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Lewis KD, Peris K, Sekulic A, Stratigos AJ, Dunn L, Eroglu Z, Chang ALS, Migden MR, Yoo SY, Mohan K, Coates E, Okoye E, Bowler T, Baurain JF, Bechter O, Hauschild A, Butler MO, Hernandez-Aya L, Licitra L, Neves RI, Ruiz ES, Seebach F, Lowy I, Goncalves P, Fury MG. Final analysis of phase II results with cemiplimab in metastatic basal cell carcinoma after hedgehog pathway inhibitors. Ann Oncol 2024; 35:221-228. [PMID: 38072158 DOI: 10.1016/j.annonc.2023.10.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Metastatic basal cell carcinoma (mBCC) is a rare condition with no effective second-line treatment options. Cemiplimab is an immune checkpoint inhibitor that blocks the binding of programmed cell death-1 (PD-1) to its ligands, programmed death-ligand 1 (PD-L1) and programmed death-ligand 2 (PD-L2). Here, we present the final analysis of cemiplimab in patients with mBCC after first-line hedgehog pathway inhibitor (HHI) treatment (NCT03132636). PATIENTS AND METHODS In this open-label, single-arm, phase II study, adults with mBCC and Eastern Cooperative Oncology Group performance status ≤1, post-HHI treatment, received cemiplimab 350 mg intravenously every 3 weeks for ≤93 weeks or until disease progression or unacceptable toxicity. The primary endpoint was objective response rate (ORR) by independent central review (ICR). Duration of response (DOR) was a key secondary endpoint. Other secondary endpoints were ORR per investigator assessment, progression-free survival (PFS), overall survival (OS), complete response rate, safety, and tolerability. RESULTS Fifty-four patients were enrolled: 70% were male and the median age of patients was 64 [interquartile range (IQR) 57.0-73.0] years. The median duration of follow-up was 8 months (IQR 4-21 months). The ORR per ICR was 22% [95% confidence interval (CI) 12% to 36%], with 2 complete responses and 10 partial responses. Among responders, the median time to response per ICR was 3 months (IQR 2-7 months). The estimated median DOR per ICR was not reached [95% CI 10 months-not evaluable (NE)]. The disease control rate was 63% (95% CI 49% to 76%) per ICR and 70% (95% CI 56% to 82%) per investigator assessment. The median PFS per ICR was 10 months (95% CI 4-16 months); the median OS was 50 months (95% CI 28 months-NE). The most common treatment-emergent adverse events were fatigue [23 (43%)] and diarrhoea [20 (37%)]. There were no treatment-related deaths. CONCLUSIONS Cemiplimab demonstrated clinically meaningful antitumour activity, including durable responses, and an acceptable safety profile in patients with mBCC who had disease progression on or intolerance to HHI therapy.
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Affiliation(s)
- K D Lewis
- Department of Medicine-Medical Oncology, University of Colorado School of Medicine, Aurora, USA.
| | - K Peris
- Department of Medicine and Translational Surgery, Dermatology, Università Cattolica del Sacro Cuore, Rome; Department of Medical and Surgical Sciences, Dermatology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - A Sekulic
- Department of Dermatology, Mayo Clinic, Scottsdale, USA
| | - A J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - L Dunn
- Department of Medicine, Head and Neck Medical Oncology, Memorial Sloan Kettering Cancer Center, New York
| | - Z Eroglu
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa
| | - A L S Chang
- Dermatology Department, Stanford University School of Medicine, Redwood City
| | - M R Migden
- Department of Dermatology and Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston; Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston
| | - S-Y Yoo
- Regeneron Pharmaceuticals, Inc., Tarrytown, USA
| | - K Mohan
- Regeneron Pharmaceuticals, Inc., Tarrytown, USA
| | - E Coates
- Regeneron Pharmaceuticals, Inc., Tarrytown, USA
| | - E Okoye
- Regeneron Pharmaceuticals, Inc., Tarrytown, USA
| | - T Bowler
- Regeneron Pharmaceuticals, Inc., Tarrytown, USA
| | - J-F Baurain
- Department of Medical Oncology, Cliniques Universitaires Saint-Luc and Université Catholique de Louvain, Brussels
| | - O Bechter
- Department of General Medical Oncology, University Hospitals, Leuven, Belgium
| | - A Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - M O Butler
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - L Hernandez-Aya
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St Louis, USA
| | - L Licitra
- Department of Medical Oncology Head and Neck Cancer, Istituto Nazionale dei Tumori, Milan; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - R I Neves
- Division of Plastic Surgery, Penn State Milton S. Hershey Medical Center, Hershey
| | - E S Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - F Seebach
- Regeneron Pharmaceuticals, Inc., Tarrytown, USA
| | - I Lowy
- Regeneron Pharmaceuticals, Inc., Tarrytown, USA
| | - P Goncalves
- Regeneron Pharmaceuticals, Inc., Tarrytown, USA
| | - M G Fury
- Regeneron Pharmaceuticals, Inc., Tarrytown, USA
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Jones W, Murphy MM, Henry F, Dunn L, Samuels TA. Improving household nutrition security and public health in the CARICOM, 2018–2022. Rev Panam Salud Publica 2022; 46:e88. [DOI: 10.26633/rpsp.2022.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022] Open
Abstract
The Caribbean is experiencing a worsening epidemic of obesity and noncommunicable diseases (NCDs) and it has the worst rates of premature mortality from cardiovascular diseases in the region of the Americas. Creating enabling environments to improve dietary diversity would help reduce obesity and diet-related NCDs. The Improving Household Nutrition Security and Public Health in the CARICOM project aimed to increase dietary diversity in the Caribbean, and to determine and implement effective, gender-sensitive interventions to improve food sovereignty, household food security, and nutrition in CARICOM states. Primary quantitative and qualitative research, scoping reviews, stakeholder engagement, implementation of interventions and dissemination activities were undertaken. This paper describes the overall project design and implementation, discusses challenges and limitations, and presents core achievements to inform further work in Small Island Developing States throughout CARICOM to advance the nutrition agenda in the Caribbean. The results of the project’s research activities are presented in other papers published in this special issue on nutrition security in CARICOM states.
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Affiliation(s)
- Waneisha Jones
- Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, Barbados
| | - Madhuvanti M. Murphy
- The George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill, Barbados
| | - Fitzroy Henry
- College of Health Sciences, University of Technology Jamaica, Kingston, Jamaica
| | - Leith Dunn
- Institute for Gender and Development Studies, University of the West Indies, Mona Campus, Kingston, Jamaica
| | - T. Alafia Samuels
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
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Youssef I, Yoon J, Zakeri K, Cohen M, Wong R, Yu Y, Kang J, Gelblum D, McBride S, Sherman E, Dunn L, Cracchiolo J, Chen L, Lee N. Physician Graded Toxicity Profiles and Survival Outcomes among Patients with Non-Metastatic Oropharyngeal Carcinoma Treated with Proton Therapy vs. Intensity-Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1399] [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: 11/29/2022]
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Migden M, Schmults C, Khushanlani N, Guminski A, Chang A, Lewis K, Ansstas G, Bowyer S, Hughes B, Schadendorf D, Modi B, Dunn L, Flatz L, Hauschild A, Yoo SY, Booth J, Seebach F, Lowy I, Fury M, Rischin D. 814P Phase II study of cemiplimab in patients with advanced cutaneous squamous cell carcinoma (CSCC): Final analysis from EMPOWER-CSCC-1 groups 1, 2 and 3. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.940] [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: 11/29/2022] Open
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Howitt C, Henry F, Rocke KD, Brown CR, Jones W, Dunn L, Samuels TA. COVID-19 and the social distribution of hunger in three Caribbean Small Island Developing States. Rev Panam Salud Publica 2022; 46:e61. [PMID: 36042709 PMCID: PMC9409604 DOI: 10.26633/rpsp.2022.61] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/29/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives.
To determine changes to income and livelihood, food consumption, and hunger due to coronavirus disease 2019 (COVID-19) in three Small Island Developing States (SIDS) in the Caribbean: Jamaica, St Kitts and Nevis, and St Vincent and the Grenadines.
Methods.
This was a cross-sectional study conducted in July 2020. Participants were selected using telephone directories and lists of mobile numbers. Data were collected through face-to-face and telephone interviews. Participants rated the impact of COVID-19 on their livelihoods and the Adult Food Security Module was used to assess hunger. To examine how these outcomes varied by sociodemographic group, multivariable logistic regression analysis was used, with odds ratios (OR) and 95% confidence intervals (CI) reported.
Results.
The analysis included 880 participants. Of these, 40% (344/871) reported some form of hunger, with 18% (153/871) classed as moderate-to-severe hunger. Almost three quarters of households reported some impact on their livelihood (640/880), with 28% (243/880) classifying this impact as moderate to severe. Women were 60% more likely to report that their livelihoods were moderately to severely affected by COVID-19 (OR 1.59; 95% CI 1.09, 2.31) and 70% more likely to experience moderate-to-severe hunger (OR 1.70; 95% CI 1.37, 2.09). The effects of COVID-19 on livelihood and hunger were greater in those with secondary-school and primary-school education compared with tertiary education.
Conclusion.
The COVID-19 pandemic is disproportionately affecting the most vulnerable segments of the population. Social protection programmes are a key component of efforts to alleviate the pandemic’s consequences; however, equitable access must be ensured.
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Affiliation(s)
- Christina Howitt
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill, Barbados
| | | | - Kern D. Rocke
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill, Barbados
| | - Catherine R. Brown
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill, Barbados
| | - Waneisha Jones
- Faculty of Medical Sciences, University of the West Indies, Cave Hill, Barbados
| | - Leith Dunn
- Institute for Gender and Development Studies, University of the West Indies, Kingston, Jamaica
| | - T. Alafia Samuels
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
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Altan M, Patnaik A, Barve M, Dunn L, Cobb P, Rosenberg A, Sharma S, Sukari A, Lee Z, Marcondes M, Zalevsky J, Tagliaferri M, Kotzin B, Sacco A. 1026TiP A phase Ib/II, open-label, multicenter, dose-escalation and dose-expansion study of NKTR-255 plus cetuximab as a salvage regimen in patients with solid tumors. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1410] [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: 10/20/2022] Open
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Kang J, Tchekmedyian V, Fan M, Wang H, Kitpanit S, Mohamed N, Rybkin A, Lee A, Chen L, Yu Y, Riaz N, McBride S, Tsai C, Ho A, Dunn L, Fetten J, Pfister D, Zhang Z, Lee N, Sherman E. Split High-Dose Cisplatin: An Alternate High-Dose Cisplatin Administration Schedule for Definitive Chemoradiation in Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.279] [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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Cohen E, Dunn L, Neupane P, Gibson M, Leidner R, Savvides P, Hyland N, Trivedi T, Dudley M, Biswas S, Williams D, Norry E. 976TiP SPEARHEAD-2 trial design: A phase II pilot trial of ADP-A2M4 in combination with pembrolizumab in patients with recurrent or metastatic head and neck cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Tsai C, McBride S, Riaz N, Kang J, Yu Y, Chen L, Gelblum D, Wong R, Boyle J, Dunn L, Sherman E, Pfister D, Lee N. Radical Reduction of Radiation Therapy Dose Prescription for Elective Treatment Areas in Human Papillomavirus (HPV) - Associated Oropharyngeal Carcinoma (OPC). Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.209] [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: 11/30/2022]
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Zakeri K, Wang H, Kang J, Lee A, Gelblum D, Sherman E, Dunn L, Boyle J, Wong R, Chen L, Yu Y, Tsai C, McBride S, Riaz N, Lee N. Outcomes of Major Salivary Gland Tumors Treated with Proton Beam Radiation Therapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Fan D, Fan M, Wang H, Lee A, Yu Y, Chen L, Tsai C, McBride S, Riaz N, Bernstein M, Mueller B, Gelblum D, Fetten J, Dunn L, Michel L, Pfister D, Ho A, Boyle J, Cohen M, Roman B, Cracchiolo J, Morris L, Ganly I, Singh B, Shaha A, Patel S, Shah J, Wong R, Sherman E, Lee N, Kang J. Last-line Local Treatment with the Quad Shot Regimen for Previously Irradiated Head and Neck Cancers. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kitpanit S, Lee A, Fan D, Fan M, Wang H, Mohamed N, Spielsinger D, Gelblum D, Sherman E, Dunn L, Boyle J, Wong R, Cohen M, Kang J, Tsai C, McBride S, Zakeri K, Chen L, Yu Y, Riaz N, Lee N. Clinical Outcomes and Toxicities in Oropharyngeal Cancer (OPC) Patients Treated with Proton Therapy: A Single Institutional Experience. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kang J, Cartano O, Fan D, Fan M, Wang H, Kitpanit S, Lee A, Gelblum D, Sherman E, Dunn L, Cohen M, Boyle J, Wong R, Tsai C, McBride S, Zakeri K, Chen L, Yu Y, Riaz N, Lee N. Changing the Paradigm in HPV-Negative Oropharyngeal Cancer: Deintensification Based on Low Risk of Locoregional Relapse. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.229] [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: 11/16/2022]
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Yu Y, Fan D, Song X, Chen L, Kang J, Tsai C, McBride S, Sherman E, Fetten J, Dunn L, Lee N, Riaz N. TERT Promoter Mutations Among Oral Cavity Cancers: A Pattern of Failure Analysis. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1604] [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: 11/16/2022]
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Yan BY, Hibler BP, Menge T, Dunn L, Ho AL, Rossi AM. Sonic Hedgehog pathway inhibitors: from clinical trials to clinical practice. Br J Dermatol 2019; 180:1260-1261. [PMID: 30693471 DOI: 10.1111/bjd.17692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- B Y Yan
- Memorial Sloan Kettering Cancer Center, Dermatology Service 16 E. 60th Street, 4th Floor Dermatology, New York, NY, 10022, U.S.A
| | - B P Hibler
- Memorial Sloan Kettering Cancer Center, Dermatology Service 16 E. 60th Street, 4th Floor Dermatology, New York, NY, 10022, U.S.A
| | - T Menge
- Memorial Sloan Kettering Cancer Center, Dermatology Service 16 E. 60th Street, 4th Floor Dermatology, New York, NY, 10022, U.S.A
| | - L Dunn
- Memorial Sloan Kettering Cancer Center, Dermatology Service 16 E. 60th Street, 4th Floor Dermatology, New York, NY, 10022, U.S.A
| | - A L Ho
- Memorial Sloan Kettering Cancer Center, Dermatology Service 16 E. 60th Street, 4th Floor Dermatology, New York, NY, 10022, U.S.A
| | - A M Rossi
- Memorial Sloan Kettering Cancer Center, Dermatology Service 16 E. 60th Street, 4th Floor Dermatology, New York, NY, 10022, U.S.A
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Barney C, Beckham T, Healy E, Branstetter A, Yaney A, Riaz N, McBride S, Tsai C, Sherman E, Dunn L, Pfister D, Tan J, Rupert R, Bonomi M, Mitchell D, Wobb J, Blakaj D, Lee N, Bhatt A. A Multi-Institutional Comparison of Carboplatin-Based Regimens Versus Cetuximab in Chemoradiation for p16(-) Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.100] [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: 12/01/2022]
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Osborn V, Tsai C, Sherman E, Pfister D, Baxi S, Dunn L, Ho A, Michel L, Riaz N, Higginson D, Leeman J, Patel S, Xie P, Li X, Lee N, McBride S. Bolus Versus Weekly Chemotherapy in Definitive Chemoradiation for Nasopharyngeal Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2017.12.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Baird RD, Ramenatte N, Watts C, Jonson A, Jones L, Biggs H, Harrison E, Oberg I, Bullen G, Williams M, Qian W, Gilbert F, Jodrell D, Caldas C, Karabatsou K, Dunn L, Jena R, Whitfield G, Chalmers A, Jefferies S, Price S. Abstract OT1-04-01: Cambridge brain mets trial 1 (CamBMT1): A proof-of-principle phase 1b / randomised phase 2 study of afatinib penetration into brain metastases for patients undergoing neurosurgical resection, both with and without prior low-dose, targeted radiotherapy. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot1-04-01] [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
Failure of drugs to cross the blood brain barrier (BBB) can be a major reason for treatment failure for patients with brain tumors. For most patients who don't respond to treatment, it is not known whether this is due to inadequate drug concentrations in the tumor, or due to drug resistance. Preliminary data suggest that low-dose radiotherapy may disrupt the BBB, and could facilitate increased drug delivery into brain tumors. Afatinib is a potent, irreversible inhibitor of EGFR / HER2 / HER4 and takes approximately 8 days to achieve steady-state concentrations in cancer patients.
Aims
CamBMT1 has been designed to investigate the delivery of afatinib into brain metastases and whether this might be enhanced by low dose-radiotherapy.
Patient Population
Key eligibility criteria
Patients with operable brain metastases from breast or lung primaries for whom neurosurgical resection would be standard of care, as determined by the local multi-disciplinary team. ECOG PS 0, 1 or 2.
Trial design
After a phase 1b safety run- in, the phase 2 part of the trial randomises patients (n=60) into 3 pre-operative arms:
Arm 1afatinib alone for 11 days, then neurosurgery on day 12Arm 2afatinib for 11 days plus a single 2 Gy fraction on day 10, then neurosurgery on day 12Arm 3afatinib for 11 days plus a single 4 Gy fraction on day 10, then neurosurgery on day 12
Primary endpoint: to compare steady-state afatinib concentration in resected brain metastases, following afatinib administered alone, or in combination with radiotherapy (2 Gy or 4 Gy). Afatinib concentrations are measured in the resected brain metastases and in plasma.
Secondary endpoints: safety of afatinib administration in combination with radiotherapy; and multi-sequence MRI (optional) to detect changes in perfusion, vascular density, blood-brain-barrier permeability and interstitial pressure.
Exploratory endpoints: molecular profiling of resected brain metastases, for comparison with paired primary lung and breast cancers; the establishment and study of patient-derived xenografts.
Statistical methods
With 20 patients randomised in each of 3 arms in the phase 2 part of CamBMT1, the trial has a power of 84% at a significance level of 20% (one-sided) to detect an increase in afatinib concentrations with targeted radiotherapy, measured as a Cohen's D (standardised mean difference) ≥0.5.
Accrual
By the end of q2 2016, phase 1b had nearly completed enrolment. The randomised phase 2 part of CamBMT1 is due to open by q4 2016 at additional Experimental Cancer Medicine Centres.
Acknowledgments
CamBMT1 is funded by Cancer Research UK, the Brain Tumour Charity and Boehringer-Ingelheim.
Citation Format: Baird RD, Ramenatte N, Watts C, Jonson A, Jones L, Biggs H, Harrison E, Oberg I, Bullen G, Williams M, Qian W, Gilbert F, Jodrell D, Caldas C, Karabatsou K, Dunn L, Jena R, Whitfield G, Chalmers A, Jefferies S, Price S. Cambridge brain mets trial 1 (CamBMT1): A proof-of-principle phase 1b / randomised phase 2 study of afatinib penetration into brain metastases for patients undergoing neurosurgical resection, both with and without prior low-dose, targeted radiotherapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT1-04-01.
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Affiliation(s)
- RD Baird
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - N Ramenatte
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - C Watts
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - A Jonson
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - L Jones
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - H Biggs
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - E Harrison
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - I Oberg
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - G Bullen
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - M Williams
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - W Qian
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - F Gilbert
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - D Jodrell
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - C Caldas
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - K Karabatsou
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - L Dunn
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - R Jena
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - G Whitfield
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - A Chalmers
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - S Jefferies
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
| | - S Price
- Cambridge Cancer Centre - Breast Cancer Research Unit, Cambridge, Cambridgeshire, United Kingdom; Cambridge Clinical Trials Unit – Cancer Theme, Cambridge, Cambridgeshire, United Kingdom; Cambridge Cancer Centre - Early Phase Clinical Trials Team, Cambridge, Cambridgeshire, United Kingdom; University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Neuro-Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom; Cancer Research UK Cambridge Institute - PK-PD Core Facility, Cambridge, Cambridgeshire, United Kingdom; University of Glasgow - Neuro-Oncology, Glasgow, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, United Kingdom; University of Cambridge - Cambridge Cancer Centre, United Kingdom
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19
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Keehan S, Taylor ML, Smith RL, Dunn L, Kron T, Franich RD. DOSE AND GAMMA-RAY SPECTRA FROM NEUTRON-INDUCED RADIOACTIVITY IN MEDICAL LINEAR ACCELERATORS FOLLOWING HIGH-ENERGY TOTAL BODY IRRADIATION. Radiat Prot Dosimetry 2016; 172:327-332. [PMID: 26598738 DOI: 10.1093/rpd/ncv480] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/15/2015] [Accepted: 10/17/2015] [Indexed: 06/05/2023]
Abstract
Production of radioisotopes in medical linear accelerators (linacs) is of concern when the beam energy exceeds the threshold for the photonuclear interaction. Staff and patients may receive a radiation dose as a result of the induced radioactivity in the linac. Gamma-ray spectroscopy was used to identify the isotopes produced following the delivery of 18 MV photon beams from a Varian 21EX and an Elekta Synergy. The prominent radioisotopes produced include 187W, 63Zn, 56Mn, 24Na and 28Al in both linac models. The dose rate was measured at the beam exit window (12.6 µSv in the first 10 min) following 18 MV total body irradiation (TBI) beams. For a throughput of 24 TBI patients per year, staff members are estimated to receive an annual dose of up to 750 μSv at the patient location. This can be further reduced to 65 μSv by closing the jaws before re-entering the treatment bunker.
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Affiliation(s)
- S Keehan
- School of Applied Sciences, RMIT University, Melbourne, Australia
| | - M L Taylor
- School of Applied Sciences, RMIT University, Melbourne, Australia
| | - R L Smith
- School of Applied Sciences, RMIT University, Melbourne, Australia
- William Buckland Radiotherapy Centre, Alfred Hospital, Melbourne, Australia
| | - L Dunn
- Australian Clinical Dosimetry Service, ARPANSA, Yallambie, Australia
| | - T Kron
- School of Applied Sciences, RMIT University, Melbourne, Australia
- Physical Sciences, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - R D Franich
- School of Applied Sciences, RMIT University, Melbourne, Australia
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20
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Ho AL, Dunn L, Sherman EJ, Fury MG, Baxi SS, Chandramohan R, Dogan S, Morris LGT, Cullen GD, Haque S, Sima CS, Ni A, Antonescu CR, Katabi N, Pfister DG. A phase II study of axitinib (AG-013736) in patients with incurable adenoid cystic carcinoma. Ann Oncol 2016; 27:1902-8. [PMID: 27566443 DOI: 10.1093/annonc/mdw287] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 07/19/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recurrent/metastatic adenoid cystic carcinoma (ACC) is an incurable disease with no standard treatments. The majority of ACCs express the oncogenic transcription factor MYB (also c-myb), often in the context of a MYB gene rearrangement. This phase II trial of the tyrosine kinase inhibitor (TKI) axitinib (Pfizer) tested the hypothesis that targeting pathways activated by MYB can be therapeutically effective for ACC. PATIENTS AND METHODS This is a minimax two-stage, phase II trial that enrolled patients with incurable ACC of any primary site. Progressive or symptomatic disease was required. Patients were treated with axitinib 5 mg oral twice daily; dose escalation was allowed. The primary end point was best overall response (BOR). An exploratory analysis correlating biomarkers to drug benefit was conducted, including next-generation sequencing (NGS) in 11 patients. RESULTS Thirty-three patients were registered and evaluable for response. Fifteen patients had the axitinib dose increased. Tumor shrinkage was achieved in 22 (66.7%); 3 (9.1%) had confirmed partial responses. Twenty-five (75.8%) patients had stable disease, 10 of whom had disease stability for >6 months. The median progression-free survival (PFS) was 5.7 months (range 0.92-21.8 months). Grade 3 axitinib-related toxicities included hypertension, oral pain and fatigue. A trend toward superior PFS was noted with the MYB/NFIB rearrangement, although this was not statistically significant. NGS revealed three tumors with 4q12 amplification, producing increased copies of axitinib-targeted genes PDGFR/KDR/KIT. Two 4q12 amplified patients achieved stable disease for >6 months, including one with significant tumor reduction and the longest PFS on study (21.8 months). CONCLUSIONS Although the primary end point was not met, axitinib exhibited clinical activity with tumor shrinkage achieved in the majority of patients with progressive disease before trial enrollment. Analysis of MYB biomarkers and genomic profiling suggests the hypothesis that 4q12 amplified ACCs are a disease subset that benefit from TKI therapy.
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Affiliation(s)
- A L Ho
- Department of Medicine Department of Medicine
| | | | - E J Sherman
- Department of Medicine Department of Medicine
| | - M G Fury
- Department of Medicine Department of Medicine
| | - S S Baxi
- Department of Medicine Department of Medicine
| | | | | | - L G T Morris
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York City, USA
| | | | - S Haque
- Department of Radiology Department of Radiology, Weill Cornell Medical College, New York City
| | - C S Sima
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York City, USA
| | - A Ni
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York City, USA
| | | | | | - D G Pfister
- Department of Medicine Department of Medicine
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21
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Yuen S, Clayton Z, Lecce L, Martinez B, Lam Y, Dunn L, Ng M. A Study Comparing Popular Cell Therapies In Vivo Shows Late-Outgrowth Endothelial Cells are the Most Effective for Therapeutic Angiogenesis. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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King E, Yuan J, Kong S, Dunn L, Stocker R, Keech A, Jenkins A, Ng M. Hypoxia Tolerance in Diabetes Mellitus: The Role of Fenofibrate in Facilitating Protective Metabolic Reprogramming. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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23
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Williams I, Lye J, Alves A, Shaw M, Keehan S, Kenny J, Lehmann J, Dunn L, Kron T. EP-1559: The Australian Clinical Dosimetry Service: The findings from a national auditing service. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32809-2] [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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24
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Miaskowski C, Cooper BA, Aouizerat B, Melisko M, Chen LM, Dunn L, Hu X, Kober KM, Mastick J, Levine JD, Hammer M, Wright F, Harris J, Armes J, Furlong E, Fox P, Ream E, Maguire R, Kearney N. The symptom phenotype of oncology outpatients remains relatively stable from prior to through 1 week following chemotherapy. Eur J Cancer Care (Engl) 2016; 26. [PMID: 26777053 DOI: 10.1111/ecc.12437] [Citation(s) in RCA: 28] [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] [Accepted: 11/26/2015] [Indexed: 01/23/2023]
Abstract
Some oncology outpatients experience a higher number of and more severe symptoms during chemotherapy (CTX). However, little is known about whether this high risk phenotype persists over time. Latent transition analysis (LTA) was used to examine the probability that patients remained in the same symptom class when assessed prior to the administration of and following their next dose of CTX. For the patients whose class membership remained consistent, differences in demographic and clinical characteristics, and quality of life (QOL) were evaluated. The Memorial Symptom Assessment Scale (MSAS) was used to evaluate symptom burden. LTA was used to identify subgroups of patients with distinct symptom experiences based on the occurrence of the MSAS symptoms. Of the 906 patients evaluated, 83.9% were classified in the same symptom occurrence class at both assessments. Of these 760 patients, 25.0% were classified as Low-Low, 44.1% as Moderate-Moderate and 30.9% as High-High. Compared to the Low-Low class, the other two classes were younger, more likely to be women and to report child care responsibilities, and had a lower functional status and a higher comorbidity scores. The two higher classes reported lower QOL scores. The use of LTA could assist clinicians to identify higher risk patients and initiate more aggressive interventions.
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Affiliation(s)
- C Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA
| | - B A Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - B Aouizerat
- College of Dentistry, New York University, New York, NY, USA
| | - M Melisko
- School of Medicine, University of California, San Francisco, CA, USA
| | - L-M Chen
- School of Medicine, University of California, San Francisco, CA, USA
| | - L Dunn
- School of Medicine, University of California, San Francisco, CA, USA
| | - X Hu
- School of Nursing, University of California, San Francisco, CA, USA
| | - K M Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - J Mastick
- School of Nursing, University of California, San Francisco, CA, USA
| | - J D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - M Hammer
- New York University College of Nursing, New York, NY, USA
| | - F Wright
- School of Nursing, Yale University, New Haven, CT, USA
| | - J Harris
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - J Armes
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - E Furlong
- School of Nursing, Midwifery, and Health Systems, University College Dublin, Dublin, Ireland
| | - P Fox
- School of Nursing, Midwifery, and Health Systems, University College Dublin, Dublin, Ireland
| | - E Ream
- School of Health Sciences, University of Surrey, Guilford, UK
| | - R Maguire
- School of Health Sciences, University of Surrey, Guilford, UK
| | - N Kearney
- School of Health Sciences, University of Surrey, Guilford, UK
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25
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Affiliation(s)
- N Holman
- National Cardiovascular Intelligence Network, Public Health England, York
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow
| | - R Gadsby
- Warwick Medical School, University of Warwick, Warwick
| | - L Dunn
- Clinical Audit, Health and Social Care Information Centre, Leeds, UK
| | - C Sylvester
- Clinical Audit, Health and Social Care Information Centre, Leeds, UK
| | - B Young
- National Cardiovascular Intelligence Network, Public Health England, York
- Salford Royal Foundation Trust, Salford, UK
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26
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Williams I, Lehmann J, Lye J, Kenny J, Alves A, Dunn L, Kron T. SU-E-P-03: The Australian Clinical Dosimetry Service, a Bespoke National Solution. Med Phys 2015. [DOI: 10.1118/1.4923938] [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: 11/07/2022] Open
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27
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Keehan S, Taylor M, Smith R, Dunn L, Kron T, Franich R. TU-F-CAMPUS-T-01: Dose and Energy Spectra From Neutron Induced Radioactivity in Medical Linear Accelerators Following High Energy Total Body Irradiation. Med Phys 2015. [DOI: 10.1118/1.4925786] [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: 11/07/2022] Open
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28
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Lehmann J, Dunn L, Lye J, Kenny JW, Alves ADC, Cole A, Asena A, Kron T, Williams IM. SU-E-T-391: Assessment and Elimination of the Angular Dependence of the Response of the NanoDot OSLD System in MV Beams. Med Phys 2014. [DOI: 10.1118/1.4888724] [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: 11/07/2022] Open
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29
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Wallace RM, Stanek D, Griese S, Krulak D, Vora NM, Pacha L, Kan V, Said M, Williams C, Burgess TH, Clausen SS, Austin C, Gabel J, Lehman M, Finelli LN, Selvaggi G, Joyce P, Gordin F, Benator D, Bettano A, Cersovsky S, Blackmore C, Jones SV, Buchanan BD, Fernandez AI, Dinelli D, Agnes K, Clark A, Gill J, Irmler M, Blythe D, Mitchell K, Whitman TJ, Zapor MJ, Zorich S, Witkop C, Jenkins P, Mora P, Droller D, Turner S, Dunn L, Williams P, Richards C, Ewing G, Chapman K, Corbitt C, Girimont T, Franka R, Recuenco S, Blanton JD, Feldman KA. A large-scale, rapid public health response to rabies in an organ recipient and the previously undiagnosed organ donor. Zoonoses Public Health 2014; 61:560-70. [PMID: 24673934 DOI: 10.1111/zph.12105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Indexed: 11/29/2022]
Abstract
This article describes and contrasts the public health response to two human rabies cases: one organ recipient diagnosed within days of symptom onset and the transplant donor who was diagnosed 18 months post-symptom onset. In response to an organ-transplant-related rabies case diagnosed in 2013, organ donor and recipient investigations were conducted by multiple public health agencies. Persons with potential exposure to infectious patient materials were assessed for rabies virus exposure. An exposure investigation was conducted to determine the source of the organ donor's infection. Over 100 persons from more than 20 agencies spent over 2700 h conducting contact investigations in healthcare, military and community settings. The 564 persons assessed include 417 healthcare workers [5.8% recommended for post-exposure prophylaxis (PEP)], 96 community contacts (15.6% recommended for PEP), 30 autopsy personnel (50% recommended for PEP), and 21 other persons (4.8% recommended for PEP). Donor contacts represented 188 assessed with 20.2% recommended for PEP, compared with 5.6% of 306 recipient contacts recommended for PEP. Human rabies cases result in substantial use of public health and medical resources, especially when diagnosis is delayed. Although rare, clinicians should consider rabies in cases of encephalitis of unexplained aetiology, particularly for cases that may result in organ donation.
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Affiliation(s)
- R M Wallace
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology (DHCPP), Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
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30
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Lehmann J, Kenny J, Lye J, Dunn L, Williams I. Trust, but verify – Accuracy of clinical commercial radiation Treatment Planning Systems. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/1742-6596/489/1/012094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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31
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Dunn L, Byrne P, Lloyd-Williams M. ‘RING US IF YOU NEED US’: THE IMPORTANCE OF REASSURANCE TO FAMILY CAREGIVERS PROVIDING HOME-BASED END-OF-LIFE CARE. BMJ Support Palliat Care 2014. [DOI: 10.1136/bmjspcare-2014-000653.43] [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: 11/04/2022]
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32
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Geary MK, McGeady L, Dunn L, Pennick L, Johnson M, Stolfi A. The demographics of the United States haemophilia treatment centre social workers: the results of a national survey. Haemophilia 2014; 20:500-5. [PMID: 24456041 DOI: 10.1111/hae.12354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 11/28/2022]
Abstract
Social Workers (SWs) are vital members of the multidisciplinary health care teams at Hemophilia Treatment Centers (HTCs) across the US. However, little research has been done to identify the demographics and qualifications of HTC SWs. In response to this lack of data, a subcommittee from the Social Work Working Group sponsored by the National Hemophilia Foundation conducted a national online survey in 2010. The authors attempted to ascertain the demographics and characteristics of SWs who work at HTCs across the country. The purpose of this article is to report the results of this online survey and evaluate the parameters of SW demographics in HTCs. Electronic surveys were sent to 143 HTC SWs. Ten were excluded and 100 were completed and returned, yielding a 75% response rate. The great majority of HTC SWs are women and almost half are middle-aged (aged 40-59). They represent a highly educated, very experienced group of professionals. When asked why respondents stayed in their positions at the HTCs, answers appeared to highly correlate to factors related to the HTC multidisciplinary team model. The high survey response rate of 75% reflects the interest of HTC SWs in obtaining data that describe and quantify their qualifications. This information may serve as validation of the haemophilia SW role in times of funding cuts. It may also give a basis for the recruitment and retention of SWs in the haemophilia field.
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Affiliation(s)
- M K Geary
- New England Hemophilia Center, UMassMemorial Hospital, Worcester, MA, USA
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Clements N, Kron T, Franich R, Dunn L, Roxby P, Aarons Y, Chesson B, Siva S, Duplan D, Ball D. The effect of irregular breathing patterns on internal target volumes in four-dimensional CT and cone-beam CT images in the context of stereotactic lung radiotherapy. Med Phys 2013; 40:021904. [PMID: 23387752 DOI: 10.1118/1.4773310] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Stereotactic lung radiotherapy is complicated by tumor motion from patient respiration. Four-dimensional CT (4DCT) imaging is a motion compensation method used in treatment planning to generate a maximum intensity projection (MIP) internal target volume (ITV). Image guided radiotherapy during treatment may involve acquiring a volumetric cone-beam CT (CBCT) image and visually aligning the tumor to the planning 4DCT MIP ITV contour. Moving targets imaged with CBCT can appear blurred and currently there are no studies reporting on the effect that irregular breathing patterns have on CBCT volumes and their alignment to 4DCT MIP ITV contours. The objective of this work was therefore to image a phantom moving with irregular breathing patterns to determine whether any configurations resulted in errors in volume contouring or alignment. METHODS A Perspex thorax phantom was used to simulate a patient. Three wooden "lung" inserts with embedded Perspex "lesions" were moved up to 4 cm with computer-generated motion patterns, and up to 1 cm with patient-specific breathing patterns. The phantom was imaged on 4DCT and CBCT with the same acquisition settings used for stereotactic lung patients in the clinic and the volumes on all phantom images were contoured. This project assessed the volumes for qualitative and quantitative changes including volume, length of the volume, and errors in alignment between CBCT volumes and 4DCT MIP ITV contours. RESULTS When motion was introduced 4DCT and CBCT volumes were reduced by up to 20% and 30% and shortened by up to 7 and 11 mm, respectively, indicating that volume was being under-represented at the extremes of motion. Banding artifacts were present in 4DCT MIP images, while CBCT volumes were largely reduced in contrast. When variable amplitudes from patient traces were used and CBCT ITVs were compared to 4DCT MIP ITVs there was a distinct trend in reduced ITV with increasing amplitude that was not seen when compared to true ITVs. Breathing patterns with a rest period following expiration resulted in well-defined superior edges and were better aligned using an edge-to-edge alignment technique. In most cases, sinusoidal motion patterns resulted in the closest agreements to true values and the smallest misalignments. CONCLUSIONS Strategies are needed to compensate for volume losses at the extremes of motion for both 4DCT MIP and CBCT images for larger and varied amplitudes, and for patterns with rest periods following expiration. Lesions moving greater than 2 cm would warrant larger treatment margins added to the 4DCT MIP ITV to account for the volume being under-represented at the extremes of motion. Lesions moving with a rest period following expiration would be better aligned using an edge-to-edge alignment technique. Sinusoidal patterns represented the ideal clinical scenario, reinforcing the importance of investigating clinically relevant motions and their effects on 4DCT MIP and CBCT volumes. Since most patients do not breathe sinusoidally this may lead to misinterpretation of previous studies using only sinusoidal motion.
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Affiliation(s)
- N Clements
- Department of Physical Sciences, Peter MacCallum Cancer Centre, East Melbourne, Australia.
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34
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Lehmann J, Kenny J, Lye J, Dunn L, Williams I. MO-D-105-04: A Nation-Wide Three Level Audit Service - the Australian Experience. Med Phys 2013. [DOI: 10.1118/1.4815230] [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: 11/07/2022] Open
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35
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Stephens K, Cooper B, Langford D, Koetters T, West C, Levine J, Elboim C, Gary A, Hamolsky D, Dunn L, Rugo H, Dodd M, Paul S, Neuhaus J, Schmidt B, Aouizerat B, Miaskowski C. Variations in inflammatory cytokine genes are associated with persistent severe breast pain after breast cancer surgery. The Journal of Pain 2013. [DOI: 10.1016/j.jpain.2013.01.463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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36
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Tappia PS, Guzman C, Dunn L, Aroutiounova N. Adverse cardiac remodeling due to maternal low protein diet is associated with alterations in expression of genes regulating glucose metabolism. Nutr Metab Cardiovasc Dis 2013; 23:130-135. [PMID: 21788123 DOI: 10.1016/j.numecd.2011.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 10/27/2010] [Revised: 03/10/2011] [Accepted: 03/28/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS We have previously shown that a maternal low protein (LP) diet during pregnancy in the rat results in adverse ventricular remodeling and contractile deficiencies of the neonatal rat heart. Since pathological cardiac hypertrophy is associated with increased expression of genes involved in glucose handling, this study was undertaken to examine if maternal LP diet alters the expression of genes encoding for some key components of glucose metabolism and uptake, and of the insulin receptor (IR) signal transduction in the heart of male offspring. METHODS AND RESULTS We determined the effect of maternal LP and normal diet (90 and 180 g/casein/kg respectively) on IR β-subunit, insulin receptor substrate (IRS)-1, phosphotyrosyl protein phosphatase (PTP) 1B, GLUT4 and phosphatidylinositol (PI) 3-kinase in male rat offspring at 24 h and at 1, 4 and 8 wks post-partum. Quantitative real-time RT-PCR revealed significant age-dependent increases in the expression of IR β-subunit, IRS-1, PTP1B, GLUT4 and PI3-kinase in the LP group with concomitant increases in corresponding protein abundance at 4 wks of age. These changes were associated with increases in left ventricular (LV) internal diameters as well as increases in LV wall thickness. CONCLUSION A maternal LP diet can induce increases in the gene expression and protein levels of key components of glucose metabolism and the IR signal transduction pathway in the neonatal rat heart, which may be related to accelerated energy supply, demand and utilization for ventricular remodeling due to compromised contractile performance during early life.
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Affiliation(s)
- P S Tappia
- I.H. Asper Clinical Research Institute, St. Boniface Hospital Research Centre, Canada.
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37
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Prosser H, Dunn L, Simpson P, Vanags L, Monger S, Tan J, Bursill C, Ng M. High Density Lipoproteins Attenuate the Vascular Complications of Diabetes Mellitus by Inhibition of Hyperglycaemia-mediated Overexpression Thioredoxin-interacting Protein. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.152] [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: 11/27/2022]
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38
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Chan K, Yuen S, Dunn L, Simpson P, Yong A, Hsu C, Guillou M, Bao S, Chawantanpipat C, Lim P, Yu Y, Celermajer D, Wu J, Ng M. Late-Outgrowth But Not Early Endothelial Progenitor Cells Enhance Ischaemia-mediated Neovascularisation and Coronary Collateral Formation – Implications for Therapeutic Angiogenesis. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.040] [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: 11/24/2022]
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Abstract
PURPOSE The use of time-resolved four-dimensional computed tomography (4D-CT) in radiotherapy requires strict quality assurance to ensure the accuracy of motion management protocols. The aim of this work was to design and test a phantom capable of large amplitude motion for use in 4D-CT, with particular interest in small lesions typical for stereotactic body radiotherapy. METHODS The phantom of "see-saw" design is light weight, capable of including various sample materials and compatible with several surrogate marker signal acquisition systems. It is constructed of polymethylmethacrylate (Perspex) and its movement is controlled via a dc motor and drive wheel. It was tested using two CT scanners with different 4D acquisition methods: the Philips Brilliance Big Bore CT (helical scan, pressure belt) and a General Electric Discovery STE PET∕CT (axial scan, infrared marker). Amplitudes ranging from 1.5 to 6.0 cm and frequencies of up to 40 cycles per minute were used to study the effect of motion on image quality. Maximum intensity projections (MIPs), as well as average intensity projections (AIPs) of moving objects were investigated and their quality dependence on the number of phase reconstruction bins assessed. RESULTS CT number discrepancies between moving and stationary objects were found to have no systematic dependence on amplitude, frequency, or specific interphase variability. MIP-delineated amplitudes of motion were found to match physical phantom amplitudes to within 2 mm for all motion scenarios tested. Objects undergoing large amplitude motions (>3.0 cm) were shown to cause artefacts in MIP and AIP projections when ten phase bins were assigned. This problem can be mitigated by increasing the number of phase bins in a 4D-CT scan. CONCLUSIONS The phantom was found to be a suitable tool for evaluating the image quality of 4D-CT motion management technology, as well as providing a quality assurance tool for intercenter∕intervendor testing of commercial 4D-CT systems. When imaging objects with large amplitudes, the completeness criterion described here indicates the number of phase bins required to prevent missing data in MIPs and AIPs. This is most relevant for small lesions undergoing large motions.
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Affiliation(s)
- L Dunn
- School of Applied Sciences and Health Innovations Research Institute, RMIT University, Melbourne, Australia
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40
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Charles PH, Crowe SB, Kairn T, Kenny J, Lehmann J, Lye J, Dunn L, Hill B, Knight RT, Langton CM, Trapp JV. The effect of very small air gaps on small field dosimetry. Phys Med Biol 2012; 57:6947-60. [DOI: 10.1088/0031-9155/57/21/6947] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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41
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Yazbeck R, Dawson P, Rogers N, West C, Keogh R, Wallace D, Polyak S, Nowak K, Burt R, Taylor J, Dunn L, Philp A, Parkinson-Lawrence E. Indigenous Health: ACTION on Prevention - 50th annual Australian Society for Medical Research National Scientific Conference. Rural Remote Health 2012; 12:2256. [PMID: 22985135] [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: 06/01/2023] Open
Abstract
The 50th annual National Scientific Conference of the Australian Society for Medical Research was held in Cairns, Queensland, 13-16 November 2011. The theme, 'Indigenous Health: ACTION on Prevention' highlighted the direct action being undertaken by health and medical researchers, as well as allied health professionals, to improve long-term health outcomes for Indigenous Australians.
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Affiliation(s)
- R Yazbeck
- School of Pharmacy and Medical Science, University of South Australia, Adelaide, South Australia, Australia.
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Yeo UJ, Taylor ML, Supple JR, Smith RL, Dunn L, Kron T, Franich RD. Is it sensible to “deform” dose? 3D experimental validation of dose-warping. Med Phys 2012; 39:5065-72. [PMID: 22894432 DOI: 10.1118/1.4736534] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- U J Yeo
- School of Applied Sciences and Health Innovations Research Institute, RMIT University, Melbourne, Victoria 3000, Australia
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Kairn T, Taylor ML, Crowe SB, Dunn L, Franich RD, Kenny J, Knight RT, Trapp JV. Monte Carlo verification of gel dosimetry measurements for stereotactic radiotherapy. Phys Med Biol 2012; 57:3359-69. [DOI: 10.1088/0031-9155/57/11/3359] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Lazar R, Lendaris A, Dunn L, Schweber A, Marshall R. Does Net Gain during Acute Stroke Recovery Exceed Daily Variability? (P01.173). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p01.173] [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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45
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46
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Chan K, Dunn L, Bao S, Lam M, Guillou M, Ni J, Midwinter R, Suarna C, Maghzal G, Cantley J, Ng M, Stocker R. Heme Oxygenase-1 is Necessary for Ischaemia-mediated Neovascularisation and Hypoxia-induced Metabolic Reprogramming. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.048] [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: 11/30/2022]
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47
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Kron T, Clements N, Aarons Y, Dunn L, Chesson B, Miller J, Roozen K, Ball D. Radiochromic film for individual patient QA in extracranial stereotactic lung radiotherapy. RADIAT MEAS 2011. [DOI: 10.1016/j.radmeas.2011.05.063] [Citation(s) in RCA: 8] [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: 12/25/2022]
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48
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Callahan J, Binns D, Dunn L, Kron T. Motion effects on SUV and lesion volume in 3D and 4D PET scanning. Australas Phys Eng Sci Med 2011; 34:489-95. [PMID: 22081269 DOI: 10.1007/s13246-011-0109-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 10/31/2011] [Indexed: 11/24/2022]
Abstract
To assess the effect of lesion motion and respiration rate on Standardised Uptake Value (SUV) and the ability of 4D PET to restore any loss in SUV and distortion of lesion volume on two PET/CT systems. A Perspex phantom with four cylindrical reservoirs filled with (18)F-FDG was used in this study. The cylinders measured 5, 10, 15, and 20 mm in diameter. A GE Discovery STE8 (GE Medical Systems Milwaukee, WI) and a Siemens Biograph 64/40 (Siemens Medical Solutions, Erlangen, Germany) scanner was used to acquire a stationary un-gated PET scan of the phantom. Multiple 10 min list mode 4D PET scans were acquired using the Varian RPM on the GE camera and the Anzai Gating system on the Siemens camera. The phantom was scanned at five different respiratory rates and motion amplitudes in a sinusoidal fashion, 15 RPM/1 cm, 15 RPM/2 cm, 15 RPM/4 cm, 30 RPM/2 cm and 7.5 RPM/2 cm (RPM-respirations per minute). Each scan was reconstructed into ten bins and as an un-gated static image. The SUVmax, SUVmean and volume were measured for all four reservoirs using Siemens TrueD analysis software. With increasing lesion movement the SUVmax and SUVmean decreased and the volume increased with the SUVmax in the smallest lesion underestimated by up to a factor of four. The SUVmax, SUVmean and volume were mostly recovered using 4D imaging regardless of amount of lesion displacement. The larger lesions showed better count recovery and volume correction than the smaller lesions. The respiratory rate had no effect of SUV or volume. Un-gated imaging of moving lesions decreases apparent SUV in small lesions significantly and overestimates volumes. 4D PET scanning recovers most of the apparent loss in SUV and distortion of volumes.
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Affiliation(s)
- J Callahan
- Centre for Molecular Imaging, Peter MacCallum Cancer Centre, East Melbourne, VIC 3002, Australia.
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Fitzgerald JC, Camprubi MD, Dunn L, Wu HC, Ip NY, Kruger R, Martins LM, Wood NW, Plun-Favreau H. Phosphorylation of HtrA2 by cyclin-dependent kinase-5 is important for mitochondrial function. Cell Death Differ 2011; 19:257-66. [PMID: 21701498 DOI: 10.1038/cdd.2011.90] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The role of the serine protease HtrA2 in neuroprotection was initially identified by the demonstration of neurodegeneration in mice lacking HtrA2 expression or function, and the interesting finding that mutations adjacent to two putative phosphorylation sites (S142 and S400) have been found in Parkinson's disease patients. However, the mechanism of this neuroprotection and the signalling pathways associated with it remain mostly unknown. Here we report that cyclin-dependent kinase-5 (Cdk5), a kinase implicated in the pathogenesis of several neurodegenerative diseases, is responsible for phosphorylating HtrA2 at S400. HtrA2 and Cdk5 interact in human and mouse cell lines and brain, and Cdk5 phosphorylates S400 on HtrA2 in a p38-dependent manner. Phosphorylation of HtrA2 at S400 is involved in maintaining mitochondrial membrane potential under stress conditions and is important for mitochondrial function, conferring cells protection against cellular stress.
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Affiliation(s)
- J C Fitzgerald
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
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Dohan DP, Laven N, Dunn L, Daugherty C, Trupin L, Hult J, Bondi M, McCabe D. “It’s a wink and a nod”: A qualitative evaluation of clinician-investigator perceptions of the benefits of early-phase (EP) clinical trials. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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