- Department of Urology, UCSF School of Medicine, San Francisco, CA, USA
| | - Gary D Steinberg
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott M Gilbert
- Department of Genitourinary Oncology, H. Lee Moffit Cancer Center and Research Institute, Tampa, FL, USA
| | - Larry G Kessler
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Angela B Smith
- Department of Urology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Chang SS. Urologic Oncology: Bladder, Penis, and Urethral Cancer, and Basic Principles of Oncology. J Urol 2023; 210:821-822. [PMID: 37615295 DOI: 10.1097/ju.0000000000003660] [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] [Received: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023]
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Cortese BD, Dusetzina SB, Luckenbaugh AN, Al Hussein Al Awamlh B, Stimson CJ, Barocas DA, Penson DF, Chang SS, Talwar R. Projected Savings for Generic Oncology Drugs Purchased via Mark Cuban Cost Plus Drug Company Versus in Medicare. J Clin Oncol 2023; 41:4664-4668. [PMID: 37290029 DOI: 10.1200/jco.23.00079] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/17/2023] [Accepted: 04/17/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE Self-administered oncology drugs contribute disproportionately to Medicare Part D spending; prices often remain high even after generic entry. Outlets for low-cost drugs such as Mark Cuban Cost Plus Drug Company (MCCPDC) offer opportunities for decreased Medicare, Part D, and beneficiary spending. We estimate potential savings if Part D plans obtained prices such as those offered under the MCCPDC for seven generic oncology drugs. METHODS Using the 2020 Medicare Part D Spending dashboard, Q3-2022 Part D formulary prices, and Q3-2022 MCCPDC prices for seven self-administered generic oncology drugs, we estimated Medicare savings by replacing Q3-2022 Part D unit costs with costs under the MCCPDC plan. RESULTS We estimate potential savings of $661.8 million (M) US dollars (USD; 78.8%) for the seven oncology drugs studied. Total savings ranged from $228.1M USD (56.1%) to $2,154.5M USD (92.4%) compared with 25th and 75th percentiles of Part D plan unit prices. The median savings replacing Part D plan prices were abiraterone $338.0M USD, anastrozole $1.2M USD, imatinib 100 mg $15.6M USD, imatinib 400 mg $212.0M USD, letrozole $1.9M USD, methotrexate $26.7M USD, raloxifene $63.8M USD, and tamoxifen $2.6M USD. All 30-day prescription drug prices offered by MCCPDC generated cost savings except for three drugs offered at the 25th percentile Part D formulary pricing: anastrozole, letrozole, and tamoxifen. CONCLUSION Replacing current Part D median formulary prices with MCCPDC pricing could yield significant savings for seven generic oncology drugs. Individual beneficiaries could save nearly $25,200 USD per year for abiraterone or between $17,500 USD and $20,500 USD for imatinib. Notably, Part D cash-pay prices for abiraterone and imatinib under the catastrophic phase of coverage were still more expensive than baseline MCCPDC prices.
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Affiliation(s)
- Brian D Cortese
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Wharton School of Business, University of Pennsylvania, Philadelphia, PA
| | - Stacie B Dusetzina
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Amy N Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | | | - C J Stimson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Sam S Chang
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Ruchika Talwar
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
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Goodman RS, Patrinely JR, Stone CA, Zimmerman E, Donald RR, Chang SS, Berkowitz ST, Finn AP, Jahangir E, Scoville EA, Reese TS, Friedman DL, Bastarache JA, van der Heijden YF, Wright JJ, Ye F, Carter N, Alexander MR, Choe JH, Chastain CA, Zic JA, Horst SN, Turker I, Agarwal R, Osmundson E, Idrees K, Kiernan CM, Padmanabhan C, Bailey CE, Schlegel CE, Chambless LB, Gibson MK, Osterman TJ, Wheless LE, Johnson DB. Accuracy and Reliability of Chatbot Responses to Physician Questions. JAMA Netw Open 2023; 6:e2336483. [PMID: 37782499 PMCID: PMC10546234 DOI: 10.1001/jamanetworkopen.2023.36483] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/22/2023] [Indexed: 10/03/2023] Open
Abstract
Importance Natural language processing tools, such as ChatGPT (generative pretrained transformer, hereafter referred to as chatbot), have the potential to radically enhance the accessibility of medical information for health professionals and patients. Assessing the safety and efficacy of these tools in answering physician-generated questions is critical to determining their suitability in clinical settings, facilitating complex decision-making, and optimizing health care efficiency. Objective To assess the accuracy and comprehensiveness of chatbot-generated responses to physician-developed medical queries, highlighting the reliability and limitations of artificial intelligence-generated medical information. Design, Setting, and Participants Thirty-three physicians across 17 specialties generated 284 medical questions that they subjectively classified as easy, medium, or hard with either binary (yes or no) or descriptive answers. The physicians then graded the chatbot-generated answers to these questions for accuracy (6-point Likert scale with 1 being completely incorrect and 6 being completely correct) and completeness (3-point Likert scale, with 1 being incomplete and 3 being complete plus additional context). Scores were summarized with descriptive statistics and compared using the Mann-Whitney U test or the Kruskal-Wallis test. The study (including data analysis) was conducted from January to May 2023. Main Outcomes and Measures Accuracy, completeness, and consistency over time and between 2 different versions (GPT-3.5 and GPT-4) of chatbot-generated medical responses. Results Across all questions (n = 284) generated by 33 physicians (31 faculty members and 2 recent graduates from residency or fellowship programs) across 17 specialties, the median accuracy score was 5.5 (IQR, 4.0-6.0) (between almost completely and complete correct) with a mean (SD) score of 4.8 (1.6) (between mostly and almost completely correct). The median completeness score was 3.0 (IQR, 2.0-3.0) (complete and comprehensive) with a mean (SD) score of 2.5 (0.7). For questions rated easy, medium, and hard, the median accuracy scores were 6.0 (IQR, 5.0-6.0), 5.5 (IQR, 5.0-6.0), and 5.0 (IQR, 4.0-6.0), respectively (mean [SD] scores were 5.0 [1.5], 4.7 [1.7], and 4.6 [1.6], respectively; P = .05). Accuracy scores for binary and descriptive questions were similar (median score, 6.0 [IQR, 4.0-6.0] vs 5.0 [IQR, 3.4-6.0]; mean [SD] score, 4.9 [1.6] vs 4.7 [1.6]; P = .07). Of 36 questions with scores of 1.0 to 2.0, 34 were requeried or regraded 8 to 17 days later with substantial improvement (median score 2.0 [IQR, 1.0-3.0] vs 4.0 [IQR, 2.0-5.3]; P < .01). A subset of questions, regardless of initial scores (version 3.5), were regenerated and rescored using version 4 with improvement (mean accuracy [SD] score, 5.2 [1.5] vs 5.7 [0.8]; median score, 6.0 [IQR, 5.0-6.0] for original and 6.0 [IQR, 6.0-6.0] for rescored; P = .002). Conclusions and Relevance In this cross-sectional study, chatbot generated largely accurate information to diverse medical queries as judged by academic physician specialists with improvement over time, although it had important limitations. Further research and model development are needed to correct inaccuracies and for validation.
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Affiliation(s)
| | - J. Randall Patrinely
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cosby A. Stone
- Department of Allergy, Pulmonology, and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eli Zimmerman
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rebecca R. Donald
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sam S. Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sean T. Berkowitz
- Vanderbilt Eye Institute, Department of Ophthalmology, Vanderbilt University Medical, Nashville, Tennessee
| | - Avni P. Finn
- Vanderbilt Eye Institute, Department of Ophthalmology, Vanderbilt University Medical, Nashville, Tennessee
| | - Eiman Jahangir
- Department of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth A. Scoville
- Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tyler S. Reese
- Department of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Debra L. Friedman
- Department of Pediatric Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julie A. Bastarache
- Department of Allergy, Pulmonology, and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yuri F. van der Heijden
- Department of Infectious Disease, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jordan J. Wright
- Department of Diabetes, Endocrinology, and Metabolism, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nicholas Carter
- Division of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine, Miami, Florida
| | - Matthew R. Alexander
- Department of Cardiovascular Medicine and Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer H. Choe
- Department of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cody A. Chastain
- Department of Infectious Disease, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John A. Zic
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sara N. Horst
- Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Isik Turker
- Department of Cardiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Rajiv Agarwal
- Department of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Evan Osmundson
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kamran Idrees
- Department of Surgical Oncology & Endocrine Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Colleen M. Kiernan
- Department of Surgical Oncology & Endocrine Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chandrasekhar Padmanabhan
- Department of Surgical Oncology & Endocrine Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christina E. Bailey
- Department of Surgical Oncology & Endocrine Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cameron E. Schlegel
- Department of Surgical Oncology & Endocrine Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lola B. Chambless
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael K. Gibson
- Department of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Travis J. Osterman
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lee E. Wheless
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Douglas B. Johnson
- Department of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
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Chang SS. Urologic Oncology: Bladder, Penis, and Urethral Cancer, and Basic Principles of Oncology. J Urol 2023; 210:715-716. [PMID: 37527370 DOI: 10.1097/ju.0000000000003630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023]
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Chang S, Giannico GA, Haugen E, Jardaneh A, Baba J, Mahadevan-Jansen A, Chang SS, Bowden AK. Multiparameter interferometric polarization-enhanced imaging differentiates carcinoma in situ from inflammation of the bladder: an ex vivo study. J Biomed Opt 2023; 28:102907. [PMID: 37576611 PMCID: PMC10415042 DOI: 10.1117/1.jbo.28.10.102907] [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] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
Significance Successful differentiation of carcinoma in situ (CIS) from inflammation in the bladder is key to preventing unnecessary biopsies and enabling accurate therapeutic decisions. Current standard-of-care diagnostic imaging techniques lack the specificity needed to differentiate these states, leading to false positives. Aim We introduce multiparameter interferometric polarization-enhanced (MultiPIPE) imaging as a promising technology to improve the specificity of detection for better biopsy guidance and clinical outcomes. Approach In this ex vivo study, we extract tissue attenuation-coefficient-based and birefringence-based parameters from MultiPIPE imaging data, collected with a bench-top system, to develop a classifier for the differentiation of benign and CIS tissues. We also analyze morphological features from second harmonic generation imaging and histology slides and perform imaging-to-morphology correlation analysis. Results MultiPIPE enhances specificity to differentiate CIS from benign tissues by nearly 20% and reduces the false-positive rate by more than four-fold over clinical standards. We also show that the MultiPIPE measurements correlate well with changes in morphological features in histological assessments. Conclusions The results of our study show the promise of MultiPIPE imaging to be used for better differentiation of bladder inflammation from flat tumors, leading to a fewer number of unnecessary procedures and shorter operating room (OR) time.
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Affiliation(s)
- Shuang Chang
- Vannderbilt University, Vanderbilt Biophotonics Center, Department of Biomedical Engineering, Nashville, Tennessee, United States
| | - Giovanna A. Giannico
- Vanderbilt University Medical Center, Department of Pathology, Microbiology, and Immunology, Nashville, Tennessee, United States
| | - Ezekiel Haugen
- Vannderbilt University, Vanderbilt Biophotonics Center, Department of Biomedical Engineering, Nashville, Tennessee, United States
| | - Ali Jardaneh
- Vanderbilt University Medical Center, Department of Urology, Nashville, Tennessee, United States
| | - Justin Baba
- Vannderbilt University, Vanderbilt Biophotonics Center, Department of Biomedical Engineering, Nashville, Tennessee, United States
| | - Anita Mahadevan-Jansen
- Vannderbilt University, Vanderbilt Biophotonics Center, Department of Biomedical Engineering, Nashville, Tennessee, United States
| | - Sam S. Chang
- Vanderbilt University Medical Center, Department of Urology, Nashville, Tennessee, United States
| | - Audrey K. Bowden
- Vannderbilt University, Vanderbilt Biophotonics Center, Department of Biomedical Engineering, Nashville, Tennessee, United States
- Vanderbilt University, Department of Electrical and Computer Engineering, Nashville, Tennessee, United States
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20
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Yao J, Liu XM, Yuan F, Luo TY, Lu ZN, Yan YF, Chang SS, Song GY. [Safety and efficacy of transcatheter aortic valve replacement using the "All in One" single artery/vessel technique]. Zhonghua Xin Xue Guan Bing Za Zhi 2023; 51:990-994. [PMID: 37709717 DOI: 10.3760/cma.j.cn112148-20230807-00058] [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: 09/16/2023]
Abstract
Objective: To explore the safety and efficacy of transcatheter aortic valve replacement (TAVR) using the "All in One" single-artery/vessel technique. Methods: This is a retrospective study. A total of 30 consecutive patients underwent TAVR using the single artery/vascular technique in Beijing Anzhen Hospital from August to December 2021 were included. Baseline clinical data, operative situation, postoperative outcomes, and incidence of adverse events during hospitalization and at one month post TAVR were analyzed. Results: Mean age was (72.6±9.7) years, 16 were male patients, STS score was (4.73±3.12)%. Four patients were diagnosed as isolated aortic regurgitation (all with tricuspid aortic valves), and 26 patients were diagnosed as aortic stenosis (AS), 10 of whom with tricuspid aortic valves and 16 of whom with bicuspid aortic valves. The single-vessel technique was applied in 3 aortic stenosis cases; the single-artery technique was applied in 27 cases. Echocardiography was performed immediately after procedure and results showed no or trace perivalvular leak in 27 cases and small perivalvular leak in 3 cases; the mean aortic transvalvular gradient of 26 AS patients decreased from (50.4±16.0) mmHg (1 mmHg=0.133 kPa) to (9.4±3.2) mmHg (P<0.001). The procedure time was (64.8±18.9) min. There were no intraoperative death, valve displacement, conversion to surgery, coronary artery occlusion in all 30 patients. There were no major cardiac adverse events such as myocardial infarction or stroke occurred during hospitalization or at follow-up. One-month follow-up echocardiography indicated prosthesis works well. The symptoms were significantly alleviated, and the Kansas City Cardiomyopathy Score (KCCQ score) of all patients increased from 48.1±18.4 to 73.5±17.6 (P<0.001). Conclusions: TAVR using the single artery/vessel technique is safe and feasible. This technique is related to reduced access complications and worthy of wide application.
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Affiliation(s)
- J Yao
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing 100029, China
| | - X M Liu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing 100029, China
| | - F Yuan
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing 100029, China
| | - T Y Luo
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing 100029, China
| | - Z N Lu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing 100029, China
| | - Y F Yan
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing 100029, China
| | - S S Chang
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing 100029, China
| | - G Y Song
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing 100029, China
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21
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Smelser WW, Wang J, Ogden KM, Chang SS, Kirschner AN. Intravesical oncolytic virotherapy and immunotherapy for non-muscle-invasive bladder cancer mouse model. BJU Int 2023; 132:298-306. [PMID: 36961272 PMCID: PMC10518025 DOI: 10.1111/bju.16012] [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] [Indexed: 03/25/2023]
Abstract
OBJECTIVES To test if intravesical instillation of both an anti-programmed cell death protein 1 (PD-1) inhibitor and an oncolytic reovirus would demonstrate a greater effect than either treatment alone, as non-muscle-invasive bladder cancer that is refractory to intravesical bacillus Calmette-Guérin can be treated by systemic anti-PD-1 immunotherapy and we previously demonstrated improved overall survival (OS) with six once-weekly instillations of intravesical anti-PD-1 in a murine model. MATERIALS AND METHODS Using an orthotopic syngeneic C3H murine model of MBT2 urothelial bladder cancer, groups of 10 mice were compared between no treatment, intravesical anti-PD-1, intravesical oncolytic reovirus, or intravesical reovirus + anti-PD-1. A single intravesical treatment session was given. The primary outcome was OS, and the secondary outcomes included long-term immunity and tumour-immune profile. RESULTS With a median follow-up of 9 months, all mice that received no treatment died with a median survival of 41 days, while the comparison median OS was not reached for reovirus (hazard ratio [HR] 14.4, 95% confidence interval [CI] 3.9-32.6; P < 0.001), anti-PD-1 (HR 28.4, 95% CI 7.0-115.9; P < 0.001), and reovirus + anti-PD-1 (HR 28.4, 95% CI 7.0-115.9; P < 0.001). Monotherapy with anti-PD-1 or reovirus demonstrated no significant differences in survival (P = 0.067). Mass cytometry showed that reovirus + anti-PD-1 treatment enriched monocytes and decreased myeloid-derived suppressor cells, generating an immuno-responsive tumour microenvironment. Depletion of CD8+ T cells eliminated the survival advantage provided by the intravesical treatment. CONCLUSIONS Treatment of murine orthotopic bladder tumours with a single instillation of intravesical reovirus, anti-PD-1 antibody, or the combination confers superior survival compared to controls. Tumour-immune microenvironment differences indicated myeloid-derived suppressor cells and CD8+ T cells mediate the treatment response.
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Affiliation(s)
- Woodson W. Smelser
- Department of Surgery, Division of Urology, Washington University in St. Louis, St. Louis, MI, Nashville, TN, USA
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jian Wang
- Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristen M. Ogden
- Department of Pediatrics, Immunology, Nashville, TN, USA
- Pathology, Microbiology, and Immunology, Nashville, TN, USA
| | - Sam S. Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Austin N. Kirschner
- Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
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22
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Chang SS. Urologic Oncology: Bladder, Penis, and Urethral Cancer, and Basic Principles of Oncology. J Urol 2023; 210:564-565. [PMID: 37334531 DOI: 10.1097/ju.0000000000003577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/20/2023]
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23
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Cortese BD, Dusetzina SB, Al Hussein Al Awamlh B, Penson DF, Chang SS, Barocas DA, Luckenbaugh AN, Scarpato KR, Moses KA, Talwar R. Estimating the Impact of the Inflation Reduction Act on the Out-of-Pocket Costs for Medicare Beneficiaries With Advanced Prostate Cancer. Urol Pract 2023; 10:476-483. [PMID: 37409930 DOI: 10.1097/upj.0000000000000425] [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: 05/08/2023] [Accepted: 06/09/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Combination systemic therapy for advanced prostate cancer has reduced mortality, but high out-of-pocket costs impose financial barriers for patients. The Inflation Reduction Act's $2,000 out-of-pocket spending cap for Medicare's prescription drug benefit (Part D) can potentially lower out-of-pocket spending for beneficiaries starting in 2025. This study aims to compare out-of-pocket spending for commonly prescribed regimens for advanced prostate cancer before and after implementation of the Inflation Reduction Act. METHODS Medication regimens constructed to treat metastatic, hormone-sensitive prostate cancer consisted of baseline androgen deprivation therapy with traditional chemotherapy, androgen receptor inhibitors, and androgen biosynthesis inhibitors. Using 2023 Medicare Part B prices and the Medicare Part D plan finder, we estimated annual out-of-pocket costs under current law and under the Inflation Reduction Act's redesigned standard Part D benefit. RESULTS Under current law, out-of-pocket costs for Part D drugs ranged from $464 to $11,336 per year. Under the Inflation Reduction Act, annual out-of-pocket costs for 2 regimens remained unchanged: androgen deprivation therapy with docetaxel and androgen deprivation therapy with abiraterone and prednisone. However, out-of-pocket costs for regimens using branded novel hormonal therapy were significantly lower under the 2025 law with potential savings estimated to be $9,336 (79.2%) for apalutamide, $9,036 (78.7%) for enzalutamide, and $8,480 (76.5%) for docetaxel and darolutamide. CONCLUSIONS The $2,000 spending cap introduced by the Inflation Reduction Act may significantly decrease out-of-pocket costs and reduce financial toxicity associated with advanced prostate cancer treatment, impacting an estimated 25,000 Medicare beneficiaries.
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Affiliation(s)
- Brian D Cortese
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Wharton School of Business, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stacie B Dusetzina
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sam S Chang
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amy N Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kristen R Scarpato
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelvin A Moses
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ruchika Talwar
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
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Chang SS. Urologic Oncology: Bladder, Penis, and Urethral Cancer, and Basic Principles of Oncology. J Urol 2023; 210:217-218. [PMID: 37102734 DOI: 10.1097/ju.0000000000003465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 04/28/2023]
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25
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Chang SS, Liu XM, Lu ZN, Yao J, Yin CQ, Wu WH, Yuan F, Luo TY, Jiang ZM, Song GY. [Feasibility study of using bridging temporary permanent pacemaker in patients with high-degree atrioventricular block after TAVR]. Zhonghua Xin Xue Guan Bing Za Zhi 2023; 51:648-655. [PMID: 37312484 DOI: 10.3760/cma.j.cn112148-20221116-00898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To determine the feasibility of using temporary permanent pacemaker (TPPM) in patients with high-degree atrioventricular block (AVB) after transcatheter aortic valve replacement (TAVR) as bridging strategy to reduce avoidable permanent pacemaker implantation. Methods: This is a prospective observational study. Consecutive patients undergoing TAVR at Beijing Anzhen Hospital and the First Affiliated Hospital of Zhengzhou University from August 2021 to February 2022 were screened. Patients with high-degree AVB and TPPM were included. Patients were followed up for 4 weeks with pacemaker interrogation at every week. The endpoint was the success rate of TPPM removal and free from permanent pacemaker at 1 month after TPPM. The criteria of removing TPPM was no indication of permanent pacing and no pacing signal in 12 lead electrocardiogram (EGG) and 24 hours dynamic EGG, meanwhile the last pacemaker interrogation indicated that ventricular pacing rate was 0. Routinely follow-up ECG was extended to 6 months after removal of TPPM. Results: Ten patients met the inclusion criteria for TPPM, aged (77.0±11.1) years, wirh 7 females. There were 7 patients with third-degree AVB, 1 patient with second-degree AVB, 2 patients with first degree AVB with PR interval>240 ms and LBBB with QRS duration>150 ms. TPPM were applied on the 10 patients for (35±7) days. Among 8 patients with high-degree AVB, 3 recovered to sinus rhythm, and 3 recovered to sinus rhythm with bundle branch block. The other 2 patients with persistent third-degree AVB received permanent pacemaker implantation. For the 2 patients with first-degree AVB and LBBB, PR interval shortened to within 200 ms. TPPM was successfully removed in 8 patients (8/10) at 1 month without permanent pacemaker implantation, of which 2 patients recovered within 24 hours after TAVR and 6 patients recovered 24 hours later after TAVR. No aggravation of conduction block or permanent pacemaker indication were observed in 8 patients during follow-up at 6 months. No procedure-related adverse events occurred in all patients. Conclusion: TPPM is reliable and safe to provide certain buffer time to distinguish whether a permanent pacemaker is necessary in patients with high-degree conduction block after TAVR.
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Affiliation(s)
- S S Chang
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - X M Liu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - Z N Lu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - J Yao
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - C Q Yin
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - W H Wu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - F Yuan
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - T Y Luo
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - Z M Jiang
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - G Y Song
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
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Chang SS, Wu JH, Cui J, Hua C, Xia SJ, He L, Li X, Ning M, Hu R, Du X, Dong JZ, Ma CS. [Analysis of dyslipidemia management status in atrial fibrillation patients with very high and high risk of atherosclerotic cardiovascular disease]. Zhonghua Xin Xue Guan Bing Za Zhi 2023; 51:642-647. [PMID: 37312483 DOI: 10.3760/cma.j.cn112148-20221020-00818] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To analyze the status of statins use and low-density lipoprotein cholesterol (LDL-C) management in patients with atrial fibrillation (AF) and very high/high risk of atherosclerotic cardiovascular disease (ASCVD) from Chinese Atrial Fibrillation Registry (CAFR). Methods: A total of 9 119 patients with AF were recruited in CAFR between January 1, 2015 to December 31, 2018, patients at very high and high risk of ASCVD were included in this study. Demographics, medical history, cardiovascular risk factors, and laboratory test results were collected. In patients with very high-risk, a threshold of 1.8 mmol/L was used as LDL-C management target and in patients with high risk, a threshold of 2.6 mmol/L was used as LDL-C management target. Statins use and LDL-C compliance rate were analyzed, multiple regression analysis was performed to explore the influencing factors of statins use. Results: 3 833 patients were selected (1 912 (21.0%) in very high risk of ASCVD group and 1 921 (21.1%) in high risk of ASCVD group). The proportion of patients with very high and high risk of ASCVD taking statins was 60.2% (1 151/1 912) and 38.6% (741/1 921), respectively. Attainment rate of LDL-C management target in patients with very high and high risk were 26.7% (511/1 912) and 36.4% (700/1 921), respectively. Conclusion: The proportion of statins use and attainment rate of LDL-C management target are low in AF patients with very high and high risk of ASCVD in this cohort. The comprehensive management in AF patients should be further strengthened, especially the primary prevention of cardiovascular disease in AF patients with very high and high risk of ASCVD.
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Affiliation(s)
- S S Chang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - J H Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - J Cui
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - C Hua
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - S J Xia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - L He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - X Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - M Ning
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - R Hu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - X Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - J Z Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - C S Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
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Liao XS, Chen W, Jiang HF, Zhou J, Wei ZR, Chang SS, Zhang F, Nie KY. [Clinical effects of superficial temporal artery lobulated perforator flaps in repairing skin and soft tissue defects after temporal tumor resection]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2023; 39:534-539. [PMID: 37805768 DOI: 10.3760/cma.j.cn501225-20220816-00347] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Objective: To explore the feasibility and clinical effects of using superficial temporal artery lobulated perforator flaps in repairing skin and soft tissue defects after tumor resection in the temporal region. Methods: A retrospective observational study method was used. From March 2017 to October 2022, ten patients with temporal skin tumors were admitted to the Affiliated Hospital of Zunyi Medical University, including six women and four men, with age ranging from 42 to 87 years. Among them, three patients had squamous cell carcinoma and seven patients had basal cell carcinoma, with disease duration ranging from 6 months to 5 years. All temporal tumors underwent expanded resection, leaving wound areas of 5.4 cm×4.2 cm to 7.0 cm×4.0 cm after tumor resection. Superficial temporal artery frontal branch flaps with areas of 5.5 cm×1.2 cm to 7.0 cm×1.5 cm, superficial temporal artery descending branch flaps with areas of 4.2 cm×3.5 cm to 5.0 cm×4.0 cm, and superficial temporal artery parietal branch flaps with areas of 4.2 cm×1.0 cm to 5.0 cm×1.0 cm were designed to repair the wounds and reconstruct the hairline. The donor areas of the flaps were closed and sutured directly. The survival of the flaps was observed on 3 to 5 days after surgery, and the healing of wounds on the donor and recipient sites was observed when the stitches were removed on 5 to 7 days after surgery. During follow-up after surgery, the appearance of the temporal area, scar hyperplasia, hairline reconstruction, and tumor recurrence were observed in the temporal region on the affected side. Results: All the flaps survived well on 3 to 5 days after surgery, and all the donor and recipient site wounds healed well on 5 to 7 days after surgery. During follow-up of 3 to 6 months after surgery, the surgical incisions were concealed; the flaps were not swollen, with a consistent color to the surrounding skin; there were no obvious hypertrophic scars; the reconstructed hairline on the affected side was not significantly different from that of the healthy side; there was no tumor recurrence in the local area. Conclusions: For large areas of skin and soft tissue defects in the temporal region, the use of superficial temporal artery lobulated perforator flaps can repair the wounds in different regions and suture the donor sites in the primary stage simultaneously. The surgical operation is simple, and the facial appearance conforms to the aesthetic requirement after surgery with no tumor recurrence in the local area but a good repair effect. This method is particularly suitable for repairing large areas of skin and soft tissue defects in the temporal region in elderly patients.
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Affiliation(s)
- X S Liao
- Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - W Chen
- Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - H F Jiang
- Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - J Zhou
- Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - Z R Wei
- Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - S S Chang
- Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - F Zhang
- Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - K Y Nie
- Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
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Laviana AA, Schiftan EG, Mashni JW, Large MC, Kaimakliotis HZ, Nolte DD, Turek JJ, An R, Morgan TA, Chang SS. Biodynamic prediction of neoadjuvant chemotherapy response: Results from a prospective multicenter study of predictive accuracy among muscle-invasive bladder cancer patients. Urol Oncol 2023; 41:295.e9-295.e17. [PMID: 36522279 DOI: 10.1016/j.urolonc.2022.11.017] [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: 08/16/2022] [Revised: 11/08/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Biodynamic signatures (temporal patterns of microscopic motion within a 3-dimensional tumor explant) offer phenomic biomarkers that are highly predictive for therapeutic response. OBJECTIVE By utilizing motility contrast tomography, which provides a simple, fast assessment of motion patterns in living tissue, we evaluated the predictive accuracy of a biodynamic drug response classifier in muscle-invasive bladder cancer (MIBC) patients undergoing neoadjuvant chemotherapy (NAC). DESIGN, SETTING, AND PARTICIPANTS One hundred five consecutive bladder cancer patients suspected of having MIBC were screened in a multi-institutional prospective observational study (NCT03739177) from July 2018 to June 2020, of whom, 30 completed NAC and radical cystectomy. INTERVENTION(S) Biodynamic signatures from treatment-naïve fresh bladder tumor specimens obtained after transurethral resection were measured in living tumor fragments challenged by standard-of-care cytotoxins. Patients received gemcitabine and cisplatin or dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin per institutional guidelines and were followed through radical cystectomy. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS A 4-level classifier was developed to predict pathologic complete response (pCR) vs. incomplete response utilizing a one-left-out cross-validation protocol to minimize over-fitting. Area under the curve evaluated predictive utility. RESULTS Thirty percent (9 of 30) achieved pCR. Utilizing the 4-level classifier, biodynamically "favored" (scoring ≥ 3) and "strongly favored" (scoring 4) regimens accurately predicted pCR at rates of 66.7% (4 of 6 patients) and 100% (4 of 4 patients), respectively. Biodynamically "favored" scores predicted pCR with 88% sensitivity and 95% negative predictive value, P < 0.0001. Only 5.0% (1 of 20 patients) achieved pCR from regimens scoring 1 or 2, indicating poor to no response from NAC. Area under the receiver operating curve was 96% (95% Confidence Interval: 79%-99%, P < 0.0001). Future direction involves validating this model prospectively. PRINCIPAL CONCLUSIONS Biodynamic scoring accurately predicts response in MIBC patients receiving NAC and holds promise to substantially improve the scope of appropriate management intervention.
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Affiliation(s)
- Aaron A Laviana
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Austin at Texas, Austin, TX.
| | | | - Joseph W Mashni
- Department of Urology, Banner MD Anderson Cancer Center, Gilbert, AZ
| | - Michael C Large
- Urology of Indiana, Community Health Network, Indianapolis, IN
| | | | | | | | - Ran An
- Animated Dynamics, Inc., Indianapolis, IN
| | | | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
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Chang SS. Urologic Oncology: Bladder, Penis, and Urethral Cancer, and Basic Principles of Oncology. J Urol 2023:101097JU0000000000003540. [PMID: 37194390 DOI: 10.1097/ju.0000000000003540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
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Shinall MC, Martin SF, Karlekar M, Hoskins A, Morgan E, Kiehl A, Bryant P, Orun OM, Raman R, Tillman BF, Hawkins AT, Brown AJ, Bailey CE, Idrees K, Chang SS, Smith JA, Tan MCB, Magge D, Penson D, Ely EW. Effects of Specialist Palliative Care for Patients Undergoing Major Abdominal Surgery for Cancer: A Randomized Clinical Trial. JAMA Surg 2023:2804881. [PMID: 37163249 PMCID: PMC10173099 DOI: 10.1001/jamasurg.2023.1396] [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: 05/11/2023]
Abstract
Importance Specialist palliative care benefits patients undergoing medical treatment of cancer; however, data are lacking on whether patients undergoing surgery for cancer similarly benefit from specialist palliative care. Objective To determine the effect of a specialist palliative care intervention on patients undergoing surgery for cure or durable control of cancer. Design, Setting, and Participants This was a single-center randomized clinical trial conducted from March 1, 2018, to October 28, 2021. Patients scheduled for specified intra-abdominal cancer operations were recruited from an academic urban referral center in the Southeastern US. Intervention Preoperative consultation with palliative care specialists and postoperative inpatient and outpatient palliative care follow-up for 90 days. Main Outcomes and Measures The prespecified primary end point was physical and functional quality of life (QoL) at postoperative day (POD) 90, measured by the Functional Assessment of Cancer Therapy-General (FACT-G) Trial Outcome Index (TOI), which is scored on a range of 0 to 56 with higher scores representing higher physical and functional QoL. Prespecified secondary end points included overall QoL at POD 90 measured by FACT-G, days alive at home until POD 90, and 1-year overall survival. Multivariable proportional odds logistic regression and Cox proportional hazards regression models were used to test the hypothesis that the intervention improved each of these end points relative to usual care in an intention-to-treat analysis. Results A total of 235 eligible patients (median [IQR] age, 65.0 [56.8-71.1] years; 141 male [60.0%]) were randomly assigned to the intervention or usual care group in a 1:1 ratio. Specialist palliative care was received by 114 patients (97%) in the intervention group and 1 patient (1%) in the usual care group. Adjusted median scores on the FACT-G TOI measure of physical and functional QoL did not differ between groups (intervention score, 46.77; 95% CI, 44.18-49.04; usual care score, 46.23; 95% CI, 43.08-48.14; P = .46). Intervention vs usual care group odds ratio (OR) was 1.17 (95% CI, 0.77-1.80). Palliative care did not improve overall QoL measured by the FACT-G score (intervention vs usual care OR, 1.09; 95% CI, 0.75-1.58), days alive at home (OR, 0.87; 95% CI, 0.69-1.11), or 1-year overall survival (hazard ratio, 0.97; 95% CI, 0.50-1.88). Conclusions and Relevance This randomized clinical trial showed no evidence that early specialist palliative care improves the QoL of patients undergoing nonpalliative cancer operations. Trial Registration ClinicalTrials.gov Identifier: NCT03436290.
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Affiliation(s)
- Myrick C Shinall
- Division of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Section of Palliative Care, Vanderbilt University Medical Center, Nashville, Tennessee
- Critical Illness, Brain Dysfunction, and Survivorship Center, Nashville, Tennessee
- Surgical Service, Tennessee Valley Veterans Affairs Healthcare System, Nashville
| | - Sara F Martin
- Section of Palliative Care, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mohana Karlekar
- Section of Palliative Care, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aimee Hoskins
- Critical Illness, Brain Dysfunction, and Survivorship Center, Nashville, Tennessee
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ellis Morgan
- Critical Illness, Brain Dysfunction, and Survivorship Center, Nashville, Tennessee
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amy Kiehl
- Critical Illness, Brain Dysfunction, and Survivorship Center, Nashville, Tennessee
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Patsy Bryant
- Critical Illness, Brain Dysfunction, and Survivorship Center, Nashville, Tennessee
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Onur M Orun
- Critical Illness, Brain Dysfunction, and Survivorship Center, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rameela Raman
- Critical Illness, Brain Dysfunction, and Survivorship Center, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Benjamin F Tillman
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
- Medical Service, Tennessee Valley Veterans Affairs Healthcare System, Nashville
| | - Alexander T Hawkins
- Division of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alaina J Brown
- Division of Gynecologic Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christina E Bailey
- Division of Surgical Oncology and Endocrine Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kamran Idrees
- Division of Surgical Oncology and Endocrine Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph A Smith
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marcus C B Tan
- Division of Surgical Oncology and Endocrine Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Deepa Magge
- Division of Surgical Oncology and Endocrine Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
- Tennessee Valley Geriatrics Research Education and Clinical Center, Tennessee Valley Veterans Affairs Healthcare System, Nashville
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship Center, Nashville, Tennessee
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Tennessee Valley Geriatrics Research Education and Clinical Center, Tennessee Valley Veterans Affairs Healthcare System, Nashville
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Coleman JA, Clark PE, Bixler BR, Buckley DI, Chang SS, Chou R, Hoffman-Censits J, Kulkarni GS, Matin SF, Pierorazio PM, Potretzke AM, Psutka SP, Raman JD, Smith AB, Smith L. Diagnosis and Management of Non-Metastatic Upper Tract Urothelial Carcinoma: AUA/SUO Guideline. J Urol 2023; 209:1071-1081. [PMID: 37096584 DOI: 10.1097/ju.0000000000003480] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
PURPOSE The purpose of this guideline is to provide a useful reference on the effective evidence-based diagnoses and management of non-metastatic upper tract urothelial carcinoma (UTUC). MATERIALS/METHODS The Pacific Northwest Evidence-based Practice Center of Oregon Health & Science University (OHSU) team conducted searches in Ovid MEDLINE (1946 to March 3rd, 2022), Cochrane Central Register of Controlled Trials (through January 2022), and Cochrane Database of Systematic Reviews (through January 2022). The searches were updated August 2022. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions (Table 1).[Table: see text]Results:This Guideline provides updated, evidence-based recommendations regarding diagnosis and management of non-metastatic UTUC including risk stratification, surveillance and survivorship. Treatments discussed include kidney sparing management, surgical management, lymph node dissection (LND), neoadjuvant/adjuvant chemotherapy and immunotherapy. CONCLUSION This standardized guideline seeks to improve clinicians' ability to evaluate and treat patients with UTUC based on available evidence. Future studies will be essential to further support these statements for improving patient care. Updates will occur as the knowledge regarding disease biology, clinical behavior and new therapeutic options develop.
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Affiliation(s)
| | - Peter E Clark
- Department of Urology, Atrium Health, Charlotte, North Carolina
| | | | - David I Buckley
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Sam S Chang
- Department of Urology, Vanderbilt Health, Nashville, Tennessee
| | - Roger Chou
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | | | - Girish S Kulkarni
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Surena F Matin
- Department of Urology, MD Anderson Cancer Center, Houston, Texas
| | | | | | - Sarah P Psutka
- Department of Urology, University of Washington Medicine, Seattle, Washington
| | - Jay D Raman
- Division of Urology, Penn State Health, Hershey, Pennsylvania
| | - Angela B Smith
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Chen W, Chang SS, Zhou J, Zhang F, Yang CL, Nie KY, Deng CL, Wei ZR. [Clinical effects of antibiotic bone cement combined with free anterolateral thigh flap in sequential treatment of diabetic foot ulcer]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2023; 39:319-324. [PMID: 37805733 DOI: 10.3760/cma.j.cn501225-20220628-00267] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Objective: To investigate the clinical effects of antibiotic bone cement combined with free anterolateral thigh flap in sequential treatment of diabetic foot ulcer (DFU) wounds. Methods: A retrospective observational study was conducted. From August 2018 to August 2021, 15 patients with DFU who met the inclusion criteria were admitted to the Affiliated Hospital of Zunyi Medical University, including 12 males and 3 females, aged 42-65 years, with a history of type 2 diabetes for 5-19 years. All the wounds of patients were complicated with local bone, muscle, or tendon defects or exposure. The wounds were covered with antibiotic bone cement after debridement in stage Ⅰ+free anterolateral thigh chimeric perforator flap (perforator flap+muscle flap) or simple free anterolateral thigh flap grafting in stage Ⅱ. The defect area of the wound after bone cement removal and debridement was 9.0 cm×5.0 cm-20.0 cm×7.0 cm, the incision area of the flap was 10.0 cm×5.0 cm-22.0 cm×7.0 cm, and the incision area of the muscle flap was 5.0 cm×3.0 cm-8.0 cm×4.0 cm. The donor sites of flaps were sutured directly. During follow-up, the situations of donor site healing and flap survival were observed. At the last follow-up, the texture and shape of the flap, the presence of new ulcers on both limbs, and the walking ability of the patient were observed. Results: During the follow-up of 8 to 21 months after operation in stage Ⅱ, the donor sites healed well with only residual linear scar; flaps in 14 patients survived completely, and the flap in 1 patient developed partial necrosis at 3 weeks after stage Ⅱ surgery, which was healed after debridement and skin grafting. At the last follow-up, the flaps were good in texture and appearance, there were no new ulcers in the affected limb or opposite limb, and the patients had no obvious impairment in daily walking function. Conclusions: To repair DFU wounds with antibiotic bone cement combined with free anterolateral thigh flap can rapidly control the infection, achieving a high survival rate of flap after operation with no obvious impairment in daily walking function of patients.
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Affiliation(s)
- W Chen
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - S S Chang
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - J Zhou
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - F Zhang
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - C L Yang
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - K Y Nie
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - C L Deng
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - Z R Wei
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
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Chang SS. Urologic Oncology: Bladder, Penis, and Urethral Cancer, and Basic Principles of Oncology. J Urol 2023; 209:1228-1229. [PMID: 36950936 DOI: 10.1097/ju.0000000000003411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
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Chamie K, Chang SS, Kramolowsky EV, Gonzalgo ML, Lechpammer S, Reddy SK, Soon-Shiong P. Quality of life in QUILT 3.032 study: Patients with BCG-unresponsive non-muscle invasive bladder cancer (NMIBC) receiving IL-15RαFc superagonist N-803 plus BCG. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.495] [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: 03/16/2023] Open
Abstract
495 Background: Patients (pts) with BCG-unresponsive NMIBC have limited treatment options and are at an increased risk for cystectomy. Nogapendekin alfa inbakicept (NAI, also known as N-803), is an interleukin-15 superagonist (IL-15RαFc), which synergizes with BCG to elicit innate immune memory resulting in durable complete responses (CRs) in this patient population. In an open-label, 3-cohort, multicenter Phase 2/3 study of intravesical BCG plus NAI in BCG-unresponsive high-grade NMIBC (QUILT 3.032; NCT03022825), pts with carcinoma in situ (CIS; Cohort A) have a CR rate of 71% (median duration 26.6 months), 89.2% cystectomy avoidance and 100% bladder cancer specific survival at 24 months. We submit here the first quality of life (QOL) data report in the same pts cohort. Methods: Cohort A: 86 pts (median age 73 years; 87% male) with histologically confirmed BCG-unresponsive CIS with or without Ta/T1 disease, treated with intravesical BCG 50 mg plus NAI 400 μg. Mean baseline ECOG score was 0.183, with 82% of pts having score = 0. QOL was measured by the EORTC QOL Questionnaire Core 30 (QLQ-C30) and QOL NIMBC-Specific 24 Questionnaire (QLQ-NMIBC24). Results: Multivariate analyses have shown no significant changes over time for any of the measured QOL domains. Mild worsening vs. baseline in feeling ill was reported by 6% and 3% of pts by week 27 and 52, while 4% and 6% reported improvement. By week 78 and 104, 7% and 9% of pts reported improvement vs. baseline in their wellbeing with the majority being stable (non-significant). No statistically significant variations were detected in the physical function (PF) score (baseline vs. week 27, 52, 78 and 104). Higher PF scores were observed in pts responding to the therapy vs. non-responders; however, baseline value of PF was also higher in responders vs. non-responders. In contrast to historical results of BCG alone, week 27 physical function scores were numerically higher than baseline, with a subsequent nadir at week 78 and recovery to baseline by week 104 (non-significant). Hospitalizations for any reason remained low (0% - 6% per assessments) during the study. Conclusions: QOL measurement supports good tolerability of the intravesical NAI plus BCG in BCG-unresponsive, high-grade NMIBC pts with CIS. These results further strengthen the evidence of a favorable benefit: risk ratio of this novel combination immunotherapy, in a challenging disease. Clinical trial information: NCT03022825 .
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Smelser WW, Tallman JE, Gupta VK, Al Hussein Al Awamlh B, Johnsen NV, Barocas DA, Kline-Quiroz C, Tomlinson CA, McEvoy MD, Hamilton-Reeves J, Chang SS. Implementation of a comprehensive prehabilitation program for patients undergoing radical cystectomy. Urol Oncol 2023; 41:108.e19-108.e27. [PMID: 36404231 DOI: 10.1016/j.urolonc.2022.10.017] [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: 05/04/2022] [Revised: 09/11/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Coordinated preoperative optimization programs for radical cystectomy (RC) are limited and non-comprehensive. We evaluated the feasibility and acceptability of a coordinated, multi-faceted prehabilitation program for RC patients at a high-volume bladder cancer referral center. METHODS We performed a narrative literature review for prehabilitation in bladder cancer management as of December 1, 2020, with specific emphasis on examining higher-level evidence sources. We selected domains with the highest level of evidence and recruited a multidisciplinary team of experts to design our program. We implemented a comprehensive prehabilitation program with a pre-defined order set as standard of care for all patients undergoing RC beginning February 1, 2021. Demographic and clinicopathologic data were collected prospectively. Rates of adherence to the prehabilitation program services were analyzed using Stata version 13. RESULTS A total of 82 patients were enrolled between February - December 2021, of which 67 (81%) had undergone RC at data cutoff. Mean age was 68 years (SD 11) and 63 (76%) identified as male. Neoadjuvant chemotherapy (NAC) was utilized in 48 (59%) patients. The mean Charlson Comorbidity Index was 3.8 (SD 2.3). 100% of patients were screened for malnutrition, with 82% consuming nutritional supplements. Fifty-two percent of patients attended physical therapy pre-op. The 30-day and 30- to 90-day rates of complications were 56% and 40%, respectively. Resource length of stay (RLOS) declined after implementation of prehabilitation. CONCLUSIONS Implementation of a comprehensive prehabilitation program at a high-volume bladder cancer referral center is feasible and has a modest effect on resource consumption and complications in our early experience.
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Affiliation(s)
- Woodson W Smelser
- Division of Urology, Washington University in St. Louis, MISSOURI, Saint Louis, MO.
| | | | | | | | | | | | - Cristina Kline-Quiroz
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center
| | - Carey A Tomlinson
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center
| | - Matthew D McEvoy
- Department of Anesthesiology, Vanderbilt University Medical Center
| | | | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center
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Liu XM, Yao J, Dong Z, Yin CQ, Wu WH, Yuan F, Luo TY, Chang SS, Yan YF, Pu JZ, Song GY. [Transcatheter aortic valve replacement via single-vessel approach technique:a case report]. Zhonghua Xin Xue Guan Bing Za Zhi 2023; 51:73-75. [PMID: 36655245 DOI: 10.3760/cma.j.cn112148-20221130-00947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- X M Liu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
| | - J Yao
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
| | - Z Dong
- Integrated Traditional and Western Medicine Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - C Q Yin
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
| | - W H Wu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
| | - F Yuan
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
| | - T Y Luo
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
| | - S S Chang
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
| | - Y F Yan
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
| | - J Z Pu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
| | - G Y Song
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
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Chang SS. Bladder, Penis, and Urethral Cancer, and Basic Principles of Oncology. J Urol 2023; 209:101097JU0000000000003163. [PMID: 36683572 DOI: 10.1097/ju.0000000000003163] [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] [Received: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 01/24/2023]
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Chamie K, Chang SS, Kramolowsky E, Gonzalgo ML, Agarwal PK, Bassett JC, Bjurlin M, Cher ML, Clark W, Cowan BE, David R, Goldfischer E, Guru K, Jalkut MW, Kaffenberger SD, Kaminetsky J, Katz AE, Koo AS, Sexton WJ, Tikhonenkov SN, Trabulsi EJ, Trainer AF, Spilman P, Huang M, Bhar P, Taha SA, Sender L, Reddy S, Soon-Shiong P. IL-15 Superagonist NAI in BCG-Unresponsive Non-Muscle-Invasive Bladder Cancer. NEJM Evid 2023; 2:EVIDoa2200167. [PMID: 38320011 DOI: 10.1056/evidoa2200167] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
IL-15 Superagonist NAI in BCG-Unresponsive NMIBCIn this trial, patients with BCG-unresponsive bladder CIS with or without Ta/T1 papillary disease or BCG-unresponsive high-grade Ta/T1 papillary NMIBC were treated with intravesical NAI, an IL-15 superagonist, plus BCG. Primary end points were CR at 3 or 6 months for patients with CIS disease and DFS rate at 12 months for those with high-grade Ta/T1 disease. CR rate was 71% (58 of 82 patients), and the DFS rate was 55.4%.
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Affiliation(s)
- Karim Chamie
- Department of Urology, UCLA Medical Center, Los Angeles
| | - Sam S Chang
- Department of Urology, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville
| | | | - Mark L Gonzalgo
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami
| | | | - Jeffrey C Bassett
- Hoag Urologic Oncology, Hoag Memorial Presbyterian Hospital, Newport Beach, CA
| | - Marc Bjurlin
- Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Michael L Cher
- Department of Urology, Wayne State University, Detroit
- Karmanos Cancer Center, Detroit
| | | | | | - Richard David
- Genesis Healthcare Partners, Greater Los Angeles Division, Sherman Oaks, CA
| | | | - Khurshid Guru
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Mark W Jalkut
- Associated Urologists of North Carolina, Raleigh, NC
| | | | | | | | - Alec S Koo
- Genesis Healthcare Partners, Torrance, CA
| | | | | | - Edouard J Trabulsi
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia
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Anderson CB, Chen L, Chang SS, McKiernan JM, Wright J. Intravesical Therapy Compared to Radical Cystectomy Among Patients With Non-Muscle Invasive Bladder Cancer Requiring Additional Treatment After Induction BCG. Clin Genitourin Cancer 2022; 20:595-603. [PMID: 35948482 DOI: 10.1016/j.clgc.2022.07.001] [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: 05/23/2022] [Accepted: 07/05/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Many patients with recurrent high-risk non-muscle invasive bladder cancer after intravesical bacillus calmette-guerin (BCG) face a difficult decision between radical cystectomy (RC) or salvage intravesical therapy (IVT). We sought to determine if there is a difference in overall survival RC and IVT after previous treatment with BCG. METHODS We performed a retrospective cohort study of patients with Ta, T1, and Tis bladder cancer treated with induction BCG in the SEER-Medicare dataset from 2000 to 2015. We used a proportional hazards regression model to compare differences in survival between patients having RC and IVT. We adjusted for confounding using a propensity score and stratified our analysis according to timing of treatment and stage at diagnosis. RESULTS We identified 3940 patients who received either IVT (79%) or RC (21%) following induction BCG. Among patients treated within 12 months of BCG, there was no significant difference in survival between RC and IVT (HR 0.92, 95% CI 0.81-1.04) and 17% of patients having early IVT ultimately required RC. Among patients treated at least 12 months after BCG, RC was associated with worse survival than IVT (HR 1.19, 95% CI 1.06-1.35) and 10% of patients having late IVT ultimately required RC. CONCLUSION Among patients with bladder cancer who required additional treatments after induction BCG, we did not observe a difference in overall survival between IVT and RC within 12 months of starting BCG. While RC remains the gold-standard for high risk recurrent NMIBC after BCG, bladder preservation with IVT may be appropriate for well-selected patients.
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Affiliation(s)
- Christopher B Anderson
- Department of Urology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY.
| | - Ling Chen
- Department of Gynecology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY
| | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - James M McKiernan
- Department of Urology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY
| | - Jason Wright
- Department of Gynecology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY
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Li Q, Liu GS, Chang SS, Guo DP, Yang F. [Association among urinary polycyclic aromatic hydrocarbons metabolites, SAHH activity and H19 expression in coke oven workers]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2022; 40:801-806. [PMID: 36510712 DOI: 10.3760/cma.j.cn121094-20210910-00451] [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] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: To investigate the relationship of polycyclic aromatic hydrocarbons (PAHs) exposure, S-adenosylhomocysteine hydrolase (SAHH) activity and long noncoding RNA H19 gene expression in the urine of coke oven workers. Methods: In September 2019, in a coking plant in Taiyuan City, 146 male workers who had worked in coke oven operations for one year were selected through a completely random sampling method, and their basic personal information was collected by questionnaire survey, and blood and urine samples were collected. The levels of 4 PAHs metabolites 2-hydroxfluorene (2-FLU), 2- hydroxynaphthalene (2-NAP), 9-hydroxyphenanthren (9-PHE), and 1-hydroxypyrene (1-OHP) in urine were detected by high performance liquid chromatography (HPLC) -fluorescence detection method. HPLC-UV detection method was used to detect the content of S-adenosylmethionine (SAM) and S-adenosylhomocysteine (SAH) in plasma, and the SAHH activity value was obtained by calculating the ratio. Reverse transcription PCR method was used to determine the H19 gene expression level. Urine levels of 2-FLU, 2-NAP, 9-PHE, and 1-OHP were divided into Q(1), Q(2), Q(3), and Q(4) groups according to quartiles (P(25), P(50), P(75)). Regression, trend test and restricted cubic splines were used to analyze the relationship among PAHs metabolites, SAHH activity, H19 gene expression and their dose-response. Results: The median age of coke oven workers was 39.60 years old, the median length of service was 20.38 years, and the urinary levels of 2-FLU, 2-NAP, 9- PHE, and 1-OHP were 0.29, 0.74, 0.09, and 0.06 μg/mmol Cr, respectively. The levels of 2-FLU, 2-NAP and 9-PHE in the urine of workers were significantly different between groups with different 1-OHP levels (P<0.05). After adjusting for age, length of service, smoking, drinking, and levels of 2-FLU, 2-NAP and 9-PHE, SAHH activity decreased with the increase of urinary 1-OHP level (OR=0.63, 95%CI: 0.41-0.98, P=0.038), showing a nonlinear relationship (P(nonlinear)= 0.030). H19 gene expression increased with the increase of urinary 1- OHP level (OR=1.51, 95%CI: 1.03-2.19, P=0.033), there was a linear relationship (P(trend)= 0.058). The relationship between the other three metabolites in urine and SAHH activity and H19 gene expression was not statistically significant (P>0.05) . Conclusion: Urinary 1-OHP level may be a risk factor for decreased SAHH activity and increased H19 gene expression in coke oven workers.
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Affiliation(s)
- Q Li
- Office of Occupational Disease Prevention and Control, Corporation of Xishan Coal Electricity Group Co. Ltd., Taiyuan 030053, China
| | - G S Liu
- Office of Occupational Disease Prevention and Control, Corporation of Xishan Coal Electricity Group Co. Ltd., Taiyuan 030053, China
| | - S S Chang
- Analysis & Inspection Center of Occupational Disease Prevention and Control, Corporation of Xishan Coal Electricity Group Co. Ltd., Taiyuan 030053, China
| | - D P Guo
- Analysis & Inspection Center of Occupational Disease Prevention and Control, Corporation of Xishan Coal Electricity Group Co. Ltd., Taiyuan 030053, China
| | - F Yang
- Scientific Research Center of Occupational Disease Prevention and Control, Corporation of Xishan Coal Electricity Group Co. Ltd., Taiyuan 030053, China
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Barrett TW, Garland NM, Freeman CL, Klar K, Dahlke J, Lancaster P, Prisco L, Chang SS, Goff LW, Russ S, Jones ID. Catching Those Who Fall Through the Cracks: Integrating a Follow-Up Process for Emergency Department Patients with Incidental Radiologic Findings. Ann Emerg Med 2022; 80:235-242. [PMID: 35752517 DOI: 10.1016/j.annemergmed.2022.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 11/01/2022]
Abstract
STUDY OBJECTIVE Abnormal findings unrelated to the indication for testing are identified on emergency department (ED) imaging studies. We report the design and implementation of an electronic health record-based interdisciplinary referral system and our experience from the first 13 months of ensuring that patients with incidental radiology findings were connected with the appropriate outpatient surveillance. METHODS Our informatics team standardized the contemporaneous reporting of critical radiology alerts using our ED trackboard and created a companion follow-up request form for the treating ED clinicians to complete. The forms were routed to nurse case managers, who arranged follow-ups based on the findings and clinical significance. The primary outcome was the proportion of ED patient visits with identified incidental findings that had documented communication of the incidental findings and surveillance plans. RESULTS Over the first 13 months after implementation, 932 ED patient visits had critical radiology alert referrals, for a total of 982 incidental findings. The primary outcome (confirmed post-ED communication and documented follow-up plan) was attained in 888 (95.3%, 95% confidence interval [CI] 93.9% to 96.6%) ED patient visits with confirmed post-ED communication and documented follow-up plans. The team was unable to contact or confirm follow-up with 44 (4.7%, 95% CI 3.4 to 6.1) patients by telephone or through the health care system's electronic communication tools. CONCLUSION We report the implementation of a standardized notification and referral system for ED patients with incidental radiology findings. The development of a reliable notification and follow-up system is an important patient safety intervention given the opportunity to potentially identify undiagnosed malignancies.
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Affiliation(s)
- Tyler W Barrett
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN.
| | - Nicholas M Garland
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Clifford L Freeman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Katharine Klar
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Jan Dahlke
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Penny Lancaster
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Larry Prisco
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Sam S Chang
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Laura W Goff
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Stephan Russ
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Ian D Jones
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
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Chamie K, Chang SS, Gonzalgo M, Kramolowsky EV, Sexton WJ, Bhar P, Reddy SK, Soon-Shiong P. Final clinical results of pivotal trial of IL-15RαFc superagonist N-803 with BCG in BCG-unresponsive CIS and papillary nonmuscle-invasive bladder cancer (NMIBC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4508] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4508 Background: Patients with NMIBC CIS unresponsive to BCG have limited treatment options. N-803 (Anktiva) is a mutant IL-15-based immunostimulatory fusion protein complex (IL15RaFc) that promotes proliferation and activation of natural killer (NK) cells and CD8+ T cells, but not regulatory T cells. Phase 1b data in BCG-naïve patients with NMIBC demonstrate that intravesical administration of N-803 with BCG induced complete response in all patients, without recurrences for the study duration of 24 months. Pembrolizumab was approved in 2020 with a 41% complete response (CR) rate in a single arm phase 2 trial of 96 patients. We report data on 160 subjects from an open-label, 3 cohort multicenter study (QUILT 3.032) of intravesical BCG plus N-803 in patients with BCG-unresponsive high-grade NMIBC (NCT03022825). Methods: All treated patients received intravesical N-803 plus BCG, consistent with the standard induction/maintenance treatment schedule. The primary endpoint for Cohort A (CIS) is incidence of CR of CIS at any time. The primary endpoint for Cohort B (Papillary) is disease-free rate (DFS) at 12 months. Results: To date, we enrolled 160 patients (83 CIS, 77 Papillary). In the overall population, median age is 72.3 years, 81% male, with mean number of prior TURBT = 4. Median number of prior BCG doses = 12. CIS patients have a CR rate of 71% (59/83), with a mediation duration of CR of 24.1 months in responders; 91% avoided cystectomy and 96% 24 month bladder cancer specific progression free survival (defined as progression to MIBC). Papillary patients have a 57% 12 month DFS rate, 48% 24 month DFS rate, and 95% avoided cystectomy. Median time to cystectomy in responders (N = 4) is 12.9 months versus 7.8 in non-responders (N = 8) for a 5.1 month delay in cystectomy. PK data shows no systemic levels of N-803; activity is confined to the bladder. Low grade treatment related AEs (grade 1-2) include dysuria (22%), pollakiurua (19%), hematuria (18%), fatigue (16%), and urgency (12%), all other AEs were seen at 7% or less. No treatment related grade 4 or 5 AE were seen. No SAE's were considered treatment related. No immune related SAE's have been seen. Conclusions: In 160 patients with BCG-unresponsive NMIBC, there is a 99% bladder cancer specific overall survival at 2 years. In CIS patients 71% CR rate with 24.1 months median duration of response, and 53% DFS rate at 18 months in Papillary disease. Cystectomy was avoided in over 90% of patients with 2 years of follow-up. The efficacy and safety profile of N-803+BCG exceeds that of other available intravesical and systemic options for BCG-unresponsive NMIBC. Clinical trial information: NCT03022825.
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Affiliation(s)
- Karim Chamie
- Department of Urology, University of California-Los Angeles, Los Angeles, CA
| | | | | | | | - Wade J. Sexton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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Tucker MD, Chen YW, Yasin HA, Ancell KK, Barocas DA, Beckermann K, Chang SS, Davis NB, Jessop A, Kaiser E, Kirschner AN, Kluwe CA, Luckenbaugh A, Moses KA, Penson DF, Sherer P, Smelser W, Wallace D, Schaffer K, Rini BI. Impact of PSMA-targeted PET/CT in the clinical management of men with advanced prostate cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e17053] [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
e17053 Background: 18F-DCFPyL (piflufolastat F 18) is a PSMA-targeted agent FDA-approved for PET imaging in men with prostate cancer. Given the recent availability for clinical use, we sought to evaluate the impact and potential changes in management after the incorporation of 18F-DCFPyL (PyL) PET/CT at an academic medical center. Methods: We reviewed the first 100 PyL PET/CT scans performed at the Vanderbilt-Ingram Cancer Center for men with prostate adenocarcinoma. Patient demographics, treatment history, and prior imaging results were recorded, along with PyL PET results, most recent PSA, and clinical management plans. Management changes were designated as change in systemic therapy, radiation, or surgery and were determined by two independent reviewers with a third reviewer for any discordant cases. Results: There were 100 men included with PyL PET scans dating from 9/1/21 to 12/31/21. The median age was 69 years, 76% of patients were white and 13% were black. The median Gleason sum at diagnosis was 7 (4+3), 55% of men had prior prostatectomy, and 38% had prior radiation to the prostate/pelvis. The median PSA prior to PyL PET scan was 1.86 (IQR 0.53-9.95 ng/mL), 32% of men had previous ADT exposure, and 15% were on ADT at the time of PyL PET scan. The clinical setting prior to PyL PET scan was initial staging 22%, biochemical recurrence 59%, m1HSPC 14%, m0CRPC 2%, and m1CRPC 3%. There were 16 patients who had a prior 18F-fluciclovine within six months of PyL PET; of these 69% (11/16) had additional disease on PyL PET not previously identified. Activity in lymph nodes was observed in 48%, bone 37%, visceral sites 3%, prostate/prostate bed 46%, and 15% had no PSMA-avid disease. Clinical staging was altered after the PyL PET scan in 55% of patients, with the most common change being from BCR to m1HSPC (40/55). Clinical management was altered in 59% of cases: systemic therapy 38%, radiation planning 46%, and surgical planning 6% (Table). Conclusions: Clinical management was affected in 59% of cases after implementation of PyL PET in this retrospective, single center review. Given the rapid adoption of PSMA-targeted PET imaging agents, further studies are needed to evaluate the clinical impact of subsequent changes to management planning, as well as to develop multidisciplinary consensus statements and protocols to guide management.[Table: see text]
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Affiliation(s)
| | - Yu-Wei Chen
- Vanderbilt Ingram Cancer Center, Nashville, TN
| | | | | | - Daniel Ari Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Sam S. Chang
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Aaron Jessop
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN
| | | | - Austin Noah Kirschner
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN
| | | | - Amy Luckenbaugh
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Kelvin A. Moses
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - David F. Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Philip Sherer
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN
| | - Woodson Smelser
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
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Smelser WW, Tallman JE, Gupta V, Chang SS. QIM22-205: Implementation of a Comprehensive Pre-Habilitation Program for Patients Undergoing Radical Cystectomy. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7135] [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: 11/17/2022]
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Chang SS, Chamie K, Gonzalgo ML, Kramolowsky EV, Sexton WJ, Reddy SK, Bhar P, Huang M, Soon-Shiong P. Positive efficacy and safety phase 3 results in both CIS and papillary cohorts BCG-unresponsive nonmuscle invasive bladder cancer (NMIBC) after IL-15RαFc superagonist N-803 (Anktiva) and BCG infusion. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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
431 Background: N-803, a high affinity IL-15 immunostimulatory fusion protein promotes proliferation and activation of natural killer (NK) cells and CD8+ T cells, but not T reg cells. Phase 1b trial demonstrated that intravesical N-803 with BCG induced complete response in all BCG-Naïve NMIBC patients, without recurrences for 24 months. An open-label, multicenter Phase 3 study (QUILT 3.032) of intravesical BCG plus N-803 in patients with BCG-unresponsive high-grade NMIBC (NCT03022825) with CIS and Papillary disease is reported. At ASCO GU 2021 we reported on CIS Cohort A and report here the full enrollment of CIS (n = 81), interim analysis of Papillary Cohort B (n = 73) and the combined efficacy and safety results in BCG unresponsive NMIBC (n = 154). Methods: All treated patients received intravesical N-803 plus BCG. The primary endpoints for papillary and CIS are disease free rate at 12 months and complete response respectively. Secondary endpoints are duration of response and cystectomy free rate. Results: Cohort A (CIS) Efficacy: Fully enrolled n = 81 with a 20.9 month median follow-up. CR rate 72% (95% CI: 60.5%, 81.1%) with median duration for 3-month responders of 24.1 months and a 60% probability of maintaining this CR for ≥ 18-months (95% CI: 43.1%, 73.5%). 12-month cystectomy free rate is 89% (95% CI: 80.1%, 94.6%), with a 100% cancer specific survival at 24-months. Cohort B (Papillary) Efficacy: To date, 73 patients have enrolled with a median follow-up of 17.3 months. The primary endpoint was met with a disease free rate at 12-months is 57% (95% CI: 43.7%, 68.5%) and at 18-months 53% (95% CI: 38.8%, 64.8%). 12-month cystectomy free rate is 95% (95% CI: 84.7%, 98.3%), with a 98% cancer specific survival at 24-months. Combined Efficacy: In the combined group (n = 154) of BCG unresponsive NMIBC, with a 19.3 months median follow-up, the 12 month cystectomy free rate was 92% (95% CI: 85.5%, 95.3%) and the 24 month OS is 94% (95% CI: 86.9%, 97.1%) with 99.5% cancer specific overall survival. Combined Safety: There were 0% treatment related SAE’s and 0% immune related SAE’s, with 4/ 154 (3%) ≥ TR Grade 3 AEs. 0% treatment related deaths have occurred as of Sept 2021 analysis date. Conclusions: N-803 and BCG was safe and well tolerated with zero percent treatment related or immune related SAEs. The primary end points of both CIS and Papillary disease were met with CR rate of 72% and 12 month Disease free rate of 57% respectively. Durable responses were noted in both cohorts and the therapy resulted in significant avoidance of cystectomy with a cystectomy free rate of 92% and a 24 month cancer specific survival of 99.5% Given the observed strong efficacy and favorable AE profile and mode of administration, N-803 represents a significant advance in the treatment option compared to existing therapies for BCG unresponsive CIS and Papillary NMIBC. Clinical trial information: NCT03022825.
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Affiliation(s)
- Sam S. Chang
- Vanderbilt University Medical Center, Nashville, TN
| | - Karim Chamie
- University of California Los Angeles, Los Angeles, CA
| | - Mark L. Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
| | | | - Wade J. Sexton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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Kamat AM, Lobo N, Lerner SP, Li R, Matulay JT, Palou J, Witjes JA, Rouprêt M, Smith AB, Chang SS, Shore ND, Steinberg GD, Dinney CP, Svatek RS, Lamm DL. Reduced Dose Intravesical Bacillus Calmette-Guérin: Why It Might Not Matter. Bladder Cancer 2022. [DOI: 10.3233/blc-211648] [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: 11/15/2022]
Abstract
When it comes to the treatment of patients with non-muscle-invasive bladder cancer (NMIBC) with intravesical bacillus Calmette-Guérin (BCG), two questions must be considered: 1) what dose to give, and 2) for how long? The issue of optimal dose and duration has been the subject of several randomized trials and is especially pertinent in the context of a global BCG shortage. Despite this, there appears to be uncertainty as to whether BCG dose or duration may be compromised in the event of shortage. As such, we wish to summarize the available evidence as an aid to the practicing urologist.
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Affiliation(s)
- Ashish M. Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Niyati Lobo
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Seth P. Lerner
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Roger Li
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Justin T. Matulay
- Department of Urology, Levine Cancer Institute/Atrium Health, Charlotte, NC, USA
| | - Joan Palou
- Department of Urology, Fundacio Puigvert, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - J. Alfred Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Morgan Rouprêt
- Urology, GRC n°5, Predictive ONCO-URO, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Angela B. Smith
- Department of Urology, University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Sam S. Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Neal D. Shore
- Department of Urology, Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | | | - Colin P. Dinney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert S. Svatek
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Donald L. Lamm
- Department of Surgery, University of Arizona and BCG Oncology, Phoenix, AZ, USA
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Cabo JJ, Tallman JE, Koch GE, Scarpato KR, Chang SS. How a Large Academic Training Program Influences Early Career Decision-making and Employment Stability in Urology. Urology 2022; 165:106-112. [DOI: 10.1016/j.urology.2022.01.002] [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] [Received: 08/18/2021] [Revised: 11/21/2021] [Accepted: 01/03/2022] [Indexed: 11/27/2022]
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Chang S, Handwerker J, Giannico GA, Chang SS, Bowden AK. Birefringent tissue-mimicking phantom for polarization-sensitive optical coherence tomography imaging. J Biomed Opt 2022; 27:074711. [PMID: 35064658 PMCID: PMC8781524 DOI: 10.1117/1.jbo.27.7.074711] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
SIGNIFICANCE Tissue birefringence is an important parameter to consider when designing realistic, tissue-mimicking phantoms. Options for suitable birefringent materials that can be used to accurately represent tissue scattering are limited. AIM To introduce a method of fabricating birefringent tissue phantoms with a commonly used material-polydimethylsiloxane (PDMS)-for imaging with polarization-sensitive optical coherence tomography (PS-OCT). APPROACH Stretch-induced birefringence was characterized in PDMS phantoms made with varying curing ratios, and the resulting phantom birefringence values were compared with those of biological tissues. RESULTS We showed that, with induced birefringence levels up to 2.1 × 10 - 4, PDMS can be used to resemble the birefringence levels in weakly birefringent tissues. We demonstrated the use of PDMS in the development of phantoms to mimic the normal and diseased bladder wall layers, which can be differentiated by their birefringence levels. CONCLUSIONS PDMS allows accurate control of tissue scattering and thickness, and it exhibits controllable birefringent properties. The use of PDMS as a birefringent phantom material can be extended to other birefringence imaging systems beyond PS-OCT and to mimic other organs.
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Affiliation(s)
- Shuang Chang
- Vanderbilt University, Vanderbilt Biophotonics Center, Department of Biomedical Engineering, Nashville, Tennessee, United States
| | - Jessica Handwerker
- Vanderbilt University, Vanderbilt Biophotonics Center, Department of Biomedical Engineering, Nashville, Tennessee, United States
| | - Giovanna A. Giannico
- Vanderbilt University Medical Center, Department of Pathology, Microbiology, and Immunology, Nashville, Tennessee, United States
| | - Sam S. Chang
- Vanderbilt University Medical Center, Department of Urology, Nashville, Tennessee, United States
| | - Audrey K. Bowden
- Vanderbilt University, Vanderbilt Biophotonics Center, Department of Biomedical Engineering, Nashville, Tennessee, United States
- Vanderbilt University, Department of Electrical and Computer Engineering, Nashville, Tennessee, United States
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Sui W, Hall ME, Barocas DA, Chang SS, Luckenbaugh AN, Moses KA, Penson DF, Wallis CJD, Laviana AA. Association Between Surgical Volume and Survival Among Patients With Variant Histologies of Bladder Cancer. Urology 2021; 159:100-106. [PMID: 34606878 DOI: 10.1016/j.urology.2021.09.009] [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] [Received: 05/10/2021] [Revised: 08/14/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine the relationship between hospital volume and the management of bladder cancer variant histology. Variant histologies of bladder cancer are rare which limits the ability for providers to develop expertise however there is a clear hospital and/or surgeon-volume relationship for management of rare or complex surgical and/or medical diseases. METHODS We queried the National Cancer Database from 2004-2016 for all cases of bladder cancer, identifying cases of variant histology. Our primary outcome was overall survival while secondary outcomes included identifying treatment patterns. Hospitals were stratified into those that managed ≤2, >2-4, >4-6, and ≥6 cases per year of variant histology. RESULTS We identified 23,284 patients with bladder cancer of variant histology who were treated at 1301 hospitals. Few institutions had high volume experience with this disease: 18.5% (n = 241) treated >2 patients annually and 5.7% (n = 76) treated >4 cases annually. Hospital volume positively correlated with utilization of early radical cystectomy (RC) in non-muscle invasive disease and neoadjuvant chemotherapy in muscle-invasive disease. On multivariable analysis, increased hospital volume was associated with improved survival. After stratifying by sub-type, hospital volume continued to be associated with improved survival for squamous, small cell, and sarcomatoid cancers. CONCLUSION Management of variant histology urothelial carcinoma at high-volume centers is associated with improved overall survival. The mechanisms of this are multifactorial, and future research should focus on improvement opportunities for low-volume hospitals, centralization of care, and/or increased access to care at high-volume centers.
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Affiliation(s)
- Wilson Sui
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Mary E Hall
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Amy N Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Kelvin A Moses
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | | | - Aaron A Laviana
- Department of Surgery & Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX.
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Kirschner AN, Wang J, Rajkumar-Calkins A, Neuzil KE, Chang SS. Intravesical Anti-PD-1 Immune Checkpoint Inhibition Treats Urothelial Bladder Cancer in a Mouse Model. J Urol 2021; 205:1336-1343. [PMID: 33356477 PMCID: PMC8112465 DOI: 10.1097/ju.0000000000001576] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Nonmuscle-invasive bladder cancer is treated by resection within the bladder and bladder instillment with bacillus Calmette-Guérin or chemotherapy. For bacillus Calmette-Guérin-refractory disease, systemic anti-PD-1 (programmed cell death protein 1) immune checkpoint inhibition is a treatment. Our aim is to test whether intravesical instillment with anti-PD-1 inhibitor treats localized bladder cancer as effectively as systemic administration. MATERIALS AND METHODS We investigated an orthotopic mouse model of urothelial bladder cancer using MBT2 cells instilled into the bladders of syngeneic, wild-type C3H mice. Groups of 10 mice received each treatment for comparison of intravesical anti-PD-1, intraperitoneal anti-PD1, and intravesical chemotherapy. The primary outcome was overall survival and secondary outcomes included long-term immunity and toxicity. RESULTS Anti-PD-1 administered by bladder instillment (intravesical route) successfully treats localized bladder cancer and has similar overall survival to anti-PD-1 by systemic route. Anti-PD-1 by either route provides a significant survival advantage over control antibody. Anti-PD-1 increases CD8+ cell infiltration in tumors, particularly when administered intravesically. Antibody treatment avoids toxicity observed for intravesical chemotherapy. Mice who cleared their tumors after initial treatment were rechallenged with tumor engraftment 3-9 months later without any additional treatment. Initial anti-PD-1-treated mice did not grow tumors when rechallenged, which suggests long-term immunity exists, but initial mitomycin-treated mice readily grew tumors indicating no immunity occurred by chemotherapy treatment. CONCLUSIONS Intravesical administration of anti-PD-1 is a promising treatment route for localized bladder cancer, with comparable overall survival to systemic anti-PD-1 in this mouse model. Intravesical anti-PD-1 increases CD8+ T cells in treated tumors and long-term immunity was seen to tumor rechallenge.
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Affiliation(s)
- Austin N. Kirschner
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA 37232
| | - Jian Wang
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA 37232
| | - Anne Rajkumar-Calkins
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA 37232
| | - Kevin E. Neuzil
- Vanderbilt University School of Medicine, Nashville, TN, USA 37232
| | - Sam S. Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, 37232
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