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Article: Synergistic Toxicities from Multiple Therapies for Synchronous Malignancies.

Patel, Shiven B / Butler, Katerina / Esther, John / Tuan, Jenny

2023 Volume 16, Issue 1, Page(s) 45–48

Abstract: Patients may present with multiple malignancies in the setting of particular environmental and occupational exposures. These patients often require combination systemic therapy, which has not yet been studied for concurrent use. While toxicities for ... ...

Abstract	Patients may present with multiple malignancies in the setting of particular environmental and occupational exposures. These patients often require combination systemic therapy, which has not yet been studied for concurrent use. While toxicities for specific chemotherapies and immunotherapies may be well known, the possibility of exaggerated toxicity due to combination therapy exists and is understudied. Several trials are underway that may shed further light on how combination therapies affect patient toxicity. This case report outlines the unfortunate development of severe edema and rash, refractory to traditional methods of management, from combining immunotherapy and chemotherapy.
Language	English
Publishing date	2023-02-06
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2458961-5
ISSN	1662-6575
ISSN	1662-6575
DOI	10.1159/000529017
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Keeping a track on leptomeningeal disease in non-small cell lung cancer: A single-institution experience with CNSide

Puri, Sonam / Malani, Rachna / Chalmers, Anna / Kerrigan, Kathleen / Patel, Shiven B / Monynahan, Kelly / Cannon, Laura / Blouw, Barbara / Akerley, Wallace

Neuro-oncology advances

2023 Volume 6, Issue 1, Page(s) vdad150

Abstract: Background: Leptomeningeal disease (LMD) is a devastating complication for patients with advanced cancer. Diagnosis and monitoring the response to therapy remains challenging due to limited sensitivity and specificity of standard-of-care (SOC) ... ...

Abstract	Background: Leptomeningeal disease (LMD) is a devastating complication for patients with advanced cancer. Diagnosis and monitoring the response to therapy remains challenging due to limited sensitivity and specificity of standard-of-care (SOC) diagnostic modalities, including cerebrospinal fluid (CSF) cytology, MRI, and clinical evaluation. These hindrances contribute to the poor survival of LMD patients. CNSide is a CLIA-validated test that detects and characterizes CSF-derived tumor cells and cell-free (cf) DNA. We performed a retrospective analysis on the utility of CNSide to analyze CSF obtained from advanced non-small cell lung cancer (aNSCLC) patients with suspected LMD treated at the Huntsman Cancer Institute in Salt Lake City, UT. Methods: CNSide was used to evaluate CSF from 15 patients with aNSCLC. CSF tumor cell quantification was performed throughout treatment for 5 patients. CSF tumor cells and cfDNA were characterized for actionable mutations. Results: In LMD-positive patients, CNSide detected CSF tumor cells in 88% (22/25) samples versus 40% (10/25) for cytology (matched samples). CSF tumor cell numbers tracked response to therapy in 5 patients where CNSide was used to quantify tumor cells throughout treatment. In 75% (9/12) of the patients, genetic alterations were detected in CSF, with the majority representing gene mutations and amplifications with therapeutic potential. The median survival for LMD patients was 16.1 m (5.2-NR). Conclusions: We show that CNSide can supplement the management of LMD in conjunction with SOC methods for the diagnosis, monitoring response to therapy, and identifying actionable mutations unique to the CSF in patients with LMD.
Language	English
Publishing date	2023-12-09
Publishing country	England
Document type	Journal Article
ZDB-ID	3009682-0
ISSN	2632-2498 ; 2632-2498
ISSN (online)	2632-2498
ISSN	2632-2498
DOI	10.1093/noajnl/vdad150
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Article: Combination of Local Ablative Therapy and Continuation of Immune Checkpoint Inhibitor (ICI) Therapy Provides Durable Treatment Response Past Oligometastatic Progression in NSCLC: A Case Report.

Griswold, Cassia R / Kerrigan, Katie / Patel, Shiven B

Case reports in oncology

2019 Volume 12, Issue 3, Page(s) 866–871

Abstract: Adenosquamous carcinoma is a rare type of non-small cell lung cancer associated with advanced disease and poor prognosis. There is limited data for the management of mixed histology disease in elderly or frail patients. A 79-year-old woman with no ... ...

Abstract	Adenosquamous carcinoma is a rare type of non-small cell lung cancer associated with advanced disease and poor prognosis. There is limited data for the management of mixed histology disease in elderly or frail patients. A 79-year-old woman with no smoking history presented with a right upper lobe lung mass on chest x-ray. Biopsy of the mass demonstrated an EGFR-amplified, PD-L1 positive adenosquamous lung cancer. The mass was surgically resected but the patient was not a candidate for adjuvant chemotherapy. The patient later developed a metastatic paraspinal lesion that was successfully managed with SBRT. Approximately six months later, the patient developed adrenal metastases and pembrolizumab was initiated. After three cycles of systemic therapy, she developed subcutaneous lesions in her back and chest wall, which were managed with palliative resection. Scans demonstrate stable disease and continued responsiveness to pembrolizumab over one year from the most recent local ablative therapy. This case illustrates the potential role of local ablative therapy for oligometastatic progression, as it may confer significant benefit in elderly patients or those with a more indolent disease course. Additionally, we have demonstrated that continuing immunotherapy past progression is reasonable in patients with no viable alternate therapy options, as delayed responses may occur.
Language	English
Publishing date	2019-11-21
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2458961-5
ISSN	1662-6575
ISSN	1662-6575
DOI	10.1159/000504473
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Article ; Online: Nivolumab-induced hypothyoidism with consequent hypothyroid related myopathy.

Johnson, Eric D / Kerrigan, Katie / Butler, Katerina / Patel, Shiven B

Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners

2019 Volume 26, Issue 1, Page(s) 224–227

Abstract: Purpose: Nivolumab is a fully human IgG4 programmed death 1 immune checkpoint inhibitor (ICI) antibody that has anti-tumor activity by selectively blocking the interaction of the programmed death 1 receptor with its two known programmed death ligands PD- ...

Abstract	Purpose: Nivolumab is a fully human IgG4 programmed death 1 immune checkpoint inhibitor (ICI) antibody that has anti-tumor activity by selectively blocking the interaction of the programmed death 1 receptor with its two known programmed death ligands PD-L1 and PD-L2. In doing so, this immune checkpoint inhibitor removes the negative signal stifling T cell activation and proliferation within the tumor microenvironment and demonstrates favorable antitumor activity. Case report: We report an interesting case of immune checkpoint inhibitor-induced primary hypothyroidism with associated hypothyroid myopathy in a young patient with surgically resected stage IIIB melanoma receiving adjuvant nivolumab. He presented 12 weeks into therapy with severe myalgias, arthralgias, and intermittent disequilibrium of unclear etiology. Laboratory evaluation demonstrated a significant elevation in thyroid stimulating hormone and creatine kinase with an undetectable free T4 with standard laboratory measurement. With thyroid hormone replacement therapy alone, he had rapid improvement in his musculoskeletal symptoms and laboratory parameters over a three-week period. Discussion: This case emphasizes the serious nature of endocrine immune-related adverse events in patients receiving immune checkpoint inhibitors. Additionally, it highlights that unlike most other immune-related adverse events, endocrine immune-related adverse events can generally be managed with adequate hormone replacement alone with swift improvements in symptoms. This allows patients to continue immune checkpoint inhibitors safely without immunosuppression which may dampen the anti-tumor activity of these agents. Conclusion: This case highlights the importance of early recognition and the appropriate management of endocrine immune-related adverse events to maximize patient safety and good outcomes.
MeSH term(s)	Adult ; Antineoplastic Agents, Immunological/adverse effects ; Humans ; Hypothyroidism/chemically induced ; Male ; Melanoma/drug therapy ; Muscular Diseases/chemically induced ; Nivolumab/adverse effects
Chemical Substances	Antineoplastic Agents, Immunological ; Nivolumab (31YO63LBSN)
Language	English
Publishing date	2019-03-16
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	1330764-2
ISSN	1477-092X ; 1078-1552
ISSN (online)	1477-092X
ISSN	1078-1552
DOI	10.1177/1078155219835912
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Article: Immunotherapy after chemoradiotherapy in stage III non-small cell lung cancer: a new standard of care?

Chalmers, Anna W / Patel, Shiven B / Akerley, Wallace

Journal of thoracic disease

2017 Volume 10, Issue 3, Page(s) 1198–1200

Language	English
Publishing date	2017-04-30
Publishing country	China
Document type	Editorial ; Comment
ZDB-ID	2573571-8
ISSN	2077-6624 ; 2072-1439
ISSN (online)	2077-6624
ISSN	2072-1439
DOI	10.21037/jtd.2018.01.160
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Article: Combination of Local Ablative Therapy and Continuation of Immune Checkpoint Inhibitor (ICI) Therapy Provides Durable Treatment Response Past Oligometastatic Progression in NSCLC: A Case Report

Griswold, Cassia R. / Kerrigan, Katie / Patel, Shiven B.

Case Reports in Oncology

2019 Volume 12, Issue 3, Page(s) 866–871

Institution	Department of Pharmacy, Mayo Clinic, Phoenix, Arizona, USA Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
Abstract	Adenosquamous carcinoma is a rare type of non-small cell lung cancer associated with advanced disease and poor prognosis. There is limited data for the management of mixed histology disease in elderly or frail patients. A 79-year-old woman with no smoking history presented with a right upper lobe lung mass on chest x-ray. Biopsy of the mass demonstrated an EGFR-amplified, PD-L1 positive adenosquamous lung cancer. The mass was surgically resected but the patient was not a candidate for adjuvant chemotherapy. The patient later developed a metastatic paraspinal lesion that was successfully managed with SBRT. Approximately six months later, the patient developed adrenal metastases and pembrolizumab was initiated. After three cycles of systemic therapy, she developed subcutaneous lesions in her back and chest wall, which were managed with palliative resection. Scans demonstrate stable disease and continued responsiveness to pembrolizumab over one year from the most recent local ablative therapy. This case illustrates the potential role of local ablative therapy for oligometastatic progression, as it may confer significant benefit in elderly patients or those with a more indolent disease course. Additionally, we have demonstrated that continuing immunotherapy past progression is reasonable in patients with no viable alternate therapy options, as delayed responses may occur.
Keywords	Oligometastatic disease ; Local ablative therapy ; Immunotherapy ; Adenosquamous NSCLC ; Elderly patient
Language	English
Publishing date	2019-11-21
Publisher	S. Karger AG
Publishing place	Basel, Switzerland
Document type	Article
Note	Case Report ; This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC).
ZDB-ID	2458961-5
ISSN	1662-6575 ; 1662-6575
ISSN (online)	1662-6575
ISSN	1662-6575
DOI	10.1159/000504473
Database	Karger publisher's database

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Article: Profile of panitumumab as first-line treatment in patients with wild-type KRAS metastatic colorectal cancer.

Patel, Shiven B / Gill, David / Garrido-Laguna, Ignacio

OncoTargets and therapy

2015 Volume 9, Page(s) 75–86

Abstract: Targeted therapies against EGFR, vascular endothelial growth factor, and vascular endothelial growth factor receptor have expanded treatment options for patients with metastatic colorectal cancer (mCRC). Unfortunately, biomarkers to identify patients ... ...

Abstract	Targeted therapies against EGFR, vascular endothelial growth factor, and vascular endothelial growth factor receptor have expanded treatment options for patients with metastatic colorectal cancer (mCRC). Unfortunately, biomarkers to identify patients that are most likely to derive benefit from targeted therapies in this disease are still needed. Indeed, only RAS mutations have been identified as predictive of lack of benefit from monoclonal antibodies against EGFR in patients with mCRC. Panitumumab is a fully humanized monoclonal antibody against EGFR. In this study, we review data to support the use of panitumumab in combination with a chemotherapy backbone, in the first line setting in patients with RAS wild-type mCRC. Ongoing efforts are aimed at identifying smaller subsets of patients within the RAS wild-type group that will derive the largest benefit from anti-EGFR therapy. In the meantime, treatment with anti-EGFR therapy should be reserved for patients with RAS wild-type mCRC.
Language	English
Publishing date	2015-12-30
Publishing country	New Zealand
Document type	Journal Article ; Review
ZDB-ID	2495130-4
ISSN	1178-6930
ISSN	1178-6930
DOI	10.2147/OTT.S68558
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Article ; Online: Prognostic Significance of Patient-Reported Outcomes in Cancer.

Kerrigan, Kathleen / Patel, Shiven B / Haaland, Benjamin / Ose, Dominik / Weinberg Chalmers, Anna / Haydell, Tyler / Meropol, Neal J / Akerley, Wallace

JCO oncology practice

2020 Volume 16, Issue 4, Page(s) e313–e323

Abstract: Purpose: Performance status (PS), an established prognostic surrogate of cancer survival, is a physician-synthesized metric of patient symptoms and mobility that is prone to bias and subjectivity. The National Cancer Institute (NCI) Patient-Reported ... ...

Abstract	Purpose: Performance status (PS), an established prognostic surrogate of cancer survival, is a physician-synthesized metric of patient symptoms and mobility that is prone to bias and subjectivity. The National Cancer Institute (NCI) Patient-Reported Outcomes Measurement Information System-Cancer (PROMIS-Ca) Bank, a patient-centric patient-reported outcome (PRO) evaluation of physical function (PF), fatigue, depression, anxiety, and pain, shares subject matter with PS and, therefore, may also be prognostic while eliminating physician interpretation. Methods: Patients at Huntsman Cancer Institute were assessed using the NCI PROMIS-Ca Bank. Using tablets at routine office visits, PF, fatigue, depression, anxiety, and pain scores were collected from patients with advanced melanoma, non-small-cell lung cancer, colorectal cancer, and breast cancer. A PRO score collected at a single time point within 6 months of metastatic diagnosis for each patient was merged with curated clinical outcome data. The association of PROs, overall survival (OS), and hospitalization-free survival (HFS) were assessed in multivariable analysis that included sex and cancer type. Results: Two hundred eighty-two complete sets of patient data were available for analysis. All 5 PRO domains were strongly prognostic of OS and HFS. While the PRO domains were interrelated with moderate to strong correlations (0.40-0.79), multivariable regression suggested that PF was most strongly associated with the clinical outcomes of OS ( Conclusion: NCI PROMIS-Ca PROs may be prognostic of both cancer survival and likelihood of hospitalization. Future prospective studies are needed for all major prognostic factors to fully understand the independent prognostic value of PROs.
MeSH term(s)	Carcinoma, Non-Small-Cell Lung ; Humans ; Lung Neoplasms ; Patient Reported Outcome Measures ; Prognosis ; Prospective Studies
Language	English
Publishing date	2020-01-09
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	3028198-2
ISSN	2688-1535 ; 2688-1527
ISSN (online)	2688-1535
ISSN	2688-1527
DOI	10.1200/JOP.19.00329
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Article ; Online: Adoption of Patient-Generated Health Data in Oncology: A Report From the NCCN EHR Oncology Advisory Group.

Stetson, Peter D / McCleary, Nadine J / Osterman, Travis / Ramchandran, Kavitha / Tevaarwerk, Amye / Wong, Tracy / Sugalski, Jessica M / Akerley, Wallace / Mercurio, Annette / Zachariah, Finly J / Yamzon, Jonathan / Stillman, Robert C / Gabriel, Peter E / Heinrichs, Tricia / Kerrigan, Kathleen / Patel, Shiven B / Gilbert, Scott M / Weiss, Everett

Journal of the National Comprehensive Cancer Network : JNCCN

2022 Volume 20, Issue 13

Abstract: Background: Collecting, monitoring, and responding to patient-generated health data (PGHD) are associated with improved quality of life and patient satisfaction, and possibly with improved patient survival in oncology. However, the current state of ... ...

Abstract	Background: Collecting, monitoring, and responding to patient-generated health data (PGHD) are associated with improved quality of life and patient satisfaction, and possibly with improved patient survival in oncology. However, the current state of adoption, types of PGHD collected, and degree of integration into electronic health records (EHRs) is unknown. Methods: The NCCN EHR Oncology Advisory Group formed a Patient-Reported Outcomes (PRO) Workgroup to perform an assessment and provide recommendations for cancer centers, researchers, and EHR vendors to advance the collection and use of PGHD in oncology. The issues were evaluated via a survey of NCCN Member Institutions. Questions were designed to assess the current state of PGHD collection, including how, what, and where PGHD are collected. Additionally, detailed questions about governance and data integration into EHRs were asked. Results: Of 28 Member Institutions surveyed, 23 responded. The collection and use of PGHD is widespread among NCCN Members Institutions (96%). Most centers (90%) embed at least some PGHD into the EHR, although challenges remain, as evidenced by 88% of respondents reporting the use of instruments not integrated. Forty-seven percent of respondents are leveraging PGHD for process automation and adherence to best evidence. Content type and integration touchpoints vary among the members, as well as governance maturity. Conclusions: The reported variability regarding PGHD suggests that it may not yet have reached its full potential for oncology care delivery. As the adoption of PGHD in oncology continues to expand, opportunities exist to enhance their utility. Among the recommendations for cancer centers is establishment of a governance process that includes patients. Researchers should consider determining which PGHD instruments confer the highest value. It is recommended that EHR vendors collaborate with cancer centers to develop solutions for the collection, interpretation, visualization, and use of PGHD.
MeSH term(s)	Humans ; Quality of Life ; Medical Oncology ; Delivery of Health Care ; Electronic Health Records ; Surveys and Questionnaires
Language	English
Publishing date	2022-01-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2250759-0
ISSN	1540-1413 ; 1540-1405
ISSN (online)	1540-1413
ISSN	1540-1405
DOI	10.6004/jnccn.2021.7088
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Article ; Online: Adoption of Patient-Generated Health Data in Oncology

Stetson, Peter D. / McCleary, Nadine J. / Osterman, Travis / Ramchandran, Kavitha / Tevaarwerk, Amye / Wong, Tracy / Sugalski, Jessica M. / Akerley, Wallace / Mercurio, Annette / Zachariah, Finly J. / Yamzon, Jonathan / Stillman, Robert C. / Gabriel, Peter E. / Heinrichs, Tricia / Kerrigan, Kathleen / Patel, Shiven B. / Gilbert, Scott M. / Weiss, Everett

Journal of the National Comprehensive Cancer Network

A Report From the NCCN EHR Oncology Advisory Group

2022 , Page(s) 1–6

Abstract	Background: Collecting, monitoring, and responding to patient-generated health data (PGHD) are associated with improved quality of life and patient satisfaction, and possibly with improved patient survival in oncology. However, the current state of adoption, types of PGHD collected, and degree of integration into electronic health records (EHRs) is unknown. Methods: The NCCN EHR Oncology Advisory Group formed a Patient-Reported Outcomes (PRO) Workgroup to perform an assessment and provide recommendations for cancer centers, researchers, and EHR vendors to advance the collection and use of PGHD in oncology. The issues were evaluated via a survey of NCCN Member Institutions. Questions were designed to assess the current state of PGHD collection, including how, what, and where PGHD are collected. Additionally, detailed questions about governance and data integration into EHRs were asked. Results: Of 28 Member Institutions surveyed, 23 responded. The collection and use of PGHD is widespread among NCCN Members Institutions (96%). Most centers (90%) embed at least some PGHD into the EHR, although challenges remain, as evidenced by 88% of respondents reporting the use of instruments not integrated. Forty-seven percent of respondents are leveraging PGHD for process automation and adherence to best evidence. Content type and integration touchpoints vary among the members, as well as governance maturity. Conclusions: The reported variability regarding PGHD suggests that it may not yet have reached its full potential for oncology care delivery. As the adoption of PGHD in oncology continues to expand, opportunities exist to enhance their utility. Among the recommendations for cancer centers is establishment of a governance process that includes patients. Researchers should consider determining which PGHD instruments confer the highest value. It is recommended that EHR vendors collaborate with cancer centers to develop solutions for the collection, interpretation, visualization, and use of PGHD.
Keywords	Oncology
Publisher	Harborside Press, LLC
Publishing country	us
Document type	Article ; Online
ZDB-ID	2250759-0
ISSN	1540-1405
ISSN	1540-1405
DOI	10.6004/jnccn.2021.7088
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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