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Ohri N, Jolly S, Cooper BT, Kabarriti R, Bodner WR, Klein J, Guha C, Viswanathan S, Shum E, Sabari JK, Cheng H, Gucalp RA, Castellucci E, Qin A, Gadgeel SM, Halmos B. Selective Personalized RadioImmunotherapy for Locally Advanced Non-Small-Cell Lung Cancer Trial (SPRINT). J Clin Oncol 2024; 42:562-570. [PMID: 37988638 DOI: 10.1200/jco.23.00627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/25/2023] [Accepted: 09/29/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE Standard therapy for locally advanced non-small-cell lung cancer (LA-NSCLC) is concurrent chemoradiotherapy followed by adjuvant durvalumab. For biomarker-selected patients with LA-NSCLC, we hypothesized that sequential pembrolizumab and risk-adapted radiotherapy, without chemotherapy, would be well-tolerated and effective. METHODS Patients with stage III NSCLC or unresectable stage II NSCLC and an Eastern Cooperative Oncology Group performance status of 0-1 were eligible for this trial. Patients with a PD-L1 tumor proportion score (TPS) of ≥50% received three cycles of induction pembrolizumab (200 mg, once every 21 days), followed by a 20-fraction course of risk-adapted thoracic radiotherapy (55 Gy delivered to tumors or lymph nodes with metabolic volume exceeding 20 cc, 48 Gy delivered to smaller lesions), followed by consolidation pembrolizumab to complete a 1-year treatment course. The primary study end point was 1-year progression-free survival (PFS). Secondary end points included response rates after induction pembrolizumab, overall survival (OS), and adverse events. RESULTS Twenty-five patients with a PD-L1 TPS of ≥50% were enrolled. The median age was 71, most patients (88%) had stage IIIA or IIIB disease, and the median PD-L1 TPS was 75%. Two patients developed disease progression during induction pembrolizumab, and two patients discontinued pembrolizumab after one infusion because of immune-related adverse events. Using RECIST criteria, 12 patients (48%) exhibited a partial or complete response after induction pembrolizumab. Twenty-four patients (96%) received definitive thoracic radiotherapy. The 1-year PFS rate is 76%, satisfying our efficacy objective. One- and 2-year OS rates are 92% and 76%, respectively. The most common grade 3 adverse events were colitis (n = 2, 8%) and esophagitis (n = 2, 8%), and no higher-grade treatment-related adverse events have occurred. CONCLUSION Pembrolizumab and risk-adapted radiotherapy, without chemotherapy, are a promising treatment approach for patients with LA-NSCLC with a PD-L1 TPS of ≥50%.
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Affiliation(s)
- Nitin Ohri
- Department of Radiation Oncology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Benjamin T Cooper
- Department of Radiation Oncology, Perlmutter Cancer Center, New York University Grossman School of Medicine, New York, NY
| | - Rafi Kabarriti
- Department of Radiation Oncology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | - William R Bodner
- Department of Radiation Oncology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | - Jonathan Klein
- Department of Radiation Oncology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | - Chandan Guha
- Department of Radiation Oncology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | - Shankar Viswanathan
- Department of Epidemiology and Population Health, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | - Elaine Shum
- Division of Medical Oncology, Department of Medicine, Perlmutter Cancer Center, New York University Grossman School of Medicine, New York, NY
| | - Joshua K Sabari
- Division of Medical Oncology, Department of Medicine, Perlmutter Cancer Center, New York University Grossman School of Medicine, New York, NY
| | - Haiying Cheng
- Department of Oncology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | - Rasim A Gucalp
- Department of Oncology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | - Enrico Castellucci
- Department of Oncology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
| | - Angel Qin
- Department of Internal Medicine, Division of Hematology-Oncology, University of Michigan, Ann Arbor, MI
| | - Shirish M Gadgeel
- Department of Internal Medicine, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI
| | - Balazs Halmos
- Department of Oncology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY
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Ohri N, Jolly S, Cooper BT, Kabarriti R, Bodner WR, Klein J, Viswanathan S, Shum E, Sabari JK, Cheng H, Gucalp RA, Castellucci E, Qin A, Gadgeel SM, Halmos B. The Selective Personalized Radio-immunotherapy for Locally Advanced NSCLC Trial (SPRINT): Initial results. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.8510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8510 Background: Standard therapy for unresectable locally advanced non-small cell lung cancer (LA-NSCLC) is concurrent chemoradiotherapy followed by adjuvant durvalumab. We performed a prospective trial testing sequential pembrolizumab and risk-adapted radiotherapy without chemotherapy for biomarker-selected LA-NSCLC patients. Methods: Patients with stage III NSCLC or unresectable stage II NSCLC, ECOG performance status 0-1, and no contraindications to protocol-specified therapy were eligible for this trial. Subjects with PD-L1 tumor proportion score (TPS) ≥ 50% underwent baseline FDG-PET/CT, received three cycles of induction pembrolizumab (200 mg, every 21 days), underwent restaging FDG-PET/CT, received risk-adapted thoracic radiotherapy (55 Gy delivered to tumors or lymph nodes with metabolic tumor volume exceeding 20 cc and 48 Gy delivered to smaller lesions, all in 20 daily fractions), and then received up to 13 cycles of additional pembrolizumab. The primary study endpoint was one-year progression-free survival (PFS). Here we report response rates following induction pembrolizumab, PFS and overall survival (OS) rates, and adverse event rates (CTCAE v. 4.03). Results: Twenty-five subjects with PD-L1 TPS ≥ 50% from three institutions were enrolled between August 2018 and November 2021. Median age was 71 (interquartile range [IQR] 62 to 77). One subject had stage II disease, 13 had stage IIIA disease, nine had stage IIIB disease, and two had stage IIIC disease. Median PD-L1 TPS was 75% (IQR 60 to 80%). Two subjects (8%) developed disease progression during induction pembrolizumab, and two subjects discontinued pembrolizumab after one infusion due to immune-related adverse events. Using RECIST 1.1 criteria, 12 subjects (48%) exhibited a partial (n = 11) or complete (n = 1) response following induction pembrolizumab on CT. Using PERCIST criteria, 12 subjects (48%) exhibited a partial response following induction pembrolizumab on PET. Four subjects had responses on PET but not on CT, and four had responses on CT but not on PET. With a median follow-up duration of 13 months, the actuarial 1-year PFS rate is 74%, and the actuarial 1-year OS rate is 95%. Grade 3 adverse events have been limited to single cases of anemia, arthritis, diarrhea, esophagitis, and pneumonitis, and no grade 4-5 adverse events have occurred. Exploratory analyses suggest that response to induction pembrolizumab on PET predicts efficacy of this treatment approach, with a 1-year PFS rate of 100% for responders, compared to 61% for non-responders (logrank p = 0.007). Conclusions: Treatment with pembrolizumab and risk-adapted radiotherapy is a promising treatment approach for LA-NSCLC patients with PD-L1 TPS ≥ 50%. Response on PET following induction pembrolizumab may be useful for identifying patients who can be treated successfully without chemotherapy. Clinical trial information: NCT03523702.
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Affiliation(s)
- Nitin Ohri
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | | | - Benjamin T. Cooper
- Perlmutter Cancer Center, New York University School of Medicine, New York, NY
| | - Rafi Kabarriti
- Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, NY
| | | | - Jonathan Klein
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Shankar Viswanathan
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Elaine Shum
- Perlmutter Cancer Center, NYU Langone Health, New York, NY
| | | | - Haiying Cheng
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Rasim A. Gucalp
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Enrico Castellucci
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Angel Qin
- University of Michigan, Rogel Cancer Center, Ann Arbor, MI
| | | | - Balazs Halmos
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
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Ohri N, Halmos B, Garg M, Levsky JM, Cheng H, Gucalp RA, Bodner WR, Kabarriti R, Berkowitz A, Yellin MJ, Keler T, Kalnicki S, Guha C. FLT3 ligand (CDX-301) and stereotactic radiotherapy for advanced non-small cell lung cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.9618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9618 Background: In a murine non-small cell lung cancer (NSCLC) model, we demonstrated synergy between localized radiotherapy and the dendritic cell growth factor fms-like tyrosine kinase 3 (FLT3) ligand. We now present results from a phase II study testing this combination in patients with advanced and treatment-refractory NSCLC. Methods: Advanced NSCLC patients with multifocal active disease after at least one line of systemic therapy and ECOG performance status 0-2 received 5 daily subcutaneous injections of CDX-301 (75 µg/kg) concurrent with stereotactic body radiotherapy (SBRT, 30-54 Gy in 1-5 fractions based on target size and location) directed at a single site of disease. Additional “cycles” of SBRT and CDX-301 could be administered at least four months after the initial study treatment, at the discretion of the treating physicians. The primary endpoint was progression-free survival four months after treatment initiation (PFS4), with a hypothesis that the PFS4 rate would exceed 40%. Secondary endpoints included overall survival (OS) duration, responses on PET (PERCIST criteria) and CT (RECIST criteria), and dose-limiting toxicities (grade ≥3 adverse events within 30 days). Lesions targeted with SBRT were excluded from response assessments. The intended sample size was 29 subjects. Blood samples were obtained for flow cytometry and other analyses of immune activation. Results: Twenty-nine subjects received study therapy between October 2016 and January 2020. Subjects received a median of 3 lines (range: 1-5) of systemic therapy prior to study enrollment, including immune checkpoint inhibitors targeting the PD-1/PD-L1 axis in 26 subjects (90%). At the time of this analysis, the actuarial PFS4 rate is 60%, which exceeds our pre-specified efficacy objective. With a median follow-up duration for living patients of 12 months, the actuarial 12-month OS rate is 55%. Partial response of lesions not targeted with SBRT (“abscopal effect”) was observed in 9 subjects (31%) using PET criteria and in 4 subjects (14%) using CT criteria. Seven subjects (24%) received a second course of SBRT and CDX-301 after initial study therapy. No dose-limiting toxicities have been observed. Only six subjects (21%) have received additional chemotherapy or immunotherapy after study treatment. Conclusions: The combination of CDX-301 and SBRT is well-tolerated and has activity as systemic therapy for advanced NSCLC. Additional studies to maximize the efficacy of this in situ vaccination approach with the addition of an agonist anti-CD40 antibody (CDX-1140) are planned. Clinical trial information: NCT02839265 .
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Affiliation(s)
- Nitin Ohri
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Balazs Halmos
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Madhur Garg
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Jeffrey M Levsky
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Haiying Cheng
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Rasim A. Gucalp
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | | | - Rafi Kabarriti
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Aviva Berkowitz
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | | | | | - Shalom Kalnicki
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Chandan Guha
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
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D'Aiello A, Gucalp RA, Tabatabaie V, Cheng H, Bloomgarden NA, Halmos B. Thyroid dysfunction in lung cancer patients treated with immune checkpoint inhibitors (ICI): Role of race, gender, and concurrent chemotherapy in a multiethnic urban cohort. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e21622] [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
e21622 Background: Immune-related adverse events (irAE) associated with ICI have been reported, but remain poorly understood. We sought to characterize patterns of thyroid dysfunction—one of the most common irAE—in a large cohort of ethnically-diverse lung cancer patients treated with ICI. Methods: A retrospective chart review of lung cancer patients receiving an anti-PD1 or PD-L1 agent from January 2016 to July 2019 was performed. Subjects included had normal baseline thyroid function. Thyrotoxicosis and hypothyroidism was defined as thyroid-stimulating hormone level less than 0.4 and greater than 4.6, respectively. Time to event analysis with inverted Kaplan Meier curves and log-rank tests were used to compare thyroid dysfunction among race, gender, and treatment subgroups. Results: We identified 256 subjects: 206 had normal baseline thyroid function and 76 went on to develop thyroid dysfunction. Rates of thyroid dysfunction by one year occurred at similar frequencies among all races. Thyrotoxicosis occurred at significantly higher rates in Black (25, 31.7%) than in White (8, 12.9%) and Hispanic (7, 16.7%) subjects. In contrast, hypothyroidism occurred more often in White (13, 21.0%) and Hispanic (18, 42.9%) than in Black (12, 15.2%) subjects. Gender and concurrent chemotherapy showed no significant association with thyroid dysfunction. Of subjects with thyrotoxicosis (N = 42), hypothyroidism followed in 33.3% (N = 14) with 1 subject receiving methimazole and 13 levothyroxine. In those subjects, median time to thyrotoxicosis and hypothyroidism was 4.0 and 7.2 weeks, respectively. Conclusions: Despite the higher prevalence of non-ICI-related thyroid disease among females and the anticipated immunosuppressive effect of chemotherapy, neither gender nor chemotherapy correlated with thyroid dysfunction; however, race did. Black subjects exhibited significantly higher rates of thyrotoxicosis. Our findings are consistent with prior research showing that thyrotoxicosis, including Graves’ disease, occurs more often in Blacks. While the pathogenesis of ICI-related thyroid dysfunction is unclear, the early onset of thyrotoxicosis demonstrated by our study calls for careful monitoring, especially for particular races. [Table: see text]
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Affiliation(s)
- Angelica D'Aiello
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Rasim A. Gucalp
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Vafa Tabatabaie
- Department of Endocrinology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Haiying Cheng
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Noah A. Bloomgarden
- Department of Endocrinology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Balazs Halmos
- Department of Medical Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
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Sukrithan V, Sandler J, Gucalp RA, Gralla RJ, Halmos B. Responses to immune checkpoint therapy in pulmonary sarcomatoid carcinoma: A retrospective review. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.8_suppl.115] [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: 12/30/2022] Open
Abstract
115 Background: Advanced Pulmonary Sarcomatoid Carcinoma (PSC) is associated with poor response to chemotherapy and a median survival of 4-6 months. PSC have a high frequency of PD-L1 positivity and high tumor mutational burden, which are markers of benefit with immune checkpoint inhibitors (ICPI). The parameters of response and survival for PSC treated in the era of immune checkpoint inhibition are unknown. Methods: A review of all cases of advanced PSC diagnosed at two institutions in Bronx, NY between 6/2015-6/2018 was performed. Responses were assessed by serial imaging obtained during routine care and graded by RECIST criteria v 1.1. Results: Five cases of advanced Stage IV PSC are reported. The median age was 57 years and all had received ICPI. All cases were smokers with a median of 30 pack-years and TPS > 75%. Three patients received Pembrolizumab as front-line therapy. Responses were seen in four out of five patients, including one complete response. The fifth patient had prolonged disease stability. After a median follow-up of 13 months, none of the patients had progressed. One patient died of infectious complications after 23 months with no evidence of progression. Four patients continue to be alive with ongoing OS ranging between 14-33 months. Conclusions: ICPI therapy has robust activity in advanced PSC and offers an effective line of therapy in this treatment-refractory aggressive malignancy. [Table: see text]
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Affiliation(s)
- Vineeth Sukrithan
- Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, NY
| | - Jason Sandler
- Department of Internal Medicine, Montefiore Medical Center, New York, NY
| | - Rasim A. Gucalp
- Department of Medical Oncology, Montefiore Medical Center, Bronx, NY
| | - Richard J. Gralla
- Albert Einstein College of Medicine-Jacobi Medical Center, Bronx, NY
| | - Balazs Halmos
- Department of Oncology, Montefiore/Albert Einstein Cancer Center, Bronx, NY
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Su CT, Bhargava A, Shah CD, Halmos B, Gucalp RA, Packer SH, Ohri N, Haramati LB, Perez-Soler R, Cheng H. Screening Patterns and Mortality Differences in Patients With Lung Cancer at an Urban Underserved Community. Clin Lung Cancer 2018; 19:e767-e773. [PMID: 29937386 DOI: 10.1016/j.cllc.2018.05.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 08/29/2017] [Revised: 05/16/2018] [Accepted: 05/28/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND The landmark National Lung Screening Trial demonstrated significant reduction in lung cancer-related mortality. However, European lung cancer screening (LCS) trials have not confirmed such benefit. We examined LCS patterns and determined the impact of LCS-led diagnosis on the mortality of newly diagnosed patients with lung cancer in an underserved community. PATIENTS AND METHODS Medical records of patients diagnosed with primary lung cancer in 2013 through 2016 (n = 855) were reviewed for primary care provider (PCP) status and LCS eligibility and completion, determined using United States Preventative Services Task Force guidelines. Univariate analyses of patient characteristics were conducted between LCS-eligible patients based on screening completion. Survival analyses were conducted using Kaplan-Meier and multivariate Cox regression. RESULTS In 2013 through 2016, 175 patients with primary lung cancer had an established PCP and were eligible for LCS. Among them, 19% (33/175) completed screening prior to diagnosis. LCS completion was associated with younger age (P = .02), active smoking status (P < .01), earlier stage at time of diagnosis (P < .01), follow-up in-network cancer treatment (P = .03), and surgical management (P < .01). LCS-eligible patients who underwent screening had improved all-cause mortality compared with those not screened (P < .01). Multivariate regression showed surgery (hazard ratio, 0.31; P = .04) significantly affected mortality. CONCLUSION To our knowledge, this is the first study to assess LCS patterns and mortality differences on patients with screen-detected lung cancer in an urban underserved setting since the inception of United States Preventative Services Task Force guidelines. Patients with a LCS-led diagnosis had improved mortality, likely owing to cancer detection at earlier stages with curative treatment, which echoes the finding of prospective trials.
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Affiliation(s)
- Christopher T Su
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Amit Bhargava
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Chirag D Shah
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Balazs Halmos
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Rasim A Gucalp
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Stuart H Packer
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Nitin Ohri
- Department of Radiation Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Linda B Haramati
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY; Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Roman Perez-Soler
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Haiying Cheng
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
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Su C, Chau V, Halmos B, Shah CD, Gucalp RA, Packer SH, Wilson K, Perez-Soler R, Cheng H. The impact of primary care access on mortality in lung cancer patients from Bronx, New York. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18614] [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)
| | | | | | - Chirag D Shah
- Department of Pulmonary Medicine, Montefiore Medical Center, Bronx, NY
| | - Rasim A. Gucalp
- Department of Medical Oncology, Montefiore Medical Center, Bronx, NY
| | | | - Kevin Wilson
- Montefiore Medical Center, Health Information Management, Bronx, NY
| | - Roman Perez-Soler
- Department of Medical Oncology, Montefiore Medical Center, Bronx, NY
| | - Haiying Cheng
- Department of Medical Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
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Attarian S, Janakiram M, Ezzati A, Gucalp RA. Dimethyl sulfoxide (DMSO) cryopreserved stem cell infusion-related seizures: A single institution experience. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e19002] [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
e19002 Background: An essential step in hematopoietic stem cell transplantation (HSCT) is the cryopreservation of stem cells in DMSO. Neurologic complications related to DMSO are well known and include strokes, seizures, encephalopathy and coma, but risk factors have not been identified. We focused on seizures as a DMSO-related neurologic adverse event. Methods: From 1/2006 to 4/2016, 982 cases of HSCT were reviewed. We identified neurologic adverse events within 24h of stem cell infusion (SCI). Results: 16 cases of neurologic adverse events occurred, including transient paresthesias (2), altered mental status (5), syncope (3), stroke (1), and 5 seizures. The mean age of the patients (pt) was 64.2 years (range 52-79), with 2 females and 3 males. All 5 pts developed seizures during SCI. 4 pts had conditioning: 2 Melphalan, 1 BEAM and 1 Bu/Cy. One pt received SCI without conditioning as a last resort to treat severe neutropenia and overwhelming sepsis. Of these 5 cases, one had a prior history of seizures in the setting of primary CNS lymphoma and 1 had a prior history of stroke, and 1 pt had an acute stroke during SCI. These 3 cases had abnormal EEG with a potential focus for seizure. Conclusions: Understanding the predisposing factors for developing seizures with SCI will improve patient safety and outcomes. History of structural brain lesions or seizure may be a risk factor for development of seizures. Applying prophylactic strategies, such as DMSO removal or prophylactic antiepileptic medications prior to SCI may decrease the risk of seizures. [Table: see text]
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Affiliation(s)
- Shirin Attarian
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Murali Janakiram
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Ali Ezzati
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Rasim A. Gucalp
- Department of Medical Oncology, Montefiore Medical Center, Bronx, NY
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Shum E, Su C, Zhu C, Gucalp RA, Haigentz M, Packer SH, Baker C, Eng Y, Ravera E, Browne R, Perez-Soler R, Halmos B, Cheng H. PD-L1 expression profile and immunotherapy (IO) experience in African American (AA) and Hispanic (H) lung cancer (LC) patients: Addressing disparities at a minority-based academic cancer center. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e18073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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
e18073 Background: Immune checkpoint inhibitors have changed the treatment paradigm for metastatic LC. Minority populations are under-represented in large IO clinical trials. Among 989 pts with newly diagnosed LC at Montefiore Medical Center - a community-based academic center from 2014-2015, 330 (33%) were AA and 195 (20%) were H. In line with practice-changing clinical studies, PD-L1 expression testing and IO have been incorporated into LC treatment. Methods: Pts receiving IO and/or had PD-L1 testing between 1/1/14-12/31/16 were identified from records obtained from pathology, pharmacy, oncology clinics and Clinical Looking Glass. Retrospective chart review was conducted. PD-L1 testing was performed using 22C3pharmDx IHC. Results: We identified 111 pts with LC who received IO and/or had PD-L1 testing, with a median age of 66. 55% were female. Based on race, 52 (47%) were AA, 24 (22%) were White, 26 (24%) were Other, and 9 (8%) were race unknown. Based on ethnicity, 30 (27%) were H, 73 (66%) were non-H and 8 (7%) were ethnicity unknown. 82% were former/current smokers. Adenocarcinoma was the dominant histology (60%). The majority were EGFR WT (91%) and ALK neg (98%). PD-L1 testing was performed in 67 (60%), including 32 (29%) AAs and 20 (18%) Hs. Archival tissue was used in 63%. PD-L1 TPS > 50% was found in 30%, 1-49% in 24%, < 1% in 37%. 62 pts received IO, including 26 (42%) AAs and 18 (29%) Hs. Nivolumab was the most commonly used agent (77%). In AAs, 8 (31%) received IO as 1st line, 13 (50%) as 2nd line, 5 (19%) as 3rd line and above. In Hs, 1 (5%) received IO as 1st line, 10 (56%) as 2nd line, 7 (39%) as 3rd line and above. Immune-related adverse events (IRAEs) were reported in 31% of AAs and 39% of Hs. Data analysis on survival is ongoing. Conclusions: Unlike the low numbers of minority pts in large clinical trials, we found no significant difference in PD-L1 testing and IO across racial and ethnic groups treated at our center. Compared to large clinical trials, we observed lower rates of IRAEs in our cohort. Our current and ongoing observations in these populations may have future implications in narrowing health disparities based on race/ethnicity.
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Affiliation(s)
- Elaine Shum
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | | | - Changcheng Zhu
- Montefiore Medical Center, Department of Pathology, Bronx, NY
| | - Rasim A. Gucalp
- Department of Medical Oncology, Montefiore Medical Center, Bronx, NY
| | - Missak Haigentz
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | | | | | - Yoko Eng
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | | | | | - Roman Perez-Soler
- Department of Medical Oncology, Montefiore Medical Center, Bronx, NY
| | - Balazs Halmos
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
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Su C, Chau V, Bhargava A, Shah CD, Ohri N, Gucalp RA, Packer SH, Perez-Soler R, Halmos B, Cheng H. Improving lung cancer diagnosis at a large urban minority-based medical center: Where can we do better? J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e18017] [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
e18017 Background: Lung cancer diagnosis is a complex process with barriers to care which are more apparent in underserved communities. We examined factors affecting lung cancer diagnosis in an underserved urban community, including demographics, lung cancer screening, and survival outcomes. Methods: All new lung cancer diagnoses with confirmed pathology at an urban academic medical center in 2015 were identified. Retrospective chart review was conducted and time from initial abnormal imaging to tissue sampling was calculated. Analyses were performed with χ2, ANOVA, linear regression, and log-rank tests. Results: In 2015, 229 patients were diagnosed with lung cancer. 36 patients (16%) expired or were referred to hospice due to clinical deterioration without treatment. 162 patients (71%) were ultimately started on therapy. Patients were predominantly Black (38%), Hispanic (30%), underserved (mean per capita income $21729), and enrolled in Medicare or Medicaid (83%). Only 62% of the patients had a PCP at time of diagnosis. Most presented at an advanced stage (63% III or IV) and 88% were former/current smokers. 78 patients (48%) were eligible for low-dose CT screening but only 9 (12%) completed screening. Screening completion was correlated with established PCP (p = 0.012). Time from abnormal imaging to biopsy was 31±40 days without significant difference across age, gender, race, ethnicity, income, insurance, and primary language. Cancers diagnosed in the inpatient vs. outpatient setting were found at a more advanced stage (p = 0.002) and had lower survival (p < 0.001). Hispanics had better survival (p = 0.008) despite lower per capita income and higher incidence of smoking. Conclusions: There was no significant difference in imaging to biopsy time across major demographic factors and they are unlikely to be a source of poor outcomes. However, the advanced stage and poor prognosis of cancers detected in the inpatient setting, proportion of patients who expired or were referred to hospice immediately after presentation, and disparity between screening eligible and completed patients underscores the critical importance of increasing lung cancer screening and establishment of primary care.
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Affiliation(s)
| | | | | | - Chirag D Shah
- Department of Pulmonary Medicine, Montefiore Medical Center, Bronx, NY
| | - Nitin Ohri
- Albert Einstein College of Medicine, New York, NY
| | - Rasim A. Gucalp
- Department of Medical Oncology, Montefiore Medical Center, Bronx, NY
| | | | - Roman Perez-Soler
- Department of Medical Oncology, Montefiore Medical Center, Bronx, NY
| | - Balazs Halmos
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
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Shum E, Halmos B, Cheng H, Perez-Soler R, Gucalp RA, Packer SH, Keller SM, Bhargava A, Eng Y, Ravera E, Baker C, Viswanathan S, Na C, Gajavelli S, Browne R, Haigentz M. Vinorelbine-induced phlebitis is common in patients receiving adjuvant chemotherapy for non-small cell lung cancer (NSCLC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e20016] [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)
- Elaine Shum
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Balazs Halmos
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | | | - Roman Perez-Soler
- Department of Medical Oncology, Montefiore Medical Center, Bronx, NY
| | - Rasim A. Gucalp
- Department of Medical Oncology, Montefiore Medical Center, Bronx, NY
| | | | - Steven M. Keller
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY
| | | | - Yoko Eng
- Montefiore Medical Center Albert Einstein College of Medicine, Bronx, NY
| | | | - Cheryl Baker
- Montefiore Einstein Center for Cancer Care, Bronx, NY
| | - Shankar Viswanathan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Cecilia Na
- Albert Einstein College of Medicine, Bronx, NY
| | | | | | - Missak Haigentz
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
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12
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Yang Y, Sharma JN, Halmos B, Gucalp RA, Haigentz M, Packer SH, Keller SM, Zhu C, Perez-Soler R, Cheng H. Unusual pattern of KRAS mutations in inner city patients with NSCLC. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e20033] [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)
| | | | - Balazs Halmos
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Rasim A. Gucalp
- Department of Medical Oncology, Montefiore Medical Center, Bronx, NY
| | - Missak Haigentz
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | | | - Steven M. Keller
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY
| | - Changcheng Zhu
- Montefiore Medical Center Department of Pathology, Bronx, NY
| | - Roman Perez-Soler
- Department of Medical Oncology, Montefiore Medical Center, Bronx, NY
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13
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Akinboro O, Bernhardt B, Hantman IR, Pomerantz D, Basak P, Gucalp RA, Jesmajian S, Phillips E. Trends and correlates of secondhand smoke exposure among non-smoking cancer survivors in the United States: 1999-2012. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10105] [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)
| | | | | | | | | | - Rasim A. Gucalp
- Department of Medical Oncology, Montefiore Medical Center, Bronx, NY
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14
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Li T, Piperdi B, Walsh WV, Kim M, Beckett LA, Wen H, Zhou K, Gucalp RA, Haigentz M, Bathini VG, Gajavelli S, Sreedhara M, Lara P, Gandara DR, Perez-Soler R. Pharmacodynamic separation (PDS) of pemetrexed (Pem) and erlotinib (Erl) in patients (pts) with advanced, EGFR wild-type (wt) Non-Small Cell Lung Cancer (NSCLC): A randomized phase II trial. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- Tianhong Li
- UC Davis Comprehensive Cancer Center, Sacramento, CA
| | | | | | - Mimi Kim
- Department of Epidemiology, Bronx, NY
| | - Laurel A. Beckett
- Department of Public Health Sciences, University of California, Davis, Davis, CA
| | - Huiyu Wen
- UC Davis Comprehensive Cancer Center, Sacramento, CA
| | - Kaili Zhou
- UC Davis Comprehensive Cancer Center, Sacramento, CA
| | - Rasim A. Gucalp
- Department of Medical Oncology, Montefiore Medical Center, Bronx, NY
| | - Missak Haigentz
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | | | | | - Meera Sreedhara
- Division of Hematology Oncology, Department of Internal Medicine, Worcester, MA
| | - Primo Lara
- UC Davis Comprehensive Cancer Center, Sacramento, CA
| | - David R. Gandara
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | - Roman Perez-Soler
- Department of Medical Oncology, Montefiore Medical Center, Bronx, NY
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15
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Akinboro O, Olorunfemi O, Hantman IR, Basak P, Phillips E, Pomerantz D, Bernhardt B, Gucalp RA, Jesmajian S. Household secondhand smoke exposure among community-dwelling cancer survivors in the United States. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9568] [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)
| | | | | | | | | | | | | | - Rasim A. Gucalp
- Department of Medical Oncology, Montefiore Medical Center, Bronx, NY
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16
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Cheng H, Inal C, Yang Y, Gucalp RA, Haigentz M, Packer SH, Zhu C, Wilson K, Perez-Soler R. EGFR mutation pattern in African American population in a community-based academic center. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8069] [Citation(s) in RCA: 2] [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)
| | | | | | - Rasim A. Gucalp
- Department of Medical Oncology, Montefiore Medical Center, Bronx, NY
| | - Missak Haigentz
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | | | - Changcheng Zhu
- Montefiore Medical Center Department of Pathology, Bronx, NY
| | - Kevin Wilson
- Montefiore Medical Center, Health Information Management, Bronx, NY
| | - Roman Perez-Soler
- Department of Medical Oncology, Montefiore Medical Center, Bronx, NY
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17
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Inal C, Yilmaz E, Cheng H, Zhu C, Pullman J, Gucalp RA, Keller SM, Perez-Soler R, Piperdi B. Effect of reflex testing by pathologists on molecular testing rates in lung cancer patients: Experience from a community-based academic center. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.8098] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Cengiz Inal
- Montefiore Medical Center Department of Medical Oncology, Bronx, NY
| | - Emrullah Yilmaz
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Haiying Cheng
- Department of Medical Oncology, Montefiore Medical Center, Bronx, NY
| | - Changcheng Zhu
- Montefiore Medical Center Department of Pathology, Bronx, NY
| | - James Pullman
- Montefiore Medical Center Department of Pathology, Bronx, NY
| | - Rasim A. Gucalp
- Montefiore Medical Center Department of Medical Oncology, Bronx, NY
| | - Steven M. Keller
- Montefiore Medical Center Department of Cardiovascular & Thoracic Surgery, Bronx, NY
| | | | - Bilal Piperdi
- Montefiore Medical Center Department of Medical Oncology, Bronx, NY
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18
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Hu MIN, Glezerman I, Leboulleux S, Insogna KL, Gucalp RA, Misiorowski W, Yu BW, Zorsky P, Tosi D, Bessudo A, Jaccard A, Tonini G, Wang H, Braun A, Jain RK. Denosumab for the treatment of bisphosphonate-refractory hypercalcemia of malignancy (HCM). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e20512] [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
e20512 Background: HCM, caused primarily by tumor-induced bone resorption, is treated with intravenous (IV) bisphosphonates (BisP), but patients (pts) can relapse or become refractory. Denosumab binds to RANK ligand (RANKL) to inhibit osteoclast-mediated bone resorption. Methods: In this single-arm, open-label, proof-of-concept study, pts with HCM (corrected serum calcium [CSC] >12.5 mg/dL [CTCAE grade ≥3]) despite IV BisP treatment ≥7 and ≤30 days before screening received subcutaneous denosumab 120 mg on days 1, 8, 15, and 28, then every 4 weeks. The primary endpoint was the proportion of pts with CSC ≤11.5 mg/dL (CTCAE grade ≤1) within 10 days of denosumab initiation. Results: The study enrolled33 pts (64% men; mean age 60 years; 76% with advanced solid tumors, 39% with bone metastases [BM]), with a median (25th, 75th percentile [Q1, Q3]) follow-up of 56 (18, 79) days. Median (Q1, Q3) baseline CSC was 13.7 (13.2, 14.2) mg/dL; 19 pts (58%) had HCM symptoms. Median (Q1, Q3) time from last BisP treatment to first dose was 17 (13, 22) days. At day 10, 21 pts (64%) reached CSC ≤11.5 mg/dL, including 54% of pts with BM and 70% without BM. Over the course of the study, 23 pts (70%) reached CSC ≤11.5 mg/dL, by a median (95% confidence interval [CI]) of 9 (5–19) days. A complete response (CSC ≤10.8 mg/dL, as defined by previous studies) occurred in 12 pts (36%) at day 10, and in 21 pts (64%) during the study, by a median (95% CI) of 23 (11–43) days. Among pts who reached CSC ≤11.5 mg/dL, the median (95% CI) duration of response was 104 (9–not estimable) days. The most frequently reported serious adverse events were worsening of HCM (5 pts, 15%) and dyspnea (3 pts, 9%). Two pts had isolated episodes of CSC levels ≤8.0 mg/dL (CTCAE grade 2); no pts had CSC <7.0 mg/dL (grade 3). No osteonecrosis of the jaw was reported. Conclusions: In this study of pts with HCM despite recent IV BisP treatment, denosumab effectively lowered serum calcium to grade ≤1 in 64% of pts within 10 days, and induced durable responses. These findings are particularly meaningful given that pts entered this study with grade ≥3 HCM within a median 17 days after receiving IV BisP. No unexpected safety findings were identified. Denosumab may offer a new treatment option for HCM in these pts. Clinical trial information: NCT00896454.
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Affiliation(s)
- Mimi I-Nan Hu
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ilya Glezerman
- Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | | | | | | | - Waldemar Misiorowski
- Endocrinology Department, Medical Center for Postgraduate Education, Warsaw, Poland
| | | | - Paul Zorsky
- Peninsula Regional Medical Center, Salisbury, MD
| | - Diego Tosi
- Centre Val d'Aurelle Paul Lamarque, Montpellier, France
| | - Alberto Bessudo
- California Cancer Associates for Research and Excellence, Encinitas, CA
| | - Arnaud Jaccard
- Centre Hospitalier Universitaire de Limoges - Hôpital Dupuytren, Limoges, France
| | - Giuseppe Tonini
- Department of Medical Oncology, Università Campus Bio-Medico, Rome, Rome, Italy
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