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Crombie JL, Jacobson CA, Redd R, Shouse G, Herrera AF, Chow VA, Gauthier J, Mullane E, Cahill K, Kline J, Romancik J, Cohen JB, Saucier A, Houot R, Armand P, Hess B. Prognostic value of early positron emission tomography in patients with large B-cell lymphoma treated with anti-CD19 chimeric antigen receptor T-cell therapy. Haematologica 2023; 108:3433-3437. [PMID: 37259597 PMCID: PMC10690912 DOI: 10.3324/haematol.2022.282345] [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] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/23/2023] [Indexed: 06/02/2023] Open
Abstract
Not available.
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Affiliation(s)
| | | | | | | | | | - Victor A Chow
- Fred Hutchinson Cancer Research Center, Seattle, WA; University of Washington, Seattle, WA
| | - Jordan Gauthier
- Fred Hutchinson Cancer Research Center, Seattle, WA; University of Washington, Seattle, WA
| | - Erin Mullane
- Fred Hutchinson Cancer Research Center, Seattle, WA; University of Washington, Seattle, WA
| | | | | | | | | | | | | | | | - Brian Hess
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
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2
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Liang G, Wang L, You Q, Cahill K, Chen C, Zhang W, Fulton N, Stock W, Odenike O, He C, Han D. Cellular Composition and 5hmC Signature Predict the Treatment Response of AML Patients to Azacitidine Combined with Chemotherapy. Adv Sci (Weinh) 2023; 10:e2300445. [PMID: 37271891 PMCID: PMC10427370 DOI: 10.1002/advs.202300445] [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] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/12/2023] [Indexed: 06/06/2023]
Abstract
Azacitidine (AZA) is a DNA methyltransferase inhibitor and epigenetic modulator that can be an effective agent in combination with chemotherapy for patients with high-risk acute myeloid leukemia (AML). However, biological factors driving the therapeutic response of such hypomethylating agent (HMA)-based therapies remain unknown. Herein, the transcriptome and/or genome-wide 5-hydroxymethylcytosine (5hmC) is characterized for 41 patients with high-risk AML from a phase 1 clinical trial treated with AZA epigenetic priming followed by high-dose cytarabine and mitoxantrone (AZA-HiDAC-Mito). Digital cytometry reveals that responders have elevated Granulocyte-macrophage-progenitor-like (GMP-like) malignant cells displaying an active cell cycle program. Moreover, the enrichment of natural killer (NK) cells predicts a favorable outcome in patients receiving AZA-HiDAC-Mito therapy or other AZA-based therapies. Comparing 5hmC profiles before and after five-day treatment of AZA shows that AZA exposure induces dose-dependent 5hmC changes, in which the magnitude correlates with overall survival (p = 0.015). An extreme gradient boosting (XGBoost) machine learning model is developed to predict the treatment response based on 5hmC levels of 11 genes, achieving an area under the curve (AUC) of 0.860. These results suggest that cellular composition markedly impacts the treatment response, and showcase the prospect of 5hmC signatures in predicting the outcomes of HMA-based therapies in AML.
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Affiliation(s)
- Guanghao Liang
- Key Laboratory of Genomic and Precision MedicineBeijing Institute of GenomicsChinese Academy of Sciences and China National Center for BioinformationBeijing100101China
- College of Future TechnologySino‐Danish CollegeUniversity of Chinese Academy of SciencesBeijing100049China
| | - Linchen Wang
- Key Laboratory of Genomic and Precision MedicineBeijing Institute of GenomicsChinese Academy of Sciences and China National Center for BioinformationBeijing100101China
- College of Future TechnologySino‐Danish CollegeUniversity of Chinese Academy of SciencesBeijing100049China
| | - Qiancheng You
- Department of Chemistry and Institute for Biophysical DynamicsThe University of ChicagoChicagoIL60637USA
- Howard Hughes Medical InstituteChicagoIL60637USA
| | - Kirk Cahill
- Section of Hematology/OncologyDepartment of MedicineUniversity of Chicago MedicineChicagoIL60637USA
| | - Chuanyuan Chen
- Key Laboratory of Genomic and Precision MedicineBeijing Institute of GenomicsChinese Academy of Sciences and China National Center for BioinformationBeijing100101China
- College of Future TechnologySino‐Danish CollegeUniversity of Chinese Academy of SciencesBeijing100049China
| | - Wei Zhang
- Department of MedicineUniversity of California, San DiegoLa JollaCA92093USA
- Bristol‐Myers SquibbSan DiegoCA92121USA
| | - Noreen Fulton
- Section of Hematology/OncologyDepartment of MedicineUniversity of Chicago MedicineChicagoIL60637USA
- Comprehensive Cancer CenterUniversity of Chicago MedicineChicagoIL60637USA
| | - Wendy Stock
- Section of Hematology/OncologyDepartment of MedicineUniversity of Chicago MedicineChicagoIL60637USA
- Comprehensive Cancer CenterUniversity of Chicago MedicineChicagoIL60637USA
| | - Olatoyosi Odenike
- Section of Hematology/OncologyDepartment of MedicineUniversity of Chicago MedicineChicagoIL60637USA
- Comprehensive Cancer CenterUniversity of Chicago MedicineChicagoIL60637USA
| | - Chuan He
- Department of Chemistry and Institute for Biophysical DynamicsThe University of ChicagoChicagoIL60637USA
- Howard Hughes Medical InstituteChicagoIL60637USA
- Department of Biochemistry and Molecular BiologyThe University of ChicagoChicagoIL60637USA
| | - Dali Han
- Key Laboratory of Genomic and Precision MedicineBeijing Institute of GenomicsChinese Academy of Sciences and China National Center for BioinformationBeijing100101China
- College of Future TechnologySino‐Danish CollegeUniversity of Chinese Academy of SciencesBeijing100049China
- Institute for Stem Cell and RegenerationChinese Academy of SciencesBeijing100101China
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3
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Cahill K, Alban J, Mortel M, Dworkin E, Kosuri S, Duvall A, Liu H, Bishop MR, Larson RA, Stock W. Low incidence of hepatic veno-occlusive disease (VOD) in patients with B-cell acute lymphoblastic leukemia (B-ALL) treated with inotuzumab ozogamicin (INO) followed by allogeneic stem cell transplantation (allo-SCT). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e19024] [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
e19024 Background: Hepatic VOD is an uncommon, but often fatal complication of allo-SCT. The risk is increased after INO, an anti-CD22 antibody conjugated to calicheamicin with high remission rates in relapsed CD22-positive B-ALL. Previous reports have described VOD rates as high as 19% in INO-treated patients who then received allo-SCT. We report our safety experience using INO followed by allo-SCT. Methods: We identified patients >18 yrs with B-ALL treated with allo-SCT and INO in the University of Chicago IRB-approved SCT database. We reviewed the EMR for patient details, toxicities (CTCAE v5.0), and outcomes. Hepatic VOD was defined according to EBMT criteria. Overall survival (OS) was from time of allo-SCT to death or last follow-up. Results: Between 2010-2021, 72 adult patients with B-ALL received allo-SCT, and 17 also received INO as salvage therapy (Table). Median follow-up was 19 months (1-110). All received ursodiol prophylaxis and 15/17 received an azole for antifungal prophylaxis. They had median 2 cycles (1-3) of INO with median of 1.9 months (1-14) from the last dose of INO to allo-SCT. For cycle 1, 13/17 (77%) received 0.8 mg/m2 on D1 and 0.5 mg/m2 on D8 and D15. Of these, 11 had a subsequent cycle (5 with same dosing and 7 had 0.5 mg/m2 on D1, D8, and D15). 1 patient had 0.5 mg/m2 on D1, D8, and D15 for 2 cycles. 3 patients received 0.8 mg/m2 on D1 and 0.4 mg/m2 on D8 and D15 for 2 cycles. After INO, 10 patients achieved CR and 3 had CRi for ORR of 13/17 (76%). The 4 patients with persistent disease despite INO went into remission with a different salvage therapy prior to allo-SCT. Conditioning regimens are listed in Table 1. No patients developed VOD after allo-SCT. Within 2 yrs of allo-SCT, 3/17 (18%) relapsed and 7/17 (41%) died. The median OS was 21.2 months [18 - NR]. Conclusions: Limiting the number of INO cycles (median 2) prior to allo-SCT, delaying allo-SCT for 2 months after INO exposure, and avoiding dual alkylating agent conditioning may have contributed to the absence of VOD in our patients. Larger data sets will be useful to validate these important safety observations.[Table: see text]
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Affiliation(s)
- Kirk Cahill
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Juan Alban
- Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Mylove Mortel
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Emily Dworkin
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL
| | - Satyajit Kosuri
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Adam Duvall
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Hongtao Liu
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Michael Russell Bishop
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Richard A. Larson
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Wendy Stock
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL
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Lachance K, Hippe D, Cahill K, Akaike T, Fonseca A, Nghiem P. 650 Improving surveillance for merkel cell carcinoma patients: A web-based tool to interpret sequential merkel cell polyomavirus antibody test results. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Patel AA, Cahill K, Saygin C, Odenike O. Cedazuridine/decitabine: from preclinical to clinical development in myeloid malignancies. Blood Adv 2021; 5:2264-2271. [PMID: 33904891 PMCID: PMC8095139 DOI: 10.1182/bloodadvances.2020002929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/23/2021] [Indexed: 12/23/2022] Open
Abstract
Since the US Food and Drug Administration (FDA) approvals of parenteral decitabine and azacitidine, DNA methyltransferase inhibitors, otherwise referred to as DNA hypomethylating agents (HMAs), have been a mainstay in the treatment of higher-risk myelodysplastic syndromes. The development of oral HMAs has been an area of active interest; however, oral bioavailability has been quite poor due to rapid metabolism by cytidine deaminase (CDA). This led to the development of the novel CDA inhibitor cedazuridine, which was combined with an oral formulation of decitabine. Preclinical work demonstrated a pharmacokinetic and pharmacodynamic profile approximate to parenteral decitabine, leading to early-phase clinical trials of oral cedazuridine-decitabine (C-DEC) in myelodysplastic syndromes and chronic myelomonocytic leukemia (CMML). A combination of oral decitabine 35 mg with oral cedazuridine 100 mg was established as the recommended phase 2 dose. Phase 2 data confirmed bioequivalence of C-DEC when compared with parenteral decitabine, and a larger phase 3 trial has demonstrated similar results, leading to the FDA approval of C-DEC for use in intermediate/high-risk myelodysplastic syndrome (MDS) and CMML. This review will focus upon the current role of HMA therapy in MDS/CMML, preclinical and clinical development of C-DEC, and potential roles of oral HMA therapy in myeloid malignancies moving forward.
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Affiliation(s)
- Anand A Patel
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Kirk Cahill
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Caner Saygin
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Olatoyosi Odenike
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL
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Hearn N, Cahill K, Atwell D, Bugg W, Chan A, Vignarajah D, Lagopoulos J, Min M. Quantitative Approaches to Locally Advanced Rectal Cancer GTV and Subvolume Contouring with Diffusion-Weighted MRI: Implications for MRI-Guided Boost Strategies. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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7
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Christian S, Arain S, Patel P, Khan I, Calip GS, Agrawal V, Sweiss K, Griffin S, Cahill K, Konig H, Esen A, Shergill A, Odenike O, Stock W, Quigley JG. A multi-institutional comparison of mitoxantrone, etoposide, and cytarabine vs high-dose cytarabine and mitoxantrone therapy for patients with relapsed or refractory acute myeloid leukemia. Am J Hematol 2020; 95:937-943. [PMID: 32311140 DOI: 10.1002/ajh.25838] [Citation(s) in RCA: 2] [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: 12/15/2019] [Revised: 03/09/2020] [Accepted: 04/13/2020] [Indexed: 12/19/2022]
Abstract
Relapsed or refractory acute myeloid leukemia (R/R AML) has a poor prognosis and is best treated with salvage chemotherapy as a bridge to allogeneic stem cell transplant (alloSCT). However, the optimal salvage therapy remains unknown. Here we compared two salvage regimens; mitoxantrone, etoposide, and cytarabine (MEC) and mitoxantrone and high-dose Ara-C (Ara-C couplets). We analyzed 155 patients treated at three academic institutions between 1998 and 2017; 87 patients received MEC and 68 received Ara-C couplets. The primary endpoint was overall response (OR). Secondary endpoints included progression-free survival (PFS), overall survival (OS), duration of hospitalization, hematologic and nonhematologic toxicities, and success in proceeding to alloSCT. Baseline characteristics of the cohorts were well matched, though patients receiving Ara-C couplets had more co-morbidities (48.5% vs 33%; P = .07). OR was achieved in 43.7% of MEC and 54.4% of Ara-C couplets patients (P = .10). Ara-C couplets patients also trended towards a longer OS and PFS, more frequently proceeded to alloSCT (31% vs 54.4%; P = .003), and experienced less febrile neutropenia (94% vs 72%; P < .001) and grade 3/4 gastrointestinal toxicities (17.2% vs 2.94%; P = .005). No significant differences in other toxicities or median duration of hospitalization were noted. This is the first multi-institutional study directly comparing these regimens in a racially diverse population of R/R AML patients. Although these regimens have equivalent efficacy in terms of achieving OR, Ara-C couplets use is associated with significant reductions in toxicities, suggesting it should be used more frequently in these patients.
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Affiliation(s)
- Sonia Christian
- Division of Hematology/Oncology, Department of MedicineUniversity of Illinois at Chicago Chicago Illinois USA
| | - Saad Arain
- Division of Hematology/Oncology, Department of MedicineUniversity of Illinois at Chicago Chicago Illinois USA
| | - Pritesh Patel
- Division of Hematology/Oncology, Department of MedicineUniversity of Illinois at Chicago Chicago Illinois USA
| | - Irum Khan
- Division of Hematology/Oncology, Department of MedicineUniversity of Illinois at Chicago Chicago Illinois USA
| | - Gregory S. Calip
- Center for Pharmacoepidemiology and Pharmacoeconomic ResearchUniversity of Illinois at Chicago Chicago Illinois USA
| | - Vaibhav Agrawal
- Division of Hematology/Oncology, Department of Medicine, Simon Cancer CenterIndiana University Purdue University at Indianapolis Indianapolis Indiana USA
| | - Karen Sweiss
- Department of Pharmacy PracticeUniversity of Illinois at Chicago Chicago Illinois USA
| | - Shawn Griffin
- Department of Pharmacy; Bone Marrow and Blood Stem Cell Transplantation ProgramIndiana University Health Indianapolis Indiana USA
| | - Kirk Cahill
- Division of Hematology/Oncology, Department of MedicineUniversity of Chicago Chicago Illinois USA
| | - Heiko Konig
- Division of Hematology/Oncology, Department of Medicine, Simon Cancer CenterIndiana University Purdue University at Indianapolis Indianapolis Indiana USA
| | - Aysenur Esen
- Division of Hematology/Oncology, Department of MedicineUniversity of Illinois at Chicago Chicago Illinois USA
| | - Ardaman Shergill
- Division of Hematology/Oncology, Department of MedicineUniversity of Illinois at Chicago Chicago Illinois USA
| | - Olatoyosi Odenike
- Division of Hematology/Oncology, Department of MedicineUniversity of Chicago Chicago Illinois USA
| | - Wendy Stock
- Division of Hematology/Oncology, Department of MedicineUniversity of Chicago Chicago Illinois USA
| | - John G. Quigley
- Division of Hematology/Oncology, Department of MedicineUniversity of Illinois at Chicago Chicago Illinois USA
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Hearn N, Atwell D, Cahill K, Elks J, Vignarajah D, Lagopoulos J, Min M. Neoadjuvant Radiotherapy Dose Escalation in Locally Advanced Rectal Cancer: a Systematic Review and Meta-analysis of Modern Treatment Approaches and Outcomes. Clin Oncol (R Coll Radiol) 2020; 33:e1-e14. [PMID: 32669228 DOI: 10.1016/j.clon.2020.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/04/2019] [Revised: 05/15/2020] [Accepted: 06/05/2020] [Indexed: 01/10/2023]
Abstract
AIMS Improving pathological complete response (pCR) rates after neoadjuvant chemoradiotherapy for locally advanced rectal cancer may facilitate surgery-sparing treatment paradigms. Radiotherapy boost has been linked to higher rates of pCR; however, outcomes in moderately escalated inverse-planning studies have not been systematically evaluated. We therefore carried out a systematic review and meta-analysis of radiation dose-escalation studies in the context of neoadjuvant therapy for locally advanced rectal cancer. MATERIALS AND METHODS A systematic search of Pubmed, EMBASE and Cochrane databases for synonyms of 'rectal cancer', 'radiotherapy' and 'boost' was carried out. Studies were screened for radiotherapy prescription >54 Gy. Prespecified quality assessment was carried out for meta-analysis inclusion suitability. Pooled estimates of pCR, acute toxicity (grade ≥3) and R0 resection rates were determined with random-effects restricted maximum-likelihood estimation. Heterogeneity was assessed with Higgins I2 and Cochran Q statistic. Subset analysis examined outcomes in modern inverse-planning studies. Meta-regression with permutation correction was carried out for each outcome against radiation dose, radiotherapy technique, boost technique, chemotherapy intensification and other patient- and treatment-related cofactors. RESULTS Forty-nine primary and three follow-up publications were included in the systematic review. Pooled estimates of pCR, toxicity and R0 resection across 37 eligible publications (n = 1817 patients) were 24.1% (95% confidence interval 21.2-27.4%), 11.2% (95% confidence interval 7.2-17.0%) and 90.7% (95% confidence interval 87.9-93.8%). Within inverse-planning studies (17 publications, n = 959 patients), these rates were 25.7% (95% confidence interval 21.0-31.1%), 9.8% (95% confidence interval 4.6-19.7%) and 95.3% (95% confidence interval 91.6-97.4%). Regression analysis did not identify any significant predictor of pCR (P > 0.05). CONCLUSIONS Radiotherapy dose escalation above 54 Gy is associated with high rates of pCR and does not seem to increase the risk of acute grade ≥3 toxicity events. pCR rates approaching 25% may be achievable utilising moderate escalation (54-60 Gy) with modern inverse-planning techniques; however, a clear dose-response relationship was not identified in regression analysis and additional evidence is awaited given the prevalence of heterogenous single-arm studies to date.
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Affiliation(s)
- N Hearn
- Department of Radiation Oncology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia; ICON Cancer Centre, Maroochydore, Queensland, Australia; University of the Sunshine Coast, Sippy Downs, Queensland, Australia.
| | - D Atwell
- Department of Radiation Oncology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia; ICON Cancer Centre, Maroochydore, Queensland, Australia; University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - K Cahill
- Department of Radiation Oncology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia; University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - J Elks
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - D Vignarajah
- Department of Radiation Oncology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia; ICON Cancer Centre, Maroochydore, Queensland, Australia
| | - J Lagopoulos
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia; Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - M Min
- Department of Radiation Oncology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia; ICON Cancer Centre, Maroochydore, Queensland, Australia; University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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Patel AA, Cahill K, Charnot-Katsikas A, Liu H, Gurbuxani S, Thirman M, Kosuri S, Artz AS, Larson RA, Stock W, Segal J, Odenike O. Clinical outcomes of IDH2-mutated advanced-phase Ph-negative myeloproliferative neoplasms treated with enasidenib. Br J Haematol 2020; 190:e48-e51. [PMID: 32358888 DOI: 10.1111/bjh.16709] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Anand A Patel
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Kirk Cahill
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | | | - Hongtao Liu
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Sandeep Gurbuxani
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA
| | - Michael Thirman
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Satyajit Kosuri
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Andrew S Artz
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA.,Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Richard A Larson
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Wendy Stock
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Jeremy Segal
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA
| | - Olatoyosi Odenike
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
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Atwell D, Elks J, Cahill K, Hearn N, Vignarajah D, Lagopoulos J, Min M. A Review of Modern Radiation Therapy Dose Escalation in Locally Advanced Head and Neck Cancer. Clin Oncol (R Coll Radiol) 2020; 32:330-341. [PMID: 31911016 DOI: 10.1016/j.clon.2019.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 09/02/2019] [Revised: 10/27/2019] [Accepted: 11/07/2019] [Indexed: 12/30/2022]
Abstract
The management of head and neck cancer is complex and often involves multimodality treatment. Certain groups of patients, such as those with inoperable or advanced disease, are at higher risk of treatment failure and may therefore benefit from radiation therapy dose escalation. This can be difficult to achieve without increasing toxicity. However, the combination of modern treatment techniques and increased research into the use of functional imaging modalities that assist with target delineation allows researchers to push this boundary further. This review aims to summarise modern dose escalation trials to identify the impact on disease outcomes and explore the growing role of functional imaging modalities. Studies experimenting with dose escalation above standard fractionated regimens as outlined in National Comprehensive Cancer Network guidelines using photon therapy were chosen for review. Seventeen papers were considered suitable for inclusion in the review. Eight studies investigated nasopharyngeal cancer, with the remainder treating a range of subsites. Six studies utilised functional imaging modalities for target delineation. Doses as high as 85.9 Gy in 2.6 Gy fractions (EQD2 90.2 Gy10) were reportedly delivered with the aid of functional imaging modalities. Dose escalation in nasopharyngeal cancer resulted in 3-year locoregional control rates of 86.6-100% and overall survival of 82-95.2%. For other mucosal primary tumour sites, 3-year locoregional control reached 68.2-85.9% and 48.4-54% for overall survival. There were no clear trends in acute or late toxicity across studies, regardless of dose or addition of chemotherapy. However, small cohort sizes and short follow-up times may have resulted in under-reporting. This review highlights the future possibilities of radiation therapy dose escalation in head and neck cancer and the potential for improved target delineation with careful patient selection and the assistance of functional imaging modalities.
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Affiliation(s)
- D Atwell
- Cancer Services, Sunshine Coast University Hospital, Birtinya, Queensland, Australia; Icon Cancer Centre, Maroochydore, Queensland, Australia; Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Sippy Downs, Queensland, Australia.
| | - J Elks
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - K Cahill
- Cancer Services, Sunshine Coast University Hospital, Birtinya, Queensland, Australia; Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - N Hearn
- Cancer Services, Sunshine Coast University Hospital, Birtinya, Queensland, Australia; Icon Cancer Centre, Maroochydore, Queensland, Australia; Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - D Vignarajah
- Cancer Services, Sunshine Coast University Hospital, Birtinya, Queensland, Australia; Icon Cancer Centre, Maroochydore, Queensland, Australia
| | - J Lagopoulos
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - M Min
- Cancer Services, Sunshine Coast University Hospital, Birtinya, Queensland, Australia; Icon Cancer Centre, Maroochydore, Queensland, Australia; Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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11
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Lachance K, Akaike T, Cahill K, Zawacki L, Singh N, Doolittle-Amieva C, Park S, Morishima C, Hutchinson K, Cater J, Galloway D, Paulson K, Nghiem P. 590 Detecting Merkel cell carcinoma recurrence using a blood test: Outcomes from 774 patients. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Affiliation(s)
- J. Quinn
- Boston College, Chestnut Hill, Massachusetts,
| | - K. Cahill
- Center on Aging & Work at Boston College, Chestnut Hill, Massachusetts
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13
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Saporta A, Davis A, Hauser W, Cahill K, Fowler K, Herzog A. Why Women with Epilepsy Discontinue Various Methods of Contraception: Interim Analysis from the Epilepsy Birth Control Registry (S06.002). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Herzog A, Davis A, Hauser W, Saporta A, Cahill K, Fowler K. Prevalence Ratios for Unintended Pregnancy on Various Contraceptive Methods and AEDs in Women with Epilepsy: Interim Analysis from the Epilepsy Birth Control Registry (S06.003). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Herzog A, Davis A, Hauser W, Saporta A, Cahill K, Fowler K. Prevalence Ratios for Unintended Pregnancy on Various Contraceptive Methods and AEDs in Women with Epilepsy: Interim Analysis from the Epilepsy Birth Control Registry (IN5-1.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.in5-1.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bavbek S, Aydın O, Ataman S, Cahill K, Castells M. Injection-site reaction to etanercept: role of skin test in the diagnosis of such reaction and successful desensitization. Allergy 2011; 66:1256-7. [PMID: 21507006 DOI: 10.1111/j.1398-9995.2011.02601.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- S Bavbek
- Department of Pulmonary Diseases, Division of Allergy, Ankara University, School of Medicine, Ankara, Turkey.
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Abstract
Cell-penetrating peptides (CPPs) such as HIV's trans-activating transcriptional activator (TAT) and polyarginine rapidly pass through the plasma membranes of mammalian cells by an unknown mechanism called transduction. They may be medically useful when fused to well-chosen chains of fewer than about 35 amino acids. The author offers a simple model of transduction in which phosphatidylserines and CPPs effectively form two plates of a capacitor with a voltage sufficient to cause the formation of transient pores (electroporation). The model is consistent with experimental data on the transduction of oligoarginine into mouse C(2)C(12) myoblasts and makes three testable predictions. [Includes supplementary material].
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Affiliation(s)
- K Cahill
- University of New Mexico, Biophysics Group, Department of Physics & Astronomy, Albuquerque, NM, USA.
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Cahill K, Javed S, Landrum A, Gaffin J, Oviedo J, Bailey A, Phipatanakul W, Mozzicato S, Bedard RM, Scippa S, Bedard RM, Stutius LM, Sheehan WJ, Rangsithienchai P, Bharmanee A, Scott JE, Young MC, Schneider LC, Phipatanakul W, Nouman G, Madhok N, Rubinstein A. Research abstracts presented at the New England Society of Allergy Fall meeting, Boston, Massachusetts, October 24‐25 2009. Allergy Asthma Proc 2010. [DOI: 10.2500/108854110791063880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wickner PG, Cahill K, Cheifetz A, Sheikh J, Gaffin JM, Sheehan WJ, Morrill J, Sawicki G, Twarog F, Cinar M, Young M, Schneider LC, Phipatanakul W, Permaul P, Stutius LM, Sheehan WJ, Rangsithienchai PA, Walter JE, Young M, Twarog F, Schneider LC, Phipatanakul W, Sheehan WJ, Rangsithienchai PA, Baxi S, Phipatanakul W, Van Stee V, Bielory L, Wheeler J, Robertson D, Bayuk J, Accetta D, Chong H, Wolf R, Kim S, Long A. Research abstracts presented at the New England Society of Allergy, Fall Meeting, Brewster, Massachusetts, October 20, 2008. Allergy Asthma Proc 2009. [DOI: 10.2500/aap.2009.30.3213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
BACKGROUND Mass media tobacco control campaigns can reach large numbers of people. Much of the literature is focused on the effects of tobacco control advertising on young people, but there are also a number of evaluations of campaigns targeting adult smokers, which show mixed results. Campaigns may be local, regional or national, and may be combined with other components of a comprehensive tobacco control policy. OBJECTIVES To assess the effectiveness of mass media interventions in reducing smoking among adults. SEARCH STRATEGY The Cochrane Tobacco Addiction Group search strategy was combined with additional searches for any studies that referred to tobacco/smoking cessation, mass media and adults. We also searched the Cochrane Register of Controlled Trials (CENTRAL) and a number of electronic databases. The last search was carried out in March 2007. SELECTION CRITERIA Controlled trials allocating communities, regions or states to intervention or control conditions; interrupted time series.Adults, 25 years or older, who regularly smoke cigarettes. Studies which cover all adults as defined in studies were included. Mass media are defined here as channels of communication such as television, radio, newspapers, billboards, posters, leaflets or booklets intended to reach large numbers of people, and which are not dependent on person-to-person contact. The purpose of the mass media campaign must be primarily to encourage smokers to quit. They could be carried out alone or in conjunction with tobacco control programmes.The primary outcome was change in smoking behaviour. This could be reported as changes in prevalence, changes in cigarette consumption, quit rates, odds of being a smoker. DATA COLLECTION AND ANALYSIS Two authors independently assessed all studies for inclusion criteria and for study quality. One author (MB) extracted data, and a second author (LS) checked them.Results were not pooled due to heterogeneity of included studies and are presented narratively and in table form. MAIN RESULTS Eleven campaigns met the inclusion criteria for this review. Studies differed in design, settings, duration, content and intensity of intervention, length of follow up, methods of evaluation and also in definitions and measures of smoking behaviour used. Among nine campaigns reporting smoking prevalence, significant decreases were observed in the California and Massachusetts statewide tobacco control campaigns compared with the rest of the USA. Some positive effects on prevalence in the whole population or in the subgroups were observed in three of the remaining seven studies. Three large-scale campaigns of the seven presenting results for tobacco consumption found statistically significant decreases. Among the seven studies presenting abstinence or quit rates, four showed some positive effect, although in one of them the effect was measured for quitting and cutting down combined. Among the three that did not show significant decreases, one demonstrated a significant intervention effect on smokers and ex-smokers combined. AUTHORS' CONCLUSIONS There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality. One state-wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign, while another (California) showed positive results only during the period of adequate funding and implementation. Six of nine studies carried out in communities or regions showed some positive effects on smoking behaviour and at least one significant change in smoking prevalence (Sydney). The intensity and duration of mass media campaigns may influence effectiveness, but length of follow up and concurrent secular trends and events can make this difficult to quantify. No consistent relationship was observed between campaign effectiveness and age, education, ethnicity or gender.
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Affiliation(s)
- M Bala
- Jagiellonian University Medical College, 2nd Department of Internal Medicine, 8 Skawinska St, Krakow, Poland, 31-066.
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Abstract
BACKGROUND Rimonabant is a selective type 1 cannabinoid (CB1) receptor antagonist. It may assist with smoking cessation by restoring the balance of the endocannabinoid system, which can be disrupted by prolonged use of nicotine. Rimonabant also seeks to address many smokers' reluctance to persist with a quit attempt because of concerns about weight gain. OBJECTIVES To determine whether selective CB1 receptor antagonists increase the numbers of people stopping smoking. To assess their effects on weight change in successful quitters and in those who try to quit but fail. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Review Group specialized register for trials, using the terms 'rimonabant' and 'smoking' in the title or abstract, or as keywords. We also searched MEDLINE, EMBASE, CINAHL and PsycINFO, using major MESH terms. We acquired electronic or paper copies of posters of preliminary trial results presented at the American Thoracic Society Meeting in 2005, and at the Society for Research on Nicotine and Tobacco European Meeting 2006. We also attempted to contact the authors of ongoing studies of rimonabant, and Sanofi Aventis (manufacturers of rimonabant). SELECTION CRITERIA Types of studies: Randomized controlled trials. TYPES OF PARTICIPANTS Adult smokers. Types of interventions: Selective CB1 receptor antagonists, such as rimonabant. Types of outcome measures: The primary outcome is smoking status at a minimum of six months after the start of treatment. We preferred sustained cessation rates to point prevalence, and biochemically verified cessation to self-reported quitting. We regarded smokers who drop out or are lost to follow up as continuing smokers. We have noted any adverse effects of treatment.A secondary outcome is weight change associated with the cessation attempt. DATA COLLECTION AND ANALYSIS Two authors checked the abstracts for relevance, and attempted to acquire full trial reports. One author extracted the data, and a second author checked them. MAIN RESULTS We found three trials which met our inclusion criteria, covering 1567 smokers (cessation: STRATUS-EU and STRATUS-US), and 1661 quitters (relapse prevention: STRATUS-WW). At one year, the pooled odds ratio (OR) for quitting with rimonabant 20 mg was 1.61 (95% confidence interval (CI) 1.12 to 2.30). No significant benefit was demonstrated for rimonabant at 5 mg dosage. Adverse events included nausea and upper respiratory tract infections. In the relapse prevention trial, smokers who had quit on the 20 mg regimen were 1(1/2) times more likely to remain abstinent on either active regimen than on placebo; the OR for the 20 mg maintenance group was 1.49 (95% CI 1.09 to 2.04, and for the 5 mg maintenance group 1.51 (95% CI 1.11 to 2.07). There appeared to be no significant benefit of maintenance treatment for the 5 mg quitters. Weight gain was reported to be significantly lower among the 20 mg quitters than in the 5 mg or placebo quitters. During treatment, overweight or obese smokers tended to lose weight, while normal weight smokers did not. AUTHORS' CONCLUSIONS From the preliminary trial reports available, rimonabant 20 mg may increase the odds of quitting approximately 1(1/2)-fold. Adverse events include nausea and upper respiratory tract infections; the risk of serious adverse events is reported to be low. However, there is current concern (August 2007) over rates of depression and suicidal thoughts in people taking rimonabant for weight control. The evidence for rimonabant in maintaining abstinence is inconclusive. Rimonabant 20 mg may moderate weight gain in the long term.
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Affiliation(s)
- K Cahill
- Department of Primary Health Care, Old Road Campus, University of Oxford, Oxford, UK, OX3 7LF.
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Abstract
BACKGROUND Rimonabant is a selective type 1 cannabinoid (CB1) receptor antagonist. It may assist with smoking cessation by restoring the balance of the endocannabinoid system, which can be disrupted by prolonged use of nicotine. Rimonabant also seeks to address many smokers' reluctance to persist with a quit attempt because of concerns about weight gain. OBJECTIVES To determine whether selective CB1 receptor antagonists increase the numbers of people stopping smoking. To assess their effects on weight change in successful quitters and in those who try to quit but fail. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Review Group specialized register for trials, using the terms 'rimonabant' and 'smoking' in the title or abstract, or as keywords. We also searched MEDLINE, EMBASE, CINAHL and PsycINFO, using major MESH terms. We acquired electronic or paper copies of posters of preliminary trial results presented at the American Thoracic Society Meeting in 2005, and at the Society for Research on Nicotine and Tobacco European Meeting 2006. We also attempted to contact the authors of ongoing studies of rimonabant, and Sanofi Aventis (manufacturers of rimonabant). SELECTION CRITERIA Types of studies: Randomized controlled trials. TYPES OF PARTICIPANTS Adult smokers. Types of interventions: Selective CB1 receptor antagonists, such as rimonabant. Types of outcome measures: The primary outcome is smoking status at a minimum of six months after the start of treatment. We preferred sustained cessation rates to point prevalence, and biochemically verified cessation to self-reported quitting. We regarded smokers who drop out or are lost to follow up as continuing smokers. We have noted any adverse effects of treatment. A secondary outcome is weight change associated with the cessation attempt. DATA COLLECTION AND ANALYSIS Two authors checked the abstracts for relevance, and attempted to acquire full trial reports. One author extracted the data, and a second author checked them. MAIN RESULTS We found three trials which met our inclusion criteria, covering 1567 smokers (cessation: STRATUS-EU and STRATUS-US), and 1661 quitters (relapse prevention: STRATUS-WW). At one year, the pooled odds ratio (OR) for quitting with rimonabant 20 mg was 1.61 (95% confidence interval (CI) 1.12 to 2.30). No significant benefit was demonstrated for rimonabant at 5 mg dosage. Adverse events included nausea and upper respiratory tract infections. In the relapse prevention trial, smokers who had quit on the 20 mg regimen were 1(1/2) times more likely to remain abstinent on either active regimen than on placebo; the OR for the 20 mg maintenance group was 1.49 (95% CI 1.09 to 2.04, and for the 5 mg maintenance group 1.51 (95% CI 1.11 to 2.07). There appeared to be no significant benefit of maintenance treatment for the 5 mg quitters.Weight gain was reported to be significantly lower among the 20 mg quitters than in the 5 mg or placebo quitters. During treatment, overweight or obese smokers tended to lose weight, while normal weight smokers did not. AUTHORS' CONCLUSIONS From the preliminary trial reports available, rimonabant 20 mg may increase the odds of quitting approximately 1 and one-half-fold. Adverse events include nausea and upper respiratory tract infections; the risk of serious adverse events is reported to be low. The evidence for rimonabant in maintaining abstinence is inconclusive. Rimonabant 20 mg may moderate weight gain in the long term.
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Affiliation(s)
- K Cahill
- Department of Primary Health Care, Old Road Campus, University of Oxford, Oxford, UK, OX3 7LF.
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Abstract
BACKGROUND Nicotine receptor partial agonists may help smokers to quit by a combination of maintaining moderate levels of dopamine to counteract withdrawal symptoms (acting as an agonist) and reducing smoking satisfaction (acting as an antagonist). Varenicline was developed as a nicotine receptor partial agonist from cytisine, a drug widely used in central and eastern Europe for smoking cessation. The first trial reports of varenicline were released in 2006, and further trials are underway. OBJECTIVES The primary objective of this review is to assess the efficacy and tolerability of nicotine receptor partial agonists, including varenicline and cytisine, for smoking cessation. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Group's specialised register for trials, using the terms ('varenicline' or 'cytisine' or 'Tabex' or 'nicotine receptor partial agonist') and 'smoking' in the title or abstract, or as keywords. We also searched MEDLINE, EMBASE, PsycINFO and CINAHL using MeSH terms and free text, and we contacted authors of trial reports for additional information where necessary. The last search was in October 2006. SELECTION CRITERIA We included randomized controlled trials which compared the treatment drug with placebo. We also included comparisons with bupropion where available. We excluded trials which did not report a minimum follow-up period of six months from start of treatment. DATA COLLECTION AND ANALYSIS We extracted data in duplicate on the type of participants, the dose and duration of treatment, the outcome measures, the randomization procedure, concealment of allocation, and completeness of follow up. The main outcome measured was abstinence from smoking after at least six months from the beginning of treatment. We used the most rigorous definition of abstinence, and preferred biochemically validated rates where they were reported. Where appropriate we performed meta-analysis using the Mantel-Haenszel fixed-effect model. MAIN RESULTS We found five trials of varenicline compared with placebo for smoking cessation; three of these also included a bupropion experimental arm. We also found one relapse prevention trial, comparing varenicline with placebo. The six trials covered 4924 participants, 2451 of whom used varenicline. We identified one trial of cytisine (Tabex) for inclusion. The pooled odds ratio (OR) for continuous abstinence at 12 months for varenicline versus placebo was 3.22 (95% confidence interval [CI] 2.43 to 4.27). The pooled OR for varenicline versus bupropion was 1.66 (95% CI 1.28 to 2.16). The main adverse effect of varenicline was nausea, which was mostly at mild to moderate levels and usually subsided over time. The two trials which tested the use of varenicline beyond the 12-week standard regimen found the drug to be well-tolerated and effective during long-term use. The one cytisine trial included in this review found that more participants taking cytisine stopped smoking compared with placebo at two-year follow up, with an OR of 1.77 (95% CI 1.30 to 2.40). AUTHORS' CONCLUSIONS Varenicline increased the odds of successful long-term smoking cessation approximately threefold compared with pharmacologically unassisted quit attempts. In trials reported so far, more participants quit successfully with varenicline than with bupropion. The effectiveness of varenicline as an aid to relapse prevention has not been clearly established. The main adverse effect of varenciline is nausea, but this is mostly at mild to moderate levels and tends to reduce with habituation. There is a need for independent trials of varenicline versus placebo, to test the early findings. There is also a need for direct comparisons with nicotine replacement therapy, and for further trials with bupropion, to establish the relative efficacy of the treatments.Cytisine may also increase the chances of quitting, but the evidence at present is inconclusive.
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Affiliation(s)
- K Cahill
- Department of Primary Health Care, Old Road Campus, University of Oxford, Oxford, UK, OX3 7LF.
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Cahill K. The 7th Annual International Business Research Forum. “International Outsourcing of Services: Expanding the Research Agenda”. Temple University, Philadelphia. April 1, 2006. Organizer: Arvind Parkhe. Journal of International Management 2005. [DOI: 10.1016/j.intman.2005.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Shabbir J, McDonnell CO, O'Sullivan JB, Cahill K, Moore A, Raminlagan R, Quinn G, Grace PA. "Is this a dagger I see before me?"--an audit of stabbings and gunshot wounds in Limerick. Ir J Med Sci 2004; 173:102-4. [PMID: 15540714 DOI: 10.1007/bf02914568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND According to a recent study in Cardiff, the incidence of stab wounds is 14 per 100,000 population per annum. No such figures are available for Ireland. AIM To evaluate the incidence, type of injury, medical consequences and outcome of patients with stab or gunshot wounds presenting to the Mid-Western Regional Hospital, Limerick, over a 12 month period. METHOD A retrospective case study of all stab and gunshot wounds presenting over a 12 month period. RESULTS Out of 62,000 new presentations to the Accident and Emergency (A&E) department, 101 (0.16%) were stabbings, giving an incidence of 33 per 100,000 population. Twenty-six patients required surgical intervention. There were three deaths. There were 10 gunshot wounds, of which 40% required surgical intervention, with no mortalities. CONCLUSION The incidence of stab wounds presenting to our institution is high. Although constituting a small percentage of presentations to the A&E department they result in considerable morbidity and surgical activity.
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Affiliation(s)
- J Shabbir
- Department of Surgery, Mid-Western Regional Hospital and National Institute of Health Sciences, University of Limerick, Ireland
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Hardin JB, Cronin SN, Cahill K. Comparison of the effectiveness of two pressure-relieving surfaces: low-air-loss versus static fluid. Ostomy Wound Manage 2000; 46:50-6. [PMID: 11189541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Limited research has been done to determine the effectiveness of the multitude of pressure reduction devices currently available for patient care. The purpose of this investigation was to examine the relative effectiveness of a dynamic low-air-loss (LAL) mattress and a static fluid mattress in reducing the risk of pressure ulcer development. The investigation consisted of two components: a comparative laboratory study and a retrospective clinical study. In the laboratory study, tissue interface pressures were measured on the two surfaces at three interface sites in a sample of six healthy adult volunteers. In the clinical study, a retrospective chart review was conducted to compare the actual incidence of pressure ulcer formation in a sample of 73 postoperative transplant patients who were placed on either the static fluid or LAL product. The instruments used were the Xsensor Pressure Mapping System (laboratory) and chart review tool (clinical). The main outcome measures included tissue interface pressures and incidence of pressure ulcer formation. The results were as follows: the laboratory study revealed significantly lower sacral pressures (t = -5.30, P = .003) on the low-air-loss mattress than on the static fluid mattress. Pressures did not differ significantly at the heel or trochanter sites. In the clinical study, the overall incidence of skin breakdown was 8.2%, with 5 occurrences (13.8%) in the LAL group and 1 occurrence (2.7%) in the static fluid group. However, this difference was not significant (Fisher's exact test = 0.107, P = .09). When considered jointly, the results of the two studies suggest that the static fluid and LAL products may be comparable in efficacy. Although the relatively small sample sizes used in the investigation limit generalizability, the results provide some initial direction for further clinical research in this area.
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Affiliation(s)
- J B Hardin
- Jewish Hospital, 217 East Chestnut Street, Louisville, Kentucky 40202, USA
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Cuhaci B, Kumar MS, Bloom RD, Pratt B, Haussman G, Laskow DA, Alidoost M, Grotkowski C, Cahill K, Butani L, Sturgill BC, Pankewycz OG. Transforming growth factor-beta levels in human allograft chronic fibrosis correlate with rate of decline in renal function. Transplantation 1999; 68:785-90. [PMID: 10515378 DOI: 10.1097/00007890-199909270-00010] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Long-term renal transplant function is limited primarily by a progressive scarring process loosely termed "chronic rejection, chronic allograft nephropathy, or allograft fibrosis." Although the etiology of transplant fibrosis is uncertain, several possible factors including chronic cyclosporin A (CsA) exposure may contribute to its pathogenesis. CsA stimulates renal fibrosis perhaps through the induction of the potent pro-sclerotic growth factor, transforming growth factor beta (TGFbeta). Previously, we demonstrated that, in human transplant biopsies, acute CsA toxicity but not acute tubular necrosis is associated with elevated levels of renal TGFbeta protein. We now examine whether long-term CsA treatment (>1 year) is associated with elevated levels of intra-allograft TGFbeta and whether heightened expression of TGFbeta is clinically significant. METHODS Using immunohistochemical techniques, we determined the relative level of expression of intrarenal TGFbeta protein in transplant biopsies. We studied biopsies obtained from 40 CsA-treated patients that were diagnosed as having chronic allograft fibrosis. Biopsies were scored as having minimal or high levels of TGFbeta. RESULTS Seventy-two percent of patients expressed high levels of intra-allograft TGFbeta. This group of patients lost renal function at an average rate of -19.5+/-17.3 ml/min/year. In contrast, patients with minimal or no TGFbeta expression experienced a decline of only -6.2+/-4.1 ml/min/year (P=0.01). CONCLUSIONS These results suggest that the majority of CsA-treated patients with biopsy proven chronic fibrosis have elevated levels of intra-graft TGFbeta that correlates with an increased rate of decline in renal function.
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Affiliation(s)
- B Cuhaci
- Department of Medicine, MCP/Hahnemann University, Hahnemann and St. Christopher's Hospital, Philadelphia, Pennsylvania 19102, USA
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Goetzel RZ, Dunn RL, Ozminkowski RJ, Satin K, Whitehead D, Cahill K. Differences between descriptive and multivariate estimates of the impact of Chevron Corporation's Health Quest Program on medical expenditures. J Occup Environ Med 1998; 40:538-45. [PMID: 9636934 DOI: 10.1097/00043764-199806000-00006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This investigation focused on alternative methods for evaluating the impact of Chevron Corporation's Health Quest Fitness Center program on medical expenditures, comparing descriptive and multivariate research designs. Many uncontrolled studies of corporate health management programs base estimates of program effectiveness on descriptive analyses such as Student's tests. Unlike more sophisticated multivariate analyses, descriptive analyses often produce biased estimates of program cost savings. To test alternative research design methods, the investigators compared inpatient and pharmacy expenditures for program participants and non-participants over a 2.5-year period, using descriptive and multivariate regression analyses. Results showed that compared with non-participants, expenditures for participants were significantly lower for subjects who used a Health Quest fitness center at least twice weekly. Previous descriptive studies suggested a much broader impact. The results underscore the need to use multivariate analyses when evaluating the financial impact of corporate health management programs, especially when randomization cannot be used to assign participation status.
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Kumar MS, Cahill K, Kumar AM, Panigrahi D, Seirka D, Singleton R, al-Abdullah IH, Laskow DA. ATGAM versus OKT3 induction therapy in cadaveric kidney transplantation: patient and graft survival, CD3 subset, infection, and cost analysis. Transplant Proc 1998; 30:1351-2. [PMID: 9636549 DOI: 10.1016/s0041-1345(98)00272-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- M S Kumar
- Division of Transplantation, Allegheny Hahnemann University Hospitals, Philadelphia, Pennsylvania 19102, USA
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Harris JR, Caldwell B, Cahill K. Measuring the public's health in an era of accountability: lessons from HEDIS. Health Plan Employer Data and Information Set. Am J Prev Med 1998; 14:9-13. [PMID: 9566931] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J R Harris
- Office of the Director, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Kaliski EM, Cahill K. Positive Moves: a teen weight management program. HMO Pract 1993; 7:168-9. [PMID: 10130725] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Anderson JE, Hardy AM, Cahill K, Aral S. HIV antibody testing and posttest counseling in the United States: data from the 1989 National Health Interview Survey. Am J Public Health 1992; 82:1533-5. [PMID: 1443305 PMCID: PMC1694605 DOI: 10.2105/ajph.82.11.1533] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
To see how successful human immunodeficiency virus (HIV) counseling and testing efforts have been in testing the United States population, particularly among those at increased risk for HIV infection, we analyzed data from the 1989 National Health Interview Survey. Twenty percent of the NHIS sample (or, in terms of the general US population, an estimated 36 million persons) reported having been tested for HIV antibodies, mostly through blood donations. Although persons with increased risk of HIV infection had been tested and counseled at a much higher rate than the general population, the majority of this group had not yet been tested.
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Affiliation(s)
- J E Anderson
- Division of Sexually Transmitted Diseases and HIV Prevention, Centers for Disease Control, Atlanta, GA 30333
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Rose B, Gillespie A, Wunderlich D, Kelley K, Dzuiba J, Shedd D, Cahill K, Zerler B. Differential effects of a murine and chimeric mouse/human anti-interleukin-2 receptor antibody on human T-cell proliferation. Immunology 1992; 76:452-9. [PMID: 1526654 PMCID: PMC1421677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The preference for interleukin-2 receptor (IL-2R) expression on activated, compared with resting T lymphocytes makes the IL-2R a promising target for selective immunosuppressive therapy. To increase the potential therapeutic effectiveness of anti-IL-2R monoclonals, a chimeric mouse/human variant was constructed from Ig genes isolated from a murine anti-human IL-2R hybridoma cell line, designated AHT54. AHT54 binds to the same or spatially related epitope as IL-2 on the p55 protein that constitutes the low- and high-affinity forms of IL-2R. Although the murine and chimeric AHT54 antibodies inhibited cell-surface binding of IL-2 to the same extent, the chimeric antibodies containing a human IgG1 constant region had substantially more anti-proliferative activity than their murine IgG1 counterparts. Our results indicated that the human constant region of the chimeric antibodies interacted more efficiently than the murine constant region with effector components present in peripheral blood mononuclear cells (PBMC).
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Affiliation(s)
- B Rose
- Molecular Therapeutics, Inc., Miles Research Center, W. Haven, Connecticut 06516
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Rose B, Gillespie A, Wunderlich D, Barbosa JA, Cahill K, Dzuiba J, Shedd D, Zerler B. A chimeric mouse/human anti-IL-2 receptor antibody with enhanced biological activities. Mol Immunol 1992; 29:131-44. [PMID: 1731187 DOI: 10.1016/0161-5890(92)90164-s] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A chimeric mouse/human MAb against the human p55 IL-2R was constructed from Ig genes isolated from a mouse hybridoma cell line, designated AHT107. AHT107 binds to a different epitope on p55 than IL-2, and similar to observations made for other rodent anti-IL-2R antibodies that do not recognize the same or spatially related epitope as IL-2, murine AHT107 did not efficiently inhibit proliferation of T-lymphocytes in mitogen and MLR PBMC stimulation assays. In contrast, the chimeric AHT107 antibodies containing a human IgG-1 constant region had substantially more anti-proliferative activity than their murine IgG-I counterparts. Our results indicated that the human constant region of the chimeric antibodies interacted more efficiently than the murine constant region with effector components present in the PBMC cultures. This conclusion was supported by our observation that F(ab')2 generated from the chimeric antibodies did not efficiently inhibit proliferation in the PBMC assays, and the chimeric antibodies did not inhibit proliferation of an antigen specific, IL-2 dependent human T-cell clone stimulated in the absence of PBMC.
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Affiliation(s)
- B Rose
- Molecular Therapeutics, Miles Research Center, W. Haven, CT 06516
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Cahill K, Prasad S. Wilson loops in three dimensions. Phys Rev D Part Fields 1989; 40:1274-1292. [PMID: 10011936 DOI: 10.1103/physrevd.40.1274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Klobutcher LA, Vailonis-Walsh AM, Cahill K, Ribas-Aparicio RM. Gene-sized macronuclear DNA molecules are clustered in micronuclear chromosomes of the ciliate Oxytricha nova. Mol Cell Biol 1986; 6:3606-13. [PMID: 3025603 PMCID: PMC367120 DOI: 10.1128/mcb.6.11.3606-3613.1986] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Following the sexual phase of its life cycle, the hypotrichous ciliate Oxytricha nova transforms a copy of its chromosomal micronucleus into a macronucleus containing short, linear DNA molecules with an average size of 2.2 kilobase pairs. In addition, more than 90% of the DNA sequences in the micronuclear genome are eliminated during this process. We have examined the organization of macronuclear DNA molecules in the micronuclear chromosomes. Macronuclear DNA molecules were found to be clustered and separated by less than 550 base pairs in two cloned segments of micronuclear DNA. Recombinant clones of two macronuclear DNA molecules that are adjacent in the micronucleus were also isolated and examined by DNA sequencing. The two macronuclear DNA molecules were found to be separated by only 90 base pairs in the micronuclear genome.
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Cahill K, Lustick S. Oxygen consumption and thermoregulation in Apis Mellifera workers and drones. Comp Biochem Physiol A Comp Physiol 1976; 55:355-7. [PMID: 9250 DOI: 10.1016/0300-9629(76)90060-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Ronaghy HA, Cahill K, Baker TD. Physician migration to the United States. One country's transfusion is another country's hemorrhage. JAMA 1974; 227:538-42. [PMID: 4859706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Henderson BE, Metselaar D, Cahill K, Timms GL, Tukei PM, Williams MC. Yellow fever immunity surveys in northern Uganda and Kenya and eastern Somalia, 1966-67. Bull World Health Organ 1968; 38:229-37. [PMID: 5302299 PMCID: PMC2554316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Recent epidemics of yellow fever in eastern Africa have stimulated serological surveys in the Karamoja district of Uganda, the northern frontier district of Kenya and the Giohar district of Somalia. All sera collected in the surveys were screened for group B arbovirus antibody using the HI test. Yellow fever immunity was confirmed by the mouse-protection test.No yellow fever immunity was found in sera collected from a residential tribal group at Karamoja but a small number of samples from persons who had previously lived outside the district showed immunity. Immunity was detected in sera from areas of the Northern Frontier district of Kenya. It is thought that this immunity may, in some areas, have resulted from extensions of the Ethiopian epidemic of 1960-62 into the region, but in another area of the district the immunity seems to have arisen from continuing focal transmission within Kenya. Yellow fever immunity was also detected in Somalia.
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