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De Silva DL, Stafford L, Skandarajah AR, Sinclair M, Devereux L, Hogg K, Kentwell M, Park A, Lal L, Zethoven M, Jayawardana MW, Chan F, Butow PN, James PA, Mann GB, Campbell IG, Lindeman GJ. Universal genetic testing for women with newly diagnosed breast cancer in the context of multidisciplinary team care. Med J Aust 2023; 218:368-373. [PMID: 37005005 PMCID: PMC10952347 DOI: 10.5694/mja2.51906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE To determine the feasibility of universal genetic testing of women with newly diagnosed breast cancer, to estimate the incidence of pathogenic gene variants and their impact on patient management, and to evaluate patient and clinician acceptance of universal testing. DESIGN, SETTING, PARTICIPANTS Prospective study of women with invasive or high grade in situ breast cancer and unknown germline status discussed at the Parkville Breast Service (Melbourne) multidisciplinary team meeting. Women were recruited to the pilot (12 June 2020 - 22 March 2021) and expansion phases (17 October 2021 - 8 November 2022) of the Mutational Assessment of newly diagnosed breast cancer using Germline and tumour genomICs (MAGIC) study. MAIN OUTCOME MEASURES Germline testing by DNA sequencing, filtered for nineteen hereditary breast and ovarian cancer genes that could be classified as actionable; only pathogenic variants were reported. Surveys before and after genetic testing assessed pilot phase participants' perceptions of genetic testing, and psychological distress and cancer-specific worry. A separate survey assessed clinicians' views on universal testing. RESULTS Pathogenic germline variants were identified in 31 of 474 expanded study phase participants (6.5%), including 28 of 429 women with invasive breast cancer (6.5%). Eighteen of the 31 did not meet current genetic testing eligibility guidelines (probability of a germline pathogenic variant ≥ 10%, based on CanRisk, or Manchester score ≥ 15). Clinical management was changed for 24 of 31 women after identification of a pathogenic variant. Including 68 further women who underwent genetic testing outside the study, 44 of 542 women carried pathogenic variants (8.1%). Acceptance of universal testing was high among both patients (90 of 103, 87%) and clinicians; no decision regret or adverse impact on psychological distress or cancer-specific worry were reported. CONCLUSION Universal genetic testing following the diagnosis of breast cancer detects clinically significant germline pathogenic variants that might otherwise be missed because of testing guidelines. Routine testing and reporting of pathogenic variants is feasible and acceptable for both patients and clinicians.
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Affiliation(s)
- Dilanka L De Silva
- The University of MelbourneMelbourneVIC
- Parkville Familial Cancer CentrePeter MacCallum Cancer Centre and Royal Melbourne HospitalMelbourneVIC
- Memorial Sloan Kettering Cancer CenterNew YorkNYUnited States of America
| | - Lesley Stafford
- The University of MelbourneMelbourneVIC
- The Royal Melbourne HospitalMelbourneVIC
| | - Anita R Skandarajah
- The University of MelbourneMelbourneVIC
- The Royal Melbourne HospitalMelbourneVIC
| | | | - Lisa Devereux
- The University of MelbourneMelbourneVIC
- Peter MacCallum Cancer CentreMelbourneVIC
| | - Kirsten Hogg
- The University of MelbourneMelbourneVIC
- Walter and Eliza Hall Institute of Medical ResearchMelbourneVIC
| | - Maira Kentwell
- The University of MelbourneMelbourneVIC
- Parkville Familial Cancer CentrePeter MacCallum Cancer Centre and Royal Melbourne HospitalMelbourneVIC
| | - Allan Park
- The Royal Melbourne HospitalMelbourneVIC
| | - Luxi Lal
- The Royal Melbourne HospitalMelbourneVIC
- Peter MacCallum Cancer CentreMelbourneVIC
- Walter and Eliza Hall Institute of Medical ResearchMelbourneVIC
| | | | - Madawa W Jayawardana
- The University of MelbourneMelbourneVIC
- Peter MacCallum Cancer CentreMelbourneVIC
| | - Fiona Chan
- The Royal Children's Hospital MelbourneMelbourneVIC
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence‐based Decision Making, the University of SydneySydneyNSW
| | - Paul A James
- The University of MelbourneMelbourneVIC
- Parkville Familial Cancer CentrePeter MacCallum Cancer Centre and Royal Melbourne HospitalMelbourneVIC
- The Royal Melbourne HospitalMelbourneVIC
- Peter MacCallum Cancer CentreMelbourneVIC
| | - G Bruce Mann
- The University of MelbourneMelbourneVIC
- The Royal Melbourne HospitalMelbourneVIC
- Royal Women's HospitalMelbourneVIC
| | - Ian G Campbell
- The University of MelbourneMelbourneVIC
- Peter MacCallum Cancer CentreMelbourneVIC
| | - Geoffrey J Lindeman
- The University of MelbourneMelbourneVIC
- Parkville Familial Cancer CentrePeter MacCallum Cancer Centre and Royal Melbourne HospitalMelbourneVIC
- Peter MacCallum Cancer CentreMelbourneVIC
- Walter and Eliza Hall Institute of Medical ResearchMelbourneVIC
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Body A, Milch V, McSorley L, Lal L, Ahern E, Ryan R, Jones G, Keefe D, Segelov E. Rapid Protocol Development, Study Startup and Enrolment of a Prospective Study of COVID-19 Vaccination for Patients with Cancer: A Collaborative Approach. Vaccines (Basel) 2022; 10:vaccines10122003. [PMID: 36560412 PMCID: PMC9785949 DOI: 10.3390/vaccines10122003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND COVID-19 is an unprecedented global health emergency. It has been highly disruptive for patients with cancer, both due to an increased burden of severe illness and due to pressure on healthcare systems. COVID-19 vaccination has been an important public health measure for this patient group. AIM The aim of this study was to describe the rapid design and startup of a multicentre study of COVID-19 vaccine response for vulnerable patients with cancer. Study startup: We set up a multicentre prospective observational study of COVID-19 vaccination response for Australian patients with cancer. Due to intensive collaboration between health services, the funding body and laboratories, we were able to develop a protocol and enrol the first patient within 52 days of the initial study proposal. Rapid startup was further enabled by prompt availability of funding and by high-level engagement of institutional review boards, allowing expedited review. Study enrolment: We rapidly enroled more than 500 patients, 80% within 4 months of study opening. Engagement and follow-up were maintained throughout the course of up to five serial vaccination doses. CONCLUSION Our study is an example of intensive collaboration inspired by the COVID-19 pandemic and may serve as an example of an agile research response to real-time public health challenges.
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Affiliation(s)
- Amy Body
- Monash Health, Clayton, VIC 3168, Australia
- Department of Medicine, Nursing and Health Sciences, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3800, Australia
- Correspondence:
| | - Vivienne Milch
- Cancer Australia, Surry Hills, NSW 2010, Australia
- School of Medicine, University of Notre Dame Australia, Sydney, NSW 2007, Australia
| | | | - Luxi Lal
- Monash Health, Clayton, VIC 3168, Australia
| | | | - Regina Ryan
- Cancer Australia, Surry Hills, NSW 2010, Australia
| | - Gayle Jones
- Cancer Australia, Surry Hills, NSW 2010, Australia
| | | | - Eva Segelov
- Monash Health, Clayton, VIC 3168, Australia
- Department of Medicine, Nursing and Health Sciences, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3800, Australia
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Segelov E, Body A, Lal L, Abdulla H, Turville S, Naing Z, Opat S, Leahy M, Balendra J, Hamad N, Mccuaig R, Rao S, Lineburg K, Smith C, MacIntyre C, Milch V, Busija L, Ahern E. 1611P Clinical determinants of SARS-CoV-2 vaccine response in adults with cancer. Ann Oncol 2022. [PMCID: PMC9472460 DOI: 10.1016/j.annonc.2022.07.1704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Segelov E, Body A, Luong V, Lopez VA, Lal L, Abdulla H, Turville S, Niang Z, Opat S, McCuaig R, Lineburg K, Rao S, Smith C, MacIntyre R, Ahern E. Abstract CT259: Comprehensive humoral and cellular immune assessments to SARS-CoV-2 (wild type, delta and omicron) following two- and three-dose vaccination schedule in a large adult cancer population: SerOzNET study: placeholder abstract. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct259] [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: Defining cancer and treatment-related factors which influence protection against COVID-19 following vaccination are important given the worse outcomes following infection in this group. Sophisticated and detailed studies which go beyond a single measure are required particularly with correlation to multiple disease and treatment factors. This study cohort is unique due to (a) very low prior COVID-19 infection at time of sampling (July-Nov 2021), (b) vaccines studied were BNT162b2 (Pf) given 3 weeks apart or ChAdOx1 (AZ) spaced 12 weeks (dose 1, 2) (c) most participants then received a third dose 2 months later (heterologous for AZ).
Methods: SerOzNET (ACTRN12621001004853) enrols Australian blood and solid cancer patients prior to vaccination, with serial blood analyses and qualitative measures. We measured neutralizing antibodies (nAb) against SARS-CoV-2 wild type (wt) and variants of concern delta and omicron, quantitative S-protein IgG antibody level (Abbott), and T-cell correlates (interferon-g, tumour necrosis factor-a, interleukins 2/4/5/13) and epigenetic profiling at baseline and 3-4 weeks post dose 1, 2 +/- 3.
Results: 379 participants were included, median age 58 years (IQR 47-66) and 60% female. 30% participants had hematological malignancies with the remainder solid organ cancers. 90% patients were on current systemic cancer treatment (most commonly chemotherapy in 41%, chemoimmunotherapy or immunotherapy in 20%). In 331 patients where treatment intent was recorded, 47% was palliative. Only one patient had known prior COVID-19 infection. Of the initial 94 participants who received Pf vaccination, median (IQR) neutralizing antibody titre 4 weeks following dose 2 was 80 (40-160) for SARS-CoV-2 wt and 40 (0-80) for delta variant.
Conclusion: Neutralizing antibody titres in this Australian cancer population following Pf vaccination appear lower than those reported elsewhere such as CAPTURE study (Fendler et al, 2021), possibly related to shorter interdose interval. Preliminary data highlights low nAb titres as expected in haematology patients but also in some cases with treatment not traditionally associated with immunosuppression such as hormonal therapy. These results will be updated in February 2022 with third dose, AZ and omicron variant data.
Citation Format: Eva Segelov, Amy Body, Vi Luong, Veronica Aedo Lopez, Luxi Lal, Hesham Abdulla, Stuart Turville, Zin Niang, Stephen Opat, Robert McCuaig, Katie Lineburg, Sudha Rao, Corey Smith, Raina MacIntyre, Elizabeth Ahern. Comprehensive humoral and cellular immune assessments to SARS-CoV-2 (wild type, delta and omicron) following two- and three-dose vaccination schedule in a large adult cancer population: SerOzNET study: placeholder abstract [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT259.
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Affiliation(s)
- Eva Segelov
- 1Monash University and Monash Health, Clayton, Australia
| | - Amy Body
- 1Monash University and Monash Health, Clayton, Australia
| | - Vi Luong
- 2Monash Health, Clayton, Australia
| | | | - Luxi Lal
- 2Monash Health, Clayton, Australia
| | | | | | - Zin Niang
- 3University of New South Wales, Sydney, Australia
| | - Stephen Opat
- 1Monash University and Monash Health, Clayton, Australia
| | - Robert McCuaig
- 4Queensland Institute of Medical Research Berghofer, Brisbane, Australia
| | - Katie Lineburg
- 4Queensland Institute of Medical Research Berghofer, Brisbane, Australia
| | - Sudha Rao
- 4Queensland Institute of Medical Research Berghofer, Brisbane, Australia
| | - Corey Smith
- 4Queensland Institute of Medical Research Berghofer, Brisbane, Australia
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Segelov E, Body A, Turville S, Smith C, Lineburg K, Rao S, McCuaig R, Opat S, Niang Z, Lal L, Luong V, Abdulla H, Lopez VA, Padhye B, Bolanos NF, Anazodo A, MacIntyre R, Downie P, O'Brien T, Ahern E. Abstract CT567: Comprehensive measures of COVID-19 vaccine efficacy in adolescent cancer patients: Results from SerOzNET. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct567] [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
The authors did not submit an updated abstract. The original abstract should be considered final.
Citation Format: Eva Segelov, Amy Body, Stuart Turville, Corey Smith, Katie Lineburg, Sudha Rao, Robert McCuaig, Stephen Opat, Zin Niang, Luxi Lal, Vi Luong, Hesham Abdulla, Veronica Aedo Lopez, Bhavna Padhye, Noemi Fuentes Bolanos, Antoinette Anazodo, Raina MacIntyre, Peter Downie, Tracey O'Brien, Elizabeth Ahern. Comprehensive measures of COVID-19 vaccine efficacy in adolescent cancer patients: Results from SerOzNET [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT567.
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Affiliation(s)
- Eva Segelov
- 1Monash University and Monash Health, Clayton, Australia
| | - Amy Body
- 2Monash University, Clayton, Australia
| | | | - Corey Smith
- 4Queensland Institute of Medical Research Berghofer, Brisbane, Australia
| | - Katie Lineburg
- 4Queensland Institute of Medical Research Berghofer, Brisbane, Australia
| | - Sudha Rao
- 4Queensland Institute of Medical Research Berghofer, Brisbane, Australia
| | - Robert McCuaig
- 4Queensland Institute of Medical Research Berghofer, Brisbane, Australia
| | | | - Zin Niang
- 3University of New South Wales, Sydney, Australia
| | - Luxi Lal
- 5Monash Health, Clayton, Australia
| | - Vi Luong
- 5Monash Health, Clayton, Australia
| | | | | | - Bhavna Padhye
- 6The Children's Hospital Westmead, Sydney, Australia
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Segelov E, Body A, Luong VTT, Aedo Lopez V, Lal L, Abdulla H, Turville S, Naing Z, Opat S, McCuaig R, Rao S, Lineburg K, Smith C, MacIntyre C, Ahern ES. Humoral and cellular immune response to Sars-CoV-2 wild-type and variants of concern following 3-dose vaccination in a large cohort of adults with cancer: The SerOzNET study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.17_suppl.lba12065] [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
LBA12065 Background: COVID-19 infection has poor outcomes for patients (pts) with cancer. Understanding vaccine response as a correlate of protection from severe infection is essential to advise pts regarding protective behaviours and optimal vaccine schedule. This Australian cohort is unique due to low rates of COVID-19 exposure at study entry (July-November 2021). and use of a 3 dose schedule. Pts initially received 2 doses of either BNT162b2 (Pf) at a 3 week interval, or ChadOx1-S (AZ) at a 6 week interval, all then received a 3rd dose, either mRNA-1273 (Mod) or Pf after 2-4 months, and finally a 4th dose at an interval of a further 3 months, for a subset. Methods: SerOzNET (ACTRN12621001004853) has enrolled pts with solid and haematological (haem) cancers prior to initial vaccination. Serial blood samples were processed for serum, PBMC and PMN at timepoints: 0, then 3-4 weeks post dose 1 then 2 then 3 then 4 (where administered). We report here neutralizing antibodies (nAb) against wild type (wt) and delta and omicron variants of concern (VOC); quantitative S-protein IgG antibody (Abbott); T-cell correlates measured by levels of interferon-g (IFN g), tumour necrosis factor-a, interleukins (IL-) 2/4/5/13; and epigenetic profiling of T cells. Results: The cohort consists of 401 pts with median age 58 (range 18-85); 59% female; 128 (32%) haem cancers. 377 (94%) are on current or recent (< 12 months) systemic therapy: 162 (43%) chemotherapy, 62 (16%) immunotherapy, 40 (10%) combined chemo/immunotherapy, 113 (29%) hormonal or targeted therapy. 42 (10%) received anti-CD20 therapy < 12 months, 6 (1.4%) had allogeneic stem cell transplant. NAb levels against wt are available for 256 pts post dose 1, 245 pts post dose 2 and 159 pts post dose 3 (will be updated). Response rates post dose were respectively 27%, 77% and 88%. Pts with haem cancer were less likely to respond to vaccination at any time compared to pts with solid cancer (p < 0.001, chi-squared test). After 3 doses, 3.8% of pts with solid cancer and 27.8% with haem cancer lacked NAb. NAb results to VOC delta are available for 92 pts post dose 2: 25/92 (27%) were negative, compared with a non-response rate to wt of 15% at same time in same pts. IFN-γ-Spike response was detectable in 18/31 (58%) and 24/30 (80%) pts post dose 1 and 2 respectively. 101 pts to date have received a 4th dose; data will be available at the meeting, as will epigenetic profiles and detailed clinicopathological correlations. Conclusions: This interim analysis shows that a significant proportion of pts with haem cancers (27.8%) lack protective Sars-CoV-2 antibodies following 3 vaccinations, whereas only 3.8% of solid cancer pts lack detectable response. Results from other B and T cell parameters may also be important in identifying pts less well protected by vaccination. Follow up is ongoing, response rate post 4th dose will be presented at the meeting. Clinical trial information: ACTRN12621001004853.
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Affiliation(s)
| | - Amy Body
- Monash Health, Clayton, Australia
| | | | | | - Luxi Lal
- Monash Health, Clayton, Australia
| | | | | | - Zin Naing
- NSW Department of Health, Sydney, Australia
| | - Stephen Opat
- Monash Health, Monash University, Clayton, Victoria, Australia
| | - Robert McCuaig
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Sudha Rao
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Katie Lineburg
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Corey Smith
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Chandini MacIntyre
- The Kirby Institute, University of New South Wales, Australia, Sydney, Australia
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De Silva DL, Skandarajah AR, Sinclair M, Kentwell M, Devereux L, Zeethoven M, Hogg K, Lal L, Stafford L, James PA, Lindeman GJ, Mann GB, Campbell IG. Abstract P3-09-02: Mutational assessment of newly diagnosed breast cancer using Germline and tumor genomICs. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p3-09-02] [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 :For patients with newly diagnosed breast cancer, real-time identification of pathogenic germline mutations in hereditary breast cancer (HBC) genes can provide important information to inform decisions regarding surgery, medical oncology, radiation oncology and to enable activate risk mitigation strategies for unaffected relatives. The potential to dramatically improve outcomes by identifying HBC gene mutation carriers at diagnosis has been demonstrated in the OlympiA. The current strategy of offering germline testing based on NCCN guidelines or validated scores inherently fails to identify all patients with germline HBC gene mutations with adverse consequences for patients and their families. Also, in about 15% of patients without HBC gene mutations, the breast tumors have characteristics suggestive of a more aggressive course. Although universal HBC gene testing has been reported for sub-types of breast cancer or at specialist centers, the MAGIC study is the first prospective trial of unselected invasive breast cancers in general practice combining upfront germline and somatic sequencing with well-validated methods to assess the acceptability of universal testing to patients and clinicians. Methods :This is an Australian multi-center prospective study with 150 consecutive consented patients who are newly diagnosed with nonmetastatic breast cancers. High-grade ductal carcinoma in-situ and pleomorphic lobular cancers were included. Germline testing was performed by whole genome sequencing on DNA from blood or saliva and the data analyzed for actionable HBC gene mutations, including large genomic rearrangements. Whole genome Tumor sequencing was performed on DNA extracted from formalin fixed paraffin-embedded diagnostic tumor and the data analyzed for actionable somatic mutations as well as scoring for homologous recombination deficiency using HRDetect and mutational signatures. The frequency of actionable HBC gene mutations and the number of additional carriers identified compared to standard referral guidelines was the primary objective. For additional analysis, a 3-generation pedigree was done and NCCN, MANCHESTER, and BOADICEA scores were calculated to see whether they would qualify for germline testing according to American and Australian guidelines. Well validated questionnaires were given pre and post-testing for all patients to assess the favorability of universal testing. Health economic analysis will be performed to see the cost vs benefit of offering germline testing. Results :A total of 12 carriers of actionable germline mutations were identified (8.0%) in BRCA1 (n=2), BRCA2 (n=1), PALB2 (n=3), CHEK2 (n=2), ATM (n=2) and PMS2 (n=2). No actionable HBC germline mutations were identified in the 14 cases diagnosed with DCIS only. Only 3 of the 12 mutation positive cases (25%) were referred by the treating clinician for germline testing and including BOADICEA and MANCHESTER scores, would only have identified 6 cases (50%) eligible for germline testing. 9/12 (75%) cases were ER positive including 4 carriers of BRCA1, BRCA2 or PALB2 mutations. Preliminary ascertainment of patient acceptance demonstrates >90% were in favor of universal testing. Among the 12 HBOC gene mutation carriers, the study changed the surgical recommendation for 7 patients (58%) which included the recommendation of B/L salpingo-oophorectomy and radiation management for 3 (25%) patients. Conclusion :Universal germline HBC gene testing is the best method for detecting carriers as over 50% are missed using current. Identifying an actionable mutation in real-time can inform the decision in all specialties involved in the treatment and has a high rate of impacting the clinical decision-making process. This approach was favored by the patients and the clinicians and provided a pathway forward for breast cancer management.
Citation Format: Dilanka L De Silva, Anita R Skandarajah, Michelle Sinclair, Maira Kentwell, Lisa Devereux, Magnus Zeethoven, Kirsten Hogg, Luxi Lal, Lesley Stafford, Paul A James, Geoffrey J Lindeman, Gregory B Mann, Ian G Campbell. Mutational assessment of newly diagnosed breast cancer using Germline and tumor genomICs [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-09-02.
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Affiliation(s)
| | | | - Michelle Sinclair
- Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Australia
| | - Maira Kentwell
- Parkville Familial Cancer Centre, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Magnus Zeethoven
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Kirsten Hogg
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Luxi Lal
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Lesley Stafford
- Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Australia
| | - Paul A James
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Geoffrey J Lindeman
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Gregory B Mann
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
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Body A, Ahern E, Lal L, Gillett K, Abdulla H, Opat S, O'Brien T, Downie P, Turville S, Munier CML, Smith C, MacIntyre CR, Segelov E. Protocol for SARS-CoV-2 post-vaccine surveillance study in Australian adults and children with cancer: an observational study of safety and serological and immunological response to SARS-CoV-2 vaccination (SerOzNET). BMC Infect Dis 2022; 22:70. [PMID: 35057745 PMCID: PMC8771167 DOI: 10.1186/s12879-021-07019-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer is associated with excess morbidity and mortality from coronavirus disease 2019 (COVID-19) following infection by the novel pandemic coronavirus SARS-CoV-2. Vaccinations against SARS-CoV-2 have been rapidly developed and proved highly effective in reducing the incidence of severe COVID-19 in clinical trials of healthy populations. However, patients with cancer were excluded from pivotal clinical trials. Early data suggest that vaccine response is less robust in patients with immunosuppressive conditions or treatments, while toxicity and acceptability of COVID-19 vaccines in the cancer population is unknown. Unanswered questions remain about the impact of various cancer characteristics (such as treatment modality and degree of immunosuppression) on serological response to and safety of COVID-19 vaccinations. Furthermore, as the virus and disease manifestations evolve, ongoing data is required to address the impact of new variants. METHODS SerOzNET is a prospective observational study of adults and children with cancer undergoing routine SARS-CoV-2 vaccination in Australia. Peripheral blood will be collected and processed at five timepoints (one pre-vaccination and four post-vaccination) for analysis of serologic responses to vaccine and exploration of T-cell immune correlates. Cohorts include: solid organ cancer (SOC) or haematological malignancy (HM) patients currently receiving (1) chemotherapy, (2) immune checkpoint inhibitors (3) hormonal or targeted therapy; (4) patients who completed chemotherapy within 6-12 months of vaccination; (5) HM patients with conditions associated with hypogammaglobulinaemia or immunocompromise; (6) SOC or HM patients with allergy to PEG or polysorbate 80. Data from healthy controls already enrolled on several parallel studies with comparable time points will be used for comparison. For children, patients with current or prior cancer who have not received recent systemic therapy will act as controls. Standardised scales for quality-of-life assessment, patient-reported toxicity and vaccine hesitancy will be obtained. DISCUSSION The SerOzNET study was commenced in June 2021 to prospectively study immune correlates of vaccination in specific cancer cohorts. The high proportion of the Australian population naïve to COVID-19 infection and vaccination at study commencement has allowed a unique window of opportunity to study vaccine-related immunity. Quality of life and patient-reported adverse events have not yet been reported in detail post-vaccination for cancer patients. Trial registration This trial is registered on the Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621001004853. Submitted for registration 25 June 2021. Registered 30 July 2021 (Retrospectively registered). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382281&isReview=true.
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Affiliation(s)
- Amy Body
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia.
- Monash University, Clayton, Melbourne, VIC, 3168, Australia.
| | - Elizabeth Ahern
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
- Monash University, Clayton, Melbourne, VIC, 3168, Australia
| | - Luxi Lal
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
- Monash University, Clayton, Melbourne, VIC, 3168, Australia
| | - Karen Gillett
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
| | - Hesham Abdulla
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
| | - Stephen Opat
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
- Monash University, Clayton, Melbourne, VIC, 3168, Australia
| | - Tracey O'Brien
- Kids Cancer Centre, Sydney Children's Hospital', Randwick, NSW, 2031, Australia
- School of Women's & Children's Health, Faculty of Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Peter Downie
- Children's Cancer Centre, Monash Children's Hospital, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
| | - Stuart Turville
- Immunovirology and Pathogenesis Program, The Kirby Institute, University of New South Wales, Kensington, Sydney NSW, 2052, Australia
| | - C Mee Ling Munier
- Immunovirology and Pathogenesis Program, The Kirby Institute, University of New South Wales, Kensington, Sydney NSW, 2052, Australia
| | - Corey Smith
- QIMR Berghofer Centre for Immunotherapy and Vaccine Development and Translational and Human Immunology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - C Raina MacIntyre
- The Kirby Institute, University of New South Wales, Kensington, Sydney NSW, 2052, Australia
| | - Eva Segelov
- Level 7, Monash Health Translational Precinct, 246 Clayton Rd, Clayton, Melbourne, VIC, 3168, Australia
- Monash University, Clayton, Melbourne, VIC, 3168, Australia
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Ryan KE, Asselin J, Fairley CK, Armishaw J, Lal L, Nguyen L, Murphy D, Traeger M, Hellard M, Hoy J, Stoové M, Wright E. Trends in Human Immunodeficiency Virus and Sexually Transmitted Infection Testing Among Gay, Bisexual, and Other Men Who Have Sex With Men After Rapid Scale-up of Preexposure Prophylaxis in Victoria, Australia. Sex Transm Dis 2020; 47:516-524. [PMID: 32658175 PMCID: PMC7357541 DOI: 10.1097/olq.0000000000001187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/15/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Scale-up of human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) has raised concerns regarding its impact on clinic capacity and access to HIV testing. We describe enrolment in PrEPX, a large PrEP implementation study in Victoria, Australia, and the impact of PrEP uptake and maintenance on existing health services. METHODS We describe enrolment between July 26, 2016, and March 31, 2018, and trends in HIV testing among PrEPX participating and nonparticipating gay and bisexual and other men who have sex with men (GBM) at 5 study clinics participating in a sentinel surveillance system (ACCESS). We evaluated HIV and STI testing trends using segmented linear regression across the prestudy (January 2015 to June 2016) and PrEPX study (July 2016 to March 2018) periods. FINDINGS There were 2,049 individuals who registered interest in study participation: 72% enrolled into the study. Study clinics enrolled participants rapidly; of 4265 people enrolled in PrEPX (98% GBM), 1000 enrolled by week 3, 88% (n = 876) of whom enrolled at ACCESS sites.Prestudy period HIV testing rates were increasing at all ACCESS sites. In the month PrEPX commenced, there was an additional 247 HIV tests among PrEPX participants (P < 0.01) and no significant change among non-PrEPX GBM (P = 0.72). Across the study period, HIV testing increased by 7.2 (P < 0.01) and 8.9 (P < 0.01) tests/month among PrEPX participants and non-PrEPX GBM, respectively. The HIV testing increased among non-PrEPX GBM at sexual health clinics (18.8 tests/month, P < 0.01) and primary care clinics (7.9 tests/month, P < 0.01). Similar trends were observed across testing for all measured STIs. CONCLUSIONS Rapid PrEP scale-up is possible without a reduction in HIV testing among GBM not using PrEP.
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Affiliation(s)
| | | | | | - Judy Armishaw
- From the Department of Infectious Disease, Alfred Health and Monash University
| | | | | | | | | | | | - Jennifer Hoy
- From the Department of Infectious Disease, Alfred Health and Monash University
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Lal L, Ryan K, Liu IY, Price B, Lockwood T, Aguirre I, Slobodian P, Lam A, Vassan M, Lim K, Silverii J, Tesoriero J, Phu J, Lim W, Naidoo B, Russell N, Rundle M, Sewell R, Cooper C, Hardman A, Quinn M, Mak A, Wright EJ. Transformation of Australian Community Pharmacies Into Good Clinical Practice Compliant Trial Pharmacies for HIV Pre-Exposure Prophylaxis. Front Pharmacol 2019; 10:1269. [PMID: 31787893 PMCID: PMC6854879 DOI: 10.3389/fphar.2019.01269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background: In Australia, clinical trial drugs are conventionally dispensed through clinical trial pharmacies only, while community pharmacies dispense drugs approved by Australia’s regulatory body. A large HIV pre-exposure prophylaxis study aimed to deliver clinical trial drug through community pharmacies to improve convenience and mimic real world prescribing. This paper describes the process of making community trials compliant with good clinical practice and reports outcomes of delivering clinical trial drug through community pharmacies. Methods: Eight community and four clinical trial pharmacies across three Australian states were approached to participate. A good clinical practice checklist was generated and pharmacies underwent a number of changes to meet clinical trial pharmacy requirements prior to study opening. Changes were made to community pharmacies to make them compliant with good clinical trial practice including; staff training, structural changes, and implementing monitoring of study drug and prescribing practices. Study drug was ordered through standard clinical trial processes and dispensed from study pharmacies by accredited pharmacists. Throughout the trial, record logs for training, prescriber signature and delegation, temperature, participant, and drug accountability were maintained at each pharmacy. The study team monitored each log and delivered on-site training to correct protocol variations. Results: Each pharmacy that was approached agreed to participate. All community pharmacies achieved good clinical practice compliance prior to dispensing study drug. Over the course of the study, 20,152 dispensations of study drug occurred, 83% of these occurred at community pharmacies. Only 2.0% of dispensations had an error, and errors were predominantly minor. On five occasions a pharmacist who was not accredited dispensed study drug. Conclusions: Community based pharmacies can undergo training and modifications to achieve good clinical practice compliance and dispense clinical trial study drug. Community based pharmacies recorded few variations from study protocol. Community based pharmacies offer a useful alternative to clinical trial pharmacies to increase convenience for study participants and expanded use of these pharmacies should be considered for large clinical trials, including HIV prevention trials.
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Affiliation(s)
- Luxi Lal
- Alfred Health, Melbourne, VIC, Australia.,Burnet Institute, HIV Elimination Program, Melbourne, VIC, Australia.,Department of Infectious Diseases, Alfred Health, Monash University, Melbourne, VIC, Australia
| | - Kathleen Ryan
- Alfred Health, Melbourne, VIC, Australia.,Burnet Institute, HIV Elimination Program, Melbourne, VIC, Australia
| | | | | | | | | | - Peter Slobodian
- Clinical Trials Pharmacy, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Ada Lam
- Clinical Trials Pharmacy, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Manoj Vassan
- Prahran Central Pharmacy, South Yarra, VIC, Australia
| | - Kie Lim
- Prahran Central Pharmacy, South Yarra, VIC, Australia
| | - John Silverii
- John Silverii's Pharmacy, Fitzroy North, VIC, Australia
| | | | - Johnny Phu
- Newton & Leung Pharmacy, Collingwood, VIC, Australia
| | - Wan Lim
- Newton & Leung Pharmacy, Collingwood, VIC, Australia
| | | | - Nick Russell
- Centre Pharmacy, Central Market Arcade, Adelaide, SA, Australia
| | | | | | | | | | - Martin Quinn
- Epic Pharmacy Kings Meadows, Launceston, TAS, Australia
| | - Anne Mak
- Alfred Health, Melbourne, VIC, Australia
| | - Edwina J Wright
- Alfred Health, Melbourne, VIC, Australia.,Burnet Institute, HIV Elimination Program, Melbourne, VIC, Australia.,Department of Infectious Diseases, Alfred Health, Monash University, Melbourne, VIC, Australia.,The Peter Doherty Institute of Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
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Cornelisse VJ, Lal L, Price B, Ryan KE, Bell C, Owen L, Wright EJ. Interest in Switching to On-Demand HIV Pre-Exposure Prophylaxis (PrEP) Among Australian Users of Daily PrEP: An Online Survey. Open Forum Infect Dis 2019; 6:ofz287. [PMID: 31304192 PMCID: PMC6612821 DOI: 10.1093/ofid/ofz287] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/14/2019] [Indexed: 12/14/2022] Open
Abstract
We surveyed 970 PrEPX study participants to evaluate interest in switching from daily to on-demand PrEP in a study setting. Interested respondents (n = 469, 48%) more commonly reported PrEP cessation (adjusted odds ratio [aOR], 3.0; P < .001), difficulty with adherence (aOR, 1.6; P = .029), infrequent sex (aOR, 3.7; P < .001), and toxicity concerns (aOR, 2.7; P < .001).
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Affiliation(s)
- Vincent J Cornelisse
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Luxi Lal
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Brian Price
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Kathleen E Ryan
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
- Burnet Institute, Melbourne, Victoria, Hobart, Australia
| | | | - Louise Owen
- Sexual Health Service Tasmania, Hobart, Australia
| | - Edwina J Wright
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
- Doherty Institute for Infection and Immunity, The University of Melbourne, Victoria, Australia
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Traeger MW, Cornelisse VJ, Asselin J, Price B, Roth NJ, Willcox J, Tee BK, Fairley CK, Chang CC, Armishaw J, Vujovic O, Penn M, Cundill P, Forgan-Smith G, Gall J, Pickett C, Lal L, Mak A, Spelman TD, Nguyen L, Murphy DA, Ryan KE, El-Hayek C, West M, Ruth S, Batrouney C, Lockwood JT, Hoy JF, Hellard ME, Stoové MA, Wright EJ. Association of HIV Preexposure Prophylaxis With Incidence of Sexually Transmitted Infections Among Individuals at High Risk of HIV Infection. JAMA 2019; 321:1380-1390. [PMID: 30964528 PMCID: PMC6459111 DOI: 10.1001/jama.2019.2947] [Citation(s) in RCA: 240] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
IMPORTANCE Emerging evidence suggests that risk of bacterial sexually transmitted infections (STIs) increases among gay and bisexual men following initiation of HIV preexposure prophylaxis (PrEP). OBJECTIVE To describe STI incidence and behavioral risk factors among a cohort of predominantly gay and bisexual men who use PrEP, and to explore changes in STI incidence following PrEP commencement. DESIGN, SETTING, AND PARTICIPANTS The Pre-exposure Prophylaxis Expanded (PrEPX) Study, a multisite, open-label intervention study, was nested within the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) clinic network. A total of 4275 participants were enrolled (July 26, 2016-April 1, 2018) in Victoria, Australia. Of these, 2981 enrolled at 5 ACCESS clinics (3 primary care, 1 sexual health, and 1 community-based HIV rapid testing service), had at least 1 follow-up visit, and were monitored until April 30, 2018. EXPOSURES Upon enrollment, participants received daily oral tenofovir disoproxil fumurate and emtricitabine for HIV PrEP, quarterly HIV and STI testing, and clinical monitoring. MAIN OUTCOMES AND MEASURES The primary outcome was incidence of chlamydia, gonorrhea, or syphilis. Incidence rates and hazard ratios describing behavioral risk factors of STI diagnosis were calculated. Incidence rate ratios (IRRs), adjusted for change in testing frequency, described changes in STI incidence from 1-year preenrollment to study follow-up among participants with preenrollment testing data (n = 1378). RESULTS Among the 2981 individuals (median age, 34 years [interquartile range, 28-42]), 98.5% identified as gay or bisexual males, 29% used PrEP prior to enrollment, 89 (3%) withdrew and were censored at date of withdrawal, leaving 2892 (97.0%) enrolled at final follow-up. During a mean follow-up of 1.1 years (3185.0 person-years), 2928 STIs were diagnosed among 1427 (48%) participants (1434 chlamydia, 1242 gonorrhea, 252 syphilis). STI incidence was 91.9 per 100 person-years, with 736 participants (25%) accounting for 2237 (76%) of all STIs. Among 2058 participants with complete data for multivariable analysis, younger age, greater partner number, and group sex were associated with greater STI risk, but condom use was not. Among 1378 participants with preenrollment testing data, STI incidence increased from 69.5 per 100 person-years prior to enrollment to 98.4 per 100 person-years during follow-up (IRR, 1.41 [95% CI, 1.29-1.56]). After adjusting for testing frequency, the increase in incidence from 1 year preenrollment to follow-up was significant for any STI (adjusted IRR, 1.12 [95% CI, 1.02-1.23]) and for chlamydia (adjusted IRR, 1.17 [95% CI, 1.04-1.33]). CONCLUSIONS AND RELEVANCE Among gay and bisexual men using PrEP, STIs were highly concentrated among a subset, and receipt of PrEP after study enrollment was associated with an increased incidence of STIs compared with preenrollment. These findings highlight the importance of frequent STI testing among gay and bisexual men using PrEP.
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Affiliation(s)
- Michael W. Traeger
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Vincent J. Cornelisse
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Prahran Market Clinic, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jason Asselin
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Brian Price
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | | | - Jeff Willcox
- Northside Clinic, Melbourne, Victoria, Australia
| | - Ban Kiem Tee
- Centre Clinic, Thorne Harbour Health, Melbourne, Victoria, Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Christina C. Chang
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jude Armishaw
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Olga Vujovic
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Matthew Penn
- PRONTO! Clinic, Thorne Harbour Health, Melbourne, Victoria, Australia
| | - Pauline Cundill
- PRONTO! Clinic, Thorne Harbour Health, Melbourne, Victoria, Australia
| | | | - John Gall
- ERA Health, Melbourne, Victoria, Australia
| | - Claire Pickett
- Ballarat Community Health Centre, Ballarat, Victoria, Australia
| | - Luxi Lal
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Anne Mak
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Tim D. Spelman
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- The Peter Doherty Institute of Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Long Nguyen
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Dean A. Murphy
- Department of Gender and Cultural Studies, University of Sydney, Sydney, New South Wales, Australia
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Kathleen E. Ryan
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Carol El-Hayek
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Michael West
- Sexual Health and Viral Hepatitis Service, Department of Health and Human Services, Government of Victoria, Melbourne, Victoria, Australia
| | - Simon Ruth
- Thorne Harbour Health, Melbourne, Victoria, Australia
| | | | - John T. Lockwood
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Jennifer F. Hoy
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Margaret E. Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark A. Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Edwina J. Wright
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
- The Peter Doherty Institute of Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
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de Wit JBF, Murphy DA, Lal L, Audsley JM, Roth N, Moore R, Tee BK, Read T, Wright EJ. O19.2 Pre-exposure prophylaxis and risk compensation: evidence of decreased condom use at three-month follow-up among predominantly gay male participants in the vicprep study. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.183] [Citation(s) in RCA: 3] [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: 11/03/2022]
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Murphy DA, de Wit JBF, Lal L, Audsley JM, Roth N, Moore R, Tee BK, Read T, Wright E. O19.3 Pills, pleasure and privacy: early experiences of pre-exposure prophylaxis among men in the vicprep study. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.184] [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: 11/03/2022]
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Hwang J, Fisch M, Zhang H, Kallen MA, Routbort M, Lal L, Vierling J, Suarez-Almazor M. Predictors of hepatitis B screening among patients with cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.180] [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
180 Background: Patients with hepatitis B virus (HBV) infection are at risk of reactivation after chemotherapy. It is unclear whether all patients or only those with certain risk factors should be screened for HBV before chemotherapy. The purpose of our study was to determine the clinical predictors of HBV screening in a single institution. Methods: In this retrospective, cross-sectional study, we evaluated new patients who received chemotherapy between 1/1/04 and 9/30/07. We collected data on patients' demographics, types of cancer and chemotherapy, and HBV risk factors such as a previous ICD-9 code for hepatitis C or other liver conditions. We searched for HBV screening as defined by an HBsAg or anti-HBc test ordered prior to chemotherapy. In univariate analyses, we examined the association between each of the patient-related variables and HBV screening. We then determined predictors of HBV screening in a multivariable logistic regression model. Results: We found 10,729 patients who had chemotherapy during the study period. Overall, 16.7% had HBV screening. All of the following predictors in the univariate analysis were significant for HBV screening at the p<0.01 level: age, gender, ethnicity, U.S. residence, cancer type, chemotherapy type, and having a HBV risk factor. In multivariable logistic regression examining predictors for screening using HBsAg, we found that Asian ethnicity (OR 1.75; 1.16-2.66), hematologic malignancies (OR 22.65; 19.3-26.31), and the receipt of rituxamab (OR 3.71; 3.03-4.48) were significant predictors at the p<0.01 level. Women were less likely to be screened than men (OR 0.68; 0.59-0.78). We repeated the analyses using the anti-HBc screening test, and the results were similar. Overall, 1.5% of the screened patients had a positive HBV test. Conclusions: We found that ethnicity, cancer types, and chemotherapy drugs predict physician-driven HBV screening. Future research is needed to study the predictors of a positive HBV screening test and reactivation of HBV after chemotherapy. [Table: see text]
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Affiliation(s)
- J. Hwang
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Baylor College of Medicine, Houston, TX
| | - M. Fisch
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Baylor College of Medicine, Houston, TX
| | - H. Zhang
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Baylor College of Medicine, Houston, TX
| | - M. A. Kallen
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Baylor College of Medicine, Houston, TX
| | - M. Routbort
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Baylor College of Medicine, Houston, TX
| | - L. Lal
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Baylor College of Medicine, Houston, TX
| | - J. Vierling
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Baylor College of Medicine, Houston, TX
| | - M. Suarez-Almazor
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Baylor College of Medicine, Houston, TX
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Hwang J, Fisch M, Zhang H, Kallen MA, Routbort M, Lal L, Vierling J, Suarez-Almazor M. Hepatitis B screening and positivity prior to chemotherapy. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.9008] [Citation(s) in RCA: 3] [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: 11/20/2022] Open
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Lal L, Wefel JS, Meyers CA, Chang EL, Franzini L, Reasonda LG, Feng C, Swint JM. Cost-effectiveness analysis based on neurocognitive function of a randomized study with stereotactic radiosurgery (SRS) alone versus SRS plus whole-brain radiation therapy (WBRT) for patients with one to three brain metastases. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e16528] [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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George C, Yesoda A, Jayakumar B, Lal L. A prospective study evaluating clinical outcomes and costs of three NNRTI-based HAART regimens in Kerala, India. J Clin Pharm Ther 2009; 34:33-40. [DOI: 10.1111/j.1365-2710.2008.00988.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [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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Wright E, Brew B, Arayawichanont A, Robertson K, Samintharapanya K, Kongsaengdao S, Lim M, Vonthanak S, Lal L, Sarim C, Huffam S, Li P, Imran D, Lewis J, Lun WH, Kamarulzaman A, Tau G, Ali ST, Kishore K, Bain MP, Dwyer R, McCormack G, Hellard M, Cherry C, McArthur J, Wesselingh S. Neurologic disorders are prevalent in HIV-positive outpatients in the Asia-Pacific region. Neurology 2008; 71:50-6. [DOI: 10.1212/01.wnl.0000316390.17248.65] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [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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Abstract
BACKGROUND Older adults frequently have conditions requiring oral anticoagulation. Although clearly benefiting from oral anticoagulation, they are at increased risk for bleeding complications. Regular monitoring to optimize anticoagulation and to reduce the chance of major bleeding complications is required. The impact of oral anticoagulation monitoring by pharmacists in patients older than 75 years of age has not been described well. OBJECTIVE To compare warfarin therapy prescribed and monitored by physicians to a pharmacist-monitored anticoagulation service in a cohort of older veterans. METHODS Retrospective chart review utilizing the Houston VA Medical Center's pharmacy database. Among all outpatients aged 75 years or older filling warfarin prescriptions between 1 March 2003 to 1 March 2005, and who were either monitored in a pharmacist's clinic or not, 103 patients per group were randomly selected. Information on demographics, indication for and length of warfarin therapy, INR values, and thromboembolic and bleeding events were abstracted. Differences were analysed using chi-squared test, Fisher's Exact test, and unpaired Student t-test. RESULTS A total of 1521 patients (440 in the pharmacist-monitored group, 1081 in the traditionally monitored group) met our inclusion criteria. One hundred and three patients per group were randomly selected for chart review. Although no significant difference in percentage of therapeutic INR values (48.1% pharmacist group, 46.4% conventional group) or in the incidence of major bleeding events was found, thromboembolic events occurred significantly less frequently in the pharmacist-monitored group (2 events vs. 12 events, P = 0.01). Minor bleeding events were more frequent in the pharmacist-monitored group (50 vs. 17, P < 0.01). However, time to follow-up after a sub- or supra-therapeutic INR was significantly shorter in the pharmacist monitored group (22 days vs. 68 days, and 14 days vs. 32 days, respectively). CONCLUSION Pharmacist-monitored anticoagulation was associated with reduced thromboembolic events, an increase in minor bleeding events, and no difference in major bleeding events. Overall such monitoring by pharmacists should be recommended for older adults.
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Affiliation(s)
- I O Poon
- Pharmacy Department, College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX 77004, USA.
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Cherry CL, Skolasky RL, Lal L, Creighton J, Hauer P, Raman SP, Moore R, Carter K, Thomas D, Ebenezer GJ, Wesselingh SL, McArthur JC. Antiretroviral use and other risks for HIV-associated neuropathies in an international cohort. Neurology 2006; 66:867-73. [PMID: 16567704 DOI: 10.1212/01.wnl.0000203336.12114.09] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore the association between specific nucleoside reverse transcriptase inhibitors and sensory neuropathies (SNs) and define the modifying roles of hepatitis C (HCV), vitamin B12 deficiency, and impaired glucose tolerance. METHODS The authors conducted a prospective cohort study of 147 HIV-infected adults at two sites chosen to emphasize demographic differences. Standardized assessments included detailed antiretroviral histories, neurologic examinations, skin biopsies for epidermal nerve quantitation, and quantitative sensory testing. RESULTS There were significant differences between subjects at Johns Hopkins University (JHU) and Monash University (MU) in gender, race, HIV transmission route, and HCV seroprevalence. Symptomatic SN was present in 49% at JHU and 55% at MU (chi2 = 4.02, p = 0.134) and was significantly more common in those at least age 40 than younger patients (odds ratio [OR] = 2.87, 95% CI = 1.27, 6.49). After adjusting for site, age, and CD4 cell count, exposure to didanosine (ddI) or stavudine (d4T) was associated with an significantly increased likelihood of symptomatic SN (ddI: OR = 3.21, 95% CI: 1.56, 6.60; d4T: OR = 7.66, 95% CI: 2.89, 20.33). Plasma HIV RNA, lactate, and HCV were not associated with SN. Quantitative vibratory testing identified neuropathy with a positive predictive value of 76% and epidermal nerve fiber densities 59%. CONCLUSIONS Exposure to stavudine and didanosine was significantly associated with a heightened risk for symptomatic sensory neuropathy. Reduced vibration thresholds and epidermal nerve fiber densities had the highest diagnostic efficiency of the laboratory indicators of neuropathy examined, but were relatively insensitive in isolation.
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Affiliation(s)
- C L Cherry
- Johns Hopkins Hospital, Baltimore, MD 21287, USA
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Abstract
The application of the mean force field in protein mutant stability prediction is explored. Based on protein main chain characteristics, including polar fraction, accessibility and dihedral angles, the mean force field was constructed to evaluate the compatibility between an amino acid residue and its environment, from which a position-dependent protein mutant profile was constructed. At each position along a protein sequence, the native residue was replaced by the other 19 types of amino acid residues. The matches were evaluated by energies from mean force field calculation, from which a mutant profile along the protein sequence was derived. General characteristics of such a profile were analyzed. Mutant stabilities for two sets of mutants in two proteins were found to be reasonable compared with experimental data, which indicates that the present method can act as a guide in protein engineering and as an effective scoring matrix in protein sequence-structure alignment studies.
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Affiliation(s)
- Y Wang
- Institute of Physical Chemistry, Peking University, Beijing, China
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