Browsing by Author "Neilan, Tomas G."

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    Clinical Outcomes Among Immunotherapy-Treated Patients With Primary Cardiac Soft Tissue Sarcomas: A Multicenter Retrospective Study
    (Elsevier, 2024-01-16) Nassar, Amin H.; El-Am, Edward; Denu, Ryan; Alaiwi, Sarah Abou; El Zarif, Talal; Macaron, Walid; Abdel-Wahab, Noha; Desai, Aakash; Smith, Caleb; Parikh, Kaushal; Abbasi, Muhannad; Farhat, Elias Bou; Williams, James M.; Collins, Jeremy D.; Al-Hader, Ahmad; McKay, Rana R.; Malvar, Carmel; Sabra, Mohamad; Zhong, Caiwei; El Alam, Raquelle; Chehab, Omar; Lima, Joao; Phan, Minh; Pria, Hanna Ferreira Dalla; Trevino, Alexandra; Neilan, Tomas G.; Kwan, Jennifer M.; Ravi, Vinod; Deshpande, Hari; Demetri, George; Choueiri, Toni K.; Naqash, Abdul Rafeh; Medicine, School of Medicine
    Background: Primary cardiac soft tissue sarcomas (CSTS) affect young adults, with dismal outcomes. Objectives: The aim of this study was to investigate the clinical outcomes of patients with CSTS receiving immune checkpoint inhibitors (ICIs). Methods: A retrospective, multi-institutional cohort study was conducted among patients with CSTS between 2015 and 2022. The patients were treated with ICI-based regimens. The Kaplan-Meier method was used to estimate overall survival (OS) and progression-free survival (PFS). Objective response rates were determined according to Response Evaluation Criteria in Solid Tumors version 1.1. Treatment-related adverse events were graded per the Common Terminology Criteria for Adverse Events version 5.0. Results: Among 24 patients with CSTS, 17 (70.8%) were White, and 13 (54.2%) were male. Eight patients (33.3%) had angiosarcoma. At the time of ICI treatment, 18 patients (75.0%) had metastatic CSTS, and 4 (16.7%) had locally advanced disease. ICIs were administered as the first-line therapy in 6 patients (25.0%) and as the second-line therapy or beyond in 18 patients (75.0%). For the 18 patients with available response data, objective response rate was 11.1% (n = 2 of 18). The median PFS and median OS in advanced and metastatic CSTS (n = 22) were 5.7 months (95% CI: 2.8-13.3 months) and 14.9 months (95% CI: 5.7-23.7 months), respectively. The median PFS and OS were significantly shorter in patients with cardiac angiosarcomas than in those with nonangiosarcoma CSTS: median PFS was 1.7 vs 11 months, respectively (P < 0.0001), and median OS was 3.0 vs 24.0 months, respectively (P = 0.008). Any grade treatment-related adverse events occurred exclusively in the 15 patients with nonangiosarcoma CSTS (n = 7 [46.7%]), of which 6 (40.0%) were grade ≥3. Conclusions: Although ICIs demonstrate modest activity in CSTS, durable benefit was observed in a subset of patients with nonangiosarcoma, albeit with higher toxicity.
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    Impact of Social Vulnerability on Comorbid Cancer and Cardiovascular Disease Mortality in the United States
    (Elsevier, 2022-09-20) Ganatra, Sarju; Dani, Sourbha S.; Kumar, Ashish; Khan, Safi U.; Wadhera, Rishi; Neilan, Tomas G.; Thavendiranathan, Paaladinesh; Barac, Ana; Hermann, Joerg; Leja, Monika; Deswal, Anita; Fradley, Michael; Liu, Jennifer E.; Sadler, Diego; Asnani, Aarti; Baldassarre, Lauren A.; Gupta, Dipti; Yang, Eric; Guha, Avirup; Brown, Sherry-Ann; Stevens, Jennifer; Hayek, Salim S.; Porter, Charles; Kalra, Ankur; Baron, Suzanne J.; Ky, Bonnie; Virani, Salim S.; Kazi, Dhruv; Nasir, Khurram; Nohria, Anju; Medicine, School of Medicine
    Background: Racial and social disparities exist in outcomes related to cancer and cardiovascular disease (CVD). Objectives: The aim of this cross-sectional study was to study the impact of social vulnerability on mortality attributed to comorbid cancer and CVD. Methods: The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database (2015-2019) was used to obtain county-level mortality data attributed to cancer, CVD, and comorbid cancer and CVD. County-level social vulnerability index (SVI) data (2014-2018) were obtained from the CDC's Agency for Toxic Substances and Disease Registry. SVI percentiles were generated for each county and aggregated to form SVI quartiles. Age-adjusted mortality rates (AAMRs) were estimated and compared across SVI quartiles to assess the impact of social vulnerability on mortality related to cancer, CVD, and comorbid cancer and CVD. Results: The AAMR for comorbid cancer and CVD was 47.75 (95% CI: 47.66-47.85) per 100,000 person-years, with higher mortality in counties with greater social vulnerability. AAMRs for cancer and CVD were also significantly greater in counties with the highest SVIs. However, the proportional increase in mortality between the highest and lowest SVI counties was greater for comorbid cancer and CVD than for either cancer or CVD alone. Adults <45 years of age, women, Asian and Pacific Islanders, and Hispanics had the highest relative increase in comorbid cancer and CVD mortality between the fourth and first SVI quartiles, without significant urban-rural differences. Conclusions: Comorbid cancer and CVD mortality increased in counties with higher social vulnerability. Improved education, resource allocation, and targeted public health interventions are needed to address inequities in cardio-oncology.