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Collin LJ, Jones J, Nash R, Switchenko JM, Ward KC, McCullough LE. Racial disparities in initiation of chemotherapy among breast cancer patients with discretionary treatment indication in the state of Georgia. Breast Cancer Res Treat 2024; 205:609-618. [PMID: 38517602 PMCID: PMC11101533 DOI: 10.1007/s10549-024-07279-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/07/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE The majority of breast cancer patients are diagnosed with early-stage estrogen receptor (ER) positive disease. Despite effective treatments for these cancers, Black women have higher mortality than White women. We investigated demographic and clinical factors associated with receipt of chemotherapy among those with a discretionary indication who are at risk for overtreatment. METHODS Using Georgia Cancer Registry data, we identified females diagnosed with ER positive breast cancer who had a discretionary indication for chemotherapy (2010-2017). We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) associating patient demographic and clinical characteristics with chemotherapy initiation overall, and comparing non-Hispanic Black (NHB) with non-Hispanic White (NHW) women within strata of patient factors. RESULTS We identified 11,993 ER positive breast cancer patients with a discretionary indication for chemotherapy. NHB patients were more likely to initiate chemotherapy compared with NHW women (OR = 1.41, 95% CI: 1.28, 1.56). Race differences in chemotherapy initiation were pronounced among those who did not receive Oncotype DX testing (OR = 1.47, 95% CI: 1.31, 1.65) and among those residing in high socioeconomic status neighborhoods (OR = 2.48, 95% CI: 1.70, 3.61). However, we observed equitable chemotherapy receipt among patients who received Oncotype DX testing (OR = 0.90, 95% CI: 0.71, 1.14), were diagnosed with grade 1 disease (OR = 1.00, 95% CI: 0.74, 1.37), and those resided in rural areas (OR = 1.01, 95% CI: 0.76, 1.36). CONCLUSION We observed racial disparities in the initiation of chemotherapy overall and by sociodemographic and clinical factors, and more equitable outcomes when clinical guidelines were followed.
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Affiliation(s)
- Lindsay J Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA.
| | - Jade Jones
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, USA
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Miller-Kleinhenz JM, Barber LE, Maliniak ML, Moubadder L, Bliss M, Streiff MJ, Switchenko JM, Ward KC, McCullough LE. Historical Redlining, Persistent Mortgage Discrimination, and Race in Breast Cancer Outcomes. JAMA Netw Open 2024; 7:e2356879. [PMID: 38376843 PMCID: PMC10879950 DOI: 10.1001/jamanetworkopen.2023.56879] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/28/2023] [Indexed: 02/21/2024] Open
Abstract
Importance Inequities created by historical and contemporary mortgage discriminatory policies have implications for health disparities. The role of persistent mortgage discrimination (PMD) in breast cancer (BC) outcomes has not been studied. Objective To estimate the race-specific association of historical redlining (HRL) with the development of BC subtypes and late-stage disease and a novel measure of PMD in BC mortality. Design, Setting, and Participants This population-based cohort study used Georgia Cancer Registry data. A total of 1764 non-Hispanic Black and White women with a BC diagnosis and residing in an area graded by the Home Owners' Loan Corporation (HOLC) in Georgia were included. Patients were excluded if they did not have a known subtype or a derived American Joint Committee on Cancer stage or if diagnosed solely by death certificate or autopsy. Participants were diagnosed with a first primary BC between January 1, 2010, to December 31, 2017, and were followed through December 31, 2019. Data were analyzed between May 1, 2022, and August 31, 2023. Exposures Scores for HRL were examined dichotomously as less than 2.5 (ie, nonredlined) vs 2.5 or greater (ie, redlined). Contemporary mortgage discrimination (CMD) scores were calculated, and PMD index was created using the combination of HRL and CMD scores. Main Outcomes and Measures Estrogen receptor (ER) status, late stage at diagnosis, and BC-specific death. Results This study included 1764 women diagnosed with BC within census tracts that were HOLC graded in Georgia. Of these, 856 women (48.5%) were non-Hispanic Black and 908 (51.5%) were non-Hispanic White; 1148 (65.1%) were diagnosed at 55 years or older; 538 (30.5%) resided in tracts with HRL scores less than 2.5; and 1226 (69.5%) resided in tracts with HRL scores 2.5 or greater. Living in HRL areas with HRL scores 2.5 or greater was associated with a 62% increased odds of ER-negative BC among non-Hispanic Black women (odds ratio [OR], 1.62 [95% CI, 1.01-2.60]), a 97% increased odds of late-stage diagnosis among non-Hispanic White women (OR, 1.97 [95% CI, 1.15-3.36]), and a 60% increase in BC mortality overall (hazard ratio, 1.60 [95% CI, 1.17-2.18]). Similarly, PMD was associated with BC mortality among non-Hispanic White women but not among non-Hispanic Black women. Conclusions and Relevance The findings of this cohort study suggest that historical racist policies and persistent discrimination have modern-day implications for BC outcomes that differ by race. These findings emphasize the need for a more nuanced investigation of the social and structural drivers of disparate BC outcomes.
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Affiliation(s)
| | - Lauren E. Barber
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Maret L. Maliniak
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Leah Moubadder
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Maya Bliss
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Micah J. Streiff
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jeffrey M. Switchenko
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kevin C. Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lauren E. McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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3
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Lalonde CS, Switchenko JM, Behera M, Bilen MA, Owonikoko TK, Kaufman JL, Nooka AK, Lewis CM, Hitron E, Collins H, Judson EC, Alese OB, Donald Harvey R, Carlisle JW. Shifting Sociodemographic Characteristics of a Phase I Clinical Trial Population at an NCI-Designated Comprehensive Cancer Center in the Southeast. Oncologist 2023; 28:1055-1063. [PMID: 37418599 PMCID: PMC10712723 DOI: 10.1093/oncolo/oyad181] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/30/2023] [Indexed: 07/09/2023] Open
Abstract
Racial and ethnic minority populations are consistently under-represented in oncology clinical trials despite comprising a disproportionate share of a cancer burden. Phase I oncology clinical trials pose a unique challenge and opportunity for minority inclusion. Here we compared the sociodemographic characteristics of patients participating in phase 1 clinical trials a National Cancer Institute ( NCI)-designated comprehensive center to all patients at the center, patients with new cancer diagnosis in metropolitan Atlanta and patients with new cancer diagnoses in the state of Georgia. From 2015 to 2020, 2325 patients (43.4% female, 56.6% male) consented to participate in a phase I trial. Grouped self-reported race distribution was 70.3% White, 26.2% Black, and 3.5% other. Of new patient registrations at Winship Cancer Institute (N = 107 497) (50% F, 50% M), grouped race distribution was 63.3% White, 32.0% Black, and 4.7% other. Patients with new cancer diagnoses in metro Atlanta from 2015 to 2016 (N = 31101) were 58.4% White, 37.2% Black, and 4.3% other. Race and sex distribution of phase I patients was significantly different than Winship patients (P < .001). Over time, percent of White patients decreased in both phase I and Winship groups (P = .009 and P < .001, respectively); percentage of females did not change in either group (P = .54 phase I, P = .063 Winship). Although phase I patients were more likely to be White, male, and privately ensured than the Winship cohort, from 2015 to 2020 the percentage of White patients in phase I trials and among all new patients treated at Winship decreased. The intent of characterizing existing disparities is to improve the representation of patients from racial and ethnic minority backgrounds in phase I clinical trials.
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Affiliation(s)
- Chloe S Lalonde
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University, Atlanta, GA, USA
| | - Madhusmita Behera
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Taofeek K Owonikoko
- Department of Hematology and Medical Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan L Kaufman
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Ajay K Nooka
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Elise Hitron
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Hannah Collins
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Emma C Judson
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Olatunji B Alese
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - R Donald Harvey
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer W Carlisle
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
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4
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Maithel SK, Keilson JM, Cao HST, Rupji M, Mahipal A, Lin BS, Javle MM, Cleary SP, Akce M, Switchenko JM, Rocha FG. ASO Visual Abstact: NEO-GAP: A Single-Arm, Phase II Feasibility Trial of Neoadjuvant Gemcitabine, Cisplatin, and Nab-paclitaxel for Resectable, High-Risk Intrahepatic Cholangiocarcinoma. Ann Surg Oncol 2023; 30:6569-6570. [PMID: 37468674 DOI: 10.1245/s10434-023-13874-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Affiliation(s)
- Shishir K Maithel
- Division of Surgical Oncology Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
| | - Jessica M Keilson
- Division of Surgical Oncology Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Hop S Tran Cao
- Department of Surgical Oncology, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Manali Rupji
- Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Amit Mahipal
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Bruce S Lin
- Division of Hematology Oncology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Milind M Javle
- Department of Medical Oncology, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Sean P Cleary
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mehmet Akce
- Department of Hematology and Oncology, Winship Cancer Institute, EmoryUniversity School of Medicine, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Flavio G Rocha
- Division of Surgical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
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Akce M, Farran B, Switchenko JM, Rupji M, Kang S, Khalil L, Ruggieri-Joyce A, Olson B, Shaib WL, Wu C, Alese OB, Diab M, Lesinski GB, El-Rayes BF. Phase II trial of nivolumab and metformin in patients with treatment-refractory microsatellite stable metastatic colorectal cancer. J Immunother Cancer 2023; 11:e007235. [PMID: 37852737 PMCID: PMC10603338 DOI: 10.1136/jitc-2023-007235] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Preclinical studies showed metformin reduces exhaustion of tumor-infiltrating lymphocytes and potentiates programmed cell death protein-1 (PD-1) blockade. We hypothesized that metformin with nivolumab would elicit potent antitumor and immune modulatory activity in metastatic microsatellite stable (MSS) colorectal cancer (CRC). We evaluated this hypothesis in a phase II study. METHODS Nivolumab (480 mg) was administered intravenously every 4 weeks while metformin (1000 mg) was given orally, two times per day following a 14-day metformin only lead-in phase. Patients ≥18 years of age, with previously treated, stage IV MSS CRC, and Eastern Cooperative Oncology Group 0-1, having received no prior anti-PD-1 agent were eligible. The primary endpoint was overall response rate with secondary endpoints of overall survival (OS) and progression-free survival (PFS). Correlative studies using paired pretreatment/on-treatment biopsies and peripheral blood evaluated a series of immune biomarkers in the tumor microenvironment and systemic circulation using ChipCytometry and flow cytometry. RESULTS A total of 24 patients were enrolled, 6 patients were replaced per protocol, 18 patients had evaluable disease. Of the 18 evaluable patients, 11/18 (61%) were women and the median age was 58 (IQR 50-67). Two patients had stable disease, but no patients had objective response, hence the study was stopped for futility. Median OS and PFS was 5.2 months (95% CI (3.2 to 11.7)) and 2.3 months (95% CI (1.7 to 2.3)). Most common grade 3/4 toxicities: Anemia (n=2), diarrhea (n=2), and fever (n=2). Metformin alone failed to increase the infiltration of T-cell subsets in the tumor, but combined metformin and nivolumab increased percentages of tumor-infiltrating leukocytes (p=0.031). Dual treatment also increased Tim3+ levels in patient tissues and decreased naïve CD8+T cells (p=0.0475). CONCLUSIONS Nivolumab and metformin were well tolerated in patients with MSS CRC but had no evidence of efficacy. Correlative studies did not reveal an appreciable degree of immune modulation from metformin alone, but showed trends in tumorous T-cell infiltration as a result of dual metformin and PD-1 blockade despite progression in a majority of patients.
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Affiliation(s)
- Mehmet Akce
- Division of Hematology and Oncology, Department of Medicine, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Batoul Farran
- Department of Oncology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jeffrey M Switchenko
- Biostatistics Shared Resource, Emory University Winship Cancer institute, Atlanta, Georgia, USA
- Department of Biostsatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Manali Rupji
- Biostatistics Shared Resource, Emory University Winship Cancer institute, Atlanta, Georgia, USA
| | - Sandra Kang
- Department of Hematology and Medical Oncology, Emory University Winship Cancer Institute, Atlanta, Georgia, USA
| | - Lana Khalil
- Department of Hematology and Medical Oncology, Emory University Winship Cancer Institute, Atlanta, Georgia, USA
| | - Amanda Ruggieri-Joyce
- Department of Hematology and Medical Oncology, Emory University Winship Cancer Institute, Atlanta, Georgia, USA
| | - Brian Olson
- Department of Hematology and Medical Oncology, Emory University Winship Cancer Institute, Atlanta, Georgia, USA
| | - Walid L Shaib
- Northwest Georgia Oncology Centers Wellstar, Marietta, Georgia, USA
| | - Christina Wu
- Division of Hematology and Oncology, Department of Internal Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Olatunji B Alese
- Department of Hematology and Medical Oncology, Emory University Winship Cancer Institute, Atlanta, Georgia, USA
| | - Maria Diab
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan, USA
- Department of Internal Medicine, Henry Ford Health, Detroit, Michigan, USA
| | - Gregory B Lesinski
- Department of Hematology and Medical Oncology, Emory University Winship Cancer Institute, Atlanta, Georgia, USA
| | - Bassel F El-Rayes
- Division of Hematology and Oncology, Department of Medicine, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
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6
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Maithel SK, Keilson JM, Cao HST, Rupji M, Mahipal A, Lin BS, Javle MM, Cleary SP, Akce M, Switchenko JM, Rocha FG. NEO-GAP: A Single-Arm, Phase II Feasibility Trial of Neoadjuvant Gemcitabine, Cisplatin, and Nab-Paclitaxel for Resectable, High-Risk Intrahepatic Cholangiocarcinoma. Ann Surg Oncol 2023; 30:6558-6566. [PMID: 37368098 PMCID: PMC10883654 DOI: 10.1245/s10434-023-13809-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/15/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE Most patients with intrahepatic cholangiocarcinoma (IHCC) develop recurrence after resection. Adjuvant capecitabine remains the standard of care for resected IHCC. A combination of gemcitabine, cisplatin, and nab-paclitaxel (GAP) was associated with a 45% response rate and 20% conversion rate among patients with unresectable biliary tract cancers. The aim of this study was to evaluate the feasibility of delivering GAP in the neoadjuvant setting for resectable, high-risk IHCC. METHODS A multi-institutional, single-arm, phase II trial was conducted for patients with resectable, high-risk IHCC, defined as tumor size > 5 cm, multiple tumors, presence of radiographic major vascular invasion, or lymph node involvement. Patients received preoperative GAP (gemcitabine 800 mg/m2, cisplatin 25 mg/m2, and nab-paclitaxel 100 mg/m2 on days 1 and 8 of a 21-day cycle) for a total of 4 cycles prior to an attempt at curative-intent surgical resection. The primary endpoint was completion of both preoperative chemotherapy and surgical resection. Secondary endpoints were adverse events, radiologic response, recurrence-free survival (RFS), and overall survival (OS). RESULTS Thirty evaluable patients were enrolled. Median age was 60.5 years. Median follow-up for all patients was 17 months. Ten patients (33%) experienced grade ≥ 3 treatment-related adverse events, the most common being neutropenia and diarrhea; 50% required ≥ 1 dose reduction. The disease control rate was 90% (progressive disease: 10%, partial response: 23%, stable disease: 67%). There was zero treatment-related mortality. Twenty-two patients (73%, 90% CI 57-86; p = 0.008) completed all chemotherapy and surgery. Two patients (9%) who successfully underwent resection had minor postoperative complications. Median length of hospital stay was 4 days. Median RFS was 7.1 months. Median OS for the entire cohort was 24 months and was not reached in patients who underwent surgical resection. CONCLUSION Neoadjuvant treatment with gemcitabine, cisplatin, and nab-paclitaxel is feasible and safe prior to resection of intrahepatic cholangiocarcinoma and does not adversely impact perioperative outcomes.
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Affiliation(s)
- Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
| | - Jessica M Keilson
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Hop S Tran Cao
- Department of Surgical Oncology, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Manali Rupji
- Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Amit Mahipal
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Bruce S Lin
- Division of Hematology Oncology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Milind M Javle
- Department of Medical Oncology, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Sean P Cleary
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mehmet Akce
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Flavio G Rocha
- Division of Surgical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
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Moreno A, Manning K, Azeem MI, Nooka AK, Ellis M, Manalo RJ, Switchenko JM, Wali B, Kaufman JL, Hofmeister CC, Joseph NS, Lonial S, Dhodapkar KM, Dhodapkar MV, Suthar MS. Divergence of variant binding/neutralizing antibodies following SARS-CoV-2 booster vaccines in myeloma: Impact of hybrid immunity. Res Sq 2023:rs.3.rs-3293339. [PMID: 37790523 PMCID: PMC10543400 DOI: 10.21203/rs.3.rs-3293339/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
We characterized virus-neutralization and spike-binding antibody profiles in myeloma patients following monovalent or bivalent-SARS-CoV-2 booster vaccination. Vaccination improves the breadth of binding antibodies but not neutralization activity against current variants. Hybrid immunity and immune imprinting impact vaccine-elicited immunity.
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Affiliation(s)
- Alberto Moreno
- Emory Vaccine Center, Emory University, Atlanta, GA
- Emory National Primate Research Center, Atlanta, GA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Kelly Manning
- Emory Vaccine Center, Emory University, Atlanta, GA
- Emory National Primate Research Center, Atlanta, GA
| | - Maryam I. Azeem
- Department of Hematology/Medical Oncology, Emory University, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA
| | - Ajay K. Nooka
- Department of Hematology/Medical Oncology, Emory University, Atlanta, GA
- Winship Cancer Institute, Atlanta, GA
| | - Madison Ellis
- Emory Vaccine Center, Emory University, Atlanta, GA
- Emory National Primate Research Center, Atlanta, GA
| | - Renee Julia Manalo
- Department of Hematology/Medical Oncology, Emory University, Atlanta, GA
| | | | - Bushra Wali
- Emory Vaccine Center, Emory University, Atlanta, GA
- Emory National Primate Research Center, Atlanta, GA
| | - Jonathan L. Kaufman
- Department of Hematology/Medical Oncology, Emory University, Atlanta, GA
- Winship Cancer Institute, Atlanta, GA
| | - Craig C. Hofmeister
- Department of Hematology/Medical Oncology, Emory University, Atlanta, GA
- Winship Cancer Institute, Atlanta, GA
| | - Nisha S. Joseph
- Department of Hematology/Medical Oncology, Emory University, Atlanta, GA
- Winship Cancer Institute, Atlanta, GA
| | - Sagar Lonial
- Department of Hematology/Medical Oncology, Emory University, Atlanta, GA
- Winship Cancer Institute, Atlanta, GA
| | - Kavita M. Dhodapkar
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA
- Winship Cancer Institute, Atlanta, GA
| | - Madhav V. Dhodapkar
- Department of Hematology/Medical Oncology, Emory University, Atlanta, GA
- Winship Cancer Institute, Atlanta, GA
| | - Mehul S. Suthar
- Emory Vaccine Center, Emory University, Atlanta, GA
- Emory National Primate Research Center, Atlanta, GA
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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Kelvin JM, Jain J, Thapa A, Qui M, Birnbaum LA, Moore SG, Zecca H, Summers RJ, Switchenko JM, Costanza E, Uricoli B, Wang X, Jui NT, Fu H, Du Y, DeRyckere D, Graham DK, Dreaden EC. Constitutively Synergistic Multiagent Drug Formulations Targeting MERTK, FLT3, and BCL-2 for Treatment of AML. Pharm Res 2023; 40:2133-2146. [PMID: 37704893 DOI: 10.1007/s11095-023-03596-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/26/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE Although high-dose, multiagent chemotherapy has improved leukemia survival rates, treatment outcomes remain poor in high-risk subsets, including acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) in infants. The development of new, more effective therapies for these patients is therefore an urgent, unmet clinical need. METHODS The dual MERTK/FLT3 inhibitor MRX-2843 and BCL-2 family protein inhibitors were screened in high-throughput against a panel of AML and MLL-rearranged precursor B-cell ALL (infant ALL) cell lines. A neural network model was built to correlate ratiometric drug synergy and target gene expression. Drugs were loaded into liposomal nanocarriers to assess primary AML cell responses. RESULTS MRX-2843 synergized with venetoclax to reduce AML cell density in vitro. A neural network classifier based on drug exposure and target gene expression predicted drug synergy and growth inhibition in AML with high accuracy. Combination monovalent liposomal drug formulations delivered defined drug ratios intracellularly and recapitulated synergistic drug activity. The magnitude and frequency of synergistic responses were both maintained and improved following drug formulation in a genotypically diverse set of primary AML bone marrow specimens. CONCLUSIONS We developed a nanoscale combination drug formulation that exploits ectopic expression of MERTK tyrosine kinase and dependency on BCL-2 family proteins for leukemia cell survival in pediatric AML and infant ALL cells. We demonstrate ratiometric drug delivery and synergistic cell killing in AML, a result achieved by a systematic, generalizable approach of combination drug screening and nanoscale formulation that may be extended to other drug pairs or diseases in the future.
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Affiliation(s)
- James M Kelvin
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30322, USA
| | - Juhi Jain
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA
- Department of Pediatrics, University of Arizona College of Medicine, and Banner University Medical Center Tucson, Tucson, AZ, 85724, USA
| | - Aashis Thapa
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Min Qui
- Department of Pharmacology and Chemical Biology, Emory Chemical Biology Discovery Center, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Lacey A Birnbaum
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30322, USA
| | - Samuel G Moore
- Systems Mass Spectrometry Core Facility, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Henry Zecca
- Department of Chemistry, Emory University, Atlanta, GA, 30322, USA
| | - Ryan J Summers
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, 30322, USA
| | - Emma Costanza
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30322, USA
| | - Biaggio Uricoli
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30322, USA
| | - Xiaodong Wang
- Center for Integrative Chemical Biology and Drug Discovery, Division of Chemical Biology and Medicinal Chemistry, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Nathan T Jui
- Department of Chemistry, Emory University, Atlanta, GA, 30322, USA
- Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Haian Fu
- Department of Pharmacology and Chemical Biology, Emory Chemical Biology Discovery Center, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, 30322, USA
| | - Yuhong Du
- Department of Pharmacology and Chemical Biology, Emory Chemical Biology Discovery Center, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, 30322, USA
| | - Deborah DeRyckere
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA
| | - Douglas K Graham
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA.
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA.
| | - Erik C Dreaden
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30322, USA.
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA.
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA.
- Winship Cancer Institute of Emory University, Atlanta, GA, 30322, USA.
- Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, 30332, USA.
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9
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Moreno A, Manning K, Azeem MI, Nooka AK, Ellis M, Manalo RJ, Switchenko JM, Wali B, Kaufman JL, Hofmeister CC, Joseph NS, Lonial S, Dhodapkar KM, Dhodapkar MV, Suthar MS. Divergence of variant binding/neutralizing antibodies following SARS-CoV-2 booster vaccines in myeloma: Impact of hybrid immunity. bioRxiv 2023:2023.08.17.553767. [PMID: 37662390 PMCID: PMC10473610 DOI: 10.1101/2023.08.17.553767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
We characterized virus-neutralization and spike-binding antibody profiles in myeloma patients following monovalent or bivalent-SARS-CoV-2 booster vaccination. Vaccination improves the breadth of binding antibodies but not neutralization activity against current variants. Hybrid immunity and immune imprinting impact vaccine-elicited immunity.
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10
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Robinson MH, Villa NY, Jaye DL, Nooka AK, Duffy A, McCachren SS, Manalo J, Switchenko JM, Barnes S, Potdar S, Azeem MI, Horvat AA, Parihar VC, Gong J, Liang Y, Smith GH, Gupta VA, Boise LH, Kaufman JL, Hofmeister CC, Joseph NS, Lonial S, Dhodapkar KM, Dhodapkar MV. Regulation of antigen-specific T cell infiltration and spatial architecture in multiple myeloma and premalignancy. J Clin Invest 2023; 133:e167629. [PMID: 37526080 PMCID: PMC10378152 DOI: 10.1172/jci167629] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 12/08/2022] [Accepted: 06/16/2023] [Indexed: 08/02/2023] Open
Abstract
Entry of antigen-specific T cells into human tumors is critical for immunotherapy, but the underlying mechanisms are poorly understood. Here, we combined high-dimensional spatial analyses with in vitro and in vivo modeling to study the mechanisms underlying immune infiltration in human multiple myeloma (MM) and its precursor monoclonal gammopathy of undetermined significance (MGUS). Clustered tumor growth was a feature of MM but not MGUS biopsies, and this growth pattern was reproduced in humanized mouse models. MM biopsies exhibited intralesional as well as spatial heterogeneity, with coexistence of T cell-rich and T cell-sparse regions and the presence of areas of T cell exclusion. In vitro studies demonstrated that T cell entry into MM clusters was regulated by agonistic signals and CD2-CD58 interactions. Upon adoptive transfer, antigen-specific T cells localized to the tumor site but required in situ DC-mediated antigen presentation for tumor entry. C-type lectin domain family 9 member A-positive (CLEC9A+) DCs appeared to mark portals of entry for gradients of T cell infiltration in MM biopsies, and their proximity to T cell factor 1-positive (TCF1+) T cells correlated with disease state and risk status. These data illustrate a role for tumor-associated DCs and in situ activation in promoting the infiltration of antigen-specific T cells in MM and provide insights into spatial alterations in tumor/immune cells with malignant evolution.
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Affiliation(s)
| | | | - David L Jaye
- Department of Pathology and Laboratory Medicine, and
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Ajay K Nooka
- Department of Hematology/Medical Oncology
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | | | | | | | | | | | | | - Maryam I Azeem
- Department of Hematology/Medical Oncology
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatric Hematology/Oncology, Emory University, Atlanta, Georgia, USA
| | | | | | - Jingjing Gong
- Pathology Department, NanoString Inc., Seattle, Washington, USA
| | - Yan Liang
- Pathology Department, NanoString Inc., Seattle, Washington, USA
| | | | - Vikas A Gupta
- Department of Hematology/Medical Oncology
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Lawrence H Boise
- Department of Hematology/Medical Oncology
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Jonathan L Kaufman
- Department of Hematology/Medical Oncology
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Craig C Hofmeister
- Department of Hematology/Medical Oncology
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Nisha S Joseph
- Department of Hematology/Medical Oncology
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Sagar Lonial
- Department of Hematology/Medical Oncology
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Kavita M Dhodapkar
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatric Hematology/Oncology, Emory University, Atlanta, Georgia, USA
| | - Madhav V Dhodapkar
- Department of Hematology/Medical Oncology
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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11
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Sawalha Y, Goyal S, Switchenko JM, Romancik JT, Kamdar M, Greenwell IB, Hess BT, Isaac KM, Portell CA, Mejia Garcia A, Goldsmith S, Grover NS, Riedell PA, Karmali R, Burkart M, Buege M, Akhtar O, Torka P, Kumar A, Hill BT, Kahl BS, Cohen JB. A multicenter analysis of the outcomes with venetoclax in patients with relapsed mantle cell lymphoma. Blood Adv 2023; 7:2983-2993. [PMID: 36809796 PMCID: PMC10320213 DOI: 10.1182/bloodadvances.2022008916] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 02/24/2023] Open
Abstract
To report the activity of venetoclax in patients with relapsed mantle cell lymphoma (MCL), we identified 81 patients treated with venetoclax monotherapy (n = 50, 62%) or in combination with a Bruton tyrosine kinase inhibitor (BTKi) (n = 16, 20%), an anti-CD20 monoclonal antibody (n = 11, 14%), or other active agents at 12 US academic medical centers. Patients had high-risk disease features including Ki67 >30% (61%), blastoid/pleomorphic histology (29%), complex karyotype (34%), and TP53 alterations (49%), and received a median of 3 prior treatments including BTKis in 91%. Venetoclax alone or in combination resulted in an overall response rate (ORR) of 40% and median progression-free (PFS) and overall survival (OS) of 3.7 and 12.5 months, respectively. The receipt of ≤3 prior treatments was associated with higher odds of response to venetoclax in a univariable analysis. In a multivariable analysis, having a high-risk Mantle Cell Lymphoma International Prognostic Index score before receiving venetoclax and disease relapse or progression within 24 months of diagnosis were associated with inferior OS whereas the use of venetoclax in combination was associated with superior OS. Although most patients (61%) had low risk for tumor lysis syndrome (TLS), 12.3% of patients developed TLS despite the implementation of several mitigation strategies. In conclusion, venetoclax resulted in good ORR but short PFS in patients with MCL who are at high risk, and may have a better role in earlier lines of treatment and/or in conation with other active agents. TLS remains an important risk in patients with MCL who initiate treatment with venetoclax.
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Affiliation(s)
- Yazeed Sawalha
- Division of Hematology, The Ohio State University, Columbus, OH
| | - Subir Goyal
- Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Jeffrey M. Switchenko
- Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Jason T. Romancik
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Manali Kamdar
- Division of Hematology, University of Colorado Denver, Denver, CO
| | - I. Brian Greenwell
- Division of Hematology and Oncology, Medical University of South Carolina, Charleston, SC
| | - Brian T. Hess
- Division of Hematology and Oncology, Medical University of South Carolina, Charleston, SC
| | - Krista M. Isaac
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | - Craig A. Portell
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | | | - Scott Goldsmith
- Department of Medicine, Washington University School of Medicine, Washington University, St. Louis, MO
| | | | - Peter A. Riedell
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Reem Karmali
- Division of Hematology and Oncology, Northwestern University, Chicago, IL
| | - Madelyn Burkart
- Division of Hematology and Oncology, Northwestern University, Chicago, IL
| | - Michael Buege
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Othman Akhtar
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Anita Kumar
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brian T. Hill
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | - Brad S. Kahl
- Department of Medicine, Washington University School of Medicine, Washington University, St. Louis, MO
| | - Jonathon B. Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
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12
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Hüls A, Van Cor S, Christensen GM, Li Z, Liu Y, Shi L, Pearce JL, Bayakly R, Lash TL, Ward K, Switchenko JM. Environmental, social and behavioral risk factors in association with spatial clustering of childhood cancer incidence. Spat Spatiotemporal Epidemiol 2023; 45:100582. [PMID: 37301597 PMCID: PMC10258443 DOI: 10.1016/j.sste.2023.100582] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/16/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Childhood cancer incidence is known to vary by age, sex, and race/ethnicity, but evidence is limited regarding external risk factors. We aim to identify harmful combinations of air pollutants and other environmental and social risk factors in association with the incidence of childhood cancer based on 2003-2017 data from the Georgia Cancer Registry. We calculated the standardized incidence ratios (SIR) of Central Nervous System (CNS) tumors, leukemia and lymphomas based on age, gender and ethnic composition in each of the 159 counties in Georgia, USA. County-level information on air pollution, socioeconomic status (SES), tobacco smoking, alcohol drinking and obesity were derived from US EPA and other public data sources. We applied two unsupervised learning tools (self-organizing map [SOM] and exposure-continuum mapping [ECM]) to identify pertinent types of multi-exposure combinations. Spatial Bayesian Poisson models (Leroux-CAR) were fit with indicators for each multi-exposure category as exposure and SIR of childhood cancers as outcomes. We identified consistent associations of environmental (pesticide exposure) and social/behavioral stressors (low socioeconomic status, alcohol) with spatial clustering of pediatric cancer class II (lymphomas and reticuloendothelial neoplasms), but not for other cancer classes. More research is needed to identify the causal risk factors for these associations.
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Affiliation(s)
- Anke Hüls
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Sara Van Cor
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Grace M Christensen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Zhenjiang Li
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Yuxi Liu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Liuhua Shi
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - John L Pearce
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Rana Bayakly
- Georgia Department of Public Health, Atlanta, GA, USA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kevin Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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13
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Olimpiadi Y, Goldenberg AR, Postlewait L, Gillespie T, Arciero C, Styblo T, Cao Y, Switchenko JM, Rizzo M. Outcomes of the same-day discharge following mastectomy before, during and after COVID-19 pandemic. J Surg Oncol 2023; 127:761-767. [PMID: 36621857 PMCID: PMC10874497 DOI: 10.1002/jso.27195] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/23/2022] [Accepted: 12/23/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES The majority of patients undergoing mastectomy before the COVID-19 pandemic were admitted for 23-h observation to the hospital. Indications for observation included drain care education, pain control and observation for possible early surgical complications. This study compared the rates of outpatient mastectomy before, during, and after the COVID-19 pandemic and indirectly evaluated the safety of same-day discharge. METHODS We retrospectively analyzed patients undergoing mastectomy using Current Procedural Terminology code 19303. RESULTS A total of 357 patients were included: 113 were treated pre-COVID-19, 82 patients during COVID-19 and 162 post-COVID-19. The rate of outpatient mastectomies tripled during the pandemic from 17% to 51% (p < 0.001); after the pandemic remain high at 48%. The rate of bilateral mastectomies decreased during the pandemic to 30% from 48% prepandemic (p = 0.015). Pectoralis muscle block utilization increased during the COVID-19 period from 36% to 59% (p = 0.002). No difference in complication rates, including surgical site infections, hematomas, and readmissions, pre and during COVID. CONCLUSIONS The rate of outpatient mastectomy increased during the COVID-19 pandemic. During this timeframe, perioperative complications did not increase, suggesting the safety of this practice. After the pandemic, the rate of outpatient mastectomy continued to be significantly higher than pre-COVID.
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Affiliation(s)
- Yuliya Olimpiadi
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Alison R. Goldenberg
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Lauren Postlewait
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Theresa Gillespie
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Cletus Arciero
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Toncred Styblo
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Yicun Cao
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Jeffrey M. Switchenko
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Monica Rizzo
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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14
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Janopaul-Naylor JR, Rupji M, Tobillo RA, Lorenz JW, Switchenko JM, Tian S, Kaka AS, Qian DC, Schlafstein AJ, Steuer CE, Remick JS, Rudra S, McDonald MW, Saba NF, Stokes WA, Patel MR, Bates JE. Ninety-day mortality following transoral robotic surgery or radiation at Commission on Cancer-accredited facilities. Head Neck 2023; 45:658-663. [PMID: 36549012 PMCID: PMC9898134 DOI: 10.1002/hed.27282] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Postoperative mortality for oropharynx squamous cell carcinoma (OPSCC) with transoral robotic surgery (TORS) varies from 0.2% to 6.5% on trials; the real-world rate is unknown. METHODS NCDB study from 2010 to 2017 for patients with cT1-2N0-2M0 OPSCC with Charleson-Deyo score 0-1. Ninety-day mortality assessed from start and end of treatment at Commission on Cancer-accredited facilities. RESULTS 3639 patients were treated with TORS and 1937 with radiotherapy. TORS cohort had more women and higher income, was younger, more often treated at academic centers, and more likely to have private insurance (all p < 0.05). Ninety-day mortality was 1.3% with TORS and 0.7% or 1.4% from start or end of radiotherapy, respectively. From end of therapy, there was no significant difference on MVA between treatment modality. CONCLUSIONS There is minimal difference between 90-day mortality in patients treated with TORS or radiotherapy for early-stage OPSCC. While overall rates are low, for patients with expectation of cure, work is needed to identify optimal treatment.
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Affiliation(s)
- James R. Janopaul-Naylor
- Department of Radiation Oncology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
| | - Manali Rupji
- Biostatistics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Rachel A. Tobillo
- Department of Radiation Oncology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
| | - Joshua W. Lorenz
- Department of Radiation Oncology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
| | - Jeffrey M. Switchenko
- Biostatistics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health at Emory University, Atlanta, Georgia, USA
| | - Sibo Tian
- Department of Radiation Oncology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
| | - Azeem S. Kaka
- Department of Otolaryngology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
| | - David C. Qian
- Department of Radiation Oncology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
| | - Ashley J. Schlafstein
- Department of Radiation Oncology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
| | - Conor E. Steuer
- Department of Hematology and Medical Oncology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
| | - Jill S. Remick
- Department of Radiation Oncology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
| | - Soumon Rudra
- Department of Radiation Oncology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
| | - Mark W. McDonald
- Department of Radiation Oncology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
| | - Nabil F. Saba
- Department of Otolaryngology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
- Department of Hematology and Medical Oncology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
| | - William A. Stokes
- Department of Radiation Oncology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
| | - Mihir R. Patel
- Department of Otolaryngology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
| | - James E. Bates
- Department of Radiation Oncology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
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15
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Azeem MI, Nooka AK, Shanmugasundaram U, Cheedarla N, Potdar S, Manalo RJ, Moreno A, Switchenko JM, Cheedarla S, Doxie DB, Radzievski R, Ellis ML, Manning KE, Wali B, Valanparambil RM, Maples KT, Baymon E, Kaufman JL, Hofmeister CC, Joseph NS, Lonial S, Roback JD, Sette A, Ahmed R, Suthar MS, Neish AS, Dhodapkar MV, Dhodapkar KM. Impaired SARS-CoV-2 Variant Neutralization and CD8+ T-cell Responses Following 3 Doses of mRNA Vaccines in Myeloma: Correlation with Breakthrough Infections. Blood Cancer Discov 2023; 4:106-117. [PMID: 36511813 PMCID: PMC9975771 DOI: 10.1158/2643-3230.bcd-22-0173] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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: 10/13/2022] [Revised: 11/23/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022] Open
Abstract
Patients with multiple myeloma (MM) mount suboptimal neutralizing antibodies (nAb) following 2 doses of SARS-CoV-2 mRNA vaccines. Currently, circulating SARS-CoV-2 variants of concern (VOC) carry the risk of breakthrough infections. We evaluated immune recognition of current VOC including BA.1, BA.2, and BA.5 in 331 racially representative patients with MM following 2 or 3 doses of mRNA vaccines. The third dose increased nAbs against WA1 in 82%, but against BA variants in only 33% to 44% of patients. Vaccine-induced nAbs correlated with receptor-binding domain (RBD)-specific class-switched memory B cells. Vaccine-induced spike-specific T cells were detected in patients without seroconversion and cross-recognized variant-specific peptides but were predominantly CD4+ T cells. Detailed clinical/immunophenotypic analysis identified features correlating with nAb/B/T-cell responses. Patients who developed breakthrough infections following 3 vaccine doses had lower live-virus nAbs, including against VOC. Patients with MM remain susceptible to SARS-CoV-2 variants following 3 vaccine doses and should be prioritized for emerging approaches to elicit variant-nAb and CD8+ T cells. SIGNIFICANCE Three doses of SARS-CoV-2 mRNA vaccines fail to yield detectable VOC nAbs in nearly 60% and spike-specific CD8+ T cells in >80% of myeloma patients. Patients who develop breakthrough infections following vaccination have low levels of live-virus nAb. This article is highlighted in the In This Issue feature, p. 101.
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Affiliation(s)
- Maryam I. Azeem
- Department of Hematology/Medical Oncology, Emory University, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Ajay K. Nooka
- Department of Hematology/Medical Oncology, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Atlanta, Georgia
| | | | | | - Sayalee Potdar
- Department of Hematology/Medical Oncology, Emory University, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Renee Julia Manalo
- Department of Hematology/Medical Oncology, Emory University, Atlanta, Georgia
| | - Alberto Moreno
- Emory Vaccine Center, Emory University, Atlanta, Georgia
- Emory National Primate Research Center, Atlanta, Georgia
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia
| | | | | | | | | | - Madison Leigh Ellis
- Emory Vaccine Center, Emory University, Atlanta, Georgia
- Emory National Primate Research Center, Atlanta, Georgia
| | - Kelly E. Manning
- Emory Vaccine Center, Emory University, Atlanta, Georgia
- Emory National Primate Research Center, Atlanta, Georgia
| | - Bushra Wali
- Emory Vaccine Center, Emory University, Atlanta, Georgia
- Emory National Primate Research Center, Atlanta, Georgia
| | | | | | | | - Jonathan L. Kaufman
- Department of Hematology/Medical Oncology, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Atlanta, Georgia
| | - Craig C. Hofmeister
- Department of Hematology/Medical Oncology, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Atlanta, Georgia
| | - Nisha S. Joseph
- Department of Hematology/Medical Oncology, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Atlanta, Georgia
| | - Sagar Lonial
- Department of Hematology/Medical Oncology, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Atlanta, Georgia
| | - John D. Roback
- Winship Cancer Institute, Atlanta, Georgia
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | | | - Rafi Ahmed
- Winship Cancer Institute, Atlanta, Georgia
- Emory Vaccine Center, Emory University, Atlanta, Georgia
- Department of Microbiology and Immunology, Emory University, Atlanta, Georgia
| | - Mehul S. Suthar
- Emory Vaccine Center, Emory University, Atlanta, Georgia
- Emory National Primate Research Center, Atlanta, Georgia
- Department of Microbiology and Immunology, Emory University, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Andrew S. Neish
- Winship Cancer Institute, Atlanta, Georgia
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | - Madhav V. Dhodapkar
- Department of Hematology/Medical Oncology, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Atlanta, Georgia
| | - Kavita M. Dhodapkar
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
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16
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Allen PB, McCook-Veal AA, Switchenko JM, Paulino DM, Niyogusaba T, Baird KM, Tarabadkar ES, Lechowicz MJ. Staging lymph nodes and blood at diagnosis in mycosis fungoides identifies patients at increased risk of progression to advanced stage: A retrospective cohort study. Cancer 2023; 129:541-550. [PMID: 36523150 PMCID: PMC9852075 DOI: 10.1002/cncr.34579] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/19/2022] [Accepted: 10/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Risk factors for progression to advanced-stage mycosis fungoides (MF) are poorly defined. METHODS The authors performed a single-center, retrospective cohort study among patients with MF at an academic medical center from 1990 to 2020 to identify clinical variables associated with progression to advanced-stage MF (stage IIB-IVB), and 388 patients who had a clinicopathologic diagnosis of early stage (IA-IIA) MF were identified from their cutaneous lymphoma database. Baseline clinical characteristics, laboratory values, imaging, and blood flow cytometry or T-cell receptor gene rearrangement (TCR) data were collected. Logistic regression was used to assess risk factors associated with progression. RESULTS Overall, 93 of 388 patients (24.0%) progressed to advanced stage. Patients who progressed had an increased risk of death (hazard ratio, 4.50; 95% CI, 2.89-7.00; p < .001). Progression was associated with a higher overall stage at diagnosis, tumor stage, lymph node stage, low-level blood involvement, as measured with TCR data and/or flow cytometry, and elevated lactate dehydrogenase (LDH). Limitations included missing data for LDH, imaging, peripheral blood TCR data, or flow cytometry assessed at diagnosis. CONCLUSIONS Staging and baseline laboratory assessments with imaging, peripheral blood flow cytometry, TCR data, and LDH in patients who have newly diagnosed MF may identify those who are at risk for progression to advanced stage.
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Affiliation(s)
- Pamela B. Allen
- Winship Cancer Institute, Department of Hematology, Atlanta GA, USA
| | | | | | | | - Tim Niyogusaba
- Winship Cancer Institute, Department of Hematology, Atlanta GA, USA
| | - Katelin M. Baird
- Winship Cancer Institute, Department of Hematology, Atlanta GA, USA
| | - Erica S. Tarabadkar
- Winship Cancer Institute, Department of Hematology, Atlanta GA, USA
- Emory University, Department of Dermatology, Atlanta GA, USA
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17
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Schoettler ML, French K, Harris A, Bryson E, Watkins B, Qayed M, Switchenko JM, Williams KM. Prospective Study of Allogeneic Pediatric Transplant Associated Thrombotic Microangiopathy-Novel Prognostic Markers, Biologic Interaction and Outcomes. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00089-1] [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: 02/07/2023]
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18
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Ajay PS, Sok C, Goyal S, Switchenko JM, Maegawa F, Gillespie TW, Paulos CM, Kooby DA, Kennedy T, Shah MM. Time to first treatment and optimal adjuvant treatment strategy in patients with resectable gastric cancer pathologically upstaged to lymph node–positive disease. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.473] [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: 01/26/2023] Open
Abstract
473 Background: Treatment strategies in resectable gastric cancer (GC) patients include perioperative chemotherapy (PEC), postoperative chemoradiation therapy (POCR), and postoperative chemotherapy (POC). Treatment delay can lead to metastases with unfavorable outcomes. We aim to identify the distribution of patients upstaged to pathologically node positive disease (pLN+) stratified by time and the optimal treatment in this cohort. Methods: We analyzed resected GC patients in the National Cancer Database (2004-2016) with clinically node negative disease (cLN-). Time from diagnosis to first definitive therapy was stratified as ≤2, >2 to ≤4, and >4 weeks. The distribution of patients upstaged from cLN- to pLN+ disease, the concordance between cLN- and pathologically lymph node negative (pLN-) disease based on treatment strategy, and time to first definitive therapy was analyzed. POC and POCR were compared to evaluate their effect on overall survival (OS) in patients with cLN- upstaged to pLN+ disease. Kaplan-Meier test, log-rank test, multivariable Cox proportional hazards analysis (MVA) were performed. Results: Of the 4,828 gastric cancer patients with cLN- disease, 514 (10.65%) patients received PEC and 4,314 (89.35%) patients received upfront surgery followed by POCR/POC. Distribution of patients stratified by time between diagnosis to first definitive treatment - chemotherapy (PEC) or surgery (POC/POCR), for ≤2 weeks was 9.5% vs. 33%, >2 - ≤4 weeks was 28.4% vs. 24.2% and >4weeks was 62% vs 42.7%, respectively. Patients upstaged from cLN- to pLN+ disease in the PEC group was 43.37%(n=206), and 70%(n=2574) in the upfront surgery group (POC/POCR). Of the 206 (43.37%) patients upstaged from cLN- to pLN+ in the PEC cohort, the upstage rate was 7.77% when chemotherapy was started within 2 weeks of diagnosis, compared to 27.67% with >2 to ≤4 weeks, and 64.56% with >4 weeks. Of the 2,574 (70%) patients upstaged in the upfront surgery cohort (POCR/POC), 30.61% were upstaged in ≤2 weeks, 24.95% in >2 to ≤4 weeks, and 44.44% in ≥4 weeks. On MVA, patients with cLN- disease that were pLN- (POCR=766, POC=341) had no significant difference in OS when treated with POCR (HR 1.11, p=0.39) compared to POC. Patients with pLN+ (POCR=2300, POC=907) disease had an association with improved OS when treated with POCR (HR 0.78, p<0.001) compared to POC. Conclusions: When resectable gastric cancer patients undergoing upfront surgery are upstaged from clinically node negative to pathologically node positive disease, postoperative chemoradiation therapy may be the optimal treatment strategy compared to postoperative chemotherapy. Clinical nodal status may not be an optimal predictor of nodal disease.
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Affiliation(s)
| | | | - Subir Goyal
- Emory University, Department of Biostatistics and Bioinformatics, Atlanta, GA
| | | | | | | | | | - David A. Kooby
- Winship Cancer Institute, Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, GA
| | | | - Mihir Maheshkumar Shah
- Winship Cancer Institute, Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, GA
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19
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Seong CS, Huang C, Boese AC, Hou Y, Koo J, Mouw JK, Rupji M, Joseph G, Johnston HR, Claussen H, Switchenko JM, Behera M, Churchman M, Kolesar JM, Arnold SM, Kerrigan K, Akerley W, Colman H, Johns MA, Arciero C, Zhou W, Marcus AI, Ramalingam SS, Fu H, Gilbert-Ross M. Loss of the endocytic tumor suppressor HD-PTP phenocopies LKB1 and promotes RAS-driven oncogenesis. bioRxiv 2023:2023.01.26.525772. [PMID: 36747658 PMCID: PMC9900931 DOI: 10.1101/2023.01.26.525772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Oncogenic RAS mutations drive aggressive cancers that are difficult to treat in the clinic, and while direct inhibition of the most common KRAS variant in lung adenocarcinoma (G12C) is undergoing clinical evaluation, a wide spectrum of oncogenic RAS variants together make up a large percentage of untargetable lung and GI cancers. Here we report that loss-of-function alterations (mutations and deep deletions) in the gene that encodes HD-PTP (PTPN23) occur in up to 14% of lung cancers in the ORIEN Avatar lung cancer cohort, associate with adenosquamous histology, and occur alongside an altered spectrum of KRAS alleles. Furthermore, we show that in publicly available early-stage NSCLC studies loss of HD-PTP is mutually exclusive with loss of LKB1, which suggests they restrict a common oncogenic pathway in early lung tumorigenesis. In support of this, knockdown of HD-PTP in RAS-transformed lung cancer cells is sufficient to promote FAK-dependent invasion. Lastly, knockdown of the Drosophila homolog of HD-PTP (dHD-PTP/Myopic) synergizes to promote RAS-dependent neoplastic progression. Our findings highlight a novel tumor suppressor that can restrict RAS-driven lung cancer oncogenesis and identify a targetable pathway for personalized therapeutic approaches for adenosquamous lung cancer.
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Affiliation(s)
- Chang-Soo Seong
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA USA
| | - Chunzi Huang
- Cancer Animal Models Shared Resource, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Austin C. Boese
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA USA
- Cancer Biology Graduate Program, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Yuning Hou
- Cancer Animal Models Shared Resource, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Junghui Koo
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA USA
| | - Janna K. Mouw
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA USA
| | - Manali Rupji
- Biostatistics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Greg Joseph
- Data and Technology Applications Shared Resource, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | | | - Henry Claussen
- Emory Integrated Computational Core, Emory University, Atlanta, GA
| | - Jeffrey M. Switchenko
- Biostatistics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Madhusmita Behera
- Data and Technology Applications Shared Resource, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | | | - Jill M. Kolesar
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | | | - Katie Kerrigan
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Wallace Akerley
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Howard Colman
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Cletus Arciero
- Department of Surgery, Emory University School of Medicine, Atlanta, GA USA
| | - Wei Zhou
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Adam I. Marcus
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Suresh S. Ramalingam
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Haian Fu
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA USA
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, USA
| | - Melissa Gilbert-Ross
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
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20
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Martin P, Cohen JB, Wang M, Kumar A, Hill B, Villa D, Switchenko JM, Kahl B, Maddocks K, Grover NS, Qi K, Parisi L, Daly K, Zhu A, Salles G. Treatment Outcomes and Roles of Transplantation and Maintenance Rituximab in Patients With Previously Untreated Mantle Cell Lymphoma: Results From Large Real-World Cohorts. J Clin Oncol 2023; 41:541-554. [PMID: 35763708 PMCID: PMC9870229 DOI: 10.1200/jco.21.02698] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Commonly used first-line (1L) treatments for mantle cell lymphoma include high-dose cytarabine-based induction followed by autologous stem-cell transplant (ASCT) for younger patients and several chemoimmunotherapy regimens for older patients. Continuous debates exist on the role of ASCT in younger patients and maintenance rituximab (MR) after bendamustine plus rituximab (BR). METHODS Retrospective data from 4,216 patients with mantle cell lymphoma in the Flatiron Health electronic record-derived deidentified database diagnosed between 2011 and 2021, mostly in US community oncology settings, were evaluated for treatment patterns and outcomes. The efficacy findings with ASCT and MR were validated in an independent cohort of 1,168 patients from 12 academic centers. RESULTS Among 3,614 patients with documented 1L treatment, BR was the most used. Among 1,265 patients age < 65 years, 30.5% received cytarabine-based induction and 23.5% received ASCT. There was no significant association between ASCT and real-world time to next treatment (hazard ratio [HR], 0.84; 95% CI, 0.68 to 1.03; P = .10) or overall survival (HR, 0.86; 95% CI, 0.63 to 1.18; P = .4) among ASCT-eligible patients. Among MR-eligible patients, MR after BR versus BR alone was associated with a longer real-world time to next treatment (HR, 1.96; 95% CI, 1.61 to 2.38; P < .001) and overall survival (HR, 1.51; 95% CI, 1.19 to 1.92; P < .001). The efficacy findings were consistent in the validation cohort. CONCLUSION In this large cohort of patients treated primarily in the US community setting, only one in four young patients received cytarabine or ASCT consolidation, suggesting the need to develop treatments that can be delivered effectively in routine clinical practice. Together with the validation cohort, data support future clinical trials exploring regimens without ASCT consolidation in young patients, whereas MR should be considered for patients after 1L BR and rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone.
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Affiliation(s)
- Peter Martin
- Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY
| | - Jonathon B Cohen
- Department of Hematology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Michael Wang
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anita Kumar
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brian Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Diego Villa
- BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Brad Kahl
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Kami Maddocks
- Arthur G James Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Natalie S Grover
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Keqin Qi
- Janssen Research and Development, Titusville, NJ
| | - Lori Parisi
- Janssen Research and Development, Oncology, Raritan, NJ
| | | | - Angeline Zhu
- Janssen Research and Development, Oncology, Raritan, NJ
| | - Gilles Salles
- Memorial Sloan Kettering Cancer Center, New York, NY
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21
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Janopaul-Naylor JR, Cao Y, McCall NS, Switchenko JM, Tian S, Chen H, Stokes WA, Kesarwala AH, McDonald MW, Shelton JW, Bradley JD, Higgins KA. Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era. Front Oncol 2023; 12:1074675. [PMID: 36733369 PMCID: PMC9888533 DOI: 10.3389/fonc.2022.1074675] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/29/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction As immunotherapy has improved distant metastasis-free survival (DMFS) in Non-Small Cell Lung Cancer (NSCLC), isolated locoregional recurrences have increased. However, management of locoregional recurrences can be challenging. We report our institutional experience with definitive intent re-irradiation using Intensity Modulated Proton Therapy (IMPT). Method Retrospective cohort study of recurrent or second primary NSCLC or LS-SCLC treated with IMPT. Kaplan-Meier method and log-rank test were used for time-to-event analyses. Results 22 patients were treated from 2019 to 2021. After first course of radiation (median 60 Gy, range 45-70 Gy), 45% received adjuvant immunotherapy. IMPT re-irradiation began a median of 28.2 months (8.8-172.9 months) after initial radiotherapy. The median IMPT dose was 60 GyE (44-60 GyE). 36% received concurrent chemotherapy with IMPT and 18% received immunotherapy after IMPT. The median patient's IMPT lung mean dose was 5.3 GyE (0.9-13.9 GyE) and 5 patients had cumulative esophagus max dose >100 GyE with 1-year overall survival (OS) 68%, 1-year local control 80%, 1-year progression free survival 45%, and 1-year DMFS 60%. Higher IMPT (HR 1.4; 95% CI 1.1-1.7, p=0.01) and initial radiotherapy mean lung doses (HR 1.3; 95% CI 1.0-1.6, p=0.04) were associated with worse OS. Two patients developed Grade 3 pneumonitis or dermatitis, one patient developed Grade 2 pneumonitis, and seven patients developed Grade 1 toxicity. There were no Grade 4 or 5 toxicities. Discussion Definitive IMPT re-irradiation for lung cancer can prolong disease control with limited toxicity, particularly in the immunotherapy era.
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Affiliation(s)
- James R. Janopaul-Naylor
- Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Yichun Cao
- Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, United States
| | - Neal S. McCall
- Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Jeffrey M. Switchenko
- Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, United States
- Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, United States
| | - Sibo Tian
- Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Haijian Chen
- Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - William A. Stokes
- Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Aparna H. Kesarwala
- Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Mark W. McDonald
- Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Joseph W. Shelton
- Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Jeffrey D. Bradley
- Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Kristin A. Higgins
- Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
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22
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Lipscomb J, Switchenko JM, Flowers CR, Gillespie TW, Wortley PM, Bayakly AR, Almon L, Ward KC. Impact of multi-agent systemic therapy on all-cause and disease-specific survival for people living with HIV who are diagnosed with non-Hodgkin lymphoma: population-based analyses from the state of Georgia. Leuk Lymphoma 2023; 64:151-160. [PMID: 36308021 PMCID: PMC9905298 DOI: 10.1080/10428194.2022.2133539] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/29/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 01/12/2023]
Abstract
For people living with HIV (PLWH) who are subsequently diagnosed with non-Hodgkin lymphoma (NHL), we investigate the impact of standard-of-care (SoC) cancer treatment on all-cause, NHL-specific, and HIV-specific survival outcomes. The focus is on a registry-derived, population-based sample of HIV + adults diagnosed with NHL within 2004-2012 in the state of Georgia. SoC treatment is defined as receipt of multi-agent systemic therapy (MAST). In multivariable survival analyses, SoC cancer treatment is significantly associated with better all-cause and NHL-specific survival, but not better HIV-specific survival across 2004-2017. Having a CD4 count <200 near the time of cancer diagnosis and Ann Arbor stage III/IV disease are associated with worse all-cause and HIV-specific survival; the effects on NHL survival trend negative but are not significant. Future work should expand the geographic base and cancers examined, deepen the level of clinical detail brought to bear, and incorporate the perspectives and recommendations of patients and providers.
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Affiliation(s)
- Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Christopher R Flowers
- Division of Cancer Medicine, Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Theresa W Gillespie
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Surgical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Lyn Almon
- Georgia Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kevin C Ward
- Georgia Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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23
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Aldrich J, Ekpo P, Rupji M, Switchenko JM, Torres MA, Kalinsky K, Bhave MA. Racial Disparities in Clinical Outcomes on Investigator-Initiated Breast Cancer Clinical Trials at an Urban Medical Center. Clin Breast Cancer 2023; 23:38-44. [PMID: 36333193 DOI: 10.1016/j.clbc.2022.10.005] [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] [Received: 05/05/2022] [Revised: 09/22/2022] [Accepted: 10/09/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Black women are 40% more likely to die of breast cancer compared to White women. Inadequate representation of Black patients in clinical trials may contribute to health care inequity. We aimed to assess breast cancer clinical outcomes in Non-Hispanic Black (Black) versus Non-Hispanic White (White) women with metastatic breast cancer (MBC) enrolled on investigator-initiated clinical trials at Winship Cancer Institute at Emory University, given the significant number of patients from underrepresented minority groups seen at Winship. MATERIALS AND METHODS Black and White women with MBC on investigator-initiated trials at Emory between 2009 and 2019 were retrospectively evaluated. Univariate analyses and multiple logistic regression models were used to assess clinical response and treatment toxicities. Differences in overall survival between groups was assessed using quantile analysis. RESULTS Sixty-two women with MBC were included (66% White vs. 34% Black). Black patients had less clinical benefit from the trial therapy as only 57% had partial response or stable disease as best response compared to 78% of White women (P = .09). Quantile analysis showed significant difference in mean survival between Whites and Blacks by the end of follow up (64 vs. 38 months). There were no significant differences in toxicities between groups. CONCLUSION Participation rates of Black women with MBC on investigator-initiated clinical trials at an urban cancer center were higher compared to key national trials. Black women had worse treatment response and survival. These results reinforce the need for assessment of tumor differences by ancestry and continued improvement in minority representation on clinical trials.
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Affiliation(s)
- Jeffrey Aldrich
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Princess Ekpo
- Department of Biology, Emory University, Atlanta, GA
| | - Manali Rupji
- Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Jeffrey M Switchenko
- Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Mylin A Torres
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Kevin Kalinsky
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Manali A Bhave
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
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24
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Gross JH, Patel MR, Switchenko JM, Chan TG, Baddour HM, Kaka A, Boyce BJ, Saba NF, Beitler JJ, El-Deiry M. Oncologic Outcomes After Clinically Node-Negative Salvage Laryngectomy. JAMA Otolaryngol Head Neck Surg 2023; 149:24-33. [PMID: 36394866 PMCID: PMC9673019 DOI: 10.1001/jamaoto.2022.3597] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/20/2022] [Indexed: 11/19/2022]
Abstract
Importance Controversy exists regarding management of the clinically node-negative neck in patients with recurrent larynx or hypopharynx cancers who received total laryngectomy after definitive radiation with or without chemotherapy. Objective To explore clinical and oncologic outcomes after elective neck dissection vs observation in patients who received clinically node-negative salvage total laryngectomy. Design, Setting, and Participants This cohort study was performed from January 2009 to June 2021 at a single, high-volume tertiary care center. Follow-up was conducted through June 2021 for all patients. Survival outcomes were based on at least 2 years of follow-up. Patients aged 18 years or older with recurrent, clinically node-negative larynx or hypopharynx tumors after definitive nonsurgical treatment who were treated with a salvage total laryngectomy were included. Data were analyzed from October 2021 through September 2022. Exposures Elective neck dissection. Main Outcomes and Measures Presence and location of occult nodal metastasis in electively dissected necks, along with differences in fistula rates and overall and disease-free survival between patients receiving elective neck dissection vs observation. Results Among 107 patients receiving clinically node-negative salvage total laryngectomy (median [IQR] age, 65.0 [57.8-71.3] years; 91 [85.0%] men), 81 patients underwent elective neck dissection (75.7%) and 26 patients underwent observation (24.3%). Among patients with elective neck dissection, 13 patients had occult nodal positivity (16.0%). Recurrent supraglottic (4 of 20 patients [20.0%]) or advanced T classification (ie, T3-T4; 12 of 61 patients [19.7%]) had an occult nodal positivity rate of 20% or more, and positive nodes were most likely to occur in levels II and III (II: 6 of 67 patients [9.0%]; III: 6 of 65 patients [9.2%]; VI: 3 of 44 patients [6.8%]; IV: 3 of 62 patients [4.8%]; V: 0 of 4 patients; I: 0 of 18 patients). There was a large difference in fistula rate between elective neck dissection (12 patients [14.8%]) and observed (8 patients [30.8%]) groups (difference, 16.0 percentage points; 95% CI, -3.4 to 35.3 percentage points), while the difference in fistula rate was negligible between 50 patients undergoing regional or free flap reconstruction (10 patients [20.0%]) vs 57 patients undergoing primary closure (10 patients [17.5%]) (difference, 2.5 percentage points; 95% CI, -12.4 to 17.3 percentage points). Undergoing elective neck dissection was not associated with a clinically meaningful improvement in overall or disease-free survival compared with observation. Recurrent hypopharynx subsite was associated with an increased risk of death (hazard ratio, 4.28; 95% CI, 1.81 to 10.09) and distant recurrence (hazard ratio, 7.94; 95% CI, 2.07 to 30.48) compared with glottic subsite. Conclusions and Relevance In this cohort study, patients with recurrent supraglottic or advanced T classification tumors had an increased occult nodal positivity rate, elective neck dissection was not associated with survival, and patients with recurrent hypopharynx subsite were more likely to have a distant recurrence and die of their disease. These findings suggest that underlying disease pathology rather than surgical management may be associated with survival outcomes in this population.
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Affiliation(s)
- Jennifer H. Gross
- Department of Otolaryngology–Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Mihir R. Patel
- Department of Otolaryngology–Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jeffrey M. Switchenko
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Tyler G. Chan
- Emory University School of Medicine, Atlanta, Georgia
| | - H. M. Baddour
- Department of Otolaryngology–Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Azeem Kaka
- Department of Otolaryngology–Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Brian J. Boyce
- Department of Otolaryngology–Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Nabil F. Saba
- Department of Otolaryngology–Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jonathan J. Beitler
- Department of Otolaryngology–Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Mark El-Deiry
- Department of Otolaryngology–Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
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Chang A, Akhtar A, Lai L, Orellana-Noia VM, Linderman SL, McCook-Veal AA, Switchenko JM, Saini M, Valanparambil RM, Blum KA, Allen PB, Lechowicz MJ, Romancik JT, Ayers A, Leal A, O'Leary CB, Churnetski MC, Baird K, Kives M, Wrammert J, Nooka AK, Koff JL, Dhodapkar MV, Suthar MS, Cohen JB, Ahmed R. Antibody binding and neutralization of live SARS-CoV-2 variants including BA.4/5 following booster vaccination of patients with B-cell malignancies. Cancer Res Commun 2022; 2:1684-1692. [PMID: 36644323 PMCID: PMC9833496 DOI: 10.1158/2767-9764.crc-22-0471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Non-Hodgkin lymphoma and chronic lymphocytic leukemia (NHL/CLL) patients elicit inadequate antibody responses after initial SARS-CoV-2 vaccination and remain at high risk of severe COVID-19 disease. We investigated IgG, IgA, and IgM responses after booster vaccination against recent SARS-CoV-2 variants including Omicron BA.5 in 67 patients. Patients had lower fold increase and total anti-spike binding titers after booster than healthy individuals. Antibody responses negatively correlated with recent anti-CD20 therapy and low B cell numbers. Antibodies generated after booster demonstrated similar binding properties against SARS-CoV-2 variants compared to those generated by healthy controls with lower binding against Omicron variants. Importantly, 43% of patients showed anti-Omicron BA.1 neutralizing antibodies after booster and all these patients also had anti-Omicron BA.5 neutralizing antibodies. NHL/CLL patients demonstrated inferior antibody responses after booster vaccination, particularly against Omicron variants. Prioritization of prophylactic and treatment agents and vaccination of patients and close contacts with updated vaccine formulations are essential.
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Affiliation(s)
- Andres Chang
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Akil Akhtar
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Lilin Lai
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
- Department of Pediatrics, Emory University Schools of Medicine, Atlanta, Georgia
- Emory National Primate Research Center, Atlanta, Georgia
| | - Victor M. Orellana-Noia
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Susanne L. Linderman
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Ashley A. McCook-Veal
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jeffrey M. Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Manpreet Saini
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
- International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - Rajesh M. Valanparambil
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Kristie A. Blum
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Pamela B. Allen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Mary Jo Lechowicz
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Jason T. Romancik
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Amy Ayers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alyssa Leal
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Colin B. O'Leary
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Michael C. Churnetski
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Katelin Baird
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Melissa Kives
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Jens Wrammert
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
- Department of Pediatrics, Emory University Schools of Medicine, Atlanta, Georgia
| | - Ajay K. Nooka
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Jean L. Koff
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Madhav V. Dhodapkar
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Mehul S. Suthar
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
- Department of Pediatrics, Emory University Schools of Medicine, Atlanta, Georgia
| | - Jonathon B. Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
- Corresponding Authors: Rafi Ahmed, Emory University School of Medicine, Atlanta, GA 30322. Phone: 404-727-4700; Fax: 404-727-3722; E-mail: ; and Jonathon B. Cohen,
| | - Rafi Ahmed
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
- Corresponding Authors: Rafi Ahmed, Emory University School of Medicine, Atlanta, GA 30322. Phone: 404-727-4700; Fax: 404-727-3722; E-mail: ; and Jonathon B. Cohen,
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Casabianca AS, Tsagkalidis V, Burchard PR, Chacon A, Melucci A, Reitz A, Swift DA, McCook AA, Switchenko JM, Shah MM, Carpizo DR. Surgery in combination with systemic chemotherapy is associated with improved survival in stage IV gallbladder cancer. Eur J Surg Oncol 2022; 48:2448-2454. [PMID: 35773092 PMCID: PMC10993821 DOI: 10.1016/j.ejso.2022.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gallbladder cancer (GBC) is the most common biliary malignancy frequently metastatic at diagnosis with poor prognosis. While surgery remains the standard for early-stage GBC, the role of surgery in patients with metastatic gastrointestinal cancers is expanding due to improvements in systemic therapies. We sought to evaluate the survival of patients with stage IV GBC undergoing surgery in an era of improved multi-agent systemic therapy. METHODS A retrospective review of the National Cancer Database was performed. Patients with stage IV GBC who underwent systemic therapy were included. Patients who received radiation therapy, palliative therapy or had missing survival data were excluded. Univariable and multivariable analysis was performed. RESULTS 4,145 patients were identified between 2004 and 2016. Mean age was 69. Surgery combined with systemic therapy predicted improved median survival compared with chemotherapy alone (11.1mo versus 6.8mo, HR 0.65, p < 0.001). Additionally, receipt of treatment after 2011 predicted improved survival (HR 0.86, p < 0.001). Patients treated with multi-agent chemotherapy in combination with surgery were associated with the greatest hazard ratio benefit (0.40, p < 0.001) versus single agent therapy alone. CONCLUSION Patients with stage IV gallbladder cancer treated with a combination of surgery and chemotherapy are associated with an improved overall survival compared to chemotherapy alone. Patients receiving care during the more recent era demonstrated improved survival. These results support a role for surgery in selected patients with stage IV gallbladder cancer receiving chemotherapy.
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Affiliation(s)
- Anthony S Casabianca
- Department of Surgery, Division of General Surgery, University of Rochester, Rochester, NY, USA
| | - Vasileios Tsagkalidis
- Department of Surgery, Division of General Surgery, University of Rochester, Rochester, NY, USA
| | - Paul R Burchard
- Department of Surgery, Division of General Surgery, University of Rochester, Rochester, NY, USA
| | - Alexander Chacon
- Department of Surgery, Division of General Surgery, University of Rochester, Rochester, NY, USA
| | - Alexa Melucci
- Department of Surgery, Division of General Surgery, University of Rochester, Rochester, NY, USA
| | - Alexandra Reitz
- Department of General Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - David A Swift
- Department of General Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Ashley A McCook
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mihir M Shah
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Darren R Carpizo
- Department of Surgery, Division of Surgical Oncology, University of Rochester, NY, USA; Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
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Melucci AD, Chacon AC, Burchard PR, Tsagkalidis V, Casabianca AS, Goyal S, Switchenko JM, Kooby DA, Staley CA, Carpizo DR, Shah MM. ASO Visual Abstract: The Impact of Carbohydrate Antigen 19-9 on Survival in Patients with Clinical Stage I and II Pancreatic Cancer. Ann Surg Oncol 2022; 29:8550. [PMID: 36088428 DOI: 10.1245/s10434-022-12538-5] [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: 09/22/2023]
Affiliation(s)
- Alexa D Melucci
- Department of Surgery, University of Rochester, Rochester, NY, USA
| | | | - Paul R Burchard
- Department of Surgery, University of Rochester, Rochester, NY, USA
| | | | | | - Subir Goyal
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - David A Kooby
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Charles A Staley
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Darren R Carpizo
- Department of Surgery, University of Rochester, Rochester, NY, USA
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Mihir M Shah
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA.
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Kokabi N, Webster LA, Elsayed M, Switchenko JM, Chen B, Brandon D, Galt J, Sethi I, Cristescu M, Kappadath SC, Schuster DM. Accuracy and Safety of Scout Dose Resin Yttrium-90 Microspheres for Radioembolization Therapy Treatment Planning: A Prospective Single-Arm Clinical Trial. J Vasc Interv Radiol 2022; 33:1578-1587.e5. [PMID: 36075560 PMCID: PMC9834905 DOI: 10.1016/j.jvir.2022.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 08/09/2022] [Accepted: 08/26/2022] [Indexed: 01/14/2023] Open
Abstract
PURPOSE To compare the accuracy and safety of 0.56 GBq resin yttrium-90 (90Y) (scout90Y) microspheres with those of technetium-99m macroaggregated albumin (MAA) in predicting the therapeutic 90Y (Rx90Y) dose for patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS This prospective single-arm clinical trial (Clinicaltrials.gov: NCT04172714) recruited patients with HCC. Patients underwent same-day mapping with MAA and scout90Y. Rx90Y activity was administered 3 days after mapping. Using paired t test and Pearson correlation, the tumor-to-normal ratio (TNR), lung shunt fraction (LSF), predicted mean tumor dose (TD), and nontumoral liver dose (NTLD) by MAA and scout90Y were compared with those by Rx90Y. Bland-Altman plots compared the level of agreement between the TNR and LSF of scout90Y and MAA with that of Rx90Y. The safety of scout90Y was evaluated by examining the discrepancy in extrahepatic activity between MAA and scout90Y. RESULTS Thirty patients were treated using 19 segmental and 14 nonsegmental (ie, 2 contiguous segments or nonsegmental) therapies. MAA had weak LSF, moderate TNR, and moderate TD linear correlation with Rx90Y. Scout90Y had a moderate LSF, strong TNR, strong TD, and very strong NTLD in correlation with those of Rx90Y. Furthermore, the TNR and LSF of scout90Y had a stronger agreement with those of Rx90Y than with those of MAA. In the nonsegmental subgroup, MAA had no significant correlation with the TD and NTLD of Rx90Y, whereas scout90Y had a very strong correlation with both of these factors. In the segmental subgroup, both MAA and scout90Y had a strong linear correlation with the TD and NTLD of Rx90Y. CONCLUSIONS Compared with MAA, scout90Y is a more accurate surrogate for Rx90Y biodistribution for nonsegmental therapies.
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Affiliation(s)
- Nima Kokabi
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
| | - Linzi A Webster
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Mohammad Elsayed
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Bernard Chen
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - David Brandon
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - James Galt
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Ila Sethi
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Mircea Cristescu
- Division of Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - S Cheenu Kappadath
- Division of Diagnostic Imaging, Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David M Schuster
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Melucci AD, Chacon AC, Burchard PR, Tsagkalidis V, Casabianca AS, Goyal S, Switchenko JM, Kooby DA, Staley CA, Carpizo DR, Shah MM. The Impact of Carbohydrate Antigen 19-9 on Survival in Patients with Clinical Stage I and II Pancreatic Cancer. Ann Surg Oncol 2022; 29:8536-8547. [PMID: 36121582 PMCID: PMC9879696 DOI: 10.1245/s10434-022-12497-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/17/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Carbohydrate antigen (CA) 19-9 is a biomarker to monitor treatment effect. A threshold to predict prognostic significance remains undefined. We evaluated the impact of CA19-9 on overall survival (OS) in patients with early-stage pancreatic cancer (PC) utilizing the National Cancer Database (NCDB). METHODS The NCDB was queried from 2010 to 2014 to identify patients with clinical stage I-II PC. Patients who had undocumented pretreatment CA19-9 were excluded. Patients were stratified into two cohorts: CA19-9 < 98 U/mL and CA19-9 ≥ 98 U/mL, and further categorized into surgery versus no surgery. Twelve- and 24-month OS rates are reported. RESULTS Overall, 32,382 patients (stage I: 12,173; stage II: 20,209) were included. The majority of stage I (52.1%) and II (60%) patients had CA19-9 ≥ 98 U/mL. Stage I-II patients with CA19-9 < 98 U/mL had improved OS rates (stage I: 67.5%, 42.6%; stage II: 59.8%, 32.8%) compared with stage I and II patients with CA19-9 ≥ 98 U/mL (stage I: 50.7%, 26.9%; stage II: 48.1%, 22%). Among resected stage I patients, CA19-9 <98 U/mL was associated with improved OS (< 98: 80.5%, 56%; ≥ 98: 70.2%, 42.8%), and a similar trend was seen in resected stage II patients (< 98: 77.6%, 49.9%; ≥ 98: 71%, 39.2%). Unresected stage I patients with lower CA19-9 had improved OS (< 98: 42.1%, 17.5; ≥ 98: 29.9%, 10%), with similar findings in unresected stage II patients (< 98: 41.1%, 15.3%; ≥ 98: 33.4%, 10.6%). CONCLUSIONS Our study demonstrated the prognostic value of CA19-9 in patients with clinical stage I-II PC, with a value < 98 U/mL demonstrating improved survival. Surgery significantly improved survival at 12 and 24 months irrespective of CA19-9.
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Affiliation(s)
| | | | | | | | | | - Subir Goyal
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jeffrey M. Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - David A. Kooby
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA
| | - Charles A. Staley
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA
| | - Darren R. Carpizo
- Department of Surgery, University of Rochester, Rochester, NY,Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Mihir M. Shah
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA
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Ajay PS, Tsagkalidis V, Casabianca A, Burchard PR, Melucci AD, Chacon A, Goyal S, Switchenko JM, Kooby DA, Carpizo DR, Shah MM. A review of hepatic epithelioid hemangioendothelioma-Analyzing patient characteristics and treatment strategies. J Surg Oncol 2022; 126:1423-1429. [PMID: 35975699 PMCID: PMC9836828 DOI: 10.1002/jso.27066] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/27/2022] [Accepted: 07/30/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Hepatic epithelioid hemangioendothelioma (HEH) is a rare vascular tumor of unknown etiology and unpredictable natural history. To date, no large-scale studies have been published evaluating this disease due to its rare occurrence. METHODS The National Cancer Database was reviewed between 2004 and 2016 to identify patients with HEH. Univariate analysis with overall survival (OS) was performed by Cox proportional hazards model. Kaplan-Meier method was used to create OS curves and compared using the log-rank test. RESULTS We identified 229 patients with HEH. The majority of patients were female (61.1%), white (84.3%), and had a Charlson-Deyo score of 0 (75%). Chemotherapeutic intervention was seen in 26% of the patients while 33% received surgical intervention in the form of wedge/segmental liver resection (n = 27), hepatectomy lobectomy/extended lobectomy (n = 18), and liver transplant (n = 22). Five-year survival in surgical patients was 90.5%, 66.5% and 81%, respectively (p = 0.485). Age greater than 55 years (hazard ratio [HR], 2.78; p < 0.001), Asian ethnicity compared to white (HR, 2.84; p = 0.012), and a higher Charlson-Deyo score (score 1: HR, 2.28; p < 0.001 and score ≥2: HR, 2.76; p = 0.011) were associated with worse OS. CONCLUSION Treatment for HEH remains variable with only a third of the patients undergoing surgery. International collaboration is necessary to determine the optimal treatment for this rare disease.
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Affiliation(s)
- Pranay S. Ajay
- Division of Surgical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vasileios Tsagkalidis
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Anthony Casabianca
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Paul R. Burchard
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Alexa D. Melucci
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Alexander Chacon
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Subir Goyal
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jeffrey M. Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - David A. Kooby
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Darren R. Carpizo
- Division of Surgical Oncology, Wilmot Caner Center, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Mihir M. Shah
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
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McCall NS, Eng TY, Shelton JW, Hanasoge S, Patel PR, Patel Jr. AB, McCook-Veal AA, Switchenko JM, Cole TE, Khanna N, Han CH, Gordon AN, Starbuck KD, Remick JS. Incidence and predictors of toxicity in the management of vulvar squamous cell carcinoma treated with radiation therapy. Gynecol Oncol Rep 2022; 44:101086. [PMID: 36281250 PMCID: PMC9587278 DOI: 10.1016/j.gore.2022.101086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/01/2022] [Accepted: 10/08/2022] [Indexed: 10/31/2022] Open
Abstract
Purpose/Objective Given the rarity of vulvar cancer, data on the incidence of acute and late severe toxicity and patients' symptom burden from radiotherapy (RT) are lacking. Materials/Methods This multi-center, single-institution study included patients with vulvar squamous cell carcinoma treated with curative intent RT between 2009 and 2020. Treatment-related acute and late grade ≥ 3 toxicities and late patient subjective symptoms (PSS) were recorded. Results Forty-two patients with predominantly stage III/IV disease (n = 25, 59.5 %) were treated with either definitive (n = 25, 59.5 %) or adjuvant (n = 17, 40.5 %) external beam RT to a median dose of 64 Gy and 59.4 Gy, respectively. Five patients received a brachytherapy boost with a median total dose of 84.3 Gy in 2 Gy-equivalent dose (EQD2). Intensity-modulated RT was used in 37 (88.1 %) of patients, and 25 patients (59.5 %) received concurrent chemotherapy. Median follow-up was 27 months. Acute grade ≥ 3 toxicity occurred in 17 patients (40.5 %), including 13 (31.0 %) acute grade 3 skin events. No factors, including total RT dose (p = 0.951), were associated with acute skin toxicity. Eleven (27.5 %) patients developed late grade ≥ 3 toxicity events, including 10 (23.8 %) late grade ≥ 3 skin toxicity events. Patients with late grade ≥ 3 skin toxicity had a higher mean body-mass index (33.0 vs 28.2 kg/m2; p = 0.009). Common late PSS included vaginal pain (n = 15, 35.7 %), skin fibrosis (n = 10, 23.8 %), and requirement of long-term opiates (n = 12, 28.6 %). Conclusion RT for vulvar cancer is associated with considerable rates of severe acute and late toxicity and PSS burden. Larger studies are needed to identify risk factors, explore toxicity mitigation strategies, and assess patient-reported outcomes.
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Affiliation(s)
- Neal S. McCall
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, United States
| | - Tony Y. Eng
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, United States
| | - Joseph W. Shelton
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, United States
| | - Sheela Hanasoge
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, United States
| | - Pretesh R. Patel
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, United States
| | - Ashish B. Patel Jr.
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, United States
| | - Ashley A. McCook-Veal
- Department of Biostatistics & Bioinformatics, Winship Cancer Institute of Emory University, United States
| | - Jeffrey M. Switchenko
- Department of Biostatistics & Bioinformatics, Winship Cancer Institute of Emory University, United States
| | - Tonya E. Cole
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, United States
| | - Namita Khanna
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Emory University, United States
| | - Chanhee H. Han
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Emory University, United States
| | - Alan N. Gordon
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Emory University, United States
| | - Kristen D. Starbuck
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Emory University, United States
| | - Jill S. Remick
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, United States,Corresponding author at: 1365 Clifton Rd, NE, Atlanta, GA 30322, United States.
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Sadigh G, Coleman D, Switchenko JM, Hopkins JO, Carlos RC. Treatment out-of-pocket cost communication and remote financial navigation in patients with cancer: a feasibility study. Support Care Cancer 2022; 30:8173-8182. [PMID: 35796885 PMCID: PMC9834906 DOI: 10.1007/s00520-022-07270-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/29/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVE We conducted a pilot study assessing the feasibility of a personalized out-of-pocket cost communication, remote financial navigation, and counseling (CostCOM) intervention in cancer patients. METHODS Twenty-three adult, newly diagnosed cancer patients at a single community oncology practice were asked to complete a survey and participate in a CostCOM intervention, including patient-specific out-of-pocket cost communication, remote financial navigation, and counseling. Feasibility was defined as patient participation in CostCOM, and its impact on financial worry measured using the Comprehensive Score for Financial Toxicity (COST) (higher score = less worry) was assessed. Eight patients' and two providers' experience with CostCOM was evaluated using qualitative interviews. RESULTS Mean patient age was 61 (78.3% female; 100% white). Of 23 CostCOM patients, 86.9% completed CostCOM, 60% of them completed a financial assistance application, and 25% of those who applied were enrolled in a co-pay assistance program. Patients' financial worry significantly improved following CostCOM (COST score of 10.0 ± 9.6 at enrollment vs. 16.9 ± 8.1 at follow-up; p < 0.001). Mean general satisfaction (out of 5) with CostCOM was 4.1 ± 0.7. In qualitative interviews following OOPC communication, 75% felt a positive impact on their mental health, and all patients reported no change in their treatment plan; 83.3% found financial navigation beneficial. In providers' interviews, buy-in from relevant stakeholders, integration of the CostCOM with existing workflow, and larger studies to assess the effectiveness of CostCOM were identified as factors needed for CostCOM implementation in practice. CONCLUSION CostCOM interventions are feasible and acceptable and decrease financial worry in patients with cancer.
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Affiliation(s)
- Gelareh Sadigh
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, Suite BG20, Atlanta, GA 30322, USA
| | - Debrua Coleman
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, Suite BG20, Atlanta, GA 30322, USA
| | - Jeffrey M. Switchenko
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | | | - Ruth C. Carlos
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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Moubadder L, Collin LJ, Nash R, Switchenko JM, Miller-Kleinhenz JM, Gogineni K, Ward KC, McCullough LE. Drivers of racial, regional, and socioeconomic disparities in late-stage breast cancer mortality. Cancer 2022; 128:3370-3382. [PMID: 35867419 DOI: 10.1002/cncr.34391] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 02/11/2022] [Revised: 05/08/2022] [Accepted: 06/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The authors identified tumor, treatment, and patient characteristics that may contribute to differences in breast cancer (BC) mortality by race, rurality, and area-level socioeconomic status (SES) among women diagnosed with stage IIIB-IV BC in Georgia. METHODS Using the Georgia Cancer Registry, 3084 patients with stage IIIB-IV primary BC (2013-2017) were identified. Cox proportional hazards regression was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) comparing mortality among non-Hispanic Black (NHB) versus non-Hispanic White (NHW), residents of rural versus urban neighborhoods, and residents of low- versus high-SES neighborhoods by tumor, treatment, and patient characteristics. The mediating effects of specific characteristics on the association between race and BC mortality were estimated. RESULTS Among the study population, 41% were NHB, 21% resided in rural counties, and 72% resided in low SES neighborhoods. The authors observed mortality disparities by race (HR, 1.27; 95% CI, 1.13, 1.41) and rurality (HR, 1.14; 95% CI, 1.00, 1.30), but not by SES (HR, 1.04; 95% CI, 0.91, 1.19). In the stratified analyses, racial disparities were the most pronounced among women with HER2 overexpressing tumors (HR, 2.30; 95% CI, 1.53, 3.45). Residing in a rural county was associated with increased mortality among uninsured women (HR, 2.25; 95% CI, 1.31, 3.86), and the most pronounced SES disparities were among younger women (<40 years: HR, 1.46; 95% CI, 0.88, 2.42). CONCLUSIONS There is considerable variation in racial, regional, and socioeconomic disparities in late-stage BC mortality by tumor, treatment, and patient characteristics.
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Affiliation(s)
- Leah Moubadder
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lindsay J Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Keerthi Gogineni
- Department of Hematology and Medical Oncology, Emory School of Medicine, Atlanta, Georgia, USA
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Chang A, Akhtar A, Linderman SL, Lai L, Orellana-Noia VM, Valanparambil R, Ahmed H, Zarnitsyna VI, McCook-Veal AA, Switchenko JM, Koff JL, Blum KA, Ayers AA, O'Leary CB, Churnetski MC, Sulaiman S, Kives M, Sheng P, Davis CW, Nooka AK, Antia R, Dhodapkar MV, Suthar MS, Cohen JB, Ahmed R. Humoral Responses Against SARS-CoV-2 and Variants of Concern After mRNA Vaccines in Patients With Non-Hodgkin Lymphoma and Chronic Lymphocytic Leukemia. J Clin Oncol 2022; 40:3020-3031. [PMID: 35436146 PMCID: PMC9470134 DOI: 10.1200/jco.22.00088] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 01/14/2022] [Revised: 02/22/2022] [Accepted: 03/25/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Patients with non-Hodgkin lymphoma including chronic lymphocytic leukemia (NHL/CLL) are at higher risk of severe SARS-CoV-2 infection. We investigated vaccine-induced antibody responses in patients with NHL/CLL against the original SARS-CoV-2 strain and variants of concern including B.1.167.2 (Delta) and B.1.1.529 (Omicron). MATERIALS AND METHODS Blood from 121 patients with NHL/CLL receiving two doses of vaccine were collected longitudinally. Antibody binding against the full-length spike protein, the receptor-binding, and N-terminal domains of the original strain and of variants was measured using a multiplex assay. Live-virus neutralization against Delta, Omicron, and the early WA1/2020 strains was measured using a focus reduction neutralization test. B cells were measured by flow cytometry. Correlation between vaccine response and clinical factors was determined. RESULTS Mean anti-SARS-CoV-2 spike immunoglobulin G-binding titers were 85-fold lower in patients with NHL/CLL compared with healthy controls, with seroconversion occurring in only 67% of patients. Neutralization titers were also lower and correlated with binding titers (P < .0001). Treatment with anti-CD20-directed therapies within 1 year resulted in 136-fold lower binding titers. Peripheral blood B-cell count also correlated with vaccine response. At 3 months from last anti-CD20-directed therapy, B-cell count ≥ 4.31/μL blood around the time of vaccination predicted response (OR 7.46, P = .04). Antibody responses also correlated with age. Importantly, neutralization titers against Delta and Omicron were reduced six- and 42-fold, respectively, with 67% of patients seropositive for WA1/2020 exhibiting seronegativity for Omicron. CONCLUSION Antibody binding and live-virus neutralization against SARS-CoV-2 and its variants of concern including Delta and Omicron were substantially lower in patients with NHL/CLL compared with healthy vaccinees. Anti-CD20-directed therapy < 1 year before vaccination and number of circulating B cells strongly predict vaccine response.
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Affiliation(s)
- Andres Chang
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA
| | - Akil Akhtar
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA
| | - Susanne L. Linderman
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA
| | - Lilin Lai
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA
- Department of Pediatrics, Emory University Schools of Medicine, Atlanta, GA
- Yerkes National Primate Research Center, Atlanta, GA
| | - Victor M. Orellana-Noia
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Rajesh Valanparambil
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA
| | - Hasan Ahmed
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA
- Department of Biology, Emory University, Atlanta, GA
| | - Veronika I. Zarnitsyna
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA
- Department of Biology, Emory University, Atlanta, GA
| | - Ashley A. McCook-Veal
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jeffrey M. Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jean L. Koff
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Kristie A. Blum
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Amy A. Ayers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Colin B. O'Leary
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Michael C. Churnetski
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Shahana Sulaiman
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Melissa Kives
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Preston Sheng
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA
| | - Carl W. Davis
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA
| | - Ajay K. Nooka
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Rustom Antia
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA
- Department of Biology, Emory University, Atlanta, GA
| | - Madhav V. Dhodapkar
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Mehul S. Suthar
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA
- Department of Pediatrics, Emory University Schools of Medicine, Atlanta, GA
| | - Jonathon B. Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Rafi Ahmed
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA
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Martini DJ, Goyal S, Switchenko JM, Lechowicz MJ, Allen PB. African American and Caucasian patients with Sézary syndrome have no differences in outcomes at an ethnically diverse urban medical center. Leuk Lymphoma 2022; 63:2094-2101. [PMID: 35481397 PMCID: PMC9842406 DOI: 10.1080/10428194.2022.2067999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Sézary syndrome (SS) is an aggressive cutaneous T-cell lymphoma with poor survival. We performed a retrospective review of SS patients at Emory University from 1990 to 2020. We collected data on race, clinical characteristics, therapy, and social determinants of health. Clinical endpoints were overall survival (OS) and time to next treatment (TTNT). Univariate association and multivariable analyses were assessed by Cox proportional hazards models. Among 62 patients, 45.2% were AA. The median OS and TTNT were 3.1 years and 6.3 months, respectively, with no difference by race. AA patients had a higher median baseline LDH (360 vs. 232, p = 0.002) and a longer delay in initiation of systemic therapy compared to CC patients (3.17 vs. 2.14 months, p = 0.039), but a shorter commute (<10 miles) and no difference in insurance coverage (p = 0.260). AA patients at an academic center had unique clinical features and treatment patterns, but similar survival to CC SS patients.
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Affiliation(s)
- Dylan J. Martini
- Department of Hematology, Winship Cancer Institute, Atlanta, GA, USA,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Subir Goyal
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | | | - Mary Jo Lechowicz
- Department of Hematology, Winship Cancer Institute, Atlanta, GA, USA
| | - Pamela B. Allen
- Department of Hematology, Winship Cancer Institute, Atlanta, GA, USA
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Farran B, Switchenko JM, Khalil L, Shaib WL, Olson B, Ruggieri A, Wu C, Alese OB, Diab M, Lesinski GB, El-Rayes B, Akce M. Abstract 3482: Correlative analysis of metformin and nivolumab combination in treatment-refractory microsatellite stable (MSS) metastatic colorectal cancer (mCRC). Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Preclinical results indicate that metformin can modulate immune cell populations in the tumor microenvironment of solid tumors by diminishing exhaustion of CD8+ tumor infiltrating cells and improving T cell responses. Studies also suggest that metformin could complement PD-1 blockade and potentiate its antitumor activity. Previously we reported the results of a phase II trial with metformin and nivolumab and here we report the findings of correlative analysis of the prospectively collected research samples of 18 patients.
Methods: We conducted a phase II trial with nivolumab and metformin in treatment-refractory microsatellite stable (MSS) metastatic colorectal cancer (mCRC). Nivolumab 480 mg IV every 4 weeks and metformin 1000 mg orally twice daily was administered in 28-day cycles following a 14-day metformin only lead-in phase. The primary endpoint was overall response rate (ORR). Secondary endpoints were overall survival (OS) and progression free survival (PFS). Pre-treatment and on-treatment research biopsies and correlative peripheral blood specimens were collected. Paired biopsies obtained at baseline and following treatment with metformin only (n=9) or metformin and nivolumab (n=9) and were stained with a panel of 13 markers using ChipCytometry technology by Canopy Biosciences. Sample was assessed prior to establishing the multiplex assay. 30 out of 36 samples were imaged and analyzed up to 30 Fields of View. Single cell recognition and quantitative biomarker analysis were performed to compare immune cell numbers and population distribution in pre- versus post-treatment samples.
Results: As previously reported, no patients had objective response based on RECIST version 1.1 and the study was stopped after the first stage for futility. Median OS and PFS was 5.1 months [95% CI (2-11.7)] and 2.3 months [95% CI (1.7-2.4)], respectively. Multiplex analysis of tissues from patients receiving lead in with metformin alone revealed fewer effector CD4 T cells and effector and effector memory CD8 T cells after treatment vs. baseline biopsy. Biopsy tissue from patients treated with metformin and nivolumab had lower pAMPK and decreased PDL-1 expression vs. baseline. The combination also increased percentages of leukocytes, effector CD4 T cells, effector and effector memory CD8 T cells as well as levels of PDL1-Tim3+ cells.
Conclusion: In the setting of MSS mCRC, metformin as a single agent did not enhance effector CD4 and CD8 T cell percentages in clinical samples in our patient cohort. Metformin in combination with nivolumab was associated with increased percentages of effector CD4 and CD8 T cells in biopsy specimens, although these improvements did not translate into enhanced clinical endpoints. Analysis of peripheral blood samples are currently underway to corroborate the findings in the tissue samples.
Citation Format: Batoul Farran, Jeffrey M. Switchenko, Lana Khalil, Walid L. Shaib, Brian Olson, Amanda Ruggieri, Christina Wu, Olatunji B. Alese, Maria Diab, Gregory B. Lesinski, Bassel El-Rayes, Mehmet Akce. Correlative analysis of metformin and nivolumab combination in treatment-refractory microsatellite stable (MSS) metastatic colorectal cancer (mCRC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3482.
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Affiliation(s)
- Batoul Farran
- 1Winship Cancer Institute of Emory University, Atlanta, GA
| | | | | | - Walid L. Shaib
- 1Winship Cancer Institute of Emory University, Atlanta, GA
| | - Brian Olson
- 1Winship Cancer Institute of Emory University, Atlanta, GA
| | | | - Christina Wu
- 1Winship Cancer Institute of Emory University, Atlanta, GA
| | | | - Maria Diab
- 1Winship Cancer Institute of Emory University, Atlanta, GA
| | | | | | - Mehmet Akce
- 1Winship Cancer Institute of Emory University, Atlanta, GA
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Maithel SK, Javle MM, Mahipal A, Lin BSL, Akce M, Switchenko JM, Rupji M, Tran Cao H, Cleary SP, Rocha FG. NEO-GAP: A phase II single-arm prospective feasibility study of neoadjuvant gemcitabine/cisplatin/nab-paclitaxel for resectable high-risk intrahepatic cholangiocarcinoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4097 Background: Given a high recurrence rate, surgical resection for localized intrahepatic cholangiocarcinoma (IHCC) is curative in only 30-35% of patients. BILCAP has established a standard of care for adjuvant therapy with monotherapy capecitabine. Gemcitabine, cisplatin and nab-paclitaxel combination chemotherapy (GAP) was associated with a response rate of 45% in biliary cancer and 20% of patients who were previously inoperable underwent margin negative resection. Based on these data, we conducted a neoadjuvant study of GAP for resectable but high-risk IHCC. Methods: A multi-institutional prospective single-arm phase II trial was conducted for patients with resectable high-risk disease, as defined by tumor size > 5cm, multiple tumors, presence of radiographic major vascular invasion, and lymph node involvement. Patients were administered 4 cycles (3 months) of preoperative GAP (gemcitabine 800 mg/m2, cisplatin 25 mg/m2 and nab-paclitaxel 100 mg/m2 on days 1 and 8 of a 21-day cycle) prior to an attempt at curative-intent surgical resection. The primary endpoint was completion of all therapy, including both preoperative chemotherapy and resection. Secondary endpoints were toxicity, radiologic response according to Response Evaluation Criteria in Solid Tumor (RECIST) criteria, RFS, and OS. Thirty evaluable patients provided 73% power to reject a null therapy completion rate of 50%, with a target completion rate of 70% using a one-sided exact test with a Type I error of 0.05. Results: Thirty-seven patients were screened and 30 evaluable patients were enrolled. The trial was sequentially activated at each of the 4 sites from 09/18-02/21 and the final patient was enrolled in 09/21. Median age was 60.5 years and 40% were female. Twenty-three patients (77%, 90% CI: 60.6-88.5%; p = 0.0026) completed all preoperative chemotherapy and underwent surgical resection. Ten patients (33%) experienced grade 3-4 treatment-related adverse events, the most common being neutropenia and diarrhea; 47% required at least one dose reduction. Partial response rate was 23% and disease control rate was 90% (PD: 10%, PR: 23%, SD: 67%). Of the 23 patients who successfully underwent surgical resection, 2 (9%) had minor postoperative complications. Median size of largest tumor was 5.5cm, median number of tumors was 3, and 39% were lymph node positive. Median length of hospital stay was 4 days. There was zero treatment related mortality. Conclusions: This study met its primary endpoint and demonstrated that neoadjuvant gemcitabine/cisplatin/nab-paclitaxel is feasible and safe prior to resection of intrahepatic cholangiocarcinoma and does not adversely impact perioperative outcomes. Continued follow-up for RFS and OS with this treatment strategy is underway and larger validation studies are planned. Clinical trial information: NCT03579771.
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Affiliation(s)
| | | | | | | | | | | | - Manali Rupji
- Winship Cancer Institute, Emory University, Atlanta, GA
| | - Hop Tran Cao
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Behera M, Joseph G, Rupji M, Huang Z, Bunn B, Wynes M, Switchenko JM, Scagliotti GV, Higgins KA, Tsao MS, Belani CP, Sequist LV, Ramalingam SS. Molecular testing and patterns of treatment in patients with NSCLC: An IASLC analysis of ASCO CancerLinQ Discovery Data. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9128] [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
9128 Background: Precision medicine has resulted in improved outcomes for non-small cell lung cancer (NSCLC); while molecular testing is considered critical for guiding treatment decisions for advanced stage NSCLC, adoption of testing in routine practice is variable. We analyzed the factors contributing to molecular testing and treatment patterns in patients with lung cancer. Methods: The ASCO CancerLinQ Discovery dataset was queried to identify patients diagnosed with lung cancer between the years 2010-2018. Data on demographics, tumor stage, histology and treatments were extracted, and receipt of molecular testing was investigated as the primary outcome. Univariate association of each clinicopathological variable with molecular testing outcome was performed using chi-square test for categorical variables and ANOVA test for numerical variables. A multivariable logistic regression analysis with backward selection at an alpha of 0.05 was reported. All analyses were conducted using SAS 9.4. Results: A total of 37,925 NSCLC patients with stage IV disease were analyzed. Patient characteristics: median age 65 years, 51% male, 68% white, 33.5% adenocarcinoma. Approximately 22% of all NSCLC patients had molecular testing results. In adenocarcinoma patients, 49% had molecular testing results available. In the stage IV group, 47% were treated with chemotherapy, 16% with immunotherapy and 3% with targeted therapy. On multivariable analysis, females were more likely to have molecular testing compared to males [(OR: 1.29 (1.22-1.37); p < 0.001]. Compared to White patients, Black patients were less likely to have molecular testing [OR: 0.89 (0.81-0.97); p = 0.009] and Asians were more likely to undergo testing [OR: 2.22 (1.79-2.75); p < 0.001]. Hispanic patients were more likely to undergo molecular testing compared to non-Hispanics [OR:1.24 (1.02-1.52); p = 0.03]. Additionally, treatment with immunotherapy [OR: 1.86 (1.72-2.01); p < 0.001] and targeted therapy [OR: 2.29 (2.00-2.64); p < 0.001] were associated with significantly higher likelihood of having molecular testing. These results were also confirmed on a subgroup analysis of adenocarcinoma patients. Conclusions: In this analysis of a US-based real-world dataset of stage IV NSCLC patients, White race and female sex are associated with higher likelihood of having molecular test performed. The percentage of patients undergoing testing remains sub-optimal.
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Affiliation(s)
| | - Gregory Joseph
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Manali Rupji
- Winship Cancer Institute, Emory University, Atlanta, GA
| | | | | | - Murry Wynes
- International Association for the Study of Lung Cancer, Aurora, CO
| | | | - Giorgio V. Scagliotti
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | | | - Ming Sound Tsao
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Lalonde CS, Switchenko JM, Behera M, Bilen MA, Owonikoko TK, Lewis CM, Hitron E, Collins H, Goodale T, Judson EC, Harvey RD, Carlisle JW. Comparison of sociodemographic characteristics of a phase 1 clinical trial population at an NCI-designated comprehensive cancer center in the Southeast to catchment area. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18591] [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
e18591 Background: Racial and ethnic minority populations are consistently under-represented in oncology clinical trials despite comprising a disproportionate share of cancer burden. Due in part to difficulties associated with participation, phase 1 trials pose a unique challenge and opportunity for minority inclusion. Here we examine the sociodemographics of phase 1 clinical trial patients at an NCI-designated Comprehensive Cancer Center compared to all patients treated at the center, patients with new cancer diagnoses in metropolitan Atlanta, and the state of Georgia (GA). Methods: Patients enrolled on phase 1 trials at the Winship Cancer Institute (WCI) from 2015-2020, identified from a data warehouse, were compared to new patient registrations at WCI from 2015-2019. Patients with cancer in metro Atlanta and GA were identified from the Surveillance, Epidemiology, and End Results (SEER) Program: Nov 2018 Submission. Covariates for the phase 1 and institutional cohort included sex, race, ECOG PS, insurance, and age at consent. Covariates for SEER patients included sex, race, and age at diagnosis. Summary statistics are reported for categorical variables using frequencies and percentages, and for continuous variables using mean, median, standard deviation, and range. One-sample proportion tests were utilized to compare observed demographic proportions on phase 1 trials with proportions calculated from new patient registrations at WCI and from SEER case data. Results: From 2015-2020, 2325 patients (43.4% F, 56.6% M) signed consent for phase 1 trials. Grouped race distribution was 70.3% White, 26.2% Black, 3.5% Other. Insurance distribution was 42.9% private, 48% government, 9.1% uninsured/other. Mean age at consent was 61.7 years (MD 63, ran 19-92). Of new patient registrations at WCI in 2015 ( N= 12358) (49.7% F, 50.3% M), grouped race distribution was 64.0% W, 28.2% B, 8% O. Atlanta 2015 SEER patients ( N= 31101) (50.3%F, 49.7%M) showed grouped race distribution 58.4% W, 37.2% B, 4.3% O. Mean age at diagnosis was 62.9. GA 2015 SEER patients ( N= 99487) (48.6%F, 51.4%M) showed grouped race distribution 71.2% W, 26.7% B, 2.1% O. Mean age at diagnosis was 64.2. The race and sex distribution of phase 1 patients was significantly different than proportions calculated from new patient registrations at WCI and SEER data from patients in Atlanta ( p< 0.001). Sex distribution was significantly different than GA SEER patients. Conclusions: Phase 1 patients were significantly more likely to be white and male, compared with patients treated at the cancer center, as well as patients with cancer in Atlanta. Race distribution was not significantly different from patients with cancer in GA. Our intent is to characterize existing disparities in order to increase representation of patients from racial and ethnic minority backgrounds in phase 1 clinical trials.
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Affiliation(s)
| | | | | | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | | | | | - Elise Hitron
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Hannah Collins
- Winship Cancer Institute of Emory University, Atlanta, GA
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McClary T, Blee SM, Avinger A, Switchenko JM, Dixon MD, Pentz RD. Accounting for the high enrollment of African Americans in Winship Cancer Institute’s myeloma clinical trials. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12016] [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
12016 Background: Multiple myeloma (MM) is twice as common in African Americans (AA) as in Whites, yet AA make up only 5% of multiple myeloma (MM) clinical trial participants nationwide. Multiple studies have attempted to identify the reasons why AA are underrepresented in clinical trials and have discovered that sociodemographic factors, a lack of understanding, mistrust of sponsors, and a variety of opportunity barriers all contribute to AA underrepresentation in clinical trials. At one cancer center, African Americans make up 33% of those enrolled in MM clinical trials. To begin to account for this success in enrolling AA in myeloma clinical trials, a survey was designed to determine whether the major barriers to AA clinical trial participation existed at this cancer center. Methods: The survey was open to any AA patient who had consented to a clinical trial. The Trust in Medical Research scale (TMR) developed by Hall et al., the Human Connection (THC) scale developed by Mack et al., and the Duke Intrinsic Religiosity Scale (DUREL) were the three main scales used in the survey. Adapted assessment questions from Advani et al were used to assess the importance of side effects in deciding to participate in clinical trials. Results: We offered the study to 76 patients and 80% (61/76) participated. The mean TMR score was 15.0 which is significantly greater than the 11.6 score observed for AAs at other institutions (p < 0.001). The mean human connection score was 57.7 which is significantly greater than the 54.6 observed in the population of the Mack study, which accrued mostly white participants (p < 0.001). The Pearson correlation coefficient between the TMR score and the human connection score is 0.37, indicating a significant positive correlation between human connection scores and trust scores (p-value = 0.002). The average score for the intrinsic religiosity section of the DUREL scale was 13 (score of 15 indicates high religiosity). The average score of importance of side effects was 8.574, significantly higher than the Advani AA response of 6.7 (p-value < 0.001). Conclusions: African Americans enrolled in clinical trials at the high enrolling cancer center had higher THC and TMR scale scores than reported nationally, both helping to facilitate trial enrollment. The high intrinsic religiosity score observed suggests that high religiosity had no impact on clinical trial participation, nor did concern about side effects. Furthermore, a high THC score was associated with a high trust score. Since this THC scale assesses whether participants believe their doctors listen carefully, care about them, offer hope, provide clear explanations, and so on, establishing a human connection may be one way to increase AA trust in providers, increase AA clinical trial enrollment and overcome other barriers.
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Affiliation(s)
| | | | - Anna Avinger
- Emory Healthcare-Winship Cancer Institute, Atlanta, GA
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Aldrich J, Switchenko JM, Kalinsky K, Bhave MA. Real-world outcomes of Black women versus non-Hispanic White women with advanced triple-negative breast cancer treated with immune checkpoint inhibitors at an urban cancer center. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1074] [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
1074 Background: Black women (BW) are disproportionately diagnosed with metastatic triple negative breast cancer (mTNBC) compared to Non-Hispanic White women (NHW). Median overall survival (OS) in mTNBC remains poor at 12-18 months. While immune checkpoint inhibitors (ICIs) are a promising treatment strategy, BW were significantly underrepresented in pivotal clinical trials that led to the approval of ICIs in mTNBC. Therefore, the efficacy, safety, and optimal biomarkers of ICI response in BW remain unknown. We sought to compare baseline characteristics and outcomes between BW and NHW with mTNBC treated with an ICI and chemotherapy at an urban tertiary care institution. Methods: BW and NHW with advanced unresectable or mTNBC treated with an ICI plus chemotherapy at Emory University between 2019 and 2021 were retrospectively evaluated. Baseline characteristics, including next generation sequencing (NGS), as well as clinical outcomes between BW and NHW were compared using Kruskal-Wallis tests and Fisher’s exact tests. Progression free survival (PFS) and OS were analyzed with the Kaplan-Meir method. Results: Forty-one women with PDL-1 positive mTNBC treated with an ICI and chemotherapy were identified [BW, n = 26 (63%) and NHW, n = 15 (37%)]. A majority of patients had relapsed disease (73%); however BW were more likely to have de novo metastatic disease compared to NHW (38% vs 7%, p = 0.03). Twenty-seven (66%) patients received atezolizumab and 14 (34%) were treated with pembrolizumab. Of the 23 (56%) patients with NGS testing, alterations in TP53, PIK3CA, and BRCA were seen in 23 (100%), 5 (31%), and 1 (6%) patient, respectively. Median tumor mutational burden was similar between BW and NHW (5 vs 7, p = 0.8). BW had numerically lower median PDL-1 (SP142) compared to NHW (1% vs 2%, p = 0.5). Rates of immune and dose-limiting chemotherapy-related adverse events were similar between BW and NHW (Table). There were no differences in ICI response between groups, though BW had fewer complete responses and a shorter median PFS compared to NHW. Median OS was 12 months in BW compared to 28 months in NHW (p = 0.1). Conclusions: Our experience with real-world use of this regimen showed that BW had fewer complete responses and a trend towards worse OS compared to NHW. BW had numerically lower median PDL-1 expression compared to NHW, suggesting further investigation of biomarkers, potentially by Race, are needed to better identify responders to ICI in mTNBC. [Table: see text]
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Affiliation(s)
- Jeffrey Aldrich
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | | | | | - Manali A. Bhave
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
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Harkins RA, Patel SP, Lee MJ, Switchenko JM, Ansell SM, Bartlett NL, Blum KA, Cashen AF, Casulo C, Friedberg JW, Johnston PB, Kahl BS, Leonard JP, Link BK, Lossos IS, Martin P, Maurer MJ, Mehta-Shah N, Reagan PM, Westin JR, Koff JL, Flowers CR. Improving eligibility criteria for first-line trials for patients with DLBCL using a US-based Delphi-method survey. Blood Adv 2022; 6:2745-2756. [PMID: 35100356 PMCID: PMC9092417 DOI: 10.1182/bloodadvances.2021006504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/24/2022] [Indexed: 12/05/2022] Open
Abstract
Recent first-line randomized controlled trials (RCTs) for patients with diffuse large B-cell lymphoma (DLBCL) have shown negative results, which may be due in part to onerous eligibility criteria limiting enrollment of poor-risk patients who require immediate treatment. We conducted a Delphi-method survey with lymphoma experts in the United States to define recommendations for essential and potentially unnecessary enrollment criteria for modern first-line DLBCL RCTs aimed at increasing clinical diversity of ensuing study groups. We first tabulated enrollment criteria from 19 DLBCL RCTs spanning the rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) era to identify common eligibility criteria from prior DLBCL RCTs for inclusion in the Delphi-method survey. We tabulated 451 total eligibility criteria comprising 51 criterion categories across 19 first-line DLBCL RCTs in the R-CHOP era. We then surveyed lymphoma clinical trial experts representing 8 academic medical centers in the United States regarding essential and unnecessary eligibility criteria for modern DLBCL RCTs. Seventeen of 29 invited clinical investigators completed the round-1 questionnaire (response rate, of 58.6%), 15 of 17 round-1 participants (88.2%) completed the round-2 survey, and all round-1 participants reviewed finalized recommendations for eligibility criteria for modern first-line DLBCL RCTs. We defined consensus recommendations for 31 modernized eligibility criteria including threshold values for 10 quantitative eligibility criteria aimed at facilitating enrollment of a clinically diverse study population in first-line DLBCL RCTs designed to improve standard-of-care therapy.
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Affiliation(s)
- R. Andrew Harkins
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Sharvil P. Patel
- Department of Quantitative Theory and Methods, Emory University, Atlanta, GA
| | - Michelle J. Lee
- Department of Internal Medicine, Morehouse University School of Medicine, Atlanta, GA
| | - Jeffrey M. Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Stephen M. Ansell
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Nancy L. Bartlett
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Kristie A. Blum
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Amanda F. Cashen
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Carla Casulo
- Division of Hematology and Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Jonathan W. Friedberg
- Division of Hematology and Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Patrick B. Johnston
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Brad S. Kahl
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - John P. Leonard
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York City, NY
| | - Brian K. Link
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Izidore S. Lossos
- Division of Hematology, Department of Medicine, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
| | - Peter Martin
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York City, NY
| | - Matt J. Maurer
- Departments of Medicine and Biostatistics, Mayo Clinic, Rochester, MN; and
| | - Neha Mehta-Shah
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Patrick M. Reagan
- Division of Hematology and Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Jason R. Westin
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jean L. Koff
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Christopher R. Flowers
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Collin LJ, Ross-Driscoll K, Nash R, Miller-Kleinhenz JM, Moubadder L, Osborn C, Subhedar PD, Gabram-Mendola SGA, Switchenko JM, Ward KC, McCullough LE. ASO Visual Abstract: Time to Surgical Treatment and Facility Characteristics as Potential Drivers of Racial Disparities in Breast Cancer Mortality: Delay, Facilities, and Breast Cancer Mortality. Ann Surg Oncol 2022. [PMID: 35474558 DOI: 10.1245/s10434-022-11794-9] [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: 11/18/2022]
Affiliation(s)
- Lindsay J Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| | - Katie Ross-Driscoll
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Leah Moubadder
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Catherine Osborn
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Preeti D Subhedar
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Sheryl G A Gabram-Mendola
- Emory University, Atlanta, GA, USA.,Georgia Center for Oncology Research and Education, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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44
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Collin LJ, Ross-Driscoll K, Nash R, Miller-Kleinhenz JM, Moubadder L, Osborn C, Subhedar PD, Gabram-Mendola SGA, Switchenko JM, Ward KC, McCullough LE. Time to Surgical Treatment and Facility Characteristics as Potential Drivers of Racial Disparities in Breast Cancer Mortality. Ann Surg Oncol 2022; 29:4728-4738. [PMID: 35435562 PMCID: PMC9703360 DOI: 10.1245/s10434-022-11720-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/21/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Black women are more likely to die of breast cancer than White women. This study evaluated the contribution of time to primary surgical management and surgical facility characteristics to racial disparities in breast cancer mortality among both Black and White women. METHODS The study identified 2224 Black and 3787 White women with a diagnosis with stages I to III breast cancer (2010-2014). Outcomes included time to surgical treatment (> 30 days from diagnosis) and breast cancer mortality. Odds ratios (ORs) and 95% confidence intervals (CIs) associating surgical facility characteristics with surgical delay were computed, and Cox proportional hazards regression was used to compute hazard ratios (HRs) and 95% CIs associating delay and facility characteristics with breast cancer mortality. RESULTS Black women were two times more likely to have a surgical delay (OR, 2.15; 95% CI, 1.92-2.41) than White women. Racial disparity in surgical delay was least pronounced among women treated at a non-profit facility (OR, 1.95; 95% CI, 1.70-2.25). The estimated mortality rate for Black women was two times that for White women (HR, 2.00; 95% CI, 1.83-2.46). Racial disparities in breast cancer mortality were least pronounced among women who experienced no surgical delay (HR, 1.81; 95% CI, 1.28-2.56), received surgery at a government facility (HR, 1.31; 95% CI, 0.76-2.27), or underwent treatment at a Commission on Cancer-accredited facility (HR, 1.82; 95% CI, 1.38-2.40). CONCLUSIONS Black women were more likely to experience a surgical delay and breast cancer death. Persistent racial disparities in breast cancer mortality were observed across facility characteristics except for government facilities.
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Affiliation(s)
- Lindsay J Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| | - Katie Ross-Driscoll
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Leah Moubadder
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Catherine Osborn
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Preeti D Subhedar
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Sheryl G A Gabram-Mendola
- Emory University, Atlanta, GA, USA.,Georgia Center for Oncology Research and Education, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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45
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Nash R, Russell MC, Miller-Kleinhenz JM, Collin LJ, Ross-Driscoll K, Switchenko JM, McCullough LE. Understanding gastrointestinal cancer mortality disparities in a racially and geographically diverse population. Cancer Epidemiol 2022; 77:102110. [PMID: 35144126 PMCID: PMC8923985 DOI: 10.1016/j.canep.2022.102110] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Gastrointestinal (GI) cancers represent a diverse group of diseases. We assessed differences in geographic and racial disparities in cancer-specific mortality across subtypes, overall and by patient characteristics, in a geographically and racially diverse US population. METHODS Clinical, sociodemographic, and treatment characteristics for patients diagnosed during 2009-2014 with colorectal cancer (CRC), pancreatic cancer, hepatocellular carcinoma (HCC), or gastric cancer in Georgia were obtained from the Surveillance, Epidemiology, and End Results Program database. Patients were classified by geography (rural or urban county) and race and followed for cancer-specific death. Multivariable Cox proportional hazards models were used to calculate stratified hazard ratios (HR) and 95% confidence intervals (CIs) for associations between geography or race and cancer-specific mortality. RESULTS Overall, 77% of the study population resided in urban counties and 33% were non-Hispanic Black (NHB). For all subtypes, NHB patients were more likely to reside in urban counties than non-Hispanic White patients. Residing in a rural county was associated with an overall increased hazard of cancer-specific mortality for HCC (HR = 1.15, 95% CI = 1.02-1.31), pancreatic (HR = 1.11, 95% CI = 1.03-1.19), and gastric cancer (HR = 1.17, 95% CI = 1.03-1.32) but near-null for CRC. Overall racial disparities were observed for CRC (HR = 1.18, 95% CI = 1.11-1.25) and HCC (HR = 1.12, 95% CI = 1.01-1.24). Geographic disparities were most pronounced among HCC patients receiving surgery. Racial disparities were pronounced among CRC patients receiving any treatment. CONCLUSION Geographic disparities were observed for the rarer GI cancer subtypes, and racial disparities were pronounced for CRC. Treatment factors appear to largely drive both disparities.
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Affiliation(s)
- Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Maria C Russell
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Lindsay J Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Katherine Ross-Driscoll
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Nooka AK, Shanmugasundaram U, Cheedarla N, Verkerke H, Edara VV, Valanparambil R, Kaufman JL, Hofmeister CC, Joseph NS, Lonial S, Azeem M, Manalo J, Switchenko JM, Chang A, Linderman SL, Roback JD, Dhodapkar KM, Ahmed R, Suthar MS, Neish AS, Dhodapkar MV. Determinants of Neutralizing Antibody Response After SARS CoV-2 Vaccination in Patients With Myeloma. J Clin Oncol 2022; 40:3057-3064. [PMID: 35259002 PMCID: PMC9462534 DOI: 10.1200/jco.21.02257] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Vaccine-induced neutralizing antibodies (nAbs) play a critical role in protection from SARS CoV-2. Patients with B-cell malignancies including myeloma are at increased risk of COVID-19-related mortality and exhibit variable serologic response to the vaccine. The capacity of vaccine-induced antibodies in these patients to neutralize SARS CoV-2 or its variants is not known. METHODS Sera from 238 patients with multiple myeloma (MM) undergoing SARS CoV-2 vaccination were analyzed. Antibodies against the SARS CoV-2 spike receptor-binding domain (RBD) and viral nucleocapsid were measured to detect serologic response to vaccine and environmental exposure to the virus. The capacity of antibodies to neutralize virus was quantified using pseudovirus neutralization assay and live virus neutralization against the initial SARS CoV-2 strain and the B1.617.2 (Delta) variant. RESULTS Vaccine-induced nAbs are detectable at much lower rates (54%) than estimated in previous seroconversion studies in MM, which did not monitor viral neutralization. In 33% of patients, vaccine-induced antispike RBD antibodies lack detectable neutralizing capacity, including against the B1.617.2 variant. Induction of nAbs is affected by race, disease, and treatment-related factors. Patients receiving mRNA1273 vaccine (Moderna) achieved significantly greater induction of nAbs compared with those receiving BNT162b2 (Pfizer; 67% v 48%, P = .006). CONCLUSION These data show that vaccine-induced antibodies in several patients with MM lack detectable virus-neutralizing activity. Vaccine-mediated induction of nAbs is affected by race, disease, vaccine, and treatment characteristics. These data have several implications for the emerging application of booster vaccines in immunocompromised hosts.
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Affiliation(s)
- Ajay K Nooka
- Department of Hematology/Medical Oncology, Emory University, Atlanta, GA.,Winship Cancer Institute, Atlanta, GA
| | | | - Narayana Cheedarla
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Hans Verkerke
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Venkata V Edara
- Emory Vaccine Center, Emory University, Atlanta, GA.,Yerkes National Primate Center, Atlanta, GA
| | - Rajesh Valanparambil
- Emory Vaccine Center, Emory University, Atlanta, GA.,Yerkes National Primate Center, Atlanta, GA
| | - Jonathan L Kaufman
- Department of Hematology/Medical Oncology, Emory University, Atlanta, GA.,Winship Cancer Institute, Atlanta, GA
| | - Craig C Hofmeister
- Department of Hematology/Medical Oncology, Emory University, Atlanta, GA.,Winship Cancer Institute, Atlanta, GA
| | - Nisha S Joseph
- Department of Hematology/Medical Oncology, Emory University, Atlanta, GA.,Winship Cancer Institute, Atlanta, GA
| | - Sagar Lonial
- Department of Hematology/Medical Oncology, Emory University, Atlanta, GA.,Winship Cancer Institute, Atlanta, GA
| | - Maryam Azeem
- Department of Hematology/Medical Oncology, Emory University, Atlanta, GA
| | - Julia Manalo
- Department of Hematology/Medical Oncology, Emory University, Atlanta, GA
| | | | - Andres Chang
- Department of Hematology/Medical Oncology, Emory University, Atlanta, GA.,Winship Cancer Institute, Atlanta, GA
| | | | - John D Roback
- Winship Cancer Institute, Atlanta, GA.,Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Kavita M Dhodapkar
- Winship Cancer Institute, Atlanta, GA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA
| | - Rafi Ahmed
- Winship Cancer Institute, Atlanta, GA.,Emory Vaccine Center, Emory University, Atlanta, GA
| | - Mehul S Suthar
- Emory Vaccine Center, Emory University, Atlanta, GA.,Yerkes National Primate Center, Atlanta, GA.,Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta, Department of Pediatrics and Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA
| | - Andrew S Neish
- Winship Cancer Institute, Atlanta, GA.,Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Madhav V Dhodapkar
- Department of Hematology/Medical Oncology, Emory University, Atlanta, GA.,Winship Cancer Institute, Atlanta, GA
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Reitz ACW, Switchenko JM, Gillespie TW. Is Medicaid Expansion Associated with Improved Nonmetastatic Colon Cancer Survival? An Analysis of the National Cancer Database. Am Surg 2022:31348211050816. [PMID: 35213813 DOI: 10.1177/00031348211050816] [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: 11/17/2022]
Abstract
METHODS This retrospective study of 86 413 patients (40-64 years old) undergoing surgical resection for a new diagnosis of invasive, nonmetastatic colon cancer included in the National Cancer Database (NCDB) from 2010 to 2015 compared overall survival (OS) in MES to NES. Cox proportional hazard models, fit for OS, and propensity score-matching (PSM) analysis were performed. RESULTS In this sample, 51 297 cases (59.2%) lived in MES and 35 116 (40.8%) in NES. Medicaid expansion states had earlier pathological stage compared to NES (stage I 25.38% vs 24.17%, stage II 32.93 vs 33.4%, and stage III 41.69 vs 42.43%; P < .001). 5-year OS in MES was higher than NES (79.1% vs 77.3%; P < .001); however, on both multivariable analysis (MVA) and PSM analysis, MES did not have significantly different OS from NES (hazard ratio (HR), .99, 95% confidence interval (CI), .95-1.03; P = .570; HR, .99, 95% CI, .95-1.03; P = .68). CONCLUSION Among NCDB patients with invasive, nonmetastatic colon cancer residing in MES at time of diagnosis was associated with earlier pathological stage. However, on both MVA and PSM analysis, OS was not significantly different in MES vs NES. Research on patient outcomes, such as receipt of guideline concordant care, can further inform the impact of insurance coverage expansion efforts on cancer outcomes.
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Affiliation(s)
- Alexandra C W Reitz
- Department of Surgery, 160352Emory University School of Medicine, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, 25798Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Theresa W Gillespie
- Department of Surgery, 160352Emory University School of Medicine, Atlanta, GA, USA.,Department of Hematology and Medical Oncology, 12239Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA, USA
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48
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Bidot S, Monsrud A, Kline M, Speak A, Martini D, Bilen MA, Switchenko JM, Zhang Y, Gerges AG, Farhat GN, Dent EA, Master VA, Tinsley ML, Harik LR. Risk Stratification of Prostatic Adenocarcinoma Metastatic to the Lymph Nodes. Arch Pathol Lab Med 2022; 146:1345-1352. [PMID: 35142822 DOI: 10.5858/arpa.2021-0247-oa] [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] [Accepted: 09/27/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The pathologic nodal staging of prostatic adenocarcinoma is binary for regional lymph nodes. Stages pN0 and pN1 indicate the absence or presence of regional nodal metastasis, respectively, whereas patients with metastasis to nonregional lymph nodes are staged as pM1a. OBJECTIVE.— To determine the risk of recurrence of pN1 prostatic adenocarcinoma patients based on the extent of nodal tumor burden. DESIGN.— We retrospectively reviewed pN1 patients with prostatic adenocarcinoma managed with radical prostatectomy seen between 2011 and 2019. Kaplan-Meier and Cox regression analyses were performed to compare disease-free survival. RESULTS.— Ninety-six patients were included (median [interquartile range] age, 62 years [57-67 years]; 70 of 96 [73%] white). On univariate analysis, age >65 years (P = .008), ≥2 positive regional lymph nodes (P < .001), and a maximum size of the tumor deposit ≥2 mm (P = .004) were significantly associated with an unfavorable outcome. Controlling for age, stage, metastatic deposit size, margin status, and the presence of extranodal extension, patients with ≥2 positive regional lymph nodes were 3.03 times more likely (95% confidence interval, 1.39-6.60; P = .005) to have an unfavorable outcome. Patients with pN1M1a stage showed a disease-free survival similar to that of pN1M0 patients, after controlling for the number of positive regional lymph nodes (P = .36). CONCLUSIONS.— Overall, pN1 patients with ≥2 positive regional lymph nodes are 3 times more likely to have an unfavorable outcome. The results suggest a benefit in further stratifying patients with metastatic prostatic adenocarcinoma to the lymph nodes into prognostically significant risk categories that could help the treating clinicians tailor subsequent patient follow-up and therapy.
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Affiliation(s)
- Samuel Bidot
- From the Department of Pathology and Laboratory Medicine (Bidot, Monsrud, Dent, Tinsley, Harik), Emory University School of Medicine, Atlanta, Georgia
| | - Ashley Monsrud
- From the Department of Pathology and Laboratory Medicine (Bidot, Monsrud, Dent, Tinsley, Harik), Emory University School of Medicine, Atlanta, Georgia
| | - Meredith Kline
- MD candidate (Kline, Speak, Martini), Emory University School of Medicine, Atlanta, Georgia
| | - Alexandra Speak
- MD candidate (Kline, Speak, Martini), Emory University School of Medicine, Atlanta, Georgia
| | - Dylan Martini
- MD candidate (Kline, Speak, Martini), Emory University School of Medicine, Atlanta, Georgia
| | - Mehmet A Bilen
- Department of Pathology Hematology and Oncology (Bilen, Master), Emory University School of Medicine, Atlanta, Georgia.,The Winship Cancer Institute of Emory University, Atlanta, Georgia (Bilen, Switchenko, Zhang, Harik)
| | - Jeffrey M Switchenko
- The Winship Cancer Institute of Emory University, Atlanta, Georgia (Bilen, Switchenko, Zhang, Harik).,The Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia (Switchenko)
| | - Yuzi Zhang
- The Winship Cancer Institute of Emory University, Atlanta, Georgia (Bilen, Switchenko, Zhang, Harik)
| | - Amany Ghaly Gerges
- Visiting physician (Gerges), Emory University School of Medicine, Atlanta, Georgia
| | - Ghada N Farhat
- The Rollins School of Public Health, Atlanta, Georgia (Farhat)
| | - Edward A Dent
- From the Department of Pathology and Laboratory Medicine (Bidot, Monsrud, Dent, Tinsley, Harik), Emory University School of Medicine, Atlanta, Georgia
| | - Viraj A Master
- Department of Pathology Hematology and Oncology (Bilen, Master), Emory University School of Medicine, Atlanta, Georgia.,Department of Pathology Urology (Master), Emory University School of Medicine, Atlanta, Georgia
| | - Mazie L Tinsley
- From the Department of Pathology and Laboratory Medicine (Bidot, Monsrud, Dent, Tinsley, Harik), Emory University School of Medicine, Atlanta, Georgia
| | - Lara R Harik
- From the Department of Pathology and Laboratory Medicine (Bidot, Monsrud, Dent, Tinsley, Harik), Emory University School of Medicine, Atlanta, Georgia.,The Winship Cancer Institute of Emory University, Atlanta, Georgia (Bilen, Switchenko, Zhang, Harik)
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49
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Blee SM, Facdol J, Dixon MD, Master V, Switchenko JM, Pentz RD. Dissemination of validated health literacy videos: A tailored approach. Cancer Med 2022; 11:1678-1687. [PMID: 35107221 PMCID: PMC8986138 DOI: 10.1002/cam4.4572] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/05/2021] [Accepted: 12/20/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Previously, we showed that chemotherapy terminology is difficult for patients to understand. Therefore, we developed short videos explaining key terminology and though proven effective, they will only be helpful if appropriately disseminated. Therefore, we aimed to determine the best dissemination method at three different healthcare settings. METHODS With consent, we interviewed healthcare workers from (1) an academic cancer center, Winship Cancer Institute (Winship) serving higher SES patients, (2) an inner-city, safety-net hospital Grady Memorial (GMH), (3) clinics serving rural Georgia, from the Winship Community Network (Network). All interviews were transcribed and analyzed using a semantic content analysis method. Suggested dissemination plans were then implemented. RESULTS Twenty-two Winship, 11 GMH, and 4 Network healthcare workers were interviewed. Seventy-two percent (n = 8) of the GMH and 100% (n = 4) of Network healthcare workers felt that the best place for patients to view the videos was in the clinic, compared to 27% (n = 6) of the Winship clinicians. 68% (n = 15) of the Winship clinicians stated an app would be the most useful format, compared to 27% (n = 3) at GMH, and 0% at Network sites. Video viewing increased after dissemination plans were implemented. CONCLUSION Educational materials explaining oncology treatment terminology enhance patient understanding, yet without proper dissemination, these tools may never reach the intended patient population. Our study shows that dissemination plans need to be tailored to each individual patient population, with rural and lower SES patients needing to view the videos during clinic visits, and patients of more means viewing them using technology at home.
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Affiliation(s)
- Shannon M Blee
- Emory University Winship Cancer Institute, Atlanta, Georgia, USA
| | | | - Margie D Dixon
- Emory University Winship Cancer Institute, Atlanta, Georgia, USA.,Emory University School of Medicine, Atlanta, Georgia, USA
| | - Viraj Master
- Emory University Winship Cancer Institute, Atlanta, Georgia, USA.,Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Rebecca D Pentz
- Emory University Winship Cancer Institute, Atlanta, Georgia, USA.,Emory University School of Medicine, Atlanta, Georgia, USA
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50
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Diab M, Goyal S, Switchenko JM, Alese OB, Shaib WL, Akce M, Wu C, El-Rayes BF. Characteristics and outcomes of patients with multiple synchronous colon cancer primaries. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.194] [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
194 Background: Patients (pts) with multiple synchronous colon cancer primaries (MCPs) constitute a unique subset of pts with colon cancer. However, there are limited published studies about these pts. The objective of this study is to compare the characteristics and outcomes of pts with MCPs to those with single colon cancer primaries (SCPs) using the largest study population to date. Methods: Data was obtained from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. Pts with synchronous MCPs were included and were matched 1:3 with pts with SCPs based on the Coarsened Exact Matching method for age, gender, and race. Only patients with multiple synchronous primaries were included (time since index = 0 months). We excluded pts with a lag time since diagnosis of index primary of 1 month or more. Univariate (UNA) and multivariable (MVA) analyses were performed to identify factors associated with patient outcomes. Kaplan-Meier analyses and Cox proportional hazards models were used to assess the association between tumor/patient characteristics and overall survival (OS). Results: A total of 3322 pts with MCPs and 9966 pts with SCPs were identified. Median age was 71 years. Majority were male (51.5%) and White (80.1%). 73.4% and 69.6% of pts had 12 or more lymph nodes examined for the MCPs and SCPs cohorts, respectively. The SCPs cohort included more T4 stage and more well- and moderately-differentiated histology. OS was significantly shorter in MCPs compared to SCPs (HR 1.29; 1.22-1.36; p < 0.001), with a 5- and 10-year OS rate of 47.8% and 28.2% for the MCPs and 56.4% and 41.6% for the SCPs, respectively, for all stages combined. In the MCPs cohort, the use of adjuvant chemotherapy was associated with an improved survival in AJCC stages II, III, and IV but not stage I. Conclusions: This is the largest study evaluating the impact of MCPs on outcomes. Across stages II to IV, pts with MCPs have a shorter survival than those with SCPs. Pts with stage II MCPs who receive adjuvant chemotherapy derive a survival benefit. Current guidelines do not list multiple synchronous primaries as a high-risk feature for stage II.
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Affiliation(s)
- Maria Diab
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Subir Goyal
- Winship Cancer Institute and Rollins School of Public Health at Emory University, Atlanta, GA
| | | | - Olatunji B. Alese
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Walid Labib Shaib
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | | | | | - Bassel F. El-Rayes
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
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