Journal of Clinical Medicine

Editorial

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2 pages, 160 KiB

Open AccessEditorial

On the Virtues of “Team Medicine”—A City of Hope Perspective

by Prakash Kulkarni and Ravi Salgia

J. Clin. Med. 2023, 12(15), 4897; https://doi.org/10.3390/jcm12154897 - 26 Jul 2023

Viewed by 954

Abstract

Our first Special Issue of the Journal of Clinical Medicine, entitled ‘Integrating Clinical and Translational Research Networks—Building Team Medicine,’ highlighted the collective experience of the City of Hope and was a tremendous success [...] Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine - Series 2)

Research

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27 pages, 1431 KiB

Open AccessArticle

Leveraging the Academic Artificial Intelligence Silecosystem to Advance the Community Oncology Enterprise

by Kevin J. McDonnell

J. Clin. Med. 2023, 12(14), 4830; https://doi.org/10.3390/jcm12144830 - 21 Jul 2023

Viewed by 3077

Abstract

Over the last 75 years, artificial intelligence has evolved from a theoretical concept and novel paradigm describing the role that computers might play in our society to a tool with which we daily engage. In this review, we describe AI in terms of [...] Read more.

Over the last 75 years, artificial intelligence has evolved from a theoretical concept and novel paradigm describing the role that computers might play in our society to a tool with which we daily engage. In this review, we describe AI in terms of its constituent elements, the synthesis of which we refer to as the AI Silecosystem. Herein, we provide an historical perspective of the evolution of the AI Silecosystem, conceptualized and summarized as a Kuhnian paradigm. This manuscript focuses on the role that the AI Silecosystem plays in oncology and its emerging importance in the care of the community oncology patient. We observe that this important role arises out of a unique alliance between the academic oncology enterprise and community oncology practices. We provide evidence of this alliance by illustrating the practical establishment of the AI Silecosystem at the City of Hope Comprehensive Cancer Center and its team utilization by community oncology providers. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine - Series 2)

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14 pages, 305 KiB

Open AccessArticle

Building Team Medicine in the Management of CNS Metastases

by Archit B. Baskaran, Robin A. Buerki, Osaama H. Khan, Vinai Gondi, Roger Stupp, Rimas V. Lukas and Victoria M. Villaflor

J. Clin. Med. 2023, 12(12), 3901; https://doi.org/10.3390/jcm12123901 - 7 Jun 2023

Viewed by 1336

Abstract

CNS metastases are often terminal for cancer patients and occur at an approximately 10-fold higher rate than primary CNS tumors. The incidence of these tumors is approximately 70,000–400,000 cases annually in the US. Advances that have occurred over the past two decades have [...] Read more.

CNS metastases are often terminal for cancer patients and occur at an approximately 10-fold higher rate than primary CNS tumors. The incidence of these tumors is approximately 70,000–400,000 cases annually in the US. Advances that have occurred over the past two decades have led to more personalized treatment approaches. Newer surgical and radiation techniques, as well as targeted and immune therapies, have enanled patient to live longer, thus increasing the risk for the development of CNS, brain, and leptomeningeal metastases (BM and LM). Patients who develop CNS metastases have often been heavily treated, and options for future treatment could best be addressed by multidisciplinary teams. Studies have indicated that patients with brain metastases have improved survival outcomes when cared for in high-volume academic institutions using multidisciplinary teams. This manuscript discusses a multidisciplinary approach for both parenchymal brain metastases as well as leptomeningeal metastases implemented in three academic institutions. Additionally, with the increasing development of healthcare systems, we discuss optimizing the management of CNS metastases across healthcare systems and integrating basic and translational science into our clinical care to further improve outcomes. This paper summarizes the existing therapeutic approaches to the treatment of BM and LM and discusses novel and emerging approaches to optimizing access to neuro-oncologic care while simultaneously integrating multidisciplinary teams in the care of patients with BM and LM. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine - Series 2)

9 pages, 212 KiB

Open AccessArticle

Overcoming Barriers to Tobacco Cessation and Lung Cancer Screening among Racial and Ethnic Minority Groups and Underserved Patients in Academic Centers and Community Network Sites: The City of Hope Experience

by Cary A. Presant, Kimlin Ashing, Dan Raz, Sophia Yeung, Brenda Gascon, Alexis Stewart, Jonjon Macalintal, Argelia Sandoval, Loretta Ehrunmwunsee, Tanyanika Phillips, Ravi Salgia, Amartej Merla, Shanmuga Subbiah, Michelle El-Hajjouie, Jeffrey Staley, Heather Graves, Ranjan Pathak, Shaira Dingal, Sagus Sampath, Beverly Laksana, Thomas Joseph, Tricia Eugenio, Veronica Degoma, Kathleen Burns, Sarah Phillips, Tingting Tan, Kelly Tarkshian, Virginia Sun, Arya Amini, Khristie Davy, Janet Cronkhite, Mary Cianfrocca, Susan Brown, Yuman Fong and Steven Rosen Show full author list Hide full author list

J. Clin. Med. 2023, 12(4), 1275; https://doi.org/10.3390/jcm12041275 - 6 Feb 2023

Viewed by 1788

Abstract

Background: Tobacco control is important for cancer patient health, but delivering effective low-dose CT (LDCT) screening and tobacco cessation is more difficult in underserved and patients from racial and ethnic minority groups. At City of Hope (COH), we have developed strategies to overcome [...] Read more.

Background: Tobacco control is important for cancer patient health, but delivering effective low-dose CT (LDCT) screening and tobacco cessation is more difficult in underserved and patients from racial and ethnic minority groups. At City of Hope (COH), we have developed strategies to overcome barriers to the delivery of LDCT and tobacco cessation. Methods: We performed a needs assessment. New tobacco control program services were implemented focusing on patients from racial and ethnic minority groups. Innovations included Whole Person Care with motivational counseling, placing clinician and nurse champions at points of care, training module and leadership newsletters, and a patient-centric personalized medicine Personalized Pathways to Success (PPS) program. Results: Emphasis on patients from racial and ethnic minority groups was implemented by training cessation personnel and lung cancer control champions. LDCT increased. Tobacco use assessment increased and abstinence was 27.2%. The PPS pilot program achieved 47% engagement in cessation, with self-reported abstinence at 3 months of 38%, with both results slightly higher in patients from racial and ethnic minority groups than in Caucasian patients. Conclusions: Tobacco cessation barrier-focused innovations can result in increased lung cancer screening and tobacco cessation reach and effectiveness, especially among patients from racial and ethnic minority groups. The PPS program is promising as a personalized medicine patient-centric approach to cessation and lung cancer screening. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine - Series 2)

8 pages, 375 KiB

Open AccessArticle

Patient Care Satisfaction and Emergency Room Utilization among Young Adult Colorectal Cancer Survivors during the SARS-CoV-2 Pandemic: Lessons Learned

by Dalia Kagramanov, Kimberly A. Miller, Phuong Gallagher, David R. Freyer, Joel E. Milam, Heinz-Josef Lenz and Afsaneh Barzi

J. Clin. Med. 2023, 12(2), 469; https://doi.org/10.3390/jcm12020469 - 6 Jan 2023

Viewed by 1837

Abstract

Introduction: Survivors of colorectal cancer (CRC) are at risk for late effects of therapy and recurrence of cancer. With recurrence rates ranging between 30–40%, follow-up care is needed for both early detection and management of late effects. Cancer care delivery for CRC patients [...] Read more.

Introduction: Survivors of colorectal cancer (CRC) are at risk for late effects of therapy and recurrence of cancer. With recurrence rates ranging between 30–40%, follow-up care is needed for both early detection and management of late effects. Cancer care delivery for CRC patients was significantly disrupted by the SARS-CoV-2 pandemic, with decreases of 40% in such services in the United States between April 2020 and 2019. Survivors were left with fewer options for care, potentially causing increases in emergency room (ER) utilization. Methods: This cross-sectional study examined the patterns of ER utilization during the SARS-CoV-2 pandemic among young adult CRC survivors and assessed the relationship between self-reported care satisfaction and ER use. Eligible participants were colon or rectal cancer survivors diagnosed between 18–39 years of age, 6–36 months from diagnosis/relapse, English speaking and residing in the United States. Multivariable logistic regression assessed the association between patient care satisfaction and ER utilization, adjusting for pandemic factors. Covariates were chosen by significance of p < 0.1 at the univariate level and perceived clinical significance. Results: The overall sample (N = 196) had mean age (SD) 32.1 (4.5); 59% were male. Tumor location was colon or rectal in 42% and 57%, respectively, and the majority (56%) were diagnosed with stage 2 disease; 42.6% reported relapsed disease, and 20% had an ostomy. Most survivors (72.5%) had between 1–4 visits to an ER in the last 12 months and were categorized as normal utilizers. Approximately 24.7% of the sample had greater than 4 visits to the ER in the last 12 months and were categorized as super-utilizers. CRC survivors that reported a delay in their follow-up care as a result of the pandemic were two times (OR: 2.05, 95% CI 0.99, 4.24) more likely to be super-utilizers of the ER. Higher self-reported satisfaction with care was associated with a 13.7% lower likelihood of being a super-utilizer (OR: 0.86, 95%CI: −0.68, 1.09). Conclusions: This study found strong associations between delays in care, self-reported care satisfaction, and being a super-utilizer of the ER during the pandemic among young adult CRC survivors off treatment. Increasing patient satisfaction and minimizing care interruptions amongst this vulnerable population may aid in mitigating over-utilization in the ER during an ongoing pandemic. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine - Series 2)

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22 pages, 4538 KiB

Open AccessArticle

Pyramidal Decision Support Framework Leverages Subspecialty Expertise across Enterprise to Achieve Superior Cancer Outcomes and Personalized, Precision Care Plans

by Linda D. Bosserman, Isa Mambetsariev, Colton Ladbury, Afsaneh Barzi, Deron Johnson, Denise Morse, Debbie Deaville, Wade Smith, Swapnil Rajurkar, Amartej Merla, George Hajjar, Daniel Kim, Jeremy Fricke, Vijay Trisal and Ravi Salgia

J. Clin. Med. 2022, 11(22), 6738; https://doi.org/10.3390/jcm11226738 - 14 Nov 2022

Cited by 4 | Viewed by 2062

Abstract

The complexity of cancer care requires integrated and continuous support to deliver appropriate care. An expert network with complementary expertise and the capability of multidisciplinary care is an integral part of contemporary oncology care. Appropriate infrastructure is necessary to empower this network to [...] Read more.

The complexity of cancer care requires integrated and continuous support to deliver appropriate care. An expert network with complementary expertise and the capability of multidisciplinary care is an integral part of contemporary oncology care. Appropriate infrastructure is necessary to empower this network to deliver personalized precision care to their patients. Providing decision support as cancer care becomes exponentially more complex with new diagnostic and therapeutic choices remains challenging. City of Hope has developed a Pyramidal Decision Support Framework to address these challenges, which were exacerbated by the COVID pandemic, health plan restrictions, and growing geographic site diversity. Optimizing efficient and targeted decision support backed by multidisciplinary cancer expertise can improve individual patient treatment plans to achieve improved care and survival wherever patients are treated. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine - Series 2)

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Review

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13 pages, 2654 KiB

Open AccessReview

Clinical Network Systems Biology: Traversing the Cancer Multiverse

by Isa Mambetsariev, Jeremy Fricke, Stephen B. Gruber, Tingting Tan, Razmig Babikian, Pauline Kim, Priya Vishnubhotla, Jianjun Chen, Prakash Kulkarni and Ravi Salgia

J. Clin. Med. 2023, 12(13), 4535; https://doi.org/10.3390/jcm12134535 - 7 Jul 2023

Cited by 3 | Viewed by 2586

Abstract

In recent decades, cancer biology and medicine have ushered in a new age of precision medicine through high-throughput approaches that led to the development of novel targeted therapies and immunotherapies for different cancers. The availability of multifaceted high-throughput omics data has revealed that [...] Read more.

In recent decades, cancer biology and medicine have ushered in a new age of precision medicine through high-throughput approaches that led to the development of novel targeted therapies and immunotherapies for different cancers. The availability of multifaceted high-throughput omics data has revealed that cancer, beyond its genomic heterogeneity, is a complex system of microenvironments, sub-clonal tumor populations, and a variety of other cell types that impinge on the genetic and non-genetic mechanisms underlying the disease. Thus, a systems approach to cancer biology has become instrumental in identifying the key components of tumor initiation, progression, and the eventual emergence of drug resistance. Through the union of clinical medicine and basic sciences, there has been a revolution in the development and approval of cancer therapeutic drug options including tyrosine kinase inhibitors, antibody–drug conjugates, and immunotherapy. This ‘Team Medicine’ approach within the cancer systems biology framework can be further improved upon through the development of high-throughput clinical trial models that utilize machine learning models, rapid sample processing to grow patient tumor cell cultures, test multiple therapeutic options and assign appropriate therapy to individual patients quickly and efficiently. The integration of systems biology into the clinical network would allow for rapid advances in personalized medicine that are often hindered by a lack of drug development and drug testing. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine - Series 2)

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13 pages, 1072 KiB

Open AccessReview

A Closer Look at EGFR Inhibitor Resistance in Non-Small Cell Lung Cancer through the Lens of Precision Medicine

by Martin Sattler, Isa Mambetsariev, Jeremy Fricke, Tingting Tan, Sariah Liu, Nagarajan Vaidehi, Evan Pisick, Tamara Mirzapoiazova, Adam G. Rock, Amartej Merla, Sunil Sharma and Ravi Salgia

J. Clin. Med. 2023, 12(5), 1936; https://doi.org/10.3390/jcm12051936 - 1 Mar 2023

Cited by 5 | Viewed by 4675

Abstract

The development of EGFR small-molecule inhibitors has provided significant benefit for the affected patient population. Unfortunately, current inhibitors are no curative therapy, and their development has been driven by on-target mutations that interfere with binding and thus inhibitory activity. Genomic studies have revealed [...] Read more.

The development of EGFR small-molecule inhibitors has provided significant benefit for the affected patient population. Unfortunately, current inhibitors are no curative therapy, and their development has been driven by on-target mutations that interfere with binding and thus inhibitory activity. Genomic studies have revealed that, in addition to these on-target mutations, there are also multiple off-target mechanisms of EGFR inhibitor resistance and novel therapeutics that can overcome these challenges are sought. Resistance to competitive 1st-generation and covalent 2nd- and 3rd-generation EGFR inhibitors is overall more complex than initially thought, and novel 4th-generation allosteric inhibitors are expected to suffer from a similar fate. Additional nongenetic mechanisms of resistance are significant and can include up to 50% of the escape pathways. These potential targets have gained recent interest and are usually not part of cancer panels that look for alterations in resistant patient specimen. We discuss the duality between genetic and nongenetic EGFR inhibitor drug resistance and summarize current team medicine approaches, wherein clinical developments, hand in hand with drug development research, drive potential opportunities for combination therapy. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine - Series 2)

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14 pages, 645 KiB

Open AccessReview

Talimogene Laherparepvec (T-VEC): A Review of the Recent Advances in Cancer Therapy

by Tiantian Zhang, Tony Hong-Ting Jou, Jerline Hsin, Zhe Wang, Kelly Huang, Jian Ye, Holly Yin and Yan Xing

J. Clin. Med. 2023, 12(3), 1098; https://doi.org/10.3390/jcm12031098 - 31 Jan 2023

Cited by 15 | Viewed by 4612

Abstract

The landscape of melanoma treatment has undergone a dramatic revolution in the past decade. The use of oncolytic viruses (OVs) represents a novel therapeutic approach that can selectively infect and lyse tumor cells and induce local and systemic antitumor immune responses. As the [...] Read more.

The landscape of melanoma treatment has undergone a dramatic revolution in the past decade. The use of oncolytic viruses (OVs) represents a novel therapeutic approach that can selectively infect and lyse tumor cells and induce local and systemic antitumor immune responses. As the first OV approved by the Food and Drug Administration (FDA) for melanoma treatment, talimogene laherparepvec (T-VEC), a genetically modified herpes simplex virus (HSV), has shown promising therapeutic effects in the treatment of advanced melanoma, both as a monotherapy or in combination with other immunotherapies, such as the immune checkpoint inhibitors (ICIs). With proven efficacy, T-VEC has been evaluated against a variety of other cancer types in a clinical trial setting. In this article, we will provide a review on OVs and the application of T-VEC in melanoma monotherapy and combination therapy. In addition, we will review the recent progress of T-VEC application in other cutaneous cancer types. Moreover, we will briefly describe our experience of T-VEC therapy at City of Hope, aiming to provide more insight for expanding its future application. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine - Series 2)

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Other

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11 pages, 637 KiB

Open AccessPerspective

Integrating Early-Stage Drug Development with Clinical Networks; Challenges and Opportunities: The City of Hope Developing Experience

by Miguel A. Villalona-Calero, Jyoti Malhotra, Vincent Chung, Yan Xing, Stacy W. Gray, Heather Hampel, Stephen Gruber and Kevin McDonnell

J. Clin. Med. 2023, 12(12), 4061; https://doi.org/10.3390/jcm12124061 - 15 Jun 2023

Cited by 1 | Viewed by 1367

Abstract

Recent data suggest that patients with advanced cancer who participate in biomarker/genomically informed early-stage clinical trials experience clinical benefit. While most early-stage clinical trials are conducted in major academic centers, the majority of cancer patients in the United States are treated in community [...] Read more.

Recent data suggest that patients with advanced cancer who participate in biomarker/genomically informed early-stage clinical trials experience clinical benefit. While most early-stage clinical trials are conducted in major academic centers, the majority of cancer patients in the United States are treated in community practices. Here, we describe ongoing efforts at the City of Hope Cancer Center to integrate our network community oncology clinical practices into our academic, centralized biomarker/genomic-driven, early-stage clinical trial program to build an understanding of the approaches that provide the benefits of early-stage clinical trial participation to community patients. Our efforts include three key initiatives: the development of a virtual “Refractory Disease” phase 1 trial matching televideo clinic, the construction of infrastructure to support the expansion of phase 1 clinical trials to a distant regional clinical satellite hub, and the implementation of an enterprise-wide precision medicine, germline, and somatic testing program. Our work at City of Hope may serve as an example to facilitate similar efforts at other institutions. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine - Series 2)

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12 pages, 616 KiB

Open AccessPerspective

Integrative Oncology and the Clinical Care Network: Challenges and Opportunities

by George Semeniuk, Bahareh Bahadini, Eugene Ahn, Jasmine Zain, Jessica Cheng, Ameish Govindarajan, Judy Rose and Richard T. Lee

J. Clin. Med. 2023, 12(12), 3946; https://doi.org/10.3390/jcm12123946 - 9 Jun 2023

Cited by 3 | Viewed by 3826

Abstract

Integrative oncology is a new and growing field of cancer care. Integrative oncology is a patient-centered, evidence-based field of comprehensive cancer care that utilizes integrative therapies such as mind-body practices, acupuncture, massage, music therapy, nutrition, and exercise in collaboration with conventional cancer treatments. [...] Read more.

Integrative oncology is a new and growing field of cancer care. Integrative oncology is a patient-centered, evidence-based field of comprehensive cancer care that utilizes integrative therapies such as mind-body practices, acupuncture, massage, music therapy, nutrition, and exercise in collaboration with conventional cancer treatments. Patient interest and utilization has been growing over the past two decades. Clinical research has shown the benefits of these approaches to improving symptom management and quality of life, and is now being incorporated into national guidelines from the National Comprehensive Cancer Network (NCCN) and American Society for Clinical Oncology (ASCO). The availability of these services at cancer centers is growing, although the structure and implementation of integrative oncology remains highly variable. This article discusses the benefits of integrative oncology and provides an overview of the current state of integrative oncology programs nationwide. Current challenges and opportunities for cancer centers to provide integrative services is reviewed in the areas of programmatic structure, clinical service, education, and research. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine - Series 2)

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8 pages, 2773 KiB

Open AccessCase Report

Complete Pathologic Response to PARP Inhibitor Olaparib in a Patient with Stage IVB Recurrent Endometrioid Endometrial Adenocarcinoma

by Rosemary Noel Senguttuvan, Christina Wei, Mustafa Raoof, Thanh H. Dellinger and Edward Wenge Wang

J. Clin. Med. 2023, 12(11), 3839; https://doi.org/10.3390/jcm12113839 - 4 Jun 2023

Cited by 4 | Viewed by 2240

Abstract

Treatment for endometrial cancer is rapidly evolving with the increased use and integration of somatic tumor RNA sequencing in clinical practice. There is a paucity of data regarding PARP inhibition in endometrial cancer given that mutations in homologous recombination genes are rare, and [...] Read more.

Treatment for endometrial cancer is rapidly evolving with the increased use and integration of somatic tumor RNA sequencing in clinical practice. There is a paucity of data regarding PARP inhibition in endometrial cancer given that mutations in homologous recombination genes are rare, and currently no FDA approval exists. A 50-year-old gravida 1 para 1 woman with a diagnosis of stage IVB poorly differentiated endometrioid endometrial adenocarcinoma presented to our comprehensive cancer center. Following surgical staging, she was placed on adjuvant chemotherapy with carboplatin/paclitaxel which was held multiple times due to poor performance status and complications. CT scan of the abdomen and pelvis following cycles 3 of adjuvant chemotherapy showed recurrent progressive disease. She received one cycle of liposomal doxorubicin but discontinued it due to severe cutaneous toxicity. Based on the BRIP1 mutation identified, the patient was placed on compassionate use of Olaparib in January 2020. Imaging during this surveillance period showed a significant decrease in hepatic, peritoneal, and extraperitoneal metastases, and eventually the patient had a clinical complete response in a year. The most recent CT A/P in December 2022 showed no sites of active recurrent or metastatic disease in the abdomen or pelvis. We present a unique case of a patient with recurrent stage IVB poorly differentiated endometrioid endometrial adenocarcinoma with multiple somatic gene mutations including BRIP1, who had a pathologic complete response following compassionate use of Olaparib for 3 years. To our knowledge, this is the first reported case of high grade endometrioid endometrial cancer that has shown a pathologic complete response to a PARP inhibitor. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine - Series 2)

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7 pages, 739 KiB

Open AccessBrief Report

The Midwest Sarcoma Trials Partnership: Bridging Academic and Community Networks in a Collaborative Approach to Sarcoma

by Natalie K. Heater, Scott Okuno, Steven Robinson, Steven Attia, Mahesh Seetharam, Brittany L. Siontis, Janet Yoon, Sant Chawla, Mohammed M. Milhem, Varun Monga, Keith Skubitz, John Charlson, Angela C. Hirbe, Mia C. Weiss, Brian Van Tine and Mark Agulnik

J. Clin. Med. 2023, 12(7), 2561; https://doi.org/10.3390/jcm12072561 - 29 Mar 2023

Cited by 2 | Viewed by 1661

Abstract

The treatment of sarcoma necessitates a collaborative approach, given its rarity and complex management. At a single institution, multidisciplinary teams of specialists determine and execute treatment plans involving surgical, radiation, and medical management. Treatment guidelines for systemic therapies in advanced or nonresectable soft [...] Read more.

The treatment of sarcoma necessitates a collaborative approach, given its rarity and complex management. At a single institution, multidisciplinary teams of specialists determine and execute treatment plans involving surgical, radiation, and medical management. Treatment guidelines for systemic therapies in advanced or nonresectable soft tissue sarcoma have advanced in recent years as new immunotherapies and targeted therapies become available. Collaboration between institutions is necessary to facilitate accrual to clinical trials. Here, we describe the success of the Midwest Sarcoma Trials Partnership (MWSTP) in creating a network encompassing large academic centers and local community sites. We propose a new model utilizing online platforms to expand the reach of clinical expertise for the treatment of advanced soft tissue sarcoma. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine - Series 2)

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6 pages, 212 KiB

Open AccessBrief Report

Difficulties in Defining Oligometastatic Prostate Cancer: Implications for Clinical Trial Accrual and Community Practice Adoption of Metastasis-Directed Therapy Approaches

by Tanya Barauskas Dorff, Saro Kasparian, Natasha Garg, Sandy Liu, Sumanta Kumar Pal, Jeffrey Wong and Savita Dandapani

J. Clin. Med. 2023, 12(5), 2011; https://doi.org/10.3390/jcm12052011 - 3 Mar 2023

Viewed by 2013

Abstract

Background: Metastasis-directed therapy is widely utilized for oligometastatic prostate cancer patients, but standard imaging does not always identify metastases definitively and, even with PSMA PET, there may be equivocal findings. Not all clinicians have access to detailed imaging review, particularly outside of academic [...] Read more.

Background: Metastasis-directed therapy is widely utilized for oligometastatic prostate cancer patients, but standard imaging does not always identify metastases definitively and, even with PSMA PET, there may be equivocal findings. Not all clinicians have access to detailed imaging review, particularly outside of academic cancer centers, and PET scan access is also limited. We sought to understand how imaging interpretation impacted recruitment to a clinical trial for oligometastatic prostate cancer. Methods: IRB approval was obtained to review medical records from all patients screened for the institutional IRB-approved clinical trial for men with oligometastatic prostate cancer involving androgen deprivation plus stereotactic radiation to all metastatic sites, as well as radium223 (NCT03361735). Clinical trial inclusion required at least one bone metastatic lesion and no more than five total sites of metastasis, including soft tissue sites. Tumor board discussion records were reviewed, along with results from additional radiology studies ordered or confirmatory biopsies performed. Clinical characteristics such as PSA level and Gleason score were studied for association with likelihood of oligometastatic disease confirmation. Results: At the time of data analysis, 18 subjects were deemed eligible and 20 were not eligible. The most common reasons for ineligibility were no confirmed bone metastasis in 16 patients (59%) and too many metastatic sites in 3 (11%). The median PSA of eligible subjects was 3.28 (range 0.4–45.5), whereas the median PSA of those found to be ineligible was 10.45 (range 3.7–26.3) when there were too many metastases identified, and 2.7 (range 0.2–34.5) when metastases were unconfirmed. PET imaging (PSMA or fluciclovine PET) increased the number of metastases, while MRI resulted in downstaging to non-metastatic disease. Conclusions: This research suggests that additional imaging (i.e., at least two independent imaging modalities of a possible metastatic lesion) or tumor board adjudication of imaging findings may be critical to correctly identify patients appropriate for enrollment in oligometastatic protocols. This should be considered as trials of metastasis-directed therapy for oligometastatic prostate cancer accrue and results are translated to broader oncology practice. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine - Series 2)

13 pages, 1211 KiB

Open AccessPerspective

The Gut Microbiome and Metastatic Renal Cell Carcinoma

by Luis Meza, Matthew Feng, Kyle Lee, Rubens Sperandio and Sumanta Kumar Pal

J. Clin. Med. 2023, 12(4), 1502; https://doi.org/10.3390/jcm12041502 - 14 Feb 2023

Cited by 6 | Viewed by 3170

Abstract

The introduction of targeted therapy (TT) and immuno-oncology (IO) agents have revolutionized the treatment of metastatic renal cell carcinoma (mRCC). However, despite the significant improvements in survival and clinical response yielded by these agents, a significant percentage of patients still experience progressive disease. [...] Read more.

The introduction of targeted therapy (TT) and immuno-oncology (IO) agents have revolutionized the treatment of metastatic renal cell carcinoma (mRCC). However, despite the significant improvements in survival and clinical response yielded by these agents, a significant percentage of patients still experience progressive disease. Evidence now suggests that microorganisms living in the gut (i.e., the gut microbiome) could be used as a biomarker for response and may also have utility in increasing response to these treatments. In this review, we present an overview of the role of the gut microbiome in cancer and its potential implications in the treatment of mRCC. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine - Series 2)

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8 pages, 1037 KiB

Open AccessOpinion

Proposed Implementation of a Patient-Centered Self-Assessment Tool for Patients with Neuroendocrine Tumors among Academic and Community Practice Sites: The City of Hope Model

by Christiana Joy Crook, Lisa Yen, Kathleen Ta, Misagh Karimi, Danny Nguyen, Richard T. Lee and Daneng Li

J. Clin. Med. 2023, 12(3), 1229; https://doi.org/10.3390/jcm12031229 - 3 Feb 2023

Viewed by 2097

Abstract

Neuroendocrine tumors are a rare type of cancer found in hormone-producing cells throughout the body. Research on disease-specific patient education assessments in this population is lacking. We previously demonstrated the feasibility and validity of NET VITALS, a patient-centered self-assessment designed to improve patients’ [...] Read more.

Neuroendocrine tumors are a rare type of cancer found in hormone-producing cells throughout the body. Research on disease-specific patient education assessments in this population is lacking. We previously demonstrated the feasibility and validity of NET VITALS, a patient-centered self-assessment designed to improve patients’ knowledge of their neuroendocrine tumor diagnosis/treatment and facilitate communication with their physician. In this report, we provide a brief overview of patient assessments that have been used for patients with neuroendocrine tumors. We summarize NET VITALS and present a proposed infrastructure for its implementation into standard clinical care in both academic and community practice settings at City of Hope. Incorporating NET VITALS into standard of care treatment for patients with neuroendocrine tumors may improve patients’ overall clinical care experience. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine - Series 2)

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12 pages, 1732 KiB

Open AccessPerspective

A Systems Biology Approach for Addressing Cisplatin Resistance in Non-Small Cell Lung Cancer

by Sravani Ramisetty, Prakash Kulkarni, Supriyo Bhattacharya, Arin Nam, Sharad S. Singhal, Linlin Guo, Tamara Mirzapoiazova, Bolot Mambetsariev, Sandeep Mittan, Jyoti Malhotra, Evan Pisick, Shanmuga Subbiah, Swapnil Rajurkar, Erminia Massarelli, Ravi Salgia and Atish Mohanty

J. Clin. Med. 2023, 12(2), 599; https://doi.org/10.3390/jcm12020599 - 11 Jan 2023

Cited by 10 | Viewed by 2604

Abstract

Translational research in medicine, defined as the transfer of knowledge and discovery from the basic sciences to the clinic, is typically achieved through interactions between members across scientific disciplines to overcome the traditional silos within the community. Thus, translational medicine underscores ‘Team Medicine’, [...] Read more.

Translational research in medicine, defined as the transfer of knowledge and discovery from the basic sciences to the clinic, is typically achieved through interactions between members across scientific disciplines to overcome the traditional silos within the community. Thus, translational medicine underscores ‘Team Medicine’, the partnership between basic science researchers and clinicians focused on addressing a specific goal in medicine. Here, we highlight this concept from a City of Hope perspective. Using cisplatin resistance in non-small cell lung cancer (NSCLC) as a paradigm, we describe how basic research scientists, clinical research scientists, and medical oncologists, in true ‘Team Science’ spirit, addressed cisplatin resistance in NSCLC and identified a previously approved compound that is able to alleviate cisplatin resistance in NSCLC. Furthermore, we discuss how a ‘Team Medicine’ approach can help to elucidate the mechanisms of innate and acquired resistance in NSCLC and develop alternative strategies to overcome drug resistance. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine - Series 2)

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13 pages, 1784 KiB

Open AccessPerspective

Addressing Drug Resistance in Cancer: A Team Medicine Approach

by Prakash Kulkarni, Atish Mohanty, Supriyo Bhattacharya, Sharad Singhal, Linlin Guo, Sravani Ramisetty, Tamara Mirzapoiazova, Bolot Mambetsariev, Sandeep Mittan, Jyoti Malhotra, Naveen Gupta, Pauline Kim, Razmig Babikian, Swapnil Rajurkar, Shanmuga Subbiah, Tingting Tan, Danny Nguyen, Amartej Merla, Sudarsan V. Kollimuttathuillam, Tanyanika Phillips, Peter Baik, Bradford Tan, Pankaj Vashi, Sagun Shrestha, Benjamin Leach, Ruchi Garg, Patricia L. Rich, F. Marc Stewart, Evan Pisick and Ravi Salgia Show full author list Hide full author list

J. Clin. Med. 2022, 11(19), 5701; https://doi.org/10.3390/jcm11195701 - 27 Sep 2022

Cited by 6 | Viewed by 2123

Abstract

Drug resistance remains one of the major impediments to treating cancer. Although many patients respond well initially, resistance to therapy typically ensues. Several confounding factors appear to contribute to this challenge. Here, we first discuss some of the challenges associated with drug resistance. [...] Read more.

Drug resistance remains one of the major impediments to treating cancer. Although many patients respond well initially, resistance to therapy typically ensues. Several confounding factors appear to contribute to this challenge. Here, we first discuss some of the challenges associated with drug resistance. We then discuss how a ‘Team Medicine’ approach, involving an interdisciplinary team of basic scientists working together with clinicians, has uncovered new therapeutic strategies. These strategies, referred to as intermittent or ‘adaptive’ therapy, which are based on eco-evolutionary principles, have met with remarkable success in potentially precluding or delaying the emergence of drug resistance in several cancers. Incorporating such treatment strategies into clinical protocols could potentially enhance the precision of delivering personalized medicine to patients. Furthermore, reaching out to patients in the network of hospitals affiliated with leading academic centers could help them benefit from such innovative treatment options. Finally, lowering the dose of the drug and its frequency (because of intermittent rather than continuous therapy) can also have a significant impact on lowering the toxicity and undesirable side effects of the drugs while lowering the financial burden carried by the patient and insurance providers. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine - Series 2)

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