Browsing by Author "O’Neill, Stacey"

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    Multi-Omics Analysis of Brain Metastasis Outcomes Following Craniotomy
    (Frontiers Media, 2021-04-06) Su, Jing; Song, Qianqian; Qasem, Shadi; O’Neill, Stacey; Lee, Jingyun; Furdui, Cristina M.; Pasche, Boris; Metheny-Barlow, Linda; Masters, Adrianna H.; Lo, Hui-Wen; Xing, Fei; Watabe, Kounosuke; Miller, Lance D.; Tatter, Stephen B.; Laxton, Adrian W.; Whitlow, Christopher T.; Chan, Michael D.; Soike, Michael H.; Ruiz, Jimmy; Biostatistics, School of Public Health
    Background: The incidence of brain metastasis continues to increase as therapeutic strategies have improved for a number of solid tumors. The presence of brain metastasis is associated with worse prognosis but it is unclear if distinctive biomarkers can separate patients at risk for CNS related death. Methods: We executed a single institution retrospective collection of brain metastasis from patients who were diagnosed with lung, breast, and other primary tumors. The brain metastatic samples were sent for RNA sequencing, proteomic and metabolomic analysis of brain metastasis. The primary outcome was distant brain failure after definitive therapies that included craniotomy resection and radiation to surgical bed. Novel prognostic subtypes were discovered using transcriptomic data and sparse non-negative matrix factorization. Results: We discovered two molecular subtypes showing statistically significant differential prognosis irrespective of tumor subtype. The median survival time of the good and the poor prognostic subtypes were 7.89 and 42.27 months, respectively. Further integrated characterization and analysis of these two distinctive prognostic subtypes using transcriptomic, proteomic, and metabolomic molecular profiles of patients identified key pathways and metabolites. The analysis suggested that immune microenvironment landscape as well as proliferation and migration signaling pathways may be responsible to the observed survival difference. Conclusion: A multi-omics approach to characterization of brain metastasis provides an opportunity to identify clinically impactful biomarkers and associated prognostic subtypes and generate provocative integrative understanding of disease.
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    Upfront immunotherapy leads to lower brain metastasis velocity in patients undergoing stereotactic radiosurgery for brain metastases
    (Old City Publishing, 2022) Abdulhaleem, Mohammed; Scott, Emmanuel; Johnston, Hannah; Isom, Scott; Lanier, Claire; LeCompte, Michael; Cramer, Christina K.; Ruiz, Jimmy; Lo, Hui-Wen; Watabe, Kuonosuke; O’Neill, Stacey; Whitlow, Christopher; Tatter, Stephen B.; Laxton, Adrian W.; Su, Jing; Chan, Michael D.; Biostatistics, School of Public Health
    Background: While immunotherapy has been shown to improve survival and decrease neurologic death in patients with brain metastases, it remains unclear whether this improvement is due to prevention of new metastasis to the brain. Method: We performed a retrospective review of patients presenting with brain metastases simultaneously with the first diagnosis of metastatic disease and were treated with upfront immunotherapy as part of their treatment regimen and stereotactic radiosurgery (SRS) to the brain metastases. We compared this cohort with a historical control population (prior to the immunotherapy era) who were treated with pre-immunotherapy standard of care systemic therapy and with SRS to the brain metastases. Results: Median overall survival time was improved in the patients receiving upfront immunotherapy compared to the historical cohort (48 months vs 8.4 months, p=0.001). Median time to distant brain failure was statistically equivalent (p=0.3) between the upfront immunotherapy cohort and historical control cohort (10.3 vs 12.6 months). Brain metastasis velocity was lower in the upfront immunotherapy cohort (median 3.72 metastases per year) than in the historical controls (median 9.48 metastases per year, p=0.001). Cumulative incidence of neurologic death at one year was 12% in the upfront immunotherapy cohort and 28% in the historical control cohort (p=0.1). Conclusions: Upfront immunotherapy appears to improve overall survival and decrease BMV compared to historical controls. While these data remain to be validated, they suggest that brain metastasis patients may benefit from concurrent immunotherapy with SRS.