Biomedical Informatics Commons^™

High-Level Ceftazidime/Avibactam Resistance In Escherichia Coli Conferred By The Novel Plasmid-Mediated Β-Lactamase Cmy-185 Variant, William C Shropshire, Bradley T Endres, Jovan Borjan, Samuel L Aitken, William C Bachman, Christi L Mcelheny, Chin-Ting Wu, Stephanie L Egge, Ayesha Khan, William R Miller, Micah M Bhatti, Pranoti Saharasbhojane, Akito Kawai, Ryan K Shields, Samuel A Shelburne, Yohei Doi

Faculty, Staff and Student Publications

OBJECTIVES: To characterize a blaCMY variant associated with ceftazidime/avibactam resistance from a serially collected Escherichia coli isolate.

METHODS: A patient with an intra-abdominal infection due to recurrent E. coli was treated with ceftazidime/avibactam. On Day 48 of ceftazidime/avibactam therapy, E. coli with a ceftazidime/avibactam MIC of >256 mg/L was identified from abdominal drainage. Illumina and Oxford Nanopore Technologies WGS was performed on serial isolates to identify potential resistance mechanisms. Site-directed mutants of CMY β-lactamase were constructed to identify amino acid residues responsible for ceftazidime/avibactam resistance.

RESULTS: WGS revealed that all three isolates were E. coli ST410. The ceftazidime/avibactam-resistant strain uniquely …

Quality Of Life In Male Breast Cancer: Prospective Study Of The International Male Breast Cancer Program (Eortc10085/Tbcrc029/Big2-07/Nabcg), Carolien P Schröder, Elise Van Leeuwen-Stok, Fatima Cardoso, Barbro Linderholm, Coralie Poncet, Antonio C Wolff, Vesna Bjelic-Radisic, Gustavo Werutsky, Miguel H Abreu, Ivana Bozovic-Spasojevic, Irma Den Hoed, Aafke H Honkoop, Maartje Los, Jose P Leone, Nicola S Russell, Tineke J Smilde, Annette W G Van Der Velden, Catherine Van Poznak, Marije M Vleugel, Rachel L Yung, Corneel Coens, Sharon H Giordano, Kathryn J Ruddy

Faculty, Staff and Student Publications

INTRODUCTION: Prospective data about quality of life (QoL) in men with breast cancer (BC) are lacking. A prospective registry (EORTC10085) of men with all BC stages, including a QoL correlative study, was performed as part of the International Male Breast Cancer Program.

METHODS: Questionnaires at BC diagnosis included the EORTC QLQ-C30 and BR23 (BC specific module), adapted for men. High functioning and global health/QoL scores indicate high functioning levels/high QoL; high symptom-focused measures scores indicate high symptoms/problems levels. EORTC reference data for healthy men and women with BC were used for comparisons.

RESULTS: Of 422 men consenting to participate, 363 …

Safety And Tolerability Of A Novel Anti-Her2 Antibody-Drug Conjugate (Pf-06804103) In Patients With Her2-Expressing Solid Tumors: A Phase 1 Dose-Escalation Study, Funda Meric-Bernstam, Emiliano Calvo, Keun Seok Lee, Victor Moreno, Yeon Hee Park, Sun Young Rha, Pavani Chalasani, Wei Zhong, Li Zhou, Steven Pirie-Shepherd, Abraham C F Leung, Giuseppe Curigliano

Faculty, Staff and Student Publications

PF-06804103 is an anti-HER2 antibody–drug conjugate with auristatin payload. We evaluated its safety, tolerability, and antitumor activity in patients with advanced/unresectable or metastatic breast and gastric cancers. This multicenter, open-label, first-in-human, phase 1 study (NCT03284723) comprised dose escalation (P1) and dose expansion (P2). In P1, adults with HER2+ breast or gastric cancer received PF-06804103 0.15–5.0 mg/kg intravenously once/21 days (Q3W); in P2, patients with HER2+ or HER2-low (IHC 1+ or IHC 2+/ISH−) breast cancer received 3.0 or 4.0 mg/kg Q3W. The primary endpoints were dose-limiting toxicities (DLT) and safety (P1), and objective response rate (ORR) assessed using RECIST v1.1 (P2). …

Deep Learning For Fully Automatic Tumor Segmentation On Serially Acquired Dynamic Contrast-Enhanced Mri Images Of Triple-Negative Breast Cancer, Zhan Xu, David E Rauch, Rania M Mohamed, Sanaz Pashapoor, Zijian Zhou, Bikash Panthi, Jong Bum Son, Ken-Pin Hwang, Benjamin C Musall, Beatriz E Adrada, Rosalind P Candelaria, Jessica W T Leung, Huong T C Le-Petross, Deanna L Lane, Frances Perez, Jason White, Alyson Clayborn, Brandy Reed, Huiqin Chen, Jia Sun, Peng Wei, Alastair Thompson, Anil Korkut, Lei Huo, Kelly K Hunt, Jennifer K Litton, Vicente Valero, Debu Tripathy, Wei Yang, Clinton Yam, Jingfei Ma

Faculty, Staff and Student Publications

Accurate tumor segmentation is required for quantitative image analyses, which are increasingly used for evaluation of tumors. We developed a fully automated and high-performance segmentation model of triple-negative breast cancer using a self-configurable deep learning framework and a large set of dynamic contrast-enhanced MRI images acquired serially over the patients' treatment course. Among all models, the top-performing one that was trained with the images across different time points of a treatment course yielded a Dice similarity coefficient of 93% and a sensitivity of 96% on baseline images. The top-performing model also produced accurate tumor size measurements, which is valuable for …

Single-Cell Characterization Of Pulmonary Nodules Implicates Suppression Of Immunosurveillance Across Early Stages Of Lung Adenocarcinoma, Jane Yanagawa, Linh M Tran, Ramin Salehi-Rad, Raymond J Lim, Camelia Dumitras, Eileen Fung, William D Wallace, Ashley E Prosper, Gregory Fishbein, Conor Shea, Rui Hong, Bitta Kahangi, John J Deng, Adam C Gower, Bin Liu, Joshua D Campbell, Sarah A Mazzilli, Jennifer E Beane, Humam Kadara, Marc E Lenburg, Avrum E Spira, Denise R Aberle, Kostyantyn Krysan, Steven M Dubinett

Faculty, Staff and Student Publications

UNLABELLED: A greater understanding of molecular, cellular, and immunological changes during the early stages of lung adenocarcinoma development could improve diagnostic and therapeutic approaches in patients with pulmonary nodules at risk for lung cancer. To elucidate the immunopathogenesis of early lung tumorigenesis, we evaluated surgically resected pulmonary nodules representing the spectrum of early lung adenocarcinoma as well as associated normal lung tissues using single-cell RNA sequencing and validated the results by flow cytometry and multiplex immunofluorescence (MIF). Single-cell transcriptomics revealed a significant decrease in gene expression associated with cytolytic activities of tumor-infiltrating natural killer and natural killer T cells. This …

Intraperitoneal Paclitaxel Is A Safe And Effective Therapeutic Strategy For Treating Mucinous Appendiceal Adenocarcinoma, Ichiaki Ito, Abdelrahman M G Yousef, Saikat Chowdhury, Princess N Dickson, Zahra A Naini, Michael G White, Karianne G Fleten, Kjersti Flatmark, Keith F Fournier, Natalie W Fowlkes, John Paul Shen

Faculty, Staff and Student Publications

Appendiceal adenocarcinomas (AAs) are a rare and heterogeneous mix of tumors for which few preclinical models exist. The rarity of AA has made performing prospective clinical trials difficult, which has partly contributed to AA remaining an orphan disease with no chemotherapeutic agents approved by the FDA for its treatment. AA has a unique biology in which it frequently forms diffuse peritoneal metastases but almost never spreads via a hematogenous route and rarely spreads to lymphatics. Given the localization of AA to the peritoneal space, intraperitoneal (IP) delivery of chemotherapy could be an effective treatment strategy. Here, we tested the efficacy …

Abemaciclib Is Effective In Palbociclib-Resistant Hormone Receptor-Positive Metastatic Breast Cancers, Juliana Navarro-Yepes, Nicole M Kettner, Xiayu Rao, Cassandra Santaella Bishop, Tuyen N Bui, Hannah F Wingate, Akshara Singareeka Raghavendra, Yan Wang, Jing Wang, Aysegul A Sahin, Funda Meric-Bernstam, Kelly K Hunt, Senthil Damodaran, Debu Tripathy, Khandan Keyomarsi

Faculty, Staff and Student Publications

Cyclin-dependent kinases 4/6 inhibitor (CDK4/6i) plus endocrine therapy (ET) is standard of care for patients with hormone receptor (HR)-positive, HER2-negative metastatic breast cancer (MBC). However, resistance to CDK4/6is plus ET remains a clinical problem with limited therapeutic options following disease progression. Different CDK4/6is might have distinct mechanisms of resistance, and therefore using them sequentially or targeting their differentially altered pathways could delay disease progression. To understand pathways leading to resistance to the CDK4/6is palbociclib and abemaciclib, we generated multiple in vitro models of palbociclib-resistant (PR) and abemaciclib-resistant (AR) cell lines as well as in vivo patient-derived xenografts (PDX) and ex …

Endocrine Therapy Synergizes With Smac Mimetics To Potentiate Antigen Presentation And Tumor Regression In Hormone Receptor-Positive Breast Cancer, Francisco Hermida-Prado, Yingtian Xie, Shira Sherman, Zsuzsanna Nagy, Douglas Russo, Tara Akhshi, Zhengtao Chu, Avery Feit, Marco Campisi, Minyue Chen, Agostina Nardone, Cristina Guarducci, Klothilda Lim, Alba Font-Tello, Irene Lee, Juana García-Pedrero, Israel Cañadas, Judith Agudo, Ying Huang, Tal Sella, Qingchun Jin, Nabihah Tayob, Elizabeth A Mittendorf, Sara M Tolaney, Xintao Qiu, Henry Long, William F Symmans, Jia-Ren Lin, Sandro Santagata, Isabelle Bedrosian, Denise A Yardley, Ingrid A Mayer, Edward T Richardson, Giacomo Oliveira, Catherine J Wu, Eugene F Schuster, Mitch Dowsett, Alana L Welm, David Barbie, Otto Metzger, Rinath Jeselsohn

Faculty, Staff and Student Publications

Immunotherapies have yet to demonstrate significant efficacy in the treatment of hormone receptor-positive (HR+) breast cancer. Given that endocrine therapy (ET) is the primary approach for treating HR+ breast cancer, we investigated the effects of ET on the tumor immune microenvironment (TME) in HR+ breast cancer. Spatial proteomics of primary HR+ breast cancer samples obtained at baseline and after ET from patients enrolled in a neoadjuvant clinical trial (NCT02764541) indicated that ET upregulated β2-microglobulin and influenced the TME in a manner that promotes enhanced immunogenicity. To gain a deeper understanding of the underlying mechanisms, the intrinsic effects of …

Setd2 Loss And Atr Inhibition Synergize To Promote Cgas Signaling And Immunotherapy Response In Renal Cell Carcinoma, Xian-De Liu, Yan-Ting Zhang, Daniel J Mcgrail, Xuesong Zhang, Truong Lam, Anh Hoang, Elshad Hasanov, Ganiraju Manyam, Christine B Peterson, Haifeng Zhu, Shwetha V Kumar, Rehan Akbani, Patrick G Pilie, Nizar M Tannir, Guang Peng, Eric Jonasch

Faculty, Staff and Student Publications

PURPOSE: Immune checkpoint blockade (ICB) demonstrates durable clinical benefits in a minority of patients with renal cell carcinoma (RCC). We aimed to identify the molecular features that determine the response and develop approaches to enhance it.

EXPERIMENTAL DESIGN: We investigated the effects of SET domain-containing protein 2 (SETD2) loss on the DNA damage response pathway, the cytosolic DNA-sensing pathway, the tumor immune microenvironment, and the response to ataxia telangiectasia and rad3-related (ATR) and checkpoint inhibition in RCC.

RESULTS: ATR inhibition activated the cyclic GMP-AMP synthase (cGAS)-interferon regulatory factor 3 (IRF3)-dependent cytosolic DNA-sensing pathway, resulting in the concurrent expression of inflammatory …

Evolving Availability And Standardization Of Patient Attributes For Matching, Yu Deng, Lacey P Gleason, Adam Culbertson, Xiaotian Chen, Elmer V Bernstam, Theresa Cullen, Ramkiran Gouripeddi, Christopher Harle, David F Hesse, Jacob Kean, John Lee, Tanja Magoc, Daniella Meeker, Toan Ong, Jyotishman Pathak, Marc Rosenman, Laura K Rusie, Akash J Shah, Lizheng Shi, Aaron Thomas, William E Trick, Shaun Grannis, Abel Kho

Faculty, Staff and Student Publications

Variation in availability, format, and standardization of patient attributes across health care organizations impacts patient-matching performance. We report on the changing nature of patient-matching features available from 2010-2020 across diverse care settings. We asked 38 health care provider organizations about their current patient attribute data-collection practices. All sites collected name, date of birth (DOB), address, and phone number. Name, DOB, current address, social security number (SSN), sex, and phone number were most commonly used for cross-provider patient matching. Electronic health record queries for a subset of 20 participating sites revealed that DOB, first name, last name, city, and postal codes …

Web-Grading-A Tool To Test Personal Grading Of Renal And Prostate Cancer, Glen Kristiansen, Matthias Schmid, Lars Egevad, Hemamali Samaratunga, Murali Varma, Kaan Inam, Hans-Jürgen Thiesen, Brett Delahunt, Yulin Dai

Faculty, Staff and Student Publications

Only a few pathologists have the opportunity to verify their personal grading through objective assessment. This study introduces a web-based grading platform to facilitate and validate the grading of renal cell carcinoma and prostate cancer. Two representative images of two clinically annotated cohorts of 100 cases each of prostate and renal cell carcinoma were used. Each participant was asked to grade a tumor series utilizing a three tiered grading system. Finally, a Kaplan-Meier curve was drawn, and the log-rank test was used for statistical testing of the p-value. The grading of 22 participants (68%) achieved prognostic significance. Further analysis highlighted …

Discoverpath: A Knowledge Refinement And Retrieval System For Interdisciplinarity On Biomedical Research, Yu-Neng Chuang, Guanchu Wang, Chia-Yuan Chang, Kwei-Herng Lai, Daochen Zha, Ruixiang Tang, Fan Yang, Alfredo Costilla Reyes, Kaixiong Zhou, Xiaoqian Jiang, Xia Hu

Faculty, Staff and Student Publications

The exponential growth in scholarly publications necessitates advanced tools for efficient article retrieval, especially in interdisciplinary fields where diverse terminologies are used to describe similar research. Traditional keyword-based search engines often fall short in assisting users who may not be familiar with specific terminologies. To address this, we present a knowledge graph based paper search engine for biomedical research to enhance the user experience in discovering relevant queries and articles. The system, dubbed DiscoverPath, employs Named Entity Recognition (NER) and part-of-speech (POS) tagging to extract terminologies and relationships from article abstracts to create a KG. To reduce information overload, DiscoverPath …

Visualization Of Patient-Generated Health Data: A Scoping Review Of Dashboard Designs, Edna Shenvi, Aziz Boxwala, Dean Sittig, Courtney Zott, Edwin Lomotan, James Swiger, Prashila Dullabh

Faculty, Staff and Student Publications

BACKGROUND: Patient-centered clinical decision support (PC CDS) aims to assist with tailoring decisions to an individual patient's needs. Patient-generated health data (PGHD), including physiologic measurements captured frequently by automated devices, provide important information for PC CDS. The volume and availability of such PGHD is increasing, but how PGHD should be presented to clinicians to best aid decision-making is unclear.

OBJECTIVES: Identify best practices in visualizations of physiologic PGHD, for designing a software application as a PC CDS tool.

METHODS: We performed a scoping review of studies of PGHD dashboards that involved clinician users in design or evaluations. We included only …

Enabling Health Data Sharing With Fine-Grained Privacy, Luca Bonomi, Sepand Gousheh, Liyue Fan

Faculty, Staff and Student Publications

Sharing health data is vital in advancing medical research and transforming knowledge into clinical practice. Meanwhile, protecting the privacy of data contributors is of paramount importance. To that end, several privacy approaches have been proposed to protect individual data contributors in data sharing, including data anonymization and data synthesis techniques. These approaches have shown promising results in providing privacy protection at the dataset level. In this work, we study the privacy challenges in enabling fine-grained privacy in health data sharing. Our work is motivated by recent research findings, in which patients and healthcare providers may have different privacy preferences and …

Evolving Availability And Standardization Of Patient Attributes For Matching, Yu Deng, Lacey P Gleason, Adam Culbertson, Xiaotian Chen, Elmer V Bernstam, Theresa Cullen, Ramkiran Gouripeddi, Christopher Harle, David F Hesse, Jacob Kean, John Lee, Tanja Magoc, Daniella Meeker, Toan Ong, Jyotishman Pathak, Marc Rosenman, Laura K Rusie, Akash J Shah, Lizheng Shi, Aaron Thomas, William E Trick, Shaun Grannis, Abel Kho

Faculty, Staff and Student Publications

Variation in availability, format, and standardization of patient attributes across health care organizations impacts patient-matching performance. We report on the changing nature of patient-matching features available from 2010-2020 across diverse care settings. We asked 38 health care provider organizations about their current patient attribute data-collection practices. All sites collected name, date of birth (DOB), address, and phone number. Name, DOB, current address, social security number (SSN), sex, and phone number were most commonly used for cross-provider patient matching. Electronic health record queries for a subset of 20 participating sites revealed that DOB, first name, last name, city, and postal codes …

Recent Insights Into The Pathogenesis And Therapeutic Targets Of Chronic Liver Diseases, Yankai Wen, Lichun Ma, Cynthia Ju

Faculty, Staff and Student Publications

Viral hepatitis, alcohol-associated liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) are the three major causes of chronic liver diseases, which account for approximately 2 million deaths per year worldwide. The current direct-acting antiviral drugs and vaccinations have effectively reduced and ameliorated viral hepatitis infection, but there are still no effective drug treatments for ALD, NAFLD and liver cancer due to the poor understanding of their pathogenesis. To better understand the pathogenesis, the fifth Chinese American Liver Society/Society of Chinese Bioscientists in America Hepatology Division Annual Symposium, which was held virtually on 21-22 October 2022, focused on the topics …

Operationalizing The Datagauge Framework In A Health Information Exchange Utilizing Hepatitis C Data, Edward Yao

Translational Projects (Open Access)

This project aims to implement the DataGauge framework in a health information exchange (HIE) setting as a proof of concept. The modified DataGauge framework, described by Diaz-Garelli et al. (2019), is utilized to test its functionality and applicability with any dataset. The specific objective of the project is to determine the number of hepatitis C-positive tests within the HIE. The implementation involved multiple iterations following the DataGauge framework's steps for data extraction and analysis. Five iterations were conducted, resulting in both successful and failed queries based on the validity of the data standards. The findings revealed that the HIE, in …

Advancing Precision Medicine: Unveiling Disease Trajectories, Decoding Biomarkers, And Tailoring Individual Treatments, Yanfei Wang

Dissertations and Theses (Open Access)

Chronic diseases are not only prevalent but also exert a considerable strain on the healthcare system, individuals, and communities. Nearly half of all Americans suffer from at least one chronic disease, which is still growing. The development of machine learning has brought new directions to chronic disease analysis. Many data scientists have devoted themselves to understanding how a disease progresses over time, which can lead to better patient management, identification of disease stages, and targeted interventions. However, due to the slow progression of chronic disease, symptoms are barely noticed until the disease is advanced, challenging early detection. Meanwhile, chronic diseases …

Cellular Responses After (Neratinib Plus Pemetrexed) Exposure In Nsclc Cells, Laurence Booth, Andrew Poklepovic, John F Hancock, Paul Dent

Faculty, Staff and Student Publications

We previously demonstrated that neratinib interacted with pemetrexed to kill non-small cell lung cancer (NSCLC) cells. From developing other drug combinations, we observed that several days following exposure, cells activated survival mechanisms to counteract drug toxicity. The present studies attempted to define mechanisms that evolve to reduce the efficacy of neratinib and pemetrexed. Neratinib and pemetrexed synergized to kill NSCLC cells expressing wild-type RAS proteins, mutant KRAS (G12S; Q61H; G12A and G12C) or mutant NRAS (Q61K) or mutant ERBB1 (L858R; L858R T790M and exon 19 deletion). Neratinib and pemetrexed interacted in a greater than additive fashion to kill after 24 …

Identifying Significant Correlates Of Purpose In Life In Older Us Military Veterans: Results From The National Health And Resilience In Veterans Study, Ian C Fischer, David B Feldman, Jack Tsai, Ilan Harpaz-Rotem, Katherine A Lucas, Stefan E Schulenberg, Robert H Pietrzak

Faculty, Staff and Student Publications

Objective: Perceived purpose in life (PIL) has been linked to a broad range of adverse physical, mental, and cognitive outcomes. However, limited research has examined factors associated with PIL that can be targeted in prevention and treatment efforts in aging populations at heightened risk of adverse outcomes. Using data from predominantly older US veterans, we sought to identify important correlates of PIL.

Methods: Cross-sectional data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 4069 US military veterans (Mage = 62.2). Elastic net and relative importance analyses were …

Medication Reconciliation During Transitions Of Care Across Institutions: A Quantitative Analysis Of Challenges And Opportunities, Alejandro Araya, Logan R Thornton, Deukwoo Kwon, Gayla M Ferguson, Linda D Highfield, Kevin O Hwang, Holly M Holmes, Elmer V Bernstam

Faculty, Staff and Student Publications

OBJECTIVE: Medication discrepancies between clinical systems may pose a patient safety hazard. In this paper, we identify challenges and quantify medication discrepancies across transitions of care.

METHODS: We used structured clinical data and free-text hospital discharge summaries to compare active medications' lists at four time points: preadmission (outpatient), at-admission (inpatient), at-discharge (inpatient), and postdischarge (outpatient). Medication lists were normalized to RxNorm. RxNorm identifiers were further processed using the RxNav API to identify the ingredient. The specific drugs and ingredients from inpatient and outpatient medication lists were compared.

RESULTS: Using RxNorm drugs, the median percentage intersection when comparing active medication lists …

Comparisons Of Medical Cost Trajectories Between Non-Hispanic Black And Non-Hispanic White Patients With Newly Diagnosed Localized Prostate Cancer, Yu Liu, Shikun Wang, Liang Li, Ying Xu, Yu Shen, Ya-Chen Tina Shih

Faculty, Staff and Student Publications

Objectives: This study applied a recently developed statistical method to compare the mean cost trajectories between non-Hispanic White (NHW) and non-Hispanic Black (NHB) patients with localized prostate cancer conditioning on patients' survival.

Methods: In this observational study, we modeled cost trajectories of NHW and NHB patients with localized prostate cancer for 3 survival durations: 24, 48, and 72 months. We also compared the cost trajectories between NHW and NHB, stratified by comorbidities scores.

Results: We find that the mean cost trajectories of NHB were significantly higher than the trajectories of NHW in the last 12 months before death, regardless of …

Dimensionality Reduction For Improving Out-Of-Distribution Detection In Medical Image Segmentation, Mckell Woodland, Nihil Patel, Mais Al Taie, Joshua P Yung, Tucker J Netherton, Ankit B Patel, Kristy K Brock

Faculty, Staff and Student Publications

Clinically-deployed deep learning-based segmentation models are known to fail on data outside of their training distributions. While clinicians review the segmentations, these models do tend to perform well in most instances, which could exacerbate automation bias. Therefore, it is critical to detect out-of-distribution images at inference to warn the clinicians that the model likely failed. This work applies the Mahalanobis distance post hoc to the bottleneck features of a Swin UNETR model that segments the liver on T1-weighted magnetic resonance imaging. By reducing the dimensions of the bottleneck features with principal component analysis, images the model failed on were detected …

Pd-1 Blockade In Combination With Dasatinib Potentiates Induction Of Anti-Acute Lymphocytic Leukemia Immunity, Paul Koller, Natalia Baran, Karine Harutyunyan, Antonio Cavazos, Saradhi Mallampati, Renee L Chin, Zhou Jiang, Xian Sun, Heng-Huan Lee, Jennifer L Hsu, Patrick Williams, Xuelin Huang, Michael A Curran, Mien-Chie Hung, Marina Konopleva

Faculty, Staff and Student Publications

Immunotherapy, in the form of hematopoietic stem cell transplantation (HSCT), has been part of the standard of care in the treatment of acute leukemia for over 40 years. Trials evaluating novel immunotherapeutic approaches, such as targeting the programmed death-1 (PD-1) pathway, have unfortunately not yielded comparable results to those seen in solid tumors. Major histocompatibility complex (MHC) proteins are cell surface proteins essential for the adaptive immune system to recognize self versus non-self. MHC typing is used to determine donor compatibility when evaluating patients for HSCT. Recently, loss of MHC class II (MHC II) was shown to be a mechanism …

Basic: A Bayesian Adaptive Synthetic-Control Design For Phase Ii Clinical Trials, Liyun Jiang, Peter F Thall, Fangrong Yan, Scott Kopetz, Ying Yuan

Faculty, Staff and Student Publications

Background: Randomized controlled trials are considered the gold standard for evaluating experimental treatments but often require large sample sizes. Single-arm trials require smaller sample sizes but are subject to bias when using historical control data for comparative inferences. This article presents a Bayesian adaptive synthetic-control design that exploits historical control data to create a hybrid of a single-arm trial and a randomized controlled trial.

Methods: The Bayesian adaptive synthetic control design has two stages. In stage 1, a prespecified number of patients are enrolled in a single arm given the experimental treatment. Based on the stage 1 data, applying propensity …

Bayesian Approach For Design And Analysis Of Medical Device Trials In The Era Of Modern Clinical Studies, Han Cao, Chen Yao, Ying Yuan

Faculty, Staff and Student Publications

Medical device technology develops rapidly, and the life cycle of a medical device is much shorter than drugs. It is necessary to evaluate the safety and effectiveness of a medical device in a timely manner to keep up with technology flux. Bayesian methods provides an efficient approach to addressing this challenge. In this article, we review the characteristics of the Bayesian approach and some Bayesian designs that were commonly used in medical device regulatory setting, including Bayesian adaptive design, Bayesian diagnostic design, Bayesian multiregional design, and Bayesian label expansion study. We illustrate these designs with medical devices approved by the …

Lurbinectedin In Patients With Pretreated Endometrial Cancer: Results From A Phase 2 Basket Clinical Trial And Exploratory Translational Study, Rebecca Kristeleit, Alexandra Leary, Jean Pierre Delord, Victor Moreno, Ana Oaknin, Daniel Castellano, Geoffrey I Shappiro, Cristian Fernández, Carmen Kahatt, Vicente Alfaro, Mariano Siguero, Daniel Rueda, Ali Zeaiter, Ahmad Awada, Ana Santaballa, Khalil Zaman, Jalid Sehouli, Vivek Subbiah

Faculty, Staff and Student Publications

Second-line treatment of endometrial cancer is an unmet medical need. Lurbinectedin showed promising antitumor activity in a phase I study in combination with doxorubicin in advanced endometrial cancer. This phase 2 Basket trial evaluated lurbinectedin 3.2 mg/m2 1-h intravenous infusion every 3 weeks in a cohort of 73 patients with pretreated endometrial cancer. The primary endpoint was overall response rate (ORR) according to RECIST v1.1. Secondary endpoints included duration of response (DoR), progression-free survival (PFS), overall survival (OS), safety and an exploratory translational study. Confirmed complete (CR) and partial response (PR) was reported in two and six patients, respectively (ORR …

Single-Cell Dissection Of Tumor Microenvironmental Response And Resistance To Cancer Therapy, Yikai Luo, Han Liang

Faculty, Staff and Student Publications

Cancer treatment strategies have evolved significantly over the years, with chemotherapy, targeted therapy, and immunotherapy as major pillars. Each modality leads to unique treatment outcomes by interacting with the tumor microenvironment (TME), which imposes a fundamental selective pressure on cancer progression. The advent of single-cell profiling technologies has revolutionized our understanding of the intricate and heterogeneous nature of the TME at an unprecedented resolution. This review delves into the commonalities and differential manifestations of how cancer therapies reshape the microenvironment in diverse cancer types. We highlight how groundbreaking immune checkpoint blockade (ICB) strategies alone or in combination with tumor-targeting treatments …

Local Continual Reassessment Methods For Dose Finding And Optimization In Drug-Combination Trials, Jingyi Zhang, Fangrong Yan, Nolan A Wages, Ruitao Lin

Faculty, Staff and Student Publications

Due to the limited sample size and large dose exploration space, obtaining a desirable dose combination is a challenging task in the early development of combination treatments for cancer patients. Most existing designs for optimizing the dose combination are model-based, requiring significant efforts to elicit parameters or prior distributions. Model-based designs also rely on intensive model calibration and may yield unstable performance in the case of model misspecification or sparse data. We propose to employ local, underparameterized models for dose exploration to reduce the hurdle of model calibration and enhance the design robustness. Building upon the framework of the partial …

Characteristics And Outcomes Of Patients With Chronic Myeloid Leukemia And T315i Mutation Treated In The Pre- And Post-Ponatinib Era, Fadi G Haddad, Koji Sasaki, Aram Bidikian, Ghayas C Issa, Tapan Kadia, Nitin Jain, Yesid Alvarado, Nicholas J Short, Naveen Pemmaraju, Sanam Loghavi, Keyur P Patel, Rashmi Kanagal-Shamanna, Musa Yilmaz, Lucia Masarova, Elias Jabbour, Hagop Kantarjian

Faculty, Staff and Student Publications

Patients with chronic myeloid leukemia (CML) and T315I mutation generally have a poor prognosis. Their outcome in the post-ponatinib era remains unclear. We reviewed patients with CML in chronic (CP) or accelerated phase (AP) who developed a T315I mutation between March 15, 2004, and July 26, 2022. Patients were divided into CP, AP, or blastic phase (BP) at the time of mutation detection. Overall survival (OS) was defined from the time of mutation detection to the date of death or last follow-up. We identified a total of 107 patients: 54 (51%) in CP, 14 (13%) in AP, and 39 (36%) …