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Joseph A, Vantanasiri K, Draganov PV, King W, Maluf-Filho F, Al-Haddad M, Albunni H, Fukami N, Mohapatra S, Aihara H, Sharma NR, Chak A, Yang D, Singh R, Jang S, Kamath S, Raja S, Murthy S, Yang Q, Iyer P, Bhatt A. Endoscopic submucosal dissection with versus without traction for pathologically staged T1B esophageal cancer: a multicenter retrospective study. Gastrointest Endosc 2024; 99:694-701. [PMID: 38042205 DOI: 10.1016/j.gie.2023.11.047] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/05/2023] [Accepted: 11/21/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND AND AIMS Positive vertical margins (VMs) are common after endoscopic submucosal dissection (ESD) of T1b esophageal cancer (EC) and are associated with an increased risk of recurrence. Traction during ESD provides better exposure of the submucosa and may allow deeper dissection, potentially reducing the risk of positive VMs. We conducted a retrospective multicenter study to compare the proportion of resections with positive VMs in ESD performed with versus without traction in pathologically staged T1b EC. METHODS Patients who underwent ESD revealing T1b EC (squamous or adenocarcinoma) at 10 academic tertiary referral centers in the United States (n = 9) and Brazil (n = 1) were included. Demographic and clinical data were abstracted. ESD using either traction techniques (tunneling, pocket) or traction devices (clip line, traction wire) were classified as ESD with traction (Tr-ESD) and those without were classified as conventional ESD without traction. The primary outcome was a negative VM. Multivariable logistic regression was used to assess associations with negative VMs. RESULTS A total of 166 patients with pathologically staged T1b EC underwent Tr-ESD (n = 63; 38%) or conventional ESD without traction (n = 103; 62%). Baseline factors were comparable between both groups. On multivariable analysis, Tr-ESD was found to be independently associated with negative VMs (odds ratio, 2.25; 95% confidence interval, 1.06-4.91; P = .037) and R0 resection (odds ratio, 2.83; 95% confidence interval, 1.33-6.23; P = .008). CONCLUSION Tr-ESD seems to be associated with higher odds of negative VMs than ESD without traction for pathologically staged T1b EC, and future well-conducted prospective studies are warranted to establish the findings of the current study.
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Affiliation(s)
- Abel Joseph
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kornpong Vantanasiri
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter V Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - William King
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Fauze Maluf-Filho
- Instituto do Cancer do Estado de São Paulo, Sao Paulo, Brazil; Department of Gastroenterology of University of Sao Paulo, Sao Paulo, São Paulo, Brazil; National Council for Scientific and Technological Development, Lago Sul, Brazil
| | | | - Hashem Albunni
- Department of Gastroenterology, Indiana University, Indianapolis, USA
| | - Norio Fukami
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Sonmoon Mohapatra
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Neil R Sharma
- Division of Interventional Oncology and Surgical Endoscopy, Parkview Cancer Institute, Fort Wayne, Indianapolis, USA
| | - Amitabh Chak
- Digestive Health Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Dennis Yang
- Department of Gastroenterology and Hepatology, Advent Health, Orlando, Florida, USA
| | - Rituraj Singh
- Division of Interventional Oncology and Surgical Endoscopy, Parkview Cancer Institute, Fort Wayne, Indianapolis, USA
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Suneel Kamath
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Siva Raja
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sudish Murthy
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Qijun Yang
- Section of Biostatistics, Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Prasad Iyer
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Amit Bhatt
- Digestive Health Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Fares S, Wehrle CJ, Hong H, Sun K, Jiao C, Zhang M, Gross A, Allkushi E, Uysal M, Kamath S, Ma WW, Modaresi Esfeh J, Linganna MW, Khalil M, Pita A, Kim J, Walsh RM, Miller C, Hashimoto K, Schlegel A, Kwon DCH, Aucejo F. Emerging and Clinically Accepted Biomarkers for Hepatocellular Carcinoma. Cancers (Basel) 2024; 16:1453. [PMID: 38672535 PMCID: PMC11047909 DOI: 10.3390/cancers16081453] [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: 02/21/2024] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death and the sixth most diagnosed malignancy worldwide. Serum alpha-fetoprotein (AFP) is the traditional, ubiquitous biomarker for HCC. However, there has been an increasing call for the use of multiple biomarkers to optimize care for these patients. AFP, AFP-L3, and prothrombin induced by vitamin K absence II (DCP) have described clinical utility for HCC, but unfortunately, they also have well established and significant limitations. Circulating tumor DNA (ctDNA), genomic glycosylation, and even totally non-invasive salivary metabolomics and/or micro-RNAS demonstrate great promise for early detection and long-term surveillance, but still require large-scale prospective validation to definitively validate their clinical validity. This review aims to provide an update on clinically available and emerging biomarkers for HCC, focusing on their respective clinical strengths and weaknesses.
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Affiliation(s)
- Sami Fares
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.F.); (H.H.); (K.S.); (C.J.); (M.Z.); (A.G.); (E.A.); (M.U.); (M.K.); (A.P.); (J.K.); (R.M.W.); (K.H.); (A.S.); (D.C.H.K.)
| | - Chase J. Wehrle
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.F.); (H.H.); (K.S.); (C.J.); (M.Z.); (A.G.); (E.A.); (M.U.); (M.K.); (A.P.); (J.K.); (R.M.W.); (K.H.); (A.S.); (D.C.H.K.)
| | - Hanna Hong
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.F.); (H.H.); (K.S.); (C.J.); (M.Z.); (A.G.); (E.A.); (M.U.); (M.K.); (A.P.); (J.K.); (R.M.W.); (K.H.); (A.S.); (D.C.H.K.)
| | - Keyue Sun
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.F.); (H.H.); (K.S.); (C.J.); (M.Z.); (A.G.); (E.A.); (M.U.); (M.K.); (A.P.); (J.K.); (R.M.W.); (K.H.); (A.S.); (D.C.H.K.)
| | - Chunbao Jiao
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.F.); (H.H.); (K.S.); (C.J.); (M.Z.); (A.G.); (E.A.); (M.U.); (M.K.); (A.P.); (J.K.); (R.M.W.); (K.H.); (A.S.); (D.C.H.K.)
| | - Mingyi Zhang
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.F.); (H.H.); (K.S.); (C.J.); (M.Z.); (A.G.); (E.A.); (M.U.); (M.K.); (A.P.); (J.K.); (R.M.W.); (K.H.); (A.S.); (D.C.H.K.)
| | - Abby Gross
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.F.); (H.H.); (K.S.); (C.J.); (M.Z.); (A.G.); (E.A.); (M.U.); (M.K.); (A.P.); (J.K.); (R.M.W.); (K.H.); (A.S.); (D.C.H.K.)
| | - Erlind Allkushi
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.F.); (H.H.); (K.S.); (C.J.); (M.Z.); (A.G.); (E.A.); (M.U.); (M.K.); (A.P.); (J.K.); (R.M.W.); (K.H.); (A.S.); (D.C.H.K.)
| | - Melis Uysal
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.F.); (H.H.); (K.S.); (C.J.); (M.Z.); (A.G.); (E.A.); (M.U.); (M.K.); (A.P.); (J.K.); (R.M.W.); (K.H.); (A.S.); (D.C.H.K.)
| | - Suneel Kamath
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.K.); (W.W.M.)
| | - Wen Wee Ma
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.K.); (W.W.M.)
| | - Jamak Modaresi Esfeh
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (J.M.E.); (M.W.L.)
| | - Maureen Whitsett Linganna
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (J.M.E.); (M.W.L.)
| | - Mazhar Khalil
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.F.); (H.H.); (K.S.); (C.J.); (M.Z.); (A.G.); (E.A.); (M.U.); (M.K.); (A.P.); (J.K.); (R.M.W.); (K.H.); (A.S.); (D.C.H.K.)
| | - Alejandro Pita
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.F.); (H.H.); (K.S.); (C.J.); (M.Z.); (A.G.); (E.A.); (M.U.); (M.K.); (A.P.); (J.K.); (R.M.W.); (K.H.); (A.S.); (D.C.H.K.)
| | - Jaekeun Kim
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.F.); (H.H.); (K.S.); (C.J.); (M.Z.); (A.G.); (E.A.); (M.U.); (M.K.); (A.P.); (J.K.); (R.M.W.); (K.H.); (A.S.); (D.C.H.K.)
| | - R. Matthew Walsh
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.F.); (H.H.); (K.S.); (C.J.); (M.Z.); (A.G.); (E.A.); (M.U.); (M.K.); (A.P.); (J.K.); (R.M.W.); (K.H.); (A.S.); (D.C.H.K.)
| | - Charles Miller
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.F.); (H.H.); (K.S.); (C.J.); (M.Z.); (A.G.); (E.A.); (M.U.); (M.K.); (A.P.); (J.K.); (R.M.W.); (K.H.); (A.S.); (D.C.H.K.)
| | - Koji Hashimoto
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.F.); (H.H.); (K.S.); (C.J.); (M.Z.); (A.G.); (E.A.); (M.U.); (M.K.); (A.P.); (J.K.); (R.M.W.); (K.H.); (A.S.); (D.C.H.K.)
| | - Andrea Schlegel
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.F.); (H.H.); (K.S.); (C.J.); (M.Z.); (A.G.); (E.A.); (M.U.); (M.K.); (A.P.); (J.K.); (R.M.W.); (K.H.); (A.S.); (D.C.H.K.)
| | - David Choon Hyuck Kwon
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.F.); (H.H.); (K.S.); (C.J.); (M.Z.); (A.G.); (E.A.); (M.U.); (M.K.); (A.P.); (J.K.); (R.M.W.); (K.H.); (A.S.); (D.C.H.K.)
| | - Federico Aucejo
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.F.); (H.H.); (K.S.); (C.J.); (M.Z.); (A.G.); (E.A.); (M.U.); (M.K.); (A.P.); (J.K.); (R.M.W.); (K.H.); (A.S.); (D.C.H.K.)
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Wehrle CJ, Raj R, Aykun N, Orabi D, Estfan B, Kamath S, Krishnamurthi S, Fujiki M, Hashimoto K, Quintini C, Kwon DCH, Diago-Uso T, Sasaki K, Aucejo FN. Correction to "Liquid Biopsy by ctDNA in Liver Transplantation for Colorectal Cancer Liver Metastasis" [J Gastrointest Surg. 2023;27(7):1498-509]. J Gastrointest Surg 2024; 28:336. [PMID: 38445929 DOI: 10.1016/j.gassur.2024.01.029] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Chase J Wehrle
- Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States.
| | - Roma Raj
- Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Nihal Aykun
- Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Danny Orabi
- Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Bassam Estfan
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Suneel Kamath
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Smitha Krishnamurthi
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Masato Fujiki
- Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Koji Hashimoto
- Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Cristiano Quintini
- Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - David Choon Hyuck Kwon
- Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Teresa Diago-Uso
- Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Kazunari Sasaki
- Department of Surgery - Abdominal Transplantation, Stanford Hospital and Clinics, Palo Alto, California, United States
| | - Federico N Aucejo
- Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
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Hong H, Wehrle CJ, Zhang M, Fares S, Stitzel H, Garib D, Estfan B, Kamath S, Krishnamurthi S, Ma WW, Kuzmanovic T, Azzato E, Yilmaz E, Modaresi Esfeh J, Linganna MW, Khalil M, Pita A, Schlegel A, Kim J, Walsh RM, Miller C, Hashimoto K, Kwon DCH, Aucejo F. Circulating Tumor DNA Profiling in Liver Transplant for Hepatocellular Carcinoma, Cholangiocarcinoma, and Colorectal Liver Metastases: A Programmatic Proof of Concept. Cancers (Basel) 2024; 16:927. [PMID: 38473290 DOI: 10.3390/cancers16050927] [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: 01/26/2024] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Circulating tumor DNA (ctDNA) is emerging as a promising, non-invasive diagnostic and surveillance biomarker in solid organ malignancy. However, its utility before and after liver transplant (LT) for patients with primary and secondary liver cancers is still underexplored. METHODS Patients undergoing LT for hepatocellular carcinoma (HCC), cholangiocarcinoma (CCA), and colorectal liver metastases (CRLM) with ctDNA testing were included. CtDNA testing was conducted pre-transplant, post-transplant, or both (sequential) from 11/2019 to 09/2023 using Guardant360, Guardant Reveal, and Guardant360 CDx. RESULTS 21 patients with HCC (n = 9, 43%), CRLM (n = 8, 38%), CCA (n = 3, 14%), and mixed HCC/CCA (n = 1, 5%) were included in the study. The median follow-up time was 15 months (range: 1-124). The median time from pre-operative testing to surgery was 3 months (IQR: 1-4; range: 0-5), and from surgery to post-operative testing, it was 9 months (IQR: 2-22; range: 0.4-112). A total of 13 (62%) patients had pre-transplant testing, with 8 (62%) having ctDNA detected (ctDNA+) and 5 (32%) not having ctDNA detected (ctDNA-). A total of 18 (86%) patients had post-transplant testing, 11 (61%) of whom were ctDNA+ and 7 (33%) of whom were ctDNA-. The absolute recurrence rates were 50% (n = 5) in those who were ctDNA+ vs. 25% (n = 1) in those who were ctDNA- in the post-transplant setting, though this difference was not statistically significant (p = 0.367). Six (29%) patients (HCC = 3, CCA = 1, CRLM = 2) experienced recurrence with a median recurrence-free survival of 14 (IQR: 6-40) months. Four of these patients had positive post-transplant ctDNA collected following diagnosis of recurrence, while one patient had positive post-transplant ctDNA collected preceding recurrence. A total of 10 (48%) patients had sequential ctDNA testing, of whom n = 5 (50%) achieved ctDNA clearance (+/-). The remainder were ctDNA+/+ (n = 3, 30%), ctDNA-/- (n = 1, 10%), and ctDNA-/+ (n = 1, 11%). Three (30%) patients showed the acquisition of new genomic alterations following transplant, all without recurrence. Overall, the median tumor mutation burden (TMB) decreased from 1.23 mut/Mb pre-transplant to 0.00 mut/Mb post-transplant. CONCLUSIONS Patients with ctDNA positivity experienced recurrence at a higher rate than the ctDNA- patients, indicating the potential role of ctDNA in predicting recurrence after curative-intent transplant. Based on sequential testing, LT has the potential to clear ctDNA, demonstrating the capability of LT in the treatment of systemic disease. Transplant providers should be aware of the potential of donor-derived cell-free DNA and improved approaches are necessary to address such concerns.
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Affiliation(s)
- Hanna Hong
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Chase J Wehrle
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Mingyi Zhang
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Sami Fares
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Henry Stitzel
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - David Garib
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Bassam Estfan
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Suneel Kamath
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Smitha Krishnamurthi
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Wen Wee Ma
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Teodora Kuzmanovic
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Elizabeth Azzato
- Molecular Pathology and Cytogenomics, Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Emrullah Yilmaz
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Jamak Modaresi Esfeh
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Maureen Whitsett Linganna
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Mazhar Khalil
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Alejandro Pita
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Andrea Schlegel
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Jaekeun Kim
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - R Matthew Walsh
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Charles Miller
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Koji Hashimoto
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - David Choon Hyuck Kwon
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Federico Aucejo
- Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Barot SV, Sangwan N, Nair KG, Schmit SL, Xiang S, Kamath S, Liska D, Khorana AA. Distinct intratumoral microbiome of young-onset and average-onset colorectal cancer. EBioMedicine 2024; 100:104980. [PMID: 38306898 PMCID: PMC10850116 DOI: 10.1016/j.ebiom.2024.104980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND The unexplained rise of young-onset CRC (yoCRC, age <50 years) is of concern. Evidence suggests that microbial dysbiosis may be a contributing factor, but the tumor microbial profile of yoCRC in comparison to average-onset CRC (aoCRC, age >60) has not been fully investigated. METHODS 16S rRNA amplicon sequencing was performed in tumor and paired adjacent non-malignant fresh frozen tissue specimens prospectively collected from 136 yoCRC and 140 aoCRC patients. Phyloseq, microbiomeSeq, metagenomeSeq, and NetComi were utilized for bioinformatics analysis. Statistical tests included Fisher's exact test, ANOVA, PERMANOVA with Bonferroni correction, linear regression, and Wilcoxon test. p-value <0.05 was considered statistically significant. FINDINGS yoCRC patients were more likely to have left-sided (72.8 vs. 54.3%), rectal (36.7% vs. 25%), and stage IV (28% vs. 15%) tumors. yoCRC tumors had significantly higher microbial alpha diversity (p = 1.5 × 10-5) and varied beta diversity (R2 = 0.31, p = 0.013) than aoCRC tumors. yoCRC tumors were enriched with Akkermansia and Bacteroides, whereas aoCRC tumors showed greater relative abundances of Bacillus, Staphylococcus, Listeria, Enterococcus, Pseudomonas, Fusobacterium, and Escherichia/Shigella. Akkermansia had a predominantly negative correlation with the microbial communities in yoCRC tumors. yoCRC and aoCRC tumors had distinct microbial profiles associated with tumor location, sidedness, stage, and obesity. Fusobacterium (R2 = -0.23, p = 0.001) and Akkermansia (R2 = 0.05, p = 0.001) abundance correlated with overall survival in yoCRC. INTERPRETATION Our study provides a comprehensive understanding of the microbial perturbations in yoCRC tumors. We identify microbial candidates that may highlight a distinct pathogenesis of yoCRC and serve as preventive, diagnostic, and therapeutic targets. FUNDING Sondra and Stephen Hardis Chair in Oncology Research (A.A.K.).
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Affiliation(s)
- Shimoli V Barot
- Cleveland Clinic Taussig Cancer Institute, Department of Hematology-Oncology, USA
| | - Naseer Sangwan
- Shared Laboratory Resources (SLR), Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kanika G Nair
- Cleveland Clinic Taussig Cancer Institute, Department of Hematology-Oncology, USA; Case Comprehensive Cancer Center, Cleveland, OH, USA; Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, OH, USA
| | - Stephanie L Schmit
- Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, OH, USA; Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Population and Cancer Prevention Program, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Shao Xiang
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Suneel Kamath
- Cleveland Clinic Taussig Cancer Institute, Department of Hematology-Oncology, USA; Case Comprehensive Cancer Center, Cleveland, OH, USA; Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, OH, USA
| | - David Liska
- Case Comprehensive Cancer Center, Cleveland, OH, USA; Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, OH, USA; Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alok A Khorana
- Cleveland Clinic Taussig Cancer Institute, Department of Hematology-Oncology, USA; Case Comprehensive Cancer Center, Cleveland, OH, USA; Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, OH, USA.
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6
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Li Y, Wu S, Zhao Y, Dinh T, Jiang D, Selfridge JE, Myers G, Wang Y, Zhao X, Tomchuck S, Dubyak G, Lee RT, Estfan B, Shapiro M, Kamath S, Mohamed A, Huang SCC, Huang AY, Conlon R, Krishnamurthi S, Eads J, Willis JE, Khorana AA, Bajor D, Wang Z. Neutrophil extracellular traps induced by chemotherapy inhibit tumor growth in murine models of colorectal cancer. J Clin Invest 2024; 134:e175031. [PMID: 38194275 PMCID: PMC10904055 DOI: 10.1172/jci175031] [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: 08/22/2023] [Accepted: 01/05/2024] [Indexed: 01/10/2024] Open
Abstract
Neutrophil extracellular traps (NETs), a web-like structure of cytosolic and granule proteins assembled on decondensed chromatin, kill pathogens and cause tissue damage in diseases. Whether NETs can kill cancer cells is unexplored. Here, we report that a combination of glutaminase inhibitor CB-839 and 5-FU inhibited the growth of PIK3CA-mutant colorectal cancers (CRCs) in xenograft, syngeneic, and genetically engineered mouse models in part through NETs. Disruption of NETs by either DNase I treatment or depletion of neutrophils in CRCs attenuated the efficacy of the drug combination. Moreover, NETs were present in tumor biopsies from patients treated with the drug combination in a phase II clinical trial. Increased NET levels in tumors were associated with longer progression-free survival. Mechanistically, the drug combination induced the expression of IL-8 preferentially in PIK3CA-mutant CRCs to attract neutrophils into the tumors. Further, the drug combination increased the levels of ROS in neutrophils, thereby inducing NETs. Cathepsin G (CTSG), a serine protease localized in NETs, entered CRC cells through the RAGE cell surface protein. The internalized CTSG cleaved 14-3-3 proteins, released BAX, and triggered apoptosis in CRC cells. Thus, our studies illuminate a previously unrecognized mechanism by which chemotherapy-induced NETs kill cancer cells.
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Affiliation(s)
- Yamu Li
- Department of Genetics and Genome Sciences
- Case Comprehensive Cancer Center
| | - Sulin Wu
- Department of Genetics and Genome Sciences
- Department of Internal Medicine
- Department of Medical Genetics, Case Western Reserve University, Cleveland, Ohio. USA
| | - Yiqing Zhao
- Department of Genetics and Genome Sciences
- Case Comprehensive Cancer Center
| | - Trang Dinh
- Department of Genetics and Genome Sciences
- Case Comprehensive Cancer Center
| | - Dongxu Jiang
- Department of Genetics and Genome Sciences
- Case Comprehensive Cancer Center
| | - J. Eva Selfridge
- Department of Genetics and Genome Sciences
- Case Comprehensive Cancer Center
- Department of Internal Medicine
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | - Yuxiang Wang
- Department of Genetics and Genome Sciences
- Case Comprehensive Cancer Center
| | - Xuan Zhao
- Department of Genetics and Genome Sciences
- Case Comprehensive Cancer Center
| | | | - George Dubyak
- Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio. USA
| | - Richard T. Lee
- Department of Internal Medicine
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Bassam Estfan
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marc Shapiro
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Suneel Kamath
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amr Mohamed
- Department of Internal Medicine
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | | | | | | | - Jennifer Eads
- Department of Internal Medicine
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Alok A. Khorana
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - David Bajor
- Department of Internal Medicine
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Zhenghe Wang
- Department of Genetics and Genome Sciences
- Case Comprehensive Cancer Center
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7
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Kamath S, Roopkumar J, Ni Y, Shen M, Bejarano P, Allende D, Nagarajan A, Nguyen T, Dergham B, Shepard D, Shapiro MA, McNamara MJ, Estfan BN, Nair KG, Khorana AA. Genomic Predictors Associated With Exceptional Response to Systemic Therapy in Advanced Pancreatic Cancer. Oncology (Williston Park) 2023; 37:488-495. [PMID: 38133563 DOI: 10.46883/2023.25921008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Exceptional response to therapy is rare in patients with advanced pancreatic cancer. This study explored potential genomic differences between typical and exceptional responses that could confer more favorable biology. METHODS We included exceptional responders and controls with advanced pancreatic cancer from Cleveland Clinic from April 2013 to August 2017. Exceptional responders were defined as patients with an overall survival of more than 18 months for metastatic disease and more than 24 months for locally advanced disease. Clinical data were obtained, and next-generation sequencing was performed. Statistical analyses comparing the 2 groups were performed using descriptive statistics, the Kaplan-Meier method, and the log-rank test. RESULTS The study comprised 4 exceptional responders and 6 controls. Both groups were well balanced in age, sex, race, and treatment regimens. Exceptional responders had significantly fewer nonsynonymous mutations than controls (2.25 vs 5.17; P = .014). A mutation count of less than 3 was associated with significantly better progression-free survival (17.2 vs 2.3 months; P = .002) and overall survival (29.4 vs 4.6 months; P = .013). Tumor mutational burden did not differ between exceptional responders and controls (4.88 vs 5.70 mut/Mb; P = .39). CONCLUSION A lower number of nonsynonymous mutations may correlate with exceptional outcomes in patients with pancreatic cancer. These findings should encourage future studies into genomic signatures of exceptional response.
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Granat LM, Thanoo N, Dettmer M, Kamath S, Bhalla R, Killeen C, Lichtman D, Griffin A, Mohammad M, Wardrop R. A Narrative Medicine Pilot Curriculum for Internal Medicine Residents. Med Sci Educ 2023; 33:1315-1317. [PMID: 38188403 PMCID: PMC10766982 DOI: 10.1007/s40670-023-01896-8] [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] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 01/09/2024]
Abstract
Narrative medicine (NM) is the practice of reflecting on patient stories, which can improve physician empathy and has been linked to higher levels of well-being. We implemented a NM curriculum for a large internal medicine residency program and report the curriculum's positive effects.
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Affiliation(s)
- Lauren M. Granat
- Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195 USA
| | - Nivaas Thanoo
- Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195 USA
| | - Matthew Dettmer
- Respiratory Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195 USA
| | - Suneel Kamath
- Department of Gastrointestinal Oncology, Taussig Cancer Center Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195 USA
| | - Rakesh Bhalla
- Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195 USA
| | - Colin Killeen
- Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195 USA
| | - Devora Lichtman
- Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195 USA
| | - Austin Griffin
- Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195 USA
| | - Mohmand Mohammad
- Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195 USA
| | - Richard Wardrop
- Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195 USA
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9
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Syed H, Sommovilla J, Burke CA, McGee S, Macaron C, Heald B, Lyu R, Schmit SL, Nair K, Kamath S, Krishnamurthi S, Khorana AA, Liska D. Referral, Uptake, and Outcome of Genetic Counseling and Testing in Patients With Early-Onset Colorectal Cancer. J Natl Compr Canc Netw 2023; 21:1156-1163.e5. [PMID: 37935108 DOI: 10.6004/jnccn.2023.7057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/11/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND The incidence of early-onset colorectal cancer (EOCRC) is rapidly increasing. Pathogenic germline variants (PGVs) are detected in 16% to 20% of patients who have EOCRC, highlighting a need for genetic counseling (GC) and multigene panel testing in these patients. We aimed to determine the rate of referral to GC and uptake and outcomes of germline testing in patients with EOCRC. METHODS We conducted a retrospective cohort study of patients aged <50 years diagnosed with colorectal cancer (CRC) from 2010 to 2019 at Cleveland Clinic. Demographic data were extracted, including age, sex, self-reported race, and family history of CRC. The proportions of patients with GC referral and completion of GC and genetic testing were investigated, and genetic testing results were analyzed. Multivariable logistic regression analysis was conducted to identify factors independently associated with GC referral and uptake. RESULTS A total of 791 patients with EOCRC (57% male and 43% female) were included; 62% were referred for GC, and of those who were referred, 79% completed a GC appointment and 77% underwent genetic testing. Of those who underwent testing, 21% had a PGV detected; 82% were in known CRC-associated genes, with those associated with Lynch syndrome and familial adenomatous polyposis the most common, and 11% were in other actionable genes. Referral to GC was positively associated with family history of CRC (odds ratio [OR], 2.11; 95% CI, 1.51-2.96) and more recent year of diagnosis (2010-2013 vs 2017-2019; OR, 5.36; 95% CI, 3.59-8.01) but negatively associated with older age at diagnosis (OR, 0.89; 95% CI, 0.86-0.92). CONCLUSIONS Referral to GC for patients with EOCRC is increasing over time; however, even in recent years, almost 25% of patients were not referred for GC. We found that 1 in 5 patients with EOCRC carry actionable PGVs, highlighting the need for health systems to implement care pathways to optimize GC referral and testing in all patients with EOCRC.
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Affiliation(s)
- Hareem Syed
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Joshua Sommovilla
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
- Sanford R. Weiss, MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, Ohio
- DeBartolo Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, Ohio
| | - Carol A Burke
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
- Sanford R. Weiss, MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, Ohio
- DeBartolo Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, Ohio
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sarah McGee
- Sanford R. Weiss, MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, Ohio
- DeBartolo Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, Ohio
- Center for Personalized Genetic Healthcare, Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Carole Macaron
- Sanford R. Weiss, MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, Ohio
- DeBartolo Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, Ohio
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brandie Heald
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
- Center for Personalized Genetic Healthcare, Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ruishen Lyu
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephanie L Schmit
- Sanford R. Weiss, MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, Ohio
- DeBartolo Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, Ohio
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
- Population and Cancer Prevention Program, Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Kanika Nair
- DeBartolo Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, Ohio
- Department of Hematology Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Suneel Kamath
- DeBartolo Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, Ohio
- Department of Hematology Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Smitha Krishnamurthi
- DeBartolo Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, Ohio
- Department of Hematology Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alok A Khorana
- DeBartolo Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, Ohio
- Department of Hematology Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - David Liska
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
- Sanford R. Weiss, MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, Ohio
- DeBartolo Center for Young-Onset Colorectal Cancer, Cleveland Clinic, Cleveland, Ohio
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Raj R, Wehrle CJ, Aykun N, Stitzel H, Ma WW, Krishnamurthi S, Estfan B, Kamath S, Kwon DCH, Aucejo F. Immunotherapy Plus Locoregional Therapy Leading to Curative-Intent Hepatectomy in HCC: Proof of Concept Producing Durable Survival Benefits Detectable with Liquid Biopsy. Cancers (Basel) 2023; 15:5220. [PMID: 37958394 PMCID: PMC10650763 DOI: 10.3390/cancers15215220] [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: 09/12/2023] [Revised: 10/25/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Immunotherapy has emerged as an improved systemic treatment for select patients with advanced unresectable HCC. Objective response is reported in 30% of patients, yet complete response (pCR) allowing for curative-intent resection is rare. Locoregional therapies (LRTs) seem to show synergistic effects with immunotherapy, though this effect has not been scientifically reported. We report a cohort of patients showing pCR to immunotherapy + LRT as a proof of concept for the proposed treatment approach for locally unresectable HCC. METHODS Patients with unresectable HCC treated with immunotherapy as an intended destination therapy from 2016 to 2023 were included. The electronic health record was queried for oncologic information, locoregional therapies, surgical interventions, and long-term outcomes. Circulating tumor DNA (ctDNA) testing was obtained using Guardant360, and tumor mutational burden (TMB) was defined as the number of somatic mutations per megabase. RESULTS Ninety-six patients with advanced HCC received immunotherapy + LRT as a destination therapy. In total, 11 of 96 patients showed a complete response according to mRECIST criteria. Four of these (36.4%) ultimately underwent curative-intent resection. The median follow-up was 24.9 (IQR 15.6-38.3) months. Overall survival rates in those with complete response at 1, 3, and 5 years were 100%, 91%, and 81.8%, respectively, which were significantly improved compared to those of the cohort not achieving pCR (p < 0.001). All four patients undergoing immunotherapy + LRT followed by curative-intent hepatectomy have no evidence of disease (NED). Of those undergoing surgery, ctDNA was cleared in 75% (n = 3), providing an additional objective measurement of complete response. All four patients were TMB+ before beginning this treatment course, with three being TMB-, indicating stable and complete disease response. CONCLUSIONS Immunotherapy + locoregional therapy can help downstage a significant proportion of patients with initially unresectable HCC, allowing for curative-intent surgery. The survival benefit associated with complete response seems durable up to 3 years after achieving this response. ctDNA measurement was converted from positive to negative in this cohort, providing additional indication of response.
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Affiliation(s)
- Roma Raj
- Cleveland Clinic Foundation, Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland, OH 44195, USA; (R.R.); (N.A.); (H.S.); (D.C.H.K.); (F.A.)
| | - Chase J. Wehrle
- Cleveland Clinic Foundation, Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland, OH 44195, USA; (R.R.); (N.A.); (H.S.); (D.C.H.K.); (F.A.)
| | - Nihal Aykun
- Cleveland Clinic Foundation, Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland, OH 44195, USA; (R.R.); (N.A.); (H.S.); (D.C.H.K.); (F.A.)
| | - Henry Stitzel
- Cleveland Clinic Foundation, Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland, OH 44195, USA; (R.R.); (N.A.); (H.S.); (D.C.H.K.); (F.A.)
| | - Wen Wee Ma
- Cleveland Clinic Foundation, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland, OH 44195, USA; (W.W.M.); (S.K.); (B.E.); (S.K.)
| | - Smitha Krishnamurthi
- Cleveland Clinic Foundation, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland, OH 44195, USA; (W.W.M.); (S.K.); (B.E.); (S.K.)
| | - Bassam Estfan
- Cleveland Clinic Foundation, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland, OH 44195, USA; (W.W.M.); (S.K.); (B.E.); (S.K.)
| | - Suneel Kamath
- Cleveland Clinic Foundation, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland, OH 44195, USA; (W.W.M.); (S.K.); (B.E.); (S.K.)
| | - David C. H. Kwon
- Cleveland Clinic Foundation, Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland, OH 44195, USA; (R.R.); (N.A.); (H.S.); (D.C.H.K.); (F.A.)
| | - Federico Aucejo
- Cleveland Clinic Foundation, Department of Hepato-Pancreato-Biliary & Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland, OH 44195, USA; (R.R.); (N.A.); (H.S.); (D.C.H.K.); (F.A.)
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11
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Bommireddy A, Billena C, Mayo ZS, Koro S, Davis RW, Chao ST, Murphy ES, Suh JH, Chan TA, Yu JS, Barnett GH, Mohammadi AM, Angelov L, Stevens G, Estfan B, Kamath S, Khorana A, Balagamwala EH. Clinical Outcomes for Patients with Brain Metastases from Upper Gastrointestinal Cancer Treated with Stereotactic Radiosurgery. Int J Radiat Oncol Biol Phys 2023; 117:e90. [PMID: 37786211 DOI: 10.1016/j.ijrobp.2023.06.847] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Prior studies have reported outcomes for brain metastases from gastrointestinal (GI) primary cancers treated with stereotactic radiosurgery (SRS); however, most include a majority of colorectal cancer. Few studies specifically evaluate SRS treatment response for brain metastases from upper GI cancers. We report our institutional outcomes for patients with upper GI cancers who were treated with SRS for brain metastases. MATERIALS/METHODS Patients with an upper GI cancer who underwent SRS for brain metastases between 1991 and 2021 were retrospectively reviewed from a single institution IRB-approved database. The primary endpoint was local failure (LF) and secondary endpoint was overall survival (OS). LF was estimated using the Cumulative Incidence Function with death as a competing risk. Survival analysis was performed with the Kaplan-Meier Method. Predictors of cumulative incidence of LF were assessed using competing risk regression. RESULTS Forty-nine patients with 107 brain metastases were analyzed. Forty-two (86%) patients were male. The median follow-up time was 6.7 months (range: 0.4-61.7 months) and median OS was 7.5 months (range: 0.9-61.7 months). The median Karnofsky Performance Score (KPS) was 80 (range: 40-100). The primary disease site was esophagus in 87 (81%) lesions, pancreas in 10 (9.3%) lesions, stomach in 5 (4.7%) lesions, liver in 2 (1.9%) lesions, gallbladder in 2 (1.9%) lesions, and small intestine in 1 (0.9%) lesion. The median metastasis size was 1.4 cm (range: 0.3-6.7 cm). The median prescription dose and fraction number were 24 Gy (range: 14-30 Gy) and 1 fraction (range: 1-2 fractions), respectively. The cumulative incidence of LF at 6 and 12 months was 5.6% (95% CI: 2.3-11%) and 12% (95% CI: 6.9-20%), respectively. Overall survival at 6 and 12 months was 59% (95% CI: 50-69%) and 35% (95% CI: 27-46%), respectively. On univariate analysis, female gender (HR = 0.19, 95% CI: 0.06-0.61, p = 0.005), Black race (HR = 0.09, 95% CI: 0.03-0.23, p = <0.001), and larger tumors (HR = 1.35, 95% CI: 1.03-1.78, p = 0.03) were significantly associated with local failure. CONCLUSION SRS for brain metastases from upper GI cancers is an appropriate treatment option and provides excellent local control. Unlike prior studies that have reported lower local control rates for all GI cancers with brain metastases treated with SRS, our data show that local failure rates in brain metastases from upper GI cancers specifically are more consistent with previously published data from other disease sites. Further studies evaluating SRS treatment response for brain metastases from GI cancers should separate upper GI and lower GI cancers.
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Affiliation(s)
- A Bommireddy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - C Billena
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Z S Mayo
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - S Koro
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - R W Davis
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - S T Chao
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - E S Murphy
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | - J H Suh
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | - T A Chan
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - J S Yu
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | - G H Barnett
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - A M Mohammadi
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - L Angelov
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - G Stevens
- Rose Ella Burkhardt Brain Tumor & Neuro-oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - B Estfan
- Department of Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | - S Kamath
- Department of Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | - A Khorana
- Department of Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | - E H Balagamwala
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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12
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Raj R, Aykun N, Wehrle CJ, Maspero M, Krishnamurthi S, Estfan B, Kamath S, Aucejo F. Immunotherapy for Advanced Hepatocellular Carcinoma-a Large Tertiary Center Experience. J Gastrointest Surg 2023; 27:2126-2134. [PMID: 37464142 DOI: 10.1007/s11605-023-05783-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/01/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Combination of immune-checkpoint inhibitor (ICI) and vascular endothelial growth factor (VEGF) antagonist has become the first line systemic treatment for advanced hepatocellular carcinoma (HCC). However, two-thirds of patients do not respond to ICI-based treatments and biomarkers for response remain elusive. METHODS Patients with advanced HCC who received Atezolizumab/Bevacizumab combination or Nivolumab during 2016-2022 were identified in our Liver Cancer Database. Retrospective review of their clinical data was performed to investigate parameters that could be predictive of immunotherapy response. RESULTS 96 patients received Atezolizumab/Bevacizumab (n=60) or Nivolumab (n=36). Median age at diagnosis was 67.1 years. 70 patients had received treatment and 26 patients were treatment naïve before starting immunotherapy. Mean pre-treatment AFP was 9780.7 (±32035) ng/mL. Confirmed objective response (complete or partial) was seen in 29% of the population (n=27). Disease remained stable in 12% (n=11) and progressed in 60% (n=56). On univariate analysis, pre-treatment AFP>400 ng/mL was associated with objective response (OR=4.5, 95% CI:1.7-11.9, p=0.0015), while white race (OR=0.35, 95% CI:0.13-0.92, p=0.030) and prior radiotherapy (OR=0.14, 95% CI:0.01-1.1, p=0.033) or systemic therapy with TKIs (OR=0.25, 95% CI:0.08-0.81, p=0.017) were associated with poor response. On multivariate analysis only AFP>400 ng/mL remained associated with response (OR=3.7, 95% CI:1.3-10.5, p=0.014). Overall survival (OS) at one and three years was 86% and 43% in responders, and 45% and 29% in non-responders, respectively. CONCLUSION In our institutional experience, treatment naivety and pre-treatment AFP>400 ng/mL were associated with objective response. Prospective studies aimed at identifying factors associated with response to immunotherapy will aide patient selection.
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Affiliation(s)
- Roma Raj
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, OH, Cleveland, USA.
| | - Nihal Aykun
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, OH, Cleveland, USA
| | - Chase J Wehrle
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, OH, Cleveland, USA
| | - Marianna Maspero
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, OH, Cleveland, USA
| | - Smitha Krishnamurthi
- Cleveland Clinic Foundation, Taussig Cancer Institute, Department of Hematology and Oncology, Cleveland, OH, USA
| | - Bassam Estfan
- Cleveland Clinic Foundation, Taussig Cancer Institute, Department of Hematology and Oncology, Cleveland, OH, USA
| | - Suneel Kamath
- Cleveland Clinic Foundation, Taussig Cancer Institute, Department of Hematology and Oncology, Cleveland, OH, USA
| | - Federico Aucejo
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, OH, Cleveland, USA.
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Subbiah V, Sahai V, Maglic D, Bruderek K, Touré BB, Zhao S, Valverde R, O'Hearn PJ, Moustakas DT, Schönherr H, Gerami-Moayed N, Taylor AM, Hudson BM, Houde DJ, Pal D, Foster L, Gunaydin H, Ayaz P, Sharon DA, Goyal L, Schram AM, Kamath S, Sherwin CA, Schmidt-Kittler O, Jen KY, Ricard F, Wolf BB, Shaw DE, Bergstrom DA, Watters J, Casaletto JB. RLY-4008, the First Highly Selective FGFR2 Inhibitor with Activity across FGFR2 Alterations and Resistance Mutations. Cancer Discov 2023; 13:2012-2031. [PMID: 37270847 PMCID: PMC10481131 DOI: 10.1158/2159-8290.cd-23-0475] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/24/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023]
Abstract
Oncogenic activation of fibroblast growth factor receptor 2 (FGFR2) drives multiple cancers and represents a broad therapeutic opportunity, yet selective targeting of FGFR2 has not been achieved. Although the clinical efficacy of pan-FGFR inhibitors (pan-FGFRi) validates FGFR2 driver status in FGFR2 fusion-positive intrahepatic cholangiocarcinoma, their benefit is limited by incomplete target coverage due to FGFR1- and FGFR4-mediated toxicities (hyperphosphatemia and diarrhea, respectively) and the emergence of FGFR2 resistance mutations. RLY-4008 is a highly selective, irreversible FGFR2 inhibitor designed to overcome these limitations. In vitro, RLY-4008 demonstrates >250- and >5,000-fold selectivity over FGFR1 and FGFR4, respectively, and targets primary alterations and resistance mutations. In vivo, RLY-4008 induces regression in multiple xenograft models-including models with FGFR2 resistance mutations that drive clinical progression on current pan-FGFRi-while sparing FGFR1 and FGFR4. In early clinical testing, RLY-4008 induced responses without clinically significant off-isoform FGFR toxicities, confirming the broad therapeutic potential of selective FGFR2 targeting. SIGNIFICANCE Patients with FGFR2-driven cancers derive limited benefit from pan-FGFRi due to multiple FGFR1-4-mediated toxicities and acquired FGFR2 resistance mutations. RLY-4008 is a highly selective FGFR2 inhibitor that targets primary alterations and resistance mutations and induces tumor regression while sparing other FGFRs, suggesting it may have broad therapeutic potential. See related commentary by Tripathi et al., p. 1964. This article is featured in Selected Articles from This Issue, p. 1949.
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Affiliation(s)
- Vivek Subbiah
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Dejan Maglic
- Relay Therapeutics, Inc., Cambridge, Massachusetts
| | | | | | | | | | | | | | | | | | | | | | | | - Debjani Pal
- Relay Therapeutics, Inc., Cambridge, Massachusetts
| | | | | | | | | | - Lipika Goyal
- Massachusetts General Hospital, Boston, Massachusetts
| | | | - Suneel Kamath
- The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | | | | | - Kai Yu Jen
- Relay Therapeutics, Inc., Cambridge, Massachusetts
| | | | - Beni B. Wolf
- Relay Therapeutics, Inc., Cambridge, Massachusetts
| | - David E. Shaw
- D. E. Shaw Research, New York, New York
- Department of Biochemistry and Molecular Biophysics, Columbia University, New York, New York
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Wehrle CJ, Raj R, Aykun N, Orabi D, Stackhouse K, Chang J, Estfan B, Kamath S, Krishnamurthi S, Walsh RM, Kwon DCH, Aucejo F. Circulating Tumor DNA in Colorectal Cancer Liver Metastasis: Analysis of Patients Receiving Liver Resection and Transplant. JCO Clin Cancer Inform 2023; 7:e2300111. [PMID: 37820293 DOI: 10.1200/cci.23.00111] [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: 06/14/2023] [Revised: 08/13/2023] [Accepted: 08/29/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE Liver metastases occur in about 50% of colorectal cancer cases and drive patient outcomes. Circulating tumor DNA (ctDNA) is emerging as a diagnostic, surveillance, and tumor mutational information tool. METHODS Patients with colorectal cancer liver metastasis (CCLM) seen in a multidisciplinary liver tumor clinic from January to August 2022 received ctDNA testing on each visit. ctDNA was obtained using the Guardant360 platform. Tumor mutational burden (TMB) is defined as the number of identified mutations per megabase of genome analyzed. RESULTS Fifty-two patients had available ctDNA, with 34 (65%) tested preoperatively and 18 (35%) postoperatively; nine patients had sequential pre- and postoperative testing. The median time to test result was 12 days (IQR, 10-13.5). There were a greater number of somatic mutations identified preoperatively (n = 29 v n = 11) and a greater genomic heterogeneity (P = .0069). The mean TMB score was 12.77 in those without pathologic response to cytotoxic therapy and 6.0 in those with pathologic response (P = .10). All nine patients with sequential testing were positive preoperatively, compared with just three (33.3%) postoperatively (P = .0090). Positive postoperative ctDNA was associated with the increased likelihood of disease recurrence after resection (57%) versus negative ctDNA (0%, P = .0419). CONCLUSION Routine ctDNA screening in patients with CCLM is logistically feasible. Liver resection and/or transplant may be associated with clearance of detectable ctDNA and a reduction in TMB or genomic heterogeneity. Persistence of ctDNA alterations postresection appears predictive of disease recurrence. Further studies are necessary to confirm these findings, and longitudinal ctDNA testing is needed to monitor changing tumor biology.
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Affiliation(s)
- Chase J Wehrle
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Roma Raj
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Nihal Aykun
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Danny Orabi
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Kathryn Stackhouse
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Jenny Chang
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Bassam Estfan
- Cleveland Clinic Foundation, Taussig Cancer Institute, Department of Hematology and Oncology, Cleveland, OH
| | - Suneel Kamath
- Cleveland Clinic Foundation, Taussig Cancer Institute, Department of Hematology and Oncology, Cleveland, OH
| | - Smitha Krishnamurthi
- Cleveland Clinic Foundation, Taussig Cancer Institute, Department of Hematology and Oncology, Cleveland, OH
| | - R Matthew Walsh
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - David Choon Hyuck Kwon
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Federico Aucejo
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
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Wehrle CJ, Raj R, Aykun N, Orabi D, Estfan B, Kamath S, Krishnamurthi S, Fujiki M, Hashimoto K, Quintini C, Kwon DCH, Diago-Uso T, Sasaki K, Aucejo FN. Liquid Biopsy by ctDNA in Liver Transplantation for Colorectal Cancer Liver Metastasis. J Gastrointest Surg 2023; 27:1498-1509. [PMID: 37273078 DOI: 10.1007/s11605-023-05723-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Colorectal cancer is a leading cause of cancer-related death worldwide. Metastatic liver disease develops in 50% of cases and drives patient outcomes. Although the ideal treatment for colorectal cancer liver metastases (CRLM) is resection, only a third of patients are suitable for this approach. Reports of liver transplantation in selected patients with unresectable CRLM have shown encouraging results compared to conventional forms of therapy. No study to date has examined the utility of liquid biopsy circulating tumor DNA (ctDNA) for evaluation of residual disease in this cohort of patients. We report a small series of liver transplantation in patients with CRLM in whom ctDNA was assessed peri-operatively. METHODS Five patients underwent liver transplantation for unresectable CRLM or liver failure following CRLM treatment from 2018 to 2022. Clinical data, cross-sectional imaging, and serum biomarkers including peri-operative ctDNA were reviewed from electronic medical records. RESULTS All patients are alive without radiologic evidence of disease at time of this publication. Median time of follow-up was 32 months (IQR 6.6-40 months). ctDNA was assessed before (4 patients) and after transplant (6 patients). One patient experienced a pulmonary recurrence that was resected, for whom pre-recurrence ctDNA was not available; the remaining patients have not experienced recurrence. Four patients are without evidence of ctDNA following transplant, and two demonstrate persistent ctDNA positivity post-transplant. Three of four patients with positive pre-transplant ctDNA remain ctDNA-negative post-transplant. CONCLUSIONS Liver transplantation for liver-confined unresectable CRLM is emerging as a valid surgical option in selected patients. The significance of liquid biopsy in this population remains elusive due to lack of data. The clearance of ctDNA after transplant in these patients with metastatic disease and despite their immunosuppression is notable. The significance and usefulness of liquid biopsy in patient selection, surveillance, and as an indication for treatment warrant further investigation.
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Affiliation(s)
- Chase J Wehrle
- Digestive Diseases and Surgery Institute, Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Roma Raj
- Digestive Diseases and Surgery Institute, Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nihal Aykun
- Digestive Diseases and Surgery Institute, Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Danny Orabi
- Digestive Diseases and Surgery Institute, Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Bassam Estfan
- Department of Hematology and Oncology, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH, USA
| | - Suneel Kamath
- Department of Hematology and Oncology, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH, USA
| | - Smitha Krishnamurthi
- Department of Hematology and Oncology, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH, USA
| | - Masato Fujiki
- Digestive Diseases and Surgery Institute, Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Koji Hashimoto
- Digestive Diseases and Surgery Institute, Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Cristiano Quintini
- Digestive Diseases and Surgery Institute, Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - David Choon Hyuck Kwon
- Digestive Diseases and Surgery Institute, Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Teresa Diago-Uso
- Digestive Diseases and Surgery Institute, Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Kazunari Sasaki
- Department of Surgery - Abdominal Transplantation, Stanford Hospital and Clinics, Palo Alto, CA, 94035, USA
| | - Federico N Aucejo
- Digestive Diseases and Surgery Institute, Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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Baker SD, Bates SE, Brooks GA, Dahut WL, Diasio RB, El-Deiry WS, Evans WE, Figg WD, Hertz DL, Hicks JK, Kamath S, Kasi PM, Knepper TC, McLeod HL, O'Donnell PH, Relling MV, Rudek MA, Sissung TM, Smith DM, Sparreboom A, Swain SM, Walko CM. DPYD Testing: Time to Put Patient Safety First. J Clin Oncol 2023; 41:2701-2705. [PMID: 36821823 PMCID: PMC10414691 DOI: 10.1200/jco.22.02364] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/02/2022] [Accepted: 01/17/2023] [Indexed: 02/25/2023] Open
Affiliation(s)
- Sharyn D. Baker
- College of Pharmacy, The Ohio State University, Columbus, OH
| | - Susan E. Bates
- Herbert Irving Comprehensive Cancer Center, Columbia University, Irving Medical Center, New York, NY
| | | | | | | | | | | | - William D. Figg
- Clinical Pharmacology Program, National Cancer Institute, Bethesda, MD
| | - Dan L. Hertz
- College of Pharmacy, University of Michigan, Ann Arbor, MI
| | - J. Kevin Hicks
- Department of Individualized Cancer Management, Moffitt Cancer Center, Tampa, FL
| | - Suneel Kamath
- Cleveland Clinic, Lerner College of Medicine, Cleveland, OH
| | | | - Todd C. Knepper
- Department of Individualized Cancer Management, Moffitt Cancer Center, Tampa, FL
| | | | | | | | | | | | - D. Max Smith
- Georgetown Lombardi Comprehensive Cancer Center and MedStar Health, Georgetown University, Washington, DC
| | - Alex Sparreboom
- College of Pharmacy, The Ohio State University, Columbus, OH
| | - Sandra M. Swain
- Georgetown Lombardi Comprehensive Cancer Center and MedStar Health, Georgetown University, Washington, DC
| | - Christine M. Walko
- Department of Individualized Cancer Management, Moffitt Cancer Center, Tampa, FL
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Mariam A, Kamath S, Schveder K, McLeod HL, Rotroff DM. Biomarkers for Response to Anti-PD-1/Anti-PD-L1 Immune Checkpoint Inhibitors: A Large Meta-Analysis. Oncology (Williston Park) 2023; 37:210-219. [PMID: 37216635 DOI: 10.46883/2023.25920995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) that block PD-1/PD-L1 have consistently demonstrated durable clinical activity across multiple histologies but have low overall response rates for many cancers-indicating that too few patients benefit from ICIs. Many studies have explored potential predictive biomarkers (eg, PD-1/PD-L1 expression, tumor mutational burden [TMB]), no consensus biomarker has been identified. METHODS This meta-analysis combined predictive accuracy metrics for various biomarkers, across multiple cancer types, to determine which biomarkers are most accurate for predicting ICI response. Data from 18,792 patients from 100 peer-reviewed studies that evaluated putative biomarkers for response to anti-PD-1/anti- PD-L1 treatment were meta-analyzed using bivariate linear mixed models. Biomarker performance was assessed based on the global area under the receiver operating characteristic curve (AUC) and 95% bootstrap confidence intervals. RESULTS PD-L1 immunohistochemistry, TMB, and multimodal biomarkers discriminated responders and nonresponders better than random assignment (AUCs >.50). Excluding multimodal biomarkers, these biomarkers correctly classified at least 50% of the responders (sensitivity 95% CIs, >.50). Notably, variation in biomarker performance was observed across cancer types. CONCLUSIONS Although some biomarkers consistently performed better, heterogeneity in performance was observed across cancer types, and additional research is needed to identify highly accurate and precise biomarkers for widespread clinical use.
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Farha N, Dima D, Ullah F, Kamath S. Precision Oncology Targets in Biliary Tract Cancer. Cancers (Basel) 2023; 15:cancers15072105. [PMID: 37046766 PMCID: PMC10093316 DOI: 10.3390/cancers15072105] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/25/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Targeted therapies in biliary tract cancer (BTC) are emerging as options for patients not who do not respond to first-line treatment. Agents acting on tumor-specific oncogenes in BTC may target fibroblast growth factor receptor 2 (FGFR2), isocitrate dehydrogenase (IDH), B-raf kinase (BRAF), and human epidermal growth factor receptor 2 (HER-2). Additionally, given the heterogeneous genetic landscape of advanced BTCs, many harbor genetic aberrations that are common among solid tumors, including RET fusions, tropomyosin receptor kinase (TRK) fusions, and high tumor mutational burden (TMB). This review aims to provide updates on the evolving array of therapeutics available, and to summarize promising works on the horizon.
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Veerwal A, Yuvraja T, Waigankar S, Shah A, Kamath S, Pednekar A. Indocyanine Green (ICG ) assisted Robotic Video Endoscopic Inguinal Lymph node (R- VEIL) dissection. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01413-6] [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: 02/12/2023]
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Veerwal A, Yuvaraja T, Waigankar S, Shah A, Kamath S, Pednekar A. Evaluating the perioperative outcomes of the novel technique of using ICG dye with firefly technology in robot assisted video endoscopic inguinal lymphadenectomy (ICG-RAVEIL): Our initial experience of 25 consecutive cases. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00949-1] [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: 02/12/2023]
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21
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Veerwal A, Yuvaraja T, Waigankar S, Shah A, Kamath S, Pednekar A. Comparing perioperative outcomes after Robot Assisted Video Endoscopic Inguinal Lymphadenectomy (RAVEIL) with Open Inguinal Lymph Node Dissection (O-ILND) using propensity score match analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00687-5] [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: 02/12/2023]
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22
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Nguyen MT, Wei W, Cooper G, Khorana AA, Kamath S. Shorter Time to Treatment Is Associated With Improved Survival in Rural Patients With Breast Cancer Despite Other Adverse Socioeconomic Factors. Oncology (Williston Park) 2023; 37:19-24. [PMID: 36724138 DOI: 10.46883/2023.25920982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cancer care in rural areas poses unique challenges, including access and proximity to care. This study examined differences in time to treatment initiation (TTI), a potential surrogate for access, and predictors of overall survival (OS) between rural and nonrural patients with breast cancer. METHODS Women with stage I to III breast cancer diagnosed between 2004 and 2012 in facilities accredited by the National Cancer Database of Commission on Cancer (CoC) were included. Differences between rural and nonrural patients in demographics, disease and treatment characteristics, socioeconomic factors, and TTI were assessed by χ2 test. The effects on OS of age, insurance status, cancer center type, community median income, percentage of the community who had not graduated from high school, and TTI were assessed using Cox models. RESULTS The study population was composed of 1,205,031 patients, 18,417 (2%) of whom were rural. Compared with nonrural patients, rural patients were more likely to be older, to be White, to receive care at nonacademic centers, to have government insurance or annual income less than $38,000, and to be less educated (P < .0001). Rural patients also had shorter median TTI (3 vs 4 weeks; P < .0001), which was associated with improved OS (P < .0001), and were more likely to have TTI less than 4 weeks and less than 8 weeks (P < .0001 for both). Shorter TTI (both <4 weeks vs 8 weeks and 4-8 weeks vs >8 weeks) was also associated with improved OS (P < .0001 for both). After adjusting for disease stage and demographic-, socioeconomic-, and treatment-related factors, rural status was associated with improved OS compared with nonrural status (HR, 0.92; 95% CI, 0.89-0.96; P < .0001). CONCLUSIONS Despite several adverse demographic and socioeconomic factors, rural patients with breast cancer with access to CoC-accredited facilities had significantly shorter TTI and better OS compared with nonrural patients. The clinical significance of this is undetermined; however, these data suggest that improving TTI can mitigate disparities in rural cancer care.
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Schram A, Borad M, Sahai V, Kamath S, Kim R, Liao C, Oh D, Ponz-Sarvisé M, Yachnin J, Shell S, Cassier P, Dotan E, Florou V, Moreno V, Park J, Tai D, Schmidt-Kittler O, Ferté C, Goyal L, Subbiah V. Identifying FGFR2 fusions/rearrangements in cholangiocarcinoma patients using a novel cfDNA algorithm for treatment with RLY-4008, a highly selective irreversible FGFR2 inhibitor. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01110-8] [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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Joseph A, Draganov PV, Maluf-Filho F, Aihara H, Fukami N, Sharma NR, Chak A, Yang D, Jawaid S, Dumot J, Alaber O, Chua T, Singh R, Mejia-Perez LK, Lyu R, Zhang X, Kamath S, Jang S, Murthy S, Vargo J, Bhatt A. Outcomes for endoscopic submucosal dissection of pathologically staged T1b esophageal cancer: a multicenter study. Gastrointest Endosc 2022; 96:445-453. [PMID: 35217020 PMCID: PMC9488538 DOI: 10.1016/j.gie.2022.02.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS The outcomes of endoscopic submucosal dissection (ESD) for T1b esophageal cancer (EC) and its recurrence rates remain unclear in the West. Using a multicenter cohort, we evaluated technical outcomes and recurrence rates of ESD in the treatment of pathologically staged T1b EC. METHODS We included patients who underwent ESD of T1b EC at 7 academic tertiary referral centers in the United States (n = 6) and Brazil (n = 1). We analyzed demographic, procedural, and histopathologic characteristics and follow-up data. Time-to-event analysis was performed to evaluate recurrence rates. RESULTS Sixty-six patients with pathologically staged T1b EC after ESD were included in the study. A preprocedure staging EUS was available in 54 patients and was Tis/T1a in 27 patients (50%) and T1b in 27 patients (50%). En-bloc resection rate was 92.4% (61/66) and R0 resection rate was 54.5% (36/66). Forty-nine of 66 patients (74.2%) did not undergo surgery immediately after resection and went on to surveillance. Ten patients had ESD resection within the curative criteria, and no recurrences were seen in a 13-month (range, 3-18.5) follow-up period in these patients. Ten of 39 patients (25.6%) with noncurative resections had residual/recurrent disease. Of the 10 patients with noncurative resection, local recurrence alone was seen in 5 patients (12.8%) and metastatic recurrence in 5 patients (12.8%). On univariate analysis, R1 resection had a higher risk of recurrent disease (hazard ratio, 6.25; 95% confidence interval, 1.29-30.36; P = .023). CONCLUSIONS EUS staging of T1b EC has poor accuracy, and a staging ESD should be considered in these patients. ESD R0 resection rates were low in T1b EC, and R1 resection was associated with recurrent disease. Patients with noncurative ESD resection of T1b EC who cannot undergo surgery should be surveyed closely, because recurrent disease was seen in 25% of these patients.
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Affiliation(s)
- Abel Joseph
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Peter V. Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Fauze Maluf-Filho
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Norio Fukami
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Neil R. Sharma
- Division of Interventional Oncology & Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, Indiana, USA
| | - Amitabh Chak
- Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
| | - Dennis Yang
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Salmaan Jawaid
- Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - John Dumot
- Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
| | - Omar Alaber
- Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
| | - Tiffany Chua
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Rituraj Singh
- Division of Interventional Oncology & Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, Indiana, USA
| | | | - Ruishen Lyu
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Xuefeng Zhang
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Suneel Kamath
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sudish Murthy
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Vargo
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amit Bhatt
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
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Shitara K, Park H, Bekaii-Saab T, Kim SS, Kamath S, Pishvaian MJ, Chen C, Zhen DB, Mayor J, Tan Q, Strickler JH. MO31-4 Phase 1b/2 trial of tucatinib+trastuzumab+/-chemotherapy or pembrolizumab in patients with metastatic HER2+ GI cancers. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.05.183] [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: 11/01/2022] Open
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Le DT, Cruz-Correa M, Bajor DL, Garcia-Carbonero R, Harris M, Pazo-Cid R, Kindler H, Yee N, Kamath S, Patel M, Fang H, Henner W, Hardesty P, Blaney M, McDevitt M, Golan T. Abstract CT246: Phase 1b/2 study of giloralimab in combination with modified FOLFIRINOX with or without budigalimab in patients with untreated metastatic pancreatic cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The 5-year survival rate for metastatic pancreatic cancer is ~3%, indicating an urgent need for novel therapies. Combination therapy with modified FOLFIRINOX (leucovorin, irinotecan, 5-fluorouracil, and oxaliplatin) and immunotherapy has been proposed for first-line metastatic pancreatic cancer to improve tolerability and clinical efficacy, respectively (NCCN, Pancreatic. 2021; Vonderheide, Annu. Rev. Med. 2020). The present study evaluates the safety, pharmacokinetics, and preliminary antitumor activity of modified FOLFIRINOX + giloralimab (CD40 agonist) with or without budigalimab (anti-PD-1) in patients with untreated metastatic pancreatic cancer.
Methods: Multicenter, randomized phase 1b/2 study (NCT04807972) in patients (18-75 years) with untreated metastatic pancreatic cancer. The phase 1b (dose escalation) examines the safety dose level of giloralimab in a triplet of modified FOLFIRINOX + giloralimab + budigalimab using a Bayesian optimal interval [BOIN] design. BOIN design is utilized to guide giloralimab escalation decisions. In phase 2 (dose expansion), patients are randomized 1:1:1 to receive treatment with modified FOLFIRINOX (cohort A), modified FOLFIRINOX + giloralimab (cohort B), or modified FOLFIRINOX + giloralimab + budigalimab (cohort C). Randomization is stratified according to Eastern Cooperative Oncology Group performance status. Primary objectives are to assess the safety and tolerability of modified FOLFIRINOX + giloralimab + budigalimab (phase 1b) and to evaluate overall survival in patients treated with modified FOLFIRINOX + giloralimab with or without budigalimab (versus those receiving modified FOLFIRINOX alone; phase 2). Secondary objectives include characterizing the pharmacokinetics of giloralimab and budigalimab in combination with modified FOLFIRINOX, assessing the efficacy of modified FOLFIRINOX + giloralimab with or without budigalimab, and evaluating the safety/tolerability of modified FOLFIRINOX + giloralimab with or without budigalimab. Patients will receive giloralimab and budigalimab intravenously in combination with modified FOLFIRINOX in a 28-day cycle. Dose-limiting toxicities are assessed during the first cycle of dosing. Adverse events are evaluated according to the National Cancer Institute Common Terminology Criteria for Adverse Events. Blood samples for pharmacokinetic analysis are collected at designated time points throughout the study. Responses are assessed by Response Evaluation Criteria in Solid Tumors version 1.1. Survival outcomes are described using the Kaplan-Meier method. Approximately 129 patients are planned to be included. Enrollment started in June 2021, with 7 patients enrolled as of November 2021.
Citation Format: Dung T. Le, Marcia Cruz-Correa, David L. Bajor, Rocio Garcia-Carbonero, Marion Harris, Roberto Pazo-Cid, Hedy Kindler, Nelson Yee, Suneel Kamath, Maulik Patel, Hua Fang, William Henner, Patrick Hardesty, Martha Blaney, Michael McDevitt, Talia Golan. Phase 1b/2 study of giloralimab in combination with modified FOLFIRINOX with or without budigalimab in patients with untreated metastatic pancreatic cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT246.
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Affiliation(s)
- Dung T. Le
- 1Johns Hopkins University, Baltimore, MD
| | | | | | | | | | | | - Hedy Kindler
- 7The University of Chicago Medicine, Chicago, IL
| | - Nelson Yee
- 8Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Suneel Kamath
- 9Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | | | - Hua Fang
- 10AbbVie Inc., South San Francisco, CA
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Joseph A, Raja S, Kamath S, Jang S, Allende D, McNamara M, Videtic G, Murthy S, Bhatt A. Esophageal adenocarcinoma: A dire need for early detection and treatment. Cleve Clin J Med 2022; 89:269-279. [PMID: 35500930 DOI: 10.3949/ccjm.89a.21053] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Esophageal cancer is the sixth most common cause of cancer-related death worldwide. Esophageal adenocarcinoma is the most common subtype of esophageal cancer in the United States, and its incidence has risen dramatically in the last few decades. Modern endoscopic and surgical techniques have significantly improved morbidity and mortality rates of patients undergoing treatment for esophageal cancer. However, most cases are diagnosed at a late stage when the prognosis is poor, emphasizing the need for an effective screening strategy. This clinical overview focuses on screening, multidisciplinary evaluation, and treatment of early esophageal adenocarcinoma.
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Affiliation(s)
- Abel Joseph
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Siva Raja
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic; Associate Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Suneel Kamath
- Department of Hematology and Medical Oncology, Cleveland Clinic; Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic; Associate Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Daniela Allende
- Department of Pathology, Cleveland Clinic; Associate Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Mike McNamara
- Department of Hematology and Medical Oncology, Cleveland Clinic; Clinical Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Gregory Videtic
- Department of Radiation Oncology, Cleveland Clinic; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Sudish Murthy
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Amit Bhatt
- Department of Gastroenterology and Hepatology, Cleveland Clinic; Clinical Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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Goyal L, Borad M, Subbiah V, Mahipal A, Kamath S, Mody K, Kelley RK, Kim R, Sahai V, El-Khoueiry A, Dotan E, Schmidt-Kittler O, Shen J, Jen KY, Deary A, Guo W, Padval M, Sherwin CAJ, Ferte C, Wolf B, Schram AM. Abstract P02-02: First results of RLY-4008, a potent and highly selective FGFR2 inhibitor in a first-in-human study in patients with FGFR2-altered cholangiocarcinoma and multiple solid tumors. Mol Cancer Ther 2021. [DOI: 10.1158/1535-7163.targ-21-p02-02] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
INTRODUCTION: Oncogenic FGFR2 alterations (fusions/rearrangements, amplifications, mutations) are key drivers in cholangiocarcinoma (CCA) and multiple solid tumors. Current pan-FGFR inhibitor (FGFRi) therapy is limited by off-isoform toxicity and acquired FGFR2 kinase domain resistance mutations. RLY-4008 is a highly selective and potent oral inhibitor designed to target both FGFR2 driver and resistance mutations. We initiated a first-in-human study in advanced solid tumors patients (pts) to define the safety, pharmacokinetics (PK) and efficacy of RLY-4008 (NCT04526106). METHODS: Adult pts received RLY-4008 QD or BID on a 4-week cycle following a BOIN escalation design. Adverse events (AEs), PK, ctDNA and anti-tumor activity (RECIST 1.1) were assessed. RESULTS: As of 16AUG21, 45 pts (35 CCA; 10 other) have been treated with RLY-4008 at total daily doses of 30-200 mg (18 pts BID; 27 pts QD). 44 pts had oncogenic FGFR2 alterations (26 fusions/13 mutations/5 amplifications). The median number of prior anti-neoplastic therapies was 3 (range 1-15). 94% (33/35) of CCA pts had prior chemotherapy and 69% (24/35) had prior FGFRi. 56% (9/16) CCA pts with prior FGFRi and evaluable ctDNA had ≥1 FGFR2 resistance mutation at baseline, most commonly at positions 549 (8/9), 617 (3/9), or 564 (2/9). RLY-4008 had rapid absorption (Tmax 1-7h), half-life to support QD dosing (18-34 h), dose-dependent exposure (AUC; Cmax) and predicted FGFR2 occupancy >85% across dose levels. The MTD has not been defined, and QD dose exploration continues to select the optimal biologically efficacious dose. AEs occurring in >20% of pts include stomatitis (49%), palmar-plantar erythrodysesthesia (PPE, 38%), dry mouth (29%), and nail toxicities (22%), majority of which were ≤Gr 2. 6 pts had Gr 1-2 retinopathy, which resolved in all cases. 5 AEs were considered dose limiting toxicities: 4 in BID (rash/PPE/mucositis/hyperbilirubinemia) and 1 in QD (retinopathy). No Gr 4/5 drug-related AEs were seen. 25 pts remain on treatment (range 1-37 weeks). RLY-4008 showed broad anti-tumor activity across dose levels and FGFR2 alterations with radiographic tumor reductions of ≥10% in 59% pts (19/32; -11% to -83%). Activity was seen in FGFRi-naïve, FGFR2-fusion+ CCA with PRs in 50% of pts (3/6, 2 confirmed and 1 pending confirmation; -56% to -83%). Activity was also seen in FGFRi pre-treated FGFR2-fusion+ CCA pts (N=16) with 16 SD, including 9 pts with tumor reduction ≥10% (from -12% to -35%). Of the FGFRi pre-treated FGFR2-fusion+ CCA patients with detectable FGFR2 resistance mutations in ctDNA at baseline, 78% (7/9) were undetectable at C2D1. CONCLUSION: RLY-4008 demonstrates promising safety, tolerability, and clinical activity in FGFR2-altered solid tumor pts, including those who progressed on prior FGFRi therapy. Consistent with the FGFR2-selective mechanism, minimal off-isoform toxicity (FGFR1-hyperphosphatemia; FGFR4-diarrhea) was seen. These encouraging data validate selective targeting of FGFR2 and suggest that RLY-4008 has potential to overcome resistance to FGFRi.
Citation Format: Lipika Goyal, Mitesh Borad, Vivek Subbiah, Amit Mahipal, Suneel Kamath, Kabir Mody, Robin Katie Kelley, Richard Kim, Vaibhav Sahai, Anthony El-Khoueiry, Efrat Dotan, Oleg Schmidt-Kittler, Jinshan Shen, Kai Yu Jen, Alicia Deary, Wei Guo, Mahesh Padval, Cori Ann J. Sherwin, Charles Ferte, Beni Wolf, Alison M. Schram. First results of RLY-4008, a potent and highly selective FGFR2 inhibitor in a first-in-human study in patients with FGFR2-altered cholangiocarcinoma and multiple solid tumors [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr P02-02.
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Affiliation(s)
| | | | - Vivek Subbiah
- 3The University of Texas M.D. Anderson Cancer Center, Houston, TX,
| | | | - Suneel Kamath
- 5Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH,
| | | | - Robin Katie Kelley
- 7UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA,
| | | | | | | | - Efrat Dotan
- 11Fox Chase Cancer Center, Philadelphia, PA,
| | | | | | - Kai Yu Jen
- 12Relay Therapeutics, Inc., Cambridge, MA,
| | | | - Wei Guo
- 12Relay Therapeutics, Inc., Cambridge, MA,
| | | | | | | | - Beni Wolf
- 12Relay Therapeutics, Inc., Cambridge, MA,
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Goyal L, Subbiah V, Mahipal A, Kamath S, Mody K, Borad M, El-Khoueiry A, Sahai V, Kim R, Kelley R, Schmidt-Kittler O, Shen J, Jen K, Deary A, Padval M, Sherwin C, Wolf B, Schram A. P-70 First-in-human study of highly selective FGFR2 inhibitor, RLY-4008, in patients with intrahepatic cholangiocarcinoma and other advanced solid tumors. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
Early esophageal cancer involves the mucosal and submucosal layers of the esophagus. Early esophageal cancer is a heterogeneous group, and achieving optimal outcomes requires a multidisciplinary approach to align patients to their optimal treatment. Although organ-sparing endoscopic resection has become the preferred management option for superficial esophageal cancer, it is not adequate in all tumors, such as high-risk lesions with poorly differentiated pathology, lymphovascular invasion, or deep submucosal invasion. In such high-risk lesions, surgery, chemotherapy, and/or radiation may be required. In this article, we present our multidisciplinary approach to early esophageal cancer.
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Affiliation(s)
- Amit Bhatt
- Department of Gastroenterology and Hepatology, A31 desk, Cleveland, Ohio 44195, USA.
| | - Suneel Kamath
- Taussig Cancer Institute, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Sudish C Murthy
- Department of Thoracic and Cardiovascular Surgery, J4-1, 9500 Euclid Ave, Cleveland, Ohio 44195, USA
| | - Siva Raja
- Department of Thoracic and Cardiovascular Surgery, J4-1, 9500 Euclid Ave, Cleveland, Ohio 44195, USA
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Hadjieconomou S, Hughes J, Kamath S. Occupational skin disease during the COVID-19 pandemic, as captured in a Dermatology staff clinic in the United Kingdom. J Eur Acad Dermatol Venereol 2020; 34:e670-e671. [PMID: 32535946 PMCID: PMC7323254 DOI: 10.1111/jdv.16754] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/26/2022]
Affiliation(s)
- S Hadjieconomou
- Dermatology Department, Princess of Wales Hospital, Bridgend, UK
| | - J Hughes
- Dermatology Department, Princess of Wales Hospital, Bridgend, UK
| | - S Kamath
- Dermatology Department, Princess of Wales Hospital, Bridgend, UK
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Khurana D, Kumar A, Kamath S, Patil A, Kaur T. Mitoxantrone in aggresive relapsing multiple sclerosis in resource limited settings. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3474] [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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Thiruvalluvan Sujatha K, Jain D, Kamath S, Kuipers J, Deen NG. Experimental and numerical investigation of a micro-structured bubble column with chemisorption. Chem Eng Sci 2017. [DOI: 10.1016/j.ces.2016.12.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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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Dharap SB, Kamath S, Kumar V. Does prehospital time affect survival of major trauma patients where there is no prehospital care? J Postgrad Med 2017; 63:169-175. [PMID: 28272069 PMCID: PMC5525481 DOI: 10.4103/0022-3859.201417] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/04/2016] [Accepted: 12/14/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Survival after major trauma is considered to be time dependent. Efficient prehospital care with rapid transport is the norm in developed countries, which is not available in many lower middle and low-income countries. The aim of this study was to assess the effect of prehospital time and primary treatment given on survival of major trauma patients in a setting without prehospital care. MATERIALS AND METHODS This prospective observational study was carried out in a university hospital in Mumbai, from January to December 2014. The hospital has a trauma service but no organized prehospital care or defined interhospital transfer protocols. All patients with life- and/or limb-threatening injuries were included in the study. Injury time and arrival time were noted and the interval was defined as "prehospital time" for the directly arriving patients and as "time to tertiary care" for those transferred. Primary outcome measure was in-hospital death (or discharge). RESULTS Of 1181 patients, 352 were admitted directly from the trauma scene and 829 were transferred from other hospitals. In-hospital mortality was associated with age, mechanism and mode of injury, shock, Glasgow Coma Score <9, Injury Severity Score ≥16, need for intubation, and ventilatory support on arrival; but neither with prehospital time nor with time to tertiary care. Transferred patients had a significantly higher mortality (odds ratio = 1.869, 95% confidence interval = 1.233-2.561, P = 0.005) despite fewer patients with severe injury. Two hundred and ninety-four (35%) of these needed airway intervention while 108 (13%) needed chest tube insertion on arrival to the trauma unit suggesting inadequate care at primary facility. CONCLUSION Mortality is not associated with prehospital time but with transfers from primary care; probably due to deficient care. To improve survival after major trauma, enhancement of resources for resuscitation and capacity building of on-duty doctors in primary centers should be a priority in countries with limited resources.
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Affiliation(s)
- SB Dharap
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - S Kamath
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - V Kumar
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
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Suresh V, Sridhar K, Vijay S, Gandhi D, Kamath S, Raghavendra K. Checklist manifesto for craniosynostosis correction. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.254] [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: 10/19/2022]
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Chakrabarti D, Deepti B, Kamath S. Description of a novel literature search methodology and its validation against PubMed. Journal of Neuroanaesthesiology and Critical Care 2017. [DOI: 10.1055/s-0038-1646210] [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: 10/27/2022] Open
Affiliation(s)
- D. Chakrabarti
- Department of Neuroanaesthesia and Critical Care, NIMHANS, Bengaluru, Karnataka, India
| | - B. Deepti
- Department of Neuroanaesthesia and Critical Care, NIMHANS, Bengaluru, Karnataka, India
| | - S. Kamath
- Department of Neuroanaesthesia and Critical Care, NIMHANS, Bengaluru, Karnataka, India
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Theerth K, Kamath S, Reddy M, Chakrabarti D. Evaluation of analgesia nociception index as a tool to monitor pain and manage analgesia during supratentorial craniotomies. Journal of Neuroanaesthesiology and Critical Care 2017. [DOI: 10.1055/s-0038-1646258] [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: 10/27/2022] Open
Affiliation(s)
- K. Theerth
- Department of Neuroanaesthesia, NIMHANS, Bengaluru, Karnataka, India
| | - S. Kamath
- Department of Neuroanaesthesia, NIMHANS, Bengaluru, Karnataka, India
| | - M. Reddy
- Department of Neuroanaesthesia, NIMHANS, Bengaluru, Karnataka, India
| | - D. Chakrabarti
- Department of Neuroanaesthesia, NIMHANS, Bengaluru, Karnataka, India
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Sullivan SB, Kamath S, McConville TH, Gray BT, Lowy FD, Gordon PG, Uhlemann AC. Staphylococcus epidermidis Protection Against Staphylococcus aureus Colonization in People Living With Human Immunodeficiency Virus in an Inner-City Outpatient Population: A Cross-Sectional Study. Open Forum Infect Dis 2016; 3:ofw234. [PMID: 28018932 PMCID: PMC5170490 DOI: 10.1093/ofid/ofw234] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 08/16/2016] [Accepted: 10/26/2016] [Indexed: 01/22/2023] Open
Abstract
Background. People living with human immunodeficiency virus (PLWH) have been disproportionally affected by methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection, in particular by clones USA300 and USA500. However, the contribution of epidemiological, bacterial, and immunological risk factors to the excess of S aureus in PLWH remain incompletely understood. Methods. In this cross-sectional study, we determined the prevalence and molecular epidemiology of S aureus colonization in 93 PLWH attending an urban human immunodeficiency virus (HIV) clinic. Participants completed a structured interview assessing demographic information and risk factors for MRSA. Swabs were obtained from the nose, throat, and groin and cultured for S aureus and Staphylococcus epidermidis. Results. Most participants had well controlled HIV infection (89, 96% CD4 >200). Thirty-six (39%) individuals were colonized with S aureus at 1 or more body sites, including 6 (6%) with MRSA. Regular gym use was a risk factor for S aureus but not MRSA carriage. In contrast, S epidermidis was present in almost all individuals (n = 84, 90%), predominantly in the nares (n = 66, 71%). Using generalized estimating equation models, we observed that the odds of S aureus colonization were significantly and drastically reduced when S epidermidis was detected (P = .0001). After controlling for site, gender, and age, we identified that the odds of S aureus colonization were 80% less if S epidermidis was present (adjusted odds ratio, 0.20; 95% confidence interval, .09–.45; P < .0001). Conclusions. Taken together, we observed a lower prevalence of S aureus and MRSA colonization than has been previously reported in PLWH. In this cohort, colonization with S epidermidis was protective against S aureus colonization.
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Affiliation(s)
| | - Suneel Kamath
- Departments ofMedicine and; Northwestern Memorial Hospital, Chicago, Illinois
| | | | | | - Franklin D Lowy
- Departments ofMedicine and; Pathology, Columbia University Medical Center, New York
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Bhat R, Shetty S, Kamath S, Rao RP. Abstract PR228. Anesth Analg 2016. [DOI: 10.1213/01.ane.0000492626.91260.09] [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: 11/05/2022]
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Abstract
Background: The role of the ‘clicky hip’ symptom as a prognostic predictor of developmental dysplasia of hip (DDH) is controversial. We aim to study the role of isolated hip clicks as a prognostic predictor of DDH. Material and methods: 235 babits with persisting or referred with clicky hip beyond six weeks of age were prospectively followed up to note the incidence of DDH. Of these 176 babies were referred for a hip click without additional risk factors. Results: 7 out of 176 cases (4 - IIa, 2 - IIb, 1 - IIc) had initial abnormal ultrasound examination based on Graf classification. However, all babies with isolated hip clicks eventually had normal hips on clinical and radiographic examination. Discussion: While screening of babies with clicky hips does help in diagnosing the odd case of DDH this is not consistently reproducible. Modifying the targeted ultrasound screening by including clicky hip as a risk factor will not reduce the incidence of missed cases. Isolated clicks in the hip joint beyond six weeks age are rarely a predictor of DDH. However when in doubt such cases should be referred to be reviewed by an orthopaedic surgeon or a radiologist experienced in hip ultrasound.
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Affiliation(s)
- S Kamath
- Monklands Hospital, Airdrie, Lanarkshire.
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Ryan S, Thwaites C, Kamath S. AB1082-HPR Providing Drug Counselling on Methotrexate Is One Occasion Enough? Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Affiliation(s)
- Brandon McMahon
- Division of Hematology and Oncology, Department of Medicine, Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Suneel Kamath
- Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Dickler A, Ivanov O, Syed A, Golder S, Proulx G, Arterberry V, Cox C, Kamath S, Bhatnagar A, Smorowski K, Packianathan S. Five Year Results of a Multicenter Trial Utilizing Electronic Brachytherapy to Deliver Intraoperative Radiation Therapy in the Treatment of Early-Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hrishi TS, Kundapur PP, Naha A, Thomas BS, Kamath S, Bhat GS. Effect of adjunctive use of green tea dentifrice in periodontitis patients - A Randomized Controlled Pilot Study. Int J Dent Hyg 2015; 14:178-83. [DOI: 10.1111/idh.12131] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2014] [Indexed: 12/18/2022]
Affiliation(s)
- TS Hrishi
- Department of Dentistry; P K Das Institute of Medical Sciences; Vaniyamkulam Palakkad Kerala
| | - PP Kundapur
- Department of Periodontology; Manipal College of Dental Sciences; Manipal University; Manipal India
| | - A Naha
- Department of Pharmaceutics; Manipal College of Pharmaceutical Sciences; Manipal University; Manipal India
| | - BS Thomas
- Department of Periodontology; Manipal College of Dental Sciences; Manipal University; Manipal India
| | - S Kamath
- Department of Biochemistry; Kasturba Medical College; Manipal University; Manipal India
| | - GS Bhat
- PDS Division; Periodontics; College of Dentistry; University of Dammam; Dammam Saudi Arabia
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Fernandes J, Ribeiro S, Garrido P, Sereno J, Costa E, Reis F, Santos-Silva A, Hirata M, Tashiro Y, Aizawa K, Endo K, Fujimori A, Morikami Y, Okada S, Kumei M, Mizobuchi N, Sakai M, Claes K, Di Giulio S, Galle J, Guerin A, Kiss I, Suranyi M, Winearls C, Wirnsberger G, Farouk M, Manamley N, Addison J, Herlitz H, Visciano B, Nazzaro P, Riccio E, Del Rio A, Mozzillo GR, Pisani A, Gupta A, Ikizler TA, Lin V, Guss C, Pratt RD, Stewart VM, Anthoney A, Blenkin S, Ahmed S, Yasumoto M, Tsuda A, Ishimura E, Ohno Y, Ichii M, Nakatani S, Mori K, Fukumoto S, Uchida J, Emoto M, Nakatani T, Inaba M, Joki N, Tanaka Y, Kubo S, Asakawa T, Hase H, Ikeda M, Inaguma D, Sakaguchi T, Shinoda T, Koiwa F, Negi S, Yamaka T, Shigematsu T, Inaguma D, Suranyi MG, Claes K, Di Giulio S, Galle J, Kiss I, Winearls C, Wirnsberger G, Farouk M, Manamley N, Addison J, Herlitz H, Guerin A, Groenendaal-Van De Meent D, Den Adel M, Rijnders S, Essers H, Golor G, Haffner S, Schaddelee M, Hirata M, Tashiro Y, Yogo K, Aizawa K, Endo K, Choukroun G, Hannedouche T, Kessler M, Laville M, Levannier M, Mignon F, Rostaing L, Rottembourg J, Jeon J, Park Y, Karanth S, Prabhu R, Bairy M, Nagaraju SP, Bhat A, Kosuru S, Parthasarathy R, Kamath S, Prasad HK, Kallurwar KP, Nishida H, Iimori S, Okado T, Rai T, Uchida S, Sasaki S, Wan Q, Cana Ruiu DC, Ashcroft R, Brown C, Williams J, Mikhail A. CKD ANAEMIA. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu147] [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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Guardado-Mendoza R, Jimenez-Ceja L, Majluf-Cruz A, Kamath S, Fiorentino TV, Casiraghi F, Velazquez AOC, DeFronzo RA, Dick E, Davalli A, Folli F. Impact of obesity severity and duration on pancreatic β- and α-cell dynamics in normoglycemic non-human primates. Int J Obes (Lond) 2013; 37:1071-8. [PMID: 23229736 PMCID: PMC3906680 DOI: 10.1038/ijo.2012.205] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 11/05/2012] [Accepted: 11/08/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Obesity is associated with high insulin and glucagon plasma levels. Enhanced β-cell function and β-cell expansion are responsible for insulin hypersecretion. It is unknown whether hyperglucagonemia is due to α-cell hypersecretion or to an increase in α-cell mass. In this study, we investigated the dynamics of the β-cell and α-cell function and mass in pancreas of obese normoglycemic baboons. METHODS Pancreatic β- and α-cell volumes were measured in 51 normoglycemic baboons divided into six groups according to overweight severity or duration. Islets morphometric parameters were correlated to overweight and to diverse metabolic and laboratory parameters. RESULTS Relative α-cell volume (RαV) and relative islet α-cell volume (RIαV) increased significantly with both overweight duration and severity. Conversely, in spite of the induction of insulin resistance, overweight produced only modest effects on relative β-cell volume (RβV) and relative islet β-cell volume (RIβV). Of note, RIβV did not increase neither with overweight duration nor with overweight severity, supposedly because of the concomitant, greater increase in RIαV. Baboons' body weights correlated with serum levels of interleukin-6 and tumor necrosis factor-α soluble receptors, demonstrating that overweight induces abnormal activation of the signaling of two cytokines known to impact differently β- and α-cell viability and replication. CONCLUSION In conclusion, overweight and insulin resistance induce in baboons a significant increase in α-cell volumes (RαV, RIαV), whereas have minimal effects on the β cells. This study suggests that an increase in the α-cell mass may precede the loss of β cells and the transition to overt hyperglycemia and diabetes.
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Affiliation(s)
- R Guardado-Mendoza
- Department of Medicine, Diabetes Division, University of Texas Health Science Center at San Antonio, TX, USA
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Cornell P, Trehane A, Thompson P, Rahmeh F, Greenwood M, Baqai TJ, Cambridge S, Shaikh M, Rooney M, Donnelly S, Tahir H, Ryan S, Kamath S, Hassell A, McCuish WJ, Bearne L, Mackenzie-Green B, Price E, Williamson L, Collins D, Tang E, Hayes J, McLoughlin YM, Chamberlain V, Campbell S, Shah P, McKenna F, Cornell P, Westlake S, Thompson P, Richards S, Homer D, Gould E, Empson B, Kemp P, Richards AG, Walker J, Taylor S, Bari SF, Alachkar M, Rajak R, Lawson T, O'Sullivan M, Samant S, Butt S, Gadsby K, Flurey CA, Morris M, Hughes R, Pollock J, Richards P, Hewlett S, Edwards KR, Rowe I, Sanders T, Dunn K, Konstantinou K, Hay E, Jones LE, Adams J, White P, Donovan-Hall M, Hislop K, Barbosa Boucas S, Nichols VP, Williamson EM, Toye F, Lamb SE, Rodham K, Gavin J, Watts L, Coulson N, Diver C, Avis M, Gupta A, Ryan SJ, Stangroom S, Pearce JM, Byrne J, Manning VL, Hurley M, Scott DL, Choy E, Bearne L, Taylor J, Morris M, Dures E, Hewlett S, Wilson A, Adams J, Larkin L, Kennedy N, Gallagher S, Fraser AD, Shrestha P, Batley M, Koduri G, Scott DL, Flurey CA, Morris M, Hughes R, Pollock J, Richards P, Hewlett S, Kumar K, Raza K, Nightingale P, Horne R, Chapman S, Greenfield S, Gill P, Ferguson AM, Ibrahim F, Scott DL, Lempp H, Tierney M, Fraser A, Kennedy N, Barbosa Boucas S, Hislop K, Dziedzic K, Arden N, Burridge J, Hammond A, Stokes M, Lewis M, Gooberman-Hill R, Coales K, Adams J, Nutland H, Dean A, Laxminarayan R, Gates L, Bowen C, Arden N, Hermsen L, Terwee CB, Leone SS, vd Zwaard B, Smalbrugge M, Dekker J, vd Horst H, Wilkie R, Ferguson AM, Nicky Thomas V, Lempp H, Cope A, Scott DL, Simpson C, Weinman J, Agarwal S, Kirkham B, Patel A, Ibrahim F, Barn R, Brandon M, Rafferty D, Sturrock R, Turner D, Woodburn J, Rafferty D, Paul L, Marshall R, Gill J, McInnes I, Roderick Porter D, Woodburn J, Hennessy K, Woodburn J, Steultjens M, Siddle HJ, Hodgson RJ, Hensor EM, Grainger AJ, Redmond A, Wakefield RJ, Helliwell PS, Hammond A, Rayner J, Law RJ, Breslin A, Kraus A, Maddison P, Thom JM, Newcombe LW, Woodburn J, Porter D, Saunders S, McCarey D, Gupta M, Turner D, McGavin L, Freeburn R, Crilly A, Lockhart JC, Ferrell WR, Goodyear C, Ledingham J, Waterman T, Berkin L, Nicolaou M, Watson P, Lillicrap M, Birrell F, Mooney J, Merkel PA, Poland F, Spalding N, Grayson P, Leduc R, Shereff D, Richesson R, Watts RA, Roussou E, Thapper M, Bateman J, Allen M, Kidd J, Parsons N, Davies D, Watt KA, Scally MD, Bosworth A, Wilkinson K, Collins S, Jacklin CB, Ball SK, Grosart R, Marks J, Litwic AE, Sriranganathan MK, Mukherjee S, Khurshid MA, Matthews SM, Hall A, Sheeran T, Baskar S, Muether M, Mackenzie-Green B, Hetherington A, Wickrematilake G, Williamson L, Daniels LE, Gwynne CE, Khan A, Lawson T, Clunie G, Stephenson S, Gaffney K, Belsey J, Harvey NC, Clarke-Harris R, Murray R, Costello P, Garrett E, Holbrook J, Teh AL, Wong J, Dogra S, Barton S, Davies L, Inskip H, Hanson M, Gluckman P, Cooper C, Godfrey K, Lillycrop K, Anderton T, Clarke S, Rao Chaganti S, Viner N, Seymour R, Edwards MH, Parsons C, Ward K, Thompson J, Prentice A, Dennison E, Cooper C, Clark E, Cumming M, Morrison L, Gould VC, Tobias J, Holroyd CR, Winder N, Osmond C, Fall C, Barker D, Ring S, Lawlor D, Tobias J, Davey Smith G, Cooper C, Harvey NC, Toms TE, Afreedi S, Salt K, Roskell S, Passey K, Price T, Venkatachalam S, Sheeran T, Davies R, Southwood TR, Kearsley-Fleet L, Hyrich KL, Kingsbury D, Quartier P, Patel G, Arora V, Kupper H, Mozaffarian N, Kearsley-Fleet L, Baildam E, Beresford MW, Davies R, Foster HE, Mowbray K, Southwood TR, Thomson W, Hyrich KL, Saunders E, Baildam E, Chieng A, Davidson J, Foster H, Gardner-Medwin J, Wedderburn L, Thomson W, Hyrich K, McErlane F, Beresford M, Baildam E, Chieng SE, Davidson J, Foster HE, Gardner-Medwin J, Lunt M, Wedderburn L, Thomson W, Hyrich K, Rooney M, Finnegan S, Gibson DS, Borg FA, Bale PJ, Armon K, Cavelle A, Foster HE, McDonagh J, Bale PJ, Armon K, Wu Q, Pesenacker AM, Stansfield A, King D, Barge D, Abinun M, Foster HE, Wedderburn L, Stanley K, Morrissey D, Parsons S, Kuttikat A, Shenker N, Garrood T, Medley S, Ferguson AM, Keeling D, Duffort P, Irving K, Goulston L, Culliford D, Coakley P, Taylor P, Hart D, Spector T, Hakim A, Arden N, Mian A, Garrood T, Magan T, Chaudhary M, Lazic S, Sofat N, Thomas MJ, Moore A, Roddy E, Peat G, Rees F, Lanyon P, Jordan N, Chaib A, Sangle S, Tungekar F, Sabharwal T, Abbs I, Khamashta M, D'Cruz D, Dzifa Dey I, Isenberg DA, Chin CW, Cheung C, Ng M, Gao F, Qiong Huang F, Thao Le T, Yong Fong K, San Tan R, Yin Wong T, Julian T, Parker B, Al-Husain A, Yvonne Alexander M, Bruce I, Jordan N, Abbs I, D'cruz D, McDonald G, Miguel L, Hall C, Isenberg DA, Magee A, Butters T, Jury E, Yee CS, Toescu V, Hickman R, Leung MH, Situnayake D, Bowman S, Gordon C, Yee CS, Toescu V, Hickman R, Leung MH, Situnayake D, Bowman S, Gordon C, Lazarus MN, Isenberg DA, Ehrenstein M, Carter LM, Isenberg DA, Ehrenstein MR, Chanchlani N, Gayed M, Yee CS, Gordon C, Ball E, Rooney M, Bell A, Reynolds JA, Ray DW, O'Neill T, Alexander Y, Bruce I, Sutton EJ, Watson KD, Isenberg D, Rahman A, Gordon C, Yee CS, Lanyon P, Jayne D, Akil M, D'Cruz D, Khamashta M, Lutalo P, Erb N, Prabu A, Edwards CJ, Youssef H, McHugh N, Vital E, Amft N, Griffiths B, Teh LS, Zoma A, Bruce I, Durrani M, Jordan N, Sangle S, D'Cruz D, Pericleous C, Ruiz-Limon P, Romay-Penabad Z, Carrera-Marin A, Garza-Garcia A, Murfitt L, Driscoll PC, Giles IP, Ioannou Y, Rahman A, Pierangeli SS, Ripoll VM, Lambrianides A, Heywood WE, Ioannou J, Giles IP, Rahman A, Stevens C, Dures E, Morris M, Knowles S, Hewlett S, Marshall R, Reddy V, Croca S, Gerona D, De La Torre Ortega I, Isenberg DA, Leandro M, Cambridge G, Reddy V, Cambridge G, Isenberg DA, Glennie M, Cragg M, Leandro M, Croca SC, Isenberg DA, Giles I, Ioannou Y, Rahman A, Croca SC, Isenberg DA, Giles I, Ioannou Y, Rahman A, Artim Esen B, Pericleous C, MacKie I, Ioannou Y, Rahman A, Isenberg DA, Giles I, Skeoch S, Haque S, Pemberton P, Bruce I. BHPR: Audit and Clinical Evaluation * 103. Dental Health in Children and Young Adults with Inflammatory Arthritis: Access to Dental Care. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jain N, Goyal N, Mukherjee K, Kamath S. Ultrasound of the abdominal wall: What lies beneath? Clin Radiol 2013; 68:85-93. [DOI: 10.1016/j.crad.2012.05.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 05/24/2012] [Accepted: 05/28/2012] [Indexed: 12/30/2022]
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