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McIlwaine SV, Mughal S, Ferrari M, Rosengard R, Malla A, Iyer S, Lepage M, Joober R, Shah JL. Pre-onset subthreshold psychotic symptoms are associated with differential treatment delays before a first episode of psychosis: Initial evidence and implications. Schizophr Res 2024; 264:549-556. [PMID: 38335764 DOI: 10.1016/j.schres.2024.01.036] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/08/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Help-seeking and treatment delays are increasingly critical areas of study in mental health services. The duration of untreated psychosis (DUP), or the time between illness onset and initiation of treatment, is a predictor of symptom remission and functioning for a first episode of psychosis (FEP). The World Health Organization recommends that specialized treatment for psychosis be initiated within the first three months of FEP onset. As a result, research has focused on factors that are associated with threshold-level DUP, while the experience of subthreshold psychotic symptoms (STPS) prior to a FEP may also complicate and present barriers to accessing care for young people. We therefore examine the possibility that STPS can impact DUP and its components. METHOD Using a follow-back cross-sectional design, we sought to describe duration of untreated illness, length of prodrome, DUP, help-seeking delay, referral delay, and number of help-seeking contacts among FEP patients who did and did not have STPS prior to psychosis onset. RESULTS We found that patients who experienced STPS had a longer median duration of untreated illness, prodrome length, DUP, and help-seeking delay compared to patients who did not have such symptoms. Referral delay did not differ substantially between the two groups. Importantly, treatment delays were extremely lengthy for many participants. CONCLUSIONS Pre-onset STPS are associated with help-seeking delays along the pathway to care even during a FEP. Examining early signs and symptoms may help to improve and tailor interventions aimed at reducing treatment delays and ultimately providing timely care when the need arises.
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Affiliation(s)
- S V McIlwaine
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Canada; Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada.
| | - S Mughal
- Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
| | - M Ferrari
- Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
| | - R Rosengard
- Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
| | - A Malla
- Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
| | - S Iyer
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Canada; Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
| | - M Lepage
- Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada; Department of Psychology, McGill University, Canada
| | - R Joober
- Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
| | - J L Shah
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Canada; Prevention and Early Intervention for Psychosis Programme (PEPP-Montreal), Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
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2
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Chauvin M, Meinsohn MC, Dasari S, May P, Iyer S, Nguyen NMP, Oliva E, Lucchini Z, Nagykery N, Kashiwagi A, Mishra R, Maser R, Wells J, Bult CJ, Mitra AK, Donahoe PK, Pépin D. Cancer-associated mesothelial cells are regulated by the anti-Müllerian hormone axis. Cell Rep 2023; 42:112730. [PMID: 37453057 DOI: 10.1016/j.celrep.2023.112730] [Citation(s) in RCA: 2] [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] [Received: 11/23/2022] [Revised: 04/27/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
Cancer-associated mesothelial cells (CAMCs) in the tumor microenvironment are thought to promote growth and immune evasion. We find that, in mouse and human ovarian tumors, cancer cells express anti-Müllerian hormone (AMH) while CAMCs express its receptor AMHR2, suggesting a paracrine axis. Factors secreted by cancer cells induce AMHR2 expression during their reprogramming into CAMCs in mouse and human in vitro models. Overexpression of AMHR2 in the Met5a mesothelial cell line is sufficient to induce expression of immunosuppressive cytokines and growth factors that stimulate ovarian cancer cell growth in an AMH-dependent way. Finally, syngeneic cancer cells implanted in transgenic mice with Amhr2-/- CAMCs grow significantly slower than in wild-type hosts. The cytokine profile of Amhr2-/- tumor-bearing mice is altered and their tumors express less immune checkpoint markers programmed-cell-death 1 (PD1) and cytotoxic T lymphocyte-associated protein 4 (CTLA4). Taken together, these data suggest that the AMH/AMHR2 axis plays a critical role in regulating the pro-tumoral function of CAMCs in ovarian cancer.
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Affiliation(s)
- M Chauvin
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - M-C Meinsohn
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - S Dasari
- Indiana University School of Medicine-Bloomington, Indiana University, Bloomington, IN, USA
| | - P May
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, MA, USA
| | - S Iyer
- Whitehead Institute for Biomedical Research, Cambridge, MA, USA
| | - N M P Nguyen
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - E Oliva
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Z Lucchini
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, MA, USA
| | - N Nagykery
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - A Kashiwagi
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - R Mishra
- Whitehead Institute for Biomedical Research, Cambridge, MA, USA
| | - R Maser
- Mouse Genome Informatics, The Jackson Laboratory, Bar Harbor, ME, USA
| | - J Wells
- Mouse Genome Informatics, The Jackson Laboratory, Bar Harbor, ME, USA
| | - C J Bult
- Mouse Genome Informatics, The Jackson Laboratory, Bar Harbor, ME, USA
| | - A K Mitra
- Indiana University School of Medicine-Bloomington, Indiana University, Bloomington, IN, USA
| | - Patricia K Donahoe
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - D Pépin
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA; Mouse Genome Informatics, The Jackson Laboratory, Bar Harbor, ME, USA.
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3
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Mikulski M, Iyer S, Well A, Subramanian S, Mery C, Owens W, Glass L, Castleberry C, Fraser C. Successful Explantation of Children from the Berlin Heart Excor Ventricular Assist Device: A Systematic Review. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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4
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Mukhopadhyay B, Holovac K, Schuebel K, Mukhopadhyay P, Cinar R, Iyer S, Marietta C, Goldman D, Kunos G. The endocannabinoid system promotes hepatocyte progenitor cell proliferation and maturation by modulating cellular energetics. Cell Death Discov 2023; 9:104. [PMID: 36966147 PMCID: PMC10039889 DOI: 10.1038/s41420-023-01400-6] [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: 11/18/2022] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 03/27/2023] Open
Abstract
The proliferation and differentiation of hepatic progenitor cells (HPCs) drive the homeostatic renewal of the liver under diverse conditions. Liver regeneration is associated with an increase in Axin2+Cnr1+ HPCs, along with a marked increase in the levels of the endocannabinoid anandamide (AEA). But the molecular mechanism linking AEA signaling to HPC proliferation and/or differentiation has not been explored. Here, we show that in vitro exposure of HPCs to AEA triggers both cell cycling and differentiation along with increased expression of Cnr1, Krt19, and Axin2. Mechanistically, we found that AEA promotes the nuclear localization of the transcription factor β-catenin, with subsequent induction of its downstream targets. Systemic analyses of cells after CRISPR-mediated knockout of the β-catenin-regulated transcriptome revealed that AEA modulates β-catenin-dependent cell cycling and differentiation, as well as interleukin pathways. Further, we found that AEA promotes OXPHOS in HPCs when amino acids and glucose are readily available as substrates, but AEA inhibits it when the cells rely primarily on fatty acid oxidation. Thus, the endocannabinoid system promotes hepatocyte renewal and maturation by stimulating the proliferation of Axin2+Cnr1+ HPCs via the β-catenin pathways while modulating the metabolic activity of their precursor cells.
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Affiliation(s)
- Bani Mukhopadhyay
- Laboratory of Physiologic Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
| | - Kellie Holovac
- Laboratory of Physiologic Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Kornel Schuebel
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Partha Mukhopadhyay
- Laboratory of Cardiovascular Physiology and Tissue Injury, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Resat Cinar
- Laboratory of Physiologic Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Sindhu Iyer
- Laboratory of Physiologic Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Cheryl Marietta
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - David Goldman
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - George Kunos
- Laboratory of Physiologic Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
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Caldwell L, Kim-Fine S, Antosh D, Husk K, Meriwether K, Long J, Heisler C, Hudson P, Lozo S, Iyer S, Weber-LeBrun E, Rogers R. Development of a standardized counseling tool for postoperative return to sexual activity after pelvic reconstructive surgery. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.12.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
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Parakh M, Pokharel R, Dawkins K, Devkota S, Li J, Iyer S. Ensemble GaAsSb/GaAs axial configured nanowire-based separate absorption, charge, and multiplication avalanche near-infrared photodetectors. Nanoscale Adv 2022; 4:3919-3927. [PMID: 36133330 PMCID: PMC9470064 DOI: 10.1039/d2na00359g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/10/2022] [Indexed: 06/16/2023]
Abstract
In this study, molecular beam epitaxially grown axially configured ensemble GaAsSb/GaAs separate absorption, charge, and multiplication (SACM) region-based nanowire avalanche photodetector device on non-patterned Si substrate is presented. Our device exhibits a low breakdown voltage (V BR) of ∼ -10 ± 2.5 V under dark, photocurrent gain (M) varying from 20 in linear mode to avalanche gain of 700 at V BR at a 1.064 μm wavelength. Positive temperature dependence of breakdown voltage ∼ 12.6 mV K-1 further affirms avalanche breakdown as the gain mechanism in our SACM NW APDs. Capacitance-voltage (C-V) and temperature-dependent noise characteristics also validated punch-through voltage ascertained from I-V measurements, and avalanche being the dominant gain mechanism in the APDs. The ensemble SACM NW APD device demonstrated a broad spectral room temperature response with a cut-off wavelength of ∼1.2 μm with a responsivity of ∼0.17-0.38 A W-1 at -3 V. This work offers a potential pathway toward realizing tunable nanowire-based avalanche photodetectors compatible with traditional Si technology.
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Affiliation(s)
- M Parakh
- Department of Nanoengineering, Joint School of Nanoscience and Nanoengineering, North Carolina A&T State University Greensboro North Carolina 27411 USA
| | - R Pokharel
- Department of Nanoengineering, Joint School of Nanoscience and Nanoengineering, North Carolina A&T State University Greensboro North Carolina 27411 USA
| | - K Dawkins
- Department of Nanoengineering, Joint School of Nanoscience and Nanoengineering, North Carolina A&T State University Greensboro North Carolina 27411 USA
| | - S Devkota
- Department of Nanoengineering, Joint School of Nanoscience and Nanoengineering, North Carolina A&T State University Greensboro North Carolina 27411 USA
| | - J Li
- Department of Nanoengineering, Joint School of Nanoscience and Nanoengineering, North Carolina A&T State University Greensboro North Carolina 27411 USA
| | - S Iyer
- Department of Nanoengineering, Joint School of Nanoscience and Nanoengineering, North Carolina A&T State University Greensboro North Carolina 27411 USA
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Besse B, Awad M, Forde P, Thomas M, Goss G, Aronson B, Hobson R, Dean E, Peters J, Iyer S, Conway J, Barrett J, Cosaert J, Dressman M, Barry S, Heymach J. OA15.05 HUDSON: An Open-Label, Multi-Drug, Biomarker-Directed Phase 2 Study in NSCLC Patients Who Progressed on Anti-PD-(L)1 Therapy. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Fong C, Iyer S, Potts L, Peckitt C, Cromarty S, Saffery C, Kidd S, Rana T, Ausec L, Gregorc A, Pointing D, Gombert M, von Loga K, Benjamin L, Starling N, Waddell T, Petty R, Uhlik M, Chau I, Cunningham D. 1226P Predicting benefit from maintenance durvalumab after first-line chemotherapy (1L CTx) in oesophagogastric adenocarcinoma (OGA) using a novel tumour microenvironment (TME) RNA-based assay. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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9
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Korambayil SM, Iyer S, Moran A, Beaton C. Are we overtreating patients with malignant colorectal polyps? A 5-year review of the ACPGBI position statement. Ann R Coll Surg Engl 2022; 104:125-129. [PMID: 34730439 PMCID: PMC9773858 DOI: 10.1308/rcsann.2021.0124] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In 2013, The Association of Coloproctology of Great Britain and Ireland (ACPGBI) issued a position statement regarding management of malignant polyps. We reviewed the management of endoscopically resected malignant colorectal polyps in a district general hospital to evaluate whether patients were being overtreated as per these guidelines. METHODS All patients who underwent a complete, non-piecemeal endoscopic removal of a malignant polyp between October 2013 and September 2018 were studied. Polyps were risk stratified for residual disease and followed up as per the ACPGBI. Patients were divided into two groups based on management after polypectomy. Primary outcome measured was the presence of residual tumour or involved lymph nodes in the resection specimen. Secondary outcomes included complications and recurrence. RESULTS Thirty-three patients were included: 21 in the non-operative group (NOG) and 12 in the operative group (OG). The ACPGBI risk score in the NOG varied between 1 and over 4 compared with the OG who all scored over 4. Two patients in the OG (16%) demonstrated residual disease. Five patients suffered a postoperative complication. No recurrences were noted in the OG and one in the NOG. CONCLUSION Our findings against a backdrop of the available literature suggest that the risk of residual disease after malignant polypectomy may not be as high as stated by the ACPGBI. As a result, there is a risk of overtreating patients and exposing them to the significant complications of surgery if careful consideration is not exercised.
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Affiliation(s)
| | - S Iyer
- Northern Devon Healthcare NHS Trust, UK
| | - A Moran
- Northern Devon Healthcare NHS Trust, UK
| | - C Beaton
- Northern Devon Healthcare NHS Trust, UK
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10
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Horwitz S, O'Connor OA, Pro B, Trümper L, Iyer S, Advani R, Bartlett NL, Christensen JH, Morschhauser F, Domingo-Domenech E, Rossi G, Kim WS, Feldman T, Menne T, Belada D, Illés Á, Tobinai K, Tsukasaki K, Yeh SP, Shustov A, Hüttmann A, Savage KJ, Yuen S, Zinzani PL, Miao H, Bunn V, Fenton K, Fanale M, Puhlmann M, Illidge T. The ECHELON-2 Trial: 5-year results of a randomized, phase 3 study of brentuximab vedotin with chemotherapy for CD30-positive peripheral T-cell lymphoma. Ann Oncol 2021; 33:288-298. [PMID: 34921960 PMCID: PMC9447792 DOI: 10.1016/j.annonc.2021.12.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/12/2021] [Accepted: 12/07/2021] [Indexed: 01/18/2023] Open
Abstract
Background: For patients with peripheral T-cell lymphoma (PTCL), outcomes using frontline treatment with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP-like therapy are typically poor. The ECHELON-2 study demonstrated that brentuximab vedotin plus cyclophosphamide, doxorubicin, and prednisone (A+CHP) exhibited statistically superior progression-free survival (PFS) per independent central review and improvements in overall survival versus CHOP for the frontline treatment of patients with systemic anaplastic large cell lymphoma or other CD30-positive PTCL. Patients and methods: ECHELON-2 is a double-blind, double-dummy, randomized, placebo-controlled, active-comparator phase III study. We present an exploratory update of the ECHELON-2 study, including an analysis of 5-year PFS per investigator in the intent-to-treat analysis group. Results: A total of 452 patients were randomized (1 : 1) to six or eight cycles of A+CHP (N = 226) or CHOP (N = 226). At median follow-up of 47.6 months, 5-year PFS rates were 51.4% [95% confidence interval (CI): 42.8% to 59.4%] with A+CHP versus 43.0% (95% CI: 35.8% to 50.0%) with CHOP (hazard ratio = 0.70; 95% CI: 0.53–0.91), and 5-year overall survival (OS) rates were 70.1% (95% CI: 63.3% to 75.9%) with A+CHP versus 61.0% (95% CI: 54.0% to 67.3%) with CHOP (hazard ratio = 0.72; 95% CI: 0.53–0.99). Both PFS and OS were generally consistent across key subgroups. Peripheral neuropathy was resolved or improved in 72% (84/117) of patients in the A+CHP arm and 78% (97/124) in the CHOP arm. Among patients who relapsed and subsequently received brentuximab vedotin, the objective response rate was 59% with brentuximab vedotin retreatment after A+CHP and 50% with subsequent brentuximab vedotin after CHOP. Conclusions: In this 5-year update of ECHELON-2, frontline treatment of patients with PTCL with A+CHP continues to provide clinically meaningful improvement in PFS and OS versus CHOP, with a manageable safety profile, including continued resolution or improvement of peripheral neuropathy.
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Affiliation(s)
- S Horwitz
- Memorial Sloan Kettering Cancer Center, New York, New York, USA.
| | - O A O'Connor
- University of Virginia Cancer Center, University of Virginia, Charlottesville, Virginia, USA
| | - B Pro
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - L Trümper
- Universitätsmedizin Göttingen, Göttingen, Germany
| | - S Iyer
- MD Anderson Cancer Center/University of Texas, Houston, Texas, USA
| | - R Advani
- Stanford Cancer Center, Blood and Marrow Transplant Program, Stanford, California, USA
| | - N L Bartlett
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | - E Domingo-Domenech
- Institut Catala D'oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - G Rossi
- Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - W S Kim
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - T Feldman
- John Theurer Cancer Center, Hackensack Meridian Health School of Medicine, Hackensack NJ
| | - T Menne
- Freeman Hospital, Newcastle upon Tyne, England
| | - D Belada
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Králové, Czech Republic and Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic
| | - Á Illés
- Debreceni Egyetem, Debrecen, Hajdu-Bihar, Hungary
| | - K Tobinai
- National Cancer Center Hospital, Tokyo, Japan
| | - K Tsukasaki
- Saitama Medical University International Medical Center, Saitama, Japan
| | - S-P Yeh
- China Medical University Hospital, Taichung, Taiwan
| | - A Shustov
- University of Washington Medical Center, Seattle, Washington, USA
| | - A Hüttmann
- Universitatsklinikum Essen, Essen, Nordrhein-Westfalen, Germany
| | - K J Savage
- Department of Medical Oncology and University of British Columbia, BC Cancer, Vancouver, British Columbia, Canada
| | - S Yuen
- Calvary Mater Newcastle Hospital, Australia
| | - P L Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli"; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italia
| | - H Miao
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, USA, a wholly owned subsidiary of Takeda Pharmaceuticals Limited
| | - V Bunn
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, USA, a wholly owned subsidiary of Takeda Pharmaceuticals Limited
| | - K Fenton
- Seagen Inc., Bothell, Washington, USA
| | - M Fanale
- Seagen Inc., Bothell, Washington, USA
| | | | - T Illidge
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Biomedical Research Centre, Manchester Academic Health Sciences Centre, Christie Hospital NHS Foundation Trust, Manchester, UK
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Korambayil SM, Iyer S, Williams DJ. Emergency hip disarticulations for severe necrotising fasciitis of the lower limb: a series of rare cases from a rural district general hospital. Ann R Coll Surg Engl 2021; 103:e223-e226. [PMID: 34192495 DOI: 10.1308/rcsann.2021.0079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hip disarticulation is the removal of the entire lower limb through the hip joint by detaching the femur from the acetabulum. This major ablative procedure is rarely performed for infection but may be required in severe necrotising fasciitis. We present a single centre retrospective review of all cases of emergency hip disarticulations in patients with necrotising fasciitis between 2010 and 2020. All five patients included in the review presented with acute lower limb pain and sepsis. Three patients had comorbidities predisposing them to necrotising fasciitis. Three were deemed to be high risk and two were at intermediate risk of developing necrotising fasciitis. There were two deaths in the postoperative period. Of the three survivors, two required revision surgery for a completion hindquarter amputation and one for flap closure. All three survivors had good functional outcomes after discharge from hospital. Despite its associated morbidity, emergency amputation of the entire lower limb is a life-saving treatment in cases of rapidly progressing necrotising fasciitis and should be considered as a first-line option in managing this condition.
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Affiliation(s)
| | - S Iyer
- Northern Devon Healthcare NHS Trust, Barnstaple, UK
| | - D J Williams
- Northern Devon Healthcare NHS Trust, Barnstaple, UK
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12
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Chegini S, Schilling C, Walgama ES, Yu KM, Thankappan K, Iyer S, Cariati P, Balasubramanian D, Kanatas A, Lai SY, McGurk M. Neck failure following pathologically node-negative neck dissection (pN0) in oral squamous cell carcinoma: a systematic review and meta-analysis. Br J Oral Maxillofac Surg 2021; 59:1157-1165. [PMID: 34281738 DOI: 10.1016/j.bjoms.2021.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/01/2021] [Indexed: 11/25/2022]
Abstract
Due to the risk of occult cervical metastasis, elective neck dissection (END) is recommended in the management of patients with early oral cavity squamous cell carcinoma (OSCC) and a clinically node-negative (cN0) neck. This paper presents a systematic review and meta-analysis of studies that recorded isolated regional recurrence (RR) in the pathologically node-negative neck dissection (pN0) neck following END in order to quantify the failure rate. Pubmed and Ovid databases were systematically searched for relevant articles published between January 2009 and January 2019. Studies reporting RR following END in patients with OSCC who had no pathological evidence of lymph node metastasis were eligible for inclusion in this meta-analysis. In addition, a selection of large head and neck units were invited to submit unpublished data. Search criteria produced a list of 5448 papers, of which 18 studies met the inclusion criteria. Three institutions contributed unpublished data. This included a total of 4824 patients with median follow-up of 34 months (2.8 years). Eight datasets included patients staged T1-T4 with RR 17.3% (469/2711), 13 datasets included patients staged T1-T2 with RR 7.5% (158/2113). Overall across all 21 studies, isolated neck recurrence was identified in 627 cases giving a RR of 13.0% (627/4824) on meta-analysis. Understanding the therapeutic effectiveness of END provides context for evaluation of clinical management of the cN0 in these patients. A pathologically negative neck does not guarantee against future recurrence.
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Affiliation(s)
- S Chegini
- Head and Neck Academic Centre, University College London, Gower St, Bloomsbury, London WC1E 6BT, United Kingdom; Department of Oral and Maxillofacial Head and Neck Surgery, University College Hospital London, 235 Euston Rd, Bloomsbury, London NW1 2BU, United Kingdom.
| | - C Schilling
- Head and Neck Academic Centre, University College London, Gower St, Bloomsbury, London WC1E 6BT, United Kingdom; Department of Oral and Maxillofacial Head and Neck Surgery, University College Hospital London, 235 Euston Rd, Bloomsbury, London NW1 2BU, United Kingdom
| | - E S Walgama
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K M Yu
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K Thankappan
- Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India
| | - S Iyer
- Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India
| | - P Cariati
- Department of Oral and Maxillofacial Surgery, Hospital General Universitario de Albacete, Albacete, Spain
| | - D Balasubramanian
- Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India
| | - A Kanatas
- Leeds General Infirmary, Great George St, Leeds LS1 3EX, United Kingdom
| | - S Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M McGurk
- Head and Neck Academic Centre, University College London, Gower St, Bloomsbury, London WC1E 6BT, United Kingdom; Department of Oral and Maxillofacial Head and Neck Surgery, University College Hospital London, 235 Euston Rd, Bloomsbury, London NW1 2BU, United Kingdom
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Bhattacharya S, Thankappan K, Sukumaran SV, Mayadevi M, Balasubramanian D, Iyer S. Volume and location of the defect as predictors of speech outcome after glossectomy: correlation with a classification. Int J Oral Maxillofac Surg 2021; 50:1533-1539. [PMID: 33714613 DOI: 10.1016/j.ijom.2021.02.026] [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: 09/22/2020] [Revised: 12/17/2020] [Accepted: 02/23/2021] [Indexed: 10/21/2022]
Abstract
The evaluation of speech outcomes after resection and reconstruction of the oral tongue remains largely unsystematic. A cross-sectional study was performed to analyse the speech outcomes of patients who underwent curative treatment with appropriate reconstruction. Sixty-nine patients were assessed for speech intelligibility and phonetics using a validated speech intelligibility assessment tool in the local language. Volume defects were classified as class I (less than one third), II (one third to half), III (half to two-thirds), or IV (two-thirds to total glossectomy). Defect location was defined as lateral, tip, or sulcus. The χ2 test and Kruskal-Wallis test were used to test volume and location as predictors. Twenty-six patients had class I defects, 29 had class II defects, seven had class III defects, and seven had class IV defects. Twenty-two patients (31.9%) received adjuvant radiotherapy. Mean vowel, consonant, word, and paragraph intelligibility were 99.27%, 86.86%, 85.52%, and 88.72%, respectively. The incremental volume of the glossectomy defect was significantly correlated with speech intelligibility scores and phonatory alterations. In classes II and III, tip resection significantly affected interdental sounds. All patients in class III had affected alveolar and alveo-palatal sounds. The results positively corroborated the volume and location of the glossectomy defect to a classification system.
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Affiliation(s)
- S Bhattacharya
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - K Thankappan
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
| | - S V Sukumaran
- Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - M Mayadevi
- Division of Swallowing Therapy, Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - D Balasubramanian
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - S Iyer
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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14
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Dudovitz RN, Biely C, Barnert ES, Coker TR, Guerrero AD, Jackson N, Schickedanz A, Szilagyi PG, Iyer S, Chung PJ. Association between school racial/ethnic composition during adolescence and adult health. Soc Sci Med 2021; 272:113719. [PMID: 33545496 DOI: 10.1016/j.socscimed.2021.113719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/24/2020] [Accepted: 01/24/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES School racial/ethnic segregation in U.S. schoolsDifferences in school racial/ethnic composition may increase health disparities by concentrating educational opportunities that confer long-term health benefits in schools serving predominantly wwhite students. For racial minority students, high concentrations of white students may increase exposure to racismis also associated with psychologicstress, which may ultimately reduceing the long-term health benefits from educational opportunities. Meanwhile associations of racial/ethnic academic tacking within schools and health have been mixed. We sought to test whether: 1) differences in racial/ethnic composition between schools and, 2) racial/ethnic distribution of students in academic tracks within schools are associated with long-term health benefits or risks for white, Black and Latinx students. METHODS We analyzed the National Longitudinal Study of Adolescent to Adult Health (12,438 participants, collected 1994-2008), to test whether the school-level segregation (percent of non-Latinx white students at participants' school during adolescence) was associated with adult health outcomes at ages 18-26 & 24-32, controlling for contextual factorscomparing Black, Latinx, and white students, and controlling for contextualf factors. A secondary analysis explored whether racial/ethnic cohorting across levels of English courses was associated with each health outcome. RESULTS Attending a school with a higher percent of white students was associated with higher adult depression scores, substance abuse, and worse self-rated health for black Black students; lower depression scores, better self-rated health, and alcohol abuse for white students; and no health differences for Latinx students. Greater within school racial/ethnic cohorting across English courses was associated with increased odds of alcohol abuse for white students; decreased odds of alcohol abuse for Black and Latinx students; and decreased odds of drug abuse for Black students. CONCLUSION Among Bblack youth, attending a school with a higher percentage of white students is associated with worse behavioral health in adulthood. Understanding the potential impacts of school racial/ethnic composition on health is critical to designing policies that maximize access to opportunity and health.Education policies should comprehensively address school quality and racism to maximize adult health.
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Affiliation(s)
- R N Dudovitz
- UCLA Department of Pediatrics and Children's Development and Innovation Institute, United States.
| | - C Biely
- UCLA Department of Pediatrics and Children's Development and Innovation Institute, United States
| | - E S Barnert
- UCLA Department of Pediatrics and Children's Development and Innovation Institute, United States
| | - T R Coker
- University of Washington Center for Child Health Behavior and Development, United States
| | - A D Guerrero
- UCLA Department of Pediatrics and Children's Development and Innovation Institute, United States
| | - N Jackson
- UCLA Division of General Internal Medicine and Health Services Research, United States
| | - A Schickedanz
- UCLA Department of Pediatrics and Children's Development and Innovation Institute, United States
| | - P G Szilagyi
- UCLA Department of Pediatrics and Children's Development and Innovation Institute, United States
| | - S Iyer
- UCLA Department of Pediatrics and Children's Development and Innovation Institute, United States
| | - P J Chung
- Kaiser Permanente School of Medicine, Health System Science, United States
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15
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Palathingal Bava E, Tarique M, Iyer S, Sahay P, Dawra R, Saluja A, Dudeja V. Pirfenidone Alleviates Features of Well-Established Chronic Pancreatitis in Mouse Models. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
Chronic pancreatitis (CP) is a fibro-inflammatory disease of pancreas with no targeted therapy and is considered irreversible. Antifibrotic agent pirfenidone is FDA approved for idiopathic pulmonary fibrosis.
However, exact molecular mechanism of its action is not clear. The aim of this study was to evaluate pirfenidone as a therapeutic agent for CP.
Methods
Caerulein-CP was induced in C57BL/6 mice by caerulein injections (50ug/kgx7, i.p., hourly x twice weekly x10 weeks). At 11 weeks, animals were randomized and assigned to either saline or pirfenidone group (400 mg/kg/d by oral gavage for 5 weeks). Mice were euthanized at 17 weeks. L-arginine induced CP was induced by i.p. injections of L-arginine (4.5g/kg x2 hourly, once a week x 4) and treatment was started after 5 weeks of start. Mice were sacrificed at early time-points after starting treatment. Single-cell suspension of pancreata were used for flow- cytometry. Pancreatic atrophy, histology, fibrosis and cytokine mRNA profile were evaluated. In vitro studies were done on stellate cells.
Results
The treated caerulein-CP mice had improvement in pancreas/mouse weight ratio, (7.03±0.41 vs. 4.75±0.28; p<0.0001). Histology scores and fibrosis markers were reduced. Pancreatic atrophy and histology scores showed significant improvement by day 14 of treatment in L-arginine CP. Flow cytometry showed that by day 7 of treatment there was significant reduction in macrophage infiltration (1.09 ± 0.18 % vs 3.26 ± 0.4 %; p<0.001) and pro-fibrotic M2 macrophage markers [IL-4 (1.5 ± 0.1 % vs 2.8 ± 0.2%; p=0.007)], while M1 marker (MHC II) did not change. mRNA levels of pro-inflammatory and pro-fibrotic cytokines decreased, and of anti-inflammatory cytokines increased. In vitro study on stellate cells showed reduction in mRNA levels of pro-fibrotic and pro-inflammatory cytokines as well as fibrosis markers in treatment group.
Conclusion
Pirfenidone ameliorates well-established CP in mouse models by altering immune cells.
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Affiliation(s)
| | - M Tarique
- Surgery, University of Miami, Miami, Florida, UNITED STATES
| | - S Iyer
- Surgery, University of Miami, Miami, Florida, UNITED STATES
| | - P Sahay
- Surgery, University of Miami, Miami, Florida, UNITED STATES
| | - R Dawra
- Surgery, University of Miami, Miami, Florida, UNITED STATES
| | - A Saluja
- Surgery, University of Miami, Miami, Florida, UNITED STATES
| | - V Dudeja
- Surgery, University of Miami, Miami, Florida, UNITED STATES
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16
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Morris C, Camacho-Gonzalez A, Chen C, Heilman S, Iyer S, Mantus G, Sanchez T, Sullivan P, Suthar M, Wrammert J, Vos M. 321 Prevalence of SARS-CoV-2 Antibodies in Pediatric Health Care Workers in Atlanta, Georgia. Ann Emerg Med 2020. [PMCID: PMC7598755 DOI: 10.1016/j.annemergmed.2020.09.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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17
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Simon MA, Iyer S, Hassan IN, Chhabra S. Unusual presentation of intussusception: Gallstone ileus. Radiography (Lond) 2020; 27:740-742. [PMID: 32943353 DOI: 10.1016/j.radi.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
Gallstone ileus is a rare pathology, occurring in an estimated 0.5% of cases, which preferentially affect females and the elderly population. This rare pathology is the result of a fistulous connection between the bowel and gallbladder. This connection allows gallstones to pass into the bowel leading to mechanical obstruction. On rare occasions the enteric gallstone can act as a lead point causing intussusception. We present a rare case of intussusception secondary to gallstone ileus in a young, relatively asymptomatic patient. CT played a critical role in diagnosis and appropriate management of our patient.
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Affiliation(s)
- M A Simon
- RWJBH - Saint Barnabas Medical Center, Livingston, NJ, 07039, USA.
| | - S Iyer
- RWJBH - Saint Barnabas Medical Center, Livingston, NJ, 07039, USA
| | - I N Hassan
- RWJBH - Saint Barnabas Medical Center, Livingston, NJ, 07039, USA
| | - S Chhabra
- RWJBH - Saint Barnabas Medical Center, Livingston, NJ, 07039, USA
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18
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Mougalian S, Kish J, Zhang J, Miller T, Liassou D, Laney J, Iyer S. 316P Real-world treatment patterns and clinical effectiveness outcomes of eribulin in metastatic breast cancer patients in community oncology centers in the United States. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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19
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Ramakrishnan N, Baronia AK, Divatia JV, Bhagwati A, Chawla R, Iyer S, Jani CK, Joad S, Kamat V, Kapadia F, Mehta Y, Myatra SN, Nagarkar S, Nayyar V, Padhy S, Rajagopalan R, Ray B, Sahu S, Sampath S, Todi S. Critical care delivery in intensive care units in India: Defining the functions, roles and responsibilities of a consultant intensivist. Indian J Crit Care Med 2020. [DOI: 10.5005/ijccm-17-s1-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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20
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Garcia EG, Veloso A, Oliveira ML, Allen JR, Loontiens S, Brunson D, Do D, Yan C, Morris R, Iyer S, Garcia SP, Iftimia N, Van Loocke W, Matthijssens F, McCarthy K, Barata JT, Speleman F, Taghon T, Gutierrez A, Van Vlierberghe P, Haas W, Blackburn JS, Langenau DM. PRL3 enhances T-cell acute lymphoblastic leukemia growth through suppressing T-cell signaling pathways and apoptosis. Leukemia 2020; 35:679-690. [PMID: 32606318 PMCID: PMC8009053 DOI: 10.1038/s41375-020-0937-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 01/06/2023]
Abstract
T cell acute lymphoblastic leukemia (T-ALL) is an aggressive malignancy of thymocytes and is largely driven by the NOTCH/MYC pathway. Yet, additional oncogenic drivers are required for transformation. Here, we identify protein tyrosine phosphatase type 4 A3 (PRL3) as a collaborating oncogenic driver in T-ALL. PRL3 is expressed in a large fraction of primary human T-ALLs and is commonly co-amplified with MYC. PRL3 also synergized with MYC to initiate early-onset ALL in transgenic zebrafish and was required for human T-ALL growth and maintenance. Mass spectrometry phosphoproteomic analysis and mechanistic studies uncovered that PRL3 suppresses downstream T cell phosphorylation signaling pathways, including those modulated by VAV1, and subsequently suppresses apoptosis in leukemia cells. Taken together, our studies have identified new roles for PRL3 as a collaborating oncogenic driver in human T-ALL and suggest that therapeutic targeting of the PRL3 phosphatase will likely be a useful treatment strategy for T-ALL.
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Affiliation(s)
- E G Garcia
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - A Veloso
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - M L Oliveira
- Instituto de Medicina Molecular João Lobo Antunes Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - J R Allen
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - S Loontiens
- Cancer Research Institute Ghent, Ghent, Belgium
| | - D Brunson
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - D Do
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - C Yan
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - R Morris
- Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - S Iyer
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - S P Garcia
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - N Iftimia
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - W Van Loocke
- Cancer Research Institute Ghent, Ghent, Belgium.,Department of Biomolecular Medicine and Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - F Matthijssens
- Cancer Research Institute Ghent, Ghent, Belgium.,Department of Biomolecular Medicine and Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - K McCarthy
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - J T Barata
- Instituto de Medicina Molecular João Lobo Antunes Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - F Speleman
- Cancer Research Institute Ghent, Ghent, Belgium.,Department of Biomolecular Medicine and Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - T Taghon
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - A Gutierrez
- Division of Hematology/Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, USA
| | - P Van Vlierberghe
- Cancer Research Institute Ghent, Ghent, Belgium.,Department of Biomolecular Medicine and Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - W Haas
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - J S Blackburn
- Department of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, Lexington, KY, 40536, USA
| | - D M Langenau
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA. .,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA. .,Harvard Stem Cell Institute, Boston, MA, 02114, USA. .,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.
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21
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Rugo HS, Diéras V, Gelmon KA, Finn RS, Slamon DJ, Martin M, Neven P, Shparyk Y, Mori A, Lu DR, Bhattacharyya H, Bartlett CHUANG, Iyer S, Johnston S, Ettl J, Harbeck N. Impact of palbociclib plus letrozole on patient-reported health-related quality of life: results from the PALOMA-2 trial. Ann Oncol 2019; 29:888-894. [PMID: 29360932 PMCID: PMC5913649 DOI: 10.1093/annonc/mdy012] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Patient-reported outcomes are integral in benefit-risk assessments of new treatment regimens. The PALOMA-2 study provides the largest body of evidence for patient-reported health-related quality of life (QOL) for patients with metastatic breast cancer (MBC) receiving first-line endocrine-based therapy (palbociclib plus letrozole and letrozole alone). Patients and methods Treatment-naïve postmenopausal women with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-) MBC were randomized 2 : 1 to palbociclib plus letrozole (n = 444) or placebo plus letrozole (n = 222). Patient-reported outcomes were assessed at baseline, day 1 of cycles 2 and 3, and day 1 of every other cycle from cycle 5 using the Functional Assessment of Cancer Therapy (FACT)-Breast and EuroQOL 5 dimensions (EQ-5D) questionnaires. Results As of 26 February 2016, the median duration of follow-up was 23 months. Baseline scores were comparable between the two treatment arms. No significant between-arm differences were observed in change from baseline in FACT-Breast Total, FACT-General Total, or EQ-5D scores. Significantly greater improvement in pain scores was observed in the palbociclib plus letrozole arm (-0.256 versus -0.098; P = 0.0183). In both arms, deterioration of FACT-Breast Total score was significantly delayed in patients without progression versus those with progression and patients with partial or complete response versus those without. No significant difference was observed in FACT-Breast and EQ-5D index scores in patients with and without neutropenia. Conclusions Overall, women with MBC receiving first-line endocrine therapy have a good QOL. The addition of palbociclib to letrozole maintains health-related QOL and improves pain scores in treatment-naïve postmenopausal patients with ER+/HER2- MBC compared with letrozole alone. Significantly greater delay in deterioration of health-related QOL was observed in patients without progression versus those who progressed and in patients with an objective response versus non-responders. ClinicalTrials.gov: NCT01740427 (https://clinicaltrials.gov/ct2/show/NCT01740427).
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Affiliation(s)
- H S Rugo
- Department of Medicine (Hematology/Oncology), University of California San Francisco Comprehensive Cancer Center, San Francisco, USA.
| | - V Diéras
- Department of Medical Oncology, Institut Curie, Paris, France
| | - K A Gelmon
- Department of Medical Oncology, British Columbia Cancer Agency-Vancouver Centre, Vancouver, Canada
| | - R S Finn
- Division of Hematology/Oncology, University of California, Los Angeles, USA
| | - D J Slamon
- Division of Hematology/Oncology, University of California, Los Angeles, USA
| | - M Martin
- Medical Oncology Service, Instituto de Investigación Sanitaria Gregorio Marañón, GEICAM, Universidad Complutense, Madrid, Spain
| | - P Neven
- Department of Oncology, Universitair Ziekenhuis Leuven-Campus Gasthuisberg, Leuven, Belgium
| | - Y Shparyk
- Department of Chemotherapy, Lviv State Oncologic Regional Treatment and Diagnostic Center, Lviv, Ukraine
| | - A Mori
- Global Product Developmen, Clinical, Pfizer s.r.l., Milan, Italy
| | - D R Lu
- Global Product Developmen, Statistics, Pfizer Inc., La Jolla, USA
| | | | | | - S Iyer
- Global Outcomes and Evidence, Pfizer Inc., New York, USA
| | - S Johnston
- Department of Medical Oncology, The Royal Marsden NHS Foundation, London, UK
| | - J Ettl
- Department of Obstetrics and Gynecology, Frauenklinik und Poliklinik Klinikum Rechts der Isar, Technische Universität München, München, Germany
| | - N Harbeck
- Department of Obstetrics and Gynecology, Brustzentrum der Universität München (LMU), München, Germany
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22
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Rugino AL, Laus K, Grandi C, Caruso D, deMartelly V, Iyer S. Postoperative Narcotic use After Ambulatory Gynecologic Surgery. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Bhalerao N, Shaikh N, Iyer S, Mani J. The reliability of the Bonini classification for frontal lobe seizures: An observational study. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Dama M, Shah J, Norman R, Iyer S, Joober R, Schmitz N, Abdel-Baki A, Malla A. Short duration of untreated psychosis enhances negative symptom remission in extended early intervention service for psychosis. Acta Psychiatr Scand 2019; 140:65-76. [PMID: 30963544 DOI: 10.1111/acps.13033] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To test whether duration of untreated psychosis (DUP) < 3 months, recommended by the World Health Organization/International Early Psychosis Association, enhances the effects of an extended early intervention service (EEIS) on symptom remission. METHOD We examined data from a randomized controlled trial in which patients who received 2 years of treatment in EIS for psychosis were subsequently randomized to either 3 years of EEIS or 3 years of regular care (RC). Using a DUP cut-off ≤ 12 weeks (approximately < 3 months), patients were split into two groups. Length of positive, negative and total symptom remission were the outcomes. RESULTS Patients (N = 217) were mostly male (68%) with schizophrenia spectrum disorder (65%); 108 (50%) received EEIS (58 had DUP ≤12 weeks; 50 had DUP >12 weeks). Interaction between treatment condition (EEIS vs. RC) and DUP cut-off ≤ 12 weeks was only significant in multiple linear regression model examining length of negative symptom remission as the outcome (adjusted β = 36.88 [SE = 15.88], t = 2.32, P = 0.02). EEIS patients with DUP ≤12 weeks achieved 25 more weeks of negative symptom remission than EEIS patients with DUP >12 weeks. CONCLUSION Having a short DUP may be critical in deriving long-term benefits from EIS for psychosis, including EEIS settings. This work empirically supports policy recommendations of reducing DUP <3 months.
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Affiliation(s)
- M Dama
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, QC, Canada
| | - J Shah
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - R Norman
- Departments of Psychiatry and Epidemiology & Biostatistics, Western University, London, ON, Canada
| | - S Iyer
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - R Joober
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - N Schmitz
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - A Abdel-Baki
- Department of Psychiatry, Universite de Montreal, Montreal, QC, Canada
| | - A Malla
- Department of Psychiatry, McGill University, Montreal, QC, Canada
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Jain P, Romaguera J, Nomie K, Zhang S, Wang L, Oriabure O, Wagner-Bartak N, Zhang L, Hagemeister F, Samaniego F, Westin J, Ju Lee H, Nastoupil L, Iyer S, Parmar S, Ok C, Kanagal-Shamanna R, Chen W, Thirumurthi S, Santos D, Badillo M, Fayad L, Neelapu S, Fowler N, Wang M. COMBINATION OF IBRUTINIB WITH RITUXIMAB (IR) IS HIGHLY EFFECTIVE IN PREVIOUSLY UNTREATED ELDERLY (>65 YEARS) PATIENTS (PTS) WITH MANTLE CELL LYMPHOMA (MCL) - PHASE II TRIAL. Hematol Oncol 2019. [DOI: 10.1002/hon.11_2629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- P. Jain
- Lymphoma and Myeloma; UT MD Anderson Cancer Center; Houston United States
| | - J. Romaguera
- Lymphoma and Myeloma; UT MD Anderson Cancer Center; Houston United States
| | - K. Nomie
- Lymphoma and Myeloma; UT MD Anderson Cancer Center; Houston United States
| | - S. Zhang
- Genomic Medicine; UTMDACC; Houston United States
| | - L. Wang
- Genomic Medicine; UTMDACC; Houston United States
| | - O. Oriabure
- Lymphoma and Myeloma; UT MD Anderson Cancer Center; Houston United States
| | | | - L. Zhang
- Lymphoma and Myeloma; UT MD Anderson Cancer Center; Houston United States
| | - F. Hagemeister
- Lymphoma and Myeloma; UT MD Anderson Cancer Center; Houston United States
| | - F. Samaniego
- Lymphoma and Myeloma; UT MD Anderson Cancer Center; Houston United States
| | - J. Westin
- Lymphoma and Myeloma; UT MD Anderson Cancer Center; Houston United States
| | - H. Ju Lee
- Lymphoma and Myeloma; UT MD Anderson Cancer Center; Houston United States
| | - L. Nastoupil
- Lymphoma and Myeloma; UT MD Anderson Cancer Center; Houston United States
| | - S. Iyer
- Lymphoma and Myeloma; UT MD Anderson Cancer Center; Houston United States
| | - S. Parmar
- Lymphoma and Myeloma; UT MD Anderson Cancer Center; Houston United States
| | - C. Ok
- Lymphoma and Myeloma; UT MD Anderson Cancer Center; Houston United States
| | | | - W. Chen
- Lymphoma and Myeloma; UT MD Anderson Cancer Center; Houston United States
| | | | - D. Santos
- Surgical Oncology; UTMDACC; Houston United States
| | - M. Badillo
- Lymphoma and Myeloma; UT MD Anderson Cancer Center; Houston United States
| | - L. Fayad
- Lymphoma and Myeloma; UT MD Anderson Cancer Center; Houston United States
| | - S. Neelapu
- Lymphoma and Myeloma; UT MD Anderson Cancer Center; Houston United States
| | - N. Fowler
- Lymphoma and Myeloma; UT MD Anderson Cancer Center; Houston United States
| | - M. Wang
- Lymphoma and Myeloma; UT MD Anderson Cancer Center; Houston United States
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Illidge T, Horwitz S, Iyer S, Bartlett N, Kim W, Tilly H, Belada D, Feldman T, Illés Á, Jacobsen E, Hüttmann A, Zinzani P, O'Connor O, Trepicchio W, Miao H, Rao S, Onsum M, Manley T, Advani R. RESPONSE TO A+CHP BY CD30 EXPRESSION IN THE ECHELON-2 TRIAL. Hematol Oncol 2019. [DOI: 10.1002/hon.92_2630] [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: 11/11/2022]
Affiliation(s)
- T. Illidge
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health; University of Manchester, National Institutes of Health and Research Biomedical Research Centre, Manchester Academic Health Sciences Centre, Christie Hospital National Health Service Foundation Trust; Manchester United Kingdom
| | - S. Horwitz
- Department of Medicine; Lymphoma Service, Memorial Sloan Kettering Cancer Center; New York United States
| | - S. Iyer
- Department of Lymphoma and Myeloma; Division of Cancer Medicine, MD Anderson Cancer Center; Houston United States
| | - N. Bartlett
- Department of Medicine; Oncology Division, Washington University School of Medicine, Siteman Cancer Center; Saint Louis United States
| | - W. Kim
- Division of Hematology-Oncology; Department of Medicine, Samsung Medical Center; Seoul Republic of Korea
| | - H. Tilly
- Department of Hematology; Centre Henri Becquerel, Université of Rouen Normandie; Rouen France
| | - D. Belada
- 4th Department of Internal Medicine - Haematology; Charles University, Hospital and Faculty of Medicine; Hradec Králové Czech Republic
| | - T. Feldman
- Hematology Division; Hackensack University Medical Center; Hackensack United States
| | - Á. Illés
- Department of Hematology; University of Debrecen, Faculty of Medicine; Debrecen Hungary
| | - E. Jacobsen
- Division of Hematologic Malignancies; Dana-Farber Cancer Institute; Boston United States
| | - A. Hüttmann
- Department of Haematology; Universitatsklinikum Essen; Essen Germany
| | - P. Zinzani
- Institute of Hematology; “Seràgnoli” University of Bologna; Bologna France
| | - O.A. O'Connor
- Department of Medicine; Columbia University Medical Center; New York United States
| | - W. Trepicchio
- Clinical Development; Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceuticals Limited; Cambridge United States
| | - H. Miao
- Clinical Development; Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceuticals Limited; Cambridge United States
| | - S. Rao
- Development; Seattle Genetics, Inc.; Bothell United States
| | - M. Onsum
- Development; Seattle Genetics, Inc.; Bothell United States
| | - T. Manley
- Development; Seattle Genetics, Inc.; Bothell United States
| | - R. Advani
- Medicine - Med/Oncology; Stanford Cancer Institute; Stanford United States
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Anand K, Pingali S, Ensor J, Neelapu S, Iyer S. COMPREHENSIVE REPORT OF ANTI-CD19 CHIMERIC ANTIGEN RECEPTOR T-CELLS (CAR-T) ASSOCIATED NON RELAPSE MORTALITY (CART-NRM) FROM FAERS. Hematol Oncol 2019. [DOI: 10.1002/hon.121_2630] [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: 11/10/2022]
Affiliation(s)
- K. Anand
- Hematology/Oncology; Houston Methodist Cancer Center; Houston United States
| | - S. Pingali
- Hematology/Oncology; Houston Methodist Cancer Center; Houston United States
| | - J. Ensor
- Hematology/Oncology; Houston Methodist Cancer Center; Houston United States
| | - S.S. Neelapu
- Lymphoma/Myeloma; UT MD Anderson Cancer Center; Houston United States
| | - S. Iyer
- Lymphoma/Myeloma; UT MD Anderson Cancer Center; Houston United States
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Turner NC, Finn RS, Martin M, Im SA, DeMichele A, Ettl J, Diéras V, Moulder S, Lipatov O, Colleoni M, Cristofanilli M, Lu DR, Mori A, Giorgetti C, Iyer S, Bartlett CH, Gelmon KA. Clinical considerations of the role of palbociclib in the management of advanced breast cancer patients with and without visceral metastases. Ann Oncol 2019; 29:669-680. [PMID: 29342248 PMCID: PMC5888946 DOI: 10.1093/annonc/mdx797] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background This report assesses the efficacy and safety of palbociclib plus endocrine therapy (ET) in women with hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer (ABC) with or without visceral metastases. Patients and methods Pre- and postmenopausal women with disease progression following prior ET (PALOMA-3; N = 521) and postmenopausal women untreated for ABC (PALOMA-2; N = 666) were randomized 2 : 1 to ET (fulvestrant or letrozole, respectively) plus palbociclib or placebo. Progression-free survival (PFS), safety, and patient-reported quality of life (QoL) were evaluated by prior treatment and visceral involvement. Results Visceral metastases incidence was higher in patients with prior resistance to ET (58.3%, PALOMA-3) than in patients naive to ET in the ABC setting (48.6%, PALOMA-2). In patients with prior resistance to ET and visceral metastases, median PFS (mPFS) was 9.2 months with palbociclib plus fulvestrant versus 3.4 months with placebo plus fulvestrant [hazard ratio (HR), 0.47; 95% confidence interval (CI), 0.35–0.61], and objective response rate (ORR) was 28.0% versus 6.7%, respectively. In patients with nonvisceral metastases, mPFS was 16.6 versus 7.3 months, HR 0.53; 95% CI 0.36–0.77. In patients with visceral disease and naive to ET in the advanced disease setting, mPFS was 19.3 months with palbociclib plus letrozole versus 12.9 months with placebo plus letrozole (HR 0.63; 95% CI 0.47–0.85); ORR was 55.1% versus 40.0%; in patients with nonvisceral disease, mPFS was not reached with palbociclib plus letrozole versus 16.8 months with placebo plus letrozole (HR 0.50; 95% CI 0.36–0.70). In patients with prior resistance to ET with visceral metastases, palbociclib plus fulvestrant significantly delayed deterioration of QoL versus placebo plus fulvestrant, whereas patient-reported QoL was maintained with palbociclib plus letrozole in patients naive to endocrine-based therapy for ABC. Conclusions Palbociclib plus ET prolonged mPFS in patients with visceral metastases, increased ORRs, and in patients previously treated for ABC, delayed QoL deterioration, presenting a standard treatment option among patients with visceral metastases amenable to endocrine-based therapy. Clinical trial registration NCT01942135, NCT01740427
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Affiliation(s)
- N C Turner
- Toby Robins Breast Cancer Research Centre, Institute of Cancer Research and Royal Marsden Hospital, London, UK.
| | - R S Finn
- Department of Medicine, David Geffen School of Medicine, Los Angeles, USA
| | - M Martin
- Department of Medicine, Hospital Gregorio Marañón, Universidad Complutense, CIBERONC, GEICAM, Madrid, Spain
| | - S-A Im
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - A DeMichele
- Department of Medicine, University of Pennsylvania, Philadelphia, USA
| | - J Ettl
- Klinik und Poliklinik fuer Frauenheilkunde Klinikum Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - V Diéras
- Department of Clinical Research, Institut Curie, Paris, France
| | - S Moulder
- Department of Breast Medical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, USA
| | - O Lipatov
- State Budget Medical Institution Republican Clinical Oncology Dispensary, Ufa, Russia
| | - M Colleoni
- European Institute of Oncology, Milan, Italy
| | - M Cristofanilli
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Chicago
| | - D R Lu
- Pfizer Inc, La Jolla, USA
| | - A Mori
- Pfizer S.r.l, Milan, Italy
| | | | - S Iyer
- Pfizer Inc, New York, USA
| | | | - K A Gelmon
- Department of Medical Oncology, British Columbia Cancer Agency-Vancouver Centre, Vancouver, Canada
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Rugo HS, Finn RS, Diéras V, Ettl J, Lipatov O, Joy AA, Harbeck N, Castrellon A, Iyer S, Lu DR, Mori A, Gauthier ER, Bartlett CH, Gelmon KA, Slamon DJ. Palbociclib plus letrozole as first-line therapy in estrogen receptor-positive/human epidermal growth factor receptor 2-negative advanced breast cancer with extended follow-up. Breast Cancer Res Treat 2019; 174:719-729. [PMID: 30632023 PMCID: PMC6438948 DOI: 10.1007/s10549-018-05125-4] [Citation(s) in RCA: 226] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 12/26/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE In the initial PALOMA-2 (NCT01740427) analysis with median follow-up of 23 months, palbociclib plus letrozole significantly prolonged progression-free survival (PFS) in women with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC) [hazard ratio (HR) 0.58; P < 0.001]. Herein, we report results overall and by subgroups with extended follow-up. METHODS In this double-blind, phase 3 study, post-menopausal women with ER+/HER2- ABC who had not received prior systemic therapy for their advanced disease were randomized 2:1 to palbociclib-letrozole or placebo-letrozole. Endpoints include investigator-assessed PFS (primary), safety, and patient-reported outcomes (PROs). RESULTS After a median follow-up of approximately 38 months, median PFS was 27.6 months for palbociclib-letrozole (n = 444) and 14.5 months for placebo-letrozole (n = 222) (HR 0.563; 1-sided P < 0.0001). All subgroups benefited from palbociclib treatment. The improvement of PFS with palbociclib-letrozole was maintained in the next 2 subsequent lines of therapy and delayed the use of chemotherapy (40.4 vs. 29.9 months for palbociclib-letrozole vs. placebo-letrozole). Safety data were consistent with the known profile. Patients' quality of life was maintained. CONCLUSIONS With approximately 15 months of additional follow-up, palbociclib plus letrozole continued to demonstrate improved PFS compared with placebo plus letrozole in the overall population and across all patient subgroups, while the safety profile remained favorable and quality of life was maintained. These data confirm that palbociclib-letrozole should be considered the standard of care for first-line therapy in patients with ER+/HER2- ABC, including those with low disease burden or long disease-free interval. Sponsored by Pfizer; ClinicalTrials.gov: NCT01740427.
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Affiliation(s)
- H S Rugo
- Department of Medicine (Hematology/Oncology), University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, 1600 Divisadero St, 2nd Floor, San Francisco, CA, 94115, USA.
| | - R S Finn
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - V Diéras
- Department of Medical Oncology, Institut Curie, Paris, France
- Centre Eugène Marquis, Rennes, France
| | - J Ettl
- Frauenklinik und Poliklinik Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - O Lipatov
- Republican Clinical Oncology Dispensary, State Budget Medical Institution, Ufa, Russia
| | - A A Joy
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - N Harbeck
- Department of Obstetrics and Gynecology, Brustzentrum der Universität München (LMU), Munich, Germany
| | - A Castrellon
- Breast Cancer Center, Memorial Cancer Institute, Hollywood, FL, USA
| | - S Iyer
- Patient and Health Impact, Pfizer Inc, New York, NY, USA
| | - D R Lu
- Clinical Statistics, Pfizer Inc, La Jolla, CA, USA
| | - A Mori
- Global Product Development, Clinical, Pfizer S.r.l, Milan, Italy
| | - E R Gauthier
- Global Product Development, Clinical, Pfizer Inc, San Francisco, CA, USA
| | - C Huang Bartlett
- Global Product Development, Clinical, Pfizer Inc, Collegeville, PA, USA
| | - K A Gelmon
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - D J Slamon
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
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Sood R, Rathod PV, Dokhe Y, Jani KK, Sivakumar V, Balasubramanian D, Iyer S, Thankappan K, Sadasivan S. PO-074 Pharyngoesophageal stricture following laryngeal-hypopharyngeal cancer treatment-management outcome. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30240-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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31
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Sood R, Paul J, Rajan S, Subramanian S, Balasubramanian D, Iyer S. PO-076 Predictors of postoperative pneumonia in patient undergoing oral cancer resection and its management. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30242-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Taylor-Stokes G, Mitra D, Waller J, Gibson K, Milligan G, Zhan L, Iyer S. Abstract P6-18-36: Real world treatment patterns and outcomes of patients receiving palbociclib plus aromatase inhibitor in the United States: Sub-groups analysis based on age, performance status and sites of metastases from the IRIS study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Ibrance Real World Insights (IRIS) is a multi-country study aimed to describe clinical characteristics, treatment patterns and clinical outcomes of patients receiving palbociclib plus aromatase inhibitor. Previously the results on the overall population within the US have been communicated. The current analysis focuses on subgroups stratified by age, performance status and visceral status.
Materials and methods: A retrospective chart review of HR+/HER2- ABC/MBC patients who received palbociclib plus aromatase inhibitor as initial endocrine based therapy for their advanced disease was conducted between June and October 2017. Physicians completed electronic case report forms, extracting data on patient demographics, clinical characteristics, treatment history/patterns and clinical outcomes.Progression free and survival rates at 12 and 24 months were estimated via Kaplan-Meier analysis.
Results: Data for the US are reported here. In total 63 physicians completed 360 eCRFs with a mean follow up time since palbociclib initiation of 12 months. Majority of the patients were >65 years (53%), and had ECOG status of 0 (30%) or 1 (56%). Overall 293 (81%) patients had metastatic disease, of which 50% had visceral metastases. Across all sub-groups, majority of patients prescribed an initial palbociclib dose of 125mg did not require a change of dose while on treatment. The 12-month and 24-month progression free and overall survival rates across subgroups are presented in Table 1. Patients with a performance status of ECOG=1 had a slightly lower progression and survival rates at 12 and 24 months compared to those with a score =0. Likewise, patients with visceral disease were observed to have slightly lower progression free and survival rates than others.
Table 1:Clinical Outcomes for the different sub-groups.Patient Sub-groups AgeECOG statusVisceral Status Up to 65 n=169Over 65 n=1910 n=1071 n=200Visceral metastases n=147Non-visceral metastases n=146Progression free survival rate at 12 months, %86.382.194.386.580.285.8Progression free survival rate at 24 months, %59.769.071.267.450.780.6Overall survival rate At 12 months, %97.992.8100.099.590.599.3Overall survival rate at 24 months, %95.185.695.796.487.290.7
Conclusions: The analysis indicates consistent trends in different clinical outcomes were observed with palbociclib plus aromatase inhibitor across patients sub-groups based on age, performance status and visceral metastases.
Citation Format: Taylor-Stokes G, Mitra D, Waller J, Gibson K, Milligan G, Zhan L, Iyer S. Real world treatment patterns and outcomes of patients receiving palbociclib plus aromatase inhibitor in the United States: Sub-groups analysis based on age, performance status and sites of metastases from the IRIS study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-36.
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Affiliation(s)
- G Taylor-Stokes
- Adelphi Real World, Bollington, United Kingdom; Pfizer, New York, NY
| | - D Mitra
- Adelphi Real World, Bollington, United Kingdom; Pfizer, New York, NY
| | - J Waller
- Adelphi Real World, Bollington, United Kingdom; Pfizer, New York, NY
| | - K Gibson
- Adelphi Real World, Bollington, United Kingdom; Pfizer, New York, NY
| | - G Milligan
- Adelphi Real World, Bollington, United Kingdom; Pfizer, New York, NY
| | - L Zhan
- Adelphi Real World, Bollington, United Kingdom; Pfizer, New York, NY
| | - S Iyer
- Adelphi Real World, Bollington, United Kingdom; Pfizer, New York, NY
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Trocio J, Lin J, Fisher MD, Hu N, Davis C, McRoy L, Walker MS, Iyer S. Abstract P6-18-29: Real-world treatment patterns and clinical outcomes with palbociclib combination therapy received in US community oncology practices. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
The treatment landscape for women with HR+/HER2- advanced and metastatic breast cancer (A/MBC) is changing as new agents are being combined with more established treatments to achieve greater efficacy in combating resistant and unresponsive disease. The present study is designed to describe patient characteristics, treatment patterns, and clinical outcomes in a cohort of women with HR+/HER2- A/MBC treated with palbociclib plus aromatase inhibitor (P+AI) or palbociclib plus fulvestrant (P+FV) in the US community oncology setting.
Methods:
Retrospective medical record data from adult women diagnosed with HR+/HER2- A/MBC who initiated P+AI or P+FV for treatment of A/MBC on or after February 3, 2015 were collected from the Vector Oncology Data Warehouse, a network comprised of 10 community oncology practices across the US. Descriptive analyses were performed on patient characteristics, treatment patterns, and clinical outcomes. Time to event outcomes (progression-free rate (PFR) and survival rate (SR)) at 12 (PFR-12, SR-12) and 24 (PFR-24, SR-24) months for the P+AI combination as first line endocrine therapy and 12 and 18 months for the P+FV combination as treatment following prior endocrine based therapy in either the adjuvant or metastatic setting.
Results:
Among 304 patients who received palbociclib combination therapy, 281 (92.4%) received it per labeled indication. Of the 281 on-label users, the focus of reporting here, 233 (82.9%) received P+AI as their initial endocrine therapy after A/MBC diagnosis; 48 (17.1%) received P+FV after prior endocrine therapy for breast cancer. Patient mean age (SD) was 63.1 (11.4) and 68.2 (10.2) years for patients receiving P+AI and P+FV, respectively. Patients were predominantly white (74.2% for P+AI and 77.1% for P+FV patients).The initial dosing for palbociclib was 125mg/day in 85.4% (n=199) of P+AI and 79.2% (n=38) of P+FV patients. Among patients who received P+AI, PFR-12 was 69.8% and PFR-24 was 46.8% with median follow up time of 10.8 months and 36.8% of progression events. The SR-12 was 89.8% and SR-24 was 71.4%. For patients who received P+FV, PFR-12 was 43.5% and PFR-18 was 39.9% with a median follow up time of 7.6 months and 50.0% of progression events. The SR-12 was 76.3% and SR-18 was 65.0%.
Conclusions:
This study provides real-world assessment of treatment patterns and clinical outcomes of patients with HR+/ HER2- A/MBC who received palbociclib in combination with an AI or a FV in US community oncology settings. These findings demonstrate the benefit of palbociclib combination therapy in a diverse real world population.
Sponsor: Pfizer, Inc.
Citation Format: Trocio J, Lin J, Fisher MD, Hu N, Davis C, McRoy L, Walker MS, Iyer S. Real-world treatment patterns and clinical outcomes with palbociclib combination therapy received in US community oncology practices [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-29.
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Affiliation(s)
- J Trocio
- Pfizer, Inc., New York, NY; Vector Oncology, Memphis, TN
| | - J Lin
- Pfizer, Inc., New York, NY; Vector Oncology, Memphis, TN
| | - MD Fisher
- Pfizer, Inc., New York, NY; Vector Oncology, Memphis, TN
| | - N Hu
- Pfizer, Inc., New York, NY; Vector Oncology, Memphis, TN
| | - C Davis
- Pfizer, Inc., New York, NY; Vector Oncology, Memphis, TN
| | - L McRoy
- Pfizer, Inc., New York, NY; Vector Oncology, Memphis, TN
| | - MS Walker
- Pfizer, Inc., New York, NY; Vector Oncology, Memphis, TN
| | - S Iyer
- Pfizer, Inc., New York, NY; Vector Oncology, Memphis, TN
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Disher T, Siddiqui M, Mitra D, Cameron C, Zhan L, Iyer S. Abstract P6-18-33: GI toxicities in metastatic breast cancer: A comprehensive literature review. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Treatments for advanced or metastatic breast cancer (aBC/mBC) are associated with gastrointestinal (GI) toxicities. The objective of this study was to assess the association between GI toxicities in mBC/aBC and health-related quality of life (HRQoL) and economic burden.
Methods
We conducted a comprehensive literature search of the Cochrane Central Register of Controlled Trials (2017), NHS Economic Evaluation Database (2016), Embase (1988 – 2017 week 34), and Ovid MEDLINE (1946 to August 2017). Eligible studies evaluated an intervention/comparator treatment in adult patients (age ≥18 years) with aBC/mBC and reported a direct connection between GI toxicities (ie, diarrhea, constipation, nausea, vomiting) and HRQoL and economic evidence. All studies published from January 2000 to August 2017 were assessed for eligibility. Editorials, case reports, conference abstracts, and studies of early, locally advanced, or inflammatory BC were excluded. Abstract and title screening, and full-text screening were conducted by single reviewers. Data were extracted by a single reviewer and verified by a second. Results were synthesized narratively.
Results
Database searches identified 3,428 articles; an additional 16 articles were identified through other sources. Ninety-four studies underwent full-text review, of which 27 reported a direct connection between GI toxicities and HRQoL (n = 11) and economic burden (n = 19). Some studies reported both HRQoL and economic data.
Patients identified treatment-related adverse events (AEs), such as GI events, as an important aspect of treatment that can affect therapy choice, discontinuation, and switching. Generally, patients with mBC had lower HRQoL than other BC groups, and increasing toxicity was associated with a greater degree of HRQoL impairment. When patients were asked to rank which AEs they most wanted to avoid, only pain ranked higher than nausea and vomiting. In a willingness to pay study, women with mBC were willing to pay $3,894 (2014 USD) per year to avoid severe diarrhea and $3,211 to avoid severe nausea.
Gastrointestinal events were among the costliest class of AEs, with mean costs as high as $4,809 (2016 USD) per episode; costs increased by 24% if events were persistent or recurrent.
Conclusions
Gastrointestinal toxicities are common in patients with aBC/mBC and have significant consequences for HRQoL and system-level economic outcomes. Frequency and implications of GI effects of treatment regimens should be considered carefully during patient counseling,, prescribing and coverage decisions in metastatic breast cancer.
Citation Format: Disher T, Siddiqui M, Mitra D, Cameron C, Zhan L, Iyer S. GI toxicities in metastatic breast cancer: A comprehensive literature review [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-33.
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Affiliation(s)
- T Disher
- Cornerstone Research Group, Inc, Burling, ON, Canada; Pfizer, New York, NY
| | - M Siddiqui
- Cornerstone Research Group, Inc, Burling, ON, Canada; Pfizer, New York, NY
| | - D Mitra
- Cornerstone Research Group, Inc, Burling, ON, Canada; Pfizer, New York, NY
| | - C Cameron
- Cornerstone Research Group, Inc, Burling, ON, Canada; Pfizer, New York, NY
| | - L Zhan
- Cornerstone Research Group, Inc, Burling, ON, Canada; Pfizer, New York, NY
| | - S Iyer
- Cornerstone Research Group, Inc, Burling, ON, Canada; Pfizer, New York, NY
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Waller J, Mitra D, Taylor-Stokes G, Gibson K, Milligan G, Zhan L, Iyer S. Abstract P6-18-21: Real world treatment patterns and outcomes of patients receiving palbociclib plus fulvestrant in the United States: Sub-groups analysis based on age, performance status and sites of metastases. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Ibrance Real World Insights (IRIS) is a multi-country study aimed to describe the clinical characteristics and understand treatment patterns and clinical outcomes of patients receiving palbociclib plus fulvestrant in real world clinical practice. Previously the results on the overall population within the US have been communicated. The current analyses focus on subgroups stratified by age, performance status and visceral status.
Materials and methods: A retrospective chart review of HR+/HER2- ABC/MBC patients was conducted between June and October 2017. Physicians extracted data from patient medical records for HR+/HER2- ABC patients who received palbociclib plus fulvestrant following disease progression with endocrine based therapy for their advanced disease. Electronic case report forms collected data covering patient demographics, clinical characteristics, treatment history/patterns and clinical outcomes.Progression free rates and survival rates at 6 and 12 months were estimated via Kaplan-Meier analysis.
Results: Data for the US are reported here. In total, 65 physicians extracted data for 292 patients who had a mean follow up time of 7.4 months. Majority of the patients were >65 years (54%), and had ECOG status of 0 (32%) or 1 (48%). Overall 224 (77%) patients had metastatic disease, of which 93 (42%) had visceral metastases. Across all sub-groups, majority of patients prescribed an initial palbociclib dose of 125mg did not require a change of dose while on treatment. The 6-month and 12-month progression free and survival rates across subgroups are presented in Table 1. Patients with a performance status of ECOG ≥ 2 had a slightly lower progression and survival rates at 6 and 12 months compared to those with a score <1. Likewise, patients with visceral disease were observed to have slightly lower progression free and survival rates than others.
Table 1:Clinical Outcomes by Patient Sub-groups.Patient Sub-groups AgeECOGstatusVisceral Status Up to 65 n=158Over 65 n=1340 n=931 n=1392+ n=60Visceral Metastases n=93Non-visceral Metastases n=131Progression free survival rate at 6 months, %95.293.297.893.490.689.694.8Progression free survival rate at 12 months, %81.277.884.683.0-73.276.5Survival rate at 6 months, %98.096.3100.098.290.692.298.9Survival rate at 12 months, %90.085.197.695.1-80.892.7
Conclusions: The analysis indicates consistent trends in different clinical outcomes were observed with palbociclib plus fulvestrant across patients sub-groups based on age, performance status and visceral metastases.
Citation Format: Waller J, Mitra D, Taylor-Stokes G, Gibson K, Milligan G, Zhan L, Iyer S. Real world treatment patterns and outcomes of patients receiving palbociclib plus fulvestrant in the United States: Sub-groups analysis based on age, performance status and sites of metastases [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-21.
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Affiliation(s)
- J Waller
- Adelphi Real World, Bollington, United Kingdom; Pfizer, New York, NY
| | - D Mitra
- Adelphi Real World, Bollington, United Kingdom; Pfizer, New York, NY
| | - G Taylor-Stokes
- Adelphi Real World, Bollington, United Kingdom; Pfizer, New York, NY
| | - K Gibson
- Adelphi Real World, Bollington, United Kingdom; Pfizer, New York, NY
| | - G Milligan
- Adelphi Real World, Bollington, United Kingdom; Pfizer, New York, NY
| | - L Zhan
- Adelphi Real World, Bollington, United Kingdom; Pfizer, New York, NY
| | - S Iyer
- Adelphi Real World, Bollington, United Kingdom; Pfizer, New York, NY
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Iyer S, Shah S, Ward C, Stains J, Folker E, Lovering R. NUCLEAR DYNAMICS AND CYTOSKELETAL COUPLING ARE ALTERED IN MURINE AGING SKELETAL MUSCLE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.381] [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: 11/13/2022] Open
Affiliation(s)
- S Iyer
- Department of Orthopaedics
| | - S Shah
- Departments of Orthopaedic Surgery and Bioengineering
| | - C Ward
- Department of Orthopaedics
| | | | | | - R Lovering
- Departments of Orthopaedics and Physiology
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Mitra D, Taylor-Stokes G, Waller J, Gibson K, Milligan G, Iyer S. Real world treatment patterns associated with palbociclib combination therapy in Germany: Results from the IRIS study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy272.328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Subramaniam N, Balasubramanian D, Murthy S, Rathod P, Vidhyadharan S, Thankappan K, Iyer S. Impact of postoperative radiotherapy on survival and loco-regional control in node-negative oral cavity tumours classified as T3 using the AJCC Cancer Staging Manual eighth edition. Int J Oral Maxillofac Surg 2018; 48:152-156. [PMID: 30243830 DOI: 10.1016/j.ijom.2018.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 08/25/2017] [Revised: 07/18/2018] [Accepted: 07/24/2018] [Indexed: 11/19/2022]
Abstract
According to the eighth edition of the AJCC Cancer Staging Manual (AJCC8), a depth of invasion (DOI) >10mm is classified as pT3, representing a locally advanced tumour requiring postoperative radiotherapy (PORT). When node-negative, however, evidence regarding whether PORT improves loco-regional control or survival is unclear. To clarify this, two cohorts of patients were studied: (1) patients classified as pT3N0 by the seventh edition of the AJCC manual (AJCC7), with DOI >10mm and a tumour diameter >4cm (17 patients who received PORT), and (2) patients classified as pT1N0 and pT2N0 by AJCC7, with DOI >10mm and a tumour diameter <4cm (55 patients who did not receive PORT). Loco-regional control and survival were analysed. PORT was found not to impact overall survival or disease-free survival. It was also found not to impact local, regional, or distant recurrence. Although the two subsets of patients considered here (DOI >10mm with tumour diameter below or above 4cm) were previously distinct, they are both considered pT3 in AJCC8. Data from this study indicate that the routine administration of PORT to patients with a DOI >10mm may not be warranted in the absence of other risk features such as nodal disease or close margins.
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Affiliation(s)
- N Subramaniam
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Edappally, Kochi, Kerala, India
| | - D Balasubramanian
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Edappally, Kochi, Kerala, India.
| | - S Murthy
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Edappally, Kochi, Kerala, India
| | - P Rathod
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Edappally, Kochi, Kerala, India
| | - S Vidhyadharan
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Edappally, Kochi, Kerala, India
| | - K Thankappan
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Edappally, Kochi, Kerala, India
| | - S Iyer
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Edappally, Kochi, Kerala, India
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Reginauld S, Cannone V, Heublein D, Iyer S, Scott C, Sangaralingham J, Burnett Jr J. 4934Circulating molecular forms of ANP and BNP in human acute decompensated Heart Failure: evidence for a relative ANP deficiency state. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.4934] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Reginauld
- Mayo Clinic, Cardiorenal Laboratory, Rochester, United States of America
| | - V Cannone
- Mayo Clinic, Cardiorenal Laboratory, Rochester, United States of America
| | - D Heublein
- Mayo Clinic, Cardiorenal Laboratory, Rochester, United States of America
| | - S Iyer
- Mayo Clinic, Cardiorenal Laboratory, Rochester, United States of America
| | - C Scott
- Mayo Clinic, Cardiorenal Laboratory, Rochester, United States of America
| | - J Sangaralingham
- Mayo Clinic, Cardiorenal Laboratory, Rochester, United States of America
| | - J Burnett Jr
- Mayo Clinic, Cardiorenal Laboratory, Rochester, United States of America
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Rugo HS, Iyer S, Huang C. Reply to the letter to the editor 'Reporting of HRQoL results from the PALOMA-2 trial: unfounded conclusions due to highly biased analyses' by Kaiser et al. Ann Oncol 2018; 29:1878. [PMID: 29873677 DOI: 10.1093/annonc/mdy206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H S Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, USA.
| | - S Iyer
- Global Outcomes and Evidence, New York, USA
| | - C Huang
- Medical Affairs, Pfizer Inc., New York, USA
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Subramaniam NR, Reddy R, Balasubramanian D, Thankappan K, Iyer S. Is pulmonary metastasectomy beneficial in head and neck squamous cell carcinoma? A review of literature. Indian J Cancer 2018; 54:2-5. [PMID: 29199651 DOI: 10.4103/ijc.ijc_170_17] [Citation(s) in RCA: 3] [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] [Indexed: 11/04/2022]
Abstract
Metastatic head and neck squamous cell carcinoma (HNSCC) has traditionally carried a dismal prognosis; however with advances in care, it has been shown that pulmonary metastasectomy is a viable therapeutic option in selected patients, palliating symptoms and improving survival. With the increasing incidence of human papilloma virus-related HNSCC and better availability of minimal access surgery, there is a need to better understand the role of pulmonary metastasectomy in the treatment of HNSCC. This article summarizes the literature on indications, results, surgical options and approaches, clinical dilemmas, and controversies associated with pulmonary metastasectomy in HNSCC, to identify suitable candidates and optimize outcomes.
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Affiliation(s)
- N R Subramaniam
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - R Reddy
- Department of Surgery, University of Sydney, Sydney, Australia
| | - D Balasubramanian
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - K Thankappan
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - S Iyer
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
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Taylor-Stokes G, Mitra D, Waller J, Gibson K, Milligan G, Iyer S. Real world treatment patterns and clinical outcomes of advanced/metastatic breast cancer patients receiving palbociclib in combination with an aromatase inhibitor: Results from the IRIS Study. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30562-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Satheesh C, Bhatt A, Singhal M, Aarthi R, Shubham K, Madhura G, Maka V, Naik R, Iyer S, Shafi G. 53P Lung cancer: Beyond EGFR and ALK dichotomy. J Thorac Oncol 2018. [DOI: 10.1016/s1556-0864(18)30330-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Henry N, Baker B, Iyer S. Frey's syndrome following a facial burn treated with botulinum toxin. Ann Burns Fire Disasters 2018; 31:47-48. [PMID: 30174572 PMCID: PMC6116648] [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] [Received: 01/16/2018] [Accepted: 01/29/2018] [Indexed: 06/08/2023]
Abstract
Frey's syndrome occurs as a result of damage to the auriculotemporal nerve, which causes inappropriate regeneration of damaged parasympathetic fibres to salivary glands to innervate the sympathetic receptors of sweat glands in the face. The symptoms are pathological flushing and sweating with gustatory stimuli. It most commonly occurs following parotid surgery and has not previously been reported following burn injury. We present a 50-year-old man who sustained 1% TBSA full thickness burn to the right side of his face as a child. This was excised and reconstructed with skin grafts as well as further revision procedures in his adult life. He incidentally reported copious amounts of gustatory sweating over his right temple region that had been present since his initial injury, occurring prior to any reconstruction, consistent with Frey's syndrome. This was confirmed with a starch iodine test, and successfully treated with Botulinum toxin injections post reconstruction. This case is the first report of Frey's syndrome following burn injury. We highlight the potential development of Frey's syndrome following facial burns, even in the reconstructed area. Botulinum toxin treatment remains effective.
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Affiliation(s)
- N. Henry
- Royal Preston Hospital, Preston, UK
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Davis KL, Kaye JA, Masters ET, Iyer S. Real-world outcomes in patients with ALK-positive non-small cell lung cancer treated with crizotinib. ACTA ACUST UNITED AC 2018; 25:e40-e49. [PMID: 29507494 DOI: 10.3747/co.25.3723] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 12/17/2022]
Abstract
Background Crizotinib has shown greater efficacy in clinical trials than chemotherapy in patients with anaplastic lymphoma kinase-positive (alk+) non-small cell lung cancer (nsclc), but little information is available on its use and outcomes in real-world settings. We therefore assessed treatment patterns and outcomes in alk+ nsclc patients treated with crizotinib in regular clinical practice. Methods A retrospective medical record review was conducted in North America for adults with alk+ nsclc treated with crizotinib as first- or later-line therapy for metastatic disease between 1 August 2011 and 31 March 2013 (for the United States) or 1 May 2012 and 31 March 2013 (for Canada). Crizotinib-related trial enrollees were excluded. Descriptive analyses were conducted to assess treatment patterns and objective response rate (orr). Progression-free survival (pfs) and overall survival (os) were descriptively analyzed using Kaplan-Meier methods. Results Data were extracted for 212 patients in the United States (n = 147) and Canada (n = 65). Mean (standard deviation [sd]) age was 58.9 (9.5) years, and 69% were male. Seventy-nine patients (37%) were deceased at record abstraction. Sixty-five percent (n = 137) initiated crizotinib as first-line therapy. Mean (sd) duration of crizotinib treatment was 8.7 (4.9) months. Objective response rate was 66% (69% for first-line recipients, 60% for second-/later-line). Median (95% ci) pfs and os from crizotinib initiation were 9.5 (8.7, 10.1) and 23.4 (19.5, -) months, respectively. One- and two-year survival probabilities were 82% and 49%, respectively. Conclusions Outcomes for crizotinib recipients in this study align with previous trials, with orr appearing more favourable in first-line recipients. Our findings indicate that crizotinib outcomes in clinical studies may translate to regular clinical practice.
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Affiliation(s)
- K L Davis
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - J A Kaye
- RTI Health Solutions, Waltham, MA, USA
| | | | - S Iyer
- Pfizer, Inc., New York, NY USA
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Jayasankaran SC, Chelakkot PG, Thankappan K, Iyer S, Moorthy S. Paralingual and sublingual space invasion in magnetic resonance imaging of squamous cell carcinoma of anterior two-thirds of tongue: Is there a prognostic significance? A prospective evaluation. Indian J Cancer 2018; 54:442-446. [PMID: 29469075 DOI: 10.4103/ijc.ijc_318_17] [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] [Indexed: 11/04/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) in tumors of anterior two-thirds of tongue has a significant role in assessing different tumor parameters, and in prognosticating. AIM This prospective study conducted in a tertiary cancer care center, focused on patients with squamous cell carcinoma of anterior two-thirds of tongue. The significance of invasion of paralingual and sublingual spaces in relation to the pathological grade of these tumors, and its predictive value in pathological nodal involvement were analyzed. MATERIALS AND METHODS All consecutive patients with the required inclusion criteria were accrued. Imaging was done with 3 Tesla MRI and invasion of sublingual and paralingual spaces were accurately assessed. Data elucidated were tabulated and analysed using IBM SPSS version 20.0. Chi-square test, nonparametric correlation using Spearman's Rho correlation, and two-independent sample test using Mann-Whitney's U-test were used to arrive at correlations between the imaging and histopathological parameters. RESULTS Sixty-three patients were analyzed. Mean age was 52.3 ± 11.45 years. 74.6% were males. MRI showed sublingual space invasion in 47.6%. 18/28 with and 11/33 without invasion had node positivity. Paralingual space involvement was observed in 31.7% of patients. Thirteen of these and 16/43 with no involvement had positive cervical nodes. No statistically significant correlation was observed. CONCLUSION This prospective study did not establish any statistically sound correlation, and robust data are lacking to support newer parameters such as sublingual space and paralingual space as probable predictors of cervical nodal involvement, and for prognostication.
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Affiliation(s)
- S C Jayasankaran
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - P G Chelakkot
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - K Thankappan
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - S Iyer
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - S Moorthy
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
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Harbeck N, Dieras V, Finn R, Gelmon KA, Walshe JM, Shparyk Y, Mori A, Lui DR, Bhattacharyya H, Iyer S, Johnston S, Rugo HS. Abstract P5-19-01: Impact of palbociclib plus letrozole on patient-reported general health status compared with letrozole alone in ER+/HER2- advanced/metastatic breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-19-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Palbociclib plus letrozole significantly improved progression-free survival (PFS) compared with letrozole plus placebo in treatment-naive postmenopausal patients with estrogen receptor-positive (ER+), human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (MBC) in the phase 3 PALOMA-2 trial. Here, we compare patient-reported general health status with extended (max 53 cycles) follow-up (data cut off May31st, 2017) (Pfizer: NCT01740427).
METHODS: PALOMA-2 randomized patients 2:1 to palbociclib + letrozole (n=444) or placebo + letrozole (n=222). Patient-reported outcomes were assessed at baseline, day 1 of cycles 1, 2, and 3, and day 1 of every other cycle from cycle 5 until the end of treatment using the EuroQol 5-Dimension Questionnaire (EQ-5D). The EQ-5D is a standardized measure of health status that consists of a descriptive system comprising the following 5 dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression rated at 3 levels (no, some, or extreme problems) and a single index score for health status (ranges generally from 0 [dead] to 1 [full health]) calculated using a standard algorithm. In addition, a visual analog scale (VAS) measured self-rated health status from 0 (worst imaginable) to 100 (best imaginable). Repeated measures mixed-effects analyses were performed to compare overall index and VAS scores between treatments, controlling for baseline.
RESULTS: Completion rates at baseline were >95% in each group. The mean (SD) scores at baseline were comparable between palbociclib plus letrozole and letrozole alone for the VAS (71.3 [21.2] vs 72.3 [19.8]) and the EQ-5D index scores (0.70 [0.25]) vs (0.73 [0.21]). Median follow up was 38 months for palbociclib plus letrozole and 37 months for letrozole only. No statistically significant difference in overall change from baseline in general health status was observed between the treatment arms. The proportion of patients reporting the presence of a problem at baseline was similar for palbociclib plus letrozole and letrozole, respectively: mobility (39% vs 39%), self-care (12% vs 12%), usual activities (44% vs 39%), pain (69% vs 65%), and anxiety/depression (54% vs 54%). No statistically significant difference in overall mean EQ-5D index scores (0.73 vs. 0.71) was observed between the treatment arms.
CONCLUSION: Addition of palbociclib to letrozole maintained general health status and EQ-5D index scores in ER+ HER2- advanced/metastatic breast cancer with no statistically significant differences observed compared to letrozole alone.
Citation Format: Harbeck N, Dieras V, Finn R, Gelmon KA, Walshe JM, Shparyk Y, Mori A, Lui DR, Bhattacharyya H, Iyer S, Johnston S, Rugo HS. Impact of palbociclib plus letrozole on patient-reported general health status compared with letrozole alone in ER+/HER2- advanced/metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-19-01.
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Affiliation(s)
- N Harbeck
- Brustzentrum der Universität München (LMU), Marchioninistrasse 15, Munchen, Germany; Institut Curie, Paris, France; University of California, Los Angeles, CA; 5British Columbia Cancer Agency-Vancouver Centre, Vancouver, BC, Canada; Cancer Trials Ireland, Dublin, Ireland; Lviv State Oncologic Regional Treatment and Diagnostic Center, Lviv, Ukraine; Pfizer s.r.l., Milan, Italy; Pfizer, Inc, La Jolla, CA; Pfizer, Inc, New York, NY; The Royal Marsden NHS Foundation, London, United Kingdom; University of California, San Francisco, CA
| | - V Dieras
- Brustzentrum der Universität München (LMU), Marchioninistrasse 15, Munchen, Germany; Institut Curie, Paris, France; University of California, Los Angeles, CA; 5British Columbia Cancer Agency-Vancouver Centre, Vancouver, BC, Canada; Cancer Trials Ireland, Dublin, Ireland; Lviv State Oncologic Regional Treatment and Diagnostic Center, Lviv, Ukraine; Pfizer s.r.l., Milan, Italy; Pfizer, Inc, La Jolla, CA; Pfizer, Inc, New York, NY; The Royal Marsden NHS Foundation, London, United Kingdom; University of California, San Francisco, CA
| | - R Finn
- Brustzentrum der Universität München (LMU), Marchioninistrasse 15, Munchen, Germany; Institut Curie, Paris, France; University of California, Los Angeles, CA; 5British Columbia Cancer Agency-Vancouver Centre, Vancouver, BC, Canada; Cancer Trials Ireland, Dublin, Ireland; Lviv State Oncologic Regional Treatment and Diagnostic Center, Lviv, Ukraine; Pfizer s.r.l., Milan, Italy; Pfizer, Inc, La Jolla, CA; Pfizer, Inc, New York, NY; The Royal Marsden NHS Foundation, London, United Kingdom; University of California, San Francisco, CA
| | - KA Gelmon
- Brustzentrum der Universität München (LMU), Marchioninistrasse 15, Munchen, Germany; Institut Curie, Paris, France; University of California, Los Angeles, CA; 5British Columbia Cancer Agency-Vancouver Centre, Vancouver, BC, Canada; Cancer Trials Ireland, Dublin, Ireland; Lviv State Oncologic Regional Treatment and Diagnostic Center, Lviv, Ukraine; Pfizer s.r.l., Milan, Italy; Pfizer, Inc, La Jolla, CA; Pfizer, Inc, New York, NY; The Royal Marsden NHS Foundation, London, United Kingdom; University of California, San Francisco, CA
| | - JM Walshe
- Brustzentrum der Universität München (LMU), Marchioninistrasse 15, Munchen, Germany; Institut Curie, Paris, France; University of California, Los Angeles, CA; 5British Columbia Cancer Agency-Vancouver Centre, Vancouver, BC, Canada; Cancer Trials Ireland, Dublin, Ireland; Lviv State Oncologic Regional Treatment and Diagnostic Center, Lviv, Ukraine; Pfizer s.r.l., Milan, Italy; Pfizer, Inc, La Jolla, CA; Pfizer, Inc, New York, NY; The Royal Marsden NHS Foundation, London, United Kingdom; University of California, San Francisco, CA
| | - Y Shparyk
- Brustzentrum der Universität München (LMU), Marchioninistrasse 15, Munchen, Germany; Institut Curie, Paris, France; University of California, Los Angeles, CA; 5British Columbia Cancer Agency-Vancouver Centre, Vancouver, BC, Canada; Cancer Trials Ireland, Dublin, Ireland; Lviv State Oncologic Regional Treatment and Diagnostic Center, Lviv, Ukraine; Pfizer s.r.l., Milan, Italy; Pfizer, Inc, La Jolla, CA; Pfizer, Inc, New York, NY; The Royal Marsden NHS Foundation, London, United Kingdom; University of California, San Francisco, CA
| | - A Mori
- Brustzentrum der Universität München (LMU), Marchioninistrasse 15, Munchen, Germany; Institut Curie, Paris, France; University of California, Los Angeles, CA; 5British Columbia Cancer Agency-Vancouver Centre, Vancouver, BC, Canada; Cancer Trials Ireland, Dublin, Ireland; Lviv State Oncologic Regional Treatment and Diagnostic Center, Lviv, Ukraine; Pfizer s.r.l., Milan, Italy; Pfizer, Inc, La Jolla, CA; Pfizer, Inc, New York, NY; The Royal Marsden NHS Foundation, London, United Kingdom; University of California, San Francisco, CA
| | - DR Lui
- Brustzentrum der Universität München (LMU), Marchioninistrasse 15, Munchen, Germany; Institut Curie, Paris, France; University of California, Los Angeles, CA; 5British Columbia Cancer Agency-Vancouver Centre, Vancouver, BC, Canada; Cancer Trials Ireland, Dublin, Ireland; Lviv State Oncologic Regional Treatment and Diagnostic Center, Lviv, Ukraine; Pfizer s.r.l., Milan, Italy; Pfizer, Inc, La Jolla, CA; Pfizer, Inc, New York, NY; The Royal Marsden NHS Foundation, London, United Kingdom; University of California, San Francisco, CA
| | - H Bhattacharyya
- Brustzentrum der Universität München (LMU), Marchioninistrasse 15, Munchen, Germany; Institut Curie, Paris, France; University of California, Los Angeles, CA; 5British Columbia Cancer Agency-Vancouver Centre, Vancouver, BC, Canada; Cancer Trials Ireland, Dublin, Ireland; Lviv State Oncologic Regional Treatment and Diagnostic Center, Lviv, Ukraine; Pfizer s.r.l., Milan, Italy; Pfizer, Inc, La Jolla, CA; Pfizer, Inc, New York, NY; The Royal Marsden NHS Foundation, London, United Kingdom; University of California, San Francisco, CA
| | - S Iyer
- Brustzentrum der Universität München (LMU), Marchioninistrasse 15, Munchen, Germany; Institut Curie, Paris, France; University of California, Los Angeles, CA; 5British Columbia Cancer Agency-Vancouver Centre, Vancouver, BC, Canada; Cancer Trials Ireland, Dublin, Ireland; Lviv State Oncologic Regional Treatment and Diagnostic Center, Lviv, Ukraine; Pfizer s.r.l., Milan, Italy; Pfizer, Inc, La Jolla, CA; Pfizer, Inc, New York, NY; The Royal Marsden NHS Foundation, London, United Kingdom; University of California, San Francisco, CA
| | - S Johnston
- Brustzentrum der Universität München (LMU), Marchioninistrasse 15, Munchen, Germany; Institut Curie, Paris, France; University of California, Los Angeles, CA; 5British Columbia Cancer Agency-Vancouver Centre, Vancouver, BC, Canada; Cancer Trials Ireland, Dublin, Ireland; Lviv State Oncologic Regional Treatment and Diagnostic Center, Lviv, Ukraine; Pfizer s.r.l., Milan, Italy; Pfizer, Inc, La Jolla, CA; Pfizer, Inc, New York, NY; The Royal Marsden NHS Foundation, London, United Kingdom; University of California, San Francisco, CA
| | - HS Rugo
- Brustzentrum der Universität München (LMU), Marchioninistrasse 15, Munchen, Germany; Institut Curie, Paris, France; University of California, Los Angeles, CA; 5British Columbia Cancer Agency-Vancouver Centre, Vancouver, BC, Canada; Cancer Trials Ireland, Dublin, Ireland; Lviv State Oncologic Regional Treatment and Diagnostic Center, Lviv, Ukraine; Pfizer s.r.l., Milan, Italy; Pfizer, Inc, La Jolla, CA; Pfizer, Inc, New York, NY; The Royal Marsden NHS Foundation, London, United Kingdom; University of California, San Francisco, CA
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Young D, Collins S, Culbertson S, Iyer S, Letko J, Valaitis S. 87: Predictors of surgical vs. non-surgical management of pelvic organ prolapse. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.12.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Noor N, Bastawros D, Eto C, Iyer S, Florian-Rodriguez M, Lavelle E, Lozo S, Haviland M, Von Bargen E, Antosh D. 01: Minimally invasive sacrocolpopexy versus vaginal uterosacral ligament suspension: Comparing anatomic outcomes at 1 year. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.12.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
The pedicled vertical rectus abdominis myocutaneous (VRAM) flap is a robust flap, which is considered to be a 'workhorse' regional option for chest wall reconstruction. We describe a previously unreported complication of partial flap loss due to 'steal syndrome', whereby arterial supply was diverted away from the flap due to dialysis from an ipsilateral arteriovenous fistula.
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Affiliation(s)
- S Young
- Department of Reconstructive and Plastic Surgery, Royal Preston Hospital , Preston , UK
| | - N Pantelide
- Department of Reconstructive and Plastic Surgery, Royal Preston Hospital , Preston , UK
| | - S Iyer
- Department of Reconstructive and Plastic Surgery, Royal Preston Hospital , Preston , UK
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