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Rabinowits G, Homsi J, Nikanjam M, Gentry R, Strasswimmer J, Venna S, Migden M, Chandra S, Ruiz E, Zhang H, McGinniss J, Seluzhytsky A, Desai J. 1094P Demographics, prior therapies and reasons for cemiplimab treatment: Prospective cemiplimAb-rwlc survivorship and epidemiology (C.A.S.E.) study in patients with advanced cutaneous squamous cell carcinoma (CSCC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1218] [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: 10/23/2022] Open
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Chmielowski B, Gordon M, Buchbinder E, Sullivan R, Cohen J, Curti B, Davar D, Homsi J, Komatsubara K, Lara-Guerra H, Alters S, Ferrati S, Eckert S, Rowlinson S, Wooldridge J, Ribas A, Carvajal R. Initial cohort expansion results of sustained arginine depletion with pegzilarginase in melanoma patients in a phase I advanced solid tumor trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy289.025] [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: 11/12/2022] Open
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Hersh EM, Del Vecchio M, Brown MP, Kefford R, Loquai C, Testori A, Bhatia S, Gutzmer R, Conry R, Haydon A, Robert C, Ernst S, Homsi J, Grob JJ, Kendra K, Agarwala SS, Li M, Clawson A, Brachmann C, Karnoub M, Elias I, Renschler MF, Hauschild A. A randomized, controlled phase III trial of nab-Paclitaxel versus dacarbazine in chemotherapy-naïve patients with metastatic melanoma. Ann Oncol 2015; 26:2267-74. [PMID: 26410620 PMCID: PMC6279094 DOI: 10.1093/annonc/mdv324] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [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: 12/09/2014] [Revised: 05/08/2015] [Accepted: 07/21/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The efficacy and safety of nab-paclitaxel versus dacarbazine in patients with metastatic melanoma was evaluated in a phase III randomized, controlled trial. PATIENTS AND METHODS Chemotherapy-naïve patients with stage IV melanoma received nab-paclitaxel 150 mg/m(2) on days 1, 8, and 15 every 4 weeks or dacarbazine 1000 mg/m(2) every 3 weeks. The primary end point was progression-free survival (PFS) by independent radiologic review; the secondary end point was overall survival (OS). RESULTS A total of 529 patients were randomized to nab-paclitaxel (n = 264) or dacarbazine (n = 265). Baseline characteristics were well balanced. The majority of patients were men (66%), had an Eastern Cooperative Oncology Group status of 0 (71%), and had M1c stage disease (65%). The median PFS (primary end point) was 4.8 months with nab-paclitaxel and 2.5 months with dacarbazine [hazard ratio (HR), 0.792; 95.1% confidence interval (CI) 0.631-0.992; P = 0.044]. The median OS was 12.6 months with nab-paclitaxel and 10.5 months with dacarbazine (HR, 0.897; 95.1% CI 0.738-1.089; P = 0.271). Independently assessed overall response rate was 15% versus 11% (P = 0.239), and disease control rate (DCR) was 39% versus 27% (P = 0.004) for nab-paclitaxel versus dacarbazine, respectively. The most common grade ≥3 treatment-related adverse events were neuropathy (nab-paclitaxel, 25% versus dacarbazine, 0%; P < 0.001), and neutropenia (nab-paclitaxel, 20% versus dacarbazine, 10%; P = 0.004). There was no correlation between secreted protein acidic and rich in cysteine (SPARC) status and PFS in either treatment arm. CONCLUSIONS nab-Paclitaxel significantly improved PFS and DCR compared with dacarbazine, with a manageable safety profile.
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Affiliation(s)
- E M Hersh
- Department of Medicine, Arizona Cancer Center, Tucson, USA
| | - M Del Vecchio
- Department of Medical Oncology, Fondazione IRCCS National Tumor Institute, Milan, Italy
| | - M P Brown
- Cancer Clinical Trials Unit, Royal Adelaide Hospital and School of Medicine, University of Adelaide, Adelaide
| | - R Kefford
- Sydney West Cancer Trials Centre/Westmead Hospital and Melanoma Institute Australia, University of Sydney, North Sydney, Australia
| | - C Loquai
- Department of Dermatology, University of Mainz, Mainz, Germany
| | - A Testori
- Melanoma and Muscle Cutaneous Sarcoma Division, European Institute of Oncology, Milan, Italy
| | - S Bhatia
- Department of Medicine, Seattle Cancer Care Alliance, Seattle, USA
| | - R Gutzmer
- Department of Dermatology and Oncology, Hannover Medical School, Hannover, Germany
| | - R Conry
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, USA
| | - A Haydon
- Department of Medical Oncology, Alfred Hospital, Melbourne, Australia
| | - C Robert
- Demartology Unit, Department of Medicine, The Gustave Roussy Cancer Institute, Villejuif, France
| | - S Ernst
- Department of Medical Oncology, London Health Sciences Center-London Regional Cancer Program, London, Canada
| | - J Homsi
- Department of Medical Oncology, Banner MD Anderson Cancer Center, Gilbert, USA
| | - J J Grob
- Department of Dermatology, Timone Hospital, APHM and Aix-Marseille University, Marseille, France
| | - K Kendra
- Department of Internal Medicine, Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus
| | - S S Agarwala
- Department of Hematology and Oncology, St Luke's Cancer Center and Temple University, Bethlehem
| | - M Li
- Biometrics and Data Operations/Translational Medicine/Biometrics and Data Operations/Clinical Research & Development/Global Medical Affairs, Celgene Corporation, Summit, USA
| | - A Clawson
- Biometrics and Data Operations/Translational Medicine/Biometrics and Data Operations/Clinical Research & Development/Global Medical Affairs, Celgene Corporation, Summit, USA
| | - C Brachmann
- Biometrics and Data Operations/Translational Medicine/Biometrics and Data Operations/Clinical Research & Development/Global Medical Affairs, Celgene Corporation, Summit, USA
| | - M Karnoub
- Biometrics and Data Operations/Translational Medicine/Biometrics and Data Operations/Clinical Research & Development/Global Medical Affairs, Celgene Corporation, Summit, USA
| | - I Elias
- Biometrics and Data Operations/Translational Medicine/Biometrics and Data Operations/Clinical Research & Development/Global Medical Affairs, Celgene Corporation, Summit, USA
| | - M F Renschler
- Biometrics and Data Operations/Translational Medicine/Biometrics and Data Operations/Clinical Research & Development/Global Medical Affairs, Celgene Corporation, Summit, USA
| | - A Hauschild
- Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
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D’Asta F, Homsi J, Clark P, Buffalo M, Melandri D, Carboni A, Pinzauti E, Graziano A, Masellis A, Bussolin L, Messineo A. Introducing the Advanced Burn Life Support (ABLS) course in Italy. Burns 2014; 40:475-9. [DOI: 10.1016/j.burns.2013.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
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Patel SP, Bedikian AY, Papadopoulos NE, Hwu W, Kim KB, Homsi J, Davies MA, Woodman SE, Radvanyi LG, Woodard K, Mahoney S, Hwu P. Ipilimumab plus temozolomide in metastatic melanoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Dorkhom SJ, Kim J, Lazar AJF, Davies MA, Homsi J, Papadopoulos NE, Hwu W, Bedikian AY, Woodman SE, Patel SP, Hwu P, Kim KB. BRAF, NRAS, and KIT mutational analysis of spindle cell melanoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8589] [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: 11/20/2022] Open
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Papadopoulos NE, Hwu W, Cain S, Posada L, Kim KB, Homsi J, Bedikian AY, Davies MA, Hwu P. Phase I trial of temozolomide, thalidimide, and lomustine in patients with metastatic melanoma in the brain. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Noor R, Wei C, Papadopoulos NE, Kim KB, Hwu W, Davies MA, Hwu P, Homsi J, McIntyre SE, Bedikian AY. Frequency of radiologically confirmed brain metastasis from time of diagnosis of stage IV disease in patients with melanoma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e19012] [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: 11/20/2022] Open
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Alvarado GC, Papadopoulos NE, Hwu W, Bedikian AY, Homsi J, Myers J, Bronstein Y, Bassett RL, Hwu P, Kim KB. The value of surveillance computed tomography scans of the pelvis in patients with head and neck primary melanomas. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e19035] [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: 11/20/2022] Open
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Bedikian AY, Sato T, Kim KB, Papadopoulos NE, Hwu W, Homsi J, Davies M, Cheung C, Imperiale SM, Prasad P, Hwu P. Phase II study of vincristine sulfate liposomes injection in patients with metastatic uveal melanoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9067] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9067 Background: Preclinical and clinical studies showed that liposomal encapsulation of vincristine sulfate (VCR) results in increased drug circulation time and accumulation of VCR at the tumor site. Marqibo has been administered safely at 2.25 mg/m2, a dose exceeding that typically employed for VCR ( dose capped at 2 mg), with tolerable clinical toxicities consistent with VCR. Of the 27 previously treated patients with metastatic melanoma in the Marqibo pharmacokinetic studies, 3 patients had a tumor response, including one patient with uveal melanoma metastatic to the lung that experienced a complete response. Methods: Patients with metastatic uveal melanoma with no more than one prior systemic therapy were enrolled. Patients with controlled brain metastases were allowed. Marqibo (2.25 mg/m2 by 1-hour intravenous infusion, no dose capping) was administered every 14 days until tumor progression. Responses were assessed every 6 weeks using the Response Evaluation Criteria in Solid Tumors (RECIST). Toxicity was assessed at least as frequently as before each dose. Results: Preliminary data is available for 22 enrolled patients (73% female). Median age was 65 years (range 38–79), 23% were previously treated with systemic chemotherapy, 86% had liver metastasis and 96% had M1c disease. Baseline serum LDH levels were elevated in 73% and were more than 2 × ULN in 37% of the patients. Twenty-one patients were evaluable for response; one patient discontinued the treatment after a single dose of therapy for toxicity without tumor progression. No patients died of drug toxicity while on the study. Twelve patients (57%) had stable disease. Estimated median survival is 6.4 months. Fourteen patients are alive, 2 for more than 12 months. Treatment related side effects were mostly grade 1 or 2; peripheral neuropathy was the only grade 3 toxicity, seen in 18% of the patients. The hematologic toxicities were minor; no neutropenia or thrombocytopenia was seen. Conclusions: Marqibo is well tolerated as single agent therapy in patients with advanced stage IV uveal melanoma. Its impact on the progression-free and overall survival of these critically ill patients will be presented. No significant financial relationships to disclose.
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Affiliation(s)
- A. Y. Bedikian
- M. D. Anderson Cancer Center, Houston, TX; Thomas Jefferson University Hospital, Philadelphia, PA; Hana Biosciences, Inc, South San Francisco, CA
| | - T. Sato
- M. D. Anderson Cancer Center, Houston, TX; Thomas Jefferson University Hospital, Philadelphia, PA; Hana Biosciences, Inc, South San Francisco, CA
| | - K. B. Kim
- M. D. Anderson Cancer Center, Houston, TX; Thomas Jefferson University Hospital, Philadelphia, PA; Hana Biosciences, Inc, South San Francisco, CA
| | - N. E. Papadopoulos
- M. D. Anderson Cancer Center, Houston, TX; Thomas Jefferson University Hospital, Philadelphia, PA; Hana Biosciences, Inc, South San Francisco, CA
| | - W. Hwu
- M. D. Anderson Cancer Center, Houston, TX; Thomas Jefferson University Hospital, Philadelphia, PA; Hana Biosciences, Inc, South San Francisco, CA
| | - J. Homsi
- M. D. Anderson Cancer Center, Houston, TX; Thomas Jefferson University Hospital, Philadelphia, PA; Hana Biosciences, Inc, South San Francisco, CA
| | - M. Davies
- M. D. Anderson Cancer Center, Houston, TX; Thomas Jefferson University Hospital, Philadelphia, PA; Hana Biosciences, Inc, South San Francisco, CA
| | - C. Cheung
- M. D. Anderson Cancer Center, Houston, TX; Thomas Jefferson University Hospital, Philadelphia, PA; Hana Biosciences, Inc, South San Francisco, CA
| | - S. M. Imperiale
- M. D. Anderson Cancer Center, Houston, TX; Thomas Jefferson University Hospital, Philadelphia, PA; Hana Biosciences, Inc, South San Francisco, CA
| | - P. Prasad
- M. D. Anderson Cancer Center, Houston, TX; Thomas Jefferson University Hospital, Philadelphia, PA; Hana Biosciences, Inc, South San Francisco, CA
| | - P. Hwu
- M. D. Anderson Cancer Center, Houston, TX; Thomas Jefferson University Hospital, Philadelphia, PA; Hana Biosciences, Inc, South San Francisco, CA
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Homsi J, Bedikian AY, Kim KB, Papadopoulos NE, Hwu W, Mahoney S, Vardeleon AG, Davies M, Hwu P. Randomized trial of two schedules of palonosetron for the prevention of nausea and vomiting in patients with metastatic melanoma receiving interleukin-2–based concurrent biochemotherapy. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20008 Background: Interleukin-2–based biochemotherapy (BCT) is a common therapy for patients (pts) with metastatic melanoma (MM). BCT induced nausea and vomiting (N/V) remains a significant problem (26% grade 3 and 4). Palonosetron (PALO) is a 5-HT3 receptor antagonist indicated for the prevention of N/V associated with chemotherapy. The recommended dosing schedule of PALO for patients on BCT is unknown. Methods: Chemo-naïve MM pts undergoing their first BCT cycle were randomized to receive PALO 0.25 mg as premedication intravenously on days 1 and 4, or the same dose on days 1, 3, and 5. The BCT regimen included: cisplatin (20 mg/m2) and vinblastine (1.6 mg/m2) on days 1–4, dacarbazine (800 mg/m2) on day 1, interleukin-2 (9 MIU/m2/day) by continuous infusion on days 1–4 and interferon alpha (5 MU/m2/day) on days 1–5. A nausea episode was defined as nausea of any severity reported by the patient or documented by the nursing staff at anytime. Pts with N/V due to known central nervous system or gastrointestinal metastases were excluded. The use of additional antiemetics was recorded. Pts were followed for 21 days (days 1–7 as inpatients). The Functional Living Index-Emesis (FLIE), an emesis- and nausea-specific questionnaire, was completed starting on day 1. Results: 30 pts were enrolled. Median age was 53 years (range 23–64). Eighteen (60%) were men. The incidences of BCT related N/V and those of nausea interfering with appetite, sleep, physical activity, social life and enjoyment of life are summarized by schedule of PALO in the table below. Conclusions: PALO administered on alternate days was more effective at controlling BCT-related N/V and reduced the need for PRN antiemetics. Better control of N/V reduced the impact of N/V on patient functioning in this population. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- J. Homsi
- M. D. Anderson Cancer Center, Houston, TX
| | | | - K. B. Kim
- M. D. Anderson Cancer Center, Houston, TX
| | | | - W. Hwu
- M. D. Anderson Cancer Center, Houston, TX
| | - S. Mahoney
- M. D. Anderson Cancer Center, Houston, TX
| | | | - M. Davies
- M. D. Anderson Cancer Center, Houston, TX
| | - P. Hwu
- M. D. Anderson Cancer Center, Houston, TX
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Homsi J, Bedikian AY, Kim KB, Papadopoulos NE, Hwu W, Mahoney SL, Davies M, Hwu P. Phase II open-label study of weekly taxoprexin (TXP) as first-line treatment in patients with metastatic cutaneous and mucosal malignant melanoma. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bedikian AY, Papadopoulos NE, Kim KB, Hwu W, Homsi J, Davies M, McIntyre S, Rohlfs M, Hwu P. Does complete response (CR) with systemic therapy (SRx) translate into long term survival in stage IV melanoma (MM)? J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9043] [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: 11/20/2022] Open
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Alvarado GC, Bedikian AY, Hwu WJ, Papadopoulos NE, Kim KB, Homsi J, Bassett RL, Kuhn RM, Hwu P. Management of venous thromboembolism (VTE) in melanoma patients with brain metastasis. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9522] [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: 11/20/2022] Open
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Homsi J, Kim LC, Goetz D, Chen D, Fishman M, Daud A. High-dose bolus interleukin-2 in elderly patients (>60 years old) with metastatic melanoma or renal cell cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.19559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
19559 Background: Although durable complete responses have been reported from using high-dose bolus interleukin-2 (HDB IL-2) in a small number of patients with metastatic melanoma and renal cell cancer (RCC), IL-2 toxicity limits its use especially in the elderly. Methods: the medical records of patients older than 60 years old with melanoma or renal cell carcinoma who received HDB IL-2 at the Moffitt Cancer Center between 2000–2005 were reviewed. The effect of increased age, primary diagnosis, and the HDB IL-2 regimen used on the side effects, number of administered doses, and survival was analyzed. Results: 55 cycles were administered to 35 patients (23 RCC, 12 melanoma, 26 men). Median age was 67 years old (range: 61–77). 17 patients received a traditional regimen (one cycle: 600,000 IU/Kg intravenously every 8 hours for 14 doses repeated in 2 weeks, maximum of 28 doses) and 18 received a clinical trial regimen (one cycle: 600,000 IU/Kg intravenously every 8 hours for 5 doses repeated weekly, maximum of 20 doses). Median number of administered cycles was 1 (range 1–4) and median number of total doses was 24 (range 3–79). Increased age was not related to total number of administered doses. Median percentage of IL-2 administered in a cycle was 75% of planned (range 11%-100%). Reasons to discontinue therapy were: oliguria (35%), hypotension (25%), and arrhythmia (15%). Side effects in all cycles were: hypotension (71%), oliguria (67%), Arrhythmia (18%), Myocardial infarction (7%), pulmonary edema (7%), hypothyroidism (4%), confusion (4%), seizures (2%) and stroke (2%). Pressors were used in 58% of all cycles. 20 patients died within a year from starting treatment and 5 lived more than 2 years (4 had RCC). Conclusions: 1) HDB IL-2 has multiple and life-threatening side effects in the elderly and caution is needed when selecting these patients to such therapy 2) the number of doses administered is comparable to that general population 3) more studies are needed to identify the population that would mostly benefit from HDB IL2. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- J. Homsi
- H. Lee Moffitt Cancer Center, Tampa, FL
| | - L. C. Kim
- H. Lee Moffitt Cancer Center, Tampa, FL
| | - D. Goetz
- H. Lee Moffitt Cancer Center, Tampa, FL
| | - D. Chen
- H. Lee Moffitt Cancer Center, Tampa, FL
| | | | - A. Daud
- H. Lee Moffitt Cancer Center, Tampa, FL
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Abstract
8025 Background: The Src/Stat 3 pathway has been implicated in the pathogenesis of several malignancies including melanoma. In the current study we evaluated the prevalence of Src and Stat3 activation in human melanoma and the effect of Src inhibitors alone or in combination with chemotherapeutic agents on melanoma cell lines. Methods: Activation of Src was measured by staining for Src-phosphotyrosine 416 (P-Src) and Stat3 by phosphotyrosine 705 Stat3 (P-Stat3). Immunohistochemistry was performed with anti-pStat3-Y705 and anti-pSrc-Y416 antibodies (Cell Signaling, Beverly, MA) on 3 melanoma subtypes. Staining of tumor cells for P-Stat3 was scored by percentage of stained cells as follows: 0 (no staining), 1 (1–25%), 2 (26–50%), 3 (>50%), and intensity 0–3 (0: absent, 1: low, 2: moderate, and 3: high). The sum of these was the composite P-Stat3 score: 0 (0), 1 (1–2), 2 (3–4), and 3 (5–6). P-Src staining was scored by intensity. Melanoma cell lines, A-375, SK-Mel-5 and SK-Mel-28 were exposed to Src inhibitors, SKI-606, PD 180970 and BMS 354825 alone or in combination with standard chemotherapy agents and IC-50 was determined by MTT assay at 24 and 72 hours. Results: 35 biopsies were stained. Median age was 66 years (range 23–90); 60% were women. 48% of all melanoma stained express P-Src; all samples express pStat3. We found a positive correlation between P-Src and P-Stat3 (Spearman coefficient=0.346, p=0.042). 46% stained only for pStat3 and 6% did not stain for either P-Src or P-Stat3. Most positively stained biopsies stained weakly for P-Src and moderately or strongly for pStat3. Src inhibitors inhibited the proliferation of melanoma cell lines; furthermore Src inhibitor treatment synergized with platinum and topoisomerase I inhibitors but not temozolomide. Conclusions: 1) Immunohistochemistry shows variable expression of P-Src and P-Stat3 in human melanoma 2) All tumors staining for P-Src also stain for P-Stat3 and the strength of staining is significantly related. 3) This data may be useful in planning future clinical trials with Src inhibitors in melanoma. [Table: see text] [Table: see text]
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Affiliation(s)
- J. Homsi
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL; University of Illinois, Chicago, IL; Mayo Clinic, Rochester, MN; City of Hope, Duarte, CA
| | - J. Messina
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL; University of Illinois, Chicago, IL; Mayo Clinic, Rochester, MN; City of Hope, Duarte, CA
| | - C. Cubutt
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL; University of Illinois, Chicago, IL; Mayo Clinic, Rochester, MN; City of Hope, Duarte, CA
| | - S. Maunglay
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL; University of Illinois, Chicago, IL; Mayo Clinic, Rochester, MN; City of Hope, Duarte, CA
| | - L. Scalf
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL; University of Illinois, Chicago, IL; Mayo Clinic, Rochester, MN; City of Hope, Duarte, CA
| | - A. Komarla
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL; University of Illinois, Chicago, IL; Mayo Clinic, Rochester, MN; City of Hope, Duarte, CA
| | - H. Yu
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL; University of Illinois, Chicago, IL; Mayo Clinic, Rochester, MN; City of Hope, Duarte, CA
| | - R. Jove
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL; University of Illinois, Chicago, IL; Mayo Clinic, Rochester, MN; City of Hope, Duarte, CA
| | - A. Daud
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL; University of Illinois, Chicago, IL; Mayo Clinic, Rochester, MN; City of Hope, Duarte, CA
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Homsi J, Nelson KA, Sarhill N, Rybicki L, LeGrand SB, Davis MP, Walsh D. A phase II study of methylphenidate for depression in advanced cancer. Am J Hosp Palliat Care 2001; 18:403-7. [PMID: 11712722 DOI: 10.1177/104990910101800610] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED This study evaluated the use of methylphenidate for depression in advanced cancer DESIGN Phase II open-label prospective study. ELIGIBILITY CRITERIA No previous use of methylphenidate or current use of other antidepressants. EVALUATION Depression and response to treatment were determined by asking the patient: "are you depressed?" Patients were assessed at baseline and at days 3, 5, and 7. TREATMENT Starting dose was 5 mg at 8:00 a.m. and 12:00 noon. The dose was titrated for lack of response on any of the assessment days. RESPONSE CRITERIA: A negative response to the question: "are you depressed?" RESULTS Some 41 patients were enrolled and 30 (15 men, 15 women) completed the study. Median age was 68 years (range: 30-90). Methylphenidate was stopped for six patients because of side effects and five were not evaluable; 21 responded to 10 mg/day on day 3; the other nine responded to 20 mg/day on day 5, 29 maintained their positive response through day 7. Anorexia, fatigue, concentration, and sedation also improved in some. All who completed the study had tolerable side effects, none of which caused treatment to stop. CONCLUSIONS Methylphenidate is effective for depression in advanced cancer A starting dose of 10 mg in divided doses is effective in most patients. Dose escalation may be needed. Improvement occurs within three days. Close monitoring of side effects is recommended.
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Affiliation(s)
- J Homsi
- Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Ohio, USA
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Abstract
Cough is a defense mechanism that prevents the entry of noxious materials into the respiratory system and clears foreign materials and excess secretions from the lungs and respiratory tract. In advanced cancer, it is a common symptom that interferes with the patient's daily activity and quality of life. Empiric treatment with antitussive agents is often needed. Two classes of antitussive drugs are available: (1) centrally acting: (a) opioids and (b) non-opioids; (2) peripherally acting: (a) directly and (b) indirectly. Antitussive availability varies widely around the world. Many antitussives, such as benzonatate, codeine, hydrocodone, and dextromethorphan, were extensively studied in the acute and chronic cough settings and showed relatively high efficacy and safety profiles. Benzonatate, clobutinol, dihydrocodeine, hydrocodone, and levodropropizine were the only antitussives specifically studied in cancer and advanced cancer cough. They all have shown to be effective and safe in recommended daily dose for cough. In advanced cancer the patient's current medications, previous antitussive use, the availability of routes of administration, any history of drug abuse, the presence of other symptoms and other factors, all have a role in the selection of antitussives for prescription. A good knowledge of the pharmacokinetics, dosage, efficacy, and side effects of the available antitussives provides for better management.
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Affiliation(s)
- J Homsi
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, The Cleveland Clinic Foundation, OH 44195, USA
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19
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Abstract
The enzymes in the cytochrome p450 monooxygenase system (CYP) are the major enzymes responsible for metabolizing medications. The CYP2D6 isomer is responsible for metabolizing certain opioids, neuroleptics, antidepressants and cardiac medications. Owing to CYP2D6's low capacity and high affinity it is easily saturated by substrate and/or inhibited, resulting in pharmacokinetic interactions. Polymorphisms of the structural gene are common, leading to wide inter-individual and ethnic differences in drug metabolism. Clinically important drug interactions, which may be anticipated in the palliative medicine population, are reviewed.
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Affiliation(s)
- M P Davis
- Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Foundation, OH 44195, USA.
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20
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Sarhill N, Walsh D, Nelson KA, Homsi J, LeGrand S, Davis MP. Methylphenidate for fatigue in advanced cancer: a prospective open-label pilot study. Am J Hosp Palliat Care 2001; 18:187-92. [PMID: 11406895 DOI: 10.1177/104990910101800310] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Psychostimulants such as methylphenidate are used for fatigue in cancer patients. We report a prospective, open-label, pilot study of the successful use of methylphenidate to treat fatigue in nine of 11 consecutive patients with advanced cancer. Seven had received radiation or chemotherapy, a median of three weeks (range from one to 30 weeks) prior to methylphenidate. A rapid onset of benefit was noted, even in the presence of mild anemia. Sedation and pain also improved in some. Only one patient had side effects severe enough to stop the medication.
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Affiliation(s)
- N Sarhill
- Harry R. Horvitz Center for Palliative Medicine, World Health Organization Demonstration Project in Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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21
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Abstract
We present a retrospective study of the frequency, pattern, and management of infections in advanced cancer. Three hundred ninety-three patients were admitted to an acute care palliative medicine unit in an 8-month period for evaluation and palliation of cancer-related symptoms and complications. One hundred fifteen had at least one positive bacteriological culture, and 100 of these patients were evaluable. One hundred fifty-two infections and 192 isolates were identified. Sixty-eight patients had polymicrobial infections. Sixty-six patients had urinary tract infections. Forty-one were found to have multisystemic infections. Eighty-one had invasive devices; 32 had more than one invasive device. Fifty-three were taking corticosteroids at the time of infection. Only 3 were neutropenic. Urinary tract infections were significantly more common in those taking corticosteroids. The median duration of antibiotic treatment was 11 days and the median hospital stay, 14 days. Twenty-eight patients died in the hospital; 10 of those who died had lung cancer, which was a statistically significant observation. In conclusion, infections are an underrecognized but common complication in nonneutropenic hospitalized patients with advanced solid tumors. Urinary tract infections appear to be associated with the use of corticosteroids. Lung cancer patients are at greater risk for fatal infections. Infections increase morbidity in debilitated patients with solid tumors, are a frequent cause of hospital admission, and are associated with significant mortality.
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Affiliation(s)
- J Homsi
- The Harry R. Horvitz Center for Palliative Medicine, A World Health Organization Demonstration Project, Cleveland Clinic Foundation, OH 44195, USA
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22
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Abstract
Psychostimulants such as methylphenidate have been used for depression in cancer patients. We report the successful use of methylphenidate to treat depression in 10 consecutive patients with advanced cancer. A rapid onset of effect was noted. Appetite, concentration, fatigue, and sedation also improved in some persons. No severe side effects were noted.
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Affiliation(s)
- J Homsi
- The Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic Taussig Cancer Center, Ohio, USA
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23
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Abstract
Cough is a common symptom in advanced cancer. Hydrocodone is the antitussive of choice in our palliative medicine inpatient unit. We reviewed the pharmacy records for the use of hydrocodone for all cancer admissions to our unit from May 1996 to December 1998. Median treatment duration with hydrocodone was three days (range 1-18). Median maximum daily dose was 15 mg (range 5-100), and median total dose during the hospital stay was 32 mg (range 5-455). Lung cancer as a primary cancer site was strongly related to the use of hydrocodone. The highest median duration of treatment (five days) was for esophageal cancer and the highest median maximum daily dose (35 mg) and total dose (75 mg) were for treating kidney cancer. This retrospective review provides information regarding the use of hydrocodone on the palliative medicine unit of the Cleveland Clinic Foundation. Controlled trials are needed to evaluate the efficacy and safety of hydrocodone for cough in advanced cancer.
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Affiliation(s)
- J Homsi
- Horvitz Center for Palliative Medicine, The Cleveland Clinic Taussig Cancer Center, Ohio, USA
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24
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Abstract
Psychostimulant medications have been used clinically and investigated in psychiatric populations, the medically ill, cancer patients and healthy people. This article discusses the pharmacology of dextroamphetamine, methylphenidate, pemoline (and other psychostimulants such as caffeine and ephedrine), their use in general medicine and cancer care, side effects, and abuse potential. Therapeutic use in children is addressed only insofar as it illustrates facets of their use in adults.
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Affiliation(s)
- J Homsi
- A World Health Organization Demonstration Project, The Harry R. Horvitz Center for Palliative Medicine, Cleveland, Ohio, USA
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25
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Abstract
This report describes our experience in the use of bioelectrical impedance analysis (BIA) as a method of nutritional assessment in a cancer patient with ascites. The BIA was an unreliable measure of body composition in this setting.
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Affiliation(s)
- N Sarhill
- The Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic Taussig Cancer Center, The Cleveland Clinic Foundation, OH 44195, USA
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26
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Nelson KA, Walsh D, Abdullah O, McDonnell F, Homsi J, Komurcu S, LeGrand SB, Zhukovsky DS. Common complications of advanced cancer. Semin Oncol 2000; 27:34-44. [PMID: 10697020] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Complications due to cancer and its treatment are common and increase in incidence and severity as the disease progresses. Central nervous system complications affect 15% to 20% of patients, and up to 75% have bone metastases at some point during the disease process. Endocrine abnormalities include hypercalcemia, adrenal insufficiency, and inappropriate antidiuretic syndrome. Hematologic disorders, malignant effusions, and gastrointestinal (GI) problems may cause significant morbidity.
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Affiliation(s)
- K A Nelson
- Harry R. Horvitz Center for Palliative Medicine, the Department of Hematology/Medical Oncology, and the Taussig Cancer Center, The Cleveland Clinic, OH 44195, USA
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27
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Komurcu S, Nelson KA, Walsh D, Donnelly SM, Homsi J, Abdullah O. Common symptoms in advanced cancer. Semin Oncol 2000; 27:24-33. [PMID: 10697019] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The relief of physical and psychological symptoms is an essential part of palliative care. Advanced cancer is an acute process; because the clinical picture changes rapidly, symptoms must be reassessed regularly, and a careful history is essential. Defining the relationship of the symptoms to the disease can defuse fear and encourage a sense of control in patients and their families. We review the pathophysiology, causes, prevalence, consequence, and management of common symptoms in advanced cancer.
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Affiliation(s)
- S Komurcu
- Harry R. Horvitz Center for Palliative Medicine and the Taussig Cancer Center, The Cleveland Clinic Foundation, OH 44195, USA
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