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  • 1
    In: Sarcoma, Hindawi Limited, Vol. 2017 ( 2017), p. 1-6
    Abstract: Background . Despite the dose-dependent response rate of sarcomas to doxorubicin, clinicians limit its cumulative dose due to cardiotoxicity. This study evaluates early evidence of cardiotoxicity in patients treated with high-dose doxorubicin given as a continuous infusion. Methods . Data was collected on patients who received 90 mg/m 2 doxorubicin as a continuous infusion and 10 gm/m 2 ifosfamide for up to 6 cycles as part of a phase II study. Cardiotoxicity was assessed with serial echocardiograms or multigated acquisition scans and serum brain natriuretic peptide and troponin levels. Tumor responses were determined by serial radiographic imaging per RECIST. Result . Out of the 48 patients enrolled, no patient developed heart failure symptoms; however, 4 out of the 38 (10%) patients with serial left ventricular ejection fraction assessments developed subclinical cardiotoxicity (asymptomatic drop in LVEF ≥ 10%). Twenty-three patients received all six 72-hour cycles of doxorubicin with a mean cumulative dose of 540 mg/m 2 . Among these patients, 4% ( n = 1 ) developed subclinical cardiotoxicity. In the advanced disease group ( n = 39 ), patients with a complete or partial response received a higher mean cumulative dose than those with stable disease ( p 〈 0.033 ). Conclusions . Doxorubicin cardiotoxicity can be limited by administering doxorubicin as a continuous infusion, allowing higher cumulative dosing to maximize efficacy.
    Type of Medium: Online Resource
    ISSN: 1357-714X , 1369-1643
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2017
    detail.hit.zdb_id: 2011839-9
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  • 2
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  American Journal of Clinical Oncology Vol. 35, No. 5 ( 2012-10), p. 462-467
    In: American Journal of Clinical Oncology, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. 5 ( 2012-10), p. 462-467
    Type of Medium: Online Resource
    ISSN: 0277-3732
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 2043067-X
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  • 3
    In: Modern Pathology, Elsevier BV, Vol. 20, No. 8 ( 2007-08), p. 811-820
    Type of Medium: Online Resource
    ISSN: 0893-3952
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2007
    detail.hit.zdb_id: 2041318-X
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  • 4
    In: Modern Pathology, Elsevier BV, Vol. 19, No. 7 ( 2006), p. 891-898
    Type of Medium: Online Resource
    ISSN: 0893-3952
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2006
    detail.hit.zdb_id: 2041318-X
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  • 5
    In: Journal of Translational Medicine, Springer Science and Business Media LLC, Vol. 4, No. 1 ( 2006-06)
    Abstract: Monocyte/macrophages (MO/MA), a polymorphic population of innate immune cells, have the potential to mediate antitumor effects, and may also contribute to protumor effects. A priming and post-chemotherapy schedule of the myeloid cell mobilizing and immune stimulatory growth factor, granulocyte monocyte stimulating factor (GM-CSF, Leukine ® ) and the MO/MA activating cytokine recombinant interferon gamma 1b (rIFN-γ1b, Actimmune ® ) has been developed. The pre- and post-chemotherapy design is based upon known in vivo kinetics and immune modulatory effects of these molecules. Carboplatin (Paraplatin ® ) was selected as the cornerstone of treatment of epithelial ovarian cancer (EOC). Methods We studied hematopoietic and immunologic effects of GM-CSF and rIFN-γ1b before and after carboplatin in patients with recurrent EOC. Potentially chemotherapy-sensitive patients with recurrent measurable tumors received subcutaneous GM-CSF (starting at 400 μg/day) for 7 days plus subcutaneous rIFN-γ1b (100 μg) on days 5 and 7, before and after intravenous carboplatin (area under the curve of 5). We performed standard hematologic assessment and monitored monocyte (MO), dendritic cell, major cell subset counts, and antibody-dependent cell-mediated cytotoxicity (ADCC) against a Her2neu + tumor cell line, as well as selected plasma inflammatory cytokine, chemokine and growth factor levels. Results Our analysis comprised only the first 3 months of treatment in the initial 25 patients. Relative to pretreatment baseline values, white blood cell, neutrophil, MO, and eosinophil counts increased ( P ≤ .001 for each); the proportion of platelets increased 9 days after the second ( P ≤ .002) and third ( P ≤ .04) carboplatin treatments; and the number of cells in the activated MO subsets CD14+HLA-DR+, CD14+CD64+, and CD14 + CXCR3 + increased ( P ≤ .04 for each); plasma levels of the proangiogenic interleukins 1α, 6, and 8 were lower ( P ≤ .03 for each); M-CSF, a product of activated MO/MA, was increased on day 9 ( P = .007); and GM-CSF was increased in plasma after GM-CSF administration ( P ≤ .04). Quality of life measurements were reduced during the GM-CSF/IFN-γ1b cycle while recovering at pre-chemotherapy baseline for FACT-G scores only. Conclusion A novel regimen of GM-CSF plus IFN-γ1b administered to 25 EOC patients receiving carboplatin increased myeloid cells, platelets and total activated MO populations during the initial 3 months; however, ADCC responses were not consistently enhanced during this period.
    Type of Medium: Online Resource
    ISSN: 1479-5876
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2006
    detail.hit.zdb_id: 2118570-0
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  • 6
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 1993
    In:  Journal of Leukocyte Biology Vol. 54, No. 4 ( 1993-10-01), p. 314-321
    In: Journal of Leukocyte Biology, Oxford University Press (OUP), Vol. 54, No. 4 ( 1993-10-01), p. 314-321
    Abstract: Pleiotropic cytokines such as interleukin-lα (IL-lα) have multiple effects on peripheral blood monocytes (PBMs). This study examined the ability of in vivo recombinant human IL-lα (rhIL-lα) therapy to enhance clinically important monocyte functions in ovarian cancer patients prior to chemotherapy. After 4 days of continuous infusion, in vivo rhIL-lα therapy amplified both the number and activity of PBMs. Therapy with rhIL-lα increased the number of PBMs sixfold. These monocytes had a significantly increased ability to produce superoxide anion in response to phorbol 12,13- dibutyrate stimulation. Their ability to secrete spontaneously the immunomodulatory cytokines IL-lα and IL-1β was significantly increased, but their ability to secrete tumor necrosis factor a (TNF-α) was not significantly elevated. These effects of rhIL-lα infusion on cytokine secretion by PBMs appear to be related to rhlL-lα-in- duced increases in the mRNA levels for these cytokines. In contrast, rhIL-lα therapy did not significantly alter PBM response to lipopolysaccharide (10 μg/ml). In summary, infused rhIL-lα, in addition to its use as a myelo- protective agent, has enhancing effects on the number and activity of PBMs. The effects of rhIL-lα infusion on PBM function demonstrated here should at least transiently increase the ability of monocytes to combat infection and enhance host immune response.
    Type of Medium: Online Resource
    ISSN: 0741-5400 , 1938-3673
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    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 1993
    detail.hit.zdb_id: 2026833-6
    SSG: 12
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  • 7
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 1993
    In:  Journal of Leukocyte Biology Vol. 53, No. 6 ( 1993-06-01), p. 640-650
    In: Journal of Leukocyte Biology, Oxford University Press (OUP), Vol. 53, No. 6 ( 1993-06-01), p. 640-650
    Abstract: In this report we describe the time-dependent effects of PIXY321 (a synthetic hybrid cytokine) treatment (500 and 750 μg/m2/day for 14 days) on six sarcoma patients. Blood was taken prior to PIXY321 injection (day 0), on days 1, 7, and 14 of treatment, and 7 days posttreatment (day 21). The number of isolated monocytes quadrupuled by day 7 and sustained a significant increase through day 14. There were significant increases in the percentage of circulating monocytes relative to total mononuclear cells on days 1 and 7 of therapy. There were no significant changes in monocyte cell surface antigens (15 checked), suggesting that the increase in monocyte numbers was not due to increased numbers of immature monocytes. The basal activity of the monocytes was not markedly altered during treatment; however, they were primed for significantly increased phorbol 12,13- dibutyrate-stimulated superoxide anion production and endotoxin-stimulated release of interleukin-1 β (IL-lβ) and tumor necrosis factor-α (TNF-α) on days of 1 and 7 of therapy. There was a significant increase of IL-β mRNA levels (unstimulated cells) on days 1 and 7, but TNF-α mRNA levels increased significantly on day 1 only. Consistent with the increase in superoxide anion production, there were increases in monocyte protein kinase C (PKC) levels on all days of therapy. There was a significant increase in PKCIIβ mRNA only on the first day of treatment. All significant changes in monocyte number and function produced by PIXY321 infusion were reversible, as there were no sustained effects on day 21 (7 days after therapy). These results indicate that the effects of PIXY321 may be mediated through up-regulation of PKC resulting in monocytes primed for increased functional activity in response to an appropriate second stimulus. J. Leukoc. Biol. 53: 640–650; 1993.
    Type of Medium: Online Resource
    ISSN: 0741-5400 , 1938-3673
    RVK:
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 1993
    detail.hit.zdb_id: 2026833-6
    SSG: 12
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  • 8
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 30, No. 15_suppl ( 2012-05-20), p. 9002-9002
    Abstract: 9002 Background: Cancer-related-fatigue (CRF) is the most common and distressing symptoms in patients with advanced cancer. Currently, there is no standard treatment for CRF. Although corticosteroids have been used in the treatment of CRF, there are no well-powered placebo-controlled trials that used a validated CRF outcome measure. The primary objective of this prospective, randomized, double-blind, placebo-controlled study is to compare the effect of DM versus placebo on CRF. Methods: Advanced cancer patients with fatigue ≥ 4/10 on the Edmonton Symptom Assessment Scale (ESAS) and at least 2 other CRF-related symptoms (pain, nausea, appetite, depression, anxiety or sleep disturbance ≥ 4/10), normal cognition, no infections and hemoglobin ≥ 9 g/L were eligible for enrollment. Patients were randomized to either receive dexamethasone 4 mg orally twice a day for 15 days (primary end point) or matching placebo. The primary outcome was the day 15 change in Functional Assessment of Chronic Illness-Fatigue (FACIT-F) subscale scores. Differences in the group means (normal distribution) were analyzed using the two-sample t-test. Results: In 83 evaluable patients (43 DM and 40 placebo), median age was 60 years, 61% were white, and 53% were female. There was no difference in the demographics and fatigue (FACIT-F subscale) between DM and placebo groups except for sex (p=0.02). The mean (SD) FACIT-F subscores at baseline and at day 15 for DM were 18 (11) and 27 (11) (p 〈 0.001) and for placebo were 21 (9) and 24 (12) (p=0.06), respectively. Mean improvement in FACIT-F subscale was significantly higher in the DM group compared to placebo (9.6 (11) vs. 3.1 (9.7), p=0.005). We found a significant difference in ESAS physical distress (p=0.02), but no differences in ESAS overall symptom distress (p=0.11) and ESAS psychological distress (P=0.88) between DM and placebo. There were insignificantly higher numbers of grade ≥3 toxicities in patients who received DM than in patients who received placebo (20/42 vs. 18/47, p=0.37). Conclusions: Dexamethasone was more effective than placebo in reducing CRF in patients with advanced cancer. Long-term safety studies are needed.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2012
    detail.hit.zdb_id: 2005181-5
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  • 9
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2017
    In:  Journal of Clinical Oncology Vol. 35, No. 8_suppl ( 2017-03-10), p. 194-194
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 35, No. 8_suppl ( 2017-03-10), p. 194-194
    Abstract: 194 Background: Growth in patient (pt) volume and limited clinic capacity can lead to long wait-times and pt/provider dissatisfaction. We have previously shown that the room pooling model, can reduce pt wait-time in the exam room, improve room utilization, and pt/providers satisfaction (ASCO 2016, Abstract 6595). One of the important goals of adopting electronic health records (EHR) is also to increase the clinical efficiencies, productivity and quality of care. The purpose of this study was to evaluate the impact of implementation of EHR on pt wait-time in the exam room and satisfaction in the Sarcoma Center. Methods: The time studies and pt and provider wait-time satisfaction surveys were carried out over 2 weeks prior to (baseline) and 6 months after the implementation of EHR. All times of when pts, mid-level providers, and doctors (MD) entered and exited the exam rooms were collected for a total sample size of 578 pts (300 before, 278 after) seen during the clinic hours and analyzed using JMP and SAS. Results: The proportion of pts seen within 30 minutes (Min) by MDs from the time pts roomed into exam room decreased by about 32% [from 53% (148/280) to 36% (94/259), p = 0.0001] post implementation of EHR. The median time for pts in the exam room waiting for MD increased (p = 0.0001) from 30 min (range: 0-126 min) to 40 min (range: 0-121 min). Although, the pt satisfaction did not significantly change [increase from 8% (23/278) to 12% (31/267) in the number of pts that were not satisfied to little-satisfied, and decrease from 92% (255/278) to 88% (236/267) in pts that were moderately to very-satisfied] , the number of times MD had to wait for an open exam room increased from 8% (5/65) to 24% (14/59, p = 0.01). The delays to see MDs were associated with longer time spent with the nurse (from median 4 to 7 min), followed by delays in seeing Mid-level provider (from 11 to 18 min). Conclusions: These findings indicate that in the initial stages of implementation of EHR, the increase in pt wait-time and reduced clinical efficiencies can be related to the learning of and adapting to the new system. Attempts targeted to the areas of delays (such as training and redesigning workflow) may reduce the pt wait-time and improve the clinical efficiency.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2017
    detail.hit.zdb_id: 2005181-5
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  • 10
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 30, No. 15_suppl ( 2012-05-20), p. e19520-e19520
    Abstract: e19520 Background: Mucositis is a common complication in cancer pts receiving CT. We have shown that palifermin (recombinant Keratinocyte Growth Factor), administered as single dose prior to CT, alleviated severe mucositis in pts receiving doxorubicin-based CT (Ann Int Med 2010). Caphosol is a supersaturated electrolyte solution of calcium phosphate that has been indicated as oral rinse for xerostomia and as an adjunct to treat OM induced by radiation or high-dose CT. Purpose of the study was to evaluate the preliminary efficacy of Caphosol in pts receiving CT. Methods: Pts were randomized 1:1 to Caphosol vs. baking soda (control) as an oral rinse five times daily from initiation of CT. All pts received doxorubicin (75 or 90 mg/m 2 by continuous infusion over 3 days) with ifosfamide (10 gm/m 2 ) or cisplatin (120 mg/m 2 ). Pts that experienced Grade (Gr) 〉 3 mucositis received palifermin (180 mcg/kg) iv 3 days before CT in subsequent cycles. Results: 28 of 30 pts received treatment and were evaluble; 15 men and 13 women, with median age 51 (range, 20-65 yrs). Incidence of Gr 〉 2 OM was 57% (8 of 14 pts) for Caphosol vs. 86% (12 of 14) for control (P=0.21). Incidence of Gr 〉 3 OM was 29% (4/14) for Caphosol vs. 43% (6/14) for control (P=0.43). However, the benefit was limited to oral but not other GI mucosal sites. Of 10 pts (Caphosol: 4, BS: 6,) with Gr 〉 3 OM, 6 crossed over to palifermin (Caphosol: 3, BS: 3); the other 4 pts (Caphosol: 1, BS: 3) came off the study. All 6 pts, that received palifermin, avoided severe OM in the next cycle. The median duration of Gr 〉 2 OM in the cycle before cross-over was 8 days (range: 5-12) vs. 0 days (0-3) in palifermin cycle (p=0.0032) and Gr 〉 3 OM was 5 days (2-7) vs. 0 days (p=0.0015). Oral assessment and the pts-reported outcome were in substantial agreement for the OM grading (weighted kappa, 0.78, 95% CI: 0.44-0.87, p 〈 0.0001). No serious adverse event related to the study drug was observed. Conclusions: There was a trend for less severe OM with Caphosol vs. control. Secondary prophylaxis with palifermin alleviated severe mucositis in all pts who previously experienced severe mucositis during multi-cycle CT.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2012
    detail.hit.zdb_id: 2005181-5
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