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  1. Book ; Online: Las fronteras de la Ilustración: itinerarios entre Historia y Derecho

    Demarchi, Giacomo / Di Chiara, Francesco / Fiocchi Malaspina, Elisabetta / Rodríguez Arrocha, Belinda / Costa, Pietro / Bragagnolo, Manuela / Hernández Santiago, Óscar / Machado Cabral, Gustavo César / Trampus, Antonio / Spigno, Irene / Bonadiman, Luca / Clements, Richard

    2021  

    Keywords Jurisprudence & general issues ; Ilustración ; Fronteras ; Circulación jurídica ; Entangled history ; Enlightenment ; Borders ; Legal circulation
    Size 1 electronic resource (313 pages)
    Publisher Universidad Carlos III de Madrid. Figuerola Institute of Social Science History
    Publishing place Madrid
    Document type Book ; Online
    Note English ; Italian ; Spanish ; Open Access
    HBZ-ID HT021048096
    ISBN 978-84-1377-447-3 ; 84-1377-447-0
    Database ZB MED Catalogue: Medicine, Health, Nutrition, Environment, Agriculture

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  2. Book ; Online: El derecho penal en la edad moderna: Nuevas aproximaciones a la doctrina y a la práctica judicial

    Machado Cabral, Gustavo César / Di Chiara, Francesco / Hernández Santiago, Óscar / Rodríguez Arrocha, Belinda / Härter, Karl

    2016  

    Abstract: The main purpose of this book is to contribute with the discussion about criminal proceedings and how doctrinal opinions spread through the South of Italy, Iberian countries and New Spain in the Early Modern age. Some relevant topics are judicial ... ...

    Abstract The main purpose of this book is to contribute with the discussion about criminal proceedings and how doctrinal opinions spread through the South of Italy, Iberian countries and New Spain in the Early Modern age. Some relevant topics are judicial discretionary, protection and application of royal competencies, as well as the importance of the decisiones in regard to the procedural activity within the high courts of Portugal and Sicily. The interdependence between Criminal law, doctrinal discourses and judicial practice within the scope of the European ius commune is a basic feature of the chapters contained in this book.---El propósito principal de esta obra colectiva es la contribución al conocimiento de los procedimientos penales y de la difusión de las diversas tendencias doctrinales en el ámbito del sur de Italia, los territorios ibéricos y Nueva España en la temprana Edad Moderna. Algunos temas relevantes son la discrecionalidad judicial, la protección y aplicación de las competencias reales, así como la importancia de las decisiones en lo que atañe a la actividad procesal en el seno de los altos tribunales de Portugal y Sicilia. Las interconexiones entre el derecho criminal, los discursos doctrinales y la práctica judicial en la órbita del ius commune europeo vertebran los capítulos de este libro
    Keywords Modern history, 1453 ; Criminal law and procedure
    Size 1 electronic resource (217 p.)
    Publisher Universidad Carlos III de Madrid. Figuerola Institute of Social Science History
    Document type Book ; Online
    Note Spanish ; Open Access
    HBZ-ID HT020091360
    ISBN 9788490858127 ; 8490858128
    Database ZB MED Catalogue: Medicine, Health, Nutrition, Environment, Agriculture

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  3. Article ; Online: Should all patients receive extended thromboprophylaxis after resection of primary lung cancer?

    Kho, Jason / Mitchell, Jenny / Curry, Nicola / Di Chiara, Francesco / Stavroulias, Dionisios / Belcher, Elizabeth

    The Journal of thoracic and cardiovascular surgery

    2022  Volume 164, Issue 6, Page(s) 1603–1611.e1

    Abstract: Objective: The optimal duration of thromboprophylaxis in patients undergoing resection of primary lung cancer is not known. We investigated the incidence of pulmonary emboli and venous thromboembolism in patients undergoing early-stage lung cancer ... ...

    Abstract Objective: The optimal duration of thromboprophylaxis in patients undergoing resection of primary lung cancer is not known. We investigated the incidence of pulmonary emboli and venous thromboembolism in patients undergoing early-stage lung cancer resection and the impact of change from short duration to extended thromboprophylaxis.
    Methods: We reviewed the outcomes of consecutive patients who underwent resection of early-stage primary lung cancer following a change in protocol from inpatient-only to extended thromboprophylaxis to 28 days. Propensity-score matching of control (routine inpatient pharmacologic thromboprophylaxis) and treatment group (extended pharmacologic thromboprophylaxis) was performed. Adjustment for covariates based on the Caprini risk assessment model was undertaken. Thromboembolic outcomes were compared between the 2 groups.
    Results: Seven hundred fifty consecutive patients underwent resection of primary lung cancer at Oxford University Hospitals NHS Foundation Trust between January 2013 and December 2018. Six hundred patients were included for analysis and propensity-score matching resulted in 253 matched pairs. Extended prophylaxis was associated with a significant reduction in pulmonary emboli (10 of 253 patients [4%] vs 1 of 253 patients [0.4%], P = .01). One patient (0.4%) developed a bleeding complication within the treatment cohort. Multivariable logistic regression model demonstrated that extended thromboprophylaxis was independently associated with a reduction in postoperative pulmonary emboli.
    Conclusions: Patients undergoing lung cancer resection surgery are at moderate-to-high risk of postoperative thromboembolic disease. Extended dalteparin for 28 days is safe and is associated with reduced incidence of pulmonary embolus in patients undergoing resection of early-stage primary lung cancer.
    MeSH term(s) Humans ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/etiology ; Venous Thromboembolism/prevention & control ; Anticoagulants/adverse effects ; Drug Administration Schedule ; Pulmonary Embolism/epidemiology ; Pulmonary Embolism/etiology ; Pulmonary Embolism/prevention & control ; Postoperative Complications/epidemiology ; Postoperative Complications/prevention & control ; Postoperative Complications/etiology ; Lung Neoplasms/surgery ; Lung Neoplasms/complications
    Chemical Substances Anticoagulants
    Language English
    Publishing date 2022-07-05
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 3104-5
    ISSN 1097-685X ; 0022-5223
    ISSN (online) 1097-685X
    ISSN 0022-5223
    DOI 10.1016/j.jtcvs.2022.06.016
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Optimal resection rate for lung cancer in the UK: how high should we go?

    Belcher, Elizabeth / Mitchell, Jenny / Stavroulias, Dionisios / Di Chiara, Francesco / Rahman, Najib

    BMJ open respiratory research

    2021  Volume 8, Issue 1

    Abstract: Background: The optimal resection rate for institutions managing early-stage primary lung cancer is not known. Whether the prognosis of patients who do not proceed to operation is determined by their comorbidities for which they were deemed at ... ...

    Abstract Background: The optimal resection rate for institutions managing early-stage primary lung cancer is not known. Whether the prognosis of patients who do not proceed to operation is determined by their comorbidities for which they were deemed at prohibitively high-operative risk, or disease progression, is uncertain. We investigated the outcomes of patients with early-stage lung cancer who were considered for surgical management.
    Methods: We reviewed the outcomes of consecutive patients who were considered for resection of early-stage primary lung cancer at Oxford University Hospitals National Health Service Foundation Trust between 2012 and 2017.
    Results: Between 29 November 2012 and 31 March 2017, 467 consecutive patients underwent resection with curative intent for primary lung cancer (operative group), while 81 patients were deemed resectable but either inoperable or did not wish to proceed to operation (non-operative group). Reason for not proceeding to resection was cardiovascular in 16 patients (19.8%), respiratory in 21 (25.9%), cardiorespiratory in 11 (13.6%), performance status in 8 (9.9%) and patient choice in 25 (30.9%) patients. Sixty-six patients (81.5%) received an alternative radical treatment. Median follow-up was 169 weeks (IQR 119-246 weeks) in the operative group and 118 weeks (IQR 74-167 weeks) in the non-operative group. Median survival of patients with early-stage lung cancer who did not proceed to operation was 2.5 years; median survival of patients undergoing lung cancer resection was undefined (p<0.0001). Lung cancer was documented as directly or indirectly leading to or contributing to death in 40 patients (76.9%). In 11 patients, the cause of death was due to comorbidities (21.2%).
    Conclusions: Patients turned down for operation in a high-resection rate UK unit have limited survival due to lung cancer progression. We conclude that 'optimal' resection rates may not have been reached in the UK even in high-resection rate centres.
    MeSH term(s) Humans ; Lung ; Lung Neoplasms/epidemiology ; Lung Neoplasms/surgery ; Prognosis ; State Medicine ; United Kingdom/epidemiology
    Language English
    Publishing date 2021-07-29
    Publishing country England
    Document type Journal Article
    ZDB-ID 2736454-9
    ISSN 2052-4439 ; 2052-4439
    ISSN (online) 2052-4439
    ISSN 2052-4439
    DOI 10.1136/bmjresp-2020-000771
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Prosthetic azygo-atrial bypass for palliation of superior vena cava syndrome.

    Durkovic, Sava / Di Chiara, Francesco / Rea, Federico

    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

    2012  Volume 41, Issue 4, Page(s) e56–8

    Abstract: We report a case of locally advanced excavated non-small cell lung cancer with superior vena cava (SVC) syndrome that underwent four cycles of induction chemotherapy. Due to early treatment failure and the impossibility applying radical radiotherapy, a ... ...

    Abstract We report a case of locally advanced excavated non-small cell lung cancer with superior vena cava (SVC) syndrome that underwent four cycles of induction chemotherapy. Due to early treatment failure and the impossibility applying radical radiotherapy, a decision was made to perform surgery. The patient underwent right intrapericardial pneumonectomy with en-bloc resection of the SVC, azygos vein and mediastinal lymph nodes. Prosthetic azygo-atrial bypass was then performed. The patient enjoys one year progression-free survival with patent graft and symptomatic relief of SVC syndrome.
    MeSH term(s) Azygos Vein/diagnostic imaging ; Azygos Vein/surgery ; Blood Vessel Prosthesis Implantation/methods ; Carcinoma, Non-Small-Cell Lung/diagnostic imaging ; Carcinoma, Non-Small-Cell Lung/surgery ; Follow-Up Studies ; Heart Atria/surgery ; Humans ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/surgery ; Male ; Middle Aged ; Palliative Care/methods ; Superior Vena Cava Syndrome/diagnostic imaging ; Superior Vena Cava Syndrome/surgery ; Tomography, X-Ray Computed
    Language English
    Publishing date 2012-04
    Publishing country Germany
    Document type Case Reports ; Journal Article
    ZDB-ID 639293-3
    ISSN 1873-734X ; 1010-7940 ; 1567-4258
    ISSN (online) 1873-734X
    ISSN 1010-7940 ; 1567-4258
    DOI 10.1093/ejcts/ezr289
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Imaging of congenital chest wall deformities.

    Mak, Sze M / Bhaludin, Basrull N / Naaseri, Sahar / Di Chiara, Francesco / Jordan, Simon / Padley, Simon

    The British journal of radiology

    2016  Volume 89, Issue 1061, Page(s) 20150595

    Abstract: To identify the anatomy and pathology of chest wall malformations presenting for consideration for corrective surgery or as a possible chest wall "mass", and to review the common corrective surgical procedures. Congenital chest wall deformities are ... ...

    Abstract To identify the anatomy and pathology of chest wall malformations presenting for consideration for corrective surgery or as a possible chest wall "mass", and to review the common corrective surgical procedures. Congenital chest wall deformities are caused by anomalies of chest wall growth, leading to sternal depression or protrusion, or are related to failure of normal spine or rib development. Cross-sectional imaging allows appreciation not only of the involved structures but also assessment of the degree of displacement or deformity of adjacent but otherwise normal structures and differentiation between anatomical deformity and neoplasia. In some cases, CT is also useful for surgical planning. The use of three-dimensional reconstructions, utilizing a low-dose technique, provides important information for the surgeon to discuss the nature of anatomical abnormalities and planned corrections with the patient and often with their parents. In this pictorial essay, we discuss the radiological features of the commonest congenital chest wall deformities and illustrate pre- and post-surgical appearances for those undergoing surgical correction.
    MeSH term(s) Adult ; Female ; Funnel Chest/diagnostic imaging ; Humans ; Imaging, Three-Dimensional ; Male ; Sternum/diagnostic imaging ; Thoracic Diseases/congenital ; Thoracic Diseases/diagnostic imaging ; Thoracic Wall/abnormalities ; Thoracic Wall/diagnostic imaging ; Tomography, X-Ray Computed ; Young Adult
    Language English
    Publishing date 2016
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2982-8
    ISSN 1748-880X ; 0007-1285
    ISSN (online) 1748-880X
    ISSN 0007-1285
    DOI 10.1259/bjr.20150595
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Single-institution experience on robot-assisted thoracoscopic operations for mediastinal diseases.

    Rea, Federico / Schiavon, Marco / Di Chiara, Francesco / Marulli, Giuseppe

    Innovations (Philadelphia, Pa.)

    2011  Volume 6, Issue 5, Page(s) 316–322

    Abstract: Objective: : After the introduction of video-assisted thoracoscopic surgery 20 years ago, the minimally invasive techniques in thoracic surgery have found a growing application. The recent introduction of robotic technology has increased the ... ...

    Abstract Objective: : After the introduction of video-assisted thoracoscopic surgery 20 years ago, the minimally invasive techniques in thoracic surgery have found a growing application. The recent introduction of robotic technology has increased the potentiality of thoracoscopic technique leading to an expansion of indications and applications, particularly for the management of mediastinal diseases. We reviewed our experience in robot-assisted thoracoscopic resection of benign and malignant mediastinal diseases.
    Methods: : Between 2002 and 2010, 108 patients (79 women and 29 men; median age 38 y) underwent robot-assisted thoracoscopy using the "da Vinci" robotic system for several mediastinal diseases. There were 100 thymectomies, 3 resections of paravertebral tumors, 1 thymic cyst, 1 ectopic goitre, 1 ectopic mediastinal parathyroidectomy, 1 thymic carcinoid, and 1 foregut cyst. Ninety-five (87.9%) patients were affected by myasthenia gravis.
    Results: : All procedures were completed successfully using the da Vinci robot; no open conversions were required, but in three (2.8%) cases, a fourth access was added. There was no surgical mortality; four (3.6%) patients had postoperative complications (two hemothorax, one chylothorax, and one fever) treated conservatively. Median operation time was 120 (range 60-300) minutes and median hospitalization was 3 (range 2-14) days. Global benefit rate for patients with myasthenia gravis reached the value of 93.4% with progressive improvement over years.
    Conclusions: : Several mediastinal operations may be feasible by using a robot-aided thoracoscopic approach. The technical innovations offered by robotic instrumentation make all procedures safer and easier when compared with standard thoracoscopic approach, with particular reference for application in mediastinal field.
    Language English
    Publishing date 2011-09
    Publishing country United States
    Document type Journal Article
    ISSN 1559-0879
    ISSN (online) 1559-0879
    DOI 10.1097/IMI.0b013e318235b783
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Changes in pulmonary function tests predict radiological response to chemotherapy in malignant pleural mesothelioma.

    Marulli, Giuseppe / Di Chiara, Francesco / Braccioni, Fausto / Perissinotto, Egle / Pasello, Giulia / Favaretto, Adolfo G / Breda, Cristiano / Rea, Federico

    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

    2013  Volume 44, Issue 1, Page(s) 104–110

    Abstract: Objectives: Response to chemotherapy in malignant pleural mesothelioma (MPM) is usually evaluated by radiological criteria, but no common agreement exists on their validity, yet. The cytoreductive effect of chemotherapy on pleural thickening may make ... ...

    Abstract Objectives: Response to chemotherapy in malignant pleural mesothelioma (MPM) is usually evaluated by radiological criteria, but no common agreement exists on their validity, yet. The cytoreductive effect of chemotherapy on pleural thickening may make the lung more expansible, reducing the restrictive ventilatory impairment. The aim of this study was to evaluate the changes in pulmonary function following chemotherapy in patients with MPM and to correlate these findings with radiological changes.
    Methods: Between 2004 and 2011, 62 consecutive patients (74% males, median age 63 years) were prospectively investigated. Modified RECIST criteria were used for radiological evaluation of response to chemotherapy. All patients underwent pulmonary function tests before and after three cycles of platinum-based chemotherapy. Changes between baseline and post-chemotherapy pulmonary function values (Δ) and their differences were assessed by means of Student's paired and unpaired t-test, respectively. Receiver operating characteristic (ROC) curve analysis was performed on spirometric parameters significantly associated with response.
    Results: Thirty (48.4%) patients had a radiological stable disease (S), 23 (37.1%) a partial response (R) and 9 (14.5%) a progressive disease (P). ΔFEV1%pred (R: 18.1 ± 18.5%; S: 0.5 ± 9.3%; P: -11 ± 13.5%; P < 0.0001), ΔFVC%pred (R: 16.1 ± 11.8%; S: 0.4 ± 11.2%; P: -9.2 ± 14.6%; P < 0.0001) and ΔVC%pred (R: 12.9 ± 15.7%; S: 1.5 ± 12.1%; P: -6.1 ± 13.2%; P = 0.001) were significantly associated with radiological response. A significant correlation was observed between ΔFEV1%pred (r = 0.46, P = 0.01), ΔFVC%pred (r = 0.43, P = 0.02) and % change in linear tumour measurement. ROC curve analysis using dichotomized radiological response (P/S vs R) as classification variables showed AUC = 0.88 (95%CI: 0.77-0.95) for ΔFEV1%pred (optimal cut-off value: +7%, sensitivity: 83%, specificity: 82%, PPV: 73%, NPV: 89%) and AUC = 0.86 (95%CI: 0.75-0.94) for ΔFVC%pred (optimal cut-off value: +6%, sensitivity: 82%, specificity: 74%, PPV: 64%, NPV: 88%).
    Conclusions: Dynamic lung volumes and radiological changes after chemotherapy seem directly related. Lung function changes could be an additional tool to better evaluate the response to chemotherapy in MPM.
    MeSH term(s) Adult ; Aged ; Analysis of Variance ; Antineoplastic Agents/therapeutic use ; Female ; Forced Expiratory Volume/physiology ; Humans ; Lung Neoplasms/drug therapy ; Lung Neoplasms/physiopathology ; Lung Neoplasms/radiotherapy ; Male ; Mesothelioma/drug therapy ; Mesothelioma/physiopathology ; Mesothelioma/radiotherapy ; Mesothelioma, Malignant ; Middle Aged ; Pleural Neoplasms/drug therapy ; Pleural Neoplasms/physiopathology ; Pleural Neoplasms/radiotherapy ; Prospective Studies ; ROC Curve ; Vital Capacity/physiology
    Chemical Substances Antineoplastic Agents
    Language English
    Publishing date 2013-01-23
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 639293-3
    ISSN 1873-734X ; 1010-7940 ; 1567-4258
    ISSN (online) 1873-734X
    ISSN 1010-7940 ; 1567-4258
    DOI 10.1093/ejcts/ezs624
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Surgical and neurologic outcomes after robotic thymectomy in 100 consecutive patients with myasthenia gravis.

    Marulli, Giuseppe / Schiavon, Marco / Perissinotto, Egle / Bugana, Antonella / Di Chiara, Francesco / Rebusso, Alessandro / Rea, Federico

    The Journal of thoracic and cardiovascular surgery

    2013  Volume 145, Issue 3, Page(s) 730–5; discussion 735–6

    Abstract: Objective: Thymectomy is a well-defined therapeutic option for patients with myasthenia gravis; however, controversies still exist about the surgical approach, indication, and timing for surgery. We reviewed our experience reporting surgical and ... ...

    Abstract Objective: Thymectomy is a well-defined therapeutic option for patients with myasthenia gravis; however, controversies still exist about the surgical approach, indication, and timing for surgery. We reviewed our experience reporting surgical and neurologic results after robotic thymectomy in patients with myasthenia gravis.
    Methods: Between 2002 and 2010, 100 patients (74 female and 26 male; median age, 37 years) underwent left-sided robotic thymectomy using the da Vinci robotic system (Intuitive Surgical, Inc, Sunnyvale, Calif). The Myasthenia Gravis Foundation of America classification was adopted for pre- and postoperative evaluation. Preoperative Myasthenia Gravis Foundation of America class was I in 10% of patients, II in 35% of patients, III in 39% of patients, and IV in 16% of patients.
    Results: Median operative time was 120 (60-300) minutes. No death or intraoperative complications occurred. Postoperative complications were observed in 6 patients (6%) (bleeding requiring blood transfusions in 3, chylothorax in 1, fever in 1, and myasthenic crisis in 1). Median hospital stay was 3 days (range, 2-14 days). Histologic analysis revealed 76 patients (76%) with hyperplasia, 7 patients (7%) with atrophy, 8 patients (8%) with small thymomas, and 9 patients (9%) with normal thymus; ectopic thymic tissue was found in 26 patients (26%). Clinical follow-up showed a 5-year probability of complete stable remission and overall improvement of 28.5% and 87.5%. Remission was significantly associated with preoperative I to II Myasthenia Gravis Foundation of America class (P = .02). A significant improvement rate was found in Myasthenia Gravis Foundation of America class I to II (P = .03) and AbAchR+ (P = .04). A high percentage of patients interrupted or reduced their medications.
    Conclusions: Robotic thymectomy is a safe and effective procedure. We observed a neurologic benefit in a great number of patients. A better clinical outcome was obtained in patients with early Myasthenia Gravis Foundation of America class.
    MeSH term(s) Adult ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Myasthenia Gravis/surgery ; Operative Time ; Postoperative Complications ; Proportional Hazards Models ; Retrospective Studies ; Robotics/methods ; Thymectomy/methods ; Treatment Outcome
    Language English
    Publishing date 2013-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3104-5
    ISSN 1097-685X ; 0022-5223
    ISSN (online) 1097-685X
    ISSN 0022-5223
    DOI 10.1016/j.jtcvs.2012.12.031
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Mitochondrial Inhibitor Atovaquone Increases Tumor Oxygenation and Inhibits Hypoxic Gene Expression in Patients with Non-Small Cell Lung Cancer.

    Skwarski, Michael / McGowan, Daniel R / Belcher, Elizabeth / Di Chiara, Francesco / Stavroulias, Dionisios / McCole, Mark / Derham, Jennifer L / Chu, Kwun-Ye / Teoh, Eugene / Chauhan, Jagat / O'Reilly, Dawn / Harris, Benjamin H L / Macklin, Philip S / Bull, Joshua A / Green, Marcus / Rodriguez-Berriguete, Gonzalo / Prevo, Remko / Folkes, Lisa K / Campo, Leticia /
    Ferencz, Petra / Croal, Paula L / Flight, Helen / Qi, Cathy / Holmes, Jane / O'Connor, James P B / Gleeson, Fergus V / McKenna, W Gillies / Harris, Adrian L / Bulte, Daniel / Buffa, Francesca M / Macpherson, Ruth E / Higgins, Geoff S

    Clinical cancer research : an official journal of the American Association for Cancer Research

    2021  Volume 27, Issue 9, Page(s) 2459–2469

    Abstract: Purpose: Tumor hypoxia fuels an aggressive tumor phenotype and confers resistance to anticancer treatments. We conducted a clinical trial to determine whether the antimalarial drug atovaquone, a known mitochondrial inhibitor, reduces hypoxia in non- ... ...

    Abstract Purpose: Tumor hypoxia fuels an aggressive tumor phenotype and confers resistance to anticancer treatments. We conducted a clinical trial to determine whether the antimalarial drug atovaquone, a known mitochondrial inhibitor, reduces hypoxia in non-small cell lung cancer (NSCLC).
    Patients and methods: Patients with NSCLC scheduled for surgery were recruited sequentially into two cohorts: cohort 1 received oral atovaquone at the standard clinical dose of 750 mg twice daily, while cohort 2 did not. Primary imaging endpoint was change in tumor hypoxic volume (HV) measured by hypoxia PET-CT. Intercohort comparison of hypoxia gene expression signatures using RNA sequencing from resected tumors was performed.
    Results: Thirty patients were evaluable for hypoxia PET-CT analysis, 15 per cohort. Median treatment duration was 12 days. Eleven (73.3%) atovaquone-treated patients had meaningful HV reduction, with median change -28% [95% confidence interval (CI), -58.2 to -4.4]. In contrast, median change in untreated patients was +15.5% (95% CI, -6.5 to 35.5). Linear regression estimated the expected mean HV was 55% (95% CI, 24%-74%) lower in cohort 1 compared with cohort 2 (
    Conclusions: This is the first clinical evidence that targeting tumor mitochondrial metabolism can reduce hypoxia and produce relevant antitumor effects at the mRNA level. Repurposing atovaquone for this purpose may improve treatment outcomes for NSCLC.
    MeSH term(s) Atovaquone/pharmacology ; Atovaquone/therapeutic use ; Carcinoma, Non-Small-Cell Lung/diagnosis ; Carcinoma, Non-Small-Cell Lung/drug therapy ; Carcinoma, Non-Small-Cell Lung/genetics ; Carcinoma, Non-Small-Cell Lung/metabolism ; Energy Metabolism ; Epithelial-Mesenchymal Transition/drug effects ; Epithelial-Mesenchymal Transition/genetics ; Female ; Gene Expression Profiling ; Gene Expression Regulation, Neoplastic ; Humans ; Immunohistochemistry ; Lung Neoplasms/diagnosis ; Lung Neoplasms/drug therapy ; Lung Neoplasms/genetics ; Lung Neoplasms/metabolism ; Male ; Mitochondria/drug effects ; Mitochondria/metabolism ; Molecular Imaging ; Oxidative Phosphorylation/drug effects ; Positron Emission Tomography Computed Tomography ; STAT3 Transcription Factor/metabolism ; Tumor Hypoxia/drug effects ; Tumor Hypoxia/genetics
    Chemical Substances STAT3 Transcription Factor ; Atovaquone (Y883P1Z2LT)
    Language English
    Publishing date 2021-02-17
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1225457-5
    ISSN 1557-3265 ; 1078-0432
    ISSN (online) 1557-3265
    ISSN 1078-0432
    DOI 10.1158/1078-0432.CCR-20-4128
    Database MEDical Literature Analysis and Retrieval System OnLINE

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