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Gogoi D, Yu H, Casey M, Baird R, Yusuf A, Forde L, O' Brien ME, West JR, Flagg T, McElvaney NG, Eden E, Mueller C, Brantly ML, Geraghty P, Reeves EP. Monocyte NLRP3 inflammasome and interleukin-1β activation modulated by alpha-1 antitrypsin therapy in deficient individuals. Thorax 2024:thorax-2023-221071. [PMID: 38418195 DOI: 10.1136/thorax-2023-221071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/02/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Altered complement component 3 (C3) activation in patients with alpha-1 antitrypsin (AAT) deficiency (AATD) has been reported. To understand the potential impact on course of inflammation, the aim of this study was to investigate whether C3d, a cleavage-product of C3, triggers interleukin (IL)-1β secretion via activation of NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasome. The objective was to explore the effect of AAT augmentation therapy in patients with AATD on the C3d/complement receptor 3 (CR3) signalling axis of monocytes and on circulating pro-inflammatory markers. METHODS Inflammatory mediators were detected in blood from patients with AATD (n=28) and patients with AATD receiving augmentation therapy (n=19). Inflammasome activation and IL-1β secretion were measured in monocytes of patients with AATD, and following C3d stimulation in the presence or absence of CR3 or NLRP3 inhibitors. RESULTS C3d acting via CR3 induces NLRP3 and pro-IL-1β production, and through induction of endoplasmic reticulum (ER) stress and calcium flux, triggers caspase-1 activation and IL-1β secretion. Treatment of individuals with AATD with AAT therapy results in decreased plasma levels of C3d (3.0±1.2 µg/mL vs 1.3±0.5 µg/mL respectively, p<0.0001) and IL-1β (115.4±30 pg/mL vs 73.3±20 pg/mL, respectively, p<0.0001), with a 2.0-fold decrease in monocyte NLRP3 protein expression (p=0.0303), despite continued ER stress activation. DISCUSSION These results provide strong insight into the mechanism of complement-driven inflammation associated with AATD. Although the described variance in C3d and NLRP3 activation decreased post AAT augmentation therapy, results demonstrate persistent C3d and monocyte ER stress, with implications for new therapeutics and clinical practice.
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Affiliation(s)
- Debananda Gogoi
- Pulmonary Clinical Science, Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Howard Yu
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Michelle Casey
- Irish Centre for Genetic Lung Disease, Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rory Baird
- Pulmonary Clinical Science, Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Azeez Yusuf
- Pulmonary Clinical Science, Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Luke Forde
- Pulmonary Clinical Science, Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michael E O' Brien
- Irish Centre for Genetic Lung Disease, Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jesse R West
- Division of Pulmonary, Critical Care and Sleep Medicine, J. Hillis Miller Health Science Center, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Tammy Flagg
- Division of Pulmonary, Critical Care and Sleep Medicine, J. Hillis Miller Health Science Center, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Noel G McElvaney
- Irish Centre for Genetic Lung Disease, Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Edward Eden
- Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Christian Mueller
- The Li Weibo Institute for Rare Diseases Research, Horae Gene Therapy Center, Worcester, MA, USA
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Mark L Brantly
- Division of Pulmonary, Critical Care and Sleep Medicine, J. Hillis Miller Health Science Center, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Patrick Geraghty
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Emer P Reeves
- Pulmonary Clinical Science, Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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Casey M, Simmonds NJ. Why don't anti-inflammatories work in cystic fibrosis? Expert Rev Respir Med 2024; 18:1-3. [PMID: 38386416 DOI: 10.1080/17476348.2024.2323189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/21/2024] [Indexed: 02/24/2024]
Affiliation(s)
- Michelle Casey
- Adult Cystic Fibrosis Centre, Royal Brompton & Harefield Hospitals, part of Guys & St Thomas' NHS Foundation Trust, London, UK
| | - Nicholas J Simmonds
- Adult Cystic Fibrosis Centre, Royal Brompton & Harefield Hospitals, part of Guys & St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
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Shabangu N, Thebe T, Casey M, Wesselmann U, Parker R. Chronic pain in female breast cancer survivors - prevalence, characteristics and contributing factors: a cross-sectional pilot study. BMC Womens Health 2023; 23:613. [PMID: 37974174 PMCID: PMC10655434 DOI: 10.1186/s12905-023-02766-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND While the global incidence of breast cancer is increasing, there is also an increase in the numbers of breast cancer survivors and in survival duration, as early detection programs are implemented, and treatments are optimized. Breast cancer survivors in several countries commonly struggle with a range of symptoms (fatigue, insomnia, depression) with 25-80% of survivors suffering from chronic pain. There is a paucity of literature reporting on breast cancer survivors in South Africa. In this pilot study we aimed to determine the prevalence of chronic pain in female breast cancer survivors attending the breast oncology clinic. METHODS A cross-sectional survey was conducted of all breast cancer survivors attending the Groote Schuur Hospital Breast Unit during one month in 2019. 44 female breast cancer survivors (median age 60.5y) completed a sociodemographic questionnaire, the Brief Pain Inventory, Pain Catastrophizing Scale and measures for neuropathic pain (DN4), health related quality of life (HRQoL; EQ-5d-3 L), physical activity (IPAQ), depression and anxiety (PHQ4), and screening questions to evaluate sleep, happiness and perceived discrimination in the language of their choice. RESULTS The prevalence of chronic pain (pain on most days for more than three months) was 59% (95%CI 44-72), a significantly higher number than the 18,3% prevalence of chronic pain reported by South African adults. 39% of the women were classified as having neuropathic pain. The median pain severity score was 3.75 (IQR = 2.75-5) and the median pain interference with function score was 4 (IQR = 2.9-5.4). The women were experiencing pain in a median of 2 different body sites (IQR = 1-3). The women with pain were more likely to be unemployed or receiving a disability grant, had significantly worse HRQoL, and significantly worse scores for risk of depression and anxiety. CONCLUSION The results of this pilot study suggest that chronic pain may be a significant burden for South African breast cancer survivors. Routine screening for chronic pain in breast cancer survivors is recommended with a larger study indicated to explore this issue further.
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Affiliation(s)
- Nelisiwe Shabangu
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital. Cape Town, Cape Town, South Africa
| | - Tselane Thebe
- Department of Oncology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Michelle Casey
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital. Cape Town, Cape Town, South Africa
| | - Ursula Wesselmann
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Department of Neurology, Department of Psychology, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital. Cape Town, Cape Town, South Africa.
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Flynn K, Murray O, O'Regan A, Hayes P, Casey M, Glynn L. Cold water swimming and its potential health benefits - a qualitative study of participants' views and experiences. Ir Med J 2023; 116:851. [PMID: 37874306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
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Casey M, Gabillard-Lefort C, McElvaney OF, McElvaney OJ, Carroll T, Heeney RC, Gunaratnam C, Reeves EP, Murphy MP, McElvaney NG. Effect of elexacaftor/tezacaftor/ivacaftor on airway and systemic inflammation in cystic fibrosis. Thorax 2023; 78:835-839. [PMID: 37208188 DOI: 10.1136/thorax-2022-219943] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 12/15/2022] [Revised: 03/27/2023] [Accepted: 04/06/2023] [Indexed: 05/21/2023]
Abstract
Treatment with elexacaftor/tezacaftor/ivacaftor (ETI) has been shown to improve lung function in people with cystic fibrosis (PWCF). However, its biological effects remain incompletely understood. Here we describe alterations in pulmonary and systemic inflammation in PWCF following initiation of ETI. To address this, we collected spontaneously expectorated sputum and matching plasma from PWCF (n=30) immediately prior to ETI therapy, then again at 3 and 12 months. Within 3 months, PWCF demonstrated reduced activity of neutrophil elastase, proteinase three and cathepsin G, and decreased concentrations of interleukin (IL)-1β and IL-8 in sputum, accompanied by decreased Pseudomonas burden and restoration of secretory leukoprotease inhibitor levels. Once treated with ETI, all airway inflammatory markers studied in PWCF had reduced to levels found in matched non-CF bronchiectasis controls. In PWCF with advanced disease, ETI resulted in decreased plasma concentrations of IL-6, C-reactive protein and soluble TNF receptor one as well as normalisation of levels of the acute phase protein, alpha-1 antitrypsin. These data clarify the immunomodulatory effects of ETI and underscore its role as a disease modifier.
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Affiliation(s)
- Michelle Casey
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Cystic Fibrosis Unit, Beaumont Hospital, Dublin, Ireland
| | | | - Oisín F McElvaney
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Oliver J McElvaney
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Cystic Fibrosis Therapeutics Development Network, Seattle, Washington, USA
| | - Tomás Carroll
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ronan C Heeney
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Cedric Gunaratnam
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Cystic Fibrosis Unit, Beaumont Hospital, Dublin, Ireland
| | - Emer P Reeves
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mark P Murphy
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Noel G McElvaney
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Cystic Fibrosis Unit, Beaumont Hospital, Dublin, Ireland
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McCauley P, Mohammed A, Casey M, Ramadan E, Galvin S, O'Neill JP, Curley G, Sulaiman I, O'Brien ME, O'Rourke J. Tracheostomy insertion in COVID-19: insertion practice and factors leading to unplanned tube exchange. J Thorac Dis 2023; 15:410-422. [PMID: 36910100 PMCID: PMC9992599 DOI: 10.21037/jtd-22-896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/12/2022] [Indexed: 02/10/2023]
Abstract
Background Tracheostomy insertion in patients with coronavirus disease 2019 (COVID-19) presents unique challenges. Patients frequently have high ventilatory requirements, and as an aerosol generating procedure, tracheostomy insertion creates the potential for staff transmission. Problems with tracheostomies contribute to morbidity and mortality, and tracheostomy changes may increase risks of staff transmission. We sought to quantify the incidence of clinically necessitated tracheostomy changes, establish the indications for change and investigate the incidence of staff transmission. Methods We conducted a single institution, retrospective, observational cohort study of all intensive care unit (ICU) patients with COVID-19 who had a tracheostomy between March 2020 and April 2021. The institution is a large tertiary referral centre in Ireland. Results Forty-three patients had a tracheostomy during the study period. All were a Shiley™ Flexible Adult Taperguard or Shiley™ XLT Tracheostomy. 14 patients (33%) required a tracheostomy change, with the majority (57%) involving a change from a standard size to an extended length tracheostomy. Persistent leak was the most common indication for change (71.6%). Other indications included patient-ventilator dyssynchrony, persistent cough and accidental decannulation. No staff transmission of COVID-19 occurred during this study. Conclusions The incidence of tracheostomy change was 33%, highlighting the importance of selecting the right tracheostomy for each patient. We discuss how key characteristics of tracheostomies such as type, size, length and inner diameter may impact flow, resistance and work of breathing, leading to unplanned tracheostomy change. No staff transmission occurred arising from tracheostomy insertion, adding to increasing evidence that tracheostomy insertion in COVID-19 appears safe with adherence to guidelines describing the correct use of personal protective equipment.
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Affiliation(s)
- Peter McCauley
- Department of Anaesthesia and Critical Care Medicine, Beaumont Hospital, Dublin, Ireland
| | - Amr Mohammed
- Department of Anaesthesia and Critical Care Medicine, Beaumont Hospital, Dublin, Ireland
| | - Michelle Casey
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Eslam Ramadan
- Department of Anaesthesia and Critical Care Medicine, Beaumont Hospital, Dublin, Ireland
| | - Sinéad Galvin
- Department of Anaesthesia and Critical Care Medicine, Beaumont Hospital, Dublin, Ireland
| | - James Paul O'Neill
- Department of Ear, Nose and Throat Surgery, Beaumont Hospital, Dublin, Ireland
| | - Gerard Curley
- Department of Anaesthesia and Critical Care Medicine, Beaumont Hospital, Dublin, Ireland
| | - Imran Sulaiman
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | | | - James O'Rourke
- Department of Anaesthesia and Critical Care Medicine, Beaumont Hospital, Dublin, Ireland
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Li H, Rozenbaum M, Casey M, Sultan MB. Estimating the effect of tafamidis on cardiovascular-related hospitalization in NYHA class III patients with transthyretin amyloid cardiomyopathy in the presence of death. Cardiology 2022; 147:398-405. [PMID: 35853436 DOI: 10.1159/000525883] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/20/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT) demonstrated the effectiveness of tafamidis for the treatment of patients with transthyretin amyloid cardiomyopathy (ATTR-CM). Tafamidis reduced mortality in all subgroups of patients studied. Tafamidis also reduced observed frequency of cardiovascular (CV)-related hospitalizations in all subgroups except those who were New York Heart Association (NYHA) class III at baseline who, paradoxically, had a higher frequency of CV-related hospitalizations than placebo. Given the greater mortality rate with placebo, this analysis assessed the impact of the confounding effect of death on the frequency of CV-related hospitalization in ATTR-ACT. METHODS In ATTR-ACT, patients with ATTR-CM were randomized to tafamidis (n = 264) or placebo (n = 177) for 30 months. Post hoc analyses first defined and compared the effect of tafamidis treatment in the subset of NYHA class III patients from each treatment arm alive at month 30. The impact of a potential survivor bias was then adjusted for using principal stratification, estimating the frequency of CV-related hospitalization in NYHA class III patients who would have survived regardless of assigned treatment group (defined as the survivor average causal effect [SACE]). RESULTS In the subset of NYHA class III patients alive at month 30, tafamidis reduced the relative risk of CV-related hospitalization versus placebo (relative risk: 0.95 [95% CI: 0.55-1.65]). In the principal stratification analyses of those patients who would survive to 30 months regardless of treatment, tafamidis treatment was associated with a 24% lower risk of CV-related hospitalization (relative risk: 0.76 [95% CI: 0.45-1.24). Similarly, there was a larger reduction in CV-related hospitalization frequency with tafamidis in NYHA class I or II patients in the SACE than was initially observed in ATTR-ACT. CONCLUSIONS Initial data from ATTR-ACT likely underestimated the effect of tafamidis on CV-related hospitalizations due to the confounding effect of death. When SACE was used to adjust for survivor bias, there was a 24% reduction in the frequency of CV-related hospitalization in NYHA class III patients treated with tafamidis.
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Affiliation(s)
- Huihua Li
- Pfizer Inc, Collegeville, Pennsylvania, USA
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Walker SM, Engelhardt T, Ahmad N, Dobby N, Masip N, Brooks P, Hare A, Casey M, De Silva S, Krishnan P, Sogbodjor LA, Walker E, King S, Nicholson K, Quinney M, Stevens P, Blevin A, Giombini M, Goonasekera C, Adil S, Bew S, Bodlani C, Gilpin D, Jinks S, Malarkkan N, Miskovic A, Pad R, Barry JW, Abbott J, Armstrong J, Cooper N, Crate L, Emery J, James K, King H, Martin P, Catenacci SS, Bomont R, Smith P, Mele S, Verzelloni A, Dix P, Bell G, Gordeva E, McKee L, Ngan E, Scheffczik J, Tan LE, Worrall M, Cassar C, Goddard K, Barlow V, Oshan V, Shah K, Bell S, Daniels L, Gandhi M, Pachter D, Perry C, Robertson A, Scott C, Waring L, Barnes D, Childs S, Norman J, Sunderland R, Disma N, Veyckemans F, Virag K, Hansen TG, Becke K, Harlet P, Vutskits L, Walker SM, de Graaff JC, Zielinska M, Simic D, Engelhardt T, Habre W. Perioperative critical events and morbidity associated with anesthesia in early life: Subgroup analysis of United Kingdom participation in the NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE) prospective multicenter observational study. Paediatr Anaesth 2022; 32:801-814. [PMID: 35438209 PMCID: PMC9322016 DOI: 10.1111/pan.14457] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE) prospective observational study reported critical events requiring intervention during 35.2% of 6542 anesthetic episodes in 5609 infants up to 60 weeks postmenstrual age. The United Kingdom (UK) was one of 31 participating countries. METHODS Subgroup analysis of UK NECTARINE cases (12.8% of cohort) to identify perioperative critical events that triggered medical interventions. Secondary aims were to describe UK practice, identify factors more commonly associated with critical events, and compare 30-day morbidity and mortality between participating UK and nonUK centers. RESULTS Seventeen UK centers recruited 722 patients (68.7% male, 36.1% born preterm, and 48.1% congenital anomalies) undergoing anesthesia for 876 surgical or diagnostic procedures at 25-60 weeks postmenstrual age. Repeat anesthesia/surgery was common: 17.6% patients prior to and 14.4% during the recruitment period. Perioperative critical events triggered interventions in 300/876 (34.3%) cases. Cardiovascular instability (16.9% of cases) and/or reduced oxygenation (11.4%) were more common in younger patients and those with co-morbidities or requiring preoperative intensive support. A higher proportion of UK than nonUK cases were graded as ASA-Physical Status scores >2 or requiring urgent or emergency procedures, and 39% required postoperative intensive care. Thirty-day morbidity (complications in 17.2%) and mortality (8/715, 1.1%) did not differ from nonUK participants. CONCLUSIONS Perioperative critical events and co-morbidities are common in neonates and young infants. Thirty-day morbidity and mortality data did not demonstrate national differences in outcome. Identifying factors associated with increased risk informs preoperative assessment, resource allocation, and discussions between clinicians and families.
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Affiliation(s)
- Suellen M. Walker
- Department of Paediatric AnaesthesiaGreat Ormond St Hospital NHS Foundation TrustLondonUK,Developmental NeurosciencesUCL GOS Institute of Child HealthLondonUK
| | - Thomas Engelhardt
- Department of AnaesthesiaMontreal Children's HospitalMontrealQCCanada
| | - Nargis Ahmad
- Department of Paediatric AnaesthesiaGreat Ormond St Hospital NHS Foundation TrustLondonUK
| | - Nadine Dobby
- Department of Paediatric AnaesthesiaGreat Ormond St Hospital NHS Foundation TrustLondonUK
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Caird R, Williamson M, Yusuf A, Gogoi D, Casey M, McElvaney NG, Reeves EP. Targeting of Glycosaminoglycans in Genetic and Inflammatory Airway Disease. Int J Mol Sci 2022; 23:ijms23126400. [PMID: 35742845 PMCID: PMC9224208 DOI: 10.3390/ijms23126400] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/02/2022] [Accepted: 06/05/2022] [Indexed: 12/10/2022] Open
Abstract
In the lung, glycosaminoglycans (GAGs) are dispersed in the extracellular matrix (ECM) occupying the interstitial space between the capillary endothelium and the alveolar epithelium, in the sub-epithelial tissue and in airway secretions. In addition to playing key structural roles, GAGs contribute to a number of physiologic processes ranging from cell differentiation, cell adhesion and wound healing. Cytokine and chemokine–GAG interactions are also involved in presentation of inflammatory molecules to respective receptors leading to immune cell migration and airway infiltration. More recently, pathophysiological roles of GAGs have been described. This review aims to discuss the biological roles and molecular interactions of GAGs, and their impact in the pathology of chronic airway diseases, such as cystic fibrosis and chronic obstructive pulmonary disease. Moreover, the role of GAGs in respiratory disease has been heightened by the current COVID-19 pandemic. This review underlines the essential need for continued research aimed at exploring the contribution of GAGs in the development of inflammation, to provide a better understanding of their biological impact, as well as leads in the development of new therapeutic agents.
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McEnery T, White MM, Gogoi D, Coleman O, Bergin D, Jundi B, Flannery R, Alsaif FAT, Landers SA, Casey M, Dunlea D, Meleady P, McElvaney NG, Reeves EP. Alpha-1 Antitrypsin Therapy Modifies Neutrophil Adhesion in Patients with Obstructive Lung Disease. Am J Respir Cell Mol Biol 2022; 67:76-88. [PMID: 35507773 DOI: 10.1165/rcmb.2021-0433oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Alpha-1 antitrypsin (AAT) deficiency (AATD) is characterized by neutrophil-dominated inflammation resulting in emphysema. The cholesterol-rich neutrophil outer plasma membrane plays a central role in adhesion and subsequent transmigration to underlying tissues. This study aimed to investigate mechanisms of increased neutrophil adhesion in AATD, and whether AAT augmentation therapy abrogates this effect. Plasma and blood neutrophils were donated by healthy controls (n=20), AATD (n=30) and AATD patients post AAT augmentation therapy (n=6). Neutrophil membrane protein expression was investigated using liquid chromatography-tandem mass spectrometry. The effect of once weekly intravenous AAT augmentation therapy was assessed by ELISAs, and calcium fluorometric, μ-calpain and cell adhesion assays. Decreased neutrophil plasma membrane cholesterol content (P=0.03), yet increased abundance of integrin alpha-M (fold change 1.91), integrin alpha-L (fold change 3.76) and cytoskeletal adaptor proteins including talin-1 (fold change 4.04), were detected on AATD neutrophil plasma membrane fractions. The described inflammatory induced structural changes were a result of >2 fold increased cytosolic calcium levels (P=0.02), leading to significant calcium dependent μ-calpain activity (3.5 fold change, P=0.005), resulting in proteolysis of the membrane cholesterol trafficking protein caveolin-1. Treatment of AAT-deficient individuals with AAT augmentation therapy resulted in increased caveolin-1 and membrane cholesterol content (111.8 ± 15.5 vs 64.18 ± 7.8 µg/ 2x107 cells pre- and post-treatment respectively, P=0.02), with concurrent decreased neutrophil integrin expression and adhesion. Results demonstrate an auxiliary benefit of AAT augmentation therapy, evident by a decrease in circulating inflammation and controlled neutrophil adhesion.
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Affiliation(s)
- Tom McEnery
- Royal College of Surgeons in Ireland, Respiratory Medicine, Dublin, Ireland
| | - Michelle M White
- Royal College of Surgeons in Ireland, Respiratory Research Division - Dept of Medicine, Dublin, Ireland
| | - Debananda Gogoi
- Royal College of Surgeons in Ireland, Respiratory Research Division - Dept of Medicine, Dublin, Ireland
| | | | - David Bergin
- Royal College of Surgeons in Ireland, Respiratory Research Division - Dept of Medicine, Dublin, Ireland
| | - Bakr Jundi
- Brigham and Women's Hospital, 1861, Division of Pulmonary and Critical Care medicine, Boston, Massachusetts, United States
| | - Ryan Flannery
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fatima Abbas T Alsaif
- Royal College of Surgeons in Ireland, Respiratory Research Division - Dept of Medicine, Dublin, Ireland
| | - Sarah A Landers
- Royal College of Surgeons in Ireland, Respiratory Research Division - Dept of Medicine, Dublin, Ireland
| | - Michelle Casey
- Royal College of Surgeons in Ireland, Respiratory Research Division - Dept of Medicine, Dublin, Ireland
| | - Danielle Dunlea
- Royal College of Surgeons in Ireland, Respiratory Research Division - Dept of Medicine, Dublin, Ireland
| | | | | | - Emer P Reeves
- Royal College of Surgeons in Ireland, Respiratory Research Division - Dept of Medicine, Dublin, Ireland;
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Worobetz A, O'Callaghan M, Walsh J, Casey M, Hayes P, Bengoechea EG, Woods C, McGrath D, Glynn LG. Exercise Compared to Mindfulness for Physical and Mental Wellbeing in Medical Students. Ir Med J 2022; 115:560. [PMID: 35532732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Aim Physical Activity (PA) and Mindfulness-Based Stress Reduction (MBSR) both have positive effects on medical student well-being. The 'MED-WELL' programme is a curricular intervention that combines PA and education on exercise as medicine. This trial evaluates whether there is a mean difference in outcomes of participants of an exercise intervention, the 'MED-WELL' programme, versus a control group which engages in a MBSR programme. Methods All second-year medical students were voluntarily allocated into the intervention or control group. Data on overall health and well-being, sleep quality, loneliness, current level of PA, and confidence in prescribing exercise as medicine was analysed from both groups at baseline and after eight weeks. Results Within groups the intervention and control groups showed statistically significant improvements in overall well-being (p=0.010, p=0.005 respectively) and in sleep quality (p<0.001, p=0.007 respectively). The intervention group had statistically significant improvements in levels of PA (p=0.003) and confidence in prescribing exercise (p<0.001). However, there were no statistically significant differences in changes in outcome measures between groups. Conclusion This study has shown that participants in an exercise intervention, the 'MED-WELL' programme, had similar improvements in overall wellbeing and sleep quality to those in a control group who participated in a MBSR programme of the same duration.
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Affiliation(s)
- A Worobetz
- School of Medicine, University of Limerick, Limerick, Ireland
| | - M O'Callaghan
- School of Medicine, University of Limerick, Limerick, Ireland
| | - J Walsh
- Department of Psychology, National University of Ireland, Galway, Ireland
| | - M Casey
- School of Medicine, University of Limerick, Limerick, Ireland
- HRB Primary Care Clinical Trials Network Ireland
| | - P Hayes
- School of Medicine, University of Limerick, Limerick, Ireland
- HRB Primary Care Clinical Trials Network Ireland
| | - E G Bengoechea
- HRB Primary Care Clinical Trials Network Ireland
- Physical Activity for Health Research Cluster, Department of Physical Education and Sport Sciences, University of Limerick, Ireland
| | - C Woods
- HRB Primary Care Clinical Trials Network Ireland
- Physical Activity for Health Research Cluster, Department of Physical Education and Sport Sciences, University of Limerick, Ireland
| | - D McGrath
- School of Medicine, University of Limerick, Limerick, Ireland
- HRB Primary Care Clinical Trials Network Ireland
| | - L G Glynn
- School of Medicine, University of Limerick, Limerick, Ireland
- HRB Primary Care Clinical Trials Network Ireland
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12
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Casey M, Donohue F. Global Public Health Disease Surveillance Systems, Now and in the Future. Ir Med J 2022; 115:535. [PMID: 35416022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- M Casey
- Department of Public Health Mid-West, Henry Street, Limerick
| | - F Donohue
- Health Intelligence Unit, Jervis House, Jervis St, Dublin
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Gabillard-Lefort C, Casey M, Glasgow AMA, Boland F, Kerr O, Marron E, Lyons AM, Gunaratnam C, McElvaney NG, Reeves EP. Trikafta Rescues CFTR and Lowers Monocyte P2X7R-Induced Inflammasome Activation in Cystic Fibrosis. Am J Respir Crit Care Med 2022; 205:783-794. [PMID: 35021019 DOI: 10.1164/rccm.202106-1426oc] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Cystic Fibrosis (CF) is caused by mutations in the CF transmembrane conductance regulator (CFTR) gene and is characterized by sustained inflammation. Adenosine-5'-Triphosphate (ATP) triggers interleukin (IL)-1β secretion via the P2X7 receptor (P2X7R) and activation of the NLRP3 (NOD-, LRR-, and pyrin domain-containing protein 3) inflammasome. OBJECTIVES To explore the effect of the CFTR modulator Trikafta (Elexacaftor/Tezacaftor/Ivacaftor) on CFTR expression and the ATP/P2X7R signaling axis in monocytes and on circulating pro-inflammatory markers. METHODS Inflammatory mediators were detected in blood from 42 patients with CF (PWCF) before and after 3 months of Trikafta therapy. Markers of inflammasome activation and IL-1β secretion were measured in monocytes, and following stimulation with ATP and lipopolysaccharides (LPS) in the presence or absence of the P2X7R inhibitor, A438079. MEASUREMENTS AND MAIN RESULTS P2X7R is overexpressed in CF monocytes and receptor inhibition decreased NLRP3 expression, caspase-1 activation, and IL-1β secretion. In vitro and in vivo, P2X7R expression is regulated by CFTR function and intracellular chloride (Cl-) levels. Trikafta therapy restored CFTR expression yet decreased P2X7R in CF monocytes, resulting in normalized Cl- and potassium efflux, and reduced intracellular calcium levels. CFTR modulator therapy decreased circulating levels of ATP and LPS and reduced inflammasome activation and IL-1β secretion. CONCLUSIONS P2X7R expression is regulated by intracellular Cl- levels, and in CF monocytes promotes inflammasome activation. Trikafta therapy significantly increased CFTR protein expression and reduced ATP/P2X7R -induced inflammasome activation. P2X7R may therefore be a promising target to reduce inflammation in PWCF non-eligible for Trikafta or other CFTR modulator therapy.
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Affiliation(s)
- Claudie Gabillard-Lefort
- Royal College of Surgeons in Ireland, Respiratory Research Division - Dept of Medicine, Dublin, Ireland
| | - Michelle Casey
- Royal College of Surgeons in Ireland, Respiratory Research Division - Dept of Medicine, Dublin, Ireland
| | - Arlene M A Glasgow
- Royal College of Surgeons in Ireland, Respiratory Research Division - Dept of Medicine, Dublin, Ireland
| | - Fiona Boland
- Royal College of Surgeons in Ireland, 8863, Population Health Sciences, Dublin, Ireland
| | - Orla Kerr
- Beaumont Hospital, 57978, Dublin, Ireland
| | | | | | - Cedric Gunaratnam
- Royal College of Surgeons in Ireland, Beaumont Hospital, Respiratory Research Division, Department of Medicine, Dublin, Ireland
| | | | - Emer P Reeves
- Royal College of Surgeons in Ireland, Respiratory Research Division - Dept of Medicine, Dublin, Ireland;
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14
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Fee LT, Gogoi D, O’Brien ME, McHugh E, Casey M, Gough C, Murphy M, Hopkins AM, Carroll TP, McElvaney NG, Reeves EP. C3d Elicits Neutrophil Degranulation and Decreases Endothelial Cell Migration, with Implications for Patients with Alpha-1 Antitrypsin Deficiency. Biomedicines 2021; 9:biomedicines9121925. [PMID: 34944741 PMCID: PMC8698851 DOI: 10.3390/biomedicines9121925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 12/25/2022] Open
Abstract
Alpha-1 antitrypsin (AAT) deficiency (AATD) is characterized by increased risk for emphysema, chronic obstructive pulmonary disease (COPD), vasculitis, and wound-healing impairment. Neutrophils play a central role in the pathogenesis of AATD. Dysregulated complement activation in AATD results in increased plasma levels of C3d. The current study investigated the impact of C3d on circulating neutrophils. Blood was collected from AATD (n = 88) or non-AATD COPD patients (n = 10) and healthy controls (HC) (n = 40). Neutrophils were challenged with C3d, and degranulation was assessed by Western blotting, ELISA, or fluorescence resonance energy transfer (FRET) substrate assays. Ex vivo, C3d levels were increased in plasma (p < 0.0001) and on neutrophil plasma membranes (p = 0.038) in AATD compared to HC. C3d binding to CR3 receptors triggered primary (p = 0.01), secondary (p = 0.004), and tertiary (p = 0.018) granule release and increased CXCL8 secretion (p = 0.02). Ex vivo plasma levels of bactericidal-permeability-increasing-protein (p = 0.02), myeloperoxidase (p < 0.0001), and lactoferrin (p < 0.0001) were significantly increased in AATD patients. In endothelial cell scratch wound assays, C3d significantly decreased cell migration (p < 0.0001), an effect potentiated by neutrophil degranulated proteins (p < 0.0001). In summary, AATD patients had increased C3d in plasma and on neutrophil membranes and, together with neutrophil-released granule enzymes, reduced endothelial cell migration and wound healing, with potential implications for AATD-related vasculitis.
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Affiliation(s)
- Laura T. Fee
- Alpha-1 Foundation Ireland, Royal College of Surgeons in Ireland, Beaumont Hospital, D02 YN77 Dublin, Ireland; (L.T.F.); (T.P.C.)
- Irish Centre for Genetic Lung Disease, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, D02 YN77 Dublin, Ireland; (D.G.); (M.E.O.); (E.M.); (M.C.); (C.G.); (M.M.); (N.G.M.)
| | - Debananda Gogoi
- Irish Centre for Genetic Lung Disease, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, D02 YN77 Dublin, Ireland; (D.G.); (M.E.O.); (E.M.); (M.C.); (C.G.); (M.M.); (N.G.M.)
| | - Michael E. O’Brien
- Irish Centre for Genetic Lung Disease, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, D02 YN77 Dublin, Ireland; (D.G.); (M.E.O.); (E.M.); (M.C.); (C.G.); (M.M.); (N.G.M.)
| | - Emer McHugh
- Irish Centre for Genetic Lung Disease, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, D02 YN77 Dublin, Ireland; (D.G.); (M.E.O.); (E.M.); (M.C.); (C.G.); (M.M.); (N.G.M.)
| | - Michelle Casey
- Irish Centre for Genetic Lung Disease, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, D02 YN77 Dublin, Ireland; (D.G.); (M.E.O.); (E.M.); (M.C.); (C.G.); (M.M.); (N.G.M.)
| | - Ciara Gough
- Irish Centre for Genetic Lung Disease, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, D02 YN77 Dublin, Ireland; (D.G.); (M.E.O.); (E.M.); (M.C.); (C.G.); (M.M.); (N.G.M.)
| | - Mark Murphy
- Irish Centre for Genetic Lung Disease, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, D02 YN77 Dublin, Ireland; (D.G.); (M.E.O.); (E.M.); (M.C.); (C.G.); (M.M.); (N.G.M.)
| | - Ann M. Hopkins
- Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, D02 YN77 Dublin, Ireland;
| | - Tomás P. Carroll
- Alpha-1 Foundation Ireland, Royal College of Surgeons in Ireland, Beaumont Hospital, D02 YN77 Dublin, Ireland; (L.T.F.); (T.P.C.)
- Irish Centre for Genetic Lung Disease, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, D02 YN77 Dublin, Ireland; (D.G.); (M.E.O.); (E.M.); (M.C.); (C.G.); (M.M.); (N.G.M.)
| | - Noel G. McElvaney
- Irish Centre for Genetic Lung Disease, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, D02 YN77 Dublin, Ireland; (D.G.); (M.E.O.); (E.M.); (M.C.); (C.G.); (M.M.); (N.G.M.)
| | - Emer P. Reeves
- Irish Centre for Genetic Lung Disease, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, D02 YN77 Dublin, Ireland; (D.G.); (M.E.O.); (E.M.); (M.C.); (C.G.); (M.M.); (N.G.M.)
- Correspondence:
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15
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Williamson M, Casey M, Gabillard-Lefort C, Alharbi A, Teo YQJ, McElvaney NG, Reeves EP. Current evidence on the effect of highly effective CFTR modulation on interleukin-8 in cystic fibrosis. Expert Rev Respir Med 2021; 16:43-56. [PMID: 34726115 DOI: 10.1080/17476348.2021.2001333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Cystic fibrosis (CF) is a genetically inherited disease, with mortality and morbidity associated with respiratory disease. The inflammatory response in CF is characterized by excessive neutrophil influx to the airways, mainly due to the increased local production and retention of interleukin-8 (IL-8), a potent neutrophil chemoattractant. AREAS COVERED We discuss how the chemokine IL-8 dominates the inflammatory profile of the airways in CF lung disease. Cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies are designed to correct the malfunctioning protein resulting from specific CFTR mutations. This review covers current evidence on the impact of CFTR impairment on levels of IL-8 and outlines the influence of effective CFTR modulation on inflammation in CF with a focus on cytokine production. Review of the literature was carried out using the PUBMED database, Google Scholar, and The Cochrane Library databases, using several appropriate generic terms. EXPERT OPINION Therapeutic interventions specifically targeting the defective CFTR protein have improved the outlook for CF. Accumulating studies on the effect of highly effective CFTR modulation on inflammation indicate an impact on IL-8 levels. Further studies are required to increase our knowledge of early onset innate inflammatory dysregulation and on anti-inflammatory mechanisms of CFTR modulators.
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Affiliation(s)
- Michael Williamson
- Royal College of Surgeons in Ireland, Irish Centre for Genetic Lung Disease, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Michelle Casey
- Royal College of Surgeons in Ireland, Irish Centre for Genetic Lung Disease, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Claudie Gabillard-Lefort
- Royal College of Surgeons in Ireland, Irish Centre for Genetic Lung Disease, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Aram Alharbi
- Royal College of Surgeons in Ireland, Irish Centre for Genetic Lung Disease, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Yu Qing Jolene Teo
- Royal College of Surgeons in Ireland, Irish Centre for Genetic Lung Disease, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Noel G McElvaney
- Royal College of Surgeons in Ireland, Irish Centre for Genetic Lung Disease, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Emer P Reeves
- Royal College of Surgeons in Ireland, Irish Centre for Genetic Lung Disease, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
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16
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Casey M, Gabillard-Lefort C, Gunaratnam C, Reeves E, McElvaney N. 559: Impact of elexacaftor/tezacaftor/ivacaftor on airway levels of ATP and IL-1b, markers of cystic fibrosis inflammation. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01982-2] [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: 10/20/2022]
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17
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Gabillard-Lefort C, Casey M, Gunaratnam C, Reeves E, McElvaney N. 550: Effect of elexacaftor/tezacaftor/ivacaftor on LPS- and ATP-induced inflammasome activation in monocytes of patients with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01973-1] [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: 12/01/2022]
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18
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Li H, Rozenbaum M, Casey M, Sultan M. Estimating treatment effect of tafamidis on hospitalisation in NYHA class III ATTR-CM patients in the presence of death using principal stratification. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Hospitalisation has been widely used as a measure of morbidity in clinical trials for chronic heart failure. As previously reported in the Transthyretin Amyloidosis Cardiomyopathy Clinical Trial (ATTR-ACT), the observed frequency of cardiovascular (CV)-related hospitalisations favoured tafamidis over placebo in all analyses except in the NYHA Class III baseline subgroup with a relative risk of 1.41 [95% CI: 1.05, 1.90]1. However, the evaluation of the causal effect of treatment on hospitalisation is complicated in the presence of death as death precludes further hospitalisation and thus limits the evaluation of hospitalisation rates between groups. This confounding effect of death is particularly relevant in NYHA Class III participants who had higher mortality rates compared to Class I or II participants.
Purpose
This aim of this study was to assess the impact of the confounding effect of death on CV-related hospitalisation.
Methods
The effect of tafamidis treatment on CV-related hospitalisations was defined and compared in the subset of participants from either treatment arm who were alive at the end of the study (ie, Month 30); however the subset of participants who survive on the tafamidis arm would be expected to have different characteristics from the subset of participants who survive on the control arm and thus these analyses do not estimate the causal effect.
To address this possible survivor bias, we additionally conducted a post hoc principal stratification analysis. Principal stratification is a statistical method to adjust for post treatment events, in this case mortality, by classifying participants according to their potential to survive under each treatment arm. Specifically, we sought to estimate the principal strata effect on CV-related hospitalisations in NYHA Class III participants who would survive irrespective of treatment assignment. Sensitivity analyses were performed to assess the model assumptions.
Results
The analysis within the subset of participants who survived at Month 30 demonstrated a relative risk of 1.1 (95% CI: 0.56, 2.16) between tafamidis and placebo. The principal stratification analyses of subjects who would survive to 30 months irrespective of treatment estimated a 0.75 (95% CI: 0.44, 1.23) relative risk between tafamidis and placebo, suggesting a 25% reduction in frequency of CV-related hospitalisations in the tafamidis arm.
Conclusion
The initial data reported in ATTR-ACT likely underestimated the true effect of tafamidis on CV-related hospitalisations due to the confounding effect of death. The analysis of treatment group among observed survivors estimated a smaller relative risk for NYHA Class III; however, this analysis does not fully address the possible survivor bias. The survivor average causal effect, which adjusts for the survival bias demonstrated a reduction in the frequency of CV-related hospitalisation in the tafamidis treated arm for NYHA Class III participants.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Pfizer
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Affiliation(s)
- H Li
- Pfizer, Rare Disease Statistics, Collegeville, United States of America
| | - M.H Rozenbaum
- Pfizer, Patient & Health Impact, Capelle A/D Ijssel, Netherlands (The)
| | - M Casey
- Pfizer, Rare Disease Statistics, Collegeville, United States of America
| | - M Sultan
- Pfizer, Global Product Development, New York, United States of America
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Mehta A, Casey M, Aylward A, Bush M, Shams R, Platts-Mills T. 166 Predicting Food Insecurity among Older Adults in the Emergency Department. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.177] [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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20
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Otani I, Lew J, Casey M, Perez A, Zhang L, Leard L, Hays S. Screening for Severe Hypogammaglobulinemia in Lung Transplant Recipients. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1072] [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] Open
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21
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Ryan DJ, Toomey S, Madden SF, Casey M, Breathnach OS, Morris PG, Grogan L, Branagan P, Costello RW, De Barra E, Hurley K, Gunaratnam C, McElvaney NG, OBrien ME, Sulaiman I, Morgan RK, Hennessy BT. Use of exhaled breath condensate (EBC) in the diagnosis of SARS-COV-2 (COVID-19). Thorax 2021; 76:86-88. [PMID: 33097604 PMCID: PMC7590263 DOI: 10.1136/thoraxjnl-2020-215705] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/24/2022]
Abstract
False negatives from nasopharyngeal swabs (NPS) using reverse transcriptase PCR (RT-PCR) in SARS-CoV-2 are high. Exhaled breath condensate (EBC) contains lower respiratory droplets that may improve detection. We performed EBC RT-PCR for SARS-CoV-2 genes (E, S, N, ORF1ab) on NPS-positive (n=16) and NPS-negative/clinically positive COVID-19 patients (n=15) using two commercial assays. EBC detected SARS-CoV-2 in 93.5% (29/31) using the four genes. Pre-SARS-CoV-2 era controls (n=14) were negative. EBC was positive in NPS negative/clinically positive patients in 66.6% (10/15) using the identical E and S (E/S) gene assay used for NPS, 73.3% (11/15) using the N/ORF1ab assay and 14/15 (93.3%) combined.
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Affiliation(s)
- Daniel J Ryan
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Sinead Toomey
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Stephen F Madden
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michelle Casey
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | | | | | - Liam Grogan
- Department of Oncology, Beaumont Hospital, Dublin, Ireland
| | - Peter Branagan
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | | | - Eoghan De Barra
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Killian Hurley
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Cedric Gunaratnam
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Noel G McElvaney
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | | | - Imran Sulaiman
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Ross K Morgan
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Bryan T Hennessy
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Oncology, Beaumont Hospital, Dublin, Ireland
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Casey M, Degtyarev E, Lechuga MJ, Aimone P, Ravaud A, Motzer RJ, Liu F, Stalbovskaya V, Tang R, Butler E, Sailer O, Halabi S, George D. Estimand framework: Are we asking the right questions? A case study in the solid tumor setting. Pharm Stat 2020; 20:324-334. [PMID: 33155417 DOI: 10.1002/pst.2079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 09/11/2020] [Accepted: 10/22/2020] [Indexed: 01/05/2023]
Abstract
The estimand framework requires a precise definition of the clinical question of interest (the estimand) as different ways of accounting for "intercurrent" events post randomization may result in different scientific questions. The initiation of subsequent therapy is common in oncology clinical trials and is considered an intercurrent event if the start of such therapy occurs prior to a recurrence or progression event. Three possible ways to account for this intercurrent event in the analysis are to censor at initiation, consider recurrence or progression events (including death) that occur before and after the initiation of subsequent therapy, or consider the start of subsequent therapy as an event in and of itself. The new estimand framework clarifies that these analyses address different questions ("does the drug delay recurrence if no patient had received subsequent therapy?" vs "does the drug delay recurrence with or without subsequent therapy?" vs "does the drug delay recurrence or start of subsequent therapy?"). The framework facilitates discussions during clinical trial planning and design to ensure alignment between the key question of interest, the analysis, and interpretation. This article is a result of a cross-industry collaboration to connect the International Council for Harmonisation E9 addendum concepts to applications. Data from previously reported randomized phase 3 studies in the renal cell carcinoma setting are used to consider common intercurrent events in solid tumor studies, and to illustrate different scientific questions and the consequences of the estimand choice for study design, data collection, analysis, and interpretation.
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Affiliation(s)
| | | | | | | | | | - Robert J Motzer
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Feng Liu
- AstraZeneca, Gaithersburg, Maryland, USA
| | | | - Rui Tang
- Servier Pharmaceuticals, Boston, Massachusetts, USA
| | - Emily Butler
- GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Oliver Sailer
- Boehringer Ingelheim Pharma GmbH & Co, Biberach, Germany
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Rao G, Ahn J, Evans A, Casey M, Vejerano E. A method to measure the partitioning coefficient of volatile organic compounds in nanoparticles. MethodsX 2020; 7:101041. [PMID: 32939351 PMCID: PMC7476312 DOI: 10.1016/j.mex.2020.101041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/19/2020] [Indexed: 11/27/2022] Open
Abstract
The partitioning behavior of volatile organic compounds (VOCs) into nanoparticles is less studied compared to those of semivolatile organic compounds (SVOCs) because of the lower concentration of the VOCs that is expected to partition into particles. One challenge in measuring the accurate partition coefficient of VOCs is quantifying their low mass fraction that sorbed on nanoparticles and differentiating them from the high VOC concentrations present in the gas-phase. Systematically characterizing the partitioning coefficient at a specific environmental condition is also difficult when sampling in the field. During field sampling, thermal and non-thermal issues such as sampling artifacts and non-equilibrium conditions because of a dynamic environment often result in considerable variability in the measured partition coefficients. In this study, we developed a bench-scale system that can achieve precise control of the experimental condition (e.g., relative humidity, temperature, and particle composition) and allow us to measure the low concentration of 1,2-dichlorobenzene in the particles. A similar set up can be used to study the low mass fraction of other VOCs partitioning in nanoparticles. The detailed but uncomplicated system setup may assist other researchers that investigate the global fate and transport and health effects of VOCs.A bench-scale system was built in the laboratory to study the gas-to-particle partitioning Experimental conditions can be controlled and easily varied The system enables the systematic study of a single environmental factor on the partitioning process
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Affiliation(s)
- Guiying Rao
- Center for Environmental Nanoscience and Risk, Department of Environmental Health Sciences, University of South Carolina, 921 Assembly St., PHRC 501D, Columbia 29208, United States
| | - Jeonghyeon Ahn
- Center for Environmental Nanoscience and Risk, Department of Environmental Health Sciences, University of South Carolina, 921 Assembly St., PHRC 501D, Columbia 29208, United States
| | - Abigail Evans
- Center for Environmental Nanoscience and Risk, Department of Environmental Health Sciences, University of South Carolina, 921 Assembly St., PHRC 501D, Columbia 29208, United States
| | - Michelle Casey
- Center for Environmental Nanoscience and Risk, Department of Environmental Health Sciences, University of South Carolina, 921 Assembly St., PHRC 501D, Columbia 29208, United States
| | - Eric Vejerano
- Center for Environmental Nanoscience and Risk, Department of Environmental Health Sciences, University of South Carolina, 921 Assembly St., PHRC 501D, Columbia 29208, United States
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Glynn LG, Cosgrove R, Halls R, Casey M, Dunne CP. Attitudes Toward Hand Hygiene Among Medical Students on Placement in Primary Care. Ir Med J 2020; 113:136. [PMID: 35575658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- L G Glynn
- School of Medicine, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - R Cosgrove
- School of Medicine, University of Limerick, Limerick, Ireland
| | - R Halls
- School of Medicine, University of Limerick, Limerick, Ireland
| | - M Casey
- School of Medicine, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - C P Dunne
- School of Medicine, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
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Brereton CJ, Wallis T, Casey M, Fox L, Pontopiddan K, Laws D, Graves J, Titmuss V, Kearney S, Evans S, Grove A, Hamid S, Richeldi L, O'Reilly KMA, Fletcher SV, Jones MG. Time taken from primary care referral to a specialist centre diagnosis of idiopathic pulmonary fibrosis: an opportunity to improve patient outcomes? ERJ Open Res 2020; 6:00120-2020. [PMID: 32714958 PMCID: PMC7369434 DOI: 10.1183/23120541.00120-2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/13/2020] [Indexed: 11/10/2022] Open
Abstract
The care of patients with idiopathic pulmonary fibrosis (IPF) has been transformed by the widespread approval of antifibrotic therapies [1]. Within primary care-based healthcare systems, the diagnosis of IPF and commencement of antifibrotic therapy typically requires a patient referral from a primary care physician to a respiratory physician in secondary care, with referral then made to a specialist interstitial lung disease (ILD) centre [2]. Following ILD centre review and multidisciplinary team (MDT) discussion, a diagnosis of IPF is made and antifibrotic therapy may be commenced. For patients with IPF, length of time in healthcare systems prior to review in an ILD clinic reflects disease severity and may impact upon patient outcomehttps://bit.ly/2TkO26r
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Affiliation(s)
- Christopher J Brereton
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK.,Clinical Experimental Sciences, University of Southampton, Southampton, UK
| | - Timothy Wallis
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Michelle Casey
- Mater Misericordiae University Hospital, Dublin, Republic of Ireland
| | - Lynn Fox
- Mater Misericordiae University Hospital, Dublin, Republic of Ireland
| | - Katarina Pontopiddan
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Diane Laws
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | | | | | | | - Sian Evans
- Salisbury NHS Foundation Trust, Salisbury, UK
| | - Alison Grove
- Hampshire Hospitals NHS Foundation Trust, Winchester, UK
| | | | - Luca Richeldi
- Universita Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Katherine M A O'Reilly
- Mater Misericordiae University Hospital, Dublin, Republic of Ireland.,School of Medicine, University College Dublin, Dublin, Republic of Ireland
| | - Sophie V Fletcher
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Mark G Jones
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK.,Clinical Experimental Sciences, University of Southampton, Southampton, UK
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26
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Degtyarev E, Rufibach K, Shentu Y, Yung G, Casey M, Englert S, Liu F, Liu Y, Sailer O, Siegel J, Sun S, Tang R, Zhou J. Assessing the Impact of COVID-19 on the Clinical Trial Objective and Analysis of Oncology Clinical Trials-Application of the Estimand Framework. Stat Biopharm Res 2020; 12:427-437. [PMID: 34191975 PMCID: PMC8011489 DOI: 10.1080/19466315.2020.1785543] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022]
Abstract
Abstract-Coronavirus disease 2019 (COVID-19) outbreak has rapidly evolved into a global pandemic. The impact of COVID-19 on patient journeys in oncology represents a new risk to interpretation of trial results and its broad applicability for future clinical practice. We identify key intercurrent events (ICEs) that may occur due to COVID-19 in oncology clinical trials with a focus on time-to-event endpoints and discuss considerations pertaining to the other estimand attributes introduced in the ICH E9 addendum. We propose strategies to handle COVID-19 related ICEs, depending on their relationship with malignancy and treatment and the interpretability of data after them. We argue that the clinical trial objective from a world without COVID-19 pandemic remains valid. The estimand framework provides a common language to discuss the impact of COVID-19 in a structured and transparent manner. This demonstrates that the applicability of the framework may even go beyond what it was initially intended for.
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Affiliation(s)
| | | | | | | | | | | | | | - Yi Liu
- Nektar Therapeutics, San Francisco, CA
| | - Oliver Sailer
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | | | | | - Rui Tang
- Servier Pharmaceuticals, Boston, MA
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27
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Conroy N, Casey M, Eichler N. Mandatory Vaccination for Ireland; An Informed Intervention or a Knee-Jerk Reaction? Ir Med J 2020; 113:97. [PMID: 32816432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- N Conroy
- Department of Public Health - East, Dr Steevens' Hospital, Dublin 8
| | - M Casey
- Department of Public Health - Mid-West, Limerick
| | - N Eichler
- Department of Public Health - East, Dr Steevens' Hospital, Dublin 8
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28
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George D, Casey M, Degtyarev E, Lechuga Frean M, Aimone P, Ravaud A, Halabi S, Motzer R. Impact of estimand selection on adjuvant treatment outcomes in renal cell carcinoma (RCC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz249.076] [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: 11/13/2022] Open
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Agarwal N, Shore ND, Dunshee C, Karsh LI, Sullivan B, Di Santo N, Elmeliegy M, Casey M, Quek RG, Czibere A, Fizazi K. TALAPRO-2: A two-part, placebo-controlled phase III study of talazoparib (TALA) with enzalutamide (ENZA) in metastatic castration-resistant prostate cancer (mCRPC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.tps337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
TPS337 Background: ENZA is approved to treat men with CRPC. TALA is a poly(ADP-ribose) polymerase (PARP) inhibitor that inhibits PARP1/PARP2 and traps PARP on DNA, preventing DNA damage repair (DDR), and causing cell death in BRCA1/2-mutated cells. TALA is approved in the US to treat germline BRCA1/2-mutated HER2- locally advanced/metastatic breast cancer. A combination of TALA with ENZA in mCRPC may improve clinical outcomes. Methods: Eligible patients (pts) in parts (P) 1 and 2 of this study are aged ≥18 years; have asymptomatic/mildly symptomatic mCRPC, ECOG PS ≤1, and no brain metastases; and have not received taxanes/novel hormonal therapy (NHT). P1 is an open label study to confirm the starting dose of TALA to be given in combination with ENZA. P2 is a randomized double-blind study that will evaluate the safety, efficacy and pt reported outcomes of TALA (0.5 mg QD) + ENZA (160 mg QD) vs placebo + ENZA in 2 cohorts (C). C1: pts with mCRPC (all comers) (N = 560); C2: pts with DDR gene mutations likely to sensitize to PARP inhibition (DDR deficient) (N = 300). Randomization will be stratified by prior treatment with NHT for castration sensitive prostate cancer (CSPC) or prior treatment with taxane-based chemotherapy for CSPC (yes/no), and DDR mutation status (deficient vs. nondeficient/unknown). For P1, the primary endpoint is safety; the secondary endpoint is pharmacokinetics of TALA and ENZA. For P2, the primary endpoint is radiographic progression-free survival (rPFS), defined as time to progression in soft tissue per RECIST v1.1 or in bone per PCWG3 criteria or death and evaluated separately in all comers (C1) and DDR-deficient (DDR-deficient pts from C1 and C2 combined, N = 380 pts) populations. The key secondary endpoint is overall survival. Efficacy will be assessed by radiography every 8 weeks up to week 25 and every 8-12 weeks thereafter. P2 analysis for rPFS is powered at 90% and 85% using a 2-sided log-rank test with alpha of 0.025, respectively, in the all comers and DDR deficient populations. This study was sponsored by Pfizer Inc. Clinical trial information: NCT03395197.
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Affiliation(s)
- Neeraj Agarwal
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
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30
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Gross-Goupil M, Kwon TG, Eto M, Ye D, Miyake H, Seo SI, Byun SS, Lee JL, Master V, Jin J, DeBenedetto R, Linke R, Casey M, Rosbrook B, Lechuga M, Valota O, Grande E, Quinn DI. Axitinib versus placebo as an adjuvant treatment of renal cell carcinoma: results from the phase III, randomized ATLAS trial. Ann Oncol 2018; 29:2371-2378. [PMID: 30346481 PMCID: PMC6311952 DOI: 10.1093/annonc/mdy454] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background The ATLAS trial compared axitinib versus placebo in patients with locoregional renal cell carcinoma (RCC) at risk of recurrence after nephrectomy. Patients and methods In a phase III, randomized, double-blind trial, patients had >50% clear-cell RCC, had undergone nephrectomy, and had no evidence of macroscopic residual or metastatic disease [independent review committee (IRC) confirmed]. The intent-to-treat population included all randomized patients [≥pT2 and/or N+, any Fuhrman grade (FG), Eastern Cooperative Oncology Group status 0/1]. Patients (stratified by risk group/country) received (1 : 1) oral twice-daily axitinib 5 mg or placebo for ≤3 years, with a 1-year minimum unless recurrence, occurrence of second primary malignancy, significant toxicity, or consent withdrawal. The primary end point was disease-free survival (DFS) per IRC. A prespecified DFS analysis in the highest-risk subpopulation (pT3, FG ≥ 3 or pT4 and/or N+, any T, any FG) was conducted. Results A total of 724 patients (363 versus 361, axitinib versus placebo) were randomized from 8 May 2012, to 1 July 2016. The trial was stopped due to futility at a preplanned interim analysis at 203 DFS events. There was no significant difference in DFS per IRC [hazard ratio (HR) = 0.870; 95% confidence interval (CI) : 0.660-1.147; P = 0.3211). In the highest-risk subpopulation, a 36% and 27% reduction in risk of a DFS event (HR; 95% CI) was observed per investigator (0.641; 0.468-0.879; P = 0.0051), and by IRC (0.735; 0.525-1.028; P = 0.0704), respectively. Overall survival data were not mature. Similar adverse events (AEs; 99% versus 92%) and serious AEs (19% versus 14%), but more grade 3/4 AEs (61% versus 30%) were reported for axitinib versus placebo. Conclusions ATLAS did not meet its primary end point; however, improvement in DFS per investigator was seen in the highest-risk subpopulation. No new safety signals were reported. Trial registration number NCT01599754.
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Affiliation(s)
- M Gross-Goupil
- Department of Medical Oncology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - T G Kwon
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - M Eto
- Department of Urology, Kyushu University, Fukuoka, Japan
| | - D Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - H Miyake
- Department of Urology, Hamamatsu University, Hamamatsu, Japan
| | - S I Seo
- Department of Urology, Sungkyunkwan University, Seoul, Republic of Korea
| | - S-S Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - J L Lee
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - V Master
- Department of Urology, Emory University School of Medicine, Atlanta, USA
| | - J Jin
- Department of Urology, Peking University First Hospital and Institute of Urology, Beijing, China
| | | | - R Linke
- SFJ Pharmaceuticals, Inc, Pleasanton, USA
| | - M Casey
- Pfizer Inc, Collegeville, USA
| | | | - M Lechuga
- Pfizer Srl, Global Product Development, Milan, Italy
| | - O Valota
- Pfizer Srl, Global Product Development, Milan, Italy
| | - E Grande
- Department of Medical Oncology, MD Anderson Cancer Center, Madrid, Spain
| | - D I Quinn
- Department of Medical Oncology, USC Keck School of Medicine Norris Comprehensive Cancer Center, Los Angeles, USA.
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George DJ, Martini JF, Staehler M, Motzer RJ, Magheli A, Donskov F, Escudier B, Li S, Casey M, Valota O, Laguerre B, Pantuck AJ, Pandha HS, Patel A, Lechuga M, Ravaud A. Phase III Trial of Adjuvant Sunitinib in Patients with High-Risk Renal Cell Carcinoma: Exploratory Pharmacogenomic Analysis. Clin Cancer Res 2018; 25:1165-1173. [PMID: 30401688 DOI: 10.1158/1078-0432.ccr-18-1724] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/28/2018] [Accepted: 11/02/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE In the S-TRAC trial, adjuvant sunitinib prolonged disease-free survival (DFS) versus placebo in patients with loco-regional renal cell carcinoma at high risk of recurrence after nephrectomy. An exploratory analysis evaluated associations between SNPs in several angiogenesis- or hypoxia-related genes and clinical outcomes in S-TRAC. PATIENTS AND METHODS Blood samples were genotyped for 10 SNPs and one insertion/deletion mutation using TaqMan assays. DFS was compared using log-rank tests for each genotype in sunitinib versus placebo groups and between genotypes within each of three (sunitinib, placebo, and combined sunitinib plus placebo) treatment groups. P values were unadjusted. RESULTS In all, 286 patients (sunitinib, n = 142; placebo, n = 144) were genotyped. Longer DFS [HR; 95% confidence interval (CI)] was observed with sunitinib versus placebo for VEGFR1 rs9554320 C/C (HR 0.44; 95% CI, 0.21-0.91; P = 0.023), VEGFR2 rs2071559 T/T (HR 0.46; 95% CI, 0.23-0.90; P = 0.020), and eNOS rs2070744 T/T (HR 0.53; 95% CI, 0.30-0.94; P = 0.028). Shorter DFS was observed for VEGFR1 rs9582036 C/A versus C/C with sunitinib, placebo, and combined therapies (P ≤ 0.05), and A/A versus C/C with sunitinib (P = 0.022). VEGFR1 rs9554320 A/C versus A/A was associated with shorter DFS in the placebo (P = 0.038) and combined (P = 0.006) groups. CONCLUSIONS Correlations between VEGFR1 and VEGFR2 SNPs and longer DFS with sunitinib suggest germline SNPs are predictive of improved outcomes with adjuvant sunitinib in patients with renal cell carcinoma. Independent validation studies are needed to confirm these findings.
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Affiliation(s)
- Daniel J George
- Department of Medical Oncology, Duke Cancer Center, Durham, North Carolina.
| | | | - Michael Staehler
- Department of Urology, University Hospital of Munich, Munich, Germany
| | - Robert J Motzer
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ahmed Magheli
- Department of Urology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Frede Donskov
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Bernard Escudier
- Department of Urology, Institut Gustave Roussy, Villejuif, France
| | - Sherry Li
- Global Product Development, Pfizer Inc, La Jolla, California
| | - Michelle Casey
- Global Product Development, Pfizer Inc., Collegeville, Pennsylvania
| | - Olga Valota
- Global Product Development, Pfizer S.r.L, Milan, Italy
| | - Brigitte Laguerre
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - Allan J Pantuck
- Department of Urology, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Hardev S Pandha
- Department of Medical Oncology, University of Surrey, Surrey, United Kingdom
| | | | - Maria Lechuga
- Global Product Development, Pfizer S.r.L, Milan, Italy
| | - Alain Ravaud
- Department of Medical Oncology, Bordeaux University Hospital, Bordeaux, France
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de Bono J, Higano C, Saad F, Miller K, Casey M, Czibere A, Healy C, Fizazi K. TALAPRO-1: An open-label, response rate phase II study of talazoparib (TALA) in men with DNA damage repair defects (DDR) and metastatic castration-resistant prostate cancer (mCRPC) who previously received taxane-based chemotherapy (CT) and progressed on ≥ 1 novel hormonal therapy (NHT). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284.068] [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: 11/14/2022] Open
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33
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George D, Pantuck A, Figlin R, Escudier B, Halabi S, Casey M, Lin X, Serfass L, Lechuga Frean M, Ravaud A. Correlations between disease-free survival (DFS) and overall survival (OS) in patients (pts) with renal cell carcinoma (RCC) at high risk for recurrence: Results from S-TRAC trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy283.090] [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: 11/14/2022] Open
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Abstract
Objective: The objective of this study was to assess rural-urban differences in caregiver use of and preferences for support services. Method: Using the 2015 Caregiving in the U.S. survey data (n = 1,389), we analyzed rural-urban differences by caregiver residence in use of and preferences for support services. We analyzed bivariate differences in service use and preferences, as well as in sociodemographic and caregiving relationship characteristics. We also assessed the correlates of service use using stratified ordered logistic regression models. Results: Approximately one third of all caregivers had used no supportive services, with few differences in service use and preference by location. For caregivers in both locations, having more financial strain was associated with greater use of services. Discussion: This article identifies broad needs for caregiver support across all geographic locations. Targeted efforts should be made to ensure access to supportive services accounting for unique barriers by geography.
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Affiliation(s)
| | - Megan Lahr
- 1 University of Minnesota, Minneapolis, USA
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35
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Patel A, Ravaud A, Motzer RJ, Pantuck AJ, Staehler MD, Escudier B, Martini JF, Krishnaswami S, Casey M, Lechuga M, Lin X, George DJ. Neutrophil-to-lymphocyte ratio as a potential prognostic factor of disease-free survival in high-risk renal cell carcinoma: Analysis of the S-TRAC trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.4562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Alain Ravaud
- Department of Medical Oncology, Hôpital Saint-André, University of Bordeaux-CHU, Bordeaux, France
| | | | - Allan J. Pantuck
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Michael D. Staehler
- University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - Bernard Escudier
- U1015 INSERM, Gustave Roussy Cancer Campus, Paris Saclay University, Villejuif, France
| | | | | | | | | | - Xun Lin
- Pfizer Oncology Inc., San Diego, CA
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Ravaud A, George DJ, Motzer RJ, Pantuck AJ, Staehler MD, Serfass L, Krishnaswami S, Casey M, DeAnnuntis LL, Lechuga M, Escudier B. Disease-free survival in patients at highest risk of recurrent renal cell carcinoma in S-TRAC. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.4565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Alain Ravaud
- Department of Medical Oncology, Hôpital Saint-André, University of Bordeaux-CHU, Bordeaux, France
| | | | | | - Allan J. Pantuck
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Michael D. Staehler
- University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
| | | | | | | | | | | | - Bernard Escudier
- U1015 INSERM, Gustave Roussy Cancer Campus, Paris Saclay University, Villejuif, France
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Potter C, Razafsky D, Wozniak D, Casey M, Penrose S, Ge X, Mahjoub MR, Hodzic D. The KASH-containing isoform of Nesprin1 giant associates with ciliary rootlets of ependymal cells. Neurobiol Dis 2018; 115:82-91. [PMID: 29630990 DOI: 10.1016/j.nbd.2018.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/14/2017] [Revised: 02/25/2018] [Accepted: 04/04/2018] [Indexed: 12/14/2022] Open
Abstract
Biallelic nonsense mutations of SYNE1 underlie a variable array of cerebellar and non-cerebellar pathologies of unknown molecular etiology. SYNE1 encodes multiple isoforms of Nesprin1 that associate with the nuclear envelope, with large cerebellar synapses and with ciliary rootlets of photoreceptors. Using two novel mouse models, we determined the expression pattern of Nesprin1 isoforms in the cerebellum whose integrity and functions are invariably affected by SYNE1 mutations. We further show that a giant isoform of Nesprin1 associates with the ciliary rootlets of ependymal cells that line brain ventricles and establish that this giant ciliary isoform of Nesprin1 harbors a KASH domain. Whereas cerebellar phenotypes are not recapitulated in Nes1gSTOP/STOP mice, these mice display a significant increase of ventricular volume. Together, these data fuel novel hypotheses about the molecular pathogenesis of SYNE1 mutations and support that KASH proteins may localize beyond the nuclear envelope in vivo.
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Affiliation(s)
- C Potter
- Department of Developmental Biology, Washington University School of Medicine, 660 S. Euclid Ave, St Louis, MO 63110, USA
| | - D Razafsky
- Department of Developmental Biology, Washington University School of Medicine, 660 S. Euclid Ave, St Louis, MO 63110, USA
| | - D Wozniak
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave, St Louis, MO 63110, USA
| | - M Casey
- Department of Developmental Biology, Washington University School of Medicine, 660 S. Euclid Ave, St Louis, MO 63110, USA
| | - S Penrose
- Department of Developmental Biology, Washington University School of Medicine, 660 S. Euclid Ave, St Louis, MO 63110, USA
| | - X Ge
- Department of Radiology, Washington University School of Medicine, 660 S. Euclid Ave, St Louis, MO 63110, USA
| | - M R Mahjoub
- Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, St Louis, MO 63110, USA
| | - D Hodzic
- Department of Developmental Biology, Washington University School of Medicine, 660 S. Euclid Ave, St Louis, MO 63110, USA.
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George DJ, Martini JF, Staehler MD, Chang YH, Breza J, Patard JJ, Motzer RJ, Magheli A, Carteni G, Donskov F, Escudier B, Li S, Casey M, Valota O, Laguerre B, Pantuck AJ, Pandha HS, Patel A, Lechuga M, Ravaud A. Phase III trial of adjuvant sunitinib in patients with high-risk renal cell carcinoma: Exploratory pharmacogenomic analysis. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
576 Background: In the phase III S-TRAC trial, adjuvant sunitinib (SU) prolonged disease-free survival (DFS) vs placebo (PBO) in patients with locoregional renal cell carcinoma at high risk of recurrence after nephrectomy (median 6.8 vs 5.6 y; hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.59–0.98; P= 0.03). An exploratory analysis evaluated associations between single nucleotide polymorphisms (SNPs) in angiogenesis-related genes and clinical outcomes in S-TRAC. Methods: Prospectively collected blood samples were genotyped for 10 SNPs and 1 insertion/deletion mutation with TaqMan assays. DFS was compared with a log-rank test for each SNP genotype in SU vs PBO arms and between SNP genotypes within each arm. P-values are unadjusted for multiplicity comparison. Results: Of 615 patients, 286 (142 SU; 144 PBO) were analyzed. There were generally no genotype frequency deviations from the Hardy-Weinberg equilibrium, but linkage disequilibrium was seen between VEGFA rs699947 and rs833061 on chromosome 6 (D′ = 1.000, r2 = 0.979). Longer DFS was observed with SU vs PBO for VEGFR1 rs9554320 C/C (median: not reached [NR] vs 5.56 y; HR 0.44, 95% CI 0.21–0.91; P= 0.023), VEGFR2 rs2071559 T/T (median: NR vs 4.47 y; HR 0.46, 95% CI 0.23–0.90; P= 0.020), and eNOS rs2070744 T/T (median: 7.07 vs 3.44 y; HR 0.53, 95% CI 0.30–0.94; P= 0.028), with a trend for VEGFR1 rs9582036 A/A (median: NR in both arms; P= 0.054) and SH3GL2 rs10963287 C/T (median: NR vs 5.35 y; P= 0.088). Shorter DFS was observed for VEGFR1 rs9582036 C/A vs C/C in the SU, PBO, and combined arms ( P< 0.05); for A/A vs common, the association was only seen in the SU arm ( P= 0.022). VEGFR1 rs9554320 A/C was associated with shorter DFS vs A/A in the PBO ( P= 0.038) and combined arm ( P= 0.006), with a trend in the SU arm ( P= 0.051). VEGFR2 rs1870377 T/T was associated with longer DFS vs A/A in the combined arms, but not in the PBO arm (n = 7 with A/A genotype in the SU arm precluded statistical tests). Conclusions: Correlations between common VEGFR1 and VEGFR2 SNPs and longer DFS with SU suggest germline SNPs are predictive of improved outcomes with adjuvant SU. Due to the exploratory nature of this analysis, prospective validation studies are needed to confirm these findings. Clinical trial information: NCT00375674.
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Affiliation(s)
| | | | - Michael D. Staehler
- University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
| | | | - Jan Breza
- Slovak Medical University in Bratislava, Bratislava, Slovakia
| | | | | | - Ahmed Magheli
- Charité Universitaetsmedizin Berlin, Berlin, Germany
| | | | | | | | - Sherry Li
- Pfizer Oncology Inc., Shanghai, China
| | | | | | | | - Allan J. Pantuck
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | | | - Anup Patel
- Spire Roding Hospital, London, United Kingdom
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George DJ, Pantuck AJ, Motzer RJ, Ravaud A, Escudier B, Staehler MD, Serfass L, Krishnaswami S, Casey M, Lechuga M, Koch G, Figlin RA. S-TRAC trial: Sensitivity analyses of disease-free survival (DFS). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.633] [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
633 Background: DFS has been frequently used as endpoint in the adjuvant setting and was the primary basis of approval for adjuvant cancer therapies. In S-TRAC, adjuvant sunitinib demonstrated a significant improvement of DFS vs. placebo in patients with locoregional renal cell carcinoma (RCC) based on blinded independent central review. DFS was defined as time from randomization until recurrence or death from any cause or second cancer. In the absence of a standard definition of DFS in RCC, multiple sensitivity analyses were performed to confirm the robustness of the DFS results from S-TRAC. Methods: Two analyses considered the time to recurrence including and excluding RCC specific deaths and contralateral kidney recurrence. Additional analyses used the same event and censoring rules as the primary analysis but considered earliest dates of relapse for equivocal new lesions later determined to be unequivocal -to align with RECIST 1.1 criteria for new lesions- and some alternative dates for secondary malignancies. Other sensitivity analyses evaluating alternative event and censoring rules as well as the imbalance in censoring in the first year in the primary analysis will also be presented. Results: The HR from select sensitivity analyses are presented in the Table. Conclusions: Results of sensitivity analyses with alternative definitions of DFS in S-TRAC demonstrated the robustness of the primary DFS analysis, with consistent HRs (0.76-0.81) favoring sunitinib. Clinical trial information: NCT00375674. [Table: see text]
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Affiliation(s)
| | - Allan J. Pantuck
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | | | - Alain Ravaud
- Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France
| | | | - Michael D. Staehler
- University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
| | | | | | | | | | - Gary Koch
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Robert A. Figlin
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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George DJ, Martini JF, Staehler M, Motzer RJ, Magheli A, Escudier B, Gerletti P, Li S, Casey M, Laguerre B, Pandha HS, Pantuck AJ, Patel A, Lechuga MJ, Ravaud A. Immune Biomarkers Predictive for Disease-Free Survival with Adjuvant Sunitinib in High-Risk Locoregional Renal Cell Carcinoma: From Randomized Phase III S-TRAC Study. Clin Cancer Res 2018; 24:1554-1561. [PMID: 29374054 DOI: 10.1158/1078-0432.ccr-17-2822] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/16/2017] [Accepted: 01/23/2018] [Indexed: 11/16/2022]
Abstract
Purpose: Adjuvant sunitinib therapy compared with placebo prolonged disease-free survival (DFS) in patients with locoregional high-risk renal cell carcinoma (RCC) in the S-TRAC trial (ClinicalTrials.gov number NCT00375674). A prospectively designed exploratory analysis of tissue biomarkers was conducted to identify predictors of treatment benefit.Experimental Design: Tissue blocks were used for immunohistochemistry (IHC) staining of programmed cell death ligand 1 (PD-L1), CD4, CD8, and CD68. DFS was compared between < versus ≥ median IHC parameter using the Kaplan-Meier method. For biomarkers with predictive potential, receiver operating characteristics curves were generated.Results: Baseline characteristics were similar in patients with (n = 191) and without (n = 419) IHC analysis. Among patients with IHC, longer DFS was observed in patients with tumor CD8+ T-cell density ≥ versus < median [median (95% CI), not reached (6.83-not reached) versus 3.47 years (1.73-not reached); hazard ratio (HR) 0.40 (95% CI, 0.20-0.81); P = 0.009] treated with sunitinib (n = 101), but not with placebo (n = 90). The sensitivity and specificity for CD8+ T-cell density in predicting DFS were 0.604 and 0.658, respectively. Shorter DFS was observed in placebo-treated patients with PD-L1+ versus PD-L1- tumors (HR 1.75; P = 0.103). Among all patients with PD-L1+ tumors, DFS was numerically longer with sunitinib versus placebo (HR 0.58; P = 0.175).Conclusions: Greater CD8+ T-cell density in tumor tissue was associated with longer DFS with sunitinib but not placebo, suggesting predictive treatment effect utility. Further independent cohort validation studies are warranted. The prognostic value of PD-L1 expression in primary tumors from patients with high-risk nonmetastatic RCC should also be further explored. Clin Cancer Res; 24(7); 1554-61. ©2018 AACR.
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Affiliation(s)
- Daniel J George
- Duke Cancer Institute, Division of Oncology, Durham, North Carolina.
| | | | | | - Robert J Motzer
- Memorial Sloan Kettering Cancer Center, Department of Oncology, New York, New York
| | - Ahmed Magheli
- Charité Universitaetsmedizin Berlin, Department of Urology, Berlin, Germany
| | - Bernard Escudier
- Institut Gustave Roussy, Department of Medical Oncology, Villejuif, France
| | | | | | | | | | - Hardev S Pandha
- University of Surrey, Department of Clinical and Experimental Medicine, Surrey, United Kingdom
| | - Allan J Pantuck
- Ronald Reagan UCLA Medical Center, Department of Urology, Los Angeles, California
| | - Anup Patel
- Spire Roding Hospital, London, United Kingdom
| | | | - Alain Ravaud
- Bordeaux University Hospital, Department of Medical Oncology, Bordeaux, France
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Wuytack F, Devane D, Stovold E, McDonnell M, Casey M, McDonnell TJ, Gillespie P, Raymakers A, Lacasse Y, McCarthy B. Comparison of outpatient and home-based exercise training programmes for COPD: A systematic review and meta-analysis. Respirology 2017; 23:272-283. [DOI: 10.1111/resp.13224] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/28/2017] [Accepted: 10/31/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Francesca Wuytack
- School of Nursing and Midwifery; National University of Ireland; Galway Ireland
| | - Declan Devane
- School of Nursing and Midwifery; National University of Ireland; Galway Ireland
| | - Elizabeth Stovold
- Cochrane Airways Group, Population Health Research Institute; St George’s University of London; London UK
| | - Melissa McDonnell
- Department of Respiratory Medicine; Galway University Hospital; Galway Ireland
| | - Michelle Casey
- Department of Respiratory Medicine; St. Vincent’s University Hospital; Dublin Ireland
| | - Timothy J. McDonnell
- Department of Respiratory Medicine; St. Vincent’s University Hospital; Dublin Ireland
| | - Paddy Gillespie
- Health Economics and Policy Analysis Centre, School of Business and Economics; National University of Ireland; Galway Ireland
| | - Adam Raymakers
- Health Economics and Policy Analysis Centre, School of Business and Economics; National University of Ireland; Galway Ireland
| | - Yves Lacasse
- Research Center Laval Hospital Institute of Cardiology and Pneumology; Laval University; Quebec Canada
| | - Bernard McCarthy
- School of Nursing and Midwifery; National University of Ireland; Galway Ireland
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Motzer RJ, Ravaud A, Patard JJ, Pandha HS, George DJ, Patel A, Chang YH, Escudier B, Donskov F, Magheli A, Carteni G, Laguerre B, Tomczak P, Breza J, Gerletti P, Lechuga M, Lin X, Casey M, Serfass L, Pantuck AJ, Staehler M. Adjuvant Sunitinib for High-risk Renal Cell Carcinoma After Nephrectomy: Subgroup Analyses and Updated Overall Survival Results. Eur Urol 2017; 73:62-68. [PMID: 28967554 DOI: 10.1016/j.eururo.2017.09.008] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/07/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Adjuvant sunitinib significantly improved disease-free survival (DFS) versus placebo in patients with locoregional renal cell carcinoma (RCC) at high risk of recurrence after nephrectomy (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.59-0.98; p=0.03). OBJECTIVE To report the relationship between baseline factors and DFS, pattern of recurrence, and updated overall survival (OS). DESIGN, SETTING, AND PARTICIPANTS Data for 615 patients randomized to sunitinib (n=309) or placebo (n=306) in the S-TRAC trial. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Subgroup DFS analyses by baseline risk factors were conducted using a Cox proportional hazards model. Baseline risk factors included: modified University of California Los Angeles integrated staging system criteria, age, gender, Eastern Cooperative Oncology Group performance status (ECOG PS), weight, neutrophil-to-lymphocyte ratio (NLR), and Fuhrman grade. RESULTS AND LIMITATIONS Of 615 patients, 97 and 122 in the sunitinib and placebo arms developed metastatic disease, with the most common sites of distant recurrence being lung (40 and 49), lymph node (21 and 26), and liver (11 and 14), respectively. A benefit of adjuvant sunitinib over placebo was observed across subgroups, including: higher risk (T3, no or undetermined nodal involvement, Fuhrman grade ≥2, ECOG PS ≥1, T4 and/or nodal involvement; hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.55-0.99; p=0.04), NLR ≤3 (HR 0.72, 95% CI 0.54-0.95; p=0.02), and Fuhrman grade 3/4 (HR 0.73, 95% CI 0.55-0.98; p=0.04). All subgroup analyses were exploratory, and no adjustments for multiplicity were made. Median OS was not reached in either arm (HR 0.92, 95% CI 0.66-1.28; p=0.6); 67 and 74 patients died in the sunitinib and placebo arms, respectively. CONCLUSIONS A benefit of adjuvant sunitinib over placebo was observed across subgroups. The results are consistent with the primary analysis, which showed a benefit for adjuvant sunitinib in patients at high risk of recurrent RCC after nephrectomy. PATIENT SUMMARY Most subgroups of patients at high risk of recurrent renal cell carcinoma after nephrectomy experienced a clinical benefit with adjuvant sunitinib. TRIAL REGISTRATION ClinicalTrials.gov NCT00375674.
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Affiliation(s)
- Robert J Motzer
- Department of Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Alain Ravaud
- Department of Medical Oncology, Bordeaux University Hospital, Bordeaux, France
| | | | - Hardev S Pandha
- Department of Clinical and Experimental Medicine and Department of Microbial Sciences, University of Surrey, Guildford, UK
| | | | | | - Yen-Hwa Chang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bernard Escudier
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Frede Donskov
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Ahmed Magheli
- Department of Urology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Giacomo Carteni
- Division of Oncology and Division of Urology, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, Naples, Italy
| | | | - Piotr Tomczak
- Klinika Onkologii Oddzial Chemioterapii, Poznan, Poland
| | - Jan Breza
- Department of Urology, Slovak Medical University in Bratislava, Bratislava, Slovakia
| | | | | | - Xun Lin
- Pfizer Inc., La Jolla, CA, USA
| | | | | | - Allan J Pantuck
- Department of Urology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Michael Staehler
- Department of Urology, University Hospital of Munich, Munich, Germany
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Henning-Smith C, Prasad S, Casey M, Kozhimannil K, Moscovice I. Rural-Urban Differences in Medicare Quality Scores Persist After Adjusting for Sociodemographic and Environmental Characteristics. J Rural Health 2017; 35:58-67. [DOI: 10.1111/jrh.12261] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/21/2017] [Accepted: 07/17/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Carrie Henning-Smith
- Division of Health Policy and Management, Rural Health Research Center; University of Minnesota School of Public Health; Minneapolis Minnesota
| | - Shailendra Prasad
- Department of Family Medicine and Community Health; University of Minnesota School of Medicine; Minneapolis Minnesota
| | - Michelle Casey
- Division of Health Policy and Management, Rural Health Research Center; University of Minnesota School of Public Health; Minneapolis Minnesota
| | - Katy Kozhimannil
- Division of Health Policy and Management, Rural Health Research Center; University of Minnesota School of Public Health; Minneapolis Minnesota
| | - Ira Moscovice
- Division of Health Policy and Management, Rural Health Research Center; University of Minnesota School of Public Health; Minneapolis Minnesota
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Jurczak W, Ramanathan S, Giri P, Romano A, Mocikova H, Clancy J, Lechuga M, Casey M, Boni J, Giza A, Hess G. Comparison of two doses of intravenous temsirolimus in patients with relapsed/refractory mantle cell lymphoma. Leuk Lymphoma 2017; 59:670-678. [PMID: 28768446 DOI: 10.1080/10428194.2017.1357175] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Temsirolimus 175 mg once-weekly for 3 weeks, followed by 75 mg once-weekly intravenously dosed (175/75 mg) is approved in the European Union for treatment of relapsed/refractory mantle cell lymphoma (MCL). A phase IV study explored whether similar efficacy, but improved safety could be achieved with 75 mg without 175 mg loading doses (ClinicaTrials.gov: NCT01180049). Patients with relapsed/refractory MCL were randomized to once-weekly temsirolimus 175/75 mg (n = 47) or 75 mg (n = 42). Treatment continued until objective disease progression. Primary endpoint: progression-free survival (PFS). Secondary endpoints included overall survival (OS) and adverse events (AEs). Median PFS was 4.3 versus 4.5 months (hazard ratio [HR] 0.731; 80% confidence interval [CI], 0.520-1.027), and median OS 18.7 versus 11.0 months (HR 0.681; 80% CI, 0.472-0.982) with 175/75 mg versus 75 mg. There were fewer patients with serious AEs, dose reduction, or death with 175/75 mg (57.4%, 48.9%, and 48.9%) versus 75 mg (73.8%, 64.3%, and 65.1%). Temsirolimus 175/75 mg remains the preferred dosing regimen for relapsed/refractory MCL.
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Affiliation(s)
- Wojciech Jurczak
- a Department of Haematology , Jagiellonian University , Kraków , Poland
| | - Sundra Ramanathan
- b Haematology Department , Cancer Care Centre, The St George Hospital , Kogarah , Australia
| | - Pratyush Giri
- c Lyell McEwin Hospital (LMH), Royal Adelaide Hospital (RAH) , Adelaide , Australia
| | - Alessandra Romano
- d Division of Hematology , A.O.U. Policlinico-Vittorio Emanuele, University of Catania , Catania , Italy
| | - Heidi Mocikova
- e Department of Clinical Hematology , University Hospital Královské Vinohrady, Third Faculty of Medicine, Charles University in Prague , Prague , Czech Republic
| | - Jill Clancy
- f inVentiv Health Clinical , Princeton , NJ , USA
| | | | | | | | - Agnieszka Giza
- a Department of Haematology , Jagiellonian University , Kraków , Poland
| | - Georg Hess
- i Department of Hematology/Oncology , Johannes Gutenberg University , Mainz , Germany
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Curneen JMG, Casey M, Laird E. The relationship between protein quantity, BMD and fractures in older adults. Ir J Med Sci 2017; 187:111-121. [PMID: 28674746 DOI: 10.1007/s11845-017-1642-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 02/15/2017] [Accepted: 05/26/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Previously, no large-scale literature reviews have focussed on the relationship between dietary protein and its impact on bone mineral density (BMD) and fracture risk-as measures of bone health-in older adults and its potential impact as a primary prevention tool. AIMS The aim of this study was to assess the impact of varying dietary protein levels on bone health. METHODS A literature review of trials concerning older adults' (>50 years of age) and animals' varying protein intake in the diet and its effect on BMD (human and animal) and fracture risk (human only) was carried out. Additionally, a review of dietary assessment tools used in these studies was also analysed. RESULTS Ten out of fourteen trials assessing BMD and dietary protein quantity in humans and 3/4 in animal trials found a positive relationship between these two parameters. Four out of seven trials investigating the relationship between dietary protein quantity and fracture risk displayed a positive, protective effect of dietary protein levels on fracture risk. Sixty-two percent of studies used the Food-Frequency Questionnaire assessment method. DISCUSSION Increased protein intake in the diet is beneficial to bone health and reduces morbidity and mortality. The importance of using dietary protein, along with calcium and vitamin D, as a primary preventative strategy should be stressed, given the health and cost benefits that this would deliver, with a possible need for a higher level of protein in the diet of an elderly person than what is currently recommended.
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Affiliation(s)
- J M G Curneen
- University College Dublin, Belfield, Dublin 4, County Dublin, Ireland.
| | - M Casey
- Department of Geriatric Medicine, St James' Hospital, James' Street, Dublin 8, County Dublin, Ireland.
| | - E Laird
- Trinity College School of Biochemistry and Immunology, St James' Hospital, James' Street, Dublin 8, County Dublin, Ireland
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Jamieson I, Sims D, Casey M, Wilkinson K, Osborne R. Utilising the Canterbury Dedicated Education Unit model of teaching and learning to support graduate nurses. ACTA ACUST UNITED AC 2017. [DOI: 10.36951/ngpxnz.2017.008] [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: 12/01/2022]
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George DJ, Martini JF, Chang YH, Staehler M, Breza J, Patard JJ, Motzer RJ, Magheli A, Escudier B, Carteni G, Gerletti P, Li S, Casey M, Laguerre B, Pandha HS, Pantuck AJ, Patel A, Lechuga M, Ravaud A. Abstract 1771: Phase 3 trial of adjuvant sunitinib in patients with high-risk renal cell carcinoma: exploratory molecular analysis of tumor biomarkers. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-1771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Adjuvant therapy with sunitinib (SU) compared with placebo (PBO) prolonged disease-free survival (DFS) in patients (pts) with loco-regional high-risk renal cell carcinoma (HR=0.76, 95% CI: 0.59-0.98; P=0.03; median[m] DFS, 6.8 vs 5.6 years). Here, we report the results of a retrospective exploratory molecular biomarker analysis using nephrectomy biospecimens from the S-TRAC trial.
Materials and Methods: Formalin-fixed paraffin-embedded tumor tissue blocks from patients who provided informed consent were used for immunohistochemistry (IHC) staining of PD-L1, CD4, CD8, and CD68. Biomarker quantification was done by automated image analysis of the regions of interest (ROI). The analysis algorithm utilized an immunoscore approach applied to ROI, reflecting assessment of both the center and invasive margin of tumors (for PD-L1 and CD8 staining). DFS was compared between biomarker stratum by < median vs ≥ median values of a particular IHC parameter using Kaplan-Meier (K-M) analysis. Receiver Operating Characteristics (ROC) curves were generated to further assess the potential clinical utility of biomarkers for which significant (P < 0.05) results were obtained in K-M analysis.
Results: In total, 191/615 (101, SU and 90, PBO) pts in the intent-to-treat population were included for IHC analysis. Baseline characteristics were similar in the subpopulations with and without IHC data. Shorter DFS was observed in the PBO group for pts with PD-L1+ vs PD-L1- tumors, although not statistically significant (HR=1.75; 95% CI: 0.89-3.46; P=0.103). In pts with PD-L1+ tumors, DFS was numerically longer for SU vs PBO (mDFS=6.17 vs 2.67 years) (HR=0.58; 95% CI: 0.26-1.29; P=0.175). In the SU group, pts with CD8+ T-cell density ≥ median (cutoff=269.5 CD8+ cells/mm2) had longer DFS (mDFS=not reached [NR]; 95% CI: 6.83-NR) than pts with CD8+ T-cell density < median (mDFS=3.47 years; 95% CI: 1.73-NR), and the difference was statistically significant (HR=0.40, 95% CI: 0.20-0.81; P=0.009), while CD8+ T-cell density showed no significant difference in DFS for PBO pts (HR=0.80, 95% CI: 0.42-1.50; P=0.484). The sensitivity and specificity for CD8+ T-cell density in predicting DFS were 0.604 and 0.658, respectively, and the optimal cutoff was 222.22 cells/mm2 with an area under ROC curve of 0.622.
Conclusions: Increased density of CD8+ T-cells in tumor tissue was associated with longer DFS in SU-randomized pts but not PBO, suggesting this may be predictive of treatment effect. Further validation in an independent cohort is warranted. The prognostic value of PD-L1 expression in primary tumors from patients with high-risk non-metastatic RCC should be further explored.
Citation Format: Daniel J. George, Jean-Francois Martini, Yen-Hwa Chang, Michael Staehler, Jan Breza, Jean-Jacques Patard, Robert J. Motzer, Ahmed Magheli, Bernard Escudier, Giacomo Carteni, Paola Gerletti, Sherry Li, Michelle Casey, Brigitte Laguerre, Hardev S. Pandha, Allan J. Pantuck, Anup Patel, Maria Lechuga, Alain Ravaud. Phase 3 trial of adjuvant sunitinib in patients with high-risk renal cell carcinoma: exploratory molecular analysis of tumor biomarkers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1771. doi:10.1158/1538-7445.AM2017-1771
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Affiliation(s)
| | | | | | | | - Jan Breza
- 5Slovak Medical University, Slovakia
| | | | | | | | | | - Giacomo Carteni
- 10Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, Italy
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FitzGerald W, Crowe B, Brennan P, Cassidy JP, Leahy M, McElroy MC, Casey M, Waller A, Mitchell C. Acute fatal haemorrhagic pneumonia caused by Streptococcus equi zooepidemicus in greyhounds in Ireland with subsequent typing of the isolates. Vet Rec 2017; 181:119. [PMID: 28600445 DOI: 10.1136/vr.104275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2017] [Indexed: 11/03/2022]
Affiliation(s)
- W FitzGerald
- Limerick Regional Veterinary Laboratory, Knockalisheen, Limerick, Ireland
| | - B Crowe
- Limerick Regional Veterinary Laboratory, Knockalisheen, Limerick, Ireland
| | - P Brennan
- Limerick Regional Veterinary Laboratory, Knockalisheen, Limerick, Ireland
| | - J P Cassidy
- Department of Veterinary Pathobiology, School of Veterinary Medicine, Belfield, Dublin 4, Ireland
| | - M Leahy
- Arra Veterinary Clinic, Tipperary, Co Tipperary, Ireland
| | - M C McElroy
- Central Veterinary Research Laboratory, Backweston, Celbridge, Co. Kildare, Ireland
| | - M Casey
- Central Veterinary Research Laboratory, Backweston, Celbridge, Co. Kildare, Ireland
| | - A Waller
- Department of Bacteriology, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk CB8 7UU, UK
| | - C Mitchell
- Department of Bacteriology, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk CB8 7UU, UK
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Rini BI, Hutson TE, Figlin RA, Lechuga M, Valota O, Serfass L, Casey M, Motzer RJ. Sunitinib in patients with metastatic renal cell carcinoma: Clinical outcome according to IMDC risk group. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.4584] [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
4584 Background: In a phase III study (NCT00083889), treatment-naïve patients (pts) with metastatic renal cell carcinoma (mRCC) of all prognostic risk groups were treated with sunitinib or interferon-α (IFN-α). Since sunitinib has become the reference standard of care and serves as the comparator in multiple randomized trials sometimes restricted to prespecified risk groups, a retrospective analysis of outcome according to prognostic group from the phase III study was performed. Methods: Investigator-assessed efficacy data were analyzed for pts based on risk group (International mRCC Database Consortium [IMDC] criteria). The objective was to determine objective response rate (ORR), median progression-free survival (mPFS), and median overall survival (mOS) benchmarks by risk group. Results: Of sunitinib-treated pts, 134 were favorable, 205 were intermediate, and 34 were poor risk. The median sunitinib treatment duration/median number of cycles was 16.7 mo/12 cycles, 11.0 mo/8 cycles and 2.6 mo/2.0 cycles for favorable-, intermediate-, and poor-risk pts, respectively. ORR, PFS, and OS benchmarks for sunitinib-treated pts are shown in the Table. In sunitinib-treated intermediate-risk pts with 1 vs 2 risk factors, respectively: ORR was 43.3% vs 40.8%, mPFS (95% confidence interval [95% CI]) was 11.2 (9.7–13.6) vs 8.5 (5.6–10.7) mo, and mOS (95% CI) was 28.2 (23.0–not estimable) vs 16.3 (13.2–19.4) mo. Conclusions: This retrospective analysis provides ORR, PFS, and OS benchmarks for current and future clinical trial interpretation in mRCC pts with different prognostic risk treated with sunitinib. [Table: see text]
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Affiliation(s)
- Brian I. Rini
- Cleveland Clinic Taussig Cancer Insitute, Cleveland, OH
| | | | - Robert A. Figlin
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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50
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Pantuck A, Patard JJ, Patel A, Ravaud A, Motzer RJ, Pandha HS, George DJ, Chang YH, Escudier B, Donskov F, Magheli A, Carteni G, Laguerre B, Tomczak P, Breza J, Gerletti P, Lechuga M, Lin X, Casey M, Staehler M. PD04-02 ADJUVANT SUNITINIB IN PATIENTS WITH HIGH RISK RENAL CELL CARCINOMA: SUBGROUP ANALYSES FROM S-TRAC TRIAL. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jan Breza
- Bratislava, Slovakia(Slovak Republic)
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