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International consensus statement on allergy and rhinology: Allergic rhinitis – 2023
Wise, Sarah K. , Damask, Cecelia, Ebert, Charles S. , Levy, Joshua M. , Lin, Sandra Y. , Luong, Amber , Rodriguez, Kenneth , Sedaghat, Ahmad R. , Toskala, Elina , Akdiş, Cezmi A. , Ansotegui, Ignacio J. , Azar, Antoine , Baroody, Fuad M. , Benninger, Michael S. , Casale, Thomas B. , Chaaban, Mohamad R. , Chew, Fook Tim , Chambliss, Jeffrey , Cianferoni, Antonella , Čustović, Adnan , Davis, Elizabeth Mahoney , DelGaudio, John M. , Flanagan, Carrie E. , Franzese, Christine B., Gill, Amarbir S. , Halderman, Ashleigh A. , Joe, Stephanie, Joshi, Shyam , Kuruvilla, Merin , Kim, Jean , Klein, Adam M. , Krouse, Helene J. , Lang, David M. , Laury, Adrienne M., Lee, Victoria S. , Loftus, Patricia A. , Marzouk, Haidy, Mims, James W., Oppenheimer, John , Orlandi, Richard R. , Phillips, Katie M. , Raymond, Mallory , Ryan, Matthew W., Sastre, J. , Schlosser, Rodney J. , Shaker, Marcus , Smith, Kristine A. , Soyka, Michael , Tang, Monica , Tantilipikorn, Pongsakorn , Taw, Malcolm B., Tversky, Jody , Tyler, Matthew A. , Veling, Maria C., Wallace, Dana , White, Andrew A. , Roland, Lauren T , Levy, Joshua M , Luong, Amber U , Sedaghat, Ahmad R , Villwock, Jennifer , Abdullah, Baharudin , Alt, Jeremiah A , Chaaban, Mohamad R , Gill, Amarbir , Kuruvilla, Merin Elizabeth , Kim, Jean , Kuan, Edward C , Lee, Victoria S , Marcus, Sonya , Mattos, Jose , McCoul, Edward D , Nayak, Jayakar V , Orlandi, Richard , Schuman, Theodore A , Smith, Kristine , Soyka, Michael B , Tantilipikorn, Pongsakorn , Tyler, Matthew A , Zhang, Luo , Schlosser, Rodney J , Chew, Fook Tim , Casale, Thomas , Alt, Jeremiah A. , Bernstein, Jonathan A. , Brook, Christopher D. , Campbell, Raewyn Gay , Ellis, Anne K. , Fokkens, Wytske Johanna , Greenhawt, Matthew , Hohlfeld, Jens Michael , Incorvaia, Cristoforo , Larenas‐Linnemann, Désirée E. , Lechner, Matt , Lee, Stella E. , Mattos, José L. , McCoul, Edward D. , Melén, Erik , Mullol, Joaquim , Nayak, Jayakar V. , Platt, Michael P. , Ramanathan, Murugappan , Raymond, Mallory J , Rhee, Chae‐Seo , Reitsma, Sietze , Sheikh, Aziz , Takashima, Masayoshi , Wang, De Yun , Zhang, Luo

International Forum of Allergy & Rhinology | March 6, 2023 | Volume: 13 | Issue: 4 | Pages: 293-859

10.1002/alr.23090 | PMID 36878860 Get It

Abstract Background In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR‐Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR‐Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence‐based findings and recommendation from the full document. Methods ICAR‐Allergic Rhinitis 2023 employed established evidence‐based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. Results ICAR‐Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. Conclusion The ICAR‐Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.
Abstract OT2-11-01: A phase 1 study of the novel immunotoxin MT-5111 in patients with HER2+ tumors: interim results
Okera, Meena , Tine, Brian Andrew Van, Mita, Monica , Valdes-Albini, Frances , Ahn, Daniel H. , Mamuye, Admasu, Pelham, Joshua, Yuet, Amy, Yurewicz, Diana, Liu, Yanning, Sandri, Andrés Machado, Edenfield, William J. , Morikawa, Aki , Gradishar, William J. , Kumar, Rajiv , Hubbard, Joleen M. , Barve, Minal , Hamilton, Erika , Wainberg, Zev A.

Cancer Research | March 2, 2023 | Volume: 83 | Issue: 5_Supplement | Pages: OT2-11-01-OT2-11-01

10.1158/1538-7445.sabcs22-ot2-11-01 Get It

Abstract MT-5111 is a 55kD engineered toxin body targeting HER2 in solid tumors that binds to an epitope distinct from trastuzumab and pertuzumab, offering potential combination strategies with other HER2-targeting agents. MT-5111 works by internalizing, self-routing through intracellular compartments to the cytosol, and inducing potent cell-kill via the enzymatic and permanent inactivation of ribosomes. This is a phase 1 study in adults with advanced HER2+ solid tumors. MT-5111 is dosed weekly IV over 30 min in every 21-day cycle until disease progression, unacceptable toxicity, death, or withdrawn consent. The study has dose escalation (Part A) cohorts enrolling patients (pts) with any HER2+ cancer (CA) and expansion (Part B) cohorts for HER2+ breast cancer (BC), Gastric or Gastroesophageal junction adenocarcinoma (GEA), or other HER2+ solid CA. As of 30 June 2022, 42 total pts had enrolled (36 in Part A on 0.5-23 µg/kg/dose, 6 pts with BC in Part B1 on 10 µg/kg/dose). Median age 65 years, 28 (66.78%) pts were female, median of 4 prior systemic and 2 prior HER2-targeting treatment (tx). 17 pts with BC, 6 with biliary CA, 9 with GEA, and 10 with other solid CA have enrolled. Of the 17 BC pts, 15 received ≥ 10 µg/kg/dose. Tx emergent adverse events (TEAEs) have been reported in 40 (95%) pts, and tx-related AEs (TRAE) occurred in 23 (55%) pts. No pt experienced G4-G5 TRAE. G1 troponin elevations were noted in 5 pts without clinical signs of cardiotoxicity (1 pt 6.75 µg/kg, 2 pts 10 µg/kg, 1 pt 17 µg/kg, 1 pt 23 µg/kg). Reversible G1/G2 infusion-related reactions were reported in 2 pts. Tx-related G1-G3 rash was observed in 5 pts (4 pts ≥ 10 µg/kg/dose); maculopapular in 2 pts, acneiform in 1 pt and associated with pruritus in 3 pts. The G3 rash developed one wk after first dose of 23 µg/kg, was declared a DLT, improved with systemic steroid therapy and the pt continued tx at the same dose without recurrence. Best overall response per RECIST thus far is stable disease (SD) in 17 pts, non-CR/non-PD in 1 pt, and progressive disease (PD) in 14 pts. 1 pt had non-CR/non-PD for 30 wks (1 μg/kg, BC); 1 pt had SD for 24wks (10 μg/kg, pancreatic); 1 pt is on tx with SD through 8 cycles (10 μg/kg, BC). Of the 10 BC pts who received ≥ 10 μg/kg/dose, the best response was 5 SD. The mean serum concentration of MT-5111 has increased in a dose-proportional manner starting at 6.75µg/kg/dose (Table 1). The soluble HER2 (sHER2) levels at end of tx were higher compared to baseline in cohorts that received ≤ 4.5µg/kg/dose, but similar or lower in cohorts that received ≥ 6.75µg/kg/dose. Higher MT-5111 doses have been well tolerated and may saturate circulating sHER2, leading to more predictable serum concentrations and tumor penetration. The Cmax in humans at doses ≥6.75 µg/kg/dose is above the in vitro IC50 for high HER2+ cell lines (0.029nM) and at 17 µg/kg/dose, above the IC50 for moderate HER2+ cells (1.6nM). In conclusion, the dose proportionate increase in serum concentration with levels above the in vitro IC50 and the leveling off/reduction of sHER2 indicate exposure to MT-5111 is at clinically therapeutic levels. Skin toxicity at higher doses may indicate on-target effect as observed in other EGFR-targeted therapies where it is associated with clinical response and a better prognosis. sHER2 biomarker data is expected for all cohorts with PK correlation and 23µg/kg safety and efficacy data. PK profile of MT-5111, C1D1 values Citation Format: Meena Okera, Brian A. Van Tine, Joleen M. Hubbard, Minal Barve, Erika Hamilton, Monica M. Mita, Frances Valdes-Albini, Daniel Ahn, Admasu Mamuye, Joshua Pelham, Amy Yuet, Diana Yurewicz, Yanning Liu, Andres Machado Sandri, William J. Edenfield, Aki Morikawa, William Gradishar, Rajiv Kumar, Zev A. Wainberg. A phase 1 study of the novel immunotoxin MT-5111 in patients with HER2+ tumors: interim results [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT2-11-01.
Abstract GS4-09: Pregnancy Outcome and Safety of Interrupting Therapy for women with endocrine responsIVE breast cancer: Primary Results from the POSITIVE Trial (IBCSG 48-14/BIG 8-13)
Partridge, Ann, Pagani, Olivia , Niman, Samuel M. , Ruggeri, Monica , Azim, Hatem A. , Saura, Cristina , Shimizu, Chikako , Sætersdal, Anna Barbro, Mailliez, Audrey , Gombos, Andrea , Kataoka, Akemi, Borštnar, Simona, Takei, Junko , Borrego, Manuel Ruíz, Bjelic‐Radisic, Vesna , Vilarino, Teresa Ferreiro, Ribi, Karin, Ruddy, Kathryn, Piccart, Martine , Korde, Larissa A. , Goldhirsch, Aron, Gelber, Richard D. , Saura, Cristina , Peccatori, Fedro A , Colleoni, Marco , Kroep, Judith R. , Warner, Ellen , Borges, Virginia F. , Amant, Frédéric , Rousset‐Jablonski, Christine , Lee, Jeong Eon , Walshe, Janice M. , Moore, Halle C. F. , Saunders, Christobel , Susnjar, Snezana , Cardoso, Fátima , Smith, Karen L. , Vilarino, Teresa Ferreiro, Ruddy, Kathryn J. , El-Abed, Sarra

Cancer Research | March 2, 2023 | Volume: 83 | Issue: 5_Supplement | Pages: GS4-09-GS4-09

10.1158/1538-7445.sabcs22-gs4-09 Get It

Abstract Background: Pregnancy after breast cancer (BC) is of substantial importance for many young women at diagnosis and during follow-up. BC treatment including standard endocrine therapy (ET) (5-10 years) may reduce ovarian reserve and the chances of subsequent successful pregnancy, given conception is contraindicated during ET. A temporary interruption of ET to attempt and carry a pregnancy in this population has never been prospectively studied. Methods: POSITIVE is a single-arm, prospective, investigator-initiated, international trial evaluating the safety and pregnancy outcomes of interrupting ET for young women with early-stage hormone-receptor-positive (HR+) BC who desire pregnancy. The primary objective is to assess the risk of BC relapse associated with ET interruption for ~2 years to achieve pregnancy. Women ≤42 years with stage I-III HR+ BC who received adjuvant ET (SERM alone, GnRH analogue plus SERM or AI) for 18 to 30 months and wished to interrupt ET to attempt pregnancy were eligible. The primary endpoint is breast cancer free interval (BCFI) defined as the time from enrollment to the first BC event (local, regional, distant recurrence or a new invasive contralateral BC). Planned sample size was 500 patients. Three interim analyses of BCFI were reviewed by the Data Safety Monitoring Committee (DSMC) to assure a 95% chance of stopping the trial early if the annual BCFI event rate exceeded 4%; with primary analysis triggered after 1600 patient years of follow-up (pyfu) and no more than 46 BCFI events defined as the safety threshold. The DSMC recommended continuing the study following each interim analysis. We now report the primary results. Results: From 12/2014 to 12/2019, 518 women were enrolled. At enrollment, the median age of participants was 37 years (27-43 years); 75.0% were nulliparous, 93.4% had stage I/II disease, 66.3% node-negative. Median time from BC diagnosis to enrollment was 29 months (IQR: 25-32). Tamoxifen alone was the most prescribed ET (41.7%), followed by tamoxifen+ovarian function suppression (35.7%). 62.0% of participants had received neo/adjuvant chemotherapy. At a median follow-up of 41 months (1638 pyfu), 44 participants had experienced a BCFI event, not exceeding the pre-specified safety threshold of 46 events. The 3-year BCFI failure percent was 8.9% (95% CI: 6.3 to 11.6%), similar to the 9.2% (95% CI: 7.6 to 10.8%) calculated in the comparative external control cohort from the SOFT/TEXT trials (Sun et al, Breast 2020). Of 497 women followed for pregnancy status, 368 (74.0%) had at least one pregnancy, 317 (63.8%) had at least one live birth, with a total of 365 babies born. Based on competing risk analysis, 76.3% of patients resumed ET (half within 26 months), 8.3% had BCFI event/death before ET resumption, and 15.4% had not resumed ET yet. Conclusions: The POSITIVE trial demonstrates that for young women with early HR+ BC desiring pregnancy, temporary interruption of ET to attempt pregnancy does not confer a greater short-term risk of recurrence than that observed in a modern historical control group that did not interrupt ET. Most participants have had a live birth. Further follow-up is planned to confirm long-term safety. These results should be considered in counselling BC patients desiring future pregnancy. Citation Format: Ann Partridge, Olivia Pagani, Samuel M. Niman, Monica Ruggeri, Fedro Alessandro A. Peccatori, Hatem A. Azim, Marco Colleoni, Cristina Saura, Chikako Shimizu, Anna Saetersdal, Judith Kroep, Audrey Mailliez, Ellen Warner, Virginia F. Borges, Frédéric Amant, Andrea Gombos, Akemi Kataoka, Christine Rousset-Jablonski, Simona Borstnar, Junko Takei, Jeong Eon Lee, Janice Walshe, Manuel Ruiz Borrego, Halle Moore, Christobel Saunders, Vesna Bjelic-Radisic, Snezana Susnjar, Fatima Cardoso, Karen L. Smith, Teresa Ferreiro Vilarino, Karin Ribi, Kathryn Ruddy, Sarra El-Abed, Martine Piccart, Larissa A. Korde, Aron Goldhirsch, Richard D. Gelber. Pregnancy Outcome and Safety of Interrupting Therapy for women with endocrine responsIVE breast cancer: Primary Results from the POSITIVE Trial (IBCSG 48-14/BIG 8-13) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr GS4-09.
Abstract GS4-02: Oncological Outcomes Following Omission of Axillary Lymph Node Dissection in Node Positive Patients Downstaging To Node Negative with Neoadjuvant Chemotherapy: the OPBC-04/EUBREAST-06/OMA study
Montagna, Giacomo , Mrdutt, Mary M., Botty, Astrid, Hwang, E. Shelley, Ingham, Abigail, Papassotiropoulos, Bärbel , Kurzeder, Christian , Aybar, Danilo Díaz, Vorburger, Denise , Matlac, Dieter Michael, Fitzal, Florian , Meani, Francesco , Fick, Franziska, Sagasser, Jacqueline, Heil, Jörg, Dedes, Konstantin J. , Romics, László , Banys‐Paluchowski, Maggie , Pérez, María del Rosario Cueva, Fehr, Mathias K. , Ditsch, Nina , Zarhi, Sebastián Solé, Küemmel, Sherko, Bruz̆as, S., Parissenti, Tamara K., Güth, Uwe , Ovalle, Valentina , Tausch, Christoph, Morrow, Monica , Kühn, Thorsten, Barrio, Andrea V. , Sevilimedu, Varadan , Boughey, Judy C. , Hoskin, Tanya L. , Rosenberger, Laura H. , Nguyen-Sträuli, Bich Doan , Matlac, Dieter Michael , Ostapenko, Edvin , Riedel, Fabian , Heil, Joerg , Díaz, Marcelo Chávez , Heidinger, Martin , Reinisch, Mattea , Maggi, Nadia , Rocco, Nicola , Gentilini, Oreste D , Paulinelli, Régis Resende , Lascio, Simona Di , Weber, William P.

Cancer Research | March 2, 2023 | Volume: 83 | Issue: 5_Supplement | Pages: GS4-02-GS4-02

10.1158/1538-7445.sabcs22-gs4-02 Get It

Abstract Background: Data on the oncologic safety of omission of axillary lymph node dissection (ALND) in node positive (N+) patients who downstage to ypN0 with neoadjuvant chemotherapy (NAC) is sparse. Additionally, there is no consensus on which axillary staging procedure should be used in this setting, sentinel lymph node biopsy (SLNB) alone or in combination with localization and retrieval of the clipped positive node, also known as targeted axillary dissection (TAD). Whether the reduction in the false negative rate observed with TAD translates into a significant reduction in the rate of axillary recurrence is unknown. We sought to evaluate oncologic outcomes after omission of ALND in a large, real-world cohort of breast cancer (BC) patients and to compare rates of axillary recurrence after SLNB with dual tracer mapping vs. TAD. Methods: Data were collected from 19 centers in the Oncoplastic Breast Consortium (OPBC) and EUBREAST networks. Patients with T1-4 biopsy-proven N1-3 BC who underwent NAC followed by axillary staging with either SLNB with dual tracer mapping or TAD and who were pathologically node negative (ypN0) were included. ypN0 was defined as the absence of any tumor or isolated tumor cells. Competing risk analysis was performed to assess the cumulative incidence rates of axillary recurrence, locoregional recurrence, and any invasive (locoregional or distant) recurrence. Two-year cumulative incidence rates were compared between TAD and SLNB using the Gray’s test. Type I error rate was set to 0.05 (α). Results: We included 785 patients (565 treated with SLNB and 220 with TAD) treated with NAC followed by surgery from 01/2014-12/2020. Median patient age was 50 years. The majority (57%) of patients had clinical T2 tumors, and 95% had N1 disease. Most (55%) were HER2+, and 21% were triple negative. Most patients (81%) received anthracycline and taxane-based chemotherapy regimens, but NAC regimens differed between patients treated with TAD and those treated with SLNB (Table 1). All patients with HER2+ tumors received anti HER2 therapy. Nodal radiotherapy was administered to 76% of patients, and was more common in patients who underwent TAD (82% TAD vs 74% SLNB, p=0.017). Breast pathologic complete response (ypT0/is) was more frequent among those patients that had TAD (80% TAD vs. 66% SLNB, p< 0.001). TAD localization was with wire in 46%, radioactive seed in 40%, ultrasound in 5%, tattoo in 2%, and with a combination of these techniques in 7%. The clipped node was successfully retrieved in 94% of TAD cases. The median number of lymph nodes removed was lower in the TAD group compared to the SLNB group [3 (IQR 3-5) vs 4 IQR 3-5), p< 0.001], as was the median number of sentinel lymph nodes [3 (IQR 2-4) vs 4 IQR 3-5), p< 0.001] (Table 1). The 5-year rates of any axillary recurrence, locoregional recurrence, and any invasive recurrence in the entire cohort were 1.1% (95%CI 0.39-2.4%), 3.1% (95%CI 1.6-5.3%) and 10% (95%CI 7.6-13%), respectively. The two-year cumulative incidence of axillary recurrence did not differ between patients treated with TAD compared to SLNB (0% vs 0.9%, p=0.19). Conclusion: Early axillary recurrence after omission of ALND in patients who successfully downstage from N+ to ypN0 with NAC is a rare event following both SLNB or TAD, and was not significantly lower in TAD than SLNB. Although longer follow-up is needed to confirm these findings, the main advantage of TAD seems to be a reduction in the number of lymph nodes removed. Overall, these results support omission of ALND in patients who successfully downstage to node negative disease after NAC. Table 1: Clinicopathological Features of the Study Cohort, Stratified by Axillary Staging Technique Citation Format: Giacomo Montagna, Mary Mrdutt, Astrid Botty, Andrea V. Barrio, Varadan Sevilimedu, Judy C. Boughey, Tanya L. Hoskin, Laura H. Rosenberger, E Shelley Hwang, Abigail Ingham, Bärbel Papassotiropoulos, Bich Doan Nguyen-Sträuli, Christian Kurzeder, Danilo Diaz Aybar, Denise Vorburger, Dieter Michael Matlac, Edvin Ostapenko, Fabian Riedel, Florian Fitzal, Francesco Meani, Franziska Fick, Jacqueline Sagasser, Jörg Heil, Konstantin J. Dedes, Laszlo Romics, Maggie Banys-Paluchowski, Maria Del Rosario Cueva Perez, Marcelo Chavez Diaz, Martin Heidinger, Mathias K. Fehr, Mattea Reinisch, Nadia Maggi, Nicola Rocco, Nina Ditsch, Oreste Davide Gentilini, Regis Resende Paulinelli, Sebastian Sole Zarhi, Sherko Küemmel, Simona Bruzas, Simona Di Lascio, Tamara Parissenti, Uwe Güth, Valentina Ovalle, Christoph Tausch, Monica Morrow, Thorsten Kühn, Walter P. Weber. Oncological Outcomes Following Omission of Axillary Lymph Node Dissection in Node Positive Patients Downstaging To Node Negative with Neoadjuvant Chemotherapy: the OPBC-04/EUBREAST-06/OMA study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr GS4-02.
AXIN2‐related oligodontia‐colorectal cancer syndrome with cleft palate as a possible new feature
Roht, Laura , Hyldebrandt, Hanne Kjensli, Stormorken, Astrid, Nordgarden, Hilde , Bos, Dennis K. , Riegert‐Johnson, Douglas L. , Mantia‐Macklin, Sarah, Ilves, Pilvi , Muru, Kai , Wojcik, Monica H. , Kahre, Tiina , Õunap, Katrin , Riegert-Johnson, Douglas, Mantia-Macklin, Sarah, Õunap, Katrin , Sijmons, Rolf H.

Molecular Genetics & Genomic Medicine | March 2, 2023 | Volume: 11 | Issue: 6 | Pages: No page available

10.1002/mgg3.2157 | PMID 36860143 Get It

AbstractBackgroundPathogenic variants in AXIN2 have been associated with tooth agenesis, colon polyps, and colon cancer. Given the rare nature of this phenotype, we set out to collect additional genotypic and phenotypic information.MethodsData were collected via a structured questionnaire. Sequencing was performed in these patients mostly due to diagnostic purpose. A little more than half of the AXIN2 variant carriers were identified by NGS; other six were family members.ResultsHere, we report 13 individuals with a heterozygous AXIN2 pathogenic/likely pathogenic variant who have a variable expression of oligodontia‐colorectal cancer syndrome (OMIM 608615) or oligodontia‐cancer predisposition syndrome (ORPHA 300576). Three individuals from one family also had cleft palate, which might represent a new clinical feature of AXIN2 phenotype, also given the fact that AXIN2 polymorphisms have been found in association with oral clefting in population studies. AXIN2 has already been added to multigene cancer panel tests; further research should be conducted to determine whether it should be added to cleft lip/palate multigene panels.ConclusionMore clarity about oligodontia‐colorectal cancer syndrome, about the variable expression, and associated cancer risks is needed to improve clinical management and to establish guidelines for surveillance. We collected information about the surveillance that was advised, which might support clinical management of these patients.
Update of penetrance estimates in Birt-Hogg-Dubé syndrome
Bruinsma, Fiona , Dowty, James G., Win, Aung Ko , Goddard, Laura C, Agrawal, Prachi , Attinà, Domenico , Bissada, Nabil K., Eisen, Daniel B. , Furuya, Mitsuko , Hansen, Thomas van Overeem , Houweling, Arjan C. , Johannesma, Paul C., Lim, Derek H.K., Lindor, Noralane M. , Luzzi, Valentina , Lynch, Maeve , Maffé, Antonella, Menko, Fred H. , Michels, Guido, Pulido, José S. , Ryu, Jay H. , Sattler, Elke , Steinlein, Ortrud K. , Tucker, Kathy , Beek, Irma van de , Riel, Lore van , Zénone, Thierry, Zompatori, Maurizo, Bondavalli, Davide , I-CONFIRM, Genetic Susceptibility Working Group, Bruinsma, Fiona Jane , Turchetti, Daniela , Maher, Eamonn R , Win, Aung K , Ryu, Jay H , Hansen, Thomas van Overeem , Luise, Monica De , Gasparre, Giuseppe , Genuardi, Maurizio , Gerdes, Anne‐Marie , Lencastre, André , Tomassetti, Sara , Steensel, Maurice A. M. Van , Zompatori, Maurizio , Walsh, Jennifer, Maher, Eamonn R. , Winship, Ingrid , I-CONFIRM, Genetic Susceptibility Working Group

Journal of Medical Genetics | February 27, 2023 | Volume: 60 | Issue: 4 | Pages: 317-326

10.1136/jmg-2022-109104 | PMID 36849229 Get It

Background Birt-Hogg-Dubé (BHD) syndrome is a rare genetic syndrome caused by pathogenic or likely pathogenic germline variants in the FLCN gene. Patients with BHD syndrome have an increased risk of fibrofolliculomas, pulmonary cysts, pneumothorax and renal cell carcinoma. There is debate regarding whether colonic polyps should be added to the criteria. Previous risk estimates have mostly been based on small clinical case series. Methods A comprehensive review was conducted to identify studies that had recruited families carrying pathogenic or likely pathogenic variants in FLCN . Pedigree data were requested from these studies and pooled. Segregation analysis was used to estimate the cumulative risk of each manifestation for carriers of FLCN pathogenic variants. Results Our final dataset contained 204 families that were informative for at least one manifestation of BHD (67 families informative for skin manifestations, 63 for lung, 88 for renal carcinoma and 29 for polyps). By age 70 years, male carriers of the FLCN variant have an estimated 19% (95% CI 12% to 31%) risk of renal tumours, 87% (95% CI 80% to 92%) of lung involvement and 87% (95% CI 78% to 93%) of skin lesions, while female carriers had an estimated 21% (95% CI 13% to 32%) risk of renal tumours, 82% (95% CI 73% to 88%) of lung involvement and 78% (95% CI 67% to 85%) of skin lesions. The cumulative risk of colonic polyps by age 70 years old was 21% (95% CI 8% to 45%) for male carriers and 32% (95% CI 16% to 53%) for female carriers. Conclusions These updated penetrance estimates, based on a large number of families, are important for the genetic counselling and clinical management of BHD syndrome.
5-Year Follow-Up Supports Curative Potential of Axicabtagene Ciloleucel in Refractory Large B-Cell Lymphoma (ZUMA-1)
Neelapu, Sattva S. , Jacobson, Caron A. , Ghobadi, Armin , Miklos, David B. , Lekakis, Lazaros J. , Oluwole, Olalekan O. , Lin, Yi , Braunschweig, Ira , Hill, Brian T. , Timmerman, John M. , Deol, Abhinav , Stiff, Patrick J. , McSweeney, Peter A., Herrera, Alex F. , Bartlett, Nancy L. , Bot, Adrian A., Shen, Rhine R. , Dong, Jinghui , Singh, Kanwarjit, Miao, Harry , Zheng, Yan , Stiff, Patrick J , Flinn, Ian W , Farooq, Umar , Goy, Andre Henri , Munoz, Javier L , Herrera, Alex F , Bartlett, Nancy L , Oluwole, Olalekan O , Miklos, David B , Ghobadi, Armin , Reagan, Patrick Michael , Flinn, Ian W. , Muñoz, Javier , Siddiqi, Tanya , Chavez, Julio C , Bot, Adrian , Kim, Jaeyeon , Locke, Frederick L.

Blood | February 23, 2023 | Volume: No volume available | Issue: No issue available | Pages: No page available

10.1182/blood.2022018893 | PMID 36821768 Get It

In phase 2 of ZUMA-1, a single-arm, multicenter, registrational trial, axicabtagene ciloleucel (axi-cel) autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy demonstrated durable responses at 2 years in patients with refractory large B-cell lymphoma (LBCL). Here, we aimed to assess survival and safety in ZUMA-1 after 5 years of follow-up. Eligible adults with refractory LBCL (diffuse large B-cell lymphoma, primary mediastinal B-cell lymphoma, and transformed follicular lymphoma) received lymphodepleting chemotherapy followed by axi-cel infusion targeted at 2×106 cells/kg. Investigator-assessed response, updated survival, safety, and pharmacokinetic outcomes were assessed in treated patients. The objective response rate in the 101 treated patients was 83% (58% complete response rate), and with a median follow-up of 63.1 months, responses were ongoing at data cutoff in 31%. Median overall survival (OS) was 25.8 months and the estimated 5-year OS rate was 42.6%. Disease-specific survival (excluding deaths unrelated to disease progression) estimated at 5 years was 51.0%. No new serious adverse events or deaths related to axi-cel were observed after additional follow-up. Peripheral blood B cells were detectable in all evaluable patients at 3 years with polyclonal B-cell recovery in 91%. Ongoing responses at 60 months were associated with early CAR T-cell expansion. In conclusion, this 5-year follow-up analysis of ZUMA-1 demonstrates sustained overall and disease-specific survival, with no new safety signals in patients with refractory LBCL. Protracted B-cell aplasia was not required for durable responses. These findings support the curative potential of axi-cel in a subset of patients with aggressive B-cell lymphomas. ClinicalTrials.gov, number NCT02348216
Occupational Characteristics Associated with Professional Fulfillment and Burnout Among U.S. Physiatrists
Trockel, Mickey , Kinney, Carolyn L. , Sliwa, James A. , Knowlton, Tiffany, Stautzenbach, Tom, Shanafelt, Tait D. , Makowski, Maryam S , Verduzco-Gutierrez, Monica , Kinney, Carolyn , Sliwa, James , Shanafelt, Tait D , Paganoni, Sabrina , Weinstein, Stuart L. , Verduzco‐Gutierrez, Monica , Kennedy, David J. , Wang, Hanhan

PM&R | February 16, 2023 | Volume: 15 | Issue: 5 | Pages: 541-551

10.1002/pmrj.12961 | PMID 36794660 Get It

AbstractIntroductionMultiple national studies suggest that, among physicians, physiatrists are at increased risk for occupational burnout.ObjectiveTo identify characteristics of the work environment associated with professional fulfillment and burnout among U.S. physiatrists.DesignBetween May and December 2021, a mixed qualitative and quantitative approach was used to identify factors contributing to professional fulfillment and burnout in physiatrists.SettingOnline interviews, focus groups, and survey.ParticipantsPhysiatrists in the AAPM&R Membership Masterfile.Main Outcome MeasuresBurnout and professional fulfillment assessed using the Stanford Professional Fulfillment Index.ResultsIndividual interviews with 21 physiatrists were conducted to identify domains that contributed to professional fulfillment followed by focus groups for further definition. Based on themes identified, scales were identified or developed to evaluate: control over schedule (6 items; Cronbach's alpha = 0.86); integration of physiatry into patient care (3 items; Cronbach's alpha = 0.71); personal‐organizational values alignment (3 items; Cronbach's alpha = 0.90); meaningfulness of physiatrist clinical work (6 items; Cronbach's alpha = 0.90); teamwork and collaboration (3 items; Cronbach's alpha = 0.89). Of 5760 physiatrists contacted in the subsequent national survey, 882 (15.4%) returned surveys (median age 52 years; 46.1% women). Overall, 42.6% (336 of 788) experienced burnout and 30.6% (244 of 798) had high levels of professional fulfillment. In multivariable analysis, each one‐point improvement in control over schedule (odds ratio [OR] = 1.96; 95% confidence interval [CI] = 1.45–2.69), integration of physiatry into patient care (OR = 1.77; 95% CI = 1.32–2.38), personal‐organizational values alignment (OR = 1.92; 95% CI = 1.48–2.52), meaningfulness of physiatrist clinical work (OR = 2.79; 95% CI = 1.71–4.71) and teamwork and collaboration score (OR = 2.11; 95% CI = 1.48–3.03) was independently associated with higher likelihood of professional fulfillment.ConclusionsControl over schedule, optimal integration of physiatry into clinical care, personal‐organizational values alignment, teamwork, and meaningfulness of physiatrist clinical work are strong and independent drivers of occupational well‐being in U.S. physiatrists. Variation in these domains by practice setting and subspecialty suggests tailored approaches are needed to promote professional fulfillment and reduce burnout among U.S. physiatrists.
Evaluating two approaches to the erector spinae plane block: an anatomical study
Harbell, Monica W. , Seamans, David P. , Koyyalamudi, Veerandra , Carey, Frederick J, Craner, Ryan C., Craner, Ryan, Harbell, Monica W , Langley, Natalie R. , Kraus, Molly B.

Regional Anesthesia & Pain Medicine | February 16, 2023 | Volume: 48 | Issue: 10 | Pages: 495-500

10.1136/rapm-2022-104132 | PMID 36797037 Get It

Background and objectives Studies show variable spread with thoracic erector spinae plane (ESP) injections. Injection sites vary from lateral end of the transverse process (TP) to 3 cm from the spinous process, with many not describing the precise site of injection. This human cadaveric study examined dye spread of ultrasound-guided thoracic ESP block at two needle locations. Methods Ultrasound-guided ESP blocks were performed on unembalmed cadavers. Methylene blue (20 mL, 0.1%) was injected in the ESP at the medial TP at level T5 (medial transverse process injection (MED), n=7) and the lateral end of the TP between T4 and T5 (injection between transverse processes (BTWN), n=7). The back muscles were dissected, and the cephalocaudal and medial-lateral dye spread documented. Results Dye spread cephalocaudally from C4-T12 in the MED group and C5-T11 in the BTWN group, and laterally to the iliocostalis muscle in five MED injections and all BTWN injections. One MED injection reached serratus anterior. Dorsal rami were dyed in five MED and all BTWN injections. Dye spread to the dorsal root ganglion and dorsal root in most injections, though more extensively in the BTWN group. The ventral root was dyed in 4 MED and 6 BTWN injections. Epidural spread in BTWN injections ranged from 3 to 12 levels (median: 5 levels), with contralateral spread in two cases and intrathecal spread in five injections. Epidural spread in MED injections was less extensive (median (range): 1 (0–3) levels); two MED injections did not enter the epidural space. Conclusion An ESP injection administered between TPs exhibits more extensive spread than a medial TP injection in a human cadaveric model.
Investigation of Shared Genetic Risk Factors Between Parkinson's Disease and Cancers
Sugier, Pierre‐Emmanuel , Lucotte, Elise A. , Domenighetti, Cloé , Law, Matthew H. , Iles, Mark M. , Brown, Kevin M. , McKay, James , Hung, Rayjean J., Karimi, Mojgan, Bacq‐Daian, Delphine, Boland, Anne , Kesminiene, Ausrele , Vathaire, Florent de , Guénel, Pascal , Sreelatha, Ashwin Ashok Kumar , Grover, Sandeep , May, Patrick , Radivojkov‐Blagojevic, Milena , Lichtner, Peter , Singleton, Andrew , Hernandez, Dena G., Edsall, Connor , Mellick, George D. , Zimprich, Alexander , Pirker, Walter , Kõks, Sulev, Lesage, Suzanne , Chartier‐Harlin, Marie‐Christine , Brockmann, Kathrin , Deutschländer, Angela , Hadjigeorgiou, G., Simitsi, Athina Maria, Petrucci, Simona , Straniero, Letizia , Brighina, Laura , Ferrarese, Carlo , Annesi, Grazia , Quattrone, Andrea , Nakayama, Akiyoshi , Kim, Yun Joong , Kolber, Pierre, Warrenburg, Bart P.C. van de , Bloem, Bastiaan R. , Aasly, Jan , Toft, Mathias , Ferreira, Joaquim J. , Bardien, Soraya , Tolosa, Eduardo , Ezquerra, Mario , Pástor, Pau , Wirdefeldt, Karin , Ran, Caroline , Puschmann, Andreas , Ygland, Emil , Morrison, Karen , Krainc, Dimitri , Burbulla, Lena F. , Krüger, Rejko , Gasser, Thomas , Sharma, Manu , Hung, Rayjean J. , Schulte, Claudia , Grover, Sandeep , May, Patrick , Bobbili, Dheeraj R , Zimprich, Alexander , Lang, Anthony E , Corvol, Jean-Christophe , Mutez, Eugénie , Brockman, Kathrin , Deutschländer, Angela B , Hadjigeorgiou, Georges M., Stefanis, Leonidas , Valente, Enza Maria , Chung, Sun Ju , Toft, Mathias , Ferreira, Joaquim J , Bardien, Soraya , Tolosa, Eduardo , Ezquerra, Mario , Tan, Manuela , Sharma, Manu , Elbaz, Alexis , Hung, Rayjean J , Puschmann, Andreas , Guénel, Pascal , Law, Matthew H , Iles, Mark M , Pastor, Pau , Koks, Sulev , Domenighetti, Cloé , Amos, Christopher I. , Olaso, Robert , Deleuze, Jean‐François , Lesueur, Fabienne , Ostroumova, Evgenia , Schulte, Claudia , Bobbili, Dheeraj Reddy , Rogaeva, Ekaterina A. , Lang, Anthony E. , Taba, Pille , Brice, Alexis , Corvol, Jean‐Christophe , Mutez, Eugénie , Dardiotis, Efthimios , Simitsi, Athina‐Maria , Valente, Enza Maria , Zecchinelli, Anna , Pezzoli, Gianni , Gagliardi, Monica , Matsuo, Hirotaka , Hattori, Nobutaka , Nishioka, Kenya , Pihlstrøm, Lasse , Guedes, Leonor Correia , Carr, Jonathan , Díez-Fairén, Mónica , Pedersen, Nancy L. , Belin, Andrea Carmine , Clarke, Carl E , Farrer, Matthew J. , Truong, Thérèse , Elbaz, Alexis

Movement Disorders | February 14, 2023 | Volume: 38 | Issue: 4 | Pages: 604-615

10.1002/mds.29337 | PMID 36788297 Get It

Abstract Background Epidemiological studies that examined the association between Parkinson's disease (PD) and cancers led to inconsistent results, but they face a number of methodological difficulties. Objective We used results from genome‐wide association studies (GWASs) to study the genetic correlation between PD and different cancers to identify common genetic risk factors. Methods We used individual data for participants of European ancestry from the Courage‐PD (Comprehensive Unbiased Risk Factor Assessment for Genetics and Environment in Parkinson's Disease; PD, N = 16,519) and EPITHYR (differentiated thyroid cancer, N = 3527) consortia and summary statistics of GWASs from iPDGC (International Parkinson Disease Genomics Consortium; PD, N = 482,730), Melanoma Meta‐Analysis Consortium (MMAC), Breast Cancer Association Consortium (breast cancer), the Prostate Cancer Association Group to Investigate Cancer Associated Alterations in the Genome (prostate cancer), International Lung Cancer Consortium (lung cancer), and Ovarian Cancer Association Consortium (ovarian cancer) (N comprised between 36,017 and 228,951 for cancer GWASs). We estimated the genetic correlation between PD and cancers using linkage disequilibrium score regression. We studied the association between PD and polymorphisms associated with cancers, and vice versa, using cross‐phenotypes polygenic risk score (PRS) analyses. Results We confirmed a previously reported positive genetic correlation of PD with melanoma (G corr = 0.16 [0.04; 0.28]) and reported an additional significant positive correlation of PD with prostate cancer (G corr = 0.11 [0.03; 0.19]). There was a significant inverse association between the PRS for ovarian cancer and PD (odds ratio [OR] = 0.89 [0.84; 0.94]). Conversely, the PRS of PD was positively associated with breast cancer (OR = 1.08 [1.06; 1.10]) and inversely associated with ovarian cancer (OR = 0.95 [0.91; 0.99]). The association between PD and ovarian cancer was mostly driven by rs183211 located in an intron of the NSF gene (17q21.31). Conclusions We show evidence in favor of a contribution of pleiotropic genes to the association between PD and specific cancers. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.