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Home > Press > Cedars-Sinai, UCLA Scientists Use New ‘Blood Biopsies’ With Experimental Device to Speed Cancer Diagnosis and Predict Disease Spread: Leading-Edge Research Is Part of National Cancer Moonshot Initiative Abstract: A team of investigators from Cedars-Sinai and UCLA is using a new blood-analysis technique and tiny experimental device to help physicians predict which cancers are likely to spread by identifying and characterizing tumor cells circulating through the blood. The investigators are conducting “liquid biopsies” by running blood through a postage-stamp-sized chip with nanowires 1,000 times thinner than a human hair and coated with antibodies, or proteins, that recognize circulating tumor cells. The device, the NanoVelcro Chip, works by “grabbing” circulating tumor cells, which break away from tumors and travel through the bloodstream, looking for places in the body to spread. Use of the chip in liquid biopsies could allow doctors to regularly and easily monitor cancer-related changes in patients, such as how well they’re responding to treatment. The research earned the lead investigators a place on the U.S. Cancer Moonshot program, an initiative led by former Vice President Joe Biden to make available more therapies to more patients and to prevent cancer. “It’s far better to draw a tube of blood once a month to monitor cancer than to make patients undergo repeated surgical procedures,” said Edwin Posadas, MD, medical director of the Urologic Oncology Program at Cedars-Sinai’s Samuel Oschin Comprehensive Cancer Institute and one of the lead investigators. “The power of this technology lies in its capacity to provide information that is equal to or even superior to traditional tumor sampling by invasive procedures.” Although some forms of prostate cancer are so slow-growing that they pose little risk to patients, other forms of the disease are lethal. Identifying which patients have which type of disease has become a crucial area of study because prostate cancer is one of the leading causes of cancer death among men in the U.S. Nearly 27,000 U.S. men are expected to die from the disease in 2017, according to the American Cancer Society. The research team has determined that in certain cancer cells, the nucleus is smaller than in other, more typical, cancer cells. Patients with the most advanced cases of aggressive prostate cancer have cells with these very small nuclei. The investigators’ teamwork also revealed that very small nuclei are associated with metastasis, or cancer spread, to the liver and lung in patients with advanced cases of prostate cancer. Those nuclei developed before the metastases were detected. Identifying very small nuclei early in the disease progression may help pinpoint which patients have high risk of developing cancer that can spread and be fatal. Hsian-Rong Tseng, PhD, professor, Department of Molecular and Medical Pharmacology in the David Geffen School of Medicine at UCLA and the other lead investigator, said that his work with Posadas is focused on improving the quality of life for cancer patients. “We’re on a mission to dramatically change patients’ everyday lives and their long-term outcomes,” Tseng said. “We now have powerful new tools to accomplish that.” Posadas and Tseng join an elite cadre of academicians, technology leaders and pharmaceutical experts as partners in the Blood Profiling Atlas in Cancer (BloodPAC) Project, a Moonshot program. Participants will collect and share data gathered from circulating tumor cells. Posadas and Tseng expect to contribute microscopic images from 1,000 circulating tumor cells that have not yet been analyzed, as well as additional data and cells they have cataloged. For the past five years, Posadas and Tseng have collected blood samples from cancer patients to profile and analyze the circulating tumor cells and other components. That process has helped them understand how prostate and other cancers evolve. The two investigators and their teams hope their findings will contribute to developing effective, targeted treatments for many types of cancer. “Minimally invasive methods to both diagnose and follow cancer, through simple blood tests, offer a unique and novel approach that can lead to earlier diagnosis and treatment, leading to more cures,” said Robert A. Figlin, MD, director of the Division of Hematology Oncology and deputy director of the Samuel Oschin Comprehensive Cancer Institute at Cedars- Sinai. About Cedars-Sinai Cedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Today, Cedars-Sinai is known for its national leadership in transforming healthcare for the benefit of patients. Cedars-Sinai impacts the future of healthcare by developing new approaches to treatment and educating tomorrow’s health professionals. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents. About the David Geffen School of Medicine at UCLA Since opening in 1951, the David Geffen School of Medicine at UCLA has grown into an internationally recognized leader in research, medical education, patient care and public service. It has almost 2,000 full-time faculty members, including recipients of the Nobel Prize, the Pulitzer Prize and the National Medal of Science. More than 1,400 residents and fellows pursue advanced training at UCLA and its affiliated hospitals, which include Ronald Reagan UCLA Medical Center. For more information, please click If you have a comment, please us. Issuers of news releases, not 7th Wave, Inc. or Nanotechnology Now, are solely responsible for the accuracy of the content.

Popescu I.,Institutul Clinic Fundeni | Fleshner P.R.,Cedars Sinai | Pezzullo J.C.,Georgetown University | Charlton P.A.,Tranzyme Pharma Inc. | And 2 more authors.
Diseases of the Colon and Rectum | Year: 2010

Purpose: Ghrelin agonist TZP-101 is a potent prokinetic. This phase 2b study evaluated TZP-101 safety and efficacy in postoperative ileus management. Methods: Adults undergoing open partial colectomy were adaptively randomized to receive 20, 40, 80, 160, 320, 480 or 600 μg/kg TZP-101 (n = 168) or the placebo (n = 68) by 30-minute IV infusion within 1 hour of surgical closure and then daily for up to 7 days. The primary efficacy end point was the time to first bowel movement. Secondary end points included the percentage of patients with return of gastrointestinal function within 72 hours, and the time to readiness for discharge. Results: TZP-101 accelerated the time to first bowel movement in all groups, with Cox proportional hazard ratios of 1.57 (P = .056) for the low-efficacious dose (80 μg/kg) and 1.67 (P = .03) for the most efficacious dose (480μg/kg). Using Kaplan-Meier analysis, the median time to first bowel movement was reduced in all TZP-101 groups by 10 to 22 hours vs. the placebo. A greater number of patients who received TZP-101 achieved recovery (P ≤ .001) by 72 hours postsurgery compared with the placebo. The median time to readiness for hospital discharge was significantly accelerated by 20.4 hours at the 480 μg/kg TZP-101 dose compared with the placebo (hazard ratio = 1.69; P = .03). The most common treatment-emergent adverse events were nausea and vomiting, which were reduced in the TZP-101 group compared with the placebo group. Conclusion: In patients undergoing major abdominal surgery, the first-in-class ghrelin agonist TZP-101 was well-tolerated and accelerated recovery of the upper and lower gastrointestinal tract, with a large proportion of subjects recovering within 72 hours compared with the placebo. © The ASCRS 2010.

Guise J.-M.,Oregon Health And Science University | O'Haire C.,Oregon Health And Science University | McPheeters M.,Vanderbilt University | Most C.,Oregon Health And Science University | And 4 more authors.
Journal of Clinical Epidemiology | Year: 2013

Objective: A major goal of patient-centered outcomes and comparative effectiveness research is to increase the involvement of stakeholders throughout the research process to provide relevant and immediately actionable information. In this report, we review the current practices for engaging stakeholders in prioritizing research. Study Design and Setting: To evaluate the range of approaches to stakeholder engagement, we reviewed the relevant literature and conducted semistructured interviews with (1) leading research organizations in the United States, Canada, and the United Kingdom; and (2) eight Evidence-based Practice Centers that engage stakeholders in comparative effectiveness research. Results: We identified 56 articles related to stakeholder engagement in research prioritization. Studies and research organizations interviewed frequently used mixed methods approaches combining in-person venues with structured ranking or voting processes such as Delphi. EPCs similarly used group web/conference calls combined with Delphi ranking or voting. Research organizations reported difficulties engaging the public and policy makers, and EPCs reported challenges engaging federal stakeholders. Conclusion: Explicit and consistent use of terminology about stakeholders was absent. In-person techniques were useful to generate ideas and clarify issues, and quantitative methods were important in the prioritization of research. Recommendations for effective stakeholder engagement and a reporting checklist were developed from the accumulation of findings. © 2013 Elsevier Inc. All rights reserved.

Kicielinski K.P.,University of Alabama at Birmingham | Chiocca E.A.,Brigham and Women's Hospital | Yu J.S.,Cedars Sinai | Gill G.M.,Oncolytics Biotech | And 2 more authors.
Molecular Therapy | Year: 2014

Reovirus, an oncolytic RNA virus exhibiting antiglioma activity, was shown in a previous single institution phase 1 study found that the inoculation of the virus to be well tolerated in patients with recurrent malignant glioma (MG). The goals of multicenter study reported herein were to determine the dose-limiting toxicity, maximum tolerated dose, and target lesion response rate when reovirus was administered in a novel fashion via intratumoral infusion for 72 hours in patients with recurrent malignant glioma. Fifteen adult patients were treated in a dose escalation study ranging from 1 × 10 8 to 1 × 10 10 tissue culture infectious dose 50, tentimes the dose achieved in the previous trial. Neurological, functional examinations, and imaging studies were completed pre-and postinfusion. There was one grade 3 adverse event (convulsions) felt to be possibly related to treatment, but no grade 4 adverse events considered probably or definitely related to treatment. Dose-limiting toxicity were not identified and a maximum tolerated dose was not reached. Evidence of antiglioma activity was seen in some patients. This first report of intratumoral infusion of reovirus in patients with recurrent malignant glioma demonstrated the approach to be safe and well tolerated, warranting further studies. © 2014 The American Society of Gene and Cell Therapy.

Emberson J.,University of Oxford | Lees K.R.,University of Glasgow | Lyden P.,Cedars Sinai | Blackwell L.,University of Oxford | And 26 more authors.
The Lancet | Year: 2014

Background Alteplase is effective for treatment of acute ischaemic stroke but debate continues about its use after longer times since stroke onset, in older patients, and among patients who have had the least or most severe strokes. We assessed the role of these factors in affecting good stroke outcome in patients given alteplase. Methods We did a pre-specified meta-analysis of individual patient data from 6756 patients in nine randomised trials comparing alteplase with placebo or open control. We included all completed randomised phase 3 trials of intravenous alteplase for treatment of acute ischaemic stroke for which data were available. Retrospective checks confirmed that no eligible trials had been omitted. We defined a good stroke outcome as no significant disability at 3-6 months, defined by a modified Rankin Score of 0 or 1. Additional outcomes included symptomatic intracranial haemorrhage (defined by type 2 parenchymal haemorrhage within 7 days and, separately, by the SITS-MOST definition of parenchymal type 2 haemorrhage within 36 h), fatal intracranial haemorrhage within 7 days, and 90-day mortality. Findings Alteplase increased the odds of a good stroke outcome, with earlier treatment associated with bigger proportional benefit. Treatment within 3·0 h resulted in a good outcome for 259 (32·9%) of 787 patients who received alteplase versus 176 (23·1%) of 762 who received control (OR 1·75, 95% CI 1·35-2·27); delay of greater than 3·0 h, up to 4·5 h, resulted in good outcome for 485 (35·3%) of 1375 versus 432 (30·1%) of 1437 (OR 1·26, 95% CI 1·05-1·51); and delay of more than 4·5 h resulted in good outcome for 401 (32·6%) of 1229 versus 357 (30·6%) of 1166 (OR 1·15, 95% CI 0·95-1·40). Proportional treatment benefits were similar irrespective of age or stroke severity. Alteplase significantly increased the odds of symptomatic intracranial haemorrhage (type 2 parenchymal haemorrhage definition 231 [6·8%] of 3391 vs 44 [1·3%] of 3365, OR 5·55, 95% CI 4·01-7·70, p<0·0001; SITS-MOST definition 124 [3·7%] vs 19 [0·6%], OR 6·67, 95% CI 4·11-10·84, p<0·0001) and of fatal intracranial haemorrhage within 7 days (91 [2·7%] vs 13 [0·4%]; OR 7·14, 95% CI 3·98-12·79, p<0·0001). The relative increase in fatal intracranial haemorrhage from alteplase was similar irrespective of treatment delay, age, or stroke severity, but the absolute excess risk attributable to alteplase was bigger among patients who had more severe strokes. There was no excess in other early causes of death and no significant effect on later causes of death. Consequently, mortality at 90 days was 608 (17·9%) in the alteplase group versus 556 (16·5%) in the control group (hazard ratio 1·11, 95% CI 0·99-1·25, p=0·07). Taken together, therefore, despite an average absolute increased risk of early death from intracranial haemorrhage of about 2%, by 3-6 months this risk was offset by an average absolute increase in disability-free survival of about 10% for patients treated within 3·0 h and about 5% for patients treated after 3·0 h, up to 4·5 h. Interpretation Irrespective of age or stroke severity, and despite an increased risk of fatal intracranial haemorrhage during the first few days after treatment, alteplase significantly improves the overall odds of a good stroke outcome when delivered within 4·5 h of stroke onset, with earlier treatment associated with bigger proportional benefits. Funding UK Medical Research Council, British Heart Foundation, University of Glasgow, University of Edinburgh. © 2014 Emberson et al. Open Access article distributed under the terms of CC BY.

News Article | November 20, 2016
Site: marketersmedia.com

Beverly Hills Sinus Center is happy to announce the newest addition to their prestigious group, Dr. Evan Walgama! Dr. Walgama is a fellowship-trained sinus and skull base surgeon and will serve as Co-Director of the Beverly Hills Sinus Center in Cedars Sinai with Dr. Arthur Wu. He has trained under many nationally prominent sinus surgeons throughout his education and is proud to offer the highest level of care available to Los Angeles patients. Dr. Walgama specializes in chronic sinusitis, nasal polyposis, sinonasal tumors, and endoscopic skull base surgery. He enjoys treating the difficult-to-control sinusitis cases, particularly those patients who have required multiple previous sinus surgeries. His goal is to perform surgery that optimizes further medical management and keeps patients from having to return to surgery. He also treats complex skull disorders such as pituitary tumors, cerebrospinal fluid leaks, chordomas, and benign or malignant nose, sinus and nasopharynx tumors. These challenging cases are often handled in collaboration with other top tier physicians to ensure the best possible outcome. Dr. Walgama graduated with honors from the University of Texas at Austin with a Bachelors degree in philosophy. He received his M.D. from the University of Texas Southwestern Medical School in Dallas and was a junior member of Alpha Omega Alpha honor society. He completed a five-year residency in Otolaryngology at the same institution where he served as chief resident at Parkland Memorial Hospital. He then completed a one-year fellowship in Endoscopic Sinus and Skull Base Surgery at Stanford University under the mentorship of Peter Hwang, MD. In addition to his clinical practice, Dr. Walgama is active in clinical research. He has presented original research at national meetings and publishes in peer-reviewed journals. He is a member of the American Academy of Otolaryngology-Head and Neck Surgery and the American Rhinologic Society. The Beverly Hills Sinus Center is known as a center of excellence in Southern California for compassionate care and cutting edge research in the field of nasal and sinus diseases. Located in the world renown Cedars-Sinai Medical Center Towers and headed by Dr. Arthur Wu, the Beverly Hills Sinus Center is the premier sinus center serving the Greater Los Angeles Area. Click Here for additional information or contact Beverly Hills Sinus Center at (310) 423-1220. For more information, please visit http://www.beverlyhillssinus.com

Jackson W.C.,University of Michigan | Schipper M.J.,University of Michigan | Johnson S.B.,University of Michigan | Foster C.,University of Michigan | And 5 more authors.
European Urology | Year: 2016

Background Limited data exist to guide the use of androgen deprivation therapy (ADT) for men treated with radiation therapy (RT) after radical prostatectomy (RP). The optimal duration of ADT in this setting is unknown. Objective To determine if the duration of ADT influences clinical outcomes for men receiving post-RP RT. Design, setting, and participants A total of 680 men who received adjuvant radiation therapy (n = 105) or salvage radiation therapy (n = 575) between 1986 and 2010 at a single tertiary care institution were reviewed retrospectively. Median follow-up post-RT was 57.8 mo. Intervention RT was delivered using three-dimensional conformal or intensity-modulated RT in 1.8-Gy fractions. For patients treated with ADT, >80% were treated with a gonadotropin-releasing hormone agonist with or without a nonsteroidal antiandrogen. Outcome measurements and statistical analysis Biochemical failure (BF), distant metastasis (DM), prostate cancer-specific mortality (PCSM), and overall mortality were assessed using Kaplan-Meier analysis and propensity score analysis. Results and limitations Overall, 144 patients (21%) received ADT with post-RP RT, most of whom had high-risk disease features such as Gleason score 8-10, seminal vesicle invasion, or pre-RT prostate-specific antigen >1 ng/ml. Median ADT duration was 12 mo (interquartile range: 6.0-23.7). Patients who received <12 mo of ADT had an association with increased BF (hazard ratio [HR]: 2.27; p = 0.003) and DM (HR: 2.48; p = 0.03) compared with patients receiving ≥12 mo of ADT. The 5-yr rates of DM were 6.0% and 23% for ≥12 and <12 mo of ADT, respectively. On propensity score analysis controlling for pretreatment and treatment-related factors, each month of ADT was associated with a decreased risk for BF (HR: 0.95; p = 0.0004), DM (HR: 0.88; p = 0.0004), and PCSM (HR: 0.90; p = 0.037). These findings are limited by the retrospective nature of our analysis. Conclusions For men with high-risk disease features receiving ADT with post-RP RT, the duration of ADT is associated with clinical outcomes. Our findings suggest that for these men an extended course of ADT ≥12 mo may be preferable. Validation of our findings is needed. Patient summary We evaluated outcomes for men with high-risk disease features treated with androgen deprivation therapy (ADT) and radiotherapy after radical prostatectomy. Longer durations of ADT resulted in improved patient outcomes. © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Ryan R.W.J.,Cedars Sinai | Chowdhary A.,Duke University | Britz G.W.,Duke University
Surgical Neurology International | Year: 2012

Background: We sought to review the current literature with regards to future risks of hemorrhage following cerebral revascularization in Moyamoya disease (MMD). Methods: We performed a comprehensive literature review using PubMed to inspect the available data on the risk of hemorrhage after revascularization in MMD. Results: In this review, we identify the risk factors associated with hemorrhage in MMD both before and after cerebral revascularization. We included proposed pathophysiology of the hemorrhagic risk, role of the type of bypass performed, treatment options, and future needs for investigation. Conclusions: The published cases and series of MMD treatment do show a risk of hemorrhage after treatment with either direct or indirect bypass both in the immediate as well as long-term future. While there are no discernible patterns in the rate of these hemorrhages, there is Class III evidence for the predictive effect of multiple microbleeds on preoperative imaging. Also, whereas revascularization, both direct and indirect, has been shown to reduce ischemic complications from MMD, there is not an association with the risk of hemorrhage after the procedure. Further studies need to be performed to help evaluate what the risk factors are and how to counsel patients as to the long-term outlook of this disease process. Copyright © 2012 Britz GW.

Koopman S.G.,Cedars Sinai | Fuchs G.,Cedars Sinai
Journal of Endourology | Year: 2013

Purpose: To review our experience with retrograde intrarenal surgery (RIRS) for management of conditions associated with intrarenal stricture and present a treatment algorithm based on the series. Patients and Methods: RIRS was offered to all patients with symptomatic intrarenal stenosis regardless of location if stone burden was 2 cm or less. With a combined endourology and lithotripsy table, patients with stones between 2 and 3 cm were also offered RIRS using a combined approach of RIRS and shockwave lithotripsy (SWL). A total of 108 patients with symptomatic stones and caliceal diverticulum or infundibular stenosis were included in the data analysis. A standard technique was used in all cases. Failures or patients not suitable for RIRS were treated with either percutaneous nephrolithotomy (PCNL) or laparoscopic surgery. Results: Successful identification and dilation/incision of the stenotic opening was accomplished in 94% of cases. Seventy-five percent of stones were managed with basketing and/or holmium laser ablation. In these patients, 90% were stone free (<2 mm stone fragments). For stones between 2 and 3 cm, the use of holmium laser in combination with SWL provided stone-free rates of 75%. Five percent of patients needed PCNL because of larger stone burden and posterior location. Conclusions: With the appropriate equipment, RIRS provides a valid treatment option for patients with intrarenal strictures. While upper pole and midrenal lesions are ideal, lower pole segments may be approached as well. A treatment algorithm based on the results provides a simplified approach for the minimally invasive management of intrarenal stenosis. © Copyright 2013, Mary Ann Liebert, Inc.

Giuliano A.E.,Cedars Sinai | Gangi A.,Cedars Sinai
Breast Journal | Year: 2015

Sentinel lymph node biopsy (SLNB) is based on the hypothesis that the sentinel lymph node (SLN) reflects the lymph-node status and a negative SLN might allow complete axillary lymph node dissection (ALND) to be avoided. Past and current sentinel lymph node clinical trials for breast carcinoma have addressed the prognostic and therapeutic benefits of this technique and as such, SLNB has become a standard of care for select breast cancer patients. This article reviews the history of SLNB as well as current guidelines and recent controversies. © 2014 Wiley Periodicals, Inc.

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