Mary Mulcahy - Academia.edu (original) (raw)
Papers by Mary Mulcahy
Oncotarget, Jan 4, 2018
Indoleamine 2,3-dioxygenase 1 (IDO1) is an enzyme with immunomodulatory properties that has emerg... more Indoleamine 2,3-dioxygenase 1 (IDO1) is an enzyme with immunomodulatory properties that has emerged as a potential immunotherapeutic target in human cancer. However, the role, expression pattern, and relevance of IDO1 in esophageal cancer (EC) are poorly understood. Here, we utilize gene expression analysis of the cancer genome atlas (TCGA) and immunohistochemistry (IHC) to better understand the role and prognostic significance of IDO1 in EC. High IDO1 mRNA levels were associated with worse overall survival (OS) in both esophageal squamous cell carcinoma (SCC) ( = 0.02) and adenocarcinoma (AC) ( = 0.036). High co-expression of IDO1 and programmed death ligand 1 (PD-L1) was associated with worse OS in SCC ( = 0.0031) and AC ( = 0.0186). IHC for IDO1 in SCC showed a significant correlation with PD-L1 ( < 0.0001) and CD3ε ( < 0.0001). EC with high IDO1 and PD-L1 expression is significantly correlated with decreased patient survival, and may correlate with increased T-cells. These...
Journal of the National Comprehensive Cancer Network : JNCCN, 2018
The NCCN Guidelines for Colon Cancer provide recommendations regarding diagnosis, pathologic stag... more The NCCN Guidelines for Colon Cancer provide recommendations regarding diagnosis, pathologic staging, surgical management, perioperative treatment, surveillance, management of recurrent and metastatic disease, and survivorship. These NCCN Guidelines Insights summarize the NCCN Colon Cancer Panel discussions for the 2018 update of the guidelines regarding risk stratification and adjuvant treatment for patients with stage III colon cancer, and treatment of V600E mutation-positive metastatic colorectal cancer with regimens containing vemurafenib.
Cancer, Jan 6, 2017
The authors hypothesized that patients with metastatic colorectal cancer (mCRC) who had tumors wi... more The authors hypothesized that patients with metastatic colorectal cancer (mCRC) who had tumors with low thymidylate synthase (TS-L) expression would have a higher response rate to combined 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) plus bevacizumab (FOLFOX/Bev) than those with high TS (TS-H) expression and that combined irinotecan and oxaliplatin (IROX) plus bevacizumab (IROX/Bev) would be more effective than FOLFOX/Bev in those with TS-H tumors. TS protein expression was determined in mCRC tissue. Patients who had TS-L tumors received FOLFOX/Bev, and those who had TS-H tumors were randomly assigned to receive either FOLFOX/Bev or IROX/Bev. The primary endpoint was the response rate (complete plus partial responses). In total, 211 of 247 patients (70% TS-H) were registered to the treatment phase. Efficacy analyses included eligible patients who had started treatment (N = 186). The response rates for patients who received IROX/Bev (TS-H), FOLFOX/Bev (TS-H), and FOLFOX/Bev (...
Hepatology (Baltimore, Md.), 2017
Y90 transarterial radioembolization (TARE) is a transarterial locoregional therapy (LRT) for hepa... more Y90 transarterial radioembolization (TARE) is a transarterial locoregional therapy (LRT) for hepatocellular carcinoma (HCC). In this study, we present overall survival outcomes (OS) in a 1000-patient cohort acquired over a 15-year period. Between December 1, 2003 and March 31, 2017, 1000 patients with HCC were treated with TARE as part of a prospective cohort study. A comprehensive review of toxicity and survival outcomes was performed. Outcomes were stratified by baseline Child-Pugh (CP) class, United Network for Organ Sharing (UNOS) and Barcelona Clinic Liver Cancer (BCLC) staging systems. Albumin and bilirubin laboratory toxicities were compared to baseline. OS outcomes were reported using censoring and intention-to-treat methodologies. All treatments were outpatient, with a median 1 treatment per patient. 506 (51%) were CP A, 450 (45%) CP B, and 44 (4%) CP C. 263 (26%) patients were BCLC A, 152 (15%) B, 541 (54%) C, and 44 (4%) D. 368 (37%) were UNOS T1/T2, 169 (17%) T3, 147 (15...
Gastroenterology, Dec 26, 2016
Conventional transarterial chemoembolization (cTACE) is used to treat patients with hepatocellula... more Conventional transarterial chemoembolization (cTACE) is used to treat patients with hepatocellular carcinoma (HCC). Radioembolization is a minimally invasive procedure that involves implantation of radioactive micron-sized particles loaded with yttrium-90 (Y90) inside the blood vessels that supply a tumor. We performed a randomized, phase 2 study to compare the effects of cTACE and Y90 radioembolization in patients with HCC. From October 2009 through October 2015, we reviewed patients with HCC of all Barcelona Clinic Liver Cancer (BCLC) stages for eligibility. Of these, 179 patients with BCLC stages A or B met our enrollment criteria and were candidates for cTACE or Y90 therapy. Patients were randomly assigned to groups that received Y90 therapy (n=24, 50% Child-Pugh A) or cTACE (n=21, 71% Child-Pugh A). The primary outcome was time to progression (TTP), evaluated by intention to treat analysis. Secondary outcomes included safety, rate of response (based on tumor size and necrosis c...
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, Jan 3, 2015
Hepatic metastases of colorectal carcinoma are a leading cause of cancer-related mortality. The v... more Hepatic metastases of colorectal carcinoma are a leading cause of cancer-related mortality. The vast majority of colorectal liver metastases become refractory to chemotherapy and biologic agents, at which point the median overall survival declines to 4-5 months. Radioembolization with yttrium-90 has been used in the salvage setting with favorable outcomes. This study reports the survival and safety outcomes of 531 patients treated with glass-based (90)Y microspheres at eight institutions, making it the largest (90)Y study for patients with Patients and METHODS: Data were retrospectively compiled from eight institutions for all (90)Y glass microsphere treatments for colorectal liver metastases. Exposure to chemotherapeutic/biologic agents, prior liver therapies, biochemical parameters prior to and following treatment, radiation dosimetry and complications were recorded. Uni- and multivariate analyses for predictors of survival were performed. Survival outcomes, clinical/biochemical a...
Journal of the National Comprehensive Cancer Network : JNCCN, 2011
The clinical spectrum of esophageal cancer has changed dramatically over the past couple of decad... more The clinical spectrum of esophageal cancer has changed dramatically over the past couple of decades. Most notably, a profound rise in esophageal adenocarcinoma and decrease in the incidence of squamous carcinomas have occurred. An understanding of the factors that influence survival for patients with localized esophageal cancer has evolved concomitantly with these changes in epidemiology. Significant advancement in endoscopic and radiographic staging allows for more selective use of treatment modalities. The treatment of localized esophageal cancer mandates a multidisciplinary approach, with treatment tailored to disease extent, location, histology, and an accurate assessment of pretreatment staging. Despite these improvements in the staging and use of multimodality therapy, only modest improvements in patient survival have been observed. This article summarizes these modern approaches to localized cancer of the esophagus.
Journal of the National Comprehensive Cancer Network : JNCCN, 2003
The past 5 years have seen significant developments in the treatment of colorectal cancer (CRC). ... more The past 5 years have seen significant developments in the treatment of colorectal cancer (CRC). New chemotherapy agents with activity in CRC have demonstrated an improvement in survival for patients with advanced CRC. Studies now are focusing on combinations and sequences of chemotherapy agents to prolong survival in second- and even third-line therapies. Oral agents have been developed and are being studied in combination chemotherapy regimens. Development of oral combinations should maintain a survival advantage with the added benefit of convenience for the patient. Drugs designed to act on specific cellular protein targets have also shown activity and are being explored further. Researchers continue to pursue immunotherapy and vaccine therapy. Studies are now focusing on how best to use the available agents. These new agents and new combinations of agents and of approaches have led and should continue to lead to improved outcomes in the treatment of patients with CRC.
Journal of the National Comprehensive Cancer Network : JNCCN, 2005
Pancreas cancer is the fourth most common cause of cancer deaths. Even for the small percentage o... more Pancreas cancer is the fourth most common cause of cancer deaths. Even for the small percentage of patients who can undergo surgical resection of the primary tumor, the risk of recurrence remains unacceptably high. For patients with localized disease that is not amenable to surgical resection, pain related to the primary tumor can significantly impair quality of life. Attempts to improve the duration and quality of life for these patients have included both chemotherapy and radiotherapy. The addition of chemotherapy to radiation may enhance the local effects of radiation or provide treatment of disease outside the radiation field. The results of clinical trials evaluating the appropriate therapy for locally advanced or resected disease have been inconsistent. In some instances, the methods used in these studies became outdated before the results were available. Hopefully, advances in radiation techniques and systemic drug therapy will provide more durable and clinically relevant res...
The multikinase inhibitors sorafenib (SO) and sunitinib (SU) have shown benefit in a wide range o... more The multikinase inhibitors sorafenib (SO) and sunitinib (SU) have shown benefit in a wide range of solid tumors. Although these agents are generally well tolerated, they may be associated with dermatologic adverse events, particularly hand-foot skin reaction (HFSR). The aim of this study is to evaluate the impact of HFSR associated with these multikinase inhibitors on patient health-related quality of life (HRQOL). Twenty-three patients with HFSR related to SO or SU were graded using the National Cancer Institute&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Common Terminology Criteria for Adverse Events (CTCAE) Version 3.0 for clinical severity and for impact on HRQOL through completion of the patient self-administered Skindex-16 (SK-16). Clinical severity scores were compared to HRQOL assessments. Of the 23 patients with HFSR, clinical severity was grade 1 in 17.4%, grade 2 in 74%, and grade 3 in 8.6%. Median SK-16 scores were reported for symptoms (53.3), emotions (30.6), and functioning subscales (33.3). Median symptoms and emotions scores positively correlated with HFSR clinical severity grade. These findings demonstrate that HFSR related to SO or SU negatively impacts HRQOL, with the symptoms domain being most significantly affected. In addition, CTCAE toxicity grading correlates with HRQOL.
Science Translational Medicine, 2014
Wnt/β-catenin signaling in T cells is activated during polyposis and colon cancer and drives infl... more Wnt/β-catenin signaling in T cells is activated during polyposis and colon cancer and drives inflammation and tumor growth by promoting expression of T H 17-associated genes including RORγt.
Pancreas, 2009
Response Evaluation Criteria in Solid Tumors (RECIST) guidelines assume spherical shape of tumors... more Response Evaluation Criteria in Solid Tumors (RECIST) guidelines assume spherical shape of tumors. Morphology of pancreatic adenocarcinoma (PAC) on multidetector row computed tomography was investigated to evaluate the applicability of RECIST guidelines. Study population comprised 16 patients with histologically confirmed localized PAC enrolled in a phase II clinical trial of chemoradiation. Pancreatic adenocarcinomas were segmented on baseline and follow-up multidetector row computed tomography with commercially available software. Tumor volumes (mL), RECIST diameter (mm), volume equivalent sphere diameter (VESD, mm), maximum 3-dimensional diameter (M3DD, mm), and elongation value were obtained. RECIST diameter, VESD and M3DD of the tumors at baseline and follow-up were compared to determine differences. Elongation values were analyzed. The significance level was set at P less than 0.05. Mean volume, RECIST diameter, VESD, M3DD, and elongation for baseline versus follow-up studies were 23.12 mL versus 19.43 mL (P &amp;amp;amp;amp;amp;amp;amp;gt; 0.05), 41.86 mm versus 39.35 mm (P &amp;amp;amp;amp;amp;amp;amp;gt; 0.05), 33.14 mm versus 32.1 mm (P &amp;amp;amp;amp;amp;amp;amp;gt; 0.05), 51.76 mm versus 51.73 mm (P &amp;amp;amp;amp;amp;amp;amp;gt; 0.05), and 0.67 versus 0.76 (P &amp;amp;amp;amp;amp;amp;amp;gt; 0.05), respectively. There was a significant difference at baseline and follow-up between RECIST diameter, VESD, and M3DD (P &amp;amp;amp;amp;amp;amp;amp;lt; 0.05, in all instances). Our results suggest that PACs are not spherical in shape. Evaluation of PAC treatment response based on RECIST guidelines may not be accurate.
Journal of Vascular and Interventional Radiology, 2008
withdrawal requiring intubation. He lost 8 fingers saving both thumbs. A total of 22 of 46 angiog... more withdrawal requiring intubation. He lost 8 fingers saving both thumbs. A total of 22 of 46 angiographically involved digits or 48% were saved with no major complications. 11 patients treated with RPA with 62 digits involved lost 31 digits for a 50% salvage rate. In both groups we observed normal perfusion with distal tuft blush in several clinically frostbitten limbs. These limbs were treated conservatively with good outcomes. CONCLUSION: Intra-arterial thrombolysis and vasodilator infusion is a safe and moderately effective treatment for limb salvage in severe acute frostbite. 48-50% of angiographically involved digits in both treatment groups improved with no tissue loss. Most failures were converted to a more distal amputation.
Journal of Vascular and Interventional Radiology, 2008
Journal of Vascular and Interventional Radiology, 2008
Journal of Vascular and Interventional Radiology, 2008
Embolic agents used in the study were micro-coils via microcatheter in coaxial and superselective... more Embolic agents used in the study were micro-coils via microcatheter in coaxial and superselective fation. Medical records were reviewed up to two years after embolization for complications, such as scrotal ischemia, impotent and infertility especially for patients who had bilateral internal pudendal arteries (IPA) embolized. RESULTS: Pelvic and selective bilateral internal pudendal arteriographies were performed in all 13 patients. Selective IPA revealed active bleeding in all patients. 11 patients showed unilateral bleed and 2 bilateral. Bilateral external pudendal arteriographies (EPA) were performed primarily in 5 patients with two having active bleed, and 3 secondarily for continuous enlargement of scrotal hematoma after IPA embolization and they were all positive for active bleed. Unilateral IPA was embolized in 11 patients, and bilateral IPA in 2. Unilateral EPA embolization was done in 5 patients. 10 patients were stable hemodynamically post embolization with H&H stabilized for Ͼ 24 hours without transfusion. 3 patients showed signs of continuous bleed and were stabilized after EPA embolization. No significant complication was encountered including patients with bilateral IPA embolization. CONCLUSION: IPA embolization for bleed from TPSD is effective and safe in stopping hemodynamically significant bleeding. EPA should be considered when intrapelvic bleed associated with scrotal/labial' hematoma, especially for patients with continuous bleed after IPA embolized.
Journal of Vascular and Interventional Radiology, 2009
Journal of Vascular and Interventional Radiology, 2009
Journal of Vascular and Interventional Radiology, 2009
dent, blinded review of magnetic resonance imaging studies was conducted to assess tumor response... more dent, blinded review of magnetic resonance imaging studies was conducted to assess tumor response according to amended RECIST criteria. RESULTS: DEB-TACE with doxorubicin showed a higher rate of complete response, objective response and disease control compared with conventional TACE (27% vs 22%; 52% vs 44%; and 63% vs 52% respectively, PϾ0.05). Patients with Child-Pugh B, ECOG 1, bilobar disease and recurrence following curative treatment showed a significant increase in objective response (pϭ0.038) compared to the control. There was a marked reduction in serious liver toxicity in patients treated with DEB-TACE. The rate of doxorubicin-related side effects was significantly lower (pϭ0.0001) in the DEB-TACE group compared with conventional TACE group. CONCLUSION: DEB-TACE with doxorubicin is safe and effective in the treatment of intermediate-stage HCC and offers a significant benefit to patients with more advanced disease.
Journal of Vascular and Interventional Radiology, 2009
Oncotarget, Jan 4, 2018
Indoleamine 2,3-dioxygenase 1 (IDO1) is an enzyme with immunomodulatory properties that has emerg... more Indoleamine 2,3-dioxygenase 1 (IDO1) is an enzyme with immunomodulatory properties that has emerged as a potential immunotherapeutic target in human cancer. However, the role, expression pattern, and relevance of IDO1 in esophageal cancer (EC) are poorly understood. Here, we utilize gene expression analysis of the cancer genome atlas (TCGA) and immunohistochemistry (IHC) to better understand the role and prognostic significance of IDO1 in EC. High IDO1 mRNA levels were associated with worse overall survival (OS) in both esophageal squamous cell carcinoma (SCC) ( = 0.02) and adenocarcinoma (AC) ( = 0.036). High co-expression of IDO1 and programmed death ligand 1 (PD-L1) was associated with worse OS in SCC ( = 0.0031) and AC ( = 0.0186). IHC for IDO1 in SCC showed a significant correlation with PD-L1 ( < 0.0001) and CD3ε ( < 0.0001). EC with high IDO1 and PD-L1 expression is significantly correlated with decreased patient survival, and may correlate with increased T-cells. These...
Journal of the National Comprehensive Cancer Network : JNCCN, 2018
The NCCN Guidelines for Colon Cancer provide recommendations regarding diagnosis, pathologic stag... more The NCCN Guidelines for Colon Cancer provide recommendations regarding diagnosis, pathologic staging, surgical management, perioperative treatment, surveillance, management of recurrent and metastatic disease, and survivorship. These NCCN Guidelines Insights summarize the NCCN Colon Cancer Panel discussions for the 2018 update of the guidelines regarding risk stratification and adjuvant treatment for patients with stage III colon cancer, and treatment of V600E mutation-positive metastatic colorectal cancer with regimens containing vemurafenib.
Cancer, Jan 6, 2017
The authors hypothesized that patients with metastatic colorectal cancer (mCRC) who had tumors wi... more The authors hypothesized that patients with metastatic colorectal cancer (mCRC) who had tumors with low thymidylate synthase (TS-L) expression would have a higher response rate to combined 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) plus bevacizumab (FOLFOX/Bev) than those with high TS (TS-H) expression and that combined irinotecan and oxaliplatin (IROX) plus bevacizumab (IROX/Bev) would be more effective than FOLFOX/Bev in those with TS-H tumors. TS protein expression was determined in mCRC tissue. Patients who had TS-L tumors received FOLFOX/Bev, and those who had TS-H tumors were randomly assigned to receive either FOLFOX/Bev or IROX/Bev. The primary endpoint was the response rate (complete plus partial responses). In total, 211 of 247 patients (70% TS-H) were registered to the treatment phase. Efficacy analyses included eligible patients who had started treatment (N = 186). The response rates for patients who received IROX/Bev (TS-H), FOLFOX/Bev (TS-H), and FOLFOX/Bev (...
Hepatology (Baltimore, Md.), 2017
Y90 transarterial radioembolization (TARE) is a transarterial locoregional therapy (LRT) for hepa... more Y90 transarterial radioembolization (TARE) is a transarterial locoregional therapy (LRT) for hepatocellular carcinoma (HCC). In this study, we present overall survival outcomes (OS) in a 1000-patient cohort acquired over a 15-year period. Between December 1, 2003 and March 31, 2017, 1000 patients with HCC were treated with TARE as part of a prospective cohort study. A comprehensive review of toxicity and survival outcomes was performed. Outcomes were stratified by baseline Child-Pugh (CP) class, United Network for Organ Sharing (UNOS) and Barcelona Clinic Liver Cancer (BCLC) staging systems. Albumin and bilirubin laboratory toxicities were compared to baseline. OS outcomes were reported using censoring and intention-to-treat methodologies. All treatments were outpatient, with a median 1 treatment per patient. 506 (51%) were CP A, 450 (45%) CP B, and 44 (4%) CP C. 263 (26%) patients were BCLC A, 152 (15%) B, 541 (54%) C, and 44 (4%) D. 368 (37%) were UNOS T1/T2, 169 (17%) T3, 147 (15...
Gastroenterology, Dec 26, 2016
Conventional transarterial chemoembolization (cTACE) is used to treat patients with hepatocellula... more Conventional transarterial chemoembolization (cTACE) is used to treat patients with hepatocellular carcinoma (HCC). Radioembolization is a minimally invasive procedure that involves implantation of radioactive micron-sized particles loaded with yttrium-90 (Y90) inside the blood vessels that supply a tumor. We performed a randomized, phase 2 study to compare the effects of cTACE and Y90 radioembolization in patients with HCC. From October 2009 through October 2015, we reviewed patients with HCC of all Barcelona Clinic Liver Cancer (BCLC) stages for eligibility. Of these, 179 patients with BCLC stages A or B met our enrollment criteria and were candidates for cTACE or Y90 therapy. Patients were randomly assigned to groups that received Y90 therapy (n=24, 50% Child-Pugh A) or cTACE (n=21, 71% Child-Pugh A). The primary outcome was time to progression (TTP), evaluated by intention to treat analysis. Secondary outcomes included safety, rate of response (based on tumor size and necrosis c...
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, Jan 3, 2015
Hepatic metastases of colorectal carcinoma are a leading cause of cancer-related mortality. The v... more Hepatic metastases of colorectal carcinoma are a leading cause of cancer-related mortality. The vast majority of colorectal liver metastases become refractory to chemotherapy and biologic agents, at which point the median overall survival declines to 4-5 months. Radioembolization with yttrium-90 has been used in the salvage setting with favorable outcomes. This study reports the survival and safety outcomes of 531 patients treated with glass-based (90)Y microspheres at eight institutions, making it the largest (90)Y study for patients with Patients and METHODS: Data were retrospectively compiled from eight institutions for all (90)Y glass microsphere treatments for colorectal liver metastases. Exposure to chemotherapeutic/biologic agents, prior liver therapies, biochemical parameters prior to and following treatment, radiation dosimetry and complications were recorded. Uni- and multivariate analyses for predictors of survival were performed. Survival outcomes, clinical/biochemical a...
Journal of the National Comprehensive Cancer Network : JNCCN, 2011
The clinical spectrum of esophageal cancer has changed dramatically over the past couple of decad... more The clinical spectrum of esophageal cancer has changed dramatically over the past couple of decades. Most notably, a profound rise in esophageal adenocarcinoma and decrease in the incidence of squamous carcinomas have occurred. An understanding of the factors that influence survival for patients with localized esophageal cancer has evolved concomitantly with these changes in epidemiology. Significant advancement in endoscopic and radiographic staging allows for more selective use of treatment modalities. The treatment of localized esophageal cancer mandates a multidisciplinary approach, with treatment tailored to disease extent, location, histology, and an accurate assessment of pretreatment staging. Despite these improvements in the staging and use of multimodality therapy, only modest improvements in patient survival have been observed. This article summarizes these modern approaches to localized cancer of the esophagus.
Journal of the National Comprehensive Cancer Network : JNCCN, 2003
The past 5 years have seen significant developments in the treatment of colorectal cancer (CRC). ... more The past 5 years have seen significant developments in the treatment of colorectal cancer (CRC). New chemotherapy agents with activity in CRC have demonstrated an improvement in survival for patients with advanced CRC. Studies now are focusing on combinations and sequences of chemotherapy agents to prolong survival in second- and even third-line therapies. Oral agents have been developed and are being studied in combination chemotherapy regimens. Development of oral combinations should maintain a survival advantage with the added benefit of convenience for the patient. Drugs designed to act on specific cellular protein targets have also shown activity and are being explored further. Researchers continue to pursue immunotherapy and vaccine therapy. Studies are now focusing on how best to use the available agents. These new agents and new combinations of agents and of approaches have led and should continue to lead to improved outcomes in the treatment of patients with CRC.
Journal of the National Comprehensive Cancer Network : JNCCN, 2005
Pancreas cancer is the fourth most common cause of cancer deaths. Even for the small percentage o... more Pancreas cancer is the fourth most common cause of cancer deaths. Even for the small percentage of patients who can undergo surgical resection of the primary tumor, the risk of recurrence remains unacceptably high. For patients with localized disease that is not amenable to surgical resection, pain related to the primary tumor can significantly impair quality of life. Attempts to improve the duration and quality of life for these patients have included both chemotherapy and radiotherapy. The addition of chemotherapy to radiation may enhance the local effects of radiation or provide treatment of disease outside the radiation field. The results of clinical trials evaluating the appropriate therapy for locally advanced or resected disease have been inconsistent. In some instances, the methods used in these studies became outdated before the results were available. Hopefully, advances in radiation techniques and systemic drug therapy will provide more durable and clinically relevant res...
The multikinase inhibitors sorafenib (SO) and sunitinib (SU) have shown benefit in a wide range o... more The multikinase inhibitors sorafenib (SO) and sunitinib (SU) have shown benefit in a wide range of solid tumors. Although these agents are generally well tolerated, they may be associated with dermatologic adverse events, particularly hand-foot skin reaction (HFSR). The aim of this study is to evaluate the impact of HFSR associated with these multikinase inhibitors on patient health-related quality of life (HRQOL). Twenty-three patients with HFSR related to SO or SU were graded using the National Cancer Institute&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Common Terminology Criteria for Adverse Events (CTCAE) Version 3.0 for clinical severity and for impact on HRQOL through completion of the patient self-administered Skindex-16 (SK-16). Clinical severity scores were compared to HRQOL assessments. Of the 23 patients with HFSR, clinical severity was grade 1 in 17.4%, grade 2 in 74%, and grade 3 in 8.6%. Median SK-16 scores were reported for symptoms (53.3), emotions (30.6), and functioning subscales (33.3). Median symptoms and emotions scores positively correlated with HFSR clinical severity grade. These findings demonstrate that HFSR related to SO or SU negatively impacts HRQOL, with the symptoms domain being most significantly affected. In addition, CTCAE toxicity grading correlates with HRQOL.
Science Translational Medicine, 2014
Wnt/β-catenin signaling in T cells is activated during polyposis and colon cancer and drives infl... more Wnt/β-catenin signaling in T cells is activated during polyposis and colon cancer and drives inflammation and tumor growth by promoting expression of T H 17-associated genes including RORγt.
Pancreas, 2009
Response Evaluation Criteria in Solid Tumors (RECIST) guidelines assume spherical shape of tumors... more Response Evaluation Criteria in Solid Tumors (RECIST) guidelines assume spherical shape of tumors. Morphology of pancreatic adenocarcinoma (PAC) on multidetector row computed tomography was investigated to evaluate the applicability of RECIST guidelines. Study population comprised 16 patients with histologically confirmed localized PAC enrolled in a phase II clinical trial of chemoradiation. Pancreatic adenocarcinomas were segmented on baseline and follow-up multidetector row computed tomography with commercially available software. Tumor volumes (mL), RECIST diameter (mm), volume equivalent sphere diameter (VESD, mm), maximum 3-dimensional diameter (M3DD, mm), and elongation value were obtained. RECIST diameter, VESD and M3DD of the tumors at baseline and follow-up were compared to determine differences. Elongation values were analyzed. The significance level was set at P less than 0.05. Mean volume, RECIST diameter, VESD, M3DD, and elongation for baseline versus follow-up studies were 23.12 mL versus 19.43 mL (P &amp;amp;amp;amp;amp;amp;amp;gt; 0.05), 41.86 mm versus 39.35 mm (P &amp;amp;amp;amp;amp;amp;amp;gt; 0.05), 33.14 mm versus 32.1 mm (P &amp;amp;amp;amp;amp;amp;amp;gt; 0.05), 51.76 mm versus 51.73 mm (P &amp;amp;amp;amp;amp;amp;amp;gt; 0.05), and 0.67 versus 0.76 (P &amp;amp;amp;amp;amp;amp;amp;gt; 0.05), respectively. There was a significant difference at baseline and follow-up between RECIST diameter, VESD, and M3DD (P &amp;amp;amp;amp;amp;amp;amp;lt; 0.05, in all instances). Our results suggest that PACs are not spherical in shape. Evaluation of PAC treatment response based on RECIST guidelines may not be accurate.
Journal of Vascular and Interventional Radiology, 2008
withdrawal requiring intubation. He lost 8 fingers saving both thumbs. A total of 22 of 46 angiog... more withdrawal requiring intubation. He lost 8 fingers saving both thumbs. A total of 22 of 46 angiographically involved digits or 48% were saved with no major complications. 11 patients treated with RPA with 62 digits involved lost 31 digits for a 50% salvage rate. In both groups we observed normal perfusion with distal tuft blush in several clinically frostbitten limbs. These limbs were treated conservatively with good outcomes. CONCLUSION: Intra-arterial thrombolysis and vasodilator infusion is a safe and moderately effective treatment for limb salvage in severe acute frostbite. 48-50% of angiographically involved digits in both treatment groups improved with no tissue loss. Most failures were converted to a more distal amputation.
Journal of Vascular and Interventional Radiology, 2008
Journal of Vascular and Interventional Radiology, 2008
Journal of Vascular and Interventional Radiology, 2008
Embolic agents used in the study were micro-coils via microcatheter in coaxial and superselective... more Embolic agents used in the study were micro-coils via microcatheter in coaxial and superselective fation. Medical records were reviewed up to two years after embolization for complications, such as scrotal ischemia, impotent and infertility especially for patients who had bilateral internal pudendal arteries (IPA) embolized. RESULTS: Pelvic and selective bilateral internal pudendal arteriographies were performed in all 13 patients. Selective IPA revealed active bleeding in all patients. 11 patients showed unilateral bleed and 2 bilateral. Bilateral external pudendal arteriographies (EPA) were performed primarily in 5 patients with two having active bleed, and 3 secondarily for continuous enlargement of scrotal hematoma after IPA embolization and they were all positive for active bleed. Unilateral IPA was embolized in 11 patients, and bilateral IPA in 2. Unilateral EPA embolization was done in 5 patients. 10 patients were stable hemodynamically post embolization with H&H stabilized for Ͼ 24 hours without transfusion. 3 patients showed signs of continuous bleed and were stabilized after EPA embolization. No significant complication was encountered including patients with bilateral IPA embolization. CONCLUSION: IPA embolization for bleed from TPSD is effective and safe in stopping hemodynamically significant bleeding. EPA should be considered when intrapelvic bleed associated with scrotal/labial' hematoma, especially for patients with continuous bleed after IPA embolized.
Journal of Vascular and Interventional Radiology, 2009
Journal of Vascular and Interventional Radiology, 2009
Journal of Vascular and Interventional Radiology, 2009
dent, blinded review of magnetic resonance imaging studies was conducted to assess tumor response... more dent, blinded review of magnetic resonance imaging studies was conducted to assess tumor response according to amended RECIST criteria. RESULTS: DEB-TACE with doxorubicin showed a higher rate of complete response, objective response and disease control compared with conventional TACE (27% vs 22%; 52% vs 44%; and 63% vs 52% respectively, PϾ0.05). Patients with Child-Pugh B, ECOG 1, bilobar disease and recurrence following curative treatment showed a significant increase in objective response (pϭ0.038) compared to the control. There was a marked reduction in serious liver toxicity in patients treated with DEB-TACE. The rate of doxorubicin-related side effects was significantly lower (pϭ0.0001) in the DEB-TACE group compared with conventional TACE group. CONCLUSION: DEB-TACE with doxorubicin is safe and effective in the treatment of intermediate-stage HCC and offers a significant benefit to patients with more advanced disease.
Journal of Vascular and Interventional Radiology, 2009