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Cleveland, OH, United States

Marten K.A.,Des Moines University | Gudena V.K.,University Hospitals Seidman Cancer Center
Cancer Biology and Therapy | Year: 2015

Anaplastic thyroid carcinoma (ATC) is a rare, poorly differentiated type of thyroid cancer occurring in less than 5% of all thyroid cancers. Patients typically have a poor prognosis with very few options for treatment.2 With current therapy of surgery, chemotherapy, and radiation, median survival is only 6 months from the time of diagnosis. Several mutations in cell cycle regulation have been discovered in ATC that contribute to its undifferentiated state, one of which is the BRAF kinase mutation. This mutation results in activation of the MAPK pathway and uncontrolled cell proliferation. In this case report, a 51 y old male presented with a 2-week history of hoarseness and was diagnosed with ATC. Genetic analysis revealed a mutation in BRAF kinase; the patient subsequently began therapy with vemurafenib, a BRAF kinase inhibitor indicated for melanoma. After an initial response, the patient quickly declined and consequently died from his disease. Anaplastic thyroid carcinoma is a deadly cancer without an effective treatment. Inhibiting mutated enzymes that drive the development of this cancer is a potential drug target that may improve outcomes in patients with ATC. © 2015 Taylor & Francis Group, LLC.

Wallace C.R.,University Hospitals Seidman Cancer Center
Orthopaedic Nursing | Year: 2012

Individuals with Type 1 and Type 2 diabetes who are managed with insulin are at risk for developing hypoglycemia, a significant consequence of insulin therapy. Symptoms of hypoglycemia develop rapidly and the condition can be life threatening. It is imperative that the inpatient team, including the orthopaedic nurse, is able to recognize the signs and symptoms, respond appropriately, and prevent hypoglycemia. It is equally important to provide the patient with education to prevent, identify, and self-manage hypoglycemia at home. A case study example is included that addresses an elderly patient with Type 2 diabetes who had a total hip arthroplasty and developed hypoglycemia postoperatively while on an orthopaedic unit. Assessment, treatment, prevention, and patient self-management education of hypoglycemia are reviewed. © 2012 by National Association of Orthopaedic Nurses.

Beatty K.,University Hospitals Seidman Cancer Center
AACN advanced critical care | Year: 2011

The start of the 21st century has produced advances in cancer care that have improved both survival rates and quality of life for many persons diagnosed with cancer. Targeted therapy has given new hope for controlling cancer as a chronic illness. Alone, or in combination with traditional therapies such as surgery, radiation, and/or chemotherapy, this new form of therapy targets malignant cells, halting tumor growth and the potential metastatic spread of disease. Toxicities are limited, but some are serious and may require intensive care. It is imperative for the experienced critical care nurse to have an understanding of these new treatment options and those on the horizon, as these therapies are the future of cancer care. Whereas in previous decades, patients with cancer may not have survived an intensive care admission for treatment complications or advanced disease, many patients now are recovering from life-threatening events, continuing treatment for their disease, and going on to live meaningful, good-quality lives.

Mohile S.G.,University of Rochester | Hardt M.,University of California at Los Angeles | Tew W.,Sloan Kettering Cancer Center | Owusu C.,University Hospitals Seidman Cancer Center | And 10 more authors.
Oncologist | Year: 2013

Background. Bevacizumab leads to improved survival for patients with metastatic colorectal cancer (CRC) or non-small cell lung cancer (NSCLC) when added to chemotherapy. Little is known about factors associated with receipt of bevacizumab, or whether bevacizamab is associated with increased toxicity when added to chemotherapy. Patients and Methods. We conducted a prospective study of patients aged ≥65 years, which evaluated the association between geriatric assessment (GA) metrics and chemotherapy toxicity. We examined differences in characteristics and outcomes of patients with CRC and NSCLC cancers who received bevacizumab with chemotherapy versus chemotherapy alone. Results. From a total of 207 patients, 27 (13%) received bevacizumab plus chemotherapy and 180 (87%) received chemotherapy alone. Groups were similar in sociodemographic and cancer characteristics. There were no baseline differences in GA domains except that patients with heart disease were less likely to receive bevacizumab (4% vs. 26%, p<.01). Seventyeight percent of patientswhohadbevacizumabhadgrade3-5 toxicity compared to only 57% who received chemotherapy alone (p =.06). Patients receiving bevacizumab were more likely to develop grade 3 hypertension than those who receivedchemotherapyalone(15%vs.2%, p<.01). In multivariable analysis, factors associated with grade 3 or more toxicity included: bevacizumab (OR: 2.86, p =.04), CRC (OR: 2.54, p<.01), and baseline anemia (OR: 2.58, p=.03). Conclusion. Heart diseasewasmorecommonin thosewhodid not receive bevacizumab. Older patients who receive bevacizumab with chemotherapy have a higher odds of developing a grade 3-5 toxicity compared with those who receive chemotherapy alone. © AlphaMed Press 2013.

Sondak V.K.,H. Lee Moffitt Cancer Center and Research Institute | King D.W.,STATKING Clinical Services | Zager J.S.,H. Lee Moffitt Cancer Center and Research Institute | Schneebaum S.,Sourasky Medical Center | And 9 more authors.
Annals of Surgical Oncology | Year: 2013

Background: [99mTc]Tilmanocept is a CD206 receptor-targeted radiopharmaceutical designed for sentinel lymph node (SLN) identification. Two nearly identical nonrandomized phase III trials compared [99mTc] tilmanocept to vital blue dye. Methods: Patients received [99mTc] tilmanocept and blue dye. SLNs identified intraoperatively as radioactive and/or blue were excised and histologically examined. The primary end point, concordance, was the proportion of blue nodes detected by [99mTc] tilmanocept; 90 % concordance was the prespecified minimum concordance level. Reverse concordance, the proportion of radioactive nodes detected by blue dye, was also calculated. The prospective statistical plan combined the data from both trials. Results: Fifteen centers contributed 154 melanoma patients who were injected with both agents and were intraoperatively evaluated. Intraoperatively, 232 of 235 blue nodes were detected by [99mTc] tilmanocept, for 98.7 % concordance (p < 0.001). [99mTc] Tilmanocept detected 364 nodes, for 63.7 % reverse concordance (232 of 364 nodes). [99mTc]Tilmanocept detected at least one node in more patients (n = 150) than blue dye (n = 138, p = 0.002). In 135 of 138 patients with at least one blue node, all blue nodes were radioactive. Melanoma was identified in the SLNs of 22.1 % of patients; all 45 melanoma-positive SLNs were detected by [99mTc]tilmanocept, whereas blue dye detected only 36 (80 %) of 45 (p = 0.004). No positive SLNs were detected exclusively by blue dye. Four of 34 node-positive patients were identified only by [ 99mTc]tilmanocept, so 4 (2.6 %) of 154 patients were correctly staged only by [99mTc]tilmanocept. No serious adverse events were attributed to [99mTc]tilmanocept. Conclusions: [99mTc] Tilmanocept met the prespecified concordance primary end point, identifying 98.7 % of blue nodes. It identified more SLNs in more patients, and identified more melanoma-containing nodes than blue dye. © 2012 The Author(s).

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