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Lemke E, van Herk WG, Singleton K, Gries G. Seasonal and Diel Communication Periods of Sympatric Pest Limonius Click Beetle Species (Coleoptera: Elateridae) in Western Canada. Environ Entomol 2022; 51:980-988. [PMID: 36124752 DOI: 10.1093/ee/nvac067] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Indexed: 06/15/2023]
Abstract
In western North America, sympatric Limonius click beetle species produce limoniic acid [(E)-4-ethyloct-4-enoic acid] as a sex pheromone component (L. canus (LeConte), L. californicus (Mannerheim)) or respond to it as a sex attractant (L. infuscatus (Motschulsky)). We tested the hypothesis that these three congeners maintain species-specificity of sexual communication through nonoverlapping seasonal occurrence and/or contrasting diel periodicity of sexual communication. Using capture times of beetles in pheromone-baited traps as a proxy for sexual communication periods, our data show that L. canus and L. californicus have seasonally distinct communication periods. Most L. canus males (>90%) were captured in April and most L. californicus males (>95%) were captured in May/June/July. As almost exclusively L. infuscatus males were captured in two separate 24-hr trapping studies, with data recordings every hour, it remains inconclusive whether the three Limonius congeners communicate at different times of the day. Males of L. infuscatus responded to pheromone lures only during daytime hours and during the warmest period each day. Captures of L. infuscatus overlapping with those of L. canus in April and those of L. californicus in May/June imply the presence of reproductive isolating mechanisms other than seasonal separation of sexual communication periods.
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Affiliation(s)
- Emily Lemke
- Agassiz Research and Development Centre, Agriculture and Agri-Food Canada, 6947 Highway 7, Agassiz, British Columbia, V0M 1A0, Canada
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Willem G van Herk
- Agassiz Research and Development Centre, Agriculture and Agri-Food Canada, 6947 Highway 7, Agassiz, British Columbia, V0M 1A0, Canada
| | - Kendal Singleton
- Agassiz Research and Development Centre, Agriculture and Agri-Food Canada, 6947 Highway 7, Agassiz, British Columbia, V0M 1A0, Canada
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Gerhard Gries
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
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Campbell MT, Lazure P, Augustyniak M, Jaimes EA, Bilen MA, Lemke E, Jacobs G, McFadden P. Mixed methods assessment of providers’ needs in the management of advanced renal cell carcinoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
313 Background: There is a paucity of data regarding the challenges associated with the timely and accurate diagnosis of Renal Cell Carcinoma (RCC) and its effective multidisciplinary management. This study aimed to assess the knowledge and skills of healthcare providers (HCPs) managing and coordinating the care of patients with advanced RCC (aRCC) across multidisciplinary teams. Methods: A sequential mixed methods needs assessment was conducted across the United States with medical oncologists (ONCs), nephrologists (NEPHs), physician assistants (PAs), nurse practitioners (NPs), and registered nurses (RNs). Interviews, transcribed and thematically analyzed, and online surveys, statistically analyzed, were triangulated. Results: A total of 305 HCPs completed an interview (n=40) or the survey (n=265): 78 ONCs, 62 NEPHs, 57 PAs, 55 NPs, 53 RNs. One third (33%) of HCPs reported suboptimal skills in adjusting the dose of a treatment for aRCC in the event of adverse reactions. Interviews underscored a lack of clarity for HCPs on when to reduce the dose or when to discontinue and/or switch to other drugs. Suboptimal knowledge and skills related to toxicities were found (Table). Breakdowns in communication across multidisciplinary teams were identified by 46% of HCPs. Of those, 61% occurred when monitoring side effects and 48% when referring to ONCs. Some NEPHs reported never, rarely, or sometimes being involved with ONCs in the management of nephritis (25%), chronic kidney disease (19%), or acute renal failure (24%). Interviews suggested the role of NEPHs in the care of aRCC is poorly recognized and that NEPHs are perceived to have limited time to spend in the care of cancer patients. Few NEPHs reported gaps in knowledge/skills managing key renal complications such as nephritis (13%/15%), chronic kidney disease (6%/15%), and acute renal failure (9%/9%). Conclusions: This study identified a need to improve HCPs’ knowledge of the signs/symptoms of treatment side effects, skills in identifying/referring patients to appropriate specialists, and skills in managing adverse events. Barriers to involving NEPHs in the co-management of aRCC included a lack of recognition of their role in managing treatment-induced renal complications.These results should inform educational interventions for professionals caring for aRCC patients.[Table: see text]
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Affiliation(s)
| | | | | | | | - Mehmet Asim Bilen
- Emory University School of Medicine, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Emily Lemke
- Medical College of Wisconsin Cancer Center, Milwaukee, WI
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Koshkin VS, Henderson N, James M, Natesan D, Freeman D, Nizam A, Su CT, Khaki AR, Osterman CK, Glover MJ, Chiang R, Makrakis D, Talukder R, Lemke E, Olsen TA, Jain J, Jang A, Ali A, Jindal T, Chou J, Friedlander TW, Hoimes C, Basu A, Zakharia Y, Barata PC, Bilen MA, Emamekhoo H, Davis NB, Shah SA, Milowsky MI, Gupta S, Campbell MT, Grivas P, Sonpavde GP, Kilari D, Alva AS. Efficacy of enfortumab vedotin in advanced urothelial cancer: Analysis from the Urothelial Cancer Network to Investigate Therapeutic Experiences (UNITE) study. Cancer 2021; 128:1194-1205. [PMID: 34882781 DOI: 10.1002/cncr.34057] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 10/27/2021] [Accepted: 11/10/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Enfortumab vedotin (EV) is a novel antibody-drug conjugate approved for advanced urothelial cancer (aUC) refractory to prior therapy. In the Urothelial Cancer Network to Investigate Therapeutic Experiences (UNITE) study, the authors looked at the experience with EV in patient subsets of interest for which activity had not been well defined in clinical trials. METHODS UNITE was a retrospective study of patients with aUC treated with recently approved agents. This initial analysis focused on patients treated with EV. Patient data were abstracted from chart reviews by investigators at each site. The observed response rate (ORR) was investigator-assessed for patients with at least 1 post-baseline scan or clear evidence of clinical progression. ORRs were compared across subsets of interest for patients treated with EV monotherapy. RESULTS The initial UNITE analysis included 304 patients from 16 institutions; 260 of these patients were treated with EV monotherapy and included in the analyses. In the monotherapy cohort, the ORR was 52%, and it was >40% in all reported subsets of interest, including patients with comorbidities previously excluded from clinical trials (baseline renal impairment, diabetes, and neuropathy) and patients with fibroblast growth factor receptor 3 (FGFR3) alterations. Progression-free survival and overall survival were 6.8 and 14.4 months, respectively. Patients with a pure urothelial histology had a higher ORR than patients with a variant histology component (58% vs 42%; P = .06). CONCLUSIONS In a large retrospective cohort, responses to EV monotherapy were consistent with data previously reported in clinical trials and were also observed in various patient subsets, including patients with variant histology, patients with FGFR3 alterations, and patients previously excluded from clinical trials with an estimated glomerular filtration rate < 30 mL/min and significant comorbidities. LAY SUMMARY Enfortumab vedotin, approved by the Food and Drug Administration in 2019, is an important new drug for the treatment of patients with advanced bladder cancer. This study looks at the effectiveness of enfortumab vedotin as it has been used at multiple centers since approval, and focuses on important patient populations previously excluded from clinical trials. These populations include patients with decreased kidney function, diabetes, and important mutations. Enfortumab vedotin is effective for treating these patients. Previously reported clinical trial data have been replicated in this real-world setting, and support the use of this drug in broader patient populations.
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Affiliation(s)
- Vadim S Koshkin
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, California
| | - Nicholas Henderson
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Marihella James
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Divya Natesan
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, California
| | - Dory Freeman
- Dana-Farber Cancer Center, Boston, Massachusetts
| | - Amanda Nizam
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christopher T Su
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Ali Raza Khaki
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington.,Stanford University, Stanford, California
| | - Chelsea K Osterman
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | | | | | - Dimitrios Makrakis
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Rafee Talukder
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Emily Lemke
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | - T Anders Olsen
- Winship Cancer Institute of Emory University, Atlanta, Georgia
| | | | - Albert Jang
- Tulane University Medical School, New Orleans, Louisiana
| | - Alicia Ali
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Tanya Jindal
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, California
| | - Jonathan Chou
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, California
| | - Terence W Friedlander
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, California
| | | | - Arnab Basu
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Pedro C Barata
- Tulane University Medical School, New Orleans, Louisiana
| | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Atlanta, Georgia
| | | | - Nancy B Davis
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | | | - Matthew I Milowsky
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Shilpa Gupta
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Petros Grivas
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | | | | | - Ajjai S Alva
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
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van Herk WG, Lemke E, Gries G, Gries R, Serrano JM, Catton H, Wanner K, Landolt PJ, Cooper WR, Meers S, Nikoukar A, Smith JL, Alamsetti SK, Etzler FE. Limoniic Acid and Its Analog as Trap Lures for Pest Limonius Species (Coleoptera: Elateridae) in North America. J Econ Entomol 2021; 114:2108-2120. [PMID: 34374412 DOI: 10.1093/jee/toab154] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Indexed: 06/13/2023]
Abstract
Four species of Limonius wireworms (Coleoptera: Elateridae), L. californicus, L. canus, L. infuscatus and L. agonus, are serious crop pests in North America. Limoniic acid, (E)-4-ethyloct-4-enoic acid, has been reported as a sex pheromone component of female L. californicus and L. canus, and a sex attractant for male L. infuscatus. In the same study, both limoniic acid and the analog (E)-5-ethyloct-4-enoic acid were highly attractive in field experiments. Moreover, six carboxylic acids in headspace volatiles of Limonius females elicited responses from male antennae but were not tested for behavioral activity. Here, we report trap catch data of Limonius spp. obtained in field experiments at 27 sites across North America. All four Limonius species were attracted to limoniic acid and to the analog but not to the carboxylic acids. Adding these carboxylic acids to limoniic acid, or to the analog, reduced its attractiveness. In dose-response studies, trap lures containing 0.4 mg or 4 mg of limoniic acid afforded large captures of L. californicus and L. infuscatus. Neither limoniic acid nor the analog were deterrent to other elaterid pest species. The broad attractiveness of limoniic acid to Limonius spp., and its non-deterrent effect on heterogeners, may facilitate the development of generic pheromone-based monitoring and management tools for multiple click beetle species.
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Affiliation(s)
- Willem G van Herk
- Agassiz Research and Development Centre, Agriculture and Agri-Food Canada, Agassiz, BC, Canada
| | - Emily Lemke
- Agassiz Research and Development Centre, Agriculture and Agri-Food Canada, Agassiz, BC, Canada
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - Gerhard Gries
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - Regine Gries
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | | | - Haley Catton
- Lethbridge Research and Development Centre, Agriculture and Agri-Food Canada, Lethbridge, AB, Canada
| | | | - Peter J Landolt
- Temperate Tree Fruit and Vegetable Research Unit, USDA-ARS, Wapato, WA, USA
| | - W Rodney Cooper
- Temperate Tree Fruit and Vegetable Research Unit, USDA-ARS, Wapato, WA, USA
| | - Scott Meers
- Crop Diversification Centre, Alberta Ministry of Agriculture and Forestry, Brooks, AB, Canada
- Mayland Consulting, Calgary, AB, Canada
| | | | - Jocelyn L Smith
- University of Guelph, Ridgetown Campus, Ridgetown, ON, Canada
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Kilari D, Szabo A, Bylow KA, Alter RS, Nelson AA, Lemke E, Hall WA, Johnson S, Langenstroer P, Jacobsohn K, Davis NB, Fung C, Milowsky MI. A phase 2 study of cabozantinib in combination with atezolizumab as neoadjuvant treatment for muscle-invasive bladder cancer (HCRN GU18-343) ABATE study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps4591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS4591 Background: ABACUS and PURE-01 trials demonstrated the activity of single agent atezolizumab and pembrolizumab respectively as neoadjuvant therapy for muscle invasive urothelial carcinoma (MIUC). However, downstaging to non-muscle invasive disease was noted in only 50 percent of patients. Resistance to programmed death (PD)- 1/L-1 antibodies is likely to include factors such as impaired dendritic cell maturation/function, infiltration of T-Regs and myeloid derived suppressor cells, impaired T-cell priming and T-cell trafficking in tumors. Cabozantinib is a tyrosine kinase inhibitor which targets MET, AXL, MER, Tyro3 and VEGFR2. Cabozantinib has a unique immunomodulatory profile and has demonstrated clinical activity as monotherapy and in combination with PD-1/L1 antibodies in various solid tumors including UC, renal cell cancer, castrate- resistant prostate cancer, and non-small cell lung cancer. We hypothesize that the combination of cabozantinib and atezolizumab as neoadjuvant therapy for MIUC would improve rates of pathologic downstaging compared to single-agent checkpoint inhibitors. Methods: ABATE(NCT04289779) is an open-label, single arm, multi-center study to assess the efficacy and safety of cabozantinib with atezolizumab as neoadjuvant therapy for cT2-T4aN0/xM0 MIUC. An estimated 38 patients will be enrolled and receive cabozantinib 40 mg PO daily with atezolizumab 1200mg every 3 weeks for a total duration of 9 weeks followed by radical cystectomy. Adults (≥18 years) with resectable UC who are either cisplatin-ineligible or decline cisplatin are eligible. Patients are required to have an ECOG PS of 0-2 and provide tumor tissue for PD-L1 analysis. UC should be predominant component (≥ 50%). Previous systemic anticancer therapies for MIUC are not permitted. CT/MRI will be performed before investigational therapy and cystectomy. Primary endpoint is pathologic response rate defined as the absence of residual muscle-invasive cancer in the surgical specimen ( < pT2). Secondary endpoints are safety and toxicity, pathologic complete response rate and event-free survival. Exploratory end points include patient-reported outcomes and outcome associations with biomarkers. Accrual began May 2020. Clinical trial information: NCT04289779.
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Affiliation(s)
| | | | | | - Robert S. Alter
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | | | | | | | | | | | | | | | - Chunkit Fung
- J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Matthew I. Milowsky
- University of North Carolina Department of Medicine, Division of Hematology/Oncology, Chapel Hill, NC
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Gries R, Alamsetti SK, van Herk WG, Catton HA, Meers S, Lemke E, Gries G. Limoniic Acid - Major Component of the Sex Pheromones of the Click Beetles Limonius canus and L. californicus. J Chem Ecol 2021; 47:123-133. [PMID: 33606109 DOI: 10.1007/s10886-020-01241-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/28/2020] [Accepted: 12/29/2020] [Indexed: 11/28/2022]
Abstract
Wireworms, the larvae of click beetles (Coleoptera: Elateridae), are soil-dwelling insect pests inflicting major economic damage on many types of agricultural crops worldwide. The objective of this work was to identify the female-produced sex pheromones of the Pacific Coast wireworm, Limonius canus LeConte, and the sugarbeet wireworm, L. californicus (Mannerheim) (Coleoptera: Elateridae). Headspace volatiles from separate groups of female L. canus and L. californicus were collected on Porapak Q and analyzed by gas chromatography with electroantennographic detection (GC-EAD) and GC-mass spectrometry. GC-EAD recordings revealed strong responses from male L. canus and male L. californicus antennae to the same compound, which appeared below GC detection threshold. The structure of this candidate pheromone component was deduced from the results of micro-analytical treatments of extracts, retention index calculations on four GC columns, and by syntheses of more than 25 model compounds which were assessed for their GC retention characteristics and electrophysiological activity. The EAD-active compound was identified as (E)-4-ethyloct-4-enoic acid, which we name limoniic acid. In field experiments in British Columbia and Alberta, Canada, traps baited with synthetic limoniic acid captured large numbers of male Limonius click beetles, whereas unbaited control traps captured few. Compared to traps baited with the analogue, (E)-5-ethyloct-4-enoic acid, traps baited with limoniic acid captured 9-times more male L. californicus, and 6.5-times more male western field wireworms, L. infuscatus Motschulsky, but 2.3-times fewer male L. canus. Limoniic acid can now be developed for detection, monitoring and possibly control of L. californicus, L. infuscatus and L. canus populations.
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Affiliation(s)
- Regine Gries
- Department of Biological Sciences, Simon Fraser University, Burnaby, British Columbia, V5A 1S6, Canada
| | - Santosh K Alamsetti
- Department of Biological Sciences, Simon Fraser University, Burnaby, British Columbia, V5A 1S6, Canada
| | - Willem G van Herk
- Agassiz Research and Development Centre, Agriculture and Agri-Food Canada, Agassiz, British Columbia, V0M 1A0, Canada
| | - Haley A Catton
- Lethbridge Research and Development Centre, Agriculture and Agri-Food Canada, Lethbridge, Alberta, T1J 4B1, Canada
| | - Scott Meers
- Mayland Consulting, Calgary, Alberta, T2E 4V5, Canada
| | - Emily Lemke
- Department of Biological Sciences, Simon Fraser University, Burnaby, British Columbia, V5A 1S6, Canada
| | - Gerhard Gries
- Department of Biological Sciences, Simon Fraser University, Burnaby, British Columbia, V5A 1S6, Canada.
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Nelson AA, Cronk R, Szabo A, Lemke E, Giever TA, Burfeind JD, Kilari D, Riese MJ, Bylow KA, Diamantopoulos LN, Khaki AR, Nezami B, MacLennan G, Draves MA, Goolamier G, Rosey S, Calaway A, Grivas P, Ponsky LE, Hoimes CJ. Emerging clinical phenotype of bone metastatic urothelial cancer (mUC): Association of early osseous metastases (EOM) and outcomes. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e17007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17007 Background: Outcomes of patients (pts) with mUC with EOM have not thoroughly been described in the age of immuno-oncology. We hypothesized that EOM is associated with worse outcomes when compared to pts with non-osseous metastases (NOM). Methods: We used a multi-institutional database of pts with mUC who received systemic treatment (trt) between March 2005 and August 2019, to assess survival and palliative outcomes of pts with EOM vs NOM at the time of metastatic diagnosis (met dx). Wilcoxon rank-sum and chi-square tests were performed. Survival was estimated by Kaplan-Meier method, Cox regression analysis was performed. Results: We identified 270 pts, 72% men, mean age 67 ± 11 years, 28% never smokers. At met dx, 27% (n = 72) had ≥ 1 EOM; these pts were more likely to have de novo metastases vs. those with recurrent metastases (42% vs 19%, p < 0.001). Pts with EOM were more likely to have a change or stop in 1st line trt due to clinical progression (30.6% vs 15.7%, p = 0.006), and received fewer total lines of systemic trt, median of 1.0 (1.0-5.0) vs. 2.0 (1.0-8.0), p = 0.05. Pts with EOM had shorter median overall survival (OS) vs. those with NOM, (6.1 vs 13.7 months, p < .0001), HR = 2.79 (95% CI:1.95-3.97, p < .0001). Median OS was shorter for pts with EOM who received 1st line immune checkpoint inhibitor (n = 14) vs platinum-based chemotherapy (n = 43), (1.6 vs 9.1 months, p = 0.003). Pts with EOM received higher opioid analgesic doses at the first and last oncology outpatient visits compared to pts with NOM with mean morphine milligram equivalent (MME) dose of 60 ± 91 vs 28 ± 65 at first visit, p = 0.004, and 171 ± 214 vs. 94 ± 229 at last visit, p < 0.001. Conclusions: The presence of EOM in mUC is associated with worse outcomes vs. pts with NOM. Pts with EOM may benefit from 1st line platinum-based chemotherapy vs. checkpoint immunotherapy. Furthermore, pts with EOM experience more pain than pts with NOM and may benefit from early engagement with palliative care. Pts with EOM represent a population with a highly unmet need for systemic, targeted and/or radiation interventions. Molecular subtypes may further define these pts and analysis is planned. We encourage ongoing clinical trials to report outcomes in pts with EOM. A consensus on reporting of non-measurable disease is also needed. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Behtash Nezami
- Case Western Reserve University-Department of Pathology, Cleveland, OH
| | - Gregory MacLennan
- Case Western Reserve University-Department of Pathology, Cleveland, OH
| | | | | | | | - Adam Calaway
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | | | - Lee Evan Ponsky
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Christopher J. Hoimes
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
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Lemke E, Sahasrabudhe D, Guancial E, Bylow K, Johnson S, Messing E, Kilari D. The Role of Metastasectomy in Urothelial Carcinoma: Where Are We in 2020? Clin Genitourin Cancer 2020; 18:e478-e483. [PMID: 32085986 DOI: 10.1016/j.clgc.2020.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
Systemic therapy is the mainstay of treatment for metastatic urothelial carcinoma (UC). Responses to first-line platinum-based therapy tend to be short-lived with potential toxicity. Despite the approval of checkpoint inhibitors, the long-term prognosis for patients with metastatic UC remains dismal. Herein we report the case of a patient with a solitary pulmonary metastatic lesion of urothelial origin as the only site of metastatic disease who remained free of disease for more than 2 years without systemic therapy after metastasectomy. We review the literature discussing the role of combined surgical and medical management of oligometastatic UC. As our case illustrates, a growing body of evidence suggests a potential role for a multimodal approach in patients with oligometastatic UC.
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Affiliation(s)
- Emily Lemke
- Department of Medicine, Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI.
| | - Deepak Sahasrabudhe
- Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, Rochester, NY
| | | | - Kathryn Bylow
- Department of Medicine, Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Scott Johnson
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Edward Messing
- Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, Rochester, NY
| | - Deepak Kilari
- Department of Medicine, Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
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Shah AY, Kotecha R, Lemke E, Chandramohan A, Chaim J, Msaouel P, Xiao L, Gao J, Campbell MT, Zurita AJ, Wang J, Corn PG, Jonasch E, Motzer RJ, Sharma P, Voss MH, Tannir NM. Outcomes of patients with metastatic clear cell renal cell carcinoma treated with second-line VEGFR-TKI after first-line immune checkpoint inhibitors. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
575 Background: Immune checkpoint inhibitors (ICI) are being increasingly utilized in front-line (1L) setting of metastatic clear-cell renal cell carcinoma (mccRCC). Limited data exist on responses and survival on second-line (2L) VEGFR-TKI therapy after 1L ICI therapy. Methods: This is a retrospective study of mccRCC patients treated with 2L VEGFR-TKI after progressive disease (PD) with 1L ICI. Patients were treated at MD Anderson Cancer Center or Memorial Sloan Kettering Cancer Center between December 2015 and February 2018. Objective response was assessed by blinded radiologists’ review using RECIST v1.1. Descriptive statistics and Kaplan-Meier method were utilized. Results: 70 patients were included in the analysis. Median age at mccRCC diagnosis was 59 years old; 8 patients (11%) had IMDC favorable-risk score, 48 (69%) had intermediate-risk score, and 14 (20%) had poor-risk score. As 1L therapy, 12 patients (17%) received anti-PD-(L)1 monotherapy with nivolumab or atezolizumab, 33 (47%) received nivolumab plus ipilimumab, and 25 (36%) received combination anti-PD-(L)1 plus bevacizumab. 2L TKI therapies included pazopanib, sunitinib, axitinib, and cabozantinib. On 2L TKI therapy, one patient (1.5%) achieved a complete remission (CR), 27 patients (39.7%) a partial response (PR), and 36 patients (52.9%) stable disease (SD), adding to a 94% disease control rate (DCR). Median progression-free survival (mPFS) was 13.2 months (95% CI: 10.1, NA). Estimated 1-yr overall survival (OS) probability was 79.6% (95% CI: 70.2 – 90.3). Median duration of 2L TKI therapy was 10.1 months. In total, 45.7% of subjects required a dose reduction, and 27% of patients discontinued treatment due to toxicity. Conclusions: In this retrospective study of patients with mccRCC receiving 2L TKI monotherapy following 1L ICI, we observed 2L antitumor activity and tolerance comparable to historical data for first-line TKI. Further studies are needed to evaluate optimal strategies and sequencing of therapies in mccRCC.
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Affiliation(s)
| | | | - Emily Lemke
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Joshua Chaim
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Pavlos Msaouel
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lianchun Xiao
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jianjun Gao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Matthew T Campbell
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amado J. Zurita
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jennifer Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Eric Jonasch
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Nizar M. Tannir
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Campbell MT, Bilen MA, Shah AY, Lemke E, Jonasch E, Venkatesan AM, Altinmakas E, Duran C, Msaouel P, Tannir NM. Cabozantinib for the treatment of patients with metastatic non-clear cell renal cell carcinoma: A retrospective analysis. Eur J Cancer 2018; 104:188-194. [PMID: 30380460 DOI: 10.1016/j.ejca.2018.08.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/23/2018] [Accepted: 08/17/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cabozantinib prolongs overall survival (OS) and progression-free survival (PFS) in patients with metastatic clear cell renal cell carcinoma (RCC) that progressed on first-line vascular endothelial growth factor receptor-tyrosine kinase inhibitor (VEGFR-TKI). The role of cabozantinib has not been established in non-clear cell renal cell carcinoma (nccRCC). METHODS This is a retrospective study of 30 patients with nccRCC who received cabozantinib from January 2013 to January 2017. Information collected included baseline characteristics, toxicity, dose reductions, PFS and OS. A fellowship trained abdominal radiologist, blinded to patient history and clinical data, assessed radiographic response using RECIST, v1.1. RESULTS With a median follow-up of 20.6 months (95% confidence interval [CI]: 11.4-28.8), median PFS was 8.6 months (95% CI: 6.1-14.7), and median OS was 25.4 months (95% CI: 15.5-35.4). Of the 28 patients with measurable disease, 4 had partial responses (2 papillary, 1 chromophobe and 1 unclassified RCC), 18 had stable disease (64.2%) and 6 had progressive disease (21.4%), resulting in a 14.3% objective response rate and a 78.6% disease control rate. Two patients with papillary RCC who had experienced disease progression on savolitinib achieved durable partial response and stable disease, respectively, following treatment with cabozantinib. Of the 21 patients who started cabozantinib at 60 mg/d, 12 (57.1%) required dose reduction due to toxicity. CONCLUSION In this retrospective study, cabozantinib produced a clinically meaningful benefit in patients with metastatic nccRCC, the majority of whom had disease progression on prior VEGFR-TKIs. Prospective trials of cabozantinib in nccRCC are warranted.
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Affiliation(s)
- Matthew T Campbell
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Department of Hematology/Medical Oncology, Atlanta, GA, USA
| | - Amishi Y Shah
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emily Lemke
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - E Jonasch
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A M Venkatesan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - E Altinmakas
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C Duran
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pavlos Msaouel
- Division of Cancer Medicine, Hematology/Medical Oncology Fellowship, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - N M Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Campbell MT, Lemke E, Elsayes KM, Bazerbashi B, Shah AY, Habra MA. A retrospective analysis of carboplatin plus etoposide in patients with adrenal cortical carcinoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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)
| | - Emily Lemke
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Khaled M. Elsayes
- Diagnostic Radiology Department,The University of Texas MD Anderson Cancer Center, Houston, TX
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Shah AY, Lemke E, Gao J, Chandramohan A, Campbell MT, Zurita AJ, Xiao L, Wang J, Corn PG, Jonasch E, Sharma P, Tannir NM. Outcomes of patients (pts) with metastatic clear-cell renal cell carcinoma (mCCRCC) treated with second-line (2L) vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKI) after first-line (1L) immune checkpoint inhibitors (ICI). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.682] [Citation(s) in RCA: 8] [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] [Indexed: 11/20/2022] Open
Abstract
682 Background: Little data exists on objective response rates (ORR), progression-free survival (PFS), and safety of 2L VEGFR-TKI after 1L ICI therapy in pts with mCCRCC. Methods: This is a retrospective study of pts with mCCRCC who received 2L VEGFR-TKI after progressive disease (PD) with 1L ICI. Tumor response was assessed by a blinded radiologist using RECIST 1.1. Descriptive statistics, the Fisher’s test, and Kaplan-Meier method were used. Results: We report on 43 pts who were treated at MDACC from 2015 till present. Median age at mCCRCC diagnosis was 59 years (range: 43-72). 33 pts had lung mets, 20 had LN mets, 14 had bone mets, and 3 had liver mets. As 1L therapy, 20 pts received nivolumab + ipilimumab, 14 received nivolumab + bevacizumab, and 9 received nivolumab. Median time on ICI therapy was 29.4 weeks. All pts had resolution of Grade 3/4 AEs from ICI and PD before initiation of VEGFR-TKI. One patient (2%) had CR, 17 pts (40%) had PR, and 25 pts (58%) had SD, leading to 100% disease control rate (DCR) as best response to 2L VEGFR-TKI. Median PFS was 10.0 months (95% CI: 7.4, NA). Estimated 1-yr overall survival (OS) was 87.5% (95% CI: 74.6 - 100). Seven pts (16%) discontinued VEGFR-TKI therapy because of AEs: Gr 3 transaminitis (3 on pazopanib), Gr 3 hand-foot skin reaction (1 on axitinib), impaired wound healing (1 on axitinib), and Gr 3 pancreatitis (1 on pazopanib, 1 on axitinib). Conclusions: In this retrospective study, we observed a 42% ORR, a 10-month median PFS, and a 100% DCR in pts with mCCRCC who received VEGFR-TKI after PD with ICI. These results inform the design of trials with 2L VEGFR-TKI after failure of ICI therapy. [Table: see text]
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Lemke E, Shah AY, Msaouel P, Bilen MA, Jonasch E, Venkatesan AM, Chandramohan A, Duran C, Tannir NM, Campbell MT. Comparing cabozantinib (C) treatment for a cohort of patients with metastatic clear cell (ccRCC) and variant histology renal cell carcinoma (vhRCC): A retrospective study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
702 Background: Both the randomized METEOR and CABOSUN studies in ccRCC found substantial benefit for patients receiving (C). We have previously reported (C) to have significant activity in vhRCC. To date no comparative data exists in evaluating the utility of (C) in ccRCC and vhRCC. Methods: This is a retrospective study of patients with ccRCC and vhRCC who received (C) at a single center from 1/2014-9/2017. Data tabulated included baseline characteristics, toxicity, dose reductions, time on (C) and survival data. A blinded radiologist assessed the radiographic response using RECIST v1.1. Cox regression analysis of time to treatment failure (TTF) in ccRCC and vhRCC was performed, adjusting for age, gender, IMDC score, neutrophil to lymphocyte ratio (NLR), prior TKI treatment, and number of metastatic sites. Statistical analysis were performed using SPSS 23.0. Results:Time to treatment failure was significantly longer in vhRCC compared with ccRCC (16.1 vs 7.64 months, HR 0.42, 95%CI 0.22-0.79, p = 0.007). This difference persisted in the adjusted Cox regression model (HR 0.36, 95% CI 0.15-0.85, p = 0.02). Conclusions: In this retrospective comparative analysis of C treated vhRCC and ccRCC patients, C was found to have substantial activity in both cohorts of patients. The IMDC score was important to predict outcome. Both heavily pretreated patients with ccRCC and those with vhRCC appeared to have substantial benefit.[Table: see text]
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Lemke E, Shah AY, Chandramohan A, Campbell MT, VanAlstine M, Jonasch E, Tannir NM. Real-world experience with cabozantinib in metastatic clear cell renal cell carcinoma (mccRCC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
684 Background: Cabozantinib (C) inhibits tyrosine kinase activity at MET, AXL, and VEGF receptors and is approved in mccRCC after progression on prior VEGFR-TKI. Little off-protocol data exists on tolerability and response. Methods: We retrospectively gathered baseline and treatment details on mccRCC patients treated with C at MD Anderson from 2015-present. Blinded radiologist determined best response by RECIST 1.1. Descriptive statistics were utilized. Results: We report on 38 patients with mccRCC treated with C in a “real-world” setting. Median age at mccRCC diagnosis was 58 years (range 37-71). 25 patients (66%) were male. 22 (58%) had de-novo metastatic disease. 4 patients had sarcomatoid dedifferentiation. 32 (84%) underwent nephrectomy. Cohort had a median of 3 sites of metastatic disease, including: bone 22 (57%), liver 9 (23%), and brain 6 (16%). 6 patients (16%) received C as 2nd line therapy, 10 (26%) as 3rd line, and 22 (58%) as 4th line or later. By IMDC risk score, 7 (18%) were favorable, 22 (58%) were intermediate, and 9 (24%) were poor risk. All patients had received at least 1 prior VEGFR-TKI and 24 (63%) had received prior immune checkpoint inhibitor. At C initiation, 20 (53%) patients had unfavorable neutrophil to lymphocyte ratio (NLR) of ≥ 3. 12 (32%) patients had favorable shift of NLR to < 3 on C. 22 patients (58%) required dose reduction and 24 (63%) required treatment break due to C-related toxicity. At time of analysis, 26 patients had discontinued treatment, with median time on treatment of 32.2 weeks (range 15.7-130.7 weeks). For the 12 patients remaining on C, median duration of therapy has been 54.3 weeks (range 26.6-68.9 weeks). 1 (3%) patient had CR, 11 patients (29%) had PR, 23 (60%) had SD, and 3 (8%) had PD as best response to C. Conclusions: C has a high disease control rate (92%) even as a late line of therapy in mccRCC. However, careful monitoring is warranted as many patients require treatment breaks and dose reductions for therapy-related toxicity. [Table: see text]
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Lemke E, Madsen L, Dains J. Vaginal Testosterone for Management of Aromatase Inhibitor–Related Sexual
Dysfunction: An Integrative Review. Oncol Nurs Forum 2017. [DOI: 10.1188/17.onf.296-301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Schaefer M, van der Ven H, Lemke E, Brühl P. Exokrine, endokrine und immunologische Parameter der Hodenfunktion nach unilateraler Hodentorsion. Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1060516] [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: 10/21/2022]
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Lemke E, Kreissl E. Indications and contraindications of sanatorium treatment of children with renal and urinary diseases. Int Urol Nephrol 1981; 13:333-5. [PMID: 7343536 DOI: 10.1007/bf02081933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The necessity for the treatment and follow-up of children with kidney disease is emphasized. Apart from specific treatment with antibiotics, corticoids and immunosuppressives in cases of pyelonephritis, urological diseases and glomerulonephritis, the possibility of a non-specific physiotherapeutic treatment in the framework of a six-week cure is pointed out. The first sanatorium for children with renal disease in the GDR has, after initial experience and together with the GDR's Society for Child Nephrology, revised the list of indications which is presented in this paper. In addition to indications, also the contraindications are given. A gross first survey of 975 treatments is presented.
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Lemke E. [Ergonomy from the viewpoint of engineers]. Zentralbl Arbeitsmed Arbeitsschutz Prophyl Ergonomie 1981; 31:162-6. [PMID: 7293540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Lemke E, Fröhling P, Metz EG. [Treatment of intracapillary-proliferative glomerulonephritis]. Z Urol Nephrol 1978; 71:385-90. [PMID: 685515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
It is reported on 137 patients with chronic intracapillary-proliferative glomerulonephritides. Of them 101 patients were treated with prednisolone, 36 patients remained untreated. The control biopsies and the observations of the course after on an average 1.8 years showed that the treated patients clinically and histologically had no better results than the untreated patients. A relatively high number of urinary tract infections and pyelonephritides was evident in patients treated with prednisolone. These diseases did not occur in patients who were not treated.
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Fröhling P, Lemke E, Lindenau K, Behla M. [Long-term therapy of renal hypertension with various antihypertensive combinations in nephrologic dispensary consultations]. Z Gesamte Inn Med 1973; 28:60-3. [PMID: 4633734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Reinschke P, Müller V, Schmalz H, Precht K, Buchali K, Grossmann P, Devaux S, Althaus P, Gerhardt W, Houda W, Klinkmann H, Rohmann H, Schwarz F, Stolpe HJ, Lachhein L, Lemke E, Müller D, Thiele P, Tredt HJ, Thieler H, Zenker K. [Review and results of acute dialysis therapy in childhood during 1960-1970]. Dtsch Gesundheitsw 1971; 26:1163-5. [PMID: 5091919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Metz EG, Fröhling P, Lemke E. [On rational and rationalized infusion therapy in internal diseases]. Z Arztl Fortbild (Jena) 1970; 64:1185-91. [PMID: 4994102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Vetter K, Burow B, Kaschube I, Lemke E, Buhl E, Kraack W. [Renal insufficiency and its dietetic treatment. II. Treatment results and dietetic indications for practice]. Dtsch Gesundheitsw 1970; 25:2097-101. [PMID: 5491298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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24
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Vetter K, Burow B, Kaschube I, Lemke E, Buhl E. [Renal insufficiency and its dietetic treatment. 1. Diet-physiologic basis and indication]. Dtsch Gesundheitsw 1970; 25:2043-7. [PMID: 5487505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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25
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Dutz H, Eckardt D, Lachhein L, Althaus P, Gerhardt W, Houda W, Jungmann K, Kallas W, Klimpel L, Klinkmann H, Lemke E, Müller D, Otto U, Precht K, Rohmann E, Thieler H, Tredt HJ, Zenker K. [Therapy of acute exogenous intoxications using hemo- and peritoneal dialysis and results of this treatment in GDR in the years 1959-1968]. Dtsch Gesundheitsw 1970; 25:1437-44. [PMID: 4945430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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26
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Semmler H, Lemke E. [ECG changes in aneurysm of the heart wall]. Z Gesamte Inn Med 1969; 24:176-80. [PMID: 5802033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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27
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Semmler H, Lemke E. [Causes and mortality in diabetic coma]. Z Arztl Fortbild (Jena) 1969; 63:218-22. [PMID: 5785477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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28
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Lemke E, Semmler H, Fröhling P. [Anuria and uremia in bilateral occlusions of the ureters]. Dtsch Gesundheitsw 1968; 23:2269-72. [PMID: 5715937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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29
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Fröhling P, Lemke E, Semmler H. [Comparative studies on the significance of zinc sulfate test in the clinical diagnosis]. Z Arztl Fortbild (Jena) 1968; 62:1051-3. [PMID: 4179968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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30
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Semmler H, Lemke E. [On the etiology, clinical therapy and diagnosis of periarteritis nodosa]. Z Gesamte Inn Med 1968; 23:378-81. [PMID: 4386848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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31
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Lemke E, Nolte B, Semmler H. [Clinical case contribution to the ray fungus disease]. Z Gesamte Inn Med 1968; 23:342-5. [PMID: 5706967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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32
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Semmler H, Lemke E. [On the problem of "virus hepatitis and gravidity"]. Z Arztl Fortbild (Jena) 1968; 62:430-2. [PMID: 5679750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Lemke E. [Clinical experience with bromsulfan in liver diagnosis]. Z Arztl Fortbild (Jena) 1967; 61:813-6. [PMID: 5592668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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