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Labbate CV, Hensley PJ, Miest TS, Qiao W, Adibi M, Shah AY, Chery L, Papadopoulos J, Siefker-Radtke AO, Gao J, Guo CC, Czerniak BA, Navai N, Kamat AM, Dinney CP, Campbell MT, Matin SF. Longitudinal GFR trends after neoadjuvant chemotherapy prior to nephroureterectomy for upper tract urothelial carcinoma. Urol Oncol 2022; 40:454.e17-454.e23. [DOI: 10.1016/j.urolonc.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/07/2022] [Accepted: 06/19/2022] [Indexed: 10/15/2022]
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Mokkapati S, Narayan VM, Manyam GC, Lim AH, Duplisea JJ, Kokorovic A, Miest TS, Mitra AP, Plote D, Anand SS, Metcalfe MJ, Dunner K, Johnson BA, Czerniak BA, Nieminen T, Heikura T, Yla-Herttuala S, Parker NR, Schluns KS, McConkey DJ, Dinney CP. Lentiviral interferon: A novel method for gene therapy in bladder cancer. Mol Ther Oncolytics 2022; 26:141-157. [PMID: 35847448 PMCID: PMC9251210 DOI: 10.1016/j.omto.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 06/07/2022] [Indexed: 11/29/2022] Open
Abstract
Interferon alpha (IFNα) gene therapy is emerging as a new treatment option for patients with non-muscle invasive bladder cancer (NMIBC). Adenoviral vectors expressing IFNα have shown clinical efficacy treating bacillus Calmette-Guerin (BCG)-unresponsive bladder cancer (BLCA). However, transient transgene expression and adenoviral immunogenicity may limit therapeutic activity. Lentiviral vectors can achieve stable transgene expression and are less immunogenic. In this study, we evaluated lentiviral vectors expressing murine IFNα (LV-IFNα) and demonstrate IFNα expression by transduced murine BLCA cell lines, bladder urothelium, and within the urine following intravesical instillation. Murine BLCA cell lines (MB49 and UPPL1541) were sensitive to IFN-mediated cell death after LV-IFNα, whereas BBN975 was inherently resistant. Upregulation of interleukin-6 (IL-6) predicted sensitivity to IFN-mediated cell death mediated by caspase signaling, which when inhibited abrogated IFN-mediated cell killing. Intravesical therapy with LV-IFNα/Syn3 in a syngeneic BLCA model significantly improved survival, and molecular analysis of treated tumors revealed upregulation of apoptotic and immune-cell-mediated death pathways. In particular, biomarker discovery analysis identified three clinically actionable targets, PD-L1, epidermal growth factor receptor (EGFR), and ALDHA1A, in murine tumors treated with LV-IFNα/Syn3. Our findings warrant the comparison of adenoviral and LV-IFNα and the study of novel combination strategies with IFNα gene therapy for the BLCA treatment.
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Affiliation(s)
- Sharada Mokkapati
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
- Corresponding author Sharada Mokkapati, PhD, University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA.
| | - Vikram M. Narayan
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Ganiraju C. Manyam
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Amy H. Lim
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Jonathan J. Duplisea
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Andrea Kokorovic
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Tanner S. Miest
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Anirban P. Mitra
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Devin Plote
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Selvalakshmi Selvaraj Anand
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Michael J. Metcalfe
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Kenneth Dunner
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Burles A. Johnson
- James Buchanan Brady Urological Institute, John Hopkins Greenberg Bladder Cancer Institute, John Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Bogdan A. Czerniak
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Tiina Nieminen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tommi Heikura
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Seppo Yla-Herttuala
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | | | - Kimberley S. Schluns
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - David J. McConkey
- James Buchanan Brady Urological Institute, John Hopkins Greenberg Bladder Cancer Institute, John Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Colin P. Dinney
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
- Corresponding author Colin P. Dinney, MD, University of Texas MD Anderson Cancer Center, CPB7.3279, 1515 Holcombe Blvd., Houston, TX 77030, USA.
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Miest TS, Leibovich B, Bardot S, Young PR, Boorjian SA, Gonzalgo M, Herrera-Hernandez L, Tollefson MK, Karnes J, Nichols P, Kroeninger T, Graham R, Lahana C, Reckner M, Newsom A, Packiriswamy N, Anoka J, Peng KW, Wiegert E, Bexon A, Naik S. Abstract P190: Safety and efficacy of neoadjuvant intravesical oncolytic MV-NIS in patients with urothelial carcinoma. Mol Cancer Ther 2021. [DOI: 10.1158/1535-7163.targ-21-p190] [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: Bladder cancer is a leading cause of cancer death in the United States1. The histology in > 90% of cases is urothelial carcinoma (UC). Tumors may present either as non-muscle-invasive (NMIBC) or muscle-invasive disease (MIBC). Current standard of care for patients with high risk NMIBC includes transurethral resection of bladder tumor (TURBT) followed by intravesical immunotherapy with Bacillus Calmette-Guerin (BCG)2. Meanwhile, patients with BCG unresponsive NMIBC or MIBC are recommended to undergo radical cystectomy (RC), which adversely impacts quality of life and is associated with significant morbidity3. MV-NIS is an investigational oncolytic measles virus with an excellent clinical safety profile4. This ongoing phase I clinical study is designed to test the safety, efficacy and identify the recommended phase 2 dose (RP2D) of intravesical MV-NIS in patients with NMIBC or MIBC who are scheduled for RC and not eligible for neoadjuvant chemotherapy. Methods: Bladder UC patients were evaluated for eligibility and provided informed consent prior to enrolling. To date 8 patients have been enrolled: 4 to the single dose safety cohort, and 4 to the multi-dose expansion cohort. Patients were administered intravesical ~1x109 TCID50 MV-NIS once at least 1 week prior to RC (safety cohort), or twice at 4 and 2 weeks prior to RC (expansion cohort). Patients were closely monitored during the 2-hour instillation period. Tumor specimens from the pre-treatment TURBT and post-treatment RC were analyzed to determine pre- and post-treatment pathological stage and evaluate tumor killing and immune cell infiltrate. Results: Intravesical MV-NIS treatment was well tolerated in all patients. Only a single Adverse Event (AE) attributable to MV-NIS treatment (Grade 1 hematuria). AEs Grade>2 were related to post-surgical complications. Tumor downstaging was observed in 4 of 8 patients. Among 4 patients in the expansion cohort, 2 had no residual disease (pT0). Central assessment of RC tissues showed significant inflammatory infiltrate in all treated bladder specimens. Detailed analyses are ongoing to characterize MV infection and immune infiltrate in bladder tissue. Conclusions: The higher-than-expected rate of tumor downstaging and pT0 pathology, paired with the significant immune infiltrate observed in post-treatment bladder tissue, provide compelling evidence that intravesical MV-NIS has clinical activity against UC. These results support the use of two doses of ~1x109 TCID50 as the RP2D in future clinical studies for BCG unresponsive NMIBC or MIBC patients. MV-NIS induced inflammation may act synergistically with checkpoint blockade therapies. References 1. Siegel, R.L., Miller, K.D. & Jemal, A. CA Cancer J Clin 69, 7-34 (2019). 2. Knowles, M.A. & Hurst, C.D. Nature reviews. Cancer 15, 25-41 (2015). 3. Zakaria, A.S., et al. Can Urol Assoc J 8, 259-267 (2014). 4. Galanis, E., et al. Cancer research 75, 22-30 (2015).
Citation Format: Tanner S. Miest, Bradley Leibovich, Stephen Bardot, Paul R. Young, Stephen A. Boorjian, Mark Gonzalgo, Loren Herrera-Hernandez, Matthew K. Tollefson, Jeffrey Karnes, Paige Nichols, Tessa Kroeninger, Rachel Graham, Carole Lahana, Monica Reckner, Alysha Newsom, Nandakumar Packiriswamy, Janice Anoka, Kah Whye Peng, Erol Wiegert, Alice Bexon, Shruthi Naik. Safety and efficacy of neoadjuvant intravesical oncolytic MV-NIS in patients with urothelial carcinoma [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr P190.
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Affiliation(s)
- Tanner S. Miest
- 1Mayo Clinic Rochester and University of Texas, Houston, TX,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shruthi Naik
- 7Vyriad Inc. and Mayo Clinic Rochester, Rochester, MN,
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Sharma V, Miest TS, Juvet TS, Toussi A, Packiam V, Chamie K, Matin SF, Boorjian SA, Thompson RH, Frank I, Tollefson MK, Potretzke AM. The Impact of Upper Tract Urothelial Carcinoma Diagnostic Modality on Intravesical Recurrence after Radical Nephroureterectomy: A Single Institution Series and Updated Meta-Analysis. J Urol 2021; 206:558-567. [PMID: 33908802 DOI: 10.1097/ju.0000000000001834] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Diagnostic ureteroscopic biopsy for upper tract urothelial carcinoma (UTUC) has been hypothesized to increase intravesical recurrence of urothelial carcinoma after radical nephroureterectomy (RNU). Moreover, the impact of ureteroscopy without biopsy or percutaneous biopsy on intravesical recurrence remains unknown. Herein, we compared post-RNU intravesical recurrences across UTUC diagnostic modalities. MATERIALS AND METHODS Patients undergoing RNU at our institution between 1995 and 2019 were categorized by UTUC diagnostic modality: 1) no ureteroscopy or percutaneous biopsy; 2) percutaneous biopsy; 3) ureteroscopy without biopsy; 4) ureteroscopic biopsy. Intravesical recurrences were compared using Kaplan-Meier analyses and Cox-proportional hazard models. Results of group 4 vs 1 were pooled with the literature using a fixed effects meta-analysis. RESULTS In a cohort of 834 RNU patients, 210 (25.2%) had undergone no ureteroscopy, 57 (6.6%) percutaneous biopsy, 125 (15.0%) ureteroscopy without biopsy, and 442 (53.0%) ureteroscopic biopsy. Two-year intravesical recurrence rates were 15.0%, 12.7%, 18.4%, and 21.9% for groups 1 through 4, respectively (p=0.09). Multivariable analysis found that group 4 had increased intravesical recurrences (HR 1.40, p=0.04) relative to group 1 while group 2 (HR 1.07, p=0.87) and group 3 (HR 1.15, p=0.54) did not. Group 4 remained associated with intravesical recurrence on subset analyses accounting for post-RNU surveillance cystoscopy frequency. On meta-analysis including 11 other series, ureteroscopic biopsy was associated with intravesical recurrence (HR 1.47, p <0.01). CONCLUSIONS Ureteroscopic biopsy before RNU, but not percutaneous biopsy or ureteroscopy without biopsy, was associated with increased intravesical recurrence. Clinical trials of intravesical chemotherapy after ureteroscopic biopsy are warranted to reduce intravesical recurrences.
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Affiliation(s)
- Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, Minnesota
- Department of Urology, University of California, Los Angeles, California
- Greater Los Angeles VA, Health Services Research and Development Program, Los Angeles, California
| | - Tanner S Miest
- Department of Urology, MD Anderson Cancer Center, Houston, Texas
| | | | - Amir Toussi
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Vignesh Packiam
- Department of Urology, University of Iowa Medical Center, Iowa City, Iowa
| | - Karim Chamie
- Department of Urology, University of California, Los Angeles, California
| | - Surena F Matin
- Department of Urology, MD Anderson Cancer Center, Houston, Texas
| | | | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, Minnesota
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Miest TS, Sharma V, Karnes RJ, Boorjian SA, Thompson RH, Frank I, Tollefson MK. Incidence and predictors of occult preoperative deep vein thrombosis at radical cystectomy for urothelial carcinoma. Can Urol Assoc J 2021; 15:E471-E475. [PMID: 33591896 DOI: 10.5489/cuaj.6852] [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: 11/19/2022]
Abstract
INTRODUCTION Patients undergoing radical cystectomy are at high perioperative risk for deep vein thrombosis due to age, malignancy, recent transurethral resection, and neoadjuvant chemotherapy. We, therefore, evaluated the incidence and predictors of occult preoperative deep vein thrombosis prior to radical cystectomy for urothelial carcinoma. METHODS We prospectively screened 52 asymptomatic patients with urothelial carcinoma undergoing radical cystectomy at our institution with lower extremity ultrasound and D-dimer assay within two weeks prior to surgery. Patients with a prior history of deep vein thrombosis and those on systemic anticoagulation were excluded. RESULTS We identified 4/52 patients (7.7%) with preoperative asymptomatic deep vein thrombosis prior to radical cystectomy. Median D-dimer for patients with and without preoperative deep vein thrombosis was 787 ng/ml(interquartile range [IQR] 365-1257) and 260 ng/ml(IQR 158-498), respectively. A D-dimer threshold of >250 ng/ml had a sensitivity of 100% and specificity of 50%, resulting in a negative predictive value of 100% and positive predictive value of 14.8% for preoperative deep vein thrombosis. Increasing the D-dimer threshold to >1000 ng/ml created a sensitivity of 50% and specificity of 85%, resulting in a negative predictive value of 92% and positive predictive value of 33%. D-dimer values did not significantly vary with neoadjuvant chemotherapy or days since transurethral resection. CONCLUSIONS Approximately 8% of patients had an occult deep vein thrombosis prior to radical cystectomy. D-dimer can provide sensitive diagnostic utility for deep vein thrombosis in the pre- radical cystectomy setting and could help guide use of preoperative lower extremity ultrasound in this high-risk patient population.
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Affiliation(s)
- Tanner S Miest
- Department of Urology, Mayo Clinic, Rochester, MN, United States
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN, United States.,Department of Urology, UCLA, Los Angeles, CA, United State.,VA Health Services Research and Development Fellowship
| | - R Jeffrey Karnes
- Department of Urology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN, United States
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Miest TS, Sharma V, Boeri L, Tollefson MK, Thompson RH, Boorjian SA, Frank I, Karnes RJ. Does Ureteral Stent Drainage Prior to Cystectomy Increase the Risk of Subsequent Upper Tract Urothelial Carcinoma and Ureteral Complications? Urology 2020; 153:215-220. [PMID: 32763318 DOI: 10.1016/j.urology.2020.07.034] [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: 03/27/2020] [Revised: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To guide management of preoperative hydronephrosis prior to radical cystectomy (RC), we compared post-RC risks of upper tract urothelial carcinoma (UTUC) and ureteroenteric anastomotic complications between ureteral stent and percutaneous nephrostomy tube drainage. METHODS Patients who underwent RC for urothelial carcinoma without a prior diagnosis of UTUC at our institution between 2000 and 2015 were included and divided into 4 patient groups: (1) no hydronephrosis (75%, N = 787); (2) hydronephrosis without preoperative upper tract drainage (13%, N = 132); (3) hydronephrosis treated with nephrostomy tube (3%, N = 36); (4) hydronephrosis treated with ureteral stent (9%, N = 94). The incidence of post-RC UTUC and ureteral complications was compared using Kaplan-Meier analyses and multivariable Cox proportional hazard modeling. RESULTS We identified a total of 1049 patients who underwent RC (median postoperative follow-up 4.3 years). Five-year post-RC UTUC incidence was 6.6%, 10.2%, 17%, 18.7% for groups 1-4, respectively (P= .13). On multivariable analysis, nephrostomy tube drainage (hazard ratio [HR] 4.10, P = .02) and preoperative ureteral stenting (HR 2.35, P = .04) were both associated with UTUC after RC, but ureteral stenting did not have a significantly higher association with UTUC than nephrostomy tube drainage. Severe hydronephrosis was also associated with development of UTUC (HR 4.03, P = .02). The incidence of ureteroenteric anastomotic complications did not vary by drainage modality. CONCLUSION Preoperative hydronephrosis was associated with UTUC after RC, but ureteral stent placement did not increase the risk of UTUC or ureteral complications relative to nephrostomy tube placement. The choice of hydronephrosis drainage pre-RC should not be guided by concern for UTUC risk.
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Affiliation(s)
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN; Los Angeles VA - UCLA Department of Urology, Los Angeles, CA
| | - Luca Boeri
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | | | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN
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Yang DY, Potretzke TA, Miest TS, Bhindi B, Lohse CM, Cheville JC, King BF, Boorjian SA, Leibovich BC, Thompson RH, Potretzke AM. Timing and distribution of early renal cell carcinoma recurrences stratified by pathological nodal status in M0 patients at the time of nephrectomy. Int J Urol 2020; 27:618-622. [PMID: 32424856 DOI: 10.1111/iju.14261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/16/2019] [Accepted: 04/17/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the timing and distribution of first renal cell carcinoma metastasis after nephrectomy stratified by nodal status. METHODS We evaluated patients treated with nephrectomy for sporadic, unilateral renal cell carcinoma between 1970 and 2011 who subsequently developed distant metastasis to three or fewer sites. Site-specific metastases-free 2-year survival rates were estimated using the Kaplan-Meier method. Associations of nodal status with time to metastasis were evaluated using multivariable Cox regression models. RESULTS A total of 1049 patients met the inclusion criteria (135 pN1, 914 pN0/x patients). The median time to identification of first distant metastasis for pN1 patients was 0.4 years (interquartile range 0.2-1.1 years) versus 2.2 years (interquartile range 0.6-6.0 years) in pN0/x patients. The most common site of metastasis was to the lung, but this occurred earlier in pN1 patients (median 0.3 years vs 2.0 years). pN1 was associated with significantly lower site-specific 2-year metastases-free survival when compared with pN0/x for lung (37% vs 70%, P < 0.001), bone (63% vs 87%, P < 0.001), non-regional lymph nodes (60% vs 96%, P < 0.001) and liver metastases (79% vs 91%, P < 0.001). On multivariable analysis, pN1 status remained significantly associated with lung, bone, and non-regional lymph node (all P < 0.001) metastases, but it was no longer associated with liver metastases (P = 0.3). CONCLUSIONS pN1 nodal status in M0 patients treated with nephrectomy for renal cell carcinoma is associated with more frequent early metastasis to sites conferring poor prognosis when compared with pN0/x. Our findings highlight the importance of rigorous, early surveillance though the multimodal use of a comprehensive history, physical, laboratory and radiological studies, as outlined in societal guidelines.
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Affiliation(s)
- David Y Yang
- Departments of, Department of, Urology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Tanner S Miest
- Departments of, Department of, Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bimal Bhindi
- Departments of, Department of, Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine M Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - John C Cheville
- Department of Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bernard F King
- Department of, Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen A Boorjian
- Departments of, Department of, Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley C Leibovich
- Departments of, Department of, Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - R Houston Thompson
- Departments of, Department of, Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron M Potretzke
- Departments of, Department of, Urology, Mayo Clinic, Rochester, Minnesota, USA
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Joseph JP, Potretzke TA, Packiam V, Sharma V, Toussi A, Miest TS, Juvet T, Boorjian SA, Thompson RH, Welle CL, Atwell TD, Leibovich BC, Tollefson MK, Potretzke AM. Percutaneous Image-guided Core Needle Biopsy for Upper Tract Urothelial Carcinoma. Urology 2019; 135:95-100. [PMID: 31655078 DOI: 10.1016/j.urology.2019.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/06/2019] [Accepted: 10/09/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To better understand the safety and diagnostic yield of percutaneous core-needle biopsy (PCNB) for upper tract urothelial carcinoma (UTUC). METHODS Of 444 patients undergoing radical nephroureterectomy (RNU) for UTUC between 2009 and 2017 at our institution, 42 who had PCNB prior to RNU were identified for analysis. Endpoints included safety, diagnostic yield, and concordance with RNU pathology. PCNB specimens were deemed histologically concordant with RNU specimens for cases when cytologic evaluation of biopsy specimen and corresponding pathologic evaluation of RNU specimen both made a histologic diagnosis of urothelial carcinoma. RESULTS Median tumor size was 3.8 cm (1.2-10.2 cm). All lesions arose from the pelvicalyceal system. CT-guidance was utilized in 52% (n = 22), and ultrasound-guidance in 48% (n = 20). Relative to RNU pathology, 95% of PCNBs demonstrated histologic concordance. Histologic grade was provided in 69% (n = 29) of PCNBs, with a 90% (n = 26) concordance with surgical pathology. Grades 1-2 and 3 complications occurred in 14.3% (n = 6) and 2.4% (n = 1), respectively. At a median follow-up of 28.2 months (range, 1.2-97.1 months) after biopsy, no cases of radiographic tract seeding were identified. CONCLUSION In our cohort of 42 patients undergoing RNU for UTUC, PCNB appeared a safe diagnostic tool with high histologic yield and grade concordance. With greater than 2 years of follow-up, no cases of tract seeding were identified.
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Affiliation(s)
| | | | | | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Amir Toussi
- Department of Urology, Mayo Clinic, Rochester, MN
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Armstrong JM, Avant RA, Charchenko CM, Westerman ME, Ziegelmann MJ, Miest TS, Trost LW. Impact of anabolic androgenic steroids on sexual function. Transl Androl Urol 2018; 7:483-489. [PMID: 30050806 PMCID: PMC6043738 DOI: 10.21037/tau.2018.04.23] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background To describe the impact of supra-physiologic anabolic-androgenic steroid (AAS) use, including agent, dosage, and duration of therapy, on sexual function. Methods We reviewed data from an online survey of AAS users to evaluate their sexual function on and off AAS. The online survey consisted of questions addressing demographics, anabolic steroid use and patterns, ancillary medications, testosterone (T)-related symptoms while on and off of therapy, as well as sexual function which was assessed using the 5-item, International Index of Erectile Function (IIEF-5). Results A total of 321 men responded to the survey, of which 90 failed to meet inclusion criteria, for a final cohort of 231 AAS users. The majority of men were Caucasian (85%), employed (62%), and younger than 35 years (58%), while an equal mix were single (47%) or married (46%). The mean IIEF-5 was 22.5, with higher scores associated with increased T dosages (>600 mg/week), use of 17-alpha alkylated hormones and anti-estrogens, and absence of concurrent medical conditions. Lower mean IIEF scores were associated with current and pre-AAS low T symptoms, self-reported angry or violent tendencies, self-reported erectile dysfunction (ED), decreased libido, decreased energy, and depression. After controlling for age, low T symptoms and decreased energy remained significantly associated with lower IIEF scores. Among 127 men reporting de novo decreased libido when not taking AAS, several factors were significantly associated including frequency and duration of T and use of adjunctive therapies, while post-cycle therapies were protective. Men who reported any other de novo symptom (decreased energy, libido, muscle mass or depression) after discontinuing T were also more likely to report de novo ED, as well as those using >10 years or for >40 weeks per year. Conclusions The long-term impact of high dose AAS use on sexual function remains poorly defined. Although high T dosages appeared to be protective of erectile function during use, de novo symptoms such as decreased libido and ED occurred more frequently after discontinuing T, particularly among those using more frequently and for longer durations. Given the importance of these findings, long-term studies evaluating the impacts of discontinuing T on sexual dysfunction are indicated.
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Affiliation(s)
| | - Ross A Avant
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Tanner S Miest
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Landon W Trost
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
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Agarwal DK, Miest TS, Granberg CF, Frank I, Gargollo PC. Pediatric Robotic Prostatectomy and Pelvic Lymphadenectomy for Embryonal Rhabdomyosarcoma. Urology 2018; 119:143-145. [PMID: 29702157 DOI: 10.1016/j.urology.2018.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/06/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
Abstract
We present the first published case of a pediatric robot-assisted prostatectomy and pelvic lymphadenectomy for refractory prostatic embryonal rhabdomyosarcoma. The patient is a 7-year-old male who had been treated with 3 cycles of chemotherapy and radiation, who underwent prostatectomy and lymphadenectomy for a recurrent mass. Surgery was uncomplicated and yielded negative surgical margins. We highlight the surgical technique and feasibility of utilizing robotic surgery for pediatric prostatectomy.
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Affiliation(s)
| | | | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN
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Sharma V, Shah PH, Miest TS, Lyon TD, Tarrell RF, Thapa P, Tollefson MK, Thompson RH, Karnes RJ, Igor F, Boorjian SA. PD15-07 THE LIMITED ROLE OF CLINICAL VARIABLES AS PREDICTORS OF PATHOLOGIC DOWNSTAGING FROM NEOADJUVANT CHEMOTHERAPY: HIGHLIGHTING THE NEED FOR GENOMIC PREDICTORS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.806] [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: 11/24/2022]
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12
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Ziegelmann M, Bailey GC, Miest TS, Westerman ME, Westerman ME, Trost LW. MP47-15 CHANGES IN ERECTILE DYSFUNCTION OVER TIME BY AGE: A COMMUNITY-BASED POPULATION STUDY. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.334] [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: 10/22/2022]
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13
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Navaratnarajah CK, Miest TS, Carfi A, Cattaneo R. Targeted entry of enveloped viruses: measles and herpes simplex virus I. Curr Opin Virol 2011; 2:43-9. [PMID: 22440965 DOI: 10.1016/j.coviro.2011.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 11/17/2011] [Accepted: 12/01/2011] [Indexed: 01/11/2023]
Abstract
We compare the receptor-based mechanisms that a small RNA virus and a larger DNA virus have evolved to drive the fusion of viral and cellular membranes. Both systems rely on tight control over triggering the concerted refolding of a trimeric fusion protein. While measles virus entry depends on a receptor-binding protein and a fusion protein only, the herpes simplex virus (HSV) is more complex and requires four viral proteins. Nevertheless, in both viruses a receptor-binding protein is required for triggering the membrane fusion process. Moreover, specificity domains can be appended to these receptor-binding proteins to target virus entry to cells expressing a designated receptor. We discuss how principles established with measles and HSV can be applied to targeting other enveloped viruses, and alternatively how retargeted envelopes can be fitted on foreign capsids.
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Affiliation(s)
- Chanakha K Navaratnarajah
- Department of Molecular Medicine, Virology and Gene Therapy Track, Mayo Graduate School, Rochester, MN 55905, USA
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14
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Abstract
Internal fertilization protects gametes from inhospitable environments and ensures sufficient proximity for gamete union. However, close contact between individuals during mating also increases the risk of pathogen transfer. We developed an approach to transfer the entomopathogenic bacterium Serratia marcescens from males to females during courtship and mating in Drosophila melanogaster. We then examined the frequency of contamination and bacterial loads of females copulating with males for varying durations, showing that while courtship is sufficient for bacterial transmission, mating significantly increases the bacterial load received in a time-independent manner. S. marcescens transmission from contaminated males during mating was sufficient to establish rapid, systemic infection and death in mated females.
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Affiliation(s)
- Tanner S Miest
- Department of Biology; Gustavus Adolphus College; St. Peter, Minnesota, USA
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15
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Yaiw KC, Miest TS, Frenzke M, Timm M, Johnston PB, Cattaneo R. CD20-targeted measles virus shows high oncolytic specificity in clinical samples from lymphoma patients independent of prior rituximab therapy. Gene Ther 2010; 18:313-7. [PMID: 21068781 DOI: 10.1038/gt.2010.150] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
New therapeutic modalities for B-cell non-Hodgkin's lymphomas (B-NHL) are needed, especially for relapsing and aggressive subtypes. Toward this end, we previously generated a fully CD20-targeted and armed measles virus, and tested its efficacy in a xenograft model of mantle cell lymphoma (MCL). Here, we quantify its spread in peripheral blood mononuclear cells and/or tissue of patients with different histological subtypes of B-NHL, including splenic marginal zone lymphoma (SMZL). CD20-targeted MV efficiently infects lymphoma cells from SMZL and MCL while sparing most cells in the CD20-negative population, in contrast to the parental vaccine-lineage MV, which infects CD20-positive and CD20-negative cells equally. Rituximab therapy (4-8 months before relapse) did not interfere with the infectivity and specificity of MV(green)H(blind)antiCD20 in patient lymphoma samples. Thus, CD20-targeted oncolytic virotherapy is likely to be effective after previous antiCD20 therapy.
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Affiliation(s)
- K-C Yaiw
- Department of Molecular Medicine, and Virology and Gene Therapy Track, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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