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Gieske MR, Kerns J, Schmitt GM, Kloecker G, Budhani IA, Nolan J, Williams VA, Alkapalan D, Ferguson K, Yadav R, Calhoun RF. Overcoming barriers to lung cancer screening using a systemwide approach with additional focus on the non-screened. J Med Screen 2024; 31:99-106. [PMID: 37855047 DOI: 10.1177/09691413231208160] [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] [Indexed: 10/20/2023]
Abstract
BACKGROUND The lung cancer screening program at St Elizabeth Healthcare (Kentucky, USA) began in 2013. Over 33,000 low-dose computed tomography lung cancer screens have been performed. From 2015 through 2021, 2595 lung cancers were diagnosed systemwide. A Screening Program with Impactful Results from Early Detection, reviews that experience; 342 (13.2%) were diagnosed by screening and 2253 (86.8%) were non-screened. As a secondary objective, the non-screened cohort was queried to determine how many additional individuals could have been screened, identifying barriers and failures to meet eligibility. METHODS Our QlikSense database extracted the lung cancer patients from the Cancer Patient Data and Management System, and identified and categorized them separately as screened or non-screened populations. Stage distribution was compared in screened and non-screened groups. Those meeting age criteria, with any smoking history, were further queried for screening eligibility, accessing the electronic medical record smoking history and audit trail, and determining if enough information was available to substantiate screening eligibility. The same methodology was applied to CMS 2015 and USPSTF 2021 criteria. RESULTS The screened and non-screened patients were accounted for in a stage migration chart demonstrating clear shift to early stage among screened lung cancer patients. Additionally, analysis of non-screened individuals is presented. CONCLUSION Of the St Elizabeth Healthcare eligible patients attributed to primary care providers, 49.6% were screened in 2021. Despite this level of success, this study highlighted a sizeable pool of additional individuals that could have been screened. We are shifting focus to the non-screened pool of patients that meet eligibility, further enhancing the impact on our community.
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Affiliation(s)
- Michael R Gieske
- Lung Cancer Screening, St Elizabeth Healthcare, Ft. Mitchell, KY, USA
| | - Jessica Kerns
- Lung Cancer Screening, St Elizabeth Healthcare, Edgewood, KY, USA
| | - Gary M Schmitt
- Radiology Associates of Northern Kentucky, Crestview Hills, KY, USA
| | - Goetz Kloecker
- Thoracic Medical Oncology, St Elizabeth Healthcare, Edgewood, KY, USA
| | - Irfan A Budhani
- Pulmonary Medicine, St Elizabeth Healthcare, Edgewood, KY, USA
| | - Joseph Nolan
- Department of Mathematics and Statistics, Northern Kentucky University, Highland Heights, KY, USA
| | - Valerie A Williams
- Division of Thoracic Surgery, St Elizabeth Healthcare, Edgewood, KY, USA
| | - Deema Alkapalan
- Deptartment of Pathology, St Elizabeth Healthcare, Edgewood, KY, USA
| | - Katelyn Ferguson
- University of Kentucky Medical School, Highland Heights, KY, USA
| | - Ryan Yadav
- University of Kentucky Medical School, Highland Heights, KY, USA
| | - Royce F Calhoun
- Division of Thoracic Surgery, St Elizabeth Healthcare, Edgewood, KY, USA
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Leal T, Kotecha R, Ramlau R, Zhang L, Milanowski J, Cobo M, Roubec J, Petruzelka L, Havel L, Kalmadi S, Ward J, Andric Z, Berghmans T, Gerber DE, Kloecker G, Panikkar R, Aerts J, Delmonte A, Pless M, Greil R, Rolfo C, Akerley W, Eaton M, Iqbal M, Langer C. Tumor Treating Fields therapy with standard systemic therapy versus standard systemic therapy alone in metastatic non-small-cell lung cancer following progression on or after platinum-based therapy (LUNAR): a randomised, open-label, pivotal phase 3 study. Lancet Oncol 2023; 24:1002-1017. [PMID: 37657460 DOI: 10.1016/s1470-2045(23)00344-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Tumor Treating Fields (TTFields) are electric fields that disrupt processes critical for cancer cell survival, leading to immunogenic cell death and enhanced antitumour immune response. In preclinical models of non-small-cell lung cancer, TTFields amplified the effects of chemotherapy and immune checkpoint inhibitors. We report primary results from a pivotal study of TTFields therapy in metastatic non-small-cell lung cancer. METHODS This randomised, open-label, pivotal phase 3 study recruited patients at 130 sites in 19 countries. Participants were aged 22 years or older with metastatic non-small-cell lung cancer progressing on or after platinum-based therapy, with squamous or non-squamous histology and ECOG performance status of 2 or less. Previous platinum-based therapy was required, but no restriction was placed on the number or type of previous lines of systemic therapy. Participants were randomly assigned (1:1) to TTFields therapy and standard systemic therapy (investigator's choice of immune checkpoint inhibitor [nivolumab, pembrolizumab, or atezolizumab] or docetaxel) or standard therapy alone. Randomisation was performed centrally using variable blocked randomisation and an interactive voice-web response system, and was stratified by tumour histology, treatment, and region. Systemic therapies were dosed according to local practice guidelines. TTFields therapy (150 kHz) was delivered continuously to the thoracic region with the recommendation to achieve an average of at least 18 h/day device usage. The primary endpoint was overall survival in the intention-to-treat population. The safety population included all patients who received any study therapy and were analysed according to the actual treatment received. The study is registered with ClinicalTrials.gov, NCT02973789. FINDINGS Between Feb 13, 2017, and Nov 19, 2021, 276 patients were enrolled and randomly assigned to receive TTFields therapy with standard therapy (n=137) or standard therapy alone (n=139). The median age was 64 years (IQR 59-70), 178 (64%) were male and 98 (36%) were female, 156 (57%) had non-squamous non-small-cell lung cancer, and 87 (32%) had received a previous immune checkpoint inhibitor. Median follow-up was 10·6 months (IQR 6·1-33·7) for patients receiving TTFields therapy with standard therapy, and 9·5 months (0·1-32·1) for patients receiving standard therapy. Overall survival was significantly longer with TTFields therapy and standard therapy than with standard therapy alone (median 13·2 months [95% CI 10·3-15·5] vs 9·9 months [8·1-11·5]; hazard ratio [HR] 0·74 [95% CI 0·56-0·98]; p=0·035). In the safety population (n=267), serious adverse events of any cause were reported in 70 (53%) of 133 patients receiving TTFields therapy plus standard therapy and 51 (38%) of 134 patients receiving standard therapy alone. The most frequent grade 3-4 adverse events were leukopenia (37 [14%] of 267), pneumonia (28 [10%]), and anaemia (21 [8%]). TTFields therapy-related adverse events were reported in 95 (71%) of 133 patients; these were mostly (81 [85%]) grade 1-2 skin and subcutaneous tissue disorders. There were three deaths related to standard therapy (two due to infections and one due to pulmonary haemorrhage) and no deaths related to TTFields therapy. INTERPRETATION TTFields therapy added to standard therapy significantly improved overall survival compared with standard therapy alone in metastatic non-small-cell lung cancer after progression on platinum-based therapy without exacerbating systemic toxicities. These data suggest that TTFields therapy is efficacious in metastatic non-small-cell lung cancer and should be considered as a treatment option to manage the disease in this setting. FUNDING Novocure.
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Affiliation(s)
- Ticiana Leal
- Winship Cancer Institute at Emory University, Atlanta, GA, USA.
| | - Rupesh Kotecha
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Rodryg Ramlau
- Poznan University of Medical Sciences, Poznan, Poland
| | - Li Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, China
| | | | - Manuel Cobo
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Jaromir Roubec
- Nemocnice AGEL Ostrava-Vítkovice, Ostrava, Czech Republic
| | | | | | | | - Jeffrey Ward
- Washington University School of Medicine, St Louis, MO, USA
| | - Zoran Andric
- University Clinical Hospital Centre Bezanijska Kosa, Belgrade, Serbia
| | - Thierry Berghmans
- Jules Bordet Institute, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - David E Gerber
- Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Joachim Aerts
- Department of Pulmonary Medicine, The Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Angelo Delmonte
- IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori (IRST), Meldola, Italy
| | - Miklos Pless
- Kantonsspital Winterthur, Winterthur, Switzerland
| | - Richard Greil
- Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Salzburg, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria; Cancer Cluster, Salzburg, Austria
| | - Christian Rolfo
- Center for Thoracic Oncology, Tisch Cancer Institute at Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Wallace Akerley
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Mussawar Iqbal
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Corey Langer
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Katiyar V, Chesney J, Kloecker G. Cellular Therapy for Lung Cancer: Focusing on Chimeric Antigen Receptor T (CAR T) Cells and Tumor-Infiltrating Lymphocyte (TIL) Therapy. Cancers (Basel) 2023; 15:3733. [PMID: 37509394 PMCID: PMC10377757 DOI: 10.3390/cancers15143733] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/03/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Lung cancer is a leading cause of morbidity and mortality in the United States and worldwide. The introduction of immune checkpoint inhibitors has led to a marked improvement in the outcomes of lung cancer patients. Despite these advances, there is a huge unmet need for therapeutic options in patients who are not candidates for targeted or immunotherapy or those who progress after first-line treatment. With its high mutational burden, lung cancer appears to be an attractive target for novel personalized treatment approaches. In this review, we provide an overview of two adoptive cell therapy approaches-chimeric antigen receptors (CAR) T-cell therapy and Tumor-infiltrating lymphocytes (TILs) in lung cancer with an emphasis on current challenges and future perspectives. While both these therapies are still in the early phases of development in lung cancer and need more refinement, they harbor the potential to be effective treatment options for this group of patients with otherwise poor prognoses.
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Affiliation(s)
- Vatsala Katiyar
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202, USA
| | - Jason Chesney
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202, USA
| | - Goetz Kloecker
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202, USA
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Bakouny Z, Labaki C, Grover P, Awosika J, Gulati S, Hsu CY, Alimohamed SI, Bashir B, Berg S, Bilen MA, Bowles D, Castellano C, Desai A, Elkrief A, Eton OE, Fecher LA, Flora D, Galsky MD, Gatti-Mays ME, Gesenhues A, Glover MJ, Gopalakrishnan D, Gupta S, Halfdanarson TR, Hayes-Lattin B, Hendawi M, Hsu E, Hwang C, Jandarov R, Jani C, Johnson DB, Joshi M, Khan H, Khan SA, Knox N, Koshkin VS, Kulkarni AA, Kwon DH, Matar S, McKay RR, Mishra S, Moria FA, Nizam A, Nock NL, Nonato TK, Panasci J, Pomerantz L, Portuguese AJ, Provenzano D, Puc M, Rao YJ, Rhodes TD, Riely GJ, Ripp JJ, Rivera AV, Ruiz-Garcia E, Schmidt AL, Schoenfeld AJ, Schwartz GK, Shah SA, Shaya J, Subbiah S, Tachiki LM, Tucker MD, Valdez-Reyes M, Weissmann LB, Wotman MT, Wulff-Burchfield EM, Xie Z, Yang YJ, Thompson MA, Shah DP, Warner JL, Shyr Y, Choueiri TK, Wise-Draper TM, Gandhi R, Gartrell BA, Goel S, Halmos B, Makower DF, O' Sullivan D, Ohri N, Portes M, Shapiro LC, Shastri A, Sica RA, Verma AK, Butt O, Campian JL, Fiala MA, Henderson JP, Monahan RS, Stockerl-Goldstein KE, Zhou AY, Bitran JD, Hallmeyer S, Mundt D, Pandravada S, Papaioannou PV, Patel M, Streckfuss M, Tadesse E, Gatson NTN, Kundranda MN, Lammers PE, Loree JM, Yu IS, Bindal P, Lam B, Peters MLB, Piper-Vallillo AJ, Egan PC, Farmakiotis D, Arvanitis P, Klein EJ, Olszewski AJ, Vieira K, Angevine AH, Bar MH, Del Prete SA, Fiebach MZ, Gulati AP, Hatton E, Houston K, Rose SJ, Steve Lo KM, Stratton J, Weinstein PL, Garcia JA, Routy B, Hoyo-Ulloa I, Dawsey SJ, Lemmon CA, Pennell NA, Sharifi N, Painter CA, Granada C, Hoppenot C, Li A, Bitterman DS, Connors JM, Demetri GD, Florez (Duma) N, Freeman DA, Giordano A, Morgans AK, Nohria A, Saliby RM, Tolaney SM, Van Allen EM, Xu WV, Zon RL, Halabi S, Zhang T, Dzimitrowicz H, Leighton JC, Graber JJ, Grivas P, Hawley JE, Loggers ET, Lyman GH, Lynch RC, Nakasone ES, Schweizer MT, Vinayak S, Wagner MJ, Yeh A, Dansoa Y, Makary M, Manikowski JJ, Vadakara J, Yossef K, Beckerman J, Goyal S, Messing I, Rosenstein LJ, Steffes DR, Alsamarai S, Clement JM, Cosin JA, Daher A, Dailey ME, Elias R, Fein JA, Hosmer W, Jayaraj A, Mather J, Menendez AG, Nadkarni R, Serrano OK, Yu PP, Balanchivadze N, Gadgeel SM, Accordino MK, Bhutani D, Bodin BE, Hershman DL, Masson C, Alexander M, Mushtaq S, Reuben DY, Bernicker EH, Deeken JF, Jeffords KJ, Shafer D, Cárdenas AI, Cuervo Campos R, De-la-Rosa-Martinez D, Ramirez A, Vilar-Compte D, Gill DM, Lewis MA, Low CA, Jones MM, Mansoor AH, Mashru SH, Werner MA, Cohen AM, McWeeney S, Nemecek ER, Williamson SP, Peters S, Smith SJ, Lewis GC, Zaren HA, Akhtari M, Castillo DR, Cortez K, Lau E, Nagaraj G, Park K, Reeves ME, O'Connor TE, Altman J, Gurley M, Mulcahy MF, Wehbe FH, Durbin EB, Nelson HH, Ramesh V, Sachs Z, Wilson G, Bardia A, Boland G, Gainor JF, Peppercorn J, Reynolds KL, Rosovsky RP, Zubiri L, Bekaii-Saab TS, Joyner MJ, Riaz IB, Senefeld JW, Shah S, Ayre SK, Bonnen M, Mahadevan D, McKeown C, Mesa RA, Ramirez AG, Salazar M, Shah PK, Wang CP, Bouganim N, Papenburg J, Sabbah A, Tagalakis V, Vinh DC, Nanchal R, Singh H, Bahadur N, Bao T, Belenkaya R, Nambiar PH, O’Cearbhaill RE, Papadopoulos EB, Philip J, Robson M, Rosenberg JE, Wilkins CR, Tamimi R, Cerrone K, Dill J, Faller BA, Alomar ME, Chandrasekhar SA, Hume EC, Islam JY, Ajmera A, Brouha SS, Cabal A, Choi S, Hsiao A, Jiang JY, Kligerman S, Park J, Razavi P, Reid EG, Bhatt PS, Mariano MG, Thomson CC, Glace M(G, Knoble JL, Rink C, Zacks R, Blau SH, Brown C, Cantrell AS, Namburi S, Polimera HV, Rovito MA, Edwin N, Herz K, Kennecke HF, Monfared A, Sautter RR, Cronin T, Elshoury A, Fleissner B, Griffiths EA, Hernandez-Ilizaliturri F, Jain P, Kariapper A, Levine E, Moffitt M, O'Connor TL, Smith LJ, Wicher CP, Zsiros E, Jabbour SK, Misdary CF, Shah MR, Batist G, Cook E, Ferrario C, Lau S, Miller WH, Rudski L, Santos Dutra M, Wilchesky M, Mahmood SZ, McNair C, Mico V, Dixon B, Kloecker G, Logan BB, Mandapakala C, Cabebe EC, Jha A, Khaki AR, Nagpal S, Schapira L, Wu JTY, Whaley D, Lopes GDL, de Cardenas K, Russell K, Stith B, Taylor S, Klamerus JF, Revankar SG, Addison D, Chen JL, Haynam M, Jhawar SR, Karivedu V, Palmer JD, Pillainayagam C, Stover DG, Wall S, Williams NO, Abbasi SH, Annis S, Balmaceda NB, Greenland S, Kasi A, Rock CD, Luders M, Smits M, Weiss M, Chism DD, Owenby S, Ang C, Doroshow DB, Metzger M, Berenberg J, Uyehara C, Fazio A, Huber KE, Lashley LN, Sueyoshi MH, Patel KG, Riess J, Borno HT, Small EJ, Zhang S, Andermann TM, Jensen CE, Rubinstein SM, Wood WA, Ahmad SA, Brownfield L, Heilman H, Kharofa J, Latif T, Marcum M, Shaikh HG, Sohal DPS, Abidi M, Geiger CL, Markham MJ, Russ AD, Saker H, Acoba JD, Choi H, Rho YS, Feldman LE, Gantt G, Hoskins KF, Khan M, Liu LC, Nguyen RH, Pasquinelli MM, Schwartz C, Venepalli NK, Vikas P, Zakharia Y, Friese CR, Boldt A, Gonzalez CJ, Su C, Su CT, Yoon JJ, Bijjula R, Mavromatis BH, Seletyn ME, Wood BR, Zaman QU, Kaklamani V, Beeghly A, Brown AJ, Charles LJ, Cheng A, Crispens MA, Croessmann S, Davis EJ, Ding T, Duda SN, Enriquez KT, French B, Gillaspie EA, Hausrath DJ, Hennessy C, Lewis JT, Li X(L, Prescott LS, Reid SA, Saif S, Slosky DA, Solorzano CC, Sun T, Vega-Luna K, Wang LL, Aboulafia DM, Carducci TM, Goldsmith KJ, Van Loon S, Topaloglu U, Moore J, Rice RL, Cabalona WD, Cyr S, Barrow McCollough B, Peddi P, Rosen LR, Ravindranathan D, Hafez N, Herbst RS, LoRusso P, Lustberg MB, Masters T, Stratton C. Interplay of Immunosuppression and Immunotherapy Among Patients With Cancer and COVID-19. JAMA Oncol 2023; 9:128-134. [PMID: 36326731 PMCID: PMC9634600 DOI: 10.1001/jamaoncol.2022.5357] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [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] [Received: 04/04/2022] [Accepted: 08/11/2022] [Indexed: 11/06/2022]
Abstract
Importance Cytokine storm due to COVID-19 can cause high morbidity and mortality and may be more common in patients with cancer treated with immunotherapy (IO) due to immune system activation. Objective To determine the association of baseline immunosuppression and/or IO-based therapies with COVID-19 severity and cytokine storm in patients with cancer. Design, Setting, and Participants This registry-based retrospective cohort study included 12 046 patients reported to the COVID-19 and Cancer Consortium (CCC19) registry from March 2020 to May 2022. The CCC19 registry is a centralized international multi-institutional registry of patients with COVID-19 with a current or past diagnosis of cancer. Records analyzed included patients with active or previous cancer who had a laboratory-confirmed infection with SARS-CoV-2 by polymerase chain reaction and/or serologic findings. Exposures Immunosuppression due to therapy; systemic anticancer therapy (IO or non-IO). Main Outcomes and Measures The primary outcome was a 5-level ordinal scale of COVID-19 severity: no complications; hospitalized without requiring oxygen; hospitalized and required oxygen; intensive care unit admission and/or mechanical ventilation; death. The secondary outcome was the occurrence of cytokine storm. Results The median age of the entire cohort was 65 years (interquartile range [IQR], 54-74) years and 6359 patients were female (52.8%) and 6598 (54.8%) were non-Hispanic White. A total of 599 (5.0%) patients received IO, whereas 4327 (35.9%) received non-IO systemic anticancer therapies, and 7120 (59.1%) did not receive any antineoplastic regimen within 3 months prior to COVID-19 diagnosis. Although no difference in COVID-19 severity and cytokine storm was found in the IO group compared with the untreated group in the total cohort (adjusted odds ratio [aOR], 0.80; 95% CI, 0.56-1.13, and aOR, 0.89; 95% CI, 0.41-1.93, respectively), patients with baseline immunosuppression treated with IO (vs untreated) had worse COVID-19 severity and cytokine storm (aOR, 3.33; 95% CI, 1.38-8.01, and aOR, 4.41; 95% CI, 1.71-11.38, respectively). Patients with immunosuppression receiving non-IO therapies (vs untreated) also had worse COVID-19 severity (aOR, 1.79; 95% CI, 1.36-2.35) and cytokine storm (aOR, 2.32; 95% CI, 1.42-3.79). Conclusions and Relevance This cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially IO, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm. Trial Registration ClinicalTrials.gov Identifier: NCT04354701.
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Affiliation(s)
- Ziad Bakouny
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chris Labaki
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Punita Grover
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Joy Awosika
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Shuchi Gulati
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Chih-Yuan Hsu
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Saif I Alimohamed
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Babar Bashir
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Mehmet A Bilen
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | | | | | - Aakash Desai
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Arielle Elkrief
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Omar E Eton
- Hartford Healthcare Cancer Institute, Hartford, Connecticut
| | | | | | | | | | | | | | | | | | | | | | - Mohamed Hendawi
- Aurora Cancer Center, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Emily Hsu
- Hartford Healthcare Cancer Institute, Hartford, Connecticut
| | - Clara Hwang
- Henry Ford Cancer Institute, Detroit, Michigan
| | - Roman Jandarov
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | | | | | - Monika Joshi
- Penn State Cancer Institute, Hershey, Pennsylvania
| | - Hina Khan
- Brown University and Lifespan Cancer Institute, Providence, Rhode Island
| | - Shaheer A Khan
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
| | - Natalie Knox
- Loyola University Medical Center, Maywood, Illinois
| | - Vadim S Koshkin
- UCSF, Helen Diller Comprehensive Cancer Center, San Francisco
| | | | - Daniel H Kwon
- UCSF, Helen Diller Comprehensive Cancer Center, San Francisco
| | - Sara Matar
- Hollings Cancer Center, MUSC, Charleston
| | - Rana R McKay
- Moores Cancer Center, UCSD, San Diego, California
| | - Sanjay Mishra
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Feras A Moria
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Nora L Nock
- Case Comprehensive Cancer Center, Department of Population and Quantitative Health Sciences, Cleveland, Ohio
| | | | - Justin Panasci
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | | | | | | | - Yuan J Rao
- George Washington University, Washington, DC
| | | | | | - Jacob J Ripp
- University of Kansas Medical Center, Kansas City
| | - Andrea V Rivera
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Andrew L Schmidt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Gary K Schwartz
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
| | | | - Justin Shaya
- Moores Cancer Center, UCSD, San Diego, California
| | - Suki Subbiah
- Stanley S. Scott Cancer Center, LSU, New Orleans, Louisiana
| | - Lisa M Tachiki
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | | | | | - Zhuoer Xie
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Michael A Thompson
- Aurora Cancer Center, Advocate Aurora Health, Milwaukee, Wisconsin.,Tempus Labs, Chicago, Illinois
| | - Dimpy P Shah
- Mays Cancer Center, UT Health, San Antonio, Texas
| | | | - Yu Shyr
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Trisha M Wise-Draper
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Omar Butt
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ang Li
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eric Lau
- for the COVID-19 and Cancer Consortium
| | | | - Kyu Park
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ting Bao
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ji Park
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Erin Cook
- for the COVID-19 and Cancer Consortium
| | | | - Susie Lau
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Anup Kasi
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Li C Liu
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | - Chris Su
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tan Ding
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | - Sara Saif
- for the COVID-19 and Cancer Consortium
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5
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Kloecker G, Nolan J, Korbee L, Calhoun R, Logan B, Flora D, Flora D, Hartman P. Social Distancing to Avoid SARS-CoV-2 Infection in Cancer and Noncancer Patients. J Patient Saf 2022; 18:788-792. [PMID: 35797588 PMCID: PMC9698080 DOI: 10.1097/pts.0000000000001058] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Social distancing has been recommended by the Centers for Disease Control and Prevention to avoid exposure to SARS-CoV-2 ( Epidemiol Prev 2020;44:353-362).Cancer patients on or after active therapy seem to be more prone to COVID being symptomatic and life-threatening. When evaluating cancer patients' risk of acquiring COVID, it is essential to know the behavior of cancer patients that will affect their risk of exposure. However, it is not known to what degree social distancing is practiced by cancer patients compared with noncancer patients and what factors lead to the decision to distance oneself. METHOD After a pilot phase using patients' MyChart messaging, links to the electronic questionnaires were texted to patients using Twillio. Responses were stored on REDCap (Vanderbilt University, Nashville, TN). Six questions about their social distancing behavior and mask wearing were posed and responses were compared between cancer and noncancer patients. Demographics, comorbidities, and a questionnaire about anxiety (Generalized Anxiety Disorder 7-item scale) were recorded. To assess differences between cancer and noncancer groups, Bonferroni-corrected χ 2 tests and proportions confidence intervals were used. RESULTS The pilot survey was sent in mid-2020 and the full survey followed in January 2021 during a high community COVID incidence. Three hundred eighty-seven cancer patients (32.4% responded) and 503 noncancer patients (22.9% responded) completed the survey. Questions about leaving their houses, driving, shopping, friends, and family indicated that patients with cancer are more cautious ( P < 0.001). Cancer patients were up to 20% more likely to distance themselves. No difference was seen in wearing a mask-both groups wore approximately 90% of the time. Most respondents were female (63% versus 71%). Cancer patients were older (>60 y, 69% versus 45%) and less likely to work (52% versus 31%) or less likely to be White collar workers (21% versus 38%). In both groups, 54% marked "not at all anxious." CONCLUSIONS Cancer patients' responses revealed a distancing behavior that would likely lower the risk exposure to SARS-CoV-2. It is unclear which of the demographic differences would account for this behavior, although remarkably anxiety was not a clear motivating factor. The high acceptance of masks is encouraging. Early publications during the pandemic and patient education suggesting a higher COVID risk for cancer patients may have reduced risk prone behavior. Considering COVID's impact on the vulnerable cancer population and uncertainty in immunosuppressed patients about clearing the virus or adequately responding to a vaccine, further studies about health behavior and health promotion during the pandemic are needed.
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Affiliation(s)
| | - Joseph Nolan
- Department of Mathematics and Statistics, Northern Kentucky University, Highland Heights, Kentucky
| | | | | | | | - Dan Flora
- From the St Elizabeth Healthcare, Edgewood
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6
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Maharaj S, Chang S, Kloecker G, Chesney J, Redman R, Rojan A. Venous and arterial thromboembolism with immunotherapy compared to platinum-based therapy. Thromb Res 2022; 217:48-51. [PMID: 35853370 DOI: 10.1016/j.thromres.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/22/2022] [Accepted: 07/11/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Satish Maharaj
- University of Louisville, KY, USA; Texas Tech University Health Sciences Center, Division of Hematology/Oncology, 4800 Alberta-MSC41007, El Paso, Texas 79905, USA.
| | - Simone Chang
- University of Louisville, KY, USA; Texas Tech University Health Sciences Center, Division of Hematology/Oncology, 4800 Alberta-MSC41007, El Paso, Texas 79905, USA
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7
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Abstract
Epidermal growth factor receptor (EGFR) mutations are present in 20–40% of non-small cell lung cancers (NSCLCs). Brain metastasis (BM) is more common in EGFR-mutated NSCLC (25–45%) compared to EGFR wild-type (15–30%). First and second-generation tyrosine kinase inhibitors (TKIs), such as erlotinib and afatinib have proven to be superior to chemotherapy in the front-line treatment of EGFR-mutated NSCLC. Osimertinib, a third-generation EGFR TKI, has demonstrated better blood brain barrier (BBB) penetration, higher rate of intracranial response (66% vs. 43%) and a lower rate of CNS progression when compared to first generation EGFR TKI. Evidence on upfront radiation vs. upfront osimertinib is limited, but rapidly evolving and being tested in ongoing comparative trials. Stereotactic radiation (SRS) is very effective in the control of BMs and has been increasingly used and consequently replacing resection of BMs. SRS also has been increasingly used in the treatment of multiple BMs. Considering the effectiveness of targeted agents such as third generation EGFR inhibitors clinicians now are more frequently faced with the decision, if systemic therapy is safe and effective enough to withhold SRS. Third generation EGFR inhibitors also have fewer adverse events as previous generations. This review discusses the current literature available for management of BM in EGFR-mutated NSCLC.
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Affiliation(s)
- Shruti Bhandari
- Division of Hematology and Medical Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Neal Dunlap
- Division of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Goetz Kloecker
- Division of Hematology and Medical Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
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8
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Kumar R, Castillero F, Bhandari S, Malapati S, Kloecker G. The Hispanic paradox in non-small cell lung cancer. Hematol Oncol Stem Cell Ther 2021; 15:21-29. [PMID: 33775613 DOI: 10.1016/j.hemonc.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/14/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE/BACKGROUND According to the U.S. Census Bureau, 18% of the total population in the United States identified themselves as Hispanic in 2016 making it the largest minority group. This study aimed to evaluate the effect of Hispanic ethnicity on the overall survival of patients with non-small cell lung cancer (NSCLC) using a large national cancer database. METHODS We used the National Cancer Database to identify patients diagnosed with NSCLC between 2010 and 2015. The two comparative groups for this study were non-Hispanic Whites (NHWs) and Hispanics. The primary outcome was overall survival. RESULTS Of the 555,475 patients included in the study, 96.9% and 3.1% were NHWs and Hispanics with a median follow up of 12.6 months (interquartile range 4.1-30.6) and 12.1 months (interquartile range 3.8-29.5), respectively. Hispanics were more likely to be uninsured, and live in areas with lower median household income or education level. In the age-, sex-, and comorbidities-adjusted Cox model, the overall survival was significantly better in Hispanics compared with NHWs (hazard ratio [HR] 0.92, 95% confidence interval 0.90-0.93, p < .001). In a demographic, socioeconomic, clinical, and facility characteristics adjusted Cox model, Hispanics had further improvement in survival (HR 0.79, 95% confidence interval 0.78-0.81, p < .001). The survival advantage was seen in all cancer stages: Stage I-HR 0.76 (0.71-0.80), Stage II-HR 0.85 (0.79-0.92), Stage III-HR 0.81 (0.77-0.85), and Stage IV-HR 0.79 (0.77-0.81). CONCLUSION Hispanic ethnicity was associated with better survival in NSCLC. This survival advantage is likely the result of complex interactions amongst several physical, social, cultural, genomic, and environmental factors.
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Affiliation(s)
- Rohit Kumar
- Division of Medical Oncology and Hematology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA.
| | | | - Shruti Bhandari
- Division of Medical Oncology and Hematology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Sindhu Malapati
- Division of Hematology and Oncology, Van Elslander Cancer Center, Ascension St. John Hospital and Medical Center, Grosse Pointe Woods, MI, USA
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9
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Gieske M, Kloecker G, Lockwood M, Kerns J, Calhoun R. CP01.03 COVID 19’s Pandemic’s Effect on a Community Lung Cancer Screening Program. J Thorac Oncol 2021. [PMCID: PMC7803149 DOI: 10.1016/j.jtho.2020.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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10
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Bayley-Veloso R, Szabo YZ, Cash E, Zimmaro L, Siwik C, Kloecker G, Salmon P, van der Gryp K, Sephton SE. The association between history of traumatic events and health-related quality of life among lung cancer patients. J Psychosoc Oncol 2020; 38:627-634. [PMID: 32597346 DOI: 10.1080/07347332.2020.1780364] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Promoting health-related quality of life (HRQOL) is a primary goal of lung cancer treatment. Trauma history and distress can negatively impact HRQOL. DESIGN A cross-sectional design examined the associations of trauma history, cancer-specific distress, and HRQOL. SAMPLE/METHOD Sixty lung cancer patients completed questionnaires on trauma history including the number and severity of traumatic events experienced. Cancer-specific distress, HRQOL, and depression were also reported. FINDINGS As hypothesized, trauma history and cancer-specific distress were negatively associated with HRQOL (all r's > -.27). Depression emerged as a confound in the association between cancer-specific distress and HRQOL. CONCLUSIONS Retrospectively-reported trauma was linked with poorer HRQOL in lung cancer patients. IMPLICATIONS Interventions aimed at improving lung cancer patients' HRQOL should consider the possible role of trauma history (both frequency and distress).
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Affiliation(s)
- René Bayley-Veloso
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA.,Lexington VA Medical Center, Lexington, Kentucky, USA
| | - Yvette Z Szabo
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA
| | - Elizabeth Cash
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA.,Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, Kentucky, USA.,James Graham Brown Cancer Center, Louisville, Kentucky, USA
| | - Lauren Zimmaro
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Chelsea Siwik
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Goetz Kloecker
- James Graham Brown Cancer Center, Louisville, Kentucky, USA
| | - Paul Salmon
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Kathleen van der Gryp
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Sandra E Sephton
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA.,James Graham Brown Cancer Center, Louisville, Kentucky, USA
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11
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Pham D, Bhandari S, Pinkston C, Oechsli M, Kloecker G. Lung Cancer Screening Registry Reveals Low-dose CT Screening Remains Heavily Underutilized. Clin Lung Cancer 2020; 21:e206-e211. [DOI: 10.1016/j.cllc.2019.09.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/14/2019] [Accepted: 09/16/2019] [Indexed: 12/17/2022]
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12
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Liu M, Tong Z, Ding C, Luo F, Wu S, Wu C, Albeituni S, He L, Hu X, Tieri D, Rouchka EC, Hamada M, Takahashi S, Gibb AA, Kloecker G, Zhang HG, Bousamra M, Hill BG, Zhang X, Yan J. Transcription factor c-Maf is a checkpoint that programs macrophages in lung cancer. J Clin Invest 2020; 130:2081-2096. [PMID: 31945018 PMCID: PMC7108920 DOI: 10.1172/jci131335] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 01/14/2020] [Indexed: 12/24/2022] Open
Abstract
Macrophages have been linked to tumor initiation, progression, metastasis, and treatment resistance. However, the transcriptional regulation of macrophages driving the protumor function remains elusive. Here, we demonstrate that the transcription factor c-Maf is a critical controller for immunosuppressive macrophage polarization and function in cancer. c-Maf controls many M2-related genes and has direct binding sites within a conserved noncoding sequence of the Csf-1r gene and promotes M2-like macrophage-mediated T cell suppression and tumor progression. c-Maf also serves as a metabolic checkpoint regulating the TCA cycle and UDP-GlcNAc biosynthesis, thus promoting M2-like macrophage polarization and activation. Additionally, c-Maf is highly expressed in tumor-associated macrophages (TAMs) and regulates TAM immunosuppressive function. Deletion of c-Maf specifically in myeloid cells results in reduced tumor burden with enhanced antitumor T cell immunity. Inhibition of c-Maf partly overcomes resistance to anti-PD-1 therapy in a subcutaneous LLC tumor model. Similarly, c-Maf is expressed in human M2 and tumor-infiltrating macrophages/monocytes as well as circulating monocytes of human non-small cell lung carcinoma (NSCLC) patients and critically regulates their immunosuppressive activity. The natural compound β-glucan downregulates c-Maf expression on macrophages, leading to enhanced antitumor immunity in mice. These findings establish a paradigm for immunosuppressive macrophage polarization and transcriptional regulation by c-Maf and suggest that c-Maf is a potential target for effective tumor immunotherapy.
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MESH Headings
- Animals
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/immunology
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/therapy
- Cell Line, Tumor
- Female
- Gene Expression Regulation, Neoplastic/immunology
- Humans
- Immunity, Cellular
- Lung Neoplasms/immunology
- Lung Neoplasms/pathology
- Lung Neoplasms/therapy
- Macrophage Activation
- Macrophages/immunology
- Macrophages/pathology
- Male
- Mice
- Mice, Knockout
- Monocytes/immunology
- Monocytes/pathology
- Neoplasms, Experimental/genetics
- Neoplasms, Experimental/immunology
- Neoplasms, Experimental/pathology
- Neoplasms, Experimental/therapy
- Proto-Oncogene Proteins c-maf/genetics
- Proto-Oncogene Proteins c-maf/immunology
- T-Lymphocytes/immunology
- T-Lymphocytes/pathology
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Affiliation(s)
- Min Liu
- Division of Immunotherapy, Hiram C. Polk, Jr., MD Department of Surgery, Immuno-Oncology Program, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky, USA
| | - Zan Tong
- Division of Immunotherapy, Hiram C. Polk, Jr., MD Department of Surgery, Immuno-Oncology Program, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky, USA
| | - Chuanlin Ding
- Division of Immunotherapy, Hiram C. Polk, Jr., MD Department of Surgery, Immuno-Oncology Program, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky, USA
| | - Fengling Luo
- Division of Immunotherapy, Hiram C. Polk, Jr., MD Department of Surgery, Immuno-Oncology Program, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky, USA
| | - Shouzhen Wu
- Division of Immunotherapy, Hiram C. Polk, Jr., MD Department of Surgery, Immuno-Oncology Program, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky, USA
| | - Caijun Wu
- Division of Immunotherapy, Hiram C. Polk, Jr., MD Department of Surgery, Immuno-Oncology Program, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky, USA
| | | | | | - Xiaoling Hu
- Division of Immunotherapy, Hiram C. Polk, Jr., MD Department of Surgery, Immuno-Oncology Program, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky, USA
| | - David Tieri
- Department of Anatomical Sciences and Neurobiology, and
| | - Eric C. Rouchka
- Department of Computer Engineering and Computer Science, University of Louisville, Louisville, Kentucky, USA
| | - Michito Hamada
- Department of Anatomy and Embryology, University of Tsukuba, Ibaraki, Japan
| | - Satoru Takahashi
- Department of Anatomy and Embryology, University of Tsukuba, Ibaraki, Japan
| | | | - Goetz Kloecker
- Division of Immunotherapy, Hiram C. Polk, Jr., MD Department of Surgery, Immuno-Oncology Program, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky, USA
| | - Huang-ge Zhang
- Department of Microbiology and Immunology, School of Medicine
| | - Michael Bousamra
- Department of Cardiovascular Thoracic Surgery, University of Louisville, Louisville, Kentucky, USA
| | | | | | - Jun Yan
- Division of Immunotherapy, Hiram C. Polk, Jr., MD Department of Surgery, Immuno-Oncology Program, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky, USA
- Department of Microbiology and Immunology, School of Medicine
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13
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Pham D, Bhandari S, Pinkston C, Oechsli M, Kloecker G. NSCLC patient "migration" for treatment: A retrospective analysis of patient characteristics, travel patterns, and survival differences. Curr Probl Cancer 2019; 44:100528. [PMID: 31771790 DOI: 10.1016/j.currproblcancer.2019.100528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Every year a significant population exists of those diagnosed with nonsmall cell lung cancer (NSCLC) who do not receive initial treatment upon diagnosis and then "migrate" to additional hospital before ultimately getting treatment. Migration to different hospitals may play a role in the decision to treat or not-to-treat, and we aimed to evaluate the potential factors that lead to treatment. METHODS A retrospective review of 6212 patients with NSCLC from 29 Kentucky hospital registries from 2012 to 2014 was performed. Variables collected included hospital accreditation status, age at diagnosis, stage, overall survival (OS), and insurance status. Hospital records were matched to Kentucky Cancer Registry records to determine the number of hospitals visited for treatment. RESULTS Most patients were treated at their initial hospital (73%). Of the remaining patients, 36% migrated to a different hospital where most received treatment (93%). Migrating to another hospital was associated with Stage I-III disease, younger age (66.4 vs 72.2 years), and longer OS (561 vs 157 days). Notably, migration was also associated with private insurance status and missing treatment modalities at the initial hospital. Treatment after migrating was associated with Stage I-II disease, younger age (65.8 vs 72.8 years), and longer OS (595 vs 153 days). After adjusting for confounders, treated migrating patients lived longer than initially treated patients (591 vs 505 days), especially among those with stage III (563 vs 495 days) and IV (379 vs 300 days) disease. CONCLUSION This analysis demonstrates a survival benefit for initially untreated patients with advanced disease who migrate to another hospital for treatment. Migration was associated with having private insurance, thus making it noteworthy of the relationship between NSCLC survival benefit and insurance status.
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Affiliation(s)
- Danh Pham
- Division of Hematology and Medical Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY
| | - Shruti Bhandari
- Division of Hematology and Medical Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY.
| | - Christina Pinkston
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY
| | - Malgorzata Oechsli
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY
| | - Goetz Kloecker
- Division of Hematology and Medical Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY
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14
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Mohanlal R, Sun Y, Kloecker G, Feinstein T, Shi Y, Han B, Bazhenova L, Du L, Huang L. P2.01-23 DUBLIN-3, a Phase (Ph) III Trial Comparing the Plinabulin (P)/Docetaxel(D) Combination with D Alone in Stage IIIb/IV NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Bhandari S, Tripathi P, Pham D, Pinkston C, Kloecker G. Performance of community-based lung cancer screening program in a Histoplasma endemic region. Lung Cancer 2019; 136:102-104. [PMID: 31479878 DOI: 10.1016/j.lungcan.2019.08.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Lung cancer screening with low dose computed-tomography (LDCT) is currently recommended for high-risk populations based on mortality benefit shown in the National Lung Screening Trial (NLST). This study evaluated performance of a community-based lung cancer screening program in a Histoplasma endemic region. MATERIALS AND METHODS Demographic and clinical information was collected through retrospective review of patients in the Lung Cancer Screening program of a Kentucky (Histoplasma endemic region) health system from 2016 and 2017. A positive LDCT screen is defined as Lung-RADS version 1.0 assessment categories 3 or 4. Patients characteristics, initial screening results and follow up were analyzed and compared to NLST results. RESULTS A total of 4500 LDCT screens were performed in 2016 (39%) and 2017 (61%) with 43% adherence rate to repeat annual screen in 2017. Mean age of patients was 64 years, with majority being females (54%) and current smokers (69%) with average 52-pack year smoking history. The rate of positive LDCT was 13.3% (600) varying based on baseline (14.6%) and annual (9.5%) screen. A total of 70 lung cancers were diagnosed among all positive LDCT screens (11.7%) with a false positive rate of 12%. CONCLUSIONS Baseline positive screens in our study are similar to NLST data with Lung-RADS criteria implementation (14.6% vs 13.6%, p = 0.15) despite being a Histoplasma endemic region. Our study shows a successful performance of a community-based lung cancer screening program in a Histoplasma endemic region.
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Affiliation(s)
- Shruti Bhandari
- University of Louisville, Division of Hematology and Medical Oncology, James Graham Brown Cancer Center, Louisville, KY, USA.
| | - Prashant Tripathi
- University of Louisville, Division of Infectious Disease, James Graham Brown Cancer Center, Louisville, KY, USA
| | - Danh Pham
- University of Louisville, Division of Hematology and Medical Oncology, James Graham Brown Cancer Center, Louisville, KY, USA
| | - Christina Pinkston
- University of Louisville, Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, Louisville, KY, USA
| | - Goetz Kloecker
- University of Louisville, Division of Hematology and Medical Oncology, James Graham Brown Cancer Center, Louisville, KY, USA
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16
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Reynolds SB, Hashmi H, Ngo P, Kloecker G. Rescue therapy for acute idiopathic thrombocytopenic purpura unresponsive to conventional treatment. BMJ Case Rep 2019; 12:12/1/bcr-2018-227717. [PMID: 30642865 DOI: 10.1136/bcr-2018-227717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 61-year-old woman with chronic lymphocytic leukaemia, with Richter's transformation to a diffuse, large, B-cell lymphoma, treated with six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone and in complete remission, presented to the hospital after her platelets were found to be 2×10³/µL in outpatient laboratory studies. She initially underwent a platelet transfusion without improvement. This was followed by 4 days of high-dose dexamethasone and intravenous immunoglobulin, which again yielded no meaningful effect. Even a single-dose rituximab failed to achieve a platelet increase after 5 days of monitoring. The patient was then given 2 mg of intravenous vincristine along with a high-dose of dexamethasone and IVIG and demonstrated substantial recovery in platelets to >50×10³/µL within 48 hours. This case study provides an overview of the current management strategies for idiopathic thrombocytopenic purpura that is unresponsive to conventional medical therapy and particularly sheds light on their therapeutic benefits and potential adverse effects.
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Affiliation(s)
- Samuel Benjamin Reynolds
- Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Hamza Hashmi
- Department of Hematology-Oncology, Louisville School of Medicine, Louisville, Kentucky, USA
| | - Phuong Ngo
- Department of Hematology-Oncology, Louisville School of Medicine, Louisville, Kentucky, USA
| | - Goetz Kloecker
- Department of Hematology-Oncology, Louisville School of Medicine, Louisville, Kentucky, USA
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17
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Bhandari S, Pham D, Pinkston C, Oechsli M, Kloecker G. P1.15-02 Migration Differences in Small Cell vs Non-Small Cell Lung Cancer. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Bhandari S, Pham D, Pinkston C, Oechsli M, Kloecker G. Timing of treatment in small cell lung cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy298.006] [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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19
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Ngo P, Pinkston C, Pham D, Kloecker G. P1.15-23 Factors Affecting Treatment in Non-Small Cell Lung Cancer Patients. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.955] [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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20
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Durm G, Althouse S, Sadiq A, Jalal S, Jabbour S, Zon R, Kloecker G, Fisher W, Reckamp K, Kio E, Langdon R, Adesunloye B, Gentzler R, Hanna N. OA01.07 Updated Results of a Phase II Trial of Concurrent Chemoradiation with Consolidation Pembrolizumab in Patients with Unresectable Stage III NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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21
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Pham D, Pinkston C, Oechsli M, Kong M, Rios-Perez J, Kloecker G. 4B.01 Lung Cancer Patients Migrate to Seek Better Care. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Byers LA, Horn L, Ghandi J, Kloecker G, Owonikoko T, Waqar SN, Krzakowski M, Cardnell RJ, Fujimoto J, Taverna P, Azab M, Camidge DR. A phase 2, open-label, multi-center study of amuvatinib in combination with platinum etoposide chemotherapy in platinum-refractory small cell lung cancer patients. Oncotarget 2017; 8:81441-81454. [PMID: 29113403 PMCID: PMC5655298 DOI: 10.18632/oncotarget.19888] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 06/08/2017] [Accepted: 07/09/2017] [Indexed: 11/25/2022] Open
Abstract
Background Amuvatinib (MP-470) is a multi-targeted kinase inhibitor with potent activity against c-Kit, synergistic with DNA-damaging agents. We evaluated amuvatinib in combination with platinum-etoposide (EP) chemotherapy by objective response rate, survival, and tolerability in platinum-refractory small cell lung cancer (SCLC) patients. Methods This study used a Simon 2-stage design requiring ≥3 centrally confirmed responses in the first 21 subjects. Subjects received EP with 300 mg amuvatinib orally three times daily in cycles of 21 days. A three-day amuvatinib run-in period before EP occurred in Cycle 1. Subjects received the same EP chemotherapy regimen given prior to progression/relapse. Results Among 23 subjects treated, we observed four PRs (17.4%) per RECIST 1.1, only two of which were centrally confirmed (8.7%, response duration 119, 151 days). Three subjects (13%) had confirmed stable disease. c-Kit H-score was ≥100 in two subjects whose respective durations of disease control were 151 and 256 days. Conclusions The addition of amuvatinib to EP chemotherapy in unselected, platinum-refractory SCLC did not meet the primary endpoint of ≥3 confirmed responses in stage 1. However, high c-Kit expression in two subjects with durable disease control suggests the potential for further study of amuvatinib in SCLC patients with high c-Kit expression.
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Affiliation(s)
| | - Leora Horn
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Goetz Kloecker
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | | | - Saiama Naheed Waqar
- Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA
| | - Maciej Krzakowski
- Centrum Onkologii-Instytut Im. M. Skłodowskiej-Curie w Warszawie, Warszawa, Poland
| | | | - Junya Fujimoto
- University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | | | | | - David Ross Camidge
- Anschutz Cancer Pavilion, University of Colorado Cancer Center, Aurora, CO, USA
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Khosravi F, Trainor PJ, Lambert C, Kloecker G, Wickstrom E, Rai SN, Panchapakesan B. Static micro-array isolation, dynamic time series classification, capture and enumeration of spiked breast cancer cells in blood: the nanotube-CTC chip. Nanotechnology 2016; 27:44LT03. [PMID: 27680886 PMCID: PMC5374058 DOI: 10.1088/0957-4484/27/44/44lt03] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We demonstrate the rapid and label-free capture of breast cancer cells spiked in blood using nanotube-antibody micro-arrays. 76-element single wall carbon nanotube arrays were manufactured using photo-lithography, metal deposition, and etching techniques. Anti-epithelial cell adhesion molecule (anti-EpCAM), Anti-human epithelial growth factor receptor 2 (anti-Her2) and non-specific IgG antibodies were functionalized to the surface of the nanotube devices using 1-pyrene-butanoic acid succinimidyl ester. Following device functionalization, blood spiked with SKBR3, MCF7 and MCF10A cells (100/1000 cells per 5 μl per device, 170 elements totaling 0.85 ml of whole blood) were adsorbed on to the nanotube device arrays. Electrical signatures were recorded from each device to screen the samples for differences in interaction (specific or non-specific) between samples and devices. A zone classification scheme enabled the classification of all 170 elements in a single map. A kernel-based statistical classifier for the 'liquid biopsy' was developed to create a predictive model based on dynamic time warping series to classify device electrical signals that corresponded to plain blood (control) or SKBR3 spiked blood (case) on anti-Her2 functionalized devices with ∼90% sensitivity, and 90% specificity in capture of 1000 SKBR3 breast cancer cells in blood using anti-Her2 functionalized devices. Screened devices that gave positive electrical signatures were confirmed using optical/confocal microscopy to hold spiked cancer cells. Confocal microscopic analysis of devices that were classified to hold spiked blood based on their electrical signatures confirmed the presence of cancer cells through staining for DAPI (nuclei), cytokeratin (cancer cells) and CD45 (hematologic cells) with single cell sensitivity. We report 55%-100% cancer cell capture yield depending on the active device area for blood adsorption with mean of 62% (∼12 500 captured off 20 000 spiked cells in 0.1 ml blood) in this first nanotube-CTC chip study.
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Affiliation(s)
- Farhad Khosravi
- Small Systems Laboratory, Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, MA 01609
| | - Patrick J Trainor
- Biostatistics Shared Facility, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40292
| | - Christopher Lambert
- Department of Chemistry & Biochemistry, Worcester Polytechnic Institute, Worcester, MA 01609
| | - Goetz Kloecker
- Medical Oncology and Hematology, Department of Medicine, University of Louisville, Louisville, KY 40292
| | - Eric Wickstrom
- Department of Biochemistry and Molecular Biology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19130, USA
| | - Shesh N Rai
- Biostatistics Shared Facility, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40292
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY 40292
| | - Balaji Panchapakesan
- Small Systems Laboratory, Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, MA 01609
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Srinivasamaharaj S, Salame BK, Rios-Perez J, Kloecker G, Perez CA. The role of alectinib in the treatment of advanced ALK-rearranged non-small-cell lung cancer. Expert Rev Anticancer Ther 2016; 16:1227-1233. [DOI: 10.1080/14737140.2016.1249857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Srividya Srinivasamaharaj
- Division of Medical Oncology and Hematology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Bilal Khameze Salame
- Division of Medical Oncology and Hematology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Jorge Rios-Perez
- Division of Medical Oncology and Hematology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Goetz Kloecker
- Division of Medical Oncology and Hematology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Cesar A. Perez
- Division of Medical Oncology and Hematology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
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25
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Rai SN, Trainor PJ, Khosravi F, Kloecker G, Panchapakesan B. Classification of biosensor time series using dynamic time warping: applications in screening cancer cells with characteristic biomarkers. ACTA ACUST UNITED AC 2016; 2016:21-29. [PMID: 27942497 PMCID: PMC5147752 DOI: 10.2147/oams.s104731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 11/23/2022]
Abstract
The development of biosensors that produce time series data will facilitate improvements in biomedical diagnostics and in personalized medicine. The time series produced by these devices often contains characteristic features arising from biochemical interactions between the sample and the sensor. To use such characteristic features for determining sample class, similarity-based classifiers can be utilized. However, the construction of such classifiers is complicated by the variability in the time domains of such series that renders the traditional distance metrics such as Euclidean distance ineffective in distinguishing between biological variance and time domain variance. The dynamic time warping (DTW) algorithm is a sequence alignment algorithm that can be used to align two or more series to facilitate quantifying similarity. In this article, we evaluated the performance of DTW distance-based similarity classifiers for classifying time series that mimics electrical signals produced by nanotube biosensors. Simulation studies demonstrated the positive performance of such classifiers in discriminating between time series containing characteristic features that are obscured by noise in the intensity and time domains. We then applied a DTW distance-based k-nearest neighbors classifier to distinguish the presence/absence of mesenchymal biomarker in cancer cells in buffy coats in a blinded test. Using a train–test approach, we find that the classifier had high sensitivity (90.9%) and specificity (81.8%) in differentiating between EpCAM-positive MCF7 cells spiked in buffy coats and those in plain buffy coats.
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Affiliation(s)
- Shesh N Rai
- Biostatistics Shared Facility, JG Brown Cancer Center, University of Louisville, KY, USA; Department of Bioinformatics and Biostatistics, University of Louisville, KY, USA
| | - Patrick J Trainor
- Department of Bioinformatics and Biostatistics, University of Louisville, KY, USA; Department of Medicine, University of Louisville, KY, USA
| | - Farhad Khosravi
- Small Systems Laboratory, Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, MA
| | - Goetz Kloecker
- Hematology and Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Balaji Panchapakesan
- Small Systems Laboratory, Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, MA
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Liu M, Luo F, Ding C, Albeituni S, Hu X, Ma Y, Cai Y, McNally L, Sanders MA, Jain D, Kloecker G, Bousamra M, Zhang HG, Higashi RM, Lane AN, Fan TWM, Yan J. Correction: Dectin-1 Activation by a Natural Product β-Glucan Converts Immunosuppressive Macrophages into an M1-like Phenotype. J Immunol 2016; 196:3968. [PMID: 27183653 DOI: 10.4049/jimmunol.1600345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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27
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Ma Y, Xiang D, Sun J, Ding C, Liu M, Hu X, Li G, Kloecker G, Zhang HG, Yan J. Correction: Targeting of Antigens to B Lymphocytes via CD19 as a Means for Tumor Vaccine Development. J Immunol 2016; 196:3969. [PMID: 27183654 DOI: 10.4049/jimmunol.1600344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Albeituni SH, Ding C, Liu M, Hu X, Luo F, Kloecker G, Bousamra M, Zhang HG, Yan J. Correction: Yeast-Derived Particulate β-Glucan Treatment Subverts the Suppression of Myeloid-Derived Suppressor Cells (MDSC) by Inducing Polymorphonuclear MDSC Apoptosis and Monocytic MDSC Differentiation to APC in Cancer. J I 2016; 196:3967. [DOI: 10.4049/jimmunol.1600346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Khosravi F, Trainor P, Rai SN, Kloecker G, Wickstrom E, Panchapakesan B. Label-free capture of breast cancer cells spiked in buffy coats using carbon nanotube antibody micro-arrays. Nanotechnology 2016; 27:13LT02. [PMID: 26901310 PMCID: PMC5065025 DOI: 10.1088/0957-4484/27/13/13lt02] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We demonstrate the rapid and label-free capture of breast cancer cells spiked in buffy coats using nanotube-antibody micro-arrays. Single wall carbon nanotube arrays were manufactured using photo-lithography, metal deposition, and etching techniques. Anti-epithelial cell adhesion molecule (EpCAM) antibodies were functionalized to the surface of the nanotube devices using 1-pyrene-butanoic acid succinimidyl ester functionalization method. Following functionalization, plain buffy coat and MCF7 cell spiked buffy coats were adsorbed on to the nanotube device and electrical signatures were recorded for differences in interaction between samples. A statistical classifier for the 'liquid biopsy' was developed to create a predictive model based on dynamic time warping to classify device electrical signals that corresponded to plain (control) or spiked buffy coats (case). In training test, the device electrical signals originating from buffy versus spiked buffy samples were classified with ∼100% sensitivity, ∼91% specificity and ∼96% accuracy. In the blinded test, the signals were classified with ∼91% sensitivity, ∼82% specificity and ∼86% accuracy. A heatmap was generated to visually capture the relationship between electrical signatures and the sample condition. Confocal microscopic analysis of devices that were classified as spiked buffy coats based on their electrical signatures confirmed the presence of cancer cells, their attachment to the device and overexpression of EpCAM receptors. The cell numbers were counted to be ∼1-17 cells per 5 μl per device suggesting single cell sensitivity in spiked buffy coats that is scalable to higher volumes using the micro-arrays.
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Affiliation(s)
- Farhad Khosravi
- Department of Mechanical Engineering, Small Systems Laboratory, Worcester Polytechnic Institute, Worcester, MA 01532, USA
| | - Patrick Trainor
- Department of Biostatistics, Biostatistics Shared Facility, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40292, USA
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY 40292, USA
| | - Shesh N Rai
- Department of Biostatistics, Biostatistics Shared Facility, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40292, USA
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY 40292, USA
| | - Goetz Kloecker
- Hematology and Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40292, USA
| | - Eric Wickstrom
- Department of Biochemistry and Molecular Biology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19130, USA
| | - Balaji Panchapakesan
- Department of Mechanical Engineering, Small Systems Laboratory, Worcester Polytechnic Institute, Worcester, MA 01532, USA
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30
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Albeituni SH, Ding C, Liu M, Hu X, Luo F, Kloecker G, Bousamra M, Zhang HG, Yan J. Yeast-Derived Particulate β-Glucan Treatment Subverts the Suppression of Myeloid-Derived Suppressor Cells (MDSC) by Inducing Polymorphonuclear MDSC Apoptosis and Monocytic MDSC Differentiation to APC in Cancer. J Immunol 2016; 196:2167-80. [PMID: 26810222 DOI: 10.4049/jimmunol.1501853] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 01/02/2016] [Indexed: 12/17/2022]
Abstract
Myeloid-derived suppressor cells (MDSC) are a heterogeneous population of immature myeloid cells that promote tumor progression. In this study, we demonstrated that activation of a C-type lectin receptor, dectin-1, in MDSC differentially modulates the function of different MDSC subsets. Yeast-derived whole β-glucan particles (WGP; a ligand to engage and activate dectin-1, oral treatment in vivo) significantly decreased tumor weight and splenomegaly in tumor-bearing mice with reduced accumulation of polymorphonuclear MDSC but not monocytic MDSC (M-MDSC), and decreased polymorphonuclear MDSC suppression in vitro through the induction of respiratory burst and apoptosis. On a different axis, WGP-treated M-MDSC differentiated into F4/80(+)CD11c(+) cells in vitro that served as potent APC to induce Ag-specific CD4(+) and CD8(+) T cell responses in a dectin-1-dependent manner. Additionally, Erk1/2 phosphorylation was required for the acquisition of APC properties in M-MDSC. Moreover, WGP-treated M-MDSC differentiated into CD11c(+) cells in vivo with high MHC class II expression and induced decreased tumor burden when inoculated s.c. with Lewis lung carcinoma cells. This effect was dependent on the dectin-1 receptor. Strikingly, patients with non-small cell lung carcinoma that had received WGP treatment for 10-14 d prior to any other treatment had a decreased frequency of CD14(-)HLA-DR(-)CD11b(+)CD33(+) MDSC in the peripheral blood. Overall, these data indicate that WGP may be a potent immune modulator of MDSC suppressive function and differentiation in cancer.
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Affiliation(s)
- Sabrin H Albeituni
- Department of Microbiology and Immunology, University of Louisville, Louisville, KY 40202
| | - Chuanlin Ding
- Division of Hematology and Medical Oncology, Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202; and
| | - Min Liu
- Division of Hematology and Medical Oncology, Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202; and
| | - Xiaoling Hu
- Division of Hematology and Medical Oncology, Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202; and
| | - Fengling Luo
- Division of Hematology and Medical Oncology, Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202; and
| | - Goetz Kloecker
- Division of Hematology and Medical Oncology, Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202; and
| | - Michael Bousamra
- Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY 40202
| | - Huang-ge Zhang
- Department of Microbiology and Immunology, University of Louisville, Louisville, KY 40202
| | - Jun Yan
- Department of Microbiology and Immunology, University of Louisville, Louisville, KY 40202; Division of Hematology and Medical Oncology, Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202; and
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31
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Liu M, Luo F, Ding C, Albeituni S, Hu X, Ma Y, Cai Y, McNally L, Sanders MA, Jain D, Kloecker G, Bousamra M, Zhang HG, Higashi RM, Lane AN, Fan TWM, Yan J. Dectin-1 Activation by a Natural Product β-Glucan Converts Immunosuppressive Macrophages into an M1-like Phenotype. J Immunol 2015; 195:5055-65. [PMID: 26453753 DOI: 10.4049/jimmunol.1501158] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 09/10/2015] [Indexed: 12/15/2022]
Abstract
Tumor-associated macrophages (TAM) with an alternatively activated phenotype have been linked to tumor-elicited inflammation, immunosuppression, and resistance to chemotherapies in cancer, thus representing an attractive target for an effective cancer immunotherapy. In this study, we demonstrate that particulate yeast-derived β-glucan, a natural polysaccharide compound, converts polarized alternatively activated macrophages or immunosuppressive TAM into a classically activated phenotype with potent immunostimulating activity. This process is associated with macrophage metabolic reprograming with enhanced glycolysis, Krebs cycle, and glutamine utilization. In addition, particulate β-glucan converts immunosuppressive TAM via the C-type lectin receptor dectin-1-induced spleen tyrosine kinase-Card9-Erk pathway. Further in vivo studies show that oral particulate β-glucan treatment significantly delays tumor growth, which is associated with in vivo TAM phenotype conversion and enhanced effector T cell activation. Mice injected with particulate β-glucan-treated TAM mixed with tumor cells have significantly reduced tumor burden with less blood vascular vessels compared with those with TAM plus tumor cell injection. In addition, macrophage depletion significantly reduced the therapeutic efficacy of particulate β-glucan in tumor-bearing mice. These findings have established a new paradigm for macrophage polarization and immunosuppressive TAM conversion and shed light on the action mode of β-glucan treatment in cancer.
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Affiliation(s)
- Min Liu
- Division of Hematology/Oncology, Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202; Department of Immunology, Wuhan University School of Medicine, Wuhan 430072, China
| | - Fengling Luo
- Division of Hematology/Oncology, Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202; Department of Immunology, Wuhan University School of Medicine, Wuhan 430072, China
| | - Chuanlin Ding
- Division of Hematology/Oncology, Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202
| | - Sabrin Albeituni
- Department of Microbiology and Immunology, University of Louisville School of Medicine, Louisville, KY 40202
| | - Xiaoling Hu
- Division of Hematology/Oncology, Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202
| | - Yunfeng Ma
- Division of Hematology/Oncology, Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202
| | - Yihua Cai
- Division of Hematology/Oncology, Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202
| | - Lacey McNally
- Division of Hematology/Oncology, Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202
| | - Mary Ann Sanders
- Department of Pathology, University of Louisville School of Medicine, Louisville, KY 40202
| | - Dharamvir Jain
- Division of Hematology/Oncology, Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202
| | - Goetz Kloecker
- Division of Hematology/Oncology, Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202
| | - Michael Bousamra
- Department of Cardiovascular Thoracic Surgery, University of Louisville, Louisville, KY 40202
| | - Huang-ge Zhang
- Department of Microbiology and Immunology, University of Louisville School of Medicine, Louisville, KY 40202
| | - Richard M Higashi
- Department of Chemistry, University of Louisville, Louisville, KY 40202; and
| | - Andrew N Lane
- Division of Hematology/Oncology, Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202; Department of Chemistry, University of Louisville, Louisville, KY 40202; and Center for Regulatory and Environmental Analytical Metabolomics, University of Louisville, Louisville, KY 40202
| | - Teresa W-M Fan
- Department of Chemistry, University of Louisville, Louisville, KY 40202; and Center for Regulatory and Environmental Analytical Metabolomics, University of Louisville, Louisville, KY 40202
| | - Jun Yan
- Division of Hematology/Oncology, Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202; Department of Microbiology and Immunology, University of Louisville School of Medicine, Louisville, KY 40202;
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Bruner A, Potts M, Schacht M, Hubert M, Vyleta MS, Kloecker G, Sharma VR, Redman RA, Coldwell DM. Treatment of metastatic bone tumors in the pelvis with bipolar radiofrequency ablation with and without PMMA cement placement. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e20543] [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)
| | | | | | | | | | | | - Vivek R. Sharma
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY
| | - Rebecca A. Redman
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY
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Abdolmohammadi A, Sears W, Rai S, Pan J, Alexander J, Kloecker G. Survey of primary care physicians on therapeutic approaches to lung and breast cancers. South Med J 2014; 107:437-42. [PMID: 25010586 DOI: 10.14423/smj.0000000000000134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Primary care physicians (PCPs) are an important part of the decision-making process in the care of patients with cancer. The survey discussed herein evaluates what percentage of academic and community PCPs recognize benefits from systemic therapy in lung and breast cancers. METHODS PCPs were surveyed regarding their beliefs toward systemic therapy in early- and late-stage lung and breast cancers and were asked to rate the importance of specific factors that influence their referral decisions. RESULTS A total of 3444 surveys were distributed, and 316 physicians (9.1%) responded: 89 academic physicians (28%) and 227 nonacademic physicians (72%). The rate of returned surveys was equal by specialty. A total of 57%, 42.1% in lung cancer and 72.6 % in breast cancer (P < 0.001) of PCPs, believe in the curative effect of systemic therapy in early stages. Sixty-six percent (58.2% in lung cancer and 75.5% in breast cancer [P < 0.001]) believe in improved disease-free survival. Although 82% believe that systemic therapy can prevent symptoms and prolong life in advanced asymptomatic disease, half (lung cancer 50.8%, breast cancer 53.1% [P = 0.5]) of the PCPs would refer symptomatic patients with advanced disease to palliative care before referral to an oncologist. The type and stage of cancer, as well as the patient's desire or reluctance to be referred to an oncologist were rated by PCPs as the most important reasons to refer patients to an oncologist (P < 0.0001). CONCLUSIONS Although a majority of PCPs in academia and the community acknowledge the positive effect of chemotherapy, the benefit of systemic therapy for early-stage lung cancer is less appreciated as compared with breast cancer. Patients' preferences influence PCPs significantly in the decision to refer patients to an oncologist.
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Affiliation(s)
- Alireza Abdolmohammadi
- From the Departments of Internal Medicine and Hematology/Oncology, University of Louisville, Louisville, Kentucky
| | - William Sears
- From the Departments of Internal Medicine and Hematology/Oncology, University of Louisville, Louisville, Kentucky
| | - Sheth Rai
- From the Departments of Internal Medicine and Hematology/Oncology, University of Louisville, Louisville, Kentucky
| | - Jianmin Pan
- From the Departments of Internal Medicine and Hematology/Oncology, University of Louisville, Louisville, Kentucky
| | - Joseph Alexander
- From the Departments of Internal Medicine and Hematology/Oncology, University of Louisville, Louisville, Kentucky
| | - Goetz Kloecker
- From the Departments of Internal Medicine and Hematology/Oncology, University of Louisville, Louisville, Kentucky
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Bhatt N, Dutta N, Rios J, McCullough K, Silverman C, Woo S, El-Ghamry M, Kloecker G, Dunlap N. Evaluation of Prognostic Variables in Patients With Small Cell Lung Cancer: The Role of Volumetric Response to Initial Therapy in Determining the Benefit of Prophylactic Cranial Irradiation. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1880] [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: 10/24/2022]
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35
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Yan J, Kloecker G, Fleming C, Bousamra M, Hansen R, Hu X, Ding C, Cai Y, Xiang D, Donninger H, Eaton JW, Clark GJ. Human polymorphonuclear neutrophils specifically recognize and kill cancerous cells. Oncoimmunology 2014; 3:e950163. [PMID: 25610737 DOI: 10.4161/15384101.2014.950163] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 06/05/2014] [Indexed: 01/21/2023] Open
Abstract
Polymorphonuclear neutrophils (PMNs), the main effectors of the innate immune system, have rarely been considered as an anticancer therapeutic tool. However, recent investigations using animal models and preliminary clinical studies have highlighted the potential antitumor efficacy of PMNs. In the current study, we find that PMNs from some healthy donors naturally have potent cancer-killing activity against 4 different human cancer cell lines. The killing activity appears to be cancer cell-specific since PMNs did not kill primary normal epithelial cells or an immortalized breast epithelial cell line. Transfecting the immortalized mammary cells with plasmids expressing activated forms of the rat sarcoma viral oncogene homolog (Ras) and teratocarcinoma oncogene 21 (TC21) oncogenes was sufficient to provoke aggressive attack by PMNs. However, transfection with activated Ras-related C3 botulinum toxin substrate (Rac1) was ineffective, suggesting specificity in PMN-targeting of neoplastic cells. Furthermore, PMNs from lung cancer patients were also found to exhibit relatively poor cancer-killing activity compared to the cytolytic activity of the average healthy donor. Taken together, our results suggest that PMN-based treatment regimens may represent a paradigm shift in cancer immunotherapy that may be easily introduced into the clinic to benefit a subset of patients with PMN-vulnerable tumors.
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Key Words
- BEN, benign ethnic neutropenia
- DBL, proto-oncogene DBL
- DPI, diphenyleneiodonium
- E:T, effector:target
- G-CSF, granulocyte-colony stimulating factor
- GM-CSF, granulocyte macrophage-colony stimulating factor
- GVHD, graft-versus-host disease
- H-Ras, Harvey rat sarcoma viral oncogene homolog
- MEK, mitogen-activated protein kinase kinase
- NADPH, nicotinamide adenine dinucleotide phosphate
- NBT, nitroblue tetrazolium
- NSCLC, non-small cell lung carcinoma
- PI3 kinase, phosphoinositide 3-kinase
- PMN, polymorphonuclear neutrophils
- ROS, reactive oxygen species
- Rac1, Ras-related C3 botulinum toxin substrate 1
- RhoA, Ras homolog family member A
- TC-21, teratocarcinoma oncogene TC21
- TGFβ, transforming growth factor
- cytotoxicity
- mAb, monoclonal antibody
- mTOR, mammalian target of rapamycin
- neutrophils
- oncogene
- tumor cells
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Affiliation(s)
- Jun Yan
- Tumor Immunobiology Program; James Graham Brown Cancer Center; Department of Medicine; University of Louisville ; Louisville, KY USA ; Division of Hematology/Oncology; James Graham Brown Cancer Center; Department of Medicine; University of Louisville ; Louisville, KY USA
| | - Goetz Kloecker
- Division of Hematology/Oncology; James Graham Brown Cancer Center; Department of Medicine; University of Louisville ; Louisville, KY USA
| | - Chris Fleming
- Tumor Immunobiology Program; James Graham Brown Cancer Center; Department of Medicine; University of Louisville ; Louisville, KY USA
| | - Michael Bousamra
- Department of Cardiovascular Thoracic Surgery; University of Louisville ; Louisville, KY USA
| | - Richard Hansen
- Tumor Immunobiology Program; James Graham Brown Cancer Center; Department of Medicine; University of Louisville ; Louisville, KY USA
| | - Xiaoling Hu
- Tumor Immunobiology Program; James Graham Brown Cancer Center; Department of Medicine; University of Louisville ; Louisville, KY USA
| | - Chuanlin Ding
- Tumor Immunobiology Program; James Graham Brown Cancer Center; Department of Medicine; University of Louisville ; Louisville, KY USA
| | - Yihua Cai
- Tumor Immunobiology Program; James Graham Brown Cancer Center; Department of Medicine; University of Louisville ; Louisville, KY USA
| | - Dong Xiang
- Division of Hematology/Oncology; James Graham Brown Cancer Center; Department of Medicine; University of Louisville ; Louisville, KY USA
| | - Howard Donninger
- Division of Hematology/Oncology; James Graham Brown Cancer Center; Department of Medicine; University of Louisville ; Louisville, KY USA ; Molecular Targets Program; James Graham Brown Cancer Center; Department of Medicine; University of Louisville ; Louisville, KY USA
| | - John W Eaton
- Division of Hematology/Oncology; James Graham Brown Cancer Center; Department of Medicine; University of Louisville ; Louisville, KY USA ; Molecular Targets Program; James Graham Brown Cancer Center; Department of Medicine; University of Louisville ; Louisville, KY USA
| | - Geoffrey J Clark
- Division of Hematology/Oncology; James Graham Brown Cancer Center; Department of Medicine; University of Louisville ; Louisville, KY USA ; Molecular Targets Program; James Graham Brown Cancer Center; Department of Medicine; University of Louisville ; Louisville, KY USA ; Department of Pharmacology and Toxicology; University of Louisville ; Louisville, KY USA
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Mezera M, Chandrasekhar M, Kloecker G, Berkel VV, Bousamra M, Dunlap NE. Evaluating patterns of failure and salvage therapy for patients treated with primary stereotactic body radiation therapy for early stage non-small cell lung cancer. ACTA ACUST UNITED AC 2014. [DOI: 10.5430/jst.v4n2p4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Khosravi F, King B, Rai S, Kloecker G, Wickstrom E, Panchapakesan B. Nanotube Devices for Digital Profiling: A focus on cancer biomarkers and circulating tumor cells. IEEE Nanotechnology Mag 2013. [DOI: 10.1109/mnano.2013.2289692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ma Y, Xiang D, Sun J, Ding C, Liu M, Hu X, Li G, Kloecker G, Zhang HG, Yan J. Targeting of antigens to B lymphocytes via CD19 as a means for tumor vaccine development. J Immunol 2013; 190:5588-99. [PMID: 23630363 PMCID: PMC3660458 DOI: 10.4049/jimmunol.1203216] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Ab therapy against surface Ags on tumor cells has demonstrated significant efficacy for some cancers. However, it is costly and patients frequently develop acquired resistance over time. In cases of Ab therapy resistance, T cell responses have been shown to be essential in controlling disease progression. Thus, vaccination that generates a sustained Ab response as well as a T cell response may be more effective and economical. In this article, we have developed a vaccination strategy by targeting protein Ags to B cells via a CD19 single-chain variable fragment miniAb. Using the tumor-associated Ag her-2/neu extracellular domain, we showed that the coengagement of CD19 and BCR induced full B cell activation to produce a high titer of Abs and enhanced CD4 Th2 response and CD8 T cell activation and differentiation. These Abs competitively inhibited humanized her-2/neu Ab binding and were capable of activating the complement and inhibiting human breast cancer growth in vitro. Therapeutic efficacy was demonstrated in vivo using murine mammary carcinoma models. Furthermore, four different extracellular domains of her-2/neu could be targeted to B cells to generate Abs against particular domains with different antitumor properties. This approach may offer a new avenue for vaccine development with significantly lower cost, which may be of use not only for cancer therapy but also for infectious agents.
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Affiliation(s)
- Yunfeng Ma
- Tumor Immunobiology Program, James Graham Brown Cancer Center, University of Louisville School of Medicine, U.S.A
- Division of Hematology/Oncology, Department of Medicine, University of Louisville School of Medicine, U.S.A
| | - Dong Xiang
- Tumor Immunobiology Program, James Graham Brown Cancer Center, University of Louisville School of Medicine, U.S.A
- Division of Hematology/Oncology, Department of Medicine, University of Louisville School of Medicine, U.S.A
- Division of Hematology and Medical Oncology, Ellis Fischel Cancer Center, University of Missouri School of Medicine, U.S.A
| | - Jinwen Sun
- Tumor Immunobiology Program, James Graham Brown Cancer Center, University of Louisville School of Medicine, U.S.A
- Department of General Surgery & Surgical Oncology, Beijing Meitan General Hospital, P.R. China
| | - Chuanlin Ding
- Tumor Immunobiology Program, James Graham Brown Cancer Center, University of Louisville School of Medicine, U.S.A
- Division of Hematology/Oncology, Department of Medicine, University of Louisville School of Medicine, U.S.A
| | - Min Liu
- Tumor Immunobiology Program, James Graham Brown Cancer Center, University of Louisville School of Medicine, U.S.A
- Division of Hematology/Oncology, Department of Medicine, University of Louisville School of Medicine, U.S.A
| | - Xiaoling Hu
- Tumor Immunobiology Program, James Graham Brown Cancer Center, University of Louisville School of Medicine, U.S.A
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Goetz Kloecker
- Division of Hematology/Oncology, Department of Medicine, University of Louisville School of Medicine, U.S.A
| | - Huang-ge Zhang
- Tumor Immunobiology Program, James Graham Brown Cancer Center, University of Louisville School of Medicine, U.S.A
- Department of Microbiology and Immunology, University of Louisville School of Medicine, U.S.A
| | - Jun Yan
- Tumor Immunobiology Program, James Graham Brown Cancer Center, University of Louisville School of Medicine, U.S.A
- Division of Hematology/Oncology, Department of Medicine, University of Louisville School of Medicine, U.S.A
- Department of Microbiology and Immunology, University of Louisville School of Medicine, U.S.A
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Xiang D, Zhang B, Doll D, Shen K, Kloecker G, Freter C. Lung cancer screening: from imaging to biomarker. Biomark Res 2013; 1:4. [PMID: 24252206 PMCID: PMC3776246 DOI: 10.1186/2050-7771-1-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 09/27/2012] [Indexed: 01/02/2023] Open
Abstract
Despite several decades of intensive effort to improve the imaging techniques for lung cancer diagnosis and treatment, primary lung cancer is still the number one cause of cancer death in the United States and worldwide. The major causes of this high mortality rate are distant metastasis evident at diagnosis and ineffective treatment for locally advanced disease. Indeed, approximately forty percent of newly diagnosed lung cancer patients have distant metastasis. Currently, the only potential curative therapy is surgical resection of early stage lung cancer. Therefore, early detection of lung cancer could potentially increase the chance of cure by surgery and underlines the importance of screening and detection of lung cancer. In the past fifty years, screening of lung cancer by chest X-Ray (CXR), sputum cytology, computed tomography (CT), fluorescence endoscopy and low-dose spiral CT (LDCT) has not improved survival except for the recent report in 2010 by the National Lung Screening Trial (NLST), which showed a 20 percent mortality reduction in high risk participants screened with LDCT compared to those screened with CXRs. Furthermore, serum biomarkers for detection of lung cancer using free circulating DNA and RNA, exosomal microRNA, circulating tumor cells and various lung cancer specific antigens have been studied extensively and novel screening methods are being developed with encouraging results. The history of lung cancer screening trials using CXR, sputum cytology and LDCT, as well as results of trials involving various serum biomarkers, are reviewed herein.
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Affiliation(s)
- Dong Xiang
- Division of Hematology and Medical Oncology, Ellis Fischel Cancer Center, University of Missouri, Columbia, MO, USA.
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40
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Kloecker G, Taylor C, Vinayek N, Taylor D. Exosomal Long Non-Coding RNA (LNCRNA) in Lung Cancer. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32740-x] [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: 10/25/2022] Open
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41
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Kloecker G, King B, Panchapakesan B. Carbon Nanotube Devices for the Detection Of Circulating Tumor Cells. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32784-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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42
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Kloecker G, Zhang, Rabinowits, Laber. Effect of zoledronic acid on tartrate-resistant acid phosphatase isoform type 5b and other bone markers in lung cancer patients with bone metastases. PLMI 2012. [DOI: 10.2147/plmi.s28837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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43
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Kloecker G, Kayali, Janjua, Laber, Miller. Phase II trial of second-line erlotinib and digoxin for nonsmall cell lung cancer (NSCLC). OAJCT 2011. [DOI: 10.2147/oajct.s16347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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44
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Panchapakesan B, Caprara R, Velasco V, Loomis J, King B, Xu P, Burkhead T, Sethu P, Stallons LJ, McGregor WG, Rai SN, Kloecker G, Wickstrom E. Micro- and nanotechnology approaches for capturing circulating tumor cells. Cancer Nanotechnol 2010; 1:3-11. [PMID: 26069475 PMCID: PMC4452034 DOI: 10.1007/s12645-010-0007-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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] [Received: 08/11/2010] [Accepted: 10/01/2010] [Indexed: 12/23/2022] Open
Abstract
Circulating tumor cells (CTC) are cells that have detached from primary tumors and circulate in the bloodstream where they are carried to other organs, leading to seeding of new tumors and metastases. CTC have been known to exist in the bloodstream for more than a century. With recent progress in the area of micro- and nanotechnology, it has been possible to adopt new approaches in CTC research. Microscale and nanoscale studies can throw some light on the time course of CTC appearance in blood and CTC overexpression profiles for cancer-related markers and galvanize the development of drugs to block metastases. CTC counts could serve as endpoint biomarkers and as prognostic markers for patients with a metastatic disease. This paper reviews some of the recent researches on using micro- and nanotechnology to capture and profile CTC.
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Affiliation(s)
- Balaji Panchapakesan
- Small Systems Laboratory, Department of Mechanical Engineering, University of Louisville, Louisville, KY 40292 USA
| | - Robert Caprara
- Small Systems Laboratory, Department of Mechanical Engineering, University of Louisville, Louisville, KY 40292 USA
| | - Vanessa Velasco
- Small Systems Laboratory, Department of Mechanical Engineering, University of Louisville, Louisville, KY 40292 USA
| | - James Loomis
- Small Systems Laboratory, Department of Mechanical Engineering, University of Louisville, Louisville, KY 40292 USA
| | - Ben King
- Small Systems Laboratory, Department of Mechanical Engineering, University of Louisville, Louisville, KY 40292 USA
| | - Peng Xu
- Small Systems Laboratory, Department of Mechanical Engineering, University of Louisville, Louisville, KY 40292 USA
| | - Tom Burkhead
- Department of Bioengineering, University of Louisville, Louisville, KY 40292 USA
| | - Palaniappan Sethu
- Department of Bioengineering, University of Louisville, Louisville, KY 40292 USA
| | - L Jay Stallons
- Department of Pharmacology and Toxicology, University of Louisville, Louisville, KY 40292 USA
| | - W Glenn McGregor
- Department of Pharmacology and Toxicology, University of Louisville, Louisville, KY 40292 USA
| | - Shesh N Rai
- Department of Bioinformatics & Biostatistics and Biostatistics Shared Facility, James Graham Brown Cancer Center, 505 S. Hancock Street, Room 211, Louisville, KY 40202 USA
| | - Goetz Kloecker
- Department of Hematology and Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40292 USA
| | - Eric Wickstrom
- Department of Biochemistry and Molecular Biology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107 USA
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45
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Kloecker G, Civelek C, Janjua M. Lung-cancer staging with PET-CT. N Engl J Med 2009; 361:1607; author reply 1608. [PMID: 19842247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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46
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Fan TWM, Lane AN, Higashi RM, Bousamra M, Kloecker G, Miller DM. Metabolic profiling identifies lung tumor responsiveness to erlotinib. Exp Mol Pathol 2009; 87:83-6. [PMID: 19409891 DOI: 10.1016/j.yexmp.2009.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Accepted: 04/27/2009] [Indexed: 10/20/2022]
Abstract
A subtype of non-small cell lung cancer, bronchioalveolar adenocarcinoma (BAC), is more prevalent in Asian female non-smokers, and is more likely to respond to treatment with tyrosine kinase inhibitors such as erlotinib and gefitinib. Nuclear magnetic resonance and mass spectrometry-based metabolomic analysis of extracts from two different lung lesions and surrounding non-cancerous tissues of a BAC patient showed novel protein and phospholipid-associated metabolic differences that correlated with tumor development as well as PET and erlotinib sensitivity.
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Affiliation(s)
- Teresa W-M Fan
- Department of Chemistry University of Louisville, Louisville, KY 40208, USA
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47
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Bousamra M, Kloecker G, Herbig S. Drive cancer out: a physician-led anti-smoking program directed at teens and adolescents. J Ky Med Assoc 2008; 106:561-565. [PMID: 19130873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Kentucky is among the states with the highest smoking-related mortality and youth smoking rates. Drive Cancer Out is a physician-led program that assesses and attempts to influence health literacy among Kentucky adolescents. Surveys on fifth-grade students identify social risk factors for smoking initiation and propose methods to decrease the rate of smoking among teenagers.
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Abstract
PURPOSE The purpose of this study was to evaluate the quality of the medical evidence available to the clinician in the practice of hematology/oncology. METHODS We selected 14 neoplastic hematologic disorders and identified 154 clinically important patient management decision/interventions, ranging from initial treatment decisions to those made for the treatment of recurrent or refractory disease. We also performed a search of the scientific literature for the years 1966 through 1996 to identify all randomized controlled trials in hematology/oncology. RESULTS We identified 783 randomized controlled trials (level 1 evidence) pertaining to 37 (24%) of the decision/interventions. An additional 32 (21%) of the decision/interventions were supported by evidence from single arm prospective studies (level 2 evidence). However, only retrospective or anecdotal evidence (level 3 evidence) was available to support 55% of the identified decision/interventions. In a retrospective review of the decision/interventions made in the management of 255 consecutive patients, 78% of the initial decision/interventions in the management of newly diagnosed hematologic/oncologic disorders could have been based on level 1 evidence. However, more than half (52%) of all the decision/interventions made in the management of these 255 patients were supported only by level 2 or 3 evidence. CONCLUSIONS We conclude that level 1 evidence to support the development of practice guidelines is available primarily for initial decision/interventions of newly diagnosed diseases. Level 1 evidence to develop guidelines for the management of relapsed or refractory malignant diseases is currently lacking.
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Affiliation(s)
- B Djulbegovic
- Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Kentucky, USA
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