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Butler C.,Medical University of South Carolina | Butler W.M.,South Carolina Oncology Associates | Rizvi A.A.,University of South Carolina
Endocrine Practice

Objective: To report our experience using kinase inhibition therapy with sorafenib in a patient with advanced adrenocortical carcinoma. Methods: We describe the clinical, laboratory, and radiologic findings of the study patient and discuss the clinical course with sorafenib therapy. Results: A 56-year-old woman presented with rapid development of virilization, cushingoid features, hypertension, weight gain, and abdominal distension. An 8-cm left adrenal lesion was found on computed tomography, removed surgically, and confirmed as adrenal carcinoma on pathologic examination. Postoperative scanning revealed metastases to both lungs and the liver that were confirmed by fine-needle biopsy, thus establishing stage IV disease. Treatment with the adrenolytic agent mitotane failed to halt disease progression. A trial of sorafenib resulted in regression and eventual resolution of bilateral metastatic lung lesions, reduction in size of the hepatic lesion, normalization of androgen hypersecretion, and marked clinical improvement. The radiologic and biochemical remission on sorafenib has continued for 28 months. Conclusion: Multiple kinase inhibitors such as sorafenib provide targeted oncologic treatment and may be effective in treating advanced adrenal cancer. © 2010 AACE. Source

Infante J.R.,Sarah Cannon Research Institute | Infante J.R.,Tennessee Oncology PLLC | Arkenau H.-T.,Sarah Cannon Research United Kingdom | Bendell J.C.,Sarah Cannon Research Institute | And 11 more authors.
Cancer Biology and Therapy

Objectives: To evaluate the 6-month overall survival, safety and tolerability of lenalidomide in combination with standard gemcitabine as first-line treatment for patients with metastatic pancreatic cancer. Results: Between May 2009 and April 2010, 72 patients (median age 64 years; 68% male; 42% ECOG PS 0) were enrolled in this multicenter, community-based study. Six-month OS was 37% (95% CI 26-48%). Median PFS and OS were 2.3 (95% CI: 1.9-3.5) and 4.7 (95% CI: 3.4-5.7) months, respectively. Eight partial responses (11%) were documented. Thirtynine patients (54%) experienced thrombocytopenia (2 patients, 3% grade 4). Hematologic toxicities resulted in dose modifications for the majority of patients. Twenty patients (28%) developed VTEs during treatment. Methods: Eligibility included previously untreated metastatic adenocarcinoma of the pancreas with metastases incurable by surgery/radiation therapy; ECOG PS 0-2; adequate organ function and prophylactic anticoagulation for venous thromboembolic events (VTEs). Patients received lenalidomide 25 mg PO (days 1-21) and gemcitabine 1,000 mg/m2 IV (days 1, 8 and 15) each 28-day cycle, with response evaluations every eight weeks. Conclusions: The observed 6-month OS (37%) of lenalidomide with gemcitabine does not suggest improvement compared with historical results with gemcitabine alone. Toxicities and dose modifications likely limited dose intensity. Further development of this regimen in pancreas cancer is not recommended. © 2012 Landes Bioscience. Source

Adams S.A.,University of South Carolina | Butler W.M.,South Carolina Oncology Associates | Fulton J.,South Carolina Comprehensive Breast Center | Heiney S.P.,University of South Carolina | And 4 more authors.

BACKGROUND: Although much has been done to examine those factors associated with higher mortality among African American women, there is a paucity of literature that examines disparities among rural African Americans in South Carolina. The purpose of this investigation was to examine the association of race and mortality among breast cancer patients in a large cohort residing in South Carolina for which treatment regimens are standardized for all patients. METHODS: Subjects included 1209 women diagnosed with breast cancer between 2000 and 2002 at a large, local hospital containing a comprehensive breast center. Kaplan-Meier survival curves were calculated to determine survival rates among African American and European American women, stratified by disease stage or other prognostic characteristics. Adjusting for various characteristics, Cox multivariate survival models were used to estimate the hazard ratio (HR). RESULTS: The 5-year overall all-cause mortality survival proportion was ∼78% for African American women and ∼89% for European American women, P < 0.01. In analyses of subpopulations of women with identical disease characteristics, African American women had significantly higher mortality than European American women for the same type of breast cancer disease. In multivariate models, African American women had significantly higher mortality than European American women for both breast cancer-specific death (HR, 2.41; 95% confidence interval [CI], 1.21-4.79) and all-cause mortality (HR, 1.42; 95% CI, 1.06-1.89). CONCLUSIONS: African American women residing in rural South Carolina had lower survival for breast cancer even after adjustment for disease-related prognostic characteristics. These findings support health interventions among African American breast cancer patients aimed at tertiary prevention strategies or further down-staging of disease at diagnosis. Cancer 2011. © 2011 American Cancer Society. African American women residing in rural South Carolina have poorer 3-year and 5-year breast cancer survival compared with European Americans. A possible biological processing basis may contribute to some of the breast cancer mortality disparities seen in South Carolina. Copyright © 2011 American Cancer Society. Source

Yang F.,University of South Carolina | Yang X.,Dorn Research Institute | Jiang H.,GraceFlow Technology | Butler W.M.,South Carolina Oncology Associates | Wang G.,University of South Carolina
Technology in Cancer Research and Treatment

Separation of cancer cells from other biological materials is significant for circulating tumor cell detection in cancer diagnosis and treatment. However, separation of one type of cancer cell from other types of cancer cells can be difficult, since they share similar morphology and biomarkers. In the present work, we have successfully manipulated and isolated LNCaP prostate cancer cells from HCT116 colorectal cancer cells, by dielectrophoresis (DEP) in a microfluidic platform in a continuous operation. In this cell sorter, the prostate cancer cells were treated as target cells and were deflected to a side channel from a main channel as they experienced a negative DEP force, when an AC electric field at the cross-over frequency of the HCT116 cells was supplied. This motion consequently led to the separation of the prostate cancer cells from the colorectal cancer cells. In this manuscript, we report the flow conditions, DEP spectra of the cancer cells and the isolation of LNCaP cells from HCT116 cells. The separation and enrichment factor have been investigated as well. © Adenine Press (2013). Source

Reitan J.F.,RJM Group LLC | Kudrik F.J.,South Carolina Oncology Associates | Fox K.,South Carolina Oncology Associates | Van Breda A.,Van Breda Research LLC. | And 2 more authors.
Journal of Medical Economics

Objective: The objective is to measure the burden of blood transfusion of Packed Red Blood Cells (PRBCs) in patients with chemotherapy-induced anemia (CIA) on the institutional outpatient transfusion center. Methods: This is a retrospective chart review (starting July 1, 2010, working backwards until 120 evaluable patients are accrued) at a single institutional transfusion center in the US. The mean and standard deviation (SD) were calculated for patient's age, pre-transfusion Hgb level, and other transfusion-related activities. Results: One hundred and twenty records were reviewed. The majority included patients who were female (71%), African American (61%), and had either Medicare (48%) or private insurance (39%). The mean patient age was 59 years and the average pre-transfusion Hgb was 7.9g/dL. The average patient visit to facility ranged from 213min for one PRBC unit to 411 minutes for three PRBC units. The mean staff time for patient evaluation was 66 minutes. Actual time for transfusion was ∼100min for each PRBC unit; 90% of patients received two PRBC units. Staff was engaged in direct patient care for an average of 322min for two PRBC units. The labor cost of transfusion (in 2011 $US) ranged from $46.13-$49.33 per PRBC unit. The estimated fully loaded bundled cost was $596.49 for transfusion of one unit of PRBC. Limitations of the study include: the site included in this study may not be applicable to all sites in practice and the evaluated patient population was varied, with the exception that all patients were treated for some type of malignancy; and the review of blood bank records for 120 patients was not 120 independent events and, as such, may not have adequately captured actual variability. Conclusions: This analysis quantifies expense in terms of time for administration of the transfusion, as well as costs associated with outpatient blood transfusions. © 2013 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted. Source

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