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  1. Article ; Online: Model-Assisted Designs for Early-Phase Clinical Trials: Simplicity Meets Superiority.

    Yuan, Ying / Lee, J Jack / Hilsenbeck, Susan G

    JCO precision oncology

    2019  Volume 3

    Abstract: Drug development enterprise is struggling because of prohibitively high costs and slow progress. There is urgent need for adoption of novel adaptive designs to improve the efficiency and success of clinical trials. A major barrier is that many ... ...

    Abstract Drug development enterprise is struggling because of prohibitively high costs and slow progress. There is urgent need for adoption of novel adaptive designs to improve the efficiency and success of clinical trials. A major barrier is that many conventional designs are inadequate for modern drug development, yet most novel adaptive designs are difficult to understand, require complicated statistical modeling, demand complex computation, and need expensive infrastructure for implementation. The objective of this article is to introduce and review a class of novel adaptive designs, known as model-assisted designs, to remove this barrier and increase the use of novel adaptive designs. Model-assisted designs enjoy superior performance comparable to more complicated, model-based adaptive designs, but their decision rule can be pretabulated and included in the protocol-thus implemented as simply as the conventional designs. We review state-of-the-art model-assisted designs for phase I clinical trials for single-agent, drug-combination and late-onset toxicity scenarios. We also briefly introduce model-assisted designs for phase II trials to handle binary, coprimary endpoints and delayed response. Freely available user-friendly software and trial examples (trialdesign.org) facilitate the adoption of model-assisted designs.
    Language English
    Publishing date 2019-10-24
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2473-4284
    ISSN (online) 2473-4284
    DOI 10.1200/PO.19.00032
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: The novel phosphatase NUDT5 is a critical regulator of triple-negative breast cancer growth.

    Qian, Jing / Ma, Yanxia / Tahaney, William M / Moyer, Cassandra L / Lanier, Amanda / Hill, Jamal / Coleman, Darian / Koupaei, Negar / Hilsenbeck, Susan G / Savage, Michelle I / Page, Brent D G / Mazumdar, Abhijit / Brown, Powel H

    Breast cancer research : BCR

    2024  Volume 26, Issue 1, Page(s) 23

    Abstract: Background: The most aggressive form of breast cancer is triple-negative breast cancer (TNBC), which lacks expression of the estrogen receptor (ER) and progesterone receptor (PR), and does not have overexpression of the human epidermal growth factor ... ...

    Abstract Background: The most aggressive form of breast cancer is triple-negative breast cancer (TNBC), which lacks expression of the estrogen receptor (ER) and progesterone receptor (PR), and does not have overexpression of the human epidermal growth factor receptor 2 (HER2). Treatment options for women with TNBC tumors are limited, unlike those with ER-positive tumors that can be treated with hormone therapy, or those with HER2-positive tumors that can be treated with anti-HER2 therapy. Therefore, we have sought to identify novel targeted therapies for TNBC. In this study, we investigated the potential of a novel phosphatase, NUDT5, as a potential therapeutic target for TNBC.
    Methods: The mRNA expression levels of NUDT5 in breast cancers were investigated using TCGA and METABRIC (Curtis) datasets. NUDT5 ablation was achieved through siRNA targeting and NUDT5 inhibition with the small molecule inhibitor TH5427. Xenograft TNBC animal models were employed to assess the effect of NUDT5 inhibition on in vivo tumor growth. Proliferation, death, and DNA replication assays were conducted to investigate the cellular biological effects of NUDT5 loss or inhibition. The accumulation of 8-oxo-guanine (8-oxoG) and the induction of γH
    Results: In this study, we demonstrated the significant role of an overexpressed phosphatase, NUDT5, in regulating oxidative DNA damage in TNBCs. Our findings indicate that loss of NUDT5 results in suppressed growth of TNBC both in vitro and in vivo. This growth inhibition is not attributed to cell death, but rather to the suppression of proliferation. The loss or inhibition of NUDT5 led to an increase in the oxidative DNA lesion 8-oxoG, and triggered the DNA damage response in the nucleus. The interference with DNA replication ultimately inhibited proliferation.
    Conclusions: NUDT5 plays a crucial role in preventing oxidative DNA damage in TNBC cells. The loss or inhibition of NUDT5 significantly suppresses the growth of TNBCs. These biological and mechanistic studies provide the groundwork for future research and the potential development of NUDT5 inhibitors as a promising therapeutic approach for TNBC patients.
    MeSH term(s) Animals ; Female ; Humans ; Cell Line, Tumor ; Cell Proliferation ; Pyrophosphatases/genetics ; Receptors, Estrogen/metabolism ; Triple Negative Breast Neoplasms/drug therapy ; Triple Negative Breast Neoplasms/genetics ; Triple Negative Breast Neoplasms/pathology
    Chemical Substances NUDT5 protein, human (EC 3.6.1.-) ; Pyrophosphatases (EC 3.6.1.-) ; Receptors, Estrogen
    Language English
    Publishing date 2024-02-05
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2015059-3
    ISSN 1465-542X ; 1465-5411
    ISSN (online) 1465-542X
    ISSN 1465-5411
    DOI 10.1186/s13058-024-01778-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Correction: The novel phosphatase NUDT5 is a critical regulator of triple-negative breast cancer growth.

    Qian, Jing / Ma, Yanxia / Tahaney, William M / Moyer, Cassandra L / Lanier, Amanda / Hill, Jamal / Coleman, Darian / Koupaei, Negar / Hilsenbeck, Susan G / Savage, Michelle I / Page, Brent D G / Mazumdar, Abhijit / Brown, Powel H

    Breast cancer research : BCR

    2024  Volume 26, Issue 1, Page(s) 53

    Language English
    Publishing date 2024-03-26
    Publishing country England
    Document type Published Erratum
    ZDB-ID 2015059-3
    ISSN 1465-542X ; 1465-5411
    ISSN (online) 1465-542X
    ISSN 1465-5411
    DOI 10.1186/s13058-024-01814-9
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Outcomes Among Minority Patients With Metastatic Colorectal Cancer in a Safety-net Health Care System.

    Lau-Min, Kelsey / Prakash, Preeti / Jo, Eunji / Thrift, Aaron P / Hilsenbeck, Susan / Musher, Benjamin L

    Clinical colorectal cancer

    2020  Volume 19, Issue 2, Page(s) e49–e57

    Abstract: Background: Metastatic colorectal cancer (CRC) outcomes continue to improve, but they vary significantly by race and ethnicity. We hypothesize that these disparities arise from unequal access to care.: Materials and methods: The Harris Health System ( ...

    Abstract Background: Metastatic colorectal cancer (CRC) outcomes continue to improve, but they vary significantly by race and ethnicity. We hypothesize that these disparities arise from unequal access to care.
    Materials and methods: The Harris Health System (HHS) is an integrated health delivery network that provides medical care to the underserved, predominantly minority population of Harris County, Texas. As the largest HHS facility and an affiliate of Baylor College of Medicine's Dan L. Duncan Comprehensive Cancer Center, Ben Taub Hospital (BTH) delivers cancer care through multidisciplinary subspecialty that prioritize access to care, adherence to evidence-based clinical pathways, integration of supportive services, and mitigation of financial toxicity. We performed a retrospective analysis of minority patients diagnosed with and treated for metastatic CRC at BTH between January 2010 and December 2012. Kaplan-Meier survival curves were compared with survival curves from randomized control trials reported during that time period.
    Results: We identified 103 patients; 40% were black, 49% were Hispanic, and 12% were Asian or Middle Eastern. Thirty-five percent reported a language other than English as their preferred language. Seventy-four percent of patients with documented coverage status were uninsured. Eighty-four percent of patients received standard chemotherapy with a clinician-reported response rate of 63%. Overall survival for BTH patients undergoing chemotherapy was superior to that of subjects enrolled in the CRYSTAL (Cetuximab Combined with Irinotecan in First-Line Therapy for Metastatic Colorectal Cancer) trial (median, 24.0 vs. 19.9 months; P = .014).
    Conclusion: HHS provides a health delivery infrastructure through which minority patients with socioeconomic challenges experience clinical outcomes comparable with highly selected patients enrolled in randomized control trials. Efforts to resolve CRC disparities should focus on improving access of at-risk populations to high-quality comprehensive cancer care.
    MeSH term(s) Academic Medical Centers/economics ; Academic Medical Centers/statistics & numerical data ; Adult ; African Americans/statistics & numerical data ; Aged ; Asian Americans/statistics & numerical data ; Colorectal Neoplasms/economics ; Colorectal Neoplasms/mortality ; Colorectal Neoplasms/therapy ; European Continental Ancestry Group/statistics & numerical data ; Female ; Healthcare Disparities/statistics & numerical data ; Hispanic Americans/statistics & numerical data ; Humans ; Kaplan-Meier Estimate ; Male ; Medically Uninsured/statistics & numerical data ; Middle Aged ; Minority Groups/statistics & numerical data ; Patient Acceptance of Health Care/statistics & numerical data ; Randomized Controlled Trials as Topic/statistics & numerical data ; Retrospective Studies ; Safety-net Providers/economics ; Safety-net Providers/statistics & numerical data ; Socioeconomic Factors
    Language English
    Publishing date 2020-01-02
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2112638-0
    ISSN 1938-0674 ; 1533-0028
    ISSN (online) 1938-0674
    ISSN 1533-0028
    DOI 10.1016/j.clcc.2019.09.002
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Self-Sampling for Human Papillomavirus Testing: Acceptability in a U.S. Safety Net Health System.

    Parker, Susan L / Amboree, Trisha L / Bulsara, Shaun / Daheri, Maria / Anderson, Matthew L / Hilsenbeck, Susan G / Jibaja-Weiss, Maria L / Zare, Mohammed / Schmeler, Kathleen M / Deshmukh, Ashish A / Chiao, Elizabeth Y / Scheurer, Michael E / Montealegre, Jane R

    American journal of preventive medicine

    2023  Volume 66, Issue 3, Page(s) 540–547

    Abstract: Introduction: Self-sampling for human papillomavirus testing is increasingly recognized as a strategy to expand cervical cancer screening access and utilization. Acceptability is a key determinant of uptake. This study assesses the acceptability of and ... ...

    Abstract Introduction: Self-sampling for human papillomavirus testing is increasingly recognized as a strategy to expand cervical cancer screening access and utilization. Acceptability is a key determinant of uptake. This study assesses the acceptability of and experiences with mailed self-sampling kits for human papillomavirus testing among underscreened patients in a safety net health system.
    Methods: A nested telephone survey was administered between 2021 and 2023 to a sample (n=272) of the 2,268 participants enrolled in the Prospective Evaluation of Self-Testing to Increase Screening trial. Trial participants include patients of a safety net health system aged 30-65 years who were not up to date on screening. Participants were asked about barriers to provider-performed screening. Kit users and nonusers were asked about their experiences.
    Results: Prevalent barriers to provider-performed screening included perceived discomfort of pelvic examination (69.4%), being uncomfortable with male providers (65.4%), and embarrassment (57.0%). Among participants who reported using the mailed kit (n=164), most reported good experiences (84.8%). Most reported self-sampling as more/equally convenient (89.0%), less/equally embarrassing (99.4%), and less/equally stressful (95.7%) than provider-performed screening. Among kit nonusers (n=43), reasons for not using the kit included forgetting about it (76.7%), preferring provider-performed screening (76.7%), and fearing cancer (67.4%).
    Conclusions: Prospective Evaluation of Self-Testing to Increase Screening trial participants generally had a positive experience with self-sampling for human papillomavirus testing. Increased comfort and reduced embarrassment/anxiety with self-sampling are relevant attributes because these were the most prevalent reported barriers to provider-performed screening. High acceptability suggests potentially high uptake when self-sampling for human papillomavirus testing receives regulatory approval and is available in safety net health systems.
    MeSH term(s) Female ; Humans ; Male ; Human Papillomavirus Viruses ; Uterine Cervical Neoplasms/prevention & control ; Self Care ; Early Detection of Cancer ; Papillomavirus Infections/diagnosis ; Papillomaviridae ; Mass Screening ; Patient Acceptance of Health Care ; Vaginal Smears
    Language English
    Publishing date 2023-11-05
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 632646-8
    ISSN 1873-2607 ; 0749-3797
    ISSN (online) 1873-2607
    ISSN 0749-3797
    DOI 10.1016/j.amepre.2023.10.020
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Phase I / II trial of metformin as a chemo-radiosensitizer in a head and neck cancer patient population.

    Kemnade, Jan O / Florez, Marcus / Sabichi, Anita / Zhang, Jun / Jhaveri, Pavan / Chen, George / Chen, Albert / Miller-Chism, Courtney / Shaun, Bulsara / Hilsenbeck, Susan G / Hernandez, David J / Skinner, Heath D / Sandulache, Vlad C

    Oral oncology

    2023  Volume 145, Page(s) 106536

    Abstract: Objectives: Retrospective studies have shown that head and neck squamous cell carcinoma (HNSCC) patients taking metformin demonstrate superior survival compared to their counterparts. We sought to determine whether metformin combined with chemoradiation ...

    Abstract Objectives: Retrospective studies have shown that head and neck squamous cell carcinoma (HNSCC) patients taking metformin demonstrate superior survival compared to their counterparts. We sought to determine whether metformin combined with chemoradiation would improve HNSCC patient survival compared to historical controls.
    Materials and methods: We conducted a Phase I/II prospective, single arm clinical trial in patients with newly diagnosed HNSCC (NCT02949700). Patients received platinum-based chemoradiation in combination with orally dosed metformin at one of 2 doses- 850 mg BID or 1500 mg BID administered during radiation, with a 2-week lead-in phase. Toxicity, disease response and survival metrics were ascertained throughout the study period.
    Results: A total of 25 patients were evaluable for toxicity and survival; 9 failed to reach the predetermined 70% compliance with the study drug. No dose limiting toxicities were identified in the Phase I component and there were no grade 4 adverse events likely related to metformin throughout the study. The primary outcome for the Phase II component was met with a response rate of 96%. Three-year overall survival was ∼70% in the per protocol p16 + cohort and 0% in the per protocol p16- cohort. Survival among participants with a ≥70% metformin compliance to <70% metformin compliance demonstrated a trend towards improvement in the ≥70% compliance cohort, though this did not reach significance.
    Conclusion: Metformin is well tolerated during concurrent chemoradiation for HNSCC. Its effectiveness as a chemo-radiosensitizer remains unclear and will require further study with randomized controlled clinical trials in this patient population.
    MeSH term(s) Humans ; Squamous Cell Carcinoma of Head and Neck/drug therapy ; Retrospective Studies ; Metformin/therapeutic use ; Prospective Studies ; Head and Neck Neoplasms/drug therapy
    Chemical Substances Metformin (9100L32L2N)
    Language English
    Publishing date 2023-08-08
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1120465-5
    ISSN 1879-0593 ; 0964-1955 ; 1368-8375
    ISSN (online) 1879-0593
    ISSN 0964-1955 ; 1368-8375
    DOI 10.1016/j.oraloncology.2023.106536
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: LOAd703, an oncolytic virus-based immunostimulatory gene therapy, combined with chemotherapy for unresectable or metastatic pancreatic cancer (LOKON001): results from arm 1 of a non-randomised, single-centre, phase 1/2 study.

    Musher, Benjamin L / Rowinsky, Eric K / Smaglo, Brandon G / Abidi, Wasif / Othman, Mohamed / Patel, Kalpesh / Jawaid, Salmaan / Jing, James / Brisco, Amanda / Leen, Ann M / Wu, Mengfen / Sandin, Linda C / Wenthe, Jessica / Eriksson, Emma / Ullenhag, Gustav J / Grilley, Bambi / Leja-Jarblad, Justyna / Hilsenbeck, Susan G / Brenner, Malcolm K /
    Loskog, Angelica S I

    The Lancet. Oncology

    2024  Volume 25, Issue 4, Page(s) 488–500

    Abstract: Background: Pancreatic ductal adenocarcinoma is characterised by low immunogenicity and an immunosuppressive tumour microenvironment. LOAd703, an oncolytic adenovirus with transgenes encoding TMZ-CD40L and 4-1BBL, lyses cancer cells selectively, ... ...

    Abstract Background: Pancreatic ductal adenocarcinoma is characterised by low immunogenicity and an immunosuppressive tumour microenvironment. LOAd703, an oncolytic adenovirus with transgenes encoding TMZ-CD40L and 4-1BBL, lyses cancer cells selectively, activates cytotoxic T cells, and induces tumour regression in preclinical models. The aim of this study was to evaluate the safety and feasibility of combining LOAd703 with chemotherapy for advanced pancreatic ductal adenocarcinoma.
    Methods: LOKON001 was a non-randomised, phase 1/2 study conducted at the Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA, and consisted of two arms conducted sequentially; the results of arm 1 are presented here. In arm 1, patients 18 years or older with previously treated or treatment-naive unresectable or metastatic pancreatic ductal adenocarcinoma were treated with standard 28-day cycles of intravenous nab-paclitaxel 125 mg/m
    Findings: Between Dec 2, 2016, and Oct 17, 2019, 23 patients were assessed for eligibility, leading to 22 patients being enrolled. One patient withdrew consent, resulting in 21 patients (13 [62%] men and eight [38%] women) assigned to a dose group (three to dose 1, four to dose 2, and 14 to dose 3). 21 patients were evaluable for safety. Median follow-up time was 6 months (IQR 4-10), and data cutoff was Jan 5, 2023. The most common treatment-emergent adverse events overall were anaemia (96 [8%] of 1237 events), lymphopenia (86 [7%] events), hyperglycaemia (70 [6%] events), leukopenia (63 [5%] events), hypertension (62 [5%] events), and hypoalbuminaemia (61 [5%] events). The most common adverse events attributed to LOAd703 were fever (14 [67%] of 21 patients), fatigue (eight [38%]), chills (seven [33%]), and elevated liver enzymes (alanine aminotransferase in five [24%], alkaline phosphatase in four [19%], and aspartate aminotransferase in four [19%]), all of which were grade 1-2, except for a transient grade 3 aminotransferase elevation occurring at dose 3. A maximum tolerated dose was not reached, thereby establishing dose 3 as the highest-evaluated safe dose when combined with nab-paclitaxel plus gemcitabine. Proportions of CD8
    Interpretation: Combining LOAd703 with nab-paclitaxel plus gemcitabine in patients with advanced pancreatic ductal adenocarcinoma was feasible and safe. To build upon this novel chemoimmunotherapeutic approach, arm 2 of LOKON001, which combines LOAd703, nab-paclitaxel plus gemcitabine, and atezolizumab, is ongoing.
    Funding: Lokon Pharma, the Swedish Cancer Society, and the Swedish Research Council.
    MeSH term(s) Male ; Humans ; Female ; Gemcitabine ; Oncolytic Viruses/genetics ; Bayes Theorem ; Pancreatic Neoplasms/therapy ; Pancreatic Neoplasms/drug therapy ; Paclitaxel ; Anemia/chemically induced ; Thrombocytopenia/chemically induced ; Adenocarcinoma/therapy ; Adenocarcinoma/drug therapy ; Albumins ; Genetic Therapy/adverse effects ; Antineoplastic Combined Chemotherapy Protocols/adverse effects ; Tumor Microenvironment
    Chemical Substances Gemcitabine ; Paclitaxel (P88XT4IS4D) ; Albumins
    Language English
    Publishing date 2024-03-28
    Publishing country England
    Document type Clinical Trial, Phase II ; Clinical Trial, Phase I ; Journal Article
    ZDB-ID 2049730-1
    ISSN 1474-5488 ; 1470-2045
    ISSN (online) 1474-5488
    ISSN 1470-2045
    DOI 10.1016/S1470-2045(24)00079-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Making sense of clinical trial data: is inverse probability of censoring weighted analysis the answer to crossover bias?

    Rimawi, Mothaffar / Hilsenbeck, Susan G

    Journal of clinical oncology : official journal of the American Society of Clinical Oncology

    2012  Volume 30, Issue 4, Page(s) 453–458

    Abstract: Ideally, therapeutic interventions are evaluated through randomized clinical trials. These trials are commonly analyzed with an intent-to-treat (ITT) approach, whereby patients are analyzed in their assigned treatment group regardless of actual treatment ...

    Abstract Ideally, therapeutic interventions are evaluated through randomized clinical trials. These trials are commonly analyzed with an intent-to-treat (ITT) approach, whereby patients are analyzed in their assigned treatment group regardless of actual treatment received. If an interim analysis of such trials demonstrates compelling evidence of a difference in benefit, ethical considerations often dictate that the trial be unblinded and participants be provided access to the more efficacious agent. Because interim analysis may not address longer-term outcomes of interest, important clinical questions such as overall survival benefit-the ultimate test of efficacy to many-may remain unanswered. The ensuing crossover disturbs randomization and may lead to biased longer-term analysis, compromising the utility of clinical data. This has been especially apparent in recent adjuvant and prevention breast cancer trials. We consider four such trials: HERA (Herceptin Adjuvant), NSABP P-1 (National Surgical Adjuvant Breast and Bowel Project Breast Cancer Prevention P-1), MA.17, and BIG 1-98 (Breast International Group 1-98), the long-term outcomes of which were complicated by unblinding and selective crossover. We also discuss the biases associated with ITT analysis and, alternatively, censoring of follow-up data (ie, dropping out) after selective crossover. Moreover, we discuss how the statistical procedure of inverse probability of censoring weighted (IPCW) analysis may be used to account for selective crossover as an alternative to ITT or censoring analysis, as was recently done for the BIG 1-98 trial. Notably, IPCW analysis may be particularly suited for detecting overall survival benefits that otherwise would not be detected with an ITT approach, as reported for the BIG 1-98 trial.
    MeSH term(s) Breast Neoplasms/drug therapy ; Chemotherapy, Adjuvant ; Cross-Over Studies ; Data Interpretation, Statistical ; Disease-Free Survival ; Female ; Humans ; Randomized Controlled Trials as Topic/methods ; Research Design ; Survival Analysis
    Language English
    Publishing date 2012-02-01
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 604914-x
    ISSN 1527-7755 ; 0732-183X
    ISSN (online) 1527-7755
    ISSN 0732-183X
    DOI 10.1200/JCO.2010.34.2808
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  9. Article ; Online: Endoscopic assessment of radiological stage IVA cervical cancer: A bivariate meta-analysis supporting an evidence-based staging algorithm proposal.

    Sapienza, Lucas G / Thomas, Justin J / Showalter, Timothy N / Echeverria, Alfredo E / Ludwig, Michelle S / Chen, Albert C / Jo, Eunji / Calsavara, Vinícius F / Hilsenbeck, Susan G / Jhingran, Anuja / Frumovitz, Michael M / Baiocchi, Glauco

    Gynecologic oncology

    2022  Volume 165, Issue 3, Page(s) 642–649

    Abstract: Objective: To optimize the use of confirmatory endoscopic exams (cystoscopy/proctoscopy) in the staging of locally advanced cervical cancer (LACC), the present study evaluates the predictive value of radiological exams (CT and MRI) to detect bladder/ ... ...

    Abstract Objective: To optimize the use of confirmatory endoscopic exams (cystoscopy/proctoscopy) in the staging of locally advanced cervical cancer (LACC), the present study evaluates the predictive value of radiological exams (CT and MRI) to detect bladder/rectum invasion.
    Methods: A systematic search of databases (PubMed and EMBASE) was performed (CRD42021270329). The inclusion criteria were: a) cervix cancer diagnosis; b) staging CT and/or MRI (index test); c) staging cystoscopy and/or proctoscopy (standard test); and d) numbers of true positives (TP), true negatives (TN), false positives (FP), and false negatives (FN) provided. A random-effects bivariate meta-analysis of positive predictive value (PPV) and negative predictive value (NPV) was performed with moderator analyses by imaging modality (CT and MRI) and prevalence.
    Results: Nineteen studies met the inclusion criteria, totaling 3480 and 1641 patients for bladder and rectum analyses, respectively. For bladder invasion (prevalence ranged from 0.9% to 34.5%), the overall PPV was 45% (95% confidence interval, 33%-57%, based on 19 studies). Per subgroup, the PPV was 31% for MRI/prevalence ≤6%, 33% for CT/prevalence ≤6%, and 69% for CT/prevalence >6%. For rectal invasion (prevalence ranged from 0.4% to 20.0%), the overall PPV was 30% (95% confidence interval, 17%-47%, based on 8 studies). Per subgroup, the PPV was 36% for MRI/prevalence ≤1%, 17% for MRI/prevalence >1%, and 38% for CT/prevalence >1%. The overall NPV for bladder invasion and rectal invasion were 98% (95% confidence interval, 97%-99%) and 100% (95% confidence interval, 99%-100%), respectively. Considering prevalence and radiological modality, the point estimate of NPV varied from 95% to 100% for bladder invasion and from 99% to 100% for rectum invasion.
    Conclusions: Due to low PPV (<50%) of radiological staging, endoscopic exams may be necessary to correctly assess radiological stage IVA LACC. However, they are not necessary after negative radiological exam (NPV ≥95%).
    MeSH term(s) Algorithms ; Cystoscopy ; Female ; Humans ; Magnetic Resonance Imaging/methods ; Neoplasm Staging ; Radiography ; Uterine Cervical Neoplasms/pathology
    Language English
    Publishing date 2022-04-08
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Review
    ZDB-ID 801461-9
    ISSN 1095-6859 ; 0090-8258
    ISSN (online) 1095-6859
    ISSN 0090-8258
    DOI 10.1016/j.ygyno.2022.03.026
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  10. Article ; Online: Methylphenidate improves weight control in childhood brain tumor survivors with hypothalamic obesity.

    Horne, Vincent E / Bielamowicz, Kevin / Nguyen, Jessica / Hilsenbeck, Susan / Lindsay, Holly / Sonabend, Rona / Wood, Alexis C / Okcu, Fatih / Sisley, Stephanie

    Pediatric blood & cancer

    2020  Volume 67, Issue 7, Page(s) e28379

    Abstract: Background: Hypothalamic obesity causes unrelenting weight gain for childhood brain tumor survivors. No single therapy has proven effective for treatment. We aimed to evaluate effectiveness of long-term methylphenidate therapy on body mass index (BMI) ... ...

    Abstract Background: Hypothalamic obesity causes unrelenting weight gain for childhood brain tumor survivors. No single therapy has proven effective for treatment. We aimed to evaluate effectiveness of long-term methylphenidate therapy on body mass index (BMI) change in children with hypothalamic obesity.
    Methods: A retrospective analysis included children with a history of brain tumor and hypothalamic obesity receiving methylphenidate (10-60 mg/day) for hypothalamic obesity. Subjects were evaluated for BMI trajectory before and after methylphenidate start. Given that z-scores can be skewed in severely obese children, we calculated BMI as a percent of the BMI at the 95th percentile for the child's age and gender (BMI% 95th).
    Results: Twelve patients with hypothalamic obesity completed methylphenidate therapy for at least 6 months (median 3.1 years, range 1.0-5.8 years). All subjects had a suprasellar tumor (nine [75%] with craniopharyngioma) and pituitary dysfunction. Pretreatment median BMI percent of the 95th percentile was 125.6% (interquartile range [IQR] 25-75: 115.3-138.3%) with BMI z-score of 2.4 (IQR 25-75: 2.1-2.6). Following methylphenidate treatment, there was a 69.9% reduction in the median slope of BMI change. Eleven of 12 patients (92%) had a reduction in the slope of their BMI change on methylphenidate treatment. Postmethylphenidate median BMI percent of the 95th percentile decrease to 115.2% (IQR 25-75: 103.6-121.2%) with median BMI z-score of 2.1 (IQR 25-75: 1.8-2.2). Mild side effects were noted in six patients.
    Conclusions: Methylphenidate use reduced and sustained BMI change in children with hypothalamic obesity. Stimulant therapy is an effective first-line agent for treatment of hypothalamic obesity.
    MeSH term(s) Brain Neoplasms/complications ; Brain Neoplasms/therapy ; Cancer Survivors/statistics & numerical data ; Central Nervous System Stimulants/therapeutic use ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Hypothalamic Diseases/diagnosis ; Hypothalamic Diseases/drug therapy ; Hypothalamic Diseases/etiology ; Male ; Methylphenidate/therapeutic use ; Obesity/diagnosis ; Obesity/drug therapy ; Obesity/etiology ; Prognosis ; Retrospective Studies ; Weight Loss/drug effects
    Chemical Substances Central Nervous System Stimulants ; Methylphenidate (207ZZ9QZ49)
    Language English
    Publishing date 2020-05-08
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 2131448-2
    ISSN 1545-5017 ; 1545-5009
    ISSN (online) 1545-5017
    ISSN 1545-5009
    DOI 10.1002/pbc.28379
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