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Hassan A, Arujunan K, Mohamed A, Katheria V, Ashton K, Ahmed R, Subar D. Incidence of incisional hernia following liver surgery for colorectal liver metastases. Does the laparoscopic approach reduce the risk? A comparative study. Ann Hepatobiliary Pancreat Surg 2024:ahbps.23-138. [PMID: 38433531 DOI: 10.14701/ahbps.23-138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/15/2024] [Accepted: 01/24/2024] [Indexed: 03/05/2024] Open
Abstract
Backgrounds/Aims No reports to compare incisional hernia (IH) incidence between laparoscopic and open colorectal liver metastases (CRLM) resections have previously been made. This is the first comparative study. Methods Single-center retrospective review of patients who underwent CRLM surgery between January 2011 and December 2018. IH relating to liver surgery was confirmed by computed tomography. Patients were divided into laparoscopic liver resection (LLR) and open liver resection (OLR) groups. Data collection included age, sex, presence of diabetes mellitus, steroid intake, history of previous hernia or liver resection, subcutaneous and peri-renal fat thickness, preoperative creatinine and albumin, American Society of Anesthesiologists (ASA) score, major liver resection, surgical site infection, synchronous presentation, and preoperative chemotherapy. Results Two hundred and forty-seven patients were included with a mean follow-up period of 41 ± 29 months (mean ± standard deviation). Eighty seven (35%) patients had LLR and 160 patients had OLR. No significant difference in the incidence of IH between LLR and OLR was found at 1 and 3 years, respectively ([10%, 19%] vs. [10%, 19%], p = 0.95). On multivariate analysis, previous hernia history (hazard ratio [HR], 2.22; 95% confidence interval [CI], 1.56-4.86) and subcutaneous fat thickness (HR, 2.22; 95% CI, 1.19-4.13) were independent risk factors. Length of hospital stay was shorter in LLR (6 ± 4 days vs. 10 ± 8 days, p < 0.001), in comparison to OLR. Conclusions In CRLM, no difference in the incidence of IH between LLR and OLR was found. Previous hernia and subcutaneous fat thickness were risk factors. Further studies are needed to assess modifiable risk factors to develop IH in LLR.
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Affiliation(s)
- Ahmed Hassan
- Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
- Blackburn Research Innovation Development Group in General Surgery (BRIDGES), Royal Blackburn Hospital, Blackburn, UK
| | - Kalaiyarasi Arujunan
- Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
| | - Ali Mohamed
- Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
| | - Vickey Katheria
- Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
| | - Kevin Ashton
- University Hospitals of Morecambe Bay NHS Foundation Trust, Royal Lancaster Infirmary, Lancaster, UK
| | - Rami Ahmed
- Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
| | - Daren Subar
- Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
- Blackburn Research Innovation Development Group in General Surgery (BRIDGES), Royal Blackburn Hospital, Blackburn, UK
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Hassan A, Elfarouq A, Katheria V, Subar D. DD-07 INCISIONAL HERNIA FOLLOWING LAPAROSCOPIC COLORECTAL LIVER METASTASIS RESECTION. FIRST COMPARATIVE STUDY. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.011] [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]
Abstract
Abstract
Aim
Since first laparoscopic liver surgery (LLR) in 1991, no literature to compare Incisional hernia (IH) incidence between LLR and open Resection (OLR). This is the first comparative study
Material and methods
Single centre retrospective review of Colorectal Liver Metastasis resections between 2011 till 2018. The primary end point is developing IH related to liver resection. Incidence of IH was compared between LLR and OLR. Factors including Age, Gender, Diabetes Mellitus, Steroid intake, Pre-op Creatinine and Albumin, Previous Liver resection ASA score were compared between both groups. Subcutaneous and peri-renal fat thickness measured as indicative of fat distribution. Numeric results presented in Mean±SD. SPSS 20 (IBM, Armonk, USA) used for statistical analysis. p ≤ 0.05 was considered statistically significant
Results
247 procedures with follow-up 41 ± 29 Months. IH was observed in 48 case (19.4%). Incidence was 10%, 19% at 1, 3 years respectively (Kaplan-Meier). 87 case (35%) had LLR and 160 (65%) OLR. OLR had lower pre-op Albumin (32±9 Vs 35±8 g/L, p 0.01, Mann-Whitney U), longer hospital stay (10±7 Vs 6±4 days, p 0.00, Mann-Whitney U) and more major liver resections i.e. Resection of 3 or more segments (58% Vs 29% in LLR, p 0.00, Chi2). No difference in IH Incidence in LLR (8%, 19% Vs 10%, 19%) and OLR at 1, 3 years respectively. Similarly, no difference in hernia size (53±37 mm in LLR Vs 50 ± 33 in OLR, p 0.96, Mann-Whitney U)
Conclusion
No difference in IH incidence or size between LLR and OLR.
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Affiliation(s)
- A Hassan
- General and HPB Surgery Department, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust , Blackburn , United Kingdom
| | - A Elfarouq
- General and HPB Surgery Department, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust , Blackburn , United Kingdom
| | - V Katheria
- General and HPB Surgery Department, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust , Blackburn , United Kingdom
| | - D Subar
- General and HPB Surgery Department, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust , Blackburn , United Kingdom
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Ambrose S, Katheria V, Shanmugam S, Ray NK. A Rare Case Report of Adenolipoma of the Breast. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02728-y] [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: 11/24/2022] Open
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Uranga C, Burhenn P, Economou D, Katheria V, Sun C, Kim H, Roberts E, Mitani D, Okamato C, Dale W, Loscalzo M. PUTTING INTO PRACTICE NURSE-LED GERIATRIC ASSESSMENT INITIATIVES THROUGHOUT THE UNITED STATES. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31214-7] [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: 11/16/2022]
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Katheria V, Poeltler DM, Brown MK, Hassen KO, Patel D, Rich W, Finer NN, Katheria AC. Early prediction of a significant patent ductus arteriosus in infants <32 weeks gestational age. J Neonatal Perinatal Med 2019; 11:265-271. [PMID: 29843271 DOI: 10.3233/npm-1771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 11/15/2022]
Abstract
BACKGROUND The optimal thresholds for identification of preterm infants at greatest risk for adverse sequelae related to patent ductus arteriosus have not been well delineated. Our aim was to determine hemodynamic parameters in the first 24 hours using continuous non-invasive vital and structural measurements to predict which infants required PDA treatment in our institution. METHODS Retrospective secondary analysis of data from infants born 23 to 32 weeks gestational age with cardiac output and stroke volume via electrical cardiometry, cerebral tissue oximetry measurements, mean arterial blood pressure (BP), heart rate, and oxygen saturation and functional echocardiography results at 12 hours of life were recorded when available (93 percent of subjects). RESULTS A total of 292 infants, of which 55 (26±2 weeks, 862±268 grams) were treated for PDA. Treated infants demonstrated increased left ventricular output (p < 0.001) and lower mean BP (p = 0.010). The optimal area under the receiver operating characteristic curve (AUC) for predicting PDA treatment in our all gestations cohort is a mean BP at 15 hours of life of <33 mm Hg (AUC = 0.854, p < 0.001, 95% CI 0.792, 0.916). For infants <28 weeks a mean BP at 13 hours of life of <33 mm Hg (AUC = 0.741, p < 0.050, 95% CI 0.642, 0.839). CONCLUSIONS In our cohort increased left ventricular output and lower mean BP predicted a clinically significant PDA requiring treatment.
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Affiliation(s)
- V Katheria
- Neonatal Research Institute at Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | - D M Poeltler
- Neonatal Research Institute at Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | - M K Brown
- Neonatal Research Institute at Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | - K O Hassen
- Neonatal Research Institute at Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | - D Patel
- Neonatal Research Institute at Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | - W Rich
- Neonatal Research Institute at Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | - N N Finer
- Neonatal Research Institute at Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | - A C Katheria
- Neonatal Research Institute at Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
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Soto-Perez-de-Celis E, Vazquez J, Kim H, Sun CL, Somlo G, Yuan Y, Waisman JR, Mortimer JE, Kruper L, Taylor L, Patel NH, Moreno J, Charles K, Roberts E, Uranga C, Levi A, Katheria V, Paredero-Perez I, Mitani D, Hurria A. Abstract P6-16-04: A self-administered geriatric assessment tool for Spanish-speaking older women with breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-16-04] [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: Almost a quarter of older adults in the United States will identify themselves as Hispanic/Latino by 2060. Our group has previously developed and validated a self-administered geriatric assessment tool which can be used to identify functional, psychological, social and cognitive impairments among older patients with various types of cancer. Among English-speaking older adults, completing this tool using paper/pencil or a tablet takes a median of 15-21 minutes (min), with < 10% needing assistance to answer it (Hurria, JOP 2016). However, the utilization of this tool among Spanish-speaking older adults has not been tested. We assessed the feasibility of administering a translated and validated Spanish version of our geriatric assessment tool for older Hispanic women with breast cancer, and identified their preferred format (tablet or paper/pencil).
Methods: Spanish-speaking women aged ≥ 65 years with a diagnosis of breast cancer completed the geriatric assessment twice on the same day. Patients were randomized into 3 groups: paper/pencil twice; tablet and paper/pencil in random order; and tablet twice. We assessed the proportion of patients requiring assistance to complete the geriatric assessment, the time needed to complete it, and the proportion of patients who thought the geriatric assessment was difficult/very difficult.
Results: 140 older women with breast cancer completed the geriatric assessment twice and were evaluable. Mean age was 71.6 years (SD 5.8), 53% had ≤ 8th grade education, 43% were married, 45% were retired, 32% were homemakers, and 6% were employed. The participants came from 13 different Spanish-speaking countries, although 70% were born in Mexico. For 90%, Spanish was their primary language, and 75% spoke only in Spanish at home. Regarding computer skills, 64% of the patients said they had none. 39% (n = 54) were unable to complete the geriatric assessment on their own; mean time to complete the geriatric assessment was 29 min (range 8-90); and 28% (n = 39) thought the geriatric assessment was difficult/very difficult. The most common reasons for needing assistance were difficulty understanding questions (39%) and visual problems (31%). Patients with ≤ 8th grade education took longer to complete the geriatric assessment (mean 37.2 vs 29.4 min, p < 0.01), and more often needed help completing the assessment (51% vs 19%, p < 0.01) than those with ≥9th grade education. 53% of the participants preferred using a tablet to answer the geriatric assessment, while 47% preferred paper/pencil.
Conclusions: A substantial proportion of Spanish-speaking older women with breast cancer required assistance to complete our self-administered geriatric assessment tool. This may be a consequence of the low educational level we found among this patient population. Tailoring assessments for diverse populations with particular attention to educational level is needed in multicultural settings.
Citation Format: Soto-Perez-de-Celis E, Vazquez J, Kim H, Sun C-L, Somlo G, Yuan Y, Waisman JR, Mortimer JE, Kruper L, Taylor L, Patel NH, Moreno J, Charles K, Roberts E, Uranga C, Levi A, Katheria V, Paredero-Perez I, Mitani D, Hurria A. A self-administered geriatric assessment tool for Spanish-speaking older women with breast cancer [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 P6-16-04.
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Affiliation(s)
- E Soto-Perez-de-Celis
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - J Vazquez
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - H Kim
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - C-L Sun
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - G Somlo
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - Y Yuan
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - JR Waisman
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - JE Mortimer
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - L Kruper
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - L Taylor
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - NH Patel
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - J Moreno
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - K Charles
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - E Roberts
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - C Uranga
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - A Levi
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - V Katheria
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - I Paredero-Perez
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - D Mitani
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
| | - A Hurria
- City of Hope, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Hospital Universitario Doctor Peset, Valencia, Spain
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O'Connor T, Soto-Perez-de-Celis E, Blanchard S, Chapman A, Kimmick G, Muss H, Luu T, Waisman JR, Li D, Mortimer J, Yuan Y, Somlo G, Stewart D, Katheria V, Levi A, Hurria A. Abstract P5-21-08: Tolerability of the combination of lapatinib and trastuzumab in older patients with HER2 positive metastatic breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-21-08] [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: 11/16/2022]
Abstract
Abstract
Background: Older adults are less likely to be included in clinical trials leading to the approval of novel cancer treatments. The Institute of Medicine and ASCO have identified therapeutic phase II trials as a key research priority to increase the evidence base for older adults with cancer. While targeted therapies may represent a less toxic option for older patients, few trials have studied their tolerability and efficacy in older adults. Here, we present a phase II study (NCT01273610) of the combination of trastuzumab and lapatinib in older patients with HER2+ metastatic breast cancer (MBC), incorporating geriatric oncology principles in the study design.
Methods: Patients age ≥ 60 years with MBC and any number of prior chemotherapy (CT) lines received trastuzumab (either 4mg/kg loading dose followed by 2mg/kg weekly or 8mg/kg followed by 6mg/kg q/3 weeks) plus lapatinib 1000 mg/m2 daily in 21-day cycles. Patients completed a pre-treatment geriatric assessment including measures of function, comorbidity, cognition, nutrition, and psychosocial status. A toxicity risk score developed for older adults receiving cytotoxic CT was calculated for each patient (Hurria et al. JCO 2011 & 2016). Relationships between tolerability (dose reductions and grade (G) ≥ 3 toxicity attributed to treatment) and risk score analyzed using a log2 transformation were assessed using generalized linear models, Student's t tests, and Fisher's exact test. Response rate (RR) and progression free survival (PFS) were evaluated.
Results: 40 patients (mean age 72 [60-92]) were accrued from 04/11 to 05/15. 25% (n = 10) were ≥ 75 years of age. 65% of patients (n = 26) had HR+ tumors and 35% (n = 14) were receiving ≥ 3rd line treatment. Median number of cycles was 4 (0-28). RR was 23% (n = 9, 95% CI 11-38%; 1 complete, 8 partial). 23% (n = 9) achieved stable disease. PFS was 2.7 months (95% CI 2.5-12). Based on the toxicity risk score, 21% (n = 8), 54% (n = 21), and 26% (n = 10) were at low, intermediate, and high risk. 70% (n = 28) of patients had G ≥ 2 toxicities and 20% (n = 8) G ≥ 3 toxicities. G 2 and 3 diarrhea occurred in 28% (n = 11) and 5% (n = 2) respectively. 5% (n = 2) were hospitalized due to treatment-related toxicity. No G ≥ 3 cardiac toxicities were observed. 23% of patients (n = 9) had treatment delays, and 43% (n = 17) required a lapatinib dose reduction. The mean toxicity risk score was higher in patients who required dose reductions (Student's t: p = 0.02). No statistically significant relationship was found between toxicity risk scores and the presence of G ≥ 3 treatment toxicity (logistic regression: OR = 3.08, 95% CI [0.54, 21.2], p = 0.22).
Conclusions: Among older patients with MBC (79% at intermediate or high risk of G ≥ 3 cytotoxic CT toxicity), trastuzumab and lapatinib were well tolerated, with only 20% experiencing G3 toxicities. The toxicity risk score was not found to be significantly related with treatment toxicity, which may be explained by the very low incidence of G3 events. Patients with a low toxicity risk score were not likely to require a lapatinib dose reduction.
Citation Format: O'Connor T, Soto-Perez-de-Celis E, Blanchard S, Chapman A, Kimmick G, Muss H, Luu T, Waisman JR, Li D, Mortimer J, Yuan Y, Somlo G, Stewart D, Katheria V, Levi A, Hurria A. Tolerability of the combination of lapatinib and trastuzumab in older patients with HER2 positive 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 P5-21-08.
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Affiliation(s)
- T O'Connor
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - E Soto-Perez-de-Celis
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - S Blanchard
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - A Chapman
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - G Kimmick
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - H Muss
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - T Luu
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - JR Waisman
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - D Li
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - J Mortimer
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - Y Yuan
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - G Somlo
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - D Stewart
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - V Katheria
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - A Levi
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - A Hurria
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
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Yuan Y, Blanchard S, Li D, Mortimer J, Waisman J, Somlo G, Yost S, Katheria V, Hurria A. Abstract OT1-02-05: Phase II clinical trial of neratinib in patients 60 and older with HER2 over-expressed or mutated breast cancer: Trial design considerations for older adults. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot1-02-05] [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: This study addresses a key knowledge gap identified by the Institute of Medicine report on quality cancer care. Although there has been a growth in the number of targeted agents approved for the treatment of breast cancer, there are limited data regarding the efficacy, toxicity, and management of side effects in older adults. Neratinib is a potent oral small molecule tyrosine kinase inhibitor. Early clinical data have demonstrated the activity of neratinib in patients who have already progressed through HER2 targeted therapies. This study is designed to evaluate the tolerability and toxicity profile of neratinib in older adults with metastatic breast cancer (MBC) incorporating geriatric oncology design considerations.
Trial Design: This is an open label, single arm, phase II study of single agent neratinib in patients with HER2 positive MBC. Neratinib is given at 240mg orally in 28 day cycles. Unique factors of this geriatric oncology trial design include: 1) pre-treatment and on-treatment geriatric assessment; 2) additional nurse toxicity visits; 3) an algorithm for aggressive management of diarrhea; 4) measurements of the pharmacokinetics (PK) of neratinib; 5) inclusion of biomarkers of aging; 6) measurement of patient adherence; and 7) evaluation of quality of life.
Eligibility Criteria: Patients must be age≥60 with histologically-proven HER2 positive MBC or MBC with HER2 receptor activating mutations. There is no limitation on the number of previous lines of therapy, but patients must have adequate organ and bone marrow functions, and a baseline LVEF ≥ 50%. Exclusion Criteria include: prior treatment with neratinib; major surgery within 28 days; uncontrolled cardiac disease; concurrent use of digoxin; or chronic diarrhea.
Specific Aims: The primary objective of this study is to identify the rate of grade 2 or higher toxicities attributed to neratinib in adult age ≥60 with HER2 over-expressing breast cancer. The secondary objectives are to describe the full toxicity profile (including all grades of gastrointestinal toxicities); to estimate the rate of dose reduction, holds and hospitalizations; to describe the PK parameters; to estimate the adherence rate to neratinib; and to estimate the overall response, clinical benefit rate, progression-free and overall survival. Furthermore, we will explore the role of a cancer-specific geriatric assessment and serum biomarkers of aging (IL-6, CRP, and D-dimer) in predicting treatment toxicities and PK parameters.
Statistical Design: We plan to enroll 40 patients age ≥60 (at least 5 patients age 75 years or older, and no more than 15 patients 60-70) in order to assure that our sample is representative of the entire age range of older adults. Given a sample size of 40 subjects, the widest half-width of the 95% confidence limits for the rate of grade 2 or higher toxicities will be less than or equal to 0.16. An interim analysis will be performed after 20 subjects have been on study for at least one cycle.
Accrual goal: 40
Contact information: Yuan Yuan MD PhD, Email: yuyuan@coh.org.
Citation Format: Yuan Y, Blanchard S, Li D, Mortimer J, Waisman J, Somlo G, Yost S, Katheria V, Hurria A. Phase II clinical trial of neratinib in patients 60 and older with HER2 over-expressed or mutated breast cancer: Trial design considerations for older adults [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT1-02-05.
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Hurria A, Synold T, Blanchard S, Wong C, Mortimer J, Luu T, Chung C, Ramani R, Katheria V, Hansen K, Jayani R, Brown J, Williams B, Rotter A, Somlo G. P5-19-05: Age-Related Changes in the Pharmacokinetics (pK), Response, and Toxicity of Weekly nab-Paclitaxel in Patients with Metastatic Breast Cancer (MBC). Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p5-19-05] [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: Although cancer is a disease of aging, few studies have evaluated the association between patient age and the pK or pharmacodynamics (pD) of cancer therapeutics. The goals of this study were 1) to evaluate the age-related changes in the pK and pD of weekly nab-paclitaxel in patients with MBC; 2) to determine response rate; and 3) to explore the relationship of age with pK and pD parameters (i.e., dose reductions, dose delays and grade ≥ 3 toxicities). Patients and Methods: Forty patients with MBC, receiving 1st or 2nd line chemotherapy, entered an IRB approved protocol to evaluate the age-related changes in the pK of weekly nab-paclitaxel administered at 100 mg/m2 IV for 3 weeks followed by a 1-week break. Patients were accrued from 4 age strata <50, 50–60, 60–70, and >70 years of age. Blood samples were collected for pK analysis with the first dose of nab-paclitaxel. Response was assessed every 2 cycles. Toxicity was graded using the NCI Common Toxicity Criteria for Adverse Events (v 3.0) and was adjudicated as attributable to nab-paclitaxel if it was possibly, probably, or definitely related. Linear regression analysis was used to examine the strength of the relationship between patient age and natural logarithm of 24 hour area under the curve (AUC). Two-sided two-sample t-tests were used to assess if there was a difference in mean age based on the presence of pD variables (i.e., dose reductions, dose delays and grade ≥ 3 toxicities). The significance level was set to 0.05.
Results: Of the 40 patients who entered the study, 39 (98%) were evaluable with a mean age of 60 (SD=13.4; min=30; max=81). Patients were accrued in the following age cohorts: <50 (n= 10; 26%), 50–60 (n= 5; 13%), 60–70 (n= 15; 38%), and >70 (n= 9; 23%) years of age. The median number of courses completed was 4 (min=1, max=21). The response rate was: 0% (n=0) CR, 31% (n=12) PR, 38% (n=15) SD. Grade 3 toxicity was experienced by 26% (n=10). We observed 8% (n=3) grade 3 hematological toxicities [neutrophils (n=1; 3%), leukocytes (n=2; 5%)] and 18% (n=7) grade 3 non-hematological toxicities [nausea and hypophosphatemia (n=1; 3%), diarrhea and infection without neutropenia (n=1; 3%), fatigue (n=2; 5%), hyponatremia (n=1; 3%), and infections without neutropenia (n=2; 5%)]. There were no cases of grade 4 or 5 toxicity. Grade 2 sensory neuropathy was experienced by 8% (n=3; no cases in the 70+ age cohort). Dose reductions or course delays were experienced by 62% (n=24) and 21% (n=8), respectively. There was a borderline significant positive association between age and natural logarithm of total nab-paclitaxel 24 hour AUC (coef=.01; se=.006; p=0.055; n=36). There were no differences in the mean ages based on the presence of grade 3 or higher toxicity (p =0.75), need for dose reductions (p=0.48), or need for dose delays (p=0.61).
Discussion: There is a borderline statistically significant relationship between age and 24 hour AUC but no differences in mean age based on pD variables (i.e., dose reductions, dose delays and grade ≥ 3 toxicities) were identified. The treatment is well-tolerated across all age groups.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-19-05.
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Affiliation(s)
| | | | | | - C Wong
- 1City of Hope, Duarte, CA
| | | | - T Luu
- 1City of Hope, Duarte, CA
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Maggiore RJ, Gross CP, Hardt M, Tew WP, Mohile SG, Klepin HD, Lichtman SM, Owusu C, Gajra A, Ramani R, Katheria V, Brown J, Jayani R, Hurria A. Polypharmacy, potentially inappropriate medications, and chemotherapy-related adverse events among older adults with cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19501] [Citation(s) in RCA: 4] [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: 11/20/2022] Open
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Klepin HD, Gajra A, Hardt M, Tew WP, Mohile SG, Owusu C, Gross CP, Lichtman SM, Ramani R, Katheria V, Brown J, Jayani R, Hansen K, Togawa K, Klapper S, Wong FL, Hurria A. Predictors of primary dose reduction (PDR) among patients (pts) age 65 and older receiving adjuvant chemotherapy (chemo). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gajra A, Hardt M, Tew WP, Mohile SG, Owusu C, Klepin HD, Gross CP, Lichtman SM, Ramani R, Brown J, Katheria V, Jayani R, Hansen K, Togawa K, Klapper S, Hurria A. Primary dose reduction (PDR) of chemotherapy (chemo) in patients (Pts) older than age 65 with advanced cancer (Ca) and toxicity outcomes. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross C, Lichtman SM, Katheria V, Klapper S, Tew WP. Predicting chemotherapy toxicity in older adults with cancer: A prospective 500 patient multicenter study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.9001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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