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Lauritsen J, Sauvé N, Tryakin A, Jiang DM, Huddart R, Heng DYC, Terbuch A, Winquist E, Chovanec M, Hentrich M, Fankhauser CD, Shamash J, Del Muro XG, Vaughn D, Heidenreich A, Sternberg CN, Sweeney C, Necchi A, Bokemeyer C, Bandak M, Jandari A, Collette L, Gillessen S, Beyer J, Daugaard G. Outcomes of relapsed clinical stage I versus de novo metastatic testicular cancer patients: an analysis of the IGCCCG Update database. Br J Cancer 2023; 129:1759-1765. [PMID: 37777577 PMCID: PMC10667594 DOI: 10.1038/s41416-023-02443-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 08/07/2023] [Accepted: 09/14/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Active surveillance after orchiectomy is the preferred management in clinical stage I (CSI) germ-cell tumours (GCT) associated with a 15 to 30% relapse rate. PATIENTS AND METHODS In the IGCCCG Update database, we compared the outcomes of gonadal disseminated GCT relapsing from initial CSI to outcomes of patients with de novo metastatic GCT. RESULTS A total of 1014 seminoma (Sem) [298 (29.4%) relapsed from CSI, 716 (70.6%) de novo] and 3103 non-seminoma (NSem) [626 (20.2%) relapsed from CSI, 2477 (79.8%) de novo] were identified. Among Sem, no statistically significant differences in PFS and OS were found between patients relapsing from CSI and de novo metastatic disease [5-year progression-free survival (5y-PFS) 87.6% versus 88.5%; 5-year overall survival (5y-OS) 93.2% versus 96.1%). Among NSem, PFS and OS were higher overall in relapsing CSI patients (5y-PFS 84.6% versus 80.0%; 5y-OS 93.3% versus 88.7%), but there were no differences within the same IGCCCG prognostic groups (HR = 0.89; 95% CI: 0.70-1.12). Relapses in the intermediate or poor prognostic groups occurred in 11/298 (4%) Sem and 112/626 (18%) NSem. CONCLUSION Relapsing CSI GCT patients expect similar survival compared to de novo metastatic patients of the same ICCCCG prognostic group. Intermediate and poor prognosis relapses from initial CSI expose patients to unnecessary toxicity from more intensive treatments.
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Affiliation(s)
- Jakob Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Nicolas Sauvé
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Alexey Tryakin
- Department of Chemotherapy, N.N.Blokhin Russian Cancer Research Center, Moscow, Russia
| | - Di Maria Jiang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Robert Huddart
- Institute of Cancer Research and Royal Marsden Hospital, Downs Road, Sutton, Surrey, UK
| | - Daniel Y C Heng
- Division of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | | | - Eric Winquist
- Department of Oncology, University of Western Ontario and London Health Sciences Centre, London, ON, Canada
| | - Michal Chovanec
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, National Cancer Institute, Bratislava, Slovakia
| | - Marcus Hentrich
- Department of Hematology/Oncology, Red Cross Hospital, Munich, Germany
| | | | | | | | - David Vaughn
- Division of Hematology/Oncology, Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA, USA
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Cora N Sternberg
- Englander Institute for Precision Medicine, Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York-Presbyterian, New York, NY, USA
| | | | - Andrea Necchi
- Vita-Salute San Raffaele University, Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and BMT with section Pneumonology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Mikkel Bandak
- Department of Consulting and Research, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Abolghassem Jandari
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Laurence Collette
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
- University of Southern Switzerland, Lugano, Switzerland
| | - Joerg Beyer
- Department of Medical Onccology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
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Roberson D, Jia H, Vaughn D, Miller C, Fogt F, Kovell RC. Effective control of recurrent and metastatic GU SCC by employing a multimodal approach in a patient with a history of radiation and transscrotal surgery for stage I seminoma. Urol Case Rep 2022; 45:102223. [PMID: 36185752 PMCID: PMC9520019 DOI: 10.1016/j.eucr.2022.102223] [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: 07/17/2022] [Revised: 09/04/2022] [Accepted: 09/11/2022] [Indexed: 11/28/2022] Open
Abstract
This 68-year-old male, with a history of treated testicular seminoma, developed scrotal SCC 30 years later, with a metastatic SCC recurrence following another interval of 10 years. He exhibited good response to multimodal therapy, though subsequently underwent orchiectomy, revealing SCC invading his solitary testicle. This case presents a unique danger of adjuvant radiation in testicular cancer survivors, demonstrates the efficacy of multimodal therapy with GU SCC, and describes a highly unusual histologic finding.
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Affiliation(s)
- Daniel Roberson
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
- Corresponding author. Division of Urology, Department of Surgery, University of Pennsylvania Health System, Perelman Center for Advanced Medicine, West Pavilion, 3rd Floor, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Hanna Jia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David Vaughn
- Division of Hematology and Oncology, Department of Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Christopher Miller
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Franz Fogt
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - R. Caleb Kovell
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
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Ardeshirrouhanifard S, Fossa SD, Huddart R, Monahan PO, Fung C, Song Y, Dolan ME, Feldman DR, Hamilton RJ, Vaughn D, Martin NE, Kollmannsberger C, Dinh P, Einhorn L, Frisina RD, Travis LB. Ototoxicity After Cisplatin-Based Chemotherapy: Factors Associated With Discrepancies Between Patient-Reported Outcomes and Audiometric Assessments. Ear Hear 2022; 43:794-807. [PMID: 35067571 PMCID: PMC9010341 DOI: 10.1097/aud.0000000000001172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To provide new information on factors associated with discrepancies between patient-reported and audiometrically defined hearing loss (HL) in adult-onset cancer survivors after cisplatin-based chemotherapy (CBCT) and to comprehensively investigate risk factors associated with audiometrically defined HL. DESIGN A total of 1410 testicular cancer survivors (TCS) ≥6 months post-CBCT underwent comprehensive audiometric assessments (0.25 to 12 kHz) and completed questionnaires. HL severity was defined using American Speech-Language-Hearing Association criteria. Multivariable multinomial regression identified factors associated with discrepancies between patient-reported and audiometrically defined HL and multivariable ordinal regression evaluated factors associated with the latter. RESULTS Overall, 34.8% of TCS self-reported HL. Among TCS without tinnitus, those with audiometrically defined HL at only extended high frequencies (EHFs) (10 to 12 kHz) (17.8%) or at both EHFs and standard frequencies (0.25 to 8 kHz) (23.4%) were significantly more likely to self-report HL than those with no audiometrically defined HL (8.1%) [odds ratio (OR) = 2.48; 95% confidence interval (CI), 1.31 to 4.68; and OR = 3.49; 95% CI, 1.89 to 6.44, respectively]. Older age (OR = 1.09; 95% CI, 1.07 to 1.11, p < 0.0001), absence of prior noise exposure (OR = 1.40; 95% CI, 1.06 to 1.84, p = 0.02), mixed/conductive HL (OR = 2.01; 95% CI, 1.34 to 3.02, p = 0.0007), no hearing aid use (OR = 5.64; 95% CI, 1.84 to 17.32, p = 0.003), and lower education (OR = 2.12; 95% CI, 1.23 to 3.67, p = 0.007 for high school or less education versus postgraduate education) were associated with greater underestimation of audiometrically defined HL severity, while tinnitus was associated with greater overestimation (OR = 4.65; 95% CI, 2.64 to 8.20 for a little tinnitus, OR = 5.87; 95% CI, 2.65 to 13.04 for quite a bit tinnitus, and OR = 10.57; 95% CI, 4.91 to 22.79 for very much tinnitus p < 0.0001). Older age (OR = 1.13; 95% CI, 1.12 to 1.15, p < 0.0001), cumulative cisplatin dose (>300 mg/m2, OR = 1.47; 95% CI, 1.21 to 1.80, p = 0.0001), and hypertension (OR = 1.80; 95% CI, 1.28 to 2.52, p = 0.0007) were associated with greater American Speech-Language-Hearing Association-defined HL severity, whereas postgraduate education (OR = 0.58; 95% CI, 0.40 to 0.85, p = 0.005) was associated with less severe HL. CONCLUSIONS Discrepancies between patient-reported and audiometrically defined HL after CBCT are due to several factors. For survivors who self-report HL but have normal audiometric findings at standard frequencies, referral to an audiologist for additional testing and inclusion of EHFs in audiometric assessments should be considered.
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Affiliation(s)
| | | | | | | | - Chunkit Fung
- University of Rochester Medical Center, Rochester, NY
| | | | | | | | | | | | | | | | - Paul Dinh
- Indiana University, Indianapolis, IN
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Tatagari V, Devine A, Cronin B, Vaughn D. Internal herniation of the right colon through the foramen of Winslow: A case report. Int J Surg Case Rep 2022; 94:107015. [PMID: 35405514 PMCID: PMC9010731 DOI: 10.1016/j.ijscr.2022.107015] [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: 02/27/2022] [Revised: 03/16/2022] [Accepted: 03/31/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction and importance Herniation through the Foramen of Winslow, also known as the epiploic foramen, is an extremely rare phenomenon with less than 200 cases reported in medical literature. Internal hernias account for less than 1% of all hernias and roughly 8% of all internal hernias occur through the foramen of Winslow. We present a case of a foramen of Winslow hernia that was not detected until direct visualization with laparoscopy. Presentation of case A 52 year-old healthy female with a surgical history of a Caesarean section presented to the ER with severe epigastric pain radiating to her back. Physical exam was positive for abdominal tenderness and guarding. Vital signs were within normal limits. Murphy’s sign and Rovsing’s sign were negative. Initial imaging studies, including a CT scan of the abdomen, and laboratory findings were unremarkable. A hepatobiliary iminodiacetic acid (HIDA) scan was performed and demonstrated non-visualization of the gallbladder suggestive of acute vs. chronic cholecystitis. Following these results the patient elected to undergo exploratory laparoscopy with potential cholecystectomy. Intra-operatively, the colon was noted to be herniated through the foramen of Winslow. The procedure was converted to an open laparotomy. The hernia was manually reduced, and a right hemicolectomy was performed to prevent recurrence of the hernia. Discussion Reports list an enlarged foramen of Winslow, excessive viscera mobility (i.e., persistent ascending mesocolon or long small bowel mesentery), and an increase in intra-abdominal pressure as potential risk factors for this particular hernia. In our case, the patient was noted to have excessive mobility of the viscera with the presence of persistent ascending mesocolon and an abnormally long right mesentery. Physical exam is usually nonspecific and laboratory findings are typically unremarkable, posing a diagnostic challenge. Additionally, radiological findings indicating presence of an internal hernia were missed in the initial CT scan read by the radiologist. Internal hernias need to be managed surgically as there is a risk of strangulation with bowel ischemia. Conclusion This rare radiographic phenomenon is difficult to diagnose radiographically and warrants further workup due to the potential risk of bowel strangulation despite negative clinical and laboratory findings. Herniation through the Foramen of Winslow, also known as the epiploic foramen, is an extremely rare phenomenon. Internal hernias may be identified on computed tomography (CT) scan. We present a case of a foramen of Winslow hernia that was not detected until direct visualization during laparoscopy. A right hemicolectomy was performed to prevent recurrence of the internal hernia. Internal hernias need to be managed surgically as there is a risk of strangulation with bowel ischemia.
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Affiliation(s)
- Vishwant Tatagari
- Department of Anesthesia, UPMC Lititz, 1500 Highlands Drive, Lititz, PA 17543, USA.
| | - Adam Devine
- Department of Internal Medicine, UPMC Lititz, 1500 Highlands Drive, Lititz, PA 17543, USA
| | - Brian Cronin
- Surgical Specialists of Lancaster, UPMC Lititz, 1500 Highlands Drive, Lititz, PA 17543, USA
| | - David Vaughn
- Surgical Specialists of Lancaster, UPMC Lititz, 1500 Highlands Drive, Lititz, PA 17543, USA
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Noth EM, Lurmann F, Perrino C, Vaughn D, Minor HA, Hammond SK. Decrease in Ambient Polycyclic Aromatic Hydrocarbon Concentrations in California's San Joaquin Valley 2000-2019. Atmos Environ (1994) 2020; 242:117818. [PMID: 32982565 PMCID: PMC7518520 DOI: 10.1016/j.atmosenv.2020.117818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
As part of our ongoing research to understand the impact of polycyclic aromatic hydrocarbon (PAH) exposures on health in the San Joaquin Valley, we evaluated airborne PAH concentration data collected over 19 years (2000-2019) at the central air monitoring site in Fresno, California. We found a dramatic decline in outdoor airborne PAH concentrations between 2000 and 2004 that has been maintained through 2019. This decline was present in both the continuous particle-bound PAHs and the filter-based individual PAHs. The decline was more extreme when restricted to winter concentrations. Annual mean PAHs concentrations in 2017- 2018 of particle-bound PAHs were 6.8 ng/m3 or 62% lower than 2000 - 2001. The decline for winter concentrations of continuous particle-bound PAHs between winter 2019 and winter 2001 was 17.2 ng/m3, a drop of 70%. The 2001 to 2018 decline in average wintertime concentrations for filter-based individual PAHs was 82%. We examined industrial emissions, on-road vehicle emissions, residential wood burning, and agricultural and biomass waste burning as possible explanations. The major decline in PAHs from 2000-2004 was coincident with and most likely due to a similar decline in the amount of agricultural and biomass waste burned in Fresno and Madera Counties. On-road vehicle emissions and residential wood burning did not decline until after 2005. Industrial emissions were too low (2% of total) to explain such large decreases in PAH concentrations.
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Affiliation(s)
- Elizabeth M. Noth
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, 2121 Berkeley Way #5302, Berkeley, CA 94720-7360
| | - Fred Lurmann
- Sonoma Technology, Inc., 1450 N. McDowell Blvd., Petaluma, CA 94954
| | - Charles Perrino
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, 2121 Berkeley Way #5302, Berkeley, CA 94720-7360
| | - David Vaughn
- Sonoma Technology, Inc., 1450 N. McDowell Blvd., Petaluma, CA 94954
| | - Hilary A. Minor
- Sonoma Technology, Inc., 1450 N. McDowell Blvd., Petaluma, CA 94954
| | - S. Katharine Hammond
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, 2121 Berkeley Way #5302, Berkeley, CA 94720-7360
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Gilligan T, Lin DW, Aggarwal R, Chism D, Cost N, Derweesh IH, Emamekhoo H, Feldman DR, Geynisman DM, Hancock SL, LaGrange C, Levine EG, Longo T, Lowrance W, McGregor B, Monk P, Picus J, Pierorazio P, Rais-Bahrami S, Saylor P, Sircar K, Smith DC, Tzou K, Vaena D, Vaughn D, Yamoah K, Yamzon J, Johnson-Chilla A, Keller J, Pluchino LA. Testicular Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 17:1529-1554. [PMID: 31805523 DOI: 10.6004/jnccn.2019.0058] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Testicular cancer is relatively uncommon and accounts for <1% of all male tumors. However, it is the most common solid tumor in men between the ages of 20 and 34 years, and the global incidence has been steadily rising over the past several decades. Several risk factors for testicular cancer have been identified, including personal or family history of testicular cancer and cryptorchidism. Testicular germ cell tumors (GCTs) comprise 95% of malignant tumors arising in the testes and are categorized into 2 main histologic subtypes: seminoma and nonseminoma. Although nonseminoma is the more clinically aggressive tumor subtype, 5-year survival rates exceed 70% with current treatment options, even in patients with advanced or metastatic disease. Radical inguinal orchiectomy is the primary treatment for most patients with testicular GCTs. Postorchiectomy management is dictated by stage, histology, and risk classification; treatment options for nonseminoma include surveillance, systemic therapy, and nerve-sparing retroperitoneal lymph node dissection. Although rarely occurring, prognosis for patients with brain metastases remains poor, with >50% of patients dying within 1 year of diagnosis. This selection from the NCCN Guidelines for Testicular Cancer focuses on recommendations for the management of adult patients with nonseminomatous GCTs.
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Affiliation(s)
- Timothy Gilligan
- 1Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Daniel W Lin
- 2University of Washington/Seattle Cancer Care Alliance
| | | | | | | | | | | | | | | | | | | | | | | | - Will Lowrance
- 14Huntsman Cancer Institute at the University of Utah
| | | | - Paul Monk
- 16The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Joel Picus
- 17Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | | | | | - Daniel Vaena
- 24St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - David Vaughn
- 25Abramson Cancer Center at the University of Pennsylvania
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7
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McAndrew NP, Dickson MA, Clark AS, Troxel AB, O'Hara MH, Colameco C, Gallager M, Gramlich K, Zafman K, Vaughn D, Schwartz GK, O'Dwyer PJ, DeMichele A. Early treatment-related neutropenia predicts response to palbociclib. Br J Cancer 2020; 123:912-918. [PMID: 32641862 PMCID: PMC7492243 DOI: 10.1038/s41416-020-0967-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 07/11/2019] [Revised: 05/13/2020] [Accepted: 06/18/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Palbociclib is highly active in oestrogen-receptor positive (ER+) metastatic breast cancer, but neutropenia is dose limiting. The goal of this study was to determine whether early neutropenia is associated with disease response to single-agent palbociclib. METHODS Blood count and disease-response data were analysed from two Phase 2 clinical trials at different institutions using single-agent palbociclib: advanced solid tumours positive for retinoblastoma protein and advanced liposarcoma. The primary endpoint was PFS. The primary exposure variable was the nadir absolute neutrophil count (ANC) during the first two cycles of treatment. RESULTS One hundred and ninety-six patients (61 breast, 135 non-breast) were evaluated between the two trials. Development of any grade neutropenia was significantly associated with longer median PFS in both the breast cancer (HR 0.29, 95% CI 0.11-0.74, p = 0.010) and non-breast cancer (HR 0.57, 95% CI 0.38-0.85, p = 0.006) cohorts. Grade 3-4 neutropenia was significantly associated with prolonged PFS in the non-breast cohort (HR 0.57, 95% CI 0.38-0.85, p = 0.006) but not in the breast cohort (HR 0.87, 95% CI 0.51-1.47, p = 0.596). Multivariate analysis yielded similar results. CONCLUSIONS Treatment-related neutropenia in the first two cycles was significantly and independently associated with prolonged PFS, suggesting that neutropenia may be a useful pharmacodynamic marker to guide individualised palbociclib dosing. CLINICAL TRIALS REGISTRATION INFORMATION Basket Trial: NCT01037790; Sarcoma Trial: NCT01209598.
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Affiliation(s)
- Nicholas P McAndrew
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark A Dickson
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Amy S Clark
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea B Troxel
- Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - Mark H O'Hara
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Maryann Gallager
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristi Gramlich
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelly Zafman
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - David Vaughn
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Gary K Schwartz
- Herbert Irving Cancer Center, Columbia University School of Medicine, New York, NY, USA
| | - Peter J O'Dwyer
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Angela DeMichele
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA. .,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.
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8
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Kerns SL, Fung C, Fossa SD, Dinh PC, Monahan P, Sesso HD, Frisina RD, Feldman DR, Hamilton RJ, Vaughn D, Martin N, Huddart R, Kollmannsberger C, Sahasrabudhe D, Ardeshir-Rouhani-Fard S, Einhorn L, Travis LB. Relationship of Cisplatin-Related Adverse Health Outcomes With Disability and Unemployment Among Testicular Cancer Survivors. JNCI Cancer Spectr 2020; 4:pkaa022. [PMID: 32704617 PMCID: PMC7368467 DOI: 10.1093/jncics/pkaa022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 01/30/2020] [Accepted: 03/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background Few data exist on the relationship of cisplatin-related adverse health outcomes (AHOs) with disability, unemployment, and self-reported health (SRH) among testicular cancer survivors (TCS). Methods A total of 1815 TCS at least 1 year postchemotherapy underwent clinical examination and completed questionnaires. Treatment data were abstracted from medical records. A cumulative burden of morbidity score (CBMPt) encompassed the number and severity of platinum-related AHOs (peripheral sensory neuropathy [PSN], hearing loss, tinnitus, renal disease). Multivariable regression assessed the association of AHOs and CBMPt with employment status and SRH, adjusting for sociodemographic and clinical characteristics. Unemployment was compared with a male normative population of similar age, race, and ethnicity. Results Almost 1 in 10 TCS was out of work (2.4%, disability leave; 6.8%, unemployed) at a median age of 37 years (median follow-up = 4 years). PSN (odds ratio [OR] = 2.89, 95% confidence interval [CI] = 1.01 to 8.26, grade 3 vs 0, P = .048), renal dysfunction defined by estimated glomerular filtration rate (OR = 12.1, 95% CI = 2.06 to 70.8, grade 2 vs 0, P = .01), pain (OR = 10.6, 95% CI = 4.40 to 25.40, grade 2 or 3 vs 0, P < .001), and CBMPt (OR = 1.46, 95% CI = 1.03 to 2.08, P = .03) were associated with disability leave; pain strongly correlated with PSN (r2 = 0.40, P < .001). Statistically significantly higher percentages of TCS were unemployed vs population norms (age-adjusted OR = 2.67, 95% CI = 2.49 to 3.02, P < .001). PSN (OR = 2.44, 95% CI = 1.28 to 4.62, grade 3 vs 0, P = .006), patient-reported hearing loss (OR = 1.82, 95% CI = 1.04 to 3.17, grade 2 or 3 vs 0, P = .04), and pain (OR = 3.75, 95% CI = 2.06 to 6.81, grade 2 or 3 vs 0, P < .001) were associated with unemployment. Increasing severity of most cisplatin-related AHOs and pain were associated with statistically significantly worse SRH. Conclusions Our findings have important implications regarding treatment-associated productivity losses and socioeconomic costs in this young population. Survivorship care strategies should include inquiries about disability and unemployment status, with efforts made to assist affected TCS in returning to the workforce.
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Affiliation(s)
- Sarah L Kerns
- University of Rochester Medical Center, Rochester, NY, USA
| | - Chunkit Fung
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | | | | | | | | | | | - David Vaughn
- University of Pennsylvania, Philadelphia, PA, USA
| | - Neil Martin
- Dana-Farber Cancer Institute, Boston, MA, USA
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9
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Sadigh S, Farahani SJ, Shah A, Vaughn D, Lal P. Differences in PD-L1-Expressing Macrophages and Immune Microenvironment in Testicular Germ Cell Tumors. Am J Clin Pathol 2020; 153:387-395. [PMID: 31802108 DOI: 10.1093/ajcp/aqz184] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 12/14/2022] Open
Abstract
OBJECTIVES To characterize the tumor microenvironment of testicular germ cell tumors (GCTs) using immunohistochemical markers. METHODS Seventy-seven orchiectomies, including 36 nonmetastatic (NM) seminomas, 15 metastatic (M) seminomas, 13 nonmetastatic nonseminomatous germ cell tumors (NSGCTs), and 13 metastatic NSGCTs, were studied with PD-1, PD-L1, FOXP3, CD68, CD163, and mismatch repair (MMR) immunohistochemistry. FOXP3+ and PD-1+ tumor-infiltrating lymphocytes (TILs) and tumor-associated macrophages (TAMs) expressing CD68 and CD163 were enumerated. PDL-1 expression was evaluated on tumor cells and macrophages. RESULTS GCTs primarily express PD-L1 on TAMs, except choriocarcinoma, where true tumor cell positivity was noted. Seminomas reveal increased intratumoral PD-L1+ TAMs compared with NSGCTs (P < .05). Activated TILs are increased in NM-seminomas compared with M-seminomas (P < .05). All GCTs retained MMR expression. CONCLUSIONS Robust PD-L1+ TAMs are significantly expanded in seminomas compared with NSGCTs. Among all GCTs, only choriocarcinoma cells reveal true positivity for PD-L1. These findings expand the realm of potentially targeted treatments for GCTs.
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Affiliation(s)
- Sam Sadigh
- Department of Anatomic Pathology, Hospital of the University of Pennsylvania, Philadelphia
| | - Sahar J Farahani
- Department of Anatomic Pathology, Hospital of the University of Pennsylvania, Philadelphia
| | - Abhishek Shah
- Department of Anatomic Pathology, Hospital of the University of Pennsylvania, Philadelphia
| | - David Vaughn
- Department of Medical Oncology, Hospital of the University of Pennsylvania, Philadelphia
| | - Priti Lal
- Department of Anatomic Pathology, Hospital of the University of Pennsylvania, Philadelphia
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Baumann B, Hwang WT, Srinivasan S, Mamtani R, Vaughn D, Xia L, Malkowicz SB, Guzzo T, Christodouleas J. PD15-05 EXTERNAL VALIDATION OF A DECISION-SUPPORT TOOL FOR BORDERLINE OPERABLE MUSCLE-INVASIVE BLADDER CANCER (MIBC) PATIENTS CHOOSING BETWEEN RADICAL CYSTECTOMY AND CHEMO-RADIOTHERAPY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.804] [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: 11/26/2022]
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Adra N, Einhorn L, Althouse S, Ammakkanavar N, Musapatika D, Albany C, Vaughn D, Hanna N. Phase II trial of pembrolizumab in patients with platinum refractory germ-cell tumors: a Hoosier Cancer Research Network Study GU14-206. Ann Oncol 2018; 29:209-214. [DOI: 10.1093/annonc/mdx680] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Baumann B, Hwang W, Wang X, Mamtani R, Vaughn D, Xia L, Malkowicz S, Guzzo T, Christodouleas J. A Decision-Support Tool to Assist Muscle-Invasive Bladder Cancer Patients Choosing Between Radical Cystectomy and Chemoradiation Therapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.280] [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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13
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O’Connor A, Buckley M, Crowley F, Vaughn D, O’Sullivan S. 244The Readability of Internet Information on Lewy Body Dementia. Age Ageing 2017. [DOI: 10.1093/ageing/afx144.226] [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: 11/14/2022] Open
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14
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Conaboy C, Santiago R, Vaughn D, Hirst R. B-13Sustained Neuropsychological Deficits Observed in Youth Sport-Related Concussion Testing Over Multiple Concussions: A Case Study. Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx076.98] [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: 11/13/2022] Open
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15
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Lynch SM, Stricker CT, Brown JC, Berardi JM, Vaughn D, Domchek S, Filseth S, Branas A, Weiss-Trainor E, Schmitz KH, Sarwer DB. Evaluation of a web-based weight loss intervention in overweight cancer survivors aged 50 years and younger. Obes Sci Pract 2017; 3:83-94. [PMID: 28392934 PMCID: PMC5358075 DOI: 10.1002/osp4.98] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 12/31/2015] [Revised: 12/08/2016] [Accepted: 12/15/2016] [Indexed: 01/29/2023] Open
Abstract
Purpose Half of adult cancer survivors under age 50 years are obese. Excess body weight is associated with cancer recurrence, and effective weight loss interventions for younger cancer survivors are needed. Commercially available, online weight loss programmes are readily accessible, but few have been studied in this population. This study employed a single‐arm, pre‐post intervention (baseline‐6 month/baseline‐12 month comparisons) to preliminarily explore feasibility, efficacy and safety of an online, commercially available weight loss programme in breast (n = 30) and testicular (n = 16) cancer survivors under age 50 years. Methods The intervention included three daily components: exercise, nutritional/behavioural modification strategies and health lessons. Intention‐to‐treat and completers analyses were conducted. Feasibility was measured by participation (number of participants enrolled/number screened), retention (number of participants attending 6/12 month study visit/number of enrolled) and self‐reported adherence rates (average of mean percent adherence to each of the three intervention components). Efficacy was assessed by changes in initial weight (percent weight loss). Safety was assessed by adverse events. Results The mean participation rate was 42%. The retention rate was 59% at 6 and 49% at 12 months. The adherence rate for all participants (completers/dropouts/lost‐to‐follow‐up) was 50.1% at 6 and 44% at 12 months. Completers reported adherence rates of 68% at 12 months. Study participants lost 5.3% body weight at 12 months; completers lost 9%. Only three unexpected adverse events (unrelated to the intervention) were reported. Conclusion Clinically significant weight loss was observed, although retention rates were low. Findings generally support preliminary feasibility, efficacy and safety of this online weight loss programme, and future randomized control trials should be explored.
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Affiliation(s)
- S M Lynch
- Cancer Prevention and Control Fox Chase Cancer Center Philadelphia PA USA; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology University of Pennsylvania Philadelphia PA USA
| | - C T Stricker
- Abramson Cancer Center University of Pennsylvania Philadelphia PA USA
| | - J C Brown
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology University of Pennsylvania Philadelphia PA USA
| | | | - D Vaughn
- Abramson Cancer Center University of Pennsylvania Philadelphia PA USA
| | - S Domchek
- Abramson Cancer Center University of Pennsylvania Philadelphia PA USA
| | - S Filseth
- Recruitment, Outreach, and Assessment Resource(ROAR), Abramson Cancer Center University of Pennsylvania Philadelphia PA USA
| | - A Branas
- Abramson Cancer Center University of Pennsylvania Philadelphia PA USA
| | | | - K H Schmitz
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology University of Pennsylvania Philadelphia PA USA
| | - D B Sarwer
- Center for Obesity Research and Education, College of Public Health Temple University Philadelphia PA USA
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Noth EM, Lurmann F, Northcross A, Perrino C, Vaughn D, Hammond SK. Spatial and Temporal Distribution of Polycyclic Aromatic Hydrocarbons and Elemental Carbon in Bakersfield, California. Air Qual Atmos Health 2016; 9:899-908. [PMID: 28083077 PMCID: PMC5221703 DOI: 10.1007/s11869-016-0399-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/21/2016] [Indexed: 05/23/2023]
Abstract
Despite increasing evidence that airborne polycyclic aromatic hydrocarbon (PAH) exposures contribute to adverse health outcomes for sensitive populations, limited data are available on short-term intraurban spatial distributions for use in epidemiologic research. Exposure assessments for airborne PAHs are uncommon because air sampling for PAHs is a labor-, equipment-, and time-intensive task. To address this gap we measured wintertime PAH concentrations during 2010-2011 in Bakersfield, California, USA, a major city in the Southern San Joaquin Valley. Specifically, 58 96-hour integrated PAH samples were collected during 4 time periods at 14 locations from November 2010 to January 2011; duplicates were collected at two sites. We also collected elemental carbon (EC) at the same 14 sites and analyzed the two time periods with the highest ambient PAH pollution. We used linear regression models to quantify the relationship between potential spatial and temporal predictors of PAH concentrations. We found that wintertime PAH concentrations in Bakersfield, CA, are best predicted by meteorological variables and traffic proximity. Our model explains a moderate amount of the variability in the data (R2=0.58), likely reflecting the major sources of PAHs in Bakersfield. We also observed that PAH concentrations were more spatially variable than EC concentrations. Comparing our data to historical monitoring data at one location in Bakersfield showed that the relatively low PAH concentrations during the 2010-2011 winter in Bakersfield is part of a long-term trend in decreasing PAH concentrations.
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Affiliation(s)
- Elizabeth M. Noth
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, 50 University Hall #7360, Berkeley, CA 94720-7360 USA
| | - Fred Lurmann
- Sonoma Technology, Inc., 1455 N. McDowell Blvd., Petaluma, CA 94954-6503
| | - Amanda Northcross
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave, NW 7th Floor, Washington, DC 20052
| | - Charles Perrino
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, 50 University Hall #7360, Berkeley, CA 94720-7360 USA
| | - David Vaughn
- Sonoma Technology, Inc., 1455 N. McDowell Blvd., Petaluma, CA 94954-6503
| | - S. Katharine Hammond
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, 50 University Hall #7360, Berkeley, CA 94720-7360 USA
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Keefe SM, Hoffman-Censits J, Cohen RB, Mamtani R, Heitjan D, Eliasof S, Nixon A, Turnbull B, Garmey EG, Gunnarsson O, Waliki M, Ciconte J, Jayaraman L, Senderowicz A, Tellez AB, Hennessy M, Piscitelli A, Vaughn D, Smith A, Haas NB. Efficacy of the nanoparticle-drug conjugate CRLX101 in combination with bevacizumab in metastatic renal cell carcinoma: results of an investigator-initiated phase I-IIa clinical trial. Ann Oncol 2016; 27:1579-85. [PMID: 27457310 DOI: 10.1093/annonc/mdw188] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 03/18/2016] [Accepted: 04/26/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Anti-angiogenic therapies are effective in metastatic renal cell carcinoma (mRCC), but resistance is inevitable. A dual-inhibition strategy focused on hypoxia-inducible factor (HIF) is hypothesized to be active in this refractory setting. CRLX101 is an investigational camptothecin-containing nanoparticle-drug conjugate (NDC), which durably inhibits HIF1α and HIF2α in preclinical models and in gastric cancer patients. Synergy was observed in the preclinical setting when combining this NDC and anti-angiogenic agents, including bevacizumab. PATIENTS AND METHODS Patients with refractory mRCC were treated every 2 weeks with bevacizumab (10 mg/kg) and escalating doses of CRLX101 (12, 15 mg/m(2)) in a 3 + 3 phase I design. An expansion cohort of 10 patients was treated at the recommended phase II dose (RP2D). Patients were treated until progressive disease or prohibitive toxicity. Adverse events (AEs) were assessed using CTCAE v4.0 and clinical outcome using RECIST v1.1. RESULTS Twenty-two patients were response-evaluable in an investigator-initiated trial at two academic medical centers. RCC histologies included clear cell (n = 12), papillary (n = 5), chromophobe (n = 2), and unclassified (n = 3). Patients received a median of two prior therapies, with at least one prior vascular endothelial tyrosine kinase inhibitor therapy (VEGF-TKI). No dose-limiting toxicities were observed. Grade ≥3 AEs related to CRLX101 included non-infectious cystitis (5 events), fatigue (3 events), anemia (2 events), diarrhea (2 events), dizziness (2 events), and 7 other individual events. Five of 22 patients (23%) achieved partial responses, including 3 of 12 patients with clear cell histology and 2 of 10 patients (20%) with non-clear cell histology. Twelve of 22 patients (55%) achieved progression-free survival (PFS) of >4 months. CONCLUSIONS CRLX101 combined with bevacizumab is safe in mRCC. This combination fulfilled the protocol's predefined threshold for further examination with responses and prolonged PFS in a heavily pretreated population. A randomized phase II clinical trial in mRCC of this combination is ongoing.
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Affiliation(s)
- S M Keefe
- Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - J Hoffman-Censits
- Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia
| | - R B Cohen
- Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - R Mamtani
- Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - D Heitjan
- Southern Methodist University, Dallas
| | | | - A Nixon
- Duke University School of Medicine, Durham
| | | | | | - O Gunnarsson
- Landspitali University Hospital, Reykjavik, Iceland
| | - M Waliki
- Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - J Ciconte
- Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | | | | | | | | | | | - D Vaughn
- Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - A Smith
- Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - N B Haas
- Abramson Cancer Center, University of Pennsylvania, Philadelphia
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Offin MD, Menachem J, Squillante C, Ky B, Vaughn D, Carver J. Association Among Hypoxemia, Patent Foramen Ovale, and Mediastinal Germ Cell Tumor: A Case Report. Ann Intern Med 2015; 163:243-4. [PMID: 26237762 DOI: 10.7326/l15-5120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/22/2022] Open
Affiliation(s)
- Michael D. Offin
- From Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan Menachem
- From Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Bonnie Ky
- From Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Vaughn
- From Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph Carver
- From Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Narayan V, Vaughn D. Pharmacokinetic and toxicity considerations in the use of neoadjuvant chemotherapy for bladder cancer. Expert Opin Drug Metab Toxicol 2015; 11:731-42. [DOI: 10.1517/17425255.2015.1005600] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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20
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Keefe SM, Hennessy M, Gunnarsson O, Mamtani R, Vaughn D, Hoffman-Censits J, Nathanson K, Lal P, Lal P, Pryma D, Eliasof S, Garmey E, Cohen RB, Haas NB. Abstract CT340: Phase 1b/2a study of the nanopharmaceutical CRLX101 with bevacizumab (bev) in the treatment of patients (pts) with refractory metastatic renal cell carcinoma (mRCC): results from the planned interim analysis. Clin Trials 2014. [DOI: 10.1158/1538-7445.am2014-ct340] [Citation(s) in RCA: 3] [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: 11/16/2022]
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Kannan V, Misra BK, Kapadia A, Bajpai R, Deshpande S, Almel S, Sankhe M, Desai K, Shaikh M, Anand V, Kannan A, Teo WY, Ross J, Bollo R, Seow WT, Tan AM, Kang SG, Kim DS, Li XN, Lau CC, Mohila CA, Adesina A, Su J, Ichimura K, Fukushima S, Matsushita Y, Tomiyama A, Niwa T, Suzuki T, Nakazato Y, Mukasa A, Kumabe T, Nagane M, Iuchi T, Mizoguchi M, Tamura K, Sugiyama K, Nakada M, Kanemura Y, Yokogami K, Matsutani M, Shibata T, Nishikawa R, Takami H, Fukushima S, Fukuoka K, Yanagisawa T, Nakamura T, Arita H, Narita Y, Shibui S, Nishikawa R, Ichimura K, Matsutani M, Sands S, Guerry W, Kretschmar C, Donahue B, Allen J, Matsutani M, Nishikawa R, Kumabe T, Sugiyama K, Nakamura H, Sawamura Y, Fujimaki T, Hattori E, Arakawa Y, Kawabata Y, Aoki T, Miyamoto S, Kagawa N, Hirayama R, Fujimoto Y, Chiba Y, Kinoshita M, Takano K, Eino D, Fukuya S, Nakanishi K, Yamamoto F, Hashii Y, Hashimoto N, Hara J, Yoshimine T, Murray M, Bartels U, Nishikawa R, Fangusaro J, Matsutani M, Nicholson J, Sumerauer D, Zapotocky M, Churackova M, Cyprova S, Zamecnik J, Malinova B, Kyncl M, Tichy M, Stary J, Lassen-Ramshad Y, von Oettingen G, Agerbaek M, Ohnishi T, Kohno S, Inoue A, Ohue S, Kohno S, Iwata S, Inoue A, Ohue S, Kumon Y, Ohnishi T, Acharya S, DeWees T, Shinohara E, Perkins S, Kato H, Fuji H, Nakasu Y, Ishida Y, Okawada S, Yang Q, Guo C, Chen Z, Alapetite C, Faure-Conter C, Verite C, Pagnier A, Laithier V, Entz-Werle N, Gorde-Grosjean S, Palenzuela G, Lemoine P, Frappaz D, Nguyen HA, Bui L, Ngoc, Cerbone M, Ederies A, Losa L, Moreno C, Sun K, Spoudeas HA, Nakano Y, Okada K, Kosaka Y, Nagashima T, Hashii Y, Kagawa N, Soejima T, Osugi Y, Sakamoto H, Hara J, Nicholson J, Alapetite C, Kortmann RD, Garre ML, Ricardi U, Saran F, Frappaz D, Calaminus G, Muda Z, Menon B, Ibrahim H, Rahman EJA, Muhamad M, Othman IS, Thevarajah A, Cheng S, Kilday JP, Laperriere N, Drake J, Bouffet E, Bartels U, Sakamoto H, Matsusaka Y, Watanabe Y, Umaba R, Hara J, Osugi Y, Alapetite C, Ruffier-Loubiere A, De Marzi L, Bolle S, Claude L, Habrand JL, Brisse H, Frappaz D, Doz F, Bourdeaut F, Dendale R, Mazal A, Fournier-Bidoz N, Fujimaki T, Fukuoka K, Shirahata M, Suzuki T, Adachi JI, Mishima K, Wakiya K, Matsutani M, Nishikawa R, Fukushima S, Yamashita S, Kato M, Nakamura H, Takami H, Suzuki T, Yanagisawa T, Mukasa A, Kumabe T, Nagane M, Sugiyama K, Tamura K, Narita Y, Shibui S, Shibata T, Ushijima T, Matsutani M, Nishikawa R, Ichimura K, Consortium IGA, Calaminus G, Kortmann RD, Frappaz D, Alapetite C, Garre ML, Ricardi U, Saran FH, Nicholson J, Calaminus G, Kortmann RD, Frappaz D, Alapetite C, Garre ML, Ricardi U, Saran FH, Nicholson J, Czech T, Nicholson J, Frappaz D, Kortmann RD, Alapetite C, Garre ML, Ricardi U, Saran F, Calaminus G, Hayden J, Bartels U, Calaminus G, Joseph R, Nicholson J, Hale J, Lindsay H, Kogiso M, Qi L, Yee TW, Huang Y, Mao H, Lin F, Baxter P, Su J, Terashima K, Perlaky L, Lau C, Parsons D, Chintagumpala M, Li XAN, Osorio D, Vaughn D, Gardner S, Mrugala M, Ferreira M, Keene C, Gonzalez-Cuyar L, Hebb A, Rockhill J, Wang L, Yamaguchi S, Burstein M, Terashima K, Ng HK, Nakamura H, He Z, Suzuki T, Nishikawa R, Natsume A, Terasaka S, Dauser R, Whitehead W, Adesina A, Sun J, Munzy D, Gibbs R, Leal S, Wheeler D, Lau C, Dhall G, Robison N, Judkins A, Krieger M, Gilles F, Park J, Lee SU, Kim T, Choi Y, Park HJ, Shin SH, Kim JY, Robison N, Dhir N, Khamani J, Margol A, Wong K, Britt B, Evans A, Nelson M, Grimm J, Finlay J, Dhall G. GERM CELL TUMOURS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou070] [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: 11/13/2022] Open
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Pond GR, Agarwal N, Bellmunt J, Choueiri TK, Qu A, Fougeray R, Vaughn D, James ND, Salhi Y, Albers P, Niegisch G, Galsky MD, Wong YN, Ko YJ, Stadler WM, O'Donnell PH, Sridhar SS, Vogelzang NJ, Necchi A, Di Lorenzo G, Sternberg CN, Mehta A, Sonpavde G. A nomogram including baseline prognostic factors to estimate the activity of second-line therapy for advanced urothelial carcinoma. BJU Int 2014; 113:E137-43. [DOI: 10.1111/bju.12564] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gregory R. Pond
- Ontario Clinical Oncology Group; McMaster University; Hamilton ON Canada
| | - Neeraj Agarwal
- Department of Medicine; Section of Hematology-Oncology Huntsman Cancer Institute; University of Utah; Salt Lake City UT USA
| | | | - Toni K. Choueiri
- Department of Medicine; Section of Hematology-Oncology Dana-Farber Cancer Institute and Harvard Medical School; Boston MA USA
| | - Angela Qu
- Institut de Recherche Pierre Fabre; Boulogne France
| | | | - David Vaughn
- Department of Medicine; Section of Hematology-Oncology University of Pennsylvania; Philadelphia PA USA
| | | | - Yacine Salhi
- Institut de Recherche Pierre Fabre; Boulogne France
| | | | | | - Matthew D. Galsky
- Department of Medicine; Section of Hematology-Oncology Tisch Cancer Center Institute; Mount Sinai School of Medicine; New York NY
| | - Yu-Ning Wong
- Department of Medicine; Section of Hematology-Oncology Fox Chase Cancer Center; Philadelphia PA USA
| | - Yoo-Joung Ko
- Sunnybrook Odette Cancer Centre; Toronto ON Canada
| | - Walter M. Stadler
- Department of Medicine; Section of Hematology-Oncology University of Chicago; Chicago IL USA
| | - Peter H. O'Donnell
- Department of Medicine; Section of Hematology-Oncology University of Chicago; Chicago IL USA
| | | | | | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori; Milan
| | | | | | - Amitkumar Mehta
- Department of Medicine; Section of Hematology-Oncology UAB (University of Alabama at Birmingham) Comprehensive Cancer Center; Birmingham AL USA
| | - Guru Sonpavde
- Department of Medicine; Section of Hematology-Oncology UAB (University of Alabama at Birmingham) Comprehensive Cancer Center; Birmingham AL USA
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Goldsmith B, Baumann BC, He J, Tucker K, Bekelman J, Deville C, Vapiwala N, Vaughn D, Keefe SM, Guzzo T, Malkowicz SB, Christodouleas JP. Occult pelvic lymph node involvement in bladder cancer: implications for definitive radiation. Int J Radiat Oncol Biol Phys 2014; 88:603-10. [PMID: 24411628 DOI: 10.1016/j.ijrobp.2013.11.211] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/08/2013] [Accepted: 11/08/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE To inform radiation treatment planning for clinically staged, node-negative bladder cancer patients by identifying clinical factors associated with the presence and location of occult pathologic pelvic lymph nodes. METHODS AND MATERIALS The records of patients with clinically staged T1-T4N0 urothelial carcinoma of the bladder undergoing radical cystectomy and pelvic lymphadenectomy at a single institution were reviewed. Logistic regression was used to evaluate associations between preoperative clinical variables and occult pathologic pelvic or common iliac lymph nodes. Percentages of patient with involved lymph node regions entirely encompassed within whole bladder (perivesicular nodal region), small pelvic (perivesicular, obturator, internal iliac, and external iliac nodal regions), and extended pelvic clinical target volume (CTV) (small pelvic CTV plus common iliac regions) were calculated. RESULTS Among 315 eligible patients, 81 (26%) were found to have involved pelvic lymph nodes at the time of surgery, with 38 (12%) having involved common iliac lymph nodes. Risk of occult pathologically involved lymph nodes did not vary with clinical T stage. On multivariate analysis, the presence of lymphovascular invasion (LVI) on preoperative biopsy was significantly associated with occult pelvic nodal involvement (odds ratio 3.740, 95% confidence interval 1.865-7.499, P<.001) and marginally associated with occult common iliac nodal involvement (odds ratio 2.307, 95% confidence interval 0.978-5.441, P=.056). The percentages of patients with involved lymph node regions entirely encompassed by whole bladder, small pelvic, and extended pelvic CTVs varied with clinical risk factors, ranging from 85.4%, 95.1%, and 100% in non-muscle-invasive patients to 44.7%, 71.1%, and 94.8% in patients with muscle-invasive disease and biopsy LVI. CONCLUSIONS Occult pelvic lymph node rates are substantial for all clinical subgroups, especially patients with LVI on biopsy. Extended coverage of pelvic lymph nodes up to the level of the common iliac nodes may be warranted in subsets of patients.
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Affiliation(s)
- Benjamin Goldsmith
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian C Baumann
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jiwei He
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kai Tucker
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Justin Bekelman
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Curtiland Deville
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neha Vapiwala
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Vaughn
- Department of Medical Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen M Keefe
- Department of Medical Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas Guzzo
- Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - S Bruce Malkowicz
- Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John P Christodouleas
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Bekelman JE, Handorf EA, Guzzo T, Evan Pollack C, Christodouleas J, Resnick MJ, Swisher-McClure S, Vaughn D, Ten Have T, Polsky D, Mitra N. Radical cystectomy versus bladder-preserving therapy for muscle-invasive urothelial carcinoma: examining confounding and misclassification biasin cancer observational comparative effectiveness research. Value Health 2013; 16:610-618. [PMID: 23796296 PMCID: PMC3694349 DOI: 10.1016/j.jval.2013.01.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 01/15/2013] [Accepted: 01/23/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Radical cystectomy (RC) is the standard treatment for muscle-invasive urothelial carcinoma of the bladder. Trimodality bladder-preserving therapy (BPT) is an alternative to RC, but randomized comparisons of RC versus BPT have proven infeasible. To compare RC versus BPT, we undertook an observational cohort study using registry and administrative claims data from the Surveillance, Epidemiology and End Results-Medicare database. METHODS We identified patients age 65 years or older diagnosed between 1995 and 2005 who received RC (n = 1426) or BPT (n = 417). We examined confounding and stage misclassification in the comparison of RC and BPT by using multivariable adjustment, propensity score-based adjustment, instrumental variable (IV) analysis, and simulations. RESULTS Patients who received BPT were older and more likely to have comorbid disease. After propensity score adjustment, BPT was associated with an increased hazard of death from any cause (hazard ratio [HR] 1.26; 95% confidence interval [CI] 1.05-1.53) and from bladder cancer (HR 1.31; 95% CI 0.97-1.77). Using the local area cystectomy rate as an instrument, IV analysis demonstrated no differences in survival between BPT and RC (death from any cause HR 1.06; 95% CI 0.78-1.31; death from bladder cancer HR 0.94; 95% CI 0.55-1.18). Simulation studies for stage misclassification yielded results consistent with the IV analysis. CONCLUSIONS Survival estimates in an observational cohort of patients who underwent RC versus BPT differ by analytic method. Multivariable and propensity score adjustment revealed greater mortality associated with BPT relative to RC, while IV analysis and simulation studies suggest that the two treatments are associated with similar survival outcomes.
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Affiliation(s)
- Justin E Bekelman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Costa L, Lin C, Grossi D, Mancini M, Swisher A, Cook C, Vaughn D, Elkins M, Sheikh U, Moore A, Jull G, Craik R, Maher C, Guirro R, Marques A, Harms M, Brooks D, Simoneau G, Strupstad J. Registrierung Klinischer Studien. physioscience 2013. [DOI: 10.1055/s-0033-1335485] [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: 10/26/2022]
Affiliation(s)
- L. Costa
- International Society of Physiotherapy Journal Editors
| | - C. Lin
- International Society of Physiotherapy Journal Editors
| | - D. Grossi
- Brazilian Journal of Physical Therapy/Revista Brasileira de Fisioterapia
| | - M. Mancini
- Brazilian Journal of Physical Therapy/Revista Brasileira de Fisioterapia
| | - A. Swisher
- Cardiopulmonary Physical Therapy Journal
| | - C. Cook
- Journal of Manual and Manipulative Therapy
| | - D. Vaughn
- Journal of Manual and Manipulative Therapy
| | | | - U. Sheikh
- Journal of Physiotherapy & Sports Medicine
| | | | | | | | | | - R. Guirro
- Physical Therapy & Research/Fisioterapia e Pesquisa
| | - A. Marques
- Physical Therapy & Research/Fisioterapia e Pesquisa
| | | | | | - G. Simoneau
- Journal of Orthopaedic & Sports Physical Therapy
| | - J. Strupstad
- Tidsskriftet Fysioterapeuten/Norwegian Journal of Physiotherapy
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Wong YN, Plimack ER, Litwin S, Vaughn D, Lee J, Song W, Hudes GR. Reply to S. Buti and S. Culine. J Clin Oncol 2013; 31:1615-6. [DOI: 10.1200/jco.2012.47.8255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Wei Song
- Pottstown Hospital, Pottstown, PA
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Bekelman J, Handorf E, Guzzo T, Christodouleas J, Resnick M, Swisher-McClure S, Vaughn D, Pollack C, Polsky D, Mitra N. Radical Cystectomy (RC) Versus Bladder Preservation Therapy (BPT) for Muscle-invasive Bladder Cancer. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.213] [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: 11/15/2022]
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Langley JM, Frenette L, Chu L, McNeil S, Halperin S, Li P, Vaughn D. A randomized, controlled non-inferiority trial comparing A(H1N1)pmd09 vaccine antigen, with and without AS03 adjuvant system, co-administered or sequentially administered with an inactivated trivalent seasonal influenza vaccine. BMC Infect Dis 2012; 12:279. [PMID: 23110320 PMCID: PMC3529122 DOI: 10.1186/1471-2334-12-279] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [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: 12/16/2011] [Accepted: 10/11/2012] [Indexed: 11/10/2022] Open
Abstract
Background At the time of the influenza A(H1N1)pmd09 pandemic it was not known if concurrent or sequential administration of seasonal trivalent influenza vaccine (TIV) with pandemic vaccine was preferred. Methods Immunogenicity and safety were assessed in 871 healthy subjects aged 19–40 years who were randomised into six groups to receive co-administration or sequential administration of TIV and two doses of A(H1N1)pmd09 vaccine (either unadjuvanted or adjuvanted with AS03, an α-tocopherol and squalene-based oil-in-water emulsion). Results Safety and immunogenicity data (by haemagglutination inhibition [HI] assay) after each dose and six months post-Dose 1 are reported here. Co-administration of A(H1N1)pmd09 vaccine with TIV reduced the HI immune responses to A(H1N1)pmd09 vaccine. However, serologic responses with both co-administration and sequential schedules met the European and US regulatory criteria for pandemic and seasonal influenza vaccines up to six months following the first vaccine dose. The AS03-adjuvanted formulation elicited higher immune responses at all time points. Prior administration or co-administration of A(H1N1)pmd09 vaccine did not affect immune responses to TIV. Conclusions Co-administration of TIV and A(H1N1)pmd09 vaccine negatively influenced A(H1N1)pmd09 vaccine immunogenicity but had no effect on TIV responses. The non-adjuvanted and adjuvanted vaccines demonstrated strong immune responses against all vaccine strains for up to six months following the first vaccine dose. Trial registration NCT00985673
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Affiliation(s)
- Joanne M Langley
- Canadian Center for Vaccinology, IWK Health Centre, Capital District Health Authority and Dalhousie University, 5850 University Avenue, Halifax, NS, Canada.
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Wong YN, Litwin S, Vaughn D, Cohen S, Plimack ER, Lee J, Song W, Dabrow M, Brody M, Tuttle H, Hudes G. Phase II trial of cetuximab with or without paclitaxel in patients with advanced urothelial tract carcinoma. J Clin Oncol 2012; 30:3545-51. [PMID: 22927525 DOI: 10.1200/jco.2012.41.9572] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The benefit of salvage chemotherapy is modest in metastatic urothelial cancer. We conducted a randomized, noncomparative phase II study to measure the efficacy of cetuximab with or without paclitaxel in patients with previously treated urothelial cancer. PATIENTS AND METHODS Patients with metastatic urothelial cancer who received one line of chemotherapy in the perioperative or metastatic setting were randomly assigned to 4-week cycles of cetuximab 250 mg/m(2) with or without paclitaxel 80 mg/m(2) per week. We used early progression as an indicator of futility. Either arm would close if seven of the initial 15 patients in that arm progressed at the first disease evaluation at 8 weeks. RESULTS We enrolled 39 evaluable patients. The single-agent cetuximab arm closed after nine of the first 11 patients progressed by 8 weeks. The combination arm completed the full accrual of 28 patients, of whom 22 patients (78.5%) had visceral disease. Twelve of 28 patients had progression-free survival greater than 16 weeks. The overall response rate was 25% (95% CI, 11% to 45%; three complete responses and four partial responses). The median progression-free survival was 16.4 weeks (95% CI, 12 to 25.1 weeks), and the median overall survival was 42 weeks (95% CI, 30.4 to 78 weeks). Treatment-related grade 3 and 4 adverse events that occurred in at least two patients were rash (six cases), fatigue (five cases), and low magnesium (three cases). CONCLUSION Although it had limited activity as a single agent, cetuximab appears to augment the antitumor activity of paclitaxel in previously treated urothelial cancers. The cetuximab and paclitaxel combination merits additional study to establish its role in the treatment of urothelial cancers.
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Affiliation(s)
- Yu-Ning Wong
- University of Pennsylvania, Philadelphia, PA, USA
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Ikematsu H, Tenjinbaru K, Li P, Madan A, Vaughn D. Evaluation of immune response following one dose of an AS03A-adjuvanted H1N1 2009 pandemic influenza vaccine in Japanese adults 65 years of age or older. Hum Vaccin Immunother 2012; 8:1119-25. [PMID: 22854661 PMCID: PMC3551884 DOI: 10.4161/hv.21081] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 11/25/2022] Open
Abstract
Objective: This study assessed the immunogenicity, long-term persistence of immune response and safety of a single dose of an A/California/07/2009 H1N1 pandemic influenza vaccine adjuvanted with AS03 (α-tocopherol and squalene based oil-in-water emulsion Adjuvant System) in subjects ≥ 65 y of age (NCT01114620). Results: At Day 21, the HI immune response met all three European guidance criteria [seroconversion rate (SCR): 60.0%; seroprotection rate (SPR): 64.0%; geometric mean fold rise (GMFR): 10.2] and the US guidance criterion for SCR. At month 6, the HI immune response against the A/California/07/2009 H1N1 strain persisted but at levels lower than that observed at Day 21 (SCR: 38.8%; SPR: 42.9%; HI antibody geometric mean titer: 27.6); the European regulatory guidance criteria for SCR and GMFR were still met. Overall, the vaccine was well-tolerated. Conclusion
A single dose of the 3.75µg HA AS03-adjuvanted H1N1 2009 pandemic vaccine induced immune responses against the vaccine strain that met the European regulatory guidance criteria at day 21 in the elderly Japanese population; the immune response persisted at lower levels at month 6. No safety concerns were identified. These results suggest that two vaccine doses might be useful for the elderly population to improve antibody induction and persistence. Methods: In this open-label, single group study, 50 subjects received one dose of the 3.75 µg hemagglutinin (HA) AS03-adjuvanted H1N1 2009 vaccine. Immunogenicity assessments were made before vaccination, 21 days and six months after vaccination using hemagglutination inhibition (HI) and microneutralization assays. Immunogenicity end points were based on US and European regulatory criteria.
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Ferguson M, Risi G, Davis M, Sheldon E, Baron M, Li P, Madariaga M, Fries L, Godeaux O, Vaughn D. Safety and long-term humoral immune response in adults after vaccination with an H1N1 2009 pandemic influenza vaccine with or without AS03 adjuvant. J Infect Dis 2012; 205:733-44. [PMID: 22315336 DOI: 10.1093/infdis/jir641] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [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
BACKGROUND In this study (NCT00985088) we evaluated different formulations of an H1N1 2009 pandemic influenza vaccine that deliver various viral hemagglutinin (HA) doses with or without AS03 (a tocopherol-based oil-in-water adjuvant system). METHODS A total of 1340 healthy subjects aged ≥18 years were randomized to receive 1 or 2 doses of an adjuvanted (3.75-μg HA/AS03(A) or 1.9-μg HA/AS03(B)) or nonadjuvanted vaccine formulation. Safety and immunogenicity (by hemagglutination-inhibition [HI] assay) after each dose and 6 months after dose 1 are reported here. RESULTS A single dose of AS03(A)-adjuvanted 3.75-μg HA H1N1 2009 induced the strongest immune responses in subjects aged 18-64 years (seroprotection rate [SPR], 97.2%; seroconversion rate [SCR], 90.1%) as well as in subjects aged >64 years (SPR, 91.1%; SCR, 78.2%) 21 days after vaccination. Six months after dose 1, subjects who received 2 doses of either the adjuvanted formulation or 1 dose of the adjuvanted 3.75-μg HA formulation continued to meet all Center for Biologics Evaluation and Research and Committee for Medicinal Products for Human Use criteria. All formulations had clinically acceptable safety profiles. CONCLUSION A single dose of the 3.75-μg HA AS03(A)-adjuvanted H1N1 2009 influenza vaccine was highly immunogenic in both age strata (18-64 and >64 years), inducing long-term persistence of the immune response until at least 6 months after dose 1.
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Beach DF, Somer RA, Hoffman-Censits J, Lin J, Wong YN, Plimack E, Plimeck E, Hudes G, Vaughn D, Bernstein GT, Morris GJ. A wealth of new options: a case presentation of the management of castration-recurrent prostate cancer. Semin Oncol 2012; 39:1-8. [PMID: 22289486 DOI: 10.1053/j.seminoncol.2011.11.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lasko B, Reich D, Madan A, Roman F, Li P, Vaughn D. Rapid immunization against H5N1: a randomized trial evaluating homologous and cross-reactive immune responses to AS03(A)-adjuvanted vaccination in adults. J Infect Dis 2011; 204:574-81. [PMID: 21791660 PMCID: PMC3144173 DOI: 10.1093/infdis/jir328] [Citation(s) in RCA: 20] [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] [Indexed: 11/30/2022] Open
Abstract
Background. Accelerated immunization schedules may help gain early control of influenza pandemics. We investigated different schedules of an AS03A-adjuvanted H5N1 vaccine. Methods. This phase II, open-label, 6-month study randomized participants (aged 18–64 years) to 2 vaccine doses administered 21 (standard schedule), 14, or 7 days apart, or on the same day. Coprimary end points were that the lower limit of the 98.75% confidence interval 14 days after the last dose must be (1) >40% for seroconversion rate (SCR) (Center for Biologics Evaluation and Research [CBER] criterion) and (2) >50% for seroprotection rate (SPR) (attainment rate for reciprocal hemagglutination inhibition titers ≥40, protocol-defined criterion) for the vaccine homologous strain (A/Indonesia/5/2005). European Committee for Human Medicinal Products (CHMP) immunogenicity criteria were also evaluated. Results. Coprimary end points were achieved (lower 98.75% confidence intervals exceeded defined values). Titers were highest with the standard schedule. Nevertheless, CBER SCR, protocol-defined SPR, and CHMP criteria were met with all schedules for the A/Indonesia/5/2005 strain. There were no significant differences between age groups (18–40 vs 41–64 years). Immune response was robust against drift variants A/turkey/Turkey/1/2005 and A/Vietnam/1194/2004. Conclusions. The AS03A-adjuvanted H5N1 vaccine in accelerated schedules offers a robust immune response against vaccine homologous and drift variant strains, allowing consideration of compressed vaccination intervals. Clinical Trials Registration. NCT00695669.
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Baumann B, Guzzo T, Vaughn D, Keefe S, Vapiwala N, Deville C, Bekelman J, Tucker K, Malkowicz B, Christodouleas J. Bladder Cancer Patterns of Pelvic Failure: Implications for Adjuvant Radiation Therapy. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.145] [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: 10/15/2022]
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Langley JM, Risi G, Caldwell M, Gilderman L, Berwald B, Fogarty C, Poling T, Riff D, Baron M, Frenette L, Sheldon E, Collins H, Shepard M, Dionne M, Brune D, Ferguson L, Vaughn D, Li P, Fries L. Dose-sparing H5N1 A/Indonesia/05/2005 pre-pandemic influenza vaccine in adults and elderly adults: a phase III, placebo-controlled, randomized study. J Infect Dis 2011; 203:1729-38. [PMID: 21606531 PMCID: PMC3100510 DOI: 10.1093/infdis/jir172] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [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 Highly pathogenic avian influenza H5N1 viruses remain a threat to human health, with potential to become pandemic agents. METHODS This phase III, placebo-controlled, observer-blinded study evaluated the immunogenicity, cross-reactivity, safety, and lot consistency of 2 doses of oil-in-water (AS03(A)) adjuvanted H5N1 A/Indonesia/05/2005 (3.75 μg hemagglutinin antigen) prepandemic candidate vaccine in 4561 adults aged 18-91 years. RESULTS Humoral antibody responses in the H5N1 vaccine groups fulfilled US and European immunogenicity licensure criteria for pandemic vaccines in all age strata 21 days after the second dose. At 6 months after the administration of the primary dose, serum antibody seroconversion rates continued to fulfill licensure criteria. Neutralizing cross-clade immune responses were demonstrated against clade 1 A/Vietnam/1194/2004. Consistency was demonstrated for 3 consecutive H5N1 vaccine lots. Temporary injection-site pain was more frequent with H5N1 vaccine than placebo (89.3% and 70.7% in the 18-64 and ≥65 years strata vs 22.2% and 14.4% in the placebo groups). Unsolicited adverse event frequency, including medically attended and serious events, was similar between groups through day 364. CONCLUSIONS In adults and elderly adults, AS03(A)-adjuvanted H5N1 candidate vaccine was highly immunogenic for A/Indonesia/05/2005, with cross-reactivity against A/Vietnam/1194/2004. Temporary injection site reactions were more frequent with H5N1 vaccine than placebo, although the H5N1 vaccine was well tolerated overall. Clinical Trials Registration. NCT00616928.
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Affiliation(s)
- Joanne M Langley
- Canadian Center for Vaccinology, Departments of Pediatrics and Community Health and Epidemiology, IWK Health Centre and Dalhousie University, Halifax, Canada.
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Kurian AA, Suryadevara S, Vaughn D, Zebley DM, Hofmann M, Kim S, Fassler SA. Laparoscopic colectomy in octogenarians and nonagenarians: a preferable option to open surgery? J Surg Educ 2010; 67:161-166. [PMID: 20630427 DOI: 10.1016/j.jsurg.2010.02.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 02/08/2010] [Accepted: 02/26/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To determine if laparoscopic colectomy is safer and more effective than open colectomy in patients older than 80 years of age. METHODS An operating room database of all colectomies performed on patients >or=80 years, from January 2002 to September 2007, was analyzed retrospectively. Data reviewed included type of operation, type of resection, length of procedure, length of stay (LOS), estimated blood loss, American Society of Anesthesiologists (ASA) grade, diagnosis, complications, mortality rates, and discharge destination, with p-values <0.05 considered significant. RESULTS One hundred thirty-nine patients underwent open procedures (Open group) during the study period versus 150 patients who underwent laparoscopic procedures (Lap group). Of the Lap group, 15 patients were converted to open cases. Forty-four patients from the Open group were excluded from the analysis as they were treated emergently, leaving 95 patients in the Open group. The mortality for open procedures was significantly higher at 9/95 (9.4%), compared with 3/150 (2%) following laparoscopic procedures (p = 0.0132). LOS was significantly longer for open procedures (11.16 days) versus laparoscopic procedures (7.11 days), p = 0.0001. Open procedures were associated with an increased risk of postoperative ileus (p < 0.02). The Open group had a higher likelihood of discharge to a nursing facility (43/87) than the Lap group (33/147), p < 0.0001. There were no significant differences in the length of procedure, estimated blood loss and postoperative complications. CONCLUSIONS Laparoscopic colectomy is a safer option that offers an improved outcome compared with open colectomy in elderly patients. Significant improvements in LOS, mortality rates, and discharge destination were observed.
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Affiliation(s)
- Ashwin A Kurian
- Department of Surgery and the Muller Center for Senior Health, Abington Memorial Hospital, Abington, Pennsylvania, USA
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Halbert CH, Coyne J, Weathers B, Mahler B, Delmoor E, Vaughn D, Malkowicz SB, Lee D, Troxel A. Racial differences in quality of life following prostate cancer diagnosis. Urology 2010; 76:559-64. [PMID: 20207396 DOI: 10.1016/j.urology.2009.09.090] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 09/06/2009] [Accepted: 09/12/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the effects of race on QOL while adjusting for subjective stress and religiosity among African American and white prostate cancer patients. Although racial differences in quality of life (QOL) have been examined between African American and white prostate cancer patients, it is not known whether differences exist while adjusting for psychological and cultural factors. We predicted that African American men would report poorer emotional and physical functioning after adjusting for these factors and that greater subjective stress and lower levels of religiosity would be associated with poorer well-being. METHODS We conducted an observational study of QOL among 194 African American and white men who were recruited from February 2003 through March 2008. RESULTS Race had a significant effect on emotional functioning after adjusting for perceptions of stress and religiosity. Compared with white men, African American men (P = .03) reported significantly greater emotional well-being. Greater subjective stress was associated significantly with poorer emotional functioning (P = .0001) and physical well-being (P = .0001). There were no racial differences in physical functioning (P = .76). CONCLUSIONS The results of this study highlight the importance of developing a better understanding of the context within which racial differences in QOL occur and translating this information into support programs for prostate cancer survivors.
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Affiliation(s)
- Chanita H Halbert
- Center for Community-Based Research and Health Disparities, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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DiPaola RS, Chen YH, Stein M, Vaughn D, Patrick-Miller L, Carducci M, Roth B, White E, Wilding G. A randomized phase II trial of mitoxantrone, estramustine and vinorelbine or bcl-2 modulation with 13-cis retinoic acid, interferon and paclitaxel in patients with metastatic castrate-resistant prostate cancer: ECOG 3899. J Transl Med 2010; 8:20. [PMID: 20178647 PMCID: PMC2837641 DOI: 10.1186/1479-5876-8-20] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [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: 11/01/2009] [Accepted: 02/24/2010] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To test the hypothesis that modulation of Bcl-2 with 13-cis retinoic acid (CRA)/interferon-alpha2b (IFN) with paclitaxel (TAX), or mitoxantrone, estramustine and vinorelbine (MEV) will have clinical activity in men with metastatic castrate-resistant prostate cancer (CRPC). METHODS 70 patients were treated with either MEV (Arm A) in a 3-week cycle or CRA/IFN/TAX with an 8-week cycle (Arm B). Patients were assessed for response, toxicity, quality of life (QOL), and the effect of treatment on Bcl-2 levels in peripheral blood mononuclear cells (PBMC). RESULTS The PSA response rates were 50% and 23%, measurable disease response rates (CR+PR) 14% and 15%, and median overall survival 19.4 months and 13.9 months on Arm A and Arm B respectively. Transient grade 4 neutropenia occurred in 18 and 2 patients, and grade 3 to 4 thrombosis in 7 patients and 1 patient in Arm A and Arm B respectively. Patients on Arm B reported a clinically significant decline in QOL between baseline and week 9/10 (.71 s.d.), and a significantly lower level of QOL than Arm A (p = 0.01). As hypothesized, Bcl-2 levels decreased with CRA/IFN therapy only in Arm B (p = 0.03). CONCLUSIONS Treatment with MEV was well tolerated and demonstrated clinical activity in patients with CRPC. Given the adverse effect of CRA/IFN/TAX on QOL, the study of other novel agents that target Bcl-2 family proteins is warranted. The feasibility of measuring Bcl-2 protein in a cooperative group setting is hypothesis generating and supports further study as a marker for Bcl-2 targeted therapy. TRIAL REGISTRATION CLINICAL TRIALS REGISTRATION NUMBER CDR0000067865.
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Affiliation(s)
- Robert S DiPaola
- Department of Medicine, The Cancer Institute of New Jersey, UMDNJ-RWJMS, New Brunswick NJ, USA.
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Onik G, Narayan P, Brunelle R, Vaughn D, Dineen M, Brown T. Saline Injection into Denonvillier's Fascia during Prostate Cryosurgery. MINIM INVASIV THER 2009. [DOI: 10.3109/13645700009093718] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Halbert CH, Weathers B, Delmoor E, Mahler B, Coyne J, Thompson HS, Have TT, Vaughn D, Malkowicz SB, Lee D. Racial differences in medical mistrust among men diagnosed with prostate cancer. Cancer 2009; 115:2553-61. [PMID: 19296516 DOI: 10.1002/cncr.24249] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [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
BACKGROUND Mistrust of healthcare providers and systems is a significant barrier to quality healthcare. However, limited empirical data are available on perceptions of medical mistrust among individuals who are diagnosed with cancer. The objective of this study was to identify sociodemographic, clinical, and cultural determinants of mistrust among men diagnosed with prostate cancer. METHODS The authors conducted an observational study among 196 African-American men (n = 71) and white men (n = 125) who were newly diagnosed with prostate cancer during 2003 through 2007. RESULTS Race, education, healthcare experiences, and cultural factors had significant effects on mistrust. African-American men (P = .01) and men who had fewer years of formal education (P = .001) reported significantly greater levels of mistrust compared with white men and men who had more education. Mistrust also was greater among men who had been seeing their healthcare provider for a longer period (P = .01) and among men with lower perceptions of interdependence (P = .01). CONCLUSIONS The current findings suggested that efforts to enhance trust among men who are diagnosed with prostate cancer should target African-American men, men with fewer socioeconomic resources, and men with lower perceptions of interdependence. Reasons for deterioration in trust associated with greater experience with specialty providers should be explored along with the effects of interventions that are designed to address the concerns of individuals who have greater mistrust.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Vaughn D, Muchmore D, Gee L, Ludington E. Dose response of recombinant human hyaluronidase effects on pharmacokinetics of regular human insulin and insulin lispro following sc injection. Can J Diabetes 2009. [DOI: 10.1016/s1499-2671(09)33198-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Canter D, Guzzo T, Resnick M, Magerfleisch L, Sonnad S, Bergey M, Tomazewski J, Vaughn D, Van Arsdalen K, Malkowicz B. The presence of lymphovascular invasion in radical cystectomy specimens from patients with urothelial carcinoma portends a poor clinical prognosis. BJU Int 2008; 102:952-7. [DOI: 10.1111/j.1464-410x.2008.07732.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [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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Sternberg CN, Petrylak D, Witjes F, Ferrero J, Eymard J, Falcon S, Chatta K, Vaughn D, Berry W, Sartor O. Satraplatin (S) demonstrates significant clinical benefits for the treatment of patients with HRPC: Results of a randomized phase III trial. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5019] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5019 Background: Chemotherapeutic options for HRPC are limited. S is a novel oral platinum compound. Methods: The SPARC trial is a multinational randomized double blind study comparing S 80 mg/m2/day x 5 q5weeks po + prednisone (P) vs placebo + P in HRPC patients (pts) who failed prior chemotherapy. In this analysis, progression-free survival (PFS) was the primary endpoint, defined as a composite endpoint of radiologic progression, symptomatic progression, skeletal events or death. All cases were blindly adjudicated for progression by an independent review committee (IRC). Results: 950 pts were accrued between Sept 2004 and Jan 2006. Baseline characteristics were well balanced between treatment arms. 51% of the pts had received prior docetaxel. 68% were ≥ 65 yrs old and 27% were ≥ 75 yrs old. Pts received a median of 4 courses in the S arm (range:1–28) vs 2 courses in the placebo arm (range 1–16). 802 pts had an IRC defined progression-free (PFS) event consisting in 80% of the cases of radiologic progression, pain progression or death. All analyses were conducted on an intent-to-treat basis. S was associated with a 31% reduction in the risk of PFS events (HR=0.69; 95% CI: 0.60–0.80; p<0.00001) and a 33% reduction in the risk of pain progression (HR=0.67; 95% CI: 0.54 - 0.83; p=0.00028). Consistent results in favor of S were found for PFS and time to pain progression in all subsets examined, including pts treated with prior docetaxel. Superior PSA response (25% vs.12%, p=0.00007), objective tumor response (7% vs. 1%, p<0.002), pain response (24% vs. 14%, p<0.005), and duration of pain response (HR=0.59; 95%CI: 0.35–1.00; p=0.049) were observed for S. Final analysis of overall survival awaits the occurrence of the pre-specified number of events. S was generally well tolerated - myelosuppression was the most frequent side effect, but grade 4 neutropenia was uncommon (4%) and a single patient had grade 4 thrombocytopenia. Grade 3/4 non-hematologic side effects included infection (4%), vomiting (2%) and diarrhea (2%). Conclusions: S is well tolerated and significantly reduces the risk of disease progression for HRPC pts who have failed prior chemotherapy. Supported by GPC Biotech and Pharmion No significant financial relationships to disclose.
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Affiliation(s)
- C. N. Sternberg
- San Camillo Forlanini Hosp, Rome, Italy; Columbia Presbyterian Medical Center, New York, NY; Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Centre Antoine Lacassagne, Nice, France; Institut Jean Godinot, Reims, France; E. Rebagliati, Lima, Peru; University of Pittsburgh, Pittsburgh, PA; University of Pennsylvania, Philadelphia, PA; Raleigh Hematology Oncology Clinic, Cary, NC; Dana-Farber Cancer Institute, Boston, MA
| | - D. Petrylak
- San Camillo Forlanini Hosp, Rome, Italy; Columbia Presbyterian Medical Center, New York, NY; Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Centre Antoine Lacassagne, Nice, France; Institut Jean Godinot, Reims, France; E. Rebagliati, Lima, Peru; University of Pittsburgh, Pittsburgh, PA; University of Pennsylvania, Philadelphia, PA; Raleigh Hematology Oncology Clinic, Cary, NC; Dana-Farber Cancer Institute, Boston, MA
| | - F. Witjes
- San Camillo Forlanini Hosp, Rome, Italy; Columbia Presbyterian Medical Center, New York, NY; Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Centre Antoine Lacassagne, Nice, France; Institut Jean Godinot, Reims, France; E. Rebagliati, Lima, Peru; University of Pittsburgh, Pittsburgh, PA; University of Pennsylvania, Philadelphia, PA; Raleigh Hematology Oncology Clinic, Cary, NC; Dana-Farber Cancer Institute, Boston, MA
| | - J. Ferrero
- San Camillo Forlanini Hosp, Rome, Italy; Columbia Presbyterian Medical Center, New York, NY; Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Centre Antoine Lacassagne, Nice, France; Institut Jean Godinot, Reims, France; E. Rebagliati, Lima, Peru; University of Pittsburgh, Pittsburgh, PA; University of Pennsylvania, Philadelphia, PA; Raleigh Hematology Oncology Clinic, Cary, NC; Dana-Farber Cancer Institute, Boston, MA
| | - J. Eymard
- San Camillo Forlanini Hosp, Rome, Italy; Columbia Presbyterian Medical Center, New York, NY; Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Centre Antoine Lacassagne, Nice, France; Institut Jean Godinot, Reims, France; E. Rebagliati, Lima, Peru; University of Pittsburgh, Pittsburgh, PA; University of Pennsylvania, Philadelphia, PA; Raleigh Hematology Oncology Clinic, Cary, NC; Dana-Farber Cancer Institute, Boston, MA
| | - S. Falcon
- San Camillo Forlanini Hosp, Rome, Italy; Columbia Presbyterian Medical Center, New York, NY; Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Centre Antoine Lacassagne, Nice, France; Institut Jean Godinot, Reims, France; E. Rebagliati, Lima, Peru; University of Pittsburgh, Pittsburgh, PA; University of Pennsylvania, Philadelphia, PA; Raleigh Hematology Oncology Clinic, Cary, NC; Dana-Farber Cancer Institute, Boston, MA
| | - K. Chatta
- San Camillo Forlanini Hosp, Rome, Italy; Columbia Presbyterian Medical Center, New York, NY; Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Centre Antoine Lacassagne, Nice, France; Institut Jean Godinot, Reims, France; E. Rebagliati, Lima, Peru; University of Pittsburgh, Pittsburgh, PA; University of Pennsylvania, Philadelphia, PA; Raleigh Hematology Oncology Clinic, Cary, NC; Dana-Farber Cancer Institute, Boston, MA
| | - D. Vaughn
- San Camillo Forlanini Hosp, Rome, Italy; Columbia Presbyterian Medical Center, New York, NY; Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Centre Antoine Lacassagne, Nice, France; Institut Jean Godinot, Reims, France; E. Rebagliati, Lima, Peru; University of Pittsburgh, Pittsburgh, PA; University of Pennsylvania, Philadelphia, PA; Raleigh Hematology Oncology Clinic, Cary, NC; Dana-Farber Cancer Institute, Boston, MA
| | - W. Berry
- San Camillo Forlanini Hosp, Rome, Italy; Columbia Presbyterian Medical Center, New York, NY; Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Centre Antoine Lacassagne, Nice, France; Institut Jean Godinot, Reims, France; E. Rebagliati, Lima, Peru; University of Pittsburgh, Pittsburgh, PA; University of Pennsylvania, Philadelphia, PA; Raleigh Hematology Oncology Clinic, Cary, NC; Dana-Farber Cancer Institute, Boston, MA
| | - O. Sartor
- San Camillo Forlanini Hosp, Rome, Italy; Columbia Presbyterian Medical Center, New York, NY; Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Centre Antoine Lacassagne, Nice, France; Institut Jean Godinot, Reims, France; E. Rebagliati, Lima, Peru; University of Pittsburgh, Pittsburgh, PA; University of Pennsylvania, Philadelphia, PA; Raleigh Hematology Oncology Clinic, Cary, NC; Dana-Farber Cancer Institute, Boston, MA
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Sartor O, Sternberg C, Witjes JA, Chatta G, Vaughn D, Berry W, Lara P, Nathan FE, McKearn T, Petrylak DP. 1014: Satraplatin Significantly Improves Progression Free Survival (PFS) and Pain Control in Patients with Advanced Hormone-Refractory Prostate Cancer (HRPC): Preliminary Results from the Phase III Sparc Trial. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31242-4] [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: 11/28/2022]
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Kalayanarooj S, Gibbons RV, Vaughn D, Green S, Nisalak A, Jarman RG, Mammen MP, Perng GC. Blood group AB is associated with increased risk for severe dengue disease in secondary infections. J Infect Dis 2007; 195:1014-7. [PMID: 17330792 DOI: 10.1086/512244] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [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: 09/28/2006] [Accepted: 11/13/2006] [Indexed: 11/03/2022] Open
Abstract
Why certain individuals progress to severe dengue disease is unknown. In this study, blood groups associated with dengue disease were investigated. ABO phenotypes were identified by use of serum from 399 patients with dengue-virus infection who participated in a cohort study. ABO blood-group frequencies were similar in primary versus secondary dengue-virus infections. However, in secondary infection, individuals with blood group AB were likely to have dengue hemorrhagic fever grade 3 than either grades 1 and 2 combined (corrected P value, <.0001; odds ratio, 0.097 [95% confidence interval, 0.03-0.33]) or dengue fever (corrected P value, <.0001; odds ratio, 0.119 [95% confidence interval, 0.04-0.37]). To our knowledge, this is the first report demonstrating an association between ABO blood group and the severity of dengue disease.
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Affiliation(s)
- Siripen Kalayanarooj
- Queen Sirikit National Institute of Child Health, US Army Medical Corps-Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
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Sun W, Sonnad SS, Furth EE, Timmons K, Caparro M, Giantonio BJ, Vaughn D, Haller DG, Shaked A, Olthoff KM. Adjuvant chemotherapy in patients with hepatocellular carcinoma After orthotopic liver transplantation. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- W. Sun
- Univ of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | - D. Vaughn
- Univ of Pennsylvania, Philadelphia, PA
| | | | - A. Shaked
- Univ of Pennsylvania, Philadelphia, PA
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Bilenker JH, Flaherty KT, Rosen M, Davis L, Gallagher M, Stevenson JP, Sun W, Vaughn D, Giantonio B, Zimmer R, Schnall M, O'Dwyer PJ. Phase I Trial of Combretastatin A-4 Phosphate with Carboplatin. Clin Cancer Res 2005; 11:1527-33. [PMID: 15746056 DOI: 10.1158/1078-0432.ccr-04-1434] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Preclinical evidence of synergy led to a phase I trial employing combretastatin A-4 phosphate (CA4P), a novel tubulin-binding antivascular drug, in combination with carboplatin. EXPERIMENTAL DESIGN Based on preclinical scheduling studies, patients were treated on day 1 of a 21-day cycle. Carboplatin was given as a 30-minute i.v. infusion and CA4P was given 60 minutes later as a 10-minute infusion. RESULTS Sixteen patients with solid tumors received 40 cycles of therapy at CA4P doses of 27 and 36 mg/m(2) together with carboplatin at area under the concentration-time curve (AUC) values of 4 and 5 mg min/mL. The dose-limiting toxicity of thrombocytopenia halted the dose escalation phase of the study. Four patients were treated at an amended dose level of CA4P of 36 mg/m(2) and carboplatin AUC of 4 mg min/mL although grade 3 neutropenia and thrombocytopenia were still observed. Three lines of evidence are adduced to suggest that a pharmacokinetic interaction between the drugs results in greater thrombocytopenia than anticipated: the carboplatin exposure (as AUC) was greater than predicted; the platelet nadirs were lower than predicted; and the deviation of the carboplatin exposure from predicted was proportional to the AUC of CA4, the active metabolite of CA4P. Patient benefit included six patients with stable disease lasting at least four cycles. CONCLUSION This study of CA4P and carboplatin given in combination showed dose-limiting thrombocytopenia. Pharmacokinetic/pharmacodynamic modeling permitted the inference that altered carboplatin pharmacokinetics caused the increment in platelet toxicity.
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Affiliation(s)
- Joshua H Bilenker
- University of Pennsylvania Cancer Center, University of the Sciences in Philadelphia, Philadelphia, PA 19104, USA.
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Latif T, Wood L, Connell C, Smith DC, Vaughn D, Lebwohl D, Peereboom D. Phase II study of oral bis (aceto) ammine dichloro (cyclohexamine) platinum (IV) (JM-216, BMS-182751) given daily x 5 in hormone refractory prostate cancer (HRPC). Invest New Drugs 2005; 23:79-84. [PMID: 15528984 DOI: 10.1023/b:drug.0000047109.76766.84] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
JM-216 is an orally bioavailable platinum compound with activity against many tumor models. The objective of this study was to determine the safety profile and anti-tumor activity of JM-216 in patients with hormone refractory prostate cancer (HRPC) when given orally daily x 5 days. In this open label phase II study JM-216 was administered orally at the dose of 120 mg/m2/d for 5 days every 4 weeks. Patients continued on the therapy until evidence of disease progression or intolerable toxicity developed. Dose escalation and de-escalation were allowed according to patient's tolerance. Thirty-nine patients were enrolled onto the study and received a total of 155 courses (median 2, range 1-16) of JM-216. Dose delays (77% of courses) and dose reductions (31% of courses) were common and were mainly due to myelosupression. Treatment was discontinued in 5 patients due to treatment related toxicities. One patient developed myelodysplastic syndrome 11 months after the start of treatment. The most frequent grade III or higher adverse events included thrombocytopenia (54%), neutropenia (52%), anemia (24%) nausea (13%), vomiting (16%) and diarrhea (28%). PSA response was assessed in 32 patients, 10 (26%) had partial response, 14 (36%) had stable disease while PSA progression was seen in 8 (21%) patients. Of 20 (54%) patients with measurable disease two patients had a documented partial response. Although JM-216 had moderate activity in HRPC when given on daily basis for 5 days, it is associated with significant treatment related toxicities in this patient population.
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Affiliation(s)
- Tahir Latif
- Department of Hematology and Medical Oncology, Taussig Cancer Center, The Cleveland Clinic Foundation, Cleveland OH 44195, USA
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Bilenker JH, Stevenson JP, Gallagher ML, Vaughn D, Cohen MB, O'Dwyer PJ. Phase I trial of the novel taxane BMS-184476 administered in combination with carboplatin every 21 days. Br J Cancer 2004; 91:213-8. [PMID: 15213727 PMCID: PMC2409820 DOI: 10.1038/sj.bjc.6601885] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 11/08/2022] Open
Abstract
The aim of the study was to determine the maximum-tolerated dose and dose-limiting toxicities for BMS-184476, in combination with carboplatin, in patients with advanced solid tumours and to describe any preliminary antitumour activity associated with this regimen. Patients received combination therapy with BMS-184476 given intravenously over 1 h followed by carboplatin administered over 30 min on day 1 of a 21-day cycle. In all, 28 patients received 146 cycles of BMS-184476 and carboplatin. Patients were enrolled at four dose levels: BMS-184476 (mg m(-2))/carboplatin (mg min ml(-1)): 40/5, 50/5, 50/6 and 60/6. Dose-limiting toxicity at 60/6 was neutropenia. Among 27 evaluable patients, 11 demonstrated stable disease for a median of 8.5 cycles. In 22 patients, the pharmacokinetics of BMS-184476 appeared independent of dose of BMS-184476. The mean+/-s.e.m. values for clearance (Cl), volume of distribution at steady state and apparent terminal half-life of BMS-184476 in the four dose groups during cycle 1 were 192+/-25 ml min m(-2), 377+/-69 l m(-2) and 33.7+/-5.9 h, respectively. An increase in the dose of carboplatin from 5 to 6 mg min ml(-1) may have decreased Cl of BMS-184476. BMS-184476 in combination with carboplatin was well tolerated at a dose of 50/6 and shows evidence of antitumour activity in a pretreated population.
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Affiliation(s)
- J H Bilenker
- Abramson Family Cancer Center, University of Pennsylvania Cancer Center, 51 N. 39th St., MAB, Philadelphia, PA 19104, USA
| | - J P Stevenson
- Abramson Family Cancer Center, University of Pennsylvania Cancer Center, 51 N. 39th St., MAB, Philadelphia, PA 19104, USA
| | - M L Gallagher
- Abramson Family Cancer Center, University of Pennsylvania Cancer Center, 51 N. 39th St., MAB, Philadelphia, PA 19104, USA
| | - D Vaughn
- Abramson Family Cancer Center, University of Pennsylvania Cancer Center, 51 N. 39th St., MAB, Philadelphia, PA 19104, USA
| | - M B Cohen
- Bristol-Myers Squibb Pharmaceutical Research Institute, Princeton, NJ 08543, USA
| | - P J O'Dwyer
- Abramson Family Cancer Center, University of Pennsylvania Cancer Center, 51 N. 39th St., MAB, Philadelphia, PA 19104, USA
- Abramson Family Cancer Center, University of Pennsylvania Cancer Center, 51 N. 39th St., MAB, Philadelphia, PA 19104, USA. E-mail:
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